Recent Articles:

Morning Headlines 11/2/16

November 1, 2016 Headlines No Comments

CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Care

CMS reduces the reporting period for the 2017 EHR Incentive Program to 90 days.

Cerner Reports Third Quarter 2016 Results

The company misses expectations for both revenue and earnings.

Meditech Form 10-Q

Meditech announces Q3 results in which revenue dropped 7 percent, but EPS jumped from $0.37 to $0.68 mostly due to reduced costs.

Business of the American Medical Association House of Delegates 2016 Interim Meeting

The AMA will consider policies that address information blocking, EHR vendor interfacing fees, and the cost of EHR conversions in its meeting in Orlando November 12-15.

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November 1, 2016 Headlines No Comments

News 11/2/16

November 1, 2016 News 5 Comments

Top News

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CMS publishes changes to the EHR Incentive Program that will allow returning EPs, hospitals, and CAHs to use any continuous 90-day reporting period between January 1 and December 31 for both 2016 and 2017.

CMS will also eliminate the clinical decision support and CPOE objectives and measures for hospitals and CAHs attesting under the Medicare EHR incentive program.

CMS says it is finalizing the process for a one-time EHR hardship exception for the Medicare EHR Incentive Program for certain eligible professionals for EPs who participate in the EHR incentive program in 2017 who will transition to MIPS in 2017.


Reader Comments

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From Pilsner: “Re: Epic’s posted study showing the change in operating margins after switching from Cerner to Epic. The data are minimally cited and the methodology is not documented. It gives Moody’s as the source, but Moody’s rates only 441 hospitals and therefore the graph must not include all hospitals that implemented Cerner and Epic from 2004 through 2015.” I would be curious about how many hospitals this graphic represents. I’m also skeptical that a change in systems was the cause of the improvement as opposed to other, more impactful changes that coincided with that change (such as being acquired by a Epic-using health system that instituted its own superior revenue cycle practices). Also, the stated average margin improvement from 3.19 percent to 6.45 percent happened over years in which hospital margins improved in general and covered hospitals that could, by definition, afford Epic. There’s too little information to infer further, but Epic’s non-marketing team has done a nice job making a compelling point without providing the details in trying to discount the headlines describing hospitals whose Epic project expense got them in trouble.

From Master Blaster: “Re: [company name omitted]. Can you please remove the rumor you ran about us?” I sometimes get requests to take down a rumor, but I don’t do that, instead offering the company a chance to provide a response or to confirm/deny, which they generally decline to do. Invariably the rumor the company wants removed turns out to be accurate and they just wanted more time to spin it publicly. It’s the same when health system CIOs email me to rather sternly suggest that I contact them before mentioning items from public records indicating the cost and status of their big implementation projects – that information doesn’t seem to require IT clarification, but they’re always welcome to provide a comment. My conclusion after doing this for 13 years: everybody loves to read rumors except those that pertain to them, which instantly transform me from a must-read news-breaker to an irresponsible trouble-maker.


FHIR

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Grahame Grieve provides a response to a reader’s question and my comments regarding FHIR.

World peace — we’ll do that next year. This year we sat it out because we wanted to handicap ourselves. (more seriously, Mr. H already quoted me about this).

From the original question, "After years of implementing HL7 and being able to do just about anything with an HL7 message," well, there’s all sorts of things you can’t do with HL7 v2, and ways you can’t do it, but for all the things you can do with HL7 v2, FHIR is an incremental improvement, not world shaking. But even there — testing, conformance, infrastructure — there’s still a lot in the increment. 

"FHIR without discipline could turn out the same way if customers don’t demand better." Yes, but also vendors understand where the other approach ends up. We’ve lived it, and in today’s social media world, we can do better for much less. So it costs less to be disciplined, and as you said, there are other reasons to get it right this time.

"Providers understandably have no incentive to exchange data with their competitors." But banks exchange data with the customer, etc. Why? In fact, there are reasons to exchange some data, some times. It’s not a binary all-or-nothing, and some providers are keen to do it. Because of cost minimization, for example. And while data sharing might allow patients to shop between systems, it can also allow systems to shop to patients previously locked in. (more about this).

For these reasons, we — the FHIR team — believe that now is a great time to spend our effort creating a better way, and we live in hope that it will make a difference for patients across the world.


HIStalk Announcements and Requests

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Ms. M reports that she’s using the iPad we provided in fulfilling her DonorsChoose grant request to assign specific reading interventions to her Texas first graders. She is also having the students record themselves as they work through the writing process, followed by taking a picture of their work and recording themselves talking the problems out.


Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: revenue up 5 percent, adjusted EPS $0.59 vs. $0.54, missing analyst expectations for both. Shares dropped 2 percent at Tuesday’s close and were down another 6 percent in early after-hours trading. The company announced plans to offer a voluntary separation plan for eligible employees.

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Telemedicine technology vendor Avizia closes its $17 million Series A funding round with a $6 million investment that includes the participation of New York-Presbyterian.

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Meditech posts Q3 results: revenue down 7 percent, EPS $0.68 vs. $0.37. Product revenue declined 26 percent while service revenue increased 2 percent, but a 47 percent drop in sales costs boosted net income to $25.5 million.

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Vital Images will acquire Karos Health, which offers “deconstructed PACS” diagnostic image viewing and sharing tools.

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Private equity firm Blackstone Group will acquire hospital physician staffing outsourcer Team Health for $6.1 billion. The company was previously owned by Blackstone, which paid $1 billion for it in 2005 and then took it public in 2009. Team Health turned down a $7.6 billion acquisition offer last year after running up a pile of debt to finance the acquisition of a competitor that didn’t really work out.

Sunquest owner Roper Technologies announces Q3 results: revenue up 7 percent, adjusted EPS $1.63 vs. $1.61, falling short on revenue expectations but beating on earnings. The company said in the earnings call that Sunquest’s revenue is two-thirds recurring and therefore new orders aren’t usually that important, but the Lab 8.0 release and a new blood bank solution will cause a record number of Q3 orders. 

A federal appeals court affirms dismissal of Fair Warning’s patent lawsuit against Iatric System regarding Iatric’s technology to detect fraud and misuse of PHI.


Sales

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Baylor Scott & White Health will use technology from Pager to provide nurse triage services to patients seeking services.


People

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Aetna promotes Patrice Wolfe to CEO of Medicity, where she will also be responsible for the company’s population health management technology products that include Healthagen Outcomes and HDMS.

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Long-term care technology vendor MatrixCare hires Gary Pederson (Richland Advisors) as SVP of life plan community solutions.

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Healthgrades promotes Andrea Pearson to EVP and chief marketing officer, Christian Dwyer to EVP of product management, and Chris Catallo (not pictured) to GM of hospital solutions.

Athenahealth hires Diane Holman (TE Connectivity) as chief people officer.


Announcements and Implementations

Health services price comparison vendor HealthSparq adds tools so that health insurers can offer their members financial rewards for choosing cost-conscious options, send them secure messages, and send them claims-based alerts to offer money-saving suggestions.

A Spok-sponsored, CHIME-administered survey of 100 CIOs finds that 81 percent name improving data security as their #1 priority over the next 18 months, while the top workflow they hope to improve with technology is care team coordination for treatment planning. Two-thirds are actively implementing secure messaging.

CareCloud will integrate population health management tools from Lightbeam Health Solutions into its EHR/PM.

Availity announces that its health information exchange technology will support the FHIR standard for eligibility, labs, diagnoses, medical attachments, and ADT and is developing a provider solution for member lookups.


Government and Politics

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Healthcare.gov was apparently again overloaded on the first day of open enrollment, but at least the site provided a polite waiting room message instead of just timing out. I put myself in yesterday to compare to today’s new prices for 2017 and the premium for my theoretical coverage would be jumping 68 percent from 2016. I can say with confidence after looking up premiums for different parts of the country that a lot of self-employed folks who earn too much for federal taxpayer subsidies are going to be paying $1,000 per month or more for Silver-level coverage with a $3,500 deductible and $7,150 out-of-pocket maximum. Another option, I suppose, would be to purchase individual coverage directly from the insurance companies that offer it, but I don’t know if that would be a better deal than the exchange. A Wall Street Journal article says Arizona is the best example of the ACA’s problems in that most counties are down to only one insurer, premiums for some plans will more than double, and higher costs and cutbacks in the federal risk corridor program have caused nearly all of the insurers to pull out.

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CMS awards its next round of Recovery Audit Contractor (RAC) contracts.


Privacy and Security

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In England, the three hospitals of the North Lincolnshire and Goole NHS Foundation Trust cancel appointments and elective procedures as they go back to paper following an attack by an unspecified computer virus. The hospital hopes to restore its systems Wednesday following Sunday’s attack. They deny that ransomware is involved.

From DataBreaches.net:

  • In England, a former hospital administrative employee is prosecuted for accessing the medical records of her former girlfriend and her partner.
  • Three former district managers of drug company Warner Chilcott are sentenced for healthcare fraud and HIPAA violations trying to boost sales of the company’s osteoporosis drugs by using patient information to fill out prior authorization forms. The company’s drugs, Atelvia and Actonel, require doctors to justify why less-expensive generic drugs can’t be used, so the drug reps completed and submitted the forms using boilerplate text that was often unrelated to the patient’s condition. The company’s former president was arrested and charged with paying kickbacks last year (including bribing high-prescribing doctors with “honoraria” for speaking at events with no educational component) but was acquitted. Warner Chilcott paid $125 million to settle its criminal and civil liability and was acquired for $5 billion by Actavis.

Other

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Among the proposed policies to be discussed at the AMA’s Interim Meeting in Orlando November 12-15 is integrating mobile health apps and devices into everyday practice. A draft resolution that calls out Epic and EClinicalWorks as “data blockers” would ask federal and state governments to prohibit withholding patient information from non-affiliated physicians and asks AMA to support legislation that would limit EHR vendor interfacing fees. Another proposed item seeks federal legislation that would eliminate medical practice costs involved with converting patient data from a replaced EHR to a new one.

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Weird News Andy notes that this story is a few months old, but still amazing. A 14-year-old girl returns to competitive ballet dancing after having her leg amputated above the knee due to osteosarcoma, when was then repaired by attaching her foot backward to her upper leg in an uncommonly performed procedure called rotationplasty to give her optimal mobility.

