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Curbside Consult with Dr. Jayne 3/28/16

March 28, 2016 Dr. Jayne 4 Comments

I spent several days this week performing an assessment of a client’s EHR support team. The IT director had been pressing leadership for more employees. The CIO, however, suspected that perhaps there were other issues on the team keeping people from being maximally productive. I had been tasked to determine not only whether there are process issues, but whether the team has the right skill sets to be effective.

You may be asking why a physician or CMIO is doing this kind of work. Even though this type of work can be done by non-physician consultants, many of the organizations I work with have found that the recommendations carry more weight when they come from a clinical informaticist.

Just observing in the office, I found the usual distractions and interruptions – instant messenger, email notifiers, and text messages which kept people from focusing on their work. Additionally, the support staff wasn’t particularly differentiated as far as which types of issues they handled. Working with somewhat of a call center mentality, staffers were expected to handle every call that came through in a round-robin fashion, regardless of the nature of the issue. Staffers were positioned to handle whatever was on the other end of the phone, even though the callers might have neurosurgical problems and the person answering the phone might be a rheumatologist.

The support team had varying levels of experience – some were clinical, some were technical, and some actually had zero healthcare IT experience and minimal training yet were expected to handle calls successfully. Part of my assessment includes individual staff interviews, during which I determined that one staffer in question had never even been to formal training on the application he was expected to support. Worse, he wasn’t a new employee, but had been there for nearly six months, and his manager had continually promised she would get him scheduled for training but never delivered.

That in itself was a red flag. It’s hard to on-board employees when you don’t have a formal training program. The best organizations I have worked with expect new hires to complete specified training and demonstrate proficiency within the first 90 days. At some, this may also include achieving certification from the vendors of the applications they are supporting, if they are not already certified. Usually those requirements are baked-in as conditions of employment, making it easier to break with someone who can’t meet expectations.

The individual interviews also uncovered that some team members had particular expertise that was going to waste considering how they were being utilized. One was a lab expert, another was a nurse, and yet another had extensive process improvement training from a previous position. Given their round-robin deployment on support tickets, their skills were going unused. Several of their responses indicated boredom and frustration.

My interview of the manager was particularly enlightening. She stopped the interview multiple times to deal with text messages, phone calls, and even people walking by the office. Observing her outside the interview, I can only describe her work habits as firefighting. Everything was a crisis requiring immediate attack.

I also interviewed a director and a vice president, neither of whom seemed particularly knowledgeable about the work going on below them. They seemed fairly content to manage from above without accountability for their teams’ performance. One flatly stated that, “Getting results is why I have managers. That’s their job, not mine” even though he acknowledged that his managers weren’t terribly effective in actually achieving the desired goals. The VP admitted he had no experience with clinical systems or working with physician groups and that he had just been given this department when the last VP left.

It was clear that culture issues were at play as well as general inefficiencies, and I included a discussion of that problem in my formal report. I was looking for additional documentation about workplace distractions and came across several recent pieces about email as one of the roots of all evil.

Despite their best intentions, people struggle with email management. This is particularly acute in organizations like my client’s, who don’t have clear policies about email use. When I’m engaged to provide guidance, I always recommend policies which include expectations for response (if you need a response in less than three business days, you need to use phone or in-person communication) as well as a specification on which types of issues belong in email and which don’t.

Interesting in some of the studies was the fact that employees using email were less likely to achieve deep work states. Over the last year, I’ve started seeing more organizations where employees never achieve deep work states. Sometimes they’re constantly dealing with customer “fires,” but more often, I’m seeing employees who are put in that position by a lack of leadership and strategic planning. In workplaces with these cultures, I often see evidence of people working from home or from their phones. When asked about these behaviors, workers often cite “the need to keep up” or the fact that they can’t get anything done at work. Both of these are just symptoms of a larger problem.

In other situations, workers may not understand how the tasks they are performing fit into larger initiatives, which can create frustration. One client I worked with in the fall was running parallel initiatives out of two teams without any coordination of efforts. Leadership didn’t account for the fact that employees have friendships across teams, and when they learned of the parallel efforts, their perception was that their projects were competing rather than complementary. This lead to a spiral of frustration as workers were suspicious that they were being set against each other or that a “losing” team might end up being downsized.

In one organization I recently visited, people were constantly told about the organization’s key objectives and vision, but there has been little to no communication about how they’re actually going to go about achieving those objectives. That type of work environment quickly leads to frustration and then to apathy. I also had concerns about workplace violence, as the marketing department had the corporate focus words imprinted on stones for employees to have as focal points on their desks. I’m betting more than a few of them get thrown from time to time.

These higher-level dysfunctional behaviors were present at my client, in addition to the micro-level dysfunction that I identified looking at their individual work habits. What the client felt was going to be a straightforward analysis of their EHR support team revealed not only a poor staffing plan and misuse of some fairly expensive human capital, but also a lack of strategic planning. There were also some other red flags in dealing with this client. I knew that my findings weren’t going to go over well because they didn’t fully support management’s original theory that the team was overwhelmed or just wasn’t working hard enough.

Fortunately, I had scheduled an onsite presentation of my findings so that we could discuss them rather than just sending them a report after the fact and having a call to review. Although some members of the leadership team seemed genuinely shocked (or at least were very good at making it look that way) the majority of them didn’t seem terribly surprised. Several of them (including the director and the VP) were skeptical of the findings and my recommendations, and based on their responses, I don’t think they’re at a point where they’re ready to make changes.

One of them actually accused me of “muck-raking,” which is a term I haven’t heard since the last time I took an American History class. Another (who apparently missed the memo on why I was there in the first place) said I was just “coming up with make-work tasks to justify my existence.” Those are pretty powerful words to say to someone who was specifically hired to complete a well-defined project, not to mention to someone who was specifically hired by your boss to figure out why your department is a disaster.

I didn’t find their responses surprising at all since they were obviously trying to defend their turf and protect their own necks. We’ll have to see what the CIO decides to do with the findings. Based on the personalities involved and their obvious resistance to change, I’m not too thrilled about the possibility of a follow-up engagement should they request one.

Regardless of where they decide to go from here, I left them with quite a few concrete recommendations for the team in question as well as for their leadership team. It’s sad to say, but clients like this are becoming the norm for me. I’m eager to do work for an organization that has leadership, vision, and focus but just needs a kick in the pants to get it done rather than one that seems oddly happy in their dysfunction.

Have any client prospects? Email me.

Email Dr. Jayne.

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March 28, 2016 Dr. Jayne 4 Comments

OpenNotes: From Grassroots Effort to Nationwide Movement

March 28, 2016 News No Comments

We look at the evolution and future of OpenNotes — from the impact it has had on patient engagement, medication adherence, and physician workflows to the technological challenges of implementing a truly vendor-agnostic tool.
By @JennHIStalk


Six years ago, the notion that patients could have electronic access to their doctor’s notes was almost unheard of. The note was a safe, private place where providers could document a clinical encounter without worrying about a patient’s reaction to their accompanying commentary. The note was for internal use only, which no doubt gave providers a certain poetic license to describe patient ailments and mindsets in the bluntest of terms. Enter OpenNotes, now a national movement that encourages providers to adopt open access to clinician notes as a standard practice of care.

A Grassroots Beginning

The movement began in 2010 as a year-long study funded by the Robert Wood Johnson Foundation that tested the OpenNotes concept with 105 PCPs and over 13,000 patients at Beth Israel Deaconess Medical Center (MA), Geisinger Health System (PA), and Harborview Medical Center (WA). The trial was considered a success, with patients reporting that access to physician notes helped them feel more educated about and in control of their care. They were also more apt to take their medications, share their notes with other caregivers, and communicate and collaborate more with their physicians.

Participating physicians experienced similar positive results, with just a handful reporting longer visits and taking extra time to address patient questions outside of regular visits. While a larger percentage reported taking more time to write notes and change documentation content, none of them stopped providing access once the trial ended.

As RWJF President and CEO Risa Lavizzo-Mourey, MD said at the trial’s conclusion, “The evidence is in. Patients support, use, and benefit from open medical notes. These results are exciting and hold tremendous promise for transforming patient care.”

Growth Gets Underway

Since results from the initial OpenNotes trial were published in 2012, the movement has expanded almost exponentially across the country. Twenty-six healthcare organizations — including the VA and most recently Duke Health (NC) — are now providing open-note access to over 6 million patients.

The movement shows no signs of slowing down thanks to an additional $10 million in funding from RWJF, Cambia Health Foundation, Gordon and Betty Moore Foundation, and Peterson Center on Healthcare that will be used to roll out OpenNotes access to 50 million patients across the country.

The investment doesn’t stop there. We Can Do Better, a nonprofit OpenNotes advocacy group that works alongside the NorthWest OpenNotes Consortium, received a grant earlier this year from the Oregon Health Authority Office of Health IT to help spread OpenNotes to small to medium-sized physician practices in Oregon, and to work with healthcare IT vendors on making OpenNotes easy to access via their EHRs and patient portals.

CHIME has also thrown its support behind the initiative, announcing last month its intent to collaborate with the OpenNotes movement on accelerating health data sharing as part of its participation in the Precision Medicine Initiative.

Change Management Trumps Technical Necessity


“There is very little funding needed for OpenNotes rollouts,” says Amy Fellows, MPH, executive director at We Can Do Better and an OpenNotes team member. “The main effort is around change management – convincing providers that this is going to be a good thing and something that won’t add to their workload. We hear that OpenNotes is a much easier and smoother rollout process than many previous facility implementations. It really is all about the upfront change management, then ripping the Band-Aid off and getting it turned on. In some cases, a small number of skeptics can delay or moderate an implementation. The issues are cultural, not technical.”

Technical requirements do, of course, need to be taken into consideration. According to Fellows, facilities using Epic and Cerner should be able to easily configure their systems to support OpenNotes. “We attended HIMSS16,” she adds, “and spoke to many other vendors about their capability to offer OpenNotes, including EClinicalWorks, Allscripts, and NextGen.”

