The GAO audits the Patient-Centered Outcomes Research Institute, concluding that the organization’s $271 million on PCORnet research network will struggle to support researchers because EHR vendors do not subscribe to an industry standard data model and therefore the organization will need to hire additional staff to support data migration and mapping.
Epic CEO Judy Faulkner tells Modern Healthcare that she will create a charitable foundation that will fund not-for-profit organizations working in and out of healthcare. “Nearly every share of stock that I own will be put in there,” she says.
A GAO audit of the PPACA-mandated Patient-Centered Outcomes Research Institute (PCORI) predicts that its PCORnet research data network will struggle because EHRs have no common data model, which will require hiring resources to process the submitted information manually. GAO also questions whether the organization’s funding will be ongoing and sufficient, but notes that PCORI plans to sell data to drug companies. (Does any healthcare organization’s business model not involve selling data to drug companies?) PCORI also notes that it doesn’t always have or need claims data. It also acknowledges that its information will rarely be complete because of lack of a national patient identifier. PCORnet has spent $106 million so far of an expected total cost of $271 million through FY2019.
From Justin Graham: “Re: infectious disease informatics docs. There are a handful of us ID/IT types. Harris Stuttman at Memorial Long Beach, Gifford Leoung at Dignity, and David Classen in Utah and a few others immediately spring to mind. I’m sure there are more since the ID procedure of choice is the chart biopsy.” I shouldn’t have ignored that tiny warning in the back of my head as I was interviewing Ogechika Alozie and mentioned that he was probably the only informatics person I know with an ID background. I’ll hide behind my carefully placed “probably” in claiming good intentions while admitting poor off-the-cuff execution. Justin and I also talked about CMIO networking at the HIMSS conference and I volunteered to coordinate something for those CMIOs who are interested – let me know if that describes you (maybe Dr. Jayne will hang out with her peers).
From Solilliquist: “Re: NantHealth rumor. They aren’t making Allscripts their sales organization. Just a few salespeople were let go and in fact new sales leadership is coming on board.” Unverified, but the source is sound.
From Watcher of the Skies: “Re: eClinicalWorks. They have installed an inpatient system in 10+ hospitals in India. They are looking at hospitals in Europe and may someway bring the product to the US.” Unverified.
From Nurse Tina: “Re: Antelope Valley Hospital EHR failure. The nurse union is asking the LA County Department of Public Health to investigate.” The California Nurses Association wants to know why the hospital didn’t have a backup plan for its unexplained system failure, which the nurses say caused a variety of clinical problems. The financially struggling hospital raised eyebrows a couple of years ago when it admitted marketing its OB services to pregnant women in China, who in return for paying their bills, earned their newborns instant US citizenship.
Cerner’s Implementation of OpenNotes
I mentioned my interest in talking to an EHR vendor about their support of OpenNotes. Cerner connected me with Brian Carter, senior director and general manager of member engagement.
Brian says Cerner’s HealtheLife patient portal has given patients access to provider documents for at least five years, so it wasn’t challenging to expose yet another document in the form of provider notes. Cerner created a facility-wide configuration setting of whether the client wants to expose the notes. A second level of granularity is provided by allowing each client the option to allow their providers to designate a specific note as “private,” but interestingly only one client has chosen that option – none of the rest of its customers allow doctors to hide individual patient notes.
I asked Brian if clients are monitoring whether patients are reading their notes. He says clients use a lot of patient engagement reports, such as showing how long it takes each provider to respond to electronic patient inquiries, and seeing how patients are interacting with the notes about them will probably become a popular measure.
Brian says that no customer has complained that a patient saw something awkward or misleading. Any issues of that type lead to having a conversation with the patient that was probably important to have for other reasons. He mentioned an HIE-like example where a confused ED patient remembered that he had access to his records at another hospital via OpenNotes and he helped staff read up on his condition, avoiding an expensive battery of lab tests that was about to be ordered (I joked that it was like a patient-carried HIE, where the providers can’t access each other’s records except through individual patients, which isn’t a bad model).
I asked about planned support for OurNotes, where patients can annotate or add their own thoughts to the chart. Brian says patients could use that to correct their meds list or report a new allergy. I asked if that is wise since the hospital would be on the hook legally to actively monitor and react to those messages that could be coming in around the clock. Brian says the option will be offered only if the patient has a scheduled appointment within an upcoming window of time, which would then allow the provider to review all of their generated notes at once and reconcile their official EHR information during the visit.
I asked if Cerner plans to support patient-entered forms to make visits more efficient. The company is developing a custom form generator to create documents that patients can complete in advance, conserving their face-to-face provider time for more important interaction. Brian gave an example of a neurology practice that has a 90-question form that the patient can complete at home, which not only saves time, it also populates discrete Millennium data fields that can trigger alerts or document workflow.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Acquisitions, Funding, Business, and Stock
Evidence-based imaging analysis vendor HealthMyne raises $4.5 million in a Series A funding round led by two Madison-area venture firms.
Kareo acquires patient engagement and marketing technology vendor DoctorBase.
Doctor house call vendor Pager raises $10.4 million from existing investors despite what would seem to be significant scaling barriers.
In Scotland, Craneware announces six-month financial results: revenue up 2 2 percent, adjusted EPS $0.165 vs. $0.143.
Epic CEO Judy Faulkner tells Modern Healthcare’s Joe Conn that she has created a private foundation that will receive all of her billions’ worth of Epic shares upon her death or any time at her discretion, guaranteeing that the company will never go public. She explains,
“One, I didn’t want the money, personally, or for my family. What would you want with all that money? It doesn’t seem right and I can’t tell you why. (We’re) putting it into a trust that can be used for the benefit of healthcare organizations, other exempt organizations and our communities. We can use it to (help) other charitable organizations that have contributed to our success. Because that’s where it came from.”
St. Peters Health Partners (NY) chooses Phytel for population health management.
Cornerstone Healthcare Group (TX) chooses MModal for documentation services and technology.
Greenville Health System (SC) will implement performance management tools from Practical Data Solutions as part of its Epic implementation.
New York’s Healthix RHIO names Todd Rogow (HealthInfoNet) as SVP/CIO.
Announcements and Implementations
Northwestern Memorial Physicians Group (IL) goes live with Forward Health Group’s PopulationManager.
For-profit consulting firm Ethisphere has been criticized in the past for charging companies to apply for its “World’s Most Ethical Company” award and charging winners again to use the resulting logo. If you’re still interested, the healthcare-related 2015 winners are Novation, Premier, Baptist Health South Florida, Cleveland Clinic, HCA, North Shore-LIJ, University Hospitals, and three Blue Cross companies. HCA also made the ethical list for the sixth year in a row despite having paid $2 billion in a 2002 settlement for Medicare fraud and another $20 million in 2005 for share dumping by several HCA executives right before the company announced poor earnings.
Zynx Health releases Consensus Builder, a web-based addition to its Knowledge Analyzer that allows clinicians to discuss and approve clinical content being developed.
Cleveland Clinic will partner with lab testing high flyer Theranos to explore the possibility of reducing testing costs and turnaround time.
Two academic medical centers in the Netherlands halt their implementation of the former Siemens Soarian, saying they are uncertain about the product’s direction under its new owner Cerner. A reader from there suggests that Cerner wasn’t showing much enthusiasm for the project at Erasmus University Medical Center Rotterdam and University Medical Center Groningen, adding that the small country has only eight academic medical centers and they are each going their own way instead of working together. Siemens announced the $55 million deal a year ago.
Allscripts will embed Elsevier’s CPM Framework nurse treatment plans product in its Sunrise EHR, clearly hoping (given the fawning press release wording) to bolster its DoD EHR bid chances. The announcement is interesting since Sunrise developer Eclipsys (acquired by Allscripts in 2010) originally owned CPM Resource Center and sold it to Elsevier in 2007 for $25 million. Eclipsys originally bought the well-traveled CPMRC in 2004 for $5 million.
Chesapeake Regional Medical Center (VA) will implement Epic using services from Bon Secours Health System subsidiary Good Health Connections, replacing McKesson Horizon.
CoverMyMeds publishes the Electronic Prior Authorization (ePA) Scorecard. Facts from it:
ePA volume is increasing 20 percent per year.
40 percent of prior authorizations are abandoned because of the workload involved.
70 percent of patients with prescriptions requiring paper-based prior authorization don’t receive the meds originally prescribed.
54 percent of EHR vendors have committed to supporting ePA, but only Allscripts, DrFirst, Epic, NextGen, NewCrop, and Practice Fusion have it available now.
67 percent of payors and 70 percent of pharmacists have committed to supporting ePA and most of them are live.
Telehealth solutions vendor Ostar Healthcare technology announces its cell-enabled, vendor-neutral gateway that integrates payer and provider systems with remote monitoring devices such as scales and glucometers.
Mark Neuenschwander has been around pharmacy-related IT for a long time, having brought out early comparative reports on automated dispensing machines and then on bedside barcoding. His new focus is on technology-assisted sterile compounding systems, those IT systems used in pharmacy IV rooms to make sure custom bags are correctly prepared (robotic systems, barcode scanning, imaging, volumetric and gravimetric analysis, etc.) His new report is available to hospitals for $349 and to everyone else for $499. I will say that when I was once asked to approve the purchase of one his reports for the IT department I was skeptical about the value, but once I saw it I (and used it) I declared it to be one of the most cost-effective information sources I had seen and I used it to plan our medication automation strategy. I’m mentioning it here since I know his work and some readers will be interested in it.
Government and Politics
Oregon finally legislatively kills its Cover Oregon health insurance exchange, having not enrolled a single citizen for its $248 million cost and generating lawsuits between the state and its developer Oracle.
The cost of the Vermont Health Connect health insurance exchange could reach $200 million and the backlog of coverage change requests stands at more than 11,000.
FDA issues draft guidance (in the form of Q&A) for using electronic informed consent in clinical studies. It addresses such issues as how subject questions are handled, how to make sure subjects understand the information, and subjects are notified of changes during the study, and whether electronic signatures can be used.
Bizarre: FDA recently developed a smart plan to stamp implantable medical devices with barcodes to allow tracking and recording them for clinical purposes. IT-inept CMS bureaucrats (the folks who brought you Healthcare.gov) are trying to kill the project, saying it’s too much trouble for them to add the ID number to claims forms, or as recently departed CMS Administrator Marilyn Tavenner explained in a February 23 complaint to two senators, “including UDIs on claims would entail significant technological challenges, costs, and risks” (to her agency, not to patients, just to be clear.) HHS Secretary Sylvia Burwell is on record as favoring including device IDs on claim forms.
Apple announces its smartwatch and its long-awaited price — $350 to $17,000, depending on style (surely only rich fools would pay $17,000 for a first-generation electronic device that will be obsolete in a year). The ship date for the Apple Watch is April 24. As expected, it requires an iPhone for connectivity and does little that the phone can’t do perfectly well on its own, with the most obvious minor benefit being that people who stare at their phones all day instead of the world around them might appear slightly less self-fixated in staring instead at their wrists. Its most important feature is that fanboys will love it and toy with it conspicuously to make the rest of us feel that our lives are barren without it. The reviews have one point in common: nobody can figure out why it exists other than because Apple says it’s cool. The best reason to stick a new, expensive input device between you and your iPhone would have been the health tracking capabilities that Apple had to leave out.
Apple also announces ResearchKit, an open source iOS software framework that allows people to connect with medical research studies via their iPhones. Developers can create testing apps that analyze voice patterns, handwriting, and gait that can then connect possible research subjects to programs and allow subjects to submit forms from their iPhones. Apps have already been developed for asthma (Mount Sinai), breast cancer symptoms (Dana-Farber), cardiovascular health (Stanford), blood glucose (Mass General), and Parkinson’s disease (University of Rochester). Sound good except that self-selected research participants don’t necessarily form a representative cohort, limiting the ability to draw inferences from their experience. There’s also the question of positively identifying candidates and their suitability based on something they type onto an iPhone screen.
