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Morning Headlines 4/3/15

April 2, 2015 Headlines No Comments

CVS Health Announces New Clinical Affiliations with Leading Medical Centers in Arizona and Illinois

CVS continues its expansion into primary care through a new partnership with Rush University Medical Center (IL)  and Tucson Medical Center (AZ), where it will provide medication counseling, chronic disease management, and health services through its MinuteClinics. CVS will also begin integrating its MinuteClinic visit notes with the health system’s EHR,

Medsphere Systems and Phoenix Health Systems Complete Merger

VistA-reseller Medsphere merges with IT consulting firm Phoenix Health Systems. The new company will retain the Medsphere name and will expand its service offerings beyond VistA implementation services to now include hosting, help desk support, and project management consulting. 

Help lower treatment costs for your patients

Practice Fusion begins embedding coupons from pharmaceutical companies directly into its e-Prescribing system so that doctors can print them out and give them to their patients. The goal, according to Practice Fusion, is to reduce the cost of prescriptions and thus improve medication adherence.

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April 2, 2015 Headlines No Comments

News 4/3/15

April 2, 2015 News 17 Comments

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The Apple-IBM partnership releases four healthcare-related apps in IBM’s MobileFirst for iOS series, although IBM is holding back the formal announcement until the HIMSS conference. The apps include an iPhone communication system for hospital nurses, an iPad workload app for hospital charge nurses, a notification and lab status app for hospital techs, and an app that allows home care nurses to upload information to an EHR.


Reader Comments 

From Mobile Gas: “Re: IBM’s MobileFirst for iOS Healthcare. It seems like smoke and mirrors since they didn’t provide a list of customers and looks like they just built a series of applications without considering apps already deployed. The hospital nurse needs tight integration with the hospital EMR and Epic and Cerner both offer point-of-care applications. They also need connections to secure messaging and alarm notification from companies like Voalte and Vocera. This will lead to further market confusion as Apple and IBM build products in the ivory tower and expect customers to figure out the integration. I think this is another sign that Apple doesn’t understand the healthcare enterprise – they could have addressed enterprise issues, such as iOS management and WiFi connectivity, and instead are building generic applications that will be hard to integrate with hospital core systems.” Most surprising to me is that IBM didn’t announce integration partnerships with Allscripts, Epic, Cerner, or Meditech and didn’t mention working with health systems to design and test their apps or to validate that they offer something important that EHR vendors don’t. I’m skeptical. Just because health systems run applications on IBM systems doesn’t mean IBM can grab EHR data indiscriminately and use it intelligently, although maybe the announcements that are being held for HIMSS contain more vendor-specific details.

From John: “Re: gender bias. Have you counted how many interviews you’ve done with men vs. women?” I haven’t counted, but it’s probably proportional to the gender ratio within the specific job roles (CEO, CMIO, etc.)  If your point is that men are disproportionately represented in those roles, then I obviously agree, although it’s a slippery slope to then propose fixing what is perceived as a societal problem based on the single factor of gender. I like to think I’m gender-blind since most of the people I’ve chosen to work with are female and some of the better interviews I’ve done were with women. I’ll interview anyone who has the potential to be interesting and who is willing to do it my way — don’t underestimate that second factor since it takes guts to be interviewed for a full transcript without knowing in advance what questions I’ll ask and not having the chance to review the answers before I publish them.

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From Kopecky: “Re: Mark Cuban. Getting flamed on Twitter for urging quarterly blood tests ‘for everything available’ as a baseline.” He’s well-intentioned even though he’s wrong. He assumes that frequent testing will create a personal baseline that will be more useful than population-based normal ranges when something changes. Here’s the problem: the more results doctors see, the more pressure they feel to do something about them because that’s how they are trained and they don’t want to get sued. Things start going wrong when patients get roped into the healthcare system … medical errors, polypharmacy, and compounded drug side effects. That’s the same problem with apps that create a continuous stream of questionably valuable medical data that someone has to review and react to. I suspect we harm far more people by providing unnecessary knee-jerk treatment than we do by not collecting enough data to support an early diagnosis. It would be great if “health” was a simple as automatically applying harm-free interventions in response to well-defined physiologic inputs or genetic analysis, but it’s not. Healthcare is often dangerous to your health.


HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor MedCPU. The tagline of the New York City-based clinical decision support company is “Accuracy is not optional.” Its MedCPU Advisor analyzes the complete electronic clinical picture (including both structured and free-text data) in real time against an algorithm matrix, providing case-specific prompting with minimal false alarms. No change in user worfklow is required since the system runs in the background with no separate logon or additional data entry required. The company’s experts build, configure, and maintain best-practice rules from its library of specialty modules with minimal client resources required. On the technology side, the company provides integration via reader technology that requires no IT resources and includes a patented Context Engine to process free text information. Founder and CEO Eyal Ephrat, MD is an obstetrician and previously founded E&C Medical Intelligence (now PeriGen). Thanks to MedCPU for supporting HIStalk. 

My YouTube search turned up a new explainer video for MedCPU Advisor.

This week on HIStalk Practice: Iora Health takes on primary care nationally with a homegrown EHR. Community Health Center serves as a model for a new telehealth program in Colorado. Australian physicians get no respect from their EHRs. Health information exchange in Georgia moves forward, as does telemedicine in Delaware. Spruce raises $15M from headline-making Kleiner Perkins. Health Informatics Director Karen Schogel, MD weighs in on MU3 at Genesis Medical Associates. Thanks for reading.

This week on HIStalk Connect: Google partners with Johnson & Johnson to co-develop a surgical robot that will integrate real-time image analysis and decision support into the surgeons workflow. In England, students with the Royal College of Art and the Imperial College London have created a self-stabilizing pen designed to help patients with Parkinson’s disease maintain legible handwriting. Apple and IBM unveil their newest batch of co-developed enterprise apps, including four apps designed for nurses. Fitbit finalizes its $18 million acquisition of Fitstar, a paid app that develops personalized workouts based on user’s fitness goals.

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If you want one of these pins, stop by our HIMSS booth # 5371 on next Monday since we intentionally ordered few enough of them to make them collectible (actually it was mostly to avoid the risk of lugging them back home). We suggested that our sponsors design their own buttons, although I don’t know which ones actually did.


HIStalkapalooza Sponsor Profile

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Visit Sagacious Consultants at HIMSS Booth # 1690 for a chat with some of the EHR industry’s smartest leaders, including founder and CEO Shane Adams and principal consultants Gordon Lashmett, George Evans, and Dr. Ron Jimenez. With experience as Epic CIOs and directors of clinical informatics, they will be available to dish out advice about your most pressing technical and operational challenges.

Sagacious Consultants will be rocking HIStalkapalooza as a Gold Sponsor. Guests can strut like rock stars on a red carpet at the House of Blues, grab a guitar or banjo prop, and strike a pose. Don’t leave without taking home a Sagacious rock poster commemorating this star-studded night for HIT.


Webinars

April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.


Acquisitions, Funding, Business, and Stock

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VistA vendor Medsphere and IT solutions provider Phoenix Health Systems merge. The Medsphere name wins, adding consulting and outsourcing services from Phoenix.

Healthland acquires revenue cycle solutions firm Rycan.


Sales

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Cedars-Sinai Health System (CA) chooses HealthLoop for automating patient follow-up.

MultiCare Connected Care (WA) selects Sandlot Solutions to create a community-wide electronic information exchange.

Xerox will incorporate SyTrue’s natural language processing and medical terminology platform into its Midas+ analytics to generate diagnostic and procedure codes from clinical documentation in real time to calculate risk and outcomes for case management.

Kindred Healthcare’s hospital division chooses transcription, front-end speech recognition, and clinical documentation improvement from MModal.


People

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Dave Levin, MD (Nordic) joins PeraHealth as physician executive.

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Ed Marx resigns as SVP/CIO of Texas Health Resources.

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Chuck Christian (St. Francis Hospital) is named VP of technology and engagement of the Indiana HIE.

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Mike Waldrum, MD, MSc, MBA, president and CEO of the University of Arizona Health network, leaves quickly after the system’s acquisition by Banner Health to become CEO of Vidant Health (NC). He was CIO at UAB Health System from 1999 to 2004.

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CognitiveScale launches a healthcare business unit that will apply cognitive computing to chronic care management and names Charles Barnett (Seton Family Healthcare) as the healthcare group’s president.


Announcements and Implementations

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Joining the CommonWell Health Alliance are Meditech, Merge, and Kareo as contributing members and PointClickCare and Surgical Information Systems as general members.

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The Chicago business paper profiles MedDocLive, started by a former Epic project manager turned medical student, which provides medical students and residents to help hospitals with their EHR go-lives.

The New Mexico HIE goes live with technology provided by Orion Health.

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Here’s an interesting graphic tweeted out by KLAS as a teaser to buy its latest $15,980 health analytics report, which according to the graphic, involved only 77 respondents of which 28 said no vendors offer emerging capabilities. Health Catalyst and Truven are at the bottom with just three votes each? I’d have to see the methodology before I’d believe that.

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Practice Fusion enables doctors to print drug coupons right from its free EHR, no doubt charging the drug companies that provide them. Patients like prescription drug samples and coupons, not usually realizing the indirect cost to themselves or those paying for their care.

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MModal announces that transcription employment at its Coimbatore, India office has reached 1,000.

Vocera announces integration of its communications system with Epic for bed cleaning and availability updates, with similar integration with other EHRs planned.

Summit Healthcare partners with S&P Consultants to offer Cerner solutions that include domain compare and synchronization, blood bank validation, and a scripting toolkit for workflow automation.

CVS Caremark announces new affiliations with Rush University Medical Center (IL) and Tucson Medical Center (AZ) that includes sending CVS prescription and visit information to the EHRs of participating providers and offering patients services via its in-store MinuteClinics. Meanwhile, CVS filings show that its CEO earned $32 million in 2014 and added another $11 million in stock value. CVS share price increased 38 percent in the past year.  

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Non-profit health information provider Healthwise offers a course on shared decision-making.


Government and Politics

Texas lawmakers are considering a bill that would prevent providers from recording a patient’s gun ownership status in their medical records. The office of Rep Stuart Spitzer, who is a surgeon, says consumers are alarmed at being asked gun-related questions during visits and that he doesn’t trust the National Security Agency and other government agencies.

Athenahealth CEO Jonathan Bush will host a $10,000 per person fundraiser at his Massachusetts home for his cousin, presidential contender Jeb Bush.


