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Curbside Consult with Dr. Jayne 7/28/14

July 28, 2014 Dr. Jayne 5 Comments

I had a chance to catch up with an old friend this weekend. He’s an OB/GYN, and as an employed physician, he’s had EHR in both the hospital and ambulatory settings for years.

Their efforts have resulted in massive amounts of data that can be mined to improve patient care. Surgeons can easily access their own outcomes data and compare morbidity and mortality data when incorporating new techniques (such as robotic surgery) into their practices.

There’s a dark side to that big data, however, and it’s starting to rear its head.

Although most laypeople are aware that babies are going to arrive when they’re going to arrive, administrators at his hospital may have missed that part of health class. They’re creating reports looking at delivery times and labor lengths under the guise of optimizing patient care. The seedy undercurrent of their research, however, is a desire to reduce staffing costs. Although they haven’t overtly said it, he suspects they’re on the verge of asking physicians to start acting in the hospital’s best interest rather than the patient’s.

I delivered babies at the beginning of my career. When you’re caring for a mother in labor, it can be hours of waiting punctuated by moments of terror. Although delivering a child is a natural human process, in the US, we’ve medicalized it for a variety of reasons. As a result, over the past quarter century, we’ve seen an increase in the percentage of babies delivered surgically (it sounds a little scarier when you say it that way, rather than “by C-section”) and there have been concerted efforts to try to reduce this trend.

It’s not just a problem in the United States. The World Health Organization has set a goal of 15 percent C-sections as realistic number for the procedure. In the US, it’s at about 28 percent, in Britain it’s 25 percent, and in Brazil, nearly 80 percent of women delivering in private hospitals have C-sections. Some blame cultural factors for the rise in the procedure. The ability to deliver “on schedule” is certainly a plus for some women as well as for their physicians. Others blame our medical payment system, because reimbursement is higher for a surgical delivery.

It’s not just C-sections, though. We’ve seen a rise in labor inductions, where drugs are used to start labor, often before the due date. Although there are definitely medical reasons when this might be indicated, it had become so prevalent (one in every five women) that ACOG, the OB/GYN professional organization, issued revised guidelines to try to ensure appropriate use of medical interventions.

Why would someone want to electively deliver a baby (through induction or C-section) anyway? Some blame the risk of litigation in the case of a poor outcome. Others blame physicians who want to deliver babies at their convenience. In my practice, I had a fair number of women request induction because they live far from their families and wanted to schedule the delivery to ensure relatives could travel to assist with the baby or help with young children at home.

In countries that spend a lot of money on post-partum home visits or in-home assistants, this may be less of an issue, because women may feel more supported at home after a delivery. Data is shared between community-based caregivers and coordinating physicians so that care can be delivered outside of the hospital. That kind of care has a cost, though, and isn’t an option for many US women, hence the request for inductions.

When thinking about cost controls, however, the idea of asking physicians to intervene in the labor and delivery process to try to better match facility staffing capacity is just too much to accept. Using data in this way sets us on a very slippery slope. What’s a little extra Pitocin? We can convince ourselves that it would be better for the baby to be delivered sooner than later, and if it happens so we can deliver before shift change, so much the better. Looks like the extra drugs may be creating some fetal distress, better prep the OR.

I haven’t delivered a baby in years, but I can’t imagine the stress of having my labor and delivery management decisions questioned by someone who has motives other than reducing maternal and neonatal morbidity and mortality.

Pregnant women are some of the most empowered patients I see in practice. They have more time to research various options and choose the best for themselves and their families, unlike patients facing cancer, injuries, and other unexpected issues. They share the knowledge of how to fight back against the medical establishment (as proven by anyone who has had a patient arrive with a 20-page Birth Plan) and are increasingly demanding of alternatives to the hospital birth experience. Many women in my area are using Doulas and Labor Coaches to have a dedicated patient advocate with them if they do deliver in hospitals. Some can cite the labor and delivery data and the risks of interventions better than a med student prepping for boards.

If the hospital is serious about this, I hope the physicians and nursing staff stand their ground. Better yet, I hope the patient community gets wind of it and reacts strongly.

As for my friend, he’s trying to work from the inside to convince hospital leaders that this is the wrong way to use big data. I hope he’s successful, but I also know he’s fearful for his job as an employed physician.

Have any other examples of misuse of Big Data? Email me.

Email Dr. Jayne.

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July 28, 2014 Dr. Jayne 5 Comments

HIStalk Interviews Linda Reed, CIO, Atlantic Health

July 28, 2014 Interviews 3 Comments

Linda Reed is VP of integrative and behavioral medicine and CIO of Atlantic Health System of Morristown, NJ.

Tell me about yourself and your job.

I’m the vice president of integrative and behavioral medicine and chief information officer. I’ve been at Atlantic Health 10 years. For the first six, I was vice president and CIO.

About five and a half years ago, I got integrative medicine, which is massage, yoga, supplements, functional medicine, and acupuncture. Then about three years ago, I got behavioral health. One of my doctor friends here says, “Who did you annoy that you were able to get such a wide variety of things?” It’s funny because I tell the CFO here that I’m like the empress of everything that is expensive that makes no money. It’s interesting. My day is right brain, left brain.

I’m a nurse by background. I’ve been a CIO for almost 20 years. I just love what I do every day. I’m an activity junkie and this job really suits that.


How much of your IT effort is focused on plumbing type work like Meaningful Use and ICD-10?

I’d say it’s probably 60 or 65 percent.

We try really hard to do some other interesting things. We’ve put a lot of effort into mobile health. We’ve got a mobile health strategic plan. We just published a mobile health app. Taking a look at some interesting new and different kind of things to do with mobile health. We’re trying to spend a lot of time there doing a little more with telemedicine. There’s all this new, cool stuff you want to do, but you’re really anchored back in the ICD-10, Meaningful Use world.

We’re doing a lot of acquisition. We’ve added two hospitals in the last three and a half years and we’ve got one more coming at the end of December. They’re all different. One hospital was on a really old platform, not the one that we’re on, so we kind of ripped and replaced. The second one that we got had put some money into the platform that they’re on, so we decided to leave that one alone because they had attested. The third one that we’re getting is a little bit of both. They’ve got two different systems on the front and back end, so we’re still looking to see exactly how that one’s going to transition in. We just went live on Tuesday with a brand new ambulatory system for our physicians. It never stops.


Which ambulatory system did you go live on?

Epic ambulatory.


Are you still primarily a McKesson shop?

Yes, we’re still McKesson.


They’ve sent some mixed signals about their healthcare IT direction. How do you see that playing out?

Their direction is Paragon. The hospital I said that had a pretty good platform that we left in place is Meditech. 

We belong to a consortium called AllSpire. That is us, Lehigh Valley, Lancaster General, Hackensack Medical Center. Of the seven members, four are already on full Epic.

We know the direction McKesson is going with Horizon. We’re going to have to make a decision in the next couple of years as to where we’re going to go. We know we’re not going to stay on Horizon.

My job is to try and give the organization options. When you take a look at what’s going on in healthcare and you start looking at the trajectory of hospital buy-ins, can you really justify a huge expense?


Nobody goes ambulatory Epic unless they’re going inpatient as well. Isn’t that predetermined?

I don’t know. I’m not really sure. Before we did this, I talked to a number of consulting companies. How much cross do you have between the people that come into your ambulatory and are in the hospital? How much back and forth do you really need? Could that be done by a summary of care, CCD, and CCDA? I’m not sure — that might be.

We’ve got a direction we could take, where we have like-for-like licenses because of all the investment we’ve made over lots of years. We’ve got an option for an integrated platform that already exists in one of environments — it might be something we want to do. We’ve got a third option that we’ve already got the ambulatory component in, and then if we wanted to work with our partners in our coalition, we could do that. What I’ve tried to do is try to give Atlantic Health multiple options to choose from.


What do you think the driver will be as to which way they go?

I think it will be looking at where we are from a volume perspective, where we want to be on the risk side, how much we want to manage what we have.

We’ve got two accountable care organizations. If we do a good job in that realm, aren’t we going to be driving patients out of our own hospitals? If we do that, we want a really, really robust ambulatory system along with population health management, analytics, and care management tools. How big does the hospital system really now have to be?


Have you looked at any of those technologies for ACOs, population health management, and analytics?

No. We stepped in gingerly. We took our time. We tried to use what we had in place.

We started off with RelayHealth. We’ve been a big user of RelayHealth for many years. RelayHealth provides the platform for our regional health information exchange. We’ve got 30 hospitals on that here. We started off with that, and then we moved into some business intelligence. We have MedVentive for population and risk management. McKesson does a lot of work in the payer space for disease management, so we’re working with them right now on putting in their care coordination tool.

We spent a little time understanding what it is we needed to do, then tried to put a few technologies in to be able to do that. We’ve got the business intelligence. We’ve got to work on the care coordination tool — that’s next. We’ve got Relay to do some of the health information exchange.

We use Imprivata Cortext, a secure texting tool. We’ve built specific directories for the ACO physicians so that they can now use that as a secure referral tool for each other.

I’ve been a customer of Imprivata in multiple organizations. They’re an easy company to do business with. I’ve used their OneSign. Our doctors love the tap-and-go because they all have their little card and their one workstation. They don’t even log off, they just tap. It closes the screen and they tap it again wherever they go — it brings up their session wherever they are. They just love that. We started using their secure texting about a year ago.


They’re using Imprivata Cortext it as their communications clearinghouse so they don’t have to play phone tag? They just send the text message and walk away?

That’s right. Our ACO put together a per-member, per-month incentive for physicians up front so the physicians don’t have to wait until savings at the end of the year. There’s a number of different sections there. There’s one for the use of technology. If they use RelayHealth, if they use Imprivata Cortext, if they automate their offices, they get a certain amount of money. For some process measures, they get it. For some outcomes, they get it. There’s a couple of other things. Their whole per-member per-month incentive is based on certain activities that they do.


I assume you need to analyze your data across the Epic on outpatient and McKesson and Meditech on inpatient. What are using for a data warehouse?

We use Horizon Performance Manager. The pop stuff all comes out of MedVentive. MedVentive has data from the EMRs, from the HIE, and whatever they might need from the hospital.


Are you looking at any technologies that can help support the clinician-patient relationship and patient engagement?

Our app is a patient-facing app. We’re constantly working on we help physicians and patients communicate.

A number of years ago, we put in RelayHealth, which had secure messaging with physicians. I had one doctor say to me, “ I will never, ever, ever, ever trade an email with a patient.” Then about a year ago, she came back and she said, “That’s not so bad.” She was telling another doctor, too, “I talk to my patients on email all the time.” It’s really interesting to see the dynamics. I think we’re probably going to be looking at doing something very similar on the mobile front.


Tell me about the mobile app.

It’s called Be Well. We have one for each one of our hospitals, because our physicians are more specific to our geographic area. It’s got a physician directory, ED wait times, and a whole bunch of different health trackers, including a way to download your Fitbit information.


Did you develop that yourself or have it developed?

We worked with a company called Axial Exchange. Everybody today will tell you that it doesn’t make any sense to go out and do that kind of work yourself when there’s just so many other companies that you can work with. 

There’s a health encyclopedia in there, but it’s the same kind of health encyclopedia we use on our website. For us, now we’re migrating from the web to mobile. That’s where we’re going there.


As a nurse, do you think nurses are underserved as far as technology that helps them do their clinical role rather than just documenting so that somebody else can send a bill or have the doctor read their notes?

That’s an interesting question. We put in Vocera a lot of years ago now. One of nurses’ biggest issues was the phone tag that they were playing with doctors. They don’t all carry around organizationally-provided smartphones. From an access to information, it could be more helpful if they did.


Do you discourage them from using their own?

We don’t. We do discourage them from SMS texting on their own. It is one of the reasons why we went out and got Cortext. Just telling people not to use SMS text and not giving them something to use makes no sense. It’s like spitting in the wind. 

The interesting thing about nurses is that we’ve got those computers on wheels. They’re on those things all the time. To take them off takes them out of their work flow. The Cortext component has a PC-based user interface, not just mobile. You can be on the COWs or you can be on the mobile.

Right now for nursing, I think it’s moving in that direction. I just don’t think that it’s quite as mobile-enabled as some of the physician tools right now.


What are the organization’s biggest strategic issues that need IT help?

Care coordination is huge. We’re kind of schizophrenic because we still are fee-for-service and we still are doing procedures and patient care in the hospitals, but we also have these ACOs. While we still need to be able to get people in and have great turnaround time, decrease the length of stay, get more turns in as much as we can, on the other side, we’re still working on how do we keep people out of the hospital and in the ACO and keep and have that gap and address all the gaps in care and the transitions of care? 