A fitness app developer says wearables (a term he deems “insufferable”) are making people less healthy as they focus entirely on hitting their easy 10,000 walking steps instead of doing actual strenuous activity. I’ve said that many times – an exercise program that doesn’t involve cardio and weights isn’t really an exercise program and instead is just plain old “activity,” which at least is better than sitting on the couch or at a desk.
Personal ECG app vendor AliveCor earns FDA approval for providing a “normal ECG” message to users or to let them know their data is unreadable and to try again.
Influential 10-year-old technology blog Gigaom shuts down due to going broke.
A HIMSS Europe report that brashly declares that health IT reduces inpatient mortality, which it “proved” by simply matching up EMR Adoption Model scores vs. weighted mortality (note the not-very-many data points wandering around all over the place). It “confirms” its conclusion by asking IT people in hospitals that spend more money on IT if those systems improved outcomes, which of course resulted in a lot of “yes” answers. Skip all the verbiage to the end, where you’ll find, “Organizations with a higher EMRAM score tended to have a low mortality rate.” That’s an Evel Knievel-sized jump away from proving that if A correlates to B, then A must have caused B. Maybe higher-spending hospitals had more cash to invest in hiring better people, or were located in an area with a milder flu season, or were more enlightened about processes and outcomes which resulted in their buying technology rather than vice versa. We also don’t know how those hospitals performed before they implemented technology, which might be the most useful of the omitted information. HIMSS has a multitude of vested interests here: selling its EMRAM, pitching the wares sold by its Diamond members, and selling memberships and publications. They failed to prove anything decisively.
PatientSafe Solutions publishes “Unsecured Texting – The Monster Underneath the Bed.”
Direct Consulting Associates is profiled in a regional business publication after being named a NEO Success Award winner recognizing top-performing companies in Northeast Ohio.
Surgical Information Systems releases a quality extract for surgery-related eMeasures.
Novation will offer its members Versus RTLS workflow solutions.
First Databank posts “Sharing Lessons Learned in NDC Data Collection and Publishing with UDI Initiative Stakeholders.”
CoverMyMeds will exhibit at the sPCMA 2015 Business Forum March 16-17 in Orlando.
Clockwise.MD is named a semifinalist in the HIMSS HX360 Innovation Challenge.
CareTech will exhibit at the ACHE Congress on Healthcare Leadership March 17-19 in Troy, MI.
Bottomline Technologies will exhibit at Microsoft Convergence 2015 March 16-19 in Atlanta.
Clinical Architecture posts “The Road to Precision Medicine.”
CitiusTech offers “Making Clinical Data Actionable for Payers.”
Culbert Healthcare Solutions highlights “Issues to Consider When Sunsetting a Legacy Practice Management System.”
Apple unveils Research Kit, an open source API designed to connect medical researchers with research study participants to improve communication and streamline data capture. Five projects are already live on the framework, including a breast cancer research project from Dana Farber, a diabetes project from Massachusetts General Hospital, and a Parkinson’s disease diagnostic tool from the University of Rochester.
CHIME and AMDIS announce a new partnership under which CHIME will provide operational, administrative, and staff support to AMIDS and AMDIS will act as the primary physician informatics advisor to CHIME. A similar arrangement was announced between the organizations in June.
I mentioned last week that I’ve been gearing up to start a new urgent care position. Unless you have been on the provider side of things, it may be difficult to understand all the moving pieces that go with a physician starting a new job.
It’s not just about adding them to the EHR and making sure they have logins. There are countless steps before you can even consider that. In addition to passing the normal steps in the hiring process (interview, reference checks, background check, drug test, pre-employment physical, etc.) there are applications for medical liability insurance and credentialing applications for all the different insurance payers. We also have to update our licenses and DEA registrations, not to mention state narcotics board certificates, hospital privileges, and more.
Since I’ve done a fair amount of locum tenens work, I was lucky to have all the required documentation already organized and scanned. The practice’s onboarding coordinator was excited about that, as was the medical liability carrier. Rumor has it that my onboarding process was one of the most streamlined they’ve had. I suppose that’s the benefit of having been on the employer side – I’ve seen what happens when a new physician stalls in filling out the paperwork and I didn’t want to be “that doctor.” It can literally take months to get everything ready to go if there’s a lot of back and forth with the documentation.
Based on the initial progress, they were convinced things would come together quickly and scheduled me for some shifts. They use staff management software that not only proactively asks me for my schedule requests, but also makes sure recipients acknowledge their receipt of the final schedules.
I started my EHR training last week while waiting for the above dominoes to fall into place. The online training was engaging, but I didn’t get very far due to the length of the modules and competing priorities on my schedule. Luckily I had completed the EHR overview, so I crossed my fingers and headed to my first day of work.
With as long as EHRs have been around, practices expect new physicians to be able to hit the ground running. Even if physicians haven’t had an EHR in the office, most of us have used electronic records in the hospital to at least some degree. Even if we’re not writing our notes on a computer, we may be doing CPOE or reviewing nursing documentation.
The practice arranged for one of their in-house trainers to stay with me during my shift. I was fortunate that she is not only a trainer, but also one of the most skilled medical assistants in the practice. She was able to teach me about office workflow and how the staff handles various situations in addition to making sure I wasn’t missing key EHR documentation.
I was honest and told her that I hadn’t completed all the training. Apparently getting through any at all was a big plus compared to other physicians she had trained. She said that most physicians don’t bother to do the self-directed learning until they work their first shift and realize they’re unprepared.
I guess that’s one way to figure out whether an EHR is truly intuitive or not, but I’m glad I didn’t take any chances. The EHR wasn’t as smooth as it had looked during the training, which was no surprise because trainers by design are skilled at making things look easy.
Most systems perform differently in the heat of battle than they do in the rarified air of the training room. This wasn’t the first time I’ve been trained on the job in an ER or urgent care – most of the time when you are a fill-in physician, that’s how things happen. Physicians who are paid hourly aren’t willing to donate their time for training and employers aren’t likely to want to pay for training time.
This system wasn’t any different from others I had used in that the first four or five patient notes were acutely painful as I tried to develop muscle memory and a feel for the different variations in the layout for the different patient complaints. Although there was another physician in the office, he was there only to back me up if I got too far behind. The organization prides itself on short wait times and immediate care and he was there to maintain standards while I got my feet wet.
By the end of the shift, I was feeling pretty good, but I’m nowhere close to the productivity I know I’ll have after two or three days in the office. Since I’ve spent the last year documenting most of my work using a paper-based template system, I was happy to be back in the EHR world. I’ll take some extra clicking any day in exchange for allergy and interaction checking, medication refill history, and clinical decision support. The e-prescribing system acted a little quirky, but I’m guessing it’s due to the fact that I’m enrolled on multiple vendor systems. Hopefully a couple of phone calls will sort that out.
At the busiest part of the day, I had 8-10 incomplete charts with a full count of patients in the exam rooms. Things slowly got easier, but I still had a pile of half-finished charts when we accepted our last patient for the night. While she received some IV medication, I was able to complete the rest of my documentation so that I could walk out the door right behind the patient. That’s always a good feeling and I know the staff appreciated the effort so they could get home as well.
Although the practice allows me to complete my charts from home, I’ve never liked that approach. I had to do that during my first EHR implementation and it was too easy to forget patient details and miss documentation. Processing refill requests and reviewing lab results is one thing, but trying to do visit note hours after the fact has never worked for me. I’m taking the immersion approach and working three shifts this week, so hopefully by the weekend I’ll be where I need to be to feel like I’m pulling my weight. It’s a heck of a way to spend a week of vacation, that’s for sure.
How long does it take your new physicians to get up to speed? Email me.
All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld” (and “SNL"): Part III – Serenity Now By Bruce Brandes
Competition. A foundational element that drives greater success in a capitalistic society. And yet, examination of the array of perceptions and reactions regarding one’s competitors in business is both fascinating and revealing.
As we get to know an entrepreneur and assess a prospective investment, an important insight is their response to the multidimensional question, “How do you view your competition?”
How an entrepreneur expresses awareness, insights, differentiation, and honesty in recognition of competition can illuminate market opportunity, commercial viability, and personal credibility. Do you deny, dismiss, disparage, or do you choose to recognize and embrace others in your space? How does that answer vary when discussing competition internally or externally? Does the stress of competition drive your organization to catalyze improvement or to react with paralyzing stress?
What lessons can be learned from the competitive battle between George Costanza and his nemesis, Lloyd Braun? Serenity now.
In our early days at Eclipsys in the late 1990s, the market was peaking with good, old-fashioned street fights to win new business from a hospital. An expansive bevy of vendors were lined up for marathon beauty pageants. Even Miss Rhode Island had a chance to compete. I was oriented with a friendly disdain for Cerner, our chief competitor of the day (hindsight obviously shows who got the last laugh).
Each vendor’s sales reps were diligently trained to know as much about what the other company could not do as they did about what their own company could do. Accuracy and validity of this information was inherently suspect. Some vendors became adept at lying better than others could tell the truth. I sometimes wonder if this was how the Soviets learned about Americans during the Cold War.
Whether with a prospective customer, recruiting a new hire, or in seeking capital from an investor, there are several potential reactions when questioned about your competition and important implications for you in how your answer may be interpreted.
Reaction 1: Denial
Apart from the Soup Nazi’s crab bisque, how many products or services today are so uniquely innovative that they are beyond compare? Yet some entrepreneurs communicate they are such game-changers that they face no competition.
Upon further questioning, they may reluctantly concede that “doing nothing” is a prospect’s only alternative. While potentially valid on rare occasions for true breakthroughs, this is almost always wrong. The arrogance of holding this belief (and the manner in which this position is often communicated) generally discredits the individual and their organization. In most procurement processes in healthcare over the last quarter century, “doing nothing” has won more competitions than anyone.
Reaction 2: Disparagement
Sometimes more intentional and overt than others, the speculation and innuendo concerning another company often elevates that other vendor’s status as a leader and reflects more poorly on you 100 percent of the time.
When Seinfeld dentist Tim Whatley announced that he had become Jewish, Jerry disparaged Whatley to a priest claiming that he only converted to Judiasm for the jokes. "This offends you as a Jewish person?” inquired the priest. No,” replied Jerry. “It offends me as a comedian.” Jerry is subsequently outcast, labeled as an “anti-dentite.”
Reaction 3: Logo Bingo
Virtually every pitch deck will have one of two versions of this slide, both of which can be effective but dangerously predictable.
The first version shows a checkbox-a-palooza with a limited number of vendor logos on one axis and a capabilities list on the other. I have never seen this slide that did not have the presenting company with the most check marks possible, which immediately raises the question what other capabilities are not on the list that should be. The second version depicts four quadrants which universally position the presenting company in the farthest upper-right corner with no competitive logos even close to the neighborhood.
Reaction 4: Just Dance
Put your best foot forward and honestly assess if this is the best mutual fit. Be realistic about how you compare with your competition and gracefully admit that you are not always the best choice. The decision may or may not be close, as Chris Farley and Patrick Swayze remind us in this classic skit from Saturday Night Live.
In a free and transparent marketplace, given fair access to decision-makers and equal opportunity to compete, the innovators delivering a superior solution with a compelling value proposition should have better than a puncher’s chance to succeed. Even better than Little Jerry Seinfeld in a cockfight. How you perceive, understand, and communicate your place in a competitive landscape is a critical factor that may dictate your market success. Here’s to hoping you don’t end up living in a van down by the river.
Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.
I’m chief medical informatics officer at Texas Tech University Health Sciences Center in El Paso. That’s a mouthful. We became an independent campus last year. We were part of the Texas Tech system, which includes Lubbock, El Paso, Amarillo, Odessa, and Dallas. We’re a separate entity legally. We’re doing a lot of separation things that happen when two organizations have been together for tens of years.
