GQ profiles Corey Lewandowski, a one time Trump campaign adviser that launched his own lobby firm after the election, offering access to Trump and influence across government agencies. Health IT vendor Flow Health hired the lobby firm to reverse a decision by the VA to cancel its contract, which it illegally agreed to pay $250,000 for if the decision was reversed.
Missouri’s effort to pass prescription drug monitoring program legislation died Friday afternoon after the Senate added a provision mandating use by providers, a clause the Missouri State Medical Association opposed. The bill then lost support and failed to pass by 6pm Friday, when the 2017 legislative session ended.
The National Data Guardian at the UK’s Department of Health states in a leaked memo that Google DeepMind’s use of real NHS medical records to test an app designed to diagnose kidney disease was legally "inappropriate.”
A bipartisan group of Senators introduce the Fair Drug Pricing Act, a bill that would require that pharmaceutical companies submit a report to HHS before increasing the price of a drug by 10 percent in one year, or by 25 percent over three years.
GQ publishes an article critical of fired Donald Trump campaign manager Corey Lewandowski, who tried to parlay his connections to the President after his June 2016 dismissal into a lucrative lobbying business that includes a health IT connection.
Among the clients Lewandoski recruited was Flow Health (the former GroupMD), which hired Lewandowski’s firm in December 2016 to pressure the VA to reconsider its termination of Flow Health’s contract for AI-powered patient care systems.
GQ reports that Lewandowski’s partner (who managed Ben Carson’s presidential campaign) told Flow Health CEO Alex Meshkin that the lobbying firm could reverse the VA’s decision because he and Lewandowski were personally vetting Trump’s picks for VA secretary. He also promised that the firm would allow Flow Health’s CEO to submit a list of his preferred choices for role of VA CIO, overseer of the Flow Health decision.
The article says that Flow Health proposed an apparently illegal payment schedule of a flat payment of $250,000 if the VA reversed its decision by February 17 and $100,000 if it took an extra week, later amended to reword the payments as severance fees. None of that mattered, as it turned out, because Trump chose as VA secretary David Shulkin, who had co-written the letter that dismissed Flow Health in the first place.
GQ says Lewandowski then proposed that Flow Health do an end-run around the VA by either appealing to Trump directly or by using Lewandowski’s appearance on the Sean Hannity talk show to trash Shulkin in hopes of getting him fired.
Lewandowski quit the firm – for which he was serving as an unregistered lobbyist — two weeks ago after widespread questions about his efforts to sell access to the President, which he calls “fake news” and for which he blames his former partner. Flow Health’s VA contract remains terminated.
Googling “Alex Meshkin” turns up a fascinating Bloomberg story from 2005 about the then-24-year-old’s questionable background as he formed a Nascar racing team that quickly failed.
From Athenahealth Spokesperson: “Re: Diego’s questions about Athenahealth’s inpatient customer MU attestations. All 35 hospitals referenced are using Athenahealth’s complete inpatient solution, including EHR, revenue cycle and financial management, care coordination, and patient engagement services. This past year, Athenahealth submitted Meaningful Use attestations on behalf of all of our hospital clients live on AthenaClinicals for Hospitals & Health Systems as of the end of 2016.”
From Cerner Observer: “Re: Mon Health, Morgantown, WV. Hearing that its Cerner go-live has been pushed back to 2019 and they’re exploring other options.” Unverified. I couldn’t find a contact there to ask for verification. I was, however, a bit annoyed to observe that the locals are so challenged to pronounce the name of the county in which they live (Monongalia) that the health system that lives in the shadow of Epic-using WVU Medicine felt the need to officially dumb down its name to “Mon Health,” giving me visions of those rainbow-colored (and uncomfortably stereotypical) Rastafarian dreadlock hats you see for sale on vacation in the Caribbean that say “Hey, Mon, we be jammin!”
From Second Responder: “Re: anniversary date. Isn’t HIStalk’s anniversary coming up soon? I remember it’s late spring.” I started writing HIStalk in June 2003, although I don’t recall the exact date.
From Judith R. Lin-Miranda: “Re: video. It’s now a common practice for new Epic customers to introduce themselves. Mary Washington Health Care just set the standard by which all others will be judged.”The elaborate video is indeed well done, including taking some digs at Siemens/Cerner Soarian that was “cobbled together” as they were “working with a third of what Soarian promised.” The video even lobs some shots at Epic’s high cost. President and CEO Mike McDermott, MD, MBA did an amazing job in the lead role. It’s better than anything ZDoggMD has done. I would give it my “Best Picture” award if I had one.
From Gory Details: “Re: press release. Here’s ours, which you probably won’t mention since we aren’t an HIStalk sponsor.” Not true. I mention every press release that I think is newsworthy to my C-level audience, which typically includes all sales and go-lives that: (a) involve a vendor, client, and event that are all significant; (b) would interest readers who don’t follow the company; and (c) contain a link to a timely press release that is well enough written that I can quickly figure out what it’s trying to say. Otherwise, readers outside the company usually aren’t interested in fluff pieces about partnerships, self-proclaimed market momentum, and minor personnel and funding events and I’ll nearly always skip those. I’ve learned over the years that every company executive thinks all of their announcements are anxiously awaited, which is nearly always not the case. Do something newsworthy and you’ll see it on this page.
HIStalk Announcements and Requests
HIStalk readers funded the DonorsChoose grant request of Ms. W, who asked for tablets and headphones for her California kindergarten class to extend their environmental studies. She reports, “The Fire tablets have been such a great learning resource for my students. They love using them to watch ‘Meet the Environmental Defenders.’ They love singing along to the song. You can hear them chanting quietly, ‘Reduce, reuse, recycle!’ They do this over and over again. Next thing you know, that tune is stuck in my head all day long!”
I’ve noticed a recent sneaky practice of call centers (both inbound and outbound) that place you on hold, but play pre-recorded keyboard clicking sounds so you think a human is on the line.
A reader offers a third punk band whose singer has a PhD (in addition to those I named, Bad Religion and The Offspring): The Descendents, which has been a major influence to untold bands that aren’t even punk for its 40 years of existence. Milo Aukerman left the band to complete his PhD in biology at UCSD and conducted post-doctoral research in biochemistry at UW-Madison. His nerdy caricature is the band’s mascot, rolled out in 1982 for the album “Milo Goes to College” that noted his temporary departure. Beyond all that academic talk, there’s a new hard-rocking album from Seether that’s worth a listen.
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
I asked John Gomez to put together a WannaCry malware webinar with only hours of lead time because his presentations are always outstanding and informative. This one he did Tuesday afternoon is no exception. I was attentive for the whole thing, which isn’t usual for me since I have a short attention span. Thanks to John for agreeing to help get information out quickly.
Acquisitions, Funding, Business, and Stock
Wisconsin startup IDAvatars, which develops healthcare avatars powered by IBM Watson, opens a funding round in hopes of raising $2 million.
Premise Health will implement Epic in its 500 work site health and wellness centers. It apparently replaces Greenway Health.
University of Miami Health System (FL) chooses Kyruus Provider Match and KyruusOne to connect patients with providers based on their clinical needs and preferences.
The Commonwealth of Virginia and Bayview Physicians Group will integrate Appriss Health’s prescription drug monitoring program analytics software into provider EHR workflow.
Mark Costanza (Nordic) joins Spok as SVP of professional services.
Announcements and Implementations
Memorial Hermann Memorial City Medical Center (TX) goes live with a digital wayfinding app powered by Connexient’s MediNav.
National Decision Support Company adds appropriate use criteria for pediatric imaging to its ACR Select product.
CPSI’s TruBridge subsidiary announces its business intelligence dashboard at the company’s user conference.
Government and Politics
Social media outcry pressures Miss USA to walk back her comments from the Q&A portion of the competition in which she stated that healthcare is a privilege rather than a right, unconvincingly explaining that what she really meant is that she is “privileged” to have healthcare, but regardless, it’s a “right” for all.
Missouri’s lost its chance to stop being the only state that doesn’t have a doctor-shopper prescription database as legislation to authorize it failed Friday after the Senate added a mandatory prescriber participation clause, which was opposed by the state medical association.
Privacy and Security
HHS says in a ransomware update call that several medical devices have been infected with the WannaCry virus, but otherwise the US healthcare system seems mostly unaffected for now. Several hospitals around the world reported that they were attacked. Northwell Health (NY) initiated its incident command system Friday morning and patched 200 computers that were behind on Microsoft security updates.
In England, a leaked February letter from National Data Guardian Dame Fiona Caldicott to Royal Free Hospital’s medical director says the hospital should not have turned over the detailed records of 1.6 million patients to Google DeepMind for testing of its Streams application, saying it was not appropriate to send Google the information without patient permission since it was not related to their care.
