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News 12/18/15

December 17, 2015 News 2 Comments

Top News

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ONC’s Health IT Policy Committee issues its congressionally-mandated interoperability report that includes these recommendations:

  • Create outcomes measures that reward well-coordinated and affordable care, such as not paying for performing duplicate lab tests.
  • Publish EHR vendor interoperability scores based on actual customer use.
  • Add Medicare payment incentives for technology-driven care coordination.
  • Convene a summit meeting to start the operationalization of ONC’s Interoperability Roadmap and the recommendations in the document.

Reader Comments

From Fair and Balanced: “Re: Epic. Our support rep has been asking questions about one of our projects, saying Epic recently started an intra-company contest for writing news stories about positive client developments. She and I both speculate that Epic is looking for stories to feed to actual media outlets. If that’s the case, I’m uneasy that Epic is going to this length to promote itself in relying on its own employees for good news rather than for it to come about via independent parties noticing it.” Unverified. I’m not sure I would find that practice objectionable other than it seems to violate Epic’s unconvincing insistence that it doesn’t practice sales and marketing. Industry magazines and sites will cover anything that a vendor or provider hands them on a silver platter regardless of news value, but it’s a tougher sell to newspapers. I was once approached by the local big-city newspaper about a story that their highly visible technology reporter was writing about mobile devices. As I was taking him around to interview people at our hospital, I was surprised at how clueless and generally weird he was (he carried what looked like a purse and stopped every five minutes to squirt drops into his eyes, plus he didn’t seem to know much about technology). The resulting piece was superficial and not insightful since he simply regurgitated selective quotes from our folks, which is probably why I’m disdainful of former reporters who proclaim themselves health IT experts simply because they’ve spent a few years working at that superficial level.


HIStalk Announcements and Requests

This week on HIStalk Practice: AMA opens up its Physician Innovation Network to beta testers. Connecticut physicians detail their telemedicine challenges. Wisconsin joins the Interstate Medical Licensure Compact. Clinicians don’t seem convinced when it comes to HIE ROI. Stericycle VP Lyn Triffletti offers physicians tips to get a handle on HIPAA. Kaiser Permanente Northwest offers members urgent care video visits. Telemedicine keeps operations running smoothly at the North Pole. Dr. Gregg describes his user experience of e-prescribing in the dark.

This week on HIStalk Connect: Rock Health publishes its annual VC funding report which says that digital health startups raised $4.3 billion in investment capital this year, matching 2014’s total. Google partners with Johnson & Johnson to launch a new surgical robot solutions business. Medtronic partners with Samsung to develop smartphone apps for patients receiving neuromodulation therapy. Four foundations invest $10 million to fund the expansion of the OpenNotes program nationally, with a goal of reaching 50 million patients within the next three years.

Listening: Intronaut, LA-based jazzy progressive rock whose sound ranges from a jamming Alice in Chains to a heavier Tool. Also, one of my favorite bands, Zip Tang, masters of complex progressive rock now evolved to a power trio with the departure of the amazing Marcus Padgett (saxophone, keyboards, vocals, and most relevant to health IT, SVP of Experian Health).


Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Insurance company/PPO Clover Health, which analyzes insurance claims to target high-risk patients with specific care manager interventions, raises $35 million in Series B funding led by Sequoia Capital, increasing its total to $135 million.

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Data-driven physician performance website MD Insider raises $12 million, increasing its total to $24 million. The round was led by Summation Health Ventures, an investment fund started by Cedars-Sinai and MemorialCare Health Systems, with Cedars-Sinai CIO Darren Dworkin joining the company’s board.

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California startup Kumba Health launches a marketplace for consumers willing to pay cash to choose physicians, labs, and imaging centers.

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Oration, which offers prescription buying tools for the employees of large, self-insured companies, releases its first app and announces $11.2 million in Series A funding.

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Toronto-based customer management software vendor NexJ Systems spins off its population health management software business into a new company, NexJ Health Holdings.

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WellDoc, which offers a prescription-only diabetes management app, raises $22 million in Series B funding, increasing its total to $27 million.