Other

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Bob Wachter, MD is ubiquitous in plugging his new book (which I haven’t read), publishing endless excerpts all over the place including a series titled “The Overdose; Harm in a Wired Hospital.” It describes a single incident at UCSF Medical Center, his employer. It should be noted that despite the manufactured drama and hype-laden headlines (such as “How Medical Tech Gave a Patient a Massive Overdose”), the patient ended up being fine with no permanent harm from UCSF’s mistakes, although the salacious if inaccurate headlines might move a few more copies than just admitting institutional errors. Stripping away the novel-like prose leaves these facts:

  • A pediatric patient (16 years old) was given 38.5 Septra DS tablets due to a series of errors resulting from the resident’s botched attempt to re-order a home med of one tablet twice daily.
  • The incident happened in July 2013, just over a year after UCSF’s Epic go-live, but Bob  doesn’t say if the resident had just started her rotation on July 1.
  • The hospital had decided to require clinicians to dose medications by weight for children under 40 kg without exception.
  • UCSF had elected not to turn on Epic’s overdose limits because teaching hospitals use research protocols that don’t always follow published standards.
  • The pediatrics resident entered the order correctly, but then had to adjust it to match the available tablet strength per UCSF policy. She then re-entered the same order incorrectly, apparently failing to notice the mg/kg dosing that, according to hospital policy, should have been present on every single order she had ever entered into Epic, including the same order she had just entered for that same patient. She entered the dose as “160” in trying to enter the milligrams of trimethoprim instead and then ignored the resulting overdose message. The resident blames UCSF’s Epic setup for issuing too many alerts and for failing to highlight the most important ones.
  • The UCSF pharmacist accepted the resident’s order after ignoring his own dose warnings.
  • The hospital had floated a a newly-licensed night shift nurse from her normal PICU assignment to the general pediatrics floor because of short staffing, She didn’t question the dose and didn’t ask the charge nurse because she “didn’t want to sound dumb,” so she helped the patient swallow 38.5 oversized tablets.

The article series isn’t finished yet, but my conclusions so far are:

  • Bob’s working the author angle of being the technology-wary guy to consumers. He writes well, but his lay audience probably won’t understand that hospitals make mistakes constantly even without technology. Paper orders were no picnic, believe me, and UCSF has some obvious people problems in putting newbies on the front line with questionable supervision. If your kid driving on a learner’s permit wrecks the family car while speeding, don’t blame the car manufacturer for not making the speedometer bigger.
  • This is a classic example of the “Swiss cheese effect,” where an event occurred only because a normally reliable system of checks and balances fell apart due to alignment of failed links in the chain (new resident, new nurse working off her normal unit, nobody caught the mistakes made by others).
  • The Epic screen is busy and doesn’t highlight the magnitude of the alert very well. UCSF’s decision not to hard-stop overdoses (in my experience, that’s probably because they don’t want to annoy easily angered doctors, although their research rationale is valid) would have prevented this mistake.
  • UCSF’s “mg/kg dosing only” rule is commendable for most but maybe not all medications. They apparently decided to make this change universally when putting in Epic. It would be interesting to see what training was offered to prescribers before this change was made and how many of them were in favor of it.  
  • IT systems often lull people into a false sense of security since the screen always looks calm and rational. The alerts don’t, as Bob suggests, throw up a big skull-and-crossbones graphic – system designers assume that it’s the human’s job to understand the situation and not to cry wolf constantly.
  • I would be interested to know what steps UCSF took to reduce insignificant drug warnings both before and after the event since Bob thinks the number is excessive. How does UCSF compare with comparable users?
  • Epic could certainly redesign its screens to call more forceful attention to the biggest error outliers (or at least those it can detect with certainty), just like your PC says “Do you really want to do this?” before allowing you to accidentally format your hard drive. Perhaps Epic’s setup could (or should) require resident-entered orders that have seemingly big problems to be verified by an attending or chief resident before shooting them off to the pharmacy for immediate dispensing. IT-reduced turnaround time is not your friend when you make a mistake.
  • Professionals have to be responsible for their actions and their judgment in using software, whether they’re doctors, accountants, or stockbrokers. UCSF put a lot of very green people on the front lines and they screwed up in ways that would have been equally horrifying with or without a computer (38.5 oversized adult tablets for a kid? Come on, just-graduated nurse, use your critical thinking skills).
  • Errors usually happen when clinical employees are overworked, interrupted, or afraid of getting chewed out and all of these issues were reported by those involved.
  • Don’t go to an academic medical center unless you really need one (and I say that having worked a long time in both academic and community hospitals). The July 1 new resident screw-up phenomenon has been well documented. Huge size and specialization means that when they float nurses as in this case, they’re dumped into a complex environment where they don’t know the people or processes. Academic attending physicians often possess big egos and make anyone who questions them (including the software analysts who configure clinical alerts) feel shamed, so nobody challenges them. Doctors and staff see so many complex, throw-out-the-rulebook cases that questionable orders are overlooked. Handoffs and intra-department communications aren’t always efficient since so many people are involved and they don’t always even know each other. Bring someone to sit by your side the whole time and question everything. I doubt the mom would have allowed her child to choke down 38.5 pills knowing it’s supposed to be a single one like she’d been giving at home.

What do you think? Clinical folks, how would your system and your people handle a potential mistake like this? Here’s a challenge for you: enter the same order for a similar patient in your test environment and send me a screenshot of what the ordering physician would see (I’ll de-identify the image). Let’s see how other hospitals and other IT systems work.

Quite a few companies observed April 1 with phony commercials and news items. This one from Microsoft announcing “MS-DOS Mobile” is pretty good. Epic had its usual home page makeover.

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The teen whose parents publicly shamed an Atlanta hospital into giving him a free heart transplant in 2013 despite his history of not complying with prescribed therapy crashes a stolen car following a crime spree and dies.


Sponsor Updates

  • Arcadia Healthcare Solutions client Yakima Valley Farm Workers Clinic will receive an IT innovator award at the HIMSS conference.
  • ESD posts 25 days of its history as it commemorates its 25th anniversary. Check out Day 7, where you’ll see its video of HIStalkapalooza 2012 in Las Vegas, which it did a great job of sponsoring. I still watch that video every couple of months because it’s fun and full of familiar faces, maybe even yours.
  • Extension Healthcare releases version 5.0 of its clinical alarm safety platform.
  • Hayes Management Consulting posts “Patient Portals: How to Balance Privacy and Engagement.
  • Healthcare Data Solutions is named Concur’s App Center Partner of the Year for the third year in a row.
  • Healthfinch asks “Is Primary Care in Rural America at Risk?”
  • QPID Health President and CEO Mike Doyle will present on maximizing technology’s value to patients and providers at the ACHE Massachusetts Spring Conference on April 15 in Needham, MA.
  • Healthgrades offers “5 Lessons I Learned from 10.10.10 in Denver.”
  • Impact Advisors offers “Population Health Management Vendor Selection.”
  • Liaison Technologies offers “Winning Lab Information Strategies for Value-Based Care.”
  • Healthwise shares “The Secret Behind Serving Up the Right Information Every Time.”
  • Holon Solutions will exhibit at the Texas Organization of Rural & Community Hospitals Annual Conference April 7-9 in Dallas.
  • Intellect Resources offers tips on “Networking at HIMSS.”
  • Galen Healthcare Solutions wraps up its experience at the InterSystems Global Summit.
  • InterSystems recaps its annual conference, Global Summit 2015.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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April 2, 2015 News 17 Comments

EPtalk by Dr. Jayne 4/2/15

April 2, 2015 Dr. Jayne 2 Comments

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I’ve been struggling to get through the Meaningful Use Stage 3 proposed rule, but finally reached the end. I’m not sure how much of it I’ve retained, although I did take good notes.

I also skimmed the certification document to get an idea of new things my vendors may be offering. A couple of them struck me as interesting additions: the family health history pedigree; expanded social, psychological, and behavioral data; and consolidated care plans. CIO John Halamka, MD and Micky Tripathi posted an excellent analysis last week that should be required reading for all hospital and software vendor executives.

My favorite section of their write-up (appropriately subtitled “The Ugly”) encapsulates my frustration as a primary care physician:

If a clinician has 12 minutes to see a patient, be empathetic, document the entire visit with sufficient granularity to justify an ICD-10 code, achieve 140 quality measures, never commit malpractice, and broadly communicate among the care team, it’s not clear how the provider has time to perform a “clinical information reconciliation” that includes not only medications and allergies, but also problem lists 80 percent of the time. Maybe we need to reduce patient volumes to 10 per day? Maybe we need more scribes or team-based care? And who is going to pay for all that increased effort in an era with declining reimbursements / payment reform?

Most of my primary care peers could deliver truly excellent care if I we only saw 10 patients per day. However, primary care physicians in my organization are expected to perform at a certain percentile based on MGMA data. The majority are seeing 30-35 patients daily, yet revenues are still declining. They’re also working longer hours with increased burnout. One of my favorite colleagues just “retired” from practice at the tender age of 48 and will be doing part-time urgent care instead.

I’m grateful to those who actually selected primary care residencies during the recent National Resident Matching Program process. Over 1,400 fourth-year US medical students selected family medicine and I salute them. To consciously choose this life given current market forces, you are either called to serve or you are a risk-taker. Fortunately, we can benefit from having more of both in the trenches. There were a total of 3,195 positions available and graduates of non-US medical schools will typically fill the remaining slots.

I mentioned last week that I had received some pre-HIMSS mailings with butchered addresses and titles. Not to be biased in reporting only questionable print media, I’ll share that this week I received three emails that fell into the category. When preparing mass communications, first make sure you’re selecting the right field for the last name. I guarantee my real name is not “Dr. O’Day,” so I didn’t read your piece. Second, “Dear Chief Nursing Executive” isn’t going to make CMIOs want to continue reading. Third, don’t call out my mostly-inactive consulting company as needing your services because my “organization is bustling and case managers are overwhelmed with ineffective ways of contacting and tracking patients.” Nothing like serving up an insult to an entity that doesn’t even have contact with patients.

While I’ve got my crankypants on, let’s talk about vendor events at HIMSS. On one end of the spectrum, we have sponsors like Divurgent who offered all HIStalk readers the opportunity to attend their HIMSS event.  On the opposite end, we have Nordic. Their event was advertised in a CHIME bulletin, but after an initial acceptance email, I received a follow up email stating I’m now declined “due to the lack of space and focus on our clients.” I guess the fact that I’m on the IT committee at one hospital who has been a client and on staff at another Epic hospital is moot. I’ll be reporting on other social events instead, but they might want to update their website since it says guests are welcome and suggests forwarding the invite to colleagues.

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I always enjoy hearing about sponsors and their philanthropic efforts. NextGen announced its Eighth Annual NextGen Cares Golf Tournament to benefit the Jayne Foundation. The scholarship fund is in memory of former client Dr. John W. Jayne, but for obvious reasons, it caught my eye. Opportunities are available for both golfers and non-golfers, including a cocktail hour and silent auction.

Have a charitable event and want to get the word out? Email me.

