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News 3/12/14

March 11, 2014 News 6 Comments

Top News

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The HIT Policy Committee submits its Meaningful Use Workgroup’s Stage 3 recommendations.


Reader Comments

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From Pointy Toes: “Re: CEHRT Hardship Exception Guidance. This is a joke. All you have to say to qualify for the Medicare hardship exemption to avoid the 2015 payment adjustment is say you  had ‘2014 Vendor Issues.’ Tavenner previously said some ‘narrow’ hardship exemptions would be granted. Sounds like anyone wanting an exemption can request it and presumably one will be granted one. Why not just push the deadline back for everyone instead of requiring providers to jump through an extra hoop?” CMS issued guidance Tuesday for EPs and hospitals worried about being hit with penalties, even going so far as to provide instructions to choose “2014 Vendor Issues” no matter what their actual issue. It is ridiculous – setting the bar high officially, then accepting a wink-wink rubber stamp excuse for anyone who can’t make it. Maybe someone should track the vendors whose non-compliant yet certified products forced their users to claim hardship.

From Canuck: “Re: rumore that UHN in Toronto is replacing QuadraMed EHR with Cerner. I believe instead it came down to Cerner and Epic and Epic won.” Unverified.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor SyTrue. The Chico, CA-based company offers a business and clinical intelligence platform that tells hospitals how their clinical objectives are being deployed; what physicians are doing; and who in the market is providing services at a given cost and outcome. It integrates and structures disparate EHR information for predictive and clinical analytics used for data analysis, electronic abstraction, outcomes analytics, operations, population management, clinical research, and patient engagement. Thanks to SyTrue for supporting HIStalk.

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Here’s one final mug shot featuring Tammi’s office de-stresser, which must have traveled furthest from Orlando while still not leaving the continental US (the UFO on a stick in the background should give a strong hint of her location).

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Thanks to the 355 folks who have completed my reader survey so far. That number provides respondents with good odds of being randomly drawn for one of three $50 Amazon gift cards, but represents only around 1 percent of HIStalk’s 30,000+ readers. Spend less than five minutes completing the survey and you’ll help me plan the next year of HIStalk and earn my appreciation besides.

I’m always looking for interesting people to interview. Know someone who would be stimulating, fun, and a straight shooter? Let me know.


Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.


Acquisitions, Funding, Business, and Stock

First-half results from Scotland-based Craneware: revenue up five percent, pre-tax profit up seven percent.

CompuGroup Medical acquires three European HIT providers: lab software provider vision4health Laufenberg & Co and office-based physician software vendors Imagine Editions and Imagine Assistance.

Quest Diagnostics completes its acquisition of Solstas Lab Partners Group and raises its full-year 2014 financial guidance.

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Employer benefits platform provider Castlight Health raises the price range of its IPO to $13-15 per share, up from the $9-11 range it set just a week ago. The company, which lost $62 million on $13 million of revenue in 2013, would receive proceeds of $140 million, valuing it at $1.5 billion. The company’s founders are Todd Park (US CTO and co-founder of athenahealth); Bryan Roberts, PhD (chairman and co-founder of venture capital firm Venrock); and Giovanni Colella, MD (founder of RelayHealth).

 


Sales

The Royal Free London NHS Foundation Trust selects OpenText to manage its scanned legacy case notes.

The Community of Hope (DC) is implementing Forward Health Group’s PopulationManager and The Guideline Advantage.

The VA awards Leidos three contracts worth $16 million to support blood bank software and the MyHealtheVet program.


People

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TeleTracking Technologies names Diane Watson (Tilt, Inc.) COO and Joseph Tetzlaff (inVentiv Health) CTO.

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Michael Hart is promoted to VP of IT applications at Arkansas Children’s Hospital.

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Craig Joseph, MD (Agnesian HealthCare) is named ICD-10 and EHR physician advisor at Texas Children’s Hospital (TX).


Announcements and Implementations

Cox Health (MO) deploys Phytel’s population health and patient engagement platform.

McKesson announces QICS for Cardiology, a CVIS-based workflow and critical results communications platform. OSF Healthcare (IL) is piloting.

QuadraMed announces GA of its QCPR 6.0 enterprise EHR, which includes bar code medication administration, a comprehensive problem list, a Web-based patient portal, the ability to create a CCD, and Canada-specific architecture requirements.

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In Canada, Bluewater Health will roll out patient flow software from Oculys.

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University of Colorado Physicians goes live on the DocASAP self-scheduling system.


Government and Politics

Office of Civil Rights fines the public health department of Skagit County, WA $215,000 for HIPAA violations involving information on 1,581 people exposed in its public web server, the first time a HIPAA fine has been levied against a local government.

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The White House launches #GeeksGetCovered, encouraging technology entrepreneurs who can now buy their own non-employer health insurance because of the Affordable Care Act to start their own businesses.

President Obama riffs hilariously with comedian Zach Galifianakis, appearing on “Between Two Ferns” to plug Healthcare.gov (“I wouldn’t be with you here today if I didn’t have something to plug … Healthcare.gov works great now.”)

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The phrase “healthcare exchange” always seems to be preceded by “troubled,” so add Maryland’s $200 million version to the list.  Like other states, it decided to create its own site, hired a contractor that it later said underperformed, missed its go-live date, and had to create a backup plan to accommodate people who wanted to enroll but couldn’t. HHS announces that it will investigate.

Hillary Clinton’s financial disclosure forms for 2012 reveal that her husband Bill took a $225,000 speaking fee from the struggling, non-profit Washington Hospital Center as it was laying off employees. The hospital also brought in George W. Bush to speak, but since his wife isn’t running for office, his fee remains confidential. Bill made a bunch of money in 2012 for addressing money-losing non-profits. Somewhere in those records is the payment he received from HIMSS if anyone knows how to locate them. I’d bet $400K.


Innovation and Research

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A NIST report says that inadequate workflow integration forces users of ambulatory EHRs to develop system workarounds, suggesting that EHR vendors develop these capabilities:

  • At-a-glance physician views of patient schedules
  • Task reminders from previous patient visits
  • Redacting and summarizing lab results
  • Draft creation of patients orders in advance
  • Conversion of working diagnoses to formal diagnoses
  • Skip or defer tasks when workload requires
  • Role-based views of progress notes
  • Visually differentiate copied-and-pasted progress note text from newly entered documentation
  • Manage referral and consultation messages with specialists
  • Track scheduled consults and lab results review

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The Charlotte, NC newspaper says that Carolinas HealthCare System will use innovative (unnamed) software and the information collected by its multiple EMR systems to identify ED patients who are likely to be readmitted, allowing team-based intervention and remote management. The system’s chief medical officer weighs in on hospitals that don’t use electronic medical records: “You don’t know how bad it is until you actually go back. It was like a time warp. The care is unsafe, it’s uncoordinated. It’s a nightmare…The system was absolutely stupid, and frightening.” I interviewed SVP/CIO Craig Richardville in September 2013. It might be time for a follow-up to talk about analytics.


Technology

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Wellocracy provides a well done comparison chart of wearable activity trackers.


Other

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A column by InfoWorld’s executor editor says a disconnect exists between complex government EHR requirements and the stubbornness of the healthcare industry to embrace them, summarizing, “We have a mess of proprietary EHR systems with highly customized processes, a set of HIEs that use different standards and protocols to connect them, and a mandate to provide human-readable data from these disparate systems. What could possibly go right?”

In England, University Hospital of North Staffordshire plans to conduct video consultations via Skype, saying the service will reduce outpatient appointments by 35 percent.

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The Gainesville, FL newspaper profiles Shadow Health, whose founder licensed avatar technology from the University of Florida to create nursing school education tools that students buy for $89.

A study finds that incorrectly flagging patients as being allergic to penicillin increases overall inpatient days by 10 percent and increases resistance to broad-spectrum antibiotics. Up to 95 percent of patients who say they are allergic to penicillin really aren’t.

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New York-Presbyterian Hospital will host a hospital hackathon this weekend in which teams will design apps for its portal that improve patient access to care. The hospital is offering $85,000 in prizes and has filled all of its slots with 120 participants. Dr. Oz provides the video introduction.


Sponsor Updates

  • Kinetic Data names CareTech Solutions “Innovator of the Year” for realizing $4.7 million in cost savings by implementing Kinetic Request.
  • Premier enhances its OperationsAdvisor labor management solution to give healthcare organizations the ability to analyze labor efficiency across multiple care settings.
  • Ryan Uteg, senior advisor for Impact Advisors, is named to Consulting Magazine’s “35 Under 35.”
  • Allscripts Sunrise is selected by Black Book as top inpatient EHR.
  • Iatric Systems will deploy integration in the EDIS and vital sign monitors as Southeast Alabama Medical Center (AL) upgrades its McKesson Paragon HIS.
  • MedAssets’ National Sourcing Collaborative cumulatively saves providers $135 million over the last three years.
  • Wolters Kluwer Health launches Bates’ Visual Guide demonstrating evidence-based physical exam techniques.
  • Santa Rosa Consulting’s Fred L. Brown is inducted into Modern Healthcare’s “Health Care Hall of Fame 2014.”
  • Kareo announces that its ICD-10 Success Checklist is available on a write-on poster.
  • NextGen Healthcare’s CMO Sarah Corley is elected to serve on the EHR Association Executive Committee.
  • Medical Economics spotlights e-MDs customer John Bender, MD of Miramont Family Medicine (CO) for expanding his practice while 30 percent of local practices have sold or closed.
  • Health Catalyst publishes a free white paper with a candid 12-point review of population health management software vendors.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

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March 11, 2014 News 6 Comments

Morning Headlines 3/11/14

March 10, 2014 Headlines No Comments

GOP senators want specifics on hardship exemptions

Six Republican senators are calling on CMS to provide more details on its plan to grant healthcare providers more lenient hardship exemptions for Stage 2 Meaningful Use.

Coroner blames "failure" of NHS computer system for boy’s death

In England, a coroner at Royal United Hospital blames a new outpatient scheduling system in his report after a three-year-old boy passes away because he missed months of appointments booked to monitor a heart condition. The appointments were properly scheduled but were lost when the hospital migrated its scheduling data to the new system.

County Government Settles Potential HIPAA Violations

The HHS Office of Civil Rights settles a HIPAA violation with Skagit County, WA for $215,000. The case marks the first time that the OCR has targeted a county government.

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March 10, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 3/10/14

March 10, 2014 Dr. Jayne 13 Comments

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This week was the beginning of what I suspect will be a long and painful project at work. If I wanted to deal with mergers and acquisitions, I would have gone to business school. Instead, I went into medical school, but nevertheless here I am.

Like so many other health systems across the US, mine has been in growth mode. We were accelerating the growth of our employed medical group going back as far as 2008. The push towards more tightly integrated delivery systems has only added fuel to the fire.

We had previously been purchasing groups in the three- to 10-physician practice space, with a couple of outliers that had 15 or so physicians. Now we’ve gone and purchased a 75-physician group. I’m sure it looked great to the hospitals as a way to further consolidate their referral bases. It was also a grab for the revenue that the new group’s imaging division was bringing in on the side.

I had the opportunity to speak with a few of their physician leaders in a couple of weeks ago. My ears perked up when they mentioned one upside of being part of our health system as “better support with IT projects including Meaningful Use and PQRS.”

Red lights started flashing in my head and alarms were going off. Thinking that PQRS or Meaningful Use are “IT projects” is like thinking that a heart/lung transplant is a “plumbing project.”

I immediately scheduled a series of meetings with their leadership and IT teams and our counterparts to figure out what had been promised by the C-suite and how we were going to deliver it. It’s bad enough to have to deal with a culture shift, but when technology and millions of dollars in incentives are involved, the problem is magnified. Our C-suite has a track record of promising technology projects that they can’t deliver (such as a complete EHR conversion in 30 days) so we quickly formed a betting pool to entertain just how bad this might get.

One of the reasons they get us into these kinds of binds is they’re afraid to involve too many people in the acquisitions. They fear that other physicians will get word of them and become demanding or that there will be a loss of bargaining power if it’s public too early. I understand that, but I also understand the need to do due diligence around merging or converting IT systems before the promises are made and the papers are signed.

Every once in a while, one of the VPs will ask someone from IT to “look under the hood” at an acquisition target, but it’s usually more along the lines of valuing their hardware, calculating their maintenance, and figuring out how to connect them to the hospital backbone than it is to assessing the quality of their data and how well their workflows and care gel with our existing best practices.