WNA may regret going for the feel-good story above since he likes OR-related oddities such as this. A patient undergoing cervical surgery is burned when the laser ignites her passed gas.


Sponsor Updates

  • HCI Group posts a podcast titled “Epic Upgrades: Key Strategies and Cost Considerations.”
  • Aprima will exhibit at the American College of Phlebology event November 3-5 in Anaheim, CA.
  • CenterX, CoverMyMeds, Cumberlad Consulting Group, Dimensional Insight, EClinicalWorks, and HealthCast will exhibit at the CHIME Fall Forum November 1-4 in Phoenix.
  • CompuGroup Medical will exhibit at the National Association of Community Health Centers FOM/IT Conference November 2-4 in Las Vegas.
  • Elsevier Clinical Solutions will present at the US News & World Report Healthcare of Tomorrow Conference November 2-4 in Washington, DC.
  • Evariant will exhibit at the Healthcare Internet Conference November 7-9 in Las Vegas.
  • KLAS names PerfectServe’s Synchrony as a top-performing care team communication platform.
  • Extension Healthcare will exhibit at the HealthAchieve Conference November 7-9 in Toronto.
  • Healthfinch will sponsor DevOp Days November 2 in Madison WI.
  • Healthwise will exhibit at Wellcentive’s annual UGM November 2-4 in Atlanta.

Blog Posts


Contacts

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

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November 1, 2016 News 5 Comments

Morning Headlines 11/1/16

October 31, 2016 Headlines No Comments

Red Cross Blood Service data breach: personal details of 550,000 blood donors leaked

In Australia,the personal information of 550,000 blood donors is exposed after a web developer working for the Red Cross inadvertently leaves an unsecured file with the information into the Internet.

Fall 2016 Leapfrog Hospital Safety Grades Out Now

The Leapfrog Group publishes its 2016 Hospital Safety Grades, ranking patient safety across 2,600 US hospitals.

Appeals court revives FTC’s bid to block Advocate/NorthShore merger

The FTC wins an appeal to block the merger of Illinois-based Advocate Health Care and NorthShore University Health System.

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October 31, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 10/31/16

October 31, 2016 Dr. Jayne No Comments

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There has been a fair amount of swirl and churn with my clients this week as they begin to digest the recently-released MACRA Final Rule. It was released with a comment period, which seems to be having some unintended consequences. Some organizations are interpreting the presence of the comment period as a license to continue to stall in their preparation efforts, as if some magical MACRA Fairy is going to swoop down and change the requirements.

It’s been tough to get some of them moving again, because they stalled after the Proposed Rule and took on other projects. I keep preaching the idea of taking baby steps. Even if we don’t think it is truly final, just pick some subprojects and get moving. It’s a hard sell for some groups, however.

Being in the trenches with small to mid-sized practices is tough. There are a fair number of groups out there who still can’t manage to tackle the basics that haven’t changed in years, particularly on the business side. I see groups with high days in accounts receivable, low net collections, and more. Most of the issues are due to process problems such as being unable or unwilling to adopt essential revenue cycle best practices.

You wouldn’t believe the number of organizations that still haven’t grasped the concept of collecting the co-pay up front, which results in a lot of chasing after the fact. Others aren’t performing insurance eligibility checks so that they know whether the patient needs to be self-pay or not. Yet others don’t have their contracts loaded into their practice management system, which makes it difficult to know whether insurers are paying as expected.

These business processes are fairly cut and dried and haven’t changed in quite some time, so when you see organizations that can’t handle them, it throws up red flags about their ability to handle change in their clinical operations. Medical billing systems were among the first pieces of automation added to the medical practice and quite a few vendors have extremely mature platforms. Compared to the relative immaturity of some clinical platforms and the constantly changing federal requirements, it feels like the business piece should just be more solid.

I also see a fair number of practices that don’t have disaster recovery figured out. No part of the country is immune from natural disasters and there are always the “small things” like power outages, disrupted data lines, water line breaks, etc. to potentially disrupt practice operations. At this point, everyone should have a business continuity plan and disaster recovery plan. For those practices that are still stalling around MACRA requirements, I’m trying to push them to go ahead and address those issues so at least they are doing something and creating some kind of positive momentum for their organization.

One of the practices I’m working with right now that is stalling the most is one where the owner is contemplating retirement just to get away from it all. He’s in his late 50s, so I wouldn’t exactly call him retirement age, but he isn’t sure he wants to move forward with all that is being asked of him. It would be one thing if he was waffling and he only had himself to consider, but there is a relatively new physician who joined his practice in the hopes of possibly buying it in a few years. They’ve dabbled in Meaningful Use in the past, but barriers like not having a patient portal block their progress. Even though their vendor offers one, the owner isn’t willing to spend the money while he debates his future.

I don’t have insight into their contract arrangement, but the junior physician has let me know he has been having second thoughts about staying in the arrangement vs. looking at other employment options. They are both aware that there are a number of large groups and health systems that have open opportunities that I suspect offer comparable working conditions, salaries, and benefits, at least for the younger physician who is still building his patient panel. Unless he’s similarly committed to practicing outside the federal incentive / penalty scheme, one of those opportunities may start to look pretty attractive, which I think is adding to the stall factor in this case.

I’ve been spending a lot of time with the both of them trying to create a strategic roadmap for the practice. Does the senior one plan to retire? Will he sell to the junior one or to a health system? Will they close altogether? Will the junior one eventually make a move to force his employer’s hand? It’s like a soap opera and I’m caught in the middle of it. It’s a blend of change leadership training and relationship counseling but hey, it pays the bills.

On a personal level, my own practice has been reviewing the Final Rule as well. Even though we’ve opted out of Meaningful Use, it’s prudent to review the next iteration and determine whether we still want to stay out of it. I’m fairly confident we’re going to continue to just say no, but it’s refreshing to know that you are working with leaders who consider the options at various turning points so that you don’t wind up simply doing things because you’ve always done them that way or because that’s how you decided to do them before. Our owners are very deliberative and data driven and it’s been refreshing to work in that kind of an environment compared to the highly reactive environments I see with most of my consulting clients.

We’re currently focused on growth and have three new locations under construction, poised to open monthly from now through January. It’s been an interesting ride. I’m not entirely bought in regarding some of the locations they’ve picked for expansion, so we’ll have to see whether their forecasts actually play out. In the meantime, it’s been fun to work with people that are so focused on processes and outcomes, independent of any regulatory shackles.

What’s your favorite Halloween candy? Email me.

Email Dr. Jayne.

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October 31, 2016 Dr. Jayne No Comments

Readers Write: Address the Disruption in Provider Data Caused by Clinically Integrated Networks and Value-Based Care

October 31, 2016 Readers Write No Comments

Address the Disruption in Provider Data Caused by Clinically Integrated Networks and Value-Based Care
By Tom White

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Hospitals that became health systems and are now morphing into clinically integrated networks (CINs) are facing increasing struggles managing their expanding patchwork of providers. These include credentialed and referring physicians, APRNs, nurses, other licensed professionals. Their provider count has often grown by five to 10 times.

Not only are there more providers, but also they are working in a wider variety of outpatient care settings. This has been a boon for consumers, as there are now many new retail healthcare locations on neighborhood street corners, but this poses an increasing challenge from a provider data perspective. Who is providing the service? What is their affiliation in the ACOs, next gen ACOs, CINs, or narrow networks? Are they sanctioned?

These problems rise from the emergence of the retail healthcare economy. The resultant growth in provider data is creating obvious and not-so-obvious consequences caused by disruptions in the provider data management process, affecting the accuracy of the provider data.

Poor provider data management tends to hurt healthcare organizations much more than they realize, especially in the context of today’s emerging retail healthcare economy and value-based reimbursement market. For hospitals and providers to succeed in these circumstances it is imperative to drive out unnecessary costs, and outdated or inaccurate provider data is a hidden source of significant costs.

As hospitals and health systems develop new alliances, it is critical to know what providers are included in a CIN, including their roles and affiliations. Efforts to collaborate over large patient populations and control value-based payments require in-depth and proprietary knowledge of provider affiliations, practice scope, and their economic models. This information is mission critical for success. Using a system that manages provider data in these areas should be a business imperative for every health system executive.

Licensed healthcare provider data management programs have historically been managed by numerous, fragmented systems across the healthcare ecosystem. Many healthcare leaders believe that electronic medical records (EMR) systems and their health information exchange (HIE) modules, credentialing, and other modern back-office IT systems have made provider data more accurate, secure, and accessible. Perhaps this is so with patient data, but this is not the case with provider data. These enterprise IT systems provide numerous benefits and may even provide a repository for some provider data, but they are not inherently designed for ongoing management of this business-critical data.

Let’s think for a minute about some specific areas in which provider data plays a vital role. Do CINs know who their providers are? How do they take these new provider networks and build the tools for consumers and providers to search and find them? Simple natural language searching (think Google searches) is how the entire world except for healthcare works. Having accurate provider data who are in-network with modern search tools should be a goal for all health systems and CINs.

Accurate provider data is critical to ensure that provider search tools can be the foundation of a successful referral management program. Potential patients that visit the hospital website and search for a local, in-network doctor or a specialist expect that the information they are presented with is accurate and current. If not, a bad customer experience could mean the loss of a patient, a loss of trust, and perhaps worst of all, a bad online review by the patient.

Physicians who use these search tools to identify specialists they can refer their patients to is a critical aspect of referral management. The range of critical data that is relied upon now goes beyond simple contact information and insurance plan participation. It might include physician communication preferences, licensing data, internal system IDs, exclusionary lists, and other sensitive internal information. This information changes frequently, but users don’t have time to ponder these facts. Inaccurate information wastes time and hurts patient satisfaction.

Inaccurate provider data causes billing delays that hurt cash flow and increases days A/R. Invoices sent to the wrong location or faxed to the wrong office are common in healthcare. Never mind issues stemming from inaccurate or incomplete address information.

