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Morning Headlines 2/9/15

February 9, 2015 Headlines No Comments

Anthem hack: Personal data stolen sells for 10X price of stolen credit card numbers

Security analysts report that the Anthem hackers should be able to sell the stolen health records for as much as $1,000 each, making them ten times more valuable than stolen credit card data.

Defense Health shoring up IT ahead of EHR move

The Defense Health Agency reports that it will spend 2015 updating its IT infrastructure in preparation for its upcoming EHR implementation.

VITL Launches Marketing Push With Super Bowl Ad

The Vermont Health Information Exchange spent $13,000 to run a 30-second regional commercial during the Super Bowl in an effort to increase patient consent rates and boost physician utilization.

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February 9, 2015 Headlines No Comments

Monday Morning Update 2/9/15

February 8, 2015 News 2 Comments

Top News

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Experts say hackers can sell the patient information exposed in Anthem’s 80 million member breach for up to $1,000 per record (or a staggering potential payout of $80 billion for the thieves) since it forms a “complete identity theft kit” that includes insurance and Social Security numbers (stored unencrypted, in Anthem’s case). A stolen credit card number is worth only $1 and insurance credentials alone fetch just $20. Anthem admits that hackers used the credentials of at least five of its IT employees for up to a month before the attack, which the company detected only when a database administrator noticed someone running queries under his user ID. Investigators are looking into evidence suggesting that China-sponsored hackers launched the attack to obtain information to be used in espionage-related phishing, which seems to be the standard, non-verifiable post-breach excuse.

Meanwhile, scammers pile on by sending bulk spam using Anthem’s logo (above) and cold-calling people claiming to offer credit monitoring trying to get recipients to divulge their own confidential information.

The healthcare- and privacy-related background of Anthem CIO Thomas Miller: zero. He came from Coca Cola just eight months ago, hired because of his background with digital marketing and loyalty programs. 


HIStalk Announcements and Requests

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Nearly 80 percent of poll respondents think the federal government should issue a national patient identifier, about the same percentage that answered positively in my 2013 poll asking the same question. They added some thoughts: (a) an opt-in version would be more acceptable; (b) the VA could use the identifier to provide information needed to process Social Security disability claims; (c) the ID should be used only for healthcare, employers can’t ask for it, and the individual owns the information associated with the number; (d) use Social Security number as the patient identifier; (e) since nobody wants their Social Security number used for fear of hacking, instead create an ID consisting of date of birth, first three letters of the last name, and the last four digits of the SSN; and (f) a private company’s solution is available now and they’re looking for partners.

New poll to your right or here: will Athenahealth be able to create a competitive, large-hospital information system by rewriting BIDMC’s internally developed WebOMR? Vote and then click the poll’s “Comments” link to elucidate further.

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Welcome to new HIStalk Platinum Sponsor CoCentrix. The Sarasota, FL-based company’s Coordinated Care Platform, built on the Microsoft Dynamics CRM solution, optimizes the behavioral health continuum for the benefit of state and local government agencies, providers, and consumers. Components include a certified HHS EHR for state agencies and community providers (intake, assessments, treatment plans, orders, documentation, billing, dashboards, and data mining), enterprise-level case management, a managed care solution, and the rather cool Caretiles integrated mobile app marketplace for consumers. The 32-year-old company has 500 customers in 42 states. Thanks to CoCentrix for supporting HIStalk.

Here’s a patient-centered overview video of CoCentrix that I found on their site.

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Sign up now if you want to come to HIStalkapalooza on April 13. I’ll have to shut the page down once I get too many requests to accommodate. I can’t necessarily invite everyone who wants to come, but I can say for sure that you won’t be invited if you don’t sign up (which is true for me as well, so I’ll register today).


Last Week’s Most Interesting News

  • Roper Industries acquires two health IT companies, including the leading laboratory middleware vendor as a complement to its Sunquest business, for $450 million following its recent acquisition of Strata Decision Technology.
  • Insurance company Anthem announces that a cyberattack exposed the information of 80 million of its customers, but says no medical or credit card information was stolen.
  • Athenahealth acquires rights to Beth Israel Deaconess Medical Center’s self-developed WebOMR hospital information system, announcing plans to rewrite it to sell to large hospitals.
  • ONC requests $92 million for its FY2016, budget, with $5 million of the 50 percent increase set aside to create a Health IT Safety Center.
  • Cerner completes its $1.3 billion acquisition of Siemens Health Services.
  • ONC publishes the draft version of its 10-year interoperability roadmap that includes a goal of allowing most patients and providers to exchange and use a common set of electronic clinical information by the end of 2017.

Acquisitions, Funding, Business, and Stock

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From Friday’s Athenahealth earnings call:

  • Chairman and CEO Jonathan Bush says the company “fell short of the finish line” in 2014 due to “over dependence on one channel partner, over focus on ambulatory medicine, and limited experience with turnaround situations.” He says those were “admission tickets to new levels of adulthood” that will allow the company to get back to 30 percent growth.
  • Bush admitted that the company’s enterprise prospects have balked at solutions that don’t address inpatient.
  • He says that the acquired RazorInsights product, built for hospitals under 50 beds and priced at around $250,000 to $500,000 per hospital, is “the multi-tenant platform we need to manage most hospitals in the country,” while BIDMC’s WebOMR can handle the more complicated hospitals. Those will be merged together to form Athena Inpatient Clinicals.
  • Bush says the company failed in missing its Net Promoter goal of 52.5 in hitting only 42 for Q4.
  • The company hired 1,300 employees in 2014, raising its total to 3,700, and will add another 1,000 in 2015.
  • Athenahealth’s CFO says RazorInsights produces “a very small amount of revenue at a loss” and that WebOMR is not immediately commercializable, so she recommended that analysts view the acquisitions as ways to eventually enter the inpatient market rather than as revenue-contributing products.
  • The company “tried to stop the bleeding on the nervous prospects” who were passing on Athenahealth to choose Epic.

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ATHN shares closed Friday down 0.8 percent. Above is the one-year chart of ATHN (blue, down 17 percent) vs. the Nasdaq (red, up 15 percent).

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From the McKesson earnings call, which had few mentions of its Technology Solutions business:

  • Technology Solutions revenue was down 7 percent due to lower revenue from Horizon Clinicals and the exited UK workforce business, in line with projections.
  • John Hammergren says McKesson is “in middle of the game” in trying to move Horizon customers to Paragon.
  • He adds, “There’s a bunch of interesting places that we’re placing bets, including CommonWell Health, that we think will pay off” as the company sells data-related products.
  • Asked about the future Technology Solutions product line, Hammergren said, “I would say though that as you think out two or three years, the EMR space and the transition away from Horizon will be more complete or complete, and we’ll see more results, we think, in terms of this pay-for-performance priority. I mentioned that HHS and others believe that the market has to move more towards a value-based reimbursement methodology. That’s going to require additional investment.”

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Crain’s Chicago Business profiles 73-year-old, near-billionaire investor Dick Kiphart, who says of his investment 10 years ago in healthcare communications company Emmi Solutions, which he sold two years ago to Primus Capital, “It stumbled for a long time. I kept my money in, and it looks like it will be a two- or three-bagger.”


People

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Jennifer Haas (Microsoft) joins Aventura as VP of marketing.

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John Hallock (CareCloud) joins Imprivata as VP of corporate communications.

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Tony Scott (VMware) is named chief information officer of the United States, replacing Steve VanRoekel.


Announcements and Implementations

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Facebook founder Mark Zuckerberg and his wife, Priscilla Chan, MD donate $75 million to San Francisco General Hospital (CA), where Chan did her pediatrics residency. The city will name the expanded facility Priscilla and Mark Zuckerberg San Francisco General Hospital and Trauma Center, which is pretty much the opposite of creatively and succinctly naming a social media website “Facebook.”


Government and Politics

The Defense Health Agency says its top 2015-2016 priorities will prepare it for its EHR implementation: continuing to work with the VA on interoperability, consolidating infrastructure, and standardizing configurations.  The agency’s director explains that, “This is an $11 billion procurement. When you think about that, this infrastructure piece is huge. So we have to think about what we’re going to do to make sure we get the best performance out of that EHR."


Technology

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A CNN report says the Apple Watch will fail (at least in compared to typically blockbuster Apple offerings) because: (a) for $350, all it does is allow users to perform existing iPhone functions from their wrists; (b) rumors are that the battery life will be awful at just 10 hours; (c) it’s rectangularly chunky compared to sleeker products already on the market; (d) it doesn’t do anything particularly compelling; and (e) it’s likely to be improved in a year, forcing users to buy it all over again.


Other

Grant-funded Vermont Information Technology Leaders pitches its new HIE to consumers by running regional Super Bowl ads on local TV stations at a cost of around $13,000 of its $195,000 marketing campaign.

University of California’s 10 campuses will require students to be vaccinated for measles starting in 2017, with students expected to enter their vaccination records into UC’s electronic system. Religious and medical exemptions will be honored, UC says.

Forbes notes the “emerging bull market” for “digital healthcare journalism,” with examples being Politico’s three-reporter subscription-only eHealth launch in 2014 and its plans to expand to an overall healthcare team of 16, the recent sale of Med City Media, and establishment of a five-reporter health and science department at BuzzFeed.

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Patients of Reid Hospital (IN) complain when the hospital tries collect debts from as far back as 2011. The hospital has apologized, saying that some patients didn’t receive the usual three monthly bills before their accounts were turned over to collection agencies by a former contract company.

The gutted healthcare system of cash-strapped Greece requires hospitalized inpatients to hire their own nurses for even basic inpatient care, but lack of money and insurance leads many of them to retain poorly trained and illegal phony nurses – often immigrants — provided by temp agencies that cruise the hospital halls handing out business cards. Hospitals say they are too understaffed to expel visitors who offer to rent TVs, bedding, and chairs to patients, adding that even the state doesn’t have the legal authority to issue fines to violators.

Weird News Andy never eliminates stories about fecal transplants, titling this one “Does this bacteria make me look fat?” Researchers suggest not using gut bacteria from overweight fecal donors to treat infections since a case study found that the recipient gained 34 pounds in the 16 months following the procedure.


