Recent Articles:

Thoma Bravo To Acquire Imprivata for $544 Million

July 13, 2016 News No Comments

image 

Imprivata will be taken private by an affiliate of private equity firm Thoma Bravo for $544 million in cash, giving shareholders a 33 percent premium to the last closing stock price.

Imprivata President and CEO Omar Hussain was quoted in a statement as saying, “We’re tremendously excited about Thoma Bravo’s investment in our company and believe this transaction represents a great outcome for our current shareholders. Given Thoma Bravo’s successful track record in both security and healthcare IT, today’s partnership is an endorsement of Imprivata’s corporate vision and our relentless focus on the customer experience — a value which has established us as the vendor of choice in healthcare IT security. We are now in a stronger position to pursue market opportunities through innovating and expanding the products and services we offer.”

Thoma Bravo’s other active healthcare IT investments include Global Healthcare Exchange, Hyland Software, Mediware, and SRS Software. It also owns Bomgar Corporation, which offers remote support and identity management solutions. 

Imprivata offers single sign-on, secure virtual desktop access, patient IT, secure messaging, and two-factor authentication. The company went public in June 2014. Share price has decreased 11 percent since.

View/Print Text Only View/Print Text Only
July 13, 2016 News No Comments

Morning Headlines 7/13/16

July 12, 2016 Headlines 1 Comment

Fact Sheet: Ransomware and HIPAA

HHS issues ransomware guidance, clarifying that successful attacks do constitute a reportable HIPAA breach.

United States Health Care Reform Progress to Date and Next Steps

President Obama publishes a data-based JAMA article outlining the impact ACA has had thus far and calling for continued reform efforts to curb costs and improve outcomes.

Dutch hospital’s appeal: No more Pokemon hunting!

The Academic Medical Centre in Amsterdam issued a plea to Pokemon Go players to please stop hunting for the characters within the hospital, a spokesman for the hospital explains “Since yesterday we’ve noticed young people walking around the building with mobile phones into places they’re not supposed to be.”

Quebecers Ahead of Rest of Canada in Use of Digital Health Technology; Still Craving More Solutions

In Quebec, a survey finds that 85 percent of the local population believes that digital health technology will lead to better care, but just 21 percent actually use any digital health solutions.

View/Print Text Only View/Print Text Only
July 12, 2016 Headlines 1 Comment

News 7/13/16

July 12, 2016 News 2 Comments

Top News

image

HHS issues HIPAA guidance for ransomware attacks, saying that a reportable HIPAA breach has occurred if the malware encrypts PHI. The only exception is if the covered entity or business associate can demonstrate that the risk of PHI compromise is low, which would be difficult to accomplish in a ransomware attack.

HHS says a breach has not occurred if the user’s data was encrypted, but with a big exception –  users who are logged into a PC have made the information on their hard drive available during their session, so if that user clicks on a phishing link or opens an infected web page that triggers ransomware encryption, impermissible disclosure has occurred.


Reader Comments

From Geno Petralli: “Re: Xcite Health. A client says they’ve been bought by Athenahealth and the EncounterPro/Xcite Health program will be sunsetted and everyone moved to Athena by 1/10/17.” Here’s Athenahealth’s official response (from the head PR person) to my inquiry about this reader’s rumor:

image

A few hours later, I received this “partnership” announcement from Xcite Health, confirming the reader’s statement that EHR/PM vendor Xcite Health is shutting down as of January 10, 2017 and is suggesting that its now-orphaned clients switch to Athenahealth.

 SNAGHTML87096f64

From Roll Liftface: “Re: HIT100 winners. This guy doesn’t appear to have a job beyond self-promotion. Next year you should mock the process by getting your readers to nominate Carrot Top or Prince.” I haven’t heard of at least half of the tweet-happy winners, who seem to participate in a lot of mutual back-scratching among the Twitterati. Twitter isn’t the real world and the job titles of some suggest more success in the former than the latter. I’m sure part of the motivation beyond self-validation is employment, but I think companies would be wary of hiring someone who spends that much time and energy tweeting.


HIStalk Announcements and Requests

image image

Elementary school librarian Ms. H in Texas created a maker space that we stocked with programmable robots and other technology kits in funding her DonorsChoose grant request. She reports, “The younger students were in awe of this technology! I had a few even say ‘It’s Magic’ and I had to respond ‘No, it’s science!’ I had first graders screaming with joy when they got their Ozobot to follow the path they had created for it.”


Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

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


Acquisitions, Funding, Business, and Stock

image

The Wall Street Journal publishes fascinating factoids about Theranos CEO Elizabeth Holmes, including that her admiration for Steve Jobs (as evidenced by her black turtlenecks) led her to maintain an Apple-like secrecy about company news until the “one more thing” type public reveal. She also hired an Academy Award-winning director to film videos of herself. She is also escorted everywhere by an earpiece-wearing security detail that refers to her as Eagle 1. The article notes that her presentation to the American Association for Clinical Chemistry next month won’t include the information she originally intended since FDA said she couldn’t, so she’s going to instead focus her talk on Theranos company history (yawn). WSJ’s readers always provide insightful comments:

  • Hey, investors in Eagle 1–do you guys really know what you’re doing? Heaven forbid that you actually consult with someone who actually KNOWS SOMETHING about diagnostics.
  • I just hope that this story helps to shed light on the loophole in the law that allowed Theranos to promote tests that were not scientifically validated or to bring a spotlight to the many start-ups that continue to raise funds on the basis of hype and revenue growth, but without any real business plan or hope of profit.
  • This is what the VC’s seemed to really lust after, the idea that Theranos was going to move the bulk of blood testing out of doctor’s offices disrupt LabCorp and Quest as if they were stodgy old taxi companies. Theranos was really an "Uber for _____" and a data hoovering company. How many more clinically relevant (but smaller and less sexy) medical companies could have been funded with the money that was wasted on this?
  • I hesitate to draw any parallels between Holmes and Jobs because Jobs actually built products that worked as advertised.
  • I know a former employee of Theranos. This person got out when they realized this company was all smoke and mirrors. Also, this person told me that the whole Elizabeth Holmes story is all PR driven fluff (boldly dropping out of Stanford, starting the company on her own, etc.). Holmes actually has a lot of political connections in DC and is related to the Fleischmann Yeast fortune. Why are there so many politicians on the Theranos board and very few MDs?
  • It is possible that the famous Reality Distortion Field attributed to Mr. Steve Jobs might have been taken one step too far in this one case.
  • She is working in that exciting grey area between novel scientific breakthrough and scam.
  • Seems "Fake it ’til you make it" doesn’t work with medical technology.

image

Protesters picket Washington State clinic operator Zoom because it doesn’t accept Medicare or Medicaid, which the company logically replies is exactly its business model in offering quick, technology-powered local care for which Medicare pays poorly if at all. Protesters, many of them representing unions and those who want universal healthcare, issued a statement saying that population segmentation causes inefficient, lower-quality healthcare. Zoom’s CEO responds, “Don’t think that we have to be all things to all people.”

image

Stella Technology acquires Zigron Healthcare to expands its web and mobile app development, ETL, BI, QA, and user experience design services.

image

ECG Management Consultants acquires the healthcare consulting division of Kurt Salmon US.

image

Emergency medical services software vendor ESO Solutions – which offers an EHR and healthcare data exchange platform — receives a growth equity investment from Accel-KKR.

image

I missed this from a couple of weeks ago: investors including Blue Shield of California buy out MeYou Health, which offers behavior modification and social tools for health plan members. The new CEO is Rick Lee, co-founder of the acquired and then failed Healthrageous. MeYou Health company was previously owned by Healthways.

Aprima will consolidate its North Texas offices and 250 employees in Richardson, TX.


Sales

In the UK, Pennine Care NHS Foundation Trust chooses FormFast for its paperless health initiatives.

image

Rady Children’s Hospital – San Diego (CA) selects Strata Decision Technology’s StrataJazz for decision support, cost accounting, and contract analytics.

image

East Texas Medical Center Regional Healthcare System (TX) chooses Orion Health’s Rhapsody Integration Engine.


People

image

Jennifer Karstens (Encore Health Resources) joins Orchestrate Healthcare as area VP.


Announcements and Implementations

image

The American Heart Association’s Institute for Precision Cardiovascular Medicine will award 14 data-related grants in the next year and will provide winners access to Amazon Web Services to analyze and share their information. The grants will cover data mining, data methods validation, development of data analysis tools, and fellowships for scientists interested in computational biology training.

image

NCQA awards Premier its first Electronic Clinical Quality Measures Certification, verifying its ability to report clinical data for HEDIS and CMS EHR inventive measures.


Government and Politics

image

President Obama writes a JAMA paper (bylined as “Barack Obama, JD”) describing the impact of the Affordable Care Act. He describes the decrease in uninsured citizens and the elimination of cost-sharing for preventive services and lifetime coverage limits. He says reform needs to continue via CMMI, ACOs, MACRA, precision medicine, and the Cancer Moonshot. He asks Congress to revisit his original proposal to offer a Medicare-like public plan that would add competition in areas served by a small number of insurers. He also wants Congress to force drug companies to disclose their actual production costs and to give CMS the authority to negotiate prices for expensive drugs. The President warns of the influence of special interest groups:

The second lesson is that special interests pose a continued obstacle to change. We worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured. Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits. We need to continue to tackle special interest dollars in politics. But we also need to reinforce the sense of mission in health care that brought us an affordable polio vaccine and widely available penicillin.

image

CMS announces that the median deductible on marketplace-issued health insurance policies is $850, down from $900 last year, when the subsidies the federal government gave to 60 percent of those policy-holders is figured in. The announcement glosses over the 40 percent of people who bought insurance from Healthcare.gov and state exchanges without federal handouts for their premiums and deductibles, the latter of which for silver-level plans are often the maximum allowed $6,800 for single coverage. As is nearly always the case in the US, the rich and the poor do well at the expense of the middle class.

The Congressional Budget Office calculates that the national debt will rise to 141 percent of the economy’s size within 20 years, eclipsing the previous high of 106 percent that followed World War II. Entitlement programs such as Medicare and Social Security are mostly responsible, along with interest payments on the ever-increasing US red ink.