Beyond clinical and financial performance gains from having more accurate information on providers is that this data can then be used in consumer and physician outreach programs across the health systems, whether part of a CIN or ACO. Hospitals are businesses, too. Historically many of their patients may be admitted through the ED, but increasingly are referred by in-network physicians or come through another outpatient service. The hospital’s marketing department may want to reach out to a network of physicians within a 200-mile radius to encourage referring patients to their facilities or simply promote a new piece of equipment or innovative procedure that’s now available at their facility. The marketing department might do searches to find these physicians and contact them. Having accurate provider ensures that these efforts are productive and efficient.

A tool is required that makes it easy for the appropriate teams in the health system to curate and update their health system provider data to create a single source of truth. This should include all credentialed and referring providers from across the entire healthcare organization, including acute, post-acute, outpatient, and long-term care environments.

While health systems can develop data governance models that require all departments to verify the accuracy of their provider data and to specify how it should be shared, this is seldom a success. Most organizations don’t know exactly who is in their pool of licensed providers and historically there has not been an IT system that can provide this comprehensive capability.

Healthcare leaders have to take a proactive approach to provider data management and can no longer afford to deny the critical role this information plays in today’s increasingly complex and challenging healthcare system. In a fee-for-service world where practitioners are paid for whatever work they perform, it may not be as critical to have accurate provider data. But in today’s value-based care market, accurate provider data is critical for running an efficient, competitive, and profitable healthcare system.

Thomas White is CEO of Phynd Technologies of Dallas, TX.

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October 31, 2016 Readers Write No Comments

Morning Headlines 10/31/16

October 30, 2016 Headlines No Comments

Why McKesson Corporation Shares Fell 23% In A Day

McKesson shares drop 23 percent following a poor Q2 financial report and lowered earnings guidance for 2017.

Athenahealth lays off more than 100 in restructuring effort

Athenahealth eliminates 150 jobs in San Francisco and Atlanta as it consolidates its R&D functions.

Nanaimo MDs offered extra pay to stick with controversial software

In Canada, Nanaimo Regional General Hospital is offering physicians extra money to keep using its recently implemented Cerner system to compensate for “the extra burden the new electronic health record has placed on many physicians during the roll-out phase of IHealth.”

Healthcare IT Trends in the UK — Who’s Winning & Losing | 2016

A Peer60 survey of hospital executives in the UK reveals a high level of concern over physician and nursing staffing shortages.

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October 30, 2016 Headlines No Comments

Monday Morning Update 10/31/16

October 30, 2016 News 3 Comments

Top News

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McKesson’s poor earnings report, released after the stock market’s close Thursday, resulted in a Friday shareholder bloodbath as MCK shares shed 23 percent of their price and continued to slide in after-hours trading Friday.

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The company’s $290 million EIS write-down was barely mentioned in the analyst call since technology isn’t a key McKesson business; it’s dumping out of healthcare IT anyway; and its failures there are insignificant compared to its exposure to a changing pharma market, uncertainty about which hit the shares of all its drug distributor competitors as well.

Drug companies can credit the unapologetically capitalistic Martin Shkreli — whose drug pricing practices at Turing Pharmaceutical created a public backlash — for their potentially less-profitable future.

Pharma is scared to death of California’s Proposition 61, which if passed will require that state agencies pay no more than the VA’s heavily discounted price for a given drug. Drug companies have spent $100 million trying to defeat it.


Reader Comments

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From HL7 Interface Engineer: “Re: FHIR. Sorry to vent, but after years of implementing HL7 and being able to do just about anything with an HL7 message, FHIR can’t solve the underlying problem of trying to connect old EHR systems as each uses the fields differently. Real-life examples I’ve experienced: (a) connecting a system with a 23-character patient ID with one holding only 12; (b) systems that may or may not allow spaces between first and middle names; and (c) a system vendor that wants ADT^A16 (pending discharge) and ADT^25 (cancel pending discharge) transactions and our system can’t send either one. Hoping someone at HIStalk will understand and either validate my feelings or explain why I’m wrong.” I don’t think  you are wrong, although that’s not what the non-techies who naively believe that FHIR will create world peace want to hear. My thoughts:

  1. Providers understandably have no incentive to exchange data with their competitors, no different in healthcare than any other big-money industry. If customers don’t care, neither will their vendors. You can’t create interoperability demand by simply developing new standards or asking for it as a downstream customer (patient). Providers would lose more business in sharing data with their competitors than they would just declining to do so since it’s not usually a patient must-have.
  2. Dissimilarly designed systems make it hard to even batch-convert data, much less handle real-time, bi-directional data exchange where errors cause missing data elements that might impact patient care.
  3. HL7 as a standard was successful, but could have been even more so if vendors hadn’t kludged their systems (and thus HL7 messages with endless custom extensions) as a lazy, check-the-box way to approximate interoperability support without enthusiasm. FHIR without discipline could turn out the same way if customers don’t demand better.
  4. The value of interoperability isn’t to the EHR or ADT systems, but rather to those systems that want their information. That stifles innovation as the smaller, newer vendor can’t get a hospital foothold without integrating with core systems and their foot-dragging vendor. The bigger, more expensive, and older system is always the transaction boss because it’s the most entrenched at a given customer site.
  5. ADT transactions are standard, but even then exceptions exist, such as those you mentioned. ADT is easy compared to clinical domains. Healthcare is a lot more complex than financial transactions that were based on standard accounting practices.
  6. Exceptions always come up due to unsynchronized upgrades among systems or corner cases, meaning someone has to monitor the error logs. That’s easier for a hospital’s IT department than a small practice with no technical resources.
  7. Paradoxically, the inflated expectations for FHIR may make it successful since everybody from the federal government to insurers and researchers is pressuring its use, giving vendors less ability to ignore it. I don’t have the expertise to say whether it’s better or worse than HL7, but we’re a lot smarter about interoperability now than back in the late 1980s when HL7 combined with interface engines instead of point-to-point custom interfaces was considered the holy grail of system-to-system communication. Maybe we’ll learn from those mistakes and do better given a blank slate. The witless punsters that put FHIR in their headlines (for which it is inarguably sexier than calling it HL7 Version 4) highlight the value of FHIR as a public relations and political tool rather than a technical one.
  8. Interface engineers got us through the days when best-of-breed systems ruled the earth and hospitals had to patch them together within their four walls. The change to single-source systems has moved the battleground outside those walls, where instead of tying together departmental systems whose vendors are equally motivated to make it work, the challenge is making competing and vastly different EHRs talk to each other in an equally competitive and inherently distrustful provider environment, something even clever engineering can’t fix.

HIStalk Announcements and Requests

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Epic’s supposedly non-existing marketing program is the most effective of all inpatient EHR vendors, according to poll respondents.

New poll to your right or here, triggered by the reader’s comment above: what impact will FHIR have on interoperability? Those taking the non-committal choice of “some” might want to click the comments link after voting to explain so that we know that you have modest expectations rather than limited knowledge.

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Welcome to new HIStalk Platinum Sponsor Haystack Informatics. The Philadelphia-based company’s security technology, created at Children’s Hospital of Philadelphia, detects hospital employee EHR snooping. Healthcare security professionals warn that insider breaches are the greatest single privacy threat, beyond the more highly publicized hacker or ransomware incidents. Instead of fixed rules, the company’s dynamic and static anomaly detection engines learn normal user behavior and call out exceptions, providing investigation workflow those incidents as well as for lost laptops, theft, and improper disposals, creating the necessary documentation for the compliance department and OCR. I sponsored their recent webinar that addressed insider threats. I was slow to notice that the company’s name comes from “a needle in a haystack,” which I assume references those few nefarious insiders among the majority of employees and staff who do nothing wrong. Thanks to Haystack Informatics for supporting HIStalk.

I found a YouTube overview of Haystack Informatics featuring CHOP AVP/CMIO Bimal Desai, MD, MBI, who is also the company’s co-founder.

Listening: new from AFI (an initialism for A Fire Inside), a hard-rocking, punk-leaning four-piece from Ukiah, CA that hasn’t changed members since 1998. They’re hard to categorize, but easy to listen to. The new single is a lot more richly polished and smooth than some of their earlier stuff.

I was thinking that instead of everyone racing for the cure or wearing pink in October for breast cancer awareness in a self-congratulatory show of support, perhaps those dozen or two Americans who aren’t already aware of it could instead wear pink and we could just take them offline individually to explain and invest the extra time and energy into public health projects.


Last Week’s Most Interesting News

  • McKesson turns in bad quarterly numbers, lowers guidance, sees shares shed nearly 25 percent of their value, writes down $290 million on its Enterprise Information Systems (EIS, which includes Paragon) business, and lays off an unspecified number of EIS employees.
  • Vocera acquires Extension Healthcare.
  • Netsmart acquires HealthMEDX.
  • Apple’s 15-year streak of increasing sales is broken due to falling iPhone demand.
  • Athenahealth misses quarterly revenue expectations and admits that its promised 30 percent bookings growth is no longer like to be achieved due to a changing (i.e., non-Meaningful Use-driven) market.

Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Athenahealth lays off nearly 150 employees in consolidating its R&D function, with 102 employees dismissed in San Francisco and 40 in Atlanta as the company focuses R&D in Watertown, MA; Austin, TX; and India.

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Germany-based medical software vendor CompuGroup Medical formally notifies Agfa of its interest in acquiring the medical imaging company. CGM’s market cap is $2.1 billion, while Belgium-based Agfa’s is around $625 million.


Decisions

  • Drew Memorial Hospital (AR) went live with Paychex time and attendance in September 2016.
  • Memorial Hospital at Craig (CO) went live with Kronos time and attendance in October 2016.
  • Hardin Medical Center (TN) will go live with Kronos HR, time and attendance, and payroll on January 1, 2017.

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


Announcements and Implementations

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Audacious Inquiry releases CAliPHR (CQM Aligned Population Health Reporting), an open source CQM calculation tool to support provider participation in federal and state incentive programs and value-based payment systems, available on Github.

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A new Peer60 report looks at healthcare IT trends in the UK, identifying as the top concern the shortage of doctors and nurses, with 76 percent of respondents saying Brexit is hurting their staffing. Net promoter scores are terrible for both EPR and PAS, but limited replacement activity (as well as equally poor scores across vendors) suggests a reluctant acceptance of the status quo.


