Recent Articles:

EPtalk by Dr. Jayne 10/19/17

October 19, 2017 Dr. Jayne 1 Comment

clip_image002 

With the growth of my business, I’ve been trying to recruit some additional consultants to the fold. We’re busy enough now to support employees along with our contractor consultants, which is a good problem to have although I don’t like the additional administrative work that comes with it. Fortunately, my partner takes care of a lot of it, but I still get pulled into a fair amount.

We are using a variety of sources to find people and have found a couple of additional contractors that I would love to hire full time. Unfortunately, they have other ongoing work that they don’t want to give up, so I’m happy for them to work with us in a relative state of 1099 bliss.

Finding contract consultants seems to be fairly easy. We see quite a few who have strong backgrounds with major firms who either want to slow down the pace or who are semi-retired. We have one consultant who was a hard-charging leader at one of the big firms who took time off for family and wants to put a toe back in the water. There’s a lot of variety. The only downside we’ve seen to working with these folks is coordinating availability around other projects. Some of them are great to work with on physician engagements because they are willing to do calls and web conferences in the evenings after physicians are done seeing patients (and after the consultants are done working with other clients during the day). Although we have to pay contractors more than we might pay an employee, even with benefits at play, we’ve been fortunate to have some high-quality players working with us.

Finding consultants as employees is a little different. Although we’ve gotten lucky with a couple of hires, there are a lot of people out there who fancy themselves as consultants but who really don’t have any experience as actual consultants. I blame this on the proliferation of the word “consultant” into job titles far and wide. At a local department store, the sales team members are “retail consultants.” At some EHR vendors, trainers are now referred to as “implementation consultants” even though they are simply delivering prescribed checklist-based training with no consultative aspect to it at all. There’s a thought that because people are great trainers, or great support analysts, or call center reps, that they’ll naturally be good consultants. I’ve found that I can train people on different EHR platforms or different revenue cycle systems far easier than I can train them to be consultants.

Being a consultant is more than being a deep subject matter expert or having process improvement skills. You have to have a large toolbox and know when to use which techniques to help move your client forward. You have to be part expert, part salesperson, part therapist, and part janitor at times. Often, we’re thrown into messy situations with lots of dysfunction, and have to push past the obvious list of projects we’re supposed to tackle to address the root issues that will prevent any of them from being successful. We have to help clients understand who on their teams is working for them and who is actually working against them and what changes they need to be successful. We have to convince people to do things they adamantly do not want to do, or to get their buy-in that at least if they won’t do what we ask them to do, that they won’t sabotage us as we try to move others through a process.

I’ve been weeding through countless resumes of people with “consultant” in their employment history who don’t seem to have practical skills for actual consulting. I’m also finding that people have trouble reading and processing a job description and mapping their qualifications to the potential role. For example, our posted job description is fairly specific about wanting to see actual consulting experience, along with at least two years working for a mid-size to large healthcare organization. I’m looking at a resume right now for someone who has only worked in ambulatory physician offices and never at a group larger than five providers. He’s also looking like a bit of a job-hopper, having moved about every 18 months over the last six years. Once can attribute a short tenure somewhere to “bad fit” or “took something because I had to,” but not when you see it repeated over and over. There’s usually something else going on there.

One of the positions we’re recruiting for is strictly clinical and we need applications to have an actual clinical credential of some kind. They can be a medical assistant, nurse, pharmacist, paramedic, etc. and we’re flexible about it, but they do have to have a credential or equivalent work experience if they worked in a situation where a credential was not involved (sometimes we see this with our military applicants). We continue to have applications by people who have been EHR analysts or EHR trainers whose only clinical experience is working with clinicians. Needless to say, I’m not impressed by their ability to read and comprehend if they apply without a credential and without some kind of other documentation of experience that would explain why they are applying without a credential. It seems like they aren’t reading for detail and that’s definitely not someone I’d want to try to build into a consultant.

I continue to be surprised by the number of just mechanically bad resumes I see. Mismatched fonts that make them look like a ransom note, failed formatting, typos, absent or overdone spacing, and more. (pro tip: emojis do not belong in a professional resume). I also see some pretty over-the-top cover letters. One applicant talked about his “excitement to take the reins of your organization and steer its future in the right direction.” He seemed to have missed the part where I was recruiting for a field consultant, not a CEO. Another resume listed a degree that I didn’t recognize and couldn’t find on Google, which is a direct trip to the recycle bin. If you have an unusual or international credential, a brief explanation would be appreciated (although I’m still suspicious that I couldn’t find it on Google).

Another applicant is a desktop support rep and has been deploying laptops to end-users for a large corporation. No mention of EHR or clinical skills and can only travel half-time despite the position being posted for at least 75 percent travel. One applicant said she could travel 10 percent. Another has been in sales for the last five years, mostly with behind-the-scenes hospital systems like autoclaves and laundry machinery. Before that, she was a real estate broker. I understand that people may be in difficult circumstances and are applying for anything that might remotely fit, but a lot of time is wasted by applications that appear to be spammed out without respect to the actual job description.

My favorite application is one from a gentleman who boasted of “creative use of accounting systems to identify opportunities to address reporting issues.” As a business owner, I usually don’t want to see the words “creative” and “accounting” in the same sentence. I’m sure he was trying to convey that they used the accounting systems in a novel way or used accounting to address a clinical problem, but we’ll have to wait and see. I scheduled a phone interview with him just out of curiosity. Other than the potential verbiage concern, he meets all the other posted criteria and has been consulting for a couple of years. Sometimes you just have a to take a chance on someone.

Have any good tales from the hiring manager trenches? Email me.

Email Dr. Jayne.

Morning Headlines 10/19/17

October 18, 2017 Headlines No Comments

Tom Marino, Drug Czar Nominee, Withdraws in Latest Setback for Trump’s Opioid Fight

A 60 Minutes and Washington Post investigative report exposes a multi-year effort by drug distributor lobbyists to push an industry-friendly bill through Congress that ultimately undercut the DEA’s drug distribution enforcement options at the height of the opioid epidemic. Rep. Tom Marino (R-PA), President Trump’s Drug Czar nominee, withdrew his name from consideration after the report called him the “chief advocate of the law that hobbled the DEA.”

IBM shares up after earnings beat

IBM reports Q3 results: $19.15 billion in revenue and $3.3o adjusted EPS, beating analyst expectations on both, but marking its 22nd straight quarter without revenue growth. The company’s AI business unit brought in $4.4 billion in revenue, up 4 percent.

Virtual Therapists Help Veterans Open Up About PTSD

Wired covers the use of teletherapy in the treatment of PTSD among veterans.

White House says Trump opposes Senate’s bipartisan Obamacare deal

In a reversal, the White House now says it opposes the bipartisan deal drafted by Senators Lamar Alexander (R-TN) and Patrick Murray (D-WA) that would stabilize ACA marketplaces and restore the payment of cost-sharing subsidies.

Morning Headlines 10/18/17

October 17, 2017 Headlines No Comments

Trump gives go ahead for Congress to work on bipartisan Obamacare deal

HELP Committee Chairman Sen. Lamar Alexander (R-TN) and Sen. Patty Murphy (D-WA) have negotiated a bi-partisan healthcare deal that will grant authorization to continue paying insurers the cost-sharing subsidies that underpin ACA individual markets for the next two years. President Trump has come out in support of the negotiations.

Trump says Obamacare is ‘dead’

Despite failing to either repeal or replace the ACA, President Trump declares a legislative victory just the same, exclaiming “Obamacare is finished, it’s dead, it’s gone. It’s no longer. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.”

Vinod Khosla on A.I., Health, and the Future of Working (or Not)

Venture Capitalist Vinod Khosla follows up on his now six-year-old blog arguing that doctors would one day be replaced by algorithms with an interview explaining, in more detail, how he sees AI supporting and, in some cases, replacing doctors.

CVS Health and Epic Announce Initiative to Help Lower Drug Costs for Patients by Providing Prescribers with Expanded Visibility to Lower Cost Alternatives

CVS, which runs Epic across its retail pharmacies, will implement Epic’s Healthy Planet population health and analytics platform to study dispensing patterns and medication adherence.

News 10/18/17

October 17, 2017 News 9 Comments

Top News

image

Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) release their bipartisan plan to stabilize the health insurance exchanges in the short term. It quickly earned President Trump’s blessing “to get us over this immediate hump.”

Reported terms of the plan, announcement of which without specific draft language sent healthcare stocks flying on Tuesday, include:

  • Payment of the ACA cost-sharing reductions that the President just ordered to be stopped would be reinstated for two years.
  • $100 million of ACA sign-up assistance would be restored.
  • The waiver process for states that want to customize ACA rules would be simplified.
  • The availability of high-deductible, less-expensive policies would be expanded to all ACA enrollees, not just those under 30 years of age.

image

Vocal ACA supporter Andy Slavitt, former CMS acting administrator, is a fan of the Murray-Alexander proposal (even though he frets that it won’t get passed or that Senate Republicans won’t stop their quest to repeal the ACA entirely) since it would:

  • Preserve the ACA.
  • Reverse some of the White House’s ACA “sabotage.”
  • Provide new affordable plan options that, while not for everyone, are still better than no insurance.
  • Bring healthier people into the market.
  • Give states the flexibility they have been demanding while protecting lower income and sicker populations.

Reader Comments

image

From Lingua Frank: “Re: grammatical errors. I recently heard a cyberscurity expert talking about ‘security tenants,’ which I assume was supposed to be ‘tenets.’ An HIT project manager described dividing a project into ‘epics’ instead of ‘epochs.’” I was about to rail about colleges that graduate students who are poor writers, but I realized that the real culprit is a culture that accepts poor grammar and writing, as well as sloppy presenters and writers who indignantly insist that we stop grammar Nazi-ing them and instead serve as their auto-correct by proxy. Facebook has taught me to immediately stop reading posts from people I don’t know personally that feature misspelled words or hideously bad grammar since I have to assume that the person is equally lazy in their logic and execution. We all make mistakes, but only some of us care enough to fix them. I’m not as militant about mistakes like these two examples since it’s easy to misuse similar-sounding words especially when you hear them more often than you read them, and if you don’t know the difference between the words, no amount of spell-check will help.

image

From Peony: “Re: Allscripts. The press release mangles the name of their new customer, Catholic Medical Center.” Indeed it does, but at least only after listing the name correctly six times. “Care Medical Center” is actually a pretty good name.


HIStalk Announcements and Requests

image

I was curious about the five-year share price performance of some of the publicly traded health IT vendors. Buying Cerner or Athenahealth would have earned you a five-year return of around 85 percent, while Allscripts and Quality Systems were dead money and buying CPSI would have lost you 40 percent over five years. With 20-20 hindsight, you would have passed on these and instead bought index funds for the S&P 500 (up 78 percent) or the Nasdaq (up 120 percent), both of which provided great returns without the white-knuckle share price rollercoaster thrills along the way. Click the chart above to enlarge.

