Recent Articles:

Morning Headlines 9/22/16

September 21, 2016 Headlines 8 Comments

Mixed reactions to CMS tool predicting impact of MACRA on providers’ bottom line

During an HHS Advisory Panel on Outreach and Education, CMS agreed to developing an online tool that will help providers estimate the impact choosing either the MIPS or APM track of MACRA will have on revenue.

Mark Zuckerberg and Priscilla Chan Pledge $3 Billion to Fighting Disease

Facebook CEO Mark Zuckerberg and his wife Priscilla Chan announce that they will invest $3 billion over the next decade on projects that align with an overall goal of preventing, curing, or managing all diseases by the end of the century.

athenahealth Works with CDC and other Specialty Societies to Combat Opioid Abuse

Athenahealth launches a data visualization dashboard trending data related to the nation’s opioid epidemic.

Anthem, Cigna Have Accused Each Other of Merger Breach

A legal filing by the Justice Department reveals that both Anthem and Cigna are accusing one another of violating the terms of their merger agreement. The Justice Department is suing to block the merger on anti-trust grounds.

View/Print Text Only View/Print Text Only
September 21, 2016 Headlines 8 Comments

CIO Unplugged 9/21/16

September 21, 2016 Ed Marx 9 Comments

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

Gotta Serve Somebody!

Contrary to some readers’ comments last blog, I remain committed to the concept that “you’re gonna have to serve somebody, yes indeed.” Bob Dylan made this slang popular with his song of the same name. (Gotta Serve Somebody).

The negative reaction to the concepts of servant or act of service in the workplace is not surprising. Disheartening, but not surprising. If you break it down simply, there are two kinds of people. Those who choose to serve and those who desire to be served. I choose the former. I choose to serve with the former as well.

I view life as service and the workplace no different. I serve my family. I serve my church. I serve my community. I serve my God. I serve my patients. I serve my boss. I serve my employer. I serve those who report to me. I serve my employees. Everything is service. Life is service. I often miss the mark and selfishness creeps in, but service is my default orientation and what I aim for.

I am not sure how a life of service mindset begins. Are we born with it? Is it developed? Is it discovered? I often reflect on it because I believe it is foundational for who we are as people and who we are as leaders. I practice a few things to keep my service orientation keen and my heart soft, and to encourage those who serve with me to do the same.

Simple things:

  • Service vocabulary. We spend most of our lives “working,” so I purposefully substitute service for work in my daily speech. It reframes the way I view things. I don’t loathe to go to work. No! I look forward to serving!
  • Voice of the customer. I programmatically create opportunities for my teams to serve. Clinician shadowing and listening sessions are just a couple of techniques.
  • Healthcare volunteering. I encourage everyone to give back through volunteering. It does not have to be a hospital setting, though healthcare volunteering does directly reinforce the concept of workplace serving. For five years, my oldest son and I volunteered weekly at a children’s hospital. For many years you would find my family spending Christmas dressed as elves accompanying Santa on his rounds.
  • Direct reports. Ask each of them how you can serve them. How you can help them reach their goals? How you may wash their feet? The greatest leaders wash feet, clean toilets and are present in all life transitions.
  • Testimonials. I try to have customers or patients give talks at every team meeting. A 10-minute talk from a patient or clinician is more effective than 500 minutes of speeches from you or me. Recently our CMO spoke to our team. Quiet in demeanor and voice, you could have heard a pin drop as she eloquently wove her personal and professional story together, culminating in reinforcing the critical nature of our team’s service. Wow!
  • Patient encounters. Engage patients whenever possible. Learn their stories. Ask them for feedback. Round with your peers!

Life is difficult and all have been hurt, bruised, offended, or abused. I will never claim to relate to it all, but I can relate to some. I believe we are born with soft hearts, but life happens. Over time, our hearts can become callous and hardened. It is tragic. It is invisible.

External appearances often mask the real world inside. Left unchecked, our attitudes and world view become jaded. I do not pretend to understand the depth of another person’s pain. I am also not going to hide my head in the sand and pretend personal pain does not impact the workplace or how we view things such as service.

While I have been fortunate to witness the softening of hearts in the workplace, I offer no magic formulas or cure-all. Transformations come from counseling, medications, prayer, and other tools I am less familiar with. I am not pushing one transformation method over another, but if you are a leader, I implore you reconsider your viewpoint if you do not believe your role should include servant leader. As a leader, one key to success is to model service, both to those you report to as well as to those who report to you. By embracing this mindset, I guarantee you and your team will transform.

I share this idea in order to break hearts. To reach a broken heart, you must first break the heart. When I see dying kids become excited from winning Bingo, my heart breaks. When I see an elderly couple hold hands one last time in the ICU, my heart breaks. When I see clinicians wrestle with the loss of life, my heart breaks. When I witness a marriage of a couple in our hospital because one of partner is too sick to go home, my heart breaks. When I hear loved ones grieve in our waiting rooms, my heart breaks.

My heart has a propensity to harden, so I constantly try to experience first-hand the impact of my team’s service. Having served this way for many years, I can attest to the fact that when entire teams are mobilized, culture changes and transformation occurs. The best thing? Not only does the organization change and become exceptional at serving patients and clinicians, the individual team members transform as well. Performance and outcomes improve.

You have to serve someone. You might as well choose what and whom.

Footnote. The best resource I have found on servant leadership is Greenleaf.

Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.

View/Print Text Only View/Print Text Only
September 21, 2016 Ed Marx 9 Comments

HIStalk Interviews Eric Widen, CEO, HBI Solutions

September 21, 2016 Interviews 2 Comments

Eric Widen is co-founder and CEO of HBI Solutions of Palo Alto, CA.


Tell me about yourself and the company.

I’ve worked in healthcare my entire career. I’ve had an eclectic mix of experience working for consultancies, electronic health record vendors, for myself for a period of time, and for providers. All with a focus on implementing technology to drive improvement, from a health system standpoint and now more so from a population standpoint.

The theme has always been around using data that’s inherent in these systems to help drive performance improvement. We founded the company on that concept of helping health systems and organizations take advantage of data to improve their performance, Specifically to improve population health approaches by leveraging data that’s mostly residing in electronic health records, which have become more ubiquitous over the last 10 or 15 years.

How do you position the company among the many that offer analytics and population health management technology?

Population health, analytics, and even predictive modeling are broad-based terms and topics. Many vendors are saying similar things.

Where we differentiate is that we’re not a platform company. We’re very much a focused solution that we term a precision health solution or precision medicine solution that’s leveraging real-time predictive models that are proprietary intellectual property that we’ve developed. These are our own real-time predictive models that we provide that drive our precision health solution. That’s a niche focus.

We’re technology platform agnostic. We see this as an important piece to identify people at risk for untoward events before those events happen. In real time, meaning leveraging electronic health record data to do that in order to keep people healthy and from creeping up the disease and cost curve over time. That engine that we built can be installed in many different types of platforms. We think it’s an important piece of the puzzle.

Population health includes analytics, care management to take care of the patients, and the interventions that are going to be applied to patients. Our focus is in real time identifying people at risk for poor outcomes before they happen and then identifying the interventions to apply to those patients in order to mitigate the risk from ever happening.

That engine is what we provide. It can be deployed on many different types of platforms, including interoperability system platforms or EMR platforms. Those two examples of interoperability solution vendors and electronic health record vendors also pitch that they do population health. They provide the platform to do that. Very few organizations are providing the specific engine that we provide.

Are providers becoming willing and able to intervene when their patients are flagged as high risk?

What happens on the provider side today is that they’re balancing multiple incentive structures. They’ve dipped their toe in the water. What we’re seeing is 10, maybe 20 percent of the health system’s population is under a new payment mechanism, meaning at risk and/or upside gain for populations. But they’re still balancing the fee-for-service methodology at the same time. These are schizophrenic conversations. Everyone agrees that future is coming and that taking care of patients and keeping them healthy is going to be the new care model going forward, but they’re not there yet.

Organizations are confused about the speed of when that’s going to happen and it freezes decision making a little bit. Organizations are being successful with the experiments in taking care of patients proactively to keep them healthy in order to make financial gain under these new payment mechanisms. Where they can carve out those patient populations and apply these methods, they’ll restructure their care management processes to do that.

They’re really struggling with that decision when and how to do that. We see them doing it well where the incentives are aligned and there is a service component to that to help them rewire their care management processes to think differently about taking care of patients pre-disease or taking them from an at-risk standpoint as opposed to post-disease, which has been the old care model.

Is it an ethical struggle for providers who are beginning to see the value of providing population health management but realize that it could cannibalize their incomes if they do it or everyone, including those for whom they’re being paid fee-for-service?

I don’t think it’s an ethical struggle. It’s a clear problem to solve. It gets back to the acceleration of when are these going to come in full force.

We have clients that have done exactly that. They’ve done such a good job at using our solution to target patients at risk, keep them out of the emergency room, keep them out of the inpatient setting, keep them on the right care programs to mitigate disease progression, whereby they have reduced admissions and volume to their hospital. They’ve had a struggle with that.

What they’ve said is that this is the right thing to do for the patients at the end of the day, to keep them healthy and out of the acute care settings. What they’re looking to do is figure out how to accelerate taking on more incentive-based contracts and risk-based contracts in order to keep this going.

I don’t think it’s unethical. They had upfront conversations about it and they’re trying to figure out strategically how to continue to navigate this process. All of the organizations we’ve talked realize it’s coming and they’re willing to prepare for it. It’s just a matter of speed.

Providers can’t just unilaterally reach out to a high-risk patient and tell them what to do. Is it a marketing challenge as well as a clinical challenge to get patients engaged in this process that’s new to them?

Disengagement from a patient standpoint is a continuous problem for care managers. The ability to engage the non-engageable is a never-ending problem for the care management folks.

What we’re seeing and what we think is important is that the applying the same interventions to the whole population is inefficient. Applying risk stratification information to your patient population allows you to target both resources and the right interventions to the right patients in order to focus. It’s a much more efficient deployment of resources in order to be successful in this game so you’re not wasting time on patients who are otherwise low risk.

The non-engaged patient population, there’s always a sub-cohort of those patients that are always there. It just requires different skills to engage them from a care management standpoint. It’s very much an approach and a methodology that these organizations need to think about to solve that problem.