Unfortunately, the ink was already dry before I knew about it. Our group president made some assumptions that since our target was on the same EHR as we are that it should be fairly easy to just “throw them on our system and have them attest with our docs.” Oh, so much easier said then done, my friend. When I started throwing out reasons why it doesn’t really work that way, he actually referred to me as Debbie Downer and reminded me that we have to make it work because we already said we would.

I can’t believe that’s what passes for leadership these days, but our health system seems to love this guy. He’s personable and kind of a teddy bear, but he’s generally all fluff and no stuff, which leaves the rest of us to scramble around behind him to try to make things work.

This week began the series of meetings to try to figure out how to deliver the impossible. We now have two installations of the EHR to deal with. Their group has a lot of primary care docs that refer to our specialists. Given the number of common patients between the platforms, I’m not confident of being able to do a clean conversion without a lot of data integrity issues and a substantial commitment for clinical cleanup even if we had a nice long time interval. That’s problem number one.

Problem number two is that both installations have to take a major upgrade before we start the attestation period for Meaningful Use on July 1. Leadership assumed we could combine the systems quickly and do a single upgrade, but in addition to the patient issue, we also have a fair amount of customization and client-specific configuration on each system that will have to be evaluated. We can’t just throw it all away and assume physicians will be immediately facile on a plain vanilla system.

We also have the issue that at least 40 of their providers are going to be attesting for MU the first time. That means that not only do we have to get their upgrade live early enough prior to July 1 that the users have enough time to burn in the new workflows and make sure they’re entering quality data, but we need to plan to have our MU and auditing teams work around the clock at the end of the quarter so we can attest for them by the deadline. Problem number three.

Let’s see, the end of that quarter also puts us at October 1, which is ICD-10 go-time. That makes problem number four.

Let’s back up a little, though. If they’re such a solid, established group, I wonder why more than half of them are just now going after MU Stage 1? That was the topic of Wednesday’s half-day working session, when I really dug into the fact that they think MU, PQRS, and other quality initiatives are IT projects. That’s when I came up with problem number five, which unfortunately is the biggest one of all. The reason they haven’t attested yet is they’ve been attempting to have IT lead all these projects without adequate operational and clinical support.

They seriously think that there is some kind of magical IT wand that will be waved around and the physicians will do what they are asked along with all the support staff. They have zero physician alignment strategy. Physicians have no financial skin in the game for MU or any of the other incentive programs. They don’t even have a standard physician contract. All the physicians have been able to negotiate their own deals even those in the same physical location. That makes it a little tricky when partners are able to earn the same income seeing dramatically different numbers of patients per month.

The IT team listed off more than a dozen resentful bitter physician disagreements without even taking a breath. At least all of our physicians were migrated to a common contract in tandem with our EHR project more than half a decade ago because we realized only money would align them with our goals. These folks (including the one operations person that bothered to show up at the meeting) acted like they have never heard such a thing.

Their staffing ratios are also a mess. Everyone has the same number of support staff regardless of specialty, productivity, or how they run their offices. There is no common scheduling methodology across their locations, which adds another worry of how we’ll do an appointment conversion if we decide to do one when we move them to our database. No wonder they were ripe for the picking — they were undoubtedly losing money with how they were running. By the end of the meeting, I was scarfing down Advil like they were the green M&Ms in Inga’s Quipstar dressing room at HIMSS.

I spent most of Friday with my trusted lieutenants trying to figure out how we’re going to do this and still preserve our sanity and keep our team intact. After looking at all the pros and cons, I think I’m going to be lucky to make it through the next two quarters without losing my own mind or quitting my job. My liver can’t take as many martinis as I think I’ll need to get through the inevitable goat rodeo this will become, so I figured it was time to find a less-harmful way to self-medicate.

My drug of choice: pastry. This week’s offering is pictured at top. I’m a big fan of doing things old-school so I can let out my stress cutting the butter into the flour by hand as I pursue the perfect crust. I can release my creative energies by trying different fillings. If I really need to escape, I can do decorative top crusts or make little designs with dough cutouts.

I may not be able to make this project work, but I’m armed and dangerous where an egg wash is concerned. I’m going to go all Martha Stewart in my free time, just without the insider trading or the prison term.

Got a recommendation for pastry therapy? Email me.

Email Dr. Jayne.

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March 10, 2014 Dr. Jayne 13 Comments

HIStalk Interviews Regina Holliday, Patient Advocate

March 10, 2014 Interviews 11 Comments

Regina Holliday is a Washington, DC-based patient advocate and artist known for painting a series of murals depicting the need for clarity and transparency in medical records. After her husband’s death from kidney cancer in 2009, she painted "73 Cents," a mural showing her husband dying in darkness surrounded by inaccessible technological tools in a closed data loop. The title refers to the cost per page charged to patients to obtain their medical records in the state of Maryland.

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Give me some background about what you do and what The Walking Gallery is.

Almost five years ago, my husband had cancer. He was in the hospital for 11 weeks. We had very little access to his electronic medical record. He died in the 12th week. I  decided I would do everything in my power — speaking, painting, writing — to try to change healthcare and make it become where the patient’s story is front and center, and within hospitals, you can get to your medical record in real time.

That’s why I paint giant murals and that’s why I started a movement called The Walking Gallery, where people have paintings on the back of their business suit jackets and the goal of the patient’s story is front and center.

 

You just spoke at the HIMSS conference. Did you leave it feeling that patient engagement and advocacy are really taking hold or is it just a few folks hoping that it is while the rest are indifferent?

I’ve spoken now at several different informatics societies. I’ve been excited to see how much HIMSS is embracing patient advocacy in a real way. It doesn’t seem to be token and it’s growing every year, which is real exciting to see. I’m sure it’s incredibly frightening for them to watch it take off.

 

HIMSS tries to serve two factions, high-paying vendors who want to sell products and providers who are their prospects and users. But usually absent from those discussion are the patients all of that technology affects.

Before I worked in healthcare, I came from the toy industry. I’m very familiar with Toy Fair, which is gigantic trade show. There’s a lot of similarities, because just like in that world, you’re focused on sales, high-dollar items, and what’s going to move that year. But you’re also really focused on the fact that your customers are children. There’s this wonderful, youthful spontaneity to that product line, the concept of selling toys.

In healthcare, we have somewhat distanced ourselves from the end user, which is patients. I’ve been wanting to see the realization come back that when you’re a vendor, when you’re a provider, whoever you are at HIMSS, inside of you, you are a patient. It’s been really exciting to see people flip and relate to themselves as their patient self before they relate to themselves as their vendor-provider self.

 

Will patients ever have that kind of power where they’re like a customer in any other industry?

Yes. It’s coming. The beautiful thing that happened to medicine was social media. The ability for patients, regular folks who have no organization behind them, to have an equal voice to a company.

While I was at HIMSS, they had trouble getting my hotel room. I was tweeting about it, and within less than two hours, I was talking to Hilton, the national channel. Later that day, I was talking to Hyatt, the national channel. That kind of power didn’t exist before — the ability as an individual to communicate with large organizations. It’s changing everything.

 

Do you think that’s really the case? At Hilton or Hyatt, you’re paying the bill, and if you’re unhappy, you stop using them. But in healthcare, you don’t necessarily get to choose where you receive your care or control what you pay for …

I disagree with that. The model of care is rapidly changing. With the Affordable Care Act and a lot of consumers becoming high-deductible plan payers, they’re determining where they’re getting their care. The ability to make choices about where you’re going to get your care affects the bottom line in institutions. With things like HCAHPS scores, patient satisfaction scores, now being publically available, with transparency in pricing becoming more and more demanded, you have an end-user consumer that’s actually becoming very empowered.

 

What do you see as the impact of the Affordable Care Act?

Major major groundswell change. People becoming very interested in the fact they have choices in policies. 2008 really hurt a lot of this country. People were wedded to a location, a job, and insurance that came with that job. Which meant that, unfortunately, a lot of people who should have been able to move so they could economically better themselves found themselves not in a position to do so.

Affordable Care Act comes on the stage. Now all of a sudden we are getting the ability to untangle our health life from our job life. That allows for a whole bunch of people to work at different organizations, start new businesses, go the freelance, self-employed contractor route when they thought they couldn’t do that before because they couldn’t get insured. That allows us to have a looser economy.

Honestly, when it comes to Americans, we are spectacular at innovation and creativity. Those things are squashed if you’re forced to stay in a job that you don’t want to be in any more. For a long time, the way we set up our insurance in this country, you were forced in that position.

 

Inpatient demand is dropping, so hospitals are using their money and clout to buy physician practices to shore up their protected markets. Will they be able to end run the trend that would place them less at the center of the healthcare universe?

Not if we do a really good job with transparency exposure in social media. You’re opening people up to what’s really going on and then make different decisions. Also, we need to get in the world view wonderful facilities that are the future of healthcare.

I just toured Eskenazi Health in Indianapolis. It’s a safety net public hospital. It’s astounding. They get it. They get where the future’s heading, which is a health and wellness hub where the community is still going to the hospital, but they’re not going to the hospital for the same reasons they used to go.

Hospitals that get it, that see the future as the way it is coming, are going to succeed. The hospitals who don’t get it, there’s a really good chance they’re going to go down.

 

It’s rare anything takes root in healthcare unless someone makes money from it. The right thing to do doesn’t always win. Does patient involvement have a strong business case?

Yes. We in the past have not looked at the potential the facility has. We were all about, “Fill the beds, fill the beds.” That’s not necessarily the future way people are going. 

Videoconferencing, mobile technologies, people wanting to have a health community. Patient communities are really, really skyrocketing. You have to think in a different way. It’s more of like a library hub direction with wellness activities and physical activities. Why can’t there be sick child care? I was in Lawrence, Kansas back when they were doing that back in the 1990s.

There’s different ways that you can make money that are wonderful, legitimate ways to make money that actually helps citizens, as opposed to the system that we’ve had that were incentives for failure. There were incentives for person getting an infection and staying longer. We have to flip that matrix to where healthiness is the incentive.

 

Putting patients at the center of healthcare is, unfortunately, a big change. For those overwhelmed by the long-term vision, what would be some short-term goals you would settle for?

I often look at the intersection of health and art. That’s one of my focuses. We need way, way more realistic visuals of care. Less stock photography, more painting. More involving regular people into the life of your hospital. 

I would like to see patients — not just a patient advisory council at hospitals, which a lot of them have — on every board and council throughout the entire facility. I’m talking like EMR workflows as well as M&M reports. We need to be part of the conversation. Because what is absolutely beautiful if you do this is that patients can say things that staff can’t. Staff may be thinking it, but politically they’re put in a position where they can’t say it. Their job can be affected. We don’t want to rock the boat. 

Patients, not in a bad way, can say the words, since we’re not hired by the institution, that everybody might be thinking but don’t feel the power to say. Once we’ve said it, all of a sudden things break open. Doors break open and pathways change. 

One of the major things I would love to see is truly embracing us as part of the team. Not a token. Don’t have us design your lobby again. But really, seriously involve us in decision-making processes and get our feedback. That’s a great short-term goal, very doable by next week.

 

What do you think would happen if you bought a random patient a HIMSS conference badge and said, “Tell me what you think about what you saw there?”

I think that would rock. We should totally do that next year. Let’s have a scholarship fund. We’ll call it the HIStalk Scholarship Fund. We will just take random people and send them to HIMSS. Let’s do it.

 

I think they would not only feel uncomfortable there, they might actually be angry to see all the machinations that go on behind the scenes that affects them but doesn’t involve them. 

I think you’re right. There’s some people who would be very freaked out. I would recommend a cross section throughout the United States. Since I speak nationally, I do find there’s major regional differences in the way people talk to folks, strangers in crowds and things like that. If we had a good cross section — West Coast, Midwest, South, East — attend HIMSS, that would be spectacular. Since it’s in Chicago this coming year, it can be an entire concept since that’s the middle of the country. I would totally be behind you on that.

 

Did you see any technology in the exhibit hall that excites you in being able to allow patients to get more involved in their care and see their own information?

This year I felt HIMSS wasn’t showing a lot of new product. I thought HIMSS was truly embracing the stuff they were introducing as new products a few years ago. Now mobile health wasn’t like this weird new thing of will it work, but pretty much an accepted reality, which that was really great to see.