Privacy and Security

image

A hospital in China apologizes to the parents of 6,000 newborns whose nursery videos were stolen by hackers and posted on the Internet. Experts say many website developers in China lack even basic security knowledge, adding that the hackers were probably just practicing their skills since the videos have no value otherwise.

A secretary fired by Jackson Health System (FL) for giving ESPN a photo showing the surgery schedule of football player Jason Pierre-Paul, whose finger was amputated following a fireworks accident last July 4, sues the hospital, claiming she’s had nightmares and headaches following what she says were false accusations. The hospital stands by its decision, saying they have electronic proof that she looked at Pierre-Paul’s chart at least four times and left work early the day the information was leaked. 


Other

image

A hospital in the Netherlands asks players of the wildly popular week-old, GPS-powered virtual reality Pokemon Go smartphone game to stop hunting the game’s imaginary monsters on its campus after several of them wander into its restricted areas. AMC’s tweet above translates to, “There is a sick Pokemon in AMC – we will take care of him. We would appreciate your not visiting.” Other businesses are facing similar headaches: a woman demands that a music festival let her daughter on its private property to play, a cafe bans the game because customers were taking up space for hours, and officials expect game-players to be injured or killed by wandering into roadways or onto railroad tracks while absorbed in gameplay. Players have run across dead bodies, been mugged in sketchy areas in the middle of the night, and admitted playing while driving. At least people who usually sit and stare at their phones all day long will finally get some exercise. I’m sure Nintendo / Niantic are quickly plotting ways to monetize their surprise hit, such as charging businesses to host destinations or to allow users to sell accomplishments back and forth, but it will probably be killed off by the next shiny object (a la Words with Friends and Second Life) before they roll something out.

I received an email touting a healthcare IT job site’s newly published “Health IT Stress Report,” which despite being overloaded with cute infographics and lofty yet lame conclusions, is based on only 470 survey respondents whose method of selection and response rate were unstated. That usually means someone stuck a survey on their website and harvested any willing, self-selected, statistically unrepresentative people who felt like filling it out.

In Canada, a survey of unstated methodology finds that only 21 percent of Quebec residents have used online health tools, causing the cheerleading digital health company authors to incorrectly conclude, “leaving 79 percent of Quebecans wanting digital tools that would allow them to take control of their personal health” (apparently the authors reckon that every single Quebec resident wants digital health tools even though they didn’t ask them.) Respondents were a lot more interested in online banking and social media even though they obligingly answered the leading questions offered about interoperability, electronic prescribing, and EHRs.

image

Weird News Andy labels this plastic surgeon as “selfieish.” The Ukraine doctor, whose motto is “Love is free, medicine is not,” specializes in breast augmentation and posting selfies and videos taken with his unconscious naked patients on social media. The shameless self-promotion is working – he has a year-long backlog of patients. 


Sponsor Updates

  • Edward-Elmhurst Health (IL) says its physicians are saving two hours per shift by using Nuance’s Dragon Medical One cloud-based clinical speech recognition.
  • Besler Consulting releases a new podcast on the comprehensive Care for Joint Replacement appeals process.
  • ECG Management Consultants will present at the HFMA Region 7 Conference July 18 in Lake Geneva, WI.
  • PMD CEO Philippe d’Offay is spotlighted in a Q&A about secure messaging for providers.
  • Forward Health Group will participate in the National Governors Association Summer Meeting 2016 July 14-17 in Des Moines, IA.
  • Impact Advisors will participate in the “Run to Home Base” fundraiser for veterans on July 25 at Fenway Park in Boston.
  • Glytec CMO Andrew Rhinehart, MD offers an overview of DPP-4 inhibitors.
  • HCS will exhibit at the Health Forum/AHA Leadership Summit July 17-19 in San Diego.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 12, 2016 News 2 Comments

Morning Headlines 7/12/16

July 11, 2016 Headlines No Comments

Impact of computerized provider order entry (CPOE) on length of stay and mortality

A JAMIA study finds a statistically significant correlation between the use of CPOE and a reduction in length of stay and mortality rates.

Under Fire, Theranos CEO Stifled Bad News

The Wall Street Journal reports that Theranos CEO Elizabeth Holmes had planned to present clinical data validating the company’s technology during her upcoming presentation at the American Association for Clinical Chemistry’s annual meeting, but because the necessary studies were not completed in time, she will present a slide deck recapping the company’s 13 year history.

Congress Shouldn’t Pass The 21st Century Cures Act In A Summer Rush

A Health Affairs article calls for the Senate to delay a vote on the 21st Century Cures Act until after its extended election-year summer recess.

The American Heart Association Announces Strategic Collaboration with Amazon Web Services to Advance Precision Cardiovascular Medicine with AWS Cloud

The American Heart Association’s Institute for Precision Cardiovascular Medicine partners with Amazon Web Services to provide cardiovascular researchers with a cloud-based infrastructure to store and share data.

View/Print Text Only View/Print Text Only
July 11, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 7/11/16

July 11, 2016 Dr. Jayne 6 Comments

I read with interest the recent alternative certification proposal from John Halamka.

I have a couple of vendor friends who work on the certification process for their respective organizations. They both describe the process as cumbersome and tedious. One of them is a nurse and says she detests the entire process since it forces adherence to rigid scripts rather than testing the actual workflows users are going to need. Those of us who have spent a bit of time implementing systems know there is a significant difference between vendor QA testing (where vendors see if the code that was produced meets the build specifications) and true user acceptance testing, where we see if the code that was produced actually meets the needs of those using the system.

Whenever I assist with running user testing events, I make sure we test features and functionality using a dual approach. Some users will be given turn-by-turn test scripts that target a new workflow component in the context of the larger existing workflow, to ensure that the new pieces don’t adversely impact any other parts of the workflow. We all know about releases that fix one thing and break another, and this seems to be the best way for many clients to catch those kinds of issues.

Another group of users will be given test scripts that are a bit more nonspecific, such as, “Prescribe these three medications, then schedule an appointment for an office visit and send a referral for a mammogram through the portal.” This approach allows us to test new features against the way users actually use the system rather than against a rigid test script.

Users are generally creative. If there’s a work-around to be found or an alternate way to do something, they’ll unearth it. Sometimes those workflows are legitimate – the vendor offers three or four different ways to do something. However, some work-arounds may take advantage of unintended functionality or existing defects, so that that when those seemingly-unrelated defects are fixed, it causes issues with other workflows. You’re generally not going to find those with rigid test scripts since you may not have any way of knowing how creative your users have gotten or what workflows they have come up with.

Of course, testing those kinds of scenarios is far beyond certification, and with as tedious as certification already is, I’m certainly not advocating expanding it. It’s just a shame though that vendors are spending time certifying their products against criteria that have little impact on the actual use of their product.

At the same time, we seem to be lacking in actual usability testing. Although vendors are being pushed to include user-centric design principles in their processes, the outcomes still vary widely. The recent dust-up with Athenahealth’s Streamlined upgrade seems to illustrate this. Judging from the comments I’ve seen and heard, it feels like there may not have been enough user acceptance testing to identify workflow problems that are causing significant issues for a good number of their clients.

Although the comments should be taken with a grain of salt (since it’s difficult to know whether clients attended training, performed testing, whether they were following best-practice workflows previously, etc.) there is always a kernel of truth to be found. I’ve been on the receiving end of enough poorly-conceived or poorly-executed vendor “enhancements” to know that they seem to make it out the door more often than they should.

Sometimes they are the product of good ideas. but the technology doesn’t really make them executable. Sometimes they are enhancements that were created for a single client as a result of a contractual obligation even though they have zero utility for the rest of the vendor’s customer base. Other times they are enhancements that were created for sales purposes, to allow for a glitzy demo that looks good yet doesn’t meet the needs of actual physicians or clinical users. Not only are they unhelpful, but a couple I’ve seen recently are downright insulting to the good sense of the average doc.

In his comments, Dr. Halamka discusses how certification has negatively impacted the industry: “Overly zealous regulatory ambition resulted in a Rule that has basically stopped industry innovation for 24-36 months.” Clients who have waited patiently for their vendors to implement basic usability enhancements know exactly what he’s talking about. Rather than improving the user experience, scarce development dollars were spent meeting the letter of the law for requirements that may never be used. He closes with some profound thoughts that made my day:

If Brexit taught us anything, it’s that over regulation leads to a demand for relief.
Pythagoras’ Theorem has 24 words
Archimedes’ Principle has 67 words
The Ten Commandments has 179 words
The US Declaration of Independence has 1,300 words
The EU regulation on the sale of cabbages has 26,911 words.
As a comparison, the 2015 Certification Rule document has 166,733 words.

Good food for thought for the governmental bodies, agencies, payers, and others whose rules define how we deliver healthcare in the US.

What do you think about excessive rulemaking? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
July 11, 2016 Dr. Jayne 6 Comments

Readers Write: Why EHRs Will Have Different Documentation Requirements for Biosimilar Dispensing, Administration, and Outcomes

July 11, 2016 Readers Write No Comments

Why EHRs Will Have Different Documentation Requirements for Biosimilar Dispensing, Administration, and Outcomes
By Tony Schueth

image

While a second biosimilar recently being approved in the United States does not a tsunami make, biosimilars are nonetheless expected to quickly become mainstream. In response, stakeholders are beginning to work on how to make them safe and useful within the parameters of today’s healthcare system because, biosimilars – like biologics – are made from living organisms, which makes them very different from today’s conventional drugs.

In fact, biosimilars are separated into two categories: biosimilars and interchangeables, both of which are treated differently from a regulatory standpoint. These differences will create challenges and opportunities in how they are integrated in electronic health records (EHRs) and user workflows as well as how patient safety may be improved.

EHRs must treat biosimilars differently than generics. As a result, EHR system vendors will need to make significant changes to accommodate the unique aspects of biosimilar dispensing, administration and outcomes.