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April 2, 2015 Dr. Jayne 2 Comments

HIStalk Interviews Nancy Ham, CEO, Medicity

April 2, 2015 Interviews No Comments

Nancy Ham is CEO of Medicity, A Healthagen Business.

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Tell me about yourself and the company.

I’ve been in healthcare IT for an embarrassing number of years now, about 25. But I’ve always been focused on the same problem, which is, how do we move data in a way that empowers physicians to improve financial and clinical outcomes? And trying to conquer the barriers of siloed systems, lack of standards, lack of interoperability to make that possible and to try to serve it up to physicians in a way that meets them where they are and ideally flows into and supports their operational and clinical workflow.

The most recent two years, I have been leading Healthagen Technology Solutions, which is Aetna’s population health technology services and enablement arm.

 

It’s a little bit confusing that the company still operates as Medicity, but is under the Healthagen group name of Aetna. How does Medicity fit into Aetna’s overall business?

Aetna acquired Medicity four years ago, recognizing that the foundation of population health is real-time clinical data and the ability to then marry that with other kinds of data – increasingly like paid claims data and biometric data — but to marry it through a robust and secure infrastructure. I often talk about the iceberg principle — what’s above the water line is the new, updated GUI and the pretty dashboards, but the first product is the data itself.

Data quality, data security, patient matching, patient consent management … that’s really hard work. Medicity — which started as a health information exchange and that was the nature of the work that they did over about 10 or 15 years – has built up this robust foundation upon which now we can attach the other population health assets and capabilities that have come to us through Healthagen or Aetna. Medicity is now the unified face to the market. All of our products, no matter where they started, are now sold and delivered through Medicity.

Some of the newer capabilities we have through Medicity are Medicity Explore, bringing to market our analytics company, formerly called HDMS. A company that’s more than 10 years old and manages more than 30 million lives through analytics.

I think that’s a really important point for your readers. As they walk into HIMSS and into the barrage of all the companies all saying, “Here’s what we do,” think about scalability and maturity capabilities. One of the first questions I always ask of an analytics company is, "How much data has processed through your engine?” Because healthcare is just this giant pile of corner cases. You have to meet them and defeat them one by one.

We have Medicity Manage, which brings in our ActiveHealth Management capabilities, which include care management analytics, risk stratification, predictive algorithms, gaps in care, registries, and also brings a really elegant provider-facing care management workflow. Because at the end of the day, the point of all this data, all these products, is to change and improve the actual care you deliver to a real person at the end of that line. You have to put all these things together.

 

Are providers really demanding interoperability or is everybody else just wishing they would?

[Laughs] They are increasingly demanding it because they’re getting into significant enough population health programs that the lack of interoperability, or the gaps that are created, are expressing themselves. Just as an example, if you are managing a panel of congestive heart failure patients, when you see gaps in the care record, you realize that’s a problem — when you don’t see that they had an admission at that hospital or when you don’t see that they had a test at that physician. It’s now impeding your actual ability to provide continuous care. 

For me, that’s what population health is about. It’s moving from episodic, snapshot blinks of the patient to a movie. It’s like going to a movie and half the scenes are missing, so you can’t follow the plot line. That’s where the lack of interoperability is showing itself at scale now, because we are moving into true population health and people are saying, "This is not working. I need the whole movie."

 

Aetna has a view into all of healthcare. What does it see coming that the market might not have figured out yet?

We have a point of view, borne out by the recent Rand study, that providers buy into the fact the world is changing. They are moving from fee-for-service to something else. They are on the journey to risk. They might be at many different places on that continuum. What’s really fun is when they are at many places on that continuum simultaneously. They are in a different place for Medicare versus Medicaid versus commercial.

Technology alone is insufficient. Services alone are insufficient. Clinical alone is insufficient. You have to fuse it all together and bring risk management, i.e, I am going to be financially at risk. How do I think about that? How do I manage actuarial pricing?

Those are capabilities that health plans have that providers traditionally haven’t had to have. You have to have data and technology to move that data around appropriately to the right physician, respecting patient consent and privacy. Then you have to have clinical workflow to take advantage of everything you are doing. It needs to come together in a different kind of interoperable way.

 

What’s the big-picture view of interoperability and where is it moving?

I see the lines blurring. Medicity is very proud to power nine statewide HIEs, and yet when I think about the work that’s happening in those states, it is about public-private partnership. A really interesting example or theme is how payers are now becoming significant participants in these networks. One of my customers has a great phrase — she calls it ecosystems. We are evolving to healthcare ecosystems.

In a healthy ecosystem, everyone contributes as well as receives. What we are seeing now is new stakeholders come to these ecosystems and say, "I’m a payer. First of all, I have data to contribute to the ecosystem. I have claims data. I have medication history data. I have care management data. Let me contribute my data to that ecosystem. Then whether you are an individual physician or hospital participating in that ecosystem, you can now benefit. Let me receive information from that ecosystem, such as real-time clinical data, alerts that a member has just been admitted to the hospital, so I can activate my own care management programs."

We think it is a fading distinction between public, private, and regional. What we see are these localized healthcare ecosystems in which increasingly we are seeing everybody in. Which is exciting because that’s been the vision all along — creating clinically-connected communities. Wherever you go as a patient, wherever your family member goes, your data is accessible, contextual, and available.

 

Who should pay the cost of interoperability? How do we make sure that we aren’t building individual proprietary silos?

First of all, I hope no one out there is thinking that their main business model is selling data or monetizing data. Data is just an input into an improved healthcare system. We are all trying to lower the cost for data to flow into these ecosystems so they benefit the actual care and cost for what is going on.

I see that increasingly, people understand this mutuality. If I want to get data, I need to provide data. By the way, it is the patient’s data. We are all trying to contribute to create that clinically complete view of the patient, so that as they navigate the healthcare system, they are getting the best possible care. What I would like to see is simply a continued investment by us as an industry in standards in interoperability so that we reduce the cost and the friction of data moving.

The monetization should be by whoever’s at risk. If you are the payer, if you are the employer, if you are the state government, if you are the federal government, if you are the provider … Whoever’s at risk financially and clinically for that patient is who is benefiting from having access to a more complete clinical and financial record — they are the ones who should underwrite the cost of having created that.

 

How would you set up an economic incentive to align the interests of those who benefit from the data with those who contribute it for someone else’s benefit?

I would love to at some point have a longer conversation about some really successful statewide networks. Colorado, Ohio, Delaware, and Vermont have achieved, or are close to achieving, 100 percent connectivity — hospitals, physicians, DME, SNF, long-term post-acute, payers, the VA, Social Security, the prison system. They have developed models where all the constituents in their community are now participating in the system and have a shared goal of improving the health of their citizens.

There are statewide models that are working very effectively now on a multi-stakeholder basis. The revenue models are all a little different, but a lot of them were started up by hospitals wanting to replace phone, fax, and courier with more modern means of delivering clinical information electronically to physicians.

Now what you are seeing is the next wave of stakeholders coming in, contributing both data and funding. Any network has a semi-fixed cost, and spreading it across now a broader community, which is exciting to see. As new people arrive, they have to connect to the network and subscribe and help underwrite its cost as well as contributing their own data.

 

What is the next level beyond where we are now with population health management technology?

In some ways, I think we are still at the first level, which is trying to create data completeness. We talk about building complete, ubiquitous, and indispensable networks. Those words have a lot of meaning for us.

Complete means data completeness. No network is ever data complete because there’s always the new frontier. We conquered a lot of real-time clinical data. Now we are all trying to get ambulatory data, CCDs, consolidated CDAs out of ambulatory practices. Payers are arriving at scale to contribute the data they have. Biometric is a new frontier. We are doing a really interesting pilot with Cleveland Clinic and Medtronic. There’s always going to be more data. We will never be data done.

Ubiquity is around Moore’s Law — the more connection points on a network, the more powerful it is. If you think of networks as being geographically-oriented, clinically-connected communities, you are always going horizontally and vertically to create more data and connectivity density.

The new wave of population health is the third word, which is indispensable. Which is about, does any of this matter? Are we creating a difference in the Triple Aim? Are we improving health, improving care, improving cost? The new wave is actual measurement in ROI.

We are going to have to embrace and learn as an industry that a lot of things we are doing right now, while interesting, aren’t transformative. Trying to figure out where we can hone in. A lot of that honing is going to maybe be the fourth new frontier, which is direct patient engagement. Engaged in their own care, with their own data, with their own protocols.

 

Do you have any final thoughts?

I’m both excited and worried about the state of the state for population health. I’m excited about the pace of innovation, the number of new entrants, the amount of invention that’s happening. But I worry that it’s a little untethered from the jobs of cost and quality. That it’s untethered from risk management and care management. I want to be sure as an industry that we are being purposeful in effecting change, not just in creating new software tools.

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April 2, 2015 Interviews No Comments

Morning Headlines 4/2/15

April 1, 2015 Headlines No Comments

How Medical Tech Gave a Patient a Massive Overdose

UCSF doctor and professor Bob Watcher, MD candidly tells the story of a recent EHR-related overdose that took place at UCSF’s Benioff Children’s Hospital in which a 16-year-old patient was given a dose of antibiotics 38 times larger than his doctor had intended. The ordering provider believed she was ordering a single 160 mg pill of Septra, but inadvertently ordered 160mg/kg, which resulted in a child being given 6,160 mg of the drug. The EHR, Epic, presented the doctor with an overdose warning but the order was placed anyway, pharmacists verified the order and filled it, and the floor nurse dutifully gave the patient 38.5 Septra pills. Fortunately the patient fully recovered.

Groundbreaking ways to deliver great healthcare.

Apple and IBM introduce four enterprise apps that they co-developed to support nurses, nurse managers, home health nurses, and technicians.

The Healing Power of Your Own Medical Records

The New York Times publishes a piece highlighting the OpenNotes movement and calling for broader patient access to medical records data.

CommonWell Health Alliance Welcomes New Members Across the Health Care Continuum

Meditech, Merge, Kareo, Surgical Information Systems, and PointClickCare have all joined the CommonWell health information exchange platform. With the new partners, CommonWell reports that its platform covers 70 percent of the acute care market and 20 percent of the ambulatory market.

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April 1, 2015 Headlines No Comments

HIStalk Interviews Tom Skelton, CEO, Surescripts

April 1, 2015 Interviews No Comments

Tom Skelton is CEO of Surescripts of Arlington, VA.

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Tell me about yourself and the company.

I’ve been involved in healthcare and healthcare IT for a little over 30 years. The first 25-plus was on the provider side of automation – physicians, hospitals, home healthcare agencies, and the like. The last five years I’ve spent running a diagnostic imaging services firm, where I had the opportunity to, for the first time in my career, focus on running a care delivery organization. That was a great change and a great opportunity for me.

 

What was it like going back to the provider side after being a vendor?

