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Monday Morning Update 12/29/14

December 27, 2014 News 11 Comments

Top News

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Cerner shares hit a 52-week high last week, closing Friday at $65.71 and valuing the company at $22 billion. The end-of-year rise sounds impressive until you examine the one-year share price graph that shows CERN shares rising 18.2 percent (blue) vs. the Nasdaq’s 15.6 percent (red), so it barely beat the Nasdaq composite index. 


Reader Comments

From Pango: “Re:  vendor employee provider experience. My company developed a rounding program where our software developers, project managers, product managers, and QA team members spent time observing a clinician in hospital departments. It was valuable because it provided insights into workflows and usability that we could not have understood other than by on-site observation. The programs were in place at several client hospitals and we maintained an active rotation of our team members who wished to participate.”

From Patti Melt: “Re: Epic. I just spent all day interfacing it to other systems. Since Neal Patterson says it can’t be done, should I buy a lottery ticket?”

From Urban Cowboy: “Re: Madison airport. If Epic is trying to eliminate consultant advertising within 50 miles of Verona, someone should tell the airport since it’s about all they have. With fewer implementations, they need all the help they can get.” Someone mentioned previously that perhaps the airport wasn’t within Epic’s rumored no-fly-ads zone since it’s a long cab ride, but Google Maps says it’s only 21.9 miles.


HIStalk Announcements and Requests

News is predictably (and thankfully) skimpy, so the biggest takeaway from this post is that you haven’t missed anything over the post-Christmas weekend.

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Dave Miller, CIO of Optimum Healthcare IT and formerly CIO of University of Arkansas for Medical Sciences, sent out an email suggesting Christmas donations to the Salvation Army, recounting how as a child the organization got his family of seven through their temporarily homelessness. Bitdefender wouldn’t let me bring up Dave’s fundraising campaign page at OnlineRedKettle.org because of a phishing warning, but I matched Dave’s $250 donation online in honor of HIStalk’s readers. Salvation Army is my #1 overall charity choice, with DonorsChoose.org running a close second.

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I’m ecstatic to report that three-quarters of respondents to my poll say they’re happier now than they were a year ago. New poll to your right or here: what is your overall impression of HIMSS? Click the poll’s “comments” link after voting to explain.


Last Week’s Most Interesting News

  • The executive director of the Connecticut Health Policy Project observes that the state’s now-defunct HIE oversight organization spent $4.3 million in federal grant money without accomplishing anything.
  • Pennsylvania’s HIE organization asks the state for $4.7 million to keep it running now that its ONC grants have expired and its efforts to bring paying organizations online and to solicit charitable donations have failed.
  • The FDA announces plans to require drug manufacturers to publish prescribing information for professionals electronically on an FDA-maintained website, eliminating the paper versions.
  • HTC Global Services acquires CareTech Solutions.
  • Boston Children’s Hospital (MA) pays $40,000 to settle state charges over the theft of an unencrypted laptop, while Northwestern Memorial Healthcare Group notifies 3,000 people that their information has been exposed by the theft of an unencrypted laptop from an employee’s car.

People

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Oneview Healthcare names Samir Batra (CareInSync) as VP of patient engagement.


Announcements and Implementations

TEDMED is offering a $1,000 discount for registrations completed by December 31 for next fall’s event, dropping the cost of the refundable, transferrable delegate pass to $3,950. This year’s event was split between San Francisco and Washington, DC and connected by video. No way I’m paying thousands of dollars to watch a big screen meeting from the other side of the country, but to each his own. The only names I immediately recognized from last year’s speaker list were swimmer Diana Nyad and Theranos CEO Elizabeth Holmes, neither of which would cause my hand to move toward my wallet.


Government and Politics

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Jeb Bush will resign from the board of for-profit hospital operator Tenet Healthcare as he explores a 2016 Presidential run. He made $300,000 from that gig last year. Tenet is worth $5 billion, with CEO Trevor Fetter holding shares worth $42 million.

A Wall Street Journal report says that Medicare is hard to fix because the agency doesn’t want to restrict care, adding that new providers aren’t vetted and inspectors never visit provider locations to see if they are real. The article points out that 45,000 new providers sign up to deliver Medicare services every month and CMS doesn’t have the resources to vet them.


Technology

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My most-used iPhone app is the outstanding, 99-cent MotionX GPS Drive navigation system. I just noticed that the company offers the also-99 cent MotionX 24/7, which includes a sleep tracker, step counter, heart rate monitor, and wake-up alarm, all integrated with Apple Health. I didn’t realize until I looked up their site that the company’s emphasis is on and quantified self rather than GPS navigation. It holds dozens of patents and licenses its technology to wearables vendors such as Nike. MotionX’s CEO and co-founder is Philippe Kahn, who invented the phone camera, founded the powerhouse 1980s software vendor Borland (Turbo Pascal, Quattro, TopSpeed/Clarion, dBase, Delphi, and Paradox), and earned simultaneous master’s degrees in mathematics and classical flute. I’m installing MotionX 24/7 now and will report back, but I can already see that it’s as well designed as I expected.

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Since I mentioned my most-used iPhone app, here’s another highly used one on the phone, desktop, and laptop: the LastPass password manager and single sign-on utility, which allows me to log on to a single Web page and have instant auto log-in to everything I use online (and to easily and centrally maintain complex and mandatory-change passwords) from any device. It’s free for personal desktop use, or an extra $12 per year to run it from mobile devices.

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This should annoy everyone smart enough to use their phone as a personal hotspot instead of paying $15 for crappy hotel Internet access: Marriott and its hotel lobbying group ask the FCC for permission to block tethering, using the extraordinarily stupid and self-serving excuse that guests might use their personal Wi-Fi connections to attack the hotel’s network, steal information from other online guests, or slow down the hotel’s Wi-Fi (all of which are arguments hotels should make for NOT using their own in-house networks, other than the fact that they profit handsomely from it). Microsoft and Google are urging the FCC to deny Marriott’s lame idea. Somehow cheap roadside hotels can offer free parking, Internet, and breakfast but the snootier, big-city ones milk their business travelers hard. Marriott’s Springhill Suites is still my favorite chain, though.


Other

The board of Massena Memorial Hospital (NY) approves spending $49,000 for a Medhost upgrade and $29,000 for a Meditech/LSS purchase. The CEO explained that the Medhost upgrade is required for complying with New York’s I-STOP mandatory electronic prescribing law, adding, “The last thing we want to do is end up sideways with the state and DEA. That would be extremely unpleasant.” 

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Eric Topol, MD tweeted this graphic of his medical smartphone concept from his new book, “The Patient Will See You Now.” Amazon’s “look inside” preview contains generous sections of the book’s content – it looks good.

This YouTube video of Derby the dog running for the first time after being fitted for 3D-printed prosthetics has received 6.8 million views for its producer, 3D Systems. The company, based in Rock Hill, SC , is traded on the New York Stock Exchange and is valued at almost $4 billion even after shares dropped 64 percent in the past year.

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The children of “American Top 40” host Casey Kasem, who died of dementia last June at 82, will share his hospital records with his widow, who is suing the hospital that cared for him. Kasem’s widow is the former Jean Thompson, who played Nick Tortelli’s curvaceous wife Loretta (with the “I Dream of Jeannie” hairdo) on “Cheers.”

The federal government upholds the firing of the head of the Phoenix VA, not because of the wait times scandal that erupted there, but because she accepted gifts from a consultant that included a family trip to Disneyland and Beyonce concert tickets.

‘Tis the season for intolerant lunatics: American Airlines removes a disruptive La Guardia passenger who was loudly berating the flight attendants and crew who had wished him “Merry Christmas.” The man, who wouldn’t calm down, said nobody should ever say Merry Christmas because not everyone celebrates it. His fellow passengers cheered when he was escorted off the plane.
 
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UPMC’s Magee –Women’s Hospital (PA) gives keepsake Christmas stockings and caps knitted by volunteers to the parents of newborns who are in the hospital over the holiday.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 27, 2014 News 11 Comments

Morning Headlines 12/24/14

December 23, 2014 Headlines 1 Comment

AMN Healthcare Acquires Avantas

AMN Healthcare, a healthcare-focused staffing firm, acquires Avantas, which builds data analytics tools for optimizing staffing and scheduling.

Medicine Is About to Get Personal

TIME reports on direct-primary care provider Qliance Health, and their efforts to provide direct to consumer primary care for a flat monthly fee, and without involving insurance.

Health IT In Connecticut – Learning From Mistakes

A director from HITE-CT, Connecticut’s quasi-public organization tasked with building its health information exchange, explains that the organization was dissolved after “wasting $4.3 million in federal grants and four years, without accomplishing anything.”

Pennsylvania eHealth Partnership Authority Annual Report to the Governor and General Assembly

The organization responsible for Pennsylvania’s HIE reports that despite very lean staffing, finding a business model capable of delivering financial sustainability remains its biggest challenge.

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December 23, 2014 Headlines 1 Comment

News 12/24/14

December 23, 2014 News 4 Comments

Top News

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Healthcare workforce services vendor AMN Healthcare acquires Avantas, saying its clients need staffing forecasting analytics.


Reader Comments

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From Sonoran Dog: “Re: Maricopa Integrated Health System. Veiled rumors from administration suggest it will have to shut down in July 2015 due to lack of funds after receiving a large bond in the November elections. Any truth to the rumors? A lot of us medical personnel are working hard to comply with every cost-cutting feature we can come up with to help.” Voters overwhelmingly approved a $935 million bond to upgrade the facilities of the 515-bed public health system that includes Maricopa Medical Center, the Arizona Burn Center, and the Level One trauma center. The CEOs of the four largest private hospitals in Phoenix (Abrazo, Banner, Dignity, and Scottsdale Lincoln) say the huge construction expense is unnecessary given the sufficient bed capacity already in place (theirs, of course.) Readers comments are welcome. Surely there’s little chance of MIHS shutting down given public support, but some sort of public-private partnership with the those other Phoenix systems would make sense.

From Czarina: “Re: vendor-provider contact. What do HIStalk readers suggest for giving vendor employees exposure to the clinical workflow and technical challenges that providers face? We want every one of our people to get out in the field, but just taking a hospital tour doesn’t seem to have much value. We’re considering encouraging volunteering, attending a local or national conference, or taking a clinician to lunch.” I should note that this isn’t a huge company, so their employees won’t overwhelm the local health systems. Ideas? I’ll be honest that in my health system IT experience, I wouldn’t see the benefit to my department in having vendor people underfoot so they could learn on my dime, so I would be somewhat resistant to committing. I like the idea of setting up a volunteer program specific to the IT department if the hospital is willing to support it – our desk-bound IT department people learned a lot just going out with the field services techs or sitting with the help desk people.

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From HITPro: “Re: cyberdefense training system. Can’t mimic real-world health system security because it is virtually non-existent.” CyberCity, created to train federal government employees to defend against cyberattacks, had to artificially boost the security capabilities of its prototype hospital because it otherwise would have been “too trivial to hack.”


HIStalk Announcements and Requests

I’ll probably slack off a bit over the next week by posting less frequently. Merry Christmas, Happy Hanukkah, and Habara Gani (and if you don’t celebrate any of these holidays, those of us who do thank you in advance for respectfully tolerating that fact).


Acquisitions, Funding, Business, and Stock

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Provider secure messaging app vendor GroupMD renames itself Flow Health, or at least that’s what I infer from the maddeningly vague company blog post announcing a change without really describing it. I probably shouldn’t be surprised given that Flow Health’s “About Us” page on its we’re-so-hip, scroll-happy website doesn’t list its founders, physical location, or history.


Sales

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Porter Medical Center (VT) chooses Summit Healthcare’s data exchange platform to meet Meaningful Use Stage 2 Direct messaging requirements.


People

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Explorys hires Greg Yarrington (Truven Health Analytics) as VP of operations and Patrick Wells (Deloitte) as VP of solutions.

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Home medical equipment manufacturer Invacare appoints Cleveland Clinic CIO Martin Harris, MD as interim board chair following the retirement of Mal Mixon. The publicly traded Ohio-based company has 5,200 employees and a market value of $533 million, with Harris holding shares worth $327,000. The company’s share price has dropped 28 percent in the past year.

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J. Robert Beyster, PhD, founder of SAIC and Leidos, died Monday at 90. He left his job working on nuclear submarines for Westinghouse in 1969 and founded SAIC at age 45.


Announcements and Implementations

The Cal INDEX HIE connects to Blue Shield of California via Orion Health.

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India’s state of Telangana rolls out the country’s first healthcare app.

Sagacious Consultants announces an Epic report-writing annual subscription that provides a fixed number of hours each month with discounts of up to $50 per hour.


Government and Politics

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The executive director of the Connecticut Health Policy Project says the now-defunct state HIE oversight organization (Health Information Technology Exchange of Connecticut, or HITE-CT) was shut down “after wasting $4.3 million in federal grants and four years without accomplishing anything.” She references a state auditor’s report that concluded that the organization was slow to react, couldn’t figure out how to fund itself, and failed to renegotiate a bad vendor contract it had signed with Axway and GE Healthcare. At its peak expense year of 2013, the organization paid $343,000 in salaries. Auditors also noted that some of the 20 members of its board often missed meetings, vacant board positions weren’t filled, and with zero revenue the organization couldn’t pay the paltry matching funds required by the federal government ($1 for each $10 in federal grant money received). The editorial’s author is correct: the only accomplishment of the group was to squander federal money.

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Acting HHS Assistant Secretary Karen DeSalvo, MD writes a Huffington Post blog post welcoming home the US Public Health Service officers who returned from fighting Ebola in Liberia this past Saturday.