Patient safety is a priority for development and use of all medicines. Manufacturers must provide safety assessments and risk management plans as part of the drug approval process by the Food and Drug Administration (FDA). Even so, biologics and biosimilars are associated with additional safety considerations because they are complex medicines made from living organisms. Even small changes during manufacturing can create unforeseen changes in biological composition of the resulting drug. These, in turn, have implications for treatment, safety, and outcomes. In order to address these issues, information about what was prescribed, administered, and outcomes must be documented in the patient’s medical record.

Substitution also is an issue because dispensed drugs may be very different than what was prescribed. As a result, it is important for physicians to know whether a substitution has been made and capture information about the drug that was administered in the patient’s medical record, especially when it comes to biologics and biosimilars. This is important for treatment and follow-up care, as well as in cases where an adverse event (AE) or patient outcome occurs later on.

Four drivers make the unique documentation requirements of biosimilars in EHR a priority.

  1. Utilization is expected to grow rapidly because of biosimilars’ lower-cost treatment for such chronic diseases as cancer and rheumatoid arthritis. It is easy to envision the availability of four biosimilars each for 20 reference products that could be available in 2020, given projected market expansions. That amounts to 100 biologics that will need to be addressed separately. As more biosimilars are approved and enter the market, it will become increasingly challenging and important to accurately identify and distinguish the source of the adverse events (AEs) from a biosimilar, its reference biologic, and other biosimilars.
  2. Physicians will need this information once biosimilars come on line and their use becomes widespread. Adverse complications — particularly immunologic reactions caused by formation of anti-drug antibodies – may occur at much later after the drug was administered. Physicians report more than a third of adverse events to the FDA, but need to know what was administered to the patient when the pharmacist performs a biosimilar substitution.
  3. Outcomes tracking and patient safety are growing priorities in healthcare. They are key pieces of the move toward value-based reimbursement and are a focus of public and private payers. Identifying, tracking, and reporting adverse events are expected to become key metrics for assessing care quality and pay-for-performance incentives.
  4. States are ahead of the curve when it comes to substitution. More than 30 are considering or have enacted substitution legislation for biosimilars, which creates urgency in how such information is captured and documented in EHRs. Some states require the pharmacy to communicate dispensing data to the prescriber’s EHR.

Because of the unique properties of biosimilar dispensing, administration and outcomes, many adjustments will be needed for documentation into EHRs used by physician offices in independent practices and integrated delivery systems (IDS). For example:

  • EHRs must be able to comprehensively record data on what was administered or dispensed for an individual patient, as well as what was prescribed. Modifications will be needed for tracking adverse event reports in various administration locations, including the physician’s office; an affiliated entity (e.g., practice infusion center); the patient’s home; or non-network providers.
  • Changes in drug data compendia will be needed to account for new naming conventions that soon will be put in place by the FDA and substitution equivalency.
  • Tracking the manufacturer and lot or batch numbers (similar to vaccine administration) can facilitate more accurate tracing of an AE back to the biologic. Fields will need be added to record the NDC code, manufacturer, and lot number of biosimilars that have been dispensed. 
  • NCPDP SCRIPT’s Medication History and RxFill transactions — already available for electronic prescribing in EHRs— can include the NDC and the recently added manufacturer and lot number as part of the notification to the prescriber. Although not widely used today, RxFill provides a compelling method to notify providers that a substitution occurred in the pharmacy.
  • EHRs will need to address barriers related to the use of biosimilars, such as creation of too many alerts; the usability of how the information is presented to the clinician; lack of consistency in the display of drugs and drug names; and conformance of screen features and workflow within and between systems.
  • IDS systems need to be interoperable and have a seamless transfer of information. This can be a challenge in trying to meld together multiple disparate health information technology systems and EHRs from different vendors.

The time is right for industry, hardware and software developers, and other stakeholders to address the opportunities and challenges posed by entrance of biologics and biosimilars into the US market. As patient safety issues arise, the EHR community must be in a position to capture and exchange needed information. Otherwise, states and other regulators could develop alternative tracking methods. Examples include state vaccine registries or prescription drug monitoring programs, which track controlled substances dispensing and vary from state to state. These programs have become complicated mechanisms for healthcare providers to address.

Tony Schueth is CEO and managing partner of Point-of-Care Partners of Coral Springs, FL.

View/Print Text Only View/Print Text Only
July 11, 2016 Readers Write No Comments

Morning Headlines 7/11/16

July 10, 2016 Headlines 1 Comment

Elizabeth Holmes of Theranos Is Barred From Running Lab for 2 Years

CMS issues an unprecedented suspension barring Theranos and Elizabeth Holmes from owning or operating a medical laboratory for two years.

Two-year longitudinal assessment of physicians’ perceptions after replacement of a longstanding homegrown electronic health record.

A two-year study monitoring physician satisfaction during and after an Epic implementation finds that satisfaction levels never returned to pre-implementation levels, refuting the notion that a J-curve exists in which satisfaction levels initially dip but then climb above pre-implementation levels as providers get used to the new system.

HHS raises interim IT leader to permanent CIO

HHS promotes Beth Anne Killoran from acting to permanent CIO.

Surprise Medical Bills Fuel Fight Between Providers, Insurers

The Wall Street Journal covers the increase in surprise medical costs incurred by patients inadvertently getting care from an out-of-network provider while at an in-network hospital.

View/Print Text Only View/Print Text Only
July 10, 2016 Headlines 1 Comment

Monday Morning Update 7/11/16

July 9, 2016 News 6 Comments

Top News

image

image

In what should be the death blow to lab processor and Silicon Valley technology wannabe Theranos, CMS bans CEO Elizabeth Holmes from any clinical laboratory ownership or involvement for two years and shuts Theranos off from receiving further payments from Medicare and Medicaid.

Theranos proved its incompetence even in its response to CMS’s warning letter: the company sent CMS five password-protected flash drives containing supporting information that was so screwed up that CMS couldn’t figure it out, with reports for the same accession number spread over multiple drives, information on the drives that didn’t match the contents of an accompanying paper binder, and random fax coversheets that were not associated with patient test reports (would you really want your specimens processed by a company that can’t keep documents straight?)

The company’s response to CMS’s death sentence inexplicably says it will keep Holmes as CEO, but hints that it might pivot away from the specimen processing business, possibly believing it can license its technology. That Theranos movie Jennifer Lawrence has signed up to do will either never be finished or it will hit theaters long after anyone still cares.

image

Meanwhile, pathology informaticist  Bruce Friedman, MD of Lab Soft News raises a good question: the American Association for Clinical Chemistry couldn’t resist giving Elizabeth Holmes stage time to promote her dying enterprise at their annual meeting that starts July 31, but shouldn’t they be even more embarrassed now that she’s been banned from the industry in which all of those actual experts work and maybe think about rescinding their questionable offer? She’s an even worse choice than some of the awful ones HIMSS has made (Dennis Quaid comes to mind). I’m starting my campaign to bring Martin Shkreli to the HIMSS stage.


Reader Comments

From Captain Ron: “Re: Epic’s search for a data visualization suite. Microsoft PowerBI, Qlik, and Tableau were in the running. After doing bake-offs, Epic decided to choose none of the above. They will support customers on any BI product they choose. Guess it’s up to the customers to build content for themselves against Clarity and Caboodle.” Unverified. 

image

From Neo Vespers: “Re: Glenwood Systems, Waterbury, CT. I’m a consultant looking for users of its GlaceEMR – my client is having problems and I can’t find other users.” I’ve never heard of the company or product, but perhaps someone will jump in.

image

From DJ D-Deadly: “Re: Politico’s e-Health News. They called you are a dirt-disher!” I resent smug attempts at cleverness in dismissing what I do as being National Enquirer-like simply because I report rumors that usually turn out to be partly or fully accurate, especially when sites make that observation even while running something they read on HIStalk and thus calling into question their entire thesis. I consider it a wash since they described me as “oracular,” which I plan to use in casual conversation every now and then. They also linked to HIStalk, unlike most of the time when reporters simply regurgitate what they’ve read here in passing it off as their original reporting.

From The PACS Designer: “Re: AI versus RI. Here in mid-2016 we’re on the cusp of a huge change in how healthcare is practiced. While artificial intelligence (AI) has been championed for decades as a solution to improved learning, healthcare will be moving toward real intelligence through the greater use of ICD-10. With the more specificity, the last year under ICD-10 Clinical Modifications (CM) has given practitioners some experience with this new format. Now on October 1 this year here in the US, we’ll begin to see the benefits of real intelligence or (RI) using ICD-10 Procedure Codes (PCS). Eric Topol from Scripps has an article highlighting where we are going with changes in healthcare through increased levels of patient engagements.” 


HIStalk Announcements and Requests

image

McKesson’s planned sale of its EIS business that includes Paragon will benefit Cerner the most, poll respondents say. However, nearly as many expect Meditech to gain ground from the sale. BP opines that McKesson made a mess of its acquisitions by sucking the energy out of them, noting particularly that the company spent $500 million developing Horizon Enterprise Revenue Management only to shut it down in favor of small-hospital Paragon. He or she blames offshore-onshore waffling, scope creep, cost, and competing internal projects that left provider executives disappointed and many McKesson employees bitter after never-ending waves of restructuring. Perhaps Kd’s wry comment is the most insightful – McKesson will benefit most because it’s dumping a cash sinkhole that it doesn’t really care about anyway.

New poll to your right or here: do HIPAA fines and settlements broadly increase privacy and security?

image image

Mrs. S from Georgia says her students are using the iPad and quiz contest software we provided in funding her DonorsChoose grant request to reinforce their math skills by competing with each other.

I can’t decide if I’m comforted or horrified that even as the headlines get worse and the potential demise of our democracy seems to be creeping ever closer, disengaged citizens who are isolated from the real world by a self-created fantasy aura of phone geegaws are now obsessed with Pokemon Go. Want to fiddle while Rome burns? There’s an app for that.