We will probably look back years from now and see the readmission focus as tactical, with an uncertain impact on outcomes and maybe even on overall cost. Will this push to identify high-risk patients extend further than just keeping them out of the ED and inpatient beds?

I think that’s right. CMS has been thoughtful about their approach for aligning incentives. They’ve gotten better over time for doing this. You see the commercial insurers following CMS’s lead.

The one metric of focusing on readmissions post-discharge, you do have to apply advanced proactive and thoughtful discharge planning to mitigate a patient from coming back, which includes understanding the local and outpatient ambulatory resources that are available in order to mitigate the acute readmission from happening. Even though it was focused on an inpatient metric, the ability to affect that measure required them to think pretty broadly about systems that are potentially external to their four walls to put these programs into place.

I thought it was a good exercise to being able to mitigate that measure or outcome on patient population against a broader portfolio of measures that they’re going to put into place, which is going to inevitably head to capitation 2.0, payment to keep patients otherwise healthy and not using unnecessary resources to stay healthy.

Couldn’t hospitals dig through their EHR data themselves without additional technology? Also, is it enough to use that inpatient data snapshot alone vs. what might have happened to that patient in the 30-day readmission window?

The philosophy is to use any and all available data on the patient in order to understand what’s going to happen in the future. EHR has provided a great, rich resource for that data set. They are real time and they’re clinically based. But you can augment that with claims data, billing data, and things like natural language processing, which is extracting information from the notes and also connecting that to publicly available data from things like the CDC or census information to understand average income levels or average education levels per ZIP code. All the information that is becoming more and more available on patients is very helpful in predicting the future that’s going to happen.

You want as much information as you can possibly get on a patient to predict the future. That includes not just the inpatient data, but the full gamut of inpatient, outpatient. You’ve got public HIEs, which can provide a rich resource if they’re structured correctly in capturing data centrally to have a longitudinal health record across the geographic area. But what you’re seeing health systems do more and more now is deploying more private HIE infrastructure to tap into that ambulatory information that’s extending beyond their four walls and at least setting up agreements with ambulatory providers to capture as much information to provide a comprehensive view on the patient.

Where solutions like what we provide come into play is allowing the machine to do as much as work as possible to help augment clinical cognitive thinking on the patient population. Computers and computer machine learning and so forth can automate a lot of information that a physician and or care manager wouldn’t otherwise be able to do. It can help them augment their clinical education and background in order to take care of patients by providing more information that they otherwise wouldn’t have.

Another component is the ability to integrate into the workflow. Risk information is helpful in providing the content to understand which interventions to apply to mitigate the risk. Automating that into the clinical workflow so that it becomes part and parcel of what a clinician and or care manager is doing on a day-to-day basis is a necessary component in order to not have bifurcated systems and make the workflow as efficient as possible.

What this gets down to is identifying proactively patients at risk with the interventions that apply to that and automating suggested care plans and orders on the patient that a physician or care manager can quickly think through in order to provide the right intervention to the patient.

Where do you see the concept of predictively identifying patients at risk playing out over the next five years?

When we first started this, there weren’t too many players in the game. What we saw mostly in the market were legacy, claims-based risk vendors who were focused on the insurance market or health plan market. What we’re seeing now are more companies like us using clinical information to provide real-time risk stratification information.

Over time, these will become more of a commodity and part and parcel of doing work because it’s necessary for organizations to think this way proactively about their patients and patient population and keep them healthy at home. All the right incentives are aligning to make this a necessary core component of taking care of patients while they’re healthy, while they’re in a pre-disease state, forever escalating up the risk curve.

View/Print Text Only View/Print Text Only
September 21, 2016 Interviews 2 Comments

Morning Headlines 9/21/16

September 20, 2016 Headlines No Comments

Doctor will see you now – on his webcam: Patient safety fears as GPs pay private firms to give consultations via computer

In England, private doctors are combating long wait times by offering telehealth visits paid for by the NHS.

McAfee Labs Threats Report

McAfee says that ransomware hackers target hospitals because they oversee a perfect intersection of “legacy systems and medical devices with weak security, plus the life and death need for immediate access to information.”

FDA launches competition to spur innovative technologies to help reduce opioid overdose deaths

The FDA launches a developer challenge to encourage the development of an app that would help fight the growing opioid epidemic by connecting “ those experiencing an overdose with the potentially life-saving antidote.”

WebMD CEO Departs By ‘Mutual Agreement’ With Company

WebMD announces that it will replace its CEO David Schlanger with its president since 2013, Steven Zatz.

View/Print Text Only View/Print Text Only
September 20, 2016 Headlines No Comments

News 9/21/16

September 20, 2016 News 6 Comments

Top News


In England, private doctors are offering third-party video visits, such as those marketed by Babylon Health, as an alternative to long appointment wait times, with NHS footing the bill. The British Medical Association warns that it’s risky for patients to receive video advice from doctors who don’t have access to their NHS medical records.

Doctors in England can get paid as video visit providers as long as the patient is outside their geographic area, which critics have called a “slippery slope towards privatization.”

Reader Comments

From  Spiffed Up: “Re: telemedicine visits. Have you ever had one?” I have not, counting myself among the 88 percent of respondents to my April 2016 poll who have not experienced a virtual visit of any kind. It would be fun to hear from doctors who have been involved in virtual visits, either as a provider or patient. I’m especially interested that despite the value we place on electronic medical records and continuity of care, we are OK with for-profit vendors of such services performing a kind of  medical speed-dating (as mentioned in the news item above from England). On the other hand, Americans tend to undervalue those ongoing relationships in reducing the art of medicine to their 30-second description of their problem, preferably with the prescription-issuing process overlapping since that’s what they really want as an outcome. Patients will score doctors highly if they offer easy parking, don’t keep patients waiting, have good bedside manner, and crank out the meds. Only in medicine do we expect vendors (doctors) to exhibit ethical behavior in not selling people profitable things that are bad for them.

HIStalk Announcements and Requests

Eight companies have taken advantage of my New Sponsor Pledge Drive specials so far in September, earning bonus months added on to their new, year-long sponsorships. Contact Lorre to join them. Usually one of the first questions companies ask Lorre is, “Can we attend HIStalkapalooza?” (answer: yes, Platinum-level sponsors get two free tickets). Another is, “Can Mr. H interview our VP of sales about a new product we’re announcing?” (answer: no, I don’t do interviews that focus on company and product pitches and I only interview CEOs).


Speaking of HIStalkapalooza, I begrudgingly agreed to do it again despite the big personal check I’ll be writing if event sponsorships don’t cover the significant cost (the House of Blues bar tab analytics from previous years suggest that a good time was had by at least some). Contact Lorre for a sponsorship information packet. We’re even offering one and only one sponsorship for big spenders who want a bunch of invitations for clients and employees, CEO stage time, backstage access, and many other customized perks.

My latest industry observation: salespeople (and thus CEOs of companies that mostly promote salespeople) rarely have advanced degrees. it’s usually a state college or no-name bachelor’s at best.


September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


Huntzinger Management Group acquires Next Wave Health Advisors.


WebMD parts ways with CEO David Schlanger by mutual agreement, replacing him with President Steven Zatz.


Morgan Stanley is reportedly facilitating discussions among Infor and buyout firms that are interested in investing in the business software company, whose value may exceed $9 billion.



McLeod Health (SC) chooses Cerner Millennium and HealtheIntent to replace its Invision and Soarian systems in seven hospitals.

Prime Healthcare chooses Santa Rosa Consulting for Epic go-live support at its 43 hospitals, with the first wave of activations scheduled for October 1.


image image

Imprivata, fresh off the close of its acquisition by Thoma Bravo, names Gus Malezis (Tripwire) as president and CEO. He replaces Omar Hussain, whose plans were not announced. 


Verscend Technologies (the former Verisk Health) hires Joe Morrissey (McKesson) as SVP of client services.


Video visit vendor HealthTap names Dan Edmonds-Waters (Edmonds Ventures) as VP of strategy and global sales operations.

Announcements and Implementations

McKesson announces Intelligence Hub, which connects its reimbursement solutions to third party solutions and to each other in providing API management, identity and access management, and application service orchestration.


ACOs using population health management solutions from Lightbeam Health Solutions delivered $84 million in savings to Medicare Shared Savings Program in 2015, the company announces.


Oneview Healthcare will hire 100 employees in 2016, half of them assigned to its headquarters in Dublin, Ireland and the rest to its offices in the US, Dubai, and Australia.


Craneware announces data transparency functionality to its chargemaster tools that allow organizations using integrated systems such as Epic and Cerner to view data in one place.


St. Louis-based Ascension will organize itself into two divisions, with the Healthcare Division covering its hospitals and clinics and its Solutions Division running its IT services, group purchasing, and investment activities that are in some cases marketed to other healthcare organizations. The company will also name its 141 hospitals consistently with “Ascension” first to emphasize its national footprint.


Surescripts will offer EHR vendors free access to its National Record Locator Service until 2019.


Coordinated Care Oklahoma will integrate DrFirst’s Backline communication and collaboration tool into its HIE.

Government and Politics


FDA announces the 2016 Naloxone App Competition, offering a $40,000 prize for an app that overdosing opioid users can use to connect with anyone nearby who is carrying the reversal drug naloxone. That’s both a creative technical solution and a sad commentary on America’s massive dependence on prescription and non-prescription narcotics.


A team from CMS’s Center for Clinical Standards and Quality wins the Federal Employee of the Year category in the annual Service to America (Sammies) awards.

The FDA, under pressure from well-organized and impassioned patient advocacy groups, approves a muscular dystrophy drug against the recommendation of experts who say there’s no evidence it works. Shares of Serapta Therapeutics — which offered as evidence only one poorly designed trial involving 12 patients — soared on the news, not surprisingly given that the new drug will cost $300,000 per year.

Privacy and Security


  • A New Zealand medical resident is fired for obtaining information from the local health boards on two members of his family, which he then used as evidence in a court case against them.
  • Four former New York nursing home aides are charged with felonies for taking iPhone pictures of residents in undignified positions and filming themselves verbally and physically tormenting a resident, with some of the images being posted to Facebook.
  • A cybersecurity firm’s brute force scan of Internet-connected FTP servers finds at least 800,000 that can be accessed without logging in.