Sponsor Updates

  • Medicity offers a recap of the HL7 conference that showcased FHIR as the “next big thing” in healthcare.
  • Sandlot Solutions writes about “Interoperability: Making the ONC’s Vision a Reality.”
  • Courtney Patterson asks, “Could Your Reporting Team Structure be Helping or Hurting Your Organization?” in the latest Sagacious Consultants blog.
  • RazorInsights will exhibit at the Rural Healthcare Leadership Conference February 8-11 in Phoenix.
  • Qpid Health’s Amy Krane summarizes the company’s recent webinar on how Partners Healthcare eliminated prior authorization.
  • Siavosh Bahrami rants about the importance of simplicity in a new pMD Charge Capture blog.
  • PatientKeeper offers a post on “The Interoperability Non-Controversy.”
  • Park Place International offers advice on “Getting Ready for the Meditech Patient and Consumer Health Portal.”
  • Patientco posts an article titled “The Importance of Payment Plans in Your Revenue Cycle Strategy.”
  • NVoq Director of Healthcare Industry Solutions Chad Hiner, RN explains why “EMR adoption will require more than financial carrots.”
  • In the latest Phynd blog, Thomas White asks, “How many employees does it take to enroll a new provider in a hospital’s EMR?”
  • Ryan Reed offers “5 Tips to Prepare for Cloud Migration” in the latest NTT Data blog.
  • Netsmart will exhibit at the Open Minds Best Management Practices Institute meeting February 12-13 in Clearwater Beach, FL.
  • MBA Health Group Consultant Nicholas Bocchino writes about the possible changes to Meaningful Use this year in its latest blog.
  • PeriGen launches its Five-Minute Challenge for labor and delivery managers.
  • Medfusion will introduce its Help Center in an event on February 12.
  • Nandini Rangaswamy asks “What works? EHR-based PHM or PHM-based EHRs?” in the latest ZeOmega blog.
  • WeiserMazars releases its Group Annual Report.
  • T-System shines a spotlight on staff member Javariah Khan in its latest Informer blog.
  • General Manager of Clinical Solutions Eric Brill writes about Voalte’s work with UCSF Medical Center Mission Bay in a new blog.
  • Stella Technology Founder and SVP of Business Development Salim Kizaraly discusses HIEs past and present in a Relentless Health Value podcast.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 8, 2015 News 2 Comments

HIStalk Interviews Todd Cozzens, Partner, Sequoia Capital

February 6, 2015 Interviews 3 Comments

Todd Cozzens is a partner with Sequoia Capital of Menlo Park, CA.

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Tell me about yourself and the company.

My career after college was trying to win the gold medal in Olympics in sailing. I did that for about six or seven years almost full time. Somehow I got my way into selling medical devices for a company named Marquette Medical Systems. We were in the early dabblings of what we called patient data management, taking all the data from the devices and creating flowsheets for clinicians in high-acuity areas.

I worked my way through Marquette and eventually took the company public with the founder. As we approached the end of the 1990s, we were approached by GE to buy the company. It was a long negotiation with Jack Welch directly and Jeff Immelt, who was running healthcare at the time. We eventually did the deal. 

Out of that, I understood that the next wave was not just the medical devices themselves, but  what clinicians — especially those in the high-acuity areas — were going to do with all the data. Akin to where we are today, with all these doctors in general having EMRs and not understanding what to do with the data. That led to Picis, which was a technology that I had seen in my travels. Eventually I struck a deal with the technical founders of Picis and we got the first seed capital. 

It was a great run with the company. We built it to the largest provider of electronic medical records for high-acuity care. We didn’t call it that at that time – it was emergency room, operating room, and ICU. Built that up to about a $175 million run rate, very profitable, with an acquisition and a couple of other things that we did to go after not just the clinical side, but the financial side of taking care of these very high-acuity, expensive patients. 

We were about to take it public in 2010. That jibed with the Affordable Care Act being finalized and a lot of players in healthcare — like insurers and providers — wondering what their future was going to be under the change. UnitedHealth Group decided they didn’t want to be a managed care company for the rest of their existence and they had all kinds of underlying assets, so they decided to broaden their scope a bit. That’s when they started looking at provider-type technologies.

Their thesis about Picis was that the brick and mortar of existing hospitals was going to eventually just become big towers of ICU, operating room, and emergency care facilities as everything moved out of the hospital into other types of settings that are more accessible and more affordable. That proved to be true — it’s happening as we speak today. The day I joined United, I gave the reins of Picis to other managers and helped with the Optum brand and started their Accountable Care Solutions division, which we built up to a pretty big part of Optum within a short time.

A number of events happened leading up to my involvement with Sequoia. When I was raising money, I never saw Sequoia. From what I learned later, they  took a hiatus from healthcare after biotech and other investments in the late 1980s. But they had gotten back into healthcare on the premise — this was before the Affordable Care Act – that no matter what happens to healthcare reform, 20 percent of GDP for healthcare is unsustainable and there will be enduring, disruptive companies that are going to help change the picture over the next 10 years. We had a number of companies that we knew or were involved with in common. I was asked to join full time in April 2012.

 

What role do investors play in the day-to-day operations and the strategy of a company?

It depends whether it’s an early-stage company or a late-stage growth company. For an early-stage company, the old adage used to be that the company had to be a bicycle ride from our office, which is adjacent to Stanford University. That’s because these young companies need support and they need help. They need mentoring and they need contacts. That was the best way we were able to help them. Plus Don Valentine, the founder of Sequoia, said, “You know, when I fly to Denver, I’m flying over 15 companies in Silicon Valley that I’m probably overlooking.” So in the early stage, there’s a lot more involvement.

In growth stage, it’s whatever you can contribute. To be a first-rate investor today, you’ve got to provide a lot of capabilities for your companies. Marketing support, hiring, what kind of systems should you have in place, etc. We’ve built up a pretty good support part of Sequoia that is dedicated to helping our founders grow their companies.

 

Is it tough as a passionate founder to have investors giving advice or issuing requirements?

I always found investors that had more than money, something about them that could be value-add to me. I had to be humble and willing to learn enough to take their advice and seek their advice on a regular basis.

For example, my first chairman was a guy named Bernard Giroud. He was president at the beginning of Intel Europe. He took Intel from a million to well over a billion in revenue. He knew everybody in the tech industry. He had seen every movie before. When I needed advice about expanding the sales force, product development, what type of people to hire, how to organize HR, finance, areas that I was less familiar with, he had great advice because he ran strategy directly for Noyce, who was the CEO of Intel and was very close to Andy Grove and the rest of the management there. He learned a lot, so taking some pages of out of his playbook was absolutely incredibly helpful to me. 

As we grew the company, we attracted board members and sought board members that were going to be value-added, whether they worked for an investor or they didn’t. An interesting example is that when Bernard left Schroder Ventures, which became Permira, they put in a kid in his place that had no value add whatsoever. In fact, I thought his judgment was really off on some things. Once you have somebody like that on your board, it’s hard to work them off. It took us a while to do that. 

Having a helpful, resourceful board is critical for a young founder. There’s just no way, as a young entrepreneur, that you have all the skills that it takes to build a company. Being a good listener is not a skill that goes readily with being a great CEO leader. You’ve got to learn how to do both.

 

How do you know when it’s time to have a conversation with the founder about taking a different role than CEO?

We see that fairly often, especially with the early-stage companies. In Silicon Valley, business models, entrepreneurship, and start-ups are at a level three generations ahead of any other place I’ve ever seen, just because of the amount of companies that are being built there now and the amount of talent that’s migrating there. Often you’ll see founders who are the technical guys who are great at building a product or they understand the consumer market or whatever, but they know and embrace bringing in a professional CEO to run the company. In healthcare, that is not often the case, because it’s often a physician founder who thinks they can do everything.

It comes naturally where you just realize that – I use this phrase even though it’s pejorative – “this person’s not going to get any taller.” In other words, they’ve reached the maximum of their skill set limit and it’s time to bring in somebody. I’ve been involved in situations where it’s been a rough ride to convince them. But I would say in almost all cases, eventually once you get through the pain and the hurdles of putting a new CEO in place, it works out.

Sometimes the problem is that you have to bring in someone who can do it all. If you bring in somebody from outside of healthcare, that’s always tough. In some cases, because of time pressures, you bring in the wrong guy. That can be even worse. You see situations like Apple. They had to bring back Steve Jobs and it turned out to be great. In the intervening times, Steve had learned a lot.

It depends on the personality, what they’re open to reach beyond their own skill set. It takes a lot of work and a lot of involvement to make one of those transitions happen. It’s not something you can do with quarterly board meetings. You have to step up your involvement in the company a lot more in those situations.

In our DNA at Sequoia is the inherent trust in the founders we partner with and we have a track record of supporting them throughout the entire growth of the company. The majority of our founders make the transition from start-up to a much bigger company. In almost all cases where the company is struggling with scaling, the founders realize the company has outgrown their skills and they proactively reach out to us to find an execution-oriented leader as the company scales. In some cases, we need to convince the founder to bring on more talent mostly to augment them, and in pretty rare cases, to replace them.

 

What do you actually do as a board member?

My first inclination is to say to myself, is what I’m out about to say at this board meeting truly helpful and necessary for the CEO and management to run a better business, or are my own "CEO / operator / control freak" instincts taking over and forcing me to spew something out? It took me a while to adapt to that, but now I think have a very strong bond and trust with the CEOs and founders I work with.

I ask the same of fellow board members. Is their advice worthy, or do they just like to hear themselves talk? God knows management doesn’t need 45 different points of view from the board  — they probably have enough internally. My colleagues at Sequoia are the best I’ve ever seen at being helpful, precise in their advice and not wasting words and time​. I’ve learned a lot from them.

Having run board meetings, I pride myself as using the board for a very positive tool to help grow the company. It’s how you manage your board, how you handle the board meeting, and how you prepare people for the board meeting. As CEO, I worked on a package of materials that the board could look at to  understand the pulse of the company before coming into the board meeting. Like presenting an ICU spreadsheet that the intensivist was used to looking at and could immediately assess the condition of the patient and what needed to be done — visually and the right information and not too much information. That took some time and I took a lot of advice from others on how to do that. What’s the package that you’re presenting? What are the main issues? 

Trying to sell the board, trying to be anything but completely transparent is the wrong way to go, because eventually someone’s going to find out. Surprises are going to develop. Boards get twisted with companies when you miss expectations. You raise money at a very high valuation and you don’t perform to that valuation. 

