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Readers Write: Harnessing Data to Support Population Health Management and the Evolution of Next-Gen Population Health Management

October 15, 2014 Readers Write No Comments

Harnessing Data to Support Population Health Management and the Evolution of Next-Gen Population Health Management
By Larry Schor


Accountable healthcare delivery is in the midst of a three-stage evolution as organizations increasingly turn to the promise of health IT and data to improve patient care and the bottom line.

First-generation accountable care is all about meeting process quality measures and closing gaps in care. At this stage, provider compensation is loosely tied to compliance with standards of care and protocols for specific common conditions, such as immunizations or screenings for diabetes and glaucoma. However, during this phase, financial rewards predominantly come in the form of bonuses for achieving quality measures with little or no downside financial risk.

As the industry currently evolves from first-generation toward middle-generation accountable care, new complexities are emerging. As such, healthcare organizations must manage clinical risk and begin assuming limited financial risk for identified patient populations.

Because both upside bonuses and limited downside financial risks exist at this stage, it is imperative that patients are clinically well controlled. Clinical data, therefore, becomes increasingly important for understanding risk. The historic reliance on claims data will no longer suffice. It is at this second stage of maturity that next-gen population health management becomes a critical strategy for managing population health because it effectively blends clinical and financial data.

Once healthcare organizations achieve next-gen population health management, mature accountable care — which is characterized by high-performing networks operating under full global risk arrangements — can be realized. This advanced care delivery model focuses on optimization and lowest total cost of care, achieved through high patient engagement as the result of personalized outreach and full next-gen population health management. The benefits of this stage of maturity will be realized through more comprehensive and precise analytics to personalize patient care, especially for those with chronic conditions.

While national initiatives are encouraging the forward momentum of accountable care, a bird’s eye view of the industry reveals that most healthcare organizations are in the very early stages of this cultural shift. Despite evolving reimbursement models that are gradually incentivizing quality outcomes and efficiency, organizations still must invest in the necessary infrastructure and embrace new workflows.

Electronic health record implementation provides one example. To date, even the most sophisticated EHRs usually are implemented as little more than electronic versions of existing processes and workflows. What is needed instead are more comprehensive and precise analytics to segment patients and personalize patient care.

Traditional analytics match demographic and claims data against quality measures, but engage all patients with similar conditions in the same manner. All patients identified with Type 2 diabetes, for instance, might be offered the same form of educational outreach. While EHRs today offer transactional clinical decision support at the point of care—some even are even adding managed care modules—they lack the capability to support the data-driven workflow of a distributed care coordination team. They are not designed to ensure top-of-license performance by all participants in the cycle of care, whether they are charged with managing a patient’s financial, clinical, or social welfare.

With new analytics, however, healthcare organizations can begin to offer a more tailored approach to care based on reviewing more comprehensive claims, clinical, and psychosocial data. As such, future success with population health management requires a data management infrastructure designed to capture an exploding volume and variety of data in real-time, much of it outside the claims stream.

Going forward, the strongest organizations will be those that most effectively harness, integrate, and analyze multiple types of data to inform the care of patient populations at the point of care. For example, claim clickstream data may reveal what treatments patients were provided in the past, but not necessarily whether they worked. Psychosocial data—such as whether a patient drives or has adequate social support—can have a massive impact on the success or failure of care, but is often embedded within provider documentation. Pharmacy, lab, and real-time clinical biometric data from devices such as wireless glucometers and scales is essential to effective care management.

Simply put, a real-time, 360-degree view of the patient, plan of care, evidence-based guidelines and psychosocial data results in more targeted, effective population health management, which in turn leads to better, more accountable care.

Effectively improving population health and the bottom line will require that data be translated into structured content readily available for analysis. Healthcare organizations today must take advantage of technology that allows storage and maintenance of data at its finest-grain level. It is no longer adequate to extract data, drop it into a data warehouse, and run pre-defined reports. This solution simply isn’t agile enough to answer new questions or handle increasing data volumes.

Instead, data must be conditioned, as data hygiene is extremely important for effectively using data out of the chute. Moreover, natural language processing also is becoming increasingly valuable for extracting actionable data from physician notes.

Cloud-based storage strategies, however, have proven most effective for supporting greater volumes of new data. Cloud environments offer an on-demand infrastructure capable of finding the right signals through the data noise that is expanding as the velocity, volume, and variety of data increases. Overall, healthcare organizations must employ technologies capable of clearly identifying relevant data and revealing that data at the point of care in a way that is quickly and easily consumable by providers.

Information is becoming a driver of consumer and clinical value in healthcare. In the near future, the use of data to enable effective population health management will align healthcare organizations with the cost and care quality goals so vital under accountable care reimbursement models. The most successful healthcare organizations, therefore, will be those that find new ways to use technology to leverage a wide range of patient data to improve both the bottom line and patient care.

Larry Schor is SVP of Medecision.

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October 15, 2014 Readers Write No Comments

Readers Write: Are You a “Check the Box” Executive?

October 15, 2014 Readers Write 1 Comment

Are You a “Check the Box” Executive?
By Dana Sellers


Over the Labor Day weekend, CMS released an update for Stage 2 Meaningful Use that provides some relief to providers struggling to fully implement the 2014 requirements. That’s great, but here’s the problem: Meaningful Use is not just an exercise to check some boxes off.

It’s more than implementing CPOE. It’s more than getting your physicians to use a problem list. It’s more than the incentive dollars. It’s about getting value beyond the implementation.

If your organization attested in 2012, you have been continuously collecting discrete standardized and coded data for close to two years. You’ve done the heavy lifting and you’re continuing to do so for Stage 2. Now you have a foundation that provides a common data platform across the organization with standardized vocabularies, regardless of different EHRs or other operational systems.

While you may be awash with all kinds of data, Meaningful Use provides specific clinical data that you can focus on. You have a means to ensure that all parts of the organization can begin to measure the same things the same way.

In a recent project, we turned our new cadre of Quintiles researchers and biostatisticians loose on a bunch of clinical data. We imposed one important ground rule: we limited the data to things that were already being collected for Meaningful Use. We asked if they could find anything interesting. In a matter of weeks, they discovered significant findings that relate directly to outcomes and cost.

Here’s the cool part. Every organization that has attested for Meaningful Use has the data needed to do the same kind of study.

Are you looking at Meaningful Use as a check-the-box exercise, or are you looking to drive real value? Have you considered the possibilities of using your current data foundation in order to improve workflow and processes?

For example, changing how the patient intake process occurs, not only for better collection of data, but also for safety and care coordination. Can you move beyond monitoring clinical process measures to conducting analytics that will drive insights for better care and outcomes?

It takes the organization thinking about Meaningful Use as a foundation for value. It requires change.

  • Break down organizational silos. No single department owns the challenges facing organizations around quality, cost, and performance. Yet multiple departments and stakeholders often try to answer the same types of questions, resulting in inefficient processes as well as conflicting answers. Create cross-departmental, multi-disciplinary teams to address these challenges.
  • Get data governance in place. Information transformation requires that data is consistent, accurate, and timely. This foundational data is a start, but still requires an organizational structure and process to provide direction and decision-making to create common definitions and apply common standards across multiple stakeholders and departments.
  • Start with the foundation. There is tremendous value in the foundational MU data. Begin to explore beyond the standard Meaningful Use process objectives. Use this foundation to evaluate how well standards are applied. Explore for other clinical insights like impacts of the use of evidence-based orders on specific disease-based populations in this data set.

Meaningful Use is not an IT project or task to cross off a project list. It is a foundation for an information journey to value.

Dana Sellers is CEO of Encore, A Quintiles Company of Houston, TX.

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October 15, 2014 Readers Write 1 Comment

Readers Write: What to Ask When Deciding to Take the CMS 68 Percent Settlement Offer

October 15, 2014 Readers Write No Comments

What to Ask When Deciding to Take the CMS 68 Percent Settlement Offer
By Bill Malm


The October 31 deadline for providers to decide whether or not to take the 68 percent settlement offer from CMS is quickly approaching. This settlement enables any provider to withdraw their pending inpatient appeals in exchange for a timely partial payment which equals 68 percent of the net allowable amount. CMS is offering this settlement in order to reduce the volume of inpatient status claims currently pending in the appeals process and to alleviate the administrative burden to both providers and Medicare.

Many healthcare organizations have already submitted their request to take this agreement, but if your hospital is still weighing the pros and cons of doing so, some key factors for consideration include the following.

