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Morning Headlines 3/10/17

March 9, 2017 Headlines No Comments

GOP Health Bill Clears 2 House Panels After Marathon Sessions

The AHCA bill passes votes in the House Energy and Commerce Committee and the House Ways and Means committee, leading up to a final House vote tentatively scheduled for the week of March 20.

Cerner, State and Local Leaders Commemorate Innovations With Ribbon-Cutting

Cerner opens the first of two towers at its new Innovation Campus.

Partners gets a fiscal health warning

Partners Healthcare (MA) has its credit outlook downgraded from stable to negative, with analysts noting that they are not concerned with the temporary bottom line hit from its Epic implementation.

Trust, confidence and Verifiable Data Audit

Google’s AI subsidiary DeepMind announces that it will build out a blockchain-like data audit tool for its healthcare customers.

News 3/10/17

March 9, 2017 News 2 Comments

Top News

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Two House panels approve the Republican ACA repeal bill, sending it to the House floor. The Ways and Means committee required an 18-hour session to endorse the American Health Care Act, while the Energy and Commerce Committee’s marathon hearing lasted more than 27 straight hours before ending with a straight party line vote.

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President Trump immediately began pitching the bill, while House Speaker Paul Ryan brought out a PowerPoint presentation hoping to gain support while declaring that the bill is a “binary choice” that suggests taking it or leaving it, now or never, with no significant changes. Sources indicate that the President told a conservative group that if the bill isn’t passed, he will allow the Affordable Care Act to fail and then blame Democrats.

The American Health Care Act has yet to be scored by the Congressional Budget Office to estimate its cost and the number of uninsured Americans before and after its implementation. On record as opposing the bill in its present form are the American Medical Association, the American Hospital Association, the Association of American Medical Colleges, the American Nurses Association, AARP, and a surprisingly bold Medicaid Chief Medical Officer Andrey Ostrovsky, MD. {correction: I originally wrote that Ostrovsky was appointed by the Trump administration, which is incorrect. He joined CMS in September 2016).


Reader Comments

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From Pixelator: “Re: Epic’s App Orchard. It follows the Apple App Store model from what I can tell. Apple doesn’t look at or copy code from apps, but it also doesn’t want to be sued by a developer of a minor app if it expands its own product into similar territory. I doubt any EHR vendor gives unfettered access to their APIs or data models that allows a vendor to sell derivative works without any control by the EHR vendor, but I’m interested in the first-hand experience of others with Cerner, Allscripts, etc.“

From Squidward Tentacles: “Re: single-payer system. I’m interested in your thoughts after reading this article in a left-leaning publication.” I’m in favor of universal healthcare, I say after years of arguing otherwise. The US is the stubborn outlier among developed countries and we’re spending ourselves into bankruptcy (both as individuals and as a nation) while lagging the pack on health indicators. Universal healthcare doesn’t necessarily mean a government-run program or one that gives citizens a blank check for their every healthcare need. Unfortunately, we’ll probably continue to out-spend and out-die our peer nations since we’ve allowed healthcare to become a political and economic class football. Our system is mediocre to good for those with means, bad for those without, and worse still for those who have income and assets that can be wiped out with a single, inevitable medical event.


HIStalk Announcements and Requests

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Reader donations funded the DonorsChoose grant request of Ms. P in Oklahoma, who asked for hands-on learning stations for her class of learning-disabled kindergartners. She says the kids love the sight word mats, are having fun with watercolors, and are using the chalkboard for practice work.

I was thinking that it’s probably time to buy a new laptop since the $300 one I use as my only computer (other than my Chromebook) is several years old. I’m discouraged that the laptop market seems dull, with prices higher than I expected and poor customer reviews. I’ve been scouring ads from BestBuy and the office supply stories for weeks with nothing rising above the pack. I was thinking it that it makes sense to upgrade when buying something new, like getting 16GB of memory and maybe a solid state drive, but I don’t want to spend $1,000 to replace a $300 device, especially when I don’t need or want a touchscreen or a two-in-one laptop. I thought sure I would feel outclassed and then be overcome with tingly anticipation upon seeing what has improved in the intervening years, but I haven’t missed much.

This week on HIStalk Practice: GuideWell acquires PopHealthCare. The Bronx RHIO selects population health reporting tools from Imat Solutions. CMS opens up 2018 Next Generation ACO applications. First Stop Health raises $1.6 million. Fitbit rethinks its product lines. PCPs in Maryland form the Chesapeake IPA. Health Fidelity’s Chris Gluhak offers HIPs tips for MIPS. Alternative Family Services selects Core Solutions EHR. A Helping Hand of Wilmington implements Mediware’s AlphaFlex. This month’s Winners Circle features Albert Wolf, MD and Todd Wolynn, MD of Kids Plus Pediatrics in Pittsburgh.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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San Francisco-based online medical clinic Virta Health, which launched this week with $37 million in funding, says it hopes to reverse type 2 diabetes in 100 million people by 2025 using individualized nutritional analysis and artificial intelligence-powered continuous monitoring and coaching. Founder and CEO Sami Inkinen also co-founded real estate site Trulia.

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Investors in China are souring at the prospects of the country’s 2,000 mobile health apps that offer consumers alternatives to overcrowded hospitals. At least three apps — of the several hundred that have attracted investments — have hit $1 billion in valuation, but investors are beginning to question whether they will ever make money since the only revenue source for the apps is advertising. The most-used medical app, insurer-owned Ping An Good Doctor (which offers free doctor consultations), raised $500 million in a Series A funding round last spring that valued the company at $3 billion. Search giant Baidu shut down its mobile health unit and at least 27 medical app vendors have closed after burning through their investor-provided cash. The surviving app vendors are trying to pivot in working with hospitals or insurance companies.

Telemedicine platform vendor GlobalMed acquires competitor TreatMD.

India-based offshore medical coding vendor Omega Healthcare Management Services acquires North Carolina-based analytics vendor WhiteSpace Health, which has development offices in India. WhiteSpace Health co-founder Sy Yellamanchali was previously SVP with MModal.

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PokitDok raises an unspecified strategic investment to further develop its APIs and blockchain solutions, increasing its total funding to $48 million.

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Cerner opens the first two towers of its Innovation campus, its seventh in the Kansas City area.


Sales

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Mount Sinai Health System (NY) chooses patient-provider matching from Kyruus for its Physician Access Services team that handles referrals for 700 providers.

Adventist Health System chooses Premier’s pharmacy clinical surveillance and analytics for medication management and antibiotic stewardship programs. Premier acquired the former TheraDoc from Hospira for $117 million in August 2014.


People

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MD Anderson Cancer Center President Ron DePinho, MD resigns, explaining that the organization needs someone who can inspire unity and apply operational focus. MDACC has struggled with a deteriorating financial position that it blames on its Epic implementation, among other factors, and has stumbled in its $62 million failed attempt to use IBM Watson for cancer care.

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CareCloud hires Greg Shorten (Validic) as chief revenue officer.


Announcements and Implementations

Medecision launches Aerial Bundled Episode Manager, which helps IDNs working under bundled payment arrangements to better identify and care for high-risk patients.

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Google’s DeepMind Health subsidiary will implement a blockchain-like Verifiable Data Audit to provide hospitals with an audit log of how the information of their patients was handled. The company says its method is different from blockchain because it will not require heavy duty computing and will be able to call out changes to any part of the stored data. According to the company,

We’ll build a dedicated online interface that authorized staff at our partner hospitals can use to examine the audit trail of DeepMind Health’s data use in real-time. It will allow continuous verification that our systems are working as they should, and enable our partners to easily query the ledger to check for particular types of data use. We’d also like to enable our partners to run automated queries, effectively setting alarms that would be triggered if anything unusual took place. And, in time, we could even give our partners the option of allowing others to check our data processing, such as individual patients or patient groups.


Government and Politics

VA Secretary David Shulkin tells the House Veterans Affairs Committee, “I’ve come to the conclusion that VA building its own software products and doing its own software development inside is not a good way to pursue this. We need to move toward commercially-tested products.”

Conan O’Brien creates a modestly funny ad that lampoons this week’s comments by Rep. Jason Chaffetz (R-UT), who lauded removing the ACA’s individual mandate and said that Americans should invest in their healthcare instead of the latest iPhone. The video also made me think of the digital heath evangelists whose never-ending parade of questionably useful apps are their hammer in search of a nail. Meanwhile, Chaffetz’s comment led family physician Kathryn Allen to immediately file paperwork to run against him.


Other

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Debt rating services revise the credit outlook of Partners HealthCare (MA) from stable to negative following its $108 million fiscal year operating loss. Analysts are worried most about continuing losses in the company’s Medicaid insurance business, adding that they aren’t worried about the temporary bottom line hits from its Epic implementation and office consolidation project.

In Minnesota, Fairview Health Services and HealthEast Care System announce plans to merge.

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Western Missouri Medical Center (MO) outsources its patient billing after patients complain about the confusing bills sent by its Cerner billing system.

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Cancer researcher Carlo Croce, MD, who has been awarded $86 million in federal research grants, has been the subject of several allegations and whistleblower complaints regarding falsified data that include Photoshopped western blots, according to a New York Times investigation. Journals have updated 20 of his papers with corrections, retractions, and editors’ notices, but Ohio State University – the recipient of $8.7 million from his grants – has repeatedly cleared him of wrongdoing. Croce had previously joined a scientific advisory board of a tobacco producer-funded group that tried to convince the public that smoking doesn’t cause cancer. It’s interesting to me is that he’s an art collector, with 400 paintings by Italian masters displayed in the 5,000-square-foot gallery he added to his $3 million mansion. Cancer has bankrupted a lot of people, but some have become wealthy from it.

Add this to the long list of reasons that “semi-private” hospital rooms make no sense at all. An inpatient returns to his bed after undergoing tests and finds that his credit cards and cellphone have been stolen from his bedside drawer. Authorities later investigating fraudulent charges on his card arrest the perpetrator – the guy who shared his hospital room.

The family of a South Carolina man who died of a severe allergic reaction sues Union County Medical Center (SC), claiming that when its locum tenens ED doctor wasn’t able to intubate him, the doctor then viewed a YouTube video on performing a cricothyrotomy, which also failed. Police arriving to investigate found the video still up on the doctor’s computer screen.

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Weird News Andy exclaims with his best Monty Python accent that “I’m not dead yet” in describing the findings of ICU doctors in which patients showed brain activity after being declared clinically dead.


Sponsor Updates

  • PokitDok launches its API developer tools on AWS Marketplace with bundled plans for patient check-in, health insurance administration, and out-of-pocket estimates. 
  • The FutureofEverything.io features Impact Advisors Principal Eric Gerard in “What’s the Future of Healthcare?”
  • Imprivata presents at the Massachusetts Health Data Consortium’s event on healthcare’s identity crisis.
  • Ingenious Med’s Practice and Enterprise charge capture and care coordination technology earn HITRUST CSF Certification.
  • InterSystems shares its show-floor presentation from HIMSS17 featuring Laura Adams from the Rhode Island Quality Institute.
  • Intelligent Medical Objects will exhibit at the Cerner UK Collaboration Forum March 13-16 in London.
  • Ovum Report recognizes Liaison Technologies as a leading B2B integration managed services provider.
  • Gartner names LogicWorks a leader in the 2017 Magic Quadrant for Public Cloud Infrastructure Managed Service Providers, Worldwide.
  • Meditech will host its Certificate Program in Clinical Informatics as a distance learning course March 21 through May 25 at MassBay Community College, Rowan College at Burlington County, and the Deborah Heart and Lung Center.
  • NVoq will exhibit at the AAOS Annual Meeting of Orthopedic Surgeons March 14-18 in San Diego.
  • Obix Perinatal Data System will exhibit at the AWHONN West Central Michigan Chapter Conference March 15 in Grand Rapids.
  • Experian Health will exhibit at HFMA Western PA March 13-14 in Washington, PA.
  • PerfectServe will exhibit at the Renal Physicians Association Annual Meeting March 17-18 in Nashville.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.

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EPtalk by Dr. Jayne 3/9/17

March 9, 2017 Dr. Jayne 3 Comments

I’m still getting back into the swing of things following my recent adventure in healthcare. I’ve enjoyed the relative downtime, although I’m getting a little stir crazy. Hopefully I’ll be cleared for travel early next week so I can keep the good stories coming from the trenches.

In the mean time, I’ve been going through my post-HIMSS and post-hospital mail. A couple of vendors need to get some money back on their marketing efforts: the postcard from eClinicalWorks arrived on Monday after HIMSS had already started, with an invitation to “The Way of Tea” at the Vital Images booth arriving on Tuesday. The grade schooler who picks up my mail when I’m gone does an excellent job sorting and bundling so that I know what mail is the oldest. I can’t wait until he grows up – I see some serious potential as a process improvement specialist.

I’ve been working my way through loads of email. A special thank you to all of you who sent well wishes and good vibes for a speedy recovery. It was nice to have those little rays of sunshine popping into my inbox.