The FDA issues a proposed rule that would require drug manufacturers to provide prescribing information for professionals in electronic form, which would then be posted on an FDA reference site. Paper versions would no longer be allowed since they can’t be updated with new information, but manufacturers would be required to staff a telephone service that would send paper copies on request.


Privacy and Security

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Mercy Medical Center  (CA) announces that a third-party transcription vendor unintentionally opened up its server to the Internet for several weeks, making the physician notes of 620 oncology patients visible in web searches. The hospital has apparently fired the responsible contractor.

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The Michigan appeals court dismisses a privacy brought by 159 people whose medical records were unintentionally made available online by a contractor for Henry Ford Health System (MI). The three-judge panel ruled that an invasion of privacy claim isn’t valid unless the plaintiff’s actions are intentional.


Other

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Time magazine profiles Qliance, a Washington-based nationally expanding concierge primary care practice that has lowered its cost to the point that it covers entire businesses (Expedia and Comcast) and even Medicaid groups for a flat monthly per-patient fee based on age. Billionaire investors include Amazon’s Jeff Bezos and Michael Dell. I really like this snip:

At the tangled heart of this dysfunction is Medicare, which by its sheer size sets the standards for insurance reimbursements. Specialists dominate the panel that sets its payment rates. Thus the system values surgeries, scans and other procedures more than it values checkups and management of existing conditions. West, a primary-care doc, explains it this way: “If I put in an hour with a patient, I will be reimbursed for one exam–the same payment I would get for seeing that patient for 11 minutes. Meanwhile, an ophthalmologist might perform three cataract surgeries in that same hour, and each surgery might be reimbursed at twice the rate of my exam. So that doctor is making six times as much money.”

And if the eye patient has questions after the surgery about her medicine or her recovery, the specialist’s office is likely to suggest that she consult with her primary caregiver. After all, neither doctor gets reimbursed for answering questions on the phone, so the chore is often traded like a hot potato. “We say primary care is critical to a healthier future,” West says, “but in every way we show value, it is at the lowest level.”

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Doctors without Borders is using donated advertising on free medical imaging social network Figure 1 (“Instagram for doctors”) to recruit Ebola volunteers. The app automatically detects faces in submitted photos and blocks them for privacy and allows users to manually block other identifying features. Images are also moderated before posting to make sure they have been de-identified. The Toronto-based company has raised $6 million in funding and was founded by (a) a professor and writer with a JD and Columbia MBA; (b) an internist who describes himself as having an “above-average sense of humor and below-average physical fitness”; and (c) an iOS app developer.

A Harvard Business Review article called “The Antidote to Fragmented Health Care” contains as  one of its recommendations universal EHRs. It doesn’t define exactly what that means, but references the VA’s VistA, Kaiser’s HealthConnect, and the OpenNotes initiative. Looking back at all the money (taxpayer and otherwise) spent on EHRs and HIEs, maybe the better and cheaper alternative would have been to buy or create a nationalized EHR. Or, as I proposed years ago, mandate use of a standardize EHR database structure with rule-defined fields and let vendors compete based on the user interfaces and add-on capabilities they sell beyond the basic database-populating parts of the EHR.

Trustees of Regional Medical Center (SC) approve an extra $500,000 to implement Cerner’s document imaging system, with its president explaining that the hospital had underestimated the number of departments that would use the system and the volume of documents to be converted.

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The annual report of the Pennsylvania eHealth Partnership Authority says its biggest challenge is funding (duh) after its ONC grant ran out earlier this year, when it asked for $1.85 million in state support. Now it wants $4.7 million for the next fiscal year, explaining that it failed to generate the charitable donations it expected, user fees that were supposed to start kicking in earlier in 2014 won’t start until mid-2015, and even then those fees “will not reach levels that contribute significantly to Authority sustainability until most HIOs are onboarded to the P3N in 2016.” Translation: we don’t don’t know how to run a business, every one of our plans and projections were wrong and have been scrapped, and it’s highly doubtful anyone will ever pay us for the services we may eventually offer. Therefore, taxpayers should provide a never-ending flow of money so a poorly conceived, ever-changing, and incompetently executed idea can be pushed onto a market that doesn’t want it.

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An apparently serious study finds that the 30-day mortality rate of high-risk heart failure and cardiac arrest patients admitted to teaching hospitals is lower when cardiologists leave to attend national conferences. I remember reading years ago that death rates dropped when hospitals were closed due to strikes.


Sponsor Updates

  • Greenway Health releases version 3.1 of PrimeMOBILE.
  • EDCO Health Information Solutions posts two new case studies involving its Solarity medical records scanning and indexing solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 23, 2014 News 4 Comments

Morning Headlines 12/23/14

December 22, 2014 Headlines No Comments

Supreme Court to Hear Arguments in Big Health Care Case on March 4

The Supreme Court will hear King v Burwell on March 4. The case argues that the Obama administration overstepped its authority by providing federal subsidies to Healthcare.gov users when the ACA’s language only authorized subsidy payments for insurance acquired through state-run exchanges.

89 ACOs will join Medicare Shared Savings Program in January

CMS announces that 89 new ACOs will join the Shared Savings Program effective January 1, 2015.

Accretive Health Provides Updated Timeline for Completion of Restatement

Accretive Health, a Chicago-based revenue cycle management company, will file its long overdue 2012 and 2013 year-end financial statements next week. The company will also publish restated 2011 statements.

Electronic Distribution of Prescribing Information for Human Prescription Drugs, Including Biological Products

A proposed rule by the FDA will require that pharmaceutical companies replace the paper-based prescription drug handouts written for doctors with electronic ones that can be updated in real-time.

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December 22, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 12/22/14

December 22, 2014 Dr. Jayne 1 Comment

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As the year closes out, my hospital’s employed physician group continues to acquire physician practices under the guise of building its accountable care network. At this stage in the game, however, the strong independent practices have either grown to a point where acquisition isn’t a viable option or have banded together as part of IPA groups and aren’t interested in being employed. For the rest, however, it seems there’s no practice too questionable for us to purchase.

I was out of the office last month when the operations leaders did due diligence on a small pediatric practice. I had heard that there were some “interesting” things noted on the site visit, but leadership was bent on purchasing it anyway. The physician is close to retirement and they figure they can just plug a new physician (straight out of residency) in July and absorb the patient volume as the owner steps away into the sunset. In the mean time, my team’s job is to get the EHR live, transform care delivery to bring them up to MU-ready standards, and deal with all the fallout.

I went to the office on Friday for an initial workflow review. One of the implementation team members is fairly new, and although skilled with EHR, has never converted a practice from paper. The team lead who was supposed to be running this one ended up having her first grandbaby arrive, so I stepped in to cover the day of shadowing.

We have a checklist of things to review and we also shadow office staff as they go through their daily activities. Ultimately we’ll create current state workflow maps and use those to derive a future state. We’ll take that back out to the practice and validate it with the physician and office manager, put together a Team Operating Agreement, and then schedule them for implementation.

Often there is a fair amount of clean-up that has to be done with the workflows and addressing that is within the purview of our implementation team. Our operations staff initially fought us on this, but finally conceded that practice roles and responsibilities, patient flow, and EHR workflow are so intertwined that they can’t be addressed separately (especially if you’re trying to bring practices live on a rapid cycle). They also didn’t have the resources to adequately handle process improvement, so it was an easy “poach” when I decided it needed to live on my team.

My initial impression from the waiting room was a good one – freshly remodeled, new furniture, adequate space, and a cool salt water fish tank that the patients were enjoying. The receptionists were friendly and using computers proficiently. The exam rooms were large, with plenty of space to add a computer workstation and not lose the room needed to park strollers and the extra family members who often come to visits with new babies. I liked the way the layout clearly separated the “on stage” patient care areas from the “off stage” staff work areas, which not only helps control clutter, but reduces risk of patients overhearing phone conversations.

Once I stepped into the staff area, a veritable house of horrors awaited me. I wasn’t sure whether they over-spent on the furnishings and remodel and tried to make it up by skimping on the rest of the office or whether they just didn’t care. The back half of the office was just dirty. From the stained butcher block table in the staff lunch room to the piles of trash bags by the back door, I couldn’t believe what I was seeing. They knew we were coming, and if this is how they present the office for an assessment, I couldn’t imagine what it would look like if we showed up unannounced.

The counters and workspaces were crowded, with open drinks and snacks in the lab area, food crumbs in the keyboard of the computer they use to access the state immunization registry, and trash on the floor. Really, trash on the floor. Not the “oops, I dropped the cap to that needle while I was drawing up that injection” kind of trash, but the “I just don’t care and can’t be bothered to walk to the can because it’s on the other side of the room” kind of piles.

The cabinets and walls were covered with so many “don’t forget to do this” or “X insurance requires that” notes and stickies that you couldn’t even see the walls. More than two-thirds of them were obscured and some of them had been there for years based on the dates.

We started the assessment and quickly determined that no staff member had been there more than a year. Most had been there less than six months and two were new that week. That’s a red flag, as was the presence of the owner’s son as office manager.

In the positive column, we knew all the clinical staff would be at least minimally tech savvy because they were using their smart phones constantly, even when work piled up and patients were waiting.

We went through our usual questions about training and on-boarding, how work is divided, patient flow, and so on. I also asked about the remodel of the front half of the office (14 months ago) and how long the son had been managing the practice (18 months).

The timing of the son’s arrival and its association with staff tenure was suspicious, as was the timing of the remodel. Pediatric practices are not exactly centers of profit, especially small solo ones. They’re a labor of love for most physicians, and if not run right, can be more chaotic than other specialties. I wasn’t sure whether the son had been brought in to try to remediate a problem or whether he was the cause. Unfortunately, the latter was confirmed when we had a chance to sit down with the physician later in the day.

I haven’t heard such a sad story in a long time. The owner’s son had gone to college with the goal of being pre-med and eventually taking over the practice. His grades weren’t good enough to get into med school, so Dad financed an MBA at a for-profit university and hired him to manage the office instead. With no understanding of medical practice management or the realities of office cash flow, he embarked on an aggressive campaign to improve the office’s appearance.

Driving them further into debt, he terminated the seasoned staff because they were costly and he assumed they were replaceable. The office spun further and further out of control and for love of family the owner didn’t want to reach out to a consultant or anyone else who could help. Ultimately, they felt they needed to sell to remain viable. He saw the purchase by the medical group as a way to continue doing what he loves and apparently wasn’t aware of the plan to add a physician to the practice in six months.

Having been in this business as long as I have, none of this should be surprising. Still, every time I hear one of these stories, it shocks my sensibilities. First, that there are physicians in this day and age of regulatory complexity that still think a practice can be family run without specific training and administrative support by someone who actually knows what they are doing. Second, that the son was still in the practice even though we had acquired it. Usually we have a pretty good track record of buying out those kinds of situations when we take over. And third, that my own employer actually thought acquiring this practice was a good idea.

Looking at reimbursement rates for general pediatrics, we won’t break even for a decade. It may be the right thing for the community, though, and I hope they acknowledge this and react accordingly when the negative financial statements start documenting what our guts already know. In the past, they haven’t been sensitive to the realities of acquiring damaged goods. Their knee-jerk reaction will likely be to push the physician out, replace him with a younger model, close the office proper, and move the “practice” (aka patient base) to an on-campus office.

In the midst of all this chaos, we’re supposed to deploy EHR and have happy satisfied end users without expending more resources than are budgeted. Good thing the OSHA, CLIA, HR, and regulatory remediation won’t come out of my budget.

We’re going to do our best with this practice. Although I’m not terribly hopeful, we’re in it to win it. As for our operational leadership, however, I’d like to throttle them.

Does your employer make business decisions that leave you shaking your head? Email me.

Email Dr. Jayne.

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December 22, 2014 Dr. Jayne 1 Comment

HIStalk Interviews John Gomez, CEO, Sensato

December 22, 2014 Interviews No Comments

John Gomez is CEO of Sensato of Asbury Park, NJ.

Tell me about yourself and the company.

Security has been a huge passion for me. It’s something that I was involved in earlier on in my career and then drifted away from and most recently got back into. Sensato is an outcome of that passion. 

The unique part of Sensato is that it focuses specifically on healthcare cybersecurity and privacy, the entire ecosystem of healthcare and healthcare information technology.

 

How would you characterize the current state of security in healthcare?

It’s scary overall. People are trying, but healthcare is unique. I’ve talked at industry events outside of healthcare in finance and telecom, and when I talk to people about healthcare, they are often shocked about the challenges that a CIO faces.

When I put it into context for people, the average hospital has 300 to 400 systems between HR, finance, and clinical systems. Then you lay on top of that security like webcams and remote door controls and patient access systems and things like that. 

It’s just such a huge attack surface for security that for it not to be overwhelming to any CIO would be surprising. That translates into what many would consider a target-rich environment, which translates into a lot of fear.

 

The Sony Pictures breach proved that any organization is vulnerable if someone decides there’s incentive for them to get into your systems. The FBI had already called out healthcare as being specifically targeted because PHI is valuable. Does that raise the stakes or the level of urgency to do something?

It does in some. If we step back, there’s multiple layers of cybersecurity and cyberterrorism. One area that we don’t talk a lot about is cyberwarfare. The challenge, and I think we’ll probably hear more and more about this from the Department of Homeland Security and the FBI, is that PHI is very valuable and very important. The challenge we have seen with Sony it that it’s almost cyberwarfare, where a foreign state attacks a corporation.

It opens your eyes to the fact that what if through cyberwarfare, hospitals, physician practices, labs, clinics, or retail pharmacies were attacked? What could be done there? It is scary when you think about the amount of systems in healthcare that are Unix-based and how many hospitals still run XP. Sony becomes wake-up call to what can happen if a foreign state decides to target the infrastructure of another country.

 

If someone wanted to cripple a hospital’s systems, what are the odds they could do it?