  • Does your hospital have significant dollars at risk or a high volume of outstanding appeals? Hospitals with a large number of appeals and/or a significant amount of revenue tied up in the appeals process may benefit from seeing the appeals through the ALJ process. Interest payments alone could outweigh any reason to settle.
  • Was your hospital’s appeal strategy based on an internal review process that appealed only strong cases, writing off weaker cases? Hospitals that had a denial review strategy and chose to appeal only those cases with a reasonable likelihood of success may not want to agree to a 32 percent reduction in payment and forfeit the Limitation on Recoupment 935 interest. On the other hand, hospitals that appealed cases indiscriminately are promised 68 percent of the net payable amount. In the end, this may result in a higher payment for these organizations.
  • What was your hospital’s recoupment strategy? Is the expected interest on a successful appeal financially substantive or marginal? If your facility allowed immediate recoupment of overpayments following receipt of Demand Letters, then your claims are not subject to 935 interest. Conversely, 935 interest is owed when claims were involuntarily recouped and you prevail at the ALJ level. For claims that wait years for an ALJ hearing, this payment could be substantial.
  • How badly do you need your money? This may seem like a silly question, but keep in mind that strong appeals and long wait times will likely result in payments with greater than 100 percent value, but it may be a very long time before you see that money. Can you afford to wait? Hospitals that accept the settlement can expect reimbursement within 60 days of a fully executed agreement.
  • What is the cost associated with pursuing your appeals? Hospitals with high costs associated with the pursuit of appeals may want to consider the settlement.  Those costs might include consultants, attorneys, and expert witnesses. The cost of internal personnel time and resources should also be considered.

Deciding whether or not to take this settlement depends on a variety of circumstances. The final decision should be based on a position of financial strength and a strategic choice rather than a short-term stopgap out of necessity.

Bill Malm is senior manager of revenue integrity communications at Craneware.

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October 15, 2014 Readers Write No Comments

Morning Headlines 10/15/14

October 15, 2014 Headlines No Comments

AMA Provides Blueprint to Improve the Meaningful Use Program

The AMA publishes a wish list of Meaningful Use Stage 3 criteria as part of a letter to CMS. Within the list, AMA calls for more flexibility on threshold measurements, reduced penalties for those that fail to meet criteria, and improved interoperability standards.

Joint HIT Committee Meeting

The ONC’s HITPC workgroup will present its conclusions after analyzing the 2013 JASON report that was highly critical of the interoperability plan being pursued in the US. The group will propose an API-based interoperability approach as a path forward.

Highmark-UPMC split raises health records concerns

Pennsylvania state representative Dan Frankel questions whether UPMC, which uses Cerner, will be able to send patient records to other health systems once it severs ties with Highmark Insurance and those patients move on to new care providers.

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October 15, 2014 Headlines No Comments

News 10/15/14

October 14, 2014 News 5 Comments

Top News


The AMA issues a Meaningful Use blueprint that calls for CMS to:

  • Waive penalties for providers that hit a 50 percent threshold.
  • Pay incentives for meeting a 75 percent threshold.
  • Make three unpopular measures optional: View/Download/Transmit, Transitions of Care, and Secure Messaging (or as an alternative, set thresholds at less than 100 percent).
  • Eliminate thresholds and menu vs. core requirements.
  • Add Stage 3 measures that are more appropriate for specialists.
  • Continue hardship exceptions for anesthesiologists, pathologists, and radiologists given their tiny attestation numbers and their use of systems provided by hospitals that don’t care all that much whether they can attest or not. AMA also wants a hospitalist exemption for those who treat large numbers of observation patients since they don’t qualify as hospital-based EPs in that setting.
  • Leave the measures in place that HITPC suggested removing, but allow providers to qualify by meeting any 10 measures.
  • Loosen the hardship exception requirements by expanding the definition of “unforeseen circumstances” and exempt hospitalists and physicians who are eligible for Social Security by the end of 2015.
  • Revamp EHR certification to cover only interoperability, quality reporting, and privacy and security.
  • Eliminate the requirement that only licensed clinicians can enter orders.
  • Create standards for electronically passing data between EHRs and registries in a standard format, eliminating the need for middleware.
  • Focus Stage 3 standards on coordination of care and new payment models rather than on data collection.

The AMA’s document also calls out C-CDA as causing interoperability problems, saying that ONC mandates its use in Stage 2 even though it has had “very little real world testing, nor was it balloted or approved for standardization by HL7” and therefore is still a draft standard with “wild variation in technology versioning.”  It urges that ONC not repeat the same process of jumping on untested standards starting with Stage 3.

Reader Comments


From Media Horse: “Re: Abraham Vergese, MD’s comments about EHRs interfering with patient care. He was the keynote speaker at athenahealth’s user conference a few years ago. It was a good speech about preserving the patient-doctor relationship, but it’s interesting that he spoke for a company that’s in essence a billing company with an attached EHR. I’m not suggesting that he’s a hypocrite, but I’m sure he was paid well.”


From Number Six: “Re: Health Data Warehousing Association conference in Portland, ME last week. I was impressed by the all-volunteer organization’s conference and the low registration fee of under $500 for 2.5 days. It was held in MaineHealth’s really nice conference center and had about 170 attendees. No vendors, just data people giving concrete details of what they’re working on in their institutions. Utah presented how they incorporate PROs into Epic and Altrius had a talk on predictive modeling, which was then covered in a ‘Sharing’ session on Day 2 since it was obvious that their specs could be implemented at other places. I highly recommend the conference HIStalk readers. Next year’s meeting is in Grand Rapids.”

From Always Be Closing (Offices): “Re: CompuGroup Medical. Closing the Boston office and terminated the sales VP and several sales reps.” Unverified, but the report is from a non-anonymous insider.


October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock


Lifestyle healthcare technology vendor Alphaeon Corp. acquires Utah-based TouchMD for $22 million. TouchMD’s apps allow plastic surgery and OB-GYN practices to educate patients on their services to “increase consultation closings at the time of service and added procedures beyond the consultation, resulting in increased practice revenue.”



Beaver Dam Community Hospitals (WI) will deploy eClinicalWorks across its eight locations.



Andrew Gelman, JD will step down as SVP of corporate development for PDR Network to run a family business, but says he will keep his hand in healthcare with occasional consulting.


Facebook CEO Mark Zuckerberg and his physician wife donate $25 million to the CDC for Ebola control.


University of Arkansas for Medical Sciences promotes Rhonda Jorden to vice chancellor for IT and CIO.

ONC names Lucia Savage, JD (UnitedHealthcare) as chief privacy officer, replacing Joy Pritts, who resigned in July.

Announcements and Implementations


Mobile Heartbeat will integrate EMR and waveform data from AirStrip’s One platform into its care team smartphone app.


Eskenazi Health (IN) will use technology from Indianapolis-based Diagnotes to alert its brain center coordinators when patients are admitted, discharged, or transferred from hospitals as reported to the state HIE.


Personal health records management app vendor Hello Doctor claims it has “gained access to an API” that gives it “access to 52 percent of clinics and hospitals in the US.” That sounds suspicious since there’s no single API out there that covers multiple vendors, leading me to believe that perhaps they’ve connected to Epic in some manner and are using the “52 percent” statement incorrectly to refer to organizations rather than patients.  

Allscripts will offer Shareable Ink’s documentation solution for surgical and clinical documentation for Sunrise.

Government and Politics


Rep. Renee Ellmers, RN (R-NC) issues a statement saying she’s pleased that CMS extended the Meaningful Use hardship exception after admitting that its submissions website wasn’t working correctly, but repeats her request (made via her proposed Flex-IT Act) that CMS reduce its 2015 Meaningful Use Stage 2 reporting period from 365 days to 90 days.

Beth Israel Deaconess Medical CenterCenter John Halamka, MD says the White House should choose someone from DC rather than Silicon Valley in replacing departed US CIO Steven VanRoekel:

I always support the federal government, but bold new ideas get lost in the complexity of procurement, contract management, and getting stakeholders to agree. Navigating the US government is difficult and complicated, and an outsider from Google or Facebook is likely to be eaten alive. Only an insider can navigate the process while offering new ideas and approaches.


HITPC’s JASON Report Task Force will deliver its conclusions today (Wednesday), proposing that current interoperability approaches should be replaced with an API-driven model starting with Meaningful Use Stage 3. It disagrees with the JASON report’s conclusions that such an approach requires new clinical and financial systems, that the market has failed in its failure to advance interoperability, or that a newly mandated software architecture is required. The task force advocates that ONC create a public interoperability API and encourage its use via the Meaningful Use program. 

ONC names 12 providers as health IT fellows. 

Executives of California’s health insurance exchange are questioned about its contracting practices as a state senator claims the organization practiced cronyism in awarding dozens of no-bid contracts, some of them to a company whose owner has close ties to Covered California’s executive director.


The chief of staff of New York City’s medical examiner’s office quits following a $10.9 million no-bid, sole-source contract award to a ICRA Sapphire, whose software has cause bodies to be mishandled or lost. The city has been paying for the system using Homeland Security grants, having awarded what one lawyer called a “lifetime contract with constantly increasing costs and poor results” and hiring the India-based company’s rep as the ME office’s CIO. The previous CIO and his girlfriend were arrested for embezzling $9 million in FEMA grants intended for tracking the remains of 9/11 victims. The just-resigned chief of staff had been promoted to the position even after getting caught stealing an airplane’s exit handle from the 9/11 debris to take home as a coffee table souvenir.