Fellows adds that OpenNotes is working to develop a best-practices sheet with recommendations for vendors on how to configure OpenNotes so that it is patient and physician friendly.

Digging Into Provider Best Practices

Fellows and her OpenNotes colleagues in the Northwest have had ample opportunity to discuss provider best practices at Northwest Open Notes Consortium quarterly meetings. “OpenNotes seems to be an evolutionary process, so even those that have done it come to learn about national efforts bringing it to mental health, inpatient, and other specialties,” she explains. “We know about 1 million patients [in the Northwest] have the ability to access their notes, but it is dependent on each organization’s strategy in promoting their patient portal, and how easy they make it to access the note, i.e. do they send an email tickler inviting patients to access their notes with a link taking them directly to that part of the patient portal after log in?”

“We believe best practice includes internal and external promotions, reminders, and easily accessible notes,” Fellows adds. “Initial implementation should include some time spent with clinicians on avoiding documentation practices that can confuse patients – acronyms, cut-and-paste approaches, confusing medication lists or problem lists. Avoiding jargon can also be helpful, i.e. ‘patient denies,’ or ‘patient complains.’ Sensitizing clinicians to terms that activate patients, like ‘obese’ or ‘addicted,’ is worthwhile, too.”

Geisinger Sets the Bar


Geisinger, an original OpenNotes trial participant, has expanded its involvement with the program by rolling it out to new physicians as part of best practices. “Right now, we’re looking at 1,700 providers including advanced practitioners and case managers across the system who access OpenNotes as part of their care,” says Rebecca Stametz, senior director of clinical innovation at Geisinger. “Looking at it from mobile utilization, we have gone from 2,005 unique users to about 150,000 with about 550,000 unique hits off of our portal.”

“Since the trial, we’ve rolled it out as a best practice across care settings, with the exception of pockets across our system like psychiatry, maternal-fetal medicine, and EENT,” Stametz says. “We’ve decided to pause on areas where we were unsure of any implications and where we felt we needed to take a deeper look. That being said, new physicians that get on-boarded, especially those in ambulatory, have access to OpenNotes. It’s now part of our care process.”

Serving up OpenNotes to patients is as easy as a visit to Geisinger’s patient portal. “It’s really one of the benefits that [they] have when enrolling with MyGeisinger or our patient portal, both Epic,” she explains. “It’s really about word of mouth – marketing it as a best practice and utilizing it via internal systems. There really isn’t anything to purchase outside of the EHR and maybe a patient portal, which most of the systems who are implementing OpenNotes already utilize.”

Measuring Success Now and Later


Given Geisinger’s track record with OpenNotes, Stametz is well poised to offer what success with OpenNotes means to the organization. “Success means that patients feel more connected to their care,” she explains. “They want OpenNotes. They feel like there’s open communication and they have confidence in their ability to manage their own care. Studying the long-term implications of end users is something that we’re going to begin to tackle now with our national partners.”

Stametz adds that little to no impact on physician workflow is also a part of Geisinger’s definition of success. “We were wondering about disruption to workflow and whether or not people actually utilize those notes if they became open,” she says. “We know that 99 percent of those patients wanted the practice to continue, so there were benefits we didn’t anticipate. We observed that some patients began to gravitate towards physicians that offered note access. I think one of the big things from a Geisinger perspective is that there was little concern or complaints from providers or patients.”

OpenNotes is just beginning to reach a maturity level that will enable researchers to determine its effect on outcomes. Thus far, the only hard data available is a paper published last fall in the Journal of Medical Internet Research that shows patients with open-note access have better blood-pressure control than those who don’t.

Fellows adds that several implementers have evaluated their efforts with surveys similar to the original OpenNotes research surveys. “Patient-reported outcomes have been very similar in each one,” she explains. “All of the implementations we are aware of have gone well with no physician workflow disruptions. Email traffic has been flat, and when made available, portal traffic has increased.”

“The most revealing metric,” Fellows adds, “has been the rate of patients opening notes and the rate of physicians hiding notes. Patients viewing notes are highly dependent on patient reminders and internal/external promotion. Hiding notes is unusual and mostly done by a small number of physicians. The incidence of hiding notes decreases with time.”

Moving Beyond Primary Care


Many OpenNotes participants are venturing into new territory. Several organizations, including BIDMC, have launched mental health pilots to gain a better understanding of how increased transparency could potentially benefit psychiatric care. Vancouver Clinic is exploring the value in allowing adolescents to view their notes with or without parental proxy access. Fellows also foresees eventually rolling out OpenNotes to more vulnerable patient populations, such as non-English speakers, those with health literacy issues, and underserved and safety net populations.

For Geisinger, the next phase of OpenNotes is about expansion and better understanding what patients want to get from its access. “What are the long-term implications for end users who have been using OpenNotes for the past five or six years?” Stametz asks. “We don’t know those answers, but we’re beginning to work with national partners like BIDMC to find out. For example, if patients and family caregivers were able to write their own narrative within the note, what would that do for goal setting, treatment planning, communication, encounter time, etc.? We’re at the tip of the iceberg with the ways we could leverage the impact OpenNotes has had and its potential in other areas.”

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March 28, 2016 News No Comments

HIStalk Interviews Matt Patterson, MD, President, AirStrip

March 28, 2016 Interviews 2 Comments

Matt Patterson, MD is president of AirStrip of San Antonio, TX.


Tell me about yourself and the company.

I’m a physician by training, with a background in head and neck surgery and as a Navy physician. I spent some time with McKinsey before joining AirStrip.

I’ve been here for four years. I was with the company during the transition from making the first FDA-cleared mobile applications for waveform-based data into a full platform called AirStrip One, which can accommodate essentially any clinical data source in a single workflow to enable a variety of care collaboration and innovation workflows.

Mobile health was a specialty niche when AirStrip was started, but now it’s a given that any software has to work well for mobile users. How is the industry is doing in that regard?

What we’ve seen is the continuation of a pattern that was around when we first started. There certainly is a push to provide a mobile extension of health IT stacks. What we are ahead on still to this day is the ability to aggregate across multiple, disparate sources of data and to stream that data to analytics, third-party, and decision support platforms, in addition to providing just the essential elements that are important for decision-making in a clinical workflow. I think that is quite distinct. We’re ahead on that, but in general, most people recognize that having a mobile extension of the software stack is a valuable addition to healthcare.

Is the Apple-like ecosystem of third-party healthcare apps real or is it just wishful thinking?

It’s more the latter. As a physician myself, I’m always skeptical about having to have too many applications to go to. It’s akin to having too many pagers on my belt walking around the hospital. Most clinicians are not necessarily looking to segment their workflow experience if they can avoid it.

That said, no single vendor is going to be able to accomplish all the things that any one clinician needs to do at any given point. You’re always going to have a number of different applications out there that are each trying to satisfy certain elements of the clinical workflow. But the concept of having a clearinghouse or a hosted environment that somehow corrals all these beasts is missing the one key point, which is, how do all of these things work together? It’s the interoperability piece that the industry is way behind on. 

We have dedicated our entire mission and product evolution around solving for the interoperability. I’m OK with whatever it takes to address the clinical workflow. Different vendors and different applications can lift different parts, but it needs to feel like a singular, unified, coherent, and elegant workflow for the clinician. Otherwise, you’ll never get adoption.

What steps are needed to open up EHRs to those third-party applications?

The most powerful lever in my mind is to make the ask with a powerful health system client at your side. What’s become very, very clear is that, despite the numerous promises of these large EMR vendors that either they can do what the health system wants them to do or that another smaller innovative company is already doing today, most health systems are waking up and realizing, "You’ve been telling me this answer for 10 years and you still haven’t delivered on the things that are already out there in the marketplace that more nimble companies are accommodating.” 

The time is now to open up complete, bi-directional APIs to allow these innovative firms to plug and play nicely with the EMR environment. That’s the most important thing. The reason I focus on that is that the typical answer that you’ll hear stems around technology standards, policy, government, and all that type of stuff. I can tell you right now the tools exist today to do complete, effective, bi-directional, Web-based APIs to all the major EMR vendors in the market.

I applaud things like FHIR and other standards. They’re a step in the right direction, but they are years and years away. The tools already exist. It’s simply the blocking that is getting in the way. The data blocking can manifest in not only technical ways. It can manifest in political ways, and it can manifest in financial ways. We’ve experienced all three.

How do you approach that issue? Are you all set in dealing with Cerner and Epic, or is it a battle every time you need to connect a new client?

It gets easier and easier. The work that we’re doing today, I never would have even imagined possible three years ago. It is absolutely moving in the right direction, albeit it much more slowly than we would like to see. 

What we have done is always use our clients as the voice, because it is the client’s voice. It’s not just AirStrip that’s out there asking for this and looking to monetize it. This is really about our clients coming to us trying to solve the problems that they have and AirStrip having a willingness to innovate through providing interoperability and workflow solutions.

We have developed very, very important strategic relationships with large IDNs across the spectrum of large healthcare IT vendors. Not just EMRs, but also on the monitoring side. We absolutely are side by side with our clients in the requests that we make, which are quite reasonable and are based on sound clinical and business cases for workflows that are in demand in the marketplace.

Are people distinguishing between interoperability as in sharing patient data among sites vs. snapping applications together within the same health system?

I don’t really see much of a distinction. Increasingly where I’ve seen the conversation turn is a patient-centered approach to interoperability. The answer is all of the above. The more that we take a more consumer and individual orientation towards data ownership and stewardship, that should be the North Star. All things should bow to that.

All efforts to monetize simple movement of data from Point A to Point B should be eliminated. The only thing that deserves monetization these days is adding value, creating workflows, and doing things with the data that are meaningful for patients.

If you take a patient- or consumer-centric view of the world, you recognize that there are challenges not only in connecting all the existing stacks within a particular health system together and making them work seamlessly, but it also includes situations like you describe where you have different facilities on different platforms and those need to communicate effectively as well.

What is the right level of FDA oversight for IT systems that have a biomedical component?