I would say it’s extremely high, whether it’s cripple the system or compromise it. The challenge of hospitals is to embrace patients and provide access to family members, that sterile vs. community-and family-oriented-environment. It does open them up to threats.

Also the entire concept that somebody that is disgruntled, whether that be a patient that feels that they were done wrong, a family member who was treated wrong, or an employee. In many communities, hospitals are the largest employers. That opens them up to a lot of challenges. 

I get worried about stating things like this because I don’t want to give people ideas, but hospitals are extremely vulnerable in my eyes. I don’t think it would take much to compromise most hospitals, whether that be through electronic attack or a physical attack that leads to an electronic attack.

 

Physician practices don’t have a lot of security resources or corporate support, while hospitals have richer data but are better secured. Which is the bigger target for hackers?

If you step back for a moment and you look at the dynamics of what’s occurring in our industry, as physician practices are becoming more involved in patient engagement and putting patient portals out there, they’re suddenly going to become much more vulnerable. In the past, they didn’t have exposed systems. You had to get in the office to launch an attack in most cases. Maybe they’re doing some faxing and things of that nature, but today a lot of physician practices either have hosted systems or patient portals.

The challenge there is a lot of these practices also have affiliations with the hospitals and pharmacies. As we start to increase the concept of population health and coordinated care, we’re having more and more of the healthcare population touching electronic systems. The vulnerability of going after a small physician practice and that launching into an attack inside of a hospital is becoming very real and very possible. It’s a scary thing that as we’re doing the right things to provide tools to our caregivers to help them do much better quality care for patients, we’re also vastly increasing the vulnerability across the spectrum of care.

 

Are the tools sophisticated enough, even if employees themselves aren’t, to prevent someone from clicking a link that installs malware that compromises entire systems?

Probably the biggest weak link is the employee or the user. They click on something or download something and it becomes an exploit. There are tools out there, but the reality is that as we learned long ago, a good offense is your best defense. Educating employees, making sure they’re up to speed, and putting policies in place that hopefully restrict them make a ton of sense.

The challenge in this industry is that we do things to make things easier without realizing the ramifications. For example,a lot of hospitals use a “bring your own device to work” or “bring your own device” policy for the physician. That’s probably one of the easiest, fastest ways to become compromised. You have devices that you don’t know what’s on them. You have no clue what that clinician has loaded on their personal device and what that can do to your network.

It becomes scary when you start thinking about other secure environments. No other real secure environment with so much at stake like healthcare would allow a “bring your own device” kind of strategy, but yet we do it. That translates into a weakened posture overall.

 

Sony Pictures failed to enforce basic security steps, such as not allowing massive data downloads or remote, anonymous e-mail logins. Is the average hospital prepared?

The challenge to hospitals or Sony or whoever it may be is that there are a lot of myths or a lot of beliefs that “this is good enough.” There are a lot of myths about security and a lot of things that people believe make them secure, when in reality, they don’t make them secure or they don’t truly provide the coverage blanket that they need.

For example, many hospitals will hide the name of their wireless access points, their SSID. They think if you can’t see my SSID, you can’t see my wireless access point, so I’m secure and people can’t get to my wireless unless it’s a guest wireless network. That’s a myth. The reality is that within 5 to 10 minutes you can figure out a hidden SSID or a hidden wireless access point. From there, you can launch a “man in the middle” attack. 

People take the basic steps and don’t realize those basic steps don’t do enough for you. In many cases, they don’t even take the basic steps, like not blocking anonymous email accounts or blocking or whitelisting certain websites or IT addresses. People just don’t know. They believe that they are doing everything they can and they don’t realize that it’s just not enough.

The attacks against Sony weren’t as sophisticated as everybody thinks. They were basic attacks. That’s scary because that continues to show that Sony just didn’t do enough to harden the environment and could have done some very, very simple things to get a much better return.

For many organizations, especially in healthcare, you feel more secure if you put things like DLP, firewalls, and intrusion detection in place, but then you forget that there are some really basic things you need to be able to deal with and do. If you don’t do them, you are susceptible to attacks.

 

How does the security exposure change if a hospital moves its EHR to a hosted system? Is it good, bad, or just a different set of issues when not running servers in a local data center?

It’s different issues. A lot the insecurity we see originates with the vendors. A lot of the products that have been developed in healthcare are old products — 10, 15, 20 years old in some cases — and never had to deal with these threats. Suddenly the base code, base logic, and approaches are moved to different environments, such as the cloud. We find that now they’re susceptible to attacks. The issues are a little bit different because we now are placing systems into environments that they may not ever been designed to support or designed to secure.

Certainly I don’t think you are more secure one way or the other.  It’s a whole bunch of different issues. You really have to step back and start thinking about how is this designed and am I exposing something new or not exposing something new.

 

Heartbleed and the Sony Pictures breach were calls to action. How are healthcare users reacting?

Things are being divided into two battle lines. There is one group of people that are thinking that Sony’s an example of if somebody wants to get to you, they’re going to get to you. There is nothing you can do about it, so why bother? Which I think is absolutely the wrong approach, especially in healthcare, because ultimately a bad enough breach could cost somebody a life.

The other side of the equation, which I think is understandable and more appropriate, is that Sony is creating a very serious wake-up call for a lot of people in the industry. They are saying, I think I’ve done everything I can, but what more can I do? Because obviously there is always a way in. How do I continue to close down those opportunities to people? 

There is a distinct parting of the ways. My hope is truly deep down that more and more people take the “what else can I do to protect the people that I’m responsible for, my employees and my patients” and less and less people take the “there is nothing I can do — eventually they’re going to get to me if that’s what they want.”

 

How does a provider make the decision as to where to focus knowing they can never be 100 percent secure?

There are some clear strategies and best practices around, how do I keep myself on top of things? How do I continually refresh my intelligence so that I can minimize the attack surface and the threats? What I would tell people — and we don’t do some of these things – is go to managed care. Think about outsourcing your security team.

The reason for that kind of stuff is that the space is so complicated that you want people who are continually the best of the best looking at your systems and looking at your security strategy on a continual basis and looking for things that digital protection strategies can’t capture.

The other thing is rotating who is doing your assessments and penetration tests. If you’re always using the same organization to do your assessments and your penetration testing, chances are your going to get the same results or very similar results over time. Mix things up. Try to use different assessment organizations and strategy consultants around security. The more you can do to get different people, different organizations to look at what’s going on in your environment, the more perspective you’re going to get.

There are a lot of people out there who are doing these kinds of things. There are a lot of good people and a few great people. The more you can change up the people that your working with and partnering over time, the better chance you’re going to find great people who can say, here’s something that you didn’t think about and you need to address it because it’s a big, big problem for you.

The other thing is as organizations are looking at their security strategies is there seems to be a separation of church and state in the hospitals. The CIO is looking at technology systems and then you have the physical security people who are looking at things like cameras and remote monitoring of infrastructure. Those two teams need to come together. 

We need to learn that from a hacker’s perspective, the hospital is one big target, whether they are coming from a physical attack and place a USB drive on a machine and gather things or hack your remote cameras or directly go after your patient portal, EMR, or lab system. To the hacker, it’s all one thing. Within the hospital, it’s important that cybersecurity and physical security worlds come together and think about a cohesive and holistic strategy.

 

Health systems worry about international hackers, yet run unencrypted laptops. Would you focus more on employee and guest defenses that are based on physical security?

I would take a leapfrog strategy where I would try to cycle through things if I were the CIO responsible for hospital security. I would try to cycle through things where there’s a period of time where we focus a lot on end user education, minimizing end-user disturbance of systems, and thinking about how do we minimize that threat. Doing things like we need to encrypt our laptops. We need to or catalog our data at rest because we don’t know what’s really out there and scan for data at rest. Because that is a big vulnerability and that’s something that an employee is going to walk away with and now we’re at risk.

The second cycle is to keep thinking about is there a external threat that’s going to compromise this, and if so, how is that going to happen? The challenge to a hospital system is that it’s such a big target compromising so many different areas. 

You’ve got to continue to look at both sides of that equation. If you could cycle back and forth and say, look at the human element of this and what’s that threat from inside the four walls and what’s the external threat, it probably would pay dividends over time.

 

Do you have any final thoughts?

Some short, quick hit strategies. Educate boards let them know what’s going on. Don’t be scared of what’s occurring. Like anything else that’s big and scary, it’s better off to face it and be very aggressive about it and deal with it. At the end of the day, nobody is ever going to regret trying their best. The only thing that you’re ever going to regret is not having tried your best.

In this world, given the stakes of patient lives, it’s something that’s important that those in charge of cybersecurity and physical security in hospitals do everything they can to try and minimize that risk.

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December 22, 2014 Interviews No Comments

Morning Headlines 12/22/14

December 22, 2014 Headlines No Comments

HTC Global Services of Troy buys Troy-based CareTech

HTC Global Services acquires CareTech, a consulting firm that focuses on health IT consulting. Both companies are headquartered in Troy, MI.

Rep. Renee Ellmers Letter to HHS

House Rep. Renee Ellmers (R-NC) and 29 other House representatives send a letter to HHS imploring Secretary Sylvia Burwell to reduce the MU Stage 2 reporting period from 365 days to 90 days.

Merge Healthcare Reaches New 12-Month High at $3.63

Merge shares reach a 52-week high, closing Friday at $3.63. Shares are up 54 percent year to date.

The NHS’s chaotic IT systems show no sign of recovery

The Guardian reports on health IT in the NHS, focusing on anecdotal tales from the recent troubled Epic implementation at Addenbrooke’s Hospital.

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December 22, 2014 Headlines No Comments

Monday Morning Update 12/22/14

December 21, 2014 News 7 Comments

Top News

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HTC Global acquires CareTech Solutions. Both companies are in Troy, MI. I reported on November 24 (tipped off by a reader) that the Federal Trade Commission had approved the acquisition.


Reader Comments

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From Vermonty: “Re: UVM and patient poaching. The fertility clinic’s staff accessed the EHR looking for candidates to contact and one of those patients complained, triggering an EHR audit that revealed the unauthorized access. Lucky for UVM it was fewer than 500 patients. UVM has filed complaints with the state and the medical society and is suing the practice. This will get ugly.” Unverified.

From The PACS Designer: “Re: health clinic of the future. Forbes had an interesting article about data inhaling, where patients and everyone in the health treatment process work from the same platform. The key element of the concept is everyone has ownership of the same data.” I didn’t get anything from it other than some very brief and generic pie in the sky thoughts, but to each his own.


Anonymous Reader Report: Being a Patient in my Own Hospital System

My husband has a tendency  for vertigo. We called 911 for a severe episode and he was taken to the ED at 10 p.m. They said the CT scan showed a brain anomaly (which our PCP later said was normal) and sent us to Hospital B at 4 a.m.  We ended up in the stroke unit, which we found out only because of the sign on the door – nobody told us. The neurologist said he was OK and discharged him. Radiology showed up at noon to do a test that we hadn’t been told about.

I started getting anxious at 4 p.m. and asked to see the hospitalist, but was told she was too busy. I paged the nurse supervisor and she could get no action either. At 9 p.m. I asked to speak to another nurse supervisor and again was told that the hospitalists was too busy. I gave up at 10 p.m and went home since my husband was feeling OK.

The next morning he was served a breakfast of straight sugar and carbs as a non-insulin dependent diabetic. Not surprisingly, his blood sugar showed a little high and they gave him insulin, which we objected to. At 9 a.m. the neurologist poked his head in wondering why we were still there after 24 hours of no contact with a physician. I again called the nurse supervisor, who finally did get the hospitalist to say he could go home.


HIStalk Announcements and Requests

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Two-thirds of poll respondents say ONC should focus on interoperability, with less than 4 percent excited at the prospect of an ONC-run health IT safety center. New poll to your right or here: as 2014 draws to a close, are you personally happier now than a year ago?

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Hot coffee was the easy winner in my poll asking which beverage readers most preferred to drink at work, racking up 56 percent of the vote. It was followed by water (16 percent) and hot tea (14 percent). The least-favorite drink from my list was non-diet soda, with only 2 percent of respondents favoring it.

Reluctant Epic User provided his own suggestion for those whose employer doesn’t provide free java: “Use only fresh, unground medium roast beans, get an AeroPress, a grinder, and a tea kettle. Leave the milk in the cows and the sweeteners at the chemical plant.” The $25 Aeropress coffee and espresso maker has 3,300 Amazon reviews and a rating of 4.5 stars, which sounds great other than it’s a bit of a pain compared to turning on the coffee maker, it makes only  four cups (which is probably really two of the size I like) per pressing, and you would have to keep the extra amount warm yourself.


Here’s the video from Ed Marx’s book launch last week for “Extraordinary Tales from a Rather Ordinary Guy.”


Last Week’s Most Interesting News

  • An Advisory Board analyst’s review of Eligible Hospital attestation numbers for Meaningful Use Stage 2 finds that 66 percent that are eligible to attest have already done so, projecting that 95 percent will have achieved MU Stage 2 by the time information from the last quarter of 2014 is available.
  • Consumer Watchdog urges Californians to opt out of the state’s HIE because the group hasn’t explained its privacy policy clearly.
  • Sony Pictures warns that HIPAA-protected information from its health plan was stolen by the hackers responsible for its huge data breach.
  • Karen DeSalvo gets a new employee as Vivek Murthy, MD, MBA is confirmed as surgeon general by the Senate.
  • The FY15 Omnibus bill includes $32 billion for DoD health programs (including its EHR project) and $344 million for the VA to modernize Vista, but keeps ONC’s budget flat at $60 million instead of the $75 million it requested.

Acquisitions, Funding, Business, and Stock


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Healthcare technology services investor Carrick Capital Partners names retired Senator William H. Frist, MD as a special advisor.