I was glad to have been on sick leave from my clinical position because I was supposed to be working the day the big Amazon Web Services outage hit. Our vendor sent quite a few emails apprising users of the status. They were apparently having a partial outage, where users could document visits but could not see images, forms, and letters. You can have a really great downtime strategy in the office, but you never know how things are going to unfold when an outage hits.

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CMS has finally updated its website with Clinical Quality Measures information for the 2017 performance period. The Meaningful Use domains have been removed and now the measures align with the Quality Payment Program and its Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) tracks. CMS invites people to submit questions about the documentation, but I wouldn’t hold my breath waiting for a response. I’m still waiting for clarification on some Chronic Care Management questions from earlier in the year.

I’ve also had a ringside (couchside?) seat for the release of the American Health Care Act, with plenty of time to digest the back-and-forth commentary from politicians and healthcare leaders. I finally had to step back after a while because it’s going to go on for months as everyone tries to get their piece of the action with the usual wheeling and dealing, negotiations, and amendments.

The so-called “repeal and replace” legislation is only 4 percent the size of the Affordable Care Act (120-odd pages vs. 2,700) so the devil will truly be in the details. I’ve talked to a couple of friends who are OB/GYN physicians and their patients are still terrified about losing coverage for contraception and preventive services. One physician has a patient who is trying to import black market IUD devices from Canada. Apparently they’re made by the same manufacturer that makes them for the US market, but the cost is less than 25 percent of what they go for in the States. That’s a sad commentary on the state of healthcare in the US.

After the Affordable Care Act went into effect, my personal insurance plan was still grandfathered and didn’t have to offer all the mandatory coverage. Late last year, the trustees of the plan voted to un-grandfather and began to offer coverage for things that were previously not covered.

I finally began to pursue a genetic consultation to address some lingering family history concerns. After months of waiting and submitting genograms, results of relatives’ testing, and more, I finally have my appointment with the geneticist next week. Of course, it’s going to be better to know one way or another, but I hope my decision to get tested doesn’t come back to haunt me if there are changes to the protections and coverage for people who know they are at higher risk for serious health issues. (At least I know I’m at zero risk for gallstones or cholecystitis now, so that’s a plus.)

I had a strange experience as a physician this week. I received an email in my consulting business account containing a link to access a summary of care record. It was from a hospital where I haven’t been on staff since before I bought this domain, so I’m not entirely sure how my address came to be linked up to their system. Sure enough, it was a patient discharge record.

I cross-referenced it against my patient panel from the last year I was in a traditional primary care practice and found the patient. I’m not sure if it was a computer glitch or whether she really still considers me to be her primary care physician after all this time, but it was a nice memory. I called the hospital and they weren’t terribly helpful in trying to figure out how it got routed to me as it did, but instructed me to simply discard the message.

Physician readers familiar with “The Match” will cringe at this news story. The cardiothoracic surgery program at New York-Presbyterian / Columbia University failed to submit its resident ranking list, meaning it will not be able to offer residency slots as part of the traditional Match Day next week. Columbia can still fill its program through the Supplemental Offer and Acceptance Program, which makes unfilled slots available for residents who did not match. This could be a boon for students who didn’t get a spot via the actual Match process, but it means that the program will most likely not have access to its top-ranked candidates.

I still remember my own Match Day, and not entirely fondly. Although my placement was a sure thing, I was on the edge of my seat waiting for my turn to open my envelope in front of my entire class. For some, it was a barbaric way to do things as we watched people’s dreams get crushed in between happy Matchers jumping up and down. Schools still have formal Match Day ceremonies where this continues to happen, although applicants can now skip the envelope and find out an hour later via email.

What’s your Match Day memory? Email me.

Email Dr. Jayne.

Morning Headlines 3/9/17

March 8, 2017 Headlines 1 Comment

Investor sues Soon-Shiong for alleged securities violations after STAT report

NantHealth stock is down 35 percent following a scathing STAT investigative report on questionable charitable donations. In response, a NantHealth investor files suit against the company, claiming that it artificially inflated the market price of its stock and  reserving the right to expand the complaint  into a class action suit.

Price breaks public silence on health IT policy

HHS Secretary Tom Price lays out his position on health IT in a written response to questions from Senator Bob Casey (D-PA), saying one way to improve care and reduce costs would be “for the federal government to continue to promote the growth of health information technology and electronic health records.”

Ron DePinho resigning MD Anderson Cancer Center presidency

MD Anderson Cancer Center President Ron DePinho resigns. He reflects on his time at the helm as one that brought positive change, but acknowledges that “there was a cost for that change, and I have added to that cost.” He says the organization needs a new president that will bring “a sharp operational focus on navigating the tectonic changes in healthcare delivery and economics.”

How Republican opposition to healthcare reform is taking shape

The Guardian analyzes the likelihood of passage for the American Health Care Act (AHCA), the Republican ACA repeal and replace bill.

Readers Write: Naked Cybersecurity

March 8, 2017 Readers Write 1 Comment

Naked Cybersecurity
By John Gomez

John Gomez is CEO of Sensato of Asbury Park, NJ.

Although the observations in this article are based on my direct experiences over the past four years working with healthcare organizations to secure their systems. I am sure that most of what I am going to share is wrong. I also will apologize upfront for presenting a viewpoint that I am sure is one-sided, and although I believe it to be reflective of the reality of cybersecurity in healthcare, it is probably wrong.

I also want to clarify who I hope will read this article, because it is certainly not meant for everyone. If you are of the belief that academic cybersecurity approaches, checkmark mentality, or putting your faith in things like commercial “trusted” security and privacy frameworks or national cybersecurity information sharing groups is a good idea, then this article is not for you. Reading it will be a total waste of your time.

In fact, if you think that what you have been doing in cybersecurity is right and spot on, this article will just annoy you. And yes, you guessed it, it will be a waste of your time.

On the other hand, if you stay up at night freaked out that despite your best efforts you are losing the battle against a well-armed and informed enemy, then brothers and sisters, you probably will find this article of interest. Yet I warn you — this is more about my opinion (as unqualified as that may be) than any academic, certified, highly-trusted approach you may find in the world of healthcare cybersecurity.

For those who are still reading along, let me drop (in the vernacular of our youth) a truth bomb. A truth bomb that I suspect anyone still reading will not find surprising, but is akin to that small child who once said, “But the emperor has no clothes.” The truth I share with you is that we are losing the cybersecurity war and losing badly. 

There, I said it. And yes, it is rather cathartic to be able to state that in public. Try it with me — I promise you will feel better and empowered. We are losing the cybersecurity war.

Despite our best efforts, despite the beliefs in fancy risk and security frameworks and the latest hyperbole regarding threat intelligence, advanced defenses, and the latest snake oil being peddled by cybersecurity vendors, we are losing ground by leaps and bounds.

If you ever wanted to know what it felt like to be on the receiving end of General Patton’s surge across Europe, just take a job in the world of healthcare cybersecurity. We have some great, passionate, talented people among our ranks, but regardless of how fast they are pedaling, the attacks are overrunning them and taking ground.

In 2016, per a PWC cybersecurity survey, organizations across industries increased their spending on cybersecurity by 20 percent. Yet despite deploying more frameworks, more technology, employing some cool AI stuff, expanding their staffs, and embracing the best practice of the day, we also learned that there was a 38 percent increase in cybersecurity attacks. The cost to remediate an attack rose by 23 percent over 2015.

Talk about a lousy return on investment. You increase spending by 20 percent, and yet you are finding your efforts to not even be closing the gap. In fact, on a cross-industry basis, we are seeing double-digit negative returns on cybersecurity investments.

Years ago, an experiment was conducted where a monkey threw a dart at a list of stocks. The goal was to see if random selection of stocks ended up worst or better than what was selected by professional and well-trained brokers. If I recall, the monkey’s picks fared better. Sadly, for those of us protecting healthcare organizations from attackers, we are seeing similar results. There is no — not one — strategy or best practice that will definitively prevent attackers from gaining access to your systems.

Speaking of attackers, just how painful has life become for their side of the seesaw? I mean, everyone is spending more money; cybersecurity is now a board-level issue; and per HIPAA, it is required that the CEO be intimate with the protection of patient data as it relates to security and privacy. Certainly all this increase in spending, resources, and attention must be making life so very hard for the cyberattacker.

Well, in 2016, the average cost of a highly-sophisticated exploit kit was $1,367, a 44 percent decrease over 2015. Thanks to easy and cheap access to cloud computing (I am looking at you, Microsoft and Amazon), the cost of an attack has dropped 40 percent over 2015. We now have attacker market that include RAS (ransomware as a service), EAS (espionage as a service), and DDoSasS (Distributed Denial of Service as a service). You can contract for any of these attack services from the comfort of your home recliner. We also have learned that the average length of time to successfully execute a breach is now less than 24 hours, a 72 percent decrease over 2015.

Net-net, attackers are winning and probably chilling out, sharing bottles of wine, nibbling on cheese, and laughing their butts off. Yet for those in the trenches, those who get up day to day fighting the good fight, none of this is new. I suspect that the front-line defenders know all of this, yet don’t have the data or podium to yell out, “The emperor has no clothes.”

Ultimately, I believe we all are united (vendors, defenders, management) in understanding that our current approaches are not working over the long term. I also suspect some will have counterarguments, point out that things aren’t that bad, and claim their solution is fault proof. As someone who works with attackers, I can tell you that you would be foolish to believe that your current approaches can thwart attackers. Especially if your approaches date back to 2010, are based on complicated frameworks and tools, and require you to subscribe to checkmark practices.

Here is a final statistical truth bomb that you may find entertaining. About a decade ago, we could detect an attacker in our networks within hours. Over time time-to-detection has evolved from hours to the current average of 265 days. If the attackers keep evolving, soon it will be over a year on average before we can detect an attacker despite our increased spending and advanced defense capabilities.

We can attribute this to advanced persistent threats (even though most attacks are not all that advanced), higher complexity of networks, and technology we defend as among the reasons attackers succeed. I am sure there is some truth in all those reasons, but you don’t win wars by pointing out what you are doing. You win wars by gearing up, toughening up, and figuring out how to fight better and more effectively than your enemy.

I guess the foundational question this article will pose is, is this a lost cause? Should we just wave the white flag and throw up our arms? That is one approach, but I have greater faith in all of you. You who stay awake at night wondering what else you can do to fight the good fight. You who take on your boards, push back against the egotistical physician, and fight to be heard for funding and attention — all to make it a little bit tougher for the attacker. I have tremendous faith for all of you who insist, “Not on my watch.”

I believe there is a lot we can do to turn the tide on the attackers. Right now, we are in a ground war, one that can benefit from technology, but that also requires us to really reconsider our core tactics and principles. One major piece of advice I would give you comes from Luke Cage of Marvel Comics — “…sometimes you have to throw out the science.”

A key approach that should be considered, debated, and tested is simplification. Rather than embrace the false of sense of security that complexity may bring, we should focus on tactics that rely on low-tech solutions that work consistently. You should be establishing last lines of defense that are based on securing high-value targets. It is critical that you take an attacker-centric viewpoint and truly understand attacker motivations. Much of this advice comes from my personal experiences in cybersecurity and in training special operation teams to take the fight to the enemy.

Simply stated, you need to embrace an assertive posture related to your cybersecurity. This is not 2010. It is 2017, and we are now dealing with attackers employing 2020 approaches. We have just seen the release of MedJack 3.0, which bypasses antivirus. We are seeing malware that is polymorphic. We are seeing attackers embrace analytics and machine learning. The answer is not a framework that recommends changing your password every 90 days? A signature-based system is not going to keep an attacker out of your network.

We need to stop putting our faith in those solutions and approaches that are complex and increase complexity. Regardless of the technical solution or tactic, your goal should be to embrace simplicity, reduce excuses, and eliminate barriers to security.

Want to practically eliminate phishing attacks? Invest in a solution that adds the word “External:” to the subject line of any e-mail that comes from outside your organization. You would be surprised how this little low-tech investment dramatically drops the success of phishing attacks. Want to reduce the length of time an attacker is in your network? Learn what scares them most and target their fears (if you don’t know that answer, e-mail me). Turn the tables, get practical, fight back.

Practical real-world security doesn’t require huge expense or complicated approaches. The most critical first step is to become like a child. Open your eyes and realize that the emperor which is healthcare cybersecurity is in the buff.

HIStalk Interviews Daniel Stein, MD, PhD, Director of Informatics, Memorial Sloan Kettering

March 8, 2017 Interviews 1 Comment

Daniel Stein, MD, PhD is director of informatics and innovation at Memorial Sloan Kettering Cancer Center in New York, NY.

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Tell me about yourself and your work.

I call myself a clinical informatician. I went to med school and then completed a PhD in informatics at Columbia. I’ve been on the informatics faculty at a few institutions. I started at Columbia and then moved over to Cornell, both of which are part of New York Presbyterian Hospital.

I was recruited to Memorial Sloan Kettering about a year and a half ago by a mentor of mine from when I was at Columbia who is now MSK’s Chief Health Informatics Officer, Pete Stetson, MD. I work for Pete as a director in health informatics, focusing on innovation.

