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EPtalk by Dr. Jayne 6/15/17

June 15, 2017 Dr. Jayne 1 Comment

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Congratulations to the University of Arizona College of Medicine – Phoenix for receiving full accreditation from the Liaison Committee on Medical Education. The school was created more than 10 years ago to help address Arizona’s physician shortage and was originally a branch campus of the UA College of Medicine – Tucson. Now, UA joins the ranks of only a few universities with multiple accredited medical schools. Starting up a new medical school is a daunting process, whether it’s a branch of an existing school or not. I had the pleasure of speaking recently with one of the faculty members at the Dell Medical School at The University of Texas at Austin who shared some of their trials and tribulations. Becoming fully accredited is quite an accomplishment.

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While EHR vendors are working on their certification testing, many are expanding the incorporation of user testing. NCQA is also getting into the act with a website usability and navigation study. I appreciate the fact that they’re trying to make the website easier to use, but I wish they’d make their recognition programs less cumbersome and more affordable for primary care practices. I’ve been contacted by multiple clients who are struggling with the transition from their 2014 program to the updated 2017 program. One of my staffers is attending the course in Washington, DC this week, and at nearly $900 for one day it’s certainly not cheap. Tack on some hotel and travel, and it’s a lot for a small practice to spend for training.

Fortune recently released its list of the 500 companies that generated the most revenue in the last year. Multiple healthcare systems made the list, including HCA Holdings, Community Health Systems, Tenet Healthcare, DaVita, Universal Health Services, LifePoint Health, Kindred Healthcare, and Genesis Healthcare. Health insurers made it on the list as well, with UnitedHealth Group ranking at number six. Other payers making the cut include Anthem, Aetna, Humana, Centene, Cigna, Molina Healthcare, and WellCare Health Plans.

A friend sent me this piece about “Perfect Non-Clinical Income Ideas for Doctors.” I had to laugh at some of the suggestions, especially considering the time pressure that many physicians face. I don’t imagine that many physicians would be up for multilevel marketing, peddling insurance, or renting out their cars. Not to mention, the author fails to appreciate the concept of “passive” income. The only side businesses I see my colleagues involved in are in the property ownership realm, and none of them are personally managing their properties.

My practice opened two new locations in the last 30 days, so I’m working more clinical shifts than I usually do. Unfortunately, that increased schedule came right when my vendor is experiencing an ongoing problem with API errors. The impact is worst when we’re trying to use the e-prescribing functionality or when staff is trying to search for the patient’s preferred pharmacy, which means it impacts pretty much every patient when it happens. Although I appreciate the communication, receiving an email every two hours that essentially says “yes it’s still going on, and no we don’t know how to fix it yet” becomes annoying. Even while I scowled at my inbox, however, I did get a kick out of a marketing email that popped in from our friends at EClinicalWorks. Apparently they’re offering an ill-timed promotion called “Make the Switch” that includes free data migration to the system. I wonder how many takers they’re getting.

A reader sent me this piece about workplace wellness programs. It references some interesting statistics that I wasn’t aware of, such as the fact that 50 percent of companies that have more than 200 workers either offer or require employees to complete biometric screenings. Of those companies, more than half offer financial incentives to employees to participate. Others mandate the screenings for employees who elect company-provided health insurance plans. I’m sure wellness programs will continue to expand, as employers try anything they can to try to control rising healthcare costs.

I’ve written about my concerns around wellness programs before, namely that programs often aren’t compliant with screening recommendations. They may require employees to participate in screenings, such as blood glucose and cholesterol, that are not recommended for their age group and that may lead to distress and interventions that ultimately do more harm than good. Another tidbit I wasn’t aware of is the fact that modifications to regulations around employee wellness programs were nestled into the Affordable Care Act, allowing employers to shift 30-50 percent of employee-only healthcare premiums onto employees who fail wellness tests. I haven’t had to participate in biometric screening since I left Big Hospital, although when you compare the hassle, invasion of privacy, and dubious science against the premiums paid by small businesses, it doesn’t seem so bad.

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I’m always on the lookout for stories of adventures in healthcare, and today I had one of my own. I was calling to make an appointment for a procedure with a provider who has multiple offices. Even though I haven’t been seen there in a couple of years, they were willing to schedule the procedure without a consultation first, which seemed unusual given the opportunity to not only collect an updated history and physical but to also generate some extra charges in a procedure-based specialty. The scheduler then paused and said, “Let me write all this down” and I assumed that she was going to take my request to a surgery scheduler, who would get back to me for the actual scheduling. She “wrote” for over a minute, and apparently used the information as a reference while she looked at the computerized scheduling system. As a process improvement person, I can’t imagine how that works given an average office’s phone volume. I can’t wait to see it in person in a couple of weeks. Needless to say, I won’t be surprised if they call me back and ask to schedule a consultation first, but you never know.

Email Dr. Jayne.

Morning Headlines 6/15/17

June 14, 2017 Headlines No Comments

American Health Care Tragedies Are Taking Over Crowdfunding

Bloomberg reports that half of the $2 billion raised on popular crowdfunding platforms like GoFundMe are being used to pay medical expenses.

Ron Peterson retiring as Johns Hopkins Health System president after 44 years

Johns Hopkins Health System President Ron Peterson announces that he will retire at the end of this year. Peterson arrived at the health system in 1973, starting as an administrative assistant.

5 people, including Michigan health chief, charged in Flint

Nick Lyon, the former director of Michigan’s Health and Human Services department, is charged with involuntary manslaughter along with five other officials as a result of the 2014 Flint water crisis.

Your Doctor’s Office Is Vulnerable to Hackers, but Congress Could Change That

MIT Technology Review weighs in on legislative changes that could improve cybersecurity for smaller health care facilities.

Morning Headlines 6/14/17

June 13, 2017 Headlines No Comments

Kieran Murphy Appointed CEO of GE Healthcare, Succeeding John Flannery

Kieran Murphy is named president and CEO of GE Healthcare, succeeding John Flannery who has been promoted to CEO and chairman elect of GE.

MEDITECH Signs 16 More Hospitals in Q1 2017

Meditech signs five new health systems, with 16 combined hospitals, to its 6.1 Web EHR in Q1.

Drones carrying defibrillators could aid heart emergencies

Researchers launched drones carrying defibrillators from a fire department to see if drones could deliver a faster response time than an ambulance, and found that drones arrived at the scene of 18 cardiac arrests within about 5 minutes of launch, almost 17 minutes faster on average than ambulances.

New Mexico Physician Chosen as AMA President-elect

At the Annual Meeting of the American Medical Association, Barbara McAneny, MD, an oncologist from Albuquerque, NM, is elected as the next president of AMA.

News 6/14/17

June 13, 2017 News 4 Comments

Top News

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An audit reveals that CMS may have paid out nearly $729 million in improper Meaningful Use incentives between 2011 and 2014. OIG auditors based their estimate on the review of 100 payments – 14 of which were made for incorrect reporting periods, or were based on incomplete verification documentation, and totaled just over $290,000. Auditors also found that CMS should not have paid out $2.3 million to providers who switched between Medicare and Medicaid incentive programs during that timeframe. OIG recommends that CMS recoup the money and undertake a more thorough review of all payments made.


Reader Comments

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From OITNB: “Re: Athenahealth/Medhost deal. I think you may have it wrong or that Medhost may have multiple suitors. Allscripts CEO Paul Black was at the Medhost office on the executive floor a few weeks back.”


Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Announcements and Implementations

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Torrance Memorial Medical Center (CA) rolls out Mobile Heartbeat’s smartphone-based clinical communications system to its 2,700 team members.


Acquisitions, Funding, Business, and Stock

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Genetic testing company Invitae acquires Ommdom, developer of the CancerGene Connect risk assessment and family history analysis tool.

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Cognizant plans to acquire TMG Health, a subsidiary of insurer Health Care Service Corp., later this year. TMG, which caters to government-sponsored health plans, will continue to provide IT and business process services to HCSC business units. Cognizant’s largest publicized acquisition was TriZetto in 2014 for $2.3 billion in cash.


People

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Erin Trimble (Athenahealth) joins Redox as VP of business development.