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Merge Healthcare shares hit a 52-week high Friday, closing at $3.59 and valuing the company at $344 million. Above is the one-year MRGE share price (blue, up 56 percent) vs. the Nasdaq (red, up 16 percent.)


Sales

MultiCare Health System (WA) joins Premier.


People

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Huntzinger Management Group promotes Nancy Ripari and William C. Reed to partner.

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CompuGroup Medical US promotes Chris Lohl to VP of R&D, ambulatory information systems.

Alice Peck Day Memorial Hospital (NH) hires Kristen Kneisel (Cornerstone Advisors) as AVP of information services.

Anthelio names co-founder Chick Young to its board.


Announcements and Implementations

Blood glucose tracking capabilities will return to the iPhone and iPad with the release of iOS 8.2, in which an Apple Health patch was added to support a measurement unit common in Europe (mmol/L) in addition to the US standard unit of mg/dL.

CIO Review names CitiusTech as one of “50 Most Promising IT Services Companies.”


Government and Politics

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Rep. Renee Ellmers (R-NC) and 29 of her House colleagues urge HHS Secretary Sylvia Burwell to reduce the 2015 Meaningful Use Stage 2 reporting period from 365 days to 90.


Privacy and Security

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Boston Children’s Hospital (MA) will pay $40,000 to settle charges brought by the state’s attorney general following the theft of an unencrypted, PHI-containing hospital laptop from a physician presenting at a conference in Argentina. The physician mistakenly thought he had erased the information of more than 2,000 patients and failed to follow BCH’s encryption policy.

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Northwestern Memorial Healthcare Group (IL) notifies almost 3,000 people that their medical information was contained on an unencrypted laptop that was stolen from an employee’s car in October.


Other

An editorial in London’s The Guardian says that the Epic-related problems at Addenbrooke Hospital are “the latest installment in a long-running saga in which British public institutions display their inability to introduce complex IT systems without causing chaos and distress.”It adds that Epic’s user interface has progressed from “abysmal and dysfunctional” to “merely ugly” but at least it works. Update: a reader pointed out that the user interface comments were directed at the physician practice system, not Epic, thus the timeframe referenced in years vs. Epic’s October go-live. The article combined both the Epic issues and other healthcare software in general. 

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I mentioned last time that I tried First Opinion, which offers free texting to physicians, and listed the pluses and minuses. Here’s an addendum: Dr. Kia did indeed text me back from India the next day to see how I was doing and we had a nice chat. I was impressed even though I don’t entirely see the point since non-US doctors can’t diagnose or prescribe.

Patient advocate and The Walking Gallery founder Regina Holliday is trying to raise $75,000 to create the Walking Gallery Center for Art and Healing in Grantsville, MD. Donate $10,000 and she’ll deliver a keynote address and workshop at your meeting.

A Black Book survey of small-hospital CFOs finds that revenue cycle system upgrades have been deferred in favor of ICD-10 and Meaningful Use projects. Two-thirds of small hospitals that said in 2012 that they would replace their RCM system still haven’t done so.

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Nurses, doctors, and pharmacists (in that order) are named as the most honest and ethical professions (and this the most trusted) in a Gallup poll. At the bottom of the list are care salespeople and members of Congress.

A study finds that less than half of the recommendations of TV huckster-doctor Dr. Oz are supported by medical evidence, while 39 percent of his recommendations were not backed by evidence and 15 percent were contradicted by it. The authors conclude that TV doctors rarely address their own conflicts of interest.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 21, 2014 News 7 Comments

Morning Headlines 12/19/14

December 18, 2014 Headlines 1 Comment

First real-world trial of impact of patient-controlled access to electronic medical records

In a small study, 105 patients are given the ability to hide certain parts of their medical record from their doctors, with a “break incase of an emergency” feature built in so that doctors could bypass the lock if needed. By the end of the six-month study, 49 percent of the patients had decided to hide some portion of their record.

Many say meaningful use Stage 2 is disastrous, but the data say otherwise

While the numbers on Meaningful Use Stage 2 seem grim, Advisory Board Senior Consultant Tony Panjamapirom says that 65 percent of the hospitals scheduled to attest to stage 2 this year have already done so, with many more expected to attest before December 31. He says that between these attestations, and those that are pursuing hardship exceptions, more than 95 percent of stage 2 eligible hospitals will be in compliance by the end of the year.

Medfusion names Allscripts and M*Modal vet as CEO

Medfusion founder Steve Malik will step down as CEO of the company, passing the reigns to Vern Davenport, formerly of MModal and Allscripts. Malik will stay on as the executive chairman.

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December 18, 2014 Headlines 1 Comment

News 12/19/14

December 18, 2014 News 8 Comments

Top News

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The research wasn’t all that great, but the methods were pretty cool. A Regenstrief study finds that half of urban clinic patients who were able to selectively hide parts of their EHR information chose to do so. That’s from a ridiculously small study cohort of 105 patients, so don’t get excited about the results just yet. What was interesting is that Regenstrief developed a system in which patients can lock clinicians out of specific sections of their own EHR information, such as as those involved sexually transmitted disease or mental health. However, the system also contains an audited  “break the glass” button that allows clinicians to override the patient’s preference in urgent situations. I like the elegance of that solution, although the challenge would seem to be adding granularity so that specific types of clinicians could see information without having to use the “break the glass” option (allowing a gynecologist to see the STD information, for example).


Reader Comments

From Sell Sider: “Re: JPMorgan healthcare investor conference in early January. Half of healthcare is there. HIStalk should have coverage or attendee Q&A or something.” The San Francisco conference is by invitation only, so I would have to rely on an attendee to write up their experiences. I’m up for it if someone is willing to share their experience. JPM covers all of healthcare, but I’m sure plenty goes on related to IT. Ben Rooks provided some background in an “Investor’s Chair” post five years ago (where has the time gone?) JPM is also one of the scumbag “too big to fail” banks that ripped off American taxpayers in creating the 2008 financial crisis through greedy speculation, earning it massive profits, $25 billion in bailout money, a $13 billion slap on the wrist, and no criminal charges.

From Tilde Squiggle: “Re: fertility clinic competition. Efforts to reduce cost appear to be stymied by The Man. What happened to free markets?” A dozen doctors and other professionals from University of Vermont Medical Center open a fertility clinic whose costs are 30 percent less than UVM’s, which is great for everybody except UVM, which is suing the group. UVM says the clinic’s employees have access to its EHR and could be using that information to poach its patients, which the clinic denies.


HIStalk Announcements and Requests

I’m interested in running a regular column by either a startup CEO or a venture capitalist who wants to share their keen insight and sharp writing skills with the world. Let me know if you are interested.

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There’s only so many ways companies can try to stand out at the HIMSS conference. Most of them are expensive and don’t work anyway, so here’s an alternative: sponsor the highly anticipated HIStalkapalooza event. I’m offering three sponsorship levels: Platinum (includes 100 invitations for customers, prospects, and employees; an information table in the welcome area; and a private opera box for entertaining); Gold (50 invitations and an information table); and Silver (a private opera box and invitations for 12-14 guests). Sponsors at all three levels will be recognized at the event and on HIStalk before and after. I don’t usually announce the venue until later, but here’s the scoop: I bought out the entire House of Blues Chicago (just off the river on North Dearborn behind the Trump) and the deal includes the ultra-swanky, members-only Foundation Room. Your company is spending a fortune to exhibit at HIMSS, so spend a little bit extra and you’ll get major exposure to the industry’s movers and shakers who read HIStalk. Contact Lorre and she’ll send information, but hurry because we’re about to close the window on new sponsors. The event is break-even at best for me and is frankly a pain in the butt to put together (I swear every year that I’m done with it), but people seem to enjoy it and I got sucked back in again in a weak moment.

This week on HIStalk Practice: Compleat Rehab and Sports Therapy Center and Hot Springs Sports Medicine select Clinicient services. CMS consultants travel to Micronesia. Fremont Family Care receives the HIMSS Ambulatory Davies Award of Excellence. Sony and Snapchat get into smartglasses. Dr. Gregg pontificates upon pain, EMRs, and appreciation. Toby Sadkin, MD puts plans for EHR replacement in perspective.

This week on HIStalk Connect: Google Ventures goes all in on digital health, quadrupling its investments in the sector during 2014. Investment funds and startup accelerators focused on digital health companies are also on the rise. In Colorado, the Quality Health Network, one of the nation’s first health information exchanges, forms a trade group with 20 other HIEs to advocate for the struggling HIE industry and explore new revenue opportunities.


Acquisitions, Funding, Business, and Stock

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Online doctor visit provider American Well closes an $81 million Series C round, raising its total to at least $128 million. I was thinking about the popularity of those $49 visits and had the same reaction as when I see two of four corners of major intersections taken up by chain drugstores and pharmacy-containing grocery stores: where are they getting all those professionals? The schools aren’t cranking out doctors and pharmacists any faster, and yet the retail demand for them keeps going up.

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Analytics vendor Predilytics raises $10 million in a Series C round. I’m trying to stay interested in the analytics marketplace, but everybody and his brother are starting up companies with splashy websites and buzzword-laden assurances of competence. This one is a real company, but I suspect that the only revenue many of the newcomers will book will come from investors rather than customers. Check back on the HIMSS15 exhibitor list of analytics vendors three years from now and I bet 80 percent of them will have failed.

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First Opinion, which offers 24×7 access to a permanently assigned physician via text messaging, raises $6 million in Series A funding. The service costs $9 per month for a guaranteed service level of 5 minutes, but is free otherwise. I downloaded the app, submitted a profile consisting only of age and gender, and was connected to Dr. Kia in India. Her profile didn’t say where she went to medical school, but it did offer that she has “1 kid” (I’ve eaten curry goat several times on Indian buffets, but I don’t think she was talking about that). I texted that I was sneezing and congested, which is true since I’m getting over a cold. She asked some questions that sounded like they were composed in advance by an English as a second language layperson to avoid wasting the doctor’s time. I received responses quickly, just like a real text messaging conversation except with oddly excited reactions to my responses (like “Alright!” and “Oh okay!”). Our conversation ended with a little personal note: “I love to take some chicken soup when I am down with a cold. With a dash of pepper the soup can make you feel much better.” She promised to check on me later and I did indeed eat (take?) a can of Progresso Light Chicken Pot Pie soup onto which I added many dashes of pepper, although in full disclosure I had already done that before I texted Dr. Kia. My analysis of First Opinion is reasonably positive, but the service has significant limitations:

Pluses

  • The app was quick to install and use. It looks like text messaging, but it’s a separate app that vibrates the phone like a new text message when the doctor responds.
  • Connection and the doctor’s response were nearly instantaneous.
  • The doctor was about as interactive and caring as you can get when texting with a stranger half a world away.
  • Her suggestions, while somewhat generic, were pretty good.
  • Promising to check back later was a nice touch regardless of whether she actually does.
  • I would have felt comfortable asking prevention-type questions: diet, exercise, etc.
  • When I restarted the app, the previous conversation was still there, plus it offered to sync with Apple Health and push the information to Dr. Kia, which was pretty cool even though I don’t know what she would have done with it.
  • I don’t know if I could have texted a photo of one relevant body part or another if the situation warranted (I was snickering at the idea of texting over something inappropriate and getting a computer-assisted “Oh okay!” from Dr. Kia.)

Minuses

  • The doctors aren’t licensed in the US, so they can’t prescribe or diagnose. The user agreement suggests that even though you’re chatting with a doctor, they’re only offering personal, anecdotal suggestions and not medical advice.
  • I’m not sure what happens for anything but the simplest conditions other than “contact your doctor,” like if I claimed to be coughing up blood or running a 104-degree temperature.
  • The doctor has zero information other than age and gender, although perhaps she would have asked if she needed anything additional.
  • She recommended decongestants and antihistamines without asking about allergies, hypertension, glaucoma, etc. A Walgreens pharmacist would have ruled those out before suggesting potentially conflicting non-prescription meds.

People

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Quality Systems names Zachary Sherburne (Spectrum Brands) as global CIO.

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LifeLabs Medical Laboratory Services hires Brian Forster (OntarioMD) as SVP/CIO.

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Medfusion promotes Vern Davenport to CEO. Founder Steve Malik, who sold the company to Intuit and then bought it back, will stay on as executive chairman. The company says it has 10 million patients using its portal.


Announcements and Implementations

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Premier, Inc. joins the Coalition for ICD-10.


Government and Politics

Tony Panjamapirom, PhD with The Advisory Board Company says hospital Meaningful Use Stage 2 attestation numbers are being misinterpreted to mean the program is failing. He says it’s true that only 35 percent of all Eligible Hospitals have met Stage 2 standards through December, but 66 percent of hospitals that were scheduled to attest in 2014 have done so. He concludes that the flexibility rule that allows hospitals to attest to Stage 1 requirements in 2014 if they have software problems means that 95 percent of hospitals will attest in 2014. The EP numbers are too preliminary to call since most of them will use the October – December 31, 2014 reporting period. In a nice finish, he says, “The MU program is not just about what providers can or should do. It is about all of us. We all need to keep in mind that the ultimate goal of the MU program is to promote better care and better health for consumers/patients, including ourselves.”Actually, the ultimate goal of the MU program was to defibrillate a wheezing US economy and get providers to buy EHRs they weren’t willing to spend their own money on, but I’ll go with Tony’s more poetic words.


Privacy and Security

The CEO of Sony Pictures was warned about IT security problems three weeks before hackers gutted its systems. The company had software problems that it blamed on software bugs and incompetent IT people, the CEO himself sent his passwords to his assistant in unsecured email, sensitive documents were stored unencrypted, and company policy required employees to keep too many old emails. An email from the CFO to the CEO (exposed, ironically, by the hackers) noted, “significant and repeated outages due to a lack of hardware capacity, running out of disk space, software patches that impacted the stability of the environment, poor system monitoring, and an unskilled support team.”