It’s like two different initiatives that we’re working on. We still have to keep the whole patient engagement and satisfaction thing going on the other side.

One of the things we did a few years ago –it’s on paper and we’re just getting ready to take a look at how to automate it — is we had created a patient itinerary report. One of the big things that patients always complain about is that they don’t know what’s going to happen to them during the day. We created a report that pulled it from different parts of our technology — what’s the patient’s name, why are you here, when did you get here, who are the care providers on your case, what medications are you on, what labs did you have ordered for you, what were the results of the labs that you had yesterday, are you going for any other tests? Then there’s a little spot for “questions to ask my doctor.” That really was pretty popular and the patients seemed to like that. We’re probably going to automate that. 

One of our next ventures in the mobile space is probably a bedside app that would give you that whole access to “my care team, my itinerary, my meds.” We also have that on our TVs right now, but we’ll look at putting it on an iPad.


Most hospitals would use an interactive patient system approach and put it on the TV, but you’re going to give patients iPads. Has anyone done that?

No. There’s a couple of places that are looking into doing it. There’s also a company out there called PadInMotion. They do some of that and they also give patients access to like Netflix and things like that on the iPad. 

The more of this education stuff that you’re going to put in front of patients, a TV on a foot wall is really a tough user interface to give patients unless the thing is like 120 inches. I don’t know how big the screen has to be. Giving them an iPad is probably a good way to do that, but again, we also have to take a look at the patient population. When my dad was in the hospital, he could barely work the remote control on the TV, much less an iPad. It’s just trying to meet the needs of the patients that are there. You have to have multiple user interfaces to help patients through all the technology we throw at them.


Physicians are moving, or moving back, into leadership roles in health systems. What advice would you offer nurses who want to move into leadership roles outside of nursing?

Don’t say no to anything. I have a job today that practically didn’t exist when I first started in my nursing career. Take on any opportunity. 

The one thing that sometimes you see with nurses is that they like to have things that are very concrete. It’s interesting because we work on the fly every day. We are the leaders of multitasking. But sometimes I think having a job that doesn’t have a very concrete job description or isn’t very clear on the time or the hours or the responsibilities — I think they shy away. They don’t realize how freeing a job that’s maybe not quite baked can be, because you can bake it yourself.

Nursing is also very isolating because you’re in those nursing units all the time. Sometimes you don’t get a lot of opportunity to meet and speak to board members, meet and speak to senior leadership. You’re just tucked away enough that you’re not exposed. That’s the other thing–say yes to any committee. Get out of the nursing unit and get some exposure.


Do you have any final thoughts?

For anybody who’s in a hospital and just thinks of healthcare as a hospital, where we are going should be frightening to you. We’re not going to be a hospital, especially if we start taking a look at the people who are going to disrupt us the most — retail medicine. 

We have to start thinking about ourselves as the providers of retail medicine. We have to think about fast access, customer service, the customer’s always right — those things that you’ve traditionally heard about retail environments. We have to stop thinking about healthcare as a civil servant-type environment where you call and you get an appointment four weeks later. It’s going to change everything we do. We’re going to have to get faster, better, and more consumer friendly very quickly.

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July 28, 2014 Interviews 3 Comments

Morning Headlines 7/28/14

July 27, 2014 Headlines 1 Comment

Departments of Labor, Health and Human Services, and Related Agencies Appropriation Bill 2015

The Senate Appropriations Committee cuts ONC’s requested $75 million budget for 2015 down to $61 million and adds a stipulation that ONC should decertify and publicly report any EHR vendors that “proactively block sharing of information.”

NPA seizes over R1bn contract claims

In South Africa, a $133 million Siemens implementation is put on hold over allegations that the local Siemens reseller engaged in bid-rigging to close the deal.

Self Regional announces security breach of patient info

Self Regional Hospital (SC) announces a data breach affecting at least 500 patients stemming from a Memorial Day office break in that led to the loss of an unencrypted laptop.

Board recaps fair at monthly meeting

In a local article, 71-bed Nevada Regional Medical Center CFO Greg Shaw blames its Cerner billing system for the hospital’s $5.6 million YTD net loss, claiming that the system incorrectly classified insurance payers and aging accounts.

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July 27, 2014 Headlines 1 Comment

Monday Morning Update 7/28/14

July 27, 2014 News 8 Comments

Top News


A draft report from the Senate Appropriations Committee, responding to HHS’s FY2015 budget request, proposes to give ONC $61 million of the $75 million it requested. It adds that ONC should publicly report and then decertify EHRs that “proactively block the sharing of information.” It also wants the Health IT Policy Committee to create a report describing the challenges to interoperability and whether certification helps or hinders it. Reading down the long list of funded projects, it’s depressing to see how much taxpayer money is being dumped into government programs that claim to help one issue or another. All that aside, the interesting dynamic here is that ONC, like every government agency unwilling to reduce its budget or authority, keeps trying to expand its mission while Congress seems to think it is overstepping its authority and questions its effectiveness. I suppose $75 million is a rounding error in the federal budget, but as a taxpayer, I might question ONC’s value, along with what I’m getting for my $25 billion in HITECH handouts to providers who mostly regret having given up control in return for strings-attached government money.

Reader Comments


From EarsToTheGround: “Re: Siemens. Well-placed sources say they’ve been told that their consultant and contractor positions are being terminated by the end of September as they phase out several EHR vendors. I don’t know if this is related to the possibility of a Cerner buyout.”


From All Hat, No Cattle: “Re: pic from the Redwood Mednet conference in Santa Rosa, CA. I see the audience is a lot of older hippie types and open source geeks like Wes Rischel, Will Ross, John Mattison, David McCallie, etc. discussing HIEs with John Halamka.” There’s nothing like that "bald spot meets gray ponytail" look when it comes to self-identifying as an IT geek or that vaguely creepy “stuck in the 1970s” sound guy at the local music bar who doesn’t have the talent or nerve to be on stage but toils in the worshipful shadows of decades-younger musicians who do.

From Laredo Dave: “Re: Weird Al. Almost every buzzword you have ever heard, all in one video.” I’ve always detested Weird Al and his heavy-handed, sophomoric parodies of current events, but this one might make me a convert since even the music is good (very CSNY-like). It even includes one of my least-favorite, unnecessary pseudo-words: “administrate.”


From Lupe: “Re: Childhood Cancer Awareness Month. It’s in September. I don’t have a million dollars to give for research, but I am the very lucky mother of a 16-year-old diagnosed a year ago. My goal, short of a cure, is to make the gold ribbon representing these horrific diseases as recognizable as a pink one for breast cancer.”


From PP: “Re: Android tablet. Which inexpensive one did you buy that you liked quite a bit?” I got an Asus MeMO Pad HD 7 in December 2013 for $119 when it was on sale at Office Depot, frustrated that a newer version of my first-generation iPad was more expensive than a laptop. I still use the Asus tablet regularly and have no regrets. Android-powered tablets are just as good or better than the ones Apple sells for multiple their price, which may be why iPad sales are nosediving. I’m a casual user (checking email, looking up stuff on the Web,  watching Netflix, and reading Kindle books around the house, all over WiFi instead of cellular), so I don’t need a $499 iPad Air or even a $229 Google Nexus 7. The just-released latest model of the MeMO Pad is $134 on Amazon.

HIStalk Announcements and Requests

The intrepid Dim-Sum provided a detailed update about the Department of Defense’s EHR procurement, so I posted it separately.


Athenahealth provided a response to the question from Watertown Boy about the effect of the company’s updated Meaningful Use calculations on those practices that have already attested. I posted their comment under the original question.


Half of my poll respondents own stock or other equity of a healthcare IT company. I’m in the other half that doesn’t. New poll to your right: do EHR vendors have too much influence on related government policy?


Welcome to new HIStalk Gold Sponsor DocuSign. Its solutions allow business to sign, send, and manage documents in the cloud, making them available and legally enforceable. Healthcare organizations such as Blue Cross Blue Shield, Cedars-Sinai, HCA, and New York-Presbyterian use DocuSign to streamline document-based processes. The result is HIPAA compliance, faster patient inboarding, shortened turnaround time for Medicare billing, and faster handling of paperwork involving credentialing, supplier contracting, and HR. I interviewed the company’s founder, Tom Gonser, a few months ago. I have received documents that required DocuSign signatures and it was infinitely easier than printing, signing, scanning, and emailing. Try it yourself with the company’s 14-day free trial. Thanks to DocuSign for supporting HIStalk.


I’ve mentioned before the really cool (and free for personal use) remote control software I use: TeamViewer, from Tampa, FL. You can remote in to someone’s computer to fix something, remote into your own desktop from your phone, transfer files, and even hold online meetings or training sessions for up to 25 people. It is unbelievably simple, reliable, and satisfying to use. Just this week I’ve used it to remote into a colleague’s PC to diagnose a Windows problem and to remote into my home desktop from my phone.


Listening: a new hard-rocking single, “Cool Kid,” from The Eeries, an unsigned Philadelphia band. Also: Young the Giant, great California indie rock. Here’s one more, this one with a healthcare IT angle: VEX (above), a locally popular early 1980s college punk band (Georgia College & State University) featuring a young Larry Stofko, now EVP of the Innovation Institute of St. Joseph Health System of Irvine, CA. VEX’s music is now on CollegeBand, which tracks down long-defunct cult college bands, digitizes their music, and sells it along with merchandise and music rights for movies and TV. That’s my kind of business.

Last Week’s Most Interesting News

  • Cerner turned in another solid quarter with record quarterly numbers. Epic may be winning most of the high-profile health system deals, but Cerner’s win rate is creeping back up, its Intermountain partnership looks promising, and the company has diversified itself into enough areas of healthcare that its future isn’t dependent on new Millennium sales. Both companies will benefit as Siemens shops its IT division and McKesson sends mixed signals about its health IT commitment.
  • The Boston Globe reviewed EHR safety in a wandering, anecdotal article that decried a lack of mandatory EHR problem reporting and the overall influence of vendors on government policy. It uncovered new information in revealing that a recent study of 5,700 malpractice claims found that EHR-related issues contributed to 46 patient deaths, although the study’s definition of EHR harm was loose: it included incidents involving missing information, incorrect user entries, and problems with providers trying to run EHRs and paper systems at the same time.
  • Two UK hospitals signed huge deals with tarnished vendors. North Bristol will replace Cerner Millennium with CSC’s Lorenzo, whose legendary vendor shortcomings (both product and implementation) killed the government’s $20 billion NPfIT, while the trusts overseeing Watford General Hospital signed a $44 million infrastructure contract with CGI, most widely known for its deep involvement with the failure of
  • Leapfrog Group’s annual report found higher hospital CPOE use, but a third of those systems fail to detect major ordering problems.
  • NantHealth SVP Dave Dyell confirmed an HIStalk reader’s rumor report that he’s leaving the company, Patrick Soon-Shiong’s wildly ambitious conglomeration of a billion dollars’ worth of acquired companies. One of those was Dave’s former employer, medical device integration company iSirona.
  • Health Evolution Partners, a healthcare IT investment vehicle launched by former National Coordinator David Brailer when he left his government position in 2007, appears to be on its last legs. Its only investor, California Public Employees’ Retirement System, wants to cash out after the rookie private equity manager Brailer delivered years of near-zero investment returns despite promising 20 to 30 percent annually. HEP lists seven current portfolio positions, none of them related to healthcare IT.


August 12 (Tuesday) 1:00 p.m. ET. City of Hope Improves the Cancer Patient Experience With Sponsored by Presenters: Fred Stevens, director of call center operations, City of Hope National Medical Center; Todd Pierce, EVP of operations and mobility, Learn how City of Hope improved patient satisfaction and intake inquiries in 16 areas, gave 75 call center representatives the information they needed to deliver a personalized and seamless interaction, improved first-call resolution, and reduced average call transaction time by 42 percent (90 seconds) for over 1 million inbound calls per year. A live demo of Salesforce1 will follow.