It was a fantastic opportunity. It was really good to work in that environment again, side by side with the physicians working to do similar things. We’re trying to improve quality. We’re trying to increase efficiency. To be right there in the trenches with them was a great learning opportunity and I took away a lot, no question.

 

Is there anything left to accomplish with electronic prescribing other than getting everyone on board with the prescribing of controlled drugs?

We’ve asked the team to focus on three things. We’re trying to optimize every segment of the e-prescribing value chain. There’s a lot that still can be done in the areas of convenience, efficiency, and accuracy. We’ve got new modules for the prescribing offering that are designed to enhance those types of things. We can provide valuable information at the point of care and help make sure the patients are getting the best that the healthcare system has to offer.

The second we’re looking for is broadening the e-prescribing footprint. We still think there are some things to be done there. Electronic prescribing of controlled substances is a great example of that.

The last is enhancing clinical connectivity — attacking things in a much more general form. We think there are great opportunities there, leveraging assets and skills that we’ve developed over the years.

Let’s go back to that optimization of e-prescribing and touch on some of the keys there. One for us, certainly, is medication history. That’s a big one. You’ve got folks standing there at the point of care, if you’ve ever had to take a loved one to the hospital and had the nurse and the ED ask the question, "What prescriptions does your father take?" You just get this blank look, or at least I did. We’re in a fortunate position where we’ve got this type of history for three-quarters of the US population. It’s a great place to be, so we’ve productized that and are making that available.

The second one is electronic prior authorization. A physician’s office has to invest significant time to prescribe what the physician believes in. Then you’ve got patients waiting at the pharmacy. You’ve got pharmacists reaching back into the physician’s office. There’s a lot of waste and a lot of opportunity there. Our CompletEPA product is designed to help address that and to improve that level of efficiency and accuracy around authorizations.

The last area in optimization comes down to adherence. You’ve probably seen some of the same studies that we have that show that, particularly when it comes to chronic diseases and chronic care, this is a vital and costly component that needs to be addressed. People are getting the prescriptions, but they’re not getting them filled or they’re not taking them to conclusion. We’ve got some tools at the point of care that can inform the physicians exactly what’s going on in that area and help ensure they’re having the right dialogue with their patients when they are face to face.

 

How do manage the patient identification issue when creating a medication history from multiple care settings?

We’re in a pretty strong position there. We’ve got 270 million patients in our MPI that we can uniquely identify. The algorithms for this identification have been refined and honed over the years. There’s a lot of work and a lot of time and energy that’s gone into that. The MPI continues to grow as the number of folks that are covered by insurance across the country is growing. If you want to get deeper on the technology, frankly I’m not that guy, but I can help connect you to that guy if you want to know exactly what we’re doing.

 

If you have claims data that includes anyone who’s ever filed an insurance claim, you must have bigger data footprint than anyone.

We’ve got a tremendous footprint. If you look at the business, this is one of the most interesting parts of it. We’ve got 270 million folks in our MPI. We’ve got connectivity to 800,000 prescribers, primarily physicians, across the country. We’ve got strong connectivity to the pharmacies — virtually every pharmacy is connected to us. We’ve got connectivity to probably slightly less than half of the health systems in the country right now. 

We’ve got an awful lot of connectivity that we can bring to bear to help people move forward. While we’re very excited about optimizing e-prescribing as the first step, and secondarily moving on to broadening that footprint. We think there’s a lot to do in the world of clinical connectedness and interoperability that’s at the forefront of everybody’s mind. We think there’s some things we can do to help there.

 

Now that EHR penetration is high, how would you gauge interoperability progress and the opportunities for Surescripts now that the network is in place?

When we look at broadening our e-prescribing footprint, we are talking about two major thrusts. The first is the electronic prescribing for controlled substances. This is a big, big issue. We’re very excited to see movement at the state level. We’re participating. In fact, we just did a webinar on this and ended up with about 500 people, so there is an awful lot of interest here. 

There’s huge benefit to the system to getting these types of prescriptions digitized. This is very sensitive information, but on the other hand, it’s a situation where also there’s a lot of fraud and abuse and these types of things can be weeded out better in a digital environment than in a manual environment.

The second piece for us is long-term care. This is an area that didn’t get caught up in the first waves of e-prescribing. The hospitals and the ambulatory settings are very penetrative, with adoption rates of greater than 70 percent, but there’s a lot of work to be done in the long-term care arena. We feel very good about being able to do that.

Those are the two in terms of the e-prescribing footprint. When we move on to enhancing clinical connectivity, that comes down to leveraging the assets that we have.

We’ve created a pretty secure environment for these things. We’re one of only 105 firms in the country at this point in time that’s achieved ISO 27001. That’s something that we’re taking very, very seriously. It’s going to underpin two solid offerings that we’ve got here, the first being a a record locator service that I’ll explain on a personal level.

My in-laws live in Pennsylvania. They spend a chunk of the winter in Florida. They have very good friends in California. They’ve had healthcare events in all three environments. If my father-in-law were ever to be admitted to a quaternary facility or something like that, to pull all of his records in, it would be difficult for them to know where to go. We can give guidance on where these folks have been seen based on what we’ve seen in the prescribing patterns and allow them then to very quickly contact facilities to get the information they’d need to inform the care that my father-in-law should receive. We’ll be demoing it at the Connectathon at the HIMSS conference. I think the market is particularly interested in this as patients become more mobile and society becomes more mobile.

The other piece for us is clinical messaging. We’ve done an awful lot of work helping hospitals connect to physicians, payers connect to physicians and hospitals, and physicians to connect to other physicians. The directory that we talked about helped enable this and underlie this. We feel real good about the opportunity here and believe there’s huge value in allowing clinicians to exchange information electronically in a secure fashion.

When we look at expanding outside of the world of e-prescribing, these are the two core offerings that you’ll see most of.

 

People see big data pipes and worry about how the overseer of that information might be selling it in some fashion. Do people ask you about that?

I agree with you. The market is very, very concerned about that. We do not package or sell any data. That is not part of our business model.

 

Is CommonWell’s work complementary to what you do or are they a competitor?

When you look across the industry, any time you have a large number of stakeholders and a really big chunk of challenges, you’re going to get different types of alliances and approaches. I think there will be continuing effort to try and move interoperability forward more aggressively, things like CommonWell, DirectTrust, Healtheway, and Carequality. There’s a whole list of them. All of them serve a valuable role. They increase awareness. They drive focus. They bring energy behind the problems. Each will have their own aspects and approaches to trying to solve this.

 

What progress are you seeing in not just making external information passively viewable, but inserting it into the provider’s workflow?

You hit it right on the head. That was one of the keys to e-prescribing. I remember when folks were pushing handhelds for the docs to do e-prescribing and portals were the way of the world. If this stuff isn’t in a natural workflow for a physician, it’s going to be very, very difficult to get the uptake that you want.

My experiences over the last five years working with physicians reinforce that. These are busy people. They care an awful lot about what they’re trying to do. They love to delegate where they can. You’ve got to work with them and get it into a natural workflow.

We did it with e-prescribing. That’s at the core of everything that we’re doing around prior authorizations, that tight integration right into the workflow allows the physician’s office to really gain some tremendous efficiency in this area. I’s something we’re quite proud of and take seriously.

 

Where do you see the company going in the next five years?

We’ve got the three legs of the stool that we’re working on — optimizing e-prescribing, broadening the footprint, and enhancing clinical connectedness. A lot of what will transpire over the next few years is going to be linked to how quickly the demand for well-packaged information begins to match the supply.

What I mean by that is, to your point, there’s a lot of data out there. There’s a lot of people that want to push data at physicians and at caregivers, but the caregivers are trying to make sure they only get what they need when they need it. The industry has a huge opportunity here, but also a huge responsibility to get that right.

I think we’ll see some increases in adoption across the interoperability spectrum, and as we do with the impetus from Congress and everybody else, this thing will start to gain momentum pretty quickly. The fact that we’re starting slowly is very natural when you’re building a network. Over the course of the next five years, I would expect this type of messaging to become pretty much ubiquitous. It’s going to drive what we’re doing and really change healthcare. It will start to put us in a position where we can reap some of the benefits of the monies that have been invested in laying the EHR foundation.

 

Do you have any final thoughts?

We’ve been very fortunate and have had some great success. We consider ourselves a leader at a national level in the interoperability space, particularly as it relates to clinical transactions. I think it’s incumbent upon us as a leader to make sure that we’re extremely focused on our customers, our partners, and the stakeholders that have helped us be successful. 

As we continue to build out the portfolio, we’re certainly going to be keeping an eye on the market. I expect a lot of changes. I expect it to be very dynamic. We’ve got to be nimble enough to respond appropriately. That’s something that we’re looking forward to building into the Surescripts of tomorrow.

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April 1, 2015 Interviews No Comments

Morning Headlines 4/1/15

March 31, 2015 Headlines 3 Comments

e-MDs Merges with MDeverywhere; Creates Market-Leading Provider of Clinical and RCM Software Solutions

Ambulatory EHR and practice management vendor e-MDs has been acquired by Martin Equity Partners and merged with existing Martin portfolio company MDeverywhere, a revenue cycle management and physician credentialing system.

Sentinel Event Alert 54: Safe use of health information technology

The Joint Commission issues a Sentinel Event Alert on the safe use of health IT, focusing on process improvement, leadership, and developing an internal culture focused on safety.

Doctor exodus over new e-health system rocks Defence

In Australia, 30 doctors resign from the Department of Defence over fears that its newly implemented EHR compromises patient safety.

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March 31, 2015 Headlines 3 Comments

News 4/1/15

March 31, 2015 News 3 Comments

Top News

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Marlin Equity Partners acquires PM/EHR vendor e-MDs and merges the company with another of its portfolio holdings, revenue cycle services vendor MDeverywhere. E-MDs founder and CEO David Winn, MD will retire.


Reader Comments

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From Abe: “Re: Allscripts. I would like to know why the information of 250 people being laid off/fired at Allscripts is not on your web site. When all was good, you had them highlighted. Now that its looking grim … nothing.” Come on, Abe, at least read the darned posts before complaining – it was right there in Monday’s edition. I obviously wasn’t present for the layoffs and companies don’t announce them, so unless one of those 250 people tells me what happened (which they didn’t), I have no way of knowing, but I went with the second-hand report of two readers. And before you claim sponsor bias, Allscripts isn’t one any more – I got tired of their ignoring their months-overdue invoices and cancelled them. Meanwhile, a third reader who doesn’t indicate whether they work for Allscripts says “this very disorganized company” is laying off 265 people. The MDRX share price has dropped 35 percent in the past year, so the ever-struggling company is surely feeling pressure to try something different as it hopes its oft-repeated “population health management” mantra makes investors forget about the legacy ambulatory EHRs and low-selling Sunrise that make up most of its business.