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GE promotes healthcare lead John Flannery to CEO and chairman elect. GE Healthcare Life Sciences CEO Kieran Murphy will take over Flannery’s role. Murphy will likely devote much of his time to strengthening GE Healthcare’s technology with the relocation of hundreds of tech workers to its office in Boston, as well as with a planned $500 million software spend over the next several years.

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Patientco hires Alan Nalle (Accenture Strategy) as chief strategy officer.

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The American Medical Association names New Mexico Oncology Hematology Consultants CEO Barbara McAneny, MD president-elect at its annual meeting. She will succeed newly sworn-in Mercy Clinic VP David Barbe, MD.

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Tycene Fritcher (Solutionreach) joins health system-focused telemedicine company Avizia as CMO.


Sales

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Greater Baltimore Medical Center (MD) selects Phynd’s Enterprise Provider Data Management solution tool to help it manage the data of 15,000 credentialed and referring providers.

Meditech signs up 16 hospitals in the first quarter of 2017.


Technology

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Caradigm releases a trio of population health tools to help Medicare ACOs understand clinical and financial risk and utilization patterns, and to identify high-risk patients who may need clinical intervention.

Glytec integrates AgaMatrix’s wireless blood glucose monitoring app with its EGlycemic Management System, giving providers the ability to offer patients more mobile and tailored insulin dosing management between appointments.


Government and Politics

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Vice President Pence stresses the president’s focus on repealing the Affordable Care Act during remarks to HHS employees. His main points focused on rising premiums, reduced coverage options due to payers leaving the exchanges, and the number of people dropping out of ACA insurance plans – figures that some have called into question. He emphasized that the Republican-crafted American Health Care Act quietly working its way through the Senate will “transition our healthcare economy away from the regulations and mandates and taxes of Obamacare to a patient-centered healthcare system built on personal responsibility, free-market competition, and state-based reform.”


Innovation and Research

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A survey of just over 1,000 consumers finds that only 17 percent believe health-related industries are the most innovative compared to sectors like consumer electronics, telecommunications, and media. Respondents have high hopes for healthcare innovation, though; 70 percent believe health IT will eventually make the biggest impact on their personal health management. They cite wearables, robotics, 3D printing, smart home devices, and AI as technologies likely to make the most waves.

Vanderbilt University Medical Center (TN) researchers create an algorithm based on hospital admissions data that is “80-90 percent accurate when predicting whether someone will attempt suicide within the next two years, and 92-percent accurate in predicting whether someone will attempt suicide within the next week.”

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Drones carrying defibrillators to the scenes of heart attacks arrive five minutes after launch – 12 minutes faster than local ambulance services, according to a study featured in JAMA. Drones were launched from a fire station within six miles of where previous cardiac arrests had occurred.


Other

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The New York Times looks at the growing role the Dark Web plays in helping opioid-pushing drug dealers sell and ship their products. Thanks to increased potency and decreased size, “enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope.”


Sponsor Updates

  • The Millenium Alliance advisory firm interviews Arcadia Healthcare Solutions VP Michael Meucci.
  • Besler Consulting releases a new podcast, “Completing your Medicare Occupational Mix Survey.”
  • CareSync publishes an infographic on annual wellness visits.
  • Docent Health will participate in Boston TechJam June 15.
  • EClinicalWorks will exhibit at The Private Healthcare Summit 2017 June 20 in London.
  • FormFast joins the Salesforce AppExchange.
  • HCS will exhibit at the Texas Hospital Association Behavioral Health Conference June 15-16 in Austin.
  • The HCI Group customer St. Luke’s University Health Network achieves HIMSS Analytics EMRAM Stage 7 status.
  • InterSystems will exhibit at the HIMSS NY Chapter Annual Conference June 20 in the Bronx.
  • Meditech South Africa celebrates 35 years.
  • InstaMed releases its Trends in Healthcare Payments Annual Report.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
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Morning Headlines 6/13/17

June 12, 2017 Headlines No Comments

Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements

An OIG report concludes that CMS inappropriately paid eligible providers $729.4 million in EHR incentive payments who did not meet meaningful use requirements.

FBI is investigating an Oregon health care startup

Oregon-based health insurance startup Zoom is under FBI investigation for retrospectively altering medical claims to make its patient population look sicker in an effort to avoid paying into risk adjustment pools.

Iowa Seeks to Revamp Affordable Care Act

Iowa state officials are seeking permission to make signification changes to its ACA marketplace in an effort to protect residents at risk of losing their insurance due to payers backing away from the exchanges.

CRISPR May Cure All Genetic Disease—One Day

CRISPR pioneer Jennifer Doudna, PhD. discusses the future of genetic editing, saying “I think it’s really likely that in the not-too-distant future it will cure genetic disease.”

Curbside Consult by Dr. Jayne 6/12/17

June 12, 2017 Dr. Jayne 2 Comments

Last week, CMS kicked off a multi-pronged outreach program to help providers prepare for the transition to the new Medicare Beneficiary Identifier (MBI). New Medicare cards, to be issued starting in April 2018, will have a new identification code for each beneficiary, which is not based on the Social Security number. Congress mandated that all cards be replaced by April 2019, and vendors have been working on adding functionality to hold the new identifiers for some time. There will be a nearly two-year transition window where providers can use either the MBI or the old Medicare number, as well as secure lookup tools for both providers and patients. The ID will include both numbers and letters – along with many others, I’ll probably still call it a “Medicare number” regardless of the presence of letters.

There are nearly 58 million people on Medicare, and the goal of the program is to fight identity theft, fraud, and illegal use of SSNs. Unfortunately, this doesn’t help the rest of us who are constantly asked to provide our SSNs across the rest of the healthcare space. I checked with a couple of my clients to see if they have plans to phase out use of the SSN in general and they haven’t really thought about it. I’ve had quite a few adventures in healthcare this year, and every single one has asked for not only my SSN but also had fields on their patient data forms to gather the SSN of a guarantor where one exists.

Even with a Congressional mandate, this process has taken years. It was in the works prior to the passage of MACRA, but that law accelerated the timetable. Although CMS has had a website about the project for some time, it’s unclear how much providers understand at this point. Providers and their office leaders have been through a lot of federally-induced change in the last few years, including the prolonged ICD-10 transition and now the distraction of MIPS, along with continued Meaningful Use pressures for our Medicaid friends. It could be that people just aren’t planning to pay too much attention until it gets closer. The other piece of it is that vendors aren’t entirely ready yet, so it’s not yet “real.” Once the new ID field starts appearing in systems, then perhaps it will be worth thinking about. I searched my email archives and found a notice from our vendor a few months ago, mentioning that it will be added to the system towards the end of 2017. One of the benefits (and sometimes challenges of) a vendor-hosted, cloud-based system is that features just appear after a brief announcement, so we’ll have to see what other communication we receive as it gets closer.

The migration to the new MBI is not just a digital change but one that will require operational and process changes as well. Practices may want to consider proactive outreach to their patients to educate them about the new cards and the need to bring them to the office, as well as to allow for additional check-in time on their first visit after they receive their new cards. Sites will need to educate staff about their cutover plan and the need to maintain both identifiers during the transition, and the fact that they can’t simply remove the old IDs from the system since claims may still be working their way through the system. Everyone should be readying a plan, even if it’s just high level at this point. I’d be interested to hear what organizations of varying sizes are doing at this stage in the game.

In other CMS news, Tuesday is the last day to submit formal comments on the FY18 Inpatient Prospective Payment System and Long Term Acute Care Hospital proposed rule. The rule also includes language around Indian Health Service and other Tribal facilities. Most notably, it modifies the EHR reporting period from full calendar year to 90 days, which many of us are eagerly awaiting. Other nuggets include a new exception from the Medicare payment adjustments for eligible professionals, hospitals, and critical access hospitals if they demonstrate that they can’t comply with being meaningful users because their EHR has been decertified. There’s always a path for no payment adjustments for EPs who furnish all their covered services in the ambulatory surgical center setting. Even if you don’t have any comments to offer, the closure of the comment period is a milestone in the countdown to a final rule, which many of us are eagerly awaiting.