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I don’t know if you saw my painting, HIMSS and HERS, that I painted at the event. I was still frustrated by the way larger demographic that is male than female at HIMSS. I even went by a booth where the women were complaining about their heels. I said, “Why don’t you just wear sensible shoes?” They were like, “Well, you know, we have to wear nice clothes because somebody could come to the booth and see us not dressed appropriately.” Whoa, is this the 1950s? Do you really think you have to be a booth babe when you’re just as competent at technology as all these guys that are in the space?

 

I heard that HIMSS had some resistance to bringing you this year because of cost even though they’ve helped you out in years past.

Well, they invited me to attend. They said they had no funding for travel or lodging.

 

You’re self-funded, right?

Yes. I don’t have an organization behind me. I started a Gittip fund, a crowdsourcing, sustaining model which is pretty cool. I was very excited. I had never seen that before. To help pay for me being at HIMSS. 

Between my babysitting fees and going there, I spent close to a thousand dollars just getting there. As patients, we aren’t being paid back by our business to be there because there isn’t one. It is one of those things that can be a hardship. That’s why I was really excited to see Chicago’s coming up, because at least it’s in the middle of the country and it’s easier to fly there so it’s not so much of a hardship to be part of the experience.

 

Not that your role wasn’t substantial this year because they at least did put you on the patient engagement stage, but what do you see as your involvement next time?

Hmm. I’d love to be on a main stage. That would totally be great. That hasn’t happened yet. My goal is one day to keynote at HIMSS. I’m sure it will happen. It’s just a matter of time.

 

How did you feel that the opening keynote, the most important speaking slot at HIMSS, went to an insurance company CEO?

It was sort of an odd choice. I think it might have been partially because of the Affordable Care Act kind of year. They thought that talking to someone from the industry, especially the insurance industry, would make a lot of sense in this timeframe.

I tend not to judge necessarily so much where a person comes from, what business they come from, but whether they are they an amazing speaker. Do they get the space and do they inspire people? I was really excited when Eric Topol’s keynote last year because he gets it. He understands the space. He understands how to inspire.

When people come to a convention or a conference, they’re not just coming there for the most current information and to get the good vendor deals. Those are really important things. But they’re also going there to recharge, to have the energy to go into next year and be better than they were the year before.

At times, it seems that HIMSS has lost sight of this. Why don’t we just stay home? We can get good deals from home. We go to an event to network with people and to recharge our soul. I look forward to embracing that more deeply in the future.

 

What would you say to healthcare software vendors?

I want you to think of your parent in that bed or your child or your wife or your husband when you’re designing software. I want you to think of them. Because every single thing you do should be to make sure they get the best possible care. God, I hope you get to that point before it happens in your very own life. If I can do anything or say anything to get you to emotionally that point where you’re thinking about them while you’re designing, then I’ve done my job.

 

An article called you the Rosa Parks of healthcare.

Because I’m a regular person. I was a teacher, a special needs mom, and a wife. I worked in a toy store for 16 years. I was normal. I decided that as a normal, regular person, I’m going to stand up to injustice. That’s what Rosa Parks did. I didn’t come from healthcare, but I will do everything I can to make it better for folks who live within it.

 

What are your thoughts for the future?

One of my major goals is that when we get to Stage 3 of Meaningful Use, we have real-time access to the medical record – nurses’ notes, progress notes, doctors’ progress notes, all labs, all information. That should be available to the hospitalized patient just as much as the discharged patient because the hospitalized patient is spending the most money and they need that information in the most timely fashion. That’s my overarching goal and everything I do is toward that overarching goal.

 

Any concluding thoughts?

This has been absolutely delightful. I look forward to us putting together the HIStalk Scholarship Fund for next year.

 

That would be fun. Unfortunately, it’s become somewhat predictable in how conferences handle patients on the podium. The person tells a moving, compelling story about a something bad that happened to them, everybody in the audience feels embarrassed and gives them a standing ovation, then they just wipe the tear from their eye and go  back to what they were doing before that allowed the problem to occur. The emotional tug is there, but nobody can figure out how turn it into something useful.

Years ago, I was a motivational speaker before lunch at a CMIO boot camp. They said, would you like to stay for lunch? I said yes, I’d love to stay for lunch, so I ate lunch with them. Then they said, now we’re going to go into our work sessions and there was that quiet pause moment. I said, can I go to the work session, too? They said, uh, well, yes, it’s going to be very technical, but you’re welcome to come. 

I sat in this giant hall with 40 CMIOs. They were talking about a specific vendor system that I had actually seen. I had gone to the company and seen it person. They were talking about problems with files where they didn’t know who the person was, like recognition of the correct patient. I said, I’m confused, you’re using so-and-so’s system and I know they have the ability to have a visual avatar. Every field can have a picture of the patient right there on the field. Why are you having this problem?

They said, no, it doesn’t, it doesn’t have that feature. I said, yes it does. The only way it doesn’t have it at your hospitals is that somebody turned it off. Everyone’s head turned to the front of the room where the man was standing in the front who’d been speaking and was in charge of these all of these facilities. He said, yeah, I just turned it off because I thought nobody would want that. 

What was so cool about that moment was that I may have been the motivational speaker of the morning, but I had information to give those individuals that they didn’t have prior to that. That’s the beauty of involving patients. They can often be that little hinge pin that can change things.

 

Did you ever consider developing a checklist of how to make an EMR more patient friendly?

We’ve talked within the Society for Participatory Medicine about concepts like that. I don’t think there’s a uniform thing yet, but it’s definitely something to put on the list of things we need to do.

There’s things about standardization at work and then there’s some things that don’t work regionally, so you want to have an overarching checklist that you can work with. But the really thing that’s important to remember is every institution works a tiny little bit differently. It’s important to catch their unique differences. That’s one of the things that overarching standards often miss.

 

What do you think about the Open Notes project?

Love it! I was on Twitter back in 2010 complaining about not having open doctor’s notes when the Robert Wood Johnson foundation tweeted to me. I was like, what are you doing? They said, we’re just holding. We’re doing this amazing study. Watch what we’re doing for the next two years. And I did. 

I was so excited at the 2012 press conference when they talked about it. I was there. It was really exciting to paint about it and talk about it. I went to Tom Delbanco and was like, you know, your whole concept made me think of the open note within music, the whole note, the patient is everything, it’s part of the communication with the provider. And Tom Delbanco said you know, it really is that. I’m a musician. The whole concept behind Open Notes was a musical note.

Isn’t that beautiful? It’s one of those things that’s the idea of all of us as provider and patient working together in the totality of ourselves.

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March 10, 2014 Interviews 11 Comments

Morning Headlines 3/10/14

March 9, 2014 Headlines No Comments

M*Modal Preparing to File for Bankruptcy

M*Modal will file for bankruptcy in the next two weeks in order to restructure its $750 million in debt.

Inside the Making of Obamacare

White House special adviser on health policy, Ezekiel Emanuel publishes a recap of the major political hurdles the Affordable Care Act had to jump on its way to becoming a law. One major issue he cites was with Medicare officials who pushed back on payment reform because it claimed that it did not have the computer infrastructure to support bundle payments.

Bain, Lemhi Seeking Buyer for Health-Care IT Company Ability Network

The PE firm that owns Ability Network Inc. is shopping the company around for a rumored $500 million. Ability provides web-based CMS claims processing.

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March 9, 2014 Headlines No Comments

Monday Morning Update 3/10/14

March 9, 2014 News 4 Comments

Top News

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The Wall Street Journal reports that transcription and speech recognition software vendor MModal will file bankruptcy this week, loaded with $750 million in debt as a result of its leveraged buyout in August 2012 and facing declining sales. The company expects to work out a debt restructuring plan in advance that will allow some of its creditors to swap the money they are owed for equity in the reorganized company. UPDATE: MModal provided this statement in response to the HIStalk news item:

MModal is continuing discussions with certain of its lenders and bondholders regarding a range of financial restructuring options to enable the company to reduce its debt and enhance its financial flexibility. We believe these discussions have been constructive and we are working towards a resolution that has the support of our lenders which would provide a positive outcome for all of our stakeholders, including our customers, employees, and suppliers. We fully expect to continue operating in the ordinary course of business and providing our customers the high level of support they have come to expect from MModal. The company has solid revenue, strong operating margins, cash flows consistent with industry norms, a large customer base, and we are continuing to invest in the future. Our operations are strong and we are generating exceptional quality metrics and high customer satisfaction. We are executing on our vision to provide the healthcare industry’s most advanced clinical documentation solutions.


Reader Comments

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From Caterwaul: “Re: readers during HIMSS. How many do you get?” Around 8,000 visits daily during the conference, peaking this year at 9,000 visits and 17,000 page views on Wednesday, February 26. For the month, it was 125,000 visits and 207,000 page views. The graph above covers the last 30 days.

From The PACS Designer: “Re: iPhone 6. Excitement is starting to build for the next generation of the iPhone, will feature for the first time a quad-core 64 bit processor along with iOS 8. Also expected at  launch is a heart rate monitor along with the much anticipated iWatch. It looks like Apple’s going for a big splash of new products in 2014.” Sometimes it feels as though the iPhone is like the iPod – a mature, somewhat commoditized market in which minor feature differentiation passes for innovation. Apple and competitors can do only so much in screwing around with the screen size and construction materials, so the real improvements have to come from the OS.

From Jeff: “Re: headlines. Is is possible to get the morning headlines and any M&A news in a daily email?” I hadn’t thought of doing that since I assume most readers just go to the site, but it’s possible. Weigh in on the reader survey if you’d like since that’s where my to-do list will come from.

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From Olga: “Re: reader comments. I get the feeling that comments are filtered since controversial topics don’t always have many.” Comments are not filtered. I approve every one except these: (a) unverifiable claims that a specific person is quitting or being fired; b) repetitive, annoying diatribes posted by the same person using different names, as in the multiple anti-EMR identities of Not Tired of Suzy, RN; (c) comments trying to publicize a company or site. I should add that the Akismet spam filter automatically deletes comments that come from known spammer IP addresses or that contain questionable content, like a bunch of links. You might be surprised at some of the comments that I’ve rejected: claims that a specifically named CEO forced a female VP to attend an orgy, assertions of deviant behavior by well-known industry figures, and full-out personal attacks on people named in given post.


HIStalk Announcements and Requests

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Half of the HIMSS conference attendees who responded to my poll said it was a good overall experience, with the remaining 25 percent each declaring it to have been either poor or great. New poll to your right, just for (anonymous) fun: how much money did you make from your primary job in 2013?

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Here are more mug shots. Theo, 18 months old, doesn’t seem to mind Dad’s mishap traveling home from HIMSS that will require Mom to fix the handle. To the right, Colleen says she has one wish for Christmas since nurses need high-capacity mugs.

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Every year right after the HIMSS conference I ask readers to complete my survey telling me what they like, don’t like, and recommend for HIStalk. It only takes a few minutes and I plan my entire year from the feedback. You will make a difference, earn my gratitude, and be entered in a drawing for three $50 Amazon gift cards. Thank you.

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I won’t overdo the DonorsChoose project updates, but I wanted to share an example of the student letters you receive when you fund a classroom project. This one from a second grader says, “Thank you for the nonfiction books. We use them for learning and reading stations. We love them.” Lots of charities do good work but spend too much of their donations on fundraising and salaries. DonorsChoose has amazing stats: 94.4 percent of donations go toward programs and services instead of overhead, the CEO is paid only $240K, and it earns an amazing score of 67.83 out of a possible 70 on Charity Navigator. I was jaded about charities having worked in wasteful hospitals until I did my homework and came up with DonorsChoose and Salvation Army. I don’t donate a penny until I check Charity Navigator because marketing overhead can be up to 90 percent for some causes that run TV ads.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

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Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.


Acquisitions, Funding, Business, and Stock

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The private equity owners of payer-provider connectivity vendor Ability Network are seeking a buyer for the company, expected to fetch up to $500 million.


Government and Politics

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Former White House advisor and oncologist Ezekiel Emanuel, MD, PhD (Rahm’s brother) writes a Wall Street Journal piece on the infighting involved in creating the Affordable Care Act. Everybody knows that HHS on one hand declares itself technologically innovative and its ONC organization demands that healthcare providers advance their technology prowess, while the CMS side of HHS’s house spends vast taxpayer fortunes on its primitive systems and the marginally competent bureaucracy required to maintain them. On bundled payments:

We presented the idea of phasing in bundled payments, especially for chronic conditions, to the rest of the White House reform team, where we found some strong support. But then we hit a brick wall. Many of our colleagues who worked for Medicare feared that creating the bundles would be too hard and warned that Medicare didn’t have the computer infrastructure to handle it. The arguments went back and forth, but the Medicare bureaucracy wouldn’t budge. Ultimately, the ACA authorized 10 demonstration projects that could be expanded if they worked—a good start, but a far cry from the more ambitious bundling plan many of us had hoped to see.