Philips Healthcare begins Netherlands hospital trials of a wearable COPD monitoring sensor that collects information on physical activity, respiratory indicators, and sleep disturbances.

A reader called my attention to Xenex, whose xenon-powered pulsed UV devices (“Germ-Zapping Robots”) can disinfect hospital rooms in a few minutes, a timely topic given Ebola. Two of the company’s executives hold doctorates from the Bloomberg School of Public Health at Johns Hopkins University, while the other two were involved with Rackspace Hosting.


Google is testing a search feature that would allow people who are Googling medical symptoms to click a “talk with a doctor now” link.


Breathometer integrates its $100 Breeze personal breathalyzer with Apple’s HealthKit.



The Brookings Institution presumably publishes intelligently written and authoritative articles on occasion, but this lame piece called “Could Better Electronic Health Records Have Prevented the First American Ebola Case?” isn’t one of them (maybe Farzad was the only person there who knew anything about healthcare IT). Its insight is zero, its valid points are few, and its flaws are many:

  • It doesn’t answer the question its sensationalistic headline asks.
  • It is based on a preliminary report that an EHR setup decision caused Texas Health Presbyterian Hospital Dallas to discharge the Ebola patient from its ED, which turned out not to be the case according to the hospital.
  • It gets the hospital name wrong even though it’s right there on the page to which the article links.
  • It wanders all over the place about EHR privacy, cost, and “voluminous files,” then meanders into healthcare policy issues, health IT competition, and a proclamation that an undefined “many”are skeptical about EHR value and the government should therefore fund outcomes research (which is already underway).


Anna McCollister-Slipp, the co-founder of an analytics company and Tricorder Xprize judge who also has Type 1 diabetes says she’s tired of waiting for digital health to flourish, pointing out that:

  • Even hospitals that took Meaningful Use money won’t allow patient-sourced data to be imported into their EHRs.
  • Most of the health apps were designed for people who are already healthy.
  • Her academic medical center does not offer online EHR access, doesn’t allow electronic communication with its physicians, and won’t provide her endocrinologist with the software that would allow him to load her glucose monitoring data to his computer.
  • None of her doctors use electronic scheduling, none offer online lab results retrieval, and only one accepts electronic refill requests.

A Pennsylvania legislator questions UPMC (PA) about its ability to send records of Highmark insurance patients to new providers when they lose access to UPMC’s hospitals on January 1. UPMC CIO Steven Shapiro says they can transfer records electronically within 24 hours, but Highmark claims UPMC will be sending faxed documents instead. UPMC uses Cerner among its variety of systems, while Highmark-owned Allegheny Health Network is moving to Epic.

Reuters covers the growing telemedicine market in China, which the government is supporting to overcome the rural-urban medical expertise gap. A report says doctors in China spend 13 hours per week online, with 80 percent of them using mobile phones.


CDC and ONC will present a webinar on Thursday, October 16 at 1:00 – 2:30 p.m. Eastern to encourage providers and EHR vendors to work together to develop Ebola screening tools. CDC’s Ebola team will present its detection algorithms and travel history / medical signs checklists.


NBC medical correspondent Nancy Snyderman, MD admits that some of her crew members broke a voluntary Ebola quarantine in going out for takeout food after returning from Liberia, where the group had been in contact with an Ebola-infected freelancer. New Jersey health officials reacted to her admission by making the quarantine mandatory.  She declined to say whether she herself was one of those involved as several locals who spotted her indicated.

Sponsor Updates

  • Predixion Software joins the Salesforce Analytics Cloud ecosystem.
  • Greenway Health’s SuccessEHS is prevalidated by NCQA to receive 27 points in auto credit toward PCMH 2011 scoring.
  • Frost & Sullivan names Validic to its 2014 Best Practices Award for Customer Value Leadership.
  • First Databank’s collaborative research paper is selected as a finalist in the Best Paper Competition by the American College of Clinical Pharmacy.
  • The Jacksonville Daily News discusses the history of military healthcare IT solutions and calls RelayHealth a “pearl.”


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.



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October 14, 2014 News 5 Comments

Morning Headline 10/14/14

October 14, 2014 Headlines No Comments

Promoting healthy competition in health IT markets

The FTC announces that it will work together with the ONC to ensure that EHR vendors are not restricting interoperability options to gain illegal competitive advantages.

2014 Report to Congress on Health IT Adoption and HIE

The ONC publishes its ARRA-mandated annual progress report on the national rollout of EHRs and HIEs. The report provides an in depth look at ONC’s various initiatives, focusing primarily on the steps that are being taken to overcome interoperability barriers.

Mass. Becomes First State To Require Price Tags For Health Care

A Massachusetts law requiring that insurers publish the prices they pay hospitals and practices for services went into effect last week. To comply, insurers are updating their websites with the once closely guarded pricing data.

NIH Invests Almost $32 Million To Increase Usability Of Biomedical Research Data

The NIH announces a new $32 million grant program called Big Data to Knowledge, or BD2K, that will be used to fund research projects aimed at developing new ways of analyzing large biomedical data sets.

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October 14, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 10/13/14

October 13, 2014 Dr. Jayne 2 Comments


We are in the process of adding a variety of self-directed learning options to our EHR training. Up until now, we have had formal classroom training for clinical support staff and practice-based group training for providers.

Although we’ve had good outcomes from training, our paradigm is fairly resource-intensive. Additionally, providers complain about the time they spend in training sessions since it often cuts into their office hours even though we offer sessions before and after typical practice schedules.

One of the advantages of a resource-intensive training program is that it is the resources are intensely involved. When we train in small groups, we can provide individualized attention and can monitor who is catching on and who might be struggling. We can also ensure immediate follow up if attendees don’t pass our competency exam.

In turn, our learners can provide feedback on the effectiveness of our curriculum and presentation style so that we can modify it if needed. This is important when we bring new specialties live that our trainers might not be as familiar with as they are with other specialties.

We’ve had online refresher training for the last several years. It’s largely in the form of recorded web presentations, although we have a number of clips that were done with Adobe Captivate. They’re tied to our learning management system so we can see how many times each piece has been viewed and whether a particular employee is taking advantage of the resources. Managers can access a report of their employees’ activities, but the sessions are not required.

Our goal was to create some 5-10 minute segments that people could watch if they were having difficulty with a particular functionality or a new feature. Feedback has been good.

Given the budgetary pressures facing healthcare organizations, we’ve been asked to enhance our online offerings with a goal of reducing classroom training time. Staff will now be required to view a core set of e-learning offerings and managers will be responsible for tracking compliance.

I’m in favor of e-learning because it can be completed at the employee’s preferred time and location. However, I’m concerned that since reduced training time is the goal, that employees will be shortchanged. I can’t see some of our managers carving out protected training time for new employees. In particular, I know some of them will expect employees to jump right into patient care and learn the EHR on the fly.

Those same managers are likely to expect employees to complete the sessions on their own time even though that’s a violation of company policy. Staff working on uncompensated time might rush the training, or worse, multitask their way through it, diminishing mastery. We have a plan to gather data on whether the new strategy is effective, but based on the number and frequency of new hires, it will likely be six months or more before we know if it’s equivalent to our current platform.

I don’t like the idea of experimenting with our practices. We’ve worked hard to have a successful program and our practices get up to speed very quickly with only rare exceptions. Although we pull new hires out of the office for several days of training, when they return to the practice, they’re able to hit the ground running.

I guess my biggest concern is that there’s really no way to shortcut the material. A trainer — whether in person, recorded, or as part of an e-learning platform — can only impart information so fast. In turn, learners can only absorb so much in a given amount of time.

If this was an experimental drug, we’d first have to experiment on healthy subjects (or those who didn’t really need the training) to make sure it was safe. If it passed those tests, we’d have to experiment on more subjects to determine if it was more effective than placebo. Finally, we’d have to have a limited head-to-head trial against current training standards to determine if we should switch to it or not. Only if it passed certain statistical tests would we use it to replace our current training platform.

Since this is mostly about saving money, you can bet we didn’t have the opportunity to really study the new approach, let alone have an actual pilot or trial. We are being forced to switch everyone over without proof that it’s not going to lead to problems. As normally happens in healthcare IT, we were given a short deadline and limited budget to get it ready.

We’ve been in the business of delivering the impossible for a long time, however, so we’re up to the challenge. As for outcomes, only time will tell.

Have you been able to pare down training and maintain quality? Have great ideas? Email me.

Email Dr. Jayne.

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October 13, 2014 Dr. Jayne 2 Comments

HIStalk Interviews Tim Burdick, MD, CMIO, OCHIN

October 13, 2014 Interviews 7 Comments

Tim Burdick, MD, MS is CMIO of OCHIN of Portland, OR.


Tell me about yourself and OCHIN.

I’m a family physician, increasing the amount of my time over the past eight years in healthcare informatics. Currently I’m one day a week in clinic at a rural health clinic as a family physician and four days a week as chief medical informatics officer at OCHIN. OCHIN runs a hosted Epic EHR for 350 clinics. Eighty-four healthcare organizations contract to use our EHR.