I spent some time this weekend at a continuing education conference at one of the local medical schools. I was looking forward to it, since it was targeted towards community physicians and was an opportunity to engage with some of the leaders in the field about the best ways we can co-manage patients. The content was outstanding, with concise presentations offering real-world advice rather than the more esoteric academic discussions I’ve seen in some of their sessions in the past. However, it was marred by attendees behaving badly. The worst example was a physician who was clearly responding to emails and/or transcribed phone messages, and who was using the voice recognition features on his phone to do so. If you have to multitask, you need to either do it non-verbally or you need to step out of the room.

The first couple of times he did it, I’m not sure people understood what was going on, because it looked like he might be having a sidebar conversation with the person next to him and was just being loud. As it continued, it was more obvious what he was doing, yet no one close to him said anything although there were plenty of people giving him dirty looks. Finally, one of the CME door monitors came forward to address the situation and he quit. Still, you have to wonder in what universe someone thinks that’s OK and how we’ve arrived at a place where people’s need to try to do it all interferes with them being a considerate member of society.

Email Dr. Jayne.

Morning Headlines 6/12/17

June 11, 2017 Headlines 1 Comment

Cost of HSE’s €35m IT system continues to rise

Ireland’s countrywide Maternal and Newborn Clinical Management System project, which includes Cerner clinical software and Deloitte project management and implementation staff, is reportedly overrunning its budget at every site that implements it.

Artificial intelligence can now predict suicide with remarkable accuracy

Researchers at Vanderbilt University Medical Center have created an algorithm that was “80-90% accurate when predicting whether someone will attempt suicide within the next two years, and 92% accurate in predicting whether someone will attempt suicide within the next week.”

Amazon poised to deliver disruption in medical supply industry

Amazon plans to use its massive distribution network to enter the medical supply distribution market.

Opioid Dealers Embrace the Dark Web to Send Deadly Drugs by Mail

Drug dealers selling opioids are turning to the Dark Web to move their products as potency increases, as the New York Times reports “enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope.”

Apple just hired the star of Stanford’s digital health efforts

Apple hires Sumbul Desai, MD and former executive director of Stanford Medicine’s center for digital health, to its healthcare team.

Monday Morning Update 6/12/17

June 11, 2017 News No Comments

Top News

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Cork University Maternal Hospital and University Hospital Kerry in Ireland report significant added expense as a result of their implementations of the nation’s first Maternal and Newborn Clinical Management System. The initial $39.2 million price tag has increased by $785,000 in Deloitte consultancy fees, with millions more expected as 17 additional hospitals prepare to go live on the Cerner-powered system over the next several years. Ireland’s Health Service attributes the over-budget, delayed implementations to a lack of expertise on the part of its clinical and business staff.

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Ireland experiences similar woes with its eHealth project, which is “not in a good place,” according to Chief Scientific Adviser Mark Ferguson, adding that the project is moving forward with several initial pilots to help alleviate patient concerns about  the digital storage of PHI. The project will ultimately include the launch of a nationwide EHR, unique identifiers for patients, and capacity for genome-sequencing.

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Providers at University Hospital Limerick are particularly depressed with projections that eHealth implementation at their facility could take up to 10 years. The hospital uses a number of different data-sharing systems, and is still plagued by an inefficient paper record-keeping system. “We have many, many computer systems in the health service,” says the hospital’s founding president, Ed Walsh, “but they don’t talk to each other. [The health service is] consumed by inefficient bureaucracy, which is based on a Victorian paper system. And until we move that, we won’t be able to move the resources necessary to provide the healthcare that the patient requires.”


Reader Comments

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From Kiwi: “Re: Orion Health’s financials. It seems to be letting an error by HCIT go uncorrected. Their Healthcare Informatics 100 listing cites $193 million in revenue in 2016, but reported financials show a different story (and the company is publicly traded). If my math is correct, the New Zealand dollar has moved between being worth about $.68 to $.74, making their earnings anywhere from $140M to $152M in 2016 and even less this for FY 2017.”


HIStalk Announcements and Requests

The anonymous vendor who donated $500 to my project to fund DonorsChoose teacher grant requests in return for mentioning a survey they’re interested in tells me they’ve almost hit the 100-response mark, which will trigger a second donation even bigger than the first. Providers, please click here and spend just a few minutes to help a classroom in need. Thank you.

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Over 75 percent of survey takers would consider switching systems if their vendor became involved in a situation akin to that of EClinicalWorks. It’s All Good contends, however, that “the basis of the allegations/settlement is not a reason to switch. There were defects. They’ve been fixed. But …  a switch could be considered because such a settlement could force the company into insolvency. Or at least support and innovation will suffer as the company tightens its’ proverbial belt so it can pay the fine.” Ross Martin wonders if this will be the tip of the health IT iceberg – one that’s similar to finding out VW wasn’t the only carmaker to game the emissions compliance system. He suspects that, “in the context of the Great Meaningful Use Land Grab of 2009 and the spend-stimulus-fast development of certification criteria, we will find a good amount of fudging among the vendors. Even vendors who complied with the letter of the reg are nowhere near enabling the plug-and-play level of interoperability we need.”

New poll to your right or here: Do you take research studies into consideration when making health IT purchasing or clinical programming decisions? Given the Washington Post’s piece last week on the tendency of journalists to make headlines out of studies they don’t truly understand and/or that are poorly designed in the first place, I’ve been wondering if hospital executives look at them with the same skeptical eye that I do. Your comments, as always, are appreciated.

I decided early on to have only two HIStalk Founding Sponsors, spots held by Medicity and Nuance since around 2007 or so. Nuance’s new marketing crew has decided that sponsoring HIStalk doesn’t interest them, meaning that their Founding spot is therefore available to the first company who commits to taking it over. Contact me at mrhistalk@gmail.com to grab Nuance’s premiere ad position on the page along with the usual Platinum sponsor benefits. Thanks to Nuance for supporting HIStalk for 10 years.

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Welcome to new HIStalk Gold Sponsor ZappRx. The Boston-based company solves the inefficient workflow and time drain involved with prescribing specialty drugs. Its platform modernizes the multi-step, manual prescribing process – often involving multiple platforms – to automatically populate prior authorization information, obtain digital patient consent, track prescriptions, and communicate bi-directionally with the specialty pharmacy, reducing administrative burden and improving team collaboration without resorting to phone calls. Patients get their critical therapy faster and more accurately with complete transparency. Practices can estimate their time savings using the company’s online calculator – the average prescription order requires just three minutes of provider time with ZappRX. Thanks to ZappRx for supporting HIStalk.


This Week in Health IT History

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One year ago:

  • Connecture, a technology company that builds online health insurance marketplaces, acquires ConnectedHealth, a benefits technology platform that helps employers choose health plans.
  • Cerner launches a one-year pilot study that will help determine whether patient’s genetic data can play a motivating role in promoting behavior change.
  • The VA fires three more administrators within the Phoenix VA Health Care System for “negligent performance of duties and failure to provide effective oversight.”
  • In light of voided test results and potential CMS sanctions, Walgreens ends its relationship with Theranos, closing all 40 of its Theranos Wellness Centers in Arizona.
  • South Australia looks for a spokesperson to reassure the public that its over budget, behind schedule 80-hospital Allscripts EHR implementation is still a worthwhile investment.

6-12-2012 9-34-40 PM

Five years ago:

  • Private equity firm TPG Growth acquires critical care systems vendor iMDsoft.
  • NIH and the National Cancer Institute announce grants to fund development of tools that empower consumers, patients, and/or their providers.
  • A CareFusion site from which medical equipment firmware updates are distributed is found to be loaded with malware, triggering a Department of Homeland Security investigation.
  • Steve Larsen, the federal government’s most powerful health insurance regulator responsible for consumer protection and insurance exchanges, quits to become EVP of Optum.

Ten years ago:

  • IBA is considering suing CSC and Connecting for Health after CSC blocked its bid to acquire ISoft.
  • The Northeastern Pennsylvania RHIO shuts down.
  • DoD’s AHLTA EMR system (formerly CHCS II) is running in 138 military treatment facilities.
  • Henry Schein tries to expand its medical software line with an offer for Australia’s Software of Excellence International.
  • The South Australian Department of Health launches big upgrades of its patient and nursing systems.

Weekly Anonymous Reader Question

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Last week’s results: Would you recommend to someone that they switch careers to health IT?

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This week’s survey: What characteristics made the worst doctor you’ve ever had so bad?