Last Week’s Most Interesting News

  • England’s NHS scraps its plans for a national database of EHR-extracted patient information after review committees criticizes its opt-out and consent policies.
  • A Congressionally-established review committee recommends that the VA replace its old software systems – including VistA – with commercial products.
  • NIH awards $55 million in grants for the recruitment of 1 million Americans for the long-term study of their personally collected data and gives Scripps Translational Sciences Institute a five-year, $120 million grant to develop apps, sensors, and processes for recruiting the “citizen scientists.”
  • Catholic Health Care Services of the Archdiocese of Philadelphia pays $650,000 to settle HIPAA charges from the 2014 theft of a company-issued iPhone that contained the information of 412 patients, the first time a business associate has been charged with HIPAA violations.
  • ONC announces its intention to measure national interoperability progress by using the responses to to existing AHA and CDC hospital surveys.
  • A security firm’s tests find that hospitals are not always keeping the PCs and servers that control biomedical equipment current with operating system and antivirus updates, creating a digital soft spot for hackers.

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

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


People

image

HHS promotes acting CIO Beth Anne Killoran to the permanent position, noting that her IT experience with the Department of Homeland Security gives her strong cybersecurity capabilities.

image image

NHS England names Keith McNeil as chief clinical information officer and Will Smart as CIO. McNeil, who is a physician, resigned as CEO of Addenbrooke’s Hospital last year just before Cambridge University Hospitals NHS Foundation Trust (which includes Addenbrooke’s and The Rosie Hospital) was placed on “special measures” for a number of patient care problems; he was also CEO when the Regulator Monitor investigated the trust’s financial challenges following its $300 million Epic rollout. Smart was CIO at Royal Free London NHS Foundation Trust, which is a Cerner shop.

image

Genetic testing IT systems vendor NextGxDx names Rob Metcalf (Digital Reasoning) as CEO. He replaces founder Mark Harris, PhD, who will take a demotion to chief innovation officer.


Government and Politics

The Department of Defense gives Cerner another no-bid contract for hosting its MHS Genesis EHR project, raising the project’s hosting costs from $50 million over 10 years to $74 million through the end of 2017. DoD says the extra cost won’t affect the overall $4.3 billion project budget. The Pentagon seems annoyed by the higher cost and says it may recompete the hosting contract next year. 


Technology

I’m questioning the quality of Wired’s breezy reporting in claiming that medical records are a “hot commodity” on the Dark Web, or as it dramatically intones, “the hidden recesses of the Internet” (accompanied by unrelated pictures lifted from Flickr users). They might well be a hot commodity as has been amply reported elsewhere, but this story adds nothing to the discussion. The reporter didn’t uncover a single new fact in simply reciting uncredited headlines from elsewhere and taking as gospel what some IBM guy told her about the Dark Web. She makes the puzzling assertion that hackers intentionally delete patient allergies from their medical record, which I’ve never heard of. She claims that doctors “are reluctant to use dual-factor authentication” without citing any source. She finishes by rambling off topic about steps patients can take to protect their information: don’t email information forms, make sure someone is standing by the fax machine if you fax something (does anyone really do that?), and ask why providers need your Social Security number. The overripe headline is like a movie trailer that baits movie-goers with the best scenes in ringing up their ticket purchase without delivering anything in return once they’ve settled into their seats. It’s pretty scary to see the low standard to which journalism is held these days, where desperate tricks to lure temporary eyeballs somehow continue convincing clueless advertisers to underwrite dumbed-down work.


Other

image

Ambulatory physicians at  University of Michigan Health System weren’t any more satisfied with Epic than with the homegrown CareWeb it replaced, a two-year study finds, refuting the common belief that post-implementation physician satisfaction improves over time in a J-curve. Instead, most measures exhibited L-curve behavior where they dropped and stayed below baseline. Physician job satisfaction decreased after Epic went live and didn’t catch up in the 25 months afterward; a majority of the doctor respondents believed throughout the two years that Epic hadn’t improved patient safety over the old system; and the EHR’s positive contribution to physician job satisfaction dropped from 62 percent with CareWeb to 8 percent with Epic.

I’ve received several “vote for me” messages via people on LinkedIn and Twitter who desperately want to be named to the pointless HIT100 list of prolific tweeters. Are they really going to be proud of winning, sprinting breathlessly to update their resumes with a faux award and feeling good about their place in the universe for having won it by strong-arming their social media contacts to support them, which suggests that those folks probably wouldn’t have chosen them otherwise?

A Wall Street Journal report says anger is building among patients who are treated in an in-network hospital but who are stuck with non-covered bills from the hospital’s out-of-network specialists. Three-fourths of ACA-issued policies provide no out-of-network coverage at all except in emergencies, and since out-of-pocket maximums don’t apply to out-of-network charges, the patient faces unlimited costs at the non-discounted rates that nobody else pays. ED doctors complain that insurers have reduce their payments knowing they have to treat their patients anyway, while insurance companies say that ED docs reject in-network rates so they can charge whatever they want on out-of-network bills.

China launches a year-long campaign that urges angry patients and their families to refrain from attacking the employees of its overloaded hospitals.


Sponsor Updates

  • Valence Health will exhibit at the AHA Leadership Summit July 17-19 in San Diego.
  • Huron Consulting Group will present at the AHA Leadership Summit July 17-19 in San Diego.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 9, 2016 News 6 Comments

Morning Headlines 7/8/16

July 7, 2016 Headlines No Comments

NHS to scrap single database of patients’ medical details

The NHS closes down its care.data initiative, a government attempt to store patient medical information in a single database.

The Number Of Health Information Exchange Efforts Is Declining, Leaving The Viability Of Broad Clinical Data Exchange Uncertain

A Health Affairs study finds that the number of health information exchanges operating has dropped from 119 to 106 as federal funding runs out, despite demand for interoperability solutions.

An Alternative Proposal for Certification

John Halamka, MD argues for simplified health IT regulations that would focus entirely on expanding FHIR- based data exchange.

Announcement of Requirements and Registration for “Blockchain and Its Emerging Role in Healthcare and Health-related Research”

ONC announces a contest soliciting ideas for how blockchain data structures might be used in healthcare.

View/Print Text Only View/Print Text Only
July 7, 2016 Headlines No Comments

News 7/8/16

July 7, 2016 News 8 Comments

Top News

image

England’s NHS scraps its plan to create Care.data, a huge national database of patient information that was to be extracted from provider EHRs.

NHS planned to sell the partially de-identified information of patients who didn’t opt out to drug companies and other willing purchasers, but decided to end the program after two commissioned reports criticized its opt-out and consent policies as being less than transparent.


Reader Comments

image

From Jolter: “Re: Athenahealth. The company is not immune to the same challenges as competitors, as feedback on this software rating site about their Streamlined upgrade says. I had caught wind on their last investor call that Streamlined isn’t well regarded within their customer base. Instead of worrying about unbreaking healthcare, they should be unbreaking AthenaClinicals.” Physician customers say Streamlined has changed Athenahealth’s EHR into a click-intensive “opaque, cumbersome product” that “has made a mockery of the Athena system” that is now “the worst system I could have ever imagined,” with Athena’s support reps blaming Microsoft or whatever browser the customer is using for their many problems. A pulmonologist says Athena is “crippling my practice” and claims the company is censoring its client forum. Athenahealth is also getting publicly ripped by many customers on Facebook over the forced upgrade. One doctor summarizes Streamlined as, “When it works, it stinks. When it does not work, it really stinks.” It’s tough to keep riding the “disruptor” horse when you’re a publicly traded company worth $5.5 billion, have an installed base of customers to maintain, and need to fawn to impatient investors who constantly demand improving profits. Imagine the outraged fun Jonathan Bush would have with this seemingly major stumble if he ran Epic or Cerner. Athena has quite a few product and acquisition balls in the air, so this is where they get to prove that they earned their seat at the Wall Street table as something more than a future-promising puppy nipping at the heels of dowdier but much larger and experienced competitors.


HIStalk Announcements and Requests

image image

We funded the DonorsChoose grant request of Mrs. D from Nevada in providing math learning games for her kindergarten students. She reports, “As I pulled each math activity out of the box, they cheered, begging me to open it! …  the students thought it was ‘amazing’ and ‘so cool’ that a complete stranger would give us math games … The real gift within that box was the gift of knowledge and understanding. For some of my students, these math games are more than just math games, they are clarity and a road to success and confidence. I have witnessed so many ‘light-bulb-moments’ while using these games. Knowing my students are grasping complex mathematical concepts (for their age) is the greatest experience!”

This week on HIStalk Practice: Sciton gets into practice support. MyIdealDoctor adds behavioral health to its telemedicine services. VITL presses for a less burdensome patient opt-out policy. HHS ramps up opioid prevention efforts, including mandatory PDMP use at FQHCs. Urgent care clinic closes in the face of telemedicine competition. AAPS caves to Brexit clickbait.


Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

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


Acquisitions, Funding, Business, and Stock

image

Scotland-based Craneware announces record sales for the year ending June 30, with revenue rising 60 percent on $58 million worth of contracts.


Sales

image

UC Irvine Health (CA) chooses Infinite Computer Solutions and Optimum Healthcare IT for EHR migration.


People

image

Nat’e Guyton, RN, PhD (Trinity Health) joins Spok as chief nursing officer.

image

Bob Sullivan (IBM Watson Health) joins interactive patient technology vendor Sonifi Solutions as GM of its healthcare division.

image

Bob Kyte (Adventist Risk Management) replaces the recently retired Don Kemper as CEO of Healthwise.


Announcements and Implementations

image

Validic joins SAP’s Connected Health ecosystem, offering users of SAP Health Engagement the ability to integrate patient-generated health data.


Government and Politics

ONC issues a white paper contest for the potential uses of blockchain in healthcare, with submissions due July 29. Up to eight winners get their  travel expenses paid to present their paper at a NIST-hosted workshop September 26-27 in Gaithersburg, MD.