The biggest thing of interest for our environment is that El Paso is about 70 to 80 percent Hispanic and we’re also on the border. It creates some unique challenges in terms of language, socioeconomics, a lot of things that big cities have anyway, but they don’t have them in the magnitude that we probably have them. We’re a new medical school as well, so that creates some of unique challenges of financing. We’re just moving forward with the challenges of healthcare, academic healthcare, and academic education that a lot of other people are dealing with at the same time.
You’re probably the only informatics person I know whose background is infectious disease with an ID fellowship. Does that impact how you think about informatics?
I hope it that it changes it a little bit. I hope I think of things in a more of a public health manner.
How I got into ID and then informatics … I was born in Nigeria, but grew up in the Twin Cities. I went back to Nigeria to go to medical school. I did a lot of public health work while I was post-medical school in Nigeria. I realized that I had no idea what I was doing in terms of the skills of basic statistics and epidemiology. I came back to Minnesota, got my MPH from there, and then did residency and fellowship.
It was during residency that my mentor, Kevin Larsen, who’s at the ONC now … we started flipping to Epic. We were one of the first hospitals in the Twin Cities to go to Epic. That whole process of EMR and notes and things being digitized for me just seemed really cool. I hated writing, so for me, it was very selfish in that it was just easy.
I’ve taken that going forward as I think about things like HIV and hepatitis C, which are my clinical specialties. I hope that I think about things at a more population level. Instead of thinking about it as one patient at a time, every encounter is important. When I talk to our president and CFO and CIO, I try to look at, how is this going to affect the organization as a whole? Not only the organization — how’s it going to affect the El Paso population as a whole?
I’ve sometimes said that public health in a sense mirrors in a way some of the thinking in clinical informatics. You have to think about populations and how it will change the effect of a population. Payment is always important to whether you’re thinking of public health or informatics. I think I’m cognizant of the fact that the public health background and the infectious disease background lets me think about that a little bit better.
We’ve always exported our public health expertise to other countries while here we just cranked out encounters. Is public health thinking now essential for practicing physicians?
I’m not sure it is necessarily essential to be a practicing physician. A lot of providers across the country, especially in Texas, do not look at healthcare IT as a good thing. They don’t look at it in an improvement in care. No matter how much information you give them about reduction in drug-drug interactions, drug-allergy interactions, cost, or sending a patient off to get five x-rays in under a week just because a couple of providers were too lazy to go get the chart from their next door neighbor … think that’s kind of crazy. But I do think that as Meaningful Use and PQRS and a host of other quality measures start to actually measure bits and pieces of what we do as providers or as health systems, it starts to build a case whereby doctors for the first time have to look at, "Oh, wow, this is how I’m doing on a global scale."
As part of my job, we have private practices that we either own or help them or do technical assistance with. It’s always amazing to me when you put just the PQRS numbers in front of a provider and they say, "I do excellent diabetes care" … we can argue about whether A1C is a process or outcome, but the fact is this: it’s what we use for parts of diagnosis and parts of monitoring, so if you haven’t ordered one in three years and you say you’re a great diabetes manager, I’m not really sure what you’re looking at. If you haven’t done a foot exam or an eye exam or any of those basic things that are outcomes of having long-term, uncontrolled diabetes, it’s really hard to make that case.
When I put it in front of some providers who are private practice guys, one or two docs who probably have four or five thousand patients, it’s always amazing to see the shock on their faces. For the first time, public health has intersected with their lives in terms of their practice and what they have to do to change their process to hopefully give their patients better care.
What systems have you worked and what do you think of the technology that’s available?
For Nigeria, I worked with a pen-and-paper technology [laughs] It was what it was. When I was at Hennepin County Medical Center in Minneapolis, we initially had a homegrown system. When I was an intern, we switched over to Epic, so we were the first residency in the Twin Cities to have Epic. By the time I became a fellow at the University of Minnesota, it was switching over to Epic. As a fellow, you know how it is — you go from the university hospital to a private hospital to the VA. I used CPRS at the VA. We had Allscripts at that point in time at the University of Minnesota. We eventually switched over to Epic.
When I came to El Paso, our county hospital, University Medical Center, uses Cerner on the inpatient side and NextGen on the outpatient side. We used CPRS for about a year and now we’re on GE on the ambulatory side. In my private practice, I have Athena, so [laughs] seven or eight different EMRs.
At one time right now, I have to understand at least four of them, which is as you can imagine, kind of a pain after a while. One of my biggest pushes to our president and our CFO is that we really need to be on one platform — to improve our interoperability, to improve the efficiency of training, a host of other things that I think it will bring to us. That’s one of the biggest pushes that we’re having right now.
Having seen those systems and thinking about population health aspects, are those systems going to be appropriate for where the payment model is shifting?
My personal take on it right now is that none of them are adequate to really do what we need to do. If we’re going to leverage data to change the way we treat patients and bend the cost curve, I don’t think Epic or Cerner or anybody on their own has the ability to do that. They’re getting into that space after the whole MU debacle and trying to get certified, but I just don’t think they have the tools right now.
There are a lot of other organizations or vendors out there that probably do it a little better. At some point in time, the big players are just going to have to collaborate or cooperate with some of the other smaller population health vendors that are out there to make it a better system because I don’t think any of them owns enough pieces right now to make it work from one end of the spectrum to the other.
What are the key projects you’re working on?
We have a pretty amazing lady who works on medical education cartoons, which you’ll say, "OK, so?" But especially for us in our region, where English is not a first language or even a language of a large percentage of our patients or clients that come into our system, it’s important that we give them ways to understand what’s going on in the healthcare system, whether it’s by pictorials that explain that one to two tablets Q4 hours is not necessarily one tablet or two tablets, you make the decision.
We as providers take a lot of things for granted. We write all these prescriptions and we never really explain it to the patient because that’s not our thing. We just send the patient off to the pharmacy, and if the line at the pharmacy is 30 people deep, it never gets explained. That’s one of the things we’re trying to put on our portal right now — some of that pictorial education and cartoons and some animations that will help patients understand their medical issues and some of their medications.
We’re in the process of aligning ourselves with Tenet Healthcare out of Dallas. They have three hospitals here in El Paso. We’re in the process of aligning ourselves with them to create a clinically integrated network. We’re just starting to look at how our data exists in each hospital and how we can create a data warehouse and start to look at our payment data and our patient data and outcomes data, things like that. For us, it’s staffing. We use a lot of that information to determine how many doctors we need in a certain specialty or a certain space over the next two to three to four years.
On the education side, we’re probably behind the curve a little bit in what some of the other places have done, but we’ve just started using secure messaging with Imprivata Cortext. The residents are really excited about that. It was interesting to me how much we pushback we had from some of the more mature physicians in the organization regarding secure texting. But the people that were doing most of the patient care and the visiting in the hospital — if you look at counts of who puts in the labs and the orders and the images — it’s all the residents. If you talk to them, they were all excited about it. That basic information of a simple count of who’s actually doing work within the EMR to justify finally to security and compliance that we really needed the secure texting process. We’re about to go live with that in our PCMH.
Those are some of the big things that we’re looking at. You know how it is. It feels like there’s always a million things going on at the same time and you’re just trying to keep abreast of them so that you don’t drown. But then you have some of the fun projects. The secure text messaging project is really cool. I’m excited about that.
We have an external referral management process that we built in-house. It’s a web-based tool that our clinics use to track referrals, see who it’s going to, and send transition of cares, so we’re excited about that, too. Those are the main things we’re working on right now.
You’ve done quite a bit of work with HIV. Are you finding ways that technology can help improve the lives of people with HIV?
Yes. One of the things that I really enjoy about being CMIO and also in practice is that I was able to get some advanced toys or to move things along quicker in my clinic. It’s kind of sad, but because politically it was a marginalized population and I had really young patients … the average age of the patient in my HIV clinic was about 24 to 26, so that’s the range. They just allowed a lot of things to happen. If you look at my HIV clinic for example, about 70-80 percent of them were already on the portal. That’s probably the highest adoption rate throughout the organization.
For me, it’s fun to be able to get — I call them my kids — my kids on the portal and have those conversations back and forth. I have two full-time case managers whose job is just to respond on the portal and get people information and access and a whole bunch of other things. We set up a system with Google Voice about two or three years ago where we were sending text messages to our patients — this was before we had the portal — that gave them reminders 72 and 24 hours before an appointment and allowed them to respond to the Google Voice message as an anonymous text from them if they weren’t going to make it. We saw our no-show rates drop from almost 40 percent to about 20 percent, which is about 50 percent improvement, so that was kind of cool to us, too.
We do Google Hangouts once in a while. I haven’t done any this year, but once a quarter we would just send out a Hangout link to people on the portal and say, "Hey, free-for-all, come online, either myself or the case manager, the pharmacist, will be online for 30 minutes to an hour and we’ll answer any of your questions." Unrestricted, talk about sex, drugs … marijuana is always the biggest question clients have, not surprisingly. We would just go at it like that, which was fun.
I also do hepatitis C and a lot of my patients are co-infected, so just getting that education out to them on the portal or using our text messaging system for me has just been really cool. You have clients come back maybe a month or two later and they say, "Hey, I read this on the portal,” or, “Thanks for sending me the reminder about my appointment. I wasn’t able to make it because I was in Las Cruces or Juarez or whatever, so I responded and rescheduled it." Just a lot of missed opportunities that we would have had before that I hope we’re reducing with some of those … I call them the little technology pieces, but they seem to have a big effect on our clients.
Do you have any final thoughts?
It’s just exciting work. I enjoy being at that intersection between public health and ID and health informatics. It’s really exciting for me, looking at work I’ve done in TB and some other stuff globally, to start to think that now we can start to measure what our providers are doing. And hopefully what our patients are doing as we talk about the bring your own device, not just from a tablet standpoint, but from a consumer trackables standpoint, be it a Fitbit or a Jawbone, I’m beginning to get clients asking me, "I have this thing, what should I do with this data?" We don’t have anywhere to ingest it yet, so we’re starting to think about that.
Even though there’s a lot of angst in the overall healthcare community about where health IT is right now, I do think that we’re going in what is sort of the right direction. We’ll probably have to branch off as time goes on, but eventually that will get us to a place where we’ll have a better idea, or at least better transparency about what our healthcare really is.
St. Mary’s Medical Center (IN) is informing 4,400 patients that their personal information was compromised when hackers gained access employee email accounts in January. The exposed information included names, date of birth, gender, date of service, insurance information, health information, and Social Security numbers.
Southern Regional Medical Center (GA) lays off 80 employees after implementing a productivity benchmarking system that shows how other hospitals around the nation of a comparable size and case mix are staffing their own departments.
The New York Times profiles Jeffrey Hammerbacher, a 32-year old Harvard trained data analytics expert that started out in finance before moving to Facebook to build their data analytics team, and is now a professor at the Icahn School of Medicine at Mount Sinai working with computational biologists to apply data analytics in medicine.
St. Mary’s Medical Center (IN) notifies 4,400 patients that their information was exposed during a January phishing attack. It’s yet another example of securing the cyber-perimeter only to have it blown wide open by unwitting employees duped by fake “click here” emails.
From EpicAlready Won: “Re: DoD. Did they really just say they expect to have their EHR — the contract for which hasn’t even officially been awarded — up and running by EOY 2015? Do they have any idea what they are getting into? What does this imply in terms of the likely winner?” DoD says it hopes to have the infrastructure in place by December 31, 2015 for a Pacific Northwest test site.
From Oh Nant: “Re: NantHealth. Bob Watson lives up this his reputation by firing the entire sales team at NantHealth. All sales will be done through Allscripts.” Unverified, but the companies signed a partnership agreement last week.
HIStalk Announcements and Requests
One-third of poll respondents say provider CIOs are always more believable than vendor VPs, although some added clarifying comments suggesting that they would have voted yes had the word “never” been replaced with “most often.” Anonymouse elaborates that both provider and vendor executives put the best possible spin on their organizations, while HIS Junkie opines that “you can’t tell a CIO from a vendor without a score card.” New poll to your right or here: do you feel welcome and appreciated when you make contact with your preferred hospital by calling, emailing, or driving to their facility? Vote and add your comments because I’m sure you have some great stories that add color to your Boolean response.