My first assignment was to help stand up and launch a new surgical platform here at MSK, which is called the Josie Robertson Surgery Center. That is an ambulatory, freestanding surgical facility for oncology cancer procedures.

Even though I was happy where I was before, Pete knew that I wouldn’t be able to turn it down. It’s quite rare in New York City to start fresh. This was a brand new facility. It was being designed from the ground up as an innovation center, to be chock full of technology and trying to use health IT and informatics to enable this place to do surgeries in a way that they’re not being done anywhere else.

I couldn’t turn that down. To me, it’s my version of Charlie and the Chocolate Factory – except in this case, the chocolate factory is a high-tech surgery center, and I’m just thrilled to be contributing as an informatician to the superb care we’re delivering.

The director of the Josie Robertson Surgical Center is anesthesiologist Brett Simon, MD, PhD. Much of the design and the success of the center is due to his visionary leadership.

What your readers may find most interesting about this surgery center is that one main goal is to do oncology surgeries in an ambulatory setting that aren’t typically done as outpatient procedures. The technology we have there plays a big role in enabling that in a manner that maintains the high quality and safety standard that we have established here at MSK.

The way we got there was that for several years before opening the surgery center, we developed a program that we call the Ambulatory Extended Recovery program, or AXR, in our surgery department. We were doing cases as if they were being done in the Ambulatory Center, but we did them in our main hospital. If for some reason the patient couldn’t go home, that would be OK.

For a few years, we learned how to figure out — through analytics and through certain patient factors, in terms of co-morbidities and other risk factors — what good candidate cases would be to do in an ambulatory setting. When it was time to open the center, which was a year ago this past January, we would know which patients we could do in this setting and which patients we couldn’t.

We have five surgical services in the center — breast, head and neck, gynecology, plastic and reconstructive, and urology. About a third of the cases that we do are AXR cases. Those are cases that typically — even here at MSK and certainly at other hospitals — wouldn’t be done with just one overnight stay, such as mastectomies with reconstruction, or minimally invasive robotic prostatectomies.

Because we took our time to figure out how to do this the right way before opening the center, and because of all of the informatics-enabled tools that we have put in place, we are seeing that not only are we doing these cases safely, we are getting overwhelmingly positive feedback from our patients. They like how smoothly the place runs and they like going home sooner rather than staying in the hospital.

We’ve looked very closely at key outcome measures over our first year and we’re seeing complication / transfer / admission rates that are even lower than we anticipated and lower than what we see reported in the literature for ambulatory surgical centers that do much simpler, non-cancer related procedures. .

What are some innovative ways IT systems are being used in the surgery center?

One of the important things we did before the center was opened was to develop procedure-specific pathways that these patients would be on. When we opened, we made changes globally throughout all of our information systems to support not only monitoring patients on these tailored pathways, but making progress on the pathways visible and apparent to all the people in the facility.

From the beginning of the surgical encounter, an order set is placed that puts the patient on the pathway in our EHR. That order set dictates everything that happens downstream from that. There are certain nursing documentation flowsheets that correspond to that order set that require documenting specific items that we monitor.

Then we have status boards that we’ve built in the EHR that show, for each patient who’s in the ambulatory surgical center, where they are on that pathway and whether they’re meeting criteria. Are they making good progress or is there something that requires attention on their specific pathway?

There’s discrete documentation that’s completed by the nurses. That documentation is rolled up into a green or red cell on a table in a status board right in the EHR. We can monitor all the patients who are in the facility in real time and determine whether they’re meeting the requirements that they need to have a safe discharge by the next day.

There are three major categories of items that we monitor in those status boards. Number one is what we call the patient’s well-being. That consists of factors like their blood pressure, heart rate, and respiratory rate, then other things like their nausea and vomiting. We take the structured documentation in those areas and roll it up to determine if they are meeting criteria for well-being. If not, we look into what’s going on and see if we can get them back on track.

We have some pathway-specific educational milestones that we have to meet depending on the surgery. For example, if the patient is a prostatectomy patient, we make sure they receive certain education around management of their Foley catheter before they go home.

Finally, we’re monitoring their activity status. We look at a combination of two things. Their ambulation — are they getting up out of bed and moving around? — and their PO intake – are they able to keep food and drink down?

We have some interesting technology that we’re leveraging for their ambulation. We have a real-time location system in the facility. RTLS is used a lot in industries outside of healthcare for things like asset tracking, to help you know where things are moving around in a facility. It’s being used more and more in healthcare. I think we’re one of the earliest, if not the first place, to try to integrate RTLS so deeply into the workflow of clinicians in a setting like this.

Everybody who is in the surgical facility wears a badge. These badges can be used to locate clinicians. They can be used to locate patients. We even give a badge to a caregiver or family member who might come with the patient so that we can let them stay where they are comfortable and we can approach them without having to call out the patient’s name in a waiting area. There’s a whole lot of things we do with RTLS that improve the patient and family experience, improve the awareness of the care team members, where people are. It’s like the Marauder’s Map in Harry Potter. You can see where everybody is in real time and see who’s in what room.

We use that for a variety of things. We have a lot of patient- and family-facing applications. When you’re in the hospital, a lot of people are coming in and out of the room. Sometimes it’s hard to keep track of who’s who, especially if you’re a little disoriented or if you’re on pain medications. One of the nice patient-facing applications of RTLS is that when you walk into one of our rooms, there’s a TV on the wall and up on the TV will pop the name of the clinician and their role. That gives people a clue of who’s walking into the room. It’s nice to give that to the patients, as so many different members of the team come in and out so frequently.

Because we are monitoring the progress of the patients through their pathway and we know when they’re in the OR and when they’re in the recovery room, we surface that information directly to the family members or caregivers down on the floor where they’re waiting. We have a big status board with a coded identifier. We can show them, now your husband is in the pre-op area, now he’s in the operating room, now he’s in the recovery room, now he’s ready for visitors. That board updates in real time. People find it very useful — they’re not just wondering what’s happening and what’s going on.

Since patients are wearing those badges, we’re using RTLS to estimate their steps they’re taking, almost like a Fitbit, and trying to work that into our clinical assessment of how they’re doing with ambulation.

We have RTLS integrated with our nurse call system and our telemetry units. If there’s an alarm that goes off in a patient’s room, the moment that one of the clinicians walks in, it will silence the alarm so they can focus on the patient and turn that off. Some neat integration there.

We’re exploring some telemedicine / telepresence. We’re facilitating discussion between some of our surgeons and the patients through videoconferencing and also exploring the use of a telepresence robot.

We have a secure text messaging platform being rolled out across the organization. We’re using it at the surgery center so that our clinicians can use text messaging as a communication modality while ensuring patient privacy. We’re tying that into other systems to try to automate text messages based on people’s roles. For example, a nurse can text the generic role “hospitalist on call” and that role will map to the individual who happens to be on call that night.

I would assume that for oncology in general and for your surgery center specifically that you must use patient engagement technology to keep a connection with the patient and family not just for that surgery, but throughout their oncology journey.

I’m glad you asked. We have a lot to talk about on that.

Of course, we have our traditional patient portal. We’re one of those organizations that has a lot of different systems just from our history. We even have two major EHRs in play, especially for surgical patients. We have a homegrown portal system that we call MyMSK. It ties it all together for the patients.

Even before they get here, we have tailored educational materials that are sent in an automated way. When the surgery is scheduled at Josie Robertson, patients will get notified through the portal that they’re having their surgery there. It gives them some basic information about where they’re going, what the facility is like, and what kind of things are there. It also gives them tailored educational material to their procedures.

We have a patient-engagement module as part of our portal we call MSK Engage. Someone might say it’s kind of like we built our own SurveyMonkey or survey platform. We specifically didn’t call it a survey platform or survey tool because we consider it a patient engagement tool. There’s a lot more to it than just delivering surveys to the patients.

We are delivering assessments to our post-operative patients and trying to capture their post-operative symptoms. We’re doing some daily symptom scoring with a pilot group of patients that are coming in through this surgical center. We’ve built a whole set of tools around that platform that monitors for results or responses that might be out of range.

There’s some interesting challenges that are posed when you do that. You have to figure out what to do when you detect something that might be worrisome or out of range. Things that might seem trivial, like figuring out who the appropriate member of the care team is to notify, is really not that trivial to automate.

Systems have a lot of different people who touch a given patient’s chart. We’ve done a lot of work on building what is now rudimentary system that we hope in the long run will become a sophisticated care team engine and notification platform so that we can, for a given patient, have a good representation of who the members of the care team are, who would need be notified if we think a patient isn’t doing all that well, and how we would get in touch with them. We’re trying to build those pieces into our patient engagement platform. We’ve got pieces of that in place now.

We recently were awarded a PCORI grant specifically for a project that we’re doing at this surgical center involving collecting daily assessments for patients post-operatively that will be starting next month. The actual work for the grant is not only about collecting how the patients are doing post-operatively, but providing them with some normative data. This way they can see how they’re doing in relation to how patients like them typically are doing on post-op Day 1, post-op Day 2, etc. until they come back for their office visit. The principal investigator of the grant is Andrea Pusic, MD, a plastic and reconstructive surgeon who developed the BREAST-Q satisfaction and quality of life assessment for breast reconstruction patients.

We’re excited about this work because we think that a lot of the anxiety and a lot of the utilization — whether it’s phone calls to the practices or visits to our urgent care center — could be ameliorated just by knowing that at this point, on Day 3, it’s normal to be feeling a certain amount of discomfort or to have a certain set of symptoms or conditions. Maybe after a certain period of time, now you’re out of that normal range, so you should give us a call or you should start to get concerned.

The grant is about the impact of sharing that normative data with the patients and seeing if we can reduce anxiety around post-operative symptoms and pain management and reduce unnecessary utilization. This is a perfect center to be exploring these types of questions.

IBM Watson for Oncology was trained at your hospital and oncology seems to be on the cutting edge of using artificial intelligence and data aggregation for everything from imaging analysis to diagnosis, all the way through to literature searches and applied informatics at the point of care. What are the most interesting potential uses of technologies that you’ve seen that are impacting oncology practice?

You highlighted a lot of it. We have multiple groups focused on precision oncology and how we can sift through the treatments that we offer, the different conditions our patients have, and the way genomic data and the tumor markers and all these things affect the decision treatments. There are a number of groups at MSK that are working in those areas.

In surgery, which I can speak to the most, especially at a place like this, we’re starting with the basics. One thing we don’t do well enough is just taking the data that we have in our EHRs and from our visits and outcomes and surfacing it to the clinicians in a way that they can get instant feedback on how they’re doing and what’s going on.

A huge part of the informatics efforts around this surgical center is collecting the data that all these systems are generating — including RTLS, so we can see where people are and how they’re moving around — and feeding it back to our chief of surgery, the director of the center, and the clinicians themselves so that they can see how they’re doing. See what their outcomes are for their different groups of patients. Because we’re in this freestanding facility where there’s a strong commitment among clinicians, staff, and nursing to innovate, we can act on that data rather quickly.

I’ll give you an example of that. We created some dashboards that look at the duration of the stays of the patients after their surgeries. We have those advanced surgeries where we expect patients to stay at least overnight. However, a lot of the cases that we’re doing, maybe a simple lumpectomy for a patient with breast cancer, they’re not intended to stay overnight. They don’t need to stay overnight.

We created a simple dashboard that shows patients who are supposed to be real, true outpatients and indicates whether they stayed longer than anticipated or if they ended up having to stay overnight, which we can facilitate for one night at this center. Just by looking at that data, we were able to find a subpopulation of our patients who seemed to be more often staying longer than they should be. When we looked into it, we found it was mostly due to pain and pain control, which we’re tracking in our structured documentation that’s associated with the pathway that these patients are on.

Our anesthesiologists and our surgeons got together and had a good collaboration. They started a new method to increase the use of local anesthesia during the procedure so that the patient’s pain was managed better. Now we’ve reduced the extended stays for these outpatients by almost half in just several months.

You’re correct that there’s a ton of promise of using AI and machine learning and algorithms and genomic data to tailor care, especially in oncology. We still have so far to go just by looking at some more basic data and surfacing it in a way that’s understandable and allows you to recognize patterns that you may not have expected and then do some hypothesis testing and improving your processes and improving the quality of the care you’re delivering. I think the whole spectrum of data analytics has a ton of potential to improve the care we deliver.

Do you have any final thoughts?

It’s been very exciting for me since I came to MSK. We just came up on our anniversary of being open open at the Josie Robertson Surgery Center in January and we’ve learned a lot. We’ve got a lot more to learn. We’re trying to keep things innovative.

We performed about 6,500 cases in that first year. About a third of those were those AXR cases where we’re really cutting edge in terms of what we’re able to do and get people home and happy and safe and following up with the engagement platform. We’re excited that the PCORI grant gives us the opportunity to learn how to maximize that. We’re certainly going to be busy.

Morning Headlines 3/8/17

March 7, 2017 Headlines 1 Comment

Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending

Telehealth services are linked to higher overall healthcare spending in a Health Affairs study that concludes that only 12 percent of virtual visits replaced a traditional office or emergency room visit, while 88 percent represented new utilization.