The government of South Australia finally funds the initial planning project for the migration of SA Health’s long-sunsetted patient administration software. The system’s vendor, Global Health, sued the government for breach of contract after it repeatedly refused to stop using the 1980s-era system, of which it is the only remaining user. The SA government has been focused on its troubled Allscripts EPAS rollout, but the state’s rural hospitals aren’t included in the implementation plan and also haven’t committed to upgrading to the current Global Health product.

image

Peer60 is doing research on Brexit’s impact on England’s NHS. I was curious about its preliminary results even though they’ve surveyed only 80 hospital leaders so far (out of 200+ responses expected). Respondents offered some interesting comments:

  • “Prior to the referendum, both campaigns threatened Armageddon if we left/stayed in EU. They both also said we’d each receive a puppy and have champagne for breakfast if we left/stayed in EU. We’d also be better looking and lose weight if we left/stayed in the EU. None of these have come true. The distinct lack of definitive outcomes, even now, make it difficult to have an opinion, apart from the long-standing one that Westminster is full of liars and has absolutely no interest in the well-being of UK citizens.”
  • “Welcome to the third world.”
  • “More likely to have positive impact as will help with controls re: EU residents who do not pay UK national insurance and taxes from using NHS resources –  this service will need to be funded in the future. We can work through the staffing issue by working differently, researchers will find ways to continue to collaborate. Impact is in needing to find work around and other change.”

image

John Halamka suggests that CMS eliminate existing EHR certification requirements and instead require vendors to demonstrate only five specific EHR capabilities:

  • Use OAUTH2/OpenID to verify trusted exchange partners.
  • Use a FHIR-based query to request an electronic endpoint address.
  • Use a RESTful approach to push data to an endpoint.
  • Use a FHIR-based query to request the location of a patient’s records.
  • Use a FHIR-based query to exchange a common data set of key elements.

The Federal Trade Commission drops its anti-trust challenge of the proposed merger of the only two hospitals in Huntington, WV following the state’s passage of a law that was intentionally written to shield hospital mergers from federal scrutiny. The FTC walks away with a warning that hospitals can work together to deliver clinical integrated care without buying each other in reducing competition, noting specifically that while it rarely intervenes in such hospital mergers, its quality and cost red flags were raised in the Huntington market.

image

The independent Commission on Care, established by Congress to review the VA following the wait times scandal, includes among its recommendations that the VA replace its “antiquated, disjointed clinical and administrative systems” with commercial software products and that it establish a VHA Care System CIO position reporting to the chief executive. The chair and vice-chair of the commission are both CEOs of provider organizations that use Epic (Henry Ford Health System and Cleveland Clinic).


Privacy and Security

A federal appeals rules that anyone who shares a password may be violating the Computer Fraud and Abuse Act, which is intended to address hackers. The case in question involved an employee who gave his company password to former employees, but the ruling could technically allow people to be prosecuted under federal law for sharing their Netflix log-ins.


Innovation and Research

image

NIH awards $55 million in precision medicine grants to study the self-contributed data of 1 million volunteers, with the lead recruiting centers being Columbia University Medical Center (NY), Northwestern University School of Medicine (IL), the University of Arizona (AZ), the University of Pittsburgh (PA), and the VA. Vanderbilt, Verily, and the Broad Institute will provide data analytics. In addition, Scripps Translational Science Institute and Eric Topol, MD (whose summary of the project is above) will  get $120 million over five years to develop apps, sensors, and processes to recruit the “citizen scientists” and give them the ability to share their collected information with their physicians. The scientist in me loves the idea, but the public health angel on my other shoulder wishes we would focus on the less-sexy blocking and tackling of reducing infant mortality, managing expensive chronic conditions, addressing social determinants of health, and resolving the ugly dichotomy of expensive “healthcare” vs. “health” in applying equal vigor to chasing goals that move the overall health needle further without having as their primary motivation the eventual lining of someone’s pocket.


Technology

The Wall Street Journal suggests that Apple fanboys resist the urge to pounce on the just-released public beta of iOS 10, warning that it’s buggy (not surprising for a beta release) and a pain to revert back to the prior version if things go wrong. The article tries to talk up a few new features, but they seem lame.


Other

image

Mylan Pharmaceuticals has jacked up the price of decades-old emergency allergy auto-injection EpiPen to nearly $600 per two-pack over the past few years, giving cash-poor, high-deductible insurance consumers and public service agencies the choice to either go without the drug or draw up the much-cheaper generic ampules into syringes as needed for emergency doses. The drug was prescribed 3.6 million times last year as Mylan turned its 2007 acquisition into a billion-dollar product that provides 40 percent of its profits, pushing federal legislation that encourages schools to stock the injections and to recommend two doses instead of one per allergic episode. Mylan, which has a market cap of $22 billion and makes a lot of money selling drugs to the federal government via Medicare, shifted its headquarters offshore in 2015 to dodge US taxes.

image

The number of HIEs has dropped from 119 to 106 as federal funding ended, a study finds, with half of the surviving ones reporting that they are not financially viable. The most prevalent HIE problems include lack of a sustainable business model, the inability to integrate HIE information into provider workflow, and lack of funding.

image

Another study in Health Affairs that reviewed AHA’s IT survey data finds that hospitals that use their area’s dominant EHR (usually Epic or Cerner) engaged in a lot more data exchange than their competitors that run other EHRs, which the authors speculate is because it’s easier to exchange information with other Cerner or Epic shops and that those vendors will help make it happen. My takeaway is that hospitals in a mostly-Cerner or mostly-Epic region that use different EHRs have to spend more money to exchange information and are thus less likely to do so, especially if their competitors are indifferent or hostile to the idea.

image

AdvancedMD tweeted out this photo of their team-building Lego derby. It’s always fun to see the folks in the trenches.

image

Smokers are less likely to buy health insurance than non-smokers, apparently because they are unwilling or unable to pay the higher smoker premiums allowed by the Affordable Care Act. The penalties levied for not being insured don’t seem to be working, especially when they represent only a small fraction of the cost of insurance.

SNAGHTML6cf00d20

I’m not entirely convinced that this Microsoft email is genuine even though he company has apologized for it, but it’s still funny to picture some low-level, corporately oppressed recruiter (whether it be at Microsoft or Epic) trying to relate to the kids he or she is recruiting by inviting them — in their cringe-worthy, baby-talk vernacular – to stop by for “hella noms” and  “dranks” just like someone’s white bread mom scanning Urban Dictionary looking for hip phrases to drop at the most embarrassing moment possible.


Sponsor Updates

  • Aprima announces that its EHR/PM meets MACRA/MIPS requirements.
  • ID Experts will present at the SANS Data Breach Summit August 18 in Chicago.
  • Navicure will exhibit at Mississippi MGMA July 13-16 in Biloxi.
  • Experian Health will exhibit at the Nebraska Association of Healthcare Access Management July 14-15 in Grand Island.
  • The SSI Group will exhibit at the FSASC Annual Conference & Trade Show July 13-15 in Orlando.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 7, 2016 News 8 Comments

EPtalk by Dr. Jayne 7/7/16

July 7, 2016 Dr. Jayne 1 Comment

clip_image002 

The Independence Day holiday is understandably one of my favorites. It had a lot more meaning to me this year and I have my clients to thank for it.

During the last 12 months, I’ve had the privilege of performing consulting engagements in locations key to our nation’s history. I started in Boston, followed by Philadelphia, then Washington DC, and back to Philadelphia. For someone who is a bit of a National Parks junkie, it was like winning the lottery.

Fortunately, many of the monuments are open late. If you hit Independence Hall at the end of the day, there’s an “express” tour that doesn’t require tickets. You don’t get to see everything, but when you’re on site with a client and trying to squeeze in some sightseeing before your flight, you take what you can get.

Of all the monuments and memorials, my favorite is the National WWII Memorial in Washington, DC. During the day, you can often catch an Honor Flight group visiting. It’s certainly something to see the veterans reacting to their memorial. Sometimes I can’t turn off the physician side of my thought processes – not only did they survive the war, but they’ve experienced first-hand many of the medical advances of the past century. Things we completely take for granted were revolutionary during their lifetimes. At night, the Memorial takes on a supernatural quality. Each of the memorials has its own special quality, but for some reason, this one particularly resonates with me.

As much as many of us feel we are living in a word full of turmoil, thinking about what we’ve been through as a society during the last 200+ years puts it somewhat in perspective. Although we may be dealing with crises in healthcare delivery that consume us on a daily basis, we’re not dealing with smallpox, polio, or whooping cough. Many of the diseases we’re fighting are somewhat self-inflicted. We don’t need a so-called “moon shot” to cure them, but rather could make a huge difference with public health initiatives, preventive services, and individual lifestyle changes.

Population health has a lot of promise, if you can get through the hype. The ability to reach out electronically to hundreds of patients based on easy-to-access data points is huge. We can do in seconds what it would have taken days to do with paper charts. For most practices, though, the focus is on the sickest of patients because we’re targeting costs as a primary indicator. We’re trying to manage the top 10-15 percent but are losing sight of the rest of the population. For those organizations that have figured out how to expand their reach into the next quartile, the long-term returns on health promotion and disease prevention could be tremendous.

As a young physician, I used to rail at the fact that Medicare would pay for insulin but didn’t have adequate coverage for diabetic education. It felt like we were spending our money in the wrong place. We also weren’t paying for preventive services, but were happy to pay when people were sick. The Affordable Care Act has changed that for the better, as has the push to look at value rather than volume.

I’d like to see it go even farther, though. Rather than focusing primarily on diabetics with the worst control, how about we focus more on the pre-diabetics and newly-diagnosed individuals who we can truly impact? It may not bend the cost curve in the short term, but it certainly will in the long term. I think organizations are trying to move in that direction, but it’s hard to find the right mix of patients to target given the typical resource constraints in care management.

There are some solid programs to look at how we do this. I’ve been following the Comprehensive Primary Care Initiative (CPCI) and its evolution into the CPC Plus program. It’s been great to see the way they looked at the program and how it worked and are now creating two different paths moving forward. Hopefully we’ll have enough practices truly embrace the program that we will be able to see how effective the different approaches are in achieving health outcomes. I’m eager to see what regions will be chosen, what payers will participate, and whether any of my clients will decide to move forward with the programs. I’d love the opportunity to be hands-on with the next generation of comprehensive care.