My advice to entrepreneurs is to prepare your boards really well for the board meetings. Some board members don’t like to even open up a PowerPoint until they either get on the plane to the board meeting or during the board meeting. Call those people prior to the board meeting – those might be people that just like to do things verbally. Walk them through it.

In the board meeting, try to get through the perfunctory issues as quickly as possible. The meat of the matter is the strategic issues that need to be discussed. Half of it’s getting the board to understand what your company is all about. Doing things like sending my board members to a local emergency room, Mount Sinai in New York or Mayo Clinic, to see how the product operates and what the user issues are. To really understand how the product is used is extremely helpful. 

You can’t give your board too much information. At those board meetings, what are the top three tough issues that we have to tackle? What are the other issues for future growth? For example, you might have a company that is doing really well. Bookings are extremely important for a young company — it’s probably the most important metric to be watching, because it’s obviously the temperature on future performance. Bookings are trending really well, expense management’s been fantastic, and you’re already 10 percent EBITDA  cash positive. You know, great. Should you be spending that 10 percent on expanding your sales force or developing that new product? Because things are going to tap out at the end of the quarter or at the end of the year. On the other hand, advising a company to run that close to the vest on cash is always a tough game to play.

Understand the business and the momentum of the product. If I’ve got a product out there that’s just absolutely lights out, has been turned into a “got to have” product, and I see that’s going to be there for the foreseeable future, I’ll do everything I can to encourage the operating team to focus on growth. Growth is scary for a young team. Getting all those bookings is a great thing, but executing on them and having satisfied customers on the other end so that cycle keeps continuing is not an easy task. 

Most companies I see that have great bookings growth, a great product, and early success with customers seem to be the management teams that can handle the “what happens when the orders have to get installed” and are usually good at bringing on the right people, experts that have done it before on the operation side to execute, in most cases. But they need a lot of help and understanding then. 

The other thing is how they look at talent. Are they the type of manager that wants just a lot of “yes” people around them, or do they want people that are going to push back, going to do the right thing? That’s another thing you’ve got to really be careful with with these boards.

 

What company characteristics are have the most impact on success?

Early on, figuring out whether this is a product or a company. By understanding the market size, the market potential that you have or is this a stepping stone to a larger market, is very, very critical. I see that in a lot of incubators. It’s great that there’s a lot of people that are taking that kind of risk with their careers and stepping out there in the cold, dark world to try to build these companies. But I wonder in many of the cases what have they done to really walk in the shoes of the people that are going to be using those products.

To me, the products that are born out of a natural need by customers or someone that’s experienced this in their family … I know a lot of great companies were built because, unfortunately, a family member had a bad experience and their life’s mission was, how are we going to fix that? But it’s really critical to understand what the market potential is. It might be just a great product that I might sell to another company, or is this going to be a company in itself with a big market potential? Those are the critical decisions that you’ve got to look at, both as the founder of those companies and the investors.

 

Do you have any final thoughts?

The idea of accelerating the move to value-based care will have a tremendous impact on healthcare. It’s going to require much more of an effort of employers putting pressure on the insurance companies and the government or CMS leading the way. We all know that when CMS sneezes, the rest of the world has a cold. Fee-for-service is still the crack cocaine of healthcare that people can’t get off. It’s going to take more than just a lot of evolution of different models, you know, shared savings plans, pilot programs by CMS. It’s going to take a real shift in the entire reimbursement system and it’s not going to come easy. But I think there’s the will there to make it happen.

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February 6, 2015 Interviews 3 Comments

Morning Headlines 2/6/15

February 5, 2015 Headlines No Comments

Roper Industries Announces Two Medical Software Acquisitions

Roper Industries, parent company of Sunquest, acquires two more health IT companies for a total of $450 million. Data Innovations, a middleware software vendor that supports hospital laboratories, and SoftWriters, a software vendor working in the long-term care space.

Exclusive: Apple’s health tech takes early lead among top hospitals

In a small survey, Reuters finds that 14 of 23 hospitals are moving forward with plans to interface with Apple’s HealthKit API, beating Google and Samsung in terms of hospital penetration.

athenahealth, Inc. Reports Fourth Quarter and Full Year 2014 Results

Athenahealth reports 2014 year end results: revenue is up 26 percent, at $752 million, adjusted EPS $1.31 vs. $1.16.

McKesson Reports Fiscal 2015 Third-Quarter Results

McKesson reports Q3 results: revenue up 37 percent to $47 billion, adjusted EPS $2.89 vs. $1.48. Revenue from its health IT business dropped seven percent to $755 million.

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February 5, 2015 Headlines No Comments

EPtalk by Dr. Jayne 2/5/15

February 5, 2015 Dr. Jayne No Comments

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Although our local groundhog said that spring was just around the corner, I’m not sure I believe it. The grey skies seem to match the mood of many of our hospital’s administrators, as they come up with long lists of IT-related projects to keep us busy even though we already have plenty to do.

Regardless of the CMS plans to shorten this year’s reporting period to 90 days, we now have a month’s worth of data and are heading out to our practices to remediate staff and reinforce workflows. It’s a good time to deliver training since business tends to be down in many practices during the first part of the year. With patients having not yet met their ever-increasing deductibles, they tend to be reluctant to come in unless absolutely needed.

I’ve been in touch with some friends in vendor circles, hearing about their plans for HIMSS and specifically what they are planning to help draw people into their booths. I’m not a fan of so-called booth babes (unless they are wearing amazing shoes and can also talk about the product they are representing) and “must be present to win” giveaways don’t do the trick either. One vendor promises a close encounter of the sensory kind, including both aromas and edibles. Knowing the team involved, I can’t way to see what they cook up.

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As I sat having dinner with someone wearing a watch that would have made Dick Tracy do a double take, I remembered that an intrepid reader had sent me an article about jewelry that camouflages  tech rather than showing it off. I’ve been keeping my eye on Ringly but hadn’t realized they raised more than $5 million last month. Although I’ve enjoyed my GPS watch and think it’s motivated me to be more active, I do wish Garmin offered something that didn’t scream “Runner!” and looked a little more businesslike.

One of the email digests I receive had a link to a fluff piece about the November round of ICD-10 testing. The American Academy of Professional Coders polled 2,000 participants, concluding that the results were positive with 90 percent reporting no payment shifts in test claims. I wasn’t able to get my hands on the full results, but some of the numbers cited looked a bit strange without current ICD-9 results for comparison. If anyone participated in testing, we’d love to hear about your experience. Additional testing is planned for April.

Speaking of ICD-10, we are planning to start training (again) at our hospital and outpatient offices within the next month. We had begun orienting providers prior to the delay and I have to admit there no longer seems to be any urgency about it. Some probably think it will be delayed again and others are just tired of the ongoing parade of regulatory changes. Our online sign-up sheets are remarkably empty, so we’ll have to start doing outreach to try to draw people in. Some specialties will face larger challenges than others and I’d rather not have a flurry of “emergency” training in September.

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ONC held its annual meeting this week in Washington DC. I’d be interested to hear impressions from attendees. In particular, was there actually a fire for the Fireside Chat with Former Senate Majority Leaders Tom Daschle and Bill Frist? Email me.

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February 5, 2015 Dr. Jayne No Comments

Readers Write: Paving the Way for Patient Voice at Health Industry Events

February 5, 2015 Readers Write 4 Comments

Paving the Way for Patient Voice at Health Industry Events
By Simone Myrie
@MyrieTash

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There is a revolution happening in healthcare. Once willing to accept their role as passive recipients of healthcare, patients are increasingly being recognized and acknowledged as consumers of healthcare.

What do I mean by this? Individuals are taking on the responsibility of shopping for their own healthcare and purchasing technology to help them better manage their health. Additionally, policy changes are propelling the shift towards consumer-centric care delivery. More emphasis is being placed on reimbursement for patient satisfaction, value-based care delivery, and increased information sharing and communication with consumers.

If health industry leaders want to rethink their approaches in response to this shift, they need to make sure they have truly engaged patients — now consumers – well represented at their major conferences and being included as active participants in the conversation about healthcare. Arguably, HIMSS is the biggest annual health conference in America. I applaud the Walking Gallery for partnering with HIStalk to sponsor a patient scholarship competition to allow for more patient attendance at HIMSS15.

Patients and their caregivers have long shouldered the responsibility of managing their health outside the four walls of the care setting. They have a wealth of information and are stewards of that information, a role that is mutually beneficial to providers. Technology is also changing the way they track, manage, and share their health information.

We know that today, 21 percent of Americans are using technology to track their symptoms. We also know that 58 percent of consumers are more likely to stay with their providers if they offer online access to their clinical health information.

Giving individuals access to their data will be critical in the more competitive, value-based healthcare system of the future. This is why the Blue Button Initiative continues to remind health industry leaders that patient expectations are changing. They want to collaborate more and are activated and engaged in ways we’ve never previously seen.

More people than ever before – regardless of pre-existing conditions or employment status – are gaining access to affordable healthcare, largely because of the Affordable Care Act. The latest numbers report 9.5 million Americans have purchased health insurance through the health insurance exchanges. More importantly, much like any other purchase that they would make, consumers are demanding choice in healthcare.

To meet that expectation, HHS has reported that over 90 percent of consumers will be able to choose from three or more issuers on the exchanges, up from 74 percent in 2014. Consumers can also choose from an average of 40 health plans for 2015 coverage, up from 30 in 2014 based on data at the county level.

With the expanded pool of Americans gaining access to healthcare services, health plans now have to rethink their marketing strategies so that they appear attractive to a new group of stakeholders beyond employers. They now have to sell themselves to individuals, a historic change in the system.

While healthcare leaders convene to talk the latest in care delivery — or better yet, patient engagement — it makes sense to have more consumers present contributing to the dialogue about them. Unfortunately, these conferences often prove to be cost prohibitive for the average individual. HIStalk and the Walking Gallery are leading by example with the latest patient scholarship competition. I suspect they will see a large group of applicants.

Given the crucial role of the individual in the new healthcare system, I hope that more patient scholarships will become the norm at every health industry conference. In the discussion of how to take healthcare into the future, we can’t afford to miss the individual consumer’s voice.

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February 5, 2015 Readers Write 4 Comments

News 2/6/15

February 5, 2015 News 2 Comments

Top News

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Anthem announces that the information of 80 million of its health insurance customers has been stolen in a “very sophisticated cyberattack.” Luckily for the company, the breach didn’t include either medical information or credit card numbers, or so it says so far. The FBI is investigating. It stands to reason that every breached organization will always claim that the attack was “sophisticated” – nobody would admit that they were hacked by primitive methods that exploited their poorly implemented security.