I haven’t sent out HIStalkapalooza invitations yet, so there’s no need to email me to inquire (and thus no need for me to respond, which is my real motivation in saying so). I will probably get them emailed out in a week or so, plus having learned from years past that emails don’t always get through spam filters, I’ll post an encoded list — like the upgrade list at the airport with some combination of name letters — so you’ll know you’re invited.
I’m about to close down registration for our sponsor-only networking reception that will be held Sunday, April 12. Those who sign up (and show up) will mingle with their normally competitive peers, eat and drink at my expense, and enjoy a low-pressure evening in which nobody is either selling or buying anything. I suppose those who don’t have will chosen an equally invigorating alternative. Contact Lorre.
Listening: Denmark-based Volbeat, whose hard rock music lies somewhere in the continuum between Metallica and Johnny Cash but still sounds fresh.
Last Week’s Most Interesting News
A group of five Republican senators says HITECH hasn’t provided taxpayer return on investment, EHRs aren’t useful to physicians, and ONC’s interoperability roadmap is too vague to guide EHR vendors.
Five healthcare IT vendor founders make the Forbes list of billionaires.
The AMA says CMS should release more ICD-10 testing details and develop a contingency plan for the upcoming switchover.
Truven Health Analytics is rumored to be planning a $3 billion IPO.
A Wall Street Journal article questions the appropriateness of drug company-paid alerts and reminders sent to patients whose doctors use Practice Fusion’s free EHR.
Allscripts says in its earnings call that it is disappointed in 2014 revenue and it should not have allowed overly optimistic Wall Street expectations to go unchallenged.
A reporter’s posthumous editorial urges that every willing cancer patient’s information be loaded to a database that both patients and doctors can access as a one-person clinical trial.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Here is the recording of Zynx Health’s recent webinar, “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions
Acquisitions, Funding, Business, and Stock
Golub Capital provides a $250 million senior credit facility to support Netsmart’s recapitalization by its owner, private equity firm Genstar Capital.
Lenovo will launch a healthcare division (for the second time in four years) on April 1, probably hoping that cybersecurity-sensitive providers will forget about its recent Superfish preinstalled spyware debacle. The company’s 2011 healthcare push tanked quickly and probably could have been easily predicted given its self-stated motivation in reviewing the healthcare market: “I know we want a piece of that, I know our partners want a piece of that, and we want to go get it with them together.” There’s not a whole lot they can do except take a few off-the-shelf products that seem interesting for healthcare users, market them separately, and train partners to sell them.
Apple will live stream the announcement of its Apple Watch today (Monday) at 1:00 p.m. Eastern, although Apple says the video will work only on specific Apple hardware and software combinations. Several Internet wags remarked that they lost an hour Sunday morning due to the DST time change and then will lose another three staring at Tim Cook and company on their screens.
Baltimore-based Emocha Mobile Health signs a one-year, $65,000 contract with Harris County, TX to monitor medication adherence in TB patients by having them record themselves taking their prescriptions and sending the smartphone video to their doctors via the company’s app (maybe nobody ever looks at it, but the fact they might could make patients more diligent, I guess). The seven-employee company, which licenses technology from Johns Hopkins, is trying to raise $1.8 million in seed funding. None of the folks involved have any apparent healthcare experience.
Depression solutions vendor SunSprite chooses Validic to collect information from its bright light exposure tools.
Announcements and Implementations
SRS will offer its users SurgiMate surgery scheduling software.
340B pharmacy platform vendor Sentry Data Systems partners with Avella Specialty Pharmacy.
Agfa Healthcare launches a patient and physician portal to display images from its system, which should be wonderful news to those patients and physicians who love logging on to separate portals for each system a hospital uses.
Government and Politics
The Illinois HIE, having blown through $19 million in HITECH money in four years and still running at a loss, doesn’t have funds allocated in the proposed state budget that will take effect July 1.
The Washington Post profiles telemedicine and other technology services offered to veterans through charity groups and the VA itself.
The New York Times profiles 32-year-old Jeffrey Hammerbacher, a Mount Sinai medical school data analyst and assistant professor who previously made fortunes working as an equities analyst, creating Facebook’s data team, and founding multi-billion dollar company Cloudera. He’s married to Rock Health co-founder Halle Tecco. His Mount Sinai team is applying data science to chronic disease for the development of personalized medicine. When at Facebook, he famously said not long before he quit knowing he was leaving IPO money on the table, “The best minds of my generation are thinking about how to make people click ads. That sucks.”
LA County’s Department of Health Services is using clinical decision support software developed by Chief Research and Innovation Officer Jeffrey Guterman, MD that applies clinical rules to encounter data to manage chronic diseases. He’s modest about his work: “It’s pretty sophisticated for healthcare, but it’s pedestrian for any other industry … As a large governmental bureaucratic organization. I think people are happy to say, ‘The providers look happier, the patients look happier, no one is complaining, this is a great change.’”
Ed Marx is writing a book called “Voices of Innovation” and invites readers to contact him about being part of it.
Medical school dean Art Kellermann, MD tweeted out this graphic created by Daniella Meeker, PhD of Rand Corporation.
Struggling Southern Regional Medical Center (GA) lays off a bunch of employees after realizing from benchmarking software reports that it was overstaffed. I always have the same question after reading stories like this: was management too stupid to notice lack of productivity until they found out that similar hospitals have fewer employees? We might as well have just one national hospital since none of them can take any action without seeing what the others are doing, with that lack of competence and/or confidence fueling an entire industry of conferences, software, and consulting services.
Unrelated, but bizarre enough to worth mentioning since it made me laugh out loud even if I did feel guilty afterward. A judge dismisses a lawsuit against Applebee’s in which a patron claimed the restaurant’s waitress should have warned him that his platter of sizzling fajitas was hot. The waitress sat the fajitas down, at which time Hiram Jimenez decided to take his brother’s hand and bow to say grace, causing his face to get splattered with hot grease. It just got worse: the man claims he pushed the platter away as a reaction but instead it ended up in his lap, which caused him to injure his arm. His attorney, Dick Weiner, is unhappy that the judge ruled that it shouldn’t have been necessary for the waitress to warn anybody that a furiously sputtering skillet full of meat might be hot. The man was fine, with no scarring, permanent injury, or financial windfall.
The SSI Group will exhibit at the VA/DC 2015 Spring Education Conference March 11-13 in Richmond, VA.
TeleTracking offers insight into how RTLS is enabling high-visibility health.
T-System’s blog focuses on “Nurse Debate: Communication Silos.”
Verisk Health will exhibit at the 15th annual Employee Healthcare Conference – East March 12-13 in New York City.
Truven Health Analytics releases its annual study identifying the 100 top U.S. hospitals based on their overall organizational performance.
Vital Images will exhibit at the ACC 15 Annual Scientific Session & Expo March 14-16 in San Diego.
Voalte discusses the challenges healthcare facilities face when moving to a new facility.
The Chicago Sun-Times features Huron Consulting Group’s Arshia Wajid and her work as founder and president of the nonprofit American Muslim Health Professionals group.
ZeOmega offers the second part in its blog series on defining population health management.
The latest ZirMed blog offers “Fresh Insight into Predictive Analytics … and Renewed Focus on ICD-10 Contingency Planning.”
The Daily Practice blog from Navicure asks, “The Times They Are a Changin’ … So How Do You Get Ready for Value-Based Modifier Payment Models?”
NTT Data offers a blog on “The Counter Effect of Mobile and How to Avoid It.”
Patientco posts “Beat Patient Debt, One Payment at a Time.”
The latest MedData blog advises, “Don’t limp towards the ICD-10 finish line. Finish strong.”
ScImage releases updated echo reporting based on new ASE 2015 quantification standards.
PatientSafe Solutions discusses the case of the frustrated phlebotomist in the second part of its quality care and mobility blog series.
The PMD “Charge Capture” blog discusses “Increasing Team Productivity with Paired Programming.”
Orion Health offers insight on “Integrating Device Data with EMR for Better, Safer Care – A Case Study.”
Perceptive Software lists “Four Reasons You Need an Enterprise Capture Strategy.”
Nordic launches a video on its successful affiliate extension project with ThedaCare.
Passport Health will exhibit at AAHAM South Florida March 11-13 in Cocoa Beach.
The latest nVoq blog covers speech-recognition solutions for mobile physicians.
Working with Startups: Assessing Viability By Michael Burke
In a previous article about accelerators and incubators, I made an argument for why it can be advantageous for purchasers of healthcare IT solutions to strike up vendor relationships with emerging startups. A drawback, however, is that more startups fail than survive.
In this article, we’ll take a closer look at the prospect of long-term viability for startups. To make it mildly entertaining (and to pay homage to Mr. H’s eclectic musical interests), we’ll compare it to a band trying to make it big in the music business.
What Are The Odds?
The stats related to long-term viability for a startup are not great. The rule of thumb popularized by the National Venture Capital Association is that 25 to 30 percent of venture-backed businesses fail.
However, this stat may be misleading and a little self-serving. Research from Shikhar Ghosh of HBS says that 75 percent of venture-funded enterprises never return cash to their investors, while 30 to 40 percent of them liquidate assets such that investors lose all their money.
The stats for a band trying to make it big are similarly grim. In 2009, only 2.1 percent of the albums released sold more than 5,000 copies. Of the lucky few bands that sold 5,000 or more albums, most didn’t make any money. The reasons most bands don’t make money are oddly similar to the reasons most venture-funded startups fail.
Winning the Lottery
When a band signs a deal with a major label, they feel like they won the lottery and that their success is guaranteed. They often get a big advance. However, they use a lot of that advance for recording the album and paying professional fees to lawyers and managers.
When the record is released, they may get lucky and sell a bunch of albums, but there are huge “recoupable” costs for video production, tour support, radio promotion, and other odds and ends. Even after selling a million records, they could still end up owing the label money.
When a startup signs a deal with a venture capital company, they feel like they, too won the lottery and that their success is guaranteed. They get a big cash injection (think “advance”). However, the cash doesn’t go in the shareholders’ pockets — it is used to fund and grow the business (just like a band uses the record company money for recording, promoting, and touring).
If the company gets lucky and folks start buying their product, things are looking good for the founders, right? Maybe. Maybe not.
When the startup signed the deal with the VC, it probably included a number of terms that are immensely preferential to the VC. The deal probably included terms that allowed the VC to exert considerable influence (if not outright control) over key decisions. The deal probably included “participating preferred” shares that allow the VC to recoup all their money (sometimes several times their original contribution) before the founders get a dime.
This means that in order for the founders to earn any money, they have to be able to sell the company for quite a bit more than they may have originally expected just to pay the “recoupable costs” (like in our band example). They are clearly motivated to swing for the fences. Because they gave up control, they can’t choose to focus on organic growth or on operating a great business. Instead, they have to go for the grand slam exit strategy.
For better or worse, raising venture capital moves the goal line for an exit, both in terms of time and value. It changes the responsibilities and objectives of an operator / founder. They must grow bigger and faster, with everything that approach includes. This may require a completely different skill set than the existing team can offer.
If you are a music fan, you may have heard of a number of bands going a different route lately. Instead of working with a major label, they release records on their own or work with a smaller label. They may not gross as much, but they’re far more likely to have a higher net. Possibly more importantly, they get to control their own destiny. Similarly, a startup may choose to bootstrap the endeavor on their own or they might take smaller investments from friends, family, or angel investors. This is the path we’ve taken with Clockwise.MD.
Either path is valid. It really depends on the goals and the circumstances.
What Really Matters for Customers
Based on what we’ve learned about the risks of working with a startup, what should purchasers of health IT do? That depends.
A health system that has its own early stage fund ostensibly knows the risks and probably doesn’t expect all of its portfolio companies to succeed. Even without a captive fund, most health systems can control the environment to some degree by leveraging their network to boost the success of the startup through referrals. The basic goal should be to avoid the 30 to 40 percent of startups that end up liquidating assets.