The FDA aligns themselves in the spirit of patient safety. That is appropriate, and that should be their mission and guiding force. It’s interesting when you get into things like what happened recently with the non-binding guidelines around interoperability, that the focus was on devices and how they communicate with the outside world. Interoperability was the focus. Somehow, that came under the realm of patient safety. I have a lot of things that I could go into on that topic, but I’ll pause there and not do that now.

Sticking with the question, there just needs to be a certain degree of risk that you cross, regardless of what you do from an application standpoint or device standpoint, where the FDA should regulate and should provide guidelines in the interest of public safety. I think that that’s appropriate. Most importantly is just to be very clear about what those situations are and then to make it as efficient as possible for innovative companies to submit their applications when appropriate and get approval.

Do you think the government climate supports innovation in healthcare IT?

I have been incredibly encouraged by what I’ve seen come out of the Capitol recently. In particular, I’ve been very encouraged with the work being done by Senator Alexander and the HELP Committee. We were referenced in a recent letter to Secretary Burwell by several members of the House of Representatives in an urgent plea to address interoperability and data blocking. There’s a lot of very, very positive momentum towards opening things up and allowing innovation to take place.

That’s another reason why just the timing of the release of the FDA’s non-binding guidelines recently on interoperability is very, very interesting to me. In some ways, I see it as a potential foil on the good conversations that have been taking place. I certainly don’t fault the FDA for wanting to address patient safety. I think that’s what they should do. But the timing is interesting. Similar to the way that HIPAA and Stark have been misused and misunderstood and that has stifled innovation, I could see almost safety blocking – that’s the only way I can put it — stifling innovation. “In the name of safety” type of thing, that the recent guidelines might have an unintended effect.

How has your experience as a Navy surgeon shaped your career?

Gosh, it did in so many different ways. I was fortunate enough to be an undersea medical officer while I was in the Navy. That allowed me to work with the fast-attack submarine group. It also allowed me to work with the Special Forces. I was the medical director at the Naval Special Warfare Center, which is the first training area for the Navy SEALs.

Navy medicine shaped my career in a few important ways. One, the concept of a flat team structure is prominent, particularly in the Special Forces community. I know that may come as a surprise when thinking of the Navy as a hierarchical place, but it’s surprisingly flat when it needs to be. There’s just an incredible esprit de corps and sense of teamwork that can happen in crisis. That gave me quite a bit of perspective on what’s important and what’s an emergency. You learn relative degrees of emergency very, very quickly in Navy medicine.

A second big thing is that it was my first introduction to telemedicine. It’s uncanny that I find myself in the situation I’m in right now, because AirStrip is obviously used a lot in various telehealth scenarios. My very first experience with telehealth was working up patients preoperatively remotely, even using scopes and some pretty advanced technologies, and never laying hands on the patient. The very next time seeing that patient was when they showed up to get an operation. Being that confident in my pre-surgical exam remotely had a profound effect on what I envisioned could be possible with application technology in healthcare. Both of those things I carry with me to this day.

Do you have any final thoughts?

We are at an important turning point when it comes to interoperability and innovation in healthcare. It’s going to take more than government regulations in order for us to get to where we need to be in the marketplace. I’m very, very encouraged that interoperability is a prominent part of the conversation coming out of HHS and coming out of the Senate and the House of Representatives. I’m very encouraged by work being done by interested parties like the Center for Medical Interoperability, because I think that what you’re seeing now is a much more patient-centered approach to the problem. When we focus on the patient, when we focus on the individual consumer, we cannot be wrong.

I envision a world very soon where consumers will essentially be allowed to hit the virtual “record” button on their medical data any time that they want to. Then have the ability on the fly, using plain English opt-in and opt-out types of scenarios and technology, to subscribe their data to anyone they want — vendor, health system, payer, provider, innovative company, you name it. Not only for their own benefit, but for the benefit of society at large. The only way we get to that place is by allowing wide-open interoperability among all of the technology players out there. We’re privileged to be a part of that ecosystem.

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March 28, 2016 Interviews 2 Comments

Dell Sells Its IT Services Business

March 28, 2016 News No Comments


Japan’s NTT Data will buy Dell’s IT services business, the former Perot Systems, for $3.05 billion. Dell is selling the business, which it acquired for $3.9 billion in 2009, to raise money to finance its $60 billion acquisition of storage vendor EMC.

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March 28, 2016 News No Comments

Morning Headlines 3/28/16

March 28, 2016 Headlines No Comments

Statement from Joseph Maldonado, MD, President, Medical Society of the State of New York

The president of the Medical Society of the State of New York asks for two exceptions to the new requirement that all prescriptions be written electronically. The first would exempt providers that write less than 25 prescriptions per year, and the second would reduce documentation requirements when technical problems temporarily force providers back to paper.

Dell Services Builds Momentum with Multiple $100M+ Deals

Dell Services signs $100 million deals with Dubai Health Authority and BCBS of Rhode Island.

Hackers Steal Data On 1.5 Million Verizon Enterprise Customers

Verizon loses 1.5 million customer records to hackers who are attempting to sell the information online for $100,000.

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March 28, 2016 Headlines No Comments

Monday Morning Update 3/28/16

March 27, 2016 News 7 Comments

Top News


New York’s mandatory e-prescribing mandate took effect Sunday despite a questionable level of prescriber readiness even after the one-year postponement a year ago. Allowed exceptions are drug items that require pharmacy compounding, parenteral drugs, items requiring lengthy patient instructions, or non-patient specific prescriptions. Paper or call-in prescriptions can be issued upon patient request or given technology failure, which then requires the prescriber to report the prescription to the state’s Department of Health, but the department has not implemented such reporting technology and suggests that prescribers just note it in the EHR instead.

Reader Comments


From No Flipping: “Re: ransomware. I searched HIStalk and there was an example from 2012, so it’s not a new problem.” I wrote about a clinic in Australia whose files were encrypted by ransomware in December 2012. I don’t recall hearing if the clinic paid the demanded $4,000 ransom, but I expect it did. Meanwhile, a ridiculously useless Wall Street Journal article manages to ask the wrong questions (or perhaps fails to understand the answers) of those it interviewed in claiming to share healthcare security best practices to prevent ransomware. The pearls of wisdom provided are: (a) assume malware will get through; (b) perform backups; (c) apply patches; and (d) educate employees. CIOs who learn anything from this breezy waste of time should probably just go ahead and quit or at least attend our webinar described below.  

From The_Epic_Guy: “Re: Epic. The company is having their implementation consultants put their Starbucks coffee into non-labeled containers to avoid reminding customers that its inexperienced people are costing a small fortune.” Unverified. I would have expected contracts to specify a per diem rate rather than individual charges so that Starbucks vs. McDonald’s coffee wouldn’t matter, but maybe that’s not the case.


From MCK Auto Pilot: “Re: McKesson. This site has interesting layoff rumors. All are unsubstantiated from employees who have been laid off, but in every exaggeration there is a kernel of truth.” Comments from claimed current or former McKesson employees complain about clueless upper management, the failed Better Health 2020 initiative, the cold manner in which employees were informed that their services would no longer be required, offshoring to India, and the likelihood that MCK will sell off what’s left of its IT business and whether anyone would want to buy it.

From Nasty Parts: “Re: Greenway layoffs. Four sales VPS have been downsized. Looks like the company is moving into a ‘protect the install base’ mode of operation.” Unverified. The four named VPs still list Greenway as their employer on LinkedIn, but most people don’t rush there first after they’ve been forcibly re-workforced.

HIStalk Announcements and Requests


Half of poll respondents work for a company that has laid people off in the past 12 months. New poll to your right or here: do you personally admire and respect the highest-ranking executive of your employer? I’ve divided the answers out into not-for-profit and for-profit choices to see if that makes a difference (which I should have done on the previous poll, too). Click the Comments link on the poll after voting to explain.


FHIR Family donated $500 to my DonorsChoose project, explaining, “HL7 has a big deadline on Monday, March 28 and I am in awe of all the work Grahame Grieve does in the background. This donation is in his name.” Through the magic of matching funds, the donation fully satisfied these teacher grant requests:

  • An iPad and case for Ms. Markussen’s first grade class in Dallas, TX
  • A laptop and document camera for Mrs. Lark’s middle school class in Brooklyn, NY
  • Math games for Ms. Burkett’s elementary school class in Independence, MO

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Mrs. Hale from Indiana says her third graders were so excited about the kid-friendly biographies we provided in funding her DonorsChoose grant request that they finish their other work early so they can work on biography projects.

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Also checking in is Mrs. Ortego, who says the headphones we provided for her Louisiana special needs elementary school class not only allow students to work without distraction, but also, “One of my greatest joys is that I have a hearing impaired student and he is able to put the headphones over his ears with no feedback from his hearing aids. This is the most amazing thing to experience. There is no frustration for this student.”

Last Week’s Most Interesting News

  • Allscripts and a private equity firm form a joint venture to acquire post-acute care EHR vendor Netsmart for $950 million.
  • The CEO of NYC Health + Hospitals denies rumors that he will be fired if the organization doesn’t go live on Epic on April 1 and dismisses reports by the former CMIO of one of its hospitals that a lack of readiness will endanger patients.
  • Three more hospitals report ransomware attacks.
  • AHIMA petitions the White House to allow HHS to work on a national patient identifier.
  • Apple announces CareKit, which will allow developers to create person health apps for the iPhone.


April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Here’s the recording of last week’s webinar, “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.”


Dell Services announces recent big contracts that Dubai Health Authority and BCBS of Rhode Island.

Government and Politics

The president of the New York State Medical Society politely asks for two changes to the just-implemented requirement that all state prescriptions be issued electronically rather than on paper or by telephone. He would like to see an exemption for those doctors who write fewer than 25 prescriptions per year and a reduction in documentation requirements when technical issues require issuing a paper prescription. Both seem reasonable to me.

Privacy and Security


Hackers steal and offer for sale the information of 1.5 million customers of Verizon Enterprise Solutions, whose services (including an extensive set of security offerings) are used by 99 percent of Fortune 500 companies.