Government and Politics

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The Ohio State Medical Association complains that the state’s medical board overreacted in sending a sternly worded letter to the state’s doctors, one-third of whom were not using the Ohio doctor-shopping database as the board requires. The top 25 doctors who weren’t looking up patients before prescribing opioids averaged 30 such prescriptions per month, while one doctor prescribed narcotics for 705 patients in one month without using the database at all. The letter had the intended effect of spurring sign-ups, also resulting in subpoenas for seven non-participating dentists for unspecified issues.


Privacy and Security

From DataBreaches.net:

  • A man treated for life-threatening injuries in a hospital’s ED says he will sue the hospital after one of its employees took photos of him that were later sent to him by someone claiming to be a friend of a nurse there.
  • The information of 1.3 million Australian citizens is exposed when a security researcher finds that the Red Cross’s donor record SQL database is accessible to Internet searches.
  • A report finds that messages sent to unsecure alpha pagers (like those still used widely by hospitals) can be easily intercepted, noting particularly that the US is the only country where detailed alert messages are automatically sent by nuclear power plant monitoring systems. The report recommends encryption, data authentication, and limiting how email-to-pager messages are managed.

Technology

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Apple finally announces a refreshed MacBook Pro line four years after its last update, creating little excitement given that the big innovation (details of which had already leaked out) was an on-screen Touch Bar along with the usual “thinner, lighter” one-upmanship. The entry-level price would buy a handful of Windows laptops or a dozen Chromebooks. Apple might want to invest some of its giant cash reserves in trying to clone Steve Jobs, who would surely not have taken the stage to do his “one more thing” bit with Apple’s unexciting, grindingly incremental improvements. You know it’s bad when the biggest takeaway from the iPhone announcements was the elimination of the headphone jack and the biggest from the MacBook announcements was that the headphone jack remains.


Other

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Money-losing Nevada Regional Medical Center (MO) provides an interesting glimpse into the odd ways Medicare pays providers. The hospital buys one medical clinic and plans to purchase another because they are designated as rural health clinics, meaning Medicare pays 2.5 times the amount the hospital would make from an inpatient or regular clinic patient. The hospital’s three rural health clinics are its highest-margin business lines courtesy of Medicare’s financial incentives to keep people out of the ED.

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Everybody knows John Halamka as a pre-eminent health IT spokesperson with endless energy and enthusiasm, but I enjoy even more his writings as a gentleman farmer and animal sanctuary operator, evidence of which I submit from his latest Unity Farm Journal:

Before I left, I cut a road from the barnyard to the new aviary area and around the back of the alpaca paddock to the edge of the new sanctuary property we’re acquiring next door. In my absence the gravel for that road arrived, so we now have a new area to drive over with farm equipment. I’ve called it Sanctuary Road … This weekend I’ll be busy doing animal care — trimming alpaca toenails, running with the dogs, giving the pigs the belly rubs they’ve been missing. I’ll be crushing and fermenting 500 pounds of apples. I’ll be racking the cider I fermented before I left. The work on the farm is invigorating and I will not miss sitting in economy seats while the person in front of you leans back all the way.

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In Canada, Island Health’s Nanaimo Regional General Hospital offers its doctors extra pay for “the extra burden the new electronic health record has placed on many physicians during the roll-out phase of IHealth.” The hospital’s doctors previously reverted back to paper charts, citing patient safety and workload concerns with its newly implemented Cerner system.

Doctors in United Arab Emirates complain that their hospital employer is docking their pay for clocking in minutes late, even when they work past their quitting time. The HR people tell them it’s an automated system and there’s nothing they can do. The doctors also note that right before orientation day, the hospital decided not to hire residents and interns even though the government pays their salaries.

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The folks at Epic, many of whom aren’t many years removed from trick-or-treating under the watchful eyes of their parents, have trotted out their Halloween-themed web decorations.


Sponsor Updates

  • Experian Health will present “Denial: It’s Not Just a River in Egypt!” at AAHAM WA November 10 in Spokane.
  • PatientMatters will present at the Missouri Hospital Association Annual Convention November 2-4 in Osage Beach.
  • AdvancedMD will introduce an all-in-one cloud site (scheduling, billing, EHR) at MGMA, also adding fully integrated telehealth capabilities and an expanded AdvancedPatient.
  • The SSI Group will exhibit at GC3 HIMSS November 3-4 at the Beau Rivage Resort & Casino in Biloxi, MS.
  • SK&A publishes a new report on “Provider Move Rates.”
  • The American College of Pathology names Aprima a certified ACP PRO Venous Registry EHR vendor.
  • Valence Health will exhibit at the National Association of Medicaid Directors November 6-8 in Arlington, VA.
  • Voalte will host its second annual user conference November 9-11 in Sarasota, FL.
  • Built in Chicago names ZirMed to its list of 2016 Top 100 Digital Companies.

Blog Posts


Contacts

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

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October 30, 2016 News 3 Comments

Morning Headlines 10/28/16

October 27, 2016 Headlines 1 Comment

McKesson Reports Fiscal 2017 Second-Quarter Results and Revised Fiscal 2017 Outlook

McKesson reports Q2 results: revenue climbed slightly to $50 billion, EPS $1.35 vs. $2.65, missing expectations for both. The company also lowered guidance, driving share prices down 13 percent in after-hours trading.

Quality Systems, Inc. Reports Fiscal 2017 Second Quarter Results

Quality Systems, parent company to NextGen, reports Q2 results: revenue remained flat at $127.2 million compared to $125.4 million during the same quarter last year, adjusted EPS $0.23 vs. $0.21, beating analyst expectations for both.

Anthem to invest $20 million in 2,000-job IT hub in Midtown’s Bank of America Plaza

Anthem announces that it will build a 2,000 employee software development center in Atlanta, at a cost of $20 million.

Cleveland Clinic Unveils Top 10 Medical Innovations Most Likley To Be Game Changers

Cleveland Clinic includes FHIR in its list of top 10 ten medical innovations that will transform healthcare in 2017.

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October 27, 2016 Headlines 1 Comment

News 10/28/16

October 27, 2016 News 3 Comments

Top News

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McKesson announces Q2 results: revenue up 2 percent, EPS $1.35 vs. $2.65, missing expectations for both. The company also lowered guidance.

McKesson will take a $290 million write-down of its Enterprise Information Solutions (Paragon) business due to “a decline in estimated cash flows” and says it is still seeking a buyer for it. As recently announced, it will retain only EIS and RelayHealth once it has divested its other health IT businesses into a new joint venture company to be formed with Change Healthcare, with closing expected in the first half of 2017 pending anti-trust review.

Technology Solutions revenue was down 6 percent with a loss of $174 million.

MCK shares dropped 13 percent in after-hours trading immediately following the announcement. They were already down 14 percent in the past year.


Reader Comments

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From Hush Hush Sweet Charlotte: “Re: McKesson. Apparently it’s really hard to send out a super confidential list of McKesson employees who are getting canned to the executive team without sending it to every employee in the business unit.”  A McKesson admin apparently mistakenly emails upcoming layoff details, including names and communication plans, to the whole business unit instead of just the executives. Anonymous commenters suggest that the Charlotte, NC-based Paragon group was hit hard Wednesday, especially in lab and ancillaries, but that’s not confirmed. An HIStalk reader says one-third of the EIS workforce was let go, some effective immediately and some “held hostage for severance benefits if they stay through March 2017.” McKesson was already trying to unload its EIS division — of which Paragon is key element along with other old systems like Star and HealthQuest – as part of its plan to get out of the health IT business by transferring the non-EIS assets to a new company formed with Change Healthcare. McKesson just announced a new version of Paragon this week, which probably gave the unfortunate salespeople a rare positive talking point right before the layoff rumors leaked out.

From LeftCoaster: “Re: CPT codes. The AMA fought hard to to keep ICD-10 from being implemented. The original ICD-10 PCS code scheme developed for the US contained codes that would have theoretically replaced CPT codes (both inpatient and outpatient procedures). We’re left with a mishmash of coding schemes with CPT for outpatients and ICD-10 PCS for inpatients.” Unverified.

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From Persnicker: “Re: your (or is that ‘you’re’) favorite HIMSS publication. It’s not cool that it can’t spell ‘its.’” Americans just keep getting dumber in confusing the contraction “it’s” with the possessive “its.” I see that mistake every day, with a misuse rate of at least 50 percent. Looking at the half-full glass, I know I can immediately stop reading since I won’t trust whatever else the careless author is attempting to communicate.


HIStalk Announcements and Requests

I’ve used Bitdefender for PC security for years, and as I installed the latest upgrade to the 2017 version, I was thinking about how smooth the process is (even though years ago I initially resisted the idea of paying for ongoing AV protection as a subscription). Too bad healthcare software usually doesn’t work like this. It’s a smart, smooth, background installation; it installs in auto-pilot mode with no tinkering required; it hides its underpinnings from the user; it provides a Web-based dashboard for managing the devices covered under the subscription (up to five in the version I have); and it now includes ransomware protection. AV protection will never be fun, but Bitdefender is at least close to painless and it’s a pretty good deal at around $50 per year for up to five devices. I had high hopes for its $99 Bitdefender Box security appliance, but reviews are awful and the company doesn’t seem to talk it up much.

This week on HIStalk Practice: New AAFP President John Meigs, MD deems MACRA, opioid abuse prevention, and workforce development his top areas of focus in the coming year. Seward Community Health Center preps for Epic go live. Signia develops telemedicine app for hearing aid users. CMS keeps the MACRA flexibility options coming. Alliance Physical Therapy pilots Docity telemedicine software. The American Red Cross and Teladoc collaborate on telemed for natural disaster victims. Athenahealth shifts gears in light of disappointing sales figures. The HIStalk Must-See Exhibitors Guide for MGMA 2016 goes live.


Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Here’s the recording of “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries” from earlier this week.


Acquisitions, Funding, Business, and Stock

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Medical device vendor Zimmer Biomet – which is developing a remote rehabilitation platform — acquires RespondWell, which provides post-surgical patients with physical therapy programs.

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Quality Systems (NextGen, Mirth, and QSI Dental) releases Q2 results: revenue up 1 percent, adjusted EPS $0.23 vs. $0.21, beating analyst expectations for both. CEO Rusty Frantz declined to comment on rumors that the company is shopping its NextGen business. EHR vendor HealthFusion, which Quality Systems acquired a year ago for $190 million, had $5 million in bookings and $10 million in revenue.