With regard to Sony, which is worse: (a) having such sloppy IT processes that a 100TB hack wasn’t noticed, or (b) buckling to demands and threats from anonymous hackers that a major film be pulled just because they invoked 9/11? As Newt Gingrich said in a tweet, “With the Sony collapse, America has lost its first cyberwar. This is a very very dangerous precedent,” although a waggish response tweet said maybe it’s Japan that lost since Sony isn’t an American company. Skeptics doubt that it was really North Korea behind the breach since the hackers didn’t mention the movie until later and the extent of the hack make it likely that it was initiated long before anybody heard about now-mothballed and apparently awful “The Interview,” of which no trace remains on the company’s site. In any case, if you needed further motivation beyond never-ending announcements of breaches and unencrypted laptops to review your organization’s security, this should do it.


Innovation and Research

A physician-authored editorial explains why most healthcare IT startups are neither disrupters or the Uber of anything: they are focusing on the wrong patients and wrong problems using technology that has limited ability to benefit the sickest and most expensive patients. He likes the Swasthya Slate diagnostic testing add-on for Android devices (which I was fascinated by and mentioned a few weeks ago) and the “hot spotting” concept of providing intensive outreach therapy to the most expensive patients.


Technology

This might make Dr. Jayne’s Christmas wish list: the $125 lab coat of travel vest company SCOTTeVEST, which contains 16 technology-enabled pockets, a system of distributing weight so that heavy pockets don’t pull, and a personal area network that connects headphones to pocketed devices.


Other

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Consumer Watchdog urges Californians to opt out of the insurance company-backed Cal Index HIE, saying that it hasn’t explained its privacy policy clearly.

Lt. Dan writes a nice piece called “HIE 2.0: Data Exchanges Face Consolidation or Elimination” on HIStalk Connect. Lt. Dan (he’s a veteran and chose that nom de plume to avoid getting fired by his full-time employer) also writes the morning headlines on HIStalk, so if you like those — and many people do, according to my reader survey results — then he’s the guy to hat tip.

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Epic claims it doesn’t market itself, but this DoD pitch on its site suggests otherwise. I get the feeling that Epic is bending quite a few of its previously sacred rules (lobbying, press contact, non-compete clause) to pretty itself up in vying for the massive federal contract.

I was thinking about continuity of care and EDs for some reason. It’s tough to be both an ED patient and an ED doc because it’s the medical version of speed dating. The patients show up unannounced, they are quickly evaluated based on mostly physical characteristics, and just enough medicine is practiced to patch them up and get them out the door quickly and into someone else’s office later for the tougher slog of managing their costly and lifestyle-crippling chronic conditions. The fact that EDs exist means that both patients and doctors accept several principles: (a) it’s OK that physician practices keep 9-5 hours and let someone else deal with problems that arise the other 16 hours of the day; (b) ED docs have confidence, misplaced or not, that they can safely and accurately decide who can go home vs. who needs to stay; and (c) patients assume that given their particular symptoms and their brief narrative, the faceless provider who may have access to little of their medical history can fix them up just as well as anyone else. We’re trying to move the industry toward doctors and patients having an ongoing, committed relationship, but patients who aren’t really sold on the benefit seem to prefer zipless, unemotional encounters via video apps, kiosks, and doc-in-the-box drugstore clinics (that in fact have only the box, not the doc). Either we’re polarizing toward two radically different kinds of encounters or some serious marketing needs to be performed to help consumers understand the value of each (never underestimate the power of convenience over everything else, as evidenced by the drive-through breakfast line at McDonald’s).

I was also thinking about labeling people as “patients,” which I struggle with every time I write. Are you a practice’s patient if you choose them as your PCP but haven’t seen them yet? If you were last hospitalized 10 years ago, are you still considered to be that hospital’s patient? We’re all patients at one time or another, so maybe the term should be retired in favor of something more descriptive of the many flavors of healthcare delivery. Or maybe less descriptive, since all patients are people or (arguably) consumers. My mental reaction to the word “patient” after decades of working in hospitals is, unfortunately, of someone who is dumped involuntarily into a confusing, paternalistic medical system that was designed for providers, not them, and where their job is to do as we tell them without complaining, wasting our time, or even participating so we can make everybody happy by sending them out the door at first opportunity. Even people who have spent a lifetime working in a hospital or practice feel vulnerable, marginalized, or poorly treated when forced into the temporary role of someone’s patient, no different than the rude awakening law-abiding citizens get when encountering the wrong side of law enforcement for the first time. I’m interested in hearing stories about what it’s like being a hospital employee who is hospitalized. I’ve only spent one night in a hospital and my reaction was somewhere between appreciation (toward caring individuals) and frustration (being treated impersonally like a widget and annoyed by the ever-present and sometimes smug inefficiency).

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Lodi Health (CA) will affiliate with Adventist Health as the latter promises to invest $100 million in an EHR and to help the hospital meet earthquake requirements.

HIMSS runs yet another list of all-too-obvious (and self-serving) tips for attending its annual conference. Here are some from me.

  • Don’t attend any educational sessions that feature even one vendor presenter because it will end up being a sales pitch. In fact, given the quality of educational sessions over the past years, seriously consider not going to any educational sessions.
  • Bring a cheap external battery charger for your phone because it will run down trying to find a signal among a zillion attendees.
  • Don’t make appointments to see vendors. You’ll regret having a fixed slot messing up your day, especially with it’s a 20-minute hike away. You’re the prospect – they’ll free up time when you show up.
  • Don’t believe anything you see or hear in the exhibit hall.
  • Use your phone’s tethering capability in the convention center for a better and faster connection. Use it in the hotel to avoid the ridiculous $15 per day charge tacked on to an already overpriced room (unless HIMSS negotiates free service again this year, which is nice.)
  • Use the opportunity to pitch yourself for your next job. It’s a target-rich environment with all those companies and employees casting lustful glances at each other and it’s always nice to feel wanted even if you spurn the employment advances.
  • Lunch options in the exhibit hall are poor, unhealthy, and overpriced (unless you’re enjoying the CIO-only luxury track for the same registration fee the rest of us peons pay for steerage class). Book a hotel that offers a free breakfast (if such a thing exists in Chicago), then graze through the day at booths giving away snacks.
  • Load up on enough sticky notes, lip balm, and thumb drives to last until next year.
  • Don’t hang around the exhibit hall until late in the afternoon just to get free happy hour food. The lines can be long and the snacks aren’t usually that great.
  • Guys, don’t flirt aggressively with women working the booth. You’re putting them in an extremely awkward situation and as hard as it is to believe, they’re not that into you.
  • Providers, don’t do anything you wouldn’t want your ED patients to see. They’re paying for your junket.
  • Don’t wear a suit unless you’re at the C level because you’ll look like a self-important douchebag. On the other hand, don’t (even on the last day of the conference) show up wearing shorts or leading toddlers.
  • Leave all the handouts you took just to be nice in your hotel room’s trash, along with your conference tote, badge, and other useless crap you accumulated. It’s not worth hauling home.
  • Stop by the microscopic HIStalk booth, which is always in almost-affordable exhibit hall Siberia near the restrooms. It’s the size of a Yugo, but usually has fun people stopping by since it gets lonesome back there.

Weird News Andy says we should fight global warming by eating chocolate chip cookies. A new study answers the age-old question: where does the fat go when you lose weight? Answer: most of it is breathed off as carbon dioxide. The author says that doesn’t contribute to global warming because humans don’t exhale ancient carbon atoms.

Vince put together a Christmas special “CIO Letters to Santa.”


Sponsor Updates

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  • RazorInsights celebrates its Founder’s Day by donating solar-powered study lamps, books, and snacks to students in a school near Bangalore, India.
  • HDS offers a white paper called “6 EHR Trends to Watch in 2015.”
  • E-MDs becomes the first EHR to exchange provider information with the infectious disease registry of the Kansas Health Information Network, helping users comply with Meaningful Use Stage 2 requirements.
  • EClinicalWorks congratulates Fremont Family Care (NE) for winning a HIMSS Davies Award of Excellence, the twelfth eCW user to win in the past seven years.
  • Greenway Health will sponsor pro golfer Blayne Barber, who will wear the company’s logo on his shirts.

EPtalk by Dr. Jayne

I ran across this piece on facility fees today. For those who have not yet encountered them, you’re lucky. The basic theme is that when hospitals employ providers to work in an “outpatient department,” they are billing in a way that charges both a facility fee and a provider fee. This may occur even if the provider’s office is not within the hospital proper, but is still identified as a department of the hospital. The principle is that the charges are to cover what CMS requires of hospitals rather than offices. The problem is that patients wind up paying on two different deductibles.

This reminded me of something that is glaringly missing in most EHR systems – easy access to cost data for tests and procedures. Most systems have formulary information that displays pricing – even if it’s just $, $$, $$$, and $!$!$!$!$ like a restaurant guide. What we really need to keep costs down is that kind of information for everything we order, including laboratory and diagnostic testing. The proliferation of so many insurance plans and product offerings makes it technically challenging to display the information in a usable fashion without negatively impacting system performance. The difficulty is compounded by the way that some of the costs are less than intuitive.

For example, if I want a glucose level and a potassium level to monitor drug therapy, it’s actually cheaper to order a basic metabolic profile (seven tests that include the two I want) instead. Now I’m forced to order tests I don’t want and that might have incidentally abnormal values that lead to more tests and greater overall cost. How do you represent that in the EHR? We’re trained to only order tests if the results will change the plan for the patient or influence the outcome, but here we are being pressured to violate that for financial reasons.

There is also a generalized concern that having cost information at the point of care will influence physicians to withhold care rather than using the information as a tool to discuss the pros and cons of a particular approach with the patient to arrive at a mutual decision. Of course such a discussion also requires time that we don’t have during a typical office visit, which skews the cost curve even further. With the potential for Meaningful Use Stage 3 requirements about to be dropped on us, I don’t look for software vendors to spend their development dollars helping us solve this problem.

In other news, Glassdoor published its list of the Top 50 places to work as determined by employees. Interesting members of the top 10 include Google, Nestle Purina PetCare (bring your dog to work!), In-N-Out Burger, and Mayo Clinic. Although several major health systems and pharmaceutical firms made the top 50, health IT vendors were decidedly missing.

Speaking of lists, results are out for the subspecialty certification exam in Clinical Informatics. Although one of my protégés reported a pass, the other two have been noticeably silent. I’ve been keeping my eye out for the full list but haven’t seen one yet. Looks like AMIA still has last year’s cohort listed on their website. If anyone has the full list, I’d appreciate being pointed in the right direction. I’d like to have my celebratory champagne (or sorrow-drowning bourbon) at the ready.

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I’ve written quite a bit about wardrobe choices for conference attendees and presenters. Several readers shared from The Atlantic a piece about physicians and their clothing choices. The author specifically mentions primary care and being somewhat put off when her new physician “clicked into the room in stilettos and a tailored expensive-looking suit.” Primary care physicians in our medical group run the gamut, from jackets and ties to wrinkled scrubs. The residency program faculty members who are women tend to favor Birkenstocks and broomstick skirts, which although stereotypical, seems to work for them. My favorite physician wears scrubs from competitor hospitals just to be ironic.

The author links out to a New York Times piece that discusses enclothed cognition, which describes the way clothing can impact thought processes. Researchers studying the phenomenon note that wearing a white coat that you believe is a physician jacket increases attention. Believing it belongs to a painter does not. Apparently it’s a subset of embodied cognition, where thought processes are based on physical experiences (including clothing) that can influence abstract concepts.

I had never heard of it using those terms, but admit it’s something I’ve experienced. Back in the days of pagers and being on call every third night during residency, it was almost a dressing ritual to receive sign-off from the outgoing call team. They’d hand off the code pager, the on-call pager, and any other pagers they might be holding while talking about the patients on the service. By the time you were done hearing about all the patients, you felt like you were wearing Batman’s utility belt and could handle whatever came your way.

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At one of the offices where I see patients, the physicians wear matching scrubs and have desk space in a shared bullpen. As I pull on my white coat and head out to see patients, it’s like readying for a sporting event. Some days are definitely more of an athletic contest than others, that’s for sure. On the flip side, I’m a sucker for black-tie events – there’s just something about putting on a floor-length ball gown that is transformative, whether you spent your day knee-deep in flu patients or up to your eyeballs in EHR documentation. Add a pair of killer shoes and a little bling and it’s even better.

Are you ready for some holiday sparkle? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 18, 2014 News 8 Comments

Morning Headlines 12/18/14

December 17, 2014 Headlines No Comments

HHS awards more than $665 million to design and test state-led efforts to improve health care quality, accessibility and affordability

HHS announces that it has awarded $665 million in grants to fund 32 state-level initiatives working to implement experimental health care payment models or service delivery models that could improve health care quality and lower costs.

More hospitals moving to improved EHRs, CMS reports

CMS releases the latest MU attestation numbers: 1,681 eligible hospitals have attested for MU Stage 2 as of December 1, up from just 840 that had attested by November 1.

Open Enrollment Week 4: December 6 – December 12, 2014

2.5 million people have used healthcare.gov to enroll in an insurance plan since the start of the 2014 open enrollment period, 52 percent are renewing policies they signed up for last year, while the rest are new customers.

State-Based Marketplaces Using ‘Clearinghouse’ Plan Management Models Are Associated With Lower Premiums

Health Affairs analyzes the premiums for health plans listed on state health insurance exchanges and finds that states that are more selective about which plans they list on the exchange, even if done in an effort to protect consumers, have significantly higher premiums than states that allow any qualifying health plan to be listed.