Epic removes regular and diet soda from its vending machines and cafeterias to promote health, so bring your own supply from a local convenience store if you’re a Diet Coke fan taking classes in Verona.

Another medical transport helicopter goes down, killing all four occupants (including the patient) in Alabama. The for-profit company’s site boasts that it has a “proven clinical tract record.”


An interesting article describes the online problems experienced by people with unusual names: those who go by a single name, those with very long or short names that don’t pass field edits, and most interesting to programmers, people whose last name is Null. These folks often have to resort to telephone calls or snail mail to do tasks everybody else can accomplish online.

Sponsor Updates

  • Forward Health Group shares the wall-sized, hand-drawn graphics created in its UnBooth at the HIMSS conference, including population health management questions posed by visitors. 
  • EClinicalWorks releases a podcast recapping EClinicalWorks Day.
  • Extension Healthcare and FormFast will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
  • The Upstate Business Journal recognizes Glytec as an Upstate biotech player.
  • The Boston Globe features Healthwise CMO Adam Husney, MD in an article on how perks from pharmaceutical companies influence prescribing medicine.
  • Cumberland Consulting Group expands its business processing outsourcing services to pharma in a partnership with revenue acceleration software vendor Revitas.
  • Recondo Technology will exhibit at the HFMA Texas State Conference on March 29 in Dallas.
  • Experian Health will exhibit at NAACOs March 28-30 in Baltimore.
  • PatientSafe Solutions and PerfectServe will exhibit at the AONE Annual Meeting March 30-April 2 in Fort Worth, TX.
  • The Doctor Freedom Podcast features PatientPay founder and CEO Tom Furr.
  • Point-of-Care Partners ECare Management Practice Lead Michael Solomon discusses optimizing EHRs.
  • Streamline Health will exhibit at the 2016 WV HIMA Annual Convention March 30-April 1 in White Sulphur Springs, WV.
  • T-System awards its Client Excellence Award to Dosher Memorial Hospital (NC) for excellence in sustainable outcomes.
  • TeleTracking, Versus Technology, and Zynx Health will exhibit at the AONE 2016 annual conference March 30-April 2 in Fort Worth, TX.
  • TeraMedica will host a healthcare IT symposium April 7 in San Francisco.
  • Huron Consulting Group releases 2016 Healthcare CEO Forum report.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.


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March 27, 2016 News 7 Comments

Morning Headlines 3/25/16

March 24, 2016 Headlines No Comments

Raju to explain financial plan to Council, defend records system

NYC Health + Hospitals President and CEO Ram Raju claims the April 1 Epic go-live was a self-imposed deadline that he would be comfortable moving if needed, clarifying that he would not be fired for making that decision.

The Evolving EPCS Landscape 2016: A Prescription for Stopping Opioid Abuse

DrFirst publishes a paper on e-prescribing of controlled substances in the US, noting that while 82 percent of retail pharmacies are EPCS enabled, only 5.8 percent of providers are setup for EPCS.

Providers must release all of patient data to patients, families

The Ohio Supreme Court rules that any patient data kept by a health care provider must be released to patients and family members on request. Officials at Aultman Hospital argued that only patient data held within the medical records department was required to be turned over.

Thomas Health System Selects Parallon as its Meditech 6.1 Partner

Thomas Health System (WV) selects Meditech 6.1, upgrading its legacy Meditech Magic system and replacing its Cerner/Siemens Soarian system.

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March 24, 2016 Headlines No Comments

News 3/25/16

March 24, 2016 News 1 Comment

Top News


Allscripts and private equity firm GI Partners form a joint venture to acquire human services and post-acute care EHR vendor Netsmart, which will be combined with the homecare software business of Allscripts. Allscripts also contributed $70 million to the joint venture, which will pay $950 million for Netsmart. The company’s name and management team will remain in place. Allscripts says the JV will have an annualized revenue of $250 million and operating income of $60 million.

Netsmart has gone through several name changes, ownership changes, and acquisitions in its 20-year direct history and earlier connections going back to 1968. It went public in 1996, sold itself to private equity buyers for $115 million in 2006, and then was then sold for an unspecified price in 2010 to another private equity firm, Genstar Capital, which is rumored to be making 4.4 times its investment in the newly announced sale.

Reader Comments


From PM_From_Haities: “Re: Allscripts paying $70 million for a joint venture. It’s hard to imagine Allscripts giving up assets with out corresponding liabilities (debt). I’m looking forward to their audited financial results since they might require certain items to be disclosed, such as whether one customer represents more than 10 percent of revenue. The other item of interest with audited results is mark-to-market accounting of the Allscripts investment in NantHealth, which delayed its IPO due to unfavorable market conditions. Allscripts’ debt covenants contain asset-to-liability requirements and an unanticipated decline in asset value could seriously impact their delicate financial picture. The bright side of this JV is that Allscripts may be allowing a product that would languish with its other zombie EHRs to blossom into something good for home health.” Unverified. MDRX shares didn’t react much following the announcement, meandering down a bit Wednesday and then down a bit more Thursday.


From Green about the Gills: “Re: Greenway. Starting a layoff cycle this week. Right-sizing post the Vitera purchase and the EHR land grab of the MU era.” Unverified. However, I do see the company has “rebranded” itself.

From The PACS Designer: “The ICD-10-CM Clinical Modifications has a code J62 for silica related disease, and under this classification falls the longest word in the English dictionary. Silicosis is a form of occupational lung disease and within this category is the 45 letter word ‘Pneumonoultramicroscopicsilicovolcanoconiosis.’”

HIStalk Announcements and Requests


Mrs. Pryor from Oklahoma says her kindergartners love the programmable robots we provided in funding her DonorsChoose grant request, adding that they are a “huge motivator” that she has integrated into her reading and math curriculum.


Also checking in is Mr. Jewell of Arkansas, who says his sixth graders have gotten a lot more excited about engineering after working with the Lego Mindstorm kits we provided. He has conducted two enrichment classes that involved building and programming the robots and now there’s a waitlist for the next class.

This week on HIStalk Practice: Signallamp Health adds CCM jobs in Scranton. Mend wins big at SXSW. PCAST advocates for the advancement of telemedicine. Wearables earn dubious accolades for their inconsistencies. Telerehabilitation startup RespondWell celebrates a $2 million funding round. Night Nurse COO Stuart Pologe offers tips on balancing HIPAA compliance with efficiency across EHRs and paper records. GAO brings cyberattacks to light on the ACA’s sixth anniversary. OneCare Vermont selects care management software from Care Navigator. The US Oncology Network’s David Fryefield, MD lays out the strategy behind empowering value-based technologies.


April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

Contact Lorre for webinar services or for one final chance at her post-HIMSS discounts. Past webinars are on our HIStalk webinars YouTube channel.


Statewide ACO OneCare Vermont chooses Care Navigator’s care management software.

Thomas Health System (WV) will implement Meditech 6.1, replacing Cerner/Siemens Soarian and Meditech Magic.


Palomar Health (CA) chooses Ascend Software for accounts payable electronic imaging automation.



Lane Regional Medical Center (LA) hires Paul Murphy (Geocent) as CIO.

Announcements and Implementations

DrFirst publishes “The Evolving EPCS Landscape 2016: A Prescription for Stopping Opioid Abuse,” which finds that most pharmacies can accept electronic prescriptions for controlled substances while only 5.8 percent of prescribers are similarly EPCS-capable.


Boehringer Ingelheim Pharmaceuticals will offer users of its asthma inhalers the chance to sign up for health system studies to determine the effectiveness of Propeller’s usage tracking inhaler sensors.

Privacy and Security

Rep. Ted Lieu (D-CA) may propose a modification to the HITECH act that would require healthcare organizations to notify patients if they’re hit by ransomware.


The New York Times, explaining how it “decoded the NFL database” to debunk the National Football League’s concussion studies, admits that it was able to re-identify many of the 887 players that were listed only by an NFL-assigned code by reviewing the concussion date, whether the game was home or away, and whether it was being played on natural or artificial grass. The paper seems pretty pleased with itself for working around the method used to protect the privacy of the players.

Walmart confirms that a programming error caused the prescription records of 5,000 of its online pharmacy customers to be displayed to the wrong user.


Do this now to help prevent having your PC infected with the Locky ransomware: allow only digitally signed macros to run. Instructions are here.

The Ohio Supreme Court rules that patients are entitled to receive all information stored about them by providers, not just those data elements the provider intentionally filed in the medical record. A hospital that was involved in a wrongful death lawsuit unsuccessfully argued that it was not required to release the deceased patient’s EKG strips because they had been stored by its risk management department.



Google registers two healthcare-related images that may or may not have something to do with new medical apps.



NYC Health + Hospitals President and CEO Ram Raju, MD says the organization’s April 1 Epic go-live date is flexible and he won’t be fired for missing the date if the system isn’t ready. He says former Elmhurst CMIO Charles Perry, MD, MBA, who resigned in comparing the upcoming go-live with the Challenger disaster, took a parting shot as a “disgruntled” employee. Raju says previous CIO Bert Robles left shortly after the Epic project started because, “I didn’t want someone learning on the job,” leading him hire Ed Marx, who was recommended by Epic CEO Judy Faulkner. NY Health + Hospitals, which is projecting a $2 billion deficit, is rumored to be spending $1.4 billion on the Epic project.


Lancaster General Health (PA) investigates a 12-hour EHR outage of unspecified origin.

Sponsor Updates

  • Medicity CEO Nancy Ham writes for the HFMA blog on “Determining the ROI of Clinical Care Technology.”
  • A record number of providers, payers, and partners gathered at the InstaMed 2016 User Conference.
  • Live Process will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
  • Navicure will exhibit at the Office Practicum User Conference March 31-April 2 in Atlantic City, NJ.
  • Obix Perinatal Data System will exhibit at the Sanford Health Perinatal, Neonatal, and Women’s Health Conference March 31 in Sioux Falls, SD.
  • The Irish Times profiles Oneview Healthcare founder Mark McCloskey.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.