Acquisitions, Funding, Business, and Stock


From the Cerner earnings call:

  • Sales revenue was up 15 percent and the total backlog is at $9.69 billion.
  • The company says many population health vendors are not aggregating and standardizing data across multiple systems, which makes them of limited value. Cerner says it offers more of a CRM-type system that includes registry functions, data warehouse, analytics, and patient engagement.
  • The ambulatory user count increased to 65,000, double number from “just four years ago” as the company says it is displacing key competitors.
  • Cerner says it is commit to “having the most open EMR,” whatever that means when marketing-minded companies claim they have it while scoffing at open source alternatives.
  • The company says its services and hosting offerings differentiate it from competitors.
  • An analyst asked if Cerner would have a rich opportunity to earn business from clients of Epic given that Epic is “relatively uninterested or unmotivated in pursuing pop health based on some of the chatter in the marketplace.” Zane Burke declined to comment, saying only that the industry needs EHR-agnostic solutions and Cerner’s will work with any EHR.
  • Marc Naughton said that Cerner will have more specifics on their Intermountain project next quarter.

I missed this earlier announcement: Google launches Calico, a health and wellness company that has already hired four prominent physicians and named as its CEO the board chair of Apple (who is also board chair at drug maker Genentech.) It seems that Google is dipping toes all over the healthcare waters right after Google co-founder Sergey Brin complained that it’s a waste of his time because it’s too regulated. Maybe he was just being cranky over the FDA’s pressure on his wife’s consumer genetics business 23andMe, which still hasn’t complied with FDA’s requirement that as a medical device, it has to submit validated proof of its accuracy to earn the agency’s marketing approval.



Surgical Information Systems names Jim Linder (Norwest Equity Partners) as acting CEO and executive chairman, replacing Ed Daihl.

Announcements and Implementations


Healthgrades joins athenahealth’s More Disruption Please program, giving athenahealth’s practice customers the ability to post appointment availability online for patient self-scheduling. In the spirit of disruption, I would urge Healthgrades to stop sticking the superfluous “Dr.” in front of every provider’s name – we understand that MD is a doctorate without needing its conferees redundantly identified as “Dr. John Smith, MD.” Every time I see that, I think of chiropractors and podiatrists, whose DC and DPM credentials don’t provide adequate ego stroking since many people don’t know what they mean. “Dr.” in front of a name should be used only in social situations where you might otherwise use Mr. or other titles – it should never be used on a website, business card, sign, online article, or obituary unless you want to emphasize your smug pomposity.



Qlik announces availability of a free desktop version of its data visualization and discovery tool.




The CFO of 71-bed Nevada Regional Medical Center (MO) blames its Cerner system for ongoing financial losses, saying that its incorrect billing requires the PFS department to analyze claims by hand. IT Director Chris Crist adds, “There’s a lot of problems from the Cerner perspective. Service requests, work orders, take a lot of time to stay on top of, and if you don’t respond to Cerner within a certain amount of time, they close the request.“ That’s a major black eye for Cerner given that its Healthy Nevada community health project is also in Nevada, MO and the hospital ended up with Millennium as part of that deal. The hospital’s CEO provided a predictably laudatory Cerner quote when Healthy Nevada was announced in July 2012, but she and the hospital’s board agreed that it was time for her to leave in February 2014.


In South Africa, the government freezes the Siemens-related EHR and radiology system contracts of Gauteng Department of Health, worth $133 million, following allegations of bid-rigging. The winning bidder of the 2007 tender, Siemens reseller-controlled Baoki Consortium, provided a health department executive with free housing. Prosecutors added that the bid was issued even though the health department didn’t have the money, infrastructure, or trained users to operate the proposed systems for 37 hospitals and 300 clinics. The systems were never implemented. The contracts were terminated in 2009 when new a Member of the Executive Council was elected. Siemens has been named innumerable times over many decades as being involved, directly or otherwise, in bribery-related contract awards, although it was a subcontractor in this transaction and wasn’t accused of doing anything wrong.


Self Regional Hospital (SC) goes public with the news that a laptop stolen in a Memorial Day weekend break-in contained information on at least 500 patients. The laptop was not encrypted. Police arrested two suspects, who said they panicked and threw the laptop into a lake. Perhaps the hospital’s apparently lack of technology sophistication in failing to encrypt PHI-containing devices extends to its website, which automatically starts playing the cheesiest, blandest royalty-free music imaginable as soon as its home page displays, with no option to shut the racket off.


Bonny from Aventura did some self-study on the CMS “Two Midnights” rule and decide to memorialize her newfound knowledge as a cartoon.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

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July 27, 2014 News 8 Comments

DoD EHR Update from Dim-Sum 7/28/14

July 26, 2014 News 4 Comments


Use cases. My goodness, is there anything more exciting than creating “To Be” scenarios where major COTS vendors can look at the DHMSM scenarios and can say with a suspicious smile, “Is that all they want, is that all they need?” The features and functionality exist in today’s EHRs. However, the operational and technical architecture to pursue this capture are complex. Not impossible, but complex.

Will a single environment that shares clinical data be enough to support a global clinical data vault? How can any team perfect performance and balance that with improving the delivery of military health? How will synchronization improve and not attenuate data collaboration? Do EMPIs become active participants in providing a variety of global patient identification aliases? Commercial EHR solutions are being deployed each and every day across the United States that meet the DHMSM requirements outlined in acute as well as ambulatory environments. How can we translate those lessons learned in to the psyche of our service integrator / partner / prime?

Now for THEATER.  In my experience with beltway software vendors, I can say with a degree of confidence that they cannot design from scratch a theater-worthy solution. These folks seem to think COBOL is cutting edge and that FTP/SFTP transfers are the only conveyance vehicles for data. These are the same folks that design their user interfaces to look like Microsoft Access or a DOS-based Excel worksheet with enough data to push all the data available in the local database. This equates to a single chaotic and cluttered view.  

Workflow means something! It really does. It is not just a word on a marketing slick. Understanding how the clinician (I am including down range medics here), technologist, and nurses work. Teams have to take the time to talk to clinicians. Translate those conversations in to a cogent way to view data respective of the clinician’s specialty.  Establish when and where it is essential to provide drill-down views — a nurse does not need to have 14 alerts that sourced data pulls from a year ago on a bunion. Data view is about relevance and moving the patient and their care along an uncluttered path. With that lesson in mind, it is my assertion that it is a mistake to assume that a CMMI software development firm could actually provide a salient solution for theater. If you doubt this, take a look at the systems that are put together today.

The smart architects will solution along the lines of repurposing a backbone of an existing patient-centric portable EHR and emergency / occupational health solution(s). Heaven forbid we take a look at solutions that actually have a client base. Low communication and non-communications standalone systems exist – they can provide portable clinical applications that can bridge the combat medic with resuscitative care as well as make the wrinkle in patient timelines affected by airevacs merely a data entry point — a step in patient care. I understand that many believe it is as complex as ear hair removal for men hitting their middle ages, but it is easier to fix than that.

The ultimate theater solution will become an invaluable transfer tool rather than a manual harbinger of medication mis-management and shadow record keeping. Therefore, the theater challenge is keeping data succinct, aligning casualty care with best practices, and an enabler for medics to stabilize data transference in preparation for transport away from harm and to the safe harbors that military medicine can afford. A transfer is a transfer, not unlike moving a patient to a skilled nursing facility or stepping a patient from critical care to a more mundane and therapeutic homeostatic environment. Recovery, therapy, and rehabilitation are the natural progression. Why not assume that the element most needed to evacuate a patient should connect rather than be an island of information that cannot be assimilated and or aggregated after the clinical data is needed?

Clinical decision support requires algorithms and data entry at key intervals in care no matter the monitoring mechanism. Closed loop medication begins with initial care folks! The perfect test bed is to automate the airevac Patient Movement Record. This has to be done and is crucial for survivability and clinical collaboration at the next point of care. Telehealth has a role and cannot only be focused on monitoring, but on collaboration and en route data transference / collaboration. Tc3 needs to add a C for computerization to embed all elements of care allowing intra- and inter-theater transfer of patient-centric data to the folks that need it most. Blood means life, as does airway management, shock management, and the medic’s ability to simplify the medication, pain, and sedation med management.  

In a nutshell, it means that the service integrators cannot rely upon CMMI firms to take an innovative approach to the theater solution. These firms lack the fundamental qualifications necessary to understand patient care and the continuum that translates into lives saved. Teams have to marvel at the way military healthcare is provided today in spite of the shortcomings of poorly constructed and non-integrated clinical solutions that have been acquired to date. No finger-pointing, just an observation as a clinical HIT guy.

Perhaps the best place to start is by simplifying and modernizing the medical terms used across all data dictionaries and tables. Design “practical” pathways that can be assumed at the next duty station, base, and post. Data liquidity and actionable analytics can only be realized with a focus on the patient and the care he or she receives. I believe that today data (in the military theater) is deemed as a commodity that needs to be dissected for affect, rather than a kinetic, ever-changing, non-quantifying entity. We have to structure that which is unstructured and assume that sharing clinical data is not a burden, but a directive.

Patient identification is a challenge. We are aware of that. Someone has to lead and state that the axiom “right care, right time, right location” really starts by implementing a uniformed medical language. Patient identification reconciliation is the cornerstone of appropriate care and avoidance of medication errors. Interventions will occur with or without an EHR. Documenting it, though, has everything to do with adherence to standards so care can be provide in a seamless manner. Even if care started in some desolate stretch of land, the care initiation is key – ask any field medic.

What efforts are being made to ensure that we do not design the same menagerie of databases that cannot be deemed as up to date? Are data sources reliable when they were designed to spec to be isolated and un-retrievable? When you manufacture anything, you start with the end in mind. How could any reputable vendor equip any clinician an EHR contributor system without any thought of data integrity to share across the enterprise?

Believe it or not, the longitudinal care record is not a mythological creature. If it was, it would be  a unicorn with a bunion and the "As Is" would relegate care to a podiatrist instead of a vet that specializes in equine hoofcare. I fear that many of the beltway firms use archaic technologies and proprietary protocols that effectively eliminate the concept of one patient ,one record.

Understanding down range medical operations as well as the rules constructed to improve survivability means effective transfers of data. This is the only tenable path to measurable outcomes.

I do hope that myopic views will be avoided and that proprietary protocols will become a lessons learned and will translate into improving the way combat care is assimilated in to a viable path to healing.

In spite of ACA legislation, ARRA HITECH investments, and CMS incentives, the commercial EHR market is not expanding, but is instead becoming more and more consolidated. Vendors are trying to compete with strategic service organizations that leverage existing HIT solutions and endeavoring to focus on smarter ways to work, applying analytics to figure out improved ways of deploying service lines that make sense. DHMSM will receive solutions that can address the ever-changing landscape of healthcare and the manner in which clinicians deliver that care. The question is more along the lines of how will teams refine the way data is shared, how liquidity of clinical data can become actionable?

The “As Is” environment is daunting, not the challenge of feature and functionality requirements. Applying the same techniques used in the commercial market segments requires an understanding of how clinicians practice medicine. A great deal of time has been invested in understanding the military enrollment process the deployment systems and even where authoritative data is being sourced. This opportunity will be won — not lost by the way transition and education proliferation is managed, how parallel operations can be kept succinct and orderly.

The transient population of 1.4 million service members is relying on the teams that are pursuing an award, but the eventual winner has to be the troops we serve. This is not a DoD solution. It is an honor to know that the real customer is that lady and that man who wears the uniform of a US service. Sorry for the soliloquy, but this is my way to convey what is on the minds of men and women designing and solutioning every hour, if not on paper or in meetings, but in our minds.  Be innovative folks, and do not lose focus on what needs to be done.

I promise next time to throw salted pretzels at primes and vendors. After all, that is why I started my controlled rants.

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July 26, 2014 News 4 Comments

Morning Headlines 7/25/14

July 24, 2014 Headlines No Comments

Health-Care Technology Firm Cerner Posts Higher Profit

Cerner reports Q2 results: revenue is up 20 percent to $852 million and bookings for the quarter are up 15 percent to $1.08 billion, adjusted EPS $0.40 vs. $0.34.

North Bristol to swap Cerner for Lorenzo

In England, North Bristol NHS Trust will replace its Cerner Millennium EPR with CSC Lorenzo. North Bristol’s medical director says that Lorenzo “ We also have significant ambitions, and we were impressed with the vision and appetite CSC showed for working with us to build a truly world-class approach to patient care.”

Health Information Technology and Health Information Services: 2014 Mid-Year Review

Healthcare Growth Partners releases its healthcare IT mid-year review, which covers investments, M&A activity, and the expansion of the health IT footprint.

NEA Baptist Clinic and Hospital will soon be integrated with an electronic medical record

NEA Baptist Clinic and Hospital (AR) will go live on Epic across its entire organization, migrating from a previous vendor in its clinic and introducing its first EHR in the hospital.