Delaware’s health department wants $87 million in FY2015 capital to upgrade its eligibility systems to meet Affordable Care Act requirements, adding that it’s too good of a deal to pass up since federal tax dollars will cover 90 percent of the cost. A Republican state representative isn’t impressed with the department’s plans. “We could have started our own endowment. It’s just staggering. This math is out of control. It’s extremely, extremely disingenuous to say this (Affordable Care Act) is saving us money.”


Innovation and Research

Engineering cadets from the United States Air Force Academy develop Neumimic as their capstone project, working with a local hospital to design a stroke recovery application based on Microsoft Xbox Kinect. The system allows patients to exercise specific muscle groups at home without a physical therapist.


Other

It’s spring-forward time as I write this on Saturday morning. Thanks if you are one of the folks who will be babysitting hospital systems tonight to make sure everything works with the change to Daylight Saving Time.

The folks at SIS put together a hilarious video that parodies vendors preparing for the HIMSS conference. It contains quite a few inside references from HIStalk (like companies that claim “HIPPA” expertise). Leave a comment with those you notice since I’m sure I didn’t catch them all.

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An interesting and scary use of big data: auto repossession companies are using vehicle-mounted recognition technologies to cruise the parking lots of malls and stadiums, capturing the license plate numbers, location, and timestamp of every car they pass. The information goes to a company in Texas whose database contains 1.8 billion scans that include the majority of American vehicles. The company is just beginning to realize the value of that information, planning to sell it to private investigators, insurance companies, and banks, who only need to match up the plate numbers to other state databases to know where any given person has been.

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Somehow this local newspaper’s headline seems Onion-like.

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Family members of deceased patients in China, like those in India, are increasingly turning violent toward the doctor or hospital involved, with 17,000 recorded incidents in 2010. An ED doctor in Guangdong province was forced last week to march with 100 friends and family members of a patient who died, accusing the doctor of malpractice. The hospital called police and he was released 30 minutes later.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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March 9, 2014 News 4 Comments

Morning Headlines 3/7/14

March 7, 2014 Headlines 3 Comments

Moody’s: 6 Hospitals With Credit Challenges Related to EHRs

Moody’s recaps the EHR-related credit downgrades that took place at US hospitals during 2013.

Use of Telemedicine Can Reduce Hospitalizations of Nursing Home Residents and Generate Savings for Medicare

A Commonwealth Fund study finds that nursing homes that used telemedicine to provide after-hours care significantly reduced hospitalization rates for their residents, compared with facilities not using this service.

Effects of Meaningful Use Functionalities on Health Care Quality, Safety, and Efficiency

ONC publishes a dashboard that consolidates 2010-2013 literature focused on MU related outcomes changes.

HIE solutions see drop in provider satisfaction

KLAS rates HIE solutions and finds that Epic, Orion, and Siemens are doing the best. Researchers note that “What is surprising is that despite the millions of dollars HIE vendors invested to add needed functionality, only about half of them are seeing their provider satisfaction scores improve."

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March 7, 2014 Headlines 3 Comments

News 3/7/14

March 6, 2014 News 1 Comment

Top News

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The Defense Health Agency, established in October 2013 as a successor to TRICARE, requests $1.6 billion to support its health IT systems in 2015. It also wants $91 million for R&D to develop a new EHR by 2017 and $68 million to integrate its systems with those of the VA. Meanwhile, the VA’s 2015 budget requests include $269 million for EHR development.


Reader Comments

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From TooMuch Coffee: “Re: WA state healthcare insurance exchange. You mention that 15k applications are stuck in limbo. I agree that’s not great, but they have signed up around 500k successfully. The site basically works, unlike OR and HI sites.” I’ve written about Oregon’s struggling exchange, so here’s the story on Hawaii’s: it received $204 million in federal funding, went live two weeks late due to software problems, has enrolled fewer than 5,000 people (at a cost of about $46,000 each), and has already been declared unsustainable without ACA rule changes since few potential customers and insurers are interested and it’s supposed to be self-funding its $15 million annual operating budget with 2 percent of the take. Meanwhile, the US Government Accountability Office says it will audit Oregon’s exchange, which cost $304 million and hasn’t enrolled a single person without manual help.

From Concerned: “Re: UHN in Toronto. Can anyone confirm that they are replacing QuadraMed EHR with Cerner?”

From Nobody Knows: “Re: value-based risk contracts. Is there a resources that details which payers and providers are engaging in them vs. those doing fee-for-service? I’ve tried AIS, HIMSS Analytics, and Billian’s and so far, no dice. Even a high-level report would be nice.”


HIStalk Announcements and Requests

inga_small This week on HIStalk Practice: You won’t want to miss the summary of my chat with eClinicalWorks CEO Girish Navani, who shares his thoughts on the MU program, population health, and health information exchange, plus provides an estimate of the company’s valuation if it were to go public. Despite the growing number of  employed physicians, work still needs to be done to integrate physicians and develop performance-based reward programs. The pay gap between primary care providers and specialists narrowed in 2013. I recap some vendor announcements from last week and muse on various HIMSS sights and sounds, including the future of Practice Fusion; Allscripts and its new tag line; what’s driving Aprima’s recent growth; and, the hot topic of ICD-10. Thanks for reading.

This week on HIStalk Connect: Samsung unveils the Galaxy S5, which integrates with both its two new smart watches and its new activity tracker. Basis, the maker of the B1 activity tracker, is acquired by Intel for a rumored $100 million. The FDA is looking for a vendor to develop social media analytics tools.

On the Jobs Board: Chief Market Strategist – Healthcare, EHR Tester, Epic Activation Consultant.

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Welcome to new HIStalk Platinum Sponsor CompuGroup Medical. You see the count of big global customer numbers in their graphic above and the owner-led and publicly traded company is expanding its US sales. Offerings include CGM Clinical (integrated PM/EHR), CGM DAQbilling (PM), CGM webEHR (EHR), CGM webPRACTICE (PM), and CGM Enterprise (PM/EHR for community health centers); LIS, outreach, and reference lab solutions; the eSERVICES Patient Portal, EMEDIX Reimbursement Solutions, and the SAM disease management platform. The new CEO of CGM US is Norbert Fischl, who has an interesting background as leader of the company’s Northern European region, managing director of a software company, McKinsey consultant, and an Internet entrepreneur. Thanks to CompuGroup Medical for supporting HIStalk.

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Here’s another update on one of our DonorsChoose projects that was paid for by the top-of-the-page ads. The 35 freshman girls in the Illinois high school taught by Teach for America teacher Ms. Schwartz are using the notebooks and colored pencils we provided to create College Bound Journals. They will fill them with goals, thoughts about their futures, and information they gather about college campuses and majors. You can see in the photo sent by the teacher that they’ve already started.  

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More remote mug sightings.

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Anne-Marie wasn’t able to get way from the family medicine practice she manages to attend the HIMSS conference, so she made her own mug. She says it’s not nearly as cool as the original, but I disagree.

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It’s time for the once-yearly HIStalk Reader Survey. It’s quick and I use the results to plan the entire next year of HIStalk, so I would really appreciate your taking five minutes or less to give me some guidance. I’ll sweeten the pot by randomly drawing three responses to receive $50 Amazon gift cards. Thanks in advance – most of the good ideas I’ve put in place came from responses to this survey.


Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.


Acquisitions, Funding, Business, and Stock

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MedAssets reports Q4 results: revenue up 4.1 percent, adjusted EPS $0.28 vs. $0.25, beating estimates on both.

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Clinical prediction software vendor Health Outcomes Services completes a $5 million financing round. CEO Jim Wilson has worked for McAuto, EDS, and Cerner and was president of Craneware before joining HOS.


People

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ArborMetrix appoints former CMS administrator and FDA commissioner Mark McClellan, MD, PhD (Brookings Institution) to its board.

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Idea Couture hires James Aita (Medicomp) as head of healthcare solutions.

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Bart Foster, founder and CEO of self-service medical kiosk maker SoloHealth, is replaced by Chairman Larry Gerdes (both above.) The company’s CFO has also resigned and an undisclosed number of employees have been laid off. Gerdes sold transcription vendor Transcend Services to Nuance for $300 million in 2012. One of SoloHealth’s investors is healthcare IT long-timer Walt Huff, the “H” in HBOC, where Gerdes was an executive from 1977 to 1991.   

Tamyra Hyatt (McKesson) joins Azalea Health as VP of marketing.


Announcements and Implementations

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The New York eHealth Collaborative and the Partnership Fund for NY call for applications for participation in the second class of the  NY Digital Health Accelerator, where 10 early- and growth-stage companies will each receive mentoring and $100,000 of investment capital.

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North Dakota officials announce the official rollout of the state’s HIN, which will connect all of North Dakota’s hospitals by the end of the year.

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The US Army deploys a software upgrade to its battlefield Medical Communications for Combat Casualty Care EMR, also known as the MC4 system, that includes an upgraded operating system, enhanced security, and patient safety improvements related to allergies and medication history.


Government and Politics

HHS includes $75 million in its 2015 budget for ONC, a $14 million increase over last year.

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ONC updates its Health IT Dashboard to include a Rand Corporation-prepared review of literature on the impacts of HIT, with a focus on MU functionalities.

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Analysis of full-year 2013 MU attestation data by Wells Fargo Securities finds that 92 percent of hospitals stuck with the same vendor for at least two years. Meditech, Allscripts, and Siemens topped the list of hospitals that stayed the vendor course, Cerner and CPSI were average, and Healthland, McKesson, and HMS lagged. It also finds that small hospitals seem to be dropping out in big numbers by the third year, perhaps because they’ve paid their EHR costs in the first two years and don’t want to deal further with MU complexity.


Innovation and Research

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Hospitalization rates declined at nursing homes that used after-hours telemedicine services, according to a Commonweath Fund-sponsored study. Researchers estimate that the use of telemedicine services could net Medicare a $120,000 savings annually per nursing home.


Technology

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Azoi announces Wello, a $199 case that turns an iPhone into a monitor for blood pressure, ECG, heart rate, blood oxygen, temperature, and lung functions.


Other

3-6-2014 12-47-31 PM

Epic, Orion, and Siemens earn the highest customer satisfaction scores in a KLAS survey on HIE solutions. Overall provider satisfaction with HIE solutions has dropped an average of eight percent since last year.

Becker’s Hospital CFO looks back at hospitals whose bond ratings have been downgraded by Moody’s Investors Services because of EHR-related budget problems: (1) Health East Care System (MN), which is spending $145 million on Epic; (2) Community Medical Center (MT), which is having cash flow problems after installing Cerner and NextGen; (3) Saint Luke’s Health System (MO), implementing Epic for $200 million; (4) Scott & White Healthcare (TX), seeing increasing costs with Epic; (5) Washington Hospital Healthcare (CA), having increased costs and a negative margin after implementing Epic; (6) Robinson Memorial Hospital (OH), with losses partially attributed to its Allscripts Sunrise implementation.

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Bloomberg News calls Mount Sinai Hospital (NY) “a heart surgery factory with obscene levels of pay,” claiming the hospital coaches patients to feign heart attack symptoms in the ED to get their stents covered by insurance, earns referrals from doctors with financial ties to the hospital, and pays its head of interventional cardiology $4.8 million per year. The head of another New York interventional cardiology program summarizes, “You essentially have physicians combing the streets of Staten Island, Queens, Brooklyn, and Bronx looking for patients they can screen on a treadmill to feed into the cath lab, where the big reimbursement comes.”

In Canada, Pierre Le Gardeur Hospital cancels all elective procedures after experiencing an unspecified computer system problem.

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Weird News Andy has his ear to the UK ground in noticing this story, in which the British public reacts to news that a marketing company used a 47 million-record hospital data extract to target Facebook and Twitter ad campaigns. Another company was found to have loaded the entire database to Google’s servers to create interactive maps. The Hospital Episodes Statistics database had been made available by the government to researchers and approved private companies. The government has a PR nightmare on its hands because de-identification is hard to describe to laypeople who react to “my hospital records are on the Internet.”