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March 24, 2016 News 1 Comment

EPtalk by Dr. Jayne 3/24/16

March 24, 2016 Dr. Jayne 4 Comments

Several readers responded to my recent request for information on EHR vital signs data entry alerts. Epic has not only color changes that indicate an out-of-range value, but the possibility of a hard alert that forces the user to address the value. I got a chuckle out of the warning for our erroneous pulse of “13270,” which read as follows:


I’m fairly certain that a pulse of 500 is incompatible with life, which makes me wonder if this is a vendor value or something the customer configured.


This week has been a veritable news roundup of interesting articles and newsy tidbits. Popular Science featured a wearable patch that can not only monitor blood glucose, but also deliver medication. Using the pH of sweat along with temperature changes that align with a high blood glucose level, when certain conditions are reached, a micro heater in the patch dissolves a layer of coating, releasing the drug metformin via microneedles. Commentary on the recent publication notes that it’s not clear whether the device can last a full 24 hours and whether it will withstand exercise and increased sweat. Its ability to deliver human-scaled drug doses is also an issue. From the physician standpoint, I’m not sure about metformin as the choice of drug due to its mechanism of action, but it’s certainly an interesting technology to think about.


Engadget reviewed a business card with built-in electrocardiograph capability from MobilECG. The card is open source and schematics are posted online, so I’m thinking perhaps my nephews would like to try their hand at building one.

Content vendor Wolters Kluwer has made its Zika Virus order sets available for download. The World Health Organization has declared it a global threat and there have already been nearly 200 cases reported in the United States. The order sets include one for infants to assess for congenital infection, as well as those for emergency department and outpatient settings. Other freely available order sets include Ebola evaluation, ischemic stroke, low back pain, myocardial infarction, pneumonia, and more.

Even though I’m behind the scenes at HIStalk, I still rely on it for healthcare IT news. I was glad to see mention of the AHIMA petition in support of a voluntary unique patient safety identifier program. Being in the healthcare trenches, I’m more worried about incorrect data matching than I am about people misusing my data, so it’s a risk I’m willing to take. It’s not the complete answer, but I can’t help but think that it would be better than what we have.


I also appreciated Mr. H’s mention of the retirement of Groupwise at BJC. I remember using Groupwise fondly – my favorite feature for scheduling recurring appointments, when you could just pick dates off the calendar rather than having to follow a straight formula. It was an absolute necessity when I had to schedule physician advisory board meetings – we alternated Tuesdays and Thursdays so that conflicts would be shared throughout the group. Also great for meetings that occurred the first and third Wednesday, etc. Much easier than sending multiple appointment series. Users can’t convince Microsoft to get rid of the unholy “Clutter” folder in Outlook, so it’s doubtful Microsoft would ever consider this type of enhancement.

HIStalk is also a place where readers can ask for feedback and advice. One emailed me asking if I knew of any companies that might have a “lab” of EHR vendors to connect to. He’s trying to test some integrations but frustrated dealing with individual vendors. If anyone knows of that kind of arrangement, leave a comment to pass along the information.

I mentioned in this week’s Curbside Consult that our practice is seeing an increase in volume that we’re at least partially attributing to the shift towards high-deductible health coverage. Price transparency is one of our talking points. Reader Intrigued asks, “For those of us who missed it or are search challenged, where did you discuss this before? Definitely interested in learning more about your experience.”

I’ve mentioned it a couple of times in passing over the last few months. As for data, we have referral tracking and patient satisfaction survey data which shows the trend. We can capture who has a high-deductible plan from our practice management system and can see who chose us for "cost" in post-visit surveys. We also can see trends on the number of patients who visit us because they can’t access their PCP or don’t have a PCP. There are definitely multiple drivers fueling our growth, but I continue to be impressed by the number of patients who are paying attention to cost.

A reader asked about my recent mention that Institute for Health Improvement courses have been approved for ABPM LLSA credit. I clarified with my source that the approved courses include: Quality Improvement Curriculum, Graduate Medical Education, and the Patient Safety Curriculum. Too bad I already took my mandatory Patient Safety course through the National Patient Safety Foundation, because it sure would have been nice to also get the LLSA credit.


I enjoy reading scholarly articles, although some are best left for bedtime. “Do You Smile with Your Nose? Stylistic Variation in Twitter Emoticons” was perfect for a mid-day break, however. Analyzing the 28 most used emoticons in American English tweets, it demonstrates “that the variants correspond to different types of users, tweeting with different vocabularies.” I shared it with a friend who edits journals for a living and she responded back with this gem, “20 PhD Students Dumb Down Their Thesis.” I’m fairly certain that #5 might have been submitted by one of my medical school classmates.


Chocolate cake as the new breakfast of champions? Thanks to Dr. Lyle Berkowitz for sharing this article summarizing research on the benefits of chocolate. Morning chocolate consumption has been found to have positive influences on weight loss and improved performance on cognitive function. I think I’m going to make chocolate part of my complete EHR implementation plan from here on out.

What’s your favorite vehicle for chocolate consumption? Email me.

Email Dr. Jayne.

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March 24, 2016 Dr. Jayne 4 Comments

Morning Headlines 3/24/16

March 23, 2016 Headlines No Comments

Allscripts is buying stake in Netsmart Technologies

Allscripts and private-equity firm GI Partners will pay a combined $950 million to acquire behavioral health software vendor Netsmart Technologies as part of a new joint venture. Allscripts will pay $70 million in cash and merge its home health software business into the new venture, resulting in a company with an annual revenue of $250 million.

Opportunities and Challenges in Advancing Health Information Technology

During testimony before the House Committee on Oversight and Government Reform, National Coordinator Karen DeSalvo, MD discussed ONC’s interoperability roadmap and the agency’s efforts to help expand the use of alternative payment models.

New HIPAA audits will target healthcare industry’s business partners

The HHS Office for Civil Rights announces that the next round of privacy and security audits will target business associates and insurers.

In Its First Year, Has Apple’s ResearchKit Revolutionized Medical Research?

Fast Company recaps ResearchKit’s first year in operation, highlighting some of the successes and barriers to growth researchers are seeing with the framework.

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March 23, 2016 Headlines No Comments

Readers Write: Time for Providers to Lead the Price Transparency Revolution

March 23, 2016 Readers Write 5 Comments

Time for Providers to Lead the Price Transparency Revolution
By Jay Deady


With ICD-10 in the rear-view mirror, providers now face a new challenge – answering the public and media call for consumer price transparency. High-deductible plans now cover nearly a quarter of those Americans with commercial insurance, raising the ante on patient financial responsibility. Yet large numbers of patients remain confused about how much they will owe for hospital services—a full 36 percent, according to one survey.

This problem, unheard of in other consumer industries, not only endangers patient satisfaction scores, but threatens to increase the bad debt load of organizations already struggling with severely low margins.

While insurance companies and employers have deployed some pricing tools, they have done a poor job of accurately representing multiple providers’ fees within a geographic area. New technologies are available from a handful of companies that let providers take the price transparency bull by the horns and lead themselves.

These technologies transcend the usual approach of mere compliance with a state’s price transparency laws. Posting a list of charges on a provider’s website may satisfy the letter of the law, but it fails to give consumers an accurate picture of what they will owe for services. Knowing this, providers have struggled to come up with an alternative that does not reveal proprietary information to their competitors. Most have concluded there is no way for them to easily accomplish this and they refer questions to patients’ insurance companies.

But it turns out the path to truly efficient, accurate, and accessible price transparency is one that healthcare consumers can take themselves—directly from the provider’s website.

Healthcare consumers want – and deserve – an accurate understanding of what they will owe for services before they are rendered. The operative word here is “accurate”—as in an estimate based on the consumer’s current levels of insurance coverage. Or, in the case of a self-pay patient, an estimate based on the provider’s discounted fees for consumers that pay fully out of pocket.

Either way, with self-service pricing, healthcare consumers generate the estimates themselves, typically from an online calculator on the provider’s website. The process is quick and hassle-free. A consumer simply inputs their name, insurance plan number, and perhaps two or three more data elements. Within 10 to 45 seconds, a complete and accurate estimate appears, giving consumers immediate, line-item insight into what they will owe.

The process is powered by rules-based engines that automatically query, retrieve, and combine data from payer portals with the hospital’s charge master data and payer contracts. Analytics plays a critical role in assuring the estimate is accurate, including analysis of previously adjudicated claims to identify variances.

Such a tool neatly solves one of the most persistent challenges with implementing price transparency: the pitfalls of making proprietary financial information public. As a provider-facing solution, and because patient-unique information needs to be entered to generate an estimate, not just anyone can use the calculators. This is vastly preferable to putting a list of total charges or paid amounts out there for all competitors to see, which neither reflects negotiated rates with payers or the patient’s accurate out-of-pocket costs.

At the same time, self-service price calculators appeal to today’s information-driven patients and nicely align with how they already seek pricing on other purchases, from airfare to mortgages.

One of the most promising advantages of a self-service price calculator is its potential to engage consumers in multiple ways. After generating a price estimate, for example, the calculator could prompt high-deductible and self-pay consumers to view payment plan options. It could even engage those patients with concerns about their ability to pay and schedule time with a financial counselor. Realistically, we can only expect such concerns to grow along with the increasing number of high-deductible health plans. Since these plans were introduced in 2006, they have increased from 4 percent to a whopping 24 percent.

A deductible payment and co-insurance spread out over a year, or whatever the time span the provider and patient agree on, is clearly more manageable than a lump sum payment. Armed with clear, accurate information about how much they will pay—and how—healthcare consumers can better plan for paying their medical bills. This in turn will help reduce a hospital’s bad debt or charity write-offs.

Most important, patients who clearly understand their financial responsibility are more likely to schedule rather than delay urgently needed care. This reason, above all others, is why providers would be wise to take control of the price transparency issue now.

Jay Deady is CEO of Recondo of Greenwood Village, CO.