If they’re simply trying to solve a problem with technology and are considering a startup’s offering as a possible solution, they can mitigate risk through some simple reflection and investigation:
Do they want to influence or control the feature set of the product? If so, they should jump in early. Companies often work hardest to serve their early adopters. Those adopters can have great influence in product development and pricing, which can serve everyone well over the long term.
Does the startup have traction? Has it achieved critical mass in the marketplace? Sometimes a startup has a compelling solution but lacks market traction or reference sites to get the customer comfortable with investing time and money. In this case, vendors can enter into a beta agreement to gain the opportunity to prove their value. This can de-risk the relationship.
How is the startup funded? What does its financial picture look like? Don’t be afraid to ask. Venture capital support certainly may not hurt a startup’s viability, but it should not be a requirement.
Talk with current customers to get an idea of how well the solution works and the level of support and flexibility at the company. For vendors, reference sites are worth their weight in gold.
Working with a startup doesn’t have to be a nail-biting adventure. It largely depends on understanding clearly what you hope to accomplish and doing your due diligence.
I’ll close with a quote from Mark Zuckerberg, founder of Facebook:
"The biggest risk is not taking any risk. In a world that’s changing really quickly, the only strategy that is guaranteed to fail is not taking risks."
Michael Burke is an Atlanta-based healthcare technology entrepreneur. He previously founded Dialog Medical and formed Lightshed Health (which offers Clockwise.MD) in September 2012.
Robert Dudzinski is EVP of the healthcare practice of West Corporation of Omaha, NE.
Tell me about yourself and the company.
I came to West via an acquisition. I was a CEO and founder of a company that it acquired about five years ago.
I’m a pharmacist by background with a doctorate. I owned, operated, and sold a prescription benefit management company and a mail-order pharmacy. I kept out of healthcare for a little bit and opened up a chain of baseball and softball stores. I had a great time with that. I got back into healthcare and started a company called SPN, Specialty Pharmacy Network, in 2004. That ultimately became an acquisition of West in 2010.
West is a publicly-traded, technology-driven communication company. We participate in about every industry — retail, finance, banking, and certainly healthcare. We’re about $2.2 billion, about 15,000 employees, and we have a full plethora of communication assets. We take a vertical approach, moving from products and services to value-added solutions in the healthcare space.
Providers for years have gotten away with hiding behind phone trees and doing anything to avoid putting a human on the line. Does that need to change?
Absolutely. The rallying cry in the market today is patient engagement and activation. To your point, that’s never been a primary initiative for provider systems. Today that’s very different. It ultimately ties back to reimbursement and now there’s a great emphasis going on in that area.
Now that providers are expected to manage populations, they have to reach out to patients instead of just waiting for them to call or show up. How can technology help?
There’s all kinds of initiatives that are going on today in trying to do outreach at scale and capacity. That’s been the big challenge for health systems and those are the solutions that they’re looking for. In other words, as providers have moved to managing larger populations, the challenge is, how I’m going to touch those people effectively? How am I going to personalize it? How am I going to change a behavior and improve an outcome? Technology can provide some of that success in doing that if it’s purposed correctly and there’s a good strategy and plan behind it.
Everybody has their own preferred way of being communicated with – text message, email, or phone call. How does a provider choose the best medium for each person?
The provider needs to start with an overarching strategy of how they’re going to approach engagement and activation. We here at West always gravitate to the notion of a unified communicate environment where you are providing preference and choice to that patient. When you do that, you provide contextual awareness amongst those channels and you have a sophistication around content that’s being delivered. Is it relevant? Is it non-redundant? All of those things start to roll up and start to create what we would call an enhanced experience. That’s what the provider is actually looking for.
Providers haven’t had much incentive to getting on the phone or email with patients because nobody was paying them to do so. Are you seeing the demand change now that there is reimbursement for keeping contact with patients and not just having them drive to the office?
Yes. Most certainly as payer organizations look to value-based pricing — we’ve heard that term ad nauseum in the marketplace today — it’s going to be a challenge and edict for the providers to reach not just the chronic patient, but those that have yet to become chronic patients. Having a strategy of addressing that population in totality is going to be an imperative for providers. No longer will they just simply have to be reactive. They’re going to need to be proactive in their approach.
I wrote about the free nurse hotline in New Mexico that is keeping thousands of people out of the ED. Is it hard for hospitals to think about being paid to keep people out of their facility?
They have to have a whole new mindset approaching population health and what it means to implement the Affordable Care Act. In your example the nurse line, we have a nurse on the line doing outreach or at least trying to promote a call prior to an ED visit. That’s a great also application for technology.
We have programs here written against our IVR systems that do a couple of things. They do a reminder on a Friday to make sure that the patient’s got their meds filled so that they’re not going to the emergency room because of a need for a refill. Number two, technology that could actually nudge the patient and remind the patient that if they have floss stuck in their teeth, that’s not an appropriate ED visit — they should be reaching back to the care coordinator or to the case manager.
Technology could play a role in facilitating, as you’ve described, that nurse line. We can do that at scale and capacity, that constant nudge and connection with the patient, allowing them to know there are alternatives to some of the thinking that they have today.
If a hospital calls you wondering what they should do both short and longer term to get more engaged with their patients, what do you recommend?
Historically, providers haven’t had a need to engage the patient and what’s expected of them today. Because of the complexity of health systems and hospital systems, we’ve put an assessment process together. It’s very simple. This usually is our first recommendation. It’s a way to give them clarity as to where they’re heading, the assets they have, what is possible, and a road map to that end.
That strategy has worked well for us. No commitment. It’s just a matter of allowing them to see outside of healthcare what organizations have done to achieve either a world-class call center persona or an understanding of the communication technology that could play a role in their discrete objectives.
As a pharmacist, are you impressed with what Walgreens and CVS are doing to engage with their customers using technology?
Absolutely. Pharmacy has always had a need to engage the patient. Pharmacy by its very nature sees the patient more often, and they also have to do it not only from a healthcare perspective, but from a retail perspective.
Pharmacy and the strategies that the pharmacies are promoting today are great models for other provider systems to look at and engage against. I like what pharmacy is doing and I think we’ll see more of that from pharmacy on a go-forward basis.
We talked about the barricades providers seem to have put up to prevent people from reaching out to them. You could argue that hospitals do that physically as well, where parking is inconvenient and departments are hard to find. Could non-physical patient interaction allow them to work around the huge disadvantage of being located on campuses that are consumer-unfriendly?
We hear that consistently across the country as we’re out there with our offerings. The mere fact of trying to navigate the ever-changing environment of a health system has been a challenge for patients. To be honest, it’s also been a challenge for the patient to call into a health system and intelligently get navigated to where they need to be.
We did a roundtable with a group of patients at a health system. One of the comments that came from the patient was, "I would rather walk to this institution than call it." That was an indictment of the fact that there is a real immaturity around how best engage patients and the importance of that engagement.
The mindset needs to change in the provider market and I think it is. They are shifting to a very different approach. We see it also even in how they present themselves and how they organize themselves. Now we have VPs of engagement. We have VPs of consumerism. We have VPs of population health that now are charged with creating an experience and recognizing all of the touch points that a patient could have. Then obviously the need to translate that into how that will either generate revenue or reduce costs.
Do you have any final thoughts?
It’s a great time to be in healthcare. The provider community has never played a more important role and I don’t think they’ve ever taken on more responsibility. The need to address consumerism, the need to think through engagement and activation strategies, the notion of gravitating to unified communication environment s going to be critical for success and not only in the provider systems. Any healthcare organization that’s looking to manage a population needs to be thinking in those terms.
Anthem has been refusing to let the Office of Personnel Management’s inspector general perform "standard vulnerability scans and configuration compliance tests" since 2013, before the recent cyber attack on its network that compromised 80 million medical records. The insurer still won’t allow the IG’s office to conduct its tests, citing a corporate policy that bars outside agencies from accessing its network.
As a CMIO, I’ve spent most of my time working for hospitals and health systems. The bulk of my experience has been in with face-to-face using a “train the trainer” model. Our in-house trainers learned from the vendor’s trainers; our trainers in turn deliver the training curriculum to end users.
As healthcare has evolved, many organizations have wanted to get away from traditional classroom training, whether due to facility, logistic, or cost issues. Having users participate in at least some kind of online or self-directed learning prior to in-person training is highly desirable.
We created this kind of training at my organization last year and it’s been fairly successful. I haven’t really been able to judge it as objectively as I’d like, however, because I already have a deep knowledge of our system and had been previously trained in the old methodology. I’m glad that my employer allows me to moonlight at other facilities.
I mentioned last month that I was going to start at a new site. Since I’m clearly a health IT geek at heart, I was actually excited to receive the email today with my password to their learning management system.
It’s clearly a vendor-driven system – my new employer didn’t go out and code this on its own. It’s branded with the vendor name and the graphics are fresh and inviting. Maybe I was looking for a reason to procrastinate, but it made me want to put aside the HL-7 specs I was reading and dive right into training. I think I was most excited about experiencing what online training might be like in a situation where I wasn’t involved with designing or maintaining it.
The system was ridiculously easy to navigate, with both a traditional navigation bar and a more graphical representation. That made me smile since I spent a lot of time arguing with some of our developers about the need for “old school” navigation when we configured our system. People have different learning styles – some are abstract thinkers and others concrete – and often seem to do better with one approach over the other. I’m more of a traditional girl, so I dove right in with the top-down navigation.
The introduction was handled with a video presentation. What struck me first was that it had background music. I haven’t seen that much in the training content I’ve used previously, but it was somewhat spa-like and unobtrusive, so I decided I liked it, although it kind of made me want to get up and light some scented candles to match the mood. Once I completed the introduction, it released me to view the courses in which I had been enrolled.
Many organizations assume providers don’t care about the practice management aspects of the system, so I was excited to see that I had been enrolled for training on the billing system as well as the clinical system. Knowing my background, they may want to revoke my enrollment in the EHR Configuration section but I am looking forward to seeing how things work with a new and different vendor.
Once I moved into the provider training, I was glad to see that it had option for both video/spoken content as well as turning off the audio and just reading. Putting myself in a typical physician’s shoes, I found it to be a little heavy on the technical jargon as it discussed virtualization and thin-client delivery. I don’t know that I need to be told that 100 million users have experienced “the promise of proven application compatibility” that is Citrix XenApp, but you can bet I’m going to use that factoid in our next office trivia contest.
I’ve spent most of my career using enterprise-class EHRs that attempt to support every specialty under the sun. This is the first time I’ve used a specialty-specific EHR. I have to admit it’s significantly different than my past experiences.
There were other exciting non-specialty features as well. In contrast to the system in place at our hospital, patients can pre-register and check in online. Instead of jumping right to the physician part, the module then walked me through the basics flow of a visit, including what the front desk staff would see and do. Not at the level where I could perform the tasks, but just to give me an idea of the features. I often think that physicians would be more forgiving of a lengthy check-in process if they understood what really went on in the front office.
This will also be the first time I’ve used an EHR that is optimized to run on an iPad. Although it looks cool, it was kind of jarring to keep looking at a screen in portrait layout rather than the landscape layout we’re all so used to. As I went through the initial training session, I saw a couple of things that raised my EHR developer hackles: inconsistent use of color and blood pressure fields where systolic and diastolic were combined are examples I noted. I know I’m more discerning than the average user, but I had thought vendors were well past those entry-level design flaws.
I have to admit, though, I drooled a bit when I saw how the system handles approximate dates. My primary vendor has struggled with this for quite some time. Maybe the way my new EHR is handling it isn’t glamorous, but it gets the job done much better than I’ve seen other vendors do it. Unfortunately, that was just a teaser during the EHR overview, and I’m going to have to wait to dig into it a little more. Each module shows the length of time allotted and most look like they’re 20-25 minutes. Since my eyelids were already drooping from a long day at the office followed by yet more snow shoveling, I decided to call it a night.