The quarterly threats report from McAfee Labs notes that hackers are targeting hospitals with ransomware because their legacy systems have weak security, employees don’t have much awareness about security, workforces are fragmented, and hospitals value immediate access to information above everything else. Interestingly, it reports that many hackers consider hospital hacking as violating the unwritten hacker code of conduct, with others worry that the resulting publicity will result in a backlash against Bitcoin. A ransomware author and distributor provides Bitcoin account screenshots that apparently prove that he raked in $121 million in just six months.

A man protests that a Montana law requiring renters to get permission from their landlords before growing medical marijuana for their own use is a HIPAA violation since it forces him to reveal medical information to a third party. Like many under-informed people (some of them in healthcare), he is mistaken in thinking HIPAA broadly guarantees medical privacy rather than requiring only that covered entities practice it (providing a roof over his head doesn’t qualify his landlord as a “covered” entity).


MIT researchers develop the experimental EQ-Radio, which uses wireless,room-based heartbeat and breathing sensors to analyze an individual’s mood with 87 percent accuracy.


McKesson CIO/CTO Kathy McElligott says that analytics and blockchain are the rising trends that most interest the company.


Microsoft says it is working to “solve” cancer by using technology to individualize cancer treatments and analyze tumor images.

Apple hires Mike Evans, MD, a Toronto family practitioner best known for his five-year series of YouTube health cartoons. He declines to provide specifics about his new job, but says it involves his ability to convey a message. He describes the future of healthcare as:

I think the way we engage people will totally change. What happens now is I see you. Let’s say you have high blood pressure. I prescribe you a pill for that. I see you two or three times a year. In the future, I’ll prescribe you an app. One of our whiteboards will drop in and explain what high blood pressure is. The phone will be bluetoothed to the cap of your pills. I’ll nudge you towards a low salt diet. All of these things will all happen in your phone. I see you two or three days a year. The phone sees you every day.

A federal labor judge awards $216,000 to two laid-off CSC employees turned whistleblowers who had complained in 2012 that the company’s occupational medicine EHR could not accurately track patient health risks. CSC went live with the system despite  acknowledging the problem, after which the employees were suspended for colluding with one of CSC’s subcontractors. The judge called CSC’s arguments “an astonishing display of chutzpah” given that the company couldn’t say what information the employees were supposed to have shared,  could not identify who suspended them, and withheld the special pay it promised the employees for the extra hours required to bring the EHR live.

In South Australia, the Allscripts Sunrise EPAS system is blamed for losing computer entries and thus not allowing a hospitalized dementia patient’s death to be reported to the coroner as the law requires. The health minister says the system is being urgently upgraded to highlight deaths that occur while undergoing treatment.


In England, Leeds Teaching Hospitals NHS Trust diverts patients after a computer problem leaves it unable to report pathology lab test results.


Drug companies that sell opioid painkillers have unleashed an army of lobbyists and donated millions of dollars to political campaigns in trying to protect their profits by defeating proposals that would restrict the prescribing of narcotics. The companies are funding non-profits, including the American Cancer Society’s Cancer Action Network, that advocate narcotics-friendly policies. Drug companies even strong-armed the passage of a Maine law that they themselves wrote that requires insurance companies to pay for their particular painkillers.


A rural hospital in Iowa complains that it can’t always reach its doctors by telephone and patients who call the hospital for appointments don’t always get through. The problem is caused by the patchwork system of telephone carriers required to deliver calls to rural America, with big telephone companies sometimes electing to simply drop a call rather than pay a rural carrier an amount that would leave it with no profit.

In Australia, NSW Health pledges to implement chemotherapy dosing guidelines in its systems following the under-dosing of at least 130 patients by a “fly-in, fly-out” oncologist who responded to a pharmacist’s questioning of doses with, “Tell them to mind their own business.” The doctor argues that oncology dosing guidelines are often outdated and says he used lower doses to reduce toxicity.

A Validic survey of drug companies finds that 60 percent have used digital health technologies in their clinical trials and 97 percent expect their use of such tools to increase.

image image


Epic UGM is underway in Verona, WI this week, with attendees and others tweeting some photos.

Sponsor Updates

  • Forward Health Group is sponsoring the Best Practices for Value-Based Care conference September 21-22 in Dallas, TX.
  • Aprima will exhibit at the American Academy of Pain Management annual meeting September 22-24 in San Antonio. The company also completes its move to new headquarters in Richardson, TX.
  • Aventura will exhibit at Health 2.0 September 25-28 in Santa Clara, CA.
  • GE Healthcare will invest €150 million to establish a biopharmaceutical manufacturing campus and advanced manufacturing training center in Ireland.
  • TeleTracking President Michael Gallup testifies before the House Ways and Means Subcommittee on Health.
  • Clinical Computer Systems will integrate its Obix Perinatal Data System with Medhost.
  • Impact Advisors is named to Modern Healthcare’s Largest Revenue Cycle Management Firms.
  • Besler Consulting releases a new podcast, “What the end of the ICD10 grace period means for your hospital.”
  • CapsuleTech and FormFast will exhibit at the InSight McKesson User Group Conference September 27-28 in San Antonio.
  • CoverMyMeds sponsors the Columbus Women in Technology Conference.
  • Cumberland Consulting Group will exhibit at HFMA’s Revenue Cycle Conference September 25-27 in Phoenix.
  • ECG Management Consultants will exhibit at the West Coast ASC Seminar September 27 in Los Angeles.
  • Built in Austin profiles E-MDs CTO Alan Ortego.
  • Extension Healthcare will exhibit at the AAMI Regional Event – Hot Topics in Clinical Care September 27-28 in Chicago.

Blog Posts


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


View/Print Text Only View/Print Text Only
September 20, 2016 News 6 Comments

Morning Headlines 9/20/16

September 19, 2016 Headlines No Comments

Centralized Repository for Public Health Agencies and Clinical Data Registry Reporting

CMS announces that it will develop a public health centralized data repository to help EP, EH and critical health hospitals find entities that accept electronic public health data.

LabMD warns FTC decision creates overbroad data-security power

Defunct clinical laboratory LabMD continues its fight against the FTC, saying that the agency is exercising unauthorized regulatory powers by leveling civil penalties against businesses it feels have inadequate data security policies.

Biden outlines a lifelong role in cancer research, but not in a Clinton White House

In a STAT interview, Vice President Joe Biden says that he will dedicate his career to cancer research once he leaves office.

High-level Meeting on Antimicrobial Resistance

The UN will convene a one-day meeting on antimicrobial resistant super bugs to discuss potential government roles in addressing the issue and  to develop “strong national, regional, and international political commitment” to combat the growing threat.

View/Print Text Only View/Print Text Only
September 19, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 9/19/16

September 19, 2016 Dr. Jayne 4 Comments

A reader clued me in to this great piece in Forbes that discusses the 15-minute office visit. It ties the origin to Medicare’s RVU (relative value unit) formula and its attempts to standardize the calculation of physician fees. The RVU formula factors in geography, practice expenses, liability insurance, and a Medicare “conversion factor” in an attempt to level the playing field for physicians. Translating the average visit’s RVUs using the American Medical Association’s then-current coding guidelines resulted in an average 15-minute office visit.

The RVU formula came into being in 1992. We’ve been through some cyclic changes in healthcare with the rise of managed care, a frenzy of hospitals purchasing practices, the subsequent divestiture of the practices, then back to integrated delivery systems and hospital ownership of physician practices. The change has recently been fueled by the rise of Accountable Care Organizations and other risk-sharing programs as well as the regulatory pressures stemming from HITECH and resulting incentive (now penalty) programs.

Medicine has changed considerably in the last 24 years. Decision-making has gotten more complex. Many patients are more empowered and take an active role in their healthcare. These visits often require more time due to detailed discussions of the pros and cons of various treatment options or diagnostic maneuvers. Unless physicians are coding based on the face-to-face time spent in counseling or coordination of care, it’s hard to get insurance payers to adequately pay for the time spent on those visits. Payers often ask for loads of documentation to justify the visit code, which results in additional work and expense to the practice.

Payers have created lists of codes they won’t pay, regardless of the medical realities. Case in point: I recently diagnosed a patient with a skin infection, most likely from time spent in a hot tub with inadequate cleaning procedures. The patient required antibiotics and I had to take a detailed history to make sure I was selecting the correct drug based on the likely infectious agents. It probably lasted less than 15 minutes, but I was rewarded a week later with a denial because the insurance company refuses to pay for a diagnosis of folliculitis. My staff had to handle the request, then send it to me for potential re-coding, and then we had to submit the claim again. Knowing how much time had already been wasted, I slapped a couple of potential diagnoses on the chart in the hopes that I’d hit the jackpot with one of them and would actually be paid.

Why is that OK? The patient had an actual problem, it required thought to diagnose, antibiotics were needed, and the visit was legitimate. Counseling on hot tub hygiene was given. The problem wasn’t self-limited and was unlikely to resolve without medical attention. I see dozens of people who come in with issues that could be easily handled by a well-trained Scout with a first aid kit and I get paid for those, but this time the insurance decided they just weren’t going to pay for that particular diagnosis.

Whenever physicians complain about everything they’re trying to cram into the 15-minute office visit, the first answer is that maybe we don’t need physicians to provide the care. Nurse practitioners and physician assistants should be used as well as various care team members with a range of clinical training experiences. Regardless of who is delivering a given level of care, it still takes time to deliver it, document it, and make sure the patient understands the steps they need to take prior to the next episode of care.

In many states, nurse practitioners and physician assistants practice independently. We just had a mini-revolt in our practice when we tried to credential our physician assistants to work without a supervising physician. The maneuver was intended to lower the cost of care, but several PAs refused to take part, reminding our leadership that their title was “physician assistant” rather than physician and that they went into the field to assist physicians rather than to try to be interchangeable with them.

I often practice alone, without a second clinician to jump in if the office gets busy. Those 15-minute visits become shorter and shorter when we have six or more patients streaming into the waiting room every hour. Most come because either they can’t get after-hours care from their primary physician or because they don’t have a primary physician. Our mission is to address their issues as completely and compassionately as possible, and knowing that payers can just decide not to pay for our services really puts a shadow over the whole concept of what we’re trying to do.