Reader Comments

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From Laura Petri: “Re: Roper acquiring Data Innovations. This is interesting because Sunquest has traditionally disliked DI and wrote their own interfaces instead. DI was viewed as a competitor. Wonder how much they paid?” The announcement didn’t break out the $450 million Roper paid for two companies. The company did announce that its three recent health IT acquisitions cost $590 million and will contribute $100 million in annual revenue, which would be a similar multiple as the $1.4 billion it paid in 2012 to buy Sunquest, which had annual revenue of only around $200 million. Apparently Roper doesn’t mind paying six times revenue. Battery Ventures bought Data Innovations in 2010 for an undisclosed price from founders looking to retire, so it surely pocketed some nice gains.


HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg sheds light on finding HIE successes. ICD-10 expert David Freedman, DPM offers best practices for making the switch by October 1. Rite Aid RediClinics debut – could Whole Foods clinics be far behind? ONC announces new funding for HIT workforce training. Hawaii moves forward with island interoperability. At-risk practices fall into the "digital divide" thanks to IT costs. Researchers offer physicians think-twice tips on Googling patients. Thanks for reading.

This week on HIStalk Connect: Under Armour acquires calorie-counter app MyFitnessPal for $475 million and fitness coaching app Endomondo for $85 million. The acquisitions will bring 100 million active users into Under Armour’s growing digital health ecosystem. ONC publishes a draft version of its ten-year, API-based interoperability roadmap. HIStalk Connect’s newest series Ramp Up kicks off with interviews from early-stage digital health investor Robert Greenglass of Waterline Ventures, and early-stage digital health startup CEO Jacob Sattelmair of Wellframe.

Listening: Australia-based indie rocker Courtney Barnett, who just announced a US tour.


Acquisitions, Funding, Business, and Stock

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Roper Industries, which owns Sunquest and which acquired Strata Decision Technology two weeks ago, buys two more health IT companies for a combined $450 million. South Burlington, VT-based Data Innovations is the largest laboratory middleware company and has 4,500 customers using its 1,000 laboratory instrument interfaces, giving Sunquest an interesting position among LIS vendors who rely on the company’s products. SoftWriters, based in Allison Park, PA, sells specialty pharmacy software.

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Rite Aid announces that it has opened RediClinics inside 24 of its drugstores in the Baltimore, Washington DC, and Philadelphia markets and will expand next in Seattle and Texas. Rite Aid acquired RediClinic in April 2014 when it had 30 grocery store locations in Houston, Austin, and San Antonio.

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Under Armour acquires two fitness tracking apps with a combined 100 million users — MyFitnessPal and Endomondo — for $560 million. The company acquired MapMyFitness for $150 million in 2013 and will “continue to redefine and elevate the Connected Fitness experience for millions of people around the world.”

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Cognizant releases Q4 results: revenue up 16 percent, adjusted EPS $0.67 vs. $0.59, beating expectations on both and sending shares to an all-time high. Increased healthcare demand and the company’s $2.8 billion cash acquisition of TriZetto in September 2014 drove the results. Healthcare makes up 25 percent of the company’s business and was its fastest-growing segment in 2014.

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McKesson announces Q3 results: revenue up 37 percent, adjusted EPS $2.89 vs. $1.48, beating expectations. Technology Solutions revenue was down 7 percent due to product retirements.

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Athenahealth announces Q4 results: revenue up 24 percent, adjusted EPS $0.58 vs. $0.57, beating estimates on both. Epocrates revenue dropped 32 percent quarter over quarter.


Sales

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Five-hospital Adventist HealthCare signs an eight-year IT outsourcing agreement with CareTech Solutions and General Dynamics Information Technology.


People

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Dave Cassel (Epic) joins Healtheway in an unspecified position overseeing its Carequality initiative.

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Industry long-timer Mike Etue, EVP of global sales at MModal, died Monday of pancreatic cancer. He was 62.


Announcements and Implementations

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Rauland-Borg announces that a new interface for its Rauland Responder provides the first instance of integration between a nurse call system and hospital’s EHR, allowing nurses to chart from patient rooms and to receive notification when important EHR information changes.

The Advisory Board Company will convene the sold out “Future of Health Care Summit” on February 18, 2015 in Washington, DC, with speakers that include National Coordinator Karen DeSalvo and executives from CMS and drug store chains.

Vocera releases a free secure texting solution for its healthcare customers and their affiliated providers.


Government and Politics

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FDA Commissioner Margaret Hamburg, MD will resign in March, with her mostly likely replacement being newly hired internist and cardiologist Robert Califf, MD (Duke Medicine).

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The VA rolls out online tracking of prescriptions ordered from its mail order pharmacy, implementing an idea offered by VA employee Kenneth Siehr.

In England, Health Secretary Jeremy Hunt announces that the Department of Health will create an online consumer diagnosis tool within two years that he hopes will reduce ED volumes.


Privacy and Security

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Students of all-female Bryn Mawr College plan to demonstrate after the college uses its student health records to send emails inviting 100 high-BMI students to enroll in a weight loss program.

MIT Review warns that 2015 will see a  big increase in “ransomware,” software that spreads to PCs via malicious emails or websites, locks all files with unbreakable encryption, and requires users to pay a ransom using untraceable Bitcoin to regain access to their information. The recommended solution: use antivirus software and make backups so that documents can be restored.


Technology

A Reuters survey of 23 top hospitals finds that 14 are piloting connectivity to HealthKit, giving Apple the jump over similar offerings from competitors Google and Samsung. BIDMC CIO John Halamka, MD says the health system has collected wearables-generated data from 250,000 patients, adding that, “Can I interface to every possible device that every patient uses? No. But Apple can.”

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The New Yorker profiles Crisis Text Line, a 24×7 crisis intervention hotline for teens that uses SMS text messaging exclusively and handles 15,000 messages per day with as many as 50 home-based counselors on duty. The service is data driven, using the information collected from 5 million texts to create counseling algorithms and to determine when crises are most likely to occur, information the founder plans to provide at no charge to school districts and police departments. Nancy Lublin (who uses the title “Chief Old Person”) also runs DoSomething.org, which helps people launch volunteer campaigns, and while still in college used a $5,000 inheritance from her great-grandfather to start Dress for Success, which provides job interview suits for underprivileged women. I guarantee that her 2012 TED talk above on texting-based crisis intervention is worth every second of your five minutes. The hurt she feels when describing teen abuse is palpable.


Other

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Healthcare Growth Partners releases its “2014 Market Review,” which is always brilliant. Eighty-nine percent of health IT-related business survey respondents said their companies are looking for 2015 acquisitions, with the most popular categories being population health and analytics and care coordination and telemedicine. Only 29 percent said they believe health IT is in a bubble. It also reflects back to 2007, when most startups incorrectly predicted that they would be acquired by an EHR vendor, to the reality that transactions often involve non-traditional acquirers looking to take an existing relationship deeper or to disrupt the market. The survey methodology is self-selecting and therefore somewhat biased toward respondents interested in acquisitions, but it’s still interesting.

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Carolinas HealthCare paid all of its 10 top executives more than $1 million in 2014 — including $5.3 million for its CEO — in a year the health system said it had to reduce expenses due to Medicare cuts.

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Baltimore Episcopal Bishop Heather Cook is indicted on 13 charges related to the death of Johns Hopkins Medicine software engineer Thomas Palermo, who was run over while bicycling on December 27. Cook is charged with drunk driving, texting while driving, and leaving the scene of an accident.


Sponsor Updates

  • Caradigm Care Management is named winner of “Most Innovative Product of the Year” by Best in Biz Awards International.
  • A PerfectServe guest blog post by physician collaboration expert Kenneth Cohn, MD addresses “The What and Why of Physician Engagement.”
  • Extension Healthcare reports a 273 percent bookings increase quarter over quarter and 54 new hospitals serviced in 2014.
  • Nordic releases a white paper titled “Return-Driven Optimization.”
  • Aspen Advisors announces that it was ranked among the top three overall IT services firms in KLAS’s annual report.
  • PatientSafe Solutions CNIO Cheryl Parker, PhD, RN publishes “Update Clinical Communication Strategy, Not Just the BYOD Policy” in PSQH. 
  • Kenneth Rashbaum of Logicworks publishes a blog post on “2015 HIPAA Audits & Implications for Healthcare Cloud Computing.”
  • InterSystems will exhibit at the iHT2 Health IT Summit February 10-11 in Miami.
  • Healthfinch has fun with EHR and brain surgeon analogies in its latest blog, “Time to Call in a Specialist.” 
  • Steven Botana writes about “The Art of Paying it Forward: Credit Balances” in the latest Hayes Management Consulting blog.
  • Senior VP Molly Mettler advocates for giving family caregivers a break in the latest Healthwise blog.
  • Maria Greger offers advice on “How to Avoid 5 Common Hiring Mistakes Startups Make” in the latest Greythorn blog.
  • Harris Corp. will also exhibit at the iHT2 Health IT Summit February 10-11 in Miami.
  • HealthTronics will participate in “The Evolving Role of MRI in Prostate Cancer Management: Detection, Staging, Surveillance, Follow Up, and Reporting” course February 7 in Santa Monica.
  • HDS posts a new blog on “Champions, Change & Culture: 3 Things the Medical Device Industry Needs Now.”
  • The HCI Group posts a new blog entitled, “6 Key Reasons Why Hospital IT Outreach Projects Fail.”
  • Andy Smith, president and co-founder of Impact Advisors, offers a new blog on the company’s recent “Best in KLAS” award.
  • HCS will exhibit at the NASL 2015 Winter Legislative & Regulatory Conference February 9-11 in Washington, D.C.
  • Brian Manning offers tips on how to thrive in a paperless office in the latest DocuSign blog.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 5, 2015 News 2 Comments

Morning Headlines 2/5/15

February 4, 2015 Headlines 2 Comments

Health Insurer Anthem Hit by Hackers

Anthem, the country’s second-largest health insurer, is reporting that hackers broke into a database containing personal information for 80 million customers. Investigators are still assessing the damage, but early reports suggest that “tens of millions” of records were stolen.