HIStalk Announcements and Requests

I have to bite my tongue (or fingers) not to correct people who refer to times as “EST,” which is inaccurate until the clocks are turned back in November. We are in “EDT” and not “EST,” but if you want to simplify, just say “ET” year-round and you’ll always be correct. I’ve also had people get confused for interviews or calls when Lorre schedules them because she’s in Arizona, which doesn’t observe Daylight Saving Time (except for the Navajo Nation) and thus is on Mountain Standard Time year round, which is the same as PDT, meaning three hours behind EDT from spring until fall and two hours behind otherwise. We do all of this to try to unsuccessfully control nature, which ignores our human tinkering and raises and sets the sun regardless of how we play with our clocks.

Welcome to new HIStalk Platinum Sponsor Medecision. The Wayne, PA based company’s Aerial population health management technology identifies high-risk patients (or members), guides them to the most appropriate care, provides their clinicians with decision support tools, and automates manual operations, all via integration with existing systems. Aerial offers a unified clinical record, seamless integration feeds, hundreds of SOAP- and REST-based services, and a modular platform with 150 published Web services and APIs to facilitate interconnectivity. It’s appropriate for any healthcare organization that is bearing risk in the move from fee-for-service to fee-for-value, supporting care coordination, care management, case and disease management, advanced clinical content, and consumer engagement. Thanks to Medecision for supporting HIStalk.

I found a just-published YouTube video that introduces Medecision.

Also sponsoring HIStalk at the Platinum level is Peer60 of American Fork, UT, which describes itself as “the best B2B research solution on the planet.” CEO Jeremy Bikman founded the company after serving as a partner/EVP at KLAS. His folks tap into the company’s network of 100,000 decision-makers get feedback, generate leads, and perform custom market research. Client HIMSS Analytics got a response rate 500 percent higher than it expected after working with the company, while Sectra standardized all of its performance metrics on the Peer60 platform. You can download a free copy of “What Hospitals Plan to Buy in 2015” or its report on interoperability, among other available free reports. You can also visit them in HIMSS Booth # 5009, where they will again be giving away cool guitars. I also noticed the sly comment on their site that interoperability is “making news in the many of the largest news sources on the planet (WSJ, Fortune, Forbes, HIStalk),” which was cute. Thanks to Peer60 for supporting HIStalk.

I headed over to YouTube looking for a Peer60 video and came across this funny one called “It Was the Patient Catapult!” 

Listening: new trippy-happy-hippie music from The Mowgli’s, who first claimed that their misuse of the apostrophe in their name “represented the marginalization of society,” but later admitted that they were just stoned when they chose it. It’s as light and frothy as a pina colada on a summery beach.

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We received the shirts that our HIMSS conference patient advocate scholarship winners will be wearing. Look for long-sleeved white shirts with Regina Holliday’s HIStalking painting on the back.


HIStalkapalooza Sponsor Profile

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HIStalkapalooza! As one of the platinum sponsors for this event, The Santa Rosa Family of Companies — Santa Rosa Consulting, Sandlot Solutions, InfoPartners, and Fortified Health Solutions — will be circulating the main floor as well as hosting up to 20 people at a time in our opera box. Stop by our caricature drawing station to pose for a fun way to remember the night! We’ll send you a digital file of your drawing after the event to avoid worries about holding the drawing all night or protecting it while travelling home after HIMSS. Bottles of water will be provided for you as you leave House of Blues so you can hydrate on the way back to your hotel for a good night’s rest for the next big day at HIMSS15.

You can find The Santa Rosa Family of Companies at various places throughout the HIMSS15 show floor: main booth #2641, Sandlot Solutions market research booth #2939, and the Fortified Health Solutions Kiosk within the Cybersecurity Pavilion. Don’t miss our presentation on Monday, April 13 at 4:45 p.m. on “The Importance of Sensitive Information Discovery.” Take a tour of all of our locations at HIMSS15 with our Passport Giveaway Program –pick up your passport, obtain your stamps at our various locations, and you’ll be entered to win prizes that grow in value with each interaction.

We look forward to seeing you in Chicago!


Webinars

April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

Here’s MedData’s webinar from Tuesday titled “Best Practices for Increasing Patient Payments.”


Acquisitions, Funding, Business, and Stock

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Forbes profiles technology companies that are springing up to support the medical marijuana industry, with the pot equivalents of Yelp, Groupon, and Monster.com joining software developers that sell legally mandated inventory and sales tracking applications. One company is even creating a cannabis futures market that allows farmers to lock in prices for their crops.


Sales

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HealthShare Exchange of Southeastern PA selects Audacious Inquiry’s encounter notification service for its regional exchange. The statewide Florida HIE’s Event Notification Service also uses the company’s technology.

Golding Living chooses HCS Interactant for revenue cycle management in its 300 long-term care centers.

Children’s Hospital Association chooses Health Catalyst’s data warehouse for its 220 hospital members.

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Greenwood Leflore Hospital (MS) chooses Dbtech’s eFolders and Interactive eForms solutions for electronic forms, document storage, and electronic signatures.


People

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HHS CTO Bryan Sivak resigns.

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Shareable Ink names board member Hal Andrews (Availity) as CEO. He replaces Laurie McGraw, who is leaving the company.

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Wake Forest Baptist Medical Center (NC) promotes VP/CIO Chad Eckes to EVP/CFO, where he will continue to oversee its IT department, and promotes Dee Emon to VP/CIO.


Announcements and Implementations

Forward Health Group joins the Health Data Consortium.

MedAptus launches Assign, which uses rules-based intelligence to automatically assign inpatients to hospitalists or other providers.

John Lynn of EMR & HIPAA posts a video interview with Vishal Gandhi, CEO of ClinicSpectrum.

Stanley Healthcare will offer Connexient’s MediNav indoor wayfinding solution.


Other

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Consumers in the US, UK, and Germany want physicians to offer exam room privacy, explain their recommendations verbally, make eye contact, and offer physical contact. They also want (but don’t usually get) enough time during their visit to discuss their concerns. A commendable two-thirds of consumers bring a list of questions to their appointment, while 39 percent have checked an online source ahead of time. An amazing 97 percent are comfortable with their doctor’s use of technology, with 58 percent of them saying exam room computers improve their experience. The Nuance-conducted survey concludes that technology should serve a supporting role to the art of medicine and that physicians should provide time for discussion, advice, exam room privacy, and engagement.  

Joint Commission issues Sentinel Event Alert #54 on the safe use of health IT and offers a free online course on the topic that’s good for one hour of CE credit.

The CSC-led EHR project of Australia’s Department of Defense, which wildly overran its budget and timelines, causes at least 30 doctors resign in protest who say the system compromises patient safety. A big concern is that anybody can modify the doctor’s entries. This is probably not the news Allscripts wanted to hear as the DoD chooses its EHR vendor since CSC and HP are its partners.

The RSA Conference bans scantily clad booth babes from the exhibit hall, specifically mandating business attire that doesn’t include tops that display excess cleavage, miniskirts, and Lycra body suits. Conference attendees said in surveys that they want access to technically competent booth reps who can answer their questions quickly, and as the Fortune article drily notes, “booth babes are usually temporary hires and therefore not your best best if you want a deep dive on the latest cryptographic solutions.” However, it also observes that only 15 percent of the conference’s 30,000 attendees are female, so the booth babe ban may reduce that number even further. It might be fun to collect photos of obvious booth babes from the HIMSS conference since they usually aren’t hard to find and then call out the vendors who can’t attract attention without the sexist eye candy.

Weird News Andy urges that we “hold the eye of newt.” Scientists testing a ninth-century folk remedy eye salve made of onion, garlic, and cow’s stomach find that it kills MRSA. I wouldn’t get too excited just yet since lots of products kill bacteria in the lab but not in humans or with effectiveness tempered by unreasonable side effects.


Sponsor Updates

  • Galen Healthcare Solutions will resell PinpointCare’s patient engagement, care coordination, and management platform.
  • PatientSafe Solutions posts “Compassionate Care Part 1: Unlocking the Shackles of the Computer.”
  • Forward Health Group posts a video of Northwestern Memorial Physicians Group talking about its use of PopulationManager.
  • ADP AdvancedMD offers “4 Foolproof Tips to Collect More Patient Payments.”
  • AtHoc offers “Connected to a Safer World.”
  • Caradigm will exhibit at the National Association of ACOs Spring Conference April 1-2 in Baltimore.
  • Culbert Healthcare Solutions offers “Improving Patient Satisfaction.”
  • HX360 names Clockwise.MD as one of four finalists in its innovation competition at HIMSS15.
  • CareSync will participate in the Live Pitch event at the AARP Health Innovation@50+ Tech Expo.
  • Clinical Architecture posts the captivating origin story of ICD-10.
  • Capsule Tech explains how “Healthcare Technology Can be Hazardous to Your Health.”
  • Besler Consulting publishes a white paper focused on Medicare cost report reviews.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 31, 2015 News 3 Comments

HIStalk Interviews Jay Katzen, President, Elsevier Clinical Solutions

March 31, 2015 Interviews No Comments

Jay Katzen is president of Elsevier Clinical Solutions.

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Tell me about yourself and the company.

I’ve been at Elsevier for just about eight years now. Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals. The goal is to empower them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries.

From a clinical solutions perspective, our goal is to deliver solutions to improve health across the care continuum, which goes to students, clinicians, and the extended care team as well as patients.

 

Elsevier’s offerings cover a lot of depth and breadth, ranging from research journals to point-of-care content. How does that help reduce the gap between knowledge discovery and actually putting information into practice?

One of the key things about Elsevier is that we cover research through action. It covers the educational side as well. Our #1 goal is to provide the right information to medical students and nursing students to help them be the best practitioners. We deliver our solutions to primarily the provider setting, although we also go into the commercial setting, which is retail pharmacies and things like that.

Generally, we provide our information to the enterprise for use by clinicians and the staff at any point of need. There are referential solutions to look up information about what’s the diagnosis, what’s the best treatment, what is the evidence supporting the information. Delivering information to be deeply embedded into their CPOE system or electronic medical record with a goal of providing the information at the point of need to make a better decision.

Part of the way we are closing the gap is that we cover across the spectrum. We also ensure that we localize it or customize it to the individual hospital’s practices.

 

Do you ever review what information people are looking up to detect trends, such as how Google Flu Trends works?

We do. I would say it’s in the early stages of some of that. We’re looking at some new products that help us analyze that more.

There’s obviously a lot of work going around big data and analytics, but we continually review a couple of things. Number one is what people search on in general. We look at click-through patterns and things like that to try to figure out if there are ways we can optimize the system to help individuals get to the answer faster. It’s also to understand whether there are gaps in what we’re providing because people may not be finding what they need. That’s on the clinical practice side.

On the research side, we look at this to see if there are areas where they want to perform new research or areas where we need to invest from a general standpoint.