Sponsor Updates

  • Vonlay concludes an Epic engagement with Aspirus (WI).
  • Physicians Interactive and McKesson Patient Relationship Solutions will jointly deliver Coupons on Demand, which will provide clinicians access to online cost-saving offers for medications.
  • Kinston Pulmonary Associates (NC) will implement NextGen PM and EMR from TSI Healthcare.
  • InterSystems joins the Global Alliance for Genomics and Health.
  • Gastroenterology-specific EHR provider gMed will add medical content from Health Language to its system.
  • E-MDs releases details on its June 5-7, 2014 User Conference and Symposium in Austin, TX.
  • CIO profiles ICSA Labs, which is now the largest government-approved EHR testing and certification body.
  • Hardin Memorial Hospital (KY) reports improved clinical response times since integrating telemetry alarms with Voalte smartphones.
  • Divurgent raises $5,000 during HIMSS for the Florida Hospital for Children.
  • RazorInsights ONE-Electronic Health Record achieves Stage 2 ONC certification.
  • Daniel Flanagan, executive consultant for Beacon Partners, discusses in the company’s blog his recommendations to ensure a clearinghouse is ready for the ICD-10 transition.
  • MedAssets estimates that its latest National Sourcing Collaborative event will drive $5 million annually in added value for its participating clients.
  • Connance expands its patient-pay solution to include predictive analytics and additional platform reporting and consumer engagement functionality.
  • On the company’s blog, MEA | NEA CEO Lindy Benton explains the significance of electronic submission of medical documentation (esMD) and health information handler (HIH).

EPtalk by Dr. Jayne

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One of my fondest memories from medical school is working the ER during Mardi Gras. I sewed up more than one reveler who didn’t really need anesthesia because they were already feeling no pain. I chuckled when one of my former classmates sent me this story about the germs residing on Mardi Gras beads. Who would have thought that beads that have been thrown around in the midst of public drunkenness might have germs? I wonder if there’s an ICD-10 code for that? Maybe there’s one for choking on the baby in the King Cake as well.

One thing I found lacking at HIMSS was the presence of wearable devices (other than on attendees). I didn’t see much vendor promotion or anything cool enough that I’d consider it (although watching people try to interact with Google Glass was pretty funny). I don’t have any experience with Fitbit, but after reading this article I heard about on Twitter, I might consider one just to have this app. The Sleep Tracker Hack, which emerged from the recent Netflix Hack Day, helps a viewer find her place after sleeping through streaming media. I just might know someone who has fallen asleep in the middle of re-watching “Grey’s Anatomy” for the last several weeks. Unfortunately the hack was part of an internal hackathon, so it may never see the light of day.

I believe in patient engagement and making health-related technology accessible to patients, but there’s such a thing as going too far. I was reading a piece about the Bellabeat Connected System that turns a smart phone into a fetal heart monitor. It also mentioned the Huggies “TweetPee” that sends a tweet when the baby wets its diaper. Seriously? Unless your infant has a urologic problem, I’m not sure tracking urination on social media will do much more than drive followers crazy.

One of my favorite HIMSS connections reached out earlier this week to ask if I would be willing to help mentor a physician who would like to join the CMIO ranks. When I first started out, I had no one to look to for advice, so I was happy to oblige. One of his questions was what I think is the most important CMIO function. I’m not sure I can pin down a single one, but one of the most important in my book is being able to be the peacemaker among IT, the operations folks, and the physicians. Certainly there are other constituencies, but those are the three that tend to be the most contentious.

I’m still surprised that nearly a third of health systems still don’t have a CMIO. The organization where my mentee works falls into that category, but at least they understand that they need to work towards filling that role even if they aren’t ready to admit they need an honest to goodness CMIO. Whether we’re called Medical Directors or Directors of Informatics or Physician Champions, we can still help organizations move forward.

His hospital is currently struggling with physician engagement and clinical oversight, so it makes sense that a physician would be uniquely positioned to assist. He’s not highly techy, but I think that’s OK – if we can master anatomy and pathophysiology, we can learn enough about networks and software to be meaningful participants. The key is knowing who our experts are and being willing and able to leverage them appropriately.

He’s worried that his hospital isn’t really ready to formalize physician leadership in the IT space. There have been comments made about fears that the CMIO “will come in and boss IT around because he’s a physician” or that he will preferentially take the physicians’ side in arguments. I’m encouraging him that even though his role is emerging,  he should ensure that  it’s well defined and that leadership is prepared to support him. Without those elements, the risk of frustration will be fairly high for all involved.

At this point, I think he’s wise to negotiate for a formal position, but I’d recommend going for something part time that lets him dip his toes in the waters of clinical informatics without locking in at an organization that might not be as ready to move forward as he thinks they might be. That will buy him some time to work on professional development and to build the skills he’ll ultimately need if he wants to make a career of this. I’ll keep you posted as I hear from him. I’m looking forward to remembering what it was like to be young and idealistic before the CMIO life started beating me down.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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March 6, 2014 News 1 Comment

CIO Unplugged 3/6/14

March 6, 2014 Ed Marx 8 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Executive Success – The Secret Unplugged, Part 2

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This is the second guest post from my wife Julie. The first one is here. She writes what she feels and it is unfiltered, straight from her perspective. She would not have it any other way! I am thankful to have married a very strong woman.

“No, no! Take your finger off that send button, Edward Marx.”

Yes, I had to stop him before he sang his own praises on this blog. For heaven’s sake, he just finished pouring out his heart in a four-part series on Identity based on humility, and now he was about to shoot himself in the foot.

I confess. It’s tough living with a “celebrity,” especially when his prominence is bigger in his head than it is in the mortal world.

Don’t get me wrong, I’m extremely proud of him for winning the “John E. Gall CIO of the Year” award. After all, how many execs choose to trample their way out of the policy box their organizations try to keep them in? How many execs have disrupted their workplace practices and standards and influenced their peers and followers to change their own organizations?

Ed has a voice that speaks volumes to improving healthcare on the technology side. He draws out leadership talent in people everywhere he goes. He absolutely deserved to win the award.

Ed was equally proud of winning the HIStalkapalooza IT Leader of the Year award.

But I can always hear the tremble in his voice that asks, “Why are these people following ME? What if I lead them in the wrong direction?”

Ultimately, time will tell on the direction part. But my response to the first question would be “vision.” Am I right? We like to go somewhere important and add significance to our sphere of influence.

Now that the 2013 award ceremony is over, my hope is that you show your admiration and appreciation by applying all the spoken and unspoken lessons you’ve learned from the 2013 CIO of the Year and revolutionize your own domain. Don’t live vicariously through Ed’s achievements and settle for complacency in your own world. Seriously, one man can only accomplish so much, but an army of like-minded leaders can advance the IT kingdom beyond its present borders and into a model worth imitating.

Yes, you do have what it takes. For some of you, the secret is to bust the box. And that would be an applause heard around the world.

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Julie’s personal highlights from the HIMSS conference:

  • A man came up to congratulate my father-in-law and said, “I want to be just like you.” (Wow! I’ve never met anyone who aspired to be an old German fart. Or a holocaust survivor.)
  • A taxi driver mistook Ed for The Edge from U2 (this is becoming the norm.)
  • A man (name withheld) said, “I appreciate Ed, but Julie always makes me smile.” (Ahh shucks.)
  • Three of Ed’s direct reports (names withheld) serving others who had fallen ill and required medical treatment
  • Taking pictures of Ed posing with Disney princesses at Epcot
  • Argentine Tango at HIStalkapalooza

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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March 6, 2014 Ed Marx 8 Comments

Morning Headlines 3/6/14

March 5, 2014 Headlines No Comments

Kaiser Permanente board member quits amid questions over conflicts

Dr. Christine Cassel, chief executive of the National Quality Forum, quits her board positions with Kaiser Permanente and Premier Inc. after ProPublica reported that she was being paid a cumulative $400,000 for her advisory role with the companies.

Defense Health Agency Wants More Money For IT Operations In 2015

The DHA has requested $1.6 billion to support operations and maintenance of its health information management systems in 2015, seven percent more than its 2014 budget.

Obama’s Budget for 2015: 10 Points for Hospitals Know

Becker’s Hospital Review evaluates President Barak Obama’s 2015 budget proposal, highlighting Medicare payment reforms, critical access hospital reimbursement changes, and increased funding for Medicaid/Medicare fraud detection programs.

US health information breaches up 137%

More than seven million health records in the United States were affected by data breaches in 2013, an increase of 137% over the previous year, according to the annual breach report..

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March 5, 2014 Headlines No Comments

Readers Write: The Data Problem

March 5, 2014 Readers Write No Comments

The Data Problem
By Randy Thomas

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Dr. Jayne asked important questions in her Curbside Consult about big data, EHR conversions, the “sheer magnitude of bad data out there,” and how best to insure the integrity of health data.

The best way to address the issue of bad data is to follow the old adage,“Begin with the end in mind.” Implementing an enterprise-wide EHR is a massive, complex undertaking. It involves considering the needs of many stakeholders when defining the build requirements. For example, workflow must support ease of use and not interfere in patient care delivery and related work processes. Furthermore, many implementation decisions focus on driving clinician adoption to ensure that both quality and efficiency objectives are met (not to mention regulatory requirements related to Meaningful Use.)

With all the multi-threaded work streams and decision processes involved in planning and executing an EHR implementation, the re-usability of captured data frequently falls out of scope. That leads to the bad data problem.

Re-usability means using data captured in any source system (EHR, ADT  materials management, patient accounting, registration, operating room, emergency department, etc.) for reporting, measurement, and analytics. Re-using the data captured in these source systems accelerates the value realized from implementing such systems and supports a virtuous cycle of performance improvement across an enterprise.

It all relates to, “You can’t manage what you don’t measure.” That is, you can’t measure something if you don’t have the right data. This leads back to the decisions made in implementing EHRs and other systems. You need to start with what data is required to measure and analyze what’s important to the organization and ensure that data can be consistently, reliably, and accurately captured at the point of origin (e.g., at registration or in the care process).

It’s not realistic, however, to expect that every bit of data about a patient should be captured in a discrete form for re-use. What’s required is a balance between supporting ease of use in the appropriate workflows and the availability of data for reusability.

An effective way to strike this balance is to create a list of data elements the organization agrees is necessary for analytics. Some detective work is required: tracing the journey of that data back to the source system and ensuring that each data element is captured as expected in the intended workflow. This requires collaboration across a multi-disciplinary team — one involving experts in quality reporting, data analysis, and clinical (or operational) workflow.

The inventory of data elements can be used to identify where each data element can be captured in the source system (e.g., EHR, ADT, etc.). This is the “data chain of trust.” Team discussion and compromise are required to design workflows that both support ease of use and capture data reliably and consistently.

With a documented inventory of data elements married to how that data will be captured in the source systems, data can start flowing into an analytics environment. Applying sound data governance principles and implementing a data profiling discipline will ensure data consistency and reliability.

Organizations don’t have to begin with a large set of discrete data, but they must recognize that any level of measurement, reporting, and analytics requires consistent, reliable, accurate data starting at the point of capture in the source systems. They should begin with the data most important to each organization and ensure that data can flow from origin to analytics in a chain of trust that is known and transparent.

From there, health systems can incrementally increase the available data as they come to understand why it’s important to capture data discretely and accurately and as more stakeholders benefit from access to that data. With the increasing value realized comes the understanding that, “It’s all about the data.”

Randy Thomas is associate partner of health analytics with Encore Health Resources.

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March 5, 2014 Readers Write No Comments

Lorre’s HIMSS Conference Summary

March 5, 2014 News 4 Comments

2-25-2014 5-30-55 AM

Last week as I was staring into the House of Blues stage lights at HIStalkapalooza wearing a gown, high heels, and a sash reading, “HIStalk To Me,” I was struck by how different it was from any other job I have had. I had to pause for a moment to remember how it all happened. Twenty years ago I was a mining industry accountant and usually wore steel-toed boots and a hard hat. That seems like another lifetime now.

A seemingly random opportunity landed me in healthcare IT, where I have been for 18 years. I worked for vendors in operations leadership and business development. I have an MBA and I am an LSS Black Belt. I thrived on the never-ending challenges, non-stop travel, and endless demands for my time.

Finding myself on stage with this dream job was the culmination of a whirlwind of recent events, too many to list. I love working with the HIStalk team and I know I am in an enviable position.