Epic gets criticism that its product is a walled garden and it’s not interoperable. What’s your opinion?

I think the interoperability frustrations cross all EHR vendors at this time. I don’t see that Epic is any better or any worse than others.

We’ve had good luck building interfaces and interoperability with other systems, with regional HIEs in and out. We have projects going with the VA, with Social Security Administration, and several HIEs. We do a million CCDA transactions with other Epic shops around the country.

Epic’s increasingly been good about opening their APIs. I’m not sure it’s fair to single out Epic. Certainly with the lack of any kind of national standard on interoperability, there hasn’t been a big push to make it happen.


Will the government every lay down a standard that everybody has to follow?

I think it is changing. Clearly Karen DeSalvo has over and over again said that she’s going to push the interoperability issue, so I see that coming. I think there have been other pressing issues for the HIT community that we needed to address before we could tackle interoperability.

The time has come for us to do it. It just hasn’t happened yet because we just weren’t there yet.


You’ve mentioned the challenge of state-specific interoperability requirements, such as California’s mental health reporting and its requirement that providers review lab results before putting them on the patient portal. Will the states standardize?

I’m not sure I see the states working together to do that. What’s happening, for example, in the case of the California legislation preventing organizations from releasing lab results to patients, as of October 1, federal law allows the laboratory companies to release results directly to patients. As a result of the federal law, state laws like the one in California are now superseded, so that’s no longer an issue for us in California.

It’s going to have to be strong federal lead on this that pulls the states into a common compliance rather than states coming together on things.


Do you have a solution to address the difficulty of connecting to state registries such as those for immunizations?

Again, it’s going to come down to standards. If we have a standard that says, these are the core data elements for an immunization registry. These are the requirements that you need to be able to do to pass that information from the EHR to the registry, from the registry back into an EHR, or from the registry to a patient portal. That will bring everybody along so that we’re not having to individually create 22 different interfaces and standards.


You operate in 22 states, but it could be a 50-state problem.

We could potentially have that problem. OCHIN is expanding. Certainly there are plenty of other large healthcare organizations that are in multiple states and having to deal with this issue as well.

If you look at Meaningful Use requirements around interoperability, if for Meaningful Use Stage 2 and Stage 3, we have to have every single eligible provider using some sort of registry list, immunization registry, or special disease registry, and we have to do one-offs in every single state, that’s not scalable, as I said in the testimony.

If we can build one interface, either to a federal registry or at least build it at the state level or the regional level or the county level, but know that those interfaces are all going to look the same and have a same standard set of data elements and same transactional messaging processes, then we can scale it up as a healthcare system.


You’ve said that some of those registries are run by drug or medical equipment vendors and charge fees as a for-profit company would. Can you tell me more about what you’ve seen?

ONC keeps a list of all the different registries — who runs the registry, what the quality registry is, whether it’s a diabetes registry or heart failure registry, and the costs associated with sending the data to those registries.

There is not good transparency around how the data are going to be used. If you’re sharing the data with that registry, can the owners of that registry then use that information? Some of it Is PHI. Can they use it for their own research purposes, their own marketing purposes, are they associated with a pharmaceutical or device company?

Some of those are fairly expensive. If you’re a larger organization, it’s going to cost you a huge amount of money to connect to one of those registries, and yet at the same time, there’s a federal mandate that we do connect to registries like those. Though we get some money back in Meaningful Use dollars, the cost of connecting to those registries on a monthly subscription basis is enormous, and frankly prohibitive.

The third piece is that healthcare organizations are hooking up to those registries and sending data just as a check box so that organizations can say, we’re sending data to a registry so we can collect our MU dollars. But the value that those registries provide back to the eligible providers is questionable.

As with most of the Meaningful Use stuff, I believe firmly that the intentions for Meaningful Use are good and that it’s pushed the healthcare industry along in the right direction, but we need to get away from doing it for check boxes to doing it to drive clinical improvement.

That means that we need to value back from those registries to the providers. It needs to be integrated back into the EHR rather than just saying here’s a website where you can go log on to a third-party app where there’s registry data about your patient population that are no way tied back to clinical care in a clinical operations.


I got two types of reader comments when I mentioned that some of the public HIEs are charging full participation prices to providers who just need to submit to public health registries. Some said they need a viable business model and a provider is either in all the way or out, while others said public health requirements shouldn’t force an organization to join as a full participant for that reason alone. What do you think?

I see both sides of that. Clearly if you’re a business and you’re going to stand up some sort of data warehouse and provide some quality metric reporting around that, that’s a difficult technology. OCHIN’s been working on it for several years. It comes at a very real cost to employ the developers and to do that work. I’m fine with organizations charging for that.

The difficulty comes when there’s a federal mandate to do this. As I said earlier, the financial incentives to do it don’t cover the cost of subscribing for these services. The transparency is that if I’m going to be paying hundreds of thousands of dollars to hook my Eligible Providers up to some registry, I need to know very, very clearly who’s collecting that money, what the money’s going to, and what kind of data use is going to happen with that information. I don’t think we have that level of transparency.

I’m not opposed to organizations collecting fees to cover their costs and even making a profit off of that. But we need to know who they are, what they’re doing with the data, and what their intentions are.

In addition, I think it would be great if the CDC, NIH, Institutes of Medicine, some of the other federal organizations could host some federal registries rather than doing it at the state level. Again, coming back to this idea of Eligible Providers in 22-plus states for OCHIN, if I can’t find a federal registry, then I’ve got to start reaching out to state registries.

The other example here would communicable disease surveillance, infectious disease surveillance registries. Those are largely at the state level. It’s just not practical for me to reach out with interfaces to 22 states. But if I can submit diabetes information, heart failure data, infectious disease surveillance data to a federal agency on a federal program at a cost that is subsidized by the federal organizations – ONC, CDC, etc. – then I can scale it up and there is less of an issue of questions about potential profiteering and lack of transparency.

It’s in the interest of organizations like CDC to start developing those federal registries and being able to collect the data and use those for national healthcare initiatives. I see it as a win-win.


Is Meaningful Use Stage 2 causing other unintended consequences that aren’t in a patient’s best interest?

That’s difficult. Yes, there are definitely unintended consequences and negative impacts. I’m firmly committed to the long-term benefits of Meaningful Use. With the significant earthquake changes that things like Meaningful Use bring along, there’s going to be the unintended consequences that we need to work through. But I don’t think that in any way negates the vision of Meaningful Use and HIT improvement processes.


Is it a short-term problem that patients are confused by having to log in to several patient portals, one for each provider, to look at their own data?

I think it’s a medium-term issue. There is a growing market for vendor-agnostic PHRs. HealthVault, Apple getting back into it, Google getting back into it. There are other third-party companies getting into this. Some of those were represented at the ONC patient engagement meetings a couple weeks ago.

I think there’s going to be a competitive market for that type of work. That’s going to drive it pretty quickly. Karen DeSalvo has mentioned at several meetings that I’ve attended that ONC is interested in supporting that process in some fashion or another. I see this issue being a two- to four-year growing pain problem that will have some solutions in the foreseeable future.


What do you think the business model or overall goal should be for public HIEs, or what we would have called a RHIOs in the old days, beyond just letting providers look at information on the screen?

The idea of having either a pass-through model or a data repository where the data are going to be held for a period of time while keeping the data in some sort of separate system … I think that model has not proven value and doesn’t have any long-term financial viability to it, as witnessed by innumerable failures of RHIOs in the past.

From a Triple Aim perspective, what we really need is for the data about a patient to get pushed through to a provider at the point of care within their EHR — whether it’s in an office visit or a care coordinator working on patient population issues — so that if that patient has had a hemoglobin A1C done by an endocrinologist a week ago at a different healthcare facility, the data are actionable in real time within the EHR.
The patient’s data need to move seamlessly across platforms. Care Everywhere works well and there are other things like that, but it still requires me to go out and look for that information and it still doesn’t move easily back and forth, even between EHR systems that are using the same vendor.

We need to get away from that model that a patient’s data exists in different instances separately and move to a place where the patient’s data coexists simultaneously and in real time in any instance of their care. That’s going to allow us to make it actionable to drive clinical decision support, panel management, and population health. That’s going to get us to Triple Aim.

The other thing it allows is on the patient-facing side of things for the patient to be able to see their information in a collated fashion and not in a siloed fashion so that they understand their healthcare picture not from the perspective of, “This is my cardiologist’s view of me. This is my pulmonologist’s view of me. This is my PCP’s view of me,” but, “This is the healthcare system’s view of me as an individual patient.”


Will the CommonWell initiative will make an appreciable difference in interoperability?

I think that’s to be determined.


Do you think Direct messaging will have a significant role or has it missed its opportunity?

Certainly some folks would say that it missed its opportunity, that the concept is so fundamentally flawed that it can never be executed on a large scale.