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July 24, 2014 Headlines No Comments

News 7/25/14

July 24, 2014 News 3 Comments

Top News


Cerner reports Q2 results: revenue up 20 percent, adjusted EPS $0.40 vs. $0.34, meeting estimates of both. Orders for the quarter totaled $1.08 billion, the best Q2 in the company’s history.

Reader Comments

From Medium-Sized Data: “Re: data extraction. I challenge all of the companies promising world-changing analytics to extract all of your HIStalk posts to produce a list of hot topics by month and year, a cool infographic, or a detailed report.” That would be pretty cool. There’s a wealth of information in those old posts: tracking vendors that promised something that was never delivered, big announcements that were just hot air, and public perception items trended by vendor based on positive or negative HIStalk mentions. Companies are welcome to take a swing at it, and if they come up with something useful, I’ll toot their horn.


From Watertown Boy: “Re: athenahealth. In a recent email to clients, they announced what appears to be their problem in over counting some of the MU items. What happens to practices that already submitted this year?” A July 21 email to customers says athenahealth “identified a need to improve our calculation logic” and will complete that work by July 25, adding its apology to customers whose performance numbers will suffer as a result. Athenahealth provided this response:

There is no impact on eligible providers who have already successfully attested for Meaningful Use (MU) this year. Athenahealth takes great pride in the integrity of our data and we proactively monitor guidance and interpretations issued by the Centers for Medicare and Medicaid Services (CMS) to ensure our system remains accurate and up to date.  Accordingly, when changes that affect our measure calculation logic are identified, athenahealth works to make the appropriate system changes and notifies clients of all recalculations, as we did this week.  In the event of system changes that impact MU measure calculations, athenahealth supports providers who have yet to attest by recalculating all associated data to determine the best time for those providers to attest with the most up to date data.


From WellTraveledGal: “Re: Beacon Partners. Announced mass layoffs of sales and consultants. Paul Sinclair, formerly of Cerner and UnitedHealth / Ingenix, joins as sales VP.” President and CEO Ralph Fargnoli provided this response:

We have not had mass layoffs of sales and consultants. Beacon Partners continues to grow because of the excellent work our experienced team of healthcare professionals is providing to health systems throughout North America. Recently, we have realigned some of our business development and consulting personnel to better support the operational, clinical, and financial performance engagements of our clients, and to meet our goals for continued growth. As we execute our business objectives for the second half of the year, we are actively recruiting for both business development and professional services positions. 

From Boy Wonder: “Re: MU timeline for 2014. I wonder when your readers think CMS will announce a decision on the proposal to change the MU timeline for 2014? It better be quickly since many providers will be targeting Q4 as their one and only shot at MU2.”



From The PACS Designer: “Re: genome discovery. Genome sequencing will cost as little as $1,000, according to the CEO of Illumina. The company has an improved MyGenome app.” It’s a pretty amazing advance, but the really amazing one would be to figure out how we’re going to pay for treating the new problems such testing reveals. We love snazzy new diagnostic techniques and decisive interventions, but aren’t so great at making them affordable. The most amazing development would be to figure out a way to get people to lose weight, exercise, and turn off their phones and interact with others in a genuine rather than electronic way to move the population health needle. Genomic discoveries are cool, but our health problems have little to do with a lack of technology.

HIStalk Announcements and Requests

This week on HIStalk Practice: MGMA begins the search for a new CEO. Kansas Health Information Network and ICA announce a record number of HIE connections. Harbin Clinic and Cigna team up for collaborative care. ONC alludes to a specific interoperability timeline by 2015. PCC Director of Pediatric Solutions Chip Hart discusses the sometimes challenging world of pediatric HIT. The HIStalk Practice Reader Survey is live. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the new interest in health data aggregation from Google, Samsung, and Apple. Researchers with Cedars-Sinai have successfully tested a biological pacemaker concept in pigs. TechCrunch reports that women’s health apps are leading in the mHealth segment in both funding and consumer engagement.


My latest pet peeve: going to a company’s site and getting hit with one of those intrusive pop-up “your opinion is important” windows asking me if I want to take a survey. No, actually what I’d like to do is instantly leave any site that is clueless about annoying its web visitors with pop-ups. It’s nice to know your customer better, but nicer still to not drive them away with heavy-handed tactics whose only benefit is to make some marketing VP feel like they are contributing to business success. At least the HIMSS version doesn’t require answering before proceeding, so even though it’s annoying, I can live with it.

Listening: Phantom Planet, Southern California indie pop that’s been around for 20 years minus a hiatus or two.

Acquisitions, Funding, Business, and Stock


Quality Systems, Inc. (the NextGen people) reports Q1 results: revenue up 8 percent, adjusted EPS $0.13 vs. $0.24, beating revenue estimates but falling short on earnings. The hospital unit continues to turn in poor performance with a loss of $3.5 million. Overall, bookings were down, earnings were down, and expenses were up.


Streamline Health reports Q1 results: revenue up 7 percent, EPS –$0.16 vs. –$0.24.


The parent company of Lumeris announces $71 million in new financing from new and existing investors, which it will use to boost its population health management capabilities and expand from eight to 20 markets for its value-based care solutions. The parent company’s other companies are Accountable Delivery System Institute (accountable care education),  Essence Healthcare (Medicare Advantage plan), and NaviNet (communication network).



Aspirus (WI) chooses Strata Decision’s StrataJazz to help manage costs in its six hospitals. 

New Haven Community Medical Group (CT) chooses athenahealth’s PM, EHR, and patient portal.


In England, North Bristol NHS Trust signs for CSC’s Lorenzo EHR, replacing Cerner Millennium. Lorenzo was the only choice offered with the now-defunct NPfIT, but previous owner iSoft and then CSC repeatedly botched implementations and missed deadlines, which was arguably the main reason that NPfIT went up in a $20 billion taxpayer-funded mushroom cloud in 2013. North Bristol admitted that its $37 million Millennium system was nothing but trouble right after its December 2011 go-live, much of that due to its own failings in not testing and training well, shortcutting data migration, and letting IT run the project. The go-live resulted in cancelled surgeries, incorrectly assigned appointments, and patients who were sent home because doctors couldn’t access their records. The trust also admitted it had underestimated Millennium’s cost, drawing the ire of government officials demanding to know why the average trust implementing Cerner was spending three times as much as those going live on System C’s Medway, which was later acquired by McKesson and then recently sold off to Symphony Technology Group as McKesson dumped its European IT business.

Announcements and Implementations


NEA Baptist Clinic and Hospital (AR) will go live on Epic inpatient and outpatient in the next couple of months as the 100-bed hospital plans for its first EMR. They’re part of Baptist Memorial Health Care of Memphis, TN.


Healthcare Growth Partners issues its always-insightful and downright eloquent healthcare IT mid-year review. This snippet is as brilliant as anything that’s been said about our healthcare challenges:

Inefficient markets typically result in a mispricing of goods and services. The cause is often due to monopolies, poor regulation, and a lack of market transparency. Each is a contributor to inefficiency in the US healthcare economy, but the primary shortcoming is the lack of market transparency, or information, needed to define the cost and quality of goods and services, otherwise known as value. In many markets, information is a tool for power and a proprietary competitive advantage. However, healthcare is not like most markets. Healthcare information is unique because it serves both a humane and a commercial purpose. At stake is the health of family, friends, neighbors, and ourselves, as well as the economy and corporate profits. Healthcare information exploited for the benefit of a few compromises the efficiency of the healthcare system as a whole. Nothing makes this clearer than the abysmal statistics of healthcare in the US. The power and profit potential for disruptive innovation in this nearly $3 trillion market is unfathomable. The advent of transparency will translate into a myriad of opportunities to drive down costs, improve outcomes, generate higher profits, and result in a stronger economy. 


The report says that companies that sell out for high multiples have these characteristics:

  • SaaS delivery that generates recurring revenue
  • Pricing alignment so that the company makes money when the customer realizes value
  • Scalable distribution that lowers the cost of acquiring a new customer
  • Providing value that will carry into the post-ACA environment instead of just exploiting current system flaws
  • Rights to the data created by their customers
  • Market leadership, strong management, and growth

Government and Politics


Women & Infants Hospital of Rhode Island will pay $150,000 to settle data breach charges resulting from a 2012 incident in which 19 unencrypted backup tapes containing the information of 12,000 prenatal diagnostic center patients disappeared. That’s not a federal HIPAA fine – $110,000 of the payment is a state civil penalty, $25,000 is for attorney fees, and $15,000 will fund an attorney general data security education campaign.

The GAO will release a report next week that outlines’s go-live problems, the cost to fix them, and the work remaining.


FTC Commissioner Julie Brill, concerned about a May report that showed 12 mobile health and fitness apps were sharing user information with 76 companies, says that third-party data use is where “the rubber hits the road when it comes to patient harm.” Despite urging that consumers be given more control on the use of their information, Brill says that no new regulations are planned.

A California appellate court dismisses a class action lawsuit that sought $1,000 for each Sutter Health patient whose information was stored on a stolen computer, a suit that had exposed Sutter to a potential $4 billion payout. The court found that the state’s Confidentiality of Medical Information Act requires proof of unauthorized access to patient information, not just possession of the physical form of the data (a hard drive, in this case) by an unauthorized individual. One of the attorneys for the patients originally said that an unencrypted computer storing the information of 4 million patients should have been stored in a windowless room under lock and key instead the office that was broken into.

The Wall Street Journal profiles William LaCorte, MD, a Louisiana internist who has pocketed $38 million as his share of 12 Medicare fraud lawsuits he filed, mostly against drug companies. He even named his newly purchased 34-foot boat Pepcid. The article also mentions a former pharmacy that found whistleblower lawsuits to be a more lucrative business, having netted it $425 million so far.


Former Procter & Gamble CEO Robert McDonald, in his confirmation hearings for Secretary of Veterans Affairs, says the agency needs to “continue to expand the use of digital technology to free human resources” and “create, with the Department of Defense, an integrated records system.”

Innovation and Research


UnitedHealthcare makes its Health4Me app available to all consumers, not just its customers. It providers doctor search and medical price review.



Allscripts receives an Intel Innovation Award for its Windows-powered Wand mobile EHR navigation system. 

Google’s Google X research group will analyze genetic and molecular information from 175 volunteers to define a healthy human, hoping that the Baseline Study’s new diagnostic tools will allow Google’s computers to find patterns that allow earlier detection of disease. That project may or may not be related to the company’s recently announced glucose-measuring contact lens.


The administrator of Bradley Healthcare and Rehabilitation Center (TN) says employees really like its new PointClickCare EHR, but adds that the system caused Medicare payment delays in its first two months. The system was configured to use the facility’s five-digit ZIP code instead of the required nine-digit code and nobody knew how to open warnings from its intermediary about incorrectly formatted claims. The facility admits that it should have trained users better before going live.

An NPR report says HIPAA was created to protect patients, but healthcare organizations are intentionally or unintentionally using it to protect their own interests, such as hospitals that refuse to give patients their own medical records claiming it’s a HIPAA violation, when in fact the law intended the opposite. It also mentions that VA management used HIPAA threats to squelch potential whistleblowers.

A patient who starting shooting in the psychiatric unit of Mercy Fitzgerald Hospital (PA) is shot by the psychiatrist he wounded, who returned fired using his personal firearm despite the hospital’s policy barring on-campus weapons except by on-duty police.

Sponsor Updates

  • Elsevier Clinical Solutions will use the clinical evidence platform of Doctor Evidence LLC in its Evidence-Based Medicine Center.
  • Perceptive Software’s Acuo Vendor VNA earns DIACAP certification as part of its 2012 DoD contract to manage clinical content for US Army and Navy hospitals around the world.
  • Etransmedia Technology shares the process of taking a state-of-the-art urology practice with on-site PT through their EHR implementation and decreasing the cost of clinical documentation by 75 percent.
  • Allscripts EHR solutions connect to the State of Arkansas HIE.
  • Ingenious Med CEO Hart Williford shares four core beliefs that have enabled him to transition companies from startup to explosive growth and maintain company morale.
  • Truven Health Analytics links clinical data to claims, enhancing oncology-focused outcomes research studies.
  • Shareable Ink’s CTO Stephen Hau discusses its expansion to an iPad version and the risks and successes involved.
  • e-MDs ranks fifth overall in the Medscape EHR Report 2014.
  • ACO Buena Vida y Salud (TX) partners with Sandlot Solutions to connect with the Rio Grande Valley HIE (TX) using Sandlot Connect.
  • The Association of Community Mental Health Center of Kansas will implement Netsmart’s CareManager while the Kansas Health Information Network will implement Netsmart’s CareConnect solution.