Listening: new from Mostly Autumn, an English progressive rock band (Pink Floyd-ish at times) formed in 1995 mostly known for near-constant touring, not signing with a big record label, and having a considerable turnover of personnel that has necessarily changed their sound over time. YouTube made a good related suggestion in 4th Labyrinth, which in addition to playing decent pop-tinged prog rock, has one of the most mesmerizing bass players you’ll ever see in Claudia McKenzie (they do a nice cover of “Locomotive Breath.”)


Webinars

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 25 (Wednesday) 1:00 ET. “Delivering the Healthcare Pricing Transparency that Consumers are Demanding.” Sponsored by: Health Catalyst. Presenter: Gene Thompson, director, Health City Cayman Islands. Health systems are unlike every other major consumer category in not providing upfront pricing information. Learn how one health system has developed predictable, transparent bundled pricing for most major specialties. Attendees will gain insight into the importance of their quality measures and their use of actual daily procedure costing rather than allocated costs. They will also learn about the strategic risk of other market participants competing with single bundled pricing. The organization’s director will expand how its years-long process is enabling healthcare delivery reform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

image

CNBC reports that Apple was recently considering acquiring its on-site medical clinic operator Crossover Health or national primary care clinic One Medical, although the sources did not indicate whether Apple’s interest was in running health clinics (which would be huge mistake and one that Apple is too smart to make) or partnering with them in an unstated technology role. The article describes Crossover Health  as a startup, which might stretch the term since the venture-backed company was founded in 2006 by Medsphere co-founder Scott Shreeve, MD after Medsphere bizarrely fired and sued him and his Medsphere co-founder brother Steve for publicly releasing source code, an odd move for an open source software vendor. Crossover Health has raised $114 million, runs four locations in Silicon Valley and one in New York City, and Scott remains as CEO, which I think takes it beyond the “startup” label.

image

Non-profit accelerator BioEnterprise Corp.will take over management of Cleveland’s county-owned, money-losing Global Center for Health Innovation. The building, which is attached to a convention center, changed its name from the less-sexy Medical Mart before it opened to a collective yawn in 2013. HIMSS signed on early as the anchor tenant.

SNAGHTML1e681cd9

Eye Care Leaders, which sells EHR/PM for ophthalmologists and optometrists, acquires competitor IMedicWare.


Sales

image

Adventist Health System will implement Glytec’s EGlycemic Management System at 39 of its hospitals.

image

Three hospitals in Belgium choose Cerner Millennium, although the company already announced University Hospital of Antwerp early this year.

CVS – whose MinuteClinic and specialty care management programs use Epic — will implement Epic’s Healthy Planet population health and analytics platform to give prescribers point-of-care information about drug formulary status, suggest lower-cost alternatives, and perform electronic prior authorization. The integration will also send a patient’s non-prescription drug purchases made via digital store front to their record in Epic’s EHR .

image

China-based Internet technology vendor Tencent – whose messaging apps are used by two-thirds of China’s population – will offer its users evidence-based consumer healthcare information from Healthwise that it calls “the best health information in the world.” 

image

Catholic Medical Center (NH) will implement Allscripts CareInMotion for population health management.


Announcements and Implementations

image

The American Medical Association launches its Integrated Health Model Initiative that will attempt to create a physician-developed holistic common data model around topics such as function, state, and goal to apply medical knowledge and improve interoperability. Initial communities are hypertension management, diabetes prevention, asthma functional status and patient goals, and defining wellness. Collaborators include AAFP, the American Heart Associaation, AMIA, Apertiva, BioReference Laboratories, CareCloud, Cerner, Clinical Architecture, IBM, Intermountain Healthcare, PCORI, PCPI, Prometheus Research, and SNOMED International. The announcement contained a lot of vague, lofty statements, so what AMA will actually do is not obvious.

image

Bernoulli Health will expand into Canada to offer its device integration, continuous monitoring, and clinical surveillance solution.

image

Healthgrades publishes its 2018 analysis of the top quality US hospitals and its “Report to the Nation.” It finds that if all hospitals performed as well as its five-star hospitals, 220,000 lives would be saved each year. Also released is the company’s National Health Index that lists the country’s 25 healthiest cities, with Minneapolis-St. Paul, Denver, Sacramento, Cincinnati, and Portland, OR taking the top five spots.

image

Voalte and Lightning Bolt Solutions will integrate their respective caregiver communications and hospital physician scheduling systems.


Government and Politics

image

President Trump declares in a Monday cabinet meeting that the term Obamacare is obsolete, explaining, “Obamacare is finished. It’s dead. It’s gone. It’s no longer. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare any more.” I’ll take all wagers that the President himself will tweet that term within a few weeks in trying to blame someone else for the inevitable “Trumpcare” meltdown.

Meanwhile, UnitedHealth Group says it’s excited about selling short-term medical plans again per the President’s executive order that extends their maximum coverage period from three months to one year. Investors loved the company’s reaction, which probably means prospective customers should be wary given the history of those policies excluding of pre-existing conditions (even if the insured person doesn’t know about them) and generating consumer complaints and lawsuits.

image

Politico reports that Seema Verma and Scott Gottlieb have fallen off President Trump’s short list to replace Tom Price as HHS secretary, with the frontrunner now being Alex Azar, a former HHS deputy secretary (basically HHS’s COO) who ran drug maker Lilly’s US operations until he left the company in January.

Three New York City doctors are sentenced to two years in prison for accepting cash, strip club tabs, and sex acts in exchange for referring patient blood samples to a private New Jersey lab company. Fifty people have been convicted so far, 36 of them doctors, for a bribery scheme run by Biodiagnostic Laboratory Services that improperly steered $100 million in Medicare and insurance payments to the company.


Privacy and Security

image

Chase Brexton Health Care (MD) notifies 17,000 patients that four of its employees fell for a phishing scam by filling out a phony email survey that gave hackers access to their email accounts. The hacker re-routed the paychecks of those employees to their own bank account. In terms of exposed PHI, the FQHC said the employee email accounts contained a lot of it that triggered the breach notice, but didn’t explain further.


Other

image

Venture capitalist Vinod Khosla famously said years ago that computers would replace doctors, which I thought was arrogant, clueless blather until I read this new interview with him that goes beyond the sound bite in elaborating on his thought process. Snips:

  • [On why he said we need algorithms rather than doctors] “I tore my ACL skiing … I did an MRI and I took it to three different docs and they recommended three different things. I said, this is stupid. There’s one right answer. When I talked to them about probability, they didn’t understand probability, and these are really good docs.”
  • “NNT (number needed to treat) is an incredibly important number that few doctors are aware of … If (medicine) was a science, for any given patient, you’d always have the same answer no matter who you ask, even if it is a probability distribution of outcomes. My goal became to change the practice of medicine, which is pretty damn good, into the science of medicine.”
  • “We don’t even measure the stuff that doctors can’t directly understand. We’re starting to run into this a little bit because in genomics, you might get 1,000 data points and no doctor can look at 1,000 data points. So in the past, we didn’t measure anything humans couldn’t consume, which meant they can at best look at a few numbers. We should have thousands of numbers per patient, per episode.”
  • “Anything that’s computing-based is near zero cost eventually. Which is why we spend way more compute cycles on a two-cent ad on Google than $10,000 medical decisions like, do you need a meniscus repair? … Let’s say you’re dealing with something serious like colon cancer. Does he know what each of the thousands of mutations could be? No, he doesn’t. So when he’s sitting down with the patient and saying, ‘You’ve got this cancer mutation,’ does he remember the 5,000 papers published in oncology journals recently? No, he doesn’t. He can’t.”
  • “There’s a company in Israel called Zebra Medical Vision (note: Khosla is an investor in the company)… In India today, they are offering reading any image for a dollar. Now that’s impactful. There aren’t enough radiologists in India … you have the analysis done almost immediately, if you are connected, for a dollar .. we will see better results than a radiologist and way faster. Higher quality, faster, and dirt cheap. The radiologist couldn’t do a phone call for a dollar. What else do you need?”
  • “There’s no reason an oncologist should be a human being. The right kind of oncologist isn’t the research oncologist. They know the most, but the guys who know how to take care of a patient are the community oncologists in Fresno or Stockton. They cannot always read all these journals, but they care for patients … They can be assisted with a virtual tumor board or an AI oncologist.”
  • “Watson could do AI. IBM has the scientific talent to do AI, but they chose to package Watson and market it for what it wasn’t. I think they can do much more, but the early efforts have been less than successful because they over marketed its capabilities.”

image

A federal judge invalidates the expired patent of drug maker Allergan for dry-eye treatment drug Restasis, allowing the sale of generic products despite Allergan’s attempt to protect its patent by transferring it to an Native American tribe to shield it from administrative review. Allergan offered the St. Regis Mohawk Tribe $13.5 million upfront and $15 million per year as long as the tribe used its sovereign immunity to keep the patent intact, a tactic the judge slammed as a “scheme to evade their legal responsibility.”

Bloomberg reviews the history of short-term medical plans that would become legal to sell again under President Trump’s executive order, recalling that those policies generated a lot of patient lawsuits for refusing to cover the cost of pre-existing conditions. A woman bought a short-term policy to cover her between jobs, was diagnosed with breast cancer, and was left on the hook for the $400,000 treatment cost when the insurer refused to pay even though she wasn’t aware that she had cancer until after she signed up. An attorney of a patient whose insurer refused to pay for treatment of his newly diagnosed throat cancer said more insurance choices isn’t necessarily a good thing: “With insurance it, doesn’t work that way. You’ve got to put everyone in the same pot.” Everyone could save a fortune by buying barebones insurance (or none at all, for that matter) if only they had a functional crystal ball, but until that happens, health systems should assume they’ll be eating a lot more cost as patients who can’t afford the patient portion of their low-coverage insurance will still show up demanding care. My biggest frustrations in the insurance debate are: (a) lack of political will to look at provider and pharma costs means every solution is just another form of cost-shifting and rationing; and (b) politicians seem clueless about how insurance and charity care works in declaring that nobody should be forced to buy insurance they don’t need, raising the question of how they know they won’t need it or who pays for the care they will demand if they guess wrong.

image

I ran a sample quote for United Healthcare’s short-term medical insurance, assuming a 40-year-old, non-smoking resident of Chicago under today’s underwriting policies. The company’s best Golden Rule-issued plan would cost $94 per month and would carry a $10,000 deductible, 60/40 co-insurance, 20 percent co-pay, and a $10,000 out-of-pocket maximum. The maximum lifetime coverage is $2 million. All payments, including ED and hospital, require the insured to pay the $10,000 deductible. No prescription benefit is included, nor is any out-of-network coverage at all (I would probably buy relatively inexpensive travel insurance with medical coverage while traveling on business or on vacation). Pre-existing conditions aren’t covered at all, defined as those for which the insured sought diagnosis or care in the previous 24 months or if the insured had symptoms for which “an ordinarily prudent person” would have sought care in the previous 12 months (at least you know upfront if that’s you). The price is great, you get United’s much-lower negotiated prices instead of paying provider list prices for cash, and people who can absorb the financial risk will be OK as long as they don’t get a new diagnosis of a chronic disease. Those with any existing or newly diagnosed chronic medical problems or who have less than $10,000 in liquid assets might not fare as well unless the ACA plans remain available so they can jump back in the next enrollment period (which isn’t really the way insurance is supposed to work).