Do you have a passion for online training? When is the last time your CMIO learned a new EHR? Email me.
A Health Affairs article written by five Republican senators says their 2013 question of what value Americans have received in return for their $35 billion HITECH investment hasn’t been answered. They say EHRs “are not meaningful for physicians,” interoperability remains elusive, the $12.5 billion CBO-predicted EHR savings haven’t been realized, and ONC’s interoperability roadmap doesn’t provide enough specific details for vendors to work from. It criticizes ONC for releasing its interoperability roadmap well after Stage 2, which “was promised to be the stage when health providers were interoperable.” The article finishes on a slightly positive note in complimenting Karen DeSalvo:
In listening to the concerns from EHR vendors and EHR users from across the care continuum, ONC has taken an important turn under the leadership of Dr. Karen DeSalvo. The previous ONC leadership did not understand the difficulty and enormity of creating government-approved products in a market that struggled to exist before government incentives arrived. As a result, our nation’s health care providers are stuck with the huge cost of unwieldy systems trying to conform to government mandates. They are stuck adopting EHR systems which don’t fit into their established workflows. And if they actually want to share their patients’ data, they are stuck with even more costs imposed by vendors. At the center of all this is the patient who must sit quietly in the exam room looking at her physician use a computer instead of directly talking with her, who likely has seen no better access to her own data, and who is struggling to understand why her doctor has such a difficult time getting her lab results.
HIStalk Announcements and Requests
I was thinking today about the kind of reader who probably shouldn’t be reading HIStalk because I won’t be able to meet their expectations. I’m not offended by losing readers who:
Assume there’s a direct relationship with how important a story is and how much space is used to describe it.
Need repeated mentions of the same story over several days, with no new information, to make sure they understand they should pay attention to it.
Enjoy catchy headlines (especially those click-desperate, frothy ones that include a number as in a “listicle”) with cartoonish action verbs that sit atop stories that fail to deliver anything insightful.
Don’t mind stories that fail to link to the source document with the hopes you’ll mistake the story as containing original reporting.
Require pictures even if they have nothing to do with the story, like generic shots of stethoscopes or smart phones, or who value slick design over substance.
Are convinced that keeping up with the industry requires spending a lot of time each day reading several sites.
Enjoy reading opinion pieces written by people who have never worked in either health IT or healthcare.
Quite a few people are writing about the study that found little overlap in the “best hospitals” lists of four organizations that create them. It’s a lost cause in my opinion – any “best” list, whether it be restaurants or plumbers, is situationally subjective and even medical experts can’t provide a definitive answer. Go to an academic medical center when you have a tricky diagnosis or need a rare surgery performed by someone who does a lot of them, but expect to have privacy and restfulness compromised by rounding teams made up of everybody and his brother popping in at all hours, expect more mistakes to be made (especially in July, on holidays, on weekends, and at night), don’t mind the happy indifference of employees who aren’t afraid of being fired, and expect to have a lot more tests done because that’s the research culture (no pun intended). Community hospitals are fine for most medical situations, but they don’t always have high volumes in what you need done, the employees they attract are probably friendlier but maybe less accomplished, and if you crash you might be a long way from somewhere better equipped to save you. I would rather see a list of the worst 30 percent of hospitals (as measured by mistakes, poor outcomes, low-quality medical staff) and then feel safe in choosing any of the others as long as you bring someone to watch everything done to you like a hawk. It also won’t matter which hospitals are “best” if you aren’t willing or able to travel halfway across the country and possibly go out of network, and for many mid-sized cities, consolidation has left only one or two choices anyway. I think for most people, long-term health is driven more by the choice of PCP and specialists rather than the big, bureaucratic building with the lights on all night that often makes things worse instead of better. The “best” hospital is the one you stay out of.
Welcome to new HIStalk Platinum Sponsor HCTec Partners. The Nashville-based HIT/HIM solutions and staffing provider offers services related to EHRs (build, implementation, training, optimization, go-live support), clinical transformation, revenue cycle and ICD-10, data migration, data warehouse, and HIM and coding. I was happy to see prominent mention on their site of the extensive benefits they offer consultants as well as the company’s “giving back” activities, such as working with Habitat for Humanity. Testimonials from clients and consultants are here. Thanks to HCTec Partners for supporting HIStalk.
I had a sign made to commemorate Atlanta’s convincing HIStalk reader poll win as healthcare IT capital of America that Jenn presented it to the folks at Metro Atlanta’s Bioscience-Health IT Leadership Council on Thursday. Receiving the award from Jenn were Council Chair Robert Hendricks of McKesson and Pat Williams, chair of the Institute of Health Information Technology and TAG Health.
This week on HIStalk Practice: Palm Medical Group picks HealthFusion as its VoC. KVC Nebraska turns to telemedicine for behavioral health services. Hospital employment loses luster with Ohio physicians. CHESS and Chase Brexton Health Care implement new pop health management tools. ClickAClinic CEO discusses telemedicine business model outlook. The Consultant’s Corner takes a look at primary care networks.
This week on HIStalk Connect: Google and Stanford University publish a paper on the use of deep learning neural networks to expedite drug discovery research. During the Mobile World Congress conference in Barcelona, Jawbone announces that it will partner with Huawei to provide access to Jawbone’s UP fitness ecosystem for the company’s growing portfolio of smartphones and wearables. Rock Health invests $100,000 in Chrono Therapeutics, a startup building a wearable device that supports smoking cessation programs by administering nicotine at strategic intervals based on the time and intensity of each user’s actual cravings.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Here’s the recording of the “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care ” webinar.
Acquisitions, Funding, Business, and Stock
I mentioned that the Forbes list of 2015 billionaires omitted Terry Ragon of InterSystems, with my speculation that his net worth should be in the same $1.5 billion neighborhood as Cerner founders Cliff Illig and Neal Patterson. Turns out he’s actually on the list at #1190 at $1.6 billion, but categorized under “technology” rather than “healthcare,” which is technically correct (no pun intended) since the company’s Cache’ database has at least some use outside of healthcare.
Stanford Health Care and GE Ventures launch Evidation Health, which will pair digital health companies with possible provider customers to define product value.
Greenville Health System (SC) chooses Caradigm’s population health management products.
CareCloud clarified a reader’s rumor report that CEO Albert Santalo was asked to step down. Per the company, he’ll be “focusing his time almost entirely on advancing our products for the next several months,” with an emphasis on meeting the needs of large-practice customers, but will remain chairman and CEO.
Announcements and Implementations
First Databank will distribute Polyglot’s Meducation simplified medication patient instructions.
Physicians at Community Memorial Health System (CA) are entering 98 percent of their orders and notes electronically into Meditech after implementing PatientKeeper’s CPOE and NoteWriter systems.
Agastha and Axon HCS add the CompletEPA electronic prior authorization solution from Surescripts to their systems.
Government and Politics
FDA releases its first mobile app, which identifies drug shortages.
HHS Secretary Sylvia Burwell publishes an article on HHS’s move to value-based payments, but reading it involves another type of payment – sending $20 to the New England Journal of Medicine for the privilege of seeing the comments of the government official whose salary is paid by your taxes. It should be law that elected officials should not publish paywall-protected articles or appear at conference sessions that require a fee or that are invitation-only. They represent all of us, so they should speak to all of us.
Here’s Karen DeSalvo’s keynote and comments from a Wednesday session on health IT at Brookings Institution.
Privacy and Security
The Australian radio station whose “morning zoo” hosts called a London hospital in 2012 claiming to be the Queen and Prince Charles and were given information on the condition of the Duchess of Cambridge may lose its license for airing the call without consent. The India-born nurse who didn’t recognize the “ridiculous comedy accents” transferred the call to the floor. The nurse committed suicide three days later, leaving a note blaming the shame of the call for her death. British prosecutors declined to press charges against the two DJs even though they probably broke Britain’s privacy and malicious communications laws, explaining that they weren’t likely to be extradited from Australia and their action was intended to be a harmless prank.
Texas Health Resources, responding to a negligence lawsuit brought by its nurse Nina Pham over her exposure to Ebola, says in an email to employees that despite her claims, it had her permission to release information about her and that it followed HIPAA rules.
The federal government’s Office of Personnel Management OIG says Anthem twice refused to allow it to perform security testing of Anthem’s systems as part of a routine OIG security audit. Anthem told the OIG that its policies don’t allow external entities to connect to its networks (Chinese hackers excluded).
An Oregon TV station uncovers an interesting privacy law: universities are allowed to dig into the health records of any student who sues them without running afoul of HIPAA. They’re covered under a separate law called FERPA.
A JAMA Internal Medicine case study profiles the case of an occasionally symptomatic patient whose tachycardia was diagnosed only after his PCP suggested he buy an AliveCor smartphone-based cardiac monitor.
RxRobots delivers four of its pain management robots to the Alberta, Canada hospital where they were developed. The robot distracts children who are undergoing painful procedures.
Garen Sarafian from Citigroup sent over the company’s analysis of the most recent Meaningful Use data titled “Stage 2 Clingers: Weak Vendors Try Holding On.” While I would be cautious about reading too much into the skimpy number of EP Stage 2 attestations, the report’s conclusions feel about right:
Cerner and Epic are increasing their Stage 2 market share (somewhat at the expense of Meditech, which is sliding a bit) and Athenahealth is succeeding on the EP side.
Provider EHR difficulties should drive a robust replacement market that will benefit those same three companies.
Low EP attestation rates should benefit quickly implementable products from Athenahealth and Practice Fusion.
A dropoff on Stage 2 attestations by users of Allscripts and NextGen could indicate declining market position, especially given their acknowledged problems with reduced client spending and satisfaction problems, respectively.
The BBC finds that the US is the most expensive place in the world to give birth, drily adding that, “there is no publicly financed health services as in most developed countries.” A Johns Hopkins professor summarizes our healthcare mess succinctly: “If you can make more money as a doctor by ordering more tests, you are going to order them and therefore patients end up getting more tests … If you don’t have health insurance in the US, hospitals and doctors will ask you to pay three to four times what someone with insurance will pay for the same service because no one is negotiating rates on their behalf.”
The AMA, seemingly unable to find anything to whine about these days other than technology and the EHRs its members bought of their own free will, twists CMS’s latest ICD-10 testing results to suggest that “the claims acceptance rate would fall from 97 percent to 81 percent if ICD-10 was implemented today.” AMA and other physician groups want CMS to develop contingency plans “to save precious heath care dollars” (the Medicare ones that arrive in the pockets of doctors) and to describe how PQRS and Meaningful Use reporting will work given that the calendar year will straddle ICD-9 and ICD-10 (that part is valid). Meanwhile, AMA’s online newsletter wraps up a supportive article with a link to its online store, where those cash-strapped doctors are invited to buy AMA’s ICD-10 data file. AMA makes a good point: CMS should release more specific testing details. It also makes a bad one: CMS should pay doctors in advance in case they have billing problems.
Weird News Andy notes what he calls a “kidney kidney kidney kidney kidney kidney” transplant. A San Francisco hospital performs six paired donation kidney transplants, using software developed by a technology executive (who underwent a kidney transplant himself years ago) that performs the number-crunching that matches unrelated donors and recipients using their medical characteristics.
VisionWare CEO Paul Roscoe provides thoughts as part of Health Data Management’s “Visionaries for 2015” special edition.
Bill Kinsley, enterprise architect for NextGen, will chair the HIMSS EHR Association’s privacy and security workgroup.
Galen Healthcare Solutions posts “Health Management Plans: A Better Way to Care for Patients.”
Extension Healthcare creates a new infographic on the “Evolution of Clinical Alarms and Text Messaging in Healthcare Communications.”
Etransmedia Technology Chairman Vikash Agrawal summarizes his experience at the Pacific Crest 10th Annual Emerging Technology Summit.
LifeImage posts “Medical Image Sharing for Neurological Care & Research.”
Holon Solutions CEO Mike McGuire explains the company’s rebranding strategy.