The editorial mentions that of the typical 15-minute office visit, physicians may spend 37 percent of the time doing paperwork. I’m fortunate to work for an organization that values physician time and staffs the practice with scribes during peak periods so that physicians and our independently-practicing PAs can focus on patients and not paperwork. Most of the time my notes and orders are complete before I walk out of the exam room, which is truly a beautiful thing. Patients appreciate our focus, but having a qualified scribe doesn’t come cheap. A good number of our scribes are students and recent graduates who are applying to medical school and who are looking for experience. It continues to amaze me that people would still consider a career in medicine after what they see in the trenches.

Using a figure of 37 percent leaves eight minutes for the actual office visit. The piece breaks down the patient activities that must fit into that time slot: social constructs like saying hello, disrobing if you didn’t change already, explaining why you’re seeking medical attention, being examined, etc. It suggests that patients shouldn’t take more than two minutes to tell their story, likening the time slot to that of a commercial break during broadcast television. “If four companies can get you to buy things in two minutes, surely you can tell your whole story.” That works if patients have focused or prepared, which is a rarity. Usually when I ask how long something has been going on, patients have to work through a series of cues to figure out the timeline. “Well, it started when I went to Michigan for Dean’s wedding, that was in the spring, no maybe it was early summer…” and there you have it.

I don’t blame patients who haven’t prepared – they should expect more than assembly line care with physicians running on the hamster wheel. They’re seeking care, not auditioning for a play or interviewing for a job. However, as long as insurance companies (including government payers like Medicare and Medicaid) are intermediaries and patients aren’t able to understand the full cost of care, things aren’t going to change. Patients who are actually paying for the physician’s time are going to demand his or her full attention, not an overly-truncated excuse of an office visit.

Building a patient-physician relationship takes time and medicine isn’t something that’s practiced by following a cookbook approach. Technology can help,but it’s not the be-all, end-all solution for healthcare’s problems. However, it seems to get most of our focus. Patient-empowerment movements have helped raise awareness of the need for greater partnership and shared decision-making in healthcare, but no one wants to pay for it. Cost control will continue to be a downward pressure with clinical and emotional consequences for both patients and caregivers. Eventually something has to give.

When will we reach the boiling point? Have ideas on how to fix things? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
September 19, 2016 Dr. Jayne 4 Comments

HIStalk Interviews Travis Bond, CEO, CareSync

September 19, 2016 Interviews No Comments

Travis Bond is founder and CEO of CareSync of Tampa, FL.


Tell me about yourself and the company.

I’m the founder and CEO of CareSync, which is my ninth company. My last company was Bond Technologies, which created one of the very first browser-based EMRs in the world. We had the opportunity to exit to the Eclipsys Corporation back in 2008, I believe.

I put the band back together in 2011 to create CareSync, which is a patient-centered electronic medical record that has a service on the side that basically acts as a record aggregator service. Carbon-based interfaces go out and get records and put them in a usable format that can be later searched, shared, and collaborated on. That all gave way to a business opportunity that CMS created in 2015 for chronic care management. That’s where we are today as one of the industry’s largest providers of chronic care management services under the new code.

Which is the chicken and which is the egg in offering a product that both consumers and their providers use?

It was probably providential in some ways that we cut our teeth on a consumer product. We weren’t bound by Washington, DC regulatory requirements for a product roadmap. What’s really useful for people when they become a clinical patient is they need information and they need resources that help them to shorten the gap between what providers are saying and doing on their behalf and how they can then respond. That product, started in 2013 and known as CareSync Plus, had about a 3 percent conversion rate when we went out and advertised it to people.

It is the CMS product that now gives us the business-to-business product. We act as the vendor on behalf of the provider to offer essentially the same service. The difference — and why we still have a chicken and an egg — is that about 5,000 members a month come onto the CareSync platform as family members. Some of those family members want the same services that CCM provides under CMS for themselves. We really couldn’t sunset a legacy product when there were still people who wanted to be more of an active caregiver or wanted to be more engaged patient.

What is the scope of the CCM business?

CMS has released information only about twice on how many people and how many claims they’ve produced. At last count several months ago, about 300,000-plus have been enrolled in CCM programs since their inception in 2015. From our point of view,  the geography of that number of claims is all 50 states. We have users in 30 states alone. It’s not really because we had any grand master plan, it’s that there is an alignment with many practices that want to try to care for people where they live, work, and play, not just at points or nodes of care.

I think CMS was disappointed that it did not ramp up as quickly because CMS had identified that they were going to pay $10+ billion every year for this program. Theoretically, it created a much bigger total adjustable market per year, $16 billion in 2015 and 2016. That number actually increases to a possible addressable market to $20+ billion because now they’ve given three new codes out to incentivize the market. One is an enrollment code and the other two are to address complex chronic care.

It’s not going away. It was a slow-starting process, but it’s being addressed from many different areas. The inevitability of chronic care management programs throughout healthcare has pretty much been set in stone and will just continue to grow as other new things have been introduced in healthcare over the last several decades, like HMOs and PCMHs and others. This is just another one in the fold that will continue to mature.

If I’m a physician and I think you’re a candidate to participate in CCM, what is your obligation as a patient?

It’s really quite simple. There is the consent process, which CMS wanted to know that there was written confirmation that a patient was elected to participate in something that they were eligible for. In this case, two or more chronic conditions. The chronic conditions, though, were very liberally interpreted by CMS, meaning that they were not going to actually put edits on what a provider thought was a chronically ill condition for the patient. If you look at ICD-9 alone, there are over 4,500 conditions which are marked or flagged chronic in nature.

From a patient’s perspective, it really is how you design the program. Patients need to have access to information, electronically or written, and have access to those that can access that information and are clinically trained or licensed 24/7. It’s more of an access from the vendor or the provider’s perspective. The patient, outside of them consenting to the program, just needs to make themselves available. The program  is designed to give back more time and resources to where patients need it and that’s in the consumption of the treatment plans that various providers are administering to them, a reconciliation of that.

We’ve found that variability of patient engagement is as wide as any that you could imagine. Some just like to be called once a month and talked to. Others will have inbound calls and want to talk extensively about their progress. We have patients that will be a few minutes a month or it could literally be in the several hundred minutes per month. Patient requirements are still low, other than their co-insurance or co-pay responsibilities.

Otherwise, it’s intended to be a service that is aggregating information, creating a comprehensive care plan that the patient can then consume and can be collaborated and administered, and then lastly, creating a health summary that can be provided back to the patient or anyone who is seeing the patient. Overall, patient requirements are still low, but it’s incumbent on the provider to maximize the value to the patient of the program as prescribed under CMS.

How does Medicare verify or monitor that services were provided and not just billed?

In the CMS program, you bill Medicare and they pay based upon whatever edits they can run through a computer system. They don’t verify until they actually audit.

This code is really no different. They’ve said at least initially in the first couple of years that they weren’t going to put edits on their claims, meaning that they weren’t going to necessarily determine whether a chronic condition had met some criteria that Medicare would feel is not chronic enough or chronic in the right way. They’ve left that up to the physicians’ discretion.

What we’ve found is we have hundreds of chronic diseases that are on our lists for the patients who we serve. As you know, there are even several thousand rare diseases that meet the chronic definition. As it stands right now, we’ve not seen any claims denied as it relates to the diagnosis that has been tied to the CPT code 99490.

How did CareSync’s recent $20 million in new funding come about and how has it changed what you do?

We were very fortunate to have a lot of venture capitalists and strategics already having conversations with as it related back to our legacy product, CareSync Plus. Many people felt that there needed to be a connective tissue, if you will, for patients where they’re in the space that we call the dark space, which is where you are when you’re not at an appointment or a hospital setting. This dark space is like trying to navigate between airports without a radar system or air traffic control. The thesis was that surely some entity or some party would benefit if patients were better monitored and/or had the opportunities to help themselves adhere to what was prescribed.

When the code came out, it was the match that lit the fire. We were setting ourselves up with people who thought that there were problems in healthcare that could be solved with a combination of nurses and technology. Having those things in place when the code came about allowed us to execute on closing financing rounds from those players. They have since then recommitted to continuing to fund CaresSync.

We feel that the chronic care management market will continue to grow significantly, especially under the new codes in MACRA. We have 18 months of solid data that shows that providers are getting paid. We’re seeing real tangible benefits for clinical outcomes as well. Nine percent of our patients that come into the system have a severe drug-to-drug interaction that no one knew about. That’s nearly one in 10, which is pretty significant because it’s the severe drug-to-drug interactions that potentially are lethal. Sixty-four percent of our patients avoided a duplicate test because they had the results with them. A provider avoided re-prescribing another test because they felt that they had the results that they needed at the time of care.

There are many things that illustrate the advantages of the program. Those things obviously matriculate back to value when you look at an investment community. The key thing in pairing up investments from the investment community and being an entity in this space is the ability to execute at scale. We have found that it is much easier to have a chronic care management program at 30 nurses than it is 300. There are natural elements of growing and scaling that process and learning a lot of things along the way.

I think that what you’ll see overall in the market is that there will be a continued interest from the investment community in supporting this dark space and the vendors that emerge from this innovation opportunity.

Are you seeing any improvement in the ability and willingness of hospitals to provide patients with their electronic records in whatever form they request?

They’re getting a little bit better, but we’re getting a lot smarter. It’s the combination of the two that has created the net result that we are getting better, faster results from the data.

There has been an implementation of these HIT systems lag, in terms of those professionals who are running these systems even knowing that there are features to share the information. There’s still the HIPAA cloud of death and despair that hangs over all of these institutions. They feel that they need to protect this data, even from those who originated it, like the patient. That becomes primarily an education step. There’s still also a lot of medical-legal sensitivity. Why does a person want their data? Do they think we did something wrong?

That’s still a case-by-case process that we have to go through at CareSync. It’s still far easier for a provider to request information than it is a vendor. A vendor is always suspect. It is slowly changing. I wouldn’t say that we have a marked increase in the amount of freedom of information posture of these institutions that hold large amounts of it, but at least we’re seeing some incremental changes in a direction for the positive.

You were selling EHRs in the heady days. Are you glad you aren’t still in the EHR business?

Yes. [laughs] I am glad that I’m not there. In retrospect, the advent of EMRs bogged down the efficiency of a visit.

Having some medical training acted as the foundation for creating our EMR program and helped me. Technology took away from a lot of the observation skills. A  good portion of medical school training is spent in diagnostics and observations of patients. Those just can’t be done simultaneously while also working through documentation requirements.