One of the reasons I think programs like CPCI work is that they’re voluntary. Practices self-select if they want to be a part of it — they know from the beginning what they are getting into. They’re not doing it because they feel pressured or because they’re trying to avoid a penalty, and I think that’s the point we’ve collectively missed with Meaningful Use and now MACRA/MIPS/ACI etc. We all understand the psychology of the carrot and the stick, and even though we know some people will never get moving until the stick is approaching, the carrot is a more powerful motivator for many. Programs like CPC+ also speak to the reasons why physicians went into primary care in the first place.

As we all wait for the MACRA final rule, many organizations are trying to figure out their strategies for the next few years. Do we want to be the kind of practice that just aims to check the box, or do we want to try to do more? How can we get our nation’s best and brightest focused on solving these complex healthcare problems? Can we start to focus on the patients in front of us as much as we’re focusing on scores and numbers?

Unfortunately, these aren’t easy questions to answer. Eventually we will get through all of this, much as our forefathers have gotten through so many other challenges that were different and yet the same. Although it may not seem easy, we’re fortunate to live in a time and place where there are many opportunities to make things better for the people we serve.

Rather than focusing on the daily chaos that surrounds us, let’s remember to think about the promise that our technology holds. Who’s with me?

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
July 7, 2016 Dr. Jayne 1 Comment

Morning Headlines 7/7/16

July 6, 2016 Headlines 1 Comment

Legal (Fraud and Abuse) Barriers to Care Transformation and How to Address Them

An AHA report suggests that the Stark Law is becoming an impediment to care coordination and the expansion of value-based payment adoption, arguing that “The risk of overutilization, which drove the passage of the Stark Law, is largely or entirely eliminated in alternative payment models.”

Island Health presses ahead on electronic record system in Nanaimo

In Canada, Island Health’s $174 million Cerner implementation moves forward amid a unanimous no confidence vote from representatives of the health system’s medical association.

HealthyCT crumbles under ACA risk adjustment charges

HealthyCT, Connecticuts co-op insurer, will shut down because it is unable to pay a $13.4 million ACA-mandated risk adjustment payment.

Valeant’s New CEO Brings Familiar Prescription

The Wall Street Journal recaps the past business decisions of Joseph Papa, the new CEO of Valeant Pharmaceuticals, as he works to turn around falling stock prices without resorting to drug price gouging.

View/Print Text Only View/Print Text Only
July 6, 2016 Headlines 1 Comment

The House Call Comeback

July 6, 2016 News No Comments

HIStalk looks at the resurgence of house calls, aided in part by government-sponsored value-based care programs, a need for increased market share, and growing consumer demand for app-enabled convenience and pricing transparency.
By @JennHIStalk

image

In today’s technology-driven society, the concept of the house call may seem quaint, evoking Norman Rockwell-esque images of the neighborhood physician toting his black bag down Main Street to Grandma’s house. Mobile health tools, however, are turning that image on its head as providers look to increase market share by increasing patient access points.

While house calls have always been around to some degree, digital health startups like Pager, Heal, and PediaQ are putting a new spin on what it means to “go to the doctor.” Even more traditional home care companies like Visiting Physicians Association are placing more emphasis on the role technology plays in caring for the elderly and chronically ill, often with the aid of government-backed incentives.

This new era of house calls is not without its detractors, however. Some physicians are quick to point out that patients can’t establish a true, trusting relationship with this new generation of house-call providers, and that care coordination will suffer. Others, especially those in more metropolitan areas, point to struggles for market share between the local health system, urgent care centers, and app-based house call companies.

Consumers will likely have the last word, as their increasing insistence on convenience and easy access, plus heightened awareness of healthcare costs, leads them away from higher-priced health system monopolies into the arms of the more tech-savvy (but somewhat unproven) competition.

Smart Phones Make the Difference

image

Dallas-based PediaQ has made technology a core part of its business model. Founded in 2014, the app-based pediatric house call provider has raised $6.4 million to date and has already expanded beyond Dallas to three additional cities in the Lone Star state.

image

“PediaQ has been developed as a function of change in our culture towards on-demand services, as well as innovation in creating new access points for health systems that are expanding their networks to capture market share,” explains CEO Jon O’Sullivan, adding that the cultural shift to making purchasing decisions via smart phone played a big part in PediaQ’s decision to steer clear of brick-and-mortar locations. “I’ve been on the business strategy side of provider services in healthcare for over 25 years now, and for much of that time I worked with health systems that sought to expand their market share through their provider networks. Throughout that time, I’ve watched the healthcare market evolve to a much more consumer-driven equation.”

While PediaQ’s funding seems to indicate investor confidence, O’Sullivan points out that building trust with customers and the surrounding healthcare community has taken time. “Initially, like any new brand, we had to spend a majority of our resources on consumer education,” he says. “However, once parents started using PediaQ and were able to experience the ease and comfort of a house call for a sick child, the results were nothing short of phenomenal. The main catalyst for our consumer activation and expansion very quickly became the users themselves.”

When it comes to perceived competition with local PCPs, O’Sullivan points out that the company sees itself as an augmenter and supporter of the relationships its customers have with their PCPs. “We’re not out to replace that relationship,” he says, “which is reflected in the fact that PediaQ focuses on after-hours care and ensures that the medical record from the visit is delivered to the PCP the next day.”

Easier Access, Less Windshield Time

Aside from apps, telemedicine has probably had the biggest impact on the resurgence in house calls. It has certainly given companies like Aspire Health and MedZed an edge over more traditional home care companies, especially when it comes to “windshield time.”

image

Technology has been crucial to the nascent success of Atlanta-based MedZed, which identifies itself as a telemedicine-enabled home care company that provides “21st century house calls” for high-risk and needy patients.

image

“We decided we had to go into the home in order to service these people,” says MedZed co-founder and chief medical officer Neil Solomon, MD. “We were also well aware that it’s very expensive to pay a doctor or even a nurse practitioner to drive all over the place, especially in certain geographies that are either very spread out or have heavy traffic, like Los Angeles. You can only do maybe four or five visits in a day if you’re driving. It’s inefficient. Plus, there aren’t enough doctors to do this in order to scale this kind of business.

“Our model utilizes telemedicine to make the delivery of care much more efficient,” Solomon says, adding that the first half of a MedZed visit is spent between a care provider and patient going over medications, screenings, and assessments, while the second half is spent on remote consult with a physician, all of which is documented in MedZed’s Drchrono EHR.

“All of our care providers can see the same notes in our EHR,” Solomon explains. “We can export those notes in a fashion that other EHRs can read. We can import laboratory and pharmacy data from other sources so that we can see the full picture of the patient.”

MedZed seems to have distinguished itself from other modern-day house call companies in that it has written its own software for HIPAA-compliant video conferencing and logistics.

“Writing the logistics software was challenging,” Solomon admits. “It helps determine where to send each care provider during the course of the day, figures out drive times, and interfaces with the PM systems of MedZed-affiliated physicians so that they can easily access our video consults. We couldn’t find software on the market that could do all of that.”

Palliative Care Made Easier

image

Founded in 2013 with high-profile help from former Senator Bill Frist, MD, Nashville, TN-based Aspire Health incorporates telemedicine as well as a number of other technologies into its business model, which focuses on home care for seriously ill and end-of-life patients. Aspire Health Chief Medical Officer Andrew Lasher, MD has seen technology make a tremendous impact on the company’s ability to provide compassionate palliative care to its patients in 11 states and Washington, DC.

image

“Patients and families are more connected than ever,” he points out. “Secure video conferencing can be an incredible adjunct to high-touch care at the bedside, and in some cases can act as a stand-alone visit. Much of what we do at Aspire is communicate – clearly and compassionately – with vulnerable patients and the people who love them. These family members often live far away, and we can use telemedicine to bring a distant family member to the bedside. There are also medical conditions that can be evaluated perfectly well with video, and many patients will tell you that the conversations they have with a doctor or nurse practitioner through telemedicine is every bit as sacred and impactful as the ones they have in person.”

“There are a number of other technology supports that can support care of the seriously ill,” Lasher adds. “We’re only just beginning to scratch the surface with remote-monitoring devices that help keep track of blood sugar, blood pressure, and that connect isolated patients to Aspire and community-based resources in moments of crisis. We’re seeing that these sorts of devices can integrate fairly seamlessly and in no way hurt the patient experience. Patients can often be reassured through technologic connection, and it only makes the care we provide more personalized.”

Aside from telemedicine, the Aspire team is also looking at solutions around the storage and transmission of advance care-planning documentation, solutions around immediate notification of when patients go to the ER or hospital, and placing tablets in patient homes that enable Aspire caregivers to monitor symptoms and needs on a daily basis. “Anything that helps us relieve a patient’s suffering or avoid an unnecessary and dangerous hospital stay is something we’ll investigate,” says Lasher. “I expect that we’ll be doing more with technology in the next year as the evidence base increases and the offerings improve.”

Analytics and Home Monitoring will be Key to Independence at Home

image

Home monitoring technologies are also in the cards for the Visiting Physicians Association, a key participant in the Independence at Home program for Medicare beneficiaries with complicated chronic health problems and disabilities. The pilot house call program, now in its second year, helped save Medicare $25 million in its first year thanks to reduced costs associated with improved medication adherence and fewer ER visits and hospital readmissions. Nine of the 14 participating practices, five of which are run by VPA, earned bonuses totaling nearly $12 million.

“VPA has achieved favorable results because of the technology we deployed into the home setting,” explains Dave Viniza, chief information officer of US Medical Management, VPA’s management services organization. “Our Aprima EHR has offline capacity second to none. Our physicians have a full patient medical record regardless of the connectivity of the patient’s home. Because we were searching for consistent, informed, real-time medical decision-making, VPA also deployed StatusScope, a home-grown application that keeps providers informed, during their visits, of recommended disease-driven protocols.”

“VPA has also used predictive analytics to identify the most at-risk patients and prevent unwanted ER visits,” he says. “By reducing those, we reduce unnecessary and unwanted hospitalizations. We’re continuing to develop those analytic tools. We’re implementing an enterprise data warehouse and dashboard analytics system, as well as implementing a care management system that will automate and streamline the development of non-physician care plans and patient management.”