Healthwise offers a blog on how it helps its customers get the information they need.
HealthMEDX will exhibit at LeadingAge Oklahoma March 10-11 in Midwest City.
Iatric Systems exhibits at the Privacy & Security Forum through March 6 in San Francisco.
Logicworks posts a new blog on the Internet of Things security.
The Wall Street Journal covers freeware-EHR vendor Practice Fusion and its decision to embed big pharma-funded vaccine reminders into its EHR. Practice Fusion CEO Ryan Howard explains “For every project we do that drives forth public health or gives data away, we need to make sure it’s balanced out by a monetizable exercise.”
The American Medical Association and 99 other professional associations are calling on CMS to improve its ICD-10 transition plan following recent end-to-end tests that resulted in 19 percent of submitted claims being kicked back, almost all due to errors made by the submitting organization.
The Supreme Court hears arguments on King v Burwell, a case that could undermine the Affordable Care Act by stripping subsidies from any consumer that purchased health insurance through Healthcare.gov. Defendants of the ACA argue that withholding subsidies from states that did not launch an insurance exchange would be tantamount to the federal government applying illegal ”coercive pressure” on states.
Understanding the Importance of Prioritizing e-Prescribing By Louis Hyman
As the industry awaits confirmation of a compliance deadline delay for the New York State e-prescribing mandate—which will require electronic prescribing of controlled and non-controlled substances—it’s important that providers don’t delay their preparation efforts, as this process can be time- and resource-consuming.
Under provisions of the New York State e-prescribing mandate and subsequent regulations (such as amendments to Title 10 NYCRR Part 80 Rules and Regulations), all prescriptions in the state must be transmitted electronically by authorized prescribers unless an exception exists. However, as many providers are struggling to meet compliance by the original March 27, 2015 deadline due to a myriad of challenges beyond their control, the New York legislature is working to pass a law to delay implementation of the mandate to March 27, 2016.
No matter the timing of the deadline, this mandate serves to be a game-changer for how providers share prescription information, and they should be aware that other states are closely watching New York’s rollout, with several already considering following suit.
The scope is intensified because the law covers both controlled and non-controlled medications and applies to all providers in New York State, including long-term and post-acute care organizations (LTPACs) and senior living facilities. Providers must start transitioning to the new requirement now to avoid significant penalties including fines, imprisonment, and/or professional license suspension or revocation.
As such, providers must make e-prescribing a priority in the midst of other major industry initiatives such as ICD-10 and Meaningful Use. However, e-prescribing easily can be incorporated into these efforts if organizations are already leveraging technology and staff training in their preparation.
To comply with the new mandate, healthcare organizations first must fully comprehend its scope. They need to look at its impact on provider, practice, and facility workflows, as well as how it ultimately affects patient or resident care. The following four best practices can help healthcare organizations engage providers and create a smoother transition:
Generate physician awareness of the implications. Regardless of the care venue, it’s important to meet with physicians to raise their level of awareness and engage them in understanding the law’s full scope. Providers need to be clear on what is expected from them within the new e-prescribing workflows, just as they adapted workflows for EHR implementations to meet Meaningful Use requirements. Building physician awareness is even more critical among those organizations that have not yet implemented an EHR and may therefore require standalone computerized order entry or electronic prescribing technology. These providers may not be accustomed to any form of e-prescribing.
Evaluate the workflows of all clinicians involved in the traditional prescribing process. This step is especially important in regard to the complex workflows in hospitals, skilled nursing facilities, and other senior living care settings. Because the law applies to both controlled and non-controlled medications and does not allow physicians to delegate the final steps within the prescribing process, four basic workflows need to be reviewed to understand how they will be impacted by e-prescribing. These workflows include: orders generated in-house for controlled medications, orders generated in-house for non-controlled medications, orders generated upon discharge for controlled medications, and orders generated upon discharge for non-controlled medications. Additionally, providers should examine specific workflows for nurses, physicians, and other clinicians. For instance, because telephone orders will no longer be accepted, healthcare organizations need to plan for physician availability during off hours and periods of high admission and discharge volumes.
Engage caregivers in decisions. Because caregivers are key stakeholders, they should be included in the workflow evaluation to gain accurate insight into the overall impact of e-prescribing. It’s important for organizations to involve these individuals in any technology selection as well to ensure the appropriate tools are in place to support necessary workflows. As part of the selection process, engage caregivers in active testing of how their workflows are accommodated on a day-to-day basis. Beyond supporting workflows, healthcare organizations also should confirm the selected technology performs on a variety of platforms used by caregivers – such as tablets, smartphones, laptops, and PCs, as the physician may not always be on site.
Train and practice e-prescribing. With workflows and technology in place, it’s now time to employ a robust training program to support efficiency and compliance by all caregivers. Providers should begin actively practicing e-prescribing as soon as possible to identify and resolve any issues prior to the compliance date.
Even with the possible New York State e-prescribing mandate deadline delay to March 27, 2016, New York providers need to make e-prescribing a priority. By focusing now on an e-prescribing strategy, healthcare organizations and providers across all care settings – including LTPACs and senior living providers – can realize the benefits to medication management and patient/resident safety while also maintaining compliance.
Louis Hyman is chief technology officer for SigmaCare.
HIStalk is funding five, $1,000 scholarships for patient advocates to attend the HIMSS conference, with conference registration credentials provided by CTG Healthcare. Applicants provided their biographies and a statement of what they hope to achieve by attending, with the winners chosen by Lorre and Regina Holliday.
I have another motive. I’ve often pondered what our patients would think of the over-the-top excesses and unchallenged claims of both providers and vendors at the HIMSS conference. I hope these attendees, clearly identified by tee shirts bearing Regina’s artwork above, will serve as neutral observers keep us all focused on the people who we say we work for, but who we may rarely see face to face.
Each attendee will attend whatever educational sessions they choose along with having access to the exhibit hall in representing the patient’s point of view. Each will provide ongoing social media commentary during the conference as well writing a summary HIStalk article afterward. We’ll announce a time where the attendees, along with other members of The Walking Gallery, will be available to meet people in the HIStalk booth.
I created a contact form for each attendee to avoid publishing their personal email addresses. Please don’t spam them, but you can get in touch about anything related to their conference goals. It’s up to each person to respond if they so choose.
I became involved in pharmaceutical drug safety issues after the death of my husband, Tim “Woody” Witczak in 2003 as a result of an undisclosed drug side effect. I have taken my personal experience and launched a national drug safety campaign through www.woodymatters.com. My work has been featured in major news media such as Fortune, Readers Digest, Consumer Reports, Wall Street Journal, New York Times, and Star Tribune. I have testified before US Senate on PDUFA/FDA reform issues as well as numerous FDA Advisory Committees. In 2008, I was appointed to the FDA’s Psychopharmalocgic Drug Advisory Committee as a Patient Representative. In 2013, I co-organized the Selling Sickness: People Before Profits international conference held in Washington, DC bringing academic scholars, healthcare reformers, consumer organizations and advocates, and progressive health journalists to develop strategies and solutions challenging the “selling of sickness.” I am an active member of the Consumer Union Safe Patient Project as well as a part of the DC-based Patient, Consumer, and Public Health coalition making sure the voice of patients and consumers is represented in healthcare/FDA related legislative issues. In addition, I was just appointed to the National Physicians Alliance Board of Directors.
Professionally, I am an advertising and marketing professional with 25 years of experience in a variety of industries (e.g. airlines, automotive, fashion, and retail). I am one of the founders of Free Arts Minnesota in 1996, a non-profit dedicated to bringing the healing powers of the arts to over 4,000 abused and neglected children in Minnesota. I earned a BA in Business and Economics at Lake Forest College in Lake Forest, Illinois.
I am excited to be granted the scholarship to attend HIMSS in Chicago. It’s a great opportunity to network with leading healthcare providers and learn about the new healthcare solutions on the horizon. I also hope to be able to infuse the patient perspective with those I meet. Oftentimes others are speaking for what “patients" want and it’s not always in alignment with the real world patient / public voice.
As someone who has spent my entire career in advertising and marketing, technology is at the core of communicating with the public. Communication is also at the center of healthcare, not only between companies, staff, hospitals, but also between provider and patients and their families. I truly believe the only way we will advance healthcare is by working together, collectively.
Since I have a unique perspective of having foot in both advertising and communications AND patient safety worlds, it will be interesting to see HIMSS through this lens.
I am looking forward to attending HIMSS in Chicago this April. As one of the lucky HIS-talking Gallery Patient Scholarship recipients, as well as a woman who lives with Lupus, I am excited about the opportunity to meet and connect with stakeholders and businesses that believe including patients in the process is vital to the creation of successful partnerships within the healthcare and wellness industries.
Currently, I co-host and moderate @LupusChat, which leads a bi-monthly Twitter Chat (#LupusChat). I am a healthcare activist and recently was the host of WEGO Health’s #HAChat on the importance of Self-Care for Healthcare Activists. I am also a Creator of POPULOVE.net, which “redefines what fans can accomplish through music,” where I write and curate some of the content for the Pop Ed. and Causes sections of the community.
Being a part of the HIS-talking Gallery Patient team at HIMSS will be an informative adventure. My enthusiasm as a passionate healthcare activist and patient voice is loud and clear. If there is a chance to meet and engage with HIMSS attendees so that together we can gain insight to how the patient experience can be incorporated into their practice and businesses I am happy to share. I hope to connect and create an open dialogue with today’s change-makers.
Why do I want to attend HIMSS? It’s the biggest event of its kind — so big that most convention halls cannot contain it. My involvement in health IT has expanded in recent years, as this is the field most likely to include patients and one of the more innovative spaces in healthcare today. HIMSS is the preeminent health IT event — it’s the place to be! So it’s critical that patients are there, too.
It is crucial that patients attend healthcare events. We are in a transitional time where patients are recognized as more important than ever, but the reality is that there may not be a single patient on stage in the course of a multi-day event.
Who am I, as I patient? I have been living with chronic illness for 21 years, since I was diagnosed with Crohn’s disease at age 13. I’ve never been able to experience life as a healthy adult, but have enough medical education to warrant an honorary doctorate. More recently I’ve developed some secondary complications from the Crohn’s disease, and also Fibromyalgia. Because of this grab bag of conditions, I am in pain and discomfort (physical or emotional) at all times, but the levels vary.
My illness is not a blessing, but I do consider it a credential, along the same lines as my MBA or project management certification. I don’t primarily identify as a person with Crohn’s disease. Rather, I identify as a patient, in general, and if pressed, as a chronic illness or invisible illness patient. For a long time I did not know about many opportunities for patients, except for volunteering with my disease-specific non-profit, or fundraising for research.
My early experiences with disclosing my illness were so traumatic and dangerous that I was in the closet for most of my life. It was not until I started using social media to find and connect with other patients that I began to learn of ways to be involved on a different scale. In my professional life, I went from a graphic designer, to an MBA student, to a project manager, to a program analyst. I started off as a small cog in a large system, but slowly began to understand, and be excited by, working as a larger system. Recently, I realized that my advocacy evolved in a similar way.
I am excited about all the awesome people I will meet at HIMSS. To improve the health care system, we must understand the challenges and motivations of all the stakeholders. I need to understand why the doctor only has eight minutes to talk to me during my appointment. I need to understand why my pharmacy can’t accept refills on certain types of medicines. I need to understand how reimbursement works, and the regulations that hospital face. I need to understand why the timelines for improvements are so far out. I need to meet pharma employees and insurance CEOs and understand that they are not the enemy. I need to tell my story to all of these people, and yes, I need to listen to theirs.
We cannot solve problems by considering a single cog, we must see the whole machine and we must understand that it’s made of human beings, all with hopes, dreams, frustrations, and solutions.
My name is Melanie Peron of Paris, France. I am the founder of the Butterfly Effect. In September 2011, I decided to make a career transition and create the Butterfly Effect after my personal experience as a patient supporter for my companion. During this time I discovered the social exclusion and all the difficulties of families and patients have to face up.