EPtalk by Dr. Jayne

Jenn tweeted about this recent Washington Post piece on Maintenance of Certification (MOC). Since I now have to maintain certification in both clinical informatics and my primary specialty, it hit close to home. Although board certification is technically “voluntary,” in my market it’s a necessity – no payers will credential you if you’re not certified.

I agree with the author that merely having certification doesn’t add a lot to my actual practice of medicine. I don’t treat chronic disease or deliver babies any more, other than in an absolute emergency. I do, however, perform a mean laceration repair and reduce dislocations like a boss. None of that is on my board exam, however.

You may be asking what this has to do with healthcare IT. It’s this: nearly everything for MOC is online and some of it is a true pain. Plus, there’s not a lot of content for some of us who are largely administrative or don’t have true continuity practices.

Case in point: my Board offers a handwashing module for MOC. If you’re in traditional practice, you’re supposed to survey your patients then key in the results and analyze them. If you’re not in continuity practice, they give you mock data that you still have to key in and analyze. How hard would it have been for them to preload the data? I’m sure the argument is I need to have the experience keying in data since the others do, but that’s ridiculous.

We’re claiming that primary care physicians should be quarterbacking healthcare delivery teams and working at the top of their licensure, yet we have them manually keying in data for recertification. Physicians at my institution are burning out at an alarming rate. This is just one more thing we ask them to do. Manually keying data isn’t a good use of our time.

On the flip side, some organizations have tried to partner with EHR vendors to extract data for quality studies. My vendor used to do this for two specialties but ended up stopping it, supposedly because the burden of keeping up the code was too great and the functionality wasn’t adopted widely by customers.

I have to admit I’ve been somewhat of a slacker with regards to MOC for my newly-minted clinical informatics subspecialty. I’m in the middle of an online cultural competency module for my primary specialty that I keep having technical difficulties, with so the idea of digging into other content doesn’t excite me.

I do obtain regular Continuing Medical Education credits, typically double what is required by my Board, which is four times what is required by my state licensing board. That’s the most valuable to me as far as keeping up because I can choose CME that’s relevant to what I actually see in practice. Cramming for a test once every 10 years (even when I can listen to all the lectures on my handy-dandy iPod) doesn’t say much about my skills listening to patients or being a clinician who can actually speak with patients in a way that they understand and makes them confident in the treatment plan.

Readers may ask, if we don’t have ongoing board certification, how will patients tell if we’re quality physicians?

It’s my great hope that eventually when we are truly meaningful users of EHR technology (not the government-speak kind of MU, but the real kind) we’ll be able to show what kind of physicians we are. How many of Dr. Jayne’s patients had failure of their laceration repairs? How many had unexpected scarring? Was her documentation readable and did she provide a patient plan in a way that the average person with a fifth-grade reading level could understand? Did she communicate back with the patient’s primary physician and arrange a follow up?

A friend of mine does minimally invasive knee replacements. He puts all of his data on his website for the world to see. He’s published multiple studies on his outcomes. All he does is knees. To me, seeing his data (including infection and complication rates) is a much better marker of his skill and competency than knowing he passed a board exam that covered the rest of the realm of orthopedic practice.

Before EHRs, trying to mine paper charts for that kind of data was nearly impossible. Most of my colleagues who were doing outcomes research used separate databases and registries and there was a lot of manual entry. Now we have the ability to study our populations at a moment’s notice. As a CMIO, I provide my physicians a sheaf of reports each month that let them know how they’re doing with respect to national standards and also to their peers. That kind of data will drive behavior change far more than reading a board review book might.

I’m hopeful for the future, but meanwhile I’m stuck with the expense and tedium of MOC.

What does your CMIO think of MOC? Email me.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

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July 24, 2014 News 3 Comments

Morning Headlines 7/24/14

July 23, 2014 Headlines No Comments

Panel approves Robert McDonald’s nomination to VA

The Senate Committee on Veterans’ Affairs confirms the nomination of Robert McDonald as the next VA Secretary in a 14-0 decision. His nomination will now move to Senate for a final vote.  In his post-confirmation statement, McDonald said that the VA needs to prove “ that it can create, with Department of Defense, an integrated records system; (and) that it can regularly and accurately produce key data for decision-makers and oversight entities.”

Study Finds 10.3M Uninsured Gained Coverage Under ACA

A NEJM study finds that 10.3 million uninsured American’s gained health insurance during the ACA open enrollment period, with eight million signing up for private insurance and 2.3 million taking Medicaid. Enrollment variations between age, gender, and ethnicity are also included in the study.

Court halts $4 billion privacy suit against Sutter Health

A $4 billion class action lawsuit against Sutter Health stemming from an earlier data breach has been thrown out because patients could not prove that their data had been accessed by anyone or used in any illegal way.

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July 23, 2014 Headlines No Comments

Readers Write: Bench, Bonus and Bondage: The Sorry Side of IT Consulting

July 23, 2014 Readers Write 3 Comments

Bench, Bonus and Bondage: The Sorry Side of IT Consulting
By Mike Lucey


If I could lose 20 pounds, I would be ready to model swimwear. That’s a nasty image for those who know me, but if I were serious, hiring a personal trainer would make sense. Or better yet, a personal exerciser!

Why not both? One person to tell me what to do and another to go and do it. I might not get the results I want, but much less effort. Think of what I would save in sneakers and tee shirts!

This wacky logic seems to be in play in our industry when it comes to hiring consultants. When I moved into consulting, it was because I figured I had some unique smarts and skills that a hospital would need. Once my smarts became their smarts or my skills were no longer needed, off I would go to the next guy. For this I would get a nice rate and the fun of doing new projects.

But what I am finding is hospitals have some consultants who offer guidance, and then other “consultants” who do the work, work that hospitals really need to be doing themselves. Part of why this happens can be found in the way consulting companies can market their services.

Bench: To start a consulting company, scrape up a pile of resumes, format them nicely, and throw them at every hospital problem you hear about until some of them stick. Now you have consultants working. As these consultants roll off projects, they go to the Bench. Yikes! Good news: you now have consultants ready for the next project. Bad news: every hour they sit on the bench they cost money (until you pull the bench out from under them). A way companies can lighten the bench is to give bonuses to the consultants that are still working to find work for the benchwarmers.

Bonus: Let your working consultants know that they will get a bonus for every benchwarmer they place. This is where the worm turns. Now those consultants you hired to solve a problem are to some degree degraded or distracted by the incentive to be a sales guy. The inclination to teach a hospital employee how to solve the next problem conflicts with an inclination to pull in a colleague from the company. Good for these companies, maybe not so good for the hospital.

Bondage: With each additional placement, each incremental bump in the billable hours (and bump in that bonus income), the idea of ending the engagement becomes more ugly and the motivation to extend more attractive. It is stressful to see a project end and face the uncertainty of the next job, stress that is magnified with the addition of each colleague and the bonus income they represent. Suddenly maintaining my value as a smart guy may depend on maintaining a certain amount of client ignorance and so client dependence – knowledge bondage.

This is how you end up with a consultant who is not just the captain of your hospital softball team, but the batting champ three years running.

We consultants have a great part to play as our industry continues to change. We bring real value helping hospitals make decisions, helping them act on those decisions, and providing resources when big projects need extra hands. That value is based on smarts, skills, and experience that hospitals don’t yet have, but can gain with our input. 

When that value wanes, not to worry — I’m off to the next project. Or I always have the modeling gig to fall back on. (note to self: find my Ab-Master.)

Mike Lucey is president of Community Hospital Advisors of Reading, MA.

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July 23, 2014 Readers Write 3 Comments

Readers Write: Is DIY Network Security a Good Idea?

July 23, 2014 Readers Write No Comments

Is DIY Network Security a Good Idea?
By Jason Riddle


Patients and clients count on healthcare providers, payers, and business associates to protect their electronic health records. For optimal care, patients need to feel comfortable divulging personal information that could cause them injury—financially, emotionally, and/or physically—should it be illegally accessed or corrupted by hackers or malware.

Additionally, covered entities are required by HIPAA/HITECH laws to maintain a certain level of network security. Violation of these regulations could result in stiff fines, a disruption in operations, and a general loss of goodwill among the people who do business with them.

Many small to medium-sized organizations are managing some if not all of their network security on their own. Here is one question they often ask:

Do we have enough protection for our patients’ data, or do we need to hire outside professionals to do the job for us?

While there is no right or wrong answer to this, there are a few factors that need to be considered.

HIPAA/HITECH was designed with built-in flexibility so that organizations could make their own decisions about their level of investment in network security. For example, a large organization may choose to hire an outside cyber security firm to monitor their networks around the clock, but a three-person doctor’s office might be hard pressed to put such an aggressive solution in place. Office for Civil Rights (OCR) auditors who are responsible for monitoring HIPAA compliance recognize that organizations of various sizes make decisions based on practical restraints.

As covered entities make decisions for (or against) increasing security, the reasoning and conclusions should systematically be written down. OCR auditors generally take into consideration all well-documented justification.

One way to think about whether or not to hire an outside vendor to assist with network security is to recognize that a solution doesn’t have to be all or nothing. For example, some companies will hire an independent third party to conduct an initial security risk analysis. This gives them the objectivity where it counts—identifying vulnerable areas and obtaining guidance on how to address them.

Once the fix-it plan is set, the internal IT team can assume the responsibility of maintaining the network’s security from there on out. This hybrid solution can oftentimes save money. Cyber security professionals will likely identify problems faster and provide guidance to tools that are both free and/or low cost.

If an organization is committed to a DIY network security solution — whether starting out with the help of professionals or taking it all on independently — it takes more than someone who is just an IT whiz to manage a network security program. There are six main areas that a security officer must be well versed in to carry out the required responsibility:

  1. Understanding HIPAA compliance. A security officer must understand the HIPAA/HITECH regulations and what compliance really means. This includes (but is not limited to) regular security risk analyses, documenting all security measures. and reporting any breaches that may have occurred.
  2. Securing the data. Firewalls and antivirus software are a must, but that’s just the minimum. Some of the other areas to be addressed are data encryption, regularly scheduled reviews of all logs (on the firewall and the server), restricted access, and regular data backups.
  3. Securing the facility and equipment. Physical access to computer equipment must be controlled at all times. Doors to the server room should be locked. When appropriate, screens should be protected from nosy passers-by. The security officer should have an eye for the logistics of the facility and areas that might pose a risk to keeping patient data secure.
  4. Monitoring mobile access. Decisions need to be made about how employees are able to access data from mobile devices. Types of data that can be obtained wirelessly might need to be limited, and employees will need to be aware of the whereabouts of their mobile devices at all times.
  5. Training the staff. A lot of security breaches are the result of human error. Everyone in the organization needs regular reminders that they are handling sensitive data and to be aware of actions they might be taking to jeopardize it.
  6. Understanding relationships with business associates. Responsibility for protecting client and patient data extends to everyone that has access to it. If a third party does the billing, for example, it’s critical that they are compliant as well.

A DIY network solution for healthcare organizations is not necessarily a bad idea. But it does need to be a well thought out one. Patients and clients are counting on it.

Jason Riddle is practice leader with LBMC Managed Security Services of Nashville, TN.

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July 23, 2014 Readers Write No Comments

Readers Write: EMR vs. EHR

July 23, 2014 Readers Write 2 Comments

By Steve Blumenthal, JD


HIStalk has asked me to explain the difference between an EMR (electronic medical record) and an EHR (electronic health record). Clearly, HIStalk needs to get out more. But I’m a nerdy lawyer and analyzing defined terms ranks up there with reading blogs about who’s being cast in the “Star Wars” reboot.

Let’s start with the source of most healthcare IT terminology, the feds—specifically, ONC. ONC’s website ( says that an EMR is “a digital version of a paper chart that contains all of a patient’s medical history from one practice.” On the other hand, an EHR is “a digital version of a patient’s paper chart.” So, clearly an EMR and EHR are differ…. Wait a sec. Is it me, or do those definitions look remarkably similar?

I think I’ve figured it out. An EMR and EHR are both a digital version of a patient’s paper chart, but an EMR only has one practice’s patient chart. So, if I never see a physician other than my internist at Vanderbilt, Vandy’s electronic record system is an EMR with respect to me. However, my daughter has seen two doctors in different practices within Vandy’s health system, so Vandy’s electronic record system would be an EHR (not an EMR) with respect to her. No, that can’t be right.

Wait, ONC has more to say. An EHR is “more than just a computerized version of a paper chart in a provider’s office.” Whew, that clears up everything. An EHR is more than an EMR. Now I can go home and finally hang the curtains in the guest bedroom.