EHR consultant Loretta Gallagher sues NYC Health + Hospitals, with a former IT director testifying that AVP Al Garofalo polled peers at a holiday party about which female consultant they would like to have sex with. The plaintiff sued NYC H+H last year, claiming her company was fired after she was refused to falsify a monthly Epic progress report as the CMIO ordered, although the health system’s OIG recommended her termination in 2015 after finding that her aunt – an HHC employee – improperly arranged to hire her and other family members.

image

Pretty funny.


Sponsor Updates

  • Black Book names MModal the leading vendor in transcription technology solutions and services as well as a top industry disruptors and challenger.
  • Spok welcomes 150 customers to its Connect 17 annual conference in New Orleans.
  • Diameter Health posts a podcast titled “Quality Measures Past, Present, and Future.
  • Meditech’s 6.1 and Client/Server EHR platform and portal earn Infoway’s certification for meeting standards in Canada. 
  • Ability Network announces the top-performing home health agencies in its annual HomeCare Elite program.
  • Agfa Healthcare releases “Enterprise Imaging crosses The Tipping Point – Episode 1.”
  • Aprima will exhibit at the Academy of Integrative Pain Management Annual Meeting October 19-21 in San Diego.
  • Besler Consulting will present at the MAPAM Annual Fall Conference October 23 in South Yarmouth, MA.
  • CarePort will exhibit at the Florida Association of ACOs annual conference October 19-20 in Orlando.
  • Clinical Architecture joins the AMA’s new Integrated Health Model Initiative.
  • The Jacksonville Business Journal recognizes CSI Healthcare IT CEO Rafe Sanson as a 2017 Ultimate CEO.
  • Direct Consulting Associates and Dimensional Insight will exhibit at the HIMSS Midwest Fall Conference October 22-24 in Indianapolis.

Blog Posts


Contacts

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

125x125_2nd_Circle

Curbside Consult with Dr. Jayne 10/16/17

October 16, 2017 Dr. Jayne No Comments

clip_image002 

I work with a fair number of dysfunctional organizations and hear regularly from readers that they can see pieces of their own organizations in my writings. I hope not too many of you see yourselves or your employers in this week’s installment, which deals with the subject of accountability.

Generally defined as responsibility, in some organizations, it has become little more than a corporate buzzword. Some groups like to throw accountability around without much mention of its companion, governance. Especially when you’re dealing with projects that are a combination of clinical/technical or operational/technical elements, governance is key.

I actually like what Wikipedia has to say about it, that “accountability is the acknowledgement and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the scope of the role or employment position and encompassing the obligation to report, explain, and be answerable for resulting consequences.”

The line about being within the scope of the role is particularly key, as I see many examples where organizations expect employees to be accountable for things beyond their control. Asking a manager to be accountable for the output of their team is fairly common, as long as it’s clearly part of the job responsibilities and the manager is given the tools needed for the team to be successful. All too often I see organizations asking leaders to be responsible for work product that is outside the expertise of their teams or to try to produce results with wishful thinking as their principal tool.

When my clients start throwing around accusations of lack of accountability or engaging in finger-pointing, I like to introduce them to tools that their leadership teams can use to better understand how accountability and responsibility really work. My favorite is the RACI matrix, although I’ve worked with different variations such as RACIQ and RASCI.

For those of you who may not have worked with a RACI matrix, it’s basically a chart of who does what in a business process. It helps clarify roles and responsibilities and can prevent the kind of “not me” conversations we see when things are not progressing according to plan. RACI illustrates that as much as we like to think about the proverbial buck-stopping with a singular individual, department, or team, the one-man-show rarely works in modern business.

RACI breaks down overall responsibility/accountability into the following subgroups:

  • Responsible. The people or teams who actually perform the work.
  • Accountable. The individual who answers for the completion of the work, which may be delegated to others or to a team. They have to approve the work done by the responsible group. To be successful, accountability needs to be owned by a single person, although I see entirely too many examples of failed attempts at shared accountability.
  • Consulted. The people who are subject matter experts or otherwise have an opinion about the work being done. Conventionally this can include legal, compliance, or other professionals who don’t have to actually do the work but whose policies may dictate how it’s done.
  • Informed. The people who need to understand the progress of the project or process. Often this may be notification that a project is complete.

We’ve all been part of projects where we find out too late that there was someone who should have been in the Consulted group, but we didn’t bring them into the process until things were too late. This results in rework, frustration, and low morale when projects have to be redone or revised.

Unless the use of a tool like RACI is baked into a company’s culture, teams may not spend enough time during planning phases to identify what inputs are needed or what communication needs to occur. The idea here is that time should be spent in deliberate thought around making sure project stakeholders are identified. When you first start doing it, it seems time-consuming and artificial to classify tasks and deliverables but after you’ve done it a few times it starts to feel natural and flows more quickly. It’s a way to prevent surprises that becomes worth the effort.

It’s also a way to help counter the siloed work that sometimes happens in larger organizations. When you have a process that forces you to actively think about who should be informed, it helps the clinical people remember to talk to the technical and operational people and so forth. It reduces the chance of a project leader being asked, “Why didn’t I know about this?” or, “How long has this been going on?” The key, however, is to have the process discipline to make sure that you’re thinking about the various parts of a project and not skipping quickly through the matrix, or just doing enough of the matrix to be able to say that you’ve done it. Leaving blanks in the chart isn’t desirable, but can be done to allow a project to move forward with near-term follow up to resolve the empty field.

One of the keys to RACI is that it can identify the way responsibility and accountability shift throughout the lifecycle of a project. At one stage, a group may simply be informed or consulted, where in a subsequent stage, they may be responsible. Accountability may move from a design manager to a build manager to a marketing manager to a sales manager as a project moves to market. Simply having the matrix as part of organizational processes can bring people together around common definitions. I’ve worked with groups who have varying definitions of accountability, which can lead to confusion and disappointment. Bringing everyone onto the same page is always a strong move towards ensuring project success, and if you’re going to use a responsibility matrix, it’s a must.

I’ve been working recently with a consultant who hails from Australia. I love learning different idioms and phrases he uses to describe situations that are common no matter where you work. In talking about ways to help organizations through their dysfunction, he introduced me to a new one that fits right in with what RACI is trying to accomplish. I think I’m going to steal his description for the next time I have to teach it to a client. Because who doesn’t like a tool that can help keep you from acting like a jellyfish at a disco?

What’s your favorite idiom? Email me.

Email Dr. Jayne.

Morning Headlines 10/17/17

October 16, 2017 Headlines 1 Comment

Trump says opioid emergency will be declared next week

President Trump indicates that he will formally declare a national emergency over the opioid epidemic as soon as next week.

VA Secretary Shulkin Has White House Interview To Head HHS

VA Secretary David Shulkin, MD heads to the White House to interview for the role of Secretary of HHS.

Apple explored buying a medical-clinic start-up as part of a bigger push into health care

CNBC’s Christine Farr reports that Apple considered entering the healthcare provider space by acquiring Crossover Health, which works with employers to build and run on-site medical clinics. Apple was reportedly in earlier talks with One Medical, but neither deal materialized.

AMA to Unleash a New Era of Patient Care

AMA announces a project to develop a shared framework for organizing health data in collaboration with IBM, Cerner, Intermountain Healthcare, American Heart Association, and American Medical Informatics Association.

HIStalk Interviews G. Cameron Deemer, President, DrFirst

October 16, 2017 Interviews 1 Comment

G. Cameron “Cam” Deemer is president of DrFirst of Rockville, MD.

image

Tell me about yourself and the company.

I’m president of DrFirst. I’ve been with the company for about 13 years. DrFirst originally began as a standalone e-prescribing vendor about 17 years ago. Since then, we’ve migrated into a technology platform vendor serving over 300 EMRs. We have a large chunk of the hospital market, which typically uses our medication history services and our discharge prescribing. We’re now migrating also into the patient-facing application space.

What challenges remain for e-prescribing now that adoption is nearly universal?

At this point, most of the physicians who are ready to adopt have access to e-prescribing. There’s a couple of pockets that we found that are still issues. A lot of this came up when New York implemented the I-STOP program and suddenly we found pockets of physicians all over the state who had not yet adopted e-prescribing for one reason or another.

For instance, think about surgeons who typically write a very limited number of scripts. They don’t really see the need for an EMR. They’re not going to see the patients on a repeated basis, things like that. There were still those pockets out there where they still had a use for standalone e-prescribing because they’re not strongly committed to EMR use yet.

The other one is physicians after hours and away from the EMR who are still writing scripts on paper or calling it into the pharmacy because they don’t have a good mobile solution. That’s a problem we’re trying to solve right now.

What is the role of technology in addressing the opioid issue?

There’s an interesting transition happening literally right now. For the first time, state PDMP data — the controlled substance registries — are being made available in the workflow for physicians through a few vendors. I would say it’s experimental right now, trying to figure out what works best for the physicians. It’s the first time they haven’t been asked to go to a separate portal, log in, enter patient information, and go through all that, which they were reluctant to do.

Instead, in the process of writing a prescription, you’re able to see all the fills the patient has had for opioids. From a physician perspective, our experience has been they love that. It just becomes part of their workflow. They don’t have to do anything special to consume it.

What I believe will happen over time is that as physicians become more aware of patient behavior, the problem will shift back to illegal drugs. States must have some strategy there to nail down that side of the issue as well.

I think we can get the legitimate drug prescribing side well under control as we move this into the workflow.

The market has shown strong interest in tools for price transparency, electronic pre-authorization, specialty drug prescribing, and especially the electronic monitoring of drug adherence. How do you see that layer of intelligence that’s built on top of e-prescribing moving to the next level?

One of the most exciting things right now is price transparency. If you look at surveys, usually the number one complaint of patients is, I have no idea how much this is going to cost. Regularly you see that pricing issues and affordability are the top reasons for patient non-compliance.

If we’re going to deal with outcomes, we need to get price transparency under control. We’ve done quite a lot of work around that in the last couple of years. Humana rolled a program out nationally with us and we gained experience in how physicians respond. Since then, it brought several additional payers into that space to contribute their information.

Payers have tried to do that to some degree, but they are reluctant to share their actual drug costs with prescribers, they don’t necessarily have access to insurance-specific charges, and they struggle to account for differences in dose forms such as a tablet vs. a liquid.

You really nailed the problem. Until now, e-prescribing vendors and EMR vendors have had access to basic formulary and benefit information as a result of participating in the e-prescribing networks. That gave us a general understanding of how drugs are covered, but without patient-specific or employer-specific information. It varies dramatically among pharmacy benefit managers, PBMs, even with the same formulary. Certainly it does not include pricing information.

We knew we had to get better than that. How do you get the real information, down to the penny, of what the patient is going to pay? The only way to do that was to do an actual adjudication of the prescription before it is sent to the pharmacy. Let the physician know that this is the exact impact, specifically for this patient under whatever part of the patient’s coverage plan they happen to be in at the moment and considering everything that’s happened before with that patient.