Last Week’s Most Interesting News

  • The VA announces it will shut down its VistA EHR and join the DoD in implementing Cerner Millennium.
  • HHS appoints Bruce Greenstein CTO.
  • Athenahealth acquires Praxify Technologies for $63 million.
  • The Health Care Industry Cybersecurity Task Force releases its report to Congress.
  • HHS alerts providers that the WannaCry ransomware attack is still causing problems for several US hospitals.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


People

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Michael Hyder, MD (Southcoast Health) joins Clearsense as president. He will also take on the role of EVP of healthcare delivery at sister company Optimum Healthcare IT.

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Apple hires Sumbul Desai, MD (Stanford Center for Digital Health) to join its healthcare team in an unidentified role.

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Arik Anderson (Terumo Cardiovascular Systems) joins smart inhaler company Adherium as CEO.


Government and Politics

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In a first for the FDA, it asks Endo Pharmaceuticals to stop selling Opana ER – an opioid that has become a favorite among drug users who have taken to crushing it and injecting it or snorting it. If Endo fails to withdraw the drug voluntarily, the FDA will force its removal by revoking its market approval. “We will continue to take regulatory steps when we see situations where an opioid product’s risks outweigh its benefits,” says FDA Commissioner Scott Gottlieb, MD “not only for its intended patient population but also in regard to its potential for misuse and abuse.”

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The Secretary of the Navy recognizes Naval Hospital Bremerton (WA) sailors for the parts they played in an ongoing process-improvement program that has so far reduced the Patient Administration Medical Records Division workload by 40 percent, and saved $156,400 and 7,300 man hours a year. In their downtime and with little prior coding know-how, the sailors developed a Medical Records Data Automation Program that now automates the daily operations of the hospital’s medical records department. MRDAP will soon serve as a transition program between the hospital’s Composite Health Care System and the forthcoming Cerner-powered MHS Genesis system. Cmdr. Robert McMahon, Director for Administration, refreshingly adds:

“What is most impressive is these young sailors had no fear of failure and despite no personal or monetary gain they continued to capture the ideas of their coworkers to improve workflows in their department that benefited everyone. Promoting innovation is like growing grass. Sometimes you already have the soil, water and sun. All that is needed is a safe and supportive environment to grow.”


Technology

Healthcare app development company Medable creates Synapse, a cloud-based tool that enables providers to launch CareKit apps for their care teams.


Privacy and Security

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After Bronx-Lebanon Hospital Center (NY) and its contractor IHealth sent threatening cease-and-desist letters to the author of DataBreaches.net (who let them know that their PHI was exposed due to an improperly configured server), the hospital tucks tail and asks her to go through the 500 mb of data she used in her original investigation to let them know which patients were affected. The audacity of the request, which did not come with an apology and with which she refuses to comply, prompts her to offer this advice:

  • Don’t rush to send legal threat letters. What your mother taught you about catching more flies with honey than vinegar appears true here, too.
  • If you wouldn’t send a legal threat to the New York Times over their reporting, don’t send one to me. This site may be small, under-funded, under-staffed, and under-appreciated, but with the support of great law firms like Covington & Burling, this site will always fight back against attempts to erode press freedom or chill speech.

Decisions

  • St. Mary Corwin Medical Center (CO) switched From Meditech to Epic in April 2017.
  • Perry Memorial Hospital (OK) will switch from Evident to Athenahealth in August 2017.
  • Jefferson Regional Medical Center (PA) is switching from Omnicell to BD Automated Dispensing Cabinets. The conversion process started last month.

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


Innovation and Research

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A survey of executives from 104 healthcare organizations points to AI as the next big thing when it comes to transforming the way the industry interacts with patients: 84 percent believe AI will “revolutionize” their encounters with healthcare consumers, while 72 percent report already using virtual assistants. Their interest in AI will likely fuel their near-term efforts to better understand what consumers want even before they articulate it. Eighty-one percent feel organizations should shape digital health tools based on patient preference rather than their own. A similar percentage believe those that understand the motivations behind consumer behavior will ultimately win the day.


Other

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McKesson CEO John Hammergren drops the price of his $22 million compound in San Francisco by $6 million after watching it sit on the market for a year. The solar-powered estate consists of a main house with six bedrooms and 10 bathrooms; a sports complex with tennis, bocce, racquetball, and squash courts, plus a gym, rock climbing wall, steam room, sauna, yoga center, and spa; and a carriage house with a five-car garage, car wash station, and banquet hall. The accompanying pool and spa have their own pool house.


Sponsor Updates

  • QuadraMed, a division of Harris Healthcare, will exhibit at the MaHIMA Annual Conference June 11-13 in Boston.
  • Salesforce publishes its “2017 Connected Patient Report.”
  • Kyruus wins the “Best Healthcare Big Data Platform” Award from MedTech Breakthrough.
  • CRN names Impact Advisors to its 2017 Solution Provider 500 list.
  • Senator Cory Booker (D-NJ) helps to christen Conduent’s new global headquarters in New Jersey.
  • Gartner names AdvancedMD a leader in its FrontRunners for Mental Health Quadrant.
  • Encore publishes a new white paper discussing the role of data governance in the shift to value-based care.

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: Would you recommend to a relative or colleague that they change careers to health IT?

June 9, 2017 Uncategorized No Comments

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I asked if readers would recommend to a relative or colleague that they change careers to health IT.


As I approach retirement, I enjoy having this debate with colleagues my age and with 30-somethings. I was initially involved in healthcare delivery, graduating to healthcare IT over time. My observation is that most of the senior workers recall what we would call a "good job," where you left work at a reasonable time, valued your home life, and were active enough that you didn’t have to pay huge fees to a gym in an effort to stay in shape.

It does not appear the majority of younger staff have ever experienced a job where they felt valued, where the company invested in them, where there were true career paths. Few report a job where a sense of loyalty was engendered. At a certain point, healthcare IT (and IT in general) evolved into this organism that demands 24/7 availability and accessibility, freely doles out periods of excessive hours, covertly considers a commitment to family an impediment to success, provides minimal mentoring and training, and where the management mantra boils down to "do more with less," "work smarter," or some similar analog. The question we deliberate: Which of the groups is happier with their career?

I would not recommend a career in health IT, with a few specialized exceptions.


Why: growth industry. Also the ability to be creative. Room to innovate, or coast or dabble, whatever fits your interests.


My wise old Italian immigrant father told me long ago when I started this crazy ride in healthcare IT that "people will always be sick and people will always need computers". Job security, there’s that. Although the ride has been bumpy at times, I look back fondly at my 25+ year career in this industry. I’ve met some fantastic people (and some not so fantastic people), and some really smart people. I’ve learned a lot, travelled a lot, and am passionate about what I do.

Went to school for finance/accounting and made the switch myself after chatting with a neighbor who was a healthcare IT guy. I thought he was pretty smart and he got me my first interview, and off I went from there. So yes, I would, but only if people were looking for something new.


An IT career professional needs to transcend any primary allegiance to IT and become a healthcare professional with an IT specialty, and become customer-focused. Depending on the person, that may be a stretch – especially mid-career.


Yes, I would. There are significant opportunities for those, particularly with a healthcare background, to contribute to on-going needs of health IT. As a licensed pharmacist who worked in retail for 18 years, then moved to the IT space, I’m finding much more satisfaction and sanity in working in the IT space than I ever found working the bench in McPharmacy. As data sharing continues to develop, it will be amazing to see what population health details will develop over the coming years.


Maybe. I enjoy working in the field because I love feeling like I can make a difference in peoples’ health even though I am not a clinician, and of course, it’s exciting to be in a growth industry. That said, it can be frustrating that not having a clinical background can mean always being seen as less credible, no matter how long you’ve been in the industry.


I just did, actually, to a friend who’s studying to be a software engineer (and who had previously considered healthcare). I told him it was an interesting and ever-changing field with enormous breadth, and that it was a way to be paid well while still doing something truly important.

My caveats: It will also make you want to rip your hair out, and possibly ruin most of your faith in doctors. (#NotAllDoctors)


No – I got in 22 years ago and having been trying to get out ever since! It’s like The Godfather III …


No. The demands are outrageous, the funding for IT initiatives takes the back seat to clinical initiatives, and healthcare is in the middle of a major upheaval based on budget and governmental initiatives. I would suggest something more stable.