On second thought, that didn’t clear up anything. The curtains will just have to wait another year.

“EHR systems are built to share information with other health care providers and organizations—such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics—so they contain information from all clinicians involved in a patient’s care.” I think we’ve found something. “Built to share information” is the key. I feel an analogy coming on.

An EMR is an earthworm, a useful creature that burrows into the earth, carrying organic material down into lower levels, breaking down dead plant material, and aerating the soil. But an earthworm is not transformative. Its life is spent toiling in the soil as an earthworm (and usually ending underneath a person’s shoe or in a bird’s gullet). On the other hand, an EHR is a caterpillar, a worm-like larva that will eventually transform into a beautiful butterfly (or somewhat less attractive moth or fruit fly). An EHR is designed for great things—collecting and distributing data from EMRs and other sources like butterflies cross-pollinating fields of flowers.

The difference between an EMR and an EHR isn’t what they are today. Let’s face it, given the interoperability issues with most EHRs today, they’re pretty much toiling in the same soil as EMRs. The difference lies in what an EHR is designed to become. That’s why the “Base EHR” definition in ONC’s EHR certification regulations says that an EHR must, in addition to including patient health information, have the capacity to do more—to provide clinical decision support, support physician order entry, capture and query information relevant to health care quality, and exchange electronic health information with other sources.

It’s actually kind of inspirational when you think about it. If you’ve got a kid, you’ve read “The Very Hungry Caterpillar.” Sure, the caterpillar eats a couple tons of food that could otherwise have been used to feed impoverished children, but then he spins a cocoon and, a short time later, becomes a beautiful butterfly. So maybe we’re spending a lot of resources on EHRs right now, but the payoff will be amazing in the end.

Unfortunately, the process of changing from a caterpillar into a butterfly is, well, disgusting. As “Scientific American” puts it, “First, the caterpillar digests itself, releasing enzymes to dissolve all of its tissues. If you were to cut open a cocoon or chrysalis at just the right time, caterpillar soup would ooze out.”


(For those of you wanting to double-check me on my quotes from ONC’s website, see here and here.

Steven E. Blumenthal is an attorney with Bone McAllester Norton PLLC of Nashville, TN.

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July 23, 2014 Readers Write 2 Comments

Health IT from the CIO’s Chair 7/23/14

July 23, 2014 Darren Dworkin 1 Comment

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

Enterprise IT Says “No” (again…)

Nobody really likes to hear “no” as an answer. Unfortunately, I think it may be part of my job to give it. That does not mean I have to like it.

The role of enterprise IT differs across large healthcare organizations, but likely also has a few common threads. Here are three I would guess to be constants.

  1. To manage total spend on IT capital and operating budgets required to maintain the operations of dozens of existing applications (most of which are mission critical).
  2. To prevent any breach of security or privacy and ensuring adherence to a growing number of regulatory obligations.
  3. To be accountable to a wide range of diverse stakeholders with many ideas on how to do more with IT.

None of these things on their own drives IT to say “no,” but together they can create enough pressure to want to leverage “no” as the answer to slow or to temporarily stop the chaotic pace that many enterprise IT groups face.

This post is not meant to be a complaint about enterprise IT. I lead an enterprise IT organization and I think central IT groups can be integral to the core of any business. But IT is changing. It’s time we challenge how we approach the IT department itself. Here are some crazy ideas to try.

Problem: IT budgets are either constrained in growth, frozen, or expected to drift down year over year.

Idea: Reduce the central IT budget to cover just the basic shared services and infrastructure — help desk, user security, dial tone, and the data network. IT should be pushed to make this part of the budget more efficient. It should be subject to the same budget expectations as, say, plant operations. Everything else should live in a line of business operating cost center or a cost center dedicated to the initiative. For example, put the lab system in the lab cost center and the expenses for that new ACO initiative in a dedicated ACO cost center.

Enterprise IT Challenge: Without budget authority, IT will be included at the table with influence. IT will need to educate many on the challenges of not just the cost to acquire and implement, but the ongoing costs to manage and support.

Benefit: Less frequent need to say “no.” More stakeholders will be involved in the shared budgeting and fewer will ask for new toys when they are still helping to find ways to pay for their own existing ones.

Problem: New solutions must be secure and avoid introducing risk.

Idea: Approach risk like an auditor evaluates risk. Health systems are filled with some of the smartest people around. Someone can always come up with an obscure edge case to represent why it might not work, but that does not mean the whole idea is bad.

Auditors understand that risk is everywhere. The objective is to manage and mitigate high risk and to prioritize focus. Enterprise IT should start to evaluate the risk of a solution based not only if risk is possible, but if it’s likely. Some problems are so big that solutions are welcome even if they don’t solve all the issues.

By way of example, using a consumer cloud storage service is better than a USB drive and probably more secure than many laptops, even if the cloud does not meet every IT requirement.

Enterprise IT Challenge: Get comfortable with incremental improvements to pave the way for the big wins. Understand that a less-secure, easy-to-use approach that will improve what is used today is better than the higher-friction perfect one we are waiting on for tomorrow.

Benefit: Faster iterations towards solutions, more “yes” answers, and a greater appreciation and understanding when a less-frequent “no” is delivered.

Problem: IT has become part of so many pieces of the healthcare delivery system. Instead of celebrating this win, IT gets caught up in the constant stream of new demands for new things. IT just can’t do it all.

Idea: Decentralize more of IT and stop asking IT to do it all. If delivering care is more efficiently done in a team setting, why can’t IT be approached the same way? This will take work in establishing guidelines, tools, and governance, but it may just be time to reimagine enterprise IT. Reporting, clinical content, workflow optimization, and new products to pilot are all great candidates to experiment with decentralization.

Enterprise IT Challenge: Three things: change, trust, and infrastructure. Like most hard things to do, sooner or later it may just come down to trust. The goal of decentralizing IT is not to let everyone just do whatever they want, but rather to work as a larger team with shared responsibility to the same outcomes. This change takes careful planning and focus. If that is not hard enough, our IT systems are probably working against us in that we lack some of the tools and infrastructure to adequately matrix our work.

Benefit: Shared goals, shared outcomes, deeper penetration of IT in the organization, and over time, the best people working on each solution (some from IT, some from the rest of the enterprise). Maybe in the end there aren’t fewer “nos,” but fewer from just IT.

The role of IT should be to enable and encourage IT. It’s time to turn enterprise IT into more of a team sport.

1-29-2014 12-54-46 PM

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

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July 23, 2014 Darren Dworkin 1 Comment

Morning Headlines 7/23/14

July 23, 2014 News 2 Comments

Hazards tied to medical records rush

The Boston Globe reports on the sometimes tragic results of the nation’s hasty implementation of EHRs, and the anti-regulatory message being broadcast by vendors.

Swiss Walgreens? $4 Billion Tax Cut Considered At Corner Of Happy, Healthy & Tax-Free

Walgreens considers moving its headquarters to Switzerland through the acquisition of Swiss-based Alliance Boots, a move that would save the company $800 million in taxes annually.

Characteristics Associated With Post-discharge Medication Errors

A small study examining post-discharge medication errors finds that 54 percent of cardiac patients reviewed had at least one error on their discharge medication list.

Hospital trust makes ‘biggest investment in IT for more than a generation’

In England, West Hertfordshire Hospitals NHS Trust signs a $44 million contract with CGI to update the IT infrastructure of its 600-bed hospital, Watford General, which came under scrutiny last year when its EHR was blamed for a scheduling issue that resulted in the death of two cancer patients.

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July 23, 2014 News 2 Comments

News 7/23/14

July 22, 2014 News 7 Comments

Top News


A Boston Globe article says that HITECH has pushed EHRs into clinical settings, but “staunch resistance to any regulation by the politically influential health records industry” has sidestepped the reporting and tracking of medical errors they cause. It cites a malpractice study that found that the most common adverse event to which EHRs contributed – of which 46 caused patient death – was often due to providers that straddle both paper and electronic records. The study also cited problems of incorrect data entry, inappropriate use of EHR copy and paste instead of entering fresh daily notes, and computer downtime.

Reader Comments


From Anonymous Tipster: “Re: Siemens acquisition. I heard from a highly placed Cerner executive that the deal will be done for $1.2 billion. It will probably shake up Cerner’s stock price, but leave it with better financial capabilities and a bigger customer base.” Unverified, but the rumor that Cerner will acquire the Siemens healthcare IT business seems to have legs and the non-anonymous folks who are telling me have well-placed sources.

From Recognize This: “Re: Nuance. I heard a rumor about major layoffs and closed job requisitions.” Unverified.


From Desai Arnaz: “Re: HITPC. I looked at the HITPC schedule and every MU Committee meeting is cancelled the rest of the year. They have met faithfully every two weeks for the past several years. What is going on?” I think the old Meaningful Use Workgroup has been replaced by Advanced Health Models and Meaningful Use under Paul Tang, and since that group was just formed, they probably haven’t put their meetings on the calendar yet. But my already-slim interest in ONC’s doings is lessening by the day, so maybe someone more attuned to HITPC’s workings can jump in with an explanation.

HIStalk Announcements and Requests

The LinkedIn Police Department has decided that my Carl Spackler photo and my use of “Mr.” as a first name makes them unhappy, so I need suggestions for alternatives. I’m at least impressed that someone at LinkedIn recognized the Cinderella boy’s photo on my profile even though it means I have to replace it.

Acquisitions, Funding, Business, and Stock


HealthEquity, which offers an online health savings account management system, announces plans for a $100 million IPO. I’m intrigued by co-founder Steve Neeleman, MD, who played Division 1 college football, ran the airport services division of an airline, wrote a book on HSAs, and still practices as a surgeon. I’m not impressed by wealth or self-importance, but I like people who are interesting in multiple ways.


PM/EHR vendor Azalea Health will merge with competitor simplifyMD, although “merge” sounds like an acquisition by Azalea Health given that the new entity keeps its name and executive team. Azalea Health got its start with a $1,000 business plan prize from the local chamber of commerce. Its founders all graduated from Valdosta State University (GA). The company will now have 70 employees with main offices in Alpharetta and Valdosta, GA.


“Smart clothing” vendor Sensoria (formerly Heapsylon), whose tagline is “The Garment is the Computer, gets a $5 million first-round investment. The Redmond, WA company was founded by former Microsoft executives, as you might suspect given its location.


England-based HealthUnlocked, which calls itself “LinkedIn for Health” in connecting people with a given condition to each other and to providers, announces plans to expand globally and its release of a new mobile app. 


Canada-based Privacy Analytics, which offers data de-identification and masking products for healthcare organizations using data for secondary purposes, gets $3.5 million in seed funding.


Epion Health, which offers a patient check-in app, receives a $4.5 million first funding round. It announced last week its participation in athenahealth’s More Disruption Please program.


Forty big US companies, some of them drug manufacturers, have recently bought small foreign firms and declare their new headquarters to be at that company’s overseas location, a loophole (“tax inversion”) that allows companies to avoid paying US taxes on their foreign profits. The latest rumored possibility: Walgreens, which has an option to buy the remaining 55 percent part of a European drug wholesaler that it doesn’t already own.


GE Chairman and CEO Jeff Immelt says GE Healthcare is facing US market challenges as hospital admissions decline and the Affordable Care Act makes hospitals wary of buying new medical equipment.



Parkview Medical Center (CO) selects the Emma clinical communication system from PatientSafe Solutions.

Community Hospital Corporation (TX) chooses the HCS Interactant EHR for its long-term care hospitals.


Fauquier Health (VA) chooses TigerText secure messaging.


In England, the trust running Watford General Hospital signs a $44 million contract with CGI to update its IT infrastructure and services. The hospital blamed its outdated IT system earlier this year after an internal review found that at least two cancer patients died when the hospital failed to send them appointment letters. CGI had a software-related problem of its own –



Population health management vendor Aegis Health names Chuck Steinmetz (Emdeon) as CIO.


Systems Made Simple elects its CMIO, Viet Nguyen, MD, to its board.

Announcements and Implementations

Coastal Healthcare Consulting announces a Meaningful Use mock audit service.

New York eHealth Collaborative announces the first seven healthcare startups selected to participate in the 2014 New York Digital Health Accelerator. They are AllazoHealth (predicting medication non-adherence; Clinigence (care gap identification); Covertix (protection of confidential information); iQuartic (analytics); Noom (weight loss app); Quality Reviews (hospital patient feedback and online ratings); and Sense Health (connecting with Medicaid patients).