“We’re also investigating appropriate home-monitoring tools for our patients,” Viniza adds. “We would like to marry the monitoring to predictive applications so that we can improve early identification of approaching medical needs. The end goal is to continue reducing ambulatory-sensitive ER and hospital utilization.”

Opportunity Abounds

While there’s no doubt that this new era of house calls is being fueled by technology, the industry-wide shift to value-based care – however slow it may be – is also helping things along.

“Patients prefer to be at home when they can be,” Lasher says. “That’s especially true for patients with chronic or life-limiting conditions. They know that the hospital isn’t always the best place to be, and that the best treatment for them may occur in their home – treatments that can help them live longer and feel better. For Aspire, seeing our patients where they live is a real privilege. Value-based care is such an accurate statement, since, for the vast majority of our patients, their own personal values make it clear what kind of care they want, and how it should be delivered.

“Clearly, there’s a lot of opportunity to expand what can be done outside the hospital or clinic, and to care for people on their own turf, rather than in a medical setting,” he adds. “Black doctors’ bags are going to be back in style, if they’re not already.”

View/Print Text Only View/Print Text Only
July 6, 2016 News No Comments

Readers Write: Election 2016

July 6, 2016 Readers Write 5 Comments

Election 2016
By Donald Trigg

image

A provocative Atlantic magazine cover this month headlines, “How American Politics Went Insane.” Jonathan Rauch explores our current reality where “chaos has become the new normal — both in campaigns and government itself.”

As we struggle to draw rational signal from the noise, one can’t help but wonder if Trumpian chaos is resident in our favorite podcasts, journals, and websites. Are byzantine rule-makings not regularly bemoaned on HIStalk?  Do we not hear classes of readers singled out (particularly for using HIPPA and HIMMS)? Are we not struck by the rather small hands on the original HIStalk graphic?  

clip_image002

HIStalk has been, all kidding aside, a thankful escape for many of us from a campaign that has been abysmal even by our diminished US standards. Fortunately, there are just 125 or so days left. And with few exceptions, these conversion dates hold.  

Here is the quadrennial cheat sheet.  

A proper understanding of the 2016 election starts with the massive advantage Democrats have in the Electoral College. The Democrats have a safe hold on 19 states (plus DC) representing 242 Electoral College votes. (Note: If you still are suffering under the delusion that the popular vote selects the president, let’s email about a couple of ideas for your trip to the Albert Gore Presidential Library). As a quick civics reminder, you only need 270 Electoral College votes to become president.  

So, with a probable shortfall of just 28 Electoral College votes to get to 270, the Democratic path is far easier. As an indicative example, a Republican could win every “swing” state from Ohio to Virginia, but lose Florida (29 EC) and thereby lose the presidency. It is not quite as challenging as running a health system with an antiquated MUMPS technical architecture, but it is still a daunting task for the GOP.         

The statistician-turned-blogger Nate Silver places the odds of a Hillary victory at 80 percent with one of his two models factoring in GDP (Q1 GDP was 1.1 percent) for a lower 75 percent chance. He probably has that about right and (spoiler alert) decisions like the Trump VP pick aren’t going to radically change that.

No matter the outcome at the top of the ticket, neither Democrats nor Republicans are likely to dominate the breadth of the electoral landscape. Republicans have a fairly solid grasp on the US House (247-188) and they also control 31 governorships. As Barron’s wrote over the long weekend, ongoing divided government will offer a muted welcome to any agenda this January.  

As for healthcare, the issue significantly trails the economy/jobs and terrorism when it comes to top voter concerns. Moreover, opinions are very settled and polarized. Forty-two percent favor the ACA, while 44 percent oppose it.  

Consequently, Clinton and Trump will use talking point level rhetoric, predominately to drive turnout. Hillary will take on big pharma, calling for caps on prescription drug costs. Trump will bemoan premium increases, call for ACA repeal, and assure us he is going to do something “fantastic.” You will feel like you are watching “Saturday Night Live.”

Notably, there is an important piece of emerging voter sentiment that we shouldn’t miss amid the posturing and platitudes. According to the June KFF poll, 90 percent are worried about the amount people pay for their healthcare premiums, while 85 percent are worried about increased cost of deductibles. Consternation over cost is growing and will be reinforced during open enrollment this fall. 

As we look out to first 100 days of the new administration, we will see a level of change on health policy that is more incremental than historic. Importantly, MACRA will continue to advance at the agency level, buttressed by solid bipartisan opposition to fee-for-service. At the state level, ongoing programmatic Medicaid changes move forward. Finally, even with the the Cadillac tax delay, employers experiment further with wellness incentives and alternative (and narrower) network design.  

In the Atlantic, Jonathan Rauch makes a lonely case for a renewed establishment that can impose some modicum of order. Few will like that treatment plan. His Chaos Syndrome diagnosis, however, is inarguable, as is his view that in the near term, “it will only get worse.”  

Donald Trigg is president of Cerner Health Ventures. In a previous life, he worked for President George W. Bush starting on the 2000 presidential campaign in Austin, Texas, and then after a brief Florida detour, in Washington, DC for the first half of Bush’s first term. 

View/Print Text Only View/Print Text Only
July 6, 2016 Readers Write 5 Comments

Morning Headlines 7/6/16

July 5, 2016 Headlines No Comments

Measuring Interoperability: Listening and Learning

ONC will address a MACRA requirement to establish metrics for measuring interoperability by incorporating two new interoperability-related questions into the AHA Information Technology Supplement Survey and the CDC’s annual National Electronic Health Record Survey.

Member Voice: ‘Medical Error’ Study Shows Major Flaws, Should Be Retracted

Neuroradiologist Shayam Sabat, MD calls for BMJ to retract a clickbait paper it published titled “Medical Error: The Third Leading Cause of Death in the US,” which he says a “shoddy piece of scientific and statistical work which cannot stand the close scrutiny of peer physician researchers and professional statisticians.”

Business Associate’s Failure to Safeguard Nursing Home Residents’ PHI Leads to $650,000 HIPAA Settlement

Catholic Health Care Services of the Archdiocese of Philadelphia will pay a $650,000 settlement stemming from a 2014 data breach that left 412 patients information exposed when an unencrypted company-issued iPhone was stolen.

Cluster failure: Why fMRI inferences for spatial extent have inflated false-positive rates

A study investigating algorithms used to process functional MRI results finds that the algorithms used generate false-positive rates up to 70 percent, leading authors to question the validity of 40,000 studies.

View/Print Text Only View/Print Text Only
July 5, 2016 Headlines No Comments

News 7/6/16

July 5, 2016 News 14 Comments

Top News

image

ONC will measure MACRA-mandated national interoperability progress using metrics from two existing surveys: the percentage of providers who say they are sending and receiving information (AHA’s Information Technology Supplement Survey) and the percentage who say they actually use the information of other providers to make clinical decisions (CDC’s annual EHR survey).


Reader Comments

image

From Addison in Madison: “Re: Epic non-competes. Epic’s modus operandi is to demand new agreements with any change in status / business. Your employer has perhaps been steady for a while, so they are operating under an old agreement. It is when something changes that Epic introduces their new demands. What changed for Accenture was the acquisition of Sagacious. Same with Navigant’s Epic-related acquisitions. When that happened, Epic put the agreement back on the table, with the new stipulations. You can expect the same if your firm is ever acquired or does any acquiring.”

From Voice of Reason: “Re: Epic non-competes. The reason Epic might be doing this is because both Sagacious and Vonlay were bought out by Accenture and Huron Consulting Group respectively. Epic might be thinking since Accenture and Huron provide a variety of consulting services, their Epic consulting division might pass on proprietary info to their other divisions that might compete with Epic. I don’t think Nordic has these restrictions since they only deal with Epic consulting.”

From Dr. T: “Re: Epic non-competes. what may happen is when Epic learns of the new facility you are going to, there is a quiet conversation with the old employer. Then they call the new employer and say, ‘We won’t do business with that person.’ Guess what happens? You don’t have a job, you can’t prove who talked to which manager/exec, and you don’t have the deep pockets to fight it. I saw it myself and almost had to get the toes out to keep counting how many times it happened with an old employer.”

From DrM: “Re: Epic non-competes. I predict Epic’s approach to the consultants will be what brings down the whole non-compete house of cards for them. Does anyone else find it strange that, shortly after starting up their own consulting firm, they impose rules on competing consulting firms that will (purely coincidentally, I’m sure) reduce the number of available consultants? Other companies have lost anti-trust suits for doing less. I also hope in the trial they bring up their trade secrets so they can be told the definition of trade secrets, i.e., you actually have to try to keep them a secret.”

From Apt Moniker: “Re: Twitterati. I, too am never sure whether Twitter means anything in real life. However, senior execs often watch their own Twitter accounts, although not the company one.” Twitter, Facebook, and LinkedIn are, at least for individual businesspeople, vanity platforms. Heavy users like feeling followed and it gives them a place to tout their self-perceived wonderfulness in humble-bragging to others who are doing exactly the same thing in a never-ending stream of self-promotion. Twitter in particular is full of updates that are simply links to questionable source material with the apparent goal of being the first to highlight something new or to appear to be better read. My experience is the same as what big web publishers have reported – I can get a ton of tweets and retweets linking to my original HIStalk page and it doesn’t boost site traffic one bit. From that I conclude that the Twitterers are happy just to read that the page exists, but free of the motivation to click the link to see what it actually says.

From See My I/O: “Re: leading CMIOs. Here’s a link to the top 15.” Sorry, that’s just the usual time-wasting magazine crap story, or in this case, a pointless but painful to watch slideshow. There’s no stated methodology behind the list – the magazine apparently just chose some names they recognized and proclaimed those CMIOs as “leading” in trying to amass clicks that advertisers might mistake for influence.


HIStalk Announcements and Requests

image image

We funded the DonorsChoose grant request of Mrs. H, whose Arkansas elementary school science class needed activity tubs for their Friday projects and labs. She reports, “The students really enjoyed the force and matter experiment in which they had to attach a balloon with a straw to a string and release it to see who’s balloon traveled the fastest. The conversations we got from students were amazing and after each group went students discussed what they could do better next time to make their balloon travel quicker. These were some fun times — we are so competitive.”