HIMSS14 started for me at the beginning of September. I had just joined the HIStalk team when I met with Mr. H and Inga to discuss my role. We already agreed I was going to be responsible for the webinar program and HIStalkU, but we knew that I as the only non-anonymous member of the team could do more.

We talked about trade shows in that September meeting, but it wasn’t until the mHealth Summit offered HIStalk a free booth as a media partner that we decided to try it since we had nothing to lose other than time and travel expenses. I have been to HIMSS and AABB many times and worked in the exhibit hall. I showed up at our impressive vendor booth and stood around talking with customers and prospects all day. How hard could it be to create a micro version of that for HIStalk?

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We considered mHealth Summit a trial run for HIMSS and decided to go with the bare minimum. I had never furnished a booth and the logistics are daunting. I learned that nothing comes with the booth. Mr. H and I debated about whether there would be a table at the front of our booth and decided to wait and see. We didn’t have any giveaways.

When I finally found our booth the morning before the exhibit hall opened on a snowy December day outside of Washington, DC, there was only a tiny patch of green carpet holding a chair and a trash can. There was no table or separation wall. Fortunately I was able to rent a table with a skirt and it was delivered in plenty of time. I had amazing booth neighbors who helped me hang our banner and they even let me use one of their power outlets.

There were 400 exhibitors and 5,500 attendees at mHealth. I was pleasantly surprised by how much booth traffic we generated. We weren’t selling anything or giving anything away. I was there to say thank you for reading and thank you for sponsoring, nothing more. There was a steady stream of people each day even though the conference doesn’t draw our core reader demographic. I met writers who later contributed to HIStalk and a few people interested in sponsoring. The best part was how much people just wanted to say hi and express their dedication to HIStalk. I was convinced a booth at HIMSS was a must-do.

HIMSS is a much bigger deal when compared with mHealth with 1,230 exhibitors and 37,000 attendees. It was painful trying to choose one of the available booth locations, all on the fringe and all seemingly uninteresting, but we did. We learned a lot from the mHealth Summit and acted on some great ideas for inexpensive booth signage.

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Our giveaways were simple but fun. We designed two lanyard pins, one to commemorate the 10-year anniversary of HIStalk this past June and the other representative of our first HIMSS conference as an exhibitor. We had coffee mugs printed with the top HIT news stories of 2013 according to HIStalk. They turned out to be a hit, and even readers who didn’t attend the conference have asked for the pins and the mugs.

When I visited the exhibit hall Sunday afternoon, I was shocked to find it far from ready for the next day. Some of the giant booths looked only half built, debris was everywhere, and forklifts raced dangerously back and forth. I couldn’t imagine everything being ready in time to open the hall at noon on Monday. I wanted to deliver the HIStalk sponsor booth signs, but the hall was such a mess and the odds of being struck by a forklift were so high that I decided to wait.

I hosted a cocktail reception for our sponsors Sunday evening. It went smoothly and everyone said they had a great time. I met a lot of interesting and energetic people and I was impressed by their obvious affinity for HIStalk. Dr. Gregg was on hand to assist me and Inga and Dr. Jayne spent some time there (anonymously, of course.) Even Mr. H made a quiet appearance, after which he left just as quietly.

Monday morning I arrived at the exhibit hall early and raring to go. I had to hustle to cover every square foot of the exhibit hall, my arms loaded with signs. Thankfully Dr. Gregg was there, too, and when we realized I was running out of time, he helped me get it done. According to my Fitbit, I exceeded my 10,000 steps/five miles goal before 10 a.m.

Our little booth was quite a way from the major thoroughfares, so I was surprised by the immediate flow of visitors when the exhibit hall opened. It was consistent throughout the show. Countless readers and sponsors stopped by to say hello and to tell me how much they love HIStalk. We had even heavier traffic when one of our VIP guests (Ed Marx, Vince Ciotti, and Robert Murphy, MD) greeted their fans in our booth.

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Once again, Dr. Gregg was a life saver. Not only did he help me with the booth setup and delivering the signs, he gave me breaks throughout each day so the non-stop visitors wouldn’t be disappointed to find an empty booth. Mike Cannavo (“The PACSman”) was also a blessing. He covered the booth, brought me lunch, and kept our swag collection current. The number of people visiting our booth was so remarkable that someone in the booth next to ours asked, “What are you selling?” I smiled when I replied that we are selling nothing — we are just saying hello and thank you.

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There was so much fun on and off each day that it would be impossible to mention it all. My top 10 are:

  1. Working with the people in the Epic booth to stage a picture of them looking at their cell phones
  2. Watching people apply temporary tattoos to the strangest places (Ed Marx takes the prize for his lower back tramp stamp)
  3. Arriving at the booth one morning to find a box of warm scones from MedData
  4. Handing out the HIStalk sponsor booth signs and seeing how everyone lit up
  5. Chatting with Ed Marx, Vince, and Dr. Murphy
  6. Seeing the women who stopped by to show me their shoes
  7. Having Inga, Dr. Jayne, and even Mr. H stop by the booth without anyone realizing it except me
  8. Receiving my own copy of Struck by Orca
  9. Trying on a Super Bowl ring
  10. Receiving countless comments and compliments and passing them along to the team

I reconnected with many colleagues and customers from the past. I receive e-mails regularly from people who see my LinkedIn profile and wonder if working for HIStalk is a real job. Talking with them wasn’t any different. Yes, it is a real job, although it is fun and exciting and it doesn’t usually feel like work. I love to chat with readers and sponsors and work on webinars. I get a lot of satisfaction from helping them develop and deliver interesting and educational productions.

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The event that was a personal stretch for me came when Mr. H asked me to accept HIStalk’s “Sunquest Industry Pioneer Award.” In my 16 years working for Sunquest, I received many opportunities to learn and grow and I almost always loved it. The same team presenting the award fired me two years ago. I can almost hear the collective gasp — why would I admit something like that publicly, and in writing no less? Let’s face it — we are all one merger, acquisition, unattainable goal, or difference of opinion away from being redundant or no longer a fit for the position. It isn’t personal. I showed up at the booth and everyone was friendly and warm. The HIStalk team stood within earshot and watched proudly. I thanked Sunquest not only for the award, but for their support and sponsorship of HIStalk. It was closure and it felt good.

Participating in the planning of an event like HIStalkapalooza was a whole new experience for me. Since the sponsor is responsible for it, it should be easy for the HIStalk team, right? No way! There is constant back and forth interaction and negotiation. It isn’t easy to strike a balance between what our readers and sponsors expect and what the sponsors of the event think they should get out of it. It was both frustrating and fun to be part of it. I learned a lot, along with everyone else, and I’m sure next year will be better because of it. The event itself was a huge success. The HISsies were entertaining and Farzad, Carl, and Ed all made an appearance to accept their awards. The food was terrific and people raved about the band for days afterward. Imprivata and all of the co-sponsors did a great job.

HIMSS14 was great for me. I met a lot of terrific people, I gained a whole new appreciation for those responsible for planning events, and I had fun. I am already thinking about what to do next year in Chicago.

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Email Lorre or follow her on Twitter.

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March 5, 2014 News 4 Comments

Morning Headlines 3/5/14

March 5, 2014 Headlines No Comments

FCC Chairman Announces New Connect2Health Task Force

FCC Chairman Tom Wheeler announces the formation of a new task force that will work to accelerate the adoption of health care technologies by leveraging broadband and other communications services.

Association Between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization, and Costs of Care

JAMA publishes a study following the performance of a Patient Centered Medical Home from its launch in 2008 through 2011, and concludes that participation in a PCMH does not directly correlate to reductions in utilization of hospital, emergency department, or ambulatory care services or reductions in total costs of care over three years.

Wake Forest Baptist’s operational revenue rises in second quarter of fiscal 2014

Wake Forest Baptist’s chief financial officer credits reduced expenses related to its Epic implementation in part for its financial turnaround. The medical center reported a loss of $23.5 million, an improvement compared with a loss of $49.8 million for the same period in the previous year.

Castlight Health amends IPO filing, hopes to raises up to $140 million

Castlight Health has updated its February IPO filing to reflect that it plans to sell between 11 million and 12.6 million shares of common stock for  $9 to $11 per share, bringing the total it hopes to raise to $140 million.

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March 5, 2014 Headlines No Comments

News 3/5/14

March 4, 2014 News 7 Comments

Top News

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FCC Chairman Tom Wheeler announces the formation of a task force that will seek ways to increase use of broadband to deliver telehealth, mobile apps, and telemedicine. Heading up CONNECT2HEALTHFCC will be Michele Ellison, a lawyer who runs the agency’s enforcement bureau. Wheeler said in the announcement, “We must leverage all available technologies to ensure that advanced health care solutions are readily accessible to all Americans, from rural and remote areas to underserved inner cities. By identifying regulatory barriers and incentives and building stronger partnerships with stakeholders in the areas of telehealth, mobile applications, and telemedicine, we can expedite this vital shift.”


Reader Comments

From Just Tim: “Re: MU stages beyond stimulus payments. What is the legislative basis to extend the MU program? MU requirements were supposed to run in conjunction with years in which payments were made, not years after penalties kick in. I’d certainly agree that if someone never got to Stage 3, they could reasonably be penalized on an ongoing basis. Otherwise, we’ve just created a large bureaucracy with the power to continue to push unfunded mandates.” Legal scholars and political junkies, the less legislative among us are calling.

From Dim-Sum: “Re: military EHR replacement. Word on the street is that the vendors of choice and partners are as follows. Six service integration (SI) firms will bid Epic. The team that is getting the most news is Leidos/Accenture/Harris. Cerner has a single exclusive SI partner (still doing research to see who that SI is). Allscripts cannot find a partner for their Sunrise. Meditech has the incumbent Northrop Grumman. McKesson walked away from GDIT/Vangent. Siemens has a yet to be named DoD giant. Competitive bids will require an investment by prime and sub software solution firm of about 1.5-2 percent of the total contract value. That means that to win a $5B deal with the DoD, the investment for resources, capabilities, compliance, and regulatory wherewithal (see FISMA, FedRAMP, DIACAP, 508, JITC etc) is $50 million USD. Good Luck beltway bandits and COTS EHR dreamers.” Unverified.

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From Brenda: “Re: Washington’s insurance exchange. Add it to the list of those having issues. By the way, I’ve recommended HIStalk to countless people and I’m glad our company has been a sponsor for about a year now.” The Healthplanfinder exchange has 15,000 applications that are stuck because the user-entered information can’t be matched to the state’s Medicaid benefits database or contain incomplete information (hello, programmer edits?) I speculate that the state incurred the wrath of the grammatical gods when it combined “health plan finder” into a single word.  

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inga_small From Charger: “Terrific correspondence from Orlando; much appreciated since I could not attend! I’m sure you have been deluged with coffee mug requests and are out of stock, but may I place an order for one upon receipt of any new inventory? I will gladly swap you one of my local Karl Strauss Brewery pint glasses in return.” Thanks for the generous offer, but sadly all the coveted coffee mugs are gone. Lorre and I are trying to convince Mr. H that the timing is perfect for the opening of an online store featuring HIStalk swag. Beauty queen sash, anyone?

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More mug sightings: Investor’s Chair contributor Ben Rooks, who obviously works standing up while looking at green ivy outside his San Francisco office; and Mike Jefferies of Longmont United Hospital, whose Spotify-HIStalk two-monitor setup looks a lot like mine. I still have a few more photos to run next time.

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From Dr. Travis: “Re: Nordic’s new office. Thought this was very cool.” I had to clarify with Travis since this is a Midwestern, tailgating, and college thing that much of the country won’t understand: it’s a cornhole platform.  

From Ion Exchanger: “Re: HIMSS booth. You had traffic in your booth back in the hall. You should get another exhibitor to give you space free in return for drawing people.” That idea has come up on occasion, although not usually from people offering space. Our first-time exhibitor experience was good, especially since it was a low-rent, homebrew operation designed solely to give Lorre a way to say hello to interested readers and sponsors. I think I’ve decided to do it again in Chicago.

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From Dr. Matt: “Re: QlikView. First there’s an Epic partnership and now I find at HIMSS that Health Catalyst offers QlikView on top of their data warehouse. Why are these big players using it?” I’ll let those organizations speak for themselves.