AMA, MATTER Partner to Create Transformative Health Care Innovation and Technology-enabled “Physician Office of the Future”

AMA is partnering with a Chicago incubator to create a health IT lab focused on growing startups that will drive efficiencies and improve care delivery for physician offices.

Under Armour Just Bought 100 Million Users Worth of Fitness Data

Under Armour acquires calorie counter app MyFitnessPal for $475 million and fitness app Endomondo for $85 million, growing its digital health ecosystem to 100 million active users.

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February 4, 2015 Headlines 2 Comments

Readers Write: Top Technologies in Private Practice for 2015 and Beyond

February 4, 2015 Readers Write No Comments

Top Technologies in Private Practice for 2015 and Beyond
By Arman Samani

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As we enter into 2015, healthcare is entering an era where it must compete for the patient’s time and attention. Mobile and cloud computing are now pervasive enablers of other technologies that physicians can and should be leveraging. Mobile and cloud are attributes of other technologies rather than a technology or trend themselves.

As payment reform is progressing and we are switching from fee-for-service to fee for value models, it is critical that private practices take steps in 2015 to prepare for this new reimbursement model. This preparation will steer practices toward doing the right things for their patients as well their businesses. Practice management, EHR, patient relationship management, actionable analytics, and interoperability are broad categories that a private practice should evaluate carefully to be prepared for long-term growth.

Health watcher technologies are enablers of proactive patient engagement. According to the recent IDTechEx report on the wearables market for healthcare, the market is projected to grow from $14 billion in 2014 to more than $70 billion in 2024. This booming market is an opportunity for physicians to shift into the role of “health watcher” for their patients. The industry can no longer function in reactive ways to patients initiating visits. Both Apple and Samsung have introduced health tracking frameworks and data repositories in their mobile devices, and as a result, consumers will soon be wearing devices such as Apple Watch and Samsung wearables.

Not only can someone track how many steps or even floors they have walked, but health statistics like heart rate and blood pressure can be measured. Private practices should think about integrating this patient base data into their EHR in order to provide proactive and preventative actions to their patient population. Not only is this the right thing to do for the patients, it increases the practice revenue, enhances reputation, and decreases healthcare costs. While appointment reminder technology is now mainstream, health reminder communications such as email, text, and phone calls will be become mainstream in 2015 and beyond.

With the rise of mobile computing, convenience will be an important factor. A 2014 study from Manhattan Research found two in five physicians agreed that using digital technology to communicate with patients will improve patient outcomes. Starting January 2015, CMS will start paying for chronic care management, wellness visits, and psychotherapy services. The telemedicine cash business has been growing for a few years and now that CMS has expanded reimbursement for telemedicine, private practices need to start putting business processes and technologies together to take advantage of this growing market and offering a convenient way for their patients to save time and get readily accessible preventative care.

With industry regulations such as ICD-10 imminent, practice management software has to be ready to support the increased complexity in coding. However, the effects of an expanded code base aren’t all about technology. Patient visits and the associated workflows, from the moment a patient arrives through to receiving a claim payment, need to change in fundamental ways. The questions that are asked and data that is collected right at the point of care are also affected. Practices need to stop thinking of coding as data entry and make it a proactive process that happens in real time. Practices that don’t plan for this shift may see a rise in claim denials — the aftermath that creates may overwhelm staff and burden the business. Practices should do ICD-10 risk assessment now.

With cloud technologies, big data is no longer only for large health systems. From patient health monitoring to quality measures, accounts receivable and payer reimbursement, and more should be provided in easy and actionable analytics. In addition to actionable analytics for the different aspects of business, it is important to benchmark a practice against other practices or the industry as whole. Otherwise, a practice might never know how well it is doing and what new goals should be set. Benchmarking tells the practice manager where their business stands compared to other practices. It helps answer questions such as how much the practice is getting paid relative to other practices and if it needs to start collecting more for certain services. Analytics can measure these factors relative to the practice’s goals and in comparison to other practices. Benchmarking is complex and time consuming, but cloud providers of EHR and practice management technologies are especially well positioned to provide these benchmarking services.

Practices are overwhelmed with data and technology providers need to move beyond providing dashboards and monitoring trends. Big data must now be a driving force for actionable alerts that trigger automated staff or even patient actions. Physicians might be asking what treatment plan or medications other doctors are prescribing for the same diagnosis. Analytics data can help with matching up patients who share the same condition so they can compare notes and even create support groups.

All practices play a role in the healthcare ecosystem. Most practices receive patient referrals from or give patient referrals to other practices or care settings. It is important to have seamless transition of care among entities to save time and money and provide patients with excellent and convenient service. Interoperability will enable sending and receiving summary of care documents and other necessary information about the patient care continuum. Interoperable systems will be able to store patient information such as discrete data points within the EHR automatically. This will allow practices to not have to ask the same questions from patient multiple times and will expedite care, increase care quality, and decrease costs by avoiding unnecessary procedures and tests.

The pace of innovation in healthcare has immense potential to advance the quality of care in 2015 and beyond. Smart practices need to prepare and adopt for upcoming healthcare reforms and provide proactive preventative care for their patients. This is not only good business but also the right thing to do for the patients and communities.

Arman Samani is CTO of ADP AdvancedMD of South Jordan, UT. 

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February 4, 2015 Readers Write No Comments

Readers Write: EHR Ease of Use is Not Easy

February 4, 2015 Readers Write 3 Comments

EHR Ease of Use is Not Easy
By Lee Farabaugh

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Usability shows no signs of losing its luster as a buzzword in health IT. Coverage of a usability collaborative involving the efforts of the Electronic Health Record Association, the American Medical Association (AMA), and the American College of Physicians to improve user-centered design of EHRs in the context of the Meaningful Use program has certainly escalated. I

It’s no secret that EHR usability is, generally-speaking, pretty abysmal. There are standouts in the realm of interface design excellence – think of the award-winning PracticeFusion and athenahealth. But the overwhelming response to EHRs from the physician community is a groundswell of complaints over poor design, longer patient encounters, time-consuming documentation, and slow information retrieval response time.

The AMA recently published an article entitled “Improving Care: Priorities to Improve Electronic Health Record Usability” that identifies eight EHR usability principles, including supporting team-based care, promoting care coordination, and reducing cognitive workload through a user-centered design (UCD) approach. But even the AMA admits that while “some vendors have implemented user-centered design … their results have been inconsistent and many other vendors have not [even] implemented UCD.”

Apparently it’s not as simple as just applying the UCD process of user research, iterative design, and usability testing to the field of EHR design. Mary Kate Foley, VP of user experience at athenahealth, perhaps says it best: “Our industry has been talking about EHRs for years now, and if it were simple to make EHRs easy to use, we’d be done by now.”

EHR interface design is still subject to the design choices of individual interaction, visual, and user experience designers. While we’ve become used to the new flat UI convention on our iPhones, the vast majority of EHRs still look like snapshots from the past. In short, we don’t typically look to EHRs to be on the cutting edge, whether in terms of visual design conventions or adherence to UI design best practices.

The AMA calls for “the development of a common style guide – designed through collaboration between physicians and vendors – so physicians who practice in different care settings can move from one EHR to another.” But it’s not just physicians who stand to benefit. This type of common design framework frees organizations to make changes to their toolset because they don’t have to fear a steep learning curve for providers on a new interface.

How can we as designers support these efforts?

  • Remember that EHR design affects not only physicians, but patients, too. Patient tools, while separate from the EHR itself, both push information to and pull information from the EHR, making patients de facto EHR users by default.
  • Acknowledge existing efforts to reach a common design language in EHR interface design. Juhan Sonin, Jeff Belden, and Catherine Plaisant, among others, have created a nice start towards an EHR style guide for the industry at InspiredEHR.org. Their work includes medication lists, allergy lists, and drug alerts.
  • Continue to push forward with additional design patterns. One area where common design vocabulary is needed is the patient banner. EHRs should employ common conventions for elements such as patient name, gender, date of birth, allergies, etc. that typically appear in this space, and balance information communication with respect for screen real estate.
  • Educate our colleagues in industry about the importance of understanding and designing for the way real humans think and work. In my course on user-centered design for healthcare at UAB’s Masters Program in Health Informatics, my students (nurses, business analysts, and EHR vendors) are learning about how humans process information, think irrationally, and act according to behavior patterns that point the way towards more intuitive design.

EHR usability isn’t easy. It involves a complex interplay of care teams, workflows, the legacy of paper charts, and the promise of a design language we can all speak. But the need is real, and as the focus on “checking the box” for MU fades away, we’ll get down to the real business of not just using EHRs in a meaningful way, but in a delightful way.

Lee Farabaugh is chief experience officer at PointClear Solutions of Atlanta, GA.

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February 4, 2015 Readers Write 3 Comments

Health IT from the CIO’s Chair 2/4/15

February 4, 2015 Darren Dworkin No Comments

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

IT and the Big Rooms

Talking about change in IT is nothing new, but it feels like less has been written about the changing role of IT in the C-suite and at the board. Since I believe we are in the midst of a new shift, I wanted to raise the topic.

For the most part, the makeup and composition of C-suites and boards defies generalization. Company size, business sector, and stage — combined with the wide breadth of talent and backgrounds that compose these groups — makes them all unique.

But if I were to generalize, I would say that the trait that cuts across most C-suites (and certainly most boards) is the aversion to risk. IT has delivered many successes over the years and certainly in the last decade, but it is still often seen though this lens of risk.

If risk is the language, how can we leverage the opportunity?

Change, Change, Change

In the 1960s, the MIS manager (remember that title?) was a stranger to the big rooms like the C-suite and board. In fact, the common habitat of MIS was in an office in the basement near the IBM mainframe.

In the late 1970s with PCs, networking, and user interfaces that finally were not just green or amber, the groundwork was laid for a fresh look at the governance role of IT as the number of computer users started to grow.

By the mid to late 1980s, the IT executive began to emerge, MIS started giving way to IT, and our first CIOs were anointed. But the real shift in the C-suites, while not yet really inviting IT to the table, began the change to centralize IT budgets and gave large amounts of control to the IT head (MIS manager or CIO, depending on how trendy the company wanted to be back then).

In the 1990s, the big rooms still viewed the discussion of IT to be mainly approving the annual IT capital budget. For the most part, they did not really react much to the explosion onto the scene of little things like distributed computing, the World Wide Web, and the mobile phone.