Lifepoint Informatics introduces a patient portal for lab results and diagnostic imaging reports.


MemorialCare Health System’s Orange Coast Memorial Medical Center (CA) goes live on the Aventura Roaming Aware Desktop.

East Jordan Family Health Centers (MI) goes live on Forward Health Group’s PopulationManager.

Vocera releases Alarm Management and Alarm Analytics, patient safety solutions that address alarm fatigue. The company also releases the latest version of Vocera Care Experience, with enhancements to its Care Rounds, Care Calls, and Business Intelligence modules.


Ping Identity announces PingID, a smartphone-based user authentication system for what it calls the “post-password era.” Any application or person requesting authentication sends a push message to the phone of the user, who then simply swipes the message to verify their identity.

Government and Politics


NPR covers Mini-Sentinel, a $116 million FDA project that will churn through medical claims data provided by 18 insurers and health plans to look for adverse drug events.

Mary R. Grealy, president of the Healthcare Leadership Council, tells a House subcommittee that for-profit companies should be given access to federal health databases to help work on disease and population health problems.

Innovation and Research

A small study finds that half of post-discharge hospital cardiac patients were taking at least one medication not listed on the discharge medication list or vice versa, a problem more commonly found with patients with low health literacy.


An Illinois-based ambulance company is testing Google Glass units from Pristine, Inc. to allow paramedics to transmit live video to the ED for real-time consultation, saying the $1,500 units are a low-cost entry to telemedicine. The test will determine whether the consumer-grade technology and available bandwidth are reliable enough for treating critical patients.

Amazon announces a limited preview of Zocalo, a fully managed cloud-based storage and synchronization service for enterprises that will compete with Dropbox, Box, Microsoft OneDrive, and many others. Zocalo costs $5 per user per month for 200GB, offers administrative and signup tools, and integrates with Active Directory. It runs on and is managed from Amazon Web Services. That’s bad news for the hugely money-losing Box, which focuses on the non-consumer market and has targeted healthcare as a key vertical.


The New York Times profiles NovaSom, which just released a wireless, at-home sleep apnea test that costs $300 (a tenth of what hospitals charge) and eliminates the patient inconvenience of being wired up and put to bed under the watchful eyes of camera-monitoring sleep technicians.


A Minnesota TV station covers Ambient Clinical Analytics, which is commercializing Mayo-developed ICU dashboard technology.



Eight-hospital UNC Health Care (NC) says it expects to bounce back this year after financial losses it attributes largely to the cost of its Epic implementation. The system delayed its approval of its new budget until the Epic rollout was further along.


The Johns Hopkins Hospital (MD) will pay $190 million to settle a class action lawsuit brought by 8,000 patients stemming from the actions of a former employed gynecologist who used a secret camera worn around his neck to record his examinations. The doctor committed suicide in early 2013 days after he was fired.

A Texas doctor says her EHR is “only a little better than a fax machine” because nobody requires that EHRs communicate with each other even though the government rewards their use. The chair of the Texas Medical Association Practice Management Council says the government has failed to set standards and wants medical societies to get involved. “Had we when this all started said we need open databases … that any EMR can understand, then the EMR vendors would have to compete on workflow and features. If we could somehow organize to say this is the way databases need to work, so that we can have this data exchangeability, then we’ll have competition on the presentation layer and the workflow.”


The CEO of Henry Ford Health System (MI) says she’s disappointed that Moody’s downgraded the health system’s bonds because of poor operating results and its $356 million Epic system, admitting that it had “two or three tough years for us with increasing uncompensated care, Medicare cuts, and the Epic impact to us that caused productivity issues.” However, she adds that the use of Epic is producing $50 million per year in savings.

Patent troll Uniloc USA files lawsuits against Cerner, CPSI, e-MDs, Epic, GE Healthcare, Greenway, Medhost, and other vendors for violating its patent, which involves displaying clinical data in a spreadsheet-type format. One of the company’s idiotic lawsuits was against Rackspace, which it said violated its patent because Linux rounds a number before performing a calculation. The judge told Uniloc to hit the road before its case even came to trial.


New York-Presbyterian Hospital (NY) is renting space at the Blueprint Health accelerator, installing its own computers and servers at the accelerator’s SoHo offices to create an “innovation space.” It will work on projects that include a system that allows inpatients (presumably pediatric ones) to play games and message each other and another involving tablet-based bedside communications. The hospital says it is also open to commercializing technologies developed by Blueprint’s startups.

The American Osteopathic Association passes a resolution urging patients not to use symptom-checker apps and websites as an alternative to an office visit, saying that such self-diagnosis tools don’t take their medical history into account and often miss drug interactions.


The husband of a pregnant woman who started early contractions three hours from the nearest hospitals uses the First Opinion app to text a doctor, who walked the couple through delivering their healthy baby. The 24-hour-per-day service offers one free consultation each month or $12 for additional ones and guarantees a doctor’s response within nine minutes. The company announced $1.4 million in new funding in May 2014, raising its total to $2.6 million. The founder and CEO intended developed the app for pregnant women, but saw an opportunity in the 85 percent of family doctor visits that he says involve five-minute conversations that end with the doctor saying, “Come back if it gets worse.”

Weird News Andy titles this story as “Getting Screwed.” A former California hospital owner admits to bribing surgeons to implant counterfeit spinal surgery hardware, some of it made by local machine shops, into patients. The bribes included cash and flights staffed by accommodating prostitutes.

Sponsor Updates

  • Besler Consulting offers a free version of its Readmission Analytics tool for hospitals to manage their 2015 QualityNet Hospital-Specific Reports, covering number of days to readmission, a summary of discharge destinations, the presence of clinical contributors, and a breakdown of facilities to which patients are being readmitted.
  • Gartner positions Perceptive Software in the Leaders Quadrant for enterprise search solutions.
  • Black Book names Nuance the #1 vendor for end-to-end clinical documentation improvement.
  • Extension Healthcare will exhibit its next generation clinical alarm management and care team collaboration solution, Extension Engage, at the Siemens Innovations ’14 conference August 10-12.
  • TeraMedica announces that seven of the top 17 hospitals on the “US News & World Report Best Hospitals” list use its image archive and management system.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.



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July 22, 2014 News 7 Comments

Morning Headlines 7/22/14

July 22, 2014 Headlines No Comments

HealthEquity Sets $100 Mil IPO Terms

HealthEquity announces IPO plans that will raise $100 million through the sale of 9.1 million shares valued at between $10 and $12. The offering is being underwritten by JPMorgan and Wells Fargo Securities.

UNC Health Care bounces back from operating loss

UNC Health Care is forecasting a $53 million profit next year, up from last year’s $12.2 million loss which CFO John Lewis attributes to expenses related to its system-wide Epic implementation.

Big Data Peeps At Your Medical Records To Find Drug Problems

NPR covers the FDA’s $116 million mini-sentinel project, a data analytics initiative aimed at uncovering unknown side effects in post-market drugs and medical devices.

iEHR redefined: DOD’s top 3 tactics in VA turf war detente

Government HealthIT traces the remaining funding allocations for the defunct iEHR program, highlighting the various modernization and interoperability projects now being pursued instead


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July 22, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 7/21/14

July 21, 2014 Dr. Jayne 4 Comments

A lot of people are talking about the recent JAMIA article that looked at whether Stage 2 Certified EHRs are ready for prime-time interoperability. It concluded that four key areas need to be addressed to improve CCDA quality. One area is “terminology vetting” for the multiple vocabularies used including SNOMED, LOINC, and RxNorm. Another area is reducing the amount of data that can be “optional” with a product still receiving certification.

I agree with both of those, as well as the paper’s assertion that document quality needs to be assessed in “real-world clinical environments.” However, it’s highly focused on the technical aspects of document exchange rather than the actual intellectual quality of the document being exchanged. I wrote about the quality (or lack thereof) of some physician notes a couple of weeks ago. Unfortunately, there are more elements besides the provider’s narrative and abbreviations that are problematic.

My health system is the ultimate best-of-breed nightmare, so I can attest to the fact that some vendors’ incorporation of the clinical problem list into the CCDA reads like one of those “choose your own adventure” novels. Is it an active problem, chronic problem, recurrent problem, or something that just happened once in the past? With some of our documents, I just cannot tell what it is trying to depict. I often feel like I have chosen a path to nowhere, just like the books.

There are fundamental differences between how physicians and other clinicians are trained to sort information. When I trained at a fairly “classical” medical school, we were taught that all of the patient’s problems were part of the Past Medical History, even those that were not truly past such as chronic hypertension, diabetes, obesity, etc. When I helped bring our organization into the EHR universe more than a decade ago, it took while for providers to get used to the idea of a chronic problem list being different from the PMH because many providers still wanted to include everything in the PMH.

Now we’re at the point where we have to educate them on the SNOMED-codified Problem List and how it differs from the ICD-10 Assessment List, even though there may be two codes that represent a single disease. I have finally gotten over it, but many of our physicians are still struggling with the concept despite having been trained two or three times.

Some of the CCDAs seem to comingle the two. It’s maddening. I’m tired of opening vendor support tickets to try to figure out if they’re functioning as designed or just messy. They must meet the letter of the law to receive certification, but that doesn’t necessarily mean they’re good for patient care or educating the patient on the conditions noted in his or her record.

Whether or not Eligible Providers are meeting the letter of the law or the spirit of the law with Meaningful Use is another hot topic. Lately, my running habit has been taking a toll on my feet, which prompted a trip to my favorite foot specialist. He’s a good friend of mine and part of a husband and wife team practice. They’re fiercely independent and have successfully deployed a Certified EHR over the past couple of years. We always chat about EHRs and where they stand.

I knew they were getting ready for attestation when the rooming technician came in with a wrist blood pressure cuff. In practice, I’ve found those kinds of cuffs to be notoriously unreliable, so I asked him if he wanted me to just self-report some numbers that would be accurate. He declined my offer and proceeded to document the 141/87 that the cuff read out. My blood pressure hasn’t ever been that high, but now it’s in my chart. When my colleague came in, I asked him what he thought about it. He wasn’t thrilled and said it sounded like some coaching was in order.

We talked a little bit about integrated vital signs monitors that would make things easier. He then he admitted that they’re thinking about throwing in the towel on MU. Their vendor has been doing a good job helping them dot the Is and cross the Ts, but the thought of an audit scares them. With all the points that must be perfect for an honest attestation, they are wondering if it’s worth the risk. Right now their patients are happy, their staff is happy, and their practice is running well enough from a business standpoint, so why upset the apple cart?

I don’t disagree with them. At times it doesn’t seem like it’s worth it. A lot of practices are just operating out of fear of future penalties or fear that commercial payers will adopt the CMS standards. Fear isn’t really a healthy way to run a business, however.

Since we’ve been friends for a long time, I offered to do a peer audit for them using my knowledge of MU to see how close to compliance they are. There are plenty of professional consulting firms that will do practice audits and they may want to ultimately do that, but are interested in seeing where they sit from a friendly point of view.

In the olden days (or in a truly free market economy) we could have traded some consulting for a free cortisone shot or something like that, but the insurers would take a dim view of that, I’m sure. Given my CMIO role, I also have to be careful about doing anything that could be interpreted as a donation from the health system so I don’t run afoul of any anti-kickback rules. When all is said and done, it will be interesting to see how many providers end up opting out of MU and what percentage of them are independent physicians.

Are any of your providers opting out of MU? Email me.

Email Dr. Jayne.

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July 21, 2014 Dr. Jayne 4 Comments

HIStalk Interviews Amy Abernethy, MD, PhD, Chief Medical Officer, Flatiron Health

July 21, 2014 Interviews 3 Comments

Amy Abernethy, MD, PhD is SVP/chief medical officer of Flatiron Health of New York, NY.


You’re going from ivory tower research and patient care to work for a start-up run by a couple of twenty-something Internet millionaires who have no healthcare experience. What do you hope to accomplish at Flatiron Health that you couldn’t do at Duke?

For the last decade or so, I’ve been working under the basic premise that a fundamental challenge in better bridging research and clinical care was the lack of interoperable or real-time data. I’ve been working on this problem from every direction, usually with cancer care and research as my demonstration model. Sometimes my approach was to focus on how to create the data stream. Sometimes I focused on cyber infrastructure. A lot of other times, my focus was from the point of view of, “If you have the data, what would you do with it next?”

In this vein, I thought about the context of clinical use as well as other problems like storing the information for research, quality, etc. in the future. It has been clear over and over again that a key bottleneck to solving the problem has been in creating the right kind of data infrastructure that is large enough and represents a broad enough footprint of the whole population.