 

Are users looking beyond just finding information to instead have it made actionable by presenting it automatically at the point where they might need it?

The industry is going much more towards point-of-need information. That’s not just for clinicians — that’s for patients as well.

As our customers evolve, they’ve made significant tens of millions or hundreds of millions of dollars of investment in their infrastructure, such as CPOE systems. The reality is that investing in systems alone is not improving quality across the care continuum. It’s not standardizing care. They need content to be embedded into their systems to drive improvement in care and to improve quality.

At least from what we’ve seen and in working with our customers, number one, they want the information more actionable. They want it embedded into the systems and tied to patient context. But they also want to make sure that it’s meaningful and that it can be impactful. Lots of research around alert fatigue. Our goal is not to alert the physician, pharmacist, or nurse on every potential thing out there — it’s to ensure that we deliver the information and that it’s going to be meaningful to them to make a better decision.

The same thing applies and is applying more to patients. We have a segment focused on patient engagement. If you look at Meaningful Use Stages 1, 2, and 3, more and more information has to be delivered to the patient with the goal of empowering the patient to take control of their care. The way to do this is not just to send general information about diabetes or Crohn’s or hip replacements — it is around customizing it to the individual needs as well as their specific instances.

The actionable information applies not only to clinicians, but applies to patients, but it also has to be delivered in the workflow, whatever the workflow might be, so it’s valuable to them versus having them be proactive and go search it. It has to be pushed down to the individual.

 

How do your products support care teams, including those that are virtual?

This is one of the benefits and differentiators we have as an organization. Our products are designed around interdisciplinary care teams, especially our care planning products, our order set products. We’ve put a lot of focus on how teams are working now and how they’re going to work in the future.

From a collaboration standpoint, some of the things we’re testing now are around patient engagement. Not just delivering information to an individual patient, but it’s also creating a seamless connection for the patients back to their clinicians. We’re looking at testing some products with some heart failure patients where they can flag things on their mobile device. That sends an alert back to their primary care physician, who can make a call and connect with the patient. There’s collaboration on the care team, but also an increased need for collaboration between the patient and the provider.

 

That sounds like your Tonic platform, where consumers can enter information on a mobile device. What kind of information can they enter and how does that flow through to the provider?

It’s a couple of things. One is the Tonic platform and one is a pilot we have which is called Digital Dialogues, which we’re doing with IMS.

Digital Dialogues is around congestive heart failure. The patient can capture information that is then sent back to the physician to create that connected network. 

Tonic is a tremendous platform that has a lot of potential to expand what we can deliver and when we can deliver it. Initially, patients go into a hospital and it’s around capturing information about that patient. The unique thing about the Tonic platform it’s a gaming-type system where it makes it fun for the patient to answer questions. Based on the questions, we can then deliver information that is more specific to them. If they have Crohn’s and we have information videos or other information on Crohn’s, we can direct it to them right at that point of need or action.

The platform allows us a lot of flexibility as far as when the patient or consumer is interacting with the platform and what we can deliver to them based on what their specific requests are, right at the point of need.

 

Is it a change in the company’s direction to go beyond supplying reference material for providers to supporting consumers who are seeking their own information, perhaps as an alternative to Web searches?

Absolutely. First of all, our primary market is to the institution for use by clinicians. But the reality is that in today’s healthcare market, the patient or consumer has to play a significant role in their care. We’re working with hospitals to implement the Tonic platform, which includes our content and information solutions. It’s the trusted provider — patients going into the hospital will get the same information that the hospital is using internally as well as when patients go home.

We cover the information needs across the spectrum, whether it’s a physician or pharmacist looking up information about a disease, what’s the best treatment, what’s the best plan of care, are there interactions, and things like that. We deliver all that from a clinical perspective, but just as importantly, we need to deliver similar type of information geared toward the patient so they can understand it and they’re empowered from a care standpoint.

If you look at the statistics today, there’s almost a trillion dollars of waste in healthcare. Big chunks of that are because patients don’t understand their care, they’re readmitted, they don’t follow the regimen that’s provided to them. It’s pretty critical that patients or consumers understand what their needs are, how to improve their care, and why it’s important to follow it, as well as what the implications are if they don’t, so that we can reduce the overall waste in the healthcare system.

 

Do you see any possibility of a single shared care plan where all of a patient’s providers and the patient themselves can contribute to it, perhaps wrapped around standard evidence-based content and some sort of workflow capability?

We’ve looked at that in the past, whether it was for care plans, order sets, or other type of content — a collaborative content creation or updating mechanism. What we’ve found is that while things are standardized across the US healthcare system or other systems, the reality is each healthcare system wants to put their own stamp on it or have their own tweaks, whether it’s care plans or order sets.

We provide mechanisms inside of an institution to collaborate across different kind of committees, whether it’s on care plans or order sets. We’ve talked to people outside to see if they want to do it in a more community-based environment, but so far, that hasn’t gotten a lot of traction.

I think it comes down to the fact that there are a lot of complexities around that, from a standpoint of keeping them current, ensuring that if evidence changes or a drug is removed, that’s propagated throughout everything. How do we reduce liability but ensure that people have access to the best information they can? Those are some of the challenges to the community-based infrastructure.

 

Where do you see the company going in the next five years?

My goal and the vision of the company is to lead the way in science, technology, and health. Healthcare is still in a state of disarray. Based on the stats from a study that came out, a thousand people die every day in the US from preventable medical errors. It’s just not acceptable. It’s our responsibility as a company to deliver our solutions to students and professionals to improve the quality of care.

If I look out at the next three to five years, it’s just continuing in the current strategy. We can significantly improve healthcare and reduce errors by ensuring that our care planning products and our order set products are implemented in these systems, utilized, and that the right training is delivered to the institution to ensure standardization of care. We’ll be delivering more and more of our information deeply embedded into our health HIT partners.

Another big component for us is around patient engagement. We talked about that already and how the patient is playing a much larger role in their care. That’s a focus for us. I see that continuing and evolving and increasing over the next three to five years.

We’re a global company. From a clinical solutions business standpoint, a significant part of our revenues comes from outside the US. We continue to invest in many countries outside the US. As the evolution of the infrastructure increases in the UK, Germany, Spain, China, Japan, etc. we continue deliver the same types of solutions and the same type of impact outside the US as well.

 

Do you have any final thoughts?

Whether it’s Elsevier or any company out there, it’s our responsibility to partner with our hospital customers, physician offices, and clinicians better to look at co-development and other ways to deliver our information. It’s our responsibility from an Elsevier perspective, and from the industry’s perspective, to solve this problem.

We’re not there. We haven’t done it yet. If you look at the stats, if anything, they’re going the wrong way. We need to be more successful in ensuring that our information and the evidence is delivered at the right point of time to improve care. It’s something that has to happen in this marketplace. It’s not sustainable and we shouldn’t accept it.

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March 31, 2015 Interviews No Comments

Morning Headlines 3/31/15

March 30, 2015 Headlines No Comments

HHS CTO steps down

Bryan Sivak will step down from his position as HHS chief technology officer at the end of April. Sivak joined HHS in 2012 and oversaw the Entrepreneurs in Residence program as well as the HHS IDEA Lab.

Scripps Selects Epic For New EHR

Scripps Health (CA) has chosen Epic as its next EHR vendor, replacing GE Healthcare’s Centricity Enterprise on the inpatient side and Allscripts Enterprise in its outpatient clinics.

Canadians Losing Out On Benefits Of Electronic Health Records

A C.D. Howe Institute report finds that widespread interoperability challenges are hindering efforts to reduce healthcare costs and improve care coordination. “Survey findings revealed that in primary care only 12 percent of physicians are notified electronically of patients’ interactions with hospitals or send and receive electronic referrals for specialist appointments,” says Denis Protti, the report’s author.

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March 30, 2015 Headlines No Comments

Readers Write: Your Interfaces Suck Because You Want Them To

March 30, 2015 Readers Write 6 Comments

Your Interfaces Suck Because You Want Them To
By T. Ruth Hertz

Your interfaces suck because you want them to. Yup, that’s the stone cold reality. 

I am looking at you Mr. /Ms. CIO. You may talk all day about interoperability, data normalization, HIEs, standards, etc. but unless the right data in the right format gets to the right place at the right time, you are wasting time and money and possibly risking patient safety.

But wait, you say. We insist that all applications have HL7 interfaces – we even put it in the contract! Yes, maybe you do, but do you take the time to get and review detailed specifications before you sign the contract? Do you require the vendors to demonstrate interfacing their application with the ones you already have? Not just give you a list of other clients that have “the same systems as you” but actually connect their system to your engine and downstream application test environments? How well would the physicians at your institution react to being given a list instead of a demo and / or site visit?

Do you let your interface experts ask the tough questions during due diligence? If you do, does it matter when the answers are wrong or evasive? Or do you just accept it when the vendor says, “You can fix it in the engine?” Do the interface experts get to go on the site visit, see the interface in action, and talk to the folks that have had to actually make the interface work?

Let’s face the facts:

  • It is in the application software vendor’s best interest to not interface well with other vendors’ apps. Selling a suite of apps that work well together but not well with others makes buying their products as a set look like the smart thing to do.
  • Application software vendors can make their interfaces work. They have the source code and the underlying database. They just need a very good reason to do so – like “no sale” if they don’t.
  • Your interface staff time isn’t free. All the time spent on analyzing, designing, and building workarounds to compensate for deficiencies in the sending and/or receiving applications costs hard money. That time is also time lost from other projects.

It’s time that the decision-makers who buy healthcare apps put a stop to this madness and insist that true interoperability be delivered by the software vendors – or no sale.

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March 30, 2015 Readers Write 6 Comments

Readers Write: A Prescription for Getting Face Time with Doctors at HIMSS

March 30, 2015 Readers Write 1 Comment

A Prescription for Getting Face Time with Doctors at HIMSS
By Chris Lundgren

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It’s no secret that it’s getting harder and harder to get face time with doctors. But I’m a sales guy, so I always see a silver lining in everything.

In this scenario, the silver lining is that doctors are just like you and me. They can’t live without their gadgets. Recent studies have shown that 75 percent of doctors own a smartphone and 55 percent use both a tablet and smartphone in their daily work. So while you may have a more difficult time connecting in person with doctors, you can still be very much connected.

The key to engaging doctors today is to use technology when the time is ripe. The upcoming HIMSS conference is the perfect example. It has a huge audience and nearly 60 percent of the attendees are healthcare providers. Let me repeat: thousands and thousands of doctors gathered in one space to live and breathe technology for five days. If that isn’t a jackpot waiting to happen, I don’t know what is.