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March 23, 2016 Readers Write 5 Comments

Advisory Panel: HIMSS conference, ransomware

March 23, 2016 Advisory Panel 1 Comment

What were the most interesting things you learned or saw at the HIMSS conference?

  • I met a number of CIOs from hospitals and health systems that either have already completed or were in the process of implementing Cerner financial and ambulatory products to result in integrated clinical and financial systems across inpatient and ambulatory. Cerner appears to continue gaining momentum and building some critical mass in their competition with Epic. VNA products continue to develop nicely. It appears there are good product options that are positioned to upset the traditional, monolithic PACS products.
  • I did not attend the HIMSS conference this year. If I attend the one in Orlando next year, it would be merely to see how off the wall they can be and how obscene and disconnected from the reality of practicing medicine today they have become. HIStalkapalooza may be the only reason for even flying there or paying for a hotel room since they are not even offering CMEs.
  • I was mostly impressed with the booths downstairs and in the side rooms. I saw some interesting applications of big data analytics finally starting to bloom. Check out Ayasdi (I have no relationship with their company). Generally it felt like there was a lot less energy and excitement than in previous years. I saw very few of my provider-side colleagues — mostly just vendors talking to other vendors (or consultants).
  • I focused on meeting with clinical decision support vendors and several that are building CDS data analytics tools, e.g., LogicStream, Stanson Health, MedCPU, Zynx, Appervita, Wolters Kluwer. Seems everyone is trying to figure out how to create some sort of dashboard that can help organizations manage their CDS alerting process. So many organizations have turned on way too many alerts and no one wants to, or perhaps is able to, make the decision to turn off excessive alerts that are overridden upwards of 95+ percent of the time. We really need to get this fixed soon or everyone will be ready to shoot their EHRs. LogicStream and Stanson Health’s data analytics platforms are both outstanding. Both appear to capture a significant amount of the data and display it in several different and useful ways. Stanson also offers their clients actual CDS content, whereas LogicStream is just the analytics platform. I heard several people asking Stanson to just sell them their analytics platform, but so far they only want to sell content and you get the platform to help you manage their content.
  • I spent the pre-conference day at the EHR-related patient safety symposium sponsored by AQIPS and ECRI among others. It was interesting to hear everyone talking about EHR-related safety issues and what we need to do to improve EHR safety. Seems that most orgs are still struggling with basic implementation and utilization and only the very mature orgs are worried about EHR-related safety. Heard a good talk by Joe Schneider on ways to avoid and manage EHR downtime that focused heavily on the ONC’s SAFER guides. If the ransomware problem doesn’t kill the EHRs, then I think EHR-related safety issues will become much more important over the next five years.
  • I didn’t go to HIMSS — it is less and less valuable each year. One long-time colleague went to his first this year and doesn’t plan to return.
  • Disappointing meeting — poor topics of education, too many vendors with chotchkeys, lack of enthusiasm for educational aspects and more towards having fun in Vegas was our perception.
  • I didn’t go to HIMSS and really haven’t heard anything (other than your posts, of course) about it from others, including vendors. I get the feeling that I didn’t miss a lot this year.
  • Population health is starting to fall into some discrete strategies, with products to match. I expect the diffuse "population health" to become several more discrete somethings like "narrow network strategy," "quality management (analytics and registries),” etc. Still looking for someone who really does it well. Interestingly, there were a lot of people talking about serious security, which I thought was excellent.  About dang time. Also, many organizations with a real cloud model getting traction with hospitals. When asked, it seems that the hospitals figure the data may well be safer with the vendor than with their own systems. Good way to get rid of liability is to not have the data stored on site?
  • The most interesting thing I saw was AccendoWave at the AT&T booth. In short, the equivalent of a thermometer for pain (based on EEG waves detected through a non-invasive headband). Even if you only differentiate drug seekers and malingerers from legitimate pain, that’s some great tech. I’m not sure what the most interesting thing I learned was. I got through about 19 hours of the education sessions this year, most of which had CME attached and were legitimate rather than vendor pitches, for which I was grateful.
  • I suppose the most entertaining things I learned might be worth mentioning: Halamka really emulates Steve Jobs and is almost as invested in brinksmanship as Eric Topol. Presenters from academic centers have an incredible degree of hubris and a pride in their “big data” volumes that is astounding. I guess “big” is a matter of perspective, but come on, folks, you’re talking about having data from one or a few facilities.
  • Themes this year seemed to be: usability, patient engagement, population health, and analytics/BI/big data. It was almost humorous how many different vendors were pitching solutions for “population health” and “value-based reimbursement” all doing different things and using different definitions.

Is your organization taking any steps related to ransomware?

  • This past year, we’ve had seven individual episodes of ransomware infections resulting in user and departmental network shares being encrypted. Luckily, we’ve been able to recover through simple data restores with little to no loss of data. These incidents, along with all of the other security news items in the industry, has our leadership more focused than ever on security. I still wonder if it’s enough. IS has been attempting to raise awareness amongst our leadership about the importance of developing a broader security program and I believe we make some relatively small progress every year. However, we still need more resources to move fast enough to keep up with the threats.
  • Reputation-based blocking of malicious links embedded in emails. Ransomware often infects the user’s computer after the user is tricked into clicking on a malicious link in a phish email. We subscribe to ProofPoint to analyze all email embedded links and attachments and then stop the malicious ones. This DOES NOT protect against malware downloaded via personal Web-based email, such as Hotmail, Gmail, Facebook, etc. We are considering blocking such services, but that is a tough row to hoe considering the culture.
  • Blocking of suspicious Web advertisers as much as we can. We plan to do more of this in the future. Malvertising is another way with which unsuspecting users browsing legitimate sites get hit with ransomware.
  • User education and awareness programs to make our community less susceptible to phishing emails. We plan to start using targeted awareness campaigns facilitated by products such as PhishMe in the future to increase user awareness. 
  • Things that we’re doing to address the infection payload: overlapping antivirus software. We have three different AVs on the email system, server environment, and desktop/laptop environment to hunt for and stop malware to include ransomware. Unfortunately, traditional AV is not super effective in detecting zero-day malware. Behavioral-based next generation AVs such as Cylance are not mature yet and are fantastically expensive, but we’re watching this space.
  • Robust backup process. We don’t pay ransom when we get hit with ransomware. We restore from backup. We use Crashplan to back up desktops and laptops.
  • Can we do more? Yes, but it would make our environment stricter. It’s a balancing act.
  • We are pretty much maintaining our patches, but we are as vulnerable to phishing as the next guy. You do what you can.
  • We are raising awareness from our board level down to the associates. The message to our board includes information about industry events and the outcome, what we are doing to minimize our risk, and how we would respond if infected with ransomware. Our associates are much more aware of the possible consequences of clicking bad email. We had an email phishing attack that resulted in an organizational-wide password expiration. This allowed for education of supervisors and managers as to why they were having them coordinate all associates changing their passwords. That level of awareness has already resulted in a more informed workforce and an increased number of reports of suspicious email.  We use real stories from other health systems to communicate our risk and it seems to work. Also, we have begun adding to our communication around events not only what IT will do to avoid a recurrence, but what our end users can do to help.  As far as technical prevention, we continue to strengthen our monitoring and blocking tools to protect our assets.
  • We’re constantly improving our security posture here, but it’s not like we’ve targeted ransomware specifically. However, we actually did see some within our organization. While running some scans from one of our newly deployed technologies, we found some ransomware on a handful of really old files (from 2002 and 2003). I’m not sure when it came in, no one was actually using those files so no one noticed the ransomware or inability to get to them. But, we just deleted them and restored them from backup and they open fine now. Not sure we needed them at all, but that’s another issue altogether.
  • We have a security vendor that provides us tools and accounting and as I understand it there have been layers of security improving in strength and coverage in IT. Also the organization is messaging to the physicians and employees how to avoid phishing and other types of targeted email based attacks.
  • We have a very aggressive information security and privacy protection strategy and always have. That said, when the bad guys really are out to get you (and they are out for all of healthcare), there is never enough precaution / preparation or defense-in-depth that’s deep enough. It’s a continuous race uphill. There are many key steps we are taking based on the latest round of evolving threats (ransomware being just one of many).
  • We are not taking any specific steps due to the recent activity. However, I have pressed our security team pretty hard on ensuring we are doing what we should be doing for our overall security program.  Our weaknesses were identified long before this latest publicized event, so we have a roadmap for all things infosec. We are covering this event in our next board meeting to remind them of our efforts and that even with a good program, we will always have risks.
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    March 23, 2016 Advisory Panel 1 Comment

    HIStalk Interviews Roger Davis, CEO, T-System

    March 23, 2016 Interviews No Comments

    Roger Davis is president and CEO of T-System of Dallas, TX.


    Tell me about yourself and the company.

    I’ve worked for over 30 years in healthcare in variable roles, including being on the provider side in academic, not-for-profit, and for-profit medicine. I’ve held a number of leadership roles companies including Accenture, GE Healthcare, Perot Systems, and Dell Computer, among others. I’ve spent a lot of time in healthcare in a lot roles on the provider side, the vendor side, and the consulting side.

    With regard to T-System, I’m very proud to be here. Our marketing people gave me a note indicating that we’ll have our twentieth birthday in June of this year, which is remarkable for a company like ours. We have domain expertise in emergency medicine and a longevity that exceeds anybody else in our market. I’m very proud to be here in this great organization.

    What are the biggest issues in the practice of emergency medicine in hospitals?

    Maybe just a slight correction in that regard. We certainly have a large component of our practice that supports hospital-based emergency departments, but it’s important to know that we are also a very strong market presence in the freestanding emergency department space, as well as in the urgent care space. We have a very broad application across that unscheduled care environment and significant footprints in each one of those.

    Having said that, there probably is a common set of challenges within that organization set, things that they share and challenges they face together. Perhaps the most important is the obligation to more actively deliver on outcomes in those healthcare spaces. Those clinical events are largely unscheduled and the outcomes can be challenging because they’re not quite sure what’s going to walk in the door at any given time. They have a unique clinical environment to deliver within. Associated with that are the challenges that the technology supporting it has to meet.