Rutland Regional Medical Center (VT) becomes the latest in a long string of hospitals that have exposed patient information by sending a bulk email to patients using CC: instead of BCC:.
Marcus Hutchins — the 22-year-old security researcher who interrupted his vacation to stop the global spread of the WannaCry virus by discovering and activating its kill switch before it hit US hospitals – is awarded a $10,000 hacker’s bounty that he will donate to charities. He works from a spare bedroom in his house in England for US-based Kryptos Logic.
Wired runs a lengthy piece describing the last creation of Steve Jobs, Apple’s $5 billion, 2.8 million square foot mother ship campus.
A graphic, moving blog post by ED physician Kristen Ott, MD explains that medical professionals use profane language outside of public spaces because they have to deal with the aftereffects of unspeakable atrocities that can’t really be described politely.
This should ring the cash registers of pharma lobbyists: three members of Congress introduce the Fair Drug Pricing Act, which would require drug companies to provide detailed cost and price records to HHS before increasing an expensive drug’s price more than 10 percent in one year or 25 percent over three years.
Australia-based surgeon Eric Levi, MBBS muses on the suicide of a Brisbane gastroenterologist, which triggered him to think about what factors lead him to his own “dark seasons” as a doctor:
Loss of control with extensive hospital call time and new physician-directed policies written by people who don’t see patients.
The impersonality of computer-assigned work, pressure to beat the timer that says tonsillectomies should take no more than 14 minutes of surgeon time, overbooked clinics, and never-ending telephone calls, all of which leave no time to reflect about life with colleagues or to spend time with friends and family. Doctors who ask for emotional support can be placed on restriction or labeled as underperforming.
Relentless administrative pressure that takes away meaningful patient engagement as medical practice transforms from a “meaningful pursuit” to a “tiresome industry” that has been “codified, sterilized, protocolized, industrialized, and regimented.”
Point-of-Care Partners publishes a white paper titled “EPrescribing Information to Improve Medication Adherence.”
Arcadia Healthcare Solutions will speak at the HFMA Region 1 annual conference May 23 in Uncasville, CT.
CapsuleTech will exhibit at the National Teaching Institute & Critical Care Exposition May 21-25 in Houston.
Besler Consulting will exhibit at the HFMA Region 1 annual conference May 23 in Uncasville, CT.
CoverMyMeds will exhibit at the QS/1 Customer Conference May 17-19 in Atlanta.
Besler Consulting releases a new podcast, “Evaluating post-discharge cost and quality.”
CTG announces expanded portfolio management and help desk services in its Application Advantage program.
Cumberland Consulting Group will sponsor the ASO Opportunities Value Visit May 17-19 in Chicago.
Impact Advisors VP Lydon Neumann is named one of Consulting Magazine’s Top 25 Consultants of 2017.
The local business paper profiles Diameter Health and its ties to Connecticut Innovations.
White House officials refute claims that the NSA deserves any blame for the WannaCry cyberattack after Microsoft President and chief legal officer Brad Smith publish a blog post publically criticizing the agency for losing control of a stockpile of unknown security vulnerabilities, saying “An equivalent scenario with conventional weapons would be the US military having some of its Tomahawk missiles stolen.”
FDA administrator Scott Gottlieb, MD issues a memo to his staff addressing his view of the agency’s role under his leadership. He discusses the importance of continuing to drive down US smoking rates, the emergency of gene therapies, the need to reduce drug prices, and the implementation of the 21st Century Cures Act.
As a small Ebola outbreak takes hold in the Democratic Republic of Congo, Merck confirms that it has stockpiled 300,000 doses of an experimental Ebola vaccine designed by scientists at Canada’s National Microbiology Laboratory that has shown “high efficacy in clinical trials and could play a vital role in protecting the most vulnerable”
John will provide an in-depth analysis of the current state of WannaCry as well as a technical review of how it operates and possible go-forward cybersecurity impacts. John will also present technical and regulatory counter-measures you should consider, specific to healthcare organizations.
I had a rare opportunity this month to do something I haven’t done in a very long time: support a go-live. A friend who owns another consulting company reached out to me to see if I could help her out with the launch of a new EHR client when one of her consultants had to back out due to a family emergency. I had a bit of a lull in my schedule, so I was happy to oblige, especially since it happened to be one of my favorite cities. The idea of grits made by people who actually know what they are doing was enough to seal the deal.
I’ve supported the EHR in question before, but not for a couple of versions. She sent over her training documentation as well as the training records for the users at the location where I’d be covering. The end users had been through quite a bit of training along with role play and simulated patients with real-time coaching for eye contact. They also were planning a soft go-live the week prior, where end users (including providers) would be entering their visits after they left the exam room.
The plan was that by the time the actual go-live occurred on Monday, everyone would have documented at least 30 patient visits and would be ready to go. Each user had to not only attest to the fact that they did the visits, but my friend had consultants going through the charts to ensure that it was done correctly and to remediate anyone who appeared to be struggling.
I arrived Monday morning to a very calm office where everyone seemed comfortable with what was about to happen. Patient visit schedules had been adjusted, giving a 15-minute break after every three patients to allow the staff to catch up. Charts had been abstracted for upcoming visits based on a rolling schedule, and for same-day and next-day appointments, they were being loaded in real time.
Of course, the providers had spent some time cleaning up the charts for patients seen in the last six months so that abstraction could be simple data entry rather than a complex game of “hunt the data.” The practice also spent the last year adjusting their scheduling processes and panel sizes to ensure they were not trying to operate way above capacity. Some physician panels were closed and others shifted to move patient volume to where there was capacity.
The practice had been live on the practice management side of the application for a few months and also had been scanning all inbound and internally created paper (including visit notes) as well as receiving lab results via interface since the first of the year. There was very little reason to need a paper chart at the time of go live, although the practice planned to pull the chart for three patient encounters (whether in person or by phone) before archiving.
After the first couple of patient visits, I began to wonder why I was there. Although some might think the pre-live activities were grossly over-engineered, they did exactly what they were designed to do, which was to make the go-live successful.
At the end of the day, the providers were asked how they felt about their schedule and the amount of blocked time and they felt they could open some additional patient visit slots for Tuesday. Tuesday also went off without a hitch, with nearly all providers opting to continue to reduce the number of blocks on their schedule for documentation time. By Thursday afternoon, everyone was running a full schedule and seeing patients reasonably on time.
Overall, providers lost very little volume during go-live week because they were extremely well prepared. The workflow I saw in the exam rooms was good, with providers being able to interact with both the computer and the patient through reconfigured exam rooms or other adaptations. It was about as textbook of a go-live as you could ask for.
I was able to spend some time debriefing with my friend on Thursday night before heading home on Friday. My big question was how much time was spent up front to ensure the smooth go-live, especially considering the amount of training, role play, patient simulations, chart clean-up, etc. She had been tracking it pretty thoroughly and the average time commitment per provider was around 60-70 hours. That included 14 hours of system training, time needed for soft-live chart notes, time spent resolving data issues during chart clean up, additional role playing/coaching, and other activities. The only thing she didn’t have an accounting for was time spent in regular staff meetings where the EHR project was discussed.
Depending on how you think about it, 60-70 hours may or may not seem like a lot of time. When you talk about losing nearly two weeks of potential patient-facing hours, it seems like a lot. But when you hear about practices that “never got back to full productivity” despite years on an EHR, it seems like a small investment.
I think the more unquantifiable factor here was the smoothness of the go-live. There were very few chaotic times and no moments of terror at my site, and by report, none at other locations, either. Things were extremely smooth and you can’t put a price on the value of that when you’re talking about the mental health of your providers and frontline staff.
My consulting buddy, who prides herself on her “white glove” service, has follow-up assessments scheduled weekly by phone for the first month and then onsite at the 30-day, 60-day, and 90-day marks. If the practice starts to struggle, she’s going to know about it.
I look at some of the EHR vendors out there offering go-live within a week or two and I wonder how well that really goes in practice. I imagine that if the practice was fully optimized and the paper charts were all in good shape, it might be possible. But for practices that are going live on EHR this late in the game, I would think that’s less common since many net new purchases are from practices that are only being dragged into technology adoption through penalties.
I’d be interested to hear from readers in the implementation space. What do your experiences look like at this stage of the game? Can you really get practices live in a couple of weeks and have the adoption stick? What happens when you leave?
The WannaCry ransomware attack that quickly spread to computers across the globe, including 48 NHS hospitals, is halted after a cybersecurity researcher, noticing that the malicious code routinely pinged an unclaimed domain, registered the domain in his own name, inadvertently halting the spread of the attack.