The PBM is the only one that knows that, so you must do an adjudication. The real challenge for us and for the PBMs was, how do you do that? It’s different. They’re used to adjudicating pharmacy claims using the data that comes from a pharmacy. They’re used to receiving certain fields and responding with certain fields in a certain way. They’ve been doing that for years.

Now you’re moving upstream to the physician. Physicians don’t prescribe the same way the pharmacies dispense. For instance, a physician isn’t concerned with a specific NDC code as a pharmacy would be, but it’s a representative NDC. They just pick one that represents that drug name and that’s typically what we send to the pharmacy. The PBM is going to need something more specific than that to adjudicate it properly in their system.

There also can frequently be mismatches, where the EMR may not have kept its drug database up to date. The PBMs generally do, but they may not sync with what the EMR is using. There might be a difference in drug compendia, where the EMR is using one set of drug databases while the PBM uses one from a different company. Nobody’s done the work to sync that up or make sure they even know which compendium is being used.

The other challenge is about how physicians write quantities in prescriptions. The physician may have a way of describing the quantity of a drug that the pharmacist understands, but that is not what the PBM requires to adjudicate a prescription rather than a claim.

Even after a couple of years, the industry is still experimenting with that, to be able to make sure that the results get closer and closer to working every time rather than erroring out because something wasn’t understood. It’s getting much better as we allow people to experiment.

The other thing, how are they going to adjudicate that claim? The PBM industry has for years had the concept of a dummy claim. A pharmacy system vendor or a pharmacy could send a dummy claim just to make sure things were adjudicating correctly. Theoretically, you could run a physician’s prescription through that same process. Once you’ve cleaned up the prescription enough that it will process through that function, how do you connect to that function? It’s usually a different connection than what we would use out of an EMR or an e-prescribing system. It’s an NCPDP claims connection.

The response may not come back fast enough since it could be a slow system. If it does come back fast enough, you still only have one answer and you need several. You need to know not just that drug, but other drugs the physician could choose from that might have more favorable pricing for the patient if they want to see alternatives.

The dummy claim system isn’t made for that. It’s not made to hit it over and over and over and over with transactions. It’s made for occasional transactions. There’s some cost on the PBM side of building their system slightly differently to allowing a transaction to process multiple times for multiple drugs that are all related, but are more preferred than the drug that was submitted.

It’s a more complex logic involving systems that have a higher requirement on them. They still need to return their response very fast before the physician loses interest and moves on.

Is there opportunity in connecting technically sophisticated pharmacy chains like CVS and Walgreens back to prescriber systems?

That’s an interesting question. With what we’ve just been discussing about price transparency, that doesn’t quite apply in the same way, but there is a connection there.

What we’ve been discussing so far was getting plan information from the PBM. On the pharmacy side, there are other options for patients. Many of the pharmacies belong to programs that provide favorable cash pricing for a patient. A patient wouldn’t necessarily know anything about that favorable pricing if they have to pay cash, and today, many plans have shifted to high deductibles and HSA-based plans. In that kind of an environment, patients are often going to be out of pocket on their drug costs, so the ability to know that a discount would apply is very important.

That’s one of the things that we combine in our price transparency solution. Not just the PBM response, but also when applicable, discount information for the patient on some of the other networks that pharmacies participate in. In that sense, we’re bringing something that’s unique to the pharmacy into the physician workflow as well.

We address the general question of communication through a secure messaging solution that we’ve been implementing at pharmacies as well as in physician offices. They can have a two-way back and forth very efficiently.

Drug chains offer patients the chance to pay cash if that would be cheaper than their co-pay, often offering the patient coupons from third-party companies like GoodRx that offer PBM-type discounts. Should that be a factor?

We’ve partnered with those companies to make those plans available to patients, but we’ve moved it upstream. Instead of the pharmacist having to take time to do that, we let the patient walk in with that information ahead of time. That’s exactly what I was talking about — the discount programs the pharmacies have available.

Where do you see the company’s opportunities going forward?

Whenever something new like this enters the industry, it’s always interesting because there are incumbents in the industry. There are people who would like to play a bigger role and everybody tries to jump in on what’s new.

Two things slow down innovation. One is attempting to drive exclusive arrangements. They assume, “If I can get every payer to be exclusive with me, then all of the physicians will have work with me as well.” It’s a way to corner the market on physicians.

The problem with that, of course, is that everyone who would like to play in the price transparency space has only part of the market attached to them. Because of that, to drive these technologies out quicker and to get more innovation in the space, it’s much better to have non-exclusive relationships, where everybody can play with everybody for the role they can provide.

That’s a very important part of helping price transparency blossom in the country. We’ll see how it develops over time. Generally, people are uncomfortable with exclusive arrangements, but that’s the ugly business side of this space that people should be aware of when they’re deciding how they want to play here.

To get back to your question about possibilities, one of the neat things we’ve seen is that in addition to increasing the rate of compliance for patients because they’re already prepared for what they’re going to see at the pharmacy, it has a real strong tie into electronic prior authorization as well. Instead of thinking of it as price transparency, think of it as understanding how to maximize the use of your benefit or maximize the use of your plan.

If the physician is writing a drug that has a prior authorization component, maybe quantity limits, in the old days before this real-time connection, nobody really knew if any individual patient had already met the criteria. When you adjudicate the prescription real time and come back with the benefit information, you know exactly whether the patient has already PA’d on that drug, or if it’s step therapy, if they have already completed the first part of the step therapy. The PBM knows that already and can just say, prior auth is not required on this one.

We’ve seen a huge decrease in prior authorization requests as a result of freeing up this benefit information from the PBMs. That’s one of the things we’re exploring. How do we apply this pricing transparency workflow to reduce the number of times something else would take the physician out of the workflow?

I was talking about how everything happened at the pharmacy previously and now we’re moving that upstream into the physician, so that when they’re writing the prescription, they can consider price. We’re also moving it downstream to the patient. Maybe the physician was busy and didn’t take the time to have a conversation with the patient about their options. It may end up that sticker shock at the pharmacy causes the patient to decide just not to get the drug and not tell the doctor that they didn’t fill their prescription.

We’re taking that same pricing information out to the patient to let them better understand their options for different venues where they could consume the drug. Maybe they get a better deal at a preferred pharmacy, or maybe a home delivery has a more favorable price. Maybe it’s one of their local pharmacies that has a better cash price than the patient can get with their plan.

We feel that patients deserve a shot at the information as well. We’re getting a huge response from patients who love the ability to see that and then have a conversation with their doctor if they see something they think would work better for them in terms of affordability.

Do you have any final thoughts?

This is an exciting new opportunity. It’s too soon to squeeze it into a one-size-fits-all space. A lot of talk in the industry is about trying to make everyone use a standard transaction for this. It’s really not the time for that. People are experimenting with APIs and different formats for prescriptions. We really ought to let it bloom and let innovation flow. This is so important that we must get it right, and the best way to get it right is to try a lot of different things.

Morning Headlines 10/16/17

October 15, 2017 Headlines 2 Comments

The CBO predicts Trump’s move to end ObamaCare subsidies will hike premiums, uninsured rate, deficits

President Trump signs an executive order ending the payment of cost-sharing subsidies to insurers to support ACA’s individual markets.

Andy Slavitt to Serve as Special Advisor to General Atlantic

Former CMS Acting Administrator Andy Slavitt accepts a position at private equity firm General Atlantic, where he will focus on healthcare investments in underserved populations.

New London family doctor, 85, says state forced her to give up medical license

An 85-year-old primary care provider in New Hampshire claims she is being forced to retire for refusing to implement an EHR, while the State Board of Medicine says she agreed to surrender her license “in light of an investigation into her record-keeping, prescribing practices, and medical decision-making.”

North Korea behind WannaCry attack which crippled the NHS after stealing US cyber weapons, Microsoft chief claims

Microsoft President Brad Smith blames North Korean hackers for launching the WannaCry cyberattack that infected several NHS hospitals earlier this year. He says, “I think at this point that all observers in the know have concluded that WannaCry was caused by North Korea using cyber tools or weapons that were stolen from the National Security Agency in the United States.”

 

Monday Morning Update 10/16/17

October 15, 2017 News 2 Comments

Top News

image

President Trump continues the dismantling of his predecessor’s programs without Congressional involvement by signing an executive order that would prohibit HHS from paying legally required (but also legally challenged) premium-lowering payments to insurers.

A CBO report from August predicted that such an order would increase premiums 20 percent immediately and increase the federal deficit by $194 billion over ten years, but would not significantly increase the number of people without insurance.

The immediate effect on the open enrollment period that starts in just over two weeks will vary by insurer and state. Some insurers built the expected action into their new premium prices, others advised insurers to assume the payments would be made in setting their prices, and the timing of the executive order makes it unlikely that insurers can get re-filed rates approved before enrollment begins, raising the possibility that they will pull out of the market.

Eighteen states have sued the White House over the executive order.

HHS Acting Secretary Eric Hargan and CMS Administrator Seema Verma release a statement supporting the order and criticizing the laws they swore to uphold, saying that “Obamacare is bad policy” and that cost-sharing reduction payments were authorized in an unlawful “unconstitutional executive action” (which is arguably true and the subject of the legal challenge).


Reader Comments

image

From Faith-Based Hill: “Re: Outcome Health. Overstating claims and fudging numbers will get you hundreds of millions in investment that you can use to buy time to hopefully turn things around. Too often the poor schmucks who try to build legitimate, ethical business get no such boost. The VC/PE world is ripe for such perverse incentives. A $5.5B valuation for putting TVs in doctors’ offices so Rx companies can prey on (cough, cough) I mean advertise to patients? How is this innovative? How is this going to actually benefit patients, lower costs, and (as their name ironically suggests) really improve outcomes? Sorry for ranting, but these Theranos-esque shysters make EHR vendors look like friggin’ Mother Teresa by comparison.” I’ll be interested to see how Outcome Health, as a privately held company, proceeds and how investors and customers react. Companies usually fire a few mid-level executive serving as scapegoats (giving them big go-away money and an ironclad NDA to prevent them from saying what really happened); apologize; and claim that the public penance marks a new chapter in the newly reinvented company’s inevitable destiny. The worst thing about Outcome’s business model of promoting drugs to patients at their vulnerable moments is that it works – doctors naively think they are immune from pharma propaganda and irrational patient pressure, but prescribing data proves otherwise. The most important “outcome” is boosting pharma’s bottom line. It’s distasteful to be reminded constantly that healthcare is like all other industries in being driven almost exclusively by profits, which was inevitable going back to the 1960s, when Medicare made the potential economic scale interesting to investors.

image

From Desperado: “Re: Cerner. Next CEO is … Zane Burke.” Unverified, but hardly shocking if true. CERN shares appeared (from my quick graph look) to have hit an all-time high after a nice run-up last, week, closing Friday at $73.57 as the company’s market cap approaches $25 billion. I’m happy that Burke at least earned an advanced degree (MBA) since so many healthcare executives rose through the sales ranks where graduate education is seen as a waste of time.