Then came Y2K. The big rooms now had to deal with not just risk from IT, but material risk. In many companies, this was among the first active involvements of IT in the business conversation. While not thought of at the time, it also laid the groundwork for the IT executive to begin to not just solve operational issues, but to help lead the conversation about what could be next.

As we passed through public financial scandals (Enron, et al.) government regulation came pouring in. IT was seen as the builder of the key infrastructures to support the bevy of new mandates. Again, IT was back in the big room solving operational issues and laying the groundwork and credibility to help lead the business.

By the mid and late 2000s, IT became intensely preoccupied with the complex roles of shifting to the distributed computing era, solidifying IT’s role delivering function through ERPs and other key business applications, managing the still-steady stream of regulatory requirements, and coping with the rise of the Internet.

As the 2010s rolled around, IT risk conversations in the big rooms began to shift from asking “What will be the risk if something bad happens?” to “What is the risk if we don’t act?”

Today, the crazy mix of social, cloud, analytics, and mobile has everyone’s attention. IT firmly has shifted from the 1990s — when only 10 percent of the leading 4,000 companies in the US even had a CIO — to greater than 50 percent of CIOs today reporting to the CEO and having accountability to at least one board committee. IT is in the room.

So Now What?

I think IT has never been in a better place.

The big rooms will still want to manage risk and ask how IT will provide stable, resilient, and dependable systems and infrastructure. But the opportunity is to exceed expectations when answering these questions and use the credibility to pitch for new investments in digital innovations that can underpin growth and expansion. IT needs to present these ideas not in terms of technology, but frame them in terms of revenue (yes, revenue).

The Next Two Big Things

1) The digitization of EVERYTHING

2) The next cyberthreat

The C-suite and board will want to know how they are effectively managing the risk that new competitors and business models won’t wipe out overnight key lines of services delivered today. This creates an unprecedented opportunity for IT to not just be part of the next conversation, but to lead it. As our friends in Silicon Valley warn us that “Software will eat the world,” IT must help our companies not defend against the thread of digitization, but lead an impressive assault forward.

Finally, cybersecurity has marched into a new era. The big rooms — primary the board — will not just ask, but expect regular updates and leadership in this area. If they are not satisfied, it will be achieved through other sources – they will get answers. IT either has to lead or we will see 80 percent of the CISOs that report into the CIO today shift directly to chief compliance or risk officers. Cybersecurity is not a concern, it is a fear.

IT is fully positioned to leverage these great opportunities. The big room is looking right at us and asking us to innovate, deliver, and lead.

Let’s not screw it up!

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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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February 4, 2015 Darren Dworkin No Comments

Morning Headlines 2/4/15

February 3, 2015 Headlines No Comments

athenahealth Collaborates with BIDMC on Inpatient Cloud-based EHR

Athenahealth acquires Beth Israel Deaconess Medical Center’s home grown inpatient EHR. Athena will scrap the code, but will use the system as a model to build its own inpatient EHR over the coming months.

Fiscal Year 2016 Budget of the US Government

ONC requests $92 million in the 2016 federal budget, of which $5 million will be used to establish a Health IT Safety Center.

HHS and ONC invest $28 Million in Health Information Exchange Grants

HHS announces $28 million in new grant money available to support the adoption of HIEs.

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February 3, 2015 Headlines No Comments

News 2/4/15

February 3, 2015 News 5 Comments

Top News

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Cerner completes its $1.3 billion acquisition of Siemens Health Services as announced in August. Cerner reiterated in the announcement that it will continue to support Siemens core systems for an unspecified period, with Soarian maintenance guaranteed for 10 years. Former SHS CEO John Glaser has joined Cerner as SVP and a member of the company’s executive cabinet. Julie Wilson, Cerner’s chief people officer, says Monday was “the biggest single hiring day in Cerner history” as its employee count jumped from 16,000 to 22,000 with the acquisition. CERN shares rose 0.57 percent Monday on the news, giving them a slightly better performance (blue, up 20 percent) than the Nasdaq as a whole (red, up 17 percent) over the past year.


Reader Comments

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From Lemmy: “Re: Athenahealth’s purchase of BIDMC’s WebOMR. Not sure why Athenahealth would be interested – WebOMR is a complete piece of crap being held together with gum.” I mentioned the acquisition in last weekend’s post as a rumor provided by reader InTheKnow, although I left out specific details since ATHN is publicly traded. More discussion follows below – I got details from John Halamka that go well beyond the announcement and invalidate some incorrect assumptions I had.

From Mr. Smith: “Re: national patient identifier. HHS and ONC are prohibited by law from even discussing anything related to an NPI even though they are acutely aware of the challenges posed by not having one. The legislative branch should address the issue, but HHS and ONC are trying to create a workable solution.”


HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor West Corporation and its healthcare practice. The Omaha, NE-based company processes billions of voice-related transactions each year. Its West Engagement Center drives patient engagement, care coordination, and provider collaboration using a variety of technologies (voice, text, email, mobile, contact center). Available solution sets include telehealth, patient access, prevention and wellness, and chronic disease management. It is used by providers, payers, and employers that are transitioning to value-based care, managing populations,  creating chronic disease care coordination programs, or adding patient engagement capability to existing population health management technologies. Sign up for an online tour here. Thanks to West Corporation for supporting HIStalk.

Here’s a YouTube video that shows how patients report their daily blood pressures using the West Engagement Center.

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We’ve received just a handful of requests from real-life patients who want to take advantage of our HIMSS15 conference scholarship ($1,000 in travel cash plus registration). We’re accepting applications through February 9 and will choose the five based on their patient stories and their writing ability. See Regina’s description and send entries to Lorre.


Acquisitions, Funding, Business, and Stock

Athenahealth makes its second recent  push into the inpatient EHR market by acquiring the WebOMR system that was developed by Beth Israel Deaconess Medical Center (MA). Terms were not disclosed. The company will integrate WebOMR with its AthenaNet system. The internal announcement from BIDMC CEO Kevin Tabb says that BIDMC will do a “trial implementation” of “some of athena’s current products” in “select areas of our network.” BIDMC’s only obligation to Athenahealth is to help its engineers understand how WebOMR works “so they can try to expand its use beyond our walls” as “the days of self-built information systems will not last forever.” Athenahealth acquired small-hospital EHR vendor RazorInsights on January 14. Athena shares ended the day up just over 1 percent, the same daily gain as the Nasdaq composite.

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I spoke to BIDMC CIO John Halamka, MD for clarification about the agreement:

  • BIDMC originally developed WebOMR as an ambulatory application, but it has been extended to include all BIDMC-developed automation – a certified inpatient EHR, OR management, oncology, laboratory, radiology, electronic medication administration record, and bedside barcoding. The only external dependency is First Databank for drug information. The only excluded module is the ED information system (which had been previously commercialized as Forerun) and the agreement doesn’t cover billing (which is performed by a McKesson application). BIDMC has done work with Google Glass and Apple Health and those components are included as well.
  • Athenahealth is buying BIDMC’s intellectual property, but it will not use BIDMC’s programming code, which was developed by a 25-member team using Cache’ and Cache’ server pages. Athenahealth will instead rewrite the entire product (or at least the parts they want to commercialize) using their own workflow, user interface, and business logic to create a new platform.
  • BIDMC will not act as Athenahealth’s development partner. What Athenahealth bought for an unstated cash investment is the intellectual property, one BIDMC FTE for two years to help them understand the applications, and access to an alpha site in BID-Needham, which has a 29-bed medical-surgical ward running Meditech (which will not be replaced there).
  • BIDMC gets a 20-year license to use the code that Athenahealth develops, but they do not have to move to Athenahealth’s version and are not precluded from replacing WebOMR with a commercial product, which Halamka says may happen at some point.
  • Halamka estimates that it will take Athenahealth 18 months to rewrite the product.
  • Athenahealth and BIDMC signed two agreements. The first covers the intellectual property as described above. The second is an agreement in which three practices within 38-site BIDMC Healthcare will begin phased implementation of Athenahealth’s ambulatory product, but BIDC has no further obligation to continue or extend the trial beyond those three practices that are participating in the trial.
  • Halamka says in a blog post that BIDMC won’t necessarily choose Athenahealth products when they consider replacing WebOMR since “we are a meritocracy and the best services at the lowest cost will win.” He adds, “Just as Mayo chose Epic to reduce the number of different IT systems, BIDMC will pursue a parsimony solution – the fewest moving parts possible. That might be one vendor, but hopefully it will not be more than two … While we want to continue to innovate, we know that commercial vendors will be able to leverage their knowledge and capabilities to build future platforms at larger scale.”

 

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Cerner rang Nasdaq’s opening bell Tuesday.

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Voalte lays off 25 percent of its staff, or around 40 employees, in a reorganization.

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Canada-based consulting and services vendor Accreon is acquired in a leveraged buyout funded by its management team, its founders, and Mansa Capital. As part of the deal, the company gives up its 49 percent ownership in Velante, which ran a controversial e-heath project in New Brunswick, and turns it over to the other partner, the New Brunswick Medical Society.


Sales

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Yale New Haven Health (CT) chooses Mobile Heartbeat’s clinical communications system.

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Boulder Community Health (CO) chooses Voalte’s smartphone caregiver communication for its newly expanded facility.

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Pocono Medical Center (PA) selects Authentidate’s telehealth solution.


People

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Murray Reicher, MD is named CEO of DR Systems, which he co-founded in 1992. He replaces co-founder Rick Porritt, who has retired.


Announcements and Implementations

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Vancouver, WA-based patient monitoring systems vendor OSTAR launches a cellular network-powered blood pressure monitoring system to reduce CHF readmissions.

Mediware announces CareTend, which combines its home care solutions into a single platform.


Government and Politics

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HHS Secretary Sylvia Burwell announces a $28 million ONC-funded HIE grant program, described as, “Grantees will address interoperability workflow challenges, technical issues, and improve the meaningful use of clinical data from external sources. Providers will be engaged from across the entire care continuum, including those who are not eligible for the Medicare and Medicaid EHR Incentive Programs such as long term care facilities, to be able to send, receive, find, and use health information both within and outside their care delivery systems.”

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ONC requests $92 million for its FY2016 budget, up from $60 million. ONC wants $5 million to establish a Health IT Safety Center that will go live in FY2016.