    Our business, our mission is to support that clinical delivery in that unique environment. You enhance those challenges with the things that everybody else in healthcare sees, like ICD-10, regulatory requirements, and additional burdens with regard to capacity for providers. All of those are challenges. All of those are issues which we bring a technology solution to in that urgent care ED space.

    What impact have your customers seen from the passage of the Affordable Care Act?

    Because of the evolution of this space, sometimes the metrics are a little bit challenged depending on who you’re talking to. What we think we see in the footprint in the folks that we serve is that the overall count of hospital-based emergency departments is probably slightly declining. Having said that, while there are fewer hospital-based emergency departments, the capacity or the volume of patients they’re seeing is increasing, based on the fact that there is an increasing funded base of patients now.

    They’re seeing more patients in fewer environments on the hospital-based ED side. That compression of capacity we think is forcing, or at least accelerating, these alternate care sites. They include freestanding emergency departments and urgent care centers. A lot of increase both in number and capacity in those two care settings, based in part on the pressures of the hospital-based EDs with regard to capacity.

    How are the needs of freestanding EDs and urgent care centers different from those of the hospital ED?

    This is one of those classic answers … if you’ve seen one, you’ve seen one. There are certainly some commonalities with regard to freestanding EDs and urgent care centers. There are multiple business models and some are unique.

    Having said that, the freestanding emergency departments, as I’m sure most of your readers know, are fully functional emergency environments, where they are able to deliver radiology and laboratory and complex care for life-threatening clinical scenarios.

    Urgent care centers more typically are a high-access, high-availability, more primary care sort of environment. They are characterized by the ability of a patient to simply walk in and receive care when they choose to and where they choose to. Urgent care centers may be the best manifestation of the scenario of converting to retail medicine that people have described historically. Urgent care centers really are that model. Freestanding EDs are a version of that model that is more focused on acute medicine and higher degrees, or higher orders, of severity.

    Your customers have a greater need than anyone to be able to quickly see a patient’s medical records from wherever they’ve been treated. Has their access to that information improved in the past few years as people focus more on interoperability?

    You’ve touched on one of the things that we spend most of our time thinking about, and certainly more recently with some of the announcements from CMS and the discussions at HIMSS — this notion of interoperability and its importance. The availability to access patient records historically is very important, certainly in our care setting as well as others.

    Maybe even more importantly, though, when we talk about interoperability from a T-System perspective, we’re more interested in what that looks like as a next version. In terms of real-time capabilities of moving data between applications in order to optimize both the provider’s capability as well as the patient outcomes, we’re really thinking more about the velocity of data movement as it supports true clinical interoperability at the care setting and for providers and patients.

    T-System joined CommonWell last year. What are you seeing as either the current or future benefit?

    We think CommonWell, together with some other organizations, represents a forward-looking view of what the relationship between application vendors should be in support of clinical care.

    In that context, I will say that early in the year, Andy Slavitt spoke at the JP Morgan Healthcare Conference. He delivered a very important viewpoint from our perspective. That speech on January 11, together with the follow-on paper they produced called “The Future of EHR,” sets the tone for organizations like CommonWell and how we think about how organizations should be interactive.

    He was very specific in terms of a requirement for “leveling the technology playing field.” He talked about a requirement for vendors to interchange data. He used the term "deadly serious" when he referenced interoperability and data exchange. He talked about referencing open APIs as a specific model for integrating data and moving it seamlessly between technologies.

    Our hope and expectation is that much of what Andy talked about in that view is reflected in organizations like CommonWell and in the behavior of our vendor peers in the healthcare space.

    Has your business been affected as health systems move from best-of-breed systems to a single-vendor approach?

    In any business vertical, there are cycles between enterprise and specialty solutions, whether that’s in finance or ERP or other. Most business verticals see this transition over time between enterprise solutions and specialty solutions.

    You could take a view that Meaningful Use at some level drove more enterprise-type behavior, as there was incentive simply to adopt a platform. Our growth was relatively level over that period of time. We were still meaningful and remained meaningful through that period.

    If you go back to what we talked about with interoperability and you think about a next cycle in that enterprise to specialty model, where organizations are looking for next levels of performance and higher tiers of technology capability, that’s where organizations like ours are primed to participate and meaningfully contribute.

    We see that, on a go-forward basis given the levels of interoperability we’re talking about, the decisions that are going to be made going forward are much more around outcomes and provider enablement as opposed to the fact that it’s nice to have a single platform.

    How have you addressed your audience’s need for usability?

    This clinical environment, this emergency environment, has to be the most challenging and demanding of providers. The technology that they utilize similarly has to behave in a way that is probably disproportionately capable to a traditional EHR because of the pressures and demands associated with that emergency environment.

    T-System, from a solution perspective, has over the last 20 years defined its value relative to that requirement. The notion of complex care delivery in a high-pressure setting is exactly what T-System was formed on 20 years ago and the value that we continue to enhance today. That includes not only the notion of a per-click model, but much more importantly, we spend an inordinate amount of effort and time and talent to refine the user interface of our products, such that they make sense clinically, but they deliver clinical value and that they support physician thinking, nurse thinking, and management of workflow within the ED. That optimizes that environment and supports the complex sorts of outcomes that they have to deliver.

    What are the ED opportunities to deliver better outcomes at a lower cost?

    At its core, beginning 20 years ago, T-System solutions were developed on clinical templates which carried embedded clinical intellectual property. All of the learning that we have developed and aggregated from an emergency perspective is collected and combined within the views that we present to clinicians. That clinical learning directly translates to optimizing clinical outcomes because it is an aggregated clinical IP set. We deliver those over each one of our clinical views. That substantially advances clinical outcomes.

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

    You used the term best-of-breed. We love that term. We love being best. Being best means enhancing those things that differentiate us and enhancing those things that provide value differently from a more traditional EHR vendor.

    We see ourselves moving in that space in a couple of different ways. First, back to Andy Slavitt’s comment, we began in 2015 to make a significant development commitment towards open API models and developing both Web delivery and open API capabilities. We have doubled down in that space given where we think the market is moving. We think our ability to interoperate and to be a leader in participating in that model is substantial and significant for us in an area where we’re focused on a go-forward basis.

    The second thing we’ll do is continue to enhance our clinical content, continue to aggregate our domain expertise and awareness, such that we will enhance outcomes as CMS and others have indicated as a priority.

    The third thing is, again beginning last year, we understood that because of the complexities of EHR environments and because of the different requirements in each of those clinical settings, we could better serve our clients by looking at a modular delivery capability as opposed to one solution, take it or leave it. In the context of developing more actively in a Web-delivered, API-enabled solution, we’re moving more toward modularizing capabilities within our solution set that we could interoperate and deliver more flexibly than we do today. A significant direction for us going forward in that five-year horizon is that modular capability with aggressive interoperability.

    Do you have any final thoughts?

    Your questions have touched on nearly every single value message we like delivering. From a personal perspective, I can’t imagine being at a better place with a better organization. The legacy here in the ED space is remarkable. I was at HIMSS talking with someone I had never met before who was an ED physician. As soon as I introduced myself and the company I was from, she couldn’t speak highly enough about T-System and her experience with our products and how it had enabled her clinically. For the almost two years I’ve been here, that scenario is played out over and over again. It makes me very grateful to be here.

    We feel positively about how our company is positioned. Our opportunity in this new season of interoperability is to be extremely meaningful across a variety of care settings, interoperating with anyone from a legacy EHR, enterprise EHR perspective. We’re excited about that. We’re glad we are where we are.

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    March 23, 2016 Interviews No Comments

    Morning Headlines 3/23/16

    March 22, 2016 Headlines No Comments

    Methodist Hospital Contains Cyber Attack

    Methodist Hospital (KY) contains the ransomware attack on its network and restores access to end users. Hackers were not paid a ransom, and an FBI investigation is ongoing.

    Hackers Take Aim At Two More Southern California Hospitals

    Hackers attack two Prime Healthcare Services hospitals in Southern California hospitals, Chino Valley Medical Center and Desert Valley Hospital. Administrators refuse to say whether a ransom was demanded, but say patient safety has not been compromised and that steps are being taken to restore full user access.

    23andMe Enables Genetic Research for ResearchKit apps

    Apple partners with genetic testing vendor 23andMe to integrate consumer genome information into ResearchKit apps.

    Call for Papers: Special Focus Issue on Safety of Health IT

    JAMIA publishes a call for submissions about the safety of all types of healthcare IT systems for an upcoming special issue.

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    March 22, 2016 Headlines No Comments

    News 3/23/16

    March 22, 2016 News 6 Comments

    Top News


    AHIMA petitions the White House to support development of a voluntary national patient identifier. Patients who opt in would be able to choose their own identifier. The petition will earn an official White House response if it gets 100,000 signatures by April 19. It calls for removing a late-1990s HHS funding restriction that prohibits the department from working on a national patient identifier.

    Reader Comments

    From Suzie HR: “Re: Cerner. A 20+ year SMS/Siemens/Cerner employee gets terminated after six months of personal leave taken for treatment of stage 4 colon cancer. Wonder if Neal Patterson is worried what will happen to him during his cancer treatment?” Unverified.

    From Helium: “Re: Epic 2015 upgrades being delayed. Not true here. We’ve discussed the fixes coming out from Epic with our technical lead at Epic and will take them when released. We are still on track for our mid-May upgrade to their latest version (v2015).” Unverified, but this is from a non-anonymous CIO who asked not to be named.

    From A Friend: “Re: Epic. Notified their customers Friday that they have become aware of a major security hole and would be distributing emergency SU’s (Epic jargon for patches) soon.” Unverified.

    From Dueling Banjos: “Re: your comment about flame-related FHIR puns. It hit my funny bone as I was reading your news update while riding BART. I was having such a good, hearty laugh over that comment that the man next to me thought I was crying and asked if I was OK. Thank you for making my day!” 