Yes, absolutely. Health IT is and will continue to grow. Given how behind the times we are with regards to so many of the technologies available, there is ample room to jump in and make a big difference. Also, it just feels good to know you are making a meaningful difference to people doing good work. I’m not just clocking in to help people find a good restaurant, respond to the latest Internet meme, or play the cool new game. We are making a difference in the health of our communities.


I don’t know that I would recommend a career change, but I would encourage recent graduates to explore health IT as a career option. My own daughters have had the pleasurable (torturous) experience of my 20 years in HIT, they aren’t so impressed with my career choices. I remind them that it kept a roof over their heads, and computers in their rooms.


There is nothing wrong with changing careers to a specific industry. It’s not like it hasn’t been done before with other industries. We all at one point reinvent ourselves. Why should healthcare be any different?


YES: You will always have a job/career where you know it matters whether or not you come to work. You will be busy beyond your wildest imagination. And if you are good, there is never a day when you will be unemployed, wonder where you will work next, or not have the ability to be challenged.

NO: In the 30 years I have worked in this industry, I have had few days “off.” The pace is grueling, the management short-sighted or not focused on the mission, and the initiatives are always under-resourced.


Nope. It’s just a negative, stressful industry. Doctors resent EHRs and hate being forced to use technology, practices are overworked and understaffed, vendors haven’t been able to add too many cool features because they need to keep up with government regulations, and now all the hacking and ransomware scares …


Not in a traditional health IT role because of the constant pressure to cut costs and shave corners. One area I would recommend as a viable opportunity would be any position related to health analytics, artificial intelligence, and machine learning.

Morning Headlines 6/9/17

June 8, 2017 Headlines No Comments

athenahealth Agrees to Acquire Praxify Technologies to Advance Cloud Platform and Mobile Innovation

Athenahealth acquires Palo Alto-based EHR optimization vendor Praxify Technologies, which analyzes the way doctors interact with EHRs and uses machine learning to optimize workflows.

One Person-One Record Clinical Information System

Nova Scotia narrows the list of vendors that will compete to implement its province-wide “one person-one record” system to Cerner and Allscripts.

Epic, Allscripts and Cerner Signal Paradigm Shift in Population Health Management

A Black Book Report lists Epic, Cerner, and Allscripts as mindshare leaders in the growing population health software vendor marketplace.

Bruce D. Greenstein: Chief Technology Officer

HHS names Bruce Greenstein as CTO. Greenstein leaves his role as President at Quartet, a data integration company working in behavioral health.

News 6/9/17

June 8, 2017 News 3 Comments

Top News

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Athenahealth acquires EHR optimization vendor Praxify Technologies for $63 million. The six year-old company employs 80 at its office in Palo Alto, CA and maintains a development presence in India. Athenahealth CTO Prakash Khot is enthusiastic about the benefits Praxify’s machine learning and natural language-processing capabilities will bring to the company’s cloud-based products. Praxify is perhaps best known for its Mira voice-enabled charting technology.


Reader Comments

From AirStrip Technologies CEO Alan Portela: “Re: Rumored NantHealth acquisition. AirStrip has not been acquired and continues to gain momentum in the industry. AirStrip has formed a strategic alliance and commercial agreement with NantHealth that leverages synergies between the AirStrip One mobile interoperability platform and the Nant platform, particularly in the areas of data aggregation, normalization, real-time data streaming and visualization. Our alliance will focus initially on supporting clinical workflows in acute-care settings, with a gradual move toward post-acute and community-based care settings.”

From GraySky: “Re: Athenahealth/Medhost deal. Athenahealth is in due diligence conversations to acquire all or part of the Medhost products. It’s looking to get access to the small community and rural hospital market that Medhost has access to with its inpatient and ED solutions. Cerner officially passed up Medhost late last year after doing due diligence. Valuation was too high in the area of $200M-$400M. Shrinking customer base that includes only a few large customers that are evaluating conversion to Cerner or Epic. Aging product suite.” Athenahealth declined to confirm or deny.


HIStalk Announcements and Requests

This week on HIStalk Practice: Siemens Healthineers finalizes its acquisition of Medicalis. Merritt Hawkins releases its annual physician recruitment/salary report. Mindcotine hopes to use virtual reality to help smokers kick the habit. Brad Boyd outlines ways to leverage MACRA to support long-term strategic goals in the Consultant’s Corner. Plaintiff dismisses lawsuit against MDLive. Hematology-Oncology Associates of Central New York nearly suffers a $250k loss due to clerical error. Salus Telehealth finds an untapped telemedicine market in summer music tours. EClinicalWorks adds telemedicine capabilities to its app. Thanks for reading.


Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


People

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Former CMS Chief Data Officer Niall Brennan joins the Health Care Cost Institute as president and executive director.

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Digital diagnostics services company Analyte Health appoints Kevin Weinstein (Valence Health) CEO. Former CEO Frank Cockerill, MD will take on the position of CMO.


Announcements and Implementations

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Einstein Healthcare Network (PA) selects Teladoc to help it jumpstart a telemedicine program that will initially focus on the health system’s 8,500 employees.

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Rush University Medical Center (IL) starts a three-month pilot of Proteus Digital Health’s Discover smart pill sensor, one that is added directly into traditional pills. The sensor detects when the pill has been ingested via a patch worn on the patient’s stomach, and then sends a signal updating an app with medication adherence data.

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Humber River Hospital in Toronto works with GE Healthcare to build a 4,500 square-foot digital command center that will aggregate and analyze real-time data from systems across the hospital to help improve staff workflows and patient care.


Technology

Meditech adds MModal’s Fluency Direct speech-recognition dictation capabilities to its Web EHR.

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Apple updates the ResearchKit app to include new tests related to range of motion, and selective and visual attention.

Cerner will integrate CareVive’s care planning software with its PowerChart Oncology EHR.

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Nuance adds PowerScribe Workflow Orchestration and PowerScribe Lung Cancer Screening to its line of screening program tools for radiologists.

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Nuance seems to have quietly acquired San Mateo, CA-based radiology solutions company Primordial, its partner in developing the aforementioned technologies.


Privacy and Security

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From DataBreaches.net:

  • Southwest Community Health Center (CT) notifies patients of a potential data breach resulting from two separate break-ins during which burglars took several computers. No mention is made of whether or not the devices were encrypted. The center is offering affected individuals free identity monitoring and restoration services.
  • Mississippi’s Medicaid Division alerts 5,220 people of potential PHI exposure stemming from six online forms managed by a third party that were sent to staff via unencrypted emails for nearly three years.
  • Public school guidance counselor and West Carolina Counseling Services owner Joseph Korzelius admits to using information from his sessions with elementary students to file $450,000 worth of false Medicaid claims. He faces up to 10 years in jail and a $250,000 fine.

Innovation and Research

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A team of researchers from MIT and Harvard develop a proof-of-concept tattoo ink that changes color based on metabolism changes in the body, allowing the tattoo to act as a low glucose or dehydration indicator.

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Healthcare researchers call out the tendency of journalists to create headlines out of health studies that are “deeply flawed,” citing several articles related to the tenuous (and later debunked) claim that EHRs do in fact lead to improved outcomes. “Health care already consumes almost a fifth of America’s GDP — two or three times every other nations’ costs despite our often inferior outcomes,” they write in their conclusion. “It is vital that all stakeholders — journalists, scientists, policymakers, editors and the public — have a better understanding of basic research design and data interpretation. During this unusual moment in history, when politicians seek out whichever facts suit their ideology, the role of good science — and good reporting — could not be more vital.”

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A Black Book survey finds that an overwhelming majority of hospital executives and managers will ultimately look to population health management-focused IT as patient accounting systems as they continue to shift their organizations to value-based care. Allscripts, Cerner, and Epic seem to have the most mindshare of those surveyed.


Government and Politics

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President Trump decides to keep Francis Collins, MD on as head of NIH, a position he has held since 2009.

A VA spokesman confirms that Cerner will replace only the agency’s EHR, and that Epic’s $624 million contract to implement an appointment scheduling program for the VA is not in jeopardy.

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HHS appoints Bruce Greenstein CTO. Greenstein was most recently president of behavioral health tech company Quartet Health, and served under Louisiana Governor Bobby Jindal as secretary of the Dept. of Health and Hospitals.