Insurer Anthem will create 2,000 jobs at its new software development center in Atlanta.

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Government contractor Cognosante acquires BITS, which provides services to the VA and DoD. BITS is involved with the VA’s open source technical support contract.

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Spok reports Q3 results: revenue down 2 percent, EPS $0.20 vs. $0.20.

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Vocera acquires Extension Healthcare for $55 million in cash. I reported the retrospectively correct rumor of Nasty Parts on October 19.

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Netsmart acquires long-term and post-acute care EHR vendor HealthMEDX.


Sales

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The Ohio State University Wexner Medical Center chooses Kyruus ProviderMatch for patient-provider matching and appointment access.

Vanderbilt Bone and Joint will use MyHealthDirect for Epic-integrated patient self-scheduling.

Sacred Heart HealthCare (PA) chooses Dbtech for document management.


People

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Ascension promotes Gerry Lewis to SVP/CIO and CEO of Ascension Information Services.

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Contract management software vendor TractManager names Trace Devanny (Nuance Healthcare) as CEO.

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Mark Costanza (Lumeris) joins Nordic as chief client officer.


Announcements and Implementations

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An actuarial study finds that Forecast Health’s predictive models are more accurate than those of its competitors in identifying potentially high-cost patients for early intervention. The Durham, NC-based company developed its analytical model with UNC Health Care.

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Athenahealth lists Healthfinch’s Swoop prescription refill management app on its marketplace.

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Stanson Health’s new clinical decision support release includes evidence-based rules for atrial fibrillation, comprehensive joint replacement, Medicare Advantage star ratings, antimicrobial stewardship, and opioid management.

Influence Health announces a new cloud-based experience management solution for healthcare marketers.


Government and Politics

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The NIH’s translational sciences group awards nine universities a $6.3 million grant to integrate the PROMIS patient-reported outcomes assessment with EHRs (including Epic and Cerner) so that the questionnaire omits irrelevant questions.

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Less than half of the 22 million people that were expected to buy health insurance via the exchanges have actually done so, with the smaller number of enrollees – most of them self-selected because they’re sicker – driving insurers to drop their participation. The risk insurance program that protects insurers from signing up a disproportionate number of sicker policyholders will end this year since the original ACA legislation mistakenly assumed that the marketplace would have stable, high enrollment by now.


Innovation and Research

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The local paper profiles non-profit Fogarty Institute for Innovation, which works out of El Camino Hospital (CA). Diagnostic image manipulation system vendor EchoPixel, whose product was probably the coolest thing I saw at the last HIMSS conference, is among the companies involved. Founder Thomas Fogarty, MD is a cardiovascular surgeon who invented the balloon catheter, founded 45 medical device companies, and holds 165 surgical instrument patents. He also owns Thomas Fogarty Winery and Vineyards, which he started in 1981.


Technology

Google cuts staff and dials back the continued rollout of its Google Fiber broadband service that is available in eight cities. Fiber deployment requires digging up streets to lay cable, but Google has acquired Webpass, which uses fiber-connected antennas that would allow Google to expand faster at a lower cost. Webpass, offered only in six metro areas, offers 1 gigabyte residential service for $60 per month. The downside is that it focuses on apartment buildings and condos with at least 10 units since a central antenna must be installed.  Some Webpass reviewers also complain of the “Netflix effect” in which speeds slow to a crawl between 6:00 and 10:00 p.m.

Cleveland Clinic names FHIR as one of its top 10 medical innovations for 2017.


Other

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The Orlando paper covers Sanford Burnham Institute, a California-based research organization that was supposed to create the centerpiece of a Lake Nona life sciences complex called Medical City that failed despite having spent $350 million worth of public and private incentives. The VA and Nemours Children’s Hospital committed to building there and University of Central Florida put its medical school in Lake Nona despite its distance from the main campus and local hospitals. University of Florida just declined to take over the Lake Nona operation of the Institute, making it likely that it will shut down entirely.

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The Johns Hopkins Hospital (MD) launches a Capacity Command Center that was designed and built by GE Healthcare. It uses engineering and predictive analytics to manage patient movement and experience, fed by alerts from 14 IT systems. The hospital reports faster inboarding of transfers, faster bed assignment for ED patients, improved morning discharges, and reduced OR transfer delays.

In Nepal, government hospitals say they can’t expand outpatient hours from 10:00 a.m. to 5:00 p.m. because their doctors skip work during the day for jobs in private clinics. Paying them extra and forcing them to clock in and out didn’t help, so hospitals have decided to publicly post each doctor’s hours on his or her nameplate, hoping patients will complain if their doctor has ducked out to moonlight.

This case should keep jurors awake. A New Orleans plastic surgeon accused of raping his former wife and recording unconscious patients without their consent sues his former business partner for cashing $3.8 million in unauthorized checks. In an unrelated incident, the former partner is charged with crashing his Lamborghini into a wall at 118 miles per hour while intoxicated, killing his passenger. He accuses the surgeon of using him to pay $375,000 in severance for an employee with whom the surgeon was carrying on a sexual relationship.

Weird News Andy opines that a UK woman’s 132-pound “tumour” (as reported in an English newspaper) is actually a “fourmour” and maybe even a “fivemour.”


Sponsor Updates

  • EMDs will offer its customers claims financing from Provider Web Capital.
  • Optimum Healthcare IT publishes a white paper titled “Community Connect – Expanding Epic into the Community.”
  • CDW Healthcare recognizes Orion Health’s blog as a “Top 50 Health IT Blog.”
  • The Institute for Critical Infrastructure Technology welcomes Protenus co-founders Robert Lord and Nick Culbertson as the newest ICIT Fellows.
  • Dimension Insight achieves top ranks in BARC’s The BI Survey 16.
  • The ECG Management Consultants 2016 Pediatric Subspecialty Physician Compensation Survey shows continuing upward compensation trend.
  • EClinicalWorks kicks off 2016 national conference with over 4,000 attendees.
  • HCS will exhibit at the 2016 LeadingAge Annual Meeting and Exposition October 30-November 2 in Indianapolis.
  • HealthCast will exhibit at the 2016 CHIME Fall Forum November 1-4 in Phoenix.
  • Impact Advisors and InterSystems will exhibit at the CHIME16 Fall CIO Forum November 1-4 in Phoenix.
  • LiveProcess will exhibit at the New England Rural Health Roundtable November 2-4 in Southbridge, MA.
  • LogicStream Health will exhibit at the AMDIS Fall Symposium November 3-5 in Phoenix.
  • Meditech celebrates Canadian Patient Safety Week.
  • Netsmart will exhibit at the New Mexico Association for Home and Hospice Care Annual Conference November 3 in Albuquerque.
  • Obix Perinatal Data System will exhibit at the Riverside Methodist Hospital Perinatal Conference November 3 in Dublin, OH.OCLC

Blog Posts


Contacts

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

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October 27, 2016 News 3 Comments

EPtalk by Dr. Jayne 10/27/16

October 27, 2016 Dr. Jayne 2 Comments

Hot on the heels of the MACRA Final Rule, CMS announced expanded opportunities for physicians to participate in Advanced Alternative Payment Models. One of the opportunities includes reopening applications for the Comprehensive Primary Care Plus (CPC+) program. This is a coordinated initiative that involves the participation of multiple commercial payers in addition to Medicare and Medicaid across specifically identified regions across the nation.

Although they initially said they would take up to 20 regions for the program, they only announced 14. It would be an easy thing to open applications for providers, but they’re also opening it for payers, which makes me wonder if they’re going to select additional regions for this new 2018 cohort. They’re also calling for new participants in the Next Generation Accountable Care Organization model for 2018.

I was on a CMS Quality Payment Program Overview webinar today. Although I give them props for nice classical hold music, it would have been better if they didn’t start late and then run over time. I’ve been on several CMS webinars lately and they tend to be overly scripted. As someone who does a lot of presentations, I appreciate their desire to make sure they deliver all the information, but there’s definitely an opportunity to be more engaging.

Because of the number of questions and the late start, they didn’t answer many of the questions posed by attendees. I understand that there were more than a thousand people on the call, and with that many questions, it illustrates how complicated these programs are and the level of concern felt by providers.

One attendee asked how CMS is going to manage the idea of patient free will and the fact that physicians are being held liable for patient behavior. The attendee gave the specific answer of a patient with lung disease who leaves the hospital and immediately starts smoking, which has the potential to skew quality numbers. She went on to ask what preparations are being made to address the possibility of patient dumping, where physicians refuse to treat patients who fail to comply with treatment plans and recommendations. Dumping (and cherry-picking, where clinicians go after the healthiest patients) has been a real issue in the past as various payer programs penalized providers for being quality outliers.

The Medicare Learning Network offers their version of a Quality Payment Program call on November 15th and interested parties still have the opportunity to enter comments on the Final Rule. Registration is open and space is limited. This is in addition to their “How to Report Across 2016 Medicare Quality Programs” call that is being held on November 1.

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There are so many things that primary care physicians must advise their patients on that it often feels like there’s not enough hours in the day. This month, one more thing has been added to the list, and it’s an item that isn’t going to be a quick conversation. The American Academy of Pediatrics has endorsed new safe sleep guidelines that recommend that infants sleep in the same room as their parents (although not in the same bed) for the first year of life. Despite recent interventions, there are still 3,500 sleep-related infant deaths each year and the new recommendations aim to reduce that number. These are the kinds of conversations that take more time than the typical office visits allow, creating additional time pressure for clinicians.

Those time pressures challenge physicians who are  being graded on how we’re doing with patient engagement. My office uses a Web-based patient engagement platform that surveys each patient or caregiver who provides an email address at check-out. Our scores (on a scale of zero to five) are part of the formula that determines whether we receive a bonus and how much it might be. Usually my scores are fives with the occasional four. The scores roll in real time and I’ll often see results from patients I saw just a few hours earlier.

Today I got a three, which was strange because all the comments associated with the score were strongly positive. Our office calls each patient who gives us less than a four, so I’ll get additional feedback on the reason for the low score. Looking at the schedule, she was seen during a patient rush when our wait time was over an hour and while I was in the process of transferring two patients to the hospital for life-threatening emergencies. It’s likely that the wait time played a role in the score, but it’s certainly discouraging for physicians who provide high-quality care but don’t carry a magic wand.