MedSolutions CareCore agrees to a $54 million settlement with OCR, putting an end to the fraud lawsuit brought against the company after it authorized thousands Medicare and Medicaid payments for procedures without validating their medically necessary.
In Canada, Island Health announces that it will no longer support alternative workflows for the nine internal medicine doctors that have refused to use the recently implemented, $174 million Cerner EHR, citing patient safety concerns over its CPOE system.
One year after going live on Epic, three physician leaders from Massachusetts General Hospital pen an opinion piece in a local paper arguing that the administrative burden caused by poorly designed EHRs software is compromising the diagnostic abilities of providers and driving good physicians into early retirement.
An unprecedented ransomware attack affects 48 of England’s 248 trusts in waves of infections that spread globally on Friday. All but six trusts say they have returned to normal operations after they were forced to divert ambulances, cancel appointments, revert to paper, and order employees to unplug network cables from PCs and telephones.
The WannaCry ransomware, which demands a $300 ransom per infected Windows machine, initially affected computers primarily in Russia, Ukraine, and Taiwan. It uses the EternalBlue exploit that was made publicly available by hackers in mid-April. At least one hospital in Canada said it was threatened by WannaCry, but its antivirus software blocked it. Two hospitals in Indonesia were also hit as well as one in Taiwan and another in Scotland.
Microsoft issued a Windows patch to protect against the exploit in March, but many machines worldwide have not been updated. NHS is still running many Windows XP PCs, for which Microsoft’s extended support and security updates ended in 2014. Microsoft has responded to the attacks by providing an unprecedented public security update for Windows XP, Windows 8, and Windows Server 2003 to address WannaCry. Both Kaspersky and Bitdefender antivirus programs already protected against it.
The Russia-based hacker group that claims responsibility for the attack says it used cyber tools that were stolen from the US National Security Agency.
A 22-year-old security researcher apparently stopped the worldwide spread of WannaCry when his tests revealed that the malware was accessing an unregistered Internet domain, which he then registered to perform further testing. In doing so, he found that the ransomware stopped activating itself around the globe. The researcher theorizes that the hackers used the domain as a “kill switch” to prevent experts from analyzing in a sandbox environment. However, he cautions that the hackers could simply change the domain name the program checks, making it imperative that Windows PCs be brought up to date on patches.
A PC can be infected via a hyperlink spread by a phishing email, a web link or advertisement, or a document link.
John Gomez of Sensato offers these tips for health systems:
Apply the SMB patch (MS17-010) to all Microsoft systems.
Close ports 22, 23, 3389, TCP 139 and 145/UDP 137 and 138.
Test backups and store them offline.
Warn users not to open attachments.
Restrict access to file-sharing sites.
Review ransomware response protocols.
HIStalk Announcements and Requests
Eighty percent of poll respondents are not happy that the House passed the American Health Care Act. Frustrated says people should actually read the bill instead of parroting the opinions of others, adding that no healthcare system can survive if only sick people sign up and both the ACA and AHCA address that. Just a Nurse Analyst wonders about the backroom deals that were struck to pass it and questions the zeal to undo anything President Obama did regardless of the impact on Americans. Cosmos says every step of the process lacked moral discipline and integrity – the headlong rush and repeated attempts to repeat the ACA, the backroom negotiations, voting without CBO analysis, and a two-vote majority that suggests compromises undeserving of the resulting White House victory party. Malvern says that our healthcare cost of $10,000 per person each year can’t be solved by attacking coverage and premiums alone. Disgusted says it’s the most cynical, heartless pieces of legislation ever, especially the Medicaid cuts and the requirement of continuous coverage to have pre-existing conditions accepted. Printgeek thinks it’s a shame that the two political parties can’t even initiate a dialogue about healthcare. Bill says at least AHCA eliminates the word “affordable” as Congress finances access by increasing the federal deficit. HITgeek says healthcare requires a community health insurance risk pool to spread the cost of involuntary events, adding, “I am sick and tired of compassionless insurance, abetted by politics, being the gatekeeper for US healthcare.”
New poll to your right or here: What’s the most important factor in reducing US healthcare costs? The presence of the word “most” means I’m not oblivious to the desirability of an easy-out “all of the above” response, although I provided an “other” box in case my mental checklist of options is incomplete.
We funded the DonorsChoose grant request of Ms. L in Michigan, who asked for Chromebooks, headphones, and academic software subscriptions for her fourth grade class. She reports, “I am a fourth grade teacher on paper, but in reality, I teach students anywhere from a first grade to a fourth grade level. This poses a very real challenge that both my students and I deal with head-on. Technology is one way to successfully mitigate this particular hardship and thanks to you, our class was able to get the technology we need to be successful! Students have grown tremendously through these online platforms; we track and celebrate their progress weekly! It also makes students feel that they are valued. They have something BRAND NEW, that people whom they will never meet gave to them. That sense of value and feeling appreciated is HUGE and cannot be overstated. Thank you, thank you, thank you for making our class feel important!”
This Week in Health IT History
One year ago:
Theranos says 2014-2015 lab test results from samples it ran using its proprietary Edison analyzer should not be trusted.
The VA releases a software development kit for its open source Enterprise Health Management Platform.
Competing Missouri HIEs argue over connectivity, member charges, and unnamed special interests.
Five years ago:
Partners HealthCare announces plans to implement Epic at a cost of $600 million.
Greenway Medical Technologies is the largest percentage gainer on the New York Stock Exchange, with shares up 20 percent since the company’s February IPO.
NextGen parent Quality Systems acquires EDIS vendor The Poseidon Group.
3M makes its Healthcare Data Dictionary available worldwide at no cost.
California’s HHS moves oversight of the Cal eConnect HIE to the Institute for Population Health Improvement.
Allscripts appoints Paul Black to its board.
A report finds that one-third of prescriptions are being sent electronically.
Fairview Health Services admits that it was getting extensive negative feedback from its employees about the strong-arm collection tactics of Accretive Health.
Weekly Anonymous Reader Question
I’m delighted that my anonymous reader question surveys are getting so many responses that they don’t fit nicely into the Monday Morning Update. I’ve posted the two most recent sets of results at these links:
This week’s survey: What is the most customer-unfriendly term or condition you’ve seen in a healthcare software contract that the customer approved? This would be a good opportunity to warn others about items they shouldn’t accept.
Meanwhile, if you have ideas for future surveys, let me know – it’s an easy way to learn what your peers are seeing or thinking.
Last Week’s Most Interesting News
ONC appoints Genevieve Morris, MA (Audacious Inquiry) to Principal Deputy National Coordinator for Health Information Technology.
Memorial Hermann Health System (TX) pays $2.4 million to settle HIPAA charges after naming an arrested patient in a press release.
Specialty EHR vendor Modernizing Medicine raises $231 million in funding.
A contractor’s error exposes patient records of Bronx-Lebanon Hospital Center (NY) to the Internet due to a misconfigured backup.
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Google parent Alphabet invests $130 million in San Francisco insurance startup Clover Health, raising its total to $425 million and valuing the company at more than $1 billion. Clover manages claims for just 25,000 Medicare Advantage customers in New Jersey and competes against much larger insurers, but says its forte is mining patient data to identify potential problems that can be addressed via a Clover-managed home visit or other intervention.
Memorial Hospital of Lafayette County (WI) will switch from Medhost to Epic in November 2017.
Kaweah Delta Health Care District (CA) will replace Cerner/Siemens Soarian with Cerner Millenium in November 2017.
Haxtun Hospital District (CO) switched from NextGen Healthcare to Athenahealth in April 2017.
Platte Valley Medical Center (CO) will go live with Infor human resources in May 2017.
These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.
Allscripts promotes Dennis Olis to interim CFO following the resignation of Melinda Whittington, who is leaving the company for unstated reasons after just over a year on the job .
Government and Politics
MedSolutions CareCore – now part of specialty benefits manager EviCore — will pay $54 million to settle an HHS fraud lawsuit in which the company authorized Medicare and Medicaid payments for procedures it had not validated as medically necessary. The company admits that its executives monitored a dashboard of medical review cases, and when the list got too long, ordered clinical reviewers to approve requests for prior authorization even though nothing had changed, which the Department of Justice says resulted in improper payment in up to 300,000 cases. EviCore was rumored earlier this month to be reviewing a sale of the company or an IPO, with its $300 million in 12-month EBITDA valuing it at up to $4 billion.
A former podiatrist pleads guilty to defrauding Medicare of $6 million by implementing an EHR in his 16-state long-term care practice to generate false patient documentation that would earn payments, such as falsely describing toenail conditions as “painful to such a degree as to affect ambulation and balance.”