From Doctor N: “Re: HIMSS conference. It was my first one. Only the HIStalk people made me feel valued as a practicing physician. The insults, lack of humility, time away from my clinic, and the lack of vendor understanding of how medicine really works will keep me from returning soon. The sessions could have been done online and the networking conversations were shortened because everyone was in a hurry to get somewhere else. I believe I have seen the American medical industrial complex at its worst. I was surprised at the number of vendor folks who are physicians and how little they know about how we pay for healthcare: SGR (which will worsen matters for providers) and $156 billion being cut from Medicare Advantage plans. They have no clue that I’m not paid for population health and most docs in my community hardly even know the meaning of the term. It is like we are buying the horseshoe, barn, and saddle in the hope that we’ll get a horse for a present. HIStalkapalooza, however, did not disappoint!”

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From Spelling CMIO: “Re: a tech solution to HIT spelling problems. As technology professionals, we ought to be able to bring our expertise to bear on the current plague of spelling confusion. I suggest we start to use regular expressions, like: HIM*S* and HIP*A* so that all variants can be brought under the welcoming umbrella of mediocrity. Heck, we could even bust out CM*S to obscure the failure to include ‘and Medicaid’ in the name of our favorite bureaucracy. We could even try E[Pp][Ii][Cc] to free the caps-lock crowd from their yoke of humiliation.” Scanning for “HIMMS” news stories turns up 56, which is pretty sloppy.

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From Frank Poggio: “Re: ONC. Issued new 2015 test criteria while at HIMSS last week. They kept repeating that this new (and extensive at 242 pages) test criteria is ‘voluntary’ for vendors. Here comes another wolf in sheep’s clothing. Do you really think the 2015 Criteria will be ‘voluntary’? How can they generate a revised list of criteria that fixes bugs and not make it required? How can they add something critical to patient safety such as UDI and not make it required? Breaking out CPOE components has been something niche vendors have been asking for since the start. So will those vendors ignore it and stick with 2014 criteria? I have worked through dozens of tests with clients since the inception of ONC and every time they expand or make a test update it soon becomes mandatory by the authorizing testing labs … and with some ATLs sooner than others. I give the 2015 version at most four months before it becomes mandatory.”


HIStalk Announcements and Requests

Listening: new from the all-female, LA-based spacey rock quartet Warpaint, which sounds a bit like Cocteau Twins (and that’s a good thing). I’m also enjoying defunct, brilliant Irish pop band The Thrills.

Some random thoughts I had regarding the HIMSS conference:

  • I was surprised and happy that the vendors of much-hyped analytics and population health management products were restrained in their pitch. Many companies talked about those products, but I didn’t hear a lot of wild claims.
  • The terms “big data” and “cloud” weren’t repeated reverentially and annoyingly to the extent that might have been expected.
  • What is population health management, exactly? It will be whatever payers say it is, no different than “quality.”
  • I’m not impressed with “big data” when healthcare is woefully indifferent to “little data.” We ignore evidence-based medicine, warnings for inappropriate or duplicate tests and drugs, and quality measures. We are sloppy about monitoring our supply chain and controlling our labor and materials costs. We pay little attention to the free exchange of information we hold about patients. We don’t like the idea that patients themselves should see our digital secrets. We should be using the information we have to its fullest before trying to tackle giant databases containing even more insights that we’ll ignore. Speak up if your hospital is different.
  • I’m not sure if patient engagement was just a token HIMSS nod or a real movement. I don’t see stretched providers getting excited about engaging patients unless government or competitive pressures force them to. It was nice to see patient advocates at the podium, even if only sporadically.
  • People are beginning to realize that EHRs aren’t necessarily the center of the universe. Small vendors are creating specific applications that use the EHR, which makes them easier to develop, cheaper, easier to use, and easier to buy since any buyer’s remorse will be several zeroes cheaper than the EHR itself. A question to ask of the dwindling number of EHR vendors might not be what their system does, but what does it allow to have done by other sources? Those companies were in the hall.
  • The government has taken a lot of innovation out of the system with Meaningful Use and ICD-10. I said from the beginning that taking MU money means making the federal government your incessantly nagging partner, but with penalties following rewards it wouldn’t have mattered anyway. I got the sense that attendees were more interested in what HHS and ONC say than what vendors were telling them.
  • Financial uncertainty as well as a big implementation and optimization ramp-up business has increased the willingness of providers to pay a premium to use consultants since they don’t want to get locked into salaried employees for specific short-life tasks. Consulting companies seemed to be generating a lot of interest.
  • Hospitals, like every swollen, inefficient, and political bureaucracy, will do whatever it takes to protect their own interests. They have money and clout and they aren’t just going to happily reduce their profits, headcount, or ambitions to reduce overall healthcare spending. Integrating their acquisitions will be a target market.
  • HIMSS is always like a boat show, but this year I’m not sure many boats were sold.

Acquisitions, Funding, Business, and Stock

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Telus Health acquires Med Access, a British Columbia-based vendor that claims its EMR is #1 in Canada with 4,000 users.

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Clinicient, a provider of RCM and clinical solutions for rehabilitation therapy, raises $15 million in Series C funding from Catalyst Investors and names Rick Jung (Medsphere) chairman and CEO.

Castlight’s IPO could raise up to $140 million based on a revised filing made this week.


Sales

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PatientPoint awards Xerox a $28 million contract to work with hospitals and physician practices to introduce PatientPoint’s digital check-in and population health management software and to provide training and support.

Denver Health selects Besler Consulting to assist in the identification of Medicare and Medicare Advantage Transfer DRG underpayments.

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UCSF Medical Center will implement Oneview Healthcare’s patient empowerment program at three Mission Bay hospitals.

The University of Miami Health System selects Lockheed Martin to manage its healthcare data, develop predictive models for risk identification, and build automated systems to give providers data at the point of care.

Florida International University’s faculty practice chooses PatientKeeper Charge Capture.

Citizens Medical Center (TX) selects MModal for transcription services and front-end speech recognition.

West Florida ACO will implement eClinicalWorks Care Coordination Medical Record.

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Forbes names Epic’s Judy Faulkner as #520 on its list of “The Richest People on the Planet,” estimating her net worth at $3.1 billion.


People

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Accretive Health appoints Patrick Funck (Segwick) SVP/CIO.

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HCI Group names Bill Bria, MD (Shriners Hospital for Children) as CMIO and Robert Steele (Sterling Healthcare Initiatives) as SVP of delivery operations.

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Greater Houston Healthconnect CEO Jim Langabeer, PhD resigns to return to his previous employer UT Health Science Center, with CTO Phil Beckett, MD named acting CEO.

Carolinas HealthCare System hires Nancy Olson, RN-C, MBA, PhD (Providence Health & Services) as its first chief nurse informatics officer.


Announcements and Implementations

inga_small WEDI, in partnership with EHNAC, will create a Practice Management Accreditation Program to review PM vendors in the areas of privacy, security, mandated standards and operating rules, and operational functions. While I am all for having minimum performance standards, is this really the best time to ask vendors to jump through one more hoop to remain competitive in the marketplace? It’s no surprise that we are seeing limited advances in product usability and innovation.

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The local business journal profiles St. Francis Hospital (CT), which goes live on Epic next month following a two-year, $120 million transition. Above is VP/CIO Linda Shanley.

Summit Health (PA) implements Wellcentive’s population health management solutions and services.

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Ontario’s Group Health Centre goes live on Epic.

Wellmont Health System (TN) transitions to Epic in its physician offices and hospitals.

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North Oaks Medical Center (LA) goes live with a two-way interface between Epic and the Masimo Patient SafetyNet remote monitoring and clinician notification system.

GetWellNetwork debuts GetWellNetwork Ambulatory, which is available on mobile and stationary devices and integrates with EHRs to provide personalized information, healthcare tools, and patient pathways.

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CoverMyMeds launches an API that enables providers of EHRs, e-prescribing systems, and PM systems to offer an NCPDP standards-compliant electronic prior authorization solution.

John Gomez launches Sensato, which will offer healthcare privacy and security assessments, guidance, and tools.

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UC Irvine Health deploys WANdisco and Hortonworks Hadoop data technology to provide real-time information for patient care. They run Allscripts Sunrise, I believe, and an unnamed data warehouse technology described in the announcement as one that “struggles with availability issues as well as the volume and variety of data it can handle.”


Government and Politics

inga_small The FDA is seeking a contractor to monitor social media chatter about drugs, medical devices, and other regulated products in order to track conversation shifts following FDA warnings. I found this move especially interesting in light of the heavy Twitter traffic during HIMSS and my realization of  the potential value of mined Twitter data. Now I’m wondering if anyone has figured out a way to combine data from social media chatter with old-school opinion polls from phone and mail surveys. That could be powerful.

ONC releases additional draft electronic clinical quality measures for review and testing for the possible inclusion in the MU and other federal programs.

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The front-page story of the March 10 issue of Time says that Healthcare.gov had so many problems that the White House was ready to shut it down and start over right after its launch. It says that it’s not clear even now who was supposed to be in charge of the launch and that people knew upfront that the site’s design was flawed.

Speaking of Healthcare.gov, HHS says it will need $1.8 billion in FY2015 to run the federal health insurance exchange.


Other

A three-year study finds that patient-centered medical homes do little to reduce costs, decrease utilization, or improve care, leading researchers to conclude, “Medical home interventions may need further refinement.”

The use of patient portals for secure messaging does not significantly change the frequency of face-to-face visits, according to a Mayo Clinic study. Weakness of the study are that portal messages were studied in a vacuum rather than in the context of all provider communication, it looked only at the number of visits rather than patient outcomes, and most of the study subjects were Mayo Clinic employees.

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Baylor Regional Medical Center announces that it will not accept the Malcolm Baldridge National Quality Award following allegations that it improperly managed a neurosurgeon who is accused of botching surgeries while under the influence of drugs. An extensive profile in the Dallas Morning News paints a disturbing picture of a physician who was labeled a sociopath and serial killer by colleagues. We featured the story in September 2013 with this summary:

A Dallas news magazine recounts the fascinating tale of a newly licensed MD-PhD neurosurgeon whose incompetence left several patients maimed or dead while the state’s medical board couldn’t stop him from practicing. Colleagues called the doctor the worst they had every seen and said his skill level was no higher than a first-year resident as he kept inadvertently slicing arteries causing patients to bleed to death, and in one case the OR team had to forcibly remove him from the OR to prevent him from killing his patient. His marketing team and his 4.5 star Healthgrades.com rating brought in plenty of new patients to his loftily named practice, Texas Neurosurgical Institute. Surgeon readers will be horrified by this recap by a peer who had to clean up one of his messes: “He had amputated a nerve root. It was just gone. And in its place is where he had placed the fusion. He’d made multiple screw holes on the left everywhere but where he had needed to be. On the right side, there was a screw through a portion of the S1 nerve root. I couldn’t believe a trained surgeon could do this. He just had no recognition of the proper anatomy. He had no idea what he was doing.” The article blames the situation on malpractice caps, laws that hold hospitals liable for damages only if their intentions are provably malicious, and a nearly powerless medical board charged more with keeping licensure records and counting CE hours than watch-guarding patient safety.

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Mike “PACSMan” Cannavo summarizes HIMSS14 from the imaging perspective in an Aunt Minnie article (simple registration is required.) He tells me that HIMSS rules even though RSNA is a bigger conference because, “The balance of power has definitely shifted from departmental solutions to facility-wide ones and IT and the CIO/CTOs make those decisions here.” Another of his observations:

HIMSS may, and probably will, command the lion’s share of the trade show budgets for VNA and cloud companies from now on. Considering there were more than two dozen vendors playing in this arena alone, plus the majors who showed various central data repository (CDR) solutions, this can affect other trade shows in terms of booth size and revenue. Given that attendance at most radiology-specific shows has been flat or declining and time spent at the shows has declined each year, HIMSS poses even more of a threat.

A group of former senators (Tom Daschle, Trent Lott, John Breaux) forms the noble-sounding Alliance for Connected Care, which will lobby Congress to protect the interests of its big-company members (Verizon, WellPoint, CVS, and Walgreens) as well as patients who benefit from telehealth services. In addition to seeking friendly governmental consideration, the group wants to lift geographic treatment limitations and build the case for telehealth as an effective care delivery mechanism. Surprisingly, HIMSS isn’t among its lengthy list of advisory board organizations. I’m always suspicious of the motivations of retired politicians anxious to make up for the income they lost while holding office, but in this case their announced intentions seem appropriate.