Allscripts accepted onto NHS London Procurement Partnership’s Clinical and Digital Information Systems (CDIS) Framework

In England, Allscripts reports that its software has been accepted into the NHS London Procurement Partnership for Clinical and Digital Information Systems for the EHR, Population Health software, and Innovation categories.

Have a Health-Related Question? WebMD Will Provide the Answer — Just Ask Alexa

Amazon Alexa will begin answering consumer health questions with clinical content provided through a partnership with WebMD.

News 3/8/17

March 7, 2017 News 13 Comments

Top News

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House Republicans unveil their plan to repeal and replace the Affordable Care Act, which they have named the American Health Care Act. It would:

  • Roll back the Medicaid expansion that insures 10 million people
  • Eliminate the requirement that people carry health insurance
  • Allow large employers to opt out of providing coverage to their full-time employees
  • Penalize those who let their insurance lapse and then sign up again
  • Replace premium subsidies with income tax credits
  • Allow insurers to charge much higher rates to older people
  • Change Medicaid from an open-ended entitlement to a per-person block grant to each state
  • Repeal the ACA-imposed tax surcharges on insurance companies, drug and device manufacturers, and citizens who earn more than $250,000.

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The proposal would continue to prohibit denial of coverage for pre-existing conditions and lifetime caps and would allowing parents to keep children through age 26 on their insurance. It would eliminate ACA-mandated basic coverage provisions, allowing insurers to issue catastrophic-only plans as they did pre-ACA.

Two House committees plan to vote on the legislation without first asking the Congressional Budget Office to perform a cost estimate or to project how many Americans would become uninsured with the changes.


Reader Comments

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From Under My Wheels: “Re: Epic’s App Orchard. A former Epic executive tells me that the legal terms of participating give Epic all intellectual property rights to the app. It might seem that they are protecting themselves in case they decide to create functionality that would compete with an App Orchard app. But another perspective is that Epic is taking customer heat for lack of innovation and App Orchard gives Epic a way to look over another company’s innovation and then squash it. It also makes customers happy because they might think they can monetize what they’ve been giving Epic for free. Judy made some big statements about openness through cozy journalists at HIMSS, but App Orchard isn’t as open as Epic would like everyone to believe.” Unverified.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Saturn Care. The company’s clinician-developed, patient-centric CDMP (Chronic Disease Management Program) supports value-based diabetes management for primary care by bringing together EHR and patient data into a single view with risk scoring and decision support tools, allowing care teams to improve both clinical (HbA1c) and behavioral (diabetes stress) outcomes. Patients provide behavioral data via mobile and other tools that the primary care team then reviews via CDMP to improve visit and care management efficiency. The company’s technology was developed with organizations such as UPMC, the VA, and Joslin Diabetes Center and has been clinically validated in an NIH study. It was designed to work within programs such as CPC+ and MACRA, which require measuring quality and cost metrics and for which the ADA guidelines are the best evidence-based means to improve outcomes. Practices can choose between a per-patient, per-month licensing structure or a turnkey services solution. Sign up for their April 12 webinar for more information. Thanks to Saturn Care for supporting HIStalk.

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We funded the DonorsChoose grant request of Ms. M in Minnesota, who asked for STEAM-related books for her fourth grade class to use in a book club-like small group exercise. She declares them to be “awesome,” as they are being used in “lit circles” in the class’s unit on sustainability, environmentalism, and conservation.

Interest has been muted (non-existent, to be precise) in my quest for contributors in these areas that I mentioned in Monday’s post. Contact me if you are interested – compensation and anonymity issues can be worked out.

  • Experts in nursing, laboratory, and pharmacy IT to provide updates in their respective subject areas at least quarterly
  • Someone to write a digital health summary every so often
  • An expert in non-US healthcare IT to write a regular summary of what’s going on outside the US
  • A leader, provider, or technologist in their 20s or 30s who can represent that point of view

Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Talent management software vendor HealthcareSource will acquire Centricity Contingent Staffing (formerly API Healthcare’s Clearview) from GE Healthcare.

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Shares in NantHealth fell 23 percent Monday and another 10 percent Tuesday following a STAT report that describes a high-profile, $12 million gift to University of Utah from founder Patrick Soon-Shiong, MD that came with strings attached – the university had to buy $10 million worth of genetic sequencing services from NantHealth in a “partnership” and also provide patient data to help the company develop a new product. The article also claims that NantHealth misled investors in its November earnings call in claiming that one-third of its GPS Cancer screening tests were purchased by the university, which the university says isn’t true since it only ordered standard genetic sequencing tests that have nothing to do with GPS Cancer. Independent attorneys asked by STAT to review the agreements questioned why the university would sign such an agreement whose wording attempted to avoid the implication of indirect self-dealing, although one was blunt in concluding, “They’re laundering the funds through the University of Utah.” Shares in NH, which closed at $18.59 on their first day of trading last June a few weeks before the University of Utah announcement, have shed 73 percent since, valuing the company at $598 million.


Announcements and Implementations

Allscripts Sunrise, CareInMotion, and 2bPrecise solutions are accepted into NHS London’s procurement program.

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WebMD adds health-related topics to Amazon Alexa-powered devices. I tried it today on the Echo – just say, “Alexa, enable WebMD skill.” It’s interesting, although it doesn’t always recognize drug generic names even when it knows the brand names.


Other

 

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A Rand medical claims analysis concludes that employer-offered telemedicine services such as Teladoc offer convenience to users with respiratory infections, but actually raise employer healthcare costs because most of their employees would not have sought care for their self-limiting conditions otherwise.

A new searchable IRS database reveals that non-profit organizations paid 2,700 employees $1 million or more in 2014, with hospital operator Ascension leading the pack in providing $17.6 million in compensation to CEO Anthony Tersigni.

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In England, a man who previously served as chair of two NHS trusts and CEO of a hospice is sentenced to two years in prison for falsifying his work history and claimed doctorate, with authorities finally discovering that his job experience was as a probation officer and a builder. The moral of the story is to always verify educational credentials, not so much because having them may or may not be a critical success factor for the job, but rather that you don’t want to hire someone who is willing earn a job by lying.


Sponsor Updates

  • The Intelligent Health Association recognizes NantHealth CEO Patrick Soon-Shiong, MD with its Special Recognition Award.
  • Meditech participates in the Northeastern University Nurse Innovation and Entrepreneurship Advisory Board, on which EVP Hoda Sayed-Friel serves.
  • Besler Consulting releases a new podcast, “Practical steps toward MACRA implementation.”
  • Carevive CEO Madelyn Herzfeld, RN discusses the challenges practice face when implementing new patient engagement tech in a new video series.
  • CoverMyMeds will sponsor the SPCMA Business Forum 2017 March 8-9 in Orlando.
  • The Relentless Health Value podcast features Diameter Health CEO Eric Rosow.
  • EClinicalWorks releases a new podcast, “Tips from a Superuser – How to Improve Functionality.”
  • Evariant releases a new case study, “Lehigh Valley Health Network: Engaging Consumers and Physicians in Tandem to Drive Revenue.”
  • InterSystems features a Q&A with HBI Solutions CEO Eric Widen.
  • InBusiness magazine includes Healthfinch VP Leah Roe in its 2017 class of “40 under 40.”

Blog Posts


Contacts

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

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Morning Headlines 3/7/17

March 6, 2017 Headlines No Comments

House GOP Releases Plan to Repeal, Replace Obamacare

House Republicans release a detailed ACA repeal and replace plan that would eliminate the individual mandate and replace subsidies with a new tax credit tied to an individual’s age and income level.

The HCI Group to Expand Its Technology Offerings

Mumbai, India-based IT services firm Tech Mahindra will acquire Jacksonville, Fla-based The HCI Group for $110 million.

How the world’s richest doctor gave away millions — then steered the cash back to his company

NantHealth stocks fall 23 percent following a STAT investigative report that found CEO Patrick Soon-Shiong publically donated $12 million to the University of Utah for a genetics research project, but mandated within the grant’s contract that $10 million be funneled directly back to NantHealth.

Missouri drug monitoring would combat abuse

Following increased pressure from neighboring state legislators, the Missouri state Senate passes a bill establishing a prescription drug monitoring program.

Delivery System Innovation

Health Affairs dedicates its March issue to innovation in care delivery, including a more than a dozen papers on the net benefits associated with specific delivery system innovations.

Curbside Consult with Dr. Jayne 3/6/17

March 6, 2017 Dr. Jayne 2 Comments

Jayne Goes to the Hospital

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You may have surmised if you follow my Twitter postings that I recently spent some time in the hospital, but not in a patient care capacity. It was one of those unplanned, middle-of-the-night type of events that no one ever wants to happen to them.

Of course, the chain of events might be different when you’re a physician. You sit at home wondering if you are over-reacting and generally second-guessing yourself. At one point, I found myself in severe pain, wondering if I could hang in there until my urgent care opened at  6 a.m. rather than risking the emergency department during flu season. When those thoughts start to cross your mind, it’s definitely time to go.

Based on my symptoms (including the fact that the pain was so bad I couldn’t bend over to put my own socks on), I had a sneaking suspicion that I was going to end up with surgery, so I grabbed my travel necessity bag and threw it in the back seat of the car. That’s the advantage of being a frequent traveler, but you never want to be that patient who rolls into the triage area with an overnight bag, so I left it in the parking lot, perhaps as wishful thinking.

My worries about being in the ED during flu season were unfounded and I wound up being the only person in the waiting room. Registration was a snap since I had my insurance card and photo ID at the ready, wanting no barriers between myself and some serious pain medication. I had to endure five minutes of bad late-night TV (some dating show involving “baggage” that was truly, truly horrid) and was called back.

There are times when you are sick, especially when you are a healthcare provider, when you wonder if you’re over-reacting to what you fear might be going on. I knew when my blood pressure was in the 160s/100s range with an elevated heart rate that whether or not my brain was over-reacting, my body most certainly had an issue with what was going on.

The ED physician ended up being the spouse of one of my urgent care colleagues, who fully appreciated what it means when a physician rolls into the ED in the middle of the night when they’re supposed to be working that morning.

Tests were ordered and an IV was started. After receiving some pain medication, I very quickly understood why people abuse it. The phrase “magic carpet ride” doesn’t begin to describe what it feels like when you see the privacy curtain flowing to the left and the door jamb scintillating off to the right side of the room.

I was pleased that my pain immediately went from 10 to 2, but even more grateful that my blood pressure and heart rate started moving more towards normal as I rolled off to get my CT scan. Once those results were back, the physician returned to complete a more thorough history and physical to prepare my admission documentation.

This time he had a scribe, or at least who I thought might be a scribe since we weren’t properly introduced. Normally I’d make a point of saying something, but I was still surfing on my cloud of Dilaudid and just wanted to know what the plan was and call my COO so he could find someone to cover my shift that was supposed to start in four hours. I was totally ruminating on that detail because I didn’t want to be “that doctor” who just doesn’t show up.

There was a parade of different nurses through the room. I received some antibiotics and some different pain medication. Then it was off to the inpatient unit to wait for the surgeon to meet me before I was whisked off to the operating room.

I received a room assignment on a brand new wing (confirmed by the new paint smell) and arrived right before shift change. Both the outgoing and incoming nurses were wonderful, explaining everything that was going on and letting me know when my next doses of antibiotics and pain medication were due. The outgoing nurse got a chuckle out of administering my intake questionnaire since I knew the answers to all the race, ethnicity, blood product acceptance, and cultural pain practices questions before she was even done asking them.

I was trussed up with DVT-preventing sequential compression leggings so I didn’t get a blood clot. Thankfully, she showed me how to disconnect myself so I could get to the restroom without having to call for help. I guess there are some benefits to being a physician.

The surgeon came by promptly and said he wanted additional confirmation of the diagnosis in the form of an ultrasound, which was performed immediately at the bedside. You know when you’re in trouble when the ultrasound tech takes a bunch of extra pictures even if you can’t see the screen.

Not more than 20 minutes after the test was done, the nurse came in to announce that they would be coming to take me to the operating room sooner than later. She was followed by a patient care tech bearing a couple of packets of pre-op scrub wipes, who dropped them off with instructions on what to do.

By this time, I had non-medical family at the bedside. They were shocked that the staff would expect the patient to do their own pre-operative prep. I’m no expert on pre-surgical care, but I’m hoping if the patient wasn’t a relatively healthy and mobile person that they would assist a bit.

I went quickly to the operating room after that, rolling out the door while reminding my family where to find the healthcare power of attorney and living will if something went wrong. I didn’t have time to get a copy before then, but you can bet that it’s in my Dropbox now. I had my noon dose of antibiotics in my lap since it would be due while I was downstairs and my nurse didn’t want them to be late.

The weekend operating room staff was excellent. I woke up feeling like no time had passed and with all my teeth still where they belonged. I’ve always been afraid of general anesthesia and having my teeth messed up during the intubation, so it was the first thing I thought of. In hindsight it’s pretty weird, but healthcare people think of all kinds of weird things based on what we’ve seen. I had a happy little pillow from the hospital auxiliary tucked under my blanket to brace myself with in case I had to cough and was back in my room in a flash.