Other

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The Government of Nova Scotia narrows the field of contenders for a “One Person, One Record Clinical Information System” to Allscripts and Cerner. Based on the procurement listing sent over by HITGeek, it looks like they beat out Evident, Harris Healthcare, and Meditech in preceding rounds that began last December.

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In other northern health IT news, the provincial auditor of Saskatchewan recommends the Ministry of Health replace its 50 year-old IT system with one that can better screen the billing activity of physicians that are still paid on a fee-for-service basis. The auditor also recommends the development of standard criteria to more efficiently identify physicians whose billing practices should be investigated.

E-prescribing of controlled substances increased year over year by 256 percent, according to the latest progress report out from Surescripts. Nearly 75 percent of prescriptions in 2016 were electronic, totaling 1.6 billion.


Sponsor Updates

  • Meditech customers lead lists of five-star and double five-star hospitals.
  • Liaison Technologies will exhibit at the Cerner North Atlantic Regional User Group June 12-14 in Springfield, MA.
  • MedData will exhibit at the Ohio Hospital Association Annual Meeting June 12-14 in Columbus.
  • Medecision, NTT Data, RelayHealth, Surescripts, and ZeOmega will exhibit at AHIP Institute & Expo June 7-9 in Austin, TX.
  • Meditech releases the latest installment of its video series, “EHealth Partnership Unites Ontario Hospitals on Meditech.”
  • Frost & Sullivan recognizes Medicomp Systems with the 2017 Enabling Technology Leadership Award.
  • National Decision Support Co. adds Society of Nuclear Medicine and Molecular Imaging Appropriate Use Criteria to its CareSelect Imaging system.
  • Navicure will exhibit at the NJ MGMA conference June 14-16 in Atlantic City.
  • Experian Health will present at the HIMSS Brand IT Marketing Conference June 15 in Las Vegas.
  • YourStory.com profiles GE Healthcare’s efforts to bring healthcare accessibility and skills to rural areas in India.

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 6/8/17

June 8, 2017 Dr. Jayne 9 Comments

There has been quite a bit of reader feedback about my recent Curbside Consult addressing the ECW settlement. Several readers agreed with my assertion that multiple vendors have gamed the certification process, with one mentioning “extraordinary actions” taken to pass the testing, but that the product was “replaced by corrected code before the production code was released.” Given the way testing occurs, I bet that type of maneuver occurs more often than we’d like. Technically that would be fraud, regardless of how they try to mitigate it. Unfortunately, other vendors haven’t been caught (yet) and/or didn’t allow the products of their deception to go into general release. Hopefully those companies are on notice and will toe the line.

Other readers called for zero tolerance for ECW and other vendors who cheat, including jail time or outright closure of the company. Some felt I was soft on ECW, even “tender.” Let me go on record as saying what they did was despicable – however, I’m a firm believer in the American justice system and we have a couple of things called the law and due process. Whether you think entering into a settlement is tantamount to pleading guilty, there has not been an admission of guilt and no criminal action has been filed that I can find, and trust me, I’ve been looking. My lack of a torch and pitchfork should not be construed as acceptance or approval of what was done. Still, I was surprised by the number of emails I received that attacked me personally or suggested I don’t respect patients. As much as I believe in justice, I also believe in redemption and this is an opportunity for ECW to make things right. As one reader said, “No one benefits if an EHR is litigated into bankruptcy.” Let’s not forget the vendors who have closed their doors abruptly in the past, holding their clients (and the data of tens of thousands of patients) hostage.

Another reader who is in the vendor space mentioned that his employer has already received calls from clients threatening to file whistleblower actions unless specific defects were fixed, regardless of whether they had anything to do with certification or not. Product liability law is a specialized discipline and I don’t think adding potentially hundreds of suits to the environment will result in positive change. Look at how healthcare has dealt with harm in the past: Until you get past the culture of fear and penalty, people are reluctant to report issues or to be part of the solution. Another vendor reader mentioned his company is considering being less transparent with their “known issues” lists because of fear of escalation to frivolous lawsuits. That would be unfortunate as well.

One reader offered an interesting thought around analyzing the percentage of budget that top vendors devote to R&D. There could certainly be some interesting data there and you could come up with some conclusions from annual reports and shareholder documentation. Unfortunately, privately held companies don’t have to disclose anything, so we’d be relying on their report. We’ve heard self-reported statements about this over the last year and many felt they were inaccurate, so it’s not likely that we will get “real” numbers anytime soon. I’d personally like to see the R&D budget compared to support compared to marketing and sales. There are several vendors I work with who spend entirely too much on the latter while shortchanging the former.

Others mentioned my lack of attention to the potential impact on clients. Frankly I think it’s too early to discuss, as we don’t have a full picture of whether those practices will be asked to repay incentive money. Any mandatory repayment would almost certainly create the potential of a class action suit against ECW. That’s precisely why I advised my colleagues on the system to sit tight and see how it unfolds and what remediation is offered and how it actually plays out. They’re in an incredibly vulnerable position right now and it would be easy for another vendor to try to take advantage of their situation. Anyone who predatorily goes after these practices should be ashamed, and I know they’re already out there. The last things these practices need is a hasty move or a poorly considered replacement decision.

Regardless of your position on the guilt or innocence of a vendor and whether the punishment was appropriate, this event has the potential to change the healthcare IT landscape in uncertain ways. I hope that other vendors take the advice of one reader and revisit their compliance programs. Ensuring a culture of honesty, accountability, and understanding of the fact that you hold people’s lives in your hands needs to be at the forefront of thought as corporate decision-making occurs. It’s unfortunately not as common in the US today as we would like, whether in healthcare, the automotive industry, or just about anywhere people are trying to make a profit.

Other readers offered answers to the question of what they’d do with the whistleblower payment, with several noting that legal fees will consume a good portion of it. One mentioned that he would donate to non-profits promoting expansion of EHR systems to practices serving indigent patient populations and that cannot afford to buy them. Or to scholarship funds for computer science students willing to commit to working with those practices to help them implement those systems. Both are great ideas, although I’d like to see vendors contributing to those kinds of initiatives outright, rather than having someone do it as a result of a legal action. Or how about scholarships for patient safety training to ensure caregivers and technology professionals know how to spot these kinds of problems? The reader also noted he’d reserve a few dollars to buy a good bottle of bourbon as a reward for a job well done. Based on the level of documentation and time spent by the whistleblower, I’d suggest more than one bottle would be in the offing.

I don’t think this is the last time we’ll see something like this, and the problem isn’t just on the vendor side. I’ve seen plenty of “creativity” and shortcuts from hospitals and health systems with homegrown systems or with vendors outside the CEHRT space, and although they won’t be caught for fraud during the certification process, they are eventually going to run afoul of patient safety. The question is whether organizations will find the settlement motivational and will clean up their houses voluntarily, or whether more headline-generating actions will need to occur to move the industry where it needs to be. The other possibility is more consolidation in an already shrinking industry, which could have unpredictable effects on innovation and emergence of new vendors. The one thing I can say for sure is that only time will tell.

Email Dr. Jayne.

Morning Headlines 6/8/17

June 7, 2017 Headlines No Comments

Epic Systems’ $600-plus million contract with VA will hold, officials say

A VA spokesman confirms that Cerner will replace only the agency’s EHR, and confirms that Epic’s $624 million contract to implement an appointment scheduling program for the VA is not in jeopardy.

Health Inequalities in the U.S.: A Good Target for our Work

Former FDA Commissioner Robert Califf, MD discusses his new role at Verily and his perspective on how to consistently translate the potential of new technology into better health

This new smart pill reminds you to take your medicine

Rush University Medical Center (IL) pilots Proteus Digital Health’s smart pill sensor, one that is added directly into traditional pills. The sensor detects when the pill has been ingested, and then sends a signal updating an app with medication adherence data.

MIT and Harvard’s Biosensing Tattoos Will Change Color When You’re Dehydrated

A team of researchers from MIT and Harvard develop a proof of concept tattoo ink that changes color based on metabolism changes in the body, allowing a tattoo to act as a low glucose or dehydration indicator.