Brian Ahier got a one-on-one interview with National Coordinator Karen DeSalvo at the HIMSS conference. She says everybody has been focused on collecting information via EHRs, but now it’s time to allow patients to participate and acknowledge that “health is more than getting people to a doctor” since only 10-20 percent of outcomes can be attributed to the healthcare system. She clearly has a public health mindset as did her predecessor and she gets a “bravo” for that.

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The CFO of Wake Forest Baptist Medical Center (NC) lists reduced Epic expenses as one element of its improved financial performance in which six-month operational losses were reduced from $49.8 million to $23.5 million. The hospital still has high expectations for Epic, saying in a bond ratings agency report, “Management believes that future financial performance must be improved from current levels, and continues to aggressively pursue both short- and long-term strategies to drive growth, reduce cost and leverage our investment in Epic.”

In England, a three-year-old cardiac surgery patient dies when the scheduling system of the hospital to which he was transferred fails to generate his follow-up appointments. According to the hospital’s pediatrics manager, “Samuel’s appointment request must have fallen through the cracks between the old and new system. The new system is now up and running as best as it can be, but as long as there is still humans entering the information there will always be room for error.”

Weird News Andy notes that Banner Health didn’t have a banner day when it inadvertently printed subscriber Social Security numbers on its health magazine’s mailing labels.


Sponsor Updates

  • Greenway Medical names Phreesia its Marketplace Partner of the Year.
  • Aprima Medical announces that over 1,500 former Allscripts MyWay customers have migrated to its platform.
  • PerfectServe introduces automatic electronic PHI filtering capabilities that remove ePHI from the body of messages sent to non-secure mobile devices.
  • Lisa Reichard, director of community healthcare relations for Billian’s HealthDATA, writes a fun blog post that includes her top 10 tales and takeaways from HIMSS14.
  • Extension Healthcare will participate in the AONE 2014 Annual Conference in Orlando March 12-15.
  • The Tennessean interviews Cumberland Consulting Group CEO Jim Lewis about the company.
  • Boston Software Systems offers a white paper that examines three steps to a successful migration. 
  • An HCS case study highlights Christian Health Care Center (NJ) and the benefits it realized following the implementation of HCS Interactant.
  • TriZetto Provider Solutions advises customers that it will continue to accept claims in print image, NSF, and legacy formats even after the ICD-10 implementation deadline.
  • E-MDs publishes video testimonials from multiple providers.
  • Clinithink’s VP of solutions Russ Anderson suggests leveraging the use of Clinical Natural Language Processing to control patient leakage.
  • Health Catalyst offers a white paper with keys to a successful data warehouse and analytics implementation.
  • Vital Images experiences significant growth across Europe, the Middle East, and Europe.
  • CommVault achieves certified integration with its Simpana 10 software and the SAP HANA platform.
  • TeleTracking Technologies, Hill-Rom, and GOJO will co-market integrations with the Hill-Rom Hand Hygiene Compliance solution.
  • Cornerstone Advisors reports that its staff has grown to 39, a 25 percent increase in the past year.
  • Divurgent will provide support to Medsphere clients in their MU, ICD-10, and value-based purchasing initiatives.
  • Gartner positions Qlik in the Leaders Quadrant of the 2014 BI and Analytics Platform Magic Quadrant report.
  • HIMSS Analytics names Allscripts its first Certified Educator of the EMR Adoption Model.
  • The Cleveland Clinic and Dell will offer Epic EMR consulting and implementation services to other health systems and practices.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

 

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March 4, 2014 News 7 Comments

Morning Headlines 3/4/14

March 3, 2014 Headlines 2 Comments

TELUS Health Acquires British Columbia-Based Electronic Medical Record Provider Med Access Inc.

Vancouver, British Columbia-based TELUS Health acquires Med Access Inc., an ambulatory EHR vendor that services 2,000 physicians across Canada. Financial terms were not disclosed.

Impact of Patient Portal Secure Messages and Electronic Visits on Adult Primary Care Office Visits

A new study published in Telemedicine and e-Health follows 2,357 patients for three years following a patient portal implementation and finds that rolling out secure messaging has no impact on total volume of office visits.

Saudi Arabia is Building a Massive Nationwide eHealth Network

Saudi Arabia publishes a 10-year eHealth strategy that calls for an integrated national-wide health information network that will connect 3,500 healthcare facilities, representing 70,000 beds.

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March 3, 2014 Headlines 2 Comments

Readers Write: National Patient Identifier: Why Patient-Matching Technology May be a Better Solution

March 3, 2014 Readers Write 3 Comments

National Patient Identifier: Why Patient-Matching Technology May be a Better Solution
By Vicki Wheatley

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Advances in technology, combined with The Patient Protection and Affordable Care Act, have begun to revive calls in the media for a national patient identifier—similar to the national provider identifier (NPI) assigned to physicians. The HIPAA legislation of 1996 included provisions for such an identifier, but they’ve never been enacted out of concerns for privacy and security.

Despite current law prohibiting the use of national patient identifiers, many proponents say creating such an identifier would make it easier to track patients across the continuum of care, leading to more effective treatments and better outcomes for patients. Others believe existing credentials such as Social Security numbers make a national patient identifier unnecessary. Lost in all the debate, however, are patient identification issues that will always exist—whether a national patient ID does or not.

Although adding a national patient identifier would provide one more data element to help confirm a patient’s identity, it still wouldn’t resolve some key record-matching challenges, nor would it fully enable organizations to use data for analytics, population health management or accountable care.

For a national identifier to work, even in theory, every single potential patient in the country would need to be assigned one—and only one—number and use it consistently. This holds true whether we generate a new identification number or use an existing one, such as a Social Security number.

For the sake of argument, let’s say Social Security numbers were to be used as national patient identifiers. Truth be told, many individuals living in or visiting the US don’t have Social Security numbers, like newborns or foreign visitors. Others may be fraudulently using someone else’s number for employment or other purposes. Additionally, using Social Security numbers as patient identifiers likely would raise security and privacy concerns due to the amount of financial and personal information already tied to them.

Just as the NPI has not been the fix-all for helping healthcare organizations exchange provider information, implementing a national patient identifier or using Social Security numbers will not resolve patient identification issues either. The reason: it won’t address concerns regarding existing information discrepancies or duplicate patient records. Additionally, like any identifier, it can be mis-keyed, transposed, or even stolen. Adding yet another identifier does not solve the patient matching conundrum.

Rather than advocating for a panacea that won’t solve the problem, healthcare organizations should instead focus on strengthening their existing enterprise patient-matching strategies, which can be easily implemented within individual organizations.

In order to provide optimal care, clinicians need to have an accurate view of the individuals they treat. Likewise, organizations as a whole must know who their patients are, what coverage they have, and which payer’s rules they must adhere to in order to receive payment. All of this information is particularly valuable when patient data is being used for analytics, accountable care, or population health management.

Thus, resolving patient identification problems is essential not only for enabling quality care, but also for supporting the financial viability of the healthcare organization. The challenges are further compounded by the fact that patient data resides across disparate systems encompassing the patient’s entire continuum of care. As a result, available patient data must be accurately linked together from within and across multiple organizations.

Unfortunately, however, errors occur. Registration staff may inadvertently transpose numbers, record nicknames instead of legal names, or fail to validate and update key data elements. Patients change addresses, phone numbers, insurance coverage, and names all the time. Data provided and collected is not always complete or accurate. Some patients forget information; others even want to hide it. To err is human, but mistakes introduced into patient records lead to discrepancies and duplicate patient records that complicate the patient identification process.

Patient-matching technology within an enterprise master patient index (EMPI) allows hospitals and health systems to bring together disparate information from various IT systems within or across organizations. This is essential for effectively managing the patient population and preparing for payment reforms. For example, an EMPI that compares patient data using probabilistic matching tools and algorithms can generate a unique enterprise identifier for each patient, eliminating the need to change information in source IT systems and enabling exchange of clinical and financial data. With an EMPI, multiple key data elements such as name, birth date, gender, address, other identifiers, and even biometrics can be used to accurately identify patients, ensuring the data in front of providers matches the patients they’re treating.

It’s a fact: as long as people are involved in providing and entering information, some level of human error remains inevitable. Yet by employing a strong strategy to address underlying identification issues, hospitals and health systems can compensate for some of the human elements that will always complicate patient identification—with or without a national patient identifier in place.

Vicki Wheatley is executive vice president of enterprise master person index solutions of QuadraMed of Reston,VA.

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March 3, 2014 Readers Write 3 Comments

Readers Write: Dr. Gregg’s “HIStalk: The Movie”

March 3, 2014 Readers Write No Comments

HIStalk: The Movie
By Dr. Gregg

dr gregg

It’s Oscar night tonight. I know this because in my house, that’s a pretty big deal; my wife is one of the most star-struck people walking the planet.

And, as it’s a night of glam and glitz and red carpets and such, it seems an appropriate time to announce the upcoming release of the star-studded extravaganza, “HIStalk: The Movie.”

No doubt you’ve heard the rumors… and it’s true! HIStalk is coming to the big screen. Featuring a cast of some of HIT’s biggest stars, including:

The one, the only – MR. H! Nobody tells it like the inimitable, and wholly inscrutable, Mr. HIStalk. Now he tells it like it is in full, glorious Technicolor with thundering DTS surround sound. Hear Mr. H blast the blatantly bland and debunk buffaloing bloggers. See him – fully facially pixelated – tear through HIT hype and tripe. Watch as he snags rumors from the ethers and exposes the raw underbelly of the simmering underworld of HIT.

The perpetually 28 year old party girl – Inga! Nobody glides through the HIMSS exhibition halls with more panache than the sultry Swede. Watch her dance the night away with HIT celebs Farzad, Jonathan, Ivo, and many more meaningfully-used macho men. Sporting in the finest footwear this side of the Champs-Elysées, she’ll dance her way straight to your hard drive.

The ever-running, always stunning – Dr. Jayne! Hear the good doctor call out unscrupulous C-suite commands for harmful cost-cutting. Watch her shoot down ill-considered patient care policies and lambast ludicrous Luddites. She’ll run a marathon of mischief as she bears the banner for CMIOs everywhere.

The million dollar mobile man – Dr. Travis! Once again riding the WiFi waves of justice, Dr. Travis will keep you in mHealth stitches as he exposes new tech that doesn’t deliver and sorts out the portably important from the connectedly comic.

The man – Lt. Dan! Need we say more?

The vivacious new HIStalk vamp – Lorre! Supremely smart and stunningly sassy, this demure little vixen will warm your digital hearts as she becomes HIT’s newest pin-up girl. We’ve no doubt that after the world sees her stunning debut performance that she’ll be adorning screensavers like no one since Farah Fawcett.

You’ll gasp in awe at the beautiful panoramic sets designed and painted by the hand of Regina Holliday.

You’ll be blown away by the homespun humor and heartwarming insights into all things HIT based upon Ed Marx’s award-winning story.

You’ll never forget the effortless flow and seamless style of Dr. Rick’s screen adaptation.

You’ll delight in the scintillating score by the lyrical genious, Dr. HITECH, founder of The American College of Medical Informatimusicology (ACMImimi.) Performed by the entire ensemble of illustrious ACMImimi fellows, you’ll hear health information rock like you’ve never heard it before.

Get out the popcorn and pull up your favorite easy chair for tonight’s Oscars, but get ready really enjoy them next year when “HIStalk: The Movie” will undoubtedly take home all the golden statues setting new standards for both Hollywood and HIT.

From the trenches…

"Never give up. And never, under any circumstances, face the facts.” – Ruth Gordon, Best Supporting Actress, “Rosemary’s Baby”

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

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March 3, 2014 Readers Write No Comments

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Reader Comments

  • Mobile Man: Very, very interesting! Thank you both. And, I must say - I love the "final thoughts". Many/Most don't end with an ...
  • IntriguedByVistA: the link ... http://www.openhealthnews.com/hotnews/vista-rivals-epic-and-cerner-major-deployments-ehr-systems...
  • IntriguedByVistA: Here's an interesting article from last October courageously contrasting Epic/Cerner with VA Vista. Any guidance / fe...
  • Mobile Man: Re: "...about using EHR data..." I am constantly amazed that healthcare IT hasn't figured out the secrets that Ba...
  • Not in Monterey: I don't like this increasing prevalence of scribes in the ED and other locations because of the game of telephone that o...

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