Privacy and Security
The local paper reports that Erie County Medical Center (NY) is still trying to recover its systems more than a month after an apparent ransomware attack.
The New York Times questions advertising drugs directly to consumers – legal in only two countries, the US and New Zealand — in noting TV commercials for a drug for an uncommon neurological condition for which it can stop uncontrolled crying or laughing. It notes that the commercial will likely pique the interest of overly emotional people well outside the drug’s target market who will pester their doctors to prescribe them the $700 per month drug.
Interesting: Dexter Holland – singer/songwriter of punk rock band The Offspring for more than 30 years – earns his PhD in molecular biology from USC with his dissertation titled “Discovery of Mature MicroRNA Sequences within the Protein-Coding Regions of Global HIV-1 Genomes: Predictions of Novel Mechanisms for Viral Infection and Pathogenicity.” As a clearly Renaissance man, he also has his own brand of hot sauce, is the former owner of a record label, and is a certified flight instructor who made a solo trip around the world in 10 days. Dr. Holland isn’t the first punk rocker to earn a PhD – Bad Religion founder Greg Graffin earned a Cornell doctorate in zoology and has taught and written on academic topics.
In Canada, Island Health tells nine internists who are refusing to use its Cerner-powered EHR because of patient safety concerns that they will no longer provide other doctors to enter their paper orders electronically. The CEO of Island Health says it’s OK that ED and ICU doctors haven’t used the systems – citing similar concerns – because they never fully transitioned to the EHR, but it’s too late for the internists to go back to paper. One of the protesting doctors, who is also president of the hospital’s medical staff, says the decree puts him in a difficult position because “it has the effect of barring me from practicing … without actually suspending me.”
Weird News Andy says that even though Sir Winston does not approve, he suggests ICD S01.22XS. In England, cocaine users are “getting Winstoned” when they use new, stiffer five-pound bank notes bearing the image of Winston Churchill to snort their drug of choice, leaving them with nose cuts.
Gartner names Salesforce a leader for the ninth consecutive year in its Magic Quadrant for the CRM Customer Engagement Center.
The SSI Group will exhibit at the HFMA Spring Joint Conference May 17 in St. Louis.
TierPoint will host a grand opening for its Dallas-Allen data center on May 18 in Allen, TX.
The Chartis Group publishes a white paper titled “The Impact of the American Health Care Act on Children’s Hospitals: Preparing for the Road Ahead.”
TransUnion publishes a new white paper, “Uncompensated Care is on the Rise.”
Conduent reports first quarter 2017 financial results.
ZirMed publishes a new infographic, “ZirMed Denials by the Numbers.”
At a CIO’s request, I asked former and current CHIME members who have either quit or thought it to explain why.
I was once a CIO member years ago. Great networking and exchange of ideas. I became vendor, and after several years, pulled out. It became a pay-to-play with diminishing value. Let me tell you, even the sponsor companies don’t like it much.
It’s become a mini-me of HIMSS.
Vendors are running the show and there is no sense of working to better the industry.
CHIMe used to be an exclusive group of of IT executives and limited number of foundation members (vendors and consultants). Now it’s a mini-HIMSS dominated by vendors, with limited value for all participants. I’m not sure what CHIME’s mission is any more.
Way more time spent with the Foundation members than with fellow CIOs.
It has become so vendor-heavy and the membership drive now allows most anyone to join.
As a CHIME Foundation member for 12 years, I am disgusted with the direction both CHIME and HIMSS are going. It has become a”Russ Branzell “let’s look as much like HIMSS as we can” show. Quantity is more important than being a true CIO venue, having invited people as far down as the director level. I talk to a lot of CIOs who are no longer attending CHIME because of their new focus on money rather than collaboration. As a vendor, I no longer get the same value and am paying a lot more money for decreased value. I still feel I have to belong, just like HIMSS, because absence in noted more than presence.
Just like HIMSS, all about collecting vendor money and less about colleagues teaching and learning from each other. It is overwhelming being a CIO and have to deal with eight vendor staff to each one of us.
As long as CHIME works to keep the vendor contacts at the highest executive levels (Carl, Judy, etc.) it is fine. Complete openness and transparency is needed to give confidence that it exists to serve its members and not enrich its leaders though lucrative associations and spin-off ventures.
I’ve been involved in HIMSS and CHIME for many years, but have limited participation due to the vendor involvement. This has changed the focus for both organizations from members to vendors.
The move away from being a CIO-focused organization to having a variety of members, especially vendor firms.
It has taken on the same mentality as HIMSS — expand the focus to more vendors and non-CIO types. I attended HIMSS for the education sessions and the focus moved away from them. I attended CHIME for networking and CIO sessions to learn what others were doing. Sorry to say this has grown so much it does not work any more. It does not matter to me anyway because I have retired. There is a group of CIOs that formed HISEA. I could not join because a competitor CIO was already a member and that rules out many. But the concept was centered on presentations of great new ideas for other CIOs.
They are selling access to us. It felt a bit more subtle in the past, but is not that way and feels far more commercial.
I don’t like the Fall Forum. Too many vendors, the focus groups are a waste. It is clearly a business, not a professional society. Too bad.
Seeing declining value from participation year to year.
I was booted from CHIME after being a long-time member because I became employed by a healthcare vendor instead of a healthcare provider. I understand the rules, but there are plenty of old timers who are still members even after they went to work on the vendor side because their company has the massive funds to become a CHIME foundation member. So two reasons why I wouldn’t rejoin CHIME even it they would let me: 1) CHIME negates your years of healthcare provider experience once you go to work for a vendor, and 2) they purposefully exclude many vendors from the foundation by charging a huge amount of money for that privilege. I think that CHIME has done great work in the past, but I hate to see it become so commercialized and HIMSS-like.
The leadership seems more committed to growing members and expanding rather than serving the needs of the current membership.
Not providing value.
Insufficient value from membership.
I am considering it. The Fall Forum was the highlight of the year for networking with fellow CIOs and the Foundation firms. The last event I went to, the experience had dramatically changed. Now vendors have booths and instead of one or two people from a Foundation firm, there are MANY. Likewise on the CIO side. There are associate members that may number greater than the number of actual CIOs in attendance. This has moved from a very effective, intimate industry leader gathering to a mini-HIMSS. And who needs that? CHIME is clearly focused on growing revenue, just like HIMSS. I hope HIMSS selects a new leader that can actually save HIMSS from itself and that CHIME leadership watches closely and learns.
I asked readers: what specific event crystallized your decision to leave your last job?
I was asked if I’d be willing to relocate after 3 years at one office. Said yes so my manager started the process. He never even told me what the HR package was, as it was so insulting. Knew then that it was time to leave the (slowly) sinking ship.
The PE firm that bought our company had little interest in the actual work we were doing. The CEO they put in place fell asleep in the first customer meeting I took him to and then after the meeting told me the customers in the meeting were idiots and he would rather get a needle stuck in his eye than attend another meeting like that.
Was notified by McKesson in fall 2016 my job would end March 31, 2017. Two months later was told I would need to train offshore resources how to utilize and quality test a large piece of clinical software. Given my training and years of front line experience in hospitals, my principles were on the line and no amount of severance was going to compensate me for principles. I turned in my two-week notice in early 2017 with several irons in the fire, but no offers. On my last day at McKesson, I got a call at noon offering me the job I was hoping for.
I took an early retirement package equaling a year’s pay, easing the way into lucrative consultancy for the next few years. However, the event that crystallized my decision was the concurrent layoff of valued colleagues who did not qualify for the package. It was the right choice.
To start a new company and see an idea turned into reality. Hopefully, hah.
Micromanaging leadership and leaders out for self-promotion over the company’s goals.
I was working 60-70 hours per week, seven days a week. My boss assigned me another project, and when I told him I couldn’t, he said something about digging deeper and that I could do just a little more. I already knew I was going to quit, but was trying to hold off one more month. That sealed me. They distributed my work among nine people.
I was a founding but minority partner in a consulting firm. After Having several disagreements with our managing partner about the future direction of the firm, I reached out to our board chair for advice. He made it clear that the managing partner was the majority owner and he would run the firm as he pleases. Great advice. I left and and subsequently founded a very successful and highly regarded consulting firm.
When the company that had acquired our niche software provider changed my network username from a name-based alpha to a nine-digit number.
Realizing they owed me nothing, and I was simply in the way.
Missing a concert of one of my favorite performers to finish up something “critical” at work then driving home from the office so late that the sun was rising.
Promoted the worst director to be the new CIO.