I don’t think anybody has shown that Direct is not viable, but I don’t think anybody has shown that Direct will work at a large scale, either. The issue of sharing directories and trust bundles across organizations that don’t have close working relationships with each other is unproven at this point.

At OCHIN, we are building out our Direct address directories. We are starting to share those with outside organizations. The uptake is slow on it. Just the mechanics of how to move the data back and forth, integrating that into clinic workflows on the clinic side, as well as how to set up those address within the EHR.

It’s still an early process technically. We’re facing things like that some organizations that we work with want every provider to have their own Direct address. If they set it up that way, then does an inbound message come through directly to that provider’s in-basket? If so, does the provider know what to do with that information and does that information get processed the right way in clinic?

Some organizations want to take the approach where the organization’s going to get a Direct address and the individual providers won’t. Then it will come in and some staff person will process those messages and move them around.

Even just simple questions like which process are we going to through with that organization address or an individual Eligible Provider address. We don’t even know how we’re going to handle that. Until we try those different things for a month or a year, I don’t think we’re going to know for sure what’s going to work in clinics.


If you were king of interoperability for a day, what would you do?

What I would really like to see right away is for the healthcare industry — healthcare providers, payers, federal government — get together a summit of thought leaders and define 30 clinical data elements that are needed to improve Triple Aim, things like hemoglobin A1C levels and left ventricular ejection fraction. Agree that these are just the basic elements that we need to start with in order to improve our Triple Aim outcomes.

Define those at a national level and figure out for those finite number of elements, how is every single EHR vendor going to really easily make that data flow out? How are we going to really easily make that data move in? What role does the federal government have in helping consolidate a national pass-through model that will at least make those common data elements available seamlessly across organizations.


Do you have any final thoughts?

The big issue here is patient matching. It really is going to come down to our ability to match our patients. Until we tackle a patient matching issue, we can come up with standards all day, but if the patient match rate is 20, 30, 40 percent, then we’re not going to get there.

I doubt there’s a political willpower to bring back to the table a conversation about a national healthcare ID. If we’re not going to do that at a federal level, then healthcare organizations and patient advocacy groups need to tackle this issue on a non-legislated fashion.

One of the things that I mentioned in my testimony would be developing a grassroots organization that allows patients to have an interoperability member card. It’s going to have on there the patient’s name the way they want it spelled consistently, down to capitalization and hyphenation. It’s going to have a date of birth, and in the case of patients who were born outside of the United States, we can’t continue to just randomly assign January 1 to tens of thousands of patients whose birthday isn’t documented.

If we use a phone number for patient matching, even if the patient’s no longer using that phone number for communicating with the clinic, we can at least continue to have them use that same phone number for patient matching.

It becomes a proxy for a standard ID, but that patient’s going to carry that card with them year after year. Those elements aren’t going to change. They can voluntarily take that card to registration at a hospital, lab, radiology facility, outpatient clinic, or the ER. The data for that patient are going to get populated in registry systems at every healthcare organization that that patient touches. That’s going to allow us to do patient matching at a much, much higher percentage.

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October 13, 2014 Interviews 7 Comments

Morning Headlines 10/13/14

October 12, 2014 Headlines No Comments

No On Proposition 46

A coalition made up mostly of California medical associations launches a website arguing against proposition 46, which would increase maximum malpractice awards, subject clinicians to random drug testing, and mandate that prescribers check the states drug abuser database before writing narcotics prescriptions.

$77 million investment in new health records technology has Alameda Health System struggling to pay its bills

Alameda Health System announces that it has nearly run out of cash, attributing its problems in large part to a failed $77 million Siemens Sorian roll out. The health system’s CFO David Cox says, “the system makes it difficult to collect the right information that you need to bill a claim and makes it hard to identify what kinds of errors are occurring. …. It’s very disjointed right now. A lot of mistakes are being made."

Second Ebola case confirmed. Texas health worker wore ‘full’ protective gear

A nurse caring for the Ebola patient that was being treated at the Texas Health Presbyterian Hospital in Dallas has tested positive for Ebola. Meanwhile, in Liberia, public health workers report that the epidemic has shown small but measurable signs of slowing.

Kaiser Permanente and their Journey to Transform their Supply Chain

Kaiser will redesign its supply chain management processes to increase the effectiveness of its unit-level inventory processes, and to streamline procedure setup by digitalizing surgeon preference cards.

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Monday Morning Update 10/13/14

October 11, 2014 News 3 Comments

Top News 


Opponents of California’s Proposition 46 – which would quadruple the maximum allowed pain and suffering medical practice award, mandate drug and alcohol testing of physicians, and require that physicians and pharmacists look up controlled substance prescription patients in the little-used CURES drug abuser database – launch a voter campaign suggesting that the CURES database would be vulnerable to hacking. Many of the coalition’s members are healthcare providers and member organizations.

Reader Comments


From Bob Loblaw: “Re: Stanley Healthcare. The complete incongruity of this reputable firm flirting in the healthcare arena was probably the need for one or more of its executives to have something to say at the cocktail circuit. None of the senior managers has healthcare experience and many of the clinical experts were jettisoned in the inevitable rightsizing. Their attempt to force the amalgamation of security organizations, furniture companies, a cart company, and a grossly overpromised acquisition of an Israeli company have resulted in a monster of Frankenstein proportions. RIFs have begun and Stanley Healthcare will be absorbed into Stanley Security.” Unverified.

HIStalk Announcements and Requests


It’s a 53-47 “no” vote on President George W. Bush as HIMSS15 keynote speaker. New poll to your right or here: should ONC create and run a national health IT safety center? The Comments link on the poll allows you to expound further.

Last Week’s Most Interesting News

  • NantHealth raises another $250 million in funding from the government of Kuwait and rounds out its executive team with several new hires.
  • GE Healthcare CEO John Dineen resigns, replaced by John Flannery, whose extensive GE experience includes none related to healthcare.
  • Ochsner Health System (LA) says it is the first of Apple’s beta sites to go live with HealthKit-Epic integration.
  • CMS reopens the EHR hardship exception period through November 30, 2014.
  • Walmart announces plans to sell health insurance in its stores and its ambition to become “the number one healthcare provider in the industry.”
  • Facebook may create online health support groups and supporting health-related apps.
  • Texas Health Resources reverses its statement that its Epic setup allowed Thomas Duncan to be discharged from its hospital without being recognized as a potential Ebola patient despite his statement that he had just arrived in the US from Liberia.


October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock


Shares of Streamline Health hit a 52-week low as the company’s market capitalization drops to under $70 million. Above is the one-year performance of STRM shares (blue) vs. the Nasdaq (green).

Government and Politics 


Internal documents suggest the overall cost of the Massachusetts health insurance exchange is much higher than the figure provided last week by Governor Dev Patrick. Temporary Medicaid plans for citizens who were unable to use the failed website will cost state and federal taxpayers $700 million, raising the exchange’s total cost to nearly $1 billion. 

Innovation and Research


California HealthCare Foundation creates a downloadable healthcare accelerator database, saying that demand for accelerators is increasing even though evidence is skimpy that their members will be successful or that the accelerators add value. An expert says the accelerator success rate is about one out of every 7-10 companies. The report adds that while entrepreneurs like joining one or more accelerators,  the need to join a second highlights the failure of the first, and that anyone with “ loft-like space, an unlimited electrical supply, some former entrepreneurs, and a good network of local supporters” can start their own accelerator. It concludes that the recent rash of newly announced accelerators may end up doing more harm than good this early in the hype cycle and many of them will not survive. The report lists six accelerator models:

  1. Independent companies, profit or non-profit, that take equity from participants (Rock Health, Healthbox).
  2. Enterprise-based, where companies provide help only to startups building a product that they themselves might want to use (Microsoft, Boston Children’s Hospital, Optum).
  3. Product-specific to expand use of a particular platform (athenahealth’s More Disruption Please).
  4. Economic development funded by governments or organizations to promote local job growth (100health, DreamIt Health, New York Digital Health Accelerator).
  5. University-affiliated programs that may primarily involve technology transfer (UCSF’s Catalyst, Boston’ Center for Integration of Medicine and Innovative Technology).
  6. Collaboration programs that connect large corporate partner sponsors to startups (Health XL, Avia).



Daughters of Charity announces that it will sell all six of its California hospitals to for-profit Prime Healthcare.


An infectious disease physician who with a colleague treated the third Ebola-infected patient in the US says that only one of the doctors entered the patient’s room to minimize contact, while the other observed via two-way video and documented in the EHR. She adds, “We joked about who had the easier job, since writing notes and orders in an electronic medical record can be a formidable task.”


Alameda Health System (CA) says it has run out of cash and used up all of its credit trying to recover from a $77 million Siemens Soarian and NextGen implementation that “did not go as well as planned.” The system’s new CFO says, “The system makes it difficult to collect the right information that you need to bill a claim and makes it hard to identify what kinds of errors are occurring. …. It’s very disjointed right now. A lot of mistakes are being made.” A physician adds, “There’s not a single part of the hospital — inpatient, outpatient, ER — that has fully functional (electronic health records).”