The next shift change signaled a change in the level of care I received. As the nurses rounded together, the incoming nurse commented about me deciding to “self-discontinue” the DVT-prevention leggings. Since I had just come up from the operating room and hadn’t left the bed yet, I had no idea what she was talking about. I still had the leggings on, but it turns out someone removed the controller and inflation tubing from my bed when they took me to the operating area. It didn’t occur to me in my post-anesthesia haze that they weren’t connected to anything. Blaming the patient for a process issue isn’t a good way to start a patient care relationship.

From there, things trended downhill. What I did have was a lovely private room with a (no kidding) 60-inch flat screen television and dietary staffer who personally went through the menu options with me for dinner and breakfast. What I did not have was timely antibiotics and pain medication or consistently visible handwashing or foaming. I also did not have a functional IV access site and had to argue to have it moved when it was oozing enough blood that it was leaking out of the dressing and onto my hospital gown.

It turns out that due to staffing and census issues, my nurse was split between two hallways. What that translated to was feeling like I wasn’t getting good care and that I was last on the list. I know hospitals are busy places and there probably were patients sicker than me, but when I’m on scheduled medications, I’m not giving you more than 15 minutes grace before I ring the call button. I was close enough to the nursing station that I could hear the call signal sounding at the desk when I rang it. I could also hear when it went into “alert mode” because it hadn’t been answered by the first-tier response time. Eventually a patient care tech answered and said she would contact my nurse, who didn’t come in.

This cycle repeated every 15 minutes until my antibiotics finally arrived. The nursing staff was equipped with Vocera two-way communications lavalieres, so there was really no excuse for lack of communications while I waited for my antibiotics to arrive over an hour and 15 minutes late.

Although she was apologetic and said she’d return in 30 minutes as soon as the infusion was over, she did not. That led to another 30 minutes of call light and alarming IV pump nonsense until someone came to the rescue.

By now it was 11 p.m. I was due for scheduled pain medication at midnight, but I was honestly afraid to go to sleep because I knew I couldn’t count on getting medications when they were due without being a call-light stalker. By this point, I wasn’t taking any narcotic pain medications, just scheduled NSAIDs, and I wanted to keep it that way. It’s a terrible thing for a patient to be afraid to sleep for fear they won’t get their meds.

As predicted, they didn’t arrive on time, leading to another 30 minutes of call-light tag before they arrived. She was happy to offer narcotics for breakthrough pain, but if a patient is doing well on scheduled meds and gets them on time, there shouldn’t be any need for breakthrough treatment. Needless to say, we had a few words about the timing of the medications.

I was finally able to sleep for about four hours, although it was restless sleep with the anti-DVT leggings pumping up every 30 seconds despite the fact that I had also received heparin shots for clot prevention and was ambulatory. The phlebotomy started at 5 a.m. I dozed a bit until vitals at 5:30. Surprise, after the last “conversation” with my nurse, my medications arrived promptly at 6 a.m.

I knew there was a good chance I’d be discharged that day, so I decided to wash up, throw on some mascara to look less pathetic, and make arrangements for a getaway car. Many surgeons round early and I was crossing my fingers for that kind of schedule. I was feeling really good, and after my Garmin registered 500 steps in the room and the administration of a second heparin shot, I decided the annoying DVT leggings really could come off.

Back when I was still delivering inpatient care at this hospital, we made a big deal about the discharge day and discharge planning and making sure the patient understood the planned schedule and would be ready to depart at the appropriate time. The primary care physicians were scolded if we rounded after 9 a.m. because that interfered with the 11 a.m. discharges.

Things must have changed because the discharge plan was significantly fluid despite my wishful thinking, lovely eyelashes, and fully dressed status. The dietary team came up to go over the lunch menu around 11 a.m. and I waved them off, saying I didn’t plan to be there for lunch. I was finally released from captivity a little after noon. I went home and immediately went to sleep, waking only when my alarm told me it was time for pain medication.

I’ve been recovering nicely with a steady diet of ibuprofen, Tylenol, and Pepcid. I’d kill for the martini that isn’t on the list of prohibited dietary items, but I’d rather wait until I can really enjoy it. Everything tastes strange, even a week out, and despite the lovely covered dishes that have showed up on my doorstep.

Urgent surgery is a heck of a way to get out of working your scheduled urgent care shift, so I wouldn’t recommend it to anyone. I’m just glad this little adventure in healthcare didn’t happen at HIMSS or on any one of my frequent trips across the country. I’m happy to be doing a little more activity every day, even though the score still stands at Gallbladder 1, Jayne 0.

I’ve mentioned my experience to friends who work in the process excellence realm at the hospital in question, so hopefully some change may come of it. I had to chuckle, though, on Wednesday, when I received a thank you card from the hospital: “It was our pleasure to provide your care throughout your stay with us. Our goal is to always provide you with quality care and excellent service.” Of all the people I interacted with, it was signed by the overnight staff who gave me the most concern about quality.

Email Dr. Jayne.

HIStalk Interviews Peter Embi, MD, CEO, Regenstrief Institute

March 6, 2017 Interviews No Comments

Peter Embi, MD, MS is president and CEO of Regenstrief Institute; professor of medicine and associate dean for informatics and health services research at Indiana University School of Medicine; vice-president for learning health systems at Indiana University Health; co-founder and chief medical officer of Signet Accel; and chair-elect of AMIA.

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Tell me about yourself and your work.

I am a physician and an informatician. My main role is as president and CEO of the Regenstrief Institute here in Indianapolis, which is a support organization to Indiana University and specifically the Indiana University School of Medicine. We work with a number of elements of the School, the University, and the various healthcare systems around the region.

I wear other hats at Indiana University. I’m a professor at IU, associate dean in the School of Medicine, and vice-president for learning health systems in the Indiana University Health System, which enables us to take a lot of the expertise that we have in informatics, health services research, and aging research and bring that to bear on how we create the learning health system of the future by leveraging our health system. Not just that health system, but also others in the region that we traditionally have collaborated with. There’s a lot more I can say about that, but those are my titles at the moment.

My history is that I’m a physician. I trained in Florida, where I was born and raised. Then I went to Oregon, where I did my internal medicine training and then did my fellowship and got a master’s degree there in informatics under the group led by Bill Hersh. Then I went to Ohio, where I had been  until a few months ago when I took this role. I started off at the Cleveland Clinic, where I did training in rheumatology and immunology. I’m still a practicing rheumatologist. That’s a pretty small part of what I do these days because of all my other responsibilities, but that is my clinical practice.

I went to University of Cincinnati for almost seven years, where I started the Center for Health Informatics and did a number of things there around informatics. Then I went to The Ohio State University, where I was until just recently. I served as the first chief research information officer for the organization, really the first person to hold that role nationally. I also served as the vice-chair and ultimately the interim chair for biomedical informatics before I departed at the end of November.

What areas of biomedical and clinical informatics are most promising or most exciting?

It’s an exciting time to be doing informatics. The kinds of things that we’re seeing emerge with what can be done — now that we’ve gone a long way toward deploying electronic health records — is very promising.

There’s a lot of work to be done to improve our use of electronic health records to make them more usable and to incorporate them into practice better. There’s a lot of interesting work ongoing to help with the efficiency and use of electronic health records. Then, some of the most exciting things have to do with how we leverage the data that’s increasingly growing from not only those electronic health records, but from other sources, like genomic data and other ‘omics, if you will — environmental data, the kinds of social and behavioral determiners of health that increasingly we all recognize to be terribly important for not only improving what we do in healthcare, but fundamentally improving health.

Part of what we need to focus on moving into the future is how to leverage the data, the technology, the capabilities that we have, and the exciting developments happening in technology — including apps, wearables, and the Internet of Things — to understand how it is that populations — not just our patients, but people generally — are interacting with the world in ways that we need to understand better if we’re going to, as a system, inform improvements in health. Keeping people healthier, preventing disease, and then when people do become sick, most effectively getting them the kind of treatment that they need. Then being able to enable research so that we can learn how to better take care of people in the future.

One of the things that I have been studying for a long time and have focused a significant part of my career on is the area of research informatics. How do we take technologies and solutions to improve the elements of the research process, whether it’s designing studies, recruiting participants for studies, or making systematic evidence generation a more routine part of what we do through practice so that we can be learning from every patient and create what the Institute of Medicine has called the learning health system at the local level as well as at the regional and national level? That provides context for a lot of the exciting things that we can do moving forward. It’s certainly a lot of what drives me and the group here at Regenstrief on a day-to-day basis. Actually, it is a lot of what drove us and continues to drive us with regard to Signet Accel, too, and the work that’s happening there.

It’s been said that Facebook knows a lot more about people than their doctor. Can we combine enough data sources to create a holistic view of an individual that can support public health instead of just episodic healthcare encounters?

That’s a critical thing that we need to be focused on as a community, as a healthcare community, and as a biomedical research community, because I don’t think we’re there yet. We all understand that there’s incredible potential to be unlocked in those sources. Despite some pockets of work that are doing excellent early work in figuring that out, we have a lot more to learn in terms of how we can take all of these other socio-behavioral determinants of health, environmental information, information about what eat, what we consume, what we breathe, the activity that we track increasingly. All of those elements that say a lot more about how healthy we are, or how not healthy we are, than the sliver of information we have when people happen to intersect with the healthcare system. To me, it’s at that intersection point while we’re simultaneously trying to improve what we do in the healthcare systems.

When people interact with their physicians, care providers, and hospitals, we need to make that as good as it can be and as evidence-based as it can be and use those encounters and opportunities to learn. But I think one of the most exciting things is exactly what you allude to, this idea that increasingly as we look at populations and we look at how we can help keep people healthier out in the community, we’re necessarily going to have to understand how we analyze and interact with all the other data in the world. That data, one can easily argue, has a much bigger impact on health than a lot of the kinds of things that we do in healthcare, except for those who are ill. That’s an area where I’m starting to focus a lot more attention and I know a lot of other people are. More work is needed, but it’s critically important.

Have incentives evolved where there’s a business case to be made for providers and thus their technology vendors to look at an individual consumer beyond those little chunks of automation that exist just to improve the business of healthcare?

It’s an open question. A lot of people are banking on that. There’s some examples of folks that are moving in the direction of recognizing the importance of that and the potential of business models around how you can help people stay healthier. There certainly are individuals who are motivated to keep themselves healthier. Some of them are voting with their wallets in terms of apps that they’re buying and devices that they’re buying, increasingly taking control of and responsibility for their own health in ways that increasingly leverage technology and information. I think we’re seeing some of that emerge. I don’t think it’s settled. 

Beyond that, we have incentives in a number of other areas in terms of our systems, one being the healthcare systems. Increasingly as they go at risk for populations — which you know inevitably is going to happen considering the cost of healthcare –  how do we go about keeping our populations healthier so that we can spend the limited dollars we have on those who are sickest and keep people healthier so that they are healthier and they cost the system less? Forward-thinking health systems are already working along those lines, focusing on programs around keeping populations healthier, keeping people out of the hospital. That kind of thing can be seen increasingly through incentives that have been aligned around some of the reforms in healthcare payments and the like that one way or another are critical to what we’re doing and have to continue.

The other is from the perspective of our society — and I think increasingly we are seeing it from the perspective of companies — that recognizes that the healthcare costs of their employees are a big part of what they spend on. That’s a big expenditure. That the more that corporations and companies that are responsible for their employees can keep them healthier, can keep them happier, they’re more productive at work, they’re more present, and they cost less when it comes to the premiums that they’re paying for their employees.

Finally, our municipal, state, and federal governments are concerned in terms of trying to keep the population healthier, because one way or another, whether it’s focused on decreasing smoking rates or decreasing our rates of obesity, generally keeping our population healthier is just better for our economy. We’re seeing more focus on that at the state level and in different levels of government in terms of some legislation that’s already been passed and that will be passed.

I think it’s multi-factorial. It’s still coming together, but it does make sense from the perspective of what it is we need as a society, as individuals, and increasingly for our economy.

Precision medicine, artificial intelligence, and the idea of a cancer moon shot get a lot of technology attention. Is that a distraction from the fact that proven, well-documented medical information isn’t being consistently used on the front lines?

I don’t know that they’re a distraction. It’s important for us to have our eye on the future and to always keep an eye on where we need to be and what major items are on the horizon that are going to help us better take care of people in more innovative and impactful ways.

I think you’re correct that we can’t do that to the exclusion of — or in any way diminishing — how we can take better care of people with what we know today. I think you’re exactly right that probably not enough attention is being paid to the kinds of improvements that we can make in what may seem like the more mundane and routine activities of just making sure that, to the extent that we can, we’re practicing healthcare in an evidence-based way, that we’re leveraging our systems in ways that are going to make that more efficient and effective and easier for everybody involved to do the right thing and keep people healthier and avoid errors and do a lot of those sorts of things.

I see those as not mutually exclusive. I think we need to be doing both. But certainly to the extent that one overrides the other, that would be a mistake, so hopefully we don’t go in that direction.