From ImageEnabler: “Re: Philips. Now requiring customers migrating away from their iSite PACS solution to use their third-party migration vendor of choice. Who owns the data again?” Unverified.

From Dr. Trump: “Re: ACA. Will Trump’s repeal of the health insurance subsidies and encouraging cheap individual health plans benefit Oscar Health, Joshua Kushner’s startup?” I expect so. The struggling Oscar was on the wrong side of Trump’s ACA wrath when he was elected since the company sold ACA plans, but it announced in April that it would start selling the kind of individual plans that will probably gain business from the executive order.


HIStalk Announcements and Requests

image

Incumbent HHS Secretary “None of the above” remains the favored candidate of poll respondents, although readers expressed tepid enthusiasm for having HUD Secretary Ben Carson swap chairs.

New poll to your right or here: what is the clinical and healthcare business impact of not having a national patient identifier?


This Week in Health IT History

One year ago:

  • Allscripts acquires CarePort.
  • AHIMA announces its plans to offer a health informatics certificate.
  • The Internet goes dark in many parts of the country when hackers hit DNS routing company Dyn.

Five years ago:

  • Wolters Kluwer announces that it will acquire Health Language.
  • NYC H+H’s board minutes explain why it chose Epic to replace QuadraMed CPR, a decision that led Allscripts to sue the health system for giving Epic the bid in what it claimed was improper procurement.
  • Google shares drop sharply when its financial printing firm releases the company’s SEC Form 8K in the middle of the day instead of after hours.
  • An IOM report finds that a health system co-managed by the DoD and VA s is spending an extra $700,000 per year for pharmacists to enter prescription data, required because their separate EHRs cannot create a sequential prescription number.

Ten years ago:

  • Medsphere settles its $50 million trade secrets and contract breach lawsuit brought against founding brothers Scott and Steve Shreeve.
  • Eclipsys announces plans to move its headquarters from Boca Raton, FL to Atlanta.
  • A Misys report concludes that doctors don’t use EMRs because they are expensive and hard to use.

Last Week’s Most Interesting News

  • A Wall Street Journal report says that waiting room digital advertising company Outcome Health misled investors about its advertising performance as fresh investment sent its valuation soaring to $5 billion.
  • President Trump signed an executive order that allows people to sidestep exchanges to buy less-expensive but less-comprehensive policies, a move that threatens to further destabilize ACA insurer risk pools.
  • Express Scripts announces plans to acquire EviCore Healthcare for $3.6 billion.

Webinars

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 25 (Wednesday) 1:00 ET. “Delivering the Healthcare Pricing Transparency that Consumers are Demanding.” Sponsored by: Health Catalyst. Presenter: Gene Thompson, director, Health City Cayman Islands. Health systems are unlike every other major consumer category in not providing upfront pricing information. Learn how one health system has developed predictable, transparent bundled pricing for most major specialties. Attendees will gain insight into the importance of their quality measures and their use of actual daily procedure costing rather than allocated costs. They will also learn about the strategic risk of other market participants competing with single bundled pricing. The organization’s director will expand how its years-long process is enabling healthcare delivery reform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Sales

Pine Rest Christian Mental Health Services (MI) chooses Epic.


People

image

Former CMS Acting Administrator Andy Slavitt joins growth equity firm General Atlantic as special advisor, focusing on healthcare investments in underserved populations. HIStalk readers are cited in General Atlantic’s announcement for voting Slavitt as their “Healthcare IT Industry Figure of the Year” for 2016.


Announcements and Implementations

image

Hospital operator Mercy’s IT organization and device maker Medtronic will work together to capture de-identified data from heart failure patients to analyze their response to cardiac resynchronization therapy. Medtronic, based in Ireland after a controversial 2015 move of its US headquarters to Dublin to dodge US taxes, sells an implantable device that offers that therapy.


Government and Politics

Two senators write to President Trump to inquire why he declared on August 10, 2017 that “the opioid crisis is an emergency and I’m saying officially right now it is an emergency” without following through on the legal rather than the rhetorical declaration that is required to take federal action.


Privacy and Security

A Microsoft executive says that the government of North Korea was responsible for using stolen NSA tools to create the WannaCry malware that hit hospitals hard earlier this year.


Other

image

A 28-year-old New York man and self-described “serial data tracker” says his two-year-old Apple Watch saved his life by alerting him that his heart rate had jumped, which turned out to be a symptom of a pulmonary embolism that was successfully treated.

An 85-year-old New Hampshire pediatrician says the state is shutting her practice down for not using an EHR and therefore not checking the state’s doctor-shopper database before prescribing, although she fails to note that she willfully signed an agreement to close the practice after an investigation into poor documentation and questionable decision-making. The Poland-trained doctor claims that New London Hospital, with which she is affiliated, is trying to steal her patients. She doesn’t believe in technology:

I cannot practice medicine because the system practices with electronics. The computer is giving the diagnosis and telling them what medicine to prescribe. They practice medicine, and I practice medical art. They manage the patient, and I treat the patient … It’s fine if you are with the system. If you are not, you are an enemy of the system.”

Patients in England report that their doctors are ridiculing and threatening patients who research their issues on the Internet before a visit.

image

CNN finds that drug companies are making hundreds of millions of dollars each year – much of it paid by Medicare – on Nuedexta, intended for treating a relatively rare condition that causes laughing and crying in multiple sclerosis patients, but being aggressively marketed by salespeople for dementia patients in nursing homes. Its manufacturer has also paid many millions to doctors in honoraria and consulting fees, with doctors who have received those payments being responsible for nearly half of the Medicare claims paid for the drug. Nuedexta, which costs over $9,000 per year, contains two ancient, dirt-cheap drugs – dextromethorphan (in over-the-counter cough syrups) and quinidine sulfate (a bark-derived heart drug that’s so old that nobody can remember when it was first used). The unfortunately not-rare condition it causes rather than cures is excessive pharma laughing all the way to the bank.

A visitor is stabbed to death in his son’s hospital room at Johns Hopkins Hospital (MD), with police investigating a domestic issue trying to determine whether it was murder or suicide.

image

In India, a bystander captures on video a hospital dumping its medical waste into a river.

Weird News Andy is singing “Sole Man” while failing to identify a good ICD-10 code after reading this story. A man in England goes into cardiac arrest after swallowing a six-inch Dover sole, saved by a first responder who was able to remove the fish after six tries. The man claimed that the fish spontaneously leaped from the water into his mouth, but a friend told the first responder that the intrepid angler was fooling around by putting the just-caught fish over his mouth, only to be rendered speechless when it wriggled down his throat.


Sponsor Updates

  • Harris Healthcare will exhibit at AHAAM’s Annual National Institute Conference October 18-22 in Nashville.
  • Vocera will exhibit at the ANIA DFW Clinical Informatics Academy October 18 in Grand Prairie, TX.
  • Black Book ranks ZeOmega number one for care management workflow applications, and includes it on its list of Top 50 Disruptive Health IT Companies.

Blog Posts


Contacts

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

125x125_2nd_Circle

Morning Headlines 10/13/17

October 12, 2017 Headlines 2 Comments

Outcome Health, a hot $5 billion startup, reportedly misled its advertisers

Outcome Health, a Chicago-based healthcare startup, reportedly raised a $500 million funding round on a $5 billion valuation that was based on misleading performance metrics and falsified growth data. The company creates patient education videos intermixed with pharmaceutical ads to be played in doctor’s office waiting rooms.

Trump begins Obamacare dismantling with executive order

President Trump signs an executive order that will create new, non-ACA regulated purchasing options for individuals shopping for health insurance plans. Advocates say sidestepping the ACA marketplaces will free payers to offer lower priced plans that do not comply with ACA protections, while critics say the move is aimed at gutting the ACA individual marketplaces of the younger, healthier demographic needed to sustain a market.

#CHC17 Day 4 Recap

At its annual user conference, Cerner’s President Zane Burke announces that CommonWell services will remain free to Cerner clients for an additional three years, through 2020. The network now holds 60 million patient records.

Doctors Feel Excluded from Health Care Value Efforts

A Harvard Business Review article by two Bain & Company’s healthcare partners argues that providers are not eager to embrace alternative payment models because they have been routinely excluded from the decision-making process.

News 10/13/17

October 12, 2017 News 7 Comments

Top News

SNAGHTML4760349

A Wall Street Journal report says that Chicago-based waiting room digital advertising company Outcome Health overcharged drug company advertisers by intentionally claiming an inflated number of screens in use, manipulating third-party ad performance analyses, and creating phony ad campaign screen shots.

The company, formerly known as ContextMedia Health, has placed three employees on paid leave pending an investigation.

A former executive who confronted co-founder and CEO Rishi Shah about questionable business practices lasted only two weeks, joining the seven executives who have left the company so far this year.

Chicago Mayor Rahm Emanuel helped dedicate a 29-story building that was renamed Outcome Tower in late September, the same day the company finalized plans to lay off 76 of its 600 employees.

Drug companies had previously obtained refunds from the company after their reps noticed that claimed devices in medical practices weren’t actually there. Outcome has also been accused of altering prescribing data from QuintilesIMS to make its campaigns look more successful, which earned Outcome a scolding from IMS.

image

Outcome Health’s last fund-raise valued it at $5 billion, making co-founders Rishi Shah and Shradha Agarwal, aged 31 and 32, respectively, paper billionaires.


Reader Comments

From Kyle vs. Givenchy: “Re: Athenahealth. Per the KLAS report, 13 of 28 Athenahealth customers have delayed or cancelled go-lives, not the 20 claimed. Seven of eight reported pharmacy-related issues, while end users are less enthusiastic than executives.” Unverified. I don’t see KLAS reports since they quit sending them to me, so I’ll take your word for what it found.

From Jake Asp: “Re: telemedicine. I didn’t see this news item mentioned.” I rarely mention telemedicine news because it has nearly zero to do with health IT. Talking to a doctor over a video connection is no different than calling them up on the telephone and that’s not going to get health IT geeks excited. I’m puzzled by health IT sites fawn over virtual visit news or proposed telehealth regulatory changes, maybe because those topics are easy for inexperienced people to write about. I go off-topic only (sometimes wildly) when I read something that I think will interest my peers and even then it’s only a tiny blurb rather than a padded-out article.


HIStalk Announcements and Requests

image

Welcome to new HIStalk Platinum Sponsor Change Healthcare. The new, Nashville-based, 15,000-employee Change Healthcare — one of the largest independent technology companies in the US — includes most of the former McKesson Technology Solutions as well as the former Emdeon, which was renamed Change Healthcare when Emdeon acquired that company in September 2015. The company serves payers (Intelligent Healthcare Network for financial and administrative transaction processing); providers (eligibility, claims, productivity, imaging, clinical workflow, and value-based care); and consumers (True View Health Shopping Platform). The company just announced healthcare’s first enterprise blockchain solution. Thanks to Change Healthcare for supporting HIStalk.