Cerner says 93 percent of its 17,000 US employees have  signed away their right to sue the company in return for $500 in stock options and ongoing eligibility for merit increases. An expert says it’s the only example he’s seen where a company will limit future merit increases to employees who decline to sign its arbitration clause.


Sales

King’s College Hospital NHS Foundation Trust chooses Allscripts Sunrise.

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The VA contracts with Cogito Corporation, which sells voice guidance technology for telephone salespeople, for software that can assess the mental health of participating veterans by analyzing their telephone conversations.


People

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Paul Kleeberg,MD (Stratis Health) joins Aledade as medical director. He served on the HIMSS board from 2011 through 2015 and was its chair through June 2015.

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Practice Fusion hires Steve Filler (Oliver Wyman) as COO and promotes Octavia Petrovici to SVP of product management.

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Dan Orenstein (Athenahealth) joins Health Catalyst as general counsel.

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Divurgent promotes Shane Danaher to national partner of client services.


Announcements and Implementations

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Robert Wood Johnson Foundation releases a dataset of all insurance plans offered on health insurance marketplaces in 2015 and 2016, supporting state-by-state analysis of premiums, deductibles, and other plan attributes. For example, the dataset shows that prices increased an average of 10 percent for all tiers in 2016, while silver plans in Alaska saw the largest jump at 35 percent to an average premium of $643.

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LauraLynn, Ireland’s children’s hospice, goes live on Oneview Healthcare’s patient engagement solutions in providing entertainment for patients and bedside access to clinical applications for clinicians.

Health information service provider MedAllies will use IBM-owned Merge Healthcare’s iConnect Network Services for image ordering and results delivery for its members. 

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Columbus, OH-based CrossChx launches its Queue fingerprint-based check-in kiosk for hospitals that it says reduces wait times by 80 percent. The company says it links a fingerprint to hospital EHR data to provide interoperability when its customers check in somewhere else. Founder and CEO Sean Lane is a former Air Force intelligence officer and NSA fellow who served five tours in Afghanistan and Iraq before founding Battlefield Telecommunications Systems.


Government and Politics

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CMS names Amino as its second national Qualified Entity, giving the doctor selection website access to Medicare’s provider-level quality and cost data. Amino has raised $20 million in three funding rounds.

HHS says few states have accepted available federal money to support data-driven Medicaid fraud detection even as improper payments have nearly doubled to 10 percent. The states that were contacted by Modern Healthcare gave several reasons: they have their own data mining efforts, they are trying to figure out if it would help, or they’re waiting to see what other states do before jumping in.


Privacy and Security

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LifeLock will pay $100 million to settle FTC charges that it overstated its data protection capabilities and engaged in deceptive advertising.


Innovation and Research

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Researchers at NYU Langone Medical Center release a free app that uses Apple’s ResearchKit to track the symptoms of concussion patients.


Other

Madison magazine reviews the impact of Epic on Wisconsin, observing that it attracts huge numbers of liberal arts degreed young professionals who often leave the company after a few years but remain in the Madison area, giving Wisconsin an enviable population of high-achieving Millennials.

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Turing Pharmaceutics CEO Martin Shkreli, the most-hated man on the Internet for hiking the price of old but important drug Daraprim by 5,000 percent after acquiring it, is arrested by federal agents and charged with securities fraud. Prosecutors claim Shkreli played a Ponzi-like financial shell game while with Retrophin, a drug company he started before Turing that eventually fired and sued him. Shkreli had previously mocked the lawsuit, saying, “The $65 million Retrophin wants from me would not dent me. I feel great. I’m licking my chops over the suits I’m going to file against them.” A wag observed that Shkreli was arrested only after he bought a rap album and started wearing hoodies, another dubbed him “Karma Bro,” while The New Yorker’s satirical piece was headlined, “Lawyer for Martin Shkreli Hikes Fees Five Thousand Per Cent.”

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Former BIDMC CEO Paul Levy writes that news media misreported details about President Jimmy Carter’s cancer, running click-baiting headlines that gave credit to a “miracle drug” (which has actually performed poorly in clinical trials) while downplaying the likely impact of surgery and radiation therapy. Levy quotes a freelance health reporter’s comments at a medical summit in 2009 that sums up the state of medical and health IT journalism pretty well:

It is not our job to satisfy you [physicians], but to keep our readers reading and our viewers viewing. The more responsible the press becomes, the less readers seem to like it.