I can tell you that here, for instance, we have a big emphasis on precision health and understanding that there’s a lot of elements to that. Of course it’s about genomics and proteomics and the like and how that can better inform tailored treatment of individuals when they develop certain conditions that have a genetic basis. But there’s also other elements of precision health which have to do with non-genetic components, a lot of the information that we have today. We’ve always wanted to make sure that when we’re treating an individual, we’re applying the best evidence to the care of that individual, taking into account their particular circumstances. If we do that right, we necessarily will benefit from a lot of knowledge that we already have.

A lot of it just informs the way we implement and deploy and use our systems today. I don’t see that necessarily as the dichotomy that it may seem, but I think it’s an important question to ask and make sure that we don’t fall into that trap of thinking that it’s just about one thing or something that we’re going to figure out 10 or 20 years from now. It’s what do we do today and what do we do in 10 years.

A newly published study found that patient advocacy groups are often funded by drug and device manufacturers in what could be perceived as a conflict of interest involving their patient members, especially in the area of support for drug pricing decisions. Is it difficult for member organizations to figure out that line between the interests of patients, provider members, and corporate members?

That’s a good question. Certainly at AMIA, we have a very diverse group of members, very thoughtful, that represent the broad constituency. Businesses are motivated by what they exist to do, which is to innovate and bring things to market and ultimately be profitable so that they can keep doing what they’re doing. While it can of course be at odds, I haven’t really found that that in any way negatively impacts what we do as a society or as an association. In fact, making sure that we’re listening to all voices and recognizing the perspectives of those who are working in different sectors actually helps to inform the overall membership.

Not to take away from the concerns that of course sometimes business interests will conflict with social good. More often than not. that’s not the case. If you find that a company is working on trying to solve a problem that is impactful to society, then it’s good to recognize that that work is ongoing and take it into account as you’re thinking about where it is that we need to be going as a group of informaticians, in that case, or as another society.

There’s clearly areas that people recognize very well around conflicts of interest and the like that need to be managed very carefully. I was the former chair of the ethics committee at AMIA and helped to author the conflict of interest policy, so I take that very seriously and we have to be very careful about that. I have found that the industry representatives who interact with professional societies tend to come at it from the perspective of, how do we all win? How does it help society? How does it help everyone? Because ultimately that creates more opportunity for them and allows them to have a bigger impact in their market, which happens to be the world. Not to be naïve about it, but I think it can be a win-win. You just have to keep your eye on the details.

Sunshine laws, being transparent, being open … increasingly because of some examples where that wasn’t done effectively and did cause problems in, for instance, the medical publishing world, right now we have very clear guidelines about making sure that whenever anybody does work, whenever they publish, whenever they talk about what they’re doing, they have to declare all of their relationships and the like. You have to know that in order to be able to then discern what’s happening.

AMIA is not, per se, a patient advocacy organization, although we obviously have patient members and are very concerned about patients as a driver of what we do, like any medical organization. So I can’t speak directly to that piece of it, but I can tell you that whole idea of transparency and openness is critical to everything we do, because trust ultimately is what that’s all about. I would think for a patient advocacy group, it’s even more important.

What makes you most optimistic about the role of informatics in improving of the healthcare system?

Everything that we do in healthcare, population health, and the like fundamentally comes down to making sure that we understand what’s happening. That means we have to have data, information, and ultimately the knowledge that comes out of analyzing all of that to be able to inform what we do moving forward.

Increasingly in the information age, people who have expertise at the intersecting points of health, healthcare, and informatics are at that junction that is going to ultimately inform how we improve the health of our populations. How do we do that in the most cost-effective way? How do we ultimately achieve the goal of having a healthier population at a lower cost?

That means that those of us who are working in this area of informatics and data science are sitting at a very exciting point, at the juncture, at a very exciting time. To be able to influence where healthcare is going and have a real impact on the lives of everybody, because everybody’s concerned with their healthcare, as they should be. That’s what excites me the most. 

The maturation of the technologies that we’re seeing now, the kinds of platforms that we have available, the interconnectedness that we have, the vast amounts of data, while daunting, are just really so promising. The health of all of us, the health of my children, is going to be so much better because of the work that we’re doing. That gets me up every day and makes me excited about what we’re doing in this field.

Tech Mahindra Will Acquire The HCI Group for $110 Million

March 6, 2017 News 1 Comment

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Mumbai, India-based IT services firm Tech Mahindra will acquire consulting firm The HCI Group for $110 million.

Tech Mahindra said in a statement, “Healthcare is one of the few sectors globally that is driving adoption of digital technologies. The acquisition will not only position Tech Mahindra as a significant player in the healthcare provider space, but will also provide an opportunity to go deeper in this space via EMR implementation and surrounding services route.”

Jacksonville, FL-based The HCI Group reports annual revenue of $114 million and has 500 employees.

Tech Mahindra has annual revenue of $4.2 billion and has 117,000 employees in 90 countries. It is part of the Mahindra Group conglomerate.

Morning Headlines 3/6/17

March 5, 2017 Headlines No Comments

Elliott Settles With Advisory Board as Strategic Review Continues

The Advisory Board Company settles with activist investor Paul Singer to delay his efforts to launch a director-election proxy fight.

ePA National Adoption Scorecard

CoverMyMeds publishes data on the availability of electronic prior authorization functionality in EHR systems, noting that vendors in control of 70 percent of the EHR market have committed to implementing electronic prior authorization functionality, while 54 percent already offer it.

NHS’ Salford Royal Trust Partners with Validic on New Integrated Care Model with Personal Health Data

In England, Salford Royal NHS Foundation Trust will begin integrating patient-generated data into its EHR from wearables and medical devices.

Jonathan Bush talks Trump and problems with health care tech

Athenahealth CEO Jonathan Bush discusses his favorable opinion of HHS Tom Price, his lingering concerns with President Trump, and he sees the political changes will impact the EHR market.

Monday Morning Update 3/6/17

March 5, 2017 News No Comments

Top News

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Advisory Board Company settles its differences with an activist investor, with SEC filings suggesting that hedge fund operator Elliott Management may be interest in acquiring some or all of the company after pressuring Advisory Board to hire an investment bank to explore strategic options.

Elliott had applied similar pressure to Cognizant Technology Solutions, of which it holds 4 percent of the outstanding shares, but reached an agreement with that company last month after Cognizant restructured its board. 

Elliott, which is ABCO’s largest shareholder with an 8.3 percent stake, declared the stock undervalued in January. (update: I incorrectly stated that new purchases reported to the SEC on Friday had raised Elliott’s ownership to 16 percent, but it remains at 8.3 percent).

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Above is the one-year price chart of ABCO (blue, up 50 percent) vs. the Nasdaq (green, up 25 percent). The company’s market cap is $1.8 billion.


HIStalk Announcements and Requests

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A slight majority of poll respondents who attended HIMSS17 say they discovered a product or service that has earned their further attention. Jef commented, “The lack of innovation is unnerving. This despite that 60 percent of exhibitors this year were first-time exhibitors! Makes one wonder where everyone has gone and why all the churn. Or maybe we know.”

New poll to your right or here: how will the health IT business change over the next year?

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A reader recommended that I pose a weekly question to readers who can answer anonymously, with a follow-up post recapping the responses. He or she suggested this first question: describe one unethical decision your employer made in the past year.

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HIStalk readers funded the DonorsChoose grant request of Ms. O in Missouri, who requested math materials for her second grade class. She says they have enabled her to differentiate the instruction and practice work she assigns, adding, “I love how I can make problems and the kids can manipulate the materials to show their thinking. I also love how even for my highest of kids I have something that they can work on because I can easily change the materials to fit what they need.”

Listening: new from Portugal.The Man (that’s not a typo – there’s a period in their name), an Alaska-formed indie pop band whose music defies simple genre categorization beyond being personal, melodic, and featuring rich, expressive vocals and an everyman stage presence that lets the band’s talent speak for itself. Their acoustic album, 2009’s “The Majestic Majesty” is unbelievably good. Their spring tour starts this week, with the band swinging through Nevada, California, Arizona, New Mexico and then moving east through the end of July (with stops in HIT-heavy Madison, Atlanta, and Philadelphia). My gosh, they are amazing.

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I’ve posted the results of my recent HIStalk reader annual survey. If you participated, thanks. I always learn from the responses. Readers suggest I pay an honorarium for regular contributions from people with these backgrounds, so let me know if you’re a candidate (note: it’s perfectly fine to write anonymously, as Dr. Jayne does, to avoid employer interference):

  • Experts in nursing, laboratory, and pharmacy IT who would provide Dr. Jayne-like updates in their respective subject areas at least quarterly
  • Someone to write a digital health summary every so often
  • An expert in non-US healthcare IT to write a regular summary of what’s going on outside the US
  • A leader, provider, or technologist in their 20s or 30s who can represent that point of view

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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This Week in Health IT History

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One year ago:

  • President Obama launched the Precision Medicine Initiative
  • HIMSS VPs John Hoyt and Norris Orms announced their retirement
  • EClinicalWorks announced plans to develop an inpatient EHR
  • Google’s DeepMind Technologies formed DeepMind Health

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Five years ago:

  • Nuance bought Transcend Technologies
  • Epocrates killed its EMR project
  • The VA halted work on its $103 million enterprise service bus that would have connected external products to the EHR it was developing with the DoD
  • Kaiser Permanente CEO George Halvorson announced that its new smartphone app got one million hits in its first month, also mentioning that 36 of the 66 EMRAM Stage 7 hospitals were KP’s

Last Week’s Most Interesting News

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  • McKesson and Change Healthcare Holdings complete the creation of Change Healthcare, which combines CHC’s software and analytics business with most of McKesson Technology Solutions in launching one of the largest health IT vendors with 15,000 employees.
  • Mayo Clinic’s year-end financial report says it will spend more than $1 billion to implement Epic.
  • An Amazon Web Services outage left some cloud-based EHR users, including those of Practice Fusion, without a system for a few hours.
  • Memorial Healthcare System (FL) pays $5.5 million to settle HIPAA charges that two employees plus another 12 of its affiliated physician practices stole patient information to file fraudulent tax returns.

Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

Just-formed Change Healthcare is looking for a new headquarters location, reportedly considering a move to Atlanta from its leased offices in Nashville.

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OhMD, which offers a texting app for patients and doctors, raises $1.2 million in a seed funding round.

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“Shark Tank” billionaire Mark Cuban invests $250,000 in Denver-based Matrix Analytics, which offers big data-powered clinical decision support. Founder and chief medical officer Aki Al-Zubaidi, DO is an assistant professor and pulmonologist at National Jewish Health.

Claims management and payments vendor Zelis acquires dental PPO provider Mavarest Dental Network.


Sales

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In England, Salford Royal NHS Foundation Trust chooses Validic to integrate patient-generated health data with its EHR, beginning with sleep and fitness information.


Decisions

  • NYU Lutheran Medical Center (NY) went live with Epic in summer 2016.
  • Fort Hamilton Hospital (OH) will go live with an Omnicell automated dispensing cabinet (ADC) in 2017.
  • St. Joseph Healthcare (ME) will go live with BD Pyxis MedStation ADC in 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


People

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Cheryl McKay, PhD, RN (Orion Health) joins Voalte as chief nursing officer.


Announcements and Implementations

Data science and point-of-decision platform vendor Clearsense will use big data technology components from Hortonworks.


Technology

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Walmart enhances its app to allow pharmacy customers to order refills from their phones, pay for them electronically, then breeze through an express lane where they use their phone’s camera to scan a QR code at the register, after which their prescription is handed over and they’re done. Walmart, can you please buy up some hospitals and physician practices?


Other

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CoverMyMeds publishes its electronic prior authorization scorecard, which finds that EHRs representing 70 percent of the market committing to implement it.

In Canada, inpatients complain about the cost of in-room TV, phone and Internet provided as a package by a private company, mostly because they can’t predict their stay and thus can’t sign up for longer-term, cheaper packages. The company says its biggest expense is revenue sharing with hospitals, but the hospital in question says it gets nothing for making the service available.

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Swedish Medical Center (CO) — which is being sued by dozens of surgery patients who learned that an HIV-positive surgical tech tampered with their IVs to steal narcotics — had outsourced its employee background checks to a private company that failed to uncover the tech’s history of addiction, drug theft, Navy court martial for drug theft, and termination from four hospitals for stealing fentanyl. The class action lawsuit now includes Texas-based PreCheck. The tech, meanwhile, had an additional year tacked on to his 6 1/2 year sentence when he decided to take a family vacation on his way to prison.

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Athenahealth’s Jonathan Bush weighs in on the state of health IT:

We’re in the Stone Age. Pretty much everybody thinks of an EHR as a piece of software. There’s no connectivity. Athena is trying to create the second generation. Doctors spend more money administering their office after investing in technology than they did before … That’s never happened in any other industry in history … If you look at companies like Allscripts and NextGen, they were in the toilet. They were about to go out of business, and all of a sudden, $35 billion in federal dollars are earmarked only for EHRs. It was like Cash for Clunkers …  in healthcare, the line is, nobody ever got fired for buying Epic. I think that a lot of people are going to get fired for buying Epic in the next few years. And by the way, this isn’t a fault of Epic. To make it to the last dinosaur, you have to be a phenomenal dinosaur. And Epic and Cerner are phenomenal companies. They’re just not network medicine companies.”