Listening: new from the amazing Michigan-based hip-hop artist NF (born Nathan Feuerstein), whose hard-hitting yet non-explicit lyrics allow focusing on the anger and self-doubt he describes rather than the usual vapid, misogynistic swagger. The 26-year-old wrote about his mother’s drug overdose death in “How Could You Leave Us?”: “I don’t get it mom, don’t you want to watch your babies grow?; I guess that pills are more important, all you have to say is no; But you won’t do it, will you? You gon’ keep popping ’til those pills kill you; I know you gone but I can still feel you.” His long tour that starts in January includes a lot of stops in health IT centers like Nashville, Atlanta, Raleigh, Boston, Madison, and Kansas City. I’m also enjoying questionably named but inarguably talented Wales-based hard rockers Catfish and the Bottlemen.

This week on HIStalk Practice: Lightbeam Health Solutions will provide population health management solutions to American College of Osteopathic Family Physicians. In the Consultant’s Corner, Brad Boyd offers tips to help practice administrators proactively address physician burnout. Azalea Health merges with Prognosis Innovation Healthcare. Vermont physicians face criticism as medical marijuana clinics attempt to take off. ZDoggMD brings the house down at MGMA. Follow-up study shows PCP antibiotic overprescribing habits could benefit from “nudges.” Hope Orthopedics of Oregon kicks off patient-reported outcomes program. Formativ Health helps independent MDs in Pennsylvania transition to value-based care.


Webinars

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 25 (Wednesday) 1:00 ET. “Delivering the Healthcare Pricing Transparency that Consumers are Demanding.” Sponsored by: Health Catalyst. Presenter: Gene Thompson, director, Health City Cayman Islands. Health systems are unlike every other major consumer category in not providing upfront pricing information. Learn how one health system has developed predictable, transparent bundled pricing for most major specialties. Attendees will gain insight into the importance of their quality measures and their use of actual daily procedure costing rather than allocated costs. They will also learn about the strategic risk of other market participants competing with single bundled pricing. The organization’s director will expand how its years-long process is enabling healthcare delivery reform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

image

Atlanta-based ambulatory EHR/PM vendor Azalea Health acquires community hospital EHR vendor Prognosis Innovation Healthcare, which was known as Prognosis Health Information Systems until it was renamed in 2014 by its new private equity owners. I interviewed Ramsey Evans, then CEO of Prognosis, way back in September 2010. He left the company in 2013 to return to Keais Records Retrieval as CFO and board chair – the Houston-based company offers electronic medical records retrieval for attorneys.

image

Consumer health benefits and wellness technology vendor Welltok acquires Tea Leaves Health, which offers consumer and physician relationship management systems. Ziff Davis, which bought 60-employee, Atlanta-based Tea Leaves for $30 million in 2015, sold it to Welltok for $83 million. Ziff Davis is owned by Internet company J2 Global, which also owns Everyday Health (MedPage Today, KevinMD.com and MayoClinic.org). ZD said in February 2017 that Tea Leaves might never make a profit.

SNAGHTML3938615

The private equity owner of revenue cycle technology vendor Practice Insight sells the business to an unnamed buyer.

image

Wellness app vendor StayWell, a subsidiary of drug maker Merck, acquires MedHelp’s health engagement platform. Meanwhile, health shopping site operator Vitals buys MedHelp’s online health communities business.


Sales

image

North Carolina Hospital Association chooses PatientPing to offer statewide, real-time care coordination.


Announcements and Implementations

image

Cerner tells its user group attendees that it will continue to offer free CommonWell services through 2020.

SNAGHTML36aea74

Flirtey, which uses drones to deliver emergency medical supplies, will send automated external defibrillators in response to 911 cardiac arrest calls received by northern Nevada emergency medical provider REMSA. 

image

Summit Healthcare chooses system integrator Speedum Technologies Health Solutions to resell its integration platform, scripting tool, and downtime reporting system.

image

EClinicalWorks will partner with clinical data registry and analytics vendor FIGmd to offer its EHR users connectivity to specialty registries.


Government and Politics

image

President Trump takes another step to kill the Affordable Care Act by signing an executive order that will make it easier for small businesses and perhaps even individuals to band together to buy health insurance across state lines (which is already legal but rarely done since it’s hard for insurers to create networks in new states and such sales require state-by-state approval). The order will also again allow the sale of short-term policies that don’t cover pre-existing conditions, which the ACA halted. Critics worry that cheap but low-quality plans will draw healthy people away from ACA plans, driving up premiums as sicker people are left without alternatives. Health systems will be watching the change in their patient bases closely. ACA expert Charles Gaba’s expert analysis is sobering and is a reminder that “slicing up the risk pool does absolutely nothing to lower the total cost of healthcare.” HHS will be responsible for setting definitions in drafting the legislation, which will likely take several months if the order survives the inevitable legal challenges.


Privacy and Security

image

A security researcher finds that the website of Equifax – fresh off its massive breach that exposed the information of 146 million people – was hacked this week, with visitors being tricked into installing an adware-pushing app posing as an update to Adobe Flash.


Other

image

Paul Purcell, administrator of STEP Pediatrics (TX), reports that Memorial Hermann some doctors are going back to paper after a nine-day performance problem caused by an EClinicalWorks upgrade.

image

An interesting review by Pew Charitable Trusts finds that a remarkable number of Americans use life-sustaining technologies in their homes and are thus vulnerable to storm-related power outages. HHS mined its Medicare claims database to create a map of people who had received government-provided medical equipment to help health officials locate them in an emergency.

In a PR move that always strikes me as a self-serving form of cost-shifting, at least one Las Vegas hospital and two ambulance services announce that they will not charge victims of the recent mass shooting for the services they received. Other patients whose circumstances were judged as less meaningful will have to cover the cost of the non-profit largesse, which would ring truer if the organizations just did it without crowing.

A Harvard Business Review article by two Bain & Company’s healthcare partners cites surveys suggesting that doctors understand that the cost of drugs and clinical care are too high, but that nobody’s inviting them to the table to figure out how to control costs, improve performance, or move to new reimbursement models.

image

Analysis finds that dialysis operator DaVita makes more than half its profit from patients who receive charity help to pay their insurance premiums, with 13 percent of its patients receiving help from the American Kidney Fund to which DaVita makes tax-free donations. The company benefits because private insurance pays more than Medicare or Medicaid, with charity-funded insured patients contributing $540 million to the company’s annual profit.

The hospitals in Ontario’s largest network are reviewing five million electronic patient records after a patient-reported error leads them to discover a few incorrect records.

image

Count me in for a comprehensive $3,300 report on the “HER” market, as it’s referred to 25 times in the announcement without the sharp-eyed editors noticing their mistake. Adding to my interest is that the company’s address from which a wide variety of crappy reports emanate is — like the addresses of some of its 25 associated publishers — a house in a residential neighborhood. The report description is loaded with fractured English as a second language, but I’ll focus on “till,” best used as a synonym for “cash register” or as a verb referring to “plow” rather than a sloppy substitute for “until.”

Ross Martin, MD and his The American College of Medical Informatimusicology debuts his new song “DigituRN” at the Tri-State Health Informatics Summit this week. The term refers to transforming the nursing profession through informatics and digital innovation.  

Weird News Andy likes that several animation studios worked with the Pediatric Brain Tumor Foundation for free to create short videos explaining procedures and conditions to children, a project they call Imaginary Friend Society.


Sponsor Updates

  • MedData and Experian Health will exhibit at the TAHFA & HFMA South Texas Fall Symposium October 15-17 in San Antonio.
  • Meditech will host the 2017 Physician and CIO Forum October 18-19 in Foxborough, MA.
  • Navicure will exhibit at the Raintree User Conference October 16-18 in San Antonio.
  • Health Catalyst is named as the 17th fastest-growing company in Utah, with sales growing 1,700 percent in five years.
  • National Decision Support Co. and Parallon Technology Solutions will exhibit at the Meditech 2017 Physician and CIO Forum October 18-19 in Foxborough, MA.
  • Netsmart will exhibit at the National Association for Home Care and Hospice Conference October 15 in Long Beach, CA.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Washington State AWHONN Conference October 15-17 in Lake Chelan, WA.

Blog Posts


Contacts

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

125x125_2nd_Circle

EPtalk by Dr. Jayne 10/12/17

October 12, 2017 Dr. Jayne No Comments

My travel schedule has been very busy with organizations that are taking advantage of the relative relaxation of requirements in some of the regulatory programs. They’re using the time to tackle workflow issues and work towards standardized best practices in preparation for the next round of regulatory hurdles. A fair number of my clients are non-profit organizations, but there are significant variations in their ability to fund these initiatives depending on how non-profit they are and how they run. We all know of non-profit organizations that have millions (if not billions) in the bank and those that run on a shoestring. At least half of my non-profit clients fall into the latter category, including community health organizations and other programs which are largely grant-funded.

Working with these organizations is a challenge and I was pulled into one of those situations last week. The practice is experiencing severe performance impairment in not only its EHR and practice management system, but in other applications. They brought their IT services in-house a couple of years ago to save money and have been trying to diagnose the issues without success.

I had recommended an IT vendor to do an assessment and it took several months to get them to agree to the cost. When he finally had the opportunity to look at the system, there are multiple potential root causes. The first is that their servers are well beyond their service life and everything is running on versions of software that are no longer supported. They haven’t taken maintenance releases or patches in more than a year on some of the applications and system resource use is off the charts. If their IT systems were a patient, I’d have to diagnose multi-system organ failure.

Now that we had data defining the problem, it was time to sit down and talk about a timeline for solutions. We discussed the fact that any attempts to enhance the EHR or the other applications would likely not have demonstrable results due to the overall performance issues. Not to mention that their situation leaves them vulnerable to total system failure, hackers, and more. Their cash-strapped state is why they gave up their white-glove IT support in the past and they’ve been holding things together with the proverbial bubble gum and duct tape since then. When you’re working with an organization that has prohibited overtime and reduced clinical shift coverage due to lack of funding, asking them to spend tens of thousands of dollars on servers and software is a non-starter. We discussed moving their system to a hosted environment to reduce some of the issues, but they don’t think they even have the cash flow to handle the monthly charges.

It’s difficult knowing that their users are experiencing the pain of using a system that often just doesn’t run properly, but that there isn’t a ready answer. Their patients are experiencing less-than-optimal care because the practice can’t implement some of the newer bells and whistles of the system because it will barely handle the basics. I spent several hours with the CEO and CFO, with the ultimate outcome being that they simply can’t afford upgrades and will have to just “make do.” They’re a safety net care provider, so it’s not like they can raise their fees or start offering lucrative cosmetic procedures to boost the bottom line. We’re now looking into additional grant programs and funding sources, but there isn’t going to be a quick fix if we can find one at all. I hate to see an organization like this flounder, but unless someone wins the lottery and throws some cash their way, they’re a bit stuck.