Realization that in five years with an HIT consulting firm, we never once talked about “the patient.” Our mission statement was embarrassing to read.
Promoting and doctor to be the head of all IT clinical applications, over 100 people, when this doctor had NO experience being in charge of any size of team before, as he told all of us when he announced his promotion. No experience leading any organization whatsoever, no business or HR training, nothing. Talk about promoting someone to his level of incompetence. How often does leadership in healthcare think that just because someone is a doctor they can do anything?
A VP valuing contracts over business ethics and being completely detached from the realities of the marketplace, both in terms of realistic revenue targets and competitive compensation for our top talent, combined with a failing new product that was doomed from the start. The final acceptance of the fact that none of this was ever going to change was the “event.”
I left my last job because it was acquired by another company that was based in the South and I didn’t want to move from the SF Bay Area. Turns out to be the best decision.
A wholesale reduction of the middle management positions in the organization, making communication with manager more difficult (had too many direct reports to effectively manage); pushing many of our previous manager’s duties down on my team with no acknowledgement, support, or consideration of any type; and finally, removing almost any chance for future career advancement in this organization.
The CEO was corrupt (the controller quit rather than approve the yearly numbers), misused federal funds (set policy to have healthcare navigators sign up patients for ACA who were illegal using made up SSNs), racist (but because he was pro-Hispanic, it was not considered racism), did not support his leaders, required the implementation of the EHR when the environment was not stable and had not been thoroughly tested, and put blame on anyone who did not agree with him. The only reason I stayed as long as I did was due to the poor economy. It was a horrible situation to be in. The CIO was the only bright spot and he left soon after I did.
I am in sales and in a previous job sold well over $XXM and as deployment of the promised technology continued to fail, we were at a point with these clients of moving into Phase 2 of the project which would have netted the company another $XXM+ and the clients stopped everything. Lawsuits quickly began to fly. It was at this point I realized my leadership at this company was simply lying. They had done the Wolf of Wall Street. Created imaginary software that was incapable of supporting the demonstration they had put together with bubble bum and duct tape. I lost over half a million in commissions on Phase 2 because they had also conned me into believing they could make it work.
It is a train wreck in healthcare and amazingly complex. The demo experience worked flawlessly on their perfect data, but drop that bad boy vision into the reality of healthcare data and KABOOM. “Mr/s. Customer, you have to give us perfect data or this won’t work. Sorry, no refunds.” Plus, their contracts were unreal with one of the customers saying they were longer and more complex than the ones they worked through with their EMR vendor.
Unbelievable. Investors should have gone after that executive team with guns blazing in a lawsuit. They even made sales pump up pipeline numbers by telling us if anyone even picks up the phone, it is a 20 percent opportunity. Then post-acquisition, if you deleted those inflated opportunities, the same executive team (CEO) would literally email you within five minutes demanding an explanation.
When the going got tough, the C-suite exec refused to take responsibility for any of the struggles being dealt with by the staff that reported to him. In fact, he was quite adept at not listening and throwing people under the bus. Finally got to the point where I got on the bus and rode off to another job.
My company was purchased and I did not believe in the management or strategy of the acquiring company.
I found termination for cause suasive.
Toxic medical director, toxic culture , being treated like three year olds .
My director seemed to be semi-sabotaging our market install. At core team meetings, she would ask leaders whether they were on schedule, and upon hearing they weren’t, she would only say OK before moving to the next person. We were months and about a million over. She knew I thought we should ask people what the hold-up was, if they needed help, more training, etc. We had a planned core team meeting with the market CFO to give a status and tell him whether we felt on track and could make our live date. My manager came in to my office right before the meeting and told me to keep my mouth shut at the meeting. I sent my resume out the next week.
When my boss left, and HIS boss left within a day of each other. This was just after a new CEO took over.
My division was sold. The buyer offered a voluntary severance package within two weeks of the sale being final.
My company was acquired by a competitor. That’s probably the most obvious sign that’s it’s time to move on.
Our company was acquired. Marketing and accounting are the first to go.
Continually getting new “managers” who kept asking me how they should do their job.
When I realize the culture and the legacy leadership was never going to change.
My boss, the CIO of a large, multi-state IDN, falling asleep in my annual performance review.
New CEO hired through board member good-old-boy network was threatened by my skills and influence over the organization. Good thing my employment contract had a decent severance clause. CEO actually offered to extend the severance for signing a draconian non-compete agreement that went far beyond original employment contract. I turned him down. CEO was fired by the board a few months later after running the company into the ground with extravagant spending on a flawed strategy.
I decided to leave my job when I was told the CFO wouldn’t support me to be named the director of the business unit I was already leading. She would have to sign off on the position even though it didn’t report up through her. We had brought in $5m of unbudgeted money into the organization. It was a political mess and I am so glad that I left for a similar director position.
ONC names Genevieve Morris, MA Principal Deputy National Coordinator for Health Information Technology. Morris has no clinical background, but worked on HIEs and Meaningful Use prior to taking on her new role.
Cerner is reportedly interested in working with Microsoft’s AI-powered Custom Vision Service, which allows applications to learn the names of items in images users upload. Joe Quint, an director over app development at Cerner, commented “That was very interesting. Being able to use this broadly across a hospital and being able to do image extraction of videos would be very cool.”
HHS appoints Genevieve Morris, MA as ONC’s principal deputy national coordinator. She was previously senior director of HIT policy with Audacious Inquiry.
Unlike her predecessor Vindell Washington, MD, Morris has no clinical education or experience (her master’s is in political science), having spent her nine-year career working on HIEs and Meaningful Use.
From Significant Other: “Re: Partners HealthCare. I worked at Partners for many years and attended a February conference featuring CEO David Torchiana, MD (who had an insightful presentation, btw.) I asked the last question, which was ‘Can you talk a bit about Partners 2.0?’ His answer was quite candid — since its formation 23 years ago, little has been done to consolidate within the now $10+ billion organization. He expects to see a $500 million reduction over the next few years as the network reinvents itself. The Brigham and Women’s Hospital early retirement offering has nothing to do with Epic and that cost.”
From Hospital Personality: “Re: Epic. Announced that they are developing a fetal monitoring solution so that customers don’t need to turn to a third party such as Perigen, GE, or Obix.” Unverified.
From Diego: “Re: hospital MU3 attestation for Athenahealth users. For the Athenahealth spokesperson, how many of the company’s stated 35 live hospitals are using the complete inpatient solution, including clinicals? How many have actually attested with the inpatient product? How many users have fully implemented the inpatient product, including clinicals, within a 12-month timeline with the past two years?”
Epic’s App Orchard
I received more reader comments about working with Epic’s App Orchard.
The experience with App Orchard thus far has been very disappointing. After paying the hefty fee for the Silver tier, we expected to receive all of the perks of the tier as discussed in the App Orchard documentation. Unfortunately, upon receiving access to the App Orchard program, it became readily apparent that much of what was promised was either not available or, in some cases, not yet built. Additionally, we were informed by App Orchard personnel that our "Sandbox" access would only be for a testing Sandbox and not an environment that we could use to demonstrate our solution to clients. The original documentation was highly misleading on this point.
The documentation also suggested that any press releases were to be submitted to the App Orchard team for review. After we went through a lot of effort constructing a press release with our PR firm and submitting it to App Orchard personnel for review, we were told that Epic would be providing developers with a standard press package.
All of this inconsistency is making us very uneasy. While we appreciate that we are one of the first few companies to join the App Orchard, and that we will be helping define the process for other companies in the future, we expected the process to be far more robust and established.
On the plus side, the App Orchard personnel have been very responsive and have provided as much help as they could given the under-developed state of the Orchard at the moment.
We applied to the Epic App Orchard right when it was opened to vendors. Our initial interaction with Epic required us needing some detailed information on the different levels that App Orchard offered. I was pleasantly surprised to see how quickly they replied and how helpful they were as we worked through this decision.
Our application was processed timely and we got the access that we needed to start working on the technical integration. We are currently working on the technical integration and will soon be planning the marketing efforts. So far, so good.
The team has been very responsive and the APIs are robust. We wish there were a bit more clarity on the pricing model for the live application (transactions vs. revenue share structures are a bit hard to follow). We also wish we had a clear sense of the timing / duration of the approval process for an application, as well as acceptance / rejection criteria.
HIStalk Announcements and Requests
Mrs. G’s DonorsChoose grant request was for STEM and engineering kits for her elementary school’s Robotic Rumblings program, noting that the city-wide STEM science fair includes few minorities and females. She reports, “The materials obtained through DonorsChoose are having quite an impact on my students. They are giving my students the opportunity to grow in the area of robotics. Their creative juices are definitely starting to soar. They are thinking and developing deeper thought processes on how to manipulate the materials. They are also learning how to better work together cooperatively. The students like working in small group settings. They appear to be quite focused when using the materials and do not want to leave when the session ends. We thank you from the bottom of our hearts. There are definitely some rumblings going on around here!!!!!!”