Problem is, doctors are going to be running from one panel to another at HIMSS, so you can’t expect to get face time with them if you haven’t engaged them prior to the conference. And the way to do that is – you guessed it – through their gadgets. Here’s what I recommend:

  1. Ask them how they’re doing. Doctors are always asking others how they’re doing. Now that the pressure is on doctors to improve patient outcomes and reduce healthcare costs in measurable ways, it’s time to ask doctors how they’re doing and what’s on their minds. A quick and easy way to do that is a survey that asks 1-3 questions such as, “What topic(s) are you most interested in at HIMSS?”, “What do you hope to gain from learning about that topic?”, and “What other concerns are on your mind?”
  2. Make them a HIMSS-only offer. Limited time offers work time and time again because they create a sense of urgency. If you want to ensure that you get some face time at HIMSS, make sure you’re prepared to make offers that will only be available at the conference. Use the results of the survey to develop the offer or gather qualitative insights from your sales reps – what have their conversations revealed about doctors’ needs right now? Take advantage of email marketing for its quick response, analytics, and segmentation capabilities.
  3. Impress them with knowledge. A recent study showed that doctors are always hungry for new research, case studies, and other clinical knowledge that can help them in their work. But here’s the catch (and also the opportunity): they’re often too busy to look for it on their own. Do the work for them by delivering valuable content. Remember, they’re busy, so don’t deluge them with a library of links. Try a short list of statistics or a link to an article to get the conversation started. Tip: Information related to patients is hot right now and there’s a treasure trove of relevant content with a quick search.

Digital engagement is an essential component to any physician communication strategy. However, to maximize the results of such a strategy, the focus should be on quality rather than quantity. In addition, integrating a quality digital campaign with the right mix of print, mail, and telemarketing can optimize any effort. Be sure to get your reps to follow up with doctors on the phone or via email after a campaign goes out. Using this multi-channel approach can boost revenue by more than 10 percent. Good luck at the conference.

Chris Lundgren is VP of strategic sales for Healthcare Data Solutions of Lincoln, NE.

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March 30, 2015 Readers Write 1 Comment

Curbside Consult with Dr. Jayne 3/30/15

March 30, 2015 Dr. Jayne 3 Comments

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I mentioned that we are having budget meetings this week. One of the hot topics is how we’re going to manage office space and various leases as we reorganize to consolidate onto a single vendor platform. The health system’s goal is to move everyone under the IT umbrella, so we’ll need more space at the mother ship.

We’ll also have to figure out what to do with existing office space leases at our regional campuses and how to transition people from one location to another in a timely fashion. Certain functions such as desktop support and provisioning will continue to be somewhat regional, so there’s going to be some delicate negotiating while we figure out which spaces to keep and which to let go.

I hadn’t given much thought to the new space they’ll be outfitting for the project. The last time I was involved in a significant office move was seven or eight years ago and we were going into a largely completed space. The biggest thing we had to decide was which staffers would be placed into which rows of cubes.

Late last week, I had the dubious pleasure of attending a half-day session to discuss design and construction of the upcoming office build-outs. Given some of the complaints we’ve gotten about the open office design at some of our newer facilities, I thought the topic might be contentious, but I had no idea just how much.

One faction came to the meeting armed with copies of a recent article in The New Yorker called “The Open-Office Trap.” It details the perils of the open office, citing examples of reduced productivity and higher levels of employee stress. Reports have also chronicled higher use of sick days and reduced cognitive performance. One study from Cornell University found that workers exposed to typical open-office noise had higher levels of the stress hormones that are typically associated with the fight-or-flight response. Another from Finland looked at whether younger employees did better with the open office platform and concluded that although they might seem to, there are trade-offs.

As we started the meeting, another attendee hastily emailed links to the Washington Post piece on the topic. The author mentions employees who have difficulty with the transition the open office paradigm and laments the lack of huddle rooms to be used when private conversations are required.

I know that the first time I had to transition from a private office to a cube, I had a hard time adapting. As a newly-minted medical director, I was given a “supercube,” which was essentially double sized with a small table for meetings. It was on a main thoroughfare in cubeland however, which seemed to invite people to plop around the table for impromptu conversations.

I was often interrupted with requests to borrow my chairs or by people just saying hello on the way to the bathroom, icemaker, elevator, or coffee pot. It was also difficult to have confidential conversations about physician behavior, especially since we didn’t have enough smaller meeting rooms. This led me to hide out in a poorly-lighted and recently-vacated office in the basement near hospital engineering, at least until that space was reassigned. The experience definitely strengthened my support for allowing staff to work from home.

Halfway through today’s already-rowdy meeting, another colleague emailed around a piece entitled “Open-Plan Workspaces Are the Work of Satan.” The meeting quickly spiraled out of control after that since it’s hard to take Formica samples and color swatches seriously after someone has invoked the Prince of Darkness. The design and construction team had brought along an intern and I’m sure she found the meeting to be highly educational, just not in the way it was originally intended.

I’m just glad I kept a low enough profile to avoid being volunteered for the subcommittee that will meet again to “continue the dialogue.” I’ve spent the last two months fretting about the future of my team and of my own career and it didn’t even occur to me that serious choices needed to be made on whether we want an aquatic color scheme or one that is desert-inspired or how many “rolling-wall” whiteboards we might need to order. I’m glad there are people that care and are thinking about these things, but at this point it feels frivolous.

The positions for our new clinical project were posted last week. It’s hard to watch my highly-qualified staff fret over whether they’ll be chosen. They’ve heard that they have to take a personality test and that there may be a preference for younger workers without “bad habits” gleaned from working with other vendors and systems.

I’m not part of the hiring decisions at all, but I certainly hope we don’t shoot ourselves in the foot by throwing away all the non-software knowledge we have amassed regarding how to effectively serve our physicians and their practices. In the mean time, I’ll have to amuse myself by running the betting pool on aquatic vs. desert color schemes.

What do you think about open offices? Email me.

Email Dr. Jayne. clip_image003

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March 30, 2015 Dr. Jayne 3 Comments

HIStalk Interviews Randy Campbell, President, FormFast

March 30, 2015 Interviews No Comments

Randy Campbell is president of FormFast of St. Louis, MO.

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Tell me about yourself and the company.

I started my career as a biology major in pre-med. I graduated, but didn’t go to med school for various reasons. My roommate, who was studying computer engineering, asked me a question one night. I thought, "Wow, this is really interesting. IT is where I need to be."

I started out in IT, software development in particular. I moved on from software development to a systems integrator, which is a company that provides hardware, software, and services to enterprises. I learned a ton in that field. Ultimately I decided I wanted to get back to a software development company in a area that I’ve always enjoyed. That was healthcare, so I ended up at FormFast.

FormFast is a privately held software company that only sells to hospitals. We’ve been in business for 23 years and have a very large market. We’ve sold to a lot of hospitals over the years.

 

How have hospitals improved care or efficiency using workflow or process automation that they couldn’t have done with an EHR alone?

That’s the sweet spot we’re in. We’re helping hospitals with all the stuff that supports their EHR and is part of the ecosystem of the hospital.

Our legacy products are electronic forms, in particular on the registration side. Being able to take the information that’s collected by the registrar and, without the expense and maintenance of paper forms, collecting that information, getting signed by the patient when necessary for consents or release of information forms, and then getting that information into a document repository. You would think that process would be core to an HIS or an EHR, but it’s not, because those vendors are more worried about the clinical processes and clinical workflow.

There’s plenty of examples elsewhere in the hospital, whether it’s in the back office, in materials management, and even with some major HIT vendors, with applications or workflows between their own applications that they don’t provide or have the capability to address. Physician coding query is an example, where the coder is able to communicate with the physician in a secure way to ensure that the appropriate codes are applied and that all the documentation is there to support those codes.

 

Hospitals that claim to be paperless still have a lot pallets of Office Depot paper and pre-printed forms coming in via the loading dock. What are the benefits of making paper processes electronic and workflow driven?

There’s the obvious cost of printing the forms themselves. A hospital is a very regulated environment, and even for forms that are part of the back office that don’t fall under particular government regulations, those forms change. 

Our traditional market has been the community hospital, but with the changes that are happening in healthcare now where so many hospital systems being purchased by larger systems or by IDNs, we’re finding ourselves in larger and larger hospital systems, including the very largest IDNs. It’s really about efficiency and being able to support their core business — which is delivering care — with systems and processes that are as sophisticated as the clinical processes need to be.

For instance, we are working with a number of hospitals around HR kinds of processes. Hospitals have a lot of transitions of staff and employees, people coming and going with mergers and acquisitions of facilities and people changing jobs. Being able to easily onboard, offboard, promote, and transfer employees becomes a major problem. It slows down their ability to focus on the more fundamental mission that they’ve got, which is providing care.

Not only do we provide software that enables hospitals to use those forms in an electronic version that easily integrates with other systems and provides the kinds of automated processing of that information and storing and archival of that information, but we also provide services to many hospitals to do the change management of those forms. That information is always changing, especially as organizations are being bought and sold.

We were having a conversation just this week around our checks application. Somebody asked, "What is the need in hospitals for an application to be able to process checks and generate financial reports and documents and so forth?" They’re changing banks, they need to change the logo, they’re part of a new hospital system, or they’re getting information from a different system. It’s amazing how dynamic the back office systems are.

Hospitals are becoming enterprises like in all other sectors. They have the same enterprise problems. With HITECH and Meaningful Use, more and more money is going into IT, and making sure that that information is in a form that it can be used, shared, and reported on is important. That’s true for the back office as much as it is for the clinical side.

 

More information is being collected from patients and families, some of whom might not be comfortable entering it using the same applications that clinicians use. Are hospitals using more electronic or scanned paper forms so that the patient-generated information isn’t just sitting in a drawer somewhere?

Yes. Hospitals are asking us to be able to present forms to patients directly, whether it’s for pre-registration or for getting consents signed before coming in.

With fee-for-value rather than fee-for-service, care is being pushed down more and more to clinics, primary care physicians, and even retail environments. That requires more ways of interfacing directly with patients instead of the traditional contact with the registrar or clinicians on the floor. We’re doing a lot of work on that because customers are asking us for more ways to engage patients.

We facilitate the ability to collect information in a very organized fashion using an interface called the form — but it could be a web application — that meets particular requirements and is easy to change. Other enterprises need to do that, and as hospitals add these additional touch points with patients, they’re going to have the same demand.

 

Is anyone doing anything interesting with barcodes?

It’s pretty exciting to be able to ensure that documents are properly identified, that they’re filed in the appropriate document management repository, and that information is not lost, misfiled, etc. A lot of our business still comes from barcoding forms. We can put not just the old style of barcodes, but 2D barcodes that can be read by the lab system and pharmacy system. We’ve worked with some major hospitals to use different kinds of barcodes that other applications within their clinical environment need to ensure that they’re able to identify that patient 100 percent accurately. The same goes for the forms themselves, the ability to ensure that those forms are stored with the appropriate medical record.