In addition to their IT woes, I was also asked to assist with some staffing issues. They’ve having trouble with physician retention and have had to start filling in with some locum tenens providers, which usually isn’t great for continuity or morale. To make matters worse, on one of the days I was there, the locum physician had the license plates stolen from her rental car. Apparently, the practice has provided special anti-theft screws to employees to secure their plates, but didn’t think about the locum. It made me think twice since I was in a rental car as well, although I didn’t think my plates from across the country would be as much of a temptation since they’re memorable and obvious, which might be a theft deterrent.

The practice is also struggling with hiring new staff, with some applicants being afraid to work at one of the organization’s locations. They don’t have the payroll to add security guards, and apparently there have been some incidents with angry drug-seekers threatening staff. This has introduced friction because the organization decided that requiring at least one male to be present on every shift was the solution and the men don’t want to work there, either. Although I can help with things like standardizing workflows to make the day flow better and people to be more efficient, I doubt the employee satisfaction that brings will do much to fix some of the deeper problems.

For people who work in other parts of the healthcare IT industry who might not always see this side of the equation, I offer it as food for thought. Whether you’re in development, marketing, public relations, finance, investing, etc. you may not always be exposed to the different situations that practices are living up to. It’s important to remember that ultimately the patients are the customers, and the teams that have to use our systems and solutions to care for them. A practice that is worried about keeping the lights on or worried about keeping its employees safe may not care very much whether your corporate logo is in one font or another or whether you’re using the most agile development methods. If they’re less than interested in what you’re trying to get them to buy, it may be because they’re farther down on the hierarchy of need than you can imagine.

This week, I’m working with a practice that is the polar opposite, one in an affluent suburb that is looking to maximize patient engagement and specialized offerings while delivering enough wow factor to lure patients from the competition. It makes me feel like I’ve gone through the looking glass into another world after last week.

Have any tips for helping practices on a shoestring budget? Email me.

Email Dr. Jayne.

Morning Headlines 10/12/17

October 11, 2017 Headlines No Comments

Trump announces Hargan as new acting HHS secretary

Eric Hargan, a Chicago-based lawyer, Bush administration HHS staffer, and member of President Trump’s transition team, has been named acting HHS secretary.

Get Ready for a Showdown! – The Secure API Server Showdown Challenge

ONC announces a FHIR-based development challenge, asking experts to deploy FHIR servers using best practice security standards. The challenge aims to “identify unknown security vulnerabilities in the way open source FHIR servers are implemented.”

Deloitte hack hit server containing emails from across US government

The Guardian reports that a hacker has compromised a Deloitte server containing email data from 350 clients, including the NIH, the State Department, the Department of Energy, the Department of Homeland Security, and the Department of Defense.

Former Cleveland Clinic Innovations executive pleads guilty to $2.7 million fraud against hospital system

Gary Fingerhut, the former executive director of Cleveland Clinic Innovations, pleads guilty to fraud charges stemming and will serve between three and five years in prison.

Morning Headlines 10/11/17

October 10, 2017 Headlines No Comments

Express Scripts to Buy Medical Gatekeeper for $3.6 Billion

Express Scripts announces that it will acquire EviCore Healthcare, a company that preapproves scans and other costly medical tests for health plans, for $3.6 billion.

How the EMR Is Increasing Innovation and Creativity in Health Care

An HBR article argues that ” just as the cell phone, originally designed as a mobile communication device, has been adapted to an unimagined array of additional functions, the EMR is serving as a platform for innovation and creativity.”

King George Hospital staff hail new iPad system making patient care safer and more efficient

In England, King George Hospital is reporting significant time savings and process improvements stemming from the implementation of System C’s Vitalpac, an iPad-based vital signs documentation system.

eClinicalWorks Announces the Support of Patient Access to Physician Notes Through OpenNotes

eClinicalWorks supports OpenNotes by pushing provider documentation directly to its patient portal.

News 10/11/17

October 10, 2017 News 4 Comments

Top News

image

Pharmacy benefits manager Express Scripts will acquire care management vendor EviCore Healthcare for $3.6 billion.

Private equity firm General Atlantic formed EviCore in 2014 in merging its acquisitions CareCore (acquired in January 2014 for an undisclosed price) and MedSolutions (acquired in November 2014 for a reported $1 billion). The company renamed itself to EviCore in June 2015. 

EviCore was rumored to be seeking a buyer in May 2017 in hoping for a valuation of more than $4 billion, but was simultaneously planning an IPO in case no acceptable offers were made.

EviCore Chairman and CEO John Arlotta has worked for General Atlantic and was previously president of Express Scripts competitor Caremark RX (now CVS Caremark).


HIStalk Announcements and Requests

Every October Lorre offers a deal for new HIStalk sponsors – sign up now and get the rest of 2017 free. Contact her if you want in before the usual pre-HIMSS rush that, shockingly, will be here before we know it.

image

I wanted to buy a baby monitor for some relatives who are new parents and ran across this IP-based camera that was so cool I had to get myself one afterward. The TenVis HD camera features two-way audio, rotation, night vision with 32-foot range, a micro SD card slot for recording, optional emailing of a snapshot or a telephone alert when it detects movement, and an app that allows viewing real-time video from anywhere. That’s a lot of technology in a $40 device. Setup was nearly instantaneous over WiFi, although I had to throttle back my router to 2.4 GHz for configuration and then switch it back to 5 GHz afterward because of some quirk. I don’t need to monitor babies, but it’s fun to check out what’s happening in the living room from anywhere in the house or anywhere in the world, while other Amazon reviewers love it for keeping an eye on elderly parents or driving their dogs crazy by talking to them from afar. My gift recipients report an added benefit that I hadn’t thought of – they’ve given the far-away grandparents access so they can take a wistful look at the little one whenever they want.


Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

image

Telahealth technology vendor Avizia acquires Seattle-based virtual clinic operator Carena.

image

Pittsburgh-based AI vendor Petuum — which  is developing  products for several industries including an EHR-powered disease and treatment module — receives a $93 million investment, increasing its total to $108 million. Two of the three founders earned PhDs from Carnegie Mellon University in computer science and machine learning, respectively.


Sales

image

Aetna selects Stanson Health to automate its clinical prior authorization process by integrating with provider EHRs to collect both discrete and free-text information.

SNAGHTML22892d20

Southwestern Health Resources (TX) chooses Phynd’s provider management system that will integrate with its Epic and credentialing systems, managing 50,000 providers in 31 hospitals.


People

image

Chris Mathia (Hyland) joins Innara Health as EVP of sales.


Announcements and Implementations

image

Clinical Architecture releases version 2.0 of its Symedical enterprise terminology management platform.

image

EClinicalWorks announces that its EHR now supports the OpenNotes initiative in allowing clinicians to share visit notes with patients via its patient portal.

image

Nokia will cease development of its $45,000, 360-degree Ozo virtual reality camera for filmmakers, saying that the VR market is developing more slowly than the company expected. Nokia will focus on digital health, enabled by its June 2016 acquisition of France-based consumer medical gadget vendor Withings for $191 million.

image

HIMSS Analytics launches a mobile version of its Logic database, giving health IT salespeople access to information about provider organizations and their technology-related activities.

image

Switzerland-based Ascom releases Digistat Vitals, which allows bedside EHR entry of vital signs and clinical scores in eliminating double entry and paper transcription.

image

PatientKeeper announces a hosted version of its physician charge capture solution.


Government and Politics

A study finds that the FDA‘s requirement that direct-to-consumer drug advertisements list side effects paradoxically increases sales of potentially dangerous drugs. The “argument dilution effect” leads consumers to assume that the mandatory long list of possible side effects – some of them included because of frequency of occurrence rather than severity – misleads them into thinking a drug isn’t likely to harm them.

image

A former Missouri nursing home company CEO is sentenced to 41 months in prison and ordered to pay $667,000 in restitution for using Medicaid payments to pay for strippers, casinos, and country clubs as residents of his facilities were given clear broth as meals and did not receive their meds because the company failed to pay its pharmacy provider.


Privacy and Security

image

Security researchers find an unsecured Amazon Web Services S3 file containing the medical information of 150,000 people, apparently patients of anticoagulant monitoring company Patient Home Monitoring Corporation.

image

In a related item, another security firm finds four unsecured, Accenture-owned AWS S3 buckets holding customer decryption keys, passwords, and certificates. Ironically, the exposed information includes software for Accenture Cloud Platform, the company’s enterprise cloud offering.


Technology

A Wall Street Journal review of scientific studies confirms my suspicion that smartphones make their users stupider. Not only do phones distract people from real-world tasks (the average phone user whips theirs out 80 times per day), keeping a phone “nearby and in sight” diminishes the ability to learn, reason, and solve problems even as users suffer from “delusions of intelligence” in confusing what they actually know vs. what they can look up on their phones. The article notes,

It isn’t just our reasoning that takes a hit when phones are around. Social skills and relationships seem to suffer as well. Because smartphones serve as constant reminders of all the friends we could be chatting with electronically, they pull at our minds when we’re talking with people in person, leaving our conversations shallower and less satisfying … The evidence that our phones can get inside our heads so forcefully is unsettling. It suggests that our thoughts and feelings, far from being sequestered in our skulls, can be skewed by external forces we’re not even aware of … A quarter-century ago, when we first started going online, we took it on faith that the web would make us smarter: More information would breed sharper thinking. We now know it isn’t that simple. The way a media device is designed and used exerts at least as much influence over our minds as does the information that the device unlocks.

image

In England, the local paper covers the use by King George Hospital of Vitalpac, an iPad-based vital signs documentation system from System C Healthcare that has reduced hourly rounding time by 75 percent. McKesson bought England-based System C for $140 million in 2011, then sold it to private equity form Symphony Technology Group in 2014 as McKesson began its health IT exit.


Other

image

Two Northern California hospitals – Santa Rosa Memorial and Queen of the Valley Medical Center — evacuate patients after Wine Country wildfires spread to 100,000 acres, burning down 1,500 buildings and killing a least 11 people. If there’s such a thing as wine futures, now would be a great time to load up.

A. James Bender, MD, medical director for clinical informatics at Virginia Mason (WA) and his Virginia Mason Center for Health Care Solutions co-author write in Harvard Business Review that the EHR is increasing innovation, with these examples:

  • Alerting clinicians about possible omissions in care based on evidence.
  • Adding transparency to patient and family engagement with ICU electronic patient scoreboards to prevent blood clots.
  • Providing intelligence, such as auto-ordering of labs when specific drugs are ordered.
  • Blocking orders for high-cost imaging studies that are not supported by evidence.

image

The local paper reports that three-hospital Maui Health System (HI) has experienced a few technology problems in the first 100 days of turning over operation of the to Kaiser Permanente. Community-based doctors say they don’t automatically receive faxed information about the hospital visits of their patients like they used to, causing billing delays.

image

The Salt Lake City, UT police chief fires the detective who handcuffed an ED nurse who refused to allow him to draw a blood sample from a patient without obtaining a warrant as hospital policy requires.

image

The work of Richard Thaler, who just won the economics Nobel  prize, has healthcare implications. His specialty is behavioral economics, which studies why people act irrationally when it comes to money, why they fail to stick with their plans, and how they choose whether to act selfishly or selflessly. He says people segregate money in mental accounts and it’s easier for them to spend someone else’s money. He also urges organizations and government to nudge people to help them make good decisions, which would make his observations on the US healthcare system interesting. He said previously that employer healthcare insurance sites are too complicated, such as displaying deductibles as a full-year sum while pricing premiums by the paycheck. One of his significant contributions involved 2006 federal retirement savings plan changes that encouraged employers to make participation opt-out rather than opt-in, which doubled participation, although he’s disappointed that companies encourage under-contribution by setting the default contribution at the minimum amount instead of escalating it over time.

image image

A woman in Japan posts Instagram-worthy photos of the hospital meals she was served following the birth of her child, making it obvious that they do things differently there. 