    HIStalk Announcements and Requests


    Welcome to new HIStalk Platinum Sponsor HealthCast. The Boise, ID-based company offers enhanced sign-on solutions that provide fast, secure access to EHRs and other software. That includes enterprise single sign-on that has a 100 percent success rate in integrating with applications; proximity card-based VDI access; and two-factor authentication for DEA-compliant electronic prescribing of controlled substances via biometrics or tokens. Physicians report that they save up to 45 minutes per day with fast-user switching, click-reducing automated workflow, and remote and roaming access to their systems. The company’s patented Qwik-Start helps community-based physicians who admit patients infrequently and therefore don’t necessarily remember their user IDs and passwords to log on to hospital systems using biometrics-activated proximity badges. Thanks to HealthCast for supporting HIStalk. 

    image image

    Vivian, who is a member of Mr. Chen’s robotics team in Massachusetts, emailed her thanks for funding their DonorsChoose grant request for pizza gift cards for feeding the team on evenings and weekends while they prepared for competition. She says, “We are so grateful that you helped us out! We needed energy to keep us going as we were very charged on getting the robot built for our competition. We have learned so much about mechanical engineering, software engineering, teamwork, and how to run the club as if it is a small business. Your donation has enhanced our learning and made it so much more enjoyable!”


    None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

    Here’s the video from last week’s webinar, “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado,” sponsored by Spok.

    Acquisitions, Funding, Business, and Stock


    Denver-based CirrusMD, which offers a white label app that allows consumer users to send messages to on-call and ED doctors, raises $1 million.


    Practice Unite and Uniphy Health will merge to offer secure messaging and collaboration solutions under the Uniphy Health name.


    In the UK, Wirral Partners chooses Cerner’s HealtheIntent for population health management.



    Indiana University Health names Mark Lantzy (Gateway Health) as SVP/CIO.


    Andy Grove, the former CEO and chairman of Intel, died Monday at 79.

    Announcements and Implementations



    Apple announces CareKit, a developer’s framework for creating personal health apps for the iPhone. Its first four modules will support health to-do lists, symptom logging, a dashboard to map symptoms to the to-do lists, and an information sharing function. The company says early adopters are using CareKit to build apps for Parkinson’s patients, post-surgery progress, home health monitoring, diabetes management, mental health, and maternal health.

    23andMe integrates with Apple’s ResearchKit, allowing developers to create apps in which study participants can upload their genetic testing results from their iPhones. It also allows researchers to offer 23andMe testing at their own expense to expand study access to non-23andMe customers. 

    Privacy and Security


    A cybersecurity firm finds that the public website of Ontario, Canada-based Norfolk General Hospital has been infecting its visitors with the TeslaCrypt ransomware. Hackers gained access to the site via an exploit in its outdated Joomla content management system.

    Methodist Hospital (KY) recovers its systems from a ransomware attack that lasted several days, saying that it was able to regain access without paying the demanded ransom.

    Two California hospitals owned by Prime Healthcare Services have been hit by an unspecified cyberattack that sounds like ransomware. The hospitals are working to restore their systems and the FBI is investigating.


    Ruby Memorial Hospital (WV) goes into lockdown mode for several hours after unspecified malware affects its clinical and security systems.


    A doctor in Canada is punished for overbilling and for keeping inaccurate electronic medical records, the latter of which he blames on not understanding the EHR of the practice he joined. He told the tribunal that he failed to change a pre-populated EHR template, but later switched EHRs.

    JAMIA issues a call for articles on the safety of health IT, with manuscripts due June 1.

    Expedia offers patients of St. Jude Children’s Research Hospital the chance to experience their “Dream Adventures” in which Expedia dispatches teams carrying live-streaming 360-degree cameras to display the adventures the children request in a virtual reality room installed at the hospital. 

    Sponsor Updates

    • Besler Consulting releases a new podcast, “Compliance pitfalls and how to understand RAC findings on your discharge status.”
    • Burwood Group will exhibit at the AONE 2016 nursing leadership conference March 31 in Fort Worth, TX.
    • Elsevier launches a history of medicine site to celebrate the 100th anniversary of its Medical Clinics clinical review publication.
    • CTG will exhibit at the 2016 Annual Health Care Symposium April 1 in Costa Mesa, CA.

    Blog Posts


    Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
    More news: HIStalk Practice, HIStalk Connect.
    Get HIStalk updates.
    Send news or rumors.
    Contact us.


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    March 22, 2016 News 6 Comments

    Morning Headlines 3/22/16

    March 21, 2016 Headlines No Comments

    CareKit Is Apple’s Ambitious New Health Monitoring and Tracking Tool

    Apple unveils CareKit, an open-source app development platform that extends functionality found in ResearchKit and HealthKit, but designed to help hospitals and patients track medical treatments and share medical information between providers.

    FCC auction will scramble patient-monitor airwaves

    Despite objections from the medical community, the FCC will move ahead with plans to auction off rights to airwaves within the 600MHz spectrum, a frequency band once reserved almost exclusively for wireless medical telemetry systems.

    Petition Calls for Unique Patient Identifier Solution

    AHIMA starts a petition calling for the development of a voluntary national patient ID system and the removal of the federal budget ban prohibiting HHS from participating in this effort.

    Scripps Health moves to reduce workforce, expenses

    Scripps Health (CA) reports a 12 percent increase in operating costs for fiscal year 2015, and announces cost saving measures that includes cutting 100 jobs and restructuring its management team.

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    March 21, 2016 Headlines No Comments

    Curbside Consult with Dr. Jayne 3/21/16

    March 21, 2016 Dr. Jayne 4 Comments


    At my clinical practice, many of my partners have been out for spring break. Since the local school districts have staggered break schedules, nearly everyone wanted the overlap weekend off, so I was happy to work the whole thing.

    Although Friday’s shift had more than its share of patients bearing the complaint of, “I just started getting sick and I’m going to Cancun and can’t be sick for break,” Saturday trended more towards, “I just got back from Cancun and am sick / hung over/sunburned.” I was starting to question my sanity until Sunday, when some “typical” patients started coming in.

    I’ve mentioned this before, but with the shift to high-deductible health coverage, we’re seeing a tremendous increase in volume. Our pricing is transparent and we’re conveniently located and provide quick service, so the business is experiencing exponential growth.

    With that comes some growing pains, however, which for me has been felt in the number of new staff members working on the teams. We have a really great training program – new staff members have formal training shifts and each shift has a different focus. One day may be clinical interview skills, another may be labs, and another may be procedures, etc. They work directly with a trainer whose only focus for the day is to train them – it’s not someone already on the care team who is training on the side.

    Even after the formal training, some staff may be more green than others. I ran across a scenario yesterday where the staff failed to notice some nonsensical entries in the EHR. Although it should have been reviewed before addition to the chart, the patient care tech missed the errors:

    • Pulse of 13270
    • Respirations of 99/minute
    • Temp of 15

    It turned out that the tech had entered the data quickly, was just tabbing through the data entry fields, and was off by one field. The blood pressure field (which should have shown 132/70) was blank and he entered those numbers without a slash in the pulse field. The error then compounded as he tabbed. He was apologetic and immediately fixed the error.

    Being in the health IT industry, I quickly flagged it as not only a human error, but also a software problem. Most of the EHRs I’ve worked with have restrictions on various data fields to prevent these kinds of errors. For example, a pulse field might only be able to hold three digits. Active or passive alerts might display for values outside the normal range.

    Although the tech should have caught it, my bigger concern is that this happened in a Meaningful Use Certified EHR. I’ve asked the practice’s technology liaison to open a ticket with the vendor and see if it’s functioning as designed or whether there is a defect. If it’s functioning as designed, I have to wonder about the certification standards. I don’t beg to have a command of the details and I know there are hundreds of pages of requirements that must be met.

    Knowing that some of the elements that are requirement for certification may not be something that physicians need or want, I’m surprised if there isn’t something in there to require safety checks for straightforward data entry like this.

    I first dealt with an EHR that handled data like this in a conversion project more than a decade ago. We had vast amounts of data that couldn’t easily be brought into our new system because the blood pressure field was a single field that would accept numbers, letters, and symbols. Assuming a sample BP of 140/90, users had entered it as:

    • 140/90 sit (meaning taken seated)
    • 140/90 R (meaning taken on the right)
    • 140/90 RA (meaning taken on the right arm)
    • 140/90 RALC (meaning taken on the right arm with a large cuff)
    • 140-90
    • 140.90
    • 140s/90d

    And so on. Our new system had separate fields for the systolic BP (top number) and diastolic BP (bottom number) as well as discrete fields for position, side, site, and cuff size. Due to the work needed in trying to cleanse the data, we quickly decided that we would just not bring any values into the new system and would start from scratch.

    Since that conversion project was so long ago and I haven’t run across the issue since, I assumed that such handling of data had gone the way of the dinosaurs. I guess it hasn’t, or I’ve just been spoiled by more sophisticated systems. But I would have hoped that with all the focus on patient safety and regulations, that we would have moved past this and that consistent handling of essential data such as vital signs would be a requirement for vendors seeking certification. How in the world can you be truly interoperable with data like this?

    We’ll see what happens with the vendor ticket and what my practice decides to do about it otherwise. If I was the CMIO, CMO, or medical director and this was my system, I’d be tracing it all the way through to find out what is being sent to the patient portal and what appears on transition of care documents and how extensive the problem might be.

    Although this particular scenario was a pretty significant and obvious error, I’m sure I could have missed less significant errors during the last couple of years. Since I’m wearing my hourly staff physician hat in this scenario, though, I’ve notified our leadership and have to let them work it as they see fit. I’ll be spending extra seconds reviewing my vitals going forward, however.

    This should be basic functionality, but I guess it’s not. I’m interested in hearing how other certified systems handle this type of data – whether they have field restrictions that would have prevented these errors, and whether they have active or passive alerts to create additional patient safety support. Consider adding a comment and sharing what you’re seeing in the trenches.

    Got screenshots? Email me.

    Email Dr. Jayne.

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    March 21, 2016 Dr. Jayne 4 Comments

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