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Speaking of magic wands, I definitely need one for a current client. I’m doing some governance work for a mid-sized health system that has been struggling with their EHR to the point where they’re ready to start looking for a new vendor. They realized how expensive a system replacement might be, so they brought me in to do a thorough review and to see if anything can be salvaged.

I found an extensive list of issues ranging from defective hosting to absent physician leadership. There are also some configuration issues with the EHR, but nothing that can’t be fixed. I’m in the middle of a follow-up consulting engagement trying to get their leadership organized around a common vision and mission. I’ve struggled with one of their clinical leaders who keeps focusing on perceived EHR issues (which are largely self-inflicted) to the exclusion of everything else. I’ve been trying to get the leadership to focus on strategic planning and creating prioritized action plans, but it’s hard to get the clinical leadership to show up, let alone participate.

Today one of the most difficult clinicians graced us with his presence after several weeks absence and proceeded to try to hijack the agenda and pull us back into a discussion of EHR issues, most of which have already been corrected. I used my best facilitator skills to try to redirect him, to try to engage the group to self-police, and to place his various rants on my “parking lot” for later discussion. He insisted that “we can’t get strategic until we get past the issues.”

That definitely wins my quote of the day award, especially since under his approach, they’ll go nowhere fast. It’s hard to make a roadmap when you haven’t decided where you’re headed. And if you don’t know whether you’re driving to the beach or to the mountains, it’s going to be hard to plot out the fuel stops and tourist attractions along the way. I was ultimately able to thwart his attempts to block the group’s progress, but it wasn’t easy.

How do you handle people who are constantly stuck in the weeds? Email me.

Email Dr. Jayne.

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October 27, 2016 Dr. Jayne 2 Comments

Morning Headlines 10/27/16

October 26, 2016 News No Comments

Why the Key Indicators to Watch on Health-Care Marketplaces Come in 2017

Kaiser Family Foundation president and CEO Drew Altman addresses premium increases and a drop off in plan options on ACA marketplaces.

Copycat enrollment websites hamper ACA sign-up efforts

A proliferation of websites competing with Healthcare.gov are causing concern for regulators working to ensure that the ACA open enrollment period runs smoothly.

Northwestern leads consortium to integrate patient-reported outcomes into electronic health records

NIH awards Northwestern University a $6.3 million grant to begin integrating patient reported outcomes into EHR systems, with both Cerner and Epic signed on to support the effort.

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October 26, 2016 News No Comments

HIStalk Interviews Stu Randle, CEO, Ivenix

October 26, 2016 Interviews No Comments

Stuart A. “Stu” Randle is president and CEO of Ivenix of Amesbury, MA.

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Tell me about yourself and the company.

I’ve been in the med tech business for 25-ish years, a lot of that with Baxter in the early years. I’ve done three small companies, this being the third one. Ivenix is focused on transforming IV infusion therapy with a fundamentally different pumping technology, IT architecture, and interoperability that we think is unmatched in the marketplace.

One of the challenges in the marketplace today is that most of the pumps that are out there have a fundamental operating platform that’s 10-plus years old. We started with a blank sheet of paper to try to move us into the iPhone era. As an example, we provide infusion information on mobile devices and desktops so the nurses have the ability to understand what’s going on with the infusion when they’re not at the bedside. That obviously helps from a nurse workflow standpoint and also significantly helps for the patient because the nurses don’t need to be there for them to know what’s happening with that infusion.

The early generation smart pumps had a lot of programming capability, but always seemed to struggle with network connectivity and library updates. How hard is it to turn that 10-year-old technology into a true connected IT device?

Really hard. Think about the pumps in the marketplace today as your desktop computer from 10 years ago. If you want that desktop computer from 10 years ago to work like an iPhone does today with apps, mobile, cybersecurity, and everything else, that’s hard to do.

Where we think we are very different is that we started with a clean sheet of paper, understanding all the issues and developing a different pumping technology, but much more so a fundamentally different IT architecture that is relevant today and not a decade old.

What are the challenges in creating a user interface that works for nurses and that FDA will approve?

The FDA has pretty specific guidelines and requirements. You have to do testing. We’ve had nurses in every couple of months for a few years now to work on the user interface.

Again, the fundamental difference with our user interface is that it’s much more like an iPhone. It’s menu driven. It’s touchscreen, as opposed to the products out there today that are mostly buttons and knobs. We have a pretty big screen so the nurse can see the infusion information standing at the door to the hospital room as opposed to standing right next to the device.

What safeguards exist to help prevent nurse programming mistakes?

The more you can program in to alleviate those and make it very difficult for the nurse to make an error, the better you’re doing. We have a number of things that help in that regard. For all the drugs, there are guidelines that can be set up by the hospital. What’s the recommended range? We notify the nurse if the programming is outside the range but still acceptable. Then there are limits beyond that where the pharmacists have said, "Don’t do that." That’s one area where we put those guidelines in place.

Our pumps also know if there are other pumps connected to that same patient. You can’t give the same patient the same drug from two different pumps. We know that what’s going on with that patient from all of the pumps connected to them. We eliminate that. We know if on one of our pumps you can deliver through two inlets, if you’re going to deliver two drugs that are incompatible with each other, we’ll notify you of that when you try to program it and say, "These drugs are incompatible. You can’t do it."

We’ve built in a number of things, partially with the work of the hospital pharmacists and their drug library, as well as the guidelines and architecture so that you can’t do things that we know are going to be harmful to the patient.

What’s the ideal state of having a smart infusion device talking to an EHR system?

We worked at HIMSS last year with one of the vendors on doing that. The more information you can deliver directly from the infusion into the EMR without any integration engine in between, the better. We are working with those guys. We can provide all that information and data and make it smooth and seamless.

Likewise, we can download orders from the hospital pharmacy directly to the pump itself. The nurse is there to verify that, yes, this is the order that we have for this patient. This is the right dosage. Pretty much hit “start” and we can go. We try to make it as seamless as possible and integrate into the entire EMR.

We’ve heard from a number of the EMR vendors as well as hospital executives that one of their primary product areas with the greatest frustration and the lack of interoperability today is infusion pumps. We think with the architecture we’ve put in place that we’re going to solve that issue.

What improvements have been made in pump alarms that just make noise until someone shuts them off?

We’ve done a couple of things to reduce them as well as to eliminate the aggravation. One of the biggest areas of alarms is air in line. We have an air eliminating filter, so we can eliminate the need for that alarm to even go off because we eliminate the problem. If the patient bends their arm and kinks it, it will give an occlusion alarm, but if the patient moves that arm again, that alarm will stop and the infusion will continue.

What quality improvement opportunities do hospitals have in using the information the system generates?

They can look at reduction in medication errors. They can look at nurse efficiency and workflow efficiency. All of our pump data is available to the biomed department or the engineering department, so the pumps know when they need to be maintained as opposed to a regularly scheduled out-of-service process. The infusion data can increase charge capture.

We are working with the hospitals to say, we have this wealth of data. How would you like to receive that? How would you like to utilize it?

What are the IT implications of implementing your system?

We work with the pharmacy on uploading the drug library, which we will do as part of the service of the installation. We’re very different from the other guys in that we do everything wirelessly. If there are cybersecurity patches, if there are software upgrades, if there are other items like that, we can do that wirelessly.

At HIMSS, I spoke to someone who was responsible at his institution for a fleet of 18,000 pumps. They had a software upgrade. For them to implement that software upgrade, they had to take each of these 18,000 pumps out of service. We do it all wirelessly, just like when you get a new app on your iPhone. Things like that are huge improvements in productivity and also certainly help on the IT side.

How to you address theoretical security risks?

We started with this clean sheet of paper. Our software guys came from other companies where they were on the receiving end of this information and know the architecture. We architected it with encryption and security similar to the banking system. We always envisioned that we would be going to the home and other areas of care. Cybersecurity was always at the forefront of our thinking in terms of safety because we want to go well beyond the hospital to the entirety of the hospital enterprise or system enterprise. We built it in on early on. We feel quite confident of our security today.

Your competitors are mostly big companies that earn exclusive contracts to provide all the infusion technology for a given health system. How do you see the company changing in the next several years?

As you noted, it’s pretty much an oligopoly today in the US, but everyone’s using technology that is analogous to a 10-year-old desktop. We’re bringing something entirely new to the market. We think that disruption and the opportunity to better integrate with the IT systems within the hospital and across the integrated delivery network or whatever their system is provides us a distinct advantage. We think it is something entirely new and different. We’re pretty optimistic about the reception we’ll receive from the US hospital market.

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October 26, 2016 Interviews No Comments

Morning Headlines 10/26/16

October 25, 2016 Headlines No Comments

AARP Sues US Over Rules for Wellness Programs

The AARP files a lawsuit against the Equal Employment Opportunity Commission arguing that regulations over workplace wellness programs violate employee confidentiality and result in a potentially inequitable workplace for older workers.

Third quarter lobbying details

Politico publishes financial details behind healthcare lobbying spending.

McKesson Announces New Release of Paragon Electronic Health Record Solution

McKesson announces the release of Paragon 14.0, which brings enhancements to its pharmacy, lab, and operating room management systems.

Your Patient Is Now Reading Your Note: Opportunities, Problems, and Prospects

The American Journal of Medicine discusses Open Notes, providing documentation tips for participating providers.

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October 25, 2016 Headlines No Comments

News 10/26/16

October 25, 2016 News 4 Comments

Top News

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AARP sues the federal government over newly issued rules that allow companies to offer employees in their wellness programs big health insurance premium rebates, saying rebates of that magnitude become coercive rather than voluntary and that employees will be forced to give their employers medical and genetic information that could be used to discriminate against them.

The Equal Employment Opportunity Commission manages the rules for employer wellness programs. Previous rules did not define the term “voluntary” or specify the types of medical exams or questionnaires employers were allowed to require of their participating employees.

The new rules allow covered entities to receive the information of wellness program participants only in an aggregate form that does not disclose the identity of specific individuals. It also prohibits employers from requiring participants to agree to share their information with other organizations as a condition of their participation.