A fourth co-conspirator pleads guilty to impersonating a Cerner employee in selling medical equipment and $6 million in investments from 50 physicians.

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Kaiser Permanente will start its own medical school that will train students on its integrated style of care. The California-based Kaiser Permanente School of Medicine will admit its first class of 48 students in 2019.

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Another medical helicopter goes down as two crew members die in an Arizona crash. It was operated by the publicly traded, Colorado-based Air Methods, the self-styled “defenders of tomorrow” that operates medical transport services as well as its 60-aircraft helicopter tourism operation (the recently acquired Blue Hawaiian in Hawaii and Sundance Helicopters in Las Vegas). It also runs a billing company for other medical transport companies, including EMS agencies and ambulance services. The company earned $741 million in revenue where it staffs its own aircraft with medical personnel and bills the patient directly, as well as $162 million from hospital contracts. It earns an average of $12,000 in net revenue per patient transported. As the pie chart above illustrates, federal taxpayers provide 60 percent of the company’s patient revenue. Air Methods likes healthcare reform, predicting that more widespread insurance to pay for its transport services will increase its annual revenue by $31 million. The company’s investor presentation lists its #1 operational challenge as “accidents.” The Glassdoor reviews of Air Methods are pretty bad, with a common theme being that it isn’t really focused on the safety of patients and staff. It has a commendably obtuse and high-falutin’ but questionably punctuated mission statement: “To be the dominant global expert of comprehensive, vertically-integrated, critical care access solutions supporting patient logistics—the movement of patients and their medical analytics.”


Sponsor Updates

  • Medicity is positioned in the Leaders category in the 2015 IDC MarketScape.
  • LiveProcess is selected as one of 50 Most Promising Healthcare Solution Providers for 2015.
  • Medication management solutions vendor HighFive will replace manual mapping of data with SyTrue’s natural language processing and terminology tools.
  • CareSync founder and CEO Travis Bond will speak at an SXSW Interactive Festival session titled “Apps and Better Medical Outcomes: Real Solutions.”
  • Orion Health launches version 6.2 of its Rhapsody integration engine.
  • T-System names five of its ED customers as winners of its client excellence award.
  • MedData celebrates its 35th anniversary.
  • Inc. Magazine names Lexmark as a new corporate logo that went viral in 2015.
  • RedHat makes Glassdoor’s list of companies with the happiest employees.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 17, 2015 News 2 Comments

EPtalk by Dr.Jayne 12/17/15

December 17, 2015 Dr. Jayne 4 Comments

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Time is flying and it’s hard to believe that HIMSS16 is barely two months ahead. My annual preparations have started, including the creation of the social schedule. It can be difficult to juggle meeting up with colleagues I only see once a year, sessions, sponsor events, and of course stalking the exhibit hall with some of my BFFs.

I booked my flights really early this year and didn’t realize that HIMSS had shifted to the Monday start, but it was easy to fill Sunday with some spa time. I have a penchant for something called Watsu, which is water-based Shiatsu massage, and there aren’t many practitioners in my part of the country. The Bellagio has a wonderful therapeutic pool, so I’m definitely going to get my Watsu on so I’m plenty relaxed for the week.

Flu season is upon us and we’re already being inundated with patients, many of whom opted out of vaccination. It’s not too late to get yours if you’re interested. Although it takes several weeks for them to reach maximum effect, flu season runs through April, so it can still be useful.

I was surprised to learn that payers are playing games with vaccination payments. Vaccines are one of the most cost-effective interventions we have in our arsenal and the flu vaccine is pretty inexpensive in the grand scheme of things. We have one payer who refuses to cover any vaccines when administered at our practice, simply because we’re an urgent care. Even if a patient comes in with a laceration that merits a tetanus shot, we can’t give it unless the patient pays out of pocket.