About a year ago, I started learning about what Flatiron was trying to do. It’s interesting the words that you described, “Internet millionaires who didn’t know anything about health IT or healthcare.” That’s exactly where I was when I first started talking to them. They would call me and I would give them a hard time on the phone, and then otherwise that was the end of the conversation. But every single time I said to them, “OK, here’s what I think you need to solve and here’s what I think you need to do next,” and then, a month or two later, they would call me back up and they had done it.

Over the course of about six to eight months, they advanced a series of what I thought were critical steps to solving this problem, at least within the cancer space. By March, the convergence of those steps got me to the point where I said to myself, ”If I’m going to truly work on this problem, solving it and taking it to the next level, then I need to not be watching from the ivory tower, but right in the middle of it. I need to help lead it forward.”


It sounds as though you’re buying into their premise that oncology needs to be disrupted.

I am absolutely buying into that premise. From the standpoint of being an oncologist, I have sincerely believed that it needed to be disrupted for a very long time. But I feel like I have been playing around with how to disrupt it and have been more nibbling on the edges rather than getting into the center of the story.

As this year has progressed and I’ve been talking more and more to Flatiron, working with important groups like the American Society of Clinical Oncology, laying out a roadmap for learning healthcare, etc. it became clear that solving this problem was part of the major disruption action.


Oncology is more patient-centered and longitudinal in treating patients for years. In your TEDMED talk, you talked about using data both from providers and from patients themselves more effectively. How do you see all of that feeding together and what’s the patient’s role in creating this data?

I’m going to take that question into two parts. On one side, I’m going to talk a little about why I think oncology is a unique space, then also talk about what I think the role of patients is.

From a standpoint of oncology being a unique space, in 2009 or so there was a paper in Health Affairs by a guy named Lynn Etheredge that set out the premise that if we’re going to solve the Medicare dilemma — in other words, making Medicare sustainable — we need to attack it from the point of view of oncology. My point is that I’m not the first person to say what I’m about to say, but it has started to crystalize and become clear over the last three to four years.

Oncology is unique because of some of what you said, which is there’s a longitudinality to it. We follow patients very intensely and have very close connections over time. It’s also a space where the science and the clinical care meet.

If you want to solve problems in learning healthcare where the science is as visible and as expected to be a part of the clinical space as the rest of clinical medicine, oncology is a good place to do that. Its a place where the conversation around a patient being involved in clinical trials is a given, not an extra conversation on the side. Then there’s an inherent urgency to cancer care and research; an inherent patient and family centeredness to it.

Then, frankly, it costs a lot of money. The expense of cancer care is going up both because it’s now becoming one of the dominant causes of death, if not the leading cause of death, worldwide. Interventions are getting more and more expensive.

We’ve got this confluence of reasons that make oncology a good use case, a demonstration model. It’s not the only place we’re ultimately going to need to solve this problem, but it’s a good place to start.

The other question that you had was something that I really believe in, which is that patients shouldn’t be a sideline in the story, but need to be central to the story. When we talk about learning health systems, it’s as if the unit of goal optimization is the health system itself. But shouldn’t it be that we’re optimizing healthcare because it’s better off for people and for patients? Instead of optimizing healthcare so that the hospital makes more money or the health system is financially sustainable, let’s focus on better care for patients, with improvement of the health system as a byproduct. That’s a much better model.

I always start off my thinking about how to tackle these problems with the patient at the center of the model. An interesting thing happens when you do that. One of the big issues in learning health systems is data linkage — the ability to take care of populations, the ability to follow people longitudinally over time. When you center the conversation on the patient first, it is much easier to think about how to solve some of those problems.

I have found that by disrupting even our way of thinking about learning health systems so that the patient is the central unit of what we’re thinking about as opposed to the health system being the central unit of what we’re thinking about, we approach solving a lot of problems much differently and smarter.

We’re also in an interesting place where the kind of data sets that we’re going to have in the future aren’t just going to be, for example, electronic health record data or administrative data. It’s going to be data generated by patients, by people, wherever they are.

I started off doing this work in patient-reported outcomes and thinking about how we ask about their symptoms, their quality of life, what is meaningful as it relates to health and healthcare. It turns out that technology enables us to imagine a world where you can ask a patient about symptoms sitting in the clinic waiting room or you can ask about symptoms when the person is sitting in their home in Asheville, North Carolina. You can follow people in between the visits, etc., gathering a much clearer picture of the longitudinal story and implications of different health interventions. 

The land of patient-generated data is getting more and more interesting. The ability to use biometrics and sensors and understand what our world looks minute to minute and day to day from an individual person viewpoint really changes the landscape of how we use big data to solve problems in healthcare. The ability to think of glucose data not just as a data point being generated by the hospital lab, but as glucometer-based data that’s coming from the home.

We’ve been collecting these kinds of data for a long time. The home glucometer is nothing new. Pain became the fifth vital sign in the 1990s. But we haven’t really systematically thought about how this is a part of our national data set in order to solve the problems of learning healthcare. When it comes to patient centricity, it shouldn’t just be a byline, but part of the way you think about designing and developing our systems.


When people think of oncology data lately, they’re probably thinking about applying genomic information to treatment decisions or sharing protocols from major cancer treatment centers. How do you see all that fitting together, particular on the genomics side?

The genomics side again is a really nice use case. I don’t think you or I believe that genomics is going to be the only scientific story in the future. There’s going to be a lot of other ones. But if we can start to get our head around how we merge what’s happening within the context of life sciences and basic sciences with clinical annotation of basic science data putting biological discoveries into context of what happens for individual patients, our science will be much better.

Those two pieces need to come together. In order for that to happen, we need to do a lot of things. One is we need the cyber infrastructure that allows that to happen. It’s the combination of bioinformatics as we’ve classically thought about it plus clinic informatics and applied informatics and the emerging combination of these, including dealing with everything from the storage, data quality, and data use issues. Also starting to think about how much information do you really need to store for this particular patient, how do we analyze it, what is the right research to conduct, and what should that look like.

Another example of what we’re going to need to deal with is trying to get our heads around if we did have a cyber infrastructure, how do we thoughtfully manage the security, confidentiality, and privacy issues? If we are bridging between questions in clinical research and healthcare quality, how do we deal with questions of permissions, consent, and human subjects protections? These pieces are starting to crystallize, but we have a long way to go.

The genomics use case also takes us into the clinical applications side. As we start to have more genomics-informed cancer care, for example, how do we help clinicians and patients make snap, very quick, well-informed decisions at point of care so that we’re surfacing in real time the right combination of this person’s genomic profile, coupled with what we know are the right drugs for that particular clinical scenario, and understanding that there are limitations to what’s possible depending on reimbursement scenarios? It needs to be the complete complement of data in order for clinical decision support systems to be truly useful and not annoying. As a very basic example, if we surface genomics plus drug information independent of reimbursement, we’re not doing anybody any good.

Ultimately, solving these problems for genomics and, along those lines, next-generation sequencing, within the context of cancer care, presents us with a great use case that’s going to be replicated multiple times.


Oncology is a lightning rod is from a societal perspective. Hospitals that suddenly start treating oncology patients as outpatients because they mark up their visit higher than oncologists in the office, for-profit cancer chains, oncologists paid to administer or incented to administer more expensive drugs, a lot of pharma influence, the pharmacoeconomics of expensive drugs versus what benefit the patient gets. All those are issues interfere with the pure science and medicine of how cancer is treated. Do you see that being something that Flatiron will help resolve?

This is the reason why data is the bridge. All of those problems have as a foundational or fundamental underpinning — the need for discrete, interoperable data that can be reused to address each of those things simultaneously. Whether or not you’re actually trying to get the science smarter or you’re trying to optimize reimbursements, you need essentially the same data points to do so.

One of the reasons that I made the jump from academia to industry is to try and figure this out. Resolving all of these problems means that first you’ve got to deal with the data bottleneck. But at the same time, you need to be doing R&D work, imagining a world when the data bottleneck is solved and answering the question of “and what do I do next.” You have to be ready to work through all of those different, as you said, lightning rod questions, which is going to take a lot of work and practice.

While ultimately the data are substrate and producing the data streams that can be analyzed to solve those different problems is a fundamental underpinning, after that you still need to advance the work in the analytics space, align culture, sand out processes including scientific methods in order to pull all of the pieces together, etc. I have this one talk that I always give on the convergence of personalized medicine, comparative effectiveness research, healthcare quality, healthcare optimization, and patient centricity. If you take all of those, the one common element is interoperable data.


Along those lines, along with the announcement of the Google Ventures investment in Flatiron was its acquisition of Altos Solutions and its oncology EMR. Was that done as a way to get quick access to a lot of oncology information without having to do individual integration with the varieties of EMR systems that are used by oncologists and hospitals?

There’s a couple of pieces of an answer here, so I’m going to take it separately. First of all, the way that Flatiron is doing its work is EHR independent. The idea is essentially to extract the data from the back end use a process of technology-enabled chart abstraction and other techniques to make it to a common data model. This dataset can then be integrated with other data feeds like the Social Security Death Index. It doesn’t matter if it’s Varian or iKnowMed or Epic Beacon from an oncology EHR standpoint.

The addition of Altos revved the engine, because at least now there’s one cloud-based oncology EHR that has essentially a single instance and doesn’t require a different setup for every single site. But is really essentially one additional extraction to an overall model. That’s the first point of efficiency.

It also catalyzes or adds a jump to the next level in terms of acceleration of footprint for the number of oncologists and therefore their patients represented in the national footprint for Flatiron. Those two things are important and near-term wins for why Flatiron bought Altos, but now you’re going to hear Amy’s part of the story.

If you take what I just said — and I love the way you said it was a lightning rod – oncology is a lightning rod for all these pieces coming together, not just solving the science and genomics, but it’s the comparative effectiveness research, figuring out how to optimize healthcare, etc. As I mentioned, data is the fundamental substrate, but then you have got to learn what to do with it next.

A lot of that also is clinical decision support for personalized medicine and other interfaces directly in the clinic at the right time with doctors and patients to make healthcare more efficient, patient centered, and of better quality. For example, better allocation of care along predefined evidence-based pathways and monitoring of whether the care provided actually aligns with the evidence. The availability of real-time education.

Altos as a cloud-based EHR will provide Flatiron with a beautiful, national scale living laboratory to try out all the different ways of using and reusing data in the context of what EHR can do for you. It’s a near-term win in terms of data sets and efficiency, but the real big win here is in terms of a national living laboratory where Flatiron and clinical partners can work together to use technology tools to make cancer care better. Now that’s a use case.


Other than that acquisition, $130 million is a pretty big investment for a startup. How will that money be used?

A key aspect of the focus of Flatiron for the next two years or so is going to be making sure that the corporate philosophy is well attended. This includes building the tools that are needed, making sure that clinical practices are well served in terms of having their data extracted and getting them meaningful processed data back that’s actionable at point of care, and the scale from the technology development side in order to support key data partners like the life sciences. We need to ensure that this happens efficiently and with the right kind of engineering focus. That’s going to be a big piece of it.

There’s also ongoing work on how we surface this information, optimal data visualization solutions, how to help clinicians and practice administrators understand the information as efficiently as possible, how do we optimally interface with patients. There’s already a current product, OncoAnalytics, that allows practices to see their data in a dashboard format. It’s really good and certainly much better than anything they’ve already got. But how do you really rev that engine up for data users of all types? That’s going to be a place of substantial investment as we think about how we can get more and more information to practices, life science partners, health systems, researchers, professional bodies, etc.

Why is that so important? We need to see all users of the data, doctors and patients and health systems and sponsors, as key constituents. To create a national data set, it needs to be sourced from many, many places and those different contributors need to see value as to why they want to keep participating and contributing. And it needs to be used. Data quality improves when data are used, not hoarded. Servicing those places is a critical focus.


Do you have any final thoughts?

One of the things that’s been interesting to me and for me is personally making this jump. I haven’t left academia entirely. I still have a 20 percent footprint at Duke, which I maintain so that I can keep working with clinicians and others on solving the problems that we will be able to solve when the data bottleneck is resolved, on mentoring, on other aspects of R&D.

While it’s clear to me that Flatiron is the right vehicle with the scale and talent needed solve this data bottleneck, it was also important to continue to develop the future talent that will be needed to support the next steps in the vision. That’s where my Duke job comes in. Academia offers a unique place for growing the next generation. We all must keep our eye on the big vision, hammer home hard on the key tasks that have to be sorted out, and prepare for the exciting future.

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July 21, 2014 Interviews 3 Comments

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