AARP questions whether programs are allowed to require participants and their spouses to complete a health risk assessment or undergo biometric testing that would expose their private information. AARP’s members are more likely to suffer from less-obvious medical conditions that could be disclosed by their participation.  


Reader Comments

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From Joy Division: “Re: NextGen Healthcare. An email was sent to all team members asking them to keep their heads down and work instead of speculating on the efforts with UBS Bank to find a buyer for the company. Most believe that Rusty Frantz was hired as CEO for just that reason.” An investor’s report from last week says NextGen parent Quality Systems has hired UBS to explore a sale and has conducted several presentations to interested parties.

From Magic Spell: “Re: patient engagement and technology. An OB/GYN practice in Arizona forces patients to arrive 1.5 hours early to fill in a lengthy DigiChart patient portal questionnaire to populate information that should already be there. Otherwise, they deny the services. The message that technology makes everyone’s life easier and helps engage patients could not be more displaced.”

From Cash Cow: “Re: CPT codes. The AMA has a lock on the coding system through a copyright and protects it as a cash cow. They insist on a seat license, which works for software but not applications that would meet an occasional or episodic need. You can’t provide a look-up service to find the numerical code or description without violating copyright or paying for an annual seat license for each unique user.” AMA charges $15.50 per user per year (named users, not concurrent). Several years ago, a court found that AMA misused its copyright in licensing CPT to CMS (it was HCFA back then) only if CMS agreed to not use competing coding systems, giving AMA a monopoly. A 2001 review by the Senate estimate that AMA earns at least $71 million per year in CPT sales and royalties, far more than it takes in from member dues.


HIStalk Announcements and Requests

I mentioned that last weekend’s health IT news was slow, so Brian Ahier provided some broader-picture material he’s reading:

  • DARPA investigates the use of blockchain to secure the country’s most sensitive information.
  • A research report forecasts a slight increase in wearable deals this year, but a big jump in VC funding mostly due to a single investor, mega-powered Magic Leap.
  • The White House publishes a report covering the future of artificial intelligence.

Acronyms often overlap across industries and here’s a good example: EHR is Heineken’s shortcut for its “Enjoy Heineken Responsibly” branding campaign.


Webinars

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Cancer care planning software vendor Carevive Systems raises $7.2 million in a Series B funding round.

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Apple’s 15-year streak of increasing annual sales is broken as falling iPhone sales reduce revenue by 9 percent.


Sales

St. Elizabeth Healthcare (OH) chooses Evariant’s marketing and physician engagement platforms.


People

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The Nemours Foundation names Marc Probst (Intermountain Healthcare) to its board.


Announcements and Implementations

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McKesson announces a new release of its Paragon EHR.

The Harvard public health school will offer a two-module, $7,210 program in “Leadership Strategies for Information Technology in Healthcare” in January and May whose faculty includes such notables as John Glaser, PhD; John Halamka, MD, MS; Joseph Kvedar, MD; Ken Mandl, MD, MPH; Blackford Middleton, MD, MPH; Dan Nigrin, MD, MS; Sue Schage, MBA; Dean Sittig, PhD; and Micky Tripathi, PhD. 

DocGraph releases a six-year Medicare cancer dataset. 


Government and Politics

Politico Morning eHealth reviews Q3 lobbyist spending:

  • AHA $4.05 million
  • AMA $3.87 million (part of that was spent to oppose a bill that would expand the military’s use of telemedicine, which AMA says would create a national medical license)
  • Athenahealth $140,000
  • Cerner $40,000
  • CHIME $10,000
  • Epic $36,000
  • Health IT Now $40,000
  • McKesson $220,000

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FDA will offer a December 5 workshop to solicit recommendations on how to improve hospital-based medical device surveillance systems and the incorporation of unique device identifiers in EHRs.


Privacy and Security

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Cybersecurity analysts say that patient information stolen in healthcare breaches is so readily available on the Dark Web that prices have dropped, with a full patient ID package fetching only $20 to $50 instead of last year’s $75 to $100.

An incorrectly configured master server in Guilford County, NC exposes the county’s EMS systems to the Internet. The server was running the Rsync file synchronization utility.


Technology

Amazon’s Jeff Bezos says the company isn’t working on specific healthcare uses for its Alexa virtual assistant, but that people there are thinking about it. He says, “I think healthcare is going to be one of those industries that is elevated and made better by machine learning and artificial intelligence and I actually think Echo and Alexa do have a role to play in that,” but cautions that even Amazon isn’t big enough to solve healthcare problems without the help of hospitals, doctors, and nurses.


Other

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A study of 128,000 people with sleep apnea finds that they are more likely to continue their positive airway pressure therapy when they are remotely monitored via wireless sensors or track their progress using ResMed’s app.

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A review of Medtronic’s upcoming MiniMed artificial pancreas says the problem is far from solved since the device works only with one expensive type of insulin; the user still has to count calories, perform finger stick readings, and administer their own bolus doses; and patients have to worry about pump and sensor errors. A professor who helped develop the device says it’s not a cure for diabetes and admits that it is “still a pain in the butt.”

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An Open Notes article in The American Journal of Medicine offers caregivers tips for creating documentation that will benefit the patient as well.

In Australia, the family of a 72-year-old patient sues the hospital where he died of the effects of a burst bladder after nurses accidentally attached an oxygen line to his urinary catheter. The family also says that caregivers were unable to determine the man’s “do not resuscitate” status because the hospital’s EPAS system failed to retrieve it.


Sponsor Updates

  • Netsmart and community care leaders connect the mind, body, and communities at Connections2016.
  • Bernoulli will host a focus group at the CHIME16 Fall CIO Forum November 1-4 in Phoenix.
  • Besler Consulting releases a new podcast, “Trends in HIM.”
  • Meditech recaps its Physician and CIO Forum.
  • Strata Decision Technology recaps the highlights of its recent client summit.
  • IDC names Caradigm a leader in its MarketScape for Population Health Management.
  • TransUnion Healthcare publishes a white paper titled “Recommended Resources for Hospital CFOs: Top 10 CFO Concerns about Revenue Cycle Management (And How to Address Them).”
  • CTG publishes a white paper titled “How Today’s Healthcare Regulatory Alphabet Soup is Driving the Need for Optimization.”

Blog Posts


Contacts

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

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October 25, 2016 News 4 Comments

Morning Headlines 10/25/16

October 24, 2016 Headlines No Comments

Catholic Health Initiatives, Dignity Health in Merger Talks

The Wall Street Journal reports that CHI and Dignity Health are in merger talks. The merger would create a 142-hospital health system with $27.8 billion in annual revenue.

VA touts patient satisfaction, but its findings are questionable

In recent years, the VA has argued that its performance should be measured by by patient satisfaction scores, rather than focusing on appointment wait time backlogs, but a new report finds that the VA has no internal tools to compare its own satisfaction scores with non-VA facilities.

Banning Tablets Is Best for Children

The American Academy of Pediatrics updates its recommendations on screen time for children to say that children under the age of 18 months should get zero screen time, and that those between the ages of two and five should be limited to just one hour per day.

Athenahealth, Allscripts websites down amid nationwide hack

The websites of both Athenahealth and Allscripts were compromised during Friday’s cyberattack on Dyn Inc. A spokesperson from Athena clarified that while portions of its site were down, access to its web-based EHR was not impacted.

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October 24, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 10/24/16

October 24, 2016 Dr. Jayne 5 Comments

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One of the family medicine journals recently published an editorial on preventing diagnostic errors in primary care. It advocates using diagnostic checklists and clinical decision support tools to make sure an appropriate differential diagnosis is considered. Although checklists can be helpful to make sure you arrive at the most likely diagnosis, sometimes physicians just want to know whether we were right and what happened to our patients.

Now that the MACRA final rule is out, we know that HHS plans to continue monitoring to see if EHR vendors are guilty of information blocking. I know I’ve mentioned this before, but I’m still waiting for someone, anyone, to come after the hospitals and health systems that are guilty of information blocking. Especially when treating a patient with an uncommon presentation or a rare diagnosis, follow-up is needed to understand whether the diagnosis was accurate and whether the treatment provided was appropriate or whether there was something more beneficial that could have been done. It’s also important for me to know whether my patients have any complications as a result of my treatment.

This week, I had a couple of rare cases and wanted to track down what happened. In both cases, I had to transfer the patient for further care – one went to a local community hospital where I was an attending physician for many years and from which I continue to receive (erroneous) patient test results. The other patient was refused by the community hospital due to the nature of his condition, so I had to send him to a tertiary referral center where I haven’t been on staff but where I know for a fact that I am in the referring physician database.

In each case, I called report to the facility, giving my name and the pertinent information on the patient’s condition. I also sent copies of the patient’s urgent care evaluation note and the CT scan performed at my facility, both with my name and credentials.

In both cases, when I tried to call for follow-up, I was stonewalled. One facility had the audacity to tell me that, “We have no idea of knowing you are who you say you are” despite the fact that I could accurately give them the patient’s name, date of birth, time of the transfer, and name of the nurse I spoke to when giving report. I urged them to look at the transfer and admission documents to verify my status.

The other facility told me they couldn’t even verify the patient had been admitted “due to HIPAA,” again despite my providing all the information including the name of the attending physician who agreed to assume care.

Last time I checked, HIPAA allows the disclosure of protected health information for treatment, payment, and healthcare operations. Even if you wanted to argue that I was no longer treating the patient, the definition of healthcare operations clearly includes: conducting quality assessment and improvement activities, including outcomes evaluation; care coordination; evaluating provider performance; and certification activities. Despite it being around for two decades, HIPAA is still misunderstood and various entities continue to cite it as a reason to prevent information sharing.

How is this not information blocking? Sharing information verbally and in writing is the precursor to interoperability. And in areas of the country like mine, where there is no consistent platform for EHR-based interoperability, it may be the only way to get information. Where are the HIPAA police when you need them?

If healthcare entities cannot understand a regulation like HIPAA after 20 years, how can there be any hope of everyone understanding MACRA and all its successor requirements that go into effect in a little more than two months?