Hopefully, programs like chronic care management and other things that try to reintroduce an experience that the patient feels comfortable in talking and sharing information and how that’s captured — I’m hoping that we can blunt some of the negative impacts that EMRs had. But I would say that if I ever had to be reincarnated, I would not go back into building any piece of software for ambulatory healthcare. That was a very painful pioneering pathway to walk.

Do EHR vendors get blamed for too many clicks and too much pointless information collection instead of those parties on the back end who require collecting that information before paying providers?

Yes. I would have to side with the EMR vendors on this one. It’s not their fault. It’s Washington, DC that creates the product road maps for vendors now. It’s not what users want.

Users want a certain amount of clicking so that they can document, recall, and have that information available for the next visit or for other providers. There’s real fundamental and foundational value to EMRs. But the direction they’ve taken in terms of usability, unfortunately, was hijacked by those that were writing the checks for them in the first place. Under ARRA,  the government was paying for them, but as a result of them paying for them, they were able to create what they were going to be under Meaningful Use.

There’s always a balance here. We are better off that we now have EMRs, undeniably. You’re in a far better place in being able to record this information a way that we can learn it more rapidly off the science of healthcare and treating those that have disease.

The disadvantage is that we’ve made the billing system on par with the IRS tax code. We’ve made it so complicated that it’s very difficult to do an effective visit with the necessary amount of documentation in a way that demonstrates what took place such that it could be reimbursed on par for what happened. I’m hoping that we’ll eventually get through this, but I’m worried about the overall physician dissatisfaction with their job as we go through this lonely period of transition.

Are consumers really gaining power, demanding their data, and becoming involved as participants in their own care or are we just wishfully thinking that was the case?

I think it’s slowly happening. The best chance that we have in terms of developing technologies for patients is that patients are becoming more consumer aware. That to me is probably the biggest weapon that we have. The patient is probably the greatest sleeping giant in all of healthcare. When you go through Uber or a good banking scenario or a good restaurant experience, you understand how brands compete for your business, your attention, and the right to serve you. They see that as a privilege. That’s how good businesses become great businesses.

Healthcare has had the patient lag, where they’ve been more passive and they’ve not really felt like they’re in an empowered position. I think a lot of things will start to accumulate to hit a tipping point where the patient will be more in a position of a consumer. When that light bulb goes off, the technology that they’re experiencing healthcare in needs to be more on par with other things that they experience in their lives.

The biggest advantage to the payer, the provider, and the patient is that when you look at where healthcare falls down, it doesn’t fall down in a science problem. It falls down in to an adherence and data-sharing problem. It’s not like we need better cures — we just really need to implement more effectively the ones we’ve already discovered.

Where do you see the company and the industry in the next 5-10 years?

We’ll be making more decisions in real time. Things like IBM Watson and other types of analytics that will be under the hood … we’ll  see like a TurboTax for health. These things have happened, so you need to do these things.

The problem with healthcare that we’re going to finally get our hands around over the next 10 years is, how do I go do those things? If somebody tells me to get an MRI, who’s going to do that for me? Innovation is going to start to fill in this last mile of putting the things that need to get done to actually getting done and being tracked. That will start to figure its way out over the next 10 years, principally because it’s being funded against something that is challenging our economy, where 86 percent of the dollars are being spent out there to manage chronic disease. If we don’t get our hands around it, we will end up breaking both the legs of the US economy.

What will change is that vendors, payers, and providers will figure out how to play nicely with the patient who ultimately is writing a big part of the check, whether in taxes or insurance premiums. They will start to find an experience to where they’re now more engaged. Not in vendor classic term of engaged, but making them a more efficient component of the healthcare equation.

View/Print Text Only View/Print Text Only
September 19, 2016 Interviews No Comments

Morning Headlines 9/19/16

September 18, 2016 Headlines No Comments

Operations Returning to Normal at ARH Facilities as Computer Systems Go Back Online

Appalachian Regional Healthcare (KY and WV) reports that its networks are back up after a cyberattack left the health system running on downtime procedures for the last three weeks.

Community Health Said to Explore Options Including Sale

Community Health System’s shares climbed 16 percent on rumors that the 158-hospital health system is looking for a buyer.

Cambridge trust sets outsourced commodity IT services market-test

In England, Cambridge University Hospital NHS Foundation Trust looks to outsource its IT infrastructure, service desk, and security services in a seven-year, $182 million request for proposal.

HHS takes steps to provide more information about clinical trials to the public

Drug and medical device companies will be required to publish all NIH-funded clinical trial results to beginning in January 2017.

View/Print Text Only View/Print Text Only
September 18, 2016 Headlines No Comments

Monday Morning Update 9/19/16

September 18, 2016 News 1 Comment

Top News


Appalachian Regional Healthcare brings the computer systems of its Kentucky and West Virginia hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by an attack of unspecified malware. At least one hospital source says the attack involved ransomware, but the hospital declined to confirm citing an ongoing federal investigation.


ARH says its IT department took its systems and network down to stop the spread of the virus, causing downtime it described as causing “some inconvenience for a few weeks.”

Reader Comments


From Follow the Money: “Re: Mayers Memorial Hospital District (CA). Their EHR was down for two weeks at a cost of $100,000.” The forwarded board of directors meeting agenda did not indicate the source of the downtime, but says half of the $100,000 was spent on “equipment to mitigate future issues.” I don’t know which system was down, but an earlier board meeting agenda mentions Paragon. It’s fun to read a small hospital’s simply written meeting information, which includes such interesting thoughts as an upcoming chocolate festival fundraiser, the poor attitudes of the ED doctors, a sticky ED door that unintentionally left the department open to the public, and the development of an IT disaster backup solution that might need to be revisited.

From HTCGLOBAL: “Re: CareTech Solutions. Jim Giordano is no longer president and CEO as of this past Friday. Seven top executives have resigned in the past six months. HTC Global continues to offshore work.” Unverified, but the company’s executive page and Giordano’s LinkedIn profile are unchanged. HTC Global Services, which offers IT and BPO services, bought the company in December 2014.

From Ex-PwC Consultant: “Re: PricewaterhouseCoopers Advisory Services. Has been quietly laying off workers all summer, with rumors of 20-25 percent let go.” Unverified.

HIStalk Announcements and Requests


Nearly half of poll respondents think the most important healthcare issue in the presidential election is healthcare costs. New poll to your right or here: who would you vote for if the presidential election were held today?

I’m excited to offer (below) the first of an ongoing series I’m calling Decisions. I’ve been talking with the folks at Definitive Healthcare about getting fresh updates about hospital software decisions and the company graciously offered to share what they learn with HIStalk readers. They didn’t even ask for anything in return, not even a plug, but it’s only fair to credit them as the source.

Last Week’s Most Interesting News

  • HHS awards $87 million in EHR improvement grants to 1,310 safety net health centers.
  • Altos announces that it will acquire Anthelio Healthcare Solutions for $275 million.
  • McKesson withdraws its participation in the independent InSight user group conference after Meditech and Cerner are invited to present alternatives to McKesson Paragon.
  • Russian backers breach the World Anti-Doping Agency’s systems and publish the medical records of Olympic athletes.
  • Apple releases iOS 10, which includes C-CDA support via HealthKit.
  • In England, NHS awards $13 million each to 12 health IT global exemplars to establish best practices.
  • Dartmouth-Hitchcock Medical Center (NH) will lay off 460 employees, blaming its financial losses on billing-related expenses and implementing of new IT systems.


September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


Money-losing, for-profit hospital operator Community Health Systems is rumored to be exploring the sale of its business, although the company’s massive debt may limit interest. Shares are down 76 percent since June 2015 even after a 16 percent jump Friday when word of the possible sale leaked out. The company operates 158 hospitals.



The Healthix HIE (NY) chooses Verato’s identity management technology, which claims to deliver up to 98 percent matching accuracy by comparing known information to that contained in commercially available databases. The VA is another customer. Verato raised $12.5 million in a single funding round in January 2015 under its original name Araxid.


  • Blue Mountain Hospital District (OR) will change time and attendance software from Healthland to ADP on October 1, 2016.
  • Valley Hospital (WA) will switch from Meditech to Cerner in 2017.
  • Lakes Regional General Hospital (NH) will move from NextGen to Cerner in December 2016.
  • Saint Clare’s Hospital – Denville (NJ) will replace Cerner with Epic in early 2018.

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

Announcements and Implementations


In England, Cambridge University Hospital NHS Foundation Trust will outsource its IT infrastructure services for an estimated $182 million over seven years. HPE provides those services now via a 10-year agreement signed when the trust chose Epic in 2012. The trust’s growing financial deficit and significant quality problems triggered the resignation of its CEO and finance director in September 2015.

Government and Politics


The National Institutes of Health will require drug and medical device companies to post the results of all NIH-funded clinical studies – not just the favorable ones – to starting January 18, 2017.


Oracle will pay $25 million in cash and provide products worth another $75 million to settle lawsuits over its performance in the failed Cover Oregon insurance exchange, for which Oracle was originally paid $240 million. The state had sought $6 billion in damages, but wasn’t willing to take the case to trial since legal fees alone would have run $1.5 million per month and it had already paid lawyers $20 million in the several lawsuits each party filed against the other.

Privacy and Security


Forward Health Group’s security expert Ed Skaife is named Up and Comer Runner-Up in an international security leadership award competition.



The three big drug companies that manufacture insulin have increased average prices more than tenfold in the past 20 years in lockstep, with all three companies expressing indignation that anyone would look at list prices since insures get big discounts. The chart above shows the price of Humalog and Novolog, but you would notice that only with sharp eyesight since the prices remained identical while rapidly increasing over 20 years.

Vince and Elise offer Part 7 of their “Rating the Ratings” series, this time looking at physician practice EHRs.