Patients are already paying big dollars for their healthcare premiums and don’t want to have to pay cash on top of it, so some of them decline and plan to follow up with their primary care physician. That can lead to gaps in care, and frankly PCPs have better things to do than give vaccines sometimes, like managing chronic illnesses and diagnosing new problems. Plus, the hardship of patients having to go two places to be treated for a single problem when we should be able to do it all at once is just a waste of resources. Just another aspect to our broken healthcare system. Although coverage is mandated, payers are finding a way around it.

I’ve been spending a lot of time in the practice and have picked up some kind of a respiratory virus. If we weren’t so focused on patient experience I’d love to hang out a sign that says, “If you’re not sicker than the doctor, you need to go home and try some cold remedies.” That’s not how we roll, though, so I apologize to the patients who are subjected to my sniffles. I like to think that I’m providing some level of patient education, since if I’m still sniffling it’s clear there’s no magic bullet to resolve all the symptoms.

I’ve been sad ever since the decongestant phenylpropanolamine was pulled from the market, because it actually worked. One of the most-used products around, phenylephrine, has been re-examined and found to be ineffective. But it’s easier to obtain than pseudoephedrine, so a lot of people try it anyway. Still, I’ll keep up with my humidifier and hot tea and hope for the best.

I’ve been playing around this week with my new technology purchase, a Microsoft Surface Pro 4. I am enjoying it, although I can’t get Outlook 2016 allow me to set up my inbox like I had it on my old computer. The change is just enough that it’s making a mess of my muscle memory, but I’ve tried everything I can think of. The settings screen looks just like it does in Outlook 2013, but it doesn’t behave the same way. Maybe it’s a bug or maybe I should just get used to it.

Speaking of bugs, the American Medical Association emailed yesterday to offer me tips and resources on how to pass the USMLE Step 3 licensing exam. Since I’ve been licensed for more than 15 years, they’re a little late. They did send a follow-up email asking me to disregard it and to enjoy my complimentary 2016 resident membership, which is even funnier.

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Speaking of funny, I spent some time surfing Glassdoor looking at reviews for a couple of employers that are clearly in a downward spiral. A friend had sent me a few links and the email arrived at a time when I really needed a laugh. For the one employer, it’s clear that they have someone occasionally posting anonymously that the company is great, but 95 percent of the other reviews are negative and the themes go back several years.

I’m sure disgruntled employees make up a good chunk of the postings, but everyone has disgruntled employees and when you look at similar companies, you don’t see that kind of skew towards the negative. If you’re in HR and you haven’t looked at your own employer’s reviews, it might be worth a few minutes of your time. Reviews with titles like “Rome is Burning” should definitely catch your attention.

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I’ve also been catching up on my holiday baking, and in the spirit of the holidays, I’ll share one of my favorite recipes. Double Chocolate Peanut Butter Chubbies are one of my favorites the last few years. They’re insanely chocolatey and you can modify the recipe by using different kinds of chocolate (or non-chocolate if you prefer) chips or different kinds of nuts. Personally, I like mine with Hershey’s Special Dark chips and chunky peanut butter.

What’s your favorite holiday cookie? Email me.

Email Dr. Jayne.

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December 17, 2015 Dr. Jayne 4 Comments

Morning Headlines 12/17/15

December 17, 2015 Headlines No Comments

Long-delayed cyber bill included in omnibus

House leaders have reached a deal on the 2016 omnibus spending bill. The bill, which was introduced Wednesday, includes the last minute addition of the Cybersecurity Information Sharing Act, a controversial bill with government surveillance implications that was designed to help the federal investigators work with private industry to combat hackers.

FDA Launches precisionFDA to Harness the Power of Scientific Collaboration

The FDA launches its web-based, genetics research platform, precisionFDA.

New data shows experts were wrong about where healthcare costs less

A study investigating geographical differences in the cost of care have analyzed 92 billion private health insurance claims and have found that spending patterns for the privately insured are not the same as those for Medicare.

RWJF releases massive health exchange data set

The Robert Wood Johnson Foundation has published a dataset containing pricing information for public exchange insurance plans, concluding that the average premium will spike between 11 and 16 percent between 2015 and 2016.