Morning Headlines 6/7/17

June 6, 2017 Headlines No Comments

WannaCry Ransomware Continues to Cause Problems for U.S. Hospitals

HHS issues a cyber notice alerting healthcare organizations that the WannaCry ransomware attack is causing major operational issues for two large, multi-state hospital systems, and reiterates that the virus continues to pose a threat.

ONC announces winners of Privacy Policy Snapshot Challenge

ONC awards a combined total of $35,000 to the three winners of its Privacy Policy Snapshot Challenge, a contest that asked developers to create new Model Privacy Notices generator that helps software vendors create consumer-facing privacy and security policy.

The Tower Of Babel In Clinical Research: PCORnet’s Common Data Model Cracks The Foundation

A Health Affairs article discusses the research potential that EHR interoperability and data analytics will have on generating clinical evidence, saying “the ability to harness good quality, usable data from EHRs will likely be as revolutionary for health care as the Internet was to other industries.”

News 6/7/17

June 6, 2017 News 6 Comments

Top News

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VA Secretary David Shulkin, MD announces the VA will shut down its VistA EHR and join the DoD in implementing Cerner Millennium, explaining, “The VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems.”

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HIStalk readers (who predicted the Cerner decision in a reader survey earlier this year) didn’t waste time weighing in once the news crossed the wire yesterday – nearly a month before Shulkin’s self-imposed decision deadline. VA Worker says, “Here we go again. VA wants to replace VistA with Cerner but will never be able to afford it.” USA First? points out that, for all the Trump Administration’s efforts to keep American jobs on American soil, they’ve chosen a vendor that has sent 3,000 software jobs overseas.

Epic also shared its reaction via a presumably non-marketing rep: “As the largest electronic health record vendor in the United States, covering two-thirds of the nation’s patients, we are proud to serve our veterans both through the VA scheduling project and through our customers that care for millions of veterans across America. These customers are the top health systems in America and we stand with them, committed and eager to ensure veterans get the very best medical care regardless of where they receive it.” 

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My thoughts are these: Cerner was the only reasonable choice since the DoD had already selected it, but it’s still surprising they went without bidding and named Cerner before negotiation with them began (that’s more of how Epic customers buy software). The company will presumably have more control over naming its price than it did with DoD, where it was a subcontractor under Leidos, and it may be that Cerner gets to keep all the money this time. It’s also to the company’s strong negotiating advantage that both Congress and the President have publicly cheered the VA’s choice of Cerner, making it unlikely that the VA wants to rule out Cerner over price negotiations. The VA has previously suggested that its price tag will be multiples of the DoD’s, perhaps well over $10 billion to $12 billion.

The systems will be theoretically interoperable, but there’s still a lot of work to be done to standardize terminology and functionality to make even the same system talk to another user whose workflows and use cases are different. There’s probably still a lot of consulting work required. It will be interesting to see which firms attempt to feed at the trough of this contract, as well as whether or not the VA and DoD will truly work as a single customer. Will Cerner and the inevitable consultants get stuck trying to broker agreements on major decisions so they don’t end up creating dissimilar systems?

It’s also worth noting that project timelines will need to be synched to avoid temporary interfaces to the legacy systems. Ironically, having the same system may require more VA-DoD cooperation than running separate ones. On the flip side, it’s also important to recognize that the VA and DoD have vastly different needs, and that in the case of the VA (unlike the DoD), its VistA system contains a lot of VA-specific non-clinical functionality, such as management modules for departments that aren’t involved in patient care. VistA is not just an EHR.


Reader Comments

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From Mighty Med: “Re: Walnut Hill Medical Center closure. The self-touted hospital of the future abruptly shuts its doors after being open for less than three years. It’s just another example of healthcare disruption gone awry.” The $100 million, 100-bed Dallas hospital did indeed cease operations as of June 1, citing only it’s decision to no longer participate in the Medicare program. A former employee wrote a Facebook farewell message (later taken down) praising his colleagues for working without the “unlimited resources” of traditional hospitals, implying that it was struggling in some way. Officials touted the facility as being designed “completely from the patient’s perspective to create a stress-free atmosphere for healthy recovery.“

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From Just Wondering: “Re: John Fleming’s desire for a single unified EHR. Is he as stupid as he sounds?” Hardly. The former Louisiana representative, businessman, and MD has done stints at the Navy Regional Medical Center (CA) and in private practice. He implemented his first EHR in 1997 and went fully paperless two years later. Fleming’s belief that “every American should have a single, unified electronic health record system that resides in the cloud and is under full control of the patient, of the individual, of the American” is the same pipe dream that dozens, if not hundreds, of health IT companies and venture capital firms have been throwing millions of dollars at for years. As the new deputy secretary of health technology reform, he’s becoming privy to the many public- and private-sector interests that will keep that pie-in-the-sky patient record from being developed anytime soon.


HIStalk Announcements and Requests

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An anonymous vendor has graciously donated $500 to my project to fund DonorsChoose teacher grant requests in return for mentioning a survey they’re interested in. They’ll also donate a bunch more money if the survey gets at least 100 responses. Providers, please click here and spend a handful of minutes and together we’ll to help a classroom in need. Thanks.


Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

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Learning management systems vendor Relias Learning acquires WhiteCloud Analytics for an undisclosed sum. Reliance has been on a bit of a spending spree since March of last year, acquiring six other companies including analytics firm Care Management Technologies.

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Aegis Health merges with digital marketing firm Clariture to form Trilliant Health. The companies will retain their brands as separate business units.


Announcements and Implementations

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Mayo Clinic (MN) will use 2bPrecise’s clinical genomics solution to add genomic information into its Epic EHR. The organizations will also work together to research and develop genomics-based care protocols, particularly for patients with cardiovascular genetic disease.

Aprima announces record growth for the fiscal year, including revenue, customer retention rate, and the relocation and expansion of its headquarters.


Technology

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Apple announces new devices and features at its developers conference – none of which are all that earth-shattering and only some of which are relevant to healthcare. The company will attempt to keep up with the virtual assistant Joneses with the introduction of a Siri-powered HomePod. It has added AI capabilities to its Watch, giving it the ability to serve up motivational fitness messages when steps are down. Users will also be able to link their devices to Dexcom’s glucose sensor via a new API. Perhaps the most potentially life-saving enhancement is the Iphone’s forthcoming “do not disturb while driving” feature, which shuts off all distracting notifications when the phone is connected to your car.

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Casenet develops a prior authorization submission and tracking tool.

PointClickCare adds Ability Network’s claims management capabilities to its EHR for long-term and post-acute care providers.

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Safety Net Connect releases an enterprise version of its Converge referral and care coordination technology that brings together behavioral and physical health, and social services.

ICare adds order sets and care plans from Zynx Health to its EHR for acute care providers and SNFs.


Government and Politics

ONC announces the winners of its Privacy Policy Snapshot Challenge, the aim of which escapes me as the number of these contests seems to increase in direct correlation to the market-worthy usefulness of their winning ideas.


Sales

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Tufts Medical Center (MA) chooses ZappRx to automate the ordering of specialty drugs, expecting to reduce the average prescribing time from 20 minutes to three minutes.

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Children’s Hospital of Wisconsin selects CRM software from Healthgrades.


Privacy and Security

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HHS alerts providers to the “significant” challenges two unnamed multi-state hospital systems are still experiencing as a result of WannaCry malware, noting that the virus can live on a machine that has been patched, and that its repeated attempts to scan can disrupt Windows operating systems.


Innovation and Research

Early performance data on IBM Watson for Oncology shows that Watson-generated treatment plans for 362 cancer cases were found to be in line with oncologist recommendations in 96 percent of lung, 81 percent of colon, and 93 percent of rectal cancer cases.


People

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Michael Caponetto (West Health) joins government healthcare program services company SynerMed as CFO.


Other

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The New York Times addresses the “virtual velvet rope” creeping into healthcare – one that is moving beyond celebrities and sheikhs taking over hospital wings and turning the more mundane world of direct primary care into one of ultra high-end concierge practices. Private Medical, for instance, charges between $40,000 and $80,000 per year per family for round-the-clock physician access and near-immediate access to specialists and hospitals across the country. Launched by HealthLoop founder Jordan Shlain, MD in 2002, the company has almost no Web presence, gaining new patients almost exclusively through word of mouth.