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This is a great quote from former National Coordinator David Blumenthal, MD, tweeted by ONC annual meeting attendee @PharmDJD: “It is cognitive dissonance to want cutthroat competitive markets but to expect healthcare players to share valuable data.” It would be great if hospitals, retail stores, quick lube stations, and hair salons shared customer information freely for the benefit of their shared customers, but only healthcare providers are being (unsuccessfully) shamed into doing so.

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Health IT equities researcher Jamie Stockton of Wells Fargo Securities provides a slice and dice of CMS’s Meaningful Use Stage 2 data. Hospital attesters included 97 percent of eligible Epic users, 63 percent of Allscripts, and 60 percent of CPSI, with everybody else falling under that number (Medhost and NextGen trailed the pack at under 40 percent). Physician Stage 2 rates were predictably abysmal, with Athenahealth out front at 58 percent and Epic at 26 percent, but vendors such as Allscripts, Greenway, Cerner, NextGen, and McKesson (the latter at 0 percent) having less than 5 percent of users attesting. Obviously it’s dangerous to read too much into the vendor vs. the customer, especially given the mass EP Stage 2 bailout.


Privacy and Security

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Paper records from several New York City hospitals are lost when a Brooklyn document warehouse is destroyed in a seven-alarm fire that scattered charred patient charts over several blocks. Cleanup crews attempted to retrieve partially burned papers that contained patient clinical and financial information. New York City Health and Hospitals Corporation is among the organizations that stored documents in the warehouse, but says that as early EHR adopter, it expects no operational impact.

The creator of PGP encryption software (now owned by Symantec) says the Sony Pictures breach highlights the need for companies to redirect efforts from security to privacy by encrypting emails and documents and retaining less information online. “If you look at all the things that have been developed – firewalls, intrusion detection systems, all these things put in place to protect computers? They haven’t really hit a home run: they keep getting breached. But if you look at the Snowden material, the one thing that does seem to do well is strong encryption. Of all the things you see getting broken into, it’s conspicuously absent from that list … In the 90s, if you were using strong encryption, you’d have to defend yourself and justify what you were doing: ‘What, are you a terrorist or a drug dealer?’ Now, if you aren’t using strong encryption, you have to justify it. You’re a doctor? What do you mean you’re not encrypting your patient records? Or you left your company laptop in a taxi with 2,000 customer names on it? You better hope that data is encrypted or you’re in trouble.”


Other

Researchers at Penn State College of Medicine suggest 10 situations where it would be acceptable for doctors to Google a patient, boiled down to (a) if they suspect the patient is lying to them about their history; (b) if the patient could be a doctor-shopping drug user; and (c) if the patient seems to have the capacity to harm themselves.

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I received the email above from a well-known B2B spammer who apparently got an email list of HIMSS15 exhibitors and is offering to sell a database of full attendee details. The fraud clues are numerous: (a) the email purporting to be from “Tracy Nixon” was clearly not written by a native English speaker; (b) the company’s website is just a placeholder full of “lorem ipsum” text; (c) the domain owner’s name is blocked in its registration records; and (d) clearly a 7,500-record HIMSS conference attendee database is at best incomplete given the 40,000 or so attendees. The same company has scammed companies in other industries by selling them junk lists at high prices and then refusing to give refunds.

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Weird News Andy titles this story “Heaven Scent” and adds that the device should be worth the cost of at least 1,000 Fitbits. A smartphone-powered cancer detection system called the SniffPhone detects the odor of lung cancer on the breath with 90 percent accuracy


Sponsor Updates

  • SyTrue CEO Kyle Silvestro posts “The Secret Life of your Healthcare Data.”
  • Verisk Health’s HEDIS measures are certified by NCQA for 2015.
  • Nordic publishes a blog post titled “Optimizing My Birkie and Your EHR.”
  • Four Medicity HIE customers are named in “Survivor: Edition HIE"–Can Statewide HIEs Achieve Sustainability?”
  • Dan Hamilton, COO of Nor-Lea Hospital District (NM), writes an article titled “Handling the Demands of a Population Boom: Using RTLS to Improve Patient Care and Workflows” about its use of Versus Advantages Clinic RTLS.
  • ADP AdvancedMD asks, “Has the ICD-10 Delay Hurt Provider Preparedness?” in its latest blog.
  • Bottomline Technologies will exhibit at the NAMIC Claims meeting February 10-12 in Phoenix, AZ.
  • Divurgent offers a new white paper entitled, “From the Trenches: Leadership Strategies from the US Navy SEALs Applied to Healthcare.”
  • Clinical Architecture’s Charlie Harp posts the second installment of the company’s blog series on “The Road to Precision Medicine.”
  • Caradigm will exhibit at the iHT2 Health IT Summit February 10-11 in Miami.
  • Matt Patterson, MD asks “What stage of Meaningful interoperability are you?” in the latest AirStrip blog.
  • CareTech Solutions will exhibit at the Health Forum Annual Rural Health Care Leadership Conference February 8-11 in Phoenix.
  • Amber Harner blogs about her trip to Costa Rica to help build houses with Habitat for Humanity, courtesy of the CoverMyMeds 2014 CoverMyQuest competition.
  • Michael Passanante writes about the physician’s role in lowering hospital readmission rates in the latest Besler Consulting blog.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 3, 2015 News 5 Comments

Morning Headlines 2/3/15

February 2, 2015 Headlines No Comments

Cerner Completes Acquisition of Siemens Health Services

Cerner announces the completion of its acquisition of Siemens Health Services. The new merged organization has a combined customer base of 21,000 facilities and an annual R&D budget of $650 million.

Community Health Systems Professional Services Corporation and Three Affiliated New Mexico Hospitals to Pay $75 Million to Settle False Claims Act Allegations

For-profit hospital chain Community Health Systems will pay $75 million to settle False Claims Act charges with the DOJ. Three New Mexico hospitals are accused of making illegal donations to county governments. The funds were used to pay the state’s share of Medicaid payments to the accused hospitals, in an effort to drive up local spending and take advantage of a federal program that reimbursed New Mexico $0.75 for ever dollar spent on rural Medicaid services.

ONC Annual Meeting, February 2 – 3

ONC’s Annual Meeting kicked off in Washington DC today. Tomorrow morning Karen DeSalvo, MD will join the former National Coordinators for an hour long round table on the state of the HIT nation.

Cost Comparison Between Home Telemonitoring and Usual Care of Older Adults: A Randomized Trial

Researcher compare the total cost of care for 205 patients over the age of 60 and find that, over the course of a 12-month period, traditional care costs the same as care supplemented with remote patient monitoring services.

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February 2, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 2/2/15

February 2, 2015 Dr. Jayne 1 Comment

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Although I still haven’t answered the "should I stay or should I go" question regarding my day job, I did make a decision to leave the practice where I’m currently providing urgent care services. I haven’t resigned yet since there’s enough strangeness that I want to have my final paycheck in hand before I do.

I didn’t really pay attention to the calendar when I sent my available days for this month, so I’m spending Super Bowl Sunday seeing patients. So far, sinusitis is leading otitis media 13 to 2 going into halftime, where we expect a rousing performance by indie rock band Motor Vehicle Accident.

I’m certainly not a job hopper. Prior to this job, I had been with the same emergency and urgent care staffing company for nearly six years. They had a huge portfolio of customers, which allowed me to experience quite a few different care settings and a variety of different inpatient and outpatient EHR systems, health information exchanges, and more. 

Last year, they lost their contracts with most of the facilities in my area when another staffing company underbid them. I’m not sure the facilities were aware that all the part-time and as-needed physician providers were going to be replaced with non-physicians, but they should have seen it coming based on the pricing model. Along with more than a dozen other part-timers, I was let go.

I didn’t see patients for a couple of months while I evaluated my options. Eventually I received a call from a recruiter which led me to this opportunity — an independently-owned urgent care with two locations. The facilities are recently renovated, the drive was reasonable, and the pay was in my range, so I gave it a shot.

The only downside was their lack of EHR. For some, that might be a bonus — the learning curve for charting is certainly very small. But for someone who is used to the safety features of an EHR (allergy and interaction checking, pediatric dosage calculation, etc.) it was a little rough. I dabbled with a freestanding eRx system for a while, but the dual data entry was a bear.

My employer is certainly nice enough, but he’s suffering from the same things that are impacting most small practices. They don’t run themselves. Without a dedicated physician leader or a hands-on management style, it’s easy to start a death spiral with staff unhappiness, turnover, patient unhappiness, and ultimately physician unhappiness. All of these conditions contribute to a negative impact on the bottom line, as does his obsession with the salt water aquarium in the waiting room.

He tends to manage from afar, yet micromanages at times. Policies and procedures are lacking, but he shows up unpredictably and criticizes how work is being done. Poor performance is not addressed and high performers are not rewarded. The staff is relatively young, and without consistent leadership or supervision, they tend to fall into the behaviors that college-age people do. Smartphone use is rampant, which not only hampers productivity, but leads to some interesting conversations that patients overhear. Staff regularly shows up either at the exact time the office is supposed to open or even after and management doesn’t seem willing to address it for fear of losing people.

Although I can put up with a fair amount of chaos, I recently figured out that there were some significant irregularities in my onboarding. Apparently I’m not fully credentialed with most payers (not even Medicare / Medicaid), which is surprising for the length of time I’ve been here. That’s a red flag right there. The next red flag was when he emailed me to let me know there was an error on my 1099 tax form and I’d have to handle it on my own. Running a practice, or any small business for that matter, is not for the faint of heart or those without education, experience, or solid advisors.

Before making the decision to leave, I put myself in his shoes and considered whether there was anything he could offer to make me stay. He’s not going to run out and implement an EHR tomorrow, so the patient safety issue remains. It’s also an efficiency issue (although a bad EHR would certainly be worse than handwriting on pre-printed paper templates). Then there’s the clinical quality issue. I have no way of sending copies of our notes to primary care physicians unless I personally fax them since there is no system in place unless there is a specific request for release of information. The primary care practices in the area have yet to embrace the patient-centered medical home model. Few of them are open outside the hours of 9 a.m. and 4 p.m. and I can’t name any that have evening or weekend hours, so we’re essentially the safety net. We don’t have access to the local HIE or the state immunization registry, so we’re actively contributing to the fragmentation of care.

I don’t see him hiring a strong office lead or spending more time at the practice himself, so the staff will continue to be relatively undisciplined. The owner isn’t clinical and there’s not a named medical director, so I don’t see any expansion of policies or procedure that could help bring things into line. Strangely enough, he’s opening a third location in a fairly dangerous part of town without commitment by providers or staff that they’re willing to work there. I’m sure that will further dilute his ability to manage the practice effectively and might make staff turnover even more of an issue than it already is.