Sponsor Updates

  • Experian Health will exhibit at the RBMA Fall Educational Conference September 25-27 in New Orleans.
  • PatientMatters will exhibit at the Minnesota Hospital Association Annual Meeting September 21-23 in Brainerd.
  • Qpid Health, Sagacious Consultants, Versus Technology, and Zynx Health will exhibit at Epic’s UGM September 21-23 in Verona, WI.
  • Red Hat announces plans for new facility in Boston.
  • The SSI Group will exhibit at the AMSURG Connections Café September 28 in Lake Buena Vista, FL.
  • Sunquest Information Systems will exhibit at CAP’16 – The Pathologists Meeting September 25-28 in Las Vegas.
  • Surescripts will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
  • Audacious Inquiry is sponsoring the SHIEC Annual Conference in Scottsdale, AZ this week.
  • Meditech will attend the 2016 InSight Annual Conference September 27-30 in San Antonio, TX.
  • TeleTracking sponsors The DAISY Award for Extraordinary Nurses.
  • Tierpoint will host Techpalooza September 22 at its facility in Durham, NC.
  • Valence Health will exhibit at the ASHHRA annual conference September 24-27 in Grapevine, TX.
  • Verscend will host its annual conference September 27-30 in Palm Desert, CA.
  • Consulting Magazine includes Huron on its list of 2016 Best Firms to Work For.
  • Healthwise is included in Fortune’s “100 Best Workplaces for Women.”
  • ZeOmega launches the ZeExchange e-newsletter.
  • ZirMed will exhibit at HBMA The Healthcare Revenue Cycle Conference September 21-23 in Atlanta.

Blog Posts


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


View/Print Text Only View/Print Text Only
September 18, 2016 News 1 Comment

Morning Headlines 9/16/16

September 15, 2016 Headlines No Comments

HHS awards over $87 million for health centers’ IT enhancements

HHS announces $87 million authorized within ACA to help  health centers in the US implement EHRs and transition to value-based reimbursement programs.

Library of Evidence to Aid Radiology Imaging Decisions, Curb Wasteful Tests

Harvard Medical School launches a free clinical decision support system designed to help doctors chose appropriate imaging tests for each patient. The system will integrate with EHR systems so that the evidence is presented to clinicians within existing workflows.

Eight Senators Introduce Emergency, One-Year Legislation Allowing States to Offer Americans More Health Insurance Options Next Year

HELP Committee Senators, including HELP chairman Lamar Alexander (R-TN) introduce a one-year emergency bill that would expand purchasing options for consumers that rely on public insurance exchanges for health insurance and waive the mandate penalty for those that did not buy insurance.

25 CIO pay packages revealed

NetworkWorld profiles the 25 highest paid CIOs, with Walgreens CIO Tim Theriault topping the list at $13.6 million and former Kaiser Permanente CIO Philip Fasano listed third in his new role at AIG, where he earns $8.4 million.

View/Print Text Only View/Print Text Only
September 15, 2016 Headlines No Comments

News 9/16/16

September 15, 2016 News 12 Comments

Top News


HHS will provide $87 million to 1,310 safety net health centers for purchasing or upgrading EHRs, supported by the ACA’s Community Health Center Fund that was extended under MACRA.


HHS reports that 98 percent of health centers use EHRs. Nearly three-fourths of the patients they serve are insured.

Reader Comments


From Lana Retentive: “Re: Charleston Area Medical Center (WV). Goes live this week in the first prominent Soarian to Millennium conversion that was supposed to have been completed in June. The go-live vendor has been asked to bring in SMEs in charging and patient accounting, but no word on whether they’re using a charge validation vendor.” Unverified.


From Xander Steel: “Re: startups. You told the would-be CEO that HIStalk readers won’t be interested in companies until they reach either $1 million in funding or $5 million in revenue. I’m not really interested in stories about capital raised when there’s no existing demand. Any chance when you disclose investment funding that you can also mention whether the company has actual revenue? I know it’s easier said than done since the companies aren’t publicly traded.” I don’t know how to get revenue information since those small companies rarely want to disclose it (which tells you that it’s likely minimal) and their numbers would be self-reported and unaudited anyway. My newsworthiness threshold of $1 million in funding is low enough that many companies can raise that much without having any paying customers, which doesn’t necessarily mean you would be wise to become one. Significant funding suggests that investors with access to inside information bought in for good reason, but that might be based on future opportunity rather than present revenue (much less profit).


From Doughboy: “Re: Epic. Can you believe that a publication ‘reported’ that the company’s R&D spending exceeds Silicon Valley companies without doing any type of verification?” I believe it. The obviously star-struck publication ran Judy Faulkner’s claim that Epic spends 50 percent of operating expenses on R&D without validating that number, then compared it to the SEC-filed data of Epic’s publicly traded competitors in trying and failing to make a point without letting those companies respond. The goal was obviously to earn clicks, not to provide useful information.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor InMediata. The Charlotte, NC-based company‘s InBanking payment reconciliation solution eliminates manual ERA payment and patient payment reconciliation to bank deposits; automates complex billing scenarios by splitting ANSI 835 files into separate billing systems; and converts paper payments to electronic files for posting and reconciliation. CEO and industry long-timer John Marron explained the “banking as the last mile” problem well when I interviewed him a few months ago, pointing out that while front-end RCM functions are mostly automated and clearinghouses have become commoditized, the back-end work (payments, reconciliation, and payment analytics) is mostly inefficiently manual. Thanks to InMediata for supporting HIStalk.

This week on HIStalk Practice: Medical associations weigh in on new MACRA options. The Maine Medical Association endorses DrFirst eRx solutions. AMD Global Telemedicine expands Massachusetts headquarters. Mediware adds PQRS reporting capabilities to its rehab EHR. Lynchburg, VA-area practices join Privia Medical Group. CompuLink gets into telemedicine.

This week on HIStalk Connect: Sanofi and Verily Life Sciences launch diabetes management company. Chrono Therapeutics raises a $47.6 million Series B. Frost & Sullivan recognizes Validic with an innovation leadership award. Samsung-backed smart belt startup raises more than double its Kickstarter goal.


I’m beginning to think that a significant percentage of health IT executives sport disfiguring facial injuries or were raised in Amish families considering that their graven image is nowhere to be found on the Internet, including on their LinkedIn profiles. I frankly distrust people whose photos aren’t available online. It’s only slightly better when someone shrinks their LinkedIn photo in failing to understand that the right process is to use a full-sized image and let LinkedIn thumbnail it automatically, which doesn’t seem too far beyond the understanding of technology executives.


September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


Huron Consulting Group renames itself to Huron.

Team messaging vendor Klara, which describes itself as “a professional WhatsApp for medicine,” raises $3 million, increasing its total to $5.5 million. The company pivoted from teledermatology software to messaging just a few weeks back. It did not inspire my confidence that the company’s website was down all day Thursday as I tried to learn more.

In Germany, officials reportedly raid the offices of eight drug wholesalers, including McKesson, to determine if they illegally conspired to avoid stealing each other’s customers.


A federal judge allows Cave Consulting Group’s antitrust lawsuit against OptumInsight to continue. CCG says OptumInsight, owned by UnitedHealth Group, controls 90 percent of the claims grouper software market only because the company it acquired in 2003, Symmetry Health Data Systems, lied on its patent application. UHG agreed in April 2015 to pay CCG $12 million for infringing on its patents.


A Network World review of the 500 largest publicly traded companies finds that 25 of them disclose CIO pay. On their list is former Kaiser Permanente CIO Phil Fasano, who joined insurer AIG in the newly created position of EVP/CIO in late 2014 and was paid $8.4 million in 2015 as the #3 top earner. Walgreens Boots Alliance CIO Tim Theriault took the #1 spot with $13.6 million.



Vigilance Health (CA) chooses population health management technology from EQHealth Solutions for chronic care management and care coordination programs in 51 California counties.

Nebraska Medicine chooses and implements Nuance Dragon Medical One for clinical documentation in Epic, with 94 percent of its surveyed doctors saying it helps them practice better medicine, 71 percent reporting that their documentation has improved, and 50 percent saying Nuance saved them at least 30 minutes per day.



Julie Boughn (Cognasante) joins Audacious Inquiry as senior director.

image image

CTG promotes Angela Rivera and Robert Barras to vice president.

Announcements and Implementations


The Department of Defense approves the participation of Fort Drum Medical Department Activity (NY) with the HIE of HealtheConnections, which will combine the military’s medical records of soldiers and families with those contributed by 300 connected civilian facilities to create a single overall view.


Harvard Medical School launches Library of Evidence, which offers free, evidence-based imaging clinical decision support that can be embedded in EHRs to help clinicians choose the most appropriate imaging tests.


Lenovo Health and LifeMed ID partner to offer an identity management solution that includes a trusted patient ID token that links to medical records. According to Lenovo Health’s website, providers can “achieve 100% accurate.”


National Decision Support Company will offer cardiac imaging appropriate use criteria from the American College of Cardiology.

Government and Politics

Eight Republican senators that include HELP committee chair Lamar Alexander (R-TN) introduce emergency, one-year legislation that would eliminate ACA-mandated penalties for those who don’t buy health insurance and would allow consumers who are covered by exchange-issued plans to use their federal government premium subsidies to buy plans elsewhere.

Privacy and Security


  • A dental practice whose patient information was exposed to the Internet explains the odd situation: (a) the practice gave live patient data to a vendor whose system it was considering; (b) the practice decided that same year not to buy that system; (c) the vendor took the server offline in 2004; and (d) somehow the server (now unsecured) was brought back online 10 years later for a two-week period in 2014 during which the practice’s patient information was exposed.
  • The Dark Overlord (or other hacker claiming to be him) threatens to publish patient information from St. Francis Health System (OK) unless it pays $15,000 by Sunday.
  • A single ransomware author claims to have made $94 million in profit during the first half of 2016.


A legal preview of patient and provider class action lawsuits brought against Banner Health (AZ) following a breach of its food service point-of-sale systems that exposed the information of 3.7 million people raises these issues:

  • The plaintiffs don’t know whether hackers actually accessed or used the information, only that they might at some point.
  • The suit does not claim breach of contract, which doesn’t always work in breach lawsuits, and instead argues that Banner made an enforceable promise without consideration (promissory estoppel).
  • The plaintiffs argue that Banner didn’t notify them promptly.
  • The case uses recent FTC enforcement actions to claim that Banner violated the FTC act that says lax cybersecurity constitutes “unfair or deceptive acts.”



Accenture announces a health IT innovation challenge tied to its venture fund.

BSX Athletics launches a Kickstarter campaign to fund its LVL wearable hydration monitor. It has raised $200,000 vs. a goal of $50,000 and is a smart idea that apparently actually works, although Kickstarter projects are notorious for failing and not everybody wants to wear a one-trick wristband 24/7 .