Kaiser Permanente is working on supply chain redesign, hoping to reduce duplicate inventory, increase patient care time of nurses, and manage expired and recalled items. They are also scanning product ID barcodes into the EHR so that product effectiveness can be reviewed electronically afterward.


Physician and professor Abraham Vergese says in an interview with Eric Topol, MD that technology is infringing on the patient-physician relationship:

It is taking us away, and society will judge us poorly about 20 years from now. They’ll look back and say, "You were complicit. Why did you let Epic and all these electronic medical records rule your life? You actually signed up to learn the new ICD codes and plug them in. Exactly what did this do for patient care?" And the answer is that it did nothing for patient care. It did everything for billing. I feel like the lone piper saying this, but it is clear that we are all feeling the frustration of being forced to do things that have nothing to do with patient care. They are all about billing.


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

More news: HIStalk Practice, HIStalk Connect.

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October 11, 2014 News 3 Comments

Morning Headlines 10/10/14

October 9, 2014 Headlines No Comments

RTI International to develop road map for health IT safety center

ONC contracts research firm RTI international to “create a roadmap for the development of a national health IT safety center.”

HIMSS and AVIA Launch HX360 to Improve Health Care Delivery through Emerging Technologies

HIMSS and digital health accelerator AVIA launch a new collaborative service designed to help hospitals adopt next-generation (non-EHR) technologies.

2014 Results from Survey on Health Data Exchange

An eHealth Initiative survey of 125 HIEs finds that achieving financial sustainability and overcoming difficulties interfacing with a multitude of EHRs are the key barriers preventing broader interoperability.

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October 9, 2014 Headlines No Comments

News 10/10/14

October 9, 2014 News 1 Comment

Top News


ONC hires RTI International to plan its national health IT safety center. Several lawmakers have questioned ONC’s legal authority to create and run such a center, particularly the part of its original plan that involved charging vendors fees.

HIStalk Announcements and Requests

This week on HIStalk Connect: Facebook investigates new healthcare-focused services, including disease-specific social media groups and Facebook-connected health apps. Healthcare billionaire Patrick Soon-Shiong’s startup NantHealth raises a $320 million Series B led by the Kuwait Investment Authority. Startup Health welcomes 13 new digital health companies to its three-year incubator program.

This week on HIStalk Practice: Virginia Women’s Center implements Keona Health tech. NHS patients are assigned non-muggle names at check-in. United Physicians rolls out Wellcentive solutions. DHMSM bidders get two more weeks. Community Health Centers of Arkansas goes with eClinicalWorks. The artist formerly known as Dr. Gregg pens a new tune. Thanks for reading.

Listening: new from Hozier, a creative Irish musician who tells lyrical stories in a variety of genres. I like it.


October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock


Box acquires medical imaging collaboration platform startup MedXT. Meanwhile, healthcare startup investor and Box CEO Aaron Levie (centimillionaire; college dropout; healthcare background or previous interest zero) posts a self-congratulatory USA Today opinion piece (it’s not very well edited with quite a few misspelled words, so it may be a paid promotion) extolling the virtues of the companies in which he holds a financial interest, saying, “There’s already an explosion of start-ups in Silicon Valley and beyond tackling healthcare, ready to transform the industry from the outside in … The Obama administration has taken the lead on pushing through legislation to increase access to care, and there’s far more that can be done on the policy side. But there’s a major role for the technology sector to play in transforming our health care system from one that lags behind its peers, to one that defines the future of health care innovation worldwide.” That’s what Google thought, too.

image image
NantHealth raises $250 million from Kuwait’s sovereign wealth fund, adding to the $100 million the fund invested earlier this year. The company also announced that Steve Curd (CareInSync) has joined as COO and KLAS co-founder Scott Holbrook has been named to the company’s board.


HIMSS and the Avia provider-driven accelerator announce HX360, which will facilitate adoption of next-generation technologies. I don’t really understand what the buzzword-laden announcement is saying the new organization will actually do. Or, for that matter, why HIMSS would partner with a for-profit that collects dues and invests directly in companies that may compete with the vendors that provide HIMSS with most of its income.



Maury Regional Medical Center (TN) selects VisionWare’s MultiVue platform.

University of Virginia Health System selects Strata Decision’s StrataJazz for decision support and cost accounting.


Hugh Chatham Memorial Hospital (NC) chooses Medhost’s Advanced Perioperative Information Management System with Anesthesia Information Management System.



Hearst Corporation promotes Charles Tuchinda, MD to president of First Databank.


Anthony J. Principi (US Department of Veterans Affairs) joins GetWellNetwork’s board.

Vince Ciotti reports that former SMS VP Jim Carter, who he profiled in the above HIS-tory segment a few years ago, has passed away. Vince adds, “I’m sure his hundreds of friends at SMS share my sad feelings tonight at this news. The good things we all share are the many memories of his ever-smiling face, infectious laugh, and always positive attitude. He will be sorely missed.” 

Announcements and Implementations

Allscripts announces GA of the FollowMyHealth Achieve care management solution for Touchworks and Sunrise users.

Visage Imaging announces a new release of its Enterprise Imaging Platform, which includes increased scalability to tens of millions of images and Epic integration. The company will exhibit at ACR’s Imaging Informatics Summit on October 29-30.

Government and Politics


HHS Secretary Sylvia Burwell says in a interview question about the Meaningful Use program, “Once we get these systems interoperable, that’s when we get the real value. You get the real value as a practicing physician, you get the real value as a consumer, and that’s the next step. At the same time, as we’re trying to move forward, we’re receiving comments and pressure to slow the implementation. This is a push-pull as we’re going through change.”



Wearables vendor Fitbit says it has no plans to integrate with Apple’s HealthKit.

Gartner identifies its “Top 10 Strategic Technology Trends for 2015”:

  1. Computing everywhere
  2. Internet of Things
  3. 3D printing
  4. Advanced, pervasive, and invisible analytics
  5. Context-rich systems
  6. Smart machines
  7. Cloud/client computing
  8. Software-defined applications and infrastructure
  9. Web-scale IT
  10. Risk-based security and self-protection



An eHealth Initiative survey of HIEs finds them concerned about the cost and challenges involved with interfacing with EHRs, but happy that Meaningful Use and regulatory requirements have sent providers their way. Nearly half of the HIEs that charge membership fees say that income doesn’t cover their expenses.

Weird News Andy titles this story “Fallopian Tubers.” Doctors investigating a woman’s abdominal pain remove a germinating potato from her reproductive tract, which she explained as, “My mom told me that if I didn’t want to get pregnant, I should put a potato up there, and I believed her.” 

Sponsor Updates

  • Beckie Cosentino, director of privacy and compliance at Etransmedia, discusses HIPAA-compliant email.
  • Orchestrate Healthcare posts “Strategies for Effective Healthcare Systems Integration Are Changing”
  • Clinovations shares a Q&A with Brian Morton discussing the business side of medical practices.
  • CitiusTech will participate in the NAHC Annual Exposition, MGMA, and the IBM Insight in October.
  • Connance and the University of Rochester Medical Center will discuss how the medical center was able to increase charity care dollars and reduce bad debt during HFMA Region 2 Fall Annual Institute October 22-24.
  • Innovative Healthcare Solutions shares how PeaceHealth (AL/WA/OR) was able to alleviate challenges and meet expectations for its Epic implementation by engaging IHS for support.
  • Sunquest announces its November anatomic pathology summit agenda.
  • Craneware will sponsor the Hospital 100 Leadership and Strategy Conference October 19-21 in California.
  • CoverMyMeds partners with Prodigy Data System to provide faster prior authorization approvals within long-term care facilities.
  • ShareCor selects Sandlot Solutions’ Sandlot Dimensions for its Louisiana Health Information Network.
  • Imprivata will showcase its single sign-on and authentication management solutions during VMworld 2014 in Europe October 14-16.
  • Premier shares a video overview by Stacey Counts at Heartland Health/Mosaic life Care (MO) of the PACT Collaborative and Premier’s PopulationFocus after participating in the first Medicare Shared Savings Program by CMS.
  • Orion Health launches eReferral province-wide in Alberta, Canada for lung cancer, breast cancer, and hip and knee joint replacement surgery referrals.
  • Besler Consulting explores the implications of the elimination of the Common Working File for acute care hospitals in a recently published issue brief.
  • The Nova Scotia Department of Health and Wellness PHR project, powered by RelayHealth, receives second place in the 2014 Canada Health Infoway Accelerate Challenge.
  • ScImage achieves DIACAP accreditation for its hybrid cloud medical imaging solution PicomEnterprise 3.x.
  • ZeOmega CEO Sam Rangaswamy is named to Dallas Business Journal’s “Who’s Who in Health Care.”
  • Strata Decision publishes the agenda for its summit and leadership symposium October 21 in Chicago.