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December 17, 2015 Headlines No Comments

Morning Headlines 12/16/15

December 15, 2015 Headlines No Comments

Foundations Unite to Support Access to Clinical Notes for 50 Million Patients Nationwide

A group of foundations will spend $10 million funding the expansion of the OpenNotes project with the goal of expanding access to 50 million patients over the next three years.

Dell Looks to Sell Perot Systems for More Than $5 Billion to Raise Cash for EMC Deal

Dells is seeking a buyer for its Perot Systems business unit, hoping to raise $5 billion from the sale to help cover the cost of its EMC acquisition.

Is Your Doctor Getting Too Much Screen Time?

The Wall Street Journal covers a recent study finding that patients rated the care they received lower when doctors looked at a computer screen more during patient examinations.

The Corporate Takeover of the Red Cross

A ProPublica report analyzes corporate challenges at the Red Cross five years after an executive team from AT&T was brought in to streamline operations. Since their arrival, the Red Cross has cut payroll by a third, eliminated thousands of jobs, and closed 450 of its 700 chapters.

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December 15, 2015 Headlines No Comments

News 12/16/15

December 15, 2015 News 2 Comments

Top News

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Five foundations, including the Gordon and Betty Moore Foundation and Robert Wood Johnson Foundation, provide $10 million to expand the reach of the OpenNotes initiative to give patients access to their visit notes.


Reader Comments

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From Mutual Arbitration: “Re: arbitration clauses. Now Uber is doing them, only they are blasting them to the smartphones of their drives who have to tap ‘agree’ to keep driving. Leave it to Uber to get 400,000 agreements signed almost instantly.”

From Petal Pusher: “Re: another outrageous hospital billing practice. A friend who was admitted to a major NYC hospital says a clinical psychologist came to his bedside, introduced herself, and asked if he wanted to talk about how he was feeling. Sure, he said, so they spoke for 20-30 minutes. She came back a few days later. Surprise – this was charged to his bill even though it wasn’t told it would be billable, he didn’t ask for it, and it was never ordered for him. He thought it was part of the hospital service, for which they billed $7,700 per day.” I suppose the message here is that when you’re hospitalized, just answering the “how are you doing” question from some stranger who wanders into your room could trigger a bill.


HIStalk Announcements and Requests

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Mrs. Shaw reports that not only were her fourth graders named the top math class in her Pennsylvania school, two of her students were among the top individual scorers as well thanks to the Chromebook and accessories we provided for math practice via DonorsChoose.

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I sent the email blast and tweet on my interview with Gerry McCarthy late Monday afternoon. Gerry emailed me four hours later to let me know that he had already received over 300 emails, calls, and LinkedIn messages in response. I appreciate knowing that since, as I told Gerry in reply, HIStalk is to me just an empty room in which I sit while attempting to fill an empty screen each day in a quite personal way, so I don’t have a good view of what it looks like on the other side of that screen even though I’ve been doing it for nearly 13 years.


Webinars

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

December 16 (Wednesday) 2:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

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

Here’s the inimitable Vince Ciotti and Frank Poggio doing Tuesday’s webinar, “CPSI Takeover of Healthland, Are You Ready?” You will no doubt be entertained by their wry humor even if you have no horse in that particular race.


Acquisitions, Funding, Business, and Stock

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Telehealth and videoconferencing platform vendor Vidyo receives a $10 million investment from the venture capital arm of Kaiser Permanente, increasing its total to $163 million.

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Telemedicine platform vendor Chiron Health raises $2.3 million in a seed round and releases its patient-facing app. The company allows practices to conduct video visits with guaranteed reimbursement.

Dell is reported to be trying to sell the former Perot Systems for more than $5 billion to help pay for its EMC acquisition, which was previously rumored in early November and reported here. Dell acquired Perot for $3.9 billion in 2009 and is rumored to be talking to Tata, Atos, Genpact, and CGI about buying it.

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In a stellar example of how American healthcare is an ugly mix of compassion and profit-seeking, Daughters of Charity Health System (CA) receives a $260 million investment from a hedge fund that also has the option to buy the six-hospital system outright after three years.