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
NantHealth reports Q1 results: revenue up 16 percent, adjusted EPS –$0.24 vs. –$0.18, missing expectations for both. NH shares continued their slide on the news, now down 83 percent since last year’s IPO.
Specialty EHR vendor Modernizing Medicine raises $231 million in a private equity investment, increasing its total to $322 million.
New York-Presbyterian promotes Peter M. Fleischut, MD to SVP/chief transformation officer.
Ivenix promotes Jesse Ambrosina to COO, George Gray to CTO/VP of R&D, Janice Clements-Skelton to VP of HR, Carolyn Malleck to VP of finance, and Ben Powers to VP of infusion systems.
Announcements and Implementations
PokitDok will build its healthcare transaction recording platform on the Linux Foundation’s open source Hyperledger Sawtooth blockchain project along with Intel Software Guard Extensions.
Vermont Information Technology Leaders and Medicity connect the Vermont HIE to the Veterans Health Information Exchange, allowing clinicians in the VA and the HIE members to view each other’s records for a veteran patient.
MModal announces enhancements to its computer-assisted physician documentation technology.
WellSpan Health brings its initial sites live on Epic.
Government and Politics
Officers in West Virginia’s state capitol arrest a veteran journalist who was attempting to ask HHS Secretary Tom Price if domestic violence would be considered a pre-existing condition under the House’s American Health Care Act. Dan Heyman was taken away in handcuffs and charged with “willful disruption of state government processes,” with the Secret Service agents who were protecting Price and White House Special Counsel Kellyanne Conway claiming they had warned Heyman that he was interfering with their work by shouting questions that Price was ignoring.
HIMSS reports that while Congress’s spending bill still won’t allow HHS to spend money to develop a national patient identifier, it encourages HHS and ONC to provide technical assistance to non-governmental organizations trying to address the patient identification issue.
President Trump threatens to withhold $7 billion per year in ACA cost-sharing reduction payments to insurance companies, which would likely drive more insurers out of the exchange market or raise premiums. The President said in an interview, “There is no Obamacare. It’s dead. Plus we’re subsidizing it and we don’t have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will, anytime I want.”
Privacy and Security
Memorial Hermann Health System (TX) pays $2.4 million to settle HIPAA charges following a 2015 incident in which it issued a press release that named an illegal immigrant who was arrested after using a phony Social Security card at one of its clinics. The hospital said it called police because of concerns about fraud, not immigration status. The woman’s husband was also in the country illegally, but had insurance through his employer.
Hackers breach two old data servers of a Memphis, TN family medicine practice using valid login credentials and demand a $10,000 ransom after encrypting its files, which the practice declined to pay since they switched EHRs 18 months ago and only those older records were involved.
Innovation and Research
Cerner says it’s interested in just-announced Microsoft technology that can identify, name, and index objects depicted in photos or video, saying it could be useful for alerting hospital nurses of patient actions that require their attention.
Healthcare Growth Partners analyzes the valuation differences for enterprise vs. healthcare software as a service companies, concluding,
If the set of health IT companies were able to grow more quickly, it is likely that their valuations would become more in line with general enterprise SaaS companies. The reason for health IT’s slow growth rate is no doubt a complex combination of factors including longer sales cycles, heavy regulation, and slow adoption rates. Potentially it may be due to the relative immaturity of the healthcare software market and a different mix of publicly traded comps in health IT as compared to the larger and more mature enterprise SaaS market.
Sonar studies at University of Mississippi Medical Center (MS) reveal that up to 7,000 human bodies are buried on the hospital’s grounds, believed to be those of patients who died in the state’s mental hospital from 1855 to 1935 when it was located on what is now hospital property. Construction work turned up 2,000 bodies three years ago. The medical center, faced with a $21 million estimate to relocate the remains, is proposing to exhume a few of them for research and then just build a memorial.
A scientific editor trolls one of the many predatory medical journals with lofty-sounding titles that will run articles from publication-desperate researchers in return for cash. He submits an article built entirely around “Seinfeld” episodes as researched at the prestigious Arthur Vandelay Urological Research Institute, listing himself as the primary investigator under the name Dr. Martin van Nostrand. The Urology & Nephrology Open Access Journal accepted the article about a made-up condition nearly verbatim, billing him for its $799 fee (a mistake on their part since he declined to pay).
Eric Topol interviews the fascinating Pardis Sabeti, MD, PhD: member of a family who emigrated from Iran just before its 1978 revolution, Rhodes scholar, physician, scientist (computational biology and medical genetics), host of an education TV series about statistics, and singer/songwriter for Thousand Days, a decent alt-rock band.
Advisory Board Chief Medical Officer Dennis Weaver, MD, MBA presented “Pragmatic Approaches to Succeed at Value-Based Payment and Care” at the World Health Care Congress Hospital and Health System Summit in Washington, DC last week.
EClinicalWorks will exhibit at the Ohio Association of Health Plans Annual Convention May 16-17 in Columbus.
GE Healthcare will supply over 200 Egyptian hospitals with 700 units of its advanced healthcare technologies.
Healthwise will exhibit at the Cerner Collaboration Forum May 16-18 in Kansas City, MO.
Huntzinger Management Group’s William Reed is named a Life Fellow Member of HIMSS.
Consulting Magazine names Impact Advisors VP Lydon Neumann one of the Top 25 Consultants of 2017.
Imprivata will exhibit at VA Healthcare 2017 2017 May 15-18 in Arlington, VA.
Entrepreneur Magazine features LogicWorks CEO Kenneth Ziegler.
Healthgrades recognizes Meditech hospitals for patient safety.
National Decision Support Company will exhibit at WEDI 2017 May 15-18 in Los Angeles.
The CMS Quality Payment Program website has been updated with an “Am I included in MIPS?” feature. Providers and organizations can search by NPI (sorry, no bulk search feature for groups yet) to determine if they are included. The site also doesn’t flag whether you’re participating in an ACO, but rather tells you to talk to the leaders managing your participation.
Forbes posts an article about the Internet making us lose trust in our doctors. I think many of us agree (at least anecdotally) that things have changed over the last decade, and exponentially so after the rise of the smart phone. The piece details a study looking at whether screenshot content can prime a pediatric patient’s parents to be biased towards a particular diagnosis. When the physician diagnosis didn’t match the Internet diagnosis, parents were less likely to trust the physician diagnosis and were more likely to say they would seek a second opinion. The researchers’ conclusions note that “conflicting online information could in some cases delay necessary medical treatment. Physicians must be aware of the influence the internet may have on parents and ensure adequate parental education to address any possible concerns.”
Physicians in the patient care trenches have known this for a while, that it can take a significant amount of counseling and discussion to counteract what “Dr. Google” or a number of other websites may have said. When it’s the occasional patient arguing with you about your clinical expertise, it can be managed, but when it feels like every patient is coming in the door with a preconceived notion about what is going on, it is a direct contributor to physician burnout. I don’t believe physicians are omniscient or that our opinions should be absolute, but sometimes you just wish your patients would trust your decades of experience and the many dollars and hours you’ve expended to arrive at your level of clinical judgment. Even a seemingly straightforward diagnosis like “contact dermatitis due to plants” can suck time out of your day when you have to engage around smart phone photos of poison oak, ivy, and sumac. Bottom line is, it doesn’t matter what plant got you, we’re going to treat you the same way regardless of botanical factors and you need to avoid coming into contact again with whatever it was.
Sometimes it’s hard for people to understand what it’s like to be a physician and the pressures we’re under outside of dealing with payers, metrics, regulations, etc. I’m talking about the actual clinical pressure to be 100 percent accurate. If you’re a good physician, it weighs on you and it’s hard to keep in balance. I recently had a situation where a patient perceived a poor outcome based on my diagnosis. She had come to the urgent care on a Saturday with back pain, which had some distinct muscular features and no acute findings on an x-ray, and was diagnosed accordingly. Our practice always has a second reader for films, and my colleague agreed with my reading. The patient was instructed to follow up with an orthopedic specialist on Monday (two days from the visit) if she was not improving. She followed up, and the orthopedist sent her for advanced imaging and diagnosed a vertebral compression fracture, then performed an expensive procedure. She came back to us demanding compensation for our missed diagnosis.