Bizarre: Arkansas will execute eight prisoners over 10 days in April even though capital punishment has been suspended there since 2005. The state wants to finish its work – punishment for murders committed before 1999 and thus prior to the execution ban — because its supply of execution drugs goes out of date on April 30 and manufacturers no longer provide it for executions. The state hopes the inmates expire before its midazolam.


Sponsor Updates

  • TransUnion publishes a new report, “Money talks: Rethinking what it means to put patients first.”
  • Verscend will exhibit at the RISE Summit March 6-8 in Nashville.
  • Solutionreach publishes an ebook titled “Medical Marketing Today: Strategies for Marketing Your Medical Practice in a Digital World.”
  • Vital Images produces a new video, “Revitalize Existing Healthcare IT Investments.”
  • ZeOmega successfully completes the Direct Trusted Agent Accreditation Program from EHNAC and DirectTrust.

Blog Posts


Contacts

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

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Reader Survey Results 2017

March 3, 2017 News No Comments

I do a reader survey once each year, usually right before the HIMSS conference. I then review the results along with other feedback I receive to plan the upcoming year. I always make at least a few changes that readers suggest. Thanks to everyone who completed the survey, including the person who won the random drawing for a $50 Amazon gift card.

I have a diverse and opinionated readership. Some people are interested in only a subset of industry topics. Others want a basic bullet list of headlines and nothing more. Still other readers either like or don’t like rumors, humor, or certain parts of HIStalk like CIO Unplugged or Readers Write. While I truly appreciate and will consider all suggestions, I don’t want to fall into the trap of “designing by committee,” where the quest to displease no one ends up in pleasing no one, either. So, don’t think I’m not listening just because I didn’t immediately act.

I’ve been able to stick to writing HIStalk for 14 years now only because I do it in a way that makes me happy and satisfied. I’m lucky to have found a self-selected audience that keeps coming back. I’m therefore in agreement with the most common “what should I change” suggestion, which is to not change anything significantly unless it’s a clear improvement that’s within my grasp. I have zero interest in getting bigger or slicker if it’s not fun.

I’ve also learned a big lesson over the years – everybody likes to read, but few like to write. Suggestions often involve getting new non-vendor contributors or participants, which would be fantastic, but that has failed every time I’ve tried. Writing is hard for most people and their jobs often limit their availability, so even the most eager writers often fade away after writing a handful of times. Read on below for the kinds of contributors I can use and would be willing to pay for (another lesson learned – consistent contribution requires some level of payment).


Respondent Characteristics

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I received 201 survey responses this year. Some respondent highlights:

  • 80 percent have worked in the industry for at least 10 years
  • 28 percent work for a provider organization
  • 8 percent are CIOs
  • 33 percent work for providers and have buying authority greater than $10,000
  • 88 percent have a higher appreciation of companies that they read about in HIStalk
  • 45 percent have a higher appreciation of companies that sponsor HIStalk
  • 92 percent say reading HIStalk helps them do their job better

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That last stat is what keeps me coming back every day. Readers, too, probably.


Elements Appreciated

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I asked which HIStalk features the respondent appreciates most. I should note that I haven’t run an Advisory Panel for a long time since I was getting fewer and fewer responses, so many respondents probably don’t recall what it is.


Suggested Changes

Here are the most frequently suggested changes, along with my responses.

Improve the search function.

I’ve added somewhat effective “search by date” capability in the sidebar. It’s not perfect, but it works well enough that even I used it when trying to find something I’ve written in a given date range.

Move the Readers Write bios to the top of the article and include that in the email notification.

Good idea. I will do that. I initially had a reason for putting the bio last, but I’ve forgotten what it was.

Create articles around questions that readers can answer anonymously.

I like that idea a lot and I’ll start that this weekend. It will fizzle out quickly if I don’t get responses, but it’s worth a shot.

Spotlight consumer digital healthcare.

I’m a hospital guy, so while I cover the topic when something interests me, it’s not a big emphasis. I would be happy to add a weekly digital health summary if someone wants to write it or help me figure out the kinds of topics it should include.

Add non-US coverage.

My non-domestic audience is about 5 percent, with the top five non-US countries being Canada, India, the UK, Netherlands, and Australia. I would be willing to add a weekly summary of non-US healthcare IT news if I can hire someone knowledgeable to write it in adding more value than I could.

Add the ability to see all of a particular type of article, like Dr. Jayne or CIO Unplugged.

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That’s available now. Hover over the Archives link at the top of the page, then click Dr. Jayne or Ed Marx to see all of their posts. You can also hover over Articles and then choose Index to see a newest-to-oldest list (rather than the full articles) by category, then click on any article to jump to it.

Add Dr. Jayne-like commentary from nursing, lab, pharmacy, etc. even if only quarterly.

I’ve appealed for such writers before with no takers, but I’ll throw it out there again and offer compensation for someone who is skilled and reliable. I always ask the person for examples of similar writing they’ve done or for them to write a sample article. That’s usually where the previously enthusiastic conversation ends. As I mentioned before, I can run the articles anonymously since I know first-hand from nearly being fired for writing HIStalk that employers aren’t always supportive.

Create an iPhone app since I like to do my reading in the morning.

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Bringing up the site on a mobile device should display the site in an easily navigated mobile format. If not, scroll down and you’ll see the “desktop/mobile” chooser. I’ve looked at full-fledged mobile apps, but they don’t seem to offer a lot more than the mobile-optimized theme I already have.

Do more with social media.

My personal experience is that social media is overrated for a site like mine. I’ve looked at the stats and there’s no uptick in actual site readership from a blitzkrieg of tweets, Facebook posts, and LinkedIn items. I’ll think about revisiting, but social media campaigns work best for consumer sites rather than business-related ones. I’m happy to take advice from experts who believe otherwise.

Don’t quit writing HIStalk.

This came up a bunch of times. I have no plans to quit. Writing HIStalk is a hobby rather than a job to me, so I have no motivation to stop doing it any more than someone else would to quit playing golf, going to movies, or having dinner parties.

I know a lot of fellow readers of the site who are in their 20s (thanks to Epic staff for encouraging employees to read the site regularly) who would love to see some representation outside of predominantly older, white male execs. That’s a totally valid and relevant piece of the industry, but there are also a lot of badass young leaders, providers, and technologists (not just start-up founders shilling product) who I’d love to see on this platform, too.

That would be great if I could fine someone, even if they have to contribute anonymously for work reasons.

Offer an honorarium to ongoing contributors.

I’m perfectly willing to do that. 

Get rid of the smoking doctor’s pipe.

I’ve made so much fun of newbies who think they possess rare insight in noticing that the logo of a healthcare IT site is a smoking doctor that I have to assume this was (like the logo) intentionally ironic. If not, I’ll counterbalance it with another reader’s suggestion – give the doctor an additional accessory of a martini.

Add a thumbs up/down capability to articles and comments.

I admit I cheated a bit in reading this comment several weeks ago and then buying the thumbs up/down plug-in that’s on the site now. It has been used nearly 3,000 times since I installed it over the holidays, including by me.

Dump Readers Write.

I admit I’ve considered this several times. I turn down a lot of articles that are boring, unoriginal, vendor-slanted, or not all that related to health IT, but most of what remains still has some of those characteristics because vendors pay their PR people crank out dull, inexpert prose in which a vendor pitch is not too cleverly concealed. I keep thinking that providers will step up to the minor challenge of stating their opinion (even anonymously), but that rarely happens.


Suggestions

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Convert webinars into podcasts so I can listen to them on my commute.

I think that’s probably doable. I also wondered whether people would appreciate having the transcribed webinar narration available to read as a PDF so they could distribute it, mark it up, etc. But let’s hear what you think – complete my little poll of which (if either) of those options you would use.

A Facebook-like look back of the news of that day five years back.

Great idea. I’ll add that to my calendar to add to each Monday Morning Update.

Use hashtags or tags of some sort so people can follow specific topics that interest them and get a weekly digest of headlines or posts relating to this topic.

Several people suggested that HIStalk posts could be repackaged into a curated summary of some type. I would have to understand the topics, but certainly one would be all items for specific vendors, which might then create a separate post (maybe on a separate site just to keep the clutter down) or as a weekly email with its own subscriber list. Tell me what you need.

Please stay focused on what you do. Additional news or too many communications can become overwhelming.

I agree, which is why I write one consolidated news article three times per week instead of blasting out every story individually. Anything I add would most likely have its own email subscriber list.

I love the idea of an email bulletin, beyond the headlines.

I agree. Email newsletters are hot again, especially if they are pithy and sassy. About three-fourths of a small number of respondents to a recent poll I ran said they would read a daily email, although I didn’t ask about a weekly one.

Facts are appreciated more than opinion.

Not to everyone. I know it seems obvious when you’re reading a site to think that every reader perceives it the same way, but I can say with certainty that it’s not that simple. More people say they read HIStalk for opinion, rumors, humor, and even music recommendations than say they wish I would stick to the same facts (usually from press releases) that every other site runs. I try not to be heavy-handed or to pedantically pontificate, but I also don’t hesitate to interject my opinion and welcome readers to agree or disagree in the comments.

Improve the home page layout. Having three columns is distracting and makes the page feel pinched when you get further down. And I never use the sponsor quick links – they just take up a lot of space on the screen, making it look busy.

I’m considering making some changes to skinny down the items in the right columns. Most are important, but they don’t necessarily need to display with each page view – a flyover menu of some sort would make them readily available without taking up space. Stay tuned.

Add one random and/or humor related item to the summary email you send for posts.

I try to do that, although I admit that I’m usually physically and emotionally drained by the time I send the email because I’ve been heads-down in deep thought for hours.

Get a DC insider to write.

I assume that means DoD and VA, although maybe I’m interpreting too narrowly and you’re actually interested in more political topics (in which case I’ll pass). As a reader, what would you like to see?

You could seriously sell your content curation and insights, especially if they were well-indexed for research purposes.  I would buy a personal subscription.

I’m not interested in selling anything, but tell me what you would find useful.


Comments

I invited respondents to say anything they want.

  • How long until you quit? I want to make sure I’m done before then; I can’t imagine doing my job without you providing the necessary information I need for my job.
  • It’s still my favorite work-related read of the day.
  • I love HIStalk. It’s my favorite guilty pleasure.
  • I like the balance of news and fun. Also appreciate your candor when people send you unsubstantiated information.
  • Love it — and you’re great, but I’ve got to say that I get downright excited to read Dr. Jayne.
  • This is a wonderful service to the community.
  • I think you do a phenomenal job of bringing the news and sharing your personal insight as a long-time industry observer. I’ve been reading HIStalk since I started working in the industry 12 years ago. I think the site could be even better if it stopped running unsubstantiated rumors as if HIStalk was the National Enquirer or Fox News.
  • Love it — specifically feel indebted to you for your summation of various complicated government rulings and policies. Also greatly admire what you have done with your reach when it comes to DonorsChoose.
  • Dr. Jayne is my favorite. I also love how Mr. H is not cow-towed by disgruntled readers. Got the balance right!
  • I continue to find HIStalk a very valued resource. You also made a recent comment about death and who cares once you are dead. I hope you are thinking about who would take over HIStalk when you lose the interest in keeping up with it. I do not think this is a prepare to die exercise — rather a realization that HIStalk is a valuable resource and honest broker of information in the HIT world and very worthy of continuing. Based on your humor, your often highlighted other interests, I assume that someday you will want to spend your time on other things beyond the care you put into HIStalk.
  • Conduct regional social events where readers can get together, or do it at Health 2.0 meeting.
  • I was once a complainer about the pro-Epic vibes and I have to say that I don’t feel the vibe anymore so if you were trying (or maybe I was over-analyzing and grew another year older?). Thanks!
  • It’s an amazing site and any criticism I have is honestly quibbling — I would hate it if you hung it up.
  • I work with the DoD and VA on their interoperability and have noticed that your periodic comments about that subject are quite dated. The two departments over the past 2-3 years are far more cooperative, interactive and mutually supporting in interoperability/data sharing needs than ever before.
  • Appreciate all of your hard work.  Yours is the first news site I look at every day since I get both news and humor.
  • It is an invaluable part of any HIS professional’s tool box.
  • Thank you for this invaluable service. I truly appreciate that you offer thoughtful commentary, and not the generic re-spewing of outdated not-news that so many other healthcare IT sites espouse. My favorite articles are often Dr. Jayne’s blogs. I love hearing about actual in-the-trenches experiences. Of course, Weird News Andy is good for a chuckle or a smh. And I appreciate the donation updates.
  • I check you daily and often share articles with others in my group. I’ve attended a few webinars and found them generally useful. On a regular basis I read something I find immediately useful for what I do, or something that spurs me to look deeper into some topic. In short, you’re great!
  • I have been reading since the beginning and I’m a big promoter. I have mandated that my executives subscribe to the blog everywhere I’ve worked. So many people don’t bother to look outside their own little empires to understand the broader industry. You force readers to do that, and I am really grateful.
  • So appreciate this resource. Single best blog I read and have read for 10 years now.
  • I’m just a lowly independent Epic consultant (10+ years) but you really have helped me do my job better. I can chit-chat with a CIO waiting in line for lunch; and when I mention something I just read in HIStalk, he/she perks up and takes notice of me and we can carry on with a well-informed conversation. I have noticed that folks can tell if one has read HIStalk. I mention your site at least three times on every gig, so word-of-mouth DOES work. I can steer clear of (or be attracted to) Epic implementations that are in trouble, depending on the mood of my checkbook and my BS tolerance at any given time. I love Dr. Jayne’s commentaries and will go back to find one if I’ve missed a week. Her perspectives from "the trenches" are very beneficial from a physician’s perspective and I enjoy her writing style very much.  Your donor matching program for kids makes my heart sing — that’s all I can say, except you are contributing to a generation of life-long learners. Ed is Ed, and I like him. Weird News Andy is a hoot — wish he’d do more, but he’s probably busy doing real work most of the time. And you, Mr. H, should be commended for maintaining a non-biased and well-written site for all of us to benefit from. You are a voice of reason (or at least, devoid of BS) in this whirlwind of healthcare drama. Your dry wit doesn’t hurt, either — I get at least one chuckle a day guaranteed, if not a belly laugh. Please keep doing what you’re doing. Peace Out and Happy 2017!!
  • Thank you for all that you do, Mr. H., and I hope you benefit from HIStalk as much as your readers do. I feel that the site is at its best when it provokes disagreement between readers, as this is a good indication of a particularly sticky problem yet to be solved.