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December 17, 2014 Headlines No Comments

Readers Write: Review of the mHealth Summit

December 17, 2014 Readers Write No Comments

Review of the mHealth Summit
By Norman Volsky

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Last week I attended the mHealth Summit in Washington, DC. I met with 25 vendors over a two-day period and came away with several takeaways regarding mHealth industry trends and the companies that correspond to each.

 

Changing Patient Behavior

Many companies are trying to change a patient’s behavior and inspire them to participate in their own rescue. If you can change a patient’s behavior that resulted in them getting sick (eating unhealthy, not exercising, smoking, etc.), that patient has a better chance of staying healthy.

  • Telcare. Mobile diabetes solution that allows patients to manage their condition more effectively by providing them with timely and actionable information. Their enterprise glucose monitoring solution enables the entire care team to be connected so they can make a difference.
  • Propeller Health. FDA-cleared asthma and COPD management vendor that helps patients and physicians better manage chronic respiratory conditions. Digital products that have therapeutic benefit.

Reducing Cost and Readmissions

These two themes go hand in hand. Health plans, ACOs, and employers are looking to treat patients outside of the four walls of a hospital. Telehealth in the form of online doctor visits is helping reduce cost significantly for the healthcare system. Monitoring patients remotely and making sure the entire continuum of care is informed can prevent readmissions, reduce the cost of care by treating patients in the appropriate care setting, and prevent catastrophic events.

  • MDLive. Consumer-focused telehealth vendor that provides concierge connected care for customers of all socioeconomic backgrounds. MDLlive has the potential to become the Uber of telehealth by providing a fully integrated end-to-end solution to its customers.
  • Twiage. Communication platform that improves clinical workflow and outcomes by allowing first responders to deliver real-time data from an ambulance to an emergency department physician.
  • Ideal Life. End-to-end remote patient monitoring vendor that has been in the space for 12 years. Allows patients to self-monitor using a wearable device.
  • TruClinic. Medical Skype on steroids. Telemedicine services vendor that allows physicians to use the same workflows they are already using daily.
  • Wellpepper. Patient engagement vendor that provides personalized mobile care plans to patients. Reduces cost by using video capabilities that reduce need for multiple physical therapy visits.
  • SnapMD. Telemedicine vendor that enables doctors (particularly specialists) to develop a digital practice in addition to their core business. Leverages built-up trust with a patient’s personal physician.
  • Lively. Personal emergency response vendor that provides non-invasive wearable device and activity sensors that monitor an elderly person’s behavior and alerts family members if their behavior changes to prevent falls and emergencies.

Managing Risk Effectively

Government regulation has changed how patient care is being paid for. The healthcare industry is morphing from a fee-for-service to a pay-for-performance environment. If a health system can effectively manage risk, they are much better positioned in the new environment.

  • Wellbe. Guided episode management vendor that helps organizations manage risk more effectively and transition into value-based care and bundled payment environment.
  • Acupera. True population health management vendor that created unique workflow engine that guides physicians on a minute-by-minute basis and assigns tasks to the appropriate care team members.

Communication, Interoperability, and Secure Messaging

Patient information is extremely sensitive and confidentiality is paramount. HIPAA compliance is required. Companies have used secure texting, communication, and interoperability to improve medication adherence, referral management, clinical workflows, and many other issues in the healthcare market.

  • CareSync. Facebook for your health. Mobile health platform that helps build a unified patient record and a common care plan. Allows doctors, family members, and friends to monitor a patient’s chronic condition and overall health.
  • Memotext. Medication adherence vendor using a secure messaging platform and behavioral questionnaires to improve patient compliance to medication regimens.
  • Health123. Patient engagement platform that allows HIPAA-compliant communication.
  • Carevia. Telecommunication platform that helps organizations with interoperability.
  • Doc Halo. True mobile health platform that improves workflows and reduces readmissions by enabling secure communication throughout the continuum of care.
  • Mobile Health One. Communication platform that allows validation at the point of registration. Solution has real-time fluidity that improves clinical workflows.
  • Shift Health. Mobile patient engagement platform that addresses survey fatigue by customizing surveys for a healthcare facility.
  • Zoeticx. Sells a middleware solution that addresses patient medical information flow. They help improve outcomes and workflows by overcoming the problems of effective health information exchange and poor EHR interoperability. Their mobile platform has care coordination tools as well as a secure messaging platform that is triggered based on events.

Miscellaneous Emerging Technology

There were several vendors I met with that were doing some unique things that did not fit into the above industry trends.

  • VisualDx. Specializes in diagnostic clinical decision support. They differentiate from other clinical decision support vendors because they are using visual diagnostics to help physicians arrive at the correct diagnosis. They also have a search tool to isolate common infectious diseases based on specific countries. The recent news surrounding misdiagnosed cases of Ebola has moved this type of technology to the top of mind of C-levels at hospitals.
  • Validic. Industry-leading digital health platform that delivers easy access and actionable data that healthcare companies can analyze effectively. It is a back-end solution that provides maintenance and integration for the entire digital health ecosystem.
  • J Street Technology. Scheduling software that automates the process of backfilling cancelled appointments. Securely texts patients to confirm appointments and makes sure doctors’ schedules are optimally filled.
  • Care Connectors. Back-end integration vendor that provides bi-directional communication and coordinated care solutions to enable the healthcare ecosystem.

Overall, I saw a lot of awesome technology. This is a growing, exciting space and I am very fortunate to talk to interesting people throughout the industry daily. It is not surprising that private equity and venture capital firms are investing heavily in the mHealth market and I think they will continue to do so for many years to come.

Norman Volsky is director of the mobile healthcare IT practice of Direct Recruiters, Inc. of Solon, OH.

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December 17, 2014 Readers Write No Comments

HIStalk Interviews Frank Fear, VP/CIO, Memorial Healthcare

December 17, 2014 Interviews 1 Comment

Frank Fear is VP of ancillary cervices and CIO of Memorial Healthcare of Owosso, MI.

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Tell me about yourself and the health system.

I’m the vice president of ancillary services and the chief information officer at Memorial Healthcare in Owosso, Michigan. Owosso is about 20 miles from Lansing, 25 miles from Flint, and 25 miles from Saginaw. We’re a 150-bed hospital with 1,100 employees and a medical staff of about 120. Employed physician offices totaling about 15 offices and 50 providers that are sprinkled throughout about a 20-mile radius from the hospital. 

Although we’re considered a community hospital, we have a lot of competition with hospitals in Lansing, Saginaw, and Flint. We’ve leveraged technology as a differentiator for us. Utilizing IT to approve efficiency, quality, safety, and frankly, trying to attract doctors. It’s very competitive for not only patients, but also attracting good doctors. I think we’ve been really successful. We’re very proud of our ability to recruit physicians. We haven’t had a lot of challenges there.

I really enjoy working here. We’re a size where we have some resources to get things done, but we’re not so big that it takes time to get things done. There’s not a lot of bureaucracy. It’s a lot of fun to work with our executive team and board. They see IT as a strategic asset and not an expense. The ability to go right to the exec team and the board and say, hey, I want to do this new, next idea that I think will have a positive impact, work with them. Apple Health integration is an example of that.

 

How will you use Apple Health integration?

We’ve had a patient portal for a while and we’ve attested for Meaningful Use Stage 2 in the hospital. As we all know, patient portal is one of those requirements. We’ve seen some mild success there, but it’s one of those things where we’re asking the patient many times to go out and access that. It’s almost passive patient engagement. We’re putting your data out there it’s available for you to better manage your care and and be more informed as a patient. But we’re really looking for the patient to go out and get that data.

We’re trying to figure out, how can we be more actively engaged with our patients? I like to think that there was some like grand, great vision that goes into this stuff. [laughs] I started thinking about and working with Frank Fortner, president of Iatric Systems, and said, you know, we’re always looking down at our phones. It’s almost embedded in our work flows now that you look at your smartphone. People are using Fitbits and they’re using different apps on their phone. Is there a way that, instead of us building an app or developing something and asking the patient to go look at it like we build a portal, can we somehow engage patients actively and leverage what they’re already doing and making it a richer experience?

We’re in the beginning phases of it. There’s no fully developed product or anything. I don’t want to give any misconception there.

Ever since I upgraded my iPhone to the 6, I pull up how many steps have I had today and say, I have to put a few more thousand steps in to keep myself at that average. How can Memorial Healthcare get in that workflow and enrich that experience for the patient?

 

The doctor can’t really do much with step counter information. Do you see the Apple Health-powered patient engagement going beyond that?

That’s our vision. [laughs] If a patient’s looking at that app on a regular basis to do steps, could we push vital signs to it? Could we push blood pressure to it? Diabetes is such an epidemic in our country. Could we push blood sugars to it and not ask the patient have to type that in? We’ve already captured some of that information at their office visit. Could we enrich that Apple Health application to make it more valuable for the patient and connect them or tie them back to their care provider? 

That’s how we’re envisioning Apple Health. Enriching that app so it’s more useful for the patient.

We look at Apple Health as just a starting point. We want to leverage that the tool that we’re developing with Iatric to push data to the next app. Let the patient choose what apps that they’re going to want to utilize. Apple Health, we thought, was a natural starting point. It’s already on the phone. You don’t have to install it. Apple’s done such a good job with usability.

Whatever comes next, we have this integration tool that would push data to these apps to make them more useful, more valuable. That’s our vision. We want to push data that we think that will make that application more usable, more valuable for them. If they’re already actively looking at it, we’ve somehow dealt with that hurdle of getting people to utilize it. They’re seeing some value there at some level. How can we extend that?

 

When you look at your IT capital budget over the next few years, where will you be making investments?

Next year we’ll be focused a lot more on real-time analytics to improve quality at the point of care. We’ve got dollars budgeted to look at data in real time as patients are in the hospital or an office visit to say, we know you have an office visit. We know you have certain chronic conditions. We see that there are certain labs being done, certain meds. Start prompting providers to query the patient or suggest something that they need to order.

On the hospital side, with Core Measures, value-based purchasing, clinical quality metrics, it’s looking at the data and then suggesting actions to providers. Starting to alert them as the discharge comes near. Or some sort of time parameter … certain antibiotics need to be given so many hours before a surgery. We start suggesting.

We’ve built a lot of that stuff into order sets, but now we want something that’s a little more dynamic that is notifying a nurse or notifying a doctor. Sepsis is a big focus for us. Having some automated tools that start looking at different data elements and notifying the nurse of potential sepsis and then notifying a physician as it escalates that they take certain actions. 

For us, the analytics is going to be more of a real-time nature. We’re already doing some stuff with population health and tools there that look at a population and look at risk stratification, identifying higher risk patients and engaging them. We’re doing some stuff there already. I don’t know if we’ll continue that investment, but when you talk about net new, it’s going to be more of that real-time actively engaging patients based on data that we already have in our systems.

 

You’re feeling good about your Meditech and Allscripts systems?

We’re on Meditech Magic. It’s a tool that we’ve had for going on 21 years at Memorial. We know we’re going to need to do something with it. But we’re spending quite a bit of time trying to understand what value will be created and what business problem will be solved by upgrading our Meditech Magic system to the latest and greatest Meditech platform or another platform.

It’s a significant capital expense, but it’s also a significant resource drain on the entire organization. It pulls us away from other projects that we could be doing that are non-IT related. We’re spending a lot of time understanding the value proposition for us before we decide to go down that road.

Meditech has not announced the end of life of Magic. There’s been some recent announcements I think that actually extend the life of our Meditech Magic system. We’re trying to leverage third-party systems to do some of the analytics that our Meditech system is challenged with since it’s a 20-plus year platform for us.

 

Which health system priorities and challenges will have the most impact on IT?

There’s a laser focus from our board all the way down to the frontline staff on clinical quality. It’s critically important that we provide the safest care, highest quality care, and frankly, the most efficient care that we can provide. We’ve hired a vice president that’s focused on process improvement and efficiency. We’re seeing cuts in reimbursement. We’re heavy Medicaid and Medicare in our region, so we need to figure out a way to be able to be sustained on that Medicare or Medicaid type of reimbursement. There’s a real focus there.

There’s a definite role that IT plays there and can play a big part. We have played a big part up to this point, but we need to elevate our game to another level and try and move away from so much implementation mode and spend a lot more time in optimization. Then when we are in implementation mode, that it’s clear to us that there’s going to be an impact to an outcome measure that’s going to improve quality and efficiency. We’re going to play a big role there. 

Employee engagement, physician engagement, and leadership development are three key strategies for us. They all center around people and engaging people. These systems that we’ve implemented directly impact our day-to-day physician workflows, directly impact our employee workflows. Really, truly engaging those folks to understand how we can improve those tools and improve their quality of life at work.

Not have the tools be an annoyance factor, to be something that enriches their work and they feel strongly about it. I’m not suggesting that they don’t feel that way, but there’s more work we can do there to ensure that we’re enriching the patient experience and not causing frustration. 

When a physician is frustrated and struggling using a system, it impacts their overall engagement. It impacts their satisfaction and ultimately impacts how they deliver care. Spending a lot of time with our physicians and staff and engaging them and improving and optimizing these tools. Making sure that we truly hear their concerns, respect them, and are sensitive to them. That doesn’t mean we can fix everything or make every change they request, but a two-way engagement where they’re bought in and they understand the limitations.

 

What should vendors know about your job and your challenges as a CIO that perhaps they don’t?

For our vendors, as much as I have a love-hate relationship with them, they’re critical to my success and the organizational success. If our systems don’t perform well and work well, it’s very difficult for an organization to be successful. It’s just the reality of it. They have a huge responsibility for being just good for basic things — good support, attentive. 