I deeply believe that little actions can bring great consequences and that is why I chosen this name. The idea was to bring sweet moments for patients and families and allow people to live normal moments in difficult times.The Butterfly Effect has several missions : providing supportive care (art therapy, aesthetics, relaxation therapy, writing workshop), a 3D social network application (Bliss), cultural action (shows in patients’ bedrooms) and research (evaluation of the supportive care and the quality of patients lives).
Some numbers: more than 1,000 patients and families received 20 shows of music and storytelling in their rooms, over 200 people received collective and individual sessions (aesthetic, relaxation therapy, art therapy, writing workshop) and a pilot study evaluating of the well-being of patients treated with chemotherapy was conducted with a team of oncologists in Victor Hugo Le Mans [April 2014-January 2015].
I’m delighted to participate to HIMSS because it will allow me to connect with people who share the same dream as me: make health policy move forward for the benefit of patients and citizens. It will also be the opportunity to meet other walkers of the Walking Gallery and that is something very meaningful for me.
Whether we live in France or in the United States, thanks to our experiences as patients, supporters, and careers, we can improve our health and I deeply believe that it is by being together we can make a real and concrete impact ! I also will be happy to show Bliss, our 3D social network, to professionals. Maybe one day Bliss will be available in the US?
Finally, six years after the first idea of The Butterfly Effect, I’m very happy and honoured to come to Chicago to live this experience and to share it all over the world.
Thank you for the generous scholarship to attend HIMSS as a patient and family advocate. My overall goal for attendance is to deepen my knowledge about HIM and current trends. It is also most important for me to understand the gap between what hospitals and healthcare companies provide for EHR / EMR and HIT support to patients, such as what patients receive via patient portals vs. what we need, which is fuller access to our chart’s medical history, test results, and even the chance to review notes and visit summaries about us. Why is it so hard for us to get our own data? And why is our data not fully portable?
As the mom case manager to Jameson, a young adult with complex congenital heart disease, we need all of his data, both to make informed decisions and also to help him become knowledgeable about his medical situation. Along with most parents of children with special healthcare needs, we share the larger mission to raise young adults who are as health confident and as medically independent as possible. For most of my son’s life I’ve had no other choice but to collect and track his data on my own. I’d like to know how to help hospitals to better engage with us, to serve us and to meet our needs as key customers, by fully understanding our experience and the role we play in managing our own and our family’s healthcare.
Another problem I’ve experienced is that HIPAA rules are often applied unevenly, leading to yet another barrier that inhibits my ability to partner with and teach my son. These challenges only strength my resolve to find new and innovative ways to break down the silos between us and open the path to access our health information.
I’m very much looking forward to attending and absorbing all I can at HIMSS, not only to further my own learning but to inform my advocacy work. I’m happy to share my perspective on HIMSS15 by blogging or writing about the event; I also hope to present to other parents in my advocacy networks back at home. Perhaps most importantly, as a HIMSS first-timer who has been repeatedly warned by seasoned past attendees, I already have my comfortable shoes at the ready!
Frank Nydam is senior director of healthcare solutions in the office of the CTO of VMware.
Tell me about yourself and the company.
I’ve been with the company for just over 12 years. The last seven have been dedicated to our healthcare provider market. My team and I develop solutions along with our customers and ISV clinical application partners to help healthcare make that jump from yesteryear to tomorrow.
CIOs have to deal with infrastructure issues such as security, mobility, and cloud computing. What worries CIOs the most?
Top of mind in the last couple weeks has been security. I’d like to touch on that, but prior to that, it’s the overwhelming complexity that healthcare CIOs are dealing with.
If you think about the last 20 years of the applications and the infrastructure they needed to build to support the hospital, they still need to support that infrastructure and application set today, yet some of those technologies are pretty old and brittle. If you look at some of the new services, EMRs, and new mobile services, it’s almost a collision between the old world and the new world. That’s on top of their mind. That’s a lot of complexity to try to fit those two worlds together.
Number two is definitely security. With the recent breaches out there, I’ve had several CIOs say to me that the only thing the board would like to talk to them about is keeping their names out of the paper. That is definitely a big issue now. Obviously with so much complexity, it’s very hard to secure assets like that. That’s been our main talking point when I’ve been on the road meeting with our customers.
Everybody was worried about external hacking against their domains, but the big problem seems to be phishing attacks used to steal administrator credentials. Do any solutions look promising for that problem?
A good analogy would be that if you look at a hard-boiled egg, it’s very secure on the perimeter. It’s got a hard shell. If you look at healthcare security, we do a good job of securing the perimeter of the hospital from intrusions. But once somebody gets in and breaks through that proverbial egg, they have the full run of the infrastructure. Once they’re in, they can start snooping around, picking up passwords, data, what have you.
We have been focused on what happens once you get through that perimeter security. We purchased a company just about two years ago called Nicira. It was a startup out of Stanford. Our goal here is to do for networking what VMware has done to the compute side, to provide policy-based network services. Not at just at the perimeter, but for every workload, and make it really intelligent that regardless of the location of that virtual machine, it’s always protected by that security policy. It can only ever talk to its web server or its client.
We feel that’s going to help what we call the east-west communications. Going back to the egg analogy, if somebody does get through the perimeter, how are we going to protect the inside of that? We’re bullish on that. It’s a solution we have been working with in our enterprise customers. We’re trying to bring that into the healthcare industry right now.
Maybe hackers are using phishing attacks because perimeter security is working and they had to look for other weaknesses. Could there be a virtual firewall for the desktop since you have control of each VMware session and also AirWatch for mobile sessions? Can you protect users similarly to the way firewalls and antivirus software work?
Absolutely. If you walk through that from a virtual desktop perspective, we created a solution called AlwaysOn Point of Care. Right off the bat, the patient records never leave the data center. We present that desktop out to the clinician, whether it’s on a mobile device, on a desktop, what have you. That first step of security is not even having the patient records outside the perimeter.
You hit it on the head. Our product called NSX provides a distributed firewall in every single ESX server that’s out there. Whether it’s a VDI desktop, a server application, what have you, we put a virtual firewall around that device, around that application. If you think about trying to do that in the physical world, it would be nearly impossible to put a physical firewall in front of every single desktop device and application out there. It’s physically impossible as well as financially impossible. That’s one of the benefits and disruptions of our technology, that ability to have a firewall in front of everything and protect it. A term out there that’s emerging for that would be called micro-segmentation.
It’s been just over a year since VMware acquired AirWatch. What are hospitals doing with it?
If you look at healthcare, there’s not only an external generational issue with patient population, but it’s internal as well. The younger physicians want that same experience that they have outside the hospital inside the hospital. Call it BOD, call it what you wish. AirWatch allows us to provide that consumer-like experience to that physician so they can take their patient records home with them and work from home. We often get, “It’s really changed my family life because I can start doing charting from home rather than being inside the hospital. It has really been a revolution for us.”
But we’re just scratching what we’re going to be able to do with the AirWatch product. If you think about higher-level features, imagine geo-fencing to be able to contextually say, the doctor is outside of the hospital, they’re at home, they want to do e-prescribing. Let’s enforce two-factor authentication so they can do e-prescribing. But if they’re inside the hospital on that specific network on that specific device, let’s make it easier for the physician to do their job and take some clicks out of that workflow.
We feel that’s that next stage. We’re calling it the next-generation clinical workspace. How do we move from the technology of 20 years ago and give that physician that workspace, that device, regardless of their location application, to get their job done?
Is a point coming where hospitals can get away from running physical data centers and managing servers and infrastructure and get back to their core mission of using rather than maintaining technology?
Absolutely. We believe it’s going to be a hybrid world, meaning that we’re going to see hospitals continue to hold on to some of their infrastructure and applications where they feel its core value to the hospital. They’ll run that on-premise in a private cloud.
But for applications that no longer fit the mission but are required for the hospital to run, we’re starting to see those applications move out to a hybrid cloud. In our world, we want that private cloud and public cloud to be connected, and that’s what we call hybrid.
Probably the biggest use case we see for hospitals right now is something we’re calling legacy decommissioning. If you think about all the mergers and acquisitions that are going on in healthcare today, hospitals are saddled with a lot of old data and old applications that may not be core to their mission any longer, but they need to take it forward for merger acquisition or for read-only. We’re allowing our customers to decommission that legacy data and those applications to a cloud that looks, feels, smells, has all the security of their private cloud, yet it sits in a VMware vCloud — what we call VMware vCloud Air. We believe that’s a great first step for a lot of these hospitals who may be wary of putting PHI in the cloud or older applications or even newer applications. That has been a big hit for us.
In medicine it’s not that we don’t have enough medical experts, they’re just not spread out equally, so Boston has a lot and North Dakota doesn’t. The same is true with technology support talent, where small, rural hospitals don’t have the same technical resources. Will a move to cloud access better distribute the technical expertise needed to keep applications running?
That’s absolutely correct. I’m personally passionate about rural healthcare. I think it’s something we as an industry need to keep an eye on, making sure that these rural community hospitals, physicians, and caregivers are getting access to the right data, new applications, what have you. The ability to run some of this in the cloud and let a developer that’s really good at MUMPS in Boston support a physician or a small community practice of North Dakota — that’s a perfect use case for helping retain our rural community healthcare centers.
It’s almost like a democratization of healthcare IT talent in the same way that you can be a C++ developer sitting in Germany working for an American company. We need to bring the same type of democratization of skill sets into healthcare.
What are small and medium community health systems doing with the cloud?
It’s funny — there’s been so much “cloud washing” over the last five or 10 years that we had found ourselves stopping using the word “cloud.” I’ve seen some CIOs actually putting in a spam filter that says any email with the word "cloud," send it to the junk bin.
We took a different approach. We sat back with our customers and focus groups and said, at the end of the day, what are you trying to get out of that? What’s the outcome you’re trying to get from going to a cloud? They came back to us with about eight outcomes that any cloud should provide. That allowed us and our customers to focus on the outcome they’re trying to get rather than this fluffy computing term called cloud.
We built a framework called vCloud for Healthcare that defines the outcomes that a hospital can consume, whether they be application delivery services like virtual desktop or AirWatch to analytical, financial, and continuity services. That has allowed the smaller hospitals to consume and find value out of it quicker. Because again, there has been so much cloud washing that some vendors were walking and saying, “We can do anything with the cloud.” It was slowing down progress and innovation. Defining the outcomes and not being too concerned about the big fluffy name has helped us move along.
I’ll give you a great example. I had mentioned earlier legacy decommissioning. It’s a great opportunity for a small community hospital to see and feel what it looks like to use the same tools that they use internally and externally and relieve some pressure — regulatory pressure, data center pressure, and financial pressure. You hit it on the head — there is a big disparity between larger IDNs and academic research centers versus the community hospitals. This has really helped them.
Do you have any final thoughts?
When I started here, we were about a 300-person company. We’re about a 17,000-person company now. It has been quite a journey over the last seven years focusing on a specific customer set. I have been able to attract some of the most passionate and talented healthcare IT professionals. I have former CIOs, CEOs across the country, and heck, some folks even have patents out there in smart room technology.
This has been not only rewarding personally and professionally, but I’d like to look back on my career to be able to say we’ve left healthcare with something positive. Not from a sales perspective or a revenue perspective, but that we can look back five or 10 years from now and say we made healthcare a little bit better for you, my family, what have you. Some would say that’s a pretty idealistic view of the world, but it’s a great way to get up every day and help our customers. I just am so jazzed about the future of what we’re going to be able to do.
We need to help healthcare IT industrialize itself. For too long it’s been a piecemeal of this part and that part. I’m excited about how we can help healthcare industrialize, to make them look, feel, and act a little bit more like financial services so they can go innovate.
I do a lot of traveling and I see a lot of frustration out there among customers just trying to keep the lights on all day. We’ve got to get you guys away from just keeping the lights on and get back to your day job so you can innovate. That’s what gets me going in the morning.
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