An HHS OIG report finds that for-profit hospices are aggressively recruiting patients who aren’t terminally ill and who may not know that choosing palliative care means they won’t receive other treatment. Medicare paid $15 billion for hospice care in 2013 and is trying to recover $1 billion from for-profit hospices in which one in three patients leave the service without dying, double the rate of non-profit hospices. In Mississippi, 41 percent of hospice patients were discharged alive. 


Former New York City Mayor Michael Bloomberg donates another $300 million to the Johns Hopkins Bloomberg School of Public Health, saying the US should lead the world in life expectancy instead of placing 31st. Bloomberg has donated $1.5 billion to Hopkins, of which the School of Public health received $684 million, explaining, “It’s a lot cheaper to prevent than to cure, and it’s certainly a lot more humane.”

A man who had been hospitalized for 22 years with spinal muscular atrophy dies at 54, to the consternation of employees who had grown attached to him. It would be interesting to see the final bill and to know who’s paying it.

Sponsor Updates

  • Impact Advisors and NTT Data make Consulting Magazine’s list of “Best Small Firms to Work For.”
  • InterSystems and Intelligent Medical Objects will exhibit at the Epic UGM September 21-23 in Verona, WI.
  • PDR Network CMO Sal Volpe, MD receives the 2016 Patient-Centered Medical Home Practice Award.
  • Live Process will exhibit at California Hospital Association Disaster Planning 2016 September 19-21 in Sacramento.
  • Nordic is named one of Madison Magazine’s best places to work.
  • Vyne President and CEO Lindy Benton presents at the HERe Conference in Nashville.
  • AlleyWatch spotlights MedCPU in its coverage of New York City startups that have raised the most amount of money.
  • Meditech and Nvoq will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
  • Navicure will exhibit at Kansas MGMA September 21-23 in Overland Park.
  • Netsmart will exhibit at the Kansas Public Health Association conference September 20 in Wichita.
  • Nordic will host an open house September 19 in Madison, WI.
  • Obix Perinatal Data System will exhibit at the Georgia Perinatal Conference September 21-23 on St. Simon’s Island.
  • Infor Healthcare will exhibit at ASHHRA 2016 September 25 in Grapevine, TX.
  • Clockwise.MD will exhibit at the UCAOA Fall conference in Nashville September 29 – October 1.
  • Christy Kaplan and Susan Tolan of The Chartis Group presented “Transforming Care Coordination: Keys to Operationalizing Your Pop Health Strategy” at the HIMSS Population Health Forum this week.

Blog Posts


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


View/Print Text Only View/Print Text Only
September 15, 2016 News 12 Comments

EPtalk by Dr. Jayne 9/15/16

September 15, 2016 Dr. Jayne No Comments

I was reminded today that this year marks the 20th anniversary of the Health Insurance Portability and Accountability Act of 1996, affectionately known as HIPAA (or HIPPA, as the case often is). As much as we lamented its beginning, most of us had no idea how much more regulation we would see in the healthcare space during the subsequent decades. Physicians and other healthcare providers are now more regulated than they have ever been, which has contributed significantly to physician burnout and early retirement in many communities.

Regulations are often nested within other policy and regulatory documents. A recent example of this is a requirement in the proposed 2017 Medicare fee schedule that would require surgeons and other procedural physicians to report a series of G codes during the postoperative period. The codes vary based on place of service, patient complexity, and time. They don’t match cleanly with existing bundled services. The fee schedule also proposes changes to the quality measures used for Accountable Care Organizations, which also met with resistance.

Sometimes CMS announces plans which benefit physicians, which feels like a rarity. The recent announcement of a “pick your pace” approach to MACRA implementation was welcomed due to the apparent flexibility of the approach. There are a few options for MIPS reporting in 2017:

  • Providers can simply test their ability to report data, doing so at least once at some point during the year. Completion of testing allows providers to avoid penalties and ensures that systems are functioning prior to greater participation in subsequent years.
  • Providers can also consider reporting for part of the calendar year. However, they must report performance in all three Composite Performance Score (CPS) categories. This approach could result in a small bonus in 2019.
  • Providers can report the full calendar year (again in all three categories) to achieve what CMS describes as a “modest” bonus in 2019.
  • Providers participating in certain Advanced Alternative Payment Models can qualify for a five percent bonus.

Selecting the third option will depend on the ability of vendors to quickly become compliant with the requirements of the final rule, which is expected to be released by early November. This means that they have very little time to achieve software readiness and upgrade thousands of providers. Depending on vendor resources and how much prep work has been done in anticipation of the release of the final rule, full-year reporting may be little more than a pipe dream.

For those of us who live and breathe this on a daily basis, having some flexibility in reporting seems refreshing. But for the large numbers of physicians and practices who have no idea what MACRA even is, let alone that these regulations are coming, the flexibility won’t be very comforting.

I recently received a blast letter from the Drug Enforcement Administration letting me know I would have to upgrade my browser in order to access DEA resources and renew my registration. That’s insignificant to many physicians, yet the DEA felt it was important enough to mail paper correspondence to every registered physician across the country. MACRA and the associated penalties and incentives are a big deal. Where is the letter to all Medicare providers? CMS is expecting physicians to follow blogs and tweets and webcasts that many physicians don’t even know exist.

I’m not absolving physicians from being responsible for what is going on in the world around them, but merely commenting on the reality of many physicians out there, which has also been reflected in various surveys and articles. Ultimately if a physician is going to contract with a payer, he or she is responsible for knowing the rules, but it certainly could be easier.

What’s also not easy is figuring out how to actually achieve savings under Alternative Payment Models. Recently CMS released performance data for 2015. The numbers show that of 404 Medicare ACOs, only 125 of them qualified for shared savings. Of the 392 Shared Savings Program ACOs, only 119 qualified for shared savings. Participation in Pioneer ACOs continues to shrink, with only 12 remaining.

I don’t think those statistics make Alternative Payment Models look appealing to the average physician. Of course the “appeal” is different for providers employed by hospitals and large health systems who are simply forced to participate. Those that weren’t successful based on the metrics are still doing the extra work required of ACO members but just not getting the shared savings payments at the end.

I do feel that CMS is listening and trying to respond. Recently they changed the rules for the Medicare Chronic Care Management services code to remove a requirement that providers have 24/7 access to patient records. The code allows providers to bill for coordination of care for patients who have chronic conditions. However, I’m not sure what kind of burden the 24/7 rule really was.

The bigger barrier in my experience is the fact that patients have to pay a portion of the charge, and many don’t see the benefit because the services performed on their behalf are often done behind the scenes – phone calls to consultants, review of personal health log data, etc. There’s also a process required to obtain patient consent for participation which adds to challenges in adopting the service. I find it funny that people who will pay for a maintenance/protection program for their phone will balk at paying for something similar to help safeguard their health.

I’m mentoring some medical students and several are out on ambulatory clinical clerkships, working with practicing community physicians. They always have questions about how regulations are going to impact them in practice. Sometimes I have answers and sometimes there are no good answers. What they see, however, is definitely driving them away from primary care, where it seems that providers feel a greater burden. We’re getting thousands of new Medicare beneficiaries each day, so the need for processes and policies is real in order to successfully manage the demands. I think many of us wish that there was just a better way.

What are you doing to celebrate the 20th anniversary of HIPAA? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
September 15, 2016 Dr. Jayne No Comments

Morning Headlines 9/15/16

September 14, 2016 Headlines No Comments

Risa Lavizzo-Mourey Stepping Down as President and CEO of Robert Wood Johnson Foundation

Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey announces that after 14 years running the $10 billion private research foundation, she will retire.

US healthcare chain unveils UK plan for private hospital overlooking Buckingham Palace

Cleveland Clinic files plans to build a 205-bed private hospital in London’s upscale West End.

49 states plus DC reduce avoidable hospital readmissions

CMS releases new data on the Hospital Readmissions Reduction Program showing that readmission rates fell by eight percent nationally. Other than Vermont, all states and Washington DC reported readmission decreases.

Slavitt says high premium increases are result of one-time effects

Acting CMS Administrator Andy Slavitt defends the increased premiums on ACA insurance exchanges by saying they are likely a one-time adjustment resulting from the end of risk adjustment payments.

View/Print Text Only View/Print Text Only
September 14, 2016 Headlines No Comments

Readers Write: The Surgeon General’s Rallying Cry Against the Opioid Epidemic Must Also Be a Call to Arms for Healthcare IT

September 14, 2016 Readers Write 2 Comments

The Surgeon General’s Rallying Cry Against the Opioid Epidemic Must Also Be a Call to Arms for Healthcare IT
By Thomas Sullivan, MD


In a rare open letter to the nation’s doctors, US Surgeon General Vivek Murthy, MD, MBA sounded a rallying cry to engage their greater participation in the opioid-abuse crisis afflicting our country. Missing from the USSG’s commendable call to arms, though, was mention of the role technology plays in reducing drug diversion and doctor shopping and providing ready access to services to support patients.

Those of us in healthcare IT know that we are critical to this cause. The USSG is talking to our customers, and we know our customers aren’t adopting as quickly as they could the substance abuse-fighting technologies that are widely available to them. This includes a variety of technology solutions such as:

  • E-prescribing technology, particularly EPCS to support the electronic prescribing of controlled substances, which is key to helping providers more efficiently deploy and monitor prescription medicines being prescribed or over-prescribed across a practice.
  • Medication adherence monitoring technology that lets providers gauge in real time, at the point of encounter, a patient’s level of compliance with drug therapy and provide patients with evidence-based support and services for self-management.
  • Clinical decision support that helps doctors avoid adverse drug events and medication errors.
  • State-run prescription drug monitoring programs (PDMPs) designed to help law enforcement track the use of controlled substances and help prescribers identify doctor shoppers and others seeking illicit access to controlled substances.

Specific to the opioid abuse epidemic, the most important next step is for physicians to be able to check PDMPs within their normal workflow. Simply said, the integration and availability of PDMP data within e-medication management solutions — e-prescribing, medication history services, medication adherence tools and the like — will result in the greatest use of PDMP data and the best one-two tech-assisted punch we have in the opioid battle.

Over the past two years, policymakers have begun to take action in using EPCS to address this crisis. This past March, New York State took a major step toward this goal when it began requiring e-prescriptions for all controlled substances as well as all non-controlled substances, frequently referred to as “legend drugs.” Known as I-STOP, the Internet System for Tracking Over-Prescribing act, originally passed in 2012, New York’s experience now serves as a case study for other states that wish to modernize their prescribing infrastructure and address opioid abuse.