EPtalk by Dr. Jayne


ONC opens a public comment period on the Draft 2014 Edition Release 2 Test Procedures. I can confidently say that most of the public has no idea what this is, let alone a comment on it. I imagine most comments will come from individuals associated with a vendor or who have a vested interest in the testing process. Anything that takes my vendors’ time and effort away from improving usability and ensuring patient safety is a problem, so I hope people who have more free time than me add some helpful comments.

In other news, CMS is reopening the hardship exception application process with a new deadline of November 30. We submitted a number of applications prior to the original July 1 deadline and still have not received determinations on about half of those providers, despite their reason for hardship all being identical. I’m not sure why the rest are delayed, but I hope CMS addresses the backlog before they start processing new applications.


I’m continuously entertained by the emails I receive as a result of being on LinkedIn. This week I’ve had no fewer than 10 requests to connect with international medical students with whom I have no connections in common. The pick of the week is one from a recruiting firm searching for a CMIO with experience using a particular vendor. Had she bothered to look at my profile, she would have seen that vendor listed exactly nowhere.

Additionally, she states that the client requires the new CMIO spend 70 percent of his or her time in clinical pursuits “to establish credibility with the medical staff and garner Physician respect.” Anyone who thinks that you can do the non-clinical work of a CMIO in 12 hours a week doesn’t understand at all what it is that we do.

The email goes on to say that eventually the role will transition to 20 percent, but doesn’t list a time period. From experience, it doesn’t matter how much time the CMIO spends in clinical pursuits, it will never be enough for some physicians. Unless you’re seeing as many patients who are as sick as their patients (who are undoubtedly the sickest patients on the planet), you are inferior.




The end of the month really heats up with healthcare IT events. First MGMA kicks off in Las Vegas on the 26th, with the CHIME Fall Forum starting the next day. The Cerner Health Conference starts November 2 along with NextGen’s One User Group Meeting. Las Vegas, San Antonio, Kansas City, Las Vegas. If you’re a best of breed CIO (and I can think of a few), you could really rack up some frequent flyer miles. If you’re attending any of them, we love to have reader feedback.

Got photos? Email me.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.



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October 9, 2014 News 1 Comment

Morning Headlines 10/9/14

October 8, 2014 Headlines No Comments

Concerned Groups to Congress: Act Now on FDASIA

58 organizations, including McKesson Corp., athenaHealth, and the US Chamber of Commerce, send a letter to Congress urging them to pass legislation to enact the health IT oversight framework that was proposed by FDASIA in April. Testing to Be Confidential will open for insurer testing this week, but insurers are being told by CMS that the process is confidential and that testing results may not be disclosed.

Robotic Surgery Brings Higher Costs, More Complications, Study Shows

Researchers from Columbia University publish a study exploring the use of robotic surgeries for ovary and ovarian cyst removal, concluding that robotic surgeries are more expensive and lead to more complications than regular minimally invasive surgery.

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October 8, 2014 Headlines No Comments

Readers Write: I-STOP May Be the Biggest Health IT Game-Changer of All

October 8, 2014 Readers Write No Comments

I-STOP May Be the Biggest Health IT Game-Changer of All
By Tony Schueth


Over the years, e-prescribing has needed and seen its share of enabling game-changers as it competes against the sub-minute it takes to write a paper prescription. But none may be bigger than the New York state law, I-STOP, that requires all prescriptions to be transmitted electronically by March 27, 2015.

More impactful than Meaningful Use, the Medicare Prescription, Drug Improvement and Modernization Act (MMA), or the Medicare Improvements for Patients and Providers Act (MIPPA)? Potentially yes, but not necessarily in a positive way or limited to e-prescribing

In August 2012, the governor of New York signed the Senate Bill 7637/Assembly Bill 10623: Internet System for Tracking Over-Prescribing (I-STOP) Act into law. At the time, New York’s Attorney General Eric Schneiderman said, “I-STOP will be a national model for smart, coordinated communication between healthcare providers and law enforcement to better serve patients, stop prescription drug trafficking, and provide treatment to those who need help.”

Unlike other states where it is optional, New York prescribers are required to check the New York State prescription drug monitoring program registry database before writing a prescription for any controlled substance. I-STOP has other provisions, as well, such as improving safeguards for distribution of prescription drugs prone to abuse; medical education courses, public awareness efforts; and establishment of an unused medication disposal program.

The State of New York obviously sees e-prescribing as part of a bolder effort to curb prescription drug abuse. Kudos to the state legislators for getting that. Electronic prescriptions flow through a secure, closed channel from prescriber to pharmacy. Each step of the process is electronically logged. It is unquestionably a vast improvement over paper in reducing fraud and impeding diversion.

A law of this magnitude from a bellwether state is impactful in many ways. Other states are surely watching and, should it be successful, will likely follow. But if it’s not successful, there will be implications, too.

The impact begins with pushing along the nascent effort of e-prescribing of controlled substances (EPCS). Although the DEA passed an interim final rule in 2010 permitting such an effort, its uptake has been slow. According to Surescripts, as of July 31, 570,000 EPCS prescriptions were transmitted via their network year to date. That puts EPCS adoption at far less than one percent since about 500 million of our 3.85 billion retail prescriptions are for controlled substances.

As a recent case study supports, the biggest challenge for EPCS is that physicians still don’t know that they can prescribe controlled substances electronically and pharmacists aren’t aware they can accept them in that manner. This lack of awareness keeps physicians and pharmacists – especially independents – from requesting such functionality from their vendors. As a result, too many EHR, e-prescribing, and pharmacy vendors assign a lower priority to EPCS with what little bandwidth they have outside of Meaningful Use, ICD-10, and NCPDP SCRIPT 10.6.

According to Surescripts, only 14 prescriber vendors are certified for EPCS. While those include three of the top five EHRs and the “ePrescribing inside” markets share leaders DrFirst and NewCrop, version issues, client factors, up-sell challenges, and other considerations mean that only a  small number of EHRs are EPCS-enabled.

Nationwide, the pharmacy side is not there yet, either. While the two largest chains are able to receive and process controlled prescriptions electronically, many of the smaller chains and independents are not. According to Surescripts, 31,000 of 67,000 pharmacy locations are enabled for EPCS.

After enhancing their products to meet the New York guidelines, however, both EHRs and pharmacy software vendors should find taking their EPCS solutions elsewhere to be less of a challenge.

All that said, nationwide, it will continue to be the classic, “Which comes first, the chicken or the egg?” situation. To get past that, it takes education and coordination, which are elements of I-STOP.

For the education component, I-STOP charged a workgroup of stakeholders and the Department of Health with responsibility to guide public awareness measures. Our EHR clients tell us they aren’t hearing from their New York customers, so are physicians in New York unaware of I-STOP? A simple Google search on I-STOP yields a few articles, most from when it launched. Hopefully, a huge campaign is planned.

The prescriber consequences are significant, especially for physicians. According to the New York Bureau of Narcotic Enforcement (BNE), non-compliance is punishable by a $2,000 fine, imprisonment not exceeding one year, or both. Furthermore, it is considered to be professional misconduct by the applicable professional boards, which could lead to suspension or revocation of professional licenses.

With government mandates, enforcement is always a question. People who know the BNE and New York’s Attorney General Office say they wouldn’t hesitate to enforce this, especially given the larger objective of curbing fraud and abuse. To be sure, I wouldn’t want to be the vendor that caused the $2,000 fine or any of the more serious consequences.

From a coordination perspective, there’s nothing like a mandate and deadline to get everyone on the same page. But the consequences are to the prescriber, not the pharmacy, and the EHR vendors just have to deal with upset clients.

So, how is it going? We don’t have the most up-to-date data about New York specifically. As of December 31, 2013, 62 percent of physicians in New York were routing prescriptions, according to Surescripts. While a lot can change in a year, 38 percent of physicians are not prescribing electronically, and as noted earlier, fewer than one percent are e-prescribing controlled substances nationally. Only one of the top two EHRs in New York is EPCS-certified through Surescripts, so the others have a lot of ground to cover by March 27, 2015.

What if large numbers miss the deadline? Issuing fines to that many prescribers will be a logistical — not to mention political — challenge. They could issue an ICD-10 or MU Stage 2-like extension or waivers. However, there’s a lot of frustration out there about those delays. New York issuing such outs or just not enforcing the law could further lessen the impact of all mandates, arguably making I-STOP the biggest game-changer ever, and not just for e-prescribing.

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

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October 8, 2014 Readers Write No Comments

Readers Write: A CIO’s Perspective on the Options for Health System Analytics

October 8, 2014 Readers Write 2 Comments

A CIO’s Perspective on the Options for Health System Analytics
By Gene Thomas


Buying an EMR is an important decision, but choosing an analytics solution is far more important. In today’s healthcare marketplace, installing an EMR is table stakes. Granted, it’s necessary and expensive table stakes, but it’s still just the starting point.

The real key to transforming healthcare performance lies in analytics and the humans that use and make data-driven decisions. An EMR captures the data. Analytics uses that data to deliver the insight needed to improve the quality and cost of care.