I know they’ve been tremendously pressured with Meaningful Use to deliver applications in such a short turnaround time. But it’s critical, beyond just being responsive and providing good customer service, that in that partnership that truly is a strategic partnership, that they spend some time understanding not just Meaningful Use, but what some of the key drivers or key focus areas that the executive team is focused on and that our board is focused on. Then working with us to try and develop applications or optimize applications to try and move whatever outcome measure that we’re focused on, that our board is focused on, our community is focused on. That takes time.

We’ve had a wonderful relationship with Iatric and I think this is an example. Frank will come up and sit down with me and we’ll have conversations about what are the main things that you’re focusing on right now. We’ve built tools in the past with them to address our strategic priorities. That’s so important, that they stay in touch and in tune with what’s going on with our organization and providing solutions that will address some of those challenges. 

Easier said than done. I know they’re under tremendous pressure to deliver regulatory compliance functionality, but if we focus just purely on the regulatory stuff, we’re not going to be successful. We need to be able to make sure that we’re addressing some of the strategic priorities that go well beyond Meaningful Use and ICD-10. That’s so tough with limited resources, but we have to find ways to address that stuff. That’s what this Apple Health thing is that we’re trying to do. Actively engage our patients to keep them connected to organization to improve quality and better care.

 

Do you have any final thoughts?

Behind the Apple Health piece, we’re spending a concerted amount of effort on the security side of the tool. Part of this implementation is going to be educating our patients on what it means to use a tool like Apple Health or any other application where they’re sharing their health data and what that will mean and implications for that. It’s tremendously powerful tools, but we’ve got to make sure that our patients understand some of the potential risks with pushing that data to a centralized repository. 

We’re developing goals for the project right now with Iatric and ensuring that the application that we’re going to leverage to push data to Apple Health that is SSL encrypted, that data isn’t stored on the actual device. Of course, once it gets pushed to Apple Health, it’s going to be stored at some level on the device, but making sure that the rigor is done there to educate patients on the risk and then do everything in our power to secure the application and ensure that the transmission process and the review of the data process is done securely.

Another piece that I feel very strongly about as we go down this Apple Health path is that data isn’t necessarily just automatically pushed. A patient is notified that, hey, there’s new data available, evaluate it and determine whether you would like this data in Apple Health. Having the patient be more actively engaged in making decisions about the data that they own. Having it notify them goes beyond that passive engagement where they have to go out to a patient portal. There’s new data there.

They may not even be sometimes be aware of it. You go to the physician office, they take your vitals, your blood pressure. Sometimes the doctor may not share the vital information or they may not share all that information with you. This is notifying the patient, here’s your data, take a look at it, and you may decide to push it to Apple Health or whatever app. Having them be more involved in the process and not just having it all push to different tools and not understanding those risks. 

Great concern and care is being placed on the sensitivity of this data and the security of it. It’s really important as anybody explores some of these commercially available tools.

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December 17, 2014 Interviews 1 Comment

Morning Headlines 12/17/14

December 16, 2014 Headlines No Comments

Sony Pictures Data Breach

Sony writes a letter to its employees to inform them that their names, social security numbers, addresses, and personal health information may have been compromised when hackers breached the company’s security system and stole internal files.

Sharing is caring? Not for medical records

The post-mortem analysis of a failed EHR interoperability project in Oregon finds that interoperability simply isn’t good business when revenue is tied to a fee-for-service reimbursement model. OHSU’s chief health informatics officer explains, “There’s no financial incentive for the providers. In fact, in many cases, the financial incentive is reversed. Better I don’t know that the patient had an MRI a month ago and repeat it because in a fee-for-service world we get paid for the procedures we do, not the ones we avoid.”

Do patients mind if their healthcare data is shared? It depends

According to a new ethics study, patients view having their health data used to support medical research, but without their consent, as morally superior to having their health data used to support marketing efforts, even if their consent was given.

Making the Cut: Which surgeon you get matters – a lot. But how do we know who the good ones are?

Researchers at Memorial Sloan Kettering have developed a software system that quantifies and compares patient outcomes across all of its surgeon, with the goal of providing detailed feedback to each surgeon about their performance.

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December 16, 2014 Headlines No Comments

News 12/17/14

December 16, 2014 News 4 Comments

Top News

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The massive Sony Pictures data breach forces the company to warn employees that hackers have their personal information (including Social Security numbers, government identifiers, and compensation information) as well as HIPAA-protected health information collected by the company’s health plans. Celebrity PHI was among the information downloaded, which should provide interesting gossip when it inevitably leaks out. A worksheet listing the company’s highest-cost health plan patients (above) was one of the documents hackers posted to the Internet as a warning. Sony Pictures hires a law firm to threaten newspapers and websites that might otherwise post embarrassing hacker-released information, a tactic that legal experts say probably won’t work since the publications would be obtaining the information legally.

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Meanwhile, the movie that apparently stoked the ire of the North Korea-based hackers premiered in LA Thursday night, with early mediocre reviews of “The Interview” raising the question of whether it was worth it, especially since the breach exposed emails in which a Sony Pictures executive griped to peers that the film is “desperately unfunny.” At least the movie will get curiosity box office revenue. Perhaps as the ultimate closing of the loop, Sony Pictures can make a movie about its own breach, featuring the “minimally talented spoiled brat” Angelina Jolie. After all, she starred in 1995’s “Hackers” before donning jewelry containing Billy Bob Thornton’s blood and then finally rebranding herself into a pouty-lipped Mother Teresa. Sony Pictures could use the ticket sales to help pay for the fines, privacy lawsuits, loss of business from exposure of its trade secrets and intellectual property, and general damage caused by incriminating emails. If they survive, that is, which should be in serious doubt at this point. The job you should be glad you don’t have is that of David Buckholtz, SVP of corporate IT at Sony Pictures Entertainment, who will never work in that town again.


Reader Comments

From Shag Dancer: “Re: HIStalk. How long does it take you to write it?” I spend at least eight hours on Tuesdays and Thursdays, sometimes more and sometimes less on the Monday Morning Update, since I research and write every word. That’s only for the heads-down writing and not all the stuff in between … I’m a fast writer, but it takes forever to wade through all the meaningless junk that I don’t mention and to make sense of the sometimes poorly presented information that I do. My job as I see it is to make it look easy and to disguise a lot of work into a quick and entertaining read.


HIStalk Announcements and Requests

I decided to add a new subcategory called “Privacy and Security” to each post since breach and threat news is frequent. I’ve placed it below the “Government and Politics” section below.

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I’m running an end-of-year special on promoted and produced webinars for those signed by December 31, so it’s a great time to contact Lorre to book a slot before the HIMSS conference.

Some company tossed a telephone book in my driveway this morning, reminding me that they still exist even though I haven’t opened one for at least five years (and when I did, I was only seeking pizza coupons). It reminded me of my first cell phone, which was not only large and sporting a walkie talkie type antenna, but also came with an downsized phone book for stashing in the glove box (where, curiously, no gloves have ever been placed).

Listening: new soulful and honest R&B crooning from K. Michelle. I listened unaware that she’s been in some trashy reality TV shows, thankfully, since the music soars despite her iffy career and lifestyle decisions.

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I’m a recent coffee convert after years of making fun of Starbucks lines and bizarre morning rituals, so I need to know whether I’ve found belated enlightenment or whether I’ve instead crossed over to the dark side. Take my poll here – what do you enjoy drinking most at work? I usually hit all the hydration checkboxes with coffee, water, and soda in the mornings and I’d still find it hard to choose a favorite, although there’s nothing like coffee to get me going (and it’s not just the caffeine – there’s something about the warmth that just works). I’m not a snob about it, though – the giant $1 cup at McDonald’s is fine.


Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

December 18 (Thursday) 1:00 ET. Virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy,” a new book by “CIO Unplugged” contributor Ed Marx. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.


Acquisitions, Funding, Business, and Stock

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Google’s venture capital fund is moving its investments from consumer Internet startups  to healthcare and life sciences, with a special interest in companies that focus on health data.

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Orion Health completes its New Zealand IPO, raising $97 million.

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Neos Technologies acquires wearables monitoring vendor AFrame Digital. I don’t know anything about the former except that it writes a bad press release, including misspelling its own name. I’ve only heard of AFrame when it received a 2011 NIH grant to study falls in the elderly. Its “About” page obscures whoever is involved with the company, so my initial “who cares” reaction is that two unsuccessful companies are trying (against all odds) to merge into one better one. I lose nearly all interest in a company whose website fails to (a) list its executives; (b) indicate the location of its headquarters; (c) showcase recent announcements; or (d) make it clear on the home page exactly what it does in a succinct, buzzword-free tagline or paragraph. If they can’t accomplish those trivial tasks, why would I want to buy anything from them?

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Lightbeam Health receives an unspecified capital investment from former Allscripts executives Glen Tullman and Lee Shapiro.

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A report published by Good Jobs First names Cerner as #3 on the list of companies linked to the Forbes 400 list of richest Americans (Neal Patterson at $1.55 billion) that have received more than $1 billion in subsidies from state and local governments trying to boost economic development. Cerner at $1.7 billion worth of taxpayer gifts trails only Intel ($5.9 billion) and Nike ($2 billion). I say blame politicians rather than the companies that were voluntarily offered taxpayer money for reasons that may or may not make good fiscal sense.

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Singapore- based RingMD, which offers consumers live video access to a global network of doctors, will establish its North American headquarters in Charleston, SC in preparation for an expanded US presence. Former programmer and founder Justin Fulcher, who is 24, started the company with the financial support of the Singapore government.  


Sales

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Massachusetts Eye and Ear (MA) chooses Medarchon’s Quarc for secure messaging.

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Hunterdon Healthcare (NJ) will use secure communications from Practice Unite.

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Genesys Health System (MI) signs up with PerfectServe for clinician communication.


People

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Mary Jahrsdoerfer, PhD, RN (Philips Healthcare) joins Extension Healthcare as chief nursing officer.

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Remote monitoring vendor Sentrian hires Lance Myers, PhD (Vivonoetics) as CTO.


Announcements and Implementations

The non-profit American Telemedicine Association launches an accreditation program for providers offering direct-to-consumer consultations, with the cost and requirements of the three-year certification disclosed only after submitting an application. Part of the package includes being able to use ATA’s accreditation seal and being listed in its consumer guide.

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Allscripts certifies the Patient Engagement Solution of non-profit Healthwise for integration with its TouchWorks EHR.

Kaiser Permanente Hawaii launches a teledermatology service in which primary care physicians can send patient photos to dermatologists for diagnosis. 

The 300th hospital goes live on Medhost’s YourCareCommunity vendor-agnostic patient portal.

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The folks at Forward Health Group got permission for me to use the above summary graphic from KLAS’s just-released “Population Health Performance” report in which Forward Health Group scored at the top of several categories and #2 overall. Phytel, Forward Health Group, and i2i Systems led the pack, while eClinicalWorks and McKesson were the only two vendors in the low-performing category.

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Wellcentive joins the CommonWell Health Alliance.


Government and Politics

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The Senate finally confirms Vivek Murthy, MD, MBA as surgeon general, filling a position that has been vacant for 17 months. President Obama nominated him in November 2013, but his statements labeling guns as a public health hazard drew opposition from the influential National Rifle Association, which ended up on the rare wrong side of a political decision.


Privacy and Security

An interesting study seems to suggest that patients think the specific use of their health information is more important than whether their consent was given in advance. That’s surprising given that our entire desired state is is driven by opt in/opt out via consent signatures. Respondents said research use is OK in most cases, but using their information for marketing (even with their consent) is not OK.

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Clay County Hospital (IL) calls the FBI after receiving an extortion email demanding cash to prevent stolen patient information from being disclosed (of which a sample was included as proof of possession). The 22-bed hospital says its servers haven’t been hacked, which would suggest that responsibility rests, as it often does, with an employee.

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Virginia Commonwealth University Health System (VA) notifies patients that the used CDs donated by one of its employees to a children’s art project contained PHI, including full clinical records and Social Security numbers. 

In Canada, Ontario’s privacy commissioner orders Rouge Valley Hospital to upgrade its computer systems, appalled that a year after several employees were found selling patient information, hospital still can’t review access records going back further than two weeks. A fun tidbit from the article: one of the employees who was selling information to Registered Education Savings Plans (RESPs) changed jobs and lost his access to the computer, after which he pulled the brilliant move of sending a formal request to IT asking to have his access restored so he could look up patient phone numbers to “sell them to RESPs in the course of his part-time employment.”


Innovation and Research

A tongue-in-cheek observational study finds that physician waiting rooms contain old, boring magazines because patients steal the others, especially newer celebrity gossip magazines. A couple of years ago I picked up a new-looking travel magazine in the lobby waiting room of one of our hospitals while waiting for a co-worker. I wondered why it featured now-defunct countries and photos of vintage automobiles until I checked the cover date, which was 1995. If only it could talk.

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”Which surgeon you get matters – a lot,” says a profile of surgical outcomes software Amplio, developed by Memorial Sloan Kettering Cancer Center. The system combines post-op patient feedback with EHR information to tell surgeons how they’re doing, which they rarely know since they assume all similarly trained surgeons have similar outcomes with any variation explainable by how sick their patients are. The article references an earlier study in which it observers could easily and accurately determine who was the better surgeon by simply watching videos of their procedures. It also cites the startling results of a 2007 study: cancer returned in 10 percent of patients whose prostate was removed by inexperienced surgeons vs. in only 1 percent of those operated on by experienced surgeons. A snip from the brilliantly written article:

There’s something powerful about having outcomes graphed so starkly. Vickers says that there was a surgeon who saw that they were so far into the wrong corner of that plot — patients weren’t recovering well, and the cancer was coming back — that they decided to stop doing the procedure. The men spared poor outcomes by this decision will never know that Amplio saved them.
 