Sponsor Updates

  • Colquitt Regional Medical Center (GA) describes the benefits it has seen from its summer 2016 go-live on Meditech 6.1.
  • Fortified Health Security President Dan Dodson will present “Out of the Dark: Seeing and Securing Network-Connected Medical Devices” at the Raleigh Health IT Summit on October 20.
  • Aprima will exhibit at the American Academy of Home Care Medicine Annual Meeting October 13-14 in Rosemont, IL.
  • Besler Consulting will present at the SC HFMA Fall Institute October 12 in Greenville.
  • Black Book publishes the results of its annual outsourced coding and HIM market client experience surveys.
  • CoverMyMeds partners with Pelotonia to raise over $100,000 for cancer research.
  • CTG will exhibit at the Northwest Arkansas Technology Summit October 17 in Rogers.
  • Direct Consulting Associates, Imprivata, and InterSystems will exhibit at the Health Connect Partners Hospital & Healthcare IT Conference October 18-20 in Chicago.
  • Dimensional Insight will exhibit at the HFMA Region 2 meeting October 18 in Verona, NY.
  • FormFast will exhibit at the ASHRM Annual Conference & Exhibition October 15-18 in Seattle.
  • Healthwise will exhibit at Philips Connect2Care October 16-18 in Los Angeles.

Blog Posts


Contacts

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

125x125_2nd_Circle

Morning Headlines 10/10/17

October 9, 2017 Headlines No Comments

Amazon is on the brink of deciding if it will make a big move into selling drugs online

CNBC’s Christine Farr reports that Amazon is in the final stages of planning its move into the healthcare space, and is considering selling prescription drugs as an entry point. The tech giant is expected to make a decision on its next steps by Thanksgiving.

Governor Brown Announces Precision Medicine Advisory Committee

California Governor Edmund Brown Jr. announces the formation of the Governor’s Advisory Committee on Precision Medicine. The committee will advise the governor on  the use of data-driven tools and analysis to help the State improve health and health care.

Trump to Sign Order Easing Health Plan Rules, Official Says

The Wall Street Journal reports that President Trump will sign an executive order this week rolling back health insurance regulations governing ACA’s individual marketplaces.

Federal prosecutors launch investigation of prominent surgeon who double-booked operations

Federal prosecutors are investigating Lenox Hill Hospital’s (NY) Chairman of Urology and Chief of Robotic Surgery at for simultaneously running operating rooms on hundreds of occasions, a practice patients did not know about.

Curbside Consult with Dr. Jayne 10/9/17

October 9, 2017 Dr. Jayne No Comments

clip_image002 

I spent another weekend seeing patients, the by-product of a practice that is expanding physically faster than it can expand its staffing. In an environment where various organizations are grappling for market share, there’s good business justification to grow quickly, but it can create pressure on the people, processes, and technology needed to support the growth.

I mentioned last week that we had a mini-release from our EHR vendor that added some clunks to the documentation workflow. The clunks are still there, with no end in sight as far as streamlining around them. They were added to facilitate document upload to a health information exchange, but we’re not connected to one. Based on some of the patients who arrived at my location, I could really have used the HIE.

The day started pretty slow, allowing me to catch up on some journal reading and continuing education. I read an interesting article on physician burnout from the state medical society in one of the states where I’m licensed but don’t practice. In addition to physician burnout, it talked about how physicians receive healthcare in general, which is to say poorly at times. There are many physicians who feel like seeking care is a burden, either to their schedules (having to cancel office days or move patients for a sick visit) or to their colleagues, who have enough on their plates.

This leads to physicians often treating themselves, which is generally a bad idea. It’s hard to be objective about your own symptoms and examining yourself isn’t the most productive diagnostic activity. Nevertheless, it happens, with studies estimating the prevalence of self-treatment from 52 to 90 percent. Physical illness can impact how we render care, as can psychological problems like burnout. The article mentions that in the particular state, licensure applications require physicians to self-report any conditions that limit or impair judgment or affects the ability to practice medicine in a safe and competent manner.

I’d argue that burnout can affect the ability to practice medicine in a competent manner – loss of empathy, loss of patience, tunnel-vision, and more – but physicians aren’t likely to self-report because that triggers the need for a sheaf of documentation and an investigation from the licensing board. The article goes on to mention a 2009 study that found that 69 percent of state medical licensing applications ask questions that would be considered “likely impermissible” or “impermissible” based on the Americans with Disability Act and relevant case law. Other countries have fewer barriers to physician care, with Norway leading the pack with a group of physicians trained by the Norwegian Medical Association to specifically care for other physicians.

It was in the context of having read this article and been thinking about physician stress and burnout that I cared for a couple of challenging patients. The first had some drug-seeking behavior that was validated by a query to my state’s Prescription Drug Monitoring Program. It’s not integrated with my EHR, but rather is a separate website, but I was happy to do those extra clicks to confirm what I suspected. Score one for technology assisting the physician, although the technology doesn’t make the conversation with the patient any easier, especially when you’re denying them the care they’re seeking. Fortunately, this was a patient who accepted her situation rather than one who became angry when I refused to prescribe oxycodone, because as an urgent care, we’re not well equipped to handle angry or potentially violent patients.

That happy technology-enabled bubble burst a few patients later, however, when I was confronted with a medically complex patient with difficult social circumstances. She had issues following a transplant for over a year, largely related to changes in her insurance and inability to get new coverage. Transplant patients need coordinated care that has many inputs, including the surgical team, organ-specific team, pharmacists, social workers, and more. Being disconnected from your team and having to rely on episodic care can result in organ rejection and serious complications. She had bounced around due to the insurance issues and then was further impacted by a recent hurricane, which displaced her to another state.

At least in her previous city, urgent care or walk-in clinic providers might be willing and able to call the transplant team for advice, regardless of the insurance coverage situation. However, providers in another state aren’t going to necessarily have that willingness to try to make that connection, especially if they’re in a stressed healthcare system. The patient realized that and had been trying to connect with a transplant group in her new state, but began to have signs of organ failure before establishing that connection.

Due to some family issues, she traveled to yet another part of the country, and several weeks and a 30-pound weight loss later, she wound up in my urgent care an hour after we closed, halfway across the country from either of her previous residences, feeling terrible and looking very ill. As soon as I heard the basics of the story from my triage nurse, I was wishing that clicky HIE popup was actually connected to something. I can log in separately to a regional HIE, but it’s a fairly immature repository that rarely contains anything useful for my local patients, so I wasn’t hopeful about finding anything on this interstate traveler. Regional HIEs often have web access for people like me, but I doubt they’d be too keen on a request from out of state, and even if they were, it’s not like that request is going to get validated and turned around at 11:00 on a Sunday evening.

After seeing the patient and dividing her concerns into short-term and longer-term categories, I started to work on a plan. One concern for transplant patients is the sensitivity of their medication regimens and their relatively immune-compromised status. In general, you can’t rely on the “bread and butter” medications we use every day because they can have serious consequences. I maximized my use of drug interaction checking but was still unsure about my plan, and had to turn to a quick literature search to see if I could get the answer. The search was fairly silent about what I was considering in my plan of care, and without documentation of safety, I couldn’t use it.

As a community physician, I don’t have any transplant colleagues I can just call up and ask questions. The hospital I’m most closely affiliated with doesn’t have transplant services, so that was a dead end as well. Since this was after closing time, we were paying overtime to our staff, and as an hourly employed non-partner physician, I couldn’t authorize more overtime to have them start to call around to the local academic centers and hope we could track down a transplant fellow on call as it approached midnight.

I was left with providing simple and supportive advice to the patient for her short-term problem, with the hopes that she could reach her original transplant team in the morning and that they would be able to offer definitive advice despite the lapse since her last visit with them. I can’t begin to describe the feelings of helplessness that these situations evoke for caregivers. We are wired to help people and our training supports that. But when we’re placed in situations like this, it’s hard to not internalize that sense of failure or the feeling that you should have been able to do more. Especially when there are multiple and ongoing situations like this, they contribute to physician burnout and further stress our healthcare system.

In thinking back through it with my CMIO hat, would a true national HIE have helped? Maybe a little. If I could have looked through past records and seen how her previous physicians handled similar symptoms, that might have given me a clue. If I could have accessed past medication lists (older than the year I could get from our Pharmacy Benefit Manager link) that might have helped. Direct messaging to providers wouldn’t have helped given the time of day or the acuteness of the situation, but at least I would have felt more like I was doing something. Direct messaging might have been tricky though, because she didn’t know the individual names of her physicians, but rather listed the transplant program as her primary care provider.

Health information technology has so much promise, but most of us are working with only bits and pieces of it and it’s not in an integrated fashion. The care we’re giving isn’t worse than it was in the paper world, but how we feel about it has changed. We feel like we should be able to do more with the technology or that we could have done better if we were fully connected along with the rest of a patient’s caregivers. There’s a certain psychic load to knowing what could be and comparing it to where we are.

I don’t know what the answers are, but hope that the people who are making healthcare policy and deciding how and if we are going to fund different healthcare initiatives think about situations like this. It’s not only how it impacts the patient, but also how it impacts the caregivers and their ability to stay resilient. In my area, losing a physician from active practice can result in between $200K and $300K in replacement and ramp-up costs, not to mention the lost patient accessibility during the transition time.

We’ve got to find a better way to ensure the available technology makes it to caregivers across the country, not just those in academic medical centers or large cities. We have to figure out how to help those who are in backwards states that don’t adequately fund PDMP or HIE efforts. We have to figure out how to get past hospitals and health systems that are actively engaging in information blocking and refuse to share patient information with the greater clinical community.

Do you see a solution in your crystal ball? Email me.

Email Dr. Jayne.

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reader Comments

  • PM_from_haities: Thanks for the reading material and recommendation, Dr. J!...
  • ex epic: At the 55:00 minute mark, he says re: asking for more money to connect community providers ... "We don't anticipate that...
  • Vaporware?: What Cerner sells and what Cerner does are two different things. When (if) Cerner and its CommonWell customers ever ...
  • kevin: Professor Reinhardt deserves the requiem shout out if nothing else but for his most oft quoted paper title, "It's the Pr...
  • ex epic: It's mind boggling that after all the pageantry and chest thumping neither DoD nor VA is going live connected to communi...

RSS Industry Events

  • An error has occurred, which probably means the feed is down. Try again later.

Sponsor Quick Links