Sales

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SPH Analytics chooses Clinical Architecture’s Symedical platform for management of clinical and administrative terminologies as well as its SIFT free text semantic interpretation tool.


People

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Bill Howard (Caradigm) joins Audacious Inquiry as senior director.

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MedSys Group promotes Ann Bartnik to VP of client services.

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Lisa Gallagher (HIMSS) and Arien Malec (RelayHealth) will replace John Halamka as co-chairs of the Health IT Standards Committee upon expiration of Halamka’s term in January.

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Drug company marketing software vendor OptimizeRX names James Brooks (iCare) as SVP of business development.


Announcements and Implementations

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Allscripts adds self-pay capability to its FollowMyHealth patient portal by integrating functionality of its Payerpath products.

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Bethesda Hospital (MN) goes live hospital-wide with Epic’s MyChart Bedside tablet app for patients and families.

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GetWellNetwork announces several recent new sales of its Marbella patient rounding data collection system.

Southwestern Vermont Medical Center goes live on the NetRelay secure messaging tool from Interbit Data.


Technology

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Microsoft will end support and updates for Internet Explorer 8 on January 12 but is selling custom support agreements for customers unable to upgrade their browser, many of which I would guess are in health systems. IE8 was released in March 2009, replaced by IE9 in March 2011.

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FDA approves the tricorder-like Checkme Pro health monitor from China-based Viatom Technology. It performs one-lead EKGs, pulse oximetry, temperature measurement, movement sensing, and cuffless blood pressure measurement.


Other

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A federal judge denies a motion brought by the Texas Medical Board that sought to dismiss Teladoc’s lawsuit against it, allowing the lawsuit to proceed. Teladoc successfully argued that the board’s rule that allows telemedicine sessions only after an initial face-to-face visit unfairly limits competition.

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Eric Topol, MD lists his top developments from 2015 that will change medicine.

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In England, dating app Tinder helps the NHS raise organ donation awareness among its younger users by suggesting they sign up as donors when they swipe a supporter’s photo.

A Wall Street Journal article recaps recent studies showing that patients resent doctors who spend a significant portion of their encounter working on a computer instead of making eye contact, suggesting that computers aren’t the problem but rather how they are physically positioned and how the doctors choose to use them. It will be interesting to see what happens as medicine shifts to newer graduates unaccustomed to looking up from their phones to see the actual world around them, or perhaps newer patients will be perfectly happy receiving their medical care from the equivalent of a Facebook post and reply.

An interesting New York Times article by Abigail Zuger, MD describes the common situation in which she uses around 10 information systems that each have their own password composition rules and expiration dates, forcing her to keep an index card listing them all in her pocket at all times. She adds, as the subject of the article suggests, that she’s seeing a “retro explosion of paper” as non-interoperable systems force reliance on hand-delivered paper or faxes. She describes what it’s like: “Who knows what the biblical stonemasons sang to themselves during work hours at their Tower of Babel? This is the soundtrack at ours: ‘What exactly did the kidney guy tell you to do?’ ‘Are you sure?’ ‘How did the ER explain that?’ ‘Could you just bring in the new pills next time?’”

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ProPublica digs into significant problems at the American Red Cross in an article called “The Corporate Takeover of the Red Cross” as the charity struggles in the fifth year under a leadership team that was mostly brought over from AT&T. The article says Red Cross has cut its payroll by a third, eliminated jobs, closed chapters in reducing their number from 700 to 250, alienated volunteers, and bungled several emergency response efforts to the point that some emergency planners have decided not to use its services. Surprisingly, its business of selling donated blood to hospitals lost $100 million in the most recent fiscal year because of revised clinical guidelines that reduced blood demand and its failure to adopt industry standard scannable labels. It plans to increase sales of its CPR training programs from $150 million per year to $700 million fizzled as actual revenue instead dropped. An internal survey found that only 35 percent of employees trust the organization’s executives — many employees call the charity “the AT&T retirement plan” — and volunteer satisfaction dropped 20 percent in one year to 32 percent. The CEO of the Center of Volunteer and Nonprofit Leadership, in observing the inept response by Red Cross after a California wildfire while running billboards using the event to solicit donations, concludes, “I view them more as