Our standard practice in this case is to convene a peer review and to also have the films re-read by a radiologist, who also failed to appreciate the compression fracture. Peer review found my treatment to be appropriate given the history and exam and the setting (urgent care). The patient was given appropriate follow-up instructions and her pain was managed adequately. Of course, we don’t have access to the advanced imaging results showing the fracture, so it’s hard to tell whether the specialist is taking advantage of a marginal finding or whether something was really there. The patient’s treatment wasn’t even delayed by my supposed misdiagnosis since she would not have been able to have advanced imaging until Monday anyway due to her insurance and its requirements. Getting a pre-certification for a non-emergent ambulatory procedure on a Saturday just doesn’t happen in our world. Assuming you agree there was a fracture, she received definitive care in a timely fashion that was more impacted by the fact that she came to care on a weekend than it was by a potential misdiagnosis.
One also has to consider the role of the urgent care, which is to rule-out any life-threatening conditions and to provide treatment for illnesses and injuries that require immediate care. Sometimes we’re also just there for convenience, for patients who don’t want to wait to see their primary care physician or whose schedules don’t mesh with their primary physician’s office hours for refills on maintenance medications. There are numerous situations in which we do not provide definitive care. Most fractures are merely stabilized and then the patient is referred for orthopedic management. For most urgent care centers, anything requiring imaging that is more than a plan film x-ray has to be referred back to a primary physician to coordinate authorization, scheduling, and follow up. We’re not in the position to order complex studies and follow up on them, and most of the time we do strive to get you back to your primary care physician for follow up.
Even when a physician feels he or she has done the right thing, and their care has been validated by a peer review and supplemental evaluation of diagnostics, it still weighs on us. There is the nagging sensation that we should have done something different, and that the patient thinks we’re bad doctors. It’s hard for people outside our world to understand what that does to a person, and culturally it’s difficult for us to find people to talk with about our experiences. It’s also legally difficult, sometimes, when you think the patient is going to sue. We end up stuck with only the risk management team to talk with and they’re not exactly caring nurturers who want to help you work through the psychological ramifications of a poor outcome and subsequent lawsuit.
Keep this in mind next time you encounter a physician who seems aggravated and preoccupied. Or any health care providers, for that matter. We’re all walking around with some baggage, and sometimes a malfunctioning EHR or one more regulatory hurdle is all it takes to break us.
A few years ago, Wayne was on an airplane when he came across a magazine article about how Texas Children’s Hospital switched to Apple iPhones to improve clinical communication and reduce noise. With some due diligence, he found that Cedars-Sinai Medical Center and several other hospitals had also switched from old ways of communicating to iPhones, and they experienced similar positive results. As our senior VP of strategic services, Wayne recognized the opportunity for UW Medicine’s Valley Medical Center to replace our old, noisy phones with smartphones.
Around the same time, James attended a dinner event for chief nursing officers in Seattle. Again, smartphones were a main topic of the discussion, representing a solution to some common clinical communication challenges.
With both of us having technical backgrounds, we started sharing ideas on how to transition from our disparate communication systems to a more modern solution. We approached our CNO and CMO with research on the value proposition of implementing a mobile communication strategy. It was easy to see how a new way of communicating would bring us additional value. Some of the improvements we hoped to achieve included:
Improving the clinician and patient experience.
Gaining workflow efficiencies.
Saving time for clinicians.
Improving communication between interdisciplinary teams.
Meeting The Joint Commission’s National Patient Safety Goals for alarm management.
At that time, we had recently deployed a new electronic health record (EHR), which gave us the opportunity to improve many other systems and workflows. Our senior leadership team felt that to get the most out of our EHR, we needed a mobile app to close the gap and provide real-time access to clinical information, allow for mobile documentation, and offer an easy way for nurses and other staff to communicate.
Our staff were already using smartphones in their personal lives and were frustrated with the multiple communication devices they were juggling (two-way radios, legacy phones, pagers, and overhead paging). We met with many of our nurses to get their input, and one said, “Anything you can do to lighten the load would be greatly appreciated.”
We started with a phased approach, rolling out iPhones to one pilot unit, then to all inpatient units and several ancillary departments for calling; secure text messaging; and notification of alarms and alerts from patient monitoring, patient elopement, and the nurse call system. This was done via Voalte and Connexall applications.
We conducted before and after analysis so we could measure the outcomes from the new clinical workflows. One area we looked at was hospital-acquired pressure ulcers and skin integrity events. Using the iPhones, our wound care nurses saw an immediate improvement in workflow by using the Epic Rover application to take a photo of the wound, which uploads the photo for documentation into the patient medical record. The physician or wound care nurses can see it immediately and even show it to the patient and their family when rounding with a physician.
With only two dedicated wound care nurses on our team, their time is extremely limited. Rather than spending time walking around looking for a physician or nurse to discuss a patient, they can now find the appropriate physician in the smartphone directory, send a photo via Rover, and ask the physician to call when he or she is available to discuss treatment. The result has been better communication among our interdisciplinary teams, more efficient use of time for our wound care team, real-time documentation to the medical record, and improved communication with patients and families.
Another area where we have made great headway with the iPhones is in reducing medication errors. Using our new workflow, a nurse changes his or her status in the directory from “available” to “busy” and types in a status message, such as “administering meds.” This lets the rest of the care team know not to interrupt that nurse until their status changes back to “available.” New workflows escalate alerts to a backup while that nurse is busy.
Today, we are using iPhones for communication on all clinical inpatient units for nurses, physicians, respiratory therapists, discharge planners, environmental services managers, and administration. We are communicating more efficiently, with about 70 percent of all communication now taking place via text message versus 30 percent via voice calls. Our very tech-savvy staff loves the new solution and has adapted well to the workflow changes. One nurse said her unit is much quieter and that the hospital “feels like a hotel, so patients can get some rest.”
In our first year using smartphones, we are still learning where we can make adjustments in our workflows to make the most of our new way of communication. Going forward, we will be analyzing workflow efficiencies, adjusting alarm settings, and managing notifications from nurse call, physiological monitors, and the EHR.
An Uncomfortable Truth About Hospital Revenue and an Overlooked Way to Gain It Back By Crystal Ewing
Crystal Ewing is manager of data integrity at ZirMed.
In a video message from last year that he surely never intended for public and regulatory scrutiny, Mayo Clinic CEO John Noseworthy, MD appeared to advise employees to prioritize patients with commercial insurance in order for the famed hospital to remain financially strong.
Months later, Mayo is still explaining exactly what Dr. Noseworthy meant. Many healthcare leaders need no further explanation, even if they personally dislike any suggestion of favoring the commercially insured over Medicare and Medicaid patients. With government reimbursement continuing its decline, most hospitals are straining to hold on to their profitability.
Still, placing hope in commercial insurance to make up the difference is misguided, especially with the rising dominance of health plans that are not only high deductible, but also require high co-payments and high co-insurance. Touted as a means of covering more Americans, these plans often put more of the financial burden on patients than simply paying for healthcare in cash at a discount.
As such, many patients with these plans may claim they have no coverage when it comes time to pay for a procedure or service. It’s hard not to empathize with their motivation for doing so, but it’s a practice that can put the hospital in a precarious position.
With self-pay patients, things become more complicated, especially since there can be a lag of 30 or more days between the time that they are treated and the time the invoice comes due. When faced with a choice between paying for housing, utilities, food for their families, auto repairs, etc. – all of which affect the present and future – or paying a hospital bill for an event that occurred in the past, the decision is easy.
When this thinking is spread across a large patient population, bad debt accumulates quickly. Additionally, patients are unlikely to pay medical bills that are greater than 5 percent of household income, according to the Advisory Board, a consulting firm for hospitals. Median household income in the U.S. is at about $53,000, suggesting that when out-of-pocket charges exceed $2,600 hospitals can forget about collecting, according to Spencer Perlman, an analyst with Height Securities in Washington.
Given the above realities, more hospitals are using automated coverage detection technology, which also finds insurance coverage that patients legitimately aren’t aware of or are unable to communicate. When patients are brought to the hospital in the grips of a heart attack, for example, or while unconscious, they’re hardly able to convey their levels of coverage. Some fully conscious patients even may forget they have coverage, or provide information on secondary rather than primary coverage, or become confused about which carrier covers them. This isn’t uncommon with elderly patients.
No matter the reason it is problematic , it is imperative that coverage verification becomes a more streamlined process at our nation’s hospitals. It can be done in a way that respects the patient and in a timely fashion to protect the hospital’s finances. The most feasible method is to pair automated coverage detection with automated eligibility verification, the latter of which is already in place at many hospitals. However, coverage detection can also be an independent, standalone process. Either way, it makes quick work of checking with thousands of healthcare payers to determine if any are the primary or secondary insurer for a given patient.