Morning Headlines 3/3/17

March 2, 2017 Headlines No Comments

McKesson and Change Healthcare Complete the Creation of New Healthcare Information Technology Company

McKesson’s Technology Solutions business unit and Change Healthcare Holdings’ analytics business unit finalize their planned merger, creating 15,000 employee Change Healthcare.

InterSystems wins multi-million pound Liverpool joint-EPR tender

In England, InterSystems is selected as the next EHR vendor for three major Liverpool NHS hospitals: Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool Women’s NHS Foundation Trust, and Aintree University Hospital NHS Foundation Trust.

Judge Certifies Overtime Case Against Cerner As Class Action

A group of Cerner systems analysts and delivery consultants have won the right to file a class action suit against the company, arguing that overtime wages had been improperly withheld.

CVS Health to Adopt Epic Electronic Health Record System for CVS Specialty Care Management Programs

CVS will implement Epic across its CVS Specialty care management programs.

News 3/3/17

March 2, 2017 News 3 Comments

Top News

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McKesson and Change Healthcare Holdings (the former Emdeon) complete the creation of the new health IT company Change Healthcare, which combines CHC’s software and analytics business with most of McKesson Technology Solutions.

McKesson will own 70 percent of the 15,000-employee Change Healthcare.

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The company’s leadership team is listed above.


Reader Comments

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From Alhambra: “Re: EClinicalWorks. The only tool available for EP MU attestation is the MAQ dashboard, which contains a disclaimer that all users must accept when they first log in. ONC is aware and investigating since a certified EHR must be able to accurately produce the required attestation reports.” Unverified as to the ONC part, but above are the screen shots provided. I’m not sure requiring acknowledgement of a standard lawyer-verbose warranty either absolves responsibility to ONC or suggests a lack of capability, so I suppose the issue is who is liable if an incorrect attestation is filed because of flawed data and whether the disclaimer is binding either way.

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From Studiously Stoic: “Re: Becker’s Healthcare ‘150 Great Places to Work.’ We won and would like it mentioned.” I should stop being surprised when an organization that wins an award fails to note the worthlessness of their “win.” Becker’s employed no reasonable methodology to come with its click-baiting list – it accepts nominations, but then just lets its “editorial team” (mostly of them recent liberal arts graduates) make up the 150 winners based on unstated criteria that doesn’t seem to involve any research beyond Googling. It’s not like they actually surveyed employees or anything. This is not newsworthy.

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From Banacek: “Re: ECG Management Consultants. Apparently cleaning house after last year’s acquisition of Kurt Salmon, with over 30 people being terminated. Senior partners are being targeted.” The company provided this response: “ECG recently completed a three-year strategic plan and organizational restructuring. This resulted in some departures and reassignments, primarily for our administrative function, but included a few consulting staff members as well. Overall departures have been minimal (fewer than five consultants from January 1 through February), and we have continued to make strategic hires – for example, in our revenue cycle and academic practices. Our business is strong and we anticipate continuing to grow in 2017.”


HIStalk Announcements and Requests

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We provided a greenhouse and gardening kits for Mrs. M’s class of severally mentally and physically disabled students in Ohio. The students are actively participating and will present their work to their families in May and can then take the seedlings home to transplant them into their own gardens.

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I’m annoyed at companies whose marketing people declare that their unchanged software has suddenly transformed into “artificial intelligence” just because it sounds cooler. AI is defined as a device that perceives and reacts to its environment in mimicking human reasoning in performing a complex, nuanced task such as solving a problem and then learning from the process to get smarter. Today’s version of AI is primitive, incapable of doing even a fraction of the intellectual processing of a not-very-bright human even when limited to a super-specialized task in a closed context. I suspect that most AI systems have a “man behind the curtain” who carefully programs the system to appear smart when it’s really not, hoping to find a profitable problem to solve without anyone digging too deeply into the methods involved. 

This week on HIStalk Practice: The Vancouver Clinic adds ActX genomic decision support. Drchrono opens its second office. CMS begins $100 million spend on helping small practices make the QPP switch. Jacksonville Children’s & Multispecialty Clinic selects PatientPay billing. The CMS Innovation Center looks for input on new pediatric care delivery models. Austin Regional Clinic adds Wolters Kluwer clinical guidelines to its Epic EHR. Coordinated care tech startup CrossTx raises $735k. Culbert Healthcare Solutions Executive Consultant Randall Shulkin shares value-based reimbursement success factors for medical groups.


Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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AnalyticsMD changes its name to Qventus.

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Consumer medication reminder free app vendor Medisafe, which apparently makes money by charging drug companies to nudge their patients into profitably taking all their ordered doses, raises $14.5 million. 

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An employee overtime lawsuit that was filed against Cerner by delivery consultants and system analysts is certified as class action. The lawyer who represents current or former Cerner employees in several related lawsuits says that Cerner’s job titles make it sound as though learning consultants and delivery consultants are highly skilled positions, but claims that in reality, “these are folks that are entry level, straight out of college, with no real minimal requirements other than a college degree and a willingness to relocate to Kansas City.”

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Tech-powered insurer Oscar, which offers exchange medical insurance policies in four states, loses $200 million in 2016. The company hopes to survive by raising prices, narrowing networks, and selling small business insurance plans to reduce its reliance on the volatile individual market.


Sales

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The DoD chooses BD’s Pyxis ES automated dispensing cabinet for its 115 inpatient facilities and pharmacies in a $100 million contract award.  BD acquired the former Carefusion – which offered Pyxis dispensing technology, Alaris smart IV pumps, MedMined surveillance software, and medical supplies — for $12.2 billion in 2014. 

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CVS Health will extend its use of Epic to its specialty pharmacy, which will join CVS’s MinuteClinic as an Epic user.

In England, three Liverpool trusts choose InterSystems TrackCare in a deal worth up to  $86 million.


People

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Signet Accel names co-founder Peter Embi, MD, MS as chief medical officer. He remains president and CEO of the Regenstrief Institute.


Government and Politics

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A federal grand jury in Texas indicts 16 people for fraudulently billing Medicare $60 million for hospice care. In addition to paying kickbacks disguised as medical director salaries and submitting false claims, the company’s CPA owner and nurses made medical decisions based on what paid the most, including placing patients on high-dose narcotics regardless of their need. The medical directors also gave their EHR log-in credentials to others to create and sign orders for services that were billed but not performed.

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CDC publishes the 500 Cities Project, which allows visually comparing and downloading the prevalence of 27 chronic health condition measures between cities and down to the census tract level in a chosen city.


Other

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Facebook is testing algorithms that can identify users who are having potentially suicidal thoughts, after which a company team will rapidly review the user’s posts and comments from friends and then send a message offering resources. Facebook is trying to balance its response to such incidents against the privacy issues that would arise if it automatically notified family, friends, or mental health groups without the user’s permission. It already allows users to manually flag suicidal posts, functionality that has now been added to Facebook Live streaming video. Facebook says it was working on the tools before a series of events in which people live streamed their suicides on Facebook Live, often with the encouragement of other Facebook users.

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Amazon Web Services explains its four-hour East Coast outage on Tuesday: a script being run by a technician to take down a few problematic servers contained a typo that instead took a bunch of servers offline, including the one that indexes all locations for running database commands. AWS says it has updated the script tool to disallow taking servers offline if any subsystem will fall below its minimum capacity. It will also speed up an existing project to improve recovery time of the indexing subsystem.

NHS auditors find a hospital’s foreign doctor with poor English proficiency looking up medical terms on Google. The hospital says the doctor no longer works there and it will now require language checks.

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A study finds that 80 percent of patient advocacy groups accept money from drug and medical device companies that sell products to people with the conditions they support, raising the question of whether the donations influence the frequent silence of those groups about drug prices. Some groups receive more than half of their funds from industry, while 40 percent of them have industry executives as board members. Even the umbrella group for patient advocacy groups took in 62 percent of its $3.5 million budget from industry. The groups claim such donations don’t affect their decisions, but the authors recommend that they be required to provide full disclosure.

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A study confirms what we all suspect and fear – people are indeed peeing in public swimming pools and hot tubs, with an analysis of artificial sweetener content in two pools suggesting they contain from 8 to 20 gallons of urine. Hot tubs had much higher urine levels. Movie gags to the contrary, no blue dye exists to call out the pee-pertrators.


Sponsor Updates

  • Medicity launches Community Interchange, which creates a single, de-duplicated, and normalized CCD for hospitals.
  • CommonWell TV interviews LifeImage CTO Janak Joshi.
  • Children’s Mercy Kansas City (KS) goes live on GetWellNetwork.
  • MedData will exhibit at HFMA Utah’s Spring Alliance Meeting March 8-10 in St. George.
  • National Decision Support Company will integrate its CareSelect decision support system with McKesson and Meditech. The company also announces that its client base has increased to 250 provider systems and 2,000 facilities in all 50 states. 
  • NVoq will exhibit at the CHA Rural Health and Hospitals Conference March 8-10 in Denver.
  • Recondo Technology releases a revenue cycle API for prior authorization, eligibility, medical necessity, and pre-service patient collection and related RCM processes.
  • NTT Data and Oracle expand their existing relationship, adding cloud capabilities to Oracle’s Healthcare Foundation analytics platform.
  • Netsmart extends its behavioral population health solutions to post-acute providers.
  • Orion Health begins migration of its Amadeus precision medicine platform to Amazon Web Services.
  • CloudWave chooses Commvault to power its backup-as-a-service healthcare offering.
  • Definitive Healthcare launches a professional services team to help customers use its healthcare data to understand the market and executive plans.
  • Obix Perinatal Data System will exhibit at the March of Dimes Perinatal Nursing Conference March 6-7 in Lombard, IL.
  • Medicomp Systems announces Quippe Clinical Lens, a web-based, problem-oriented clinician view of relevant clinical information from EHRs and HIEs.
  • Experian Health will exhibit at the FL AAHAM meeting March 8-10 in Palm Coast, FL.
  • Uniphy Health releases UH4, an enterprise collaboration platform that supports patient-centric communications and provides real-time patient data at the point of care.
  • Kyruus integrates ProviderMatch with Salesforce Health CLoud.
  • PatientKeeper previews its new e-book, “Healthcare IT 2017-2022: First Comes Change, Then Comes Value.”
  • PokitDok joins the AWS Marketplace, becoming an APN advanced technology partner.
  • QuadraMed will exhibit at the ANA Annual Conference March 8-9 in Tampa, FL.
  • Imprivata integrates its PatientSecure positive patient ID solution with registration kiosks from CTS, Vecna, and PatientWorks.
  • The SSI Group will exhibit at the HFMA Region 5 Dixie Institute March 9 in Savannah, GA.
  • The Surescripts National Record Locator Service is live at 14 health systems nationwide.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Reader Comments

  • Bill Lynch: Excellent article, Dr. Butler!...
  • InformaticsMD: I think there's a LOT to learn from VistA on many fronts. I used the book "Medical Informatics 20/20: Quality And El...
  • InformaticsMD: To "Fake News"... If I knew who you were, I'd consider shoving a bottle of my mother's heart medication that Bad Heal...
  • Dr. Rick: Hi Ben, Fedupvet, Ben there, Big House, Tonya Wills, VFJ, Sam Lawrence and everyone else who posted a comment. Thanks...
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