Sponsor Updates

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  • Direct Consulting Associates donates fabric and stuffed animal kits to help middle-school students make stuffed animals, blankets, and pillows for local charities.
  • ClinicalArchitecture partners with OpenAirWare to more easily integrate patient data from standard clinical information exchange formats with its Advanced Clinical Awareness Suite.
  • Software Advice names AdvancedMD a 2017 Mental Health FrontRunners Quadrant Leader.
  • Agfa HealthCare successfully completes the recertification audit cycle for its information security management system.
  • Aprima Medical Software will exhibit at the NJ MGMA meeting June 14-16 in Atlantic City.
  • Bernoulli Health will exhibit at AAMI Conference and Expo June 9-12 in Austin, TX.
  • Besler Consulting releases a new podcast, “Looking at price data on local healthcare markets across the United States.”
  • Kyruus will host its ATLAS Conference on patient access September 19-20 in Boston.
  • Casenet, Cumberland Consulting Group, EClinicalWorks, InstaMed, and InterSystems will exhibit at AHIP Institute & Expo June 7-9 in Austin, TX.
  • Dimensional Insight remains a top performer in the Wisdom of Crowds 2017 Business Intelligence Market Study.
  • Casenet clients and employees donate gift bags to children at CHA Cambridge Hospital (MA).
  • ECG Management Consultants will present at the 2017 Science of Team Science Annual Conference June 13 in Clearwater, FL.
  • Glytec will exhibit at the American Diabetes Association Scientific Sessions June 9-13 in San Diego.
  • Healthwise will exhibit at the Cerner North Atlantic Regional User Group June 12-14 in Springfield, MA.
  • Iatric Systems will exhibit at the NCHICA AMC Security & Privacy Conference June 12-14 in Chapel Hill, NC.
  • The Atlanta Business Chronicle names Ingenious Med a “Pacesetter” for the fifth consecutive year.
  • Kyruus will exhibit at the Annual Conference of Healthcare Call Centers June 7-9 in Salt Lake City.
  • Inc. Magazine includes PMD on its list of best places to work.
  • Definitive Healthcare CEO Jason Krantz is named a finalist for E&Y’s Entrepreneur Of The Year 2017 New England Award.
  • Imprivata releases a new report, “High-value, complex clinical workflows require enhanced communications capabilities.”

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 6/6/17

June 5, 2017 Headlines No Comments

Kansas City-based Cerner wins VA contract

VA Secretary David Shulkin, MD announces that the VA will shut down its VistA EHR and join the DoD in implementing Cerner Millennium, explaining, “The VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems."

Early experience with IBM Watson for Oncology cognitive computing system for lung and colorectal cancer treatment.

At the 2017 ASCO Annual Meeting, IBM presents performance data on Watson for Oncology.  A multidisciplinary tumor board and Watson for Oncology both independently reviewed and generated treatment plan recommendations for 362 cancer cases, after which Watson-generated treatment plans were found to be in line with oncologist recommendations in 96 percent of lung, 81 percent of colon, and 93 percent of rectal cancer cases.

Dallas’ Walnut Hill Medical Center confirms its abrupt closure

Walnut Hill Medical Center, which billed itself as the “hospital of the future” when it opened in 2014 , closes suddenly. Officials declined to provide details, other than to say that the hospital’s provider agreement with Medicare had expired and it would cease operations after June 1.

Curbside Consult with Dr. Jayne 6/5/17

June 5, 2017 Dr. Jayne 14 Comments

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Quite a few people called or emailed this week to find out what I thought of the EClinicalWorks settlement. Two of them were ECW users asking for my advice on whether they should change EHRs and, if so, what I thought they should be looking at. For those practices potentially impacted by the alleged wrongdoing, it’s a very uncertain time. My advice was to pause and let the dust settle before making any decisions. Neither of the ECW physicians I talked to this week had concerns about how the system is actually performing based on their scope of use, and felt fairly confident that they’re not experiencing functionality issues that impact patient care.

As for those that reached out simply curious about what I thought, I’ll share what I had to say. There were several allegations addressed in the settlement. I say “allegations” deliberately because ECW hasn’t admitted guilt nor has it been proven in a court of law. Everyone can speculate on the fact that they settled, but given that I have a plaintiff’s attorney in the family, I understand how expensive litigation can be and how $155 million may be a bargain compared to having to mount a defense, deal with the side effects of having half your company (and your customers) deposed, and having ongoing distraction that impacts your ability to keep the lights on and the business running.

First, let’s look at the kickback issue. The suit alleged that it gave kickbacks to customers for promoting its products, including payments for reference site visits. Many of the vendors I’ve worked with would also fall into this category. During my days at Big Hospital System, we regularly received extra attention from our vendor in exchange for being a reference site, and at times we also received credits against our software maintenance payments. I’m sure that could be construed as a kickback, although our site visits were quite “tell it like it is” rather than pure attempts to induce anyone to switch to the vendor. We always insisted that the vendor reps stay out of the discussion and sit in the back of the room or outside the room altogether. It looks like ECW also paid a bonus when prospects actually signed, and paid individual physicians to do references, which is a little murkier.

The way it’s described in the actual filing, any “manufacturers of products paid for in whole or in part by federal healthcare programs may not offer or pay any remuneration, in cash or in kind, directly or indirectly, to induce physicians or hospitals or others to order or recommend products paid for in whole or in part by Federal healthcare programs such as Medicare and Medicaid.” If you take that at face value, then the medical device reps need to stop wooing the cardiologists and orthopedic surgeons, regardless of whether they’re reporting their meals and tchotchkes in compliance with Open Payments. The language also applies to services, so the people from hospice that bring lunch while they explain the services they offer are guilty as well, even though they’re a nonprofit.

Next, let’s look at the issue of cheating on certification. Although some of what they did (such as hard coding the RxNorm codes for the test scripts rather than having the system access the entire library) is pretty egregious, anyone who’s been part of a certification process knows that there’s a gray area between complying with the test scripts and complying with the spirit of the requirement versus the letter of the requirement. There’s plenty of functionality out there that passes the test scripts but isn’t user friendly or sometimes isn’t even usable.

Let’s also look at the allegation that ECW “released software without adequate testing and overly relied on customers to identify bugs and other problems. Some bugs and problems – even some identified as ‘critical’ or ‘urgent’ – persisted on ECW’s bug list for months and even years. ECW lacked reliable version control, so problems addressed in one version of the software or for one particular user could reappear in other versions or remain unaddressed for other customers.” I’m currently working with half a dozen vendors who could fall into that description, and can name a few more to round out the group. Nearly every vendor I’ve worked with is guilty of this to some degree.

As a customer, I’ve been part of beta testing programs that are more like alphas, and have seen code that doesn’t seem to have been tested by anyone conscious. Sure, the coded functionality may have met the technical requirement specifications, so it passed, but when deployed to the field it’s broken or simply useless. I heard from a couple of friends who work for vendors that they were taking joy in ECWs pain. I challenged them to think about their own situations, and whether they’ve ever let a regression error go out the door. It sobered them up pretty quickly. Developers who live in glass houses definitely should not throw stones, because they could be the next ones in the spotlight.

That takes me to looking at the whistleblower component. There was quite a bit of buzz around the fact that the software technician who filed the original suit will receive $30 million. I’m wondering if this is going to be an incentive for individuals to try to prove wrongdoing across the industry in exchange for a potential windfall. Hopefully, this will spur vendors to pay more attention (and devote more resources) to defect resolution as well as defect prevention, since most vendors likely have a backlog of issues needing remediation. On the other hand, it could lead to a lot of rock-turning during which plenty of creepy crawlies will come to light. If vendors have robust systems to manage their issues they’ll persevere, but if not, potential whistleblowers could create a lot of noise that will create distractions that may ultimately harm customers.

Hopefully this settlement will be a call to action for vendors to get their houses in order, and bring greater transparency to the sausage-making that is the certification process. It’s been interesting, though, to see the number of people putting the blame on the certification process itself. The bottom line is that there are rules; if we think they are unfair, we should seek to have them changed in an orderly way rather than just flout them. It will be interesting to look back on this in six months or a year and see whether it’s changed anything or whether it just goes down as another footnote on corporate wrongdoing.

What would you do with a $30 million whistleblower settlement? Email me.

Email Dr. Jayne.

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