It’s like an analytics dashboard, or a leaderboard, or a report card, or… well, it’s like a lot of things that have existed in a lot of other fields for a long time. And it kind of makes you wonder, why has it taken so long for a tool like this to come to surgeons?
 
The answer is that Amplio has cleverly avoided the pitfalls of some previous efforts. For instance, in 1989, New York state began publicly reporting the mortality rates of cardiovascular surgeons. Because the data was “risk-adjusted”—an unfavorable outcome would be considered less bad, or not counted at all, if the patient was at risk to begin with — surgeons started pretending their patients were a lot worse off than they were. In some cases, they avoided patients who looked like goners. “The sickest patients weren’t being treated,” Vickers says. One investigation into why mortality in New York had dropped for a certain procedure, the coronary artery bypass graft, concluded that it was just because New York hospitals were sending the highest-risk patients to Ohio.


Technology

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The CEO of Withings apologizes to purchasers of its Aura sleep device, acknowledging that in its rush to get the product on the market, the company left out important features such as heart rate tracking and the ability to view results immediately. They’re trying to fix some of the problems with updates.


Other

The Portland, OR newspaper covers the failure of a local interoperability project that started eight years ago, concluding that it didn’t work even though most hospitals are on Epic because: (a) hospitals bear the cost while insurance companies reap the benefit; (b) hospitals get paid for the procedures they perform rather than those whose duplication they avoid; (c) even information that is successfully exchanged doesn’t always make sense to the recipient. Thus reads the boilerplate RHIO epitaph.

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A new Consumer Reports survey of recently hospitalized patients finds that those who didn’t feel respected by staff during their stay were 2.5 times more likely to experience a medical error, with an alarming 30 percent of those surveyed saying they actually did. A third of respondents say they weren’t treated like responsible adults, while 40 percent report that doctors and nurses interrupted them instead of listening. The article, which will appear in the February 2015 issue, suggests that patients choose a hospital carefully, invite doctors to sit down and talk, write things down, and bring along a trusted ally to help. I asked Consumer Reports about the survey’s methodology, with the positives being that it was a national representative sample with a high confidence level. The negatives that I can determine (without seeing the actual survey instrument that I asked for) are that patients self-reported whether an error occurred and nothing was mentioned about error significance (getting a daily aspirin an hour late might be reported as a medical error by some patients). Interesting but not surprising to me is that all of the lowest-safety, lowest-respect hospitals (listed above) are in big metro areas, with a heavy Chicago representation. As I always say, go to a big academic medical center if you require tricky diagnosis or surgery; otherwise, a mid-sized community hospital that does a lot of whatever you need is your best bet.

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The latest article in the New York Times series “Paying Till It Hurts” reviews the cost of diagnostic tests, which it describes as “what liquor is to the hospitality industry: a profit center with large and often arbitrary markups.” Example: an outpatient EKG done by a community hospital’s technician took 30 minutes and was billed at $5,500, while the same test performed by a Harvard hospital and cardiologist over 1.5 hours was billed at only $1,400 (the article should have mentioned what the graph shows, that Medicare didn’t pay the funny money in either case, instead reimbursing around $400 for each). Eric Topol, MD summarizes the economic incentive as, “At many hospitals, the threshold for ordering an echocardiogram is the presence of a heart.”

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The bonds of 109-bed Mayers Memorial Hospital District (CA) are downgraded, primarily because of EHR-related capital expenses and resulting lower cash collections. The hospital, which implemented McKesson Paragon, is down to 3.5 days of cash on hand.

A New Zealand coroner warns doctors to pay attention to the clinical warnings generated by their EHRs after ruling that a patient died after his doctor prescribed quinine inappropriately. The coroner also noted that hospital records aren’t available to physician practices.

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In England, a lead nurse in an endoscopy unit hangs himself after expressing concerns about staff shortages and the introduction of a new hospital computer system that was causing a patient backlog, forcing him to work 80 hours per week.

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Also in England, doctors at Royal Free Hospital warn that patients are being endangered by its implementation of the OpenText document management system that has created scanning backlog, causing patients to arrive for new visits while their paper records are still piled up in a scanning contractor’s warehouse. The hospital was bragging just a few months ago about the problems that OpenText solved in sending scanned records to its Cerner EPR system.

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Duke University Health System (NC) hospitalist Ricky Bloomfield, MD provides the remote chronic monitoring billing codes he mentioned at his mHealth Summit session on Apple HealthKit: the new E&M 99490 for  monthly chronic care management ($42.60 per month) that could be combined with CPT 99090 or 99091 to yield $99.52 per month. He warns that nobody has actually tried billing Medicare or any other insurer using these codes yet, so it’s a work in progress.

Only in America: the family of an Ohio inmate who raped and killed a woman who was 30 weeks pregnant sues just about everybody for his painful execution that was performed using the untested two-drug combination of midazolam and hydromorphone. Named in the lawsuit are the manufacturer of the drugs (Hospira) and their distributor (McKesson), companies the family says should have known would cause suffering. In an interesting twist, a prison guard says the inmate told him before he died that his attorney urged him to feign suffocation with a prearranged “thumbs up” signal as the injections were started in the hopes that the governor would stop the execution.

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Weird News Andy says, “They really do have skin in the game.” Scientists develop artificial skin for prosthetics that can feel warmth and other attributes. Or as WNA adds, “for Terminator v0.1.”


Sponsor Updates

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I invited sponsors to send photos of their holiday activities since I like to put faces with company names. The folks from Direct Consulting Associates providing shots of their company gathering.

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Employees of PerfectServe collected donations for the Florence Crittenton Agency in Tennessee, donating clothing and 10 suitcases for the agency’s “Wheels of Hope” campaign that allows children who arrive carrying their belongings in a trash bag to leave with their own suitcase.

  • Visage Imaging posts its “RSNA 2014: Visage’s Top Five.”
  • RazorInsights doubled its client base, increased revenue by 200 percent, and hired 80 new employees during 2014.
  • GetWellNetwork Ambulatory earns ONC-ACB 2014 Edition Modular EHR Certification. The company also announces that CEO Michael O’Neil will present at the 2014 HIMSS Middle East Integrated Health Innovations Conference this week. 
  • Nuance announces that KLAS rated it #1 for regulatory reporting in “Quality Management 2014: The Race Gets Closer.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 16, 2014 News 4 Comments

Morning Headlines 12/16/14

December 15, 2014 Headlines No Comments

Senate confirms Vivek Murthy as surgeon general

The Senate confirms Vivek Murthy, MD as the next US Surgeon General. Murthy previously worked as a Brigham and Women’s internal medicine physician.

The Antidote to Fragmented Health Care

A Harvard Business Review article describes the problems patients experience when receiving care in poorly coordinated health care systems and then calls for payment reform, a shift toward promoting wellness, and a universal EHR as key steps that could help the problem.

Personal Health Record Reach in the Veterans Health Administration: A Cross-Sectional Analysis

Researchers measuring the reach of the VA’s patient portal find that 19 percent of all veterans that receive healthcare from the VA had registered for the portal, 11 percent had refilled prescriptions via the portal, and two percent had sent secure messages to providers. However, the study also found that patients with certain mental disorders, a history of alcohol or drug abuse, or a history of stroke had lower rates of adoption.

Tennessee Governor Moves To Expand Medicaid Coverage

Tennessee Governor Bill Haslam will expand Medicaid coverage to low-income residents using federal funds made available through the Affordable Care Act. Tennessee is the third state to expand Medicaid coverage since last month’s midterm elections.

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December 15, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 12/15/14

December 15, 2014 Dr. Jayne No Comments

I wrote last week about a “Forbes Style File” piece that offered fashion tips for women presenting at and attending conferences. The topic has generated more comments and emails than anything I’ve written about in the last year, which in itself is an interesting commentary. Although to be fair, it’s a pretty slow time of the year for healthcare IT news.

I asked for readers who were attending the mHealth Summit to send their thoughts and observations. Cindy Wright, president of Thomas Wright Partners, offers her own take on the event.


MHealth Exhibitor Fashion to Go

I want to thank Dr. Jayne for adding a little additional fun to the mHealth Summit by sharing Forbes’ fashion advice column, written specifically for the mHealth Summit. It made me wonder why in the world Forbes is giving advice on how to build a wardrobe. Just for women, not men? And why this particular conference?

I attended last year and did not see any atrocities that might have provoked such a story, but found myself on high alert for any over the top offensive dress as I attended a number of really informative sessions and presentations. All presenters were very professional, and yes, dressed appropriately. Darn it.

However, being in the business of marketing and communications — which includes public relations — I concern myself with brands and images. Fortunately, I work with adults who mostly have good common sense and know how to dress themselves and even know where to go for help when in doubt of appropriateness. I am not so much concerned with choice of kitten heels or flats, but how you and your company might best reflect your brand.

Being the good marketing professional and huntress that I am, I spent some quality time in the exhibit hall visiting with business owners and hard-working entrepreneurs. Among the large hall of exhibitors, I did find a number of really creative dressers who stood out among the crowd. They were great representatives of their brand. Fun and engaging. Confident in their lively attire. Most importantly, they drew me to them and were engaging. So important, especially if you are new to the arena and maybe even a startup. Oh yeah, and these fashionistas did not follow the rules brought to you by the good people at Forbes.

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Men in Kilts traveled "across the pond" from Nugensis to share their "views" that improve patient care. The clan of four offered Scotch whisky and fun demos for takers.

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Dapper European Milan Steskal, proud founder and COO of Mentegram, punches up his gray pinstripe suit with a blast of orange, picking up the color palette in company brand. His app helps keep mental health patients connected with professionals and support team and so much more.

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Mother and daughter team Glenda and Brittany Gerald, co-founders of MobiDox Health Technologies, not only engage patients in disease management and drug safety, but also engage attendees having fun with coordinated outfits that reflect their business offerings. Where do you find a dress that looks like a keyboard or pharmaceuticals? Not just anyone can pull this off and yet Brittany does while mom plays it cool Chanel style.


Thanks again to Cindy for sharing her thoughts. I hope to spend some time with her stalking the halls at HIMSS. It will be interesting to get a professional opinion on what hits the runway (ahem, trade show floor) in Chicago.

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From Met My Match: “So clearly the issue here is inappropriate dress.” Thanks for steering us back to a piece on the larger issue, which is that women speakers are “still few and far between” at conferences. The piece highlights a Rock Health exploration of the gender gap in speaker counts.

One reader commented on the original piece that, “A far more interesting topic is the dynamics of power in professional dress. The trainer can show up in jeans and t-shirts, but the trainees need to present a more polished look. How common is it to have different rules for the executive level? I’m curious how many of you see this power divide or double standard in your organizations.”

With regard to the trainer in jeans and a t-shirt, I think that has a lot more to do with organizational culture than it does with a true power divide. One of the vendors we work with has a very casual culture, which is reflected in its employees’ attire even when they go out to client sites. That’s been a problem for some of our offices and we have had to include a “dress code” request whenever staff comes on site. We don’t need them in suits, but a collared polo-type shirt is the minimum of our brand of business casual.

When we conducted our ambulatory rollout a decade ago, we were worried about members of the team having too much personal variation in dress and also wanted our staff to be easily recognizable when out in the practices. We bought each implementation team member polo shirts with our project logo on them, to be worn with the brown, black, or blue pants of their choice (no jeans). Although not cheap, it was money well spent as we didn’t have to deal with any dress code issues on the team. The biggest problem we had was being made fun of by our trainees, because it turned out that the particular shirts we picked out were also chosen by a local auto parts store.

Even looking at similar organizations, the dress code for similar job roles varies dramatically. While we get away with polos and khakis here, implementers at large medical group I visited in Texas wear dresses and heels every day (they are all women). While that may seem unusual to some, in their corporate culture if they showed up in anything less formal than that brand of business dress, they might lose respect. Who knows what would happen if they tried to show up in scrubs, which is what implementers at our hospital wear? They have a different color than any of the other staff members (who are categorized by color – nurses navy, techs blue, doctors green, etc.). They also wear safety green vests and look like a roadside hazard crew, but they’re definitely easy to find.

Looking at our corporate environment, I think the president of our medical group is perceived as too casual. He often wears open-collared shirts when most of our male physicians wear shirt and tie, if not a jacket also. He’s also not a physician, so it’s hard to tell whether dressing up a bit more would help him be more respected.

Most of the women in our corporate environment wear skirt suits or dresses. I personally prefer pants, and on one rare occasion when I did wear a dress, one of my analysts announced to the team that indeed Dr. J did actually have legs. The old adage about dressing for the job you want rather than the job you have is still out there, and when I see people that are too informally dressed for the situation, it always crosses my mind.

Thinking too much about wardrobe can sometimes backfire. I attended a vendor user group last year and they had decided to put the staff in more casual attire to try to appear more accessible to their clients. It was a calculated move and I felt bad for them when I overheard clients mentioning that they didn’t like it since most of the clients were wearing suits. I’m not sure the power dynamic worked in the right direction. Instead of feeling more powerful, some of the clients felt anxious or annoyed.

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We’ve all heard that “clothes make the (wo)man” and one of my favorite Broadway tunes (“My Strongest Suit” from “Aida”) is a great play on that. The number occurs at a point in the story when Princess Amneris realizes that she’s been groomed to focus her efforts on appearance when she has the skills to do more for the people around her.

As the year winds down and people go into a more thoughtful and potentially resolution-making state of mind, I challenge everyone to think about how appearance and dress influence our thoughts. What can we do to focus more on material, meaning, and message? And where can I find that pill-print dress? Email me.

Email Dr. Jayne.

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December 15, 2014 Dr. Jayne No Comments

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