Hoping that I was just dealing with overworked floor staff who may not understand the nuances of clinical follow-up, I decided to go up the chain and see if I could find another way to get the information I need. I ran a couple of reports out of my EHR and found out how many patients I personally referred to the hospitals in question, as well as how many patients our practice overall had referred in the last year. Knowing that the hospitals have programs where community physicians can have access to their clinical data, I decided to ask for courtesy access. If that failed, I planned to cite the transfer volumes and make a compelling case to be able to access the records in the name of practice-related quality improvement activities. We’re the largest independent urgent care in our metropolitan area and we generate substantial referral volume, so I was hoping they’d bite one way or the other.

Both of them gave me the same response. Unless I apply for and obtain medical staff privileges at the hospital, they have no way to give me access. Being on staff means that you have to actually admit or otherwise attend to patients in the hospital, which isn’t covered under my medical liability insurance since I’m no longer practicing traditional primary care. It’s the reason why I resigned my privileges during my most recent reappointment process to the previously mentioned community hospital, because I couldn’t meet the ongoing requirements.

Hearing the tertiary referral hospital cite the medical staff requirement was especially funny since I know for a fact that they have hundreds of students, researchers, and quality review staff who have access to their clinical data repository, as do payer claims auditors and others. I’m familiar with the fact that they have robust methods for auditing chart access since I helped lead the consensus-building around those methods in my former life. I may also know where the proverbial bones are buried since at least one of their executives worked to stymie our efforts to build a health information exchange.

Yet regulators are going after EHR vendors rather than going after hospitals that refuse to share information with relevant physicians and even with patients themselves. The same hospitals that have accepted countless millions of EHR incentive program money in recent years and who hope to continue drawing down federal dollars continue to be part of the problem despite some feasible solutions.

I’m not letting this go, but plan to continue working may way up the chain at both hospitals. I’m also going to ask at a couple of other area hospitals that receive our patients to see if they will bite and therefore create a precedent. I have a feeling I’m more likely to be blocked then allowed access to the clinical information superhighway.

How does your hospital handle records access and follow up for referring physicians? Email me.

Email Dr. Jayne.

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October 24, 2016 Dr. Jayne 5 Comments

Counting the Costs of a Data Breach

October 24, 2016 News 1 Comment

Fallout from a data breach affects much more than a provider’s bottom line. HIStalk looks at the impact ransomware attacks have on provider credibility and patient loyalty, plus offers tips on shopping for identity theft protection services.
By @JennHIStalk

Data breaches continue to make headlines, and while health IT system infiltrations may not garner as much press as those allegedly perpetrated by Russian hackers, they have providers and patients on edge all the same.

Much has been made of the breaches themselves – how attackers got in, how much ransom was paid, resultant HIPAA violations, etc. – yet little focus has been placed on the post-breach cleanup, which has perhaps the greatest impact on patients and the reputation of healthcare organizations.

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In attempting to handle the aftermath, providers typically send out communications with language similar to that included in Rainbow Children’s Clinic’s (TX) recent letter to the 33,368 patients affected by an August ransomware attack on its servers:

Notification letters mailed today include information about the incident and steps potentially impacted individuals can take to monitor and protect their personal information. Rainbow Children’s Clinic has established a toll-free call center to answer patient questions about the incident and related concerns. The call center is available Monday through Friday from 8:00 am to 8:00 pm, Central Time and can be reached at 1-844-607-1700. In addition, out of an abundance of caution, Rainbow Children’s Clinic is offering potentially impacted individuals monitoring and identity theft resolution through Equifax at no cost. Additional information and recommendations for protecting personal information can be found on the Rainbow Children’s Clinic website at www.rainbowchildrens.com.

The establishment of call centers, websites, and free identity theft resolution for affected individuals may seem logical, but they all come at a cost that some providers just can’t afford. Athens Orthopedic Clinic (GA) has suffered a tremendous amount of community fallout in the wake of a June ransomware attack that affected 200,000 patients. Patients have taken to the local paper and social media to voice their frustrations with not being told immediately about the breach and to condemn the clinic for not offering to pay for credit monitoring.

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“Many patients are upset and frustrated with the situation,” AOC CEO Kayo Elliott said in a statement. “And of course, they wish we could pay for extended credit monitoring. So do we. We truly regret that we are unable to do so, as we are not able to spend the many millions of dollars it would cost us to pay for credit monitoring for nearly 200,000 patients and keep Athens Orthopedic as a viable business. I recognize and am truly sorry for the position this puts our patients in.”

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The mea culpa continued with an op-ed authored by AOC surgeon Chip Ogburn, MD who pleaded with the community for understanding and brought to light the impact AOC’s cleanup methods have had on its reputation. “We are upset with the potential mark this leaves on the credibility and integrity of our clinic,” he wrote in the Athens Banner-Herald. “For 50 years we have endeavored to provide Athens with the highest level of orthopedic care and are even more committed to that promise today.”

Despite AOC’s public-relations efforts, it’s been reported that two law firms are investigating the possibility of pursuing class-action lawsuits against the clinic. Such PR nightmares, while a potentially business-ending burden for AOC, highlight the importance other providers need to place on preparing for such attacks. And while security assessments should be done and protections put in place, clean-up costs like credit monitoring services must be taken into account, too. Preparing for, dealing with, and cleaning up data breaches seem to have become a cost of doing business.

Providers Get Proactive With Identity Theft Protection Services

As with any type of data breach, patients are typically directed to the credit-monitoring and reporting services of three institutions – TransUnion, Equifax, and Experian. While they aren’t the only companies that offer identity protection services, they are the most well known.

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“TransUnion and other credit bureaus are resources for monitoring and protecting credit,” explains Gerry McCarthy, president of TransUnion’s healthcare solutions. “Our monitoring services include fraud alerts for any credit changes, access to live professionals to discuss any credit issues, and optional identity restoration services. In the event of a breach, providers will work with TransUnion and the other credit bureaus to set up monitoring services for affected patients.”

“We are starting to see proactive contracting with our healthcare customers who already utilize our RCM services,” he adds. “They are preparing to act quickly in case of a breach. Our credit and credit-monitoring usage by healthcare organizations has increased dramatically over the past two years. We believe this will be a standard service offered in both healthcare and other industries that deal in both consumer healthcare and financial data.”

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Michael Bruemmer, vice president of consumer protection at Experian Consumer Services, backs up McCarthy’s provider utilization figures. “Last year, we serviced about 3,600 different data breaches and 40 percent of them involved healthcare, including pharma, payers, and business associates,” he says. “We’re seeing the biggest growth in smaller entities tied to a rise in ransomware. About 25 percent of our clients that we’ve been involved with in these circumstances have actually paid the ransom.”

With such an increase, Bruemmer is certain that proactive identity theft protection services will soon become a regular cost of doing business, and perhaps even a customer service / loyalty differentiator. He cites the Blue Cross Blue Shield Association as an example: “They announced last August that all of their plans – 34 separate BCBS entities around the country – will provide free identity theft protection for any of their current members if they want to sign up. This would be in advance of a breach. That was something that the association got behind, and I think that’s a great leading example of where identity theft protection is going to be used as a preventative measure for all patients, employees … even BAs and their staff. If a breach happens after that, they don’t have to scramble and go through the process because people already signed up for it.”

“I think it’s important for patients, especially if they’re switching providers or reviewing their physician’s annual privacy policy, to start asking questions like, ‘Where do you have my records? Where are they being stored? What security practices do you have in place? If something bad were to happen, would you respond?’ I think those are fair questions to ask with any type of provider, whether it’s your dentist, doctor, or pharmacist, let alone your insurance company.”

Shopping Around

Providing such services ahead of a breach sounds nice in theory, but how viable of a solution is it for the average provider, especially independent practices that operate with little cash on hand? Bruemmer explains that Experian’s pricing is based on a number of factors.

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“We have a rate card that we publish out to clients that request it,” he says. “It’s an a la carte menu with prices tiered from quantity one up to the millions of people that could be affected. There are various pricing tiers and it is by each service. You have a cost for notifications, a cost for call center, and then a cost for the product itself. It depends on the circumstances, because in most cases, you’re going to be pricing by the number of people that actually sign up for a product. Let’s say there are 10,000 people affected by a breach. We would charge a wholesale rate for identity theft protection for only those people who subscribe to that protection. We then bill that back to the client who paid for this on behalf of the patients at the end of the breach.”

Aside from price, Bruemmer suggests that providers look at a credit-monitoring company’s experience, performance record, and response time when shopping around for such services. “They should be asking, how many breaches have you serviced? Have you serviced more complex breaches? Will you service small breaches? And then they should look at the performance record by asking, how big a breach have you serviced? What’s your customer satisfaction rating? Do you have any complaints? Any Triple A ratings from the Better Business Bureau?”

“Those are the typical things to look for,” he explains. “The third most important differentiator is response time, because the clock is ticking after a breach is discovered. The response time to a breach – determining how many people were affected and what type of information was compromised – to become legally compliant is important. The fourth factor is actually price, or the price-value relationship.”

Don’t Forget to Use It

Bruemmer stresses that once a provider has invested in such services, it’s important that their affected patients actually use them. “My advice for patients is to, first of all, read the notification letter, email, or visit the website of your provider. Second, take advantage of the services made available to you free of charge. There’s no reason not to sign up for it. Some consumers worry about giving us their information, but we’ve already got things like their Social Security numbers. We don’t allow fraudsters to get in. Last but not least, be curious about things that might happen and ask questions. I’ve already mentioned the questions you’ll want to ask a new provider, but also watch out for any new accounts, any unsolicited emails or letters that you might not normally receive. Those might be early indicators that someone is trying to get more pieces of your identity or use your identity against you. The more curious you are, the easier it is to spot these things. It goes without saying that you should pay attention to the free credit monitoring report or Dark Web service alerts included as part of your provider’s identity theft protection package. We have some people that sign up for the service and they never look at their alerts, which is just unconscionable.”

Be Proactive to Keep the Doors Open

Providers eager to avoid AOC’s predicament should, as McCarthy stresses, “be proactive and ensure they have contingency plans to protect patient information in case of a data breach. This includes having a relationship with a credit monitoring service to protect that information, the long-term identity of patients, and their credit.” It seems that in this digital day and age, taking such proactive measures might also just save a provider’s reputation.

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October 24, 2016 News 1 Comment

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