Maine as well now will require opioid medications to be prescribed electronically via Drug Enforcement Agency-certified EPCS solutions beginning in July 2017. Several other states including Massachusetts, Missouri and Maryland are also considering or working to pass mandatory EPCS requirements for prescribers.

Unfortunately, neither New York nor Maine PDMP data is currently accessible to health IT vendors for integration into the prescribing workflow of providers.

E-prescribing – the direct digital transfer of patient prescriptions from provider to pharmacy – is broadly recognized as an important tool in helping promote patient safety, convenience, and overall efficiency for all stakeholders in the prescription process. E-prescribing is well understood to assist prescribers by allowing patients and doctors to better guard against medication errors, such as drug-to-drug interactions, reduce common errors inherent in paper-based prescribing — including illegible handwriting, misinterpreted abbreviations, and unclear dosages, — and provide critical decision support tools.

Despite the fact that, nationwide, more than 70 percent of doctors transmit most prescriptions electronically, the vast majority of these prescriptions are only for legend drugs. In comparison, less than 10 percent are using EPCS solutions to e-prescribe controlled substances. However, in New York, the I-STOP legislation has driven adoption of EPCS to over an estimated 70 percent. As such, all indications are that the laws passed in New York and Maine mandating use of EPCS and PDMPs will almost certainly prove helpful in curbing opioid abuse, fraud, and diversion and help prevent possible addiction down the line.

However, full adoption of PDMPs will likely never be achieved until the PDMP information is accessible in the doctor’s technology workflow. Ultimately, the opioid-abuse battle needs to be fought through states enabling their respective PDMP data to flow through doctors’ own workflows, as opposed to requiring that physicians and clinicians go outside their familiar software tool and interact with a separate portal in order to access their respective state PDMP databases.

In the case of New York State, the Medical Society of the State of New York conducted a survey that found a large percentage of prescribers believed that forcing mandatory compliance was placing an undue burden on their practices. No doubt, physicians feel overburdened with IT mandates. Improving integration between PDMPs and electronic health records will alleviate some of these burdens and allow for better compliance.

States must work more closely with the healthcare community to remove obstacles that will allow as close to 100 percent compliance as possible. Every state has the opportunity to learn from New York to smooth implementation and drive adoption to make a meaningful impact on the growing opioid abuse epidemic. Leadership in healthcare IT companies must be more vocal about our role and responsibilities in enabling doctors on the ground.

With the US Surgeon General weighing in, those of us in the healthcare IT community must rise up to make our voices heard. The importance of integrating e-medication management tools and EPCS solutions with PDMP data cannot be overestimated. It is the best path toward helping our customers — the doctors — make the right decision, at the right time, with the right data, on the right platforms.

Thomas Sullivan, MD is chief strategy and privacy officer of DrFirst of Rockville, MD.

View/Print Text Only View/Print Text Only
September 14, 2016 Readers Write 2 Comments

Readers Write: The Electronic Health Record and The Golden Spike

September 14, 2016 Readers Write 1 Comment

The Electronic Health Record and The Golden Spike
By Frank D. Byrne, MD


On May 10, 1869, at a ceremony in Utah, Leland Stanford drove the final spike to join the first transcontinental railroad across the US. Considered one of the great technological feats of the 19th century, the railroad would become a revolutionary transportation network that changed the young country.


For the past few years, the healthcare industry and the patients in its care have experienced a similar “Golden Spike Era” through the deployment of the electronic health record (EHR). Others have used this analogy, including author Robert Wachter, MD at a recent excellent presentation at the American College of Healthcare Executives 2016 Congress on Healthcare Leadership.

Why is this comparison relevant? While the Utah ceremony marked the completion of a transcontinental railroad, it did not actually mark the completion of a seamless coast-to-coast rail network. Key gaps remained and a true coast-to-coast rail link was not achieved until more than a year later and required ongoing further improvements.

Similarly, while a recent study indicated that 96 percent of hospitals possessed a certified EHR technology and 84 percent had adopted at least a basic EHR system in 2015, there is still much more needed to achieve optimized deployment of the EHR to make healthcare better, safer, more efficient, and to improve the health of our communities.

Nonetheless, the EHR is one of the major advances in healthcare in my professional lifetime. It is an essential tool in progress toward the Institute for Healthcare Improvement’s “Triple Aim for Healthcare”– better patient experience, lower per-capita cost, and improved population health. We cannot achieve those laudable goals without mining and analyzing the data imbedded in the EHR to generate useful information to guide our actions. Advances in data science are enabling the development of meaningful predictive analytics, clinical decision support, and other tools that will advance quality, safety, and efficiency.

But there is much work to do. Christine Sinsky, MD, vice president of professional satisfaction for the American Medical Association, and others have written with concern about dissatisfied physicians, nurses, and other clinicians who feel the EHR is distracting them from patients care and meaningful interactions with their patients.

“Contemporary medical records are used for purposes that extend beyond supporting patient and caregiver … the primary purpose, i.e. the support of cognition and thoughtful, concise communication, has been crowded out,” Sinsky and co-author Stephen Martin, MD note in a recent article.

Perhaps you’ve also seen the sobering drawing by a seven-year-old girl depicting a doctor focused on the computer screen with his back to her, his patient.


Some of the EHR’s shortcomings may be the result of lack of end user input prior to implementation, possibly due to the implementing organization not incorporating the extensive research gathered by the EHR providers. Further, even if one gets end-user input prior to implementation, there’s always challenges prior to go-live, and it seems to me that optimization after implementation has been under-resourced. And let’s not look at temporary ”fixes” as the best and final answer. I was dismayed recently to see “hiring medical scribes” listed as one of the top 10 best practices in a recent Modern Healthcare poll.

Don’t get me wrong, to have a long game, you must have a successful plan to get through today, and if hiring scribes can mitigate physician dissatisfaction until the systems are improved, so be it. But scribes are a temporary work-around, not a system solution.

As an advisor to an early-stage venture capital fund, I’ve enjoyed listening to many interesting and inspiring pitches for new technology solutions. Initially, my algorithm used to rate these ideas was:

  • Is it a novel idea?
  • Will enough people or organizations pay for it?
  • Do they have the right customer?
  • Do they have the right revenue model?

Thanks to the input of physicians, nurses, therapists, and other clinicians, and the work of Dr. Sinsky and others, I quickly added a fifth, very important vital sign: Will it make the lives of those providing care better? Similarly, author, speaker and investor Dave Chase added a fourth element to the Triple Aim, caregiver experience, making it the Quadruple Aim.

When I was in training, we carried the “Washington Manual” and “Sanford’s Antimicrobial Guide” in the pockets of our white coats as references and thought we had most of the resources we needed to provide exceptional care. Now, caregivers suffer from information overload of both clinical data and academic knowledge. Some query Google right in front of their patients to find answers.

In healthcare today, we work within a community of diverse skills and backgrounds, including clinicians, non-clinicians, computer scientists, EHR providers, administrators, and others. To achieve our goal of improving health and healthcare for individuals and communities, we must work together to organize, structure, mine, and present the massive amounts of data accumulated in the EHR. To me, the concept of population health is meaningless unless you are improving health and outcomes for my family, my friends and me. Just as the placement of “The Golden Spike” was only the beginning of railroad transportation becoming a transformational force in American life, the fact that 96 percent of U.S. hospitals possess a certified EHR is just the beginning.

I have been accused of being a relentless optimist, but I firmly believe we can use the EHR to improve the caregiver and patient experience (I believe patients will and should have access to their entire medical record, for example), and fulfill the other necessary functions that Sinsky and Martin describe as distractions from the medical records’ primary purpose: “quality evaluations, practitioner monitoring, billing justification, audit defense, disability determinations, health insurance risk assessments, legal actions, and research.”

Lastly, there is one more similarity to “The Golden Spike.” In 1904 a new railroad route was built bypassing the Utah track segment that included that historic spot. It shortened the distance traveled by 43 miles and avoided curves and grades, rendering the segment obsolete. Already, many EHR tools, applications and companies have come and gone. Many of the tools we use now remain rudimentary compared with what we really need. We must use what we have to learn and continuously improve, and frankly, we need to pick up the pace. The patients, families and communities depending on us deserve no less.

Frank D. Byrne, MD is the former president of St. Mary’s Hospital and Parkview Hospital and a senior executive advisor to HealthX Ventures.

View/Print Text Only View/Print Text Only
September 14, 2016 Readers Write 1 Comment

Morning Headlines 9/14/16

September 13, 2016 Headlines No Comments

Atos to acquire Anthelio Healthcare Solutions

French consulting firm Atos acquires Anthelio Healthcare Solutions for $275 million.

HIMSS launches international buddy programme to support NHS Digital Exemplars

HIMSS offers to match the 12 NHS hospitals recently selected to establish themselves as digital health “exemplar” with US hospitals capable of offering guidance and relevant expertise.

Electronic Capabilities for Patient Engagement among U.S. Non-Federal Acute Care Hospitals: 2012-2015

ONC reports that 95 percent of US hospitals allow patients to electronically view their health information, while only 69 percent offer patients the ability to electronically view, download, or transmit their health information.

The Mobile Doc

Apple releases iOS 10, which includes HealthKit support for C-CDA, which will let patients download their medical records into HealthKit and share parts of that information with other apps. Duke Health (NC) reports that it has already updated its patient portal to support the new functionality.

View/Print Text Only View/Print Text Only
September 13, 2016 Headlines No Comments

Subscribe to Updates



Text Ads

Report News and Rumors

No title

Anonymous online form
Rumor line: 801.HIT.NEWS



Founding Sponsors


Platinum Sponsors




































































Gold Sponsors





















Reader Comments

  • Pharmacy Joe: Thanks for the tip about text2codes! I overhear docs talking about the hassle of coding all the time, and this looks ve...
  • Peter: RE: Judy/Epic – You’d think at some point her clients or prospects would care about a perpetual stream intentional m...
  • Former Epic: Epic definitely does marketing, but the local media (around Madison) has drank the Epic koolaid for years now. Epic only...
  • Epic Consultant: You just know that Epic is going to make the new booster NVTs really difficult for consultants to do....
  • Ginni's Jeopardy: IBM Watson will not be successful in healthcare IT until it pivots and aligns its product to help healthcare providers a...

Sponsor Quick Links