That continues to be a problem. It really is amazing that some of these very fundamental processes within a hospital still seem to have some real inefficiencies. I think it’s just because of inertia. All of the focus has been on getting electronic health records in place. Some of these other important supporting processes have been somewhat neglected. But I think that’s changing.

 

Do you have any final thoughts?

IT can help enterprises and hospitals are becoming enterprise organizations. They’re operating more like businesses.

We and other healthcare IT companies can help hospitals, especially with these new initiatives, become more efficient. They’ve got a lot of systems. They’ve got a lot of applications. There’s a lot of change in their environment. There’s a lot of things that IT can do to help improve their ability to operate as a business. The more they can operate efficiently as a business, the more they’re going to be able to focus on their core business of providing care to patients.

It’s exciting to see what we can bring to hospitals, perhaps things things they weren’t aware of or weren’t exploiting. It’s exciting for me and for FormFast to be part of that.

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March 30, 2015 Interviews No Comments

Morning Headlines 3/30/15

March 29, 2015 Headlines No Comments

Senate delays vote on Medicare payment fix for two weeks

The Senate will not vote on the House-approved SGR repeal bill until mid-April, after its two-week recess ends.

Johnson & Johnson Announces Definitive Agreement To Collaborate With Google To Advance Surgical Robotics

Google and Johnson & Johnson will partner to develop a surgical robot that will leverage Google code to support surgeons.

Nearly Seven in 10 Patients Would Avoid Healthcare Providers That Experience a Data Breach

A Transunion Healthcare survey finds that 65 percent of respondents would avoid a healthcare provider that had experienced a data breach. Younger respondents were less forgiving than older respondents, with 73 percent of 18 to 34 year olds reporting that they would likely switch providers over a data breach.

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March 29, 2015 Headlines No Comments

Monday Morning Update 3/30/15

March 28, 2015 News 5 Comments

Top News

The Senate won’t review or approve the House-passed doc fix bill until after its two-week recess ends on April 13. You may recall that 2014’s one-year ICD-10 delay was inserted when the Senate, working hours before the previous SGR patch was set to expire, couldn’t muster enough votes to pass its own version of SGR bill that didn’t include the delay.


Reader Comments

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From Raygun: “Re: Epic. They’ve never posted in social media, but I got this in my LinkedIn stream.”

From Hanoi Hotel: “Re: [vendor name omitted.] Supposedly laying off 300 people. Trying to get better intel.” I’ve omitted the name of the publicly traded company. Update: a second reader confirmed the first reader’s statement that the company is Allscripts.


HIStalk Announcements and Requests

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The least-trusted interoperability organization is CommonWell, according to 50 percent of readers. If you add the totals of its members that are listed in the poll, the distrust number increases to 78 percent vs. Epic’s 22 percent. Respondent James explained his thought: “McKesson’s CEO has said in quarterly calls that he expects CommonWell to gush licensing money any day. Cerner’s documentation is near impossible to find. Epic’s HL7 documentation is there for all to see but that doesn’t do much in the expense department. Athena’s API is non-healthcare-industry-standard, which is a good thing, but it can’t move the market.” A third of the votes came from the Madison area, although Epic was hosting a bunch of customers there and there’s no way to separate their votes from those of Epic employees. New poll to your right or here: what’s the #1 reasons you would decline to do business with a startup?

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A year ago I donated most of the proceeds from the Top Spot banner ad at the top of every HIStalk page (it mostly ran during the HIMSS conference) to classroom projects via DonorsChoose.org. Teach for America teacher Ms. Moore sent photos this week of her students enjoying the 50 library books we as HIStalk readers donated to her school (with matching funds from the Bill & Melinda Gates Foundation). Her school, in which 65 percent of students get free or reduced price lunches, is the sixth-highest performing school in North Carolina, with 97 percent of students performing at or above grade level and 100 percent of seniors accepted to college (85 percent of those are the first in their families to attend college). The Top Spot banners are still available if your company wants HIMSS exposure and to help me fund more classrooms in need.

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Our networking event for HIStalk sponsors will be held Sunday evening (April 12). I’m offering great food and a premium open bar at a nice venue not far from the river and Miracle Mile. I had this last-minute thought: if you’re the CEO of a non-sponsor startup and want to network with some great folks, tell me why you’d like to come and I’ll choose up to five to join us at my expense.


Last Week’s Most Interesting News

  • The House passes an SGR doc fix bill that is free of ICD-10 delay language.
  • HHS publishes drafts of Meaningful Use Stage 3 and 2015 certification requirements.
  • Industry leaders John Halamka and Micky Tripathi question the direction and value of ONC’s Meaningful User and EHR certification programs.
  • Vermont’s governor threatens to shut down the state’s floundering health insurance exchange and move to Healthcare.gov.
  • The head of the Department of Defense’s EHR project suggests that it will choose the bid group that offers the best services, not necessarily the best EHR.

HIStalkpalooza Sponsor Profiles

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Do you need a little Tonic to help face those Healthcare Challenges? Visit Elsevier booth #2207 to witness how our innovative solutions and services empower patients and providers and improve clinical outcomes embedding trusted medical content at every stage in the patient journey. Participate in our exciting Healthcare Challenge and win special event giveaways. Are you curious to learn about extreme patient engagement? If that doesn’t convince you, than how about cocktails and mocktails served with a flair? Please join us for our daily in-booth happy hours. We look forward to seeing you there.

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Mark your calendars… HIStalkapalooza gold sponsor Divurgent will be bringing back their ever-popular Children’s Hospital Charity Drive to the HIMSS exhibit floor to raise monies for Ann & Robert H. Lurie Children’s Hospital of Chicago. Divurgent’s booth #1891 will feature a fast-paced, interactive Trivia Charity Drive, inspired by the explosively popular mobile app game, Trivia Crack. It will be hard to miss the vibrantly-colored Trivia Charity Wheel as HIMSS attendees spin to see what trivia category they will land on, along with what donation value Divurgent will contribute on the attendee’s behalf. Make sure to visit booth #1891 to help Divurgent meet their goal of raising $5,000 for Lurie Children’s.To view all of Divurgent’s exciting events and happenings during HIMSS, click here.


Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.


Acquisitions, Funding, Business, and Stock

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Valence Health will move to a new Chicago location as it plans to add 500 jobs by 2019.

Vince continues his 2014 review of health IT vendors in covering those that serve large health systems – Cerner, McKesson, Epic, Allscripts, and GE Healthcare.  


Sales

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Public Hospitals Authority of the Bahamas chooses Surgical information Systems for perioperative systems.


Announcements and Implementations

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EClinicalWorks subsidiary Healow announces integration with several wearable and fitness tracker products.


Government and Politics

Programming website GitHub is hit by a distributed denial of service attack from what appears to be the Chinese government, which is unhappy about GitHub tools that allow China-based users to bypass their government’s censorship.


Privacy and Security

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A TransUnion Healthcare survey finds that two-thirds of recent patients (with a heavy representation of younger ones) would avoid a provider that has experienced a data breach. Half of the consumers expect to be notified within one day of the breach (hopefully of its announcement rather than the actual event since it’s foolish to announce a breach before doing preliminary investigation) and about the same percentage expect a dedicated phone hotline and website to answer their questions.


Technology

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The local TV station profiles Seattle Children’s use of software from local startup Luum, which tracks how employees commute to work so that the employer can reward the use of sustainable transportation. Seattle Children’s gives employees a free fancy coffee if they don’t drive to work in a car.

Johnson & Johnson-owned medical device vendor Ethicon signs a collaboration agreement with Google to develop a robot-assisted surgical platform.

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I’m interested in a couple of new apps (Meerkat and Periscope) that allow someone to stream a video broadcast from their smartphones to their chosen Twitter followers. It would be kind of cool to watch a live stream of the HIMSS keynotes or to show a first-person view of what’s going on at HIStalkapalooza.


Other

The City of Baltimore uses its Netsmart EHR to remind employees who are treating heroin addicts to test them for HIV and refer them to HIV care if positive.

I missed this until @Farzad_MD tweeted it out: great investor advice presented as quotes from venture capitalist Paul Graham:

“What investors are looking for when they invest in a startup is the possibility that it could become a giant. It may be a small possibility, but it has to be non-zero. They’re not interested in funding companies that will top out at a certain point.  A startup is a company designed to grow fast. Being newly founded does not in itself make a company a startup. Nor is it necessary for a startup to work on technology, or take venture funding, or have some sort of  ‘exit.’ The only essential thing is growth. Everything else we associate with startups follows from growth.… To grow rapidly, you need to make something you can sell to a big market … If you want to start a startup, you’re probably going to have to think of something fairly novel. A startup has to make something it can deliver to a large market, and ideas of that type are so valuable that all the obvious ones are already taken…. Usually, successful startups happen because the founders are sufficiently different from other people – ideas few others can see seem obvious to them.

Weird News Jeff channels WNA in providing this family-unfriendly story. Two UC Berkeley researchers develop SmartBod, an adaptive biofeedback app that manages the most personal of wearables in order to guarantee a happy ending, tracks performance over time, and allows proudly sharing the results with social media. If that’s not enough, the last names of the scientists (who are in fact a couple) are Klinger and Wang.


Sponsor Updates

  • Zynx Health client Meritage ACO (CA) achieves successful reduction of at-risk patient readmissions.
  • Senator Lois Wolk (D-CA) recognizes Geni Bennetts, MD of WeiserMazars as one of the Third Senate District’s “Women of the Year.”
  • Huron Consulting Group will sponsor and exhibit at the 2015 Cancer Center Administrators Forum March 29-31 in Lexington, KY.
  • Verisk Health offers “How the Boomers will Change the Shape of Medicare.”
  • T-System President and CEO Roger Davis weighs in on EHR interoperability.
  • Shareable Ink names Chris Buckley as regional sales director of the year.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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March 28, 2015 News 5 Comments

Morning Headlines 3/27/15

March 26, 2015 Headlines No Comments

Cost Estimate and Supplemental Analyses for H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015

The CBO estimates that the House-passed SGR repeal bill will increase the federal deficit by $141 billion over the next ten years. The bill is now with the Senate.

The CMS and ONC NPRMs

John Halamka, MD weighs in on the recently published MU3 rules, concluding “The sheer number of requirements may create a very high, expensive and complex set of barriers to product entry.  It may stifle innovation in our country and reduce the global competitiveness for the entire US Health IT industry.”

Rethinking Radiology Informatics

An article in the American Journal of Roentgenology suggests that the ongoing shift to centralize IT services in hospitals has left radiology departments, which were often early health IT adopters, with fewer clinical IT experts and less control over the direction of innovation in their specialty.

Introducing TeleMED Assist from Seniors Wireless

Seniors Wireless launches a $30 per month telehealth service that promises unlimited 24/7 access to physicians by telephone or video for anyone over the age of 55.

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March 26, 2015 Headlines No Comments

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