Improving quality and cost is on everyone’s mind. At the organization where I serve as CIO, Memorial Hospital at Gulfport in Mississippi, it is a critical priority. The majority of our volume comes from Medicare and Medicaid beneficiaries and the uninsured. We are a not-for-profit, single-hospital system. We have to focus on costs and quality in order to continue to serve our community.

Fortunately, we’re advancing steadily along the path of putting infrastructure in place to drive the necessary improvement. We rolled out our integrated EMR this spring and we are now implementing our analytics solution.

I started this article by stating how important analytics is. Choosing what type of analytics solution to implement was not a decision we took lightly. I want to outline here the factors we considered as we made that choice.

I wouldn’t say that selecting our EMR solution was easy, but the fact that there were only a handful of viable options certainly simplified the process. Choosing an analytics solution was a different story. A wide variety of analytics solutions are available and they all claim to drive quality and cost improvement. We looked at BI tools. We researched multiple vendors with point solutions that address areas like capitated payments, fee-for-quality, and ACOs.

Ultimately, we decided that the right solution for our enterprise-wide analytics strategy would be an enterprise data warehouse (EDW). But even then there were several possible paths to take. We could build our own EDW, we could adopt our EMR vendor’s emerging EDW solution, or we could implement an EDW solution from a third-party analytics specialist vendor.

We quickly dismissed the option of building it ourselves. We simply didn’t have the time or resources for a trial-and-error, homegrown approach. That left us to decide between our EMR vendor’s EDW and a specialist’s solution. We went with the specialist’s solution.

Our EMR vendor’s EDW was relatively inexpensive and there was something attractive about the convenience of having one less vendor to manage. Still, I approached their EDW offering with some skepticism. I trusted their ability to handle all of the transactional functionality that is an EMR vendor’s core competency, but analytics is not part of that core competency.

Ultimately, we set three criteria as essential in an vendor. Any analytics vendor we selected would have to demonstrate the following.

A significant track record with analytics

EMR vendors really don’t have an analytics track record. Their analytics experience lies mainly in tactical operational reporting. They can easily tell me how many of my patients are on a certain medication, but my improvement initiatives will require much greater sophistication.

Specialist vendors, on the other hand, have been living and breathing nothing but analytics for years (and sometimes even decades). The best ones can share concrete examples of how their solutions have driven measurable quality and cost improvement.

The agile data architecture required to handle big data

Our EMR vendor is obviously an expert on transactional systems architecture, but that doesn’t translate to expertise in architecting a powerful analytics solution that runs on a completely different type of database. With so much volatility in healthcare today, I wanted to be sure I had a flexible architecture for analytics that could expertly adapt to new rules, standards, vocabularies, and use cases.

The ability to integrate data from multiple systems, including competitors

This was a huge consideration for us. EMR vendors are generally unwilling or unable to pull data from external sources, particularly competitive systems. We needed a solution that was source-system neutral and only the third-party analytics specialists could deliver that. Integrating data from just about any system you can imagine is their core competency. My understanding is that some EMR vendors have recognized the need to allow integration of data from beyond the EMR, but they are years behind the specialists in terms of doing this well.

I recently came across a 2013 survey by CHIME that found that 80 percent of CIOs believe analytics is an important strategic goal, but that only 45 percent feel they have a handle on it. I don’t claim to be an expert on analytics, but I hope that this brief account of my experience so far will be helpful to some.

My biggest piece of advice to any colleague that has yet to tackle analytics is to get started as soon as possible. I believe that CIOs need to change. Our focus can’t be just on the bits, bytes, databases, and servers. All of that is still an important element of what we do, and I have a staff that takes care of those details, but my focus as CIO is to provide data and information to all stakeholders—our executives, our clinicians, our patients, and more—to help drive better outcomes. That means a top area of focus for me is on analytics.

Gene Thomas is chief information officer of Memorial Hospital in Gulfport, MS.

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October 8, 2014 Readers Write 2 Comments

Readers Write: Communicating Across the Continuum

October 8, 2014 Readers Write No Comments

Communicating Across the Continuum
By Steve Whitehurst


As consumerism continues to permeate the healthcare industry, hospitals must place more emphasis on how they treat their patients across the entire care continuum, inside and outside the four walls of their facility. To do this, patients must be addressed at every touch point in order to fully meet their needs and sustain their satisfaction.

Though increasingly important, many hospitals struggle with supporting patients’ 24/7 communication needs due to limited staff, reduced budgets, and unclear communication expectations. Yet without a communication plan in place, interacting with and keeping patients engaged and satisfied can be very difficult, thereby limiting a hospital’s ability to sustain an enhanced patient experience, increase patient satisfaction, keep patients compliant with their care plans, and build brand loyalty—not to mention it can potentially increasing the risk for readmission.

By creating a comprehensive communication strategy leveraging a mixture of communication services leveraging live operators and clinicians as well as automated technology platforms across the continuum, hospitals can effectively manage their interactions with patients inside and outside the facility’s walls to increase both care quality and patient experience.

With Meaningful Use incentives and other regulations driving the implementation of patient portals, many healthcare organizations are pouring resources into electronic communication platforms that use email or direct messaging to communicate with patients. Although these methods certainly improve engagement, they are not always effective at reaching all patients or providing personalized attention.

For instance, most patient portals are capable of delivering educational material to patients. However, there’s no way of knowing whether the patient actually reads and understands the information unless someone directly asks and engages the patient in conversation. Whether face-to-face or over the phone, once personal interactions are lost, the organization loses its ability to make sure patients are adhering to their medications and complying with their care plans.

Conversely, hospitals that employ high-touch communication strategies, such as the following, can engage patients across the continuum to promote more favorable outcomes, in addition to realizing measurable improvements in patient satisfaction and HCAHPS scores.

  • Live voice follow-up after discharge. One of the most effective methods for reaching patients, this communication tactic enables organizations to know when they’ve reached patients and provide personalized communication to their patients by asking and answering questions, ensuring patients are adhering to their medication and care plans, and providing additional education. Statistics show that patient satisfaction improves when communication services like live voice are leveraged at specific touch points in a patient’s care continuum.
  • Communication to support care coordination. For patients with complex conditions, multiple comorbidities, or who are high-risk for readmission, communication services can improve care coordination by going beyond discharge follow-up to help patients navigate their care plans. These services, for instance, can help patients with medication management (including medication reconciliation and adherence), disease management, and health coaching. As an example, when patients are prescribed new medications or receive changes to previous prescriptions, it can be difficult to figure out which medications should be taken, when they should be taken, and specific side effects to look for. Care coordination follow-up support can help patients navigate these questions, ensuring they take medications in the most appropriate way. Likewise, these services can also identify barriers patients may have in obtaining or taking their medications and offer solutions to help with adherence.
  • Answering services. Inbound services that receive calls from patients provide opportunities for healthcare organizations to address questions or concerns immediately rather than waiting for providers to return phone calls. When these services are managed by highly trained teams qualified to listen to and answer patient concerns, it allows organizations to meet patients’ needs more efficiently in a timely manner, thus increasing patient satisfaction levels.
  • Automated services. Although live voice interactions are most effective for facilitating conversations between patients and providers, automated services can be useful for routine patient outreach, such as reminding patients to schedule and attend upcoming appointments or refill prescriptions. By leveraging automated services in appropriate situations, organizations can concentrate their human resources on more meaningful interactions with patients.

Whether managed in-house or outsourced, a comprehensive communications plan will enable hospitals to continue the patient-provider conversation long after patients leave the facility, enhancing their experience throughout the entire care continuum.

Steve Whitehurst is the vice president and general manager of Stericycle Communication Solutions.

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Morning Headlines 10/8/14

October 7, 2014 Headlines 1 Comment

Payment Adjustments & Hardship Exceptions

CMS announces that it will reopen the submission period for hardship exception applications for both eligible professionals and eligible hospitals, with a new application deadline set for November 30.

John Flannery to Lead GE Healthcare

GE Healthcare CEO John Dineen  announces his resignation, effective immediately.  He is reportedly leaving the company to pursue leadership opportunities outside GE. Dineen will re replaced by John Flannery, GE’s current head of business development.

Ochsner Health System First Epic Client to Fully Integrate with Apple HealthKit

Ochsner Health System (LA) announces that it has connected its Epic EHR with Apple’s HealthKit to capture daily weight readings from wireless scales that are issued to heart failure patients enrolled in the health system’s remote patient monitoring program.

Health Care Website Fix Cost Mass. Additional $26M, Patrick Says

Massachusetts Governor Deval Patrick announces that the state’s health insurance exchange is fixed, costing $26 million to repair and bringing the total cost of the exchange to $254 million.

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October 7, 2014 Headlines 1 Comment

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Reader Comments

  • mike: re: journal articles behind paywalls -- I've had some success in finding such articles using the google scholar search e...
  • Joe Heyman: I think MU has accomplished as much as it can. I think now that additional requirements are just causing physicians in ...
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