Often, as much as 15 percent more instances of billable insurance are uncovered with superior processes and technology. Even just some quick mental calculation can see how this would recoup millions of dollars for many large hospital systems. It’s also significantly over the 1 to 5 percent rate achieved by manual and legacy coverage detection.
Much of this improvement is due to the huge data sets that now power some business intelligence engines, encompassing billions of historical health insurance transactions for millions of Americans. As these insights are tested against a pre-identified set of payers, algorithms can match the key data attributes that confirm coverage and the information needed to file the claim.
What has yet to be quantified but surely exists is the reduction in future collections activity with patients. Despite jargon that describes these patients as “empowered consumers,” the reality is they are struggling to pay their bills and rely on hospitals to help them navigate this uncertain terrain. In turn, hospitals must be fully informed about all of a patient’s sources of payment, including if commercial insurance coverage exists.
There is nothing unethical about seeking such information, only for using it to prioritize patients who it turns out are commercially covered. Clearly hospitals should be setting their sights on treating all patients, regardless of source of payment. The ability to do so is greatly enhanced when hospitals can identify all sources.
Teladoc reports Q1 results: revenue climbed 60 percent to $43 million, while net losses remained flat. EPS –$0.30 vs. –$0.40, beating analyst expectations on both. Share prices jumped 25 percent on the news.
A DataBreaches.net investigation finds that up to several million records of Bronx-Lebanon Hospital Center (NY) were exposed after its revenue cycle contractor, iHealth Innovations, apparently misconfigured an rsync backup
From Dr. Evil: “Re: EviCore. The specialty benefits manager is considering a sale or IPO, valuing itself at $4 billion. It pays to build a business around denying care.” The company describes its services as “comprehensive care management solutions,” although the emphasis seems to be on reducing cost via evidence-based solutions. It’s a good approach, although it fails to address out-of-control provider, drug, and device costs and instead focuses on restricting what is ordered. It’s an often-missed point that all of the political wrangling over health insurance would be much less necessary if costs were made reasonable, an even more daunting and therefore unlikely legislative accomplishment since the folks making fortunes on the backs of sick people also employ lobbyists.
Epic’s App Orchard
I received these unverified reader comments when I asked for first-person experience with Epic’s App Orchard.
I have worked extensively with Epic Corp over the past two years with their iterations of the App Orchard. The rules of the road require that an app developer permit Epic to take whatever IP they choose, if Epic believes it makes sense to include in future releases of Epic software. Epic will reject apps that directly compete with Epic functionality, as determined by Epic’s current and future roadmap. Further, the 30 percent fee they charge is too broad in scope for the app revenue (if there is any). Most importantly, originally, only Epic clients could submit apps to the Orchard, effectively locking out the global collective genius of non-Epic entrepreneurs (I am not sure if such a restriction remains). Based on the approach to their App Orchard, Epic seems to be trying to respond to the market demand for "open" as heavily advertised by Cerner as their competitive differentiator. However, Epic also seems to want to control the Epic app environment and has absolutely no motivation to loosen their model to the wild, as Judy mentioned several times that such a move would be the end of Epic.
We have started working with Epic to build out an API integration under the App Orchard. For us, the biggest concern are the revenue sharing terms. For a software vendor that is operating under tight margins in a competitive market, having to factor in up to a 25 percent gross revenue share is an impossible burden. From our perspective, the App Orchard is a blatant money grab from companies trying to innovate on the edges of the Epic ecosystem.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor Softek Solutions. The Prairie Village, KS-based company’s OnTrack software and consulting services optimize revenue integrity and system performance for Cerner Millennium hospitals (and those preparing to move to Millennium). Its Charge Integrity Control provides visibility into revenue management by correlating patient orders and charges throughout the transaction process –one customer found a lab charge error that lost them $3 million in appropriate billing over four months before they found it instantly with Charge Integrity Control. Revenue Conversion Services allows correction of application, workflow, and configuration problems that otherwise would cause millions of dollars in lost revenue right after a Cerner go-live — a single hospital called Softek three months after go-live and avoided $20 million in annualized lost charges due to orders that weren’t charging, a location-specific workflow problem with ordering, and ED batch charges that weren’t actually charging. The company also provides Millennium system performance optimization software and services as well as conversion and purge maintenance assistance using proprietary diagnostics. Thanks to Softek Solutions for supporting HIStalk.
I finally pulled the trigger on replacing of my years-old, $300 laptop that I use for everything. I chose an Acer Aspire E15, which has pretty decent specs for $621: an AMD FX 9800p CPU with 2 MB L2 cache, 16 GB of DDR 4 SDRAM, a 128 GB solid state drive running Windows 10, a 1-terabyte hard drive for data, a 15.6-inch display powered by a Radeon R8 dual graphics video card with 2 GB of dedicated VRAM, and thankfully nearly zero pre-installed bloatware. I’ve had no problems so far getting it loaded up.
HIStalk readers funded the DonorsChoose grant request of Mrs. S in California, who asked for a 3Doodler child-safe 3-D printing system (it was actually inexpensive at just $113 for everything, plus our donation was matched). She reports, “I would like to thank you from 22 very excited third grade students that have really been enjoying and benefiting from your generous donation! We have been using our 3Doodler pen each Friday afternoon during our STEAM centers time and I have truly observed some fantastic skill building. Some of the benefits that are very noticeable to me are an increased attention to detail, improved direction following within a detailed task, increased patience for a task, increased observation of the steps necessary for a positive outcome, and an increased motivation to try something new! You have made a difference!”
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Video visit provider Teladoc reports Q1 results: revenue up 60 percent, EPS –$0.30 vs. –$0.40, beating analyst expectations for both.
Reed Liggin (Athenahealth) joins electronic prescribing system vendor EazyScripts as CEO. He was president and CEO of the small-hospital information system vendor RazorInsights that was acquired by Athenahealth in January 2015.
Telehealth solution provider Avizia hires Joe Quinn (ComScore) as CFO.
Health Symmetric hires Bob Teague, MD (Quorum Health Resources) as chief medical officer. The company’s website uses a lot of vague gibberish in not saying exactly what it is they’re selling other than a “healthcare platform” that uses APIs.
Announcements and Implementations
Intelligent Medical Objects is awarded a patent for its concept-based terminology management system that allows rapid distribution of terminology changes to the company’s EHR vendor partners. Clinician-entered terms are matched with appropriate billing and reference codes that capture clinical intent.
Hybrid IT vendor TierPoint will expand its Hawthorne, NY data center campus for the third time, adding 38,000 square feet of raised floor to the existing facility that includes 52,000 square feet of raised floor plus a 70,000 square foot recovery and business continuity center.
PeriGen releases PeriWatch, a perinatal analytics system that integrates WatchChild fetal monitoring with PeriCALM decision support and adds a maternal dashboard.
Penn Medicine Center for Health Care Innovation (PA wins ECRI Institute’s health device award for its app development platform that extracts clinical information from the EHR and other sources.
Government and Politics
In England, the Cambridge University Hospitals trust will decide this summer whether to outsource commodity IT services that include enterprise infrastructure, service desk, and end-user computing in a tender expected to total $180 million over seven years. The trust says its increasing Epic use has created a need to expand its services.
The White House appoints Gopal Khanna (Illinois Department of Innovation and Technology) as director of AHRQ.
Innovation and Research
University of Illinois at Urbana-Champaign is working on a virtual physician agent that can describe lab test results to patients via a patient portal, targeting older adults with conversational speaking, context-appropriate facial features, and other body cues that can help with retention.
St. Mary’s Hospital (NJ) celebrates Nursing Week by laying off seven nurses and 13 med techs.
The local paper profiles Ability Network CEO Mark Pulido.
Black Book identifies 10 top MACRA trends challenging providers with value-based care and quality metrics.
Agfa Healthcare launches a new version of its Integrated Care Suite.
Besler Consulting releases a new podcast, “Healthcare in the first 100 days of the Trump presidency.”
Washingtonian names The Advisory Board Company CEO Robert Musslewhite as one of its biennial Tech Titans.
Casenet announces its Connect 2017 speaker lineup, led by client executives from Cigna and Healthfirst.
CoverMyMeds will exhibit at the American Academy of Ambulatory Care Nursing Annual Conference May 10-13 in New Orleans.
Boston Software posts a white paper titled “Eliminate the Pain of EMR Upgrade Testing” that describes use of its Cognauto system to validate and set appropriate expectations for each department regarding the added benefits of the EMR upgrade.
The Hartford Business Journal interviews Diameter Health CEO Eric Rosow.
Health Professional Radio interviews Docent Health co-founder Paul Roscoe.
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