I pledged transparency to a reader who asked me awhile back to list not just new HIStalk sponsors, but also those companies that don’t renew. I don’t like doing that because I take it as a personal failure, but I promised. With that, I’ll say goodbye and thanks to the following companies with whom I parted ways in the past year because they were acquired, went a different direction, tightened their belts, or lost the employee who was my only contact there.

AirStrip
Anthelio Healthcare Solutions
AT&T
Aviance Suite
Awarepoint
Burwood Group
CareTech Solutions
CitiusTech
DataMotion
Greencastle Group
Greenway Medical Technologies
MBA HealthGroup
McKinnis Consulting
MedAptus
Oneview Healthcare
PDS
Porter Research
Provation Medical
Sensato
Streamline Health
VMware
XG Health Solutions


Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

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


Acquisitions, Funding, Business, and Stock

image

Digital pathology startup Proscia raises $1 million. The founder and CEO just earned his BS from Johns Hopkins. I’m amused that the company’s write-up says the team has filed “over eight patents” and been involved with “more than four technology companies,” making me wonder what’s wrong with just saying “nine” and “five.”

UnitedHealth Group sues publicly traded American Renal Associates Holdings for fraud, complaining that the dialysis company convinced its Medicare- and Medicaid-eligible patients to instead sign up for UnitedHealth insurance at no charge, arranging to have their premiums paid by a charity whose funding comes from providers who benefit from having better-insured patients. Government programs pay American Renal Associates about $300 for a dialysis treatment while it can bill UHG $4,000 for the same session, giving the company a profitable loophole in billing more in claims than it costs to pay for the patient’s insurance. The Affordable Care Act requires insurance companies to accept all people regardless of their health, but HHS has been vague on whether it’s OK for charities that receive most of their funding from providers to pay individual premiums directly.


Sales

Mayo Clinic will implement Visage Imaging’s Visage 7 enterprise imaging platform throughout its radiology practices.


Announcements and Implementations

image

Carefluence earns the first API certification issued under ONC’s criteria, with Carefluence Open API 1.0 earning certification for patient selection, data category request, and data request. I note several misspellings on its home page, including a claim that it was designed to “demistify” interoperability, which suggests fog removal. The company’s website has minimal information (such as location and management team), but it appears to be connected to the equally reticent technology vendor ModuleMD.

Among the winners of MD Buyline’s user satisfaction surveys are Aesynt (pharmacy robotics), CareFusion (pharmacy automation), Epic (EHR), GE Healthcare (cardiology PACS, perinatal information systems, RTLS,and time and attendance), Healthcare Insights (financial decision support), McKesson (staff scheduling), Philips (PACS), Premier (ERP), SCC Soft Computer (laboratory information system), Siemens Healthineers (cardiology PACS), and Vital (3D advanced visualization).


Government and Politics

image

The government of South Australia continues to defend its over-budget and delayed $315 million EPAS patient care system even as the auditor-general warns that the project is underfunded and unlikely to deliver $113 million in savings. The Allscripts Sunrise system is live at some sites and will be phased in when the new flagship Royal Adelaide Hospital opens.


Privacy and Security

Catholic Health Care Services of the Archdiocese of Philadelphia will pay a $650,000 HIPAA settlement related to the 2014 theft of a PHI-containing, company-issued iPhone that was not password protected. The phone contained the information of 412 residents of the six nursing homes it owned and managed. OCR found that CHCS had not published a policy about taking mobile devices off campus and had not developed a risk analysis and risk management plan. Most interesting is that CHCS was charged as a business associate rather than as a covered entity since it was the corporate parent of the nursing homes and provided technology services to them.

image

Atlantic Health System (NJ) sends 5,000 randomly selected employees an email saying they’re getting raises, telling them to just confirm by clicking a link and entering their employee ID number, data of birth, and ZIP code. One-fourth of them opened the email and two-thirds of those provided their personal information. The email was actually a phishing test that mimicked known hacker practices such as using an originating email address ending in .com instead of .org. Several employees complained that the promised raise wasn’t real, but on the upside, quite a few reported the email as suspicious and warned co-workers not to fall for the trap.


Innovation and Research

Researchers find statistical bugs in the software that interprets functional MRI results, leading them to question the validity of 40,000 studies.Poor archiving and data sharing practices mean the existing studies can’t be re-analyzed with better software.


Technology

London’s Moorfields Eye Hospital is sharing de-identified eye scans with Google DeepMind, which is developing artificial intelligence for early detection of diabetic retinopathy and macular degeneration.

image

An Apple iOS 10 update this month will allow iPhone users to sign up as organ donors with the Donate Life America registry and be flagged as an organ, eye, and tissue donor on the phone’s Medical ID emergency information display.


Other

image

Neuroradiologist Shyam Sabat, MD calls for BMJ to retract the “shoddy science” tabloid-like pseudo-study it published in May that claimed medical errors are the third-leading cause of death in the US. His analysis of the paper finds that four studies were improperly combined into a meta-analysis that really left just one 2004 Healthgrades study of Medicare recipients, which the authors then wildly extrapolated to all inpatient admissions. He concludes,

How a reputed group such as the BMJ could not see through these simple but outrageous statistical blunders is anyone’s guess. Did the overwhelming incentive to get a spice tabloid-type, eye-catching headlined paper prevent the editorial process from taking common sense decisions? The result is that the US medical community is being ridiculed by media and people not only from the US but the whole world who cannot understand how US medical system is so incompetent despite spending the maximum in the world and attracting the best talents from all over the world.

The Boston Globe notes the trend of doctors working night shifts in hospitals, where “nocturnalists” oversee the activities of overworked residents, reduce the number of calls to attendings, and get patients out of the ED and into beds when indicated.

image

Cleveland stakes its claim as “The Medical Capital” by launching a rebranding initiative, a new website, and a new testimonial video. In other words, you should take their word for it because they blew through a ton of marketing money in proclaiming themselves #1. Maybe it will draw business, but I can recall many weed-infested empty lots bordering desolate highways festooned with signs proclaiming that area to be some town’s “high-tech corridor” that never quite caught on.

Dear naive people who cry foul when drug companies raise the prices of critical drugs for no good reason, saying those companies are “putting profits ahead of patients:” that’s exactly what for-profit companies are supposed to do. It’s unconscionable when health systems and insurance companies hide their huge bottom lines behind non-profit status, but for-profit corporations exist for a singular purpose, to deliver maximal profits to shareholders. The understandable outrage would be better focused on advocating for government-led drug price involvement like the rest of the world uses, which leaves US consumers footing the bill for most drug company profits and research investment.

image

Powell Valley Hospital (WY), which struggled for years to get its $2 million NextGen hospital EHR working well enough to earn Meaningful Use money, learns that the product’s new owner, Harris Computer Corporation, won’t add MU Stage 3 capabilities to the product. Harris has offered to replace NextGen with QuadraMed for just the installation cost, but the hospital would still need to spend over $1 million. Harris confirmed that it will provide only break-fix support for the NextGen hospital system, saying it acquired the product because NextGen was going to shut it down anyway.

A former naturopath (ND) who left a lucrative practice after observing a colleague administered an unapproved cancer drug says that “naturopathic services are quackery” and scoffs at ND ambitions to be recognized as primary care physicians. She writes,

Essentially, naturopaths want to be allowed to take shortcuts. Instead of attending medical school, naturopaths attend their own, self-accredited programs with low acceptance standards and faculty who are not qualified to teach medicine. Instead of a standardized and peer-reviewed medical licensing exam, naturopaths take their own secretive licensing exam that tests on homeopathy and other dubious treatments. What little medical standards that seem to be tested on the exam have been botched, like the one question in which a child is gasping for air and the correct answer on how to treat is to give a homeopathic remedy.


Sponsor Updates

  • Clockwise.MD will exhibit at the UCAOA Regional Conference in Philadelphia on July 14-15.
  • Audacious Inquiry comments on MACRA NPRM V5.
  • Boston Software Systems launches a podcast series covering EHR migration, system optimization, and the sunsetting of legacy systems.
  • CareSync is featured in a USF Health article on Tampa’s digital health opportunities.
  • ClinicalArchitecture will exhibit at the Military & Government HER & Health IT Symposium July 13-14 in Arlington, VA.
  • Cumberland Consulting Group will attend the 340B Coalition Summer Conference July 11-13 in Washington, DC.
  • Elsevier will develop a free benchmarking report detailing the current landscape of cancer research and collaborations as part of the national Cancer Moonshot initiative.
  • Healthfinch joins the Athenahealth Marketplace.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 5, 2016 News 14 Comments

Morning Headlines 7/5/16

July 4, 2016 Headlines No Comments

Conflicker Used In New Wave of Hospital IoT Device Attacks

A report from IT security firm TrapX Labs concludes that internet-connected medical devices remain a digital soft spot for hackers attempting to infiltrate networks.

NHS seeks cure for its costly digital headache

The Guardian discusses the need to improve data security as England pushes forward with its plans of digitalizing NHS medical records.

CMS updates rule allowing claims data to be sold

CMS publishes a final rule that will expand access to its claims data through the “Qualified Entity Program,” which grants approved organizations access to CMS data sets that include patient-identifiable claims information.

Here’s How a Hacker Extorts a Clinic

TheDarkOverlord , the anonymous hacker responsible for selling four healthcare databases on the dark web last week, says in an interview that he does not feel bad about what he is doing because he is “furthering the enhanced security and development of new protections.”

View/Print Text Only View/Print Text Only
July 4, 2016 Headlines No Comments

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Follow

Reader Comments

  • Publius: The NYC Health & Hospitals link directs to a Seeking Alpha article of PINC's Q4 earnings call transcript. I don't se...
  • Bg: It is for the NHS !...
  • Defiant: WOW! What news! Two Cerner HIEs are able to exchange information. Isn't the real news here that this is news?...
  • Curious Vendor Exec: I understand why big companies feel like they have to exhibit at HIMSS - their competition is there and they have enough...
  • Dave Holland: Thanks for sharing this Ed. Remembering my passion actually goes a little in the opposite direction. It's the fear o...

Sponsor Quick Links