Although I don’t see him embracing new technology like the HIE or immunization registry web portals, I also don’t see him abandoning some of the problematic technology we already have. The computer-assisted coding system is a concern since it codes the visits after documentation is complete and providers don’t have a chance to confirm or correct the E&M codes before they’re released to the practice management system. Although most of my coding has been consistent with what I would have manually coded, it’s just another red flag.

On one hand I feel bad leaving because the patients are genuinely appreciative and certainly need physicians who understand their needs. But on the other hand, knowing what’s at stake from a regulatory standpoint and that I could wind up personally liable for any creative coding or billing that is occurring, I can’t afford to stay. 

I’ve got a new clinical endeavor lined up, one where they’ll ensure I’m fully credentialed before I see patients and where an EHR is already in place. They’re using a system I’ve never worked with, so I am looking forward to the new challenge. If nothing else, learning a brand new system will surely make for some good stories.

What makes a new employee run shrieking? Email me.

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February 2, 2015 Dr. Jayne 1 Comment

HIStalk Interviews Alan Weiss, MD, Director of Medical Informatics, Memorial Hermann Medical Group

February 2, 2015 Interviews 3 Comments

Alan Weiss, MD, MBA is director of medical informatics with Memorial Hermann Medical Group of Houston, TX.

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Tell me about yourself and the organization.

I’m a general internist by training. I have a computer science background and an MBA. I’ve been involved in the development of EMRs for about 15 years. I practiced at the Cleveland Clinic for about 10 years doing EMR implementation and practicing.

I’ve been at Memorial Hermann for about a year and a half. It’s a 10-hospital system, about to become a 12-hospital system, with an outpatient medical group directly affiliated with about 170 providers. We’re a GE shop on the ambulatory side and a Cerner shop on the inpatient side. We also have an affiliated group of physicians, about 600 to 700, on a whole different group of EMRs, with our biggest one probably being eClinicalWorks. We are the largest healthcare provider here in Houston.

 

What is the state of EHRs and in what areas should they be better?

EHRs need to improve. When people talk about the current state, I always think about what the basics are of EMR — what does it have to do? It has to be able to allow providers to look at data, to enter orders, and to write notes in a clean and efficient manner. A lot of the EMRs don’t allow for this. Each EMR has its benefits and its drawbacks, but if you can do those three simply and easily, that’s when providers can use the tool as best as possible.

 

What is the place for the doctor’s true narrative and rather than text generated from click boxes?

I think we’re going to see a throwback away from the computer-generated text and back into true narrative. It’s gone too far. It doesn’t have a whole lot of meaning and notes are way too long. It doesn’t convey the clinical impression, which is what we need to provide the best care we can.

 

It wasn’t doctors who originally wanted to click boxes to create text. Do they have enough voice to turn the EHR back into a record that’s for them and not for someone else?

There are providers out there who love the being able to do all the clicking of text and checking the boxes to get things done. But it’s more to get things done, not to create the narrative. The problem is that the narrative that’s created through clicking boxes becomes a hard to read mess.

I think we’re going to see everything change back into a much better narrative. A better way of actually describing what providers want from the EHR, which is an easy way to document, but also a way that gives their notes meaning to them.

 

What parts of the note could give clinicians an immediate sense for what’s going on with that patient?

There’s a whole movement of trying to get the notes to be meaningful again. One of the best ones is to change your SOAP note — Subjective, Objective, Assessment, Plan — into an APSO note, where your assessment and plan are at the top. If you want additional information, you can go through and see the rest of the information. 

Many organizations have changed from SOAP to APSO as a way of making sure that the assessment and plan, which is what you really want, is right in your face with the supporting documentation later on. I think we’re going to see more of that as time goes on.

 

What do you think about the OpenNotes initiative and the new plan to allow patients to contribute to the notes?

It’s probably going to be the way of the future. I think we’re going to see open notes. I don’t see anything wrong with having patients see the notes the providers have written. It’s actually very good, and especially for patients who are very concerned about their own health, seeing what the providers write will help them. I think it will also help some providers write better notes in the process of providing care. That’s going to be great.

It’s interesting that in the whole notion of having the patients come in and add to the notes themselves; we have started looking at ways of taking some of the surveys that patients are filling out and incorporating those into the notes. It can have some very positive effects, especially when it comes to patient engagement.

 

Will the least technically savvy patients do that?

The technical savviness of patients versus physicians is interesting. I tend to think that patients right now are more technically savvy than a lot of physicians. They want more apps, they want more access to their data, and they want to be able to access their physicians all the time in as many ways that they possibly can. 

The technical savvy aspect is extremely important. The patients,though, who are least technically savvy also have some of the greatest health problems. For that population, we still need a better strategy.

 

What are some system-agnostic EHR changes you might recommend to improve care?

I’ve worked ambulatory and I’ve worked inpatient. You have to really distinguish between the two.

On the inpatient side, certainly order sets and standards are a lot easier to implement than on the ambulatory side. The ambulatory side is more of people doing whatever they want to do. It’s much easier to create rewards to get people to do either the right thing or to stop ordering the wrong thing. That’s much easier on the inpatient side.

On the ambulatory side, sometimes the right thing to do is actually not to change your EMR, but to give reports. For instance, we’ve got a very simple report that shows providers their top 20 medications, the ranking, and the amount. When we show it to the providers, they start to see patterns. We have one provider who saw their pattern with  very high antibiotic prescribing, lots of Zithromax, lots of Z-Paks prescribed. In fact, she was providing about one or two Z-Paks a day on average to her patients. When she realized that that was the most common medication and not the most appropriate medication for what she was seeing, she changed her behavior. She has reduced her prescribing of Z-Paks by two-thirds.

That’s the kind of thing you may do outside of the EMR itself. If you can provide those simple reports showing behaviors, they can often have a bigger effect than making huge changes in the EMR itself.

 

As more physicians who practice in ambulatory setting are acquired or are working more collaboratively on the patient as a whole via new payment models, will they see EHRs as the bad guy that enforces rules that they didn’t follow when they were on their own?

I don’t think it’s going to be EHRs. I think it’s going to be the medical practice itself. When you’re in large groups, you’re being held accountable for all of the costs. At the same time, you’re going to have a natural progression where everybody is going to be seeing that they have to be responsible for every single order they put in.

 

What is the medical group doing with managing populations and not just encounters?

We’re doing a huge amount of population health. We’re doing a lot of analytics, looking at gaps in care where we can better provide care for diabetics who are falling outside the ranges of desired HbA1C and other testing. We’re trying to make sure all the screens are being done.

We have a great population health program that is doing some wonderful things. We are part of ACO, and as part of that ACO and the analytics that it provides, we’ve become one of the highest savings ACOs in the country.

 

How are people reaching out to the patients who might need an intervention or education? They aren’t necessarily used to getting a call from a medical practice.

A lot of patients want it. They want people to be involved in their care, but certainly there are ways of making sure that the patients have access to the things they’re missing.

For instance, we have a patient portal that provides a way for our patients to check the things that are due for them. At the same time, the diabetics who haven’t been in for a while or who need testing done tend to like it that we’re reaching out. It makes them feel like we care about them, and in fact, we do care about them. It gives them a way of closing the loop in some of the testing that they need. Most patients are reacting very positively to it.

 

What opportunities and challenges do you see with being paid for value instead of volume?

Part of the problem is that what patients often want are more tests and more medications. The conflict that I see is that the advertising that’s out there, what’s on the Internet, seems to get patients to want to have all those tests done. It’s more testosterone testing, thyroid testing, checking this and checking that.

If anything, if you look at all of those news articles about the tests you should have, a lot of it is creating almost like a culture of fear. You have to get certain tests done in order to make sure you are healthy. Those are the kind of things that are coming out of the general advertising. Yet at the same time, all of the data shows we should be doing less testing.

For instance, there’s no reason to check for kidney problems in an otherwise healthy person without high blood pressure. There’s no reason to check for urine or chest X-rays or EKGs unless you have a reason for doing it. But the common practice often is that those things are checked and the patients demand them and want them.

It’s the same kind of thing with antibiotics. When patients come in for a URI, they want and they expect antibiotics because that’s what they think the medical practice should be giving them. They’ve taken time off from work or school and they feel like they need something to justify them being there. I’ve had friends who have said to me that if they don’t give them something, the patient has threatened to go see other doctors.

Certainly there are patient satisfaction scores that are part of this whole issue, the need to satisfy the patient and give them what they want. We have to divorce that. We have to start thinking about what we should be doing. What is good evidence and what do the patients really need. That’s going to be the big conflict that we are going to have in the next five to 10 years to try and rein in some of the healthcare costs.

 

Do you have any final thoughts?

EHRs are just one great tool to help us. If anything, it makes it easier to provide care in the EHR. I’ve been on EHR since I finished my residency almost 15 years ago and I would never go back to a paper system. There’s just absolutely no way. For me, it’s the way things should get done.

What I look forward to being able to do is to optimize EHRs to create a healthcare system that helps you to provide the best care possible. If we do it the right way, we can rein in costs. We can provide better care. We can take care of those gaps. It will work its way through, but the EHR has to be the backbone. It has to be the new tool for us.

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February 2, 2015 Interviews 3 Comments

Cerner Closes Siemens Acquisition

February 2, 2015 News 4 Comments

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Cerner announced this morning that it has completed its $1.3 billion acquisition of Siemens Health Services as announced in August.

Cerner Chairman and CEO Neal Patterson said in a statement, “"By combining client bases, investments in R&D, and associates, we are in a great position to lead clients through one of the most dynamic eras in healthcare. Cerner remains focused on key development areas including population health, physician experience, open platforms, revenue cycle, and mobility. We see these as critical areas of investment to ensure providers can meet growing regulatory demands and control costs, while continuing to improve quality of care."

Cerner says its 2015 revenue will be around $5 billion, its employee count has increased to 21,000, and its annualized research and development expense will be $650 million.

Cerner reiterated in the announcement that it will continue to support Siemens core systems for an unspecified period, with Soarian maintenance guaranteed for 10 years. Former SHS CEO John Glaser has joined Cerner as SVP and a member of the company’s executive cabinet.

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February 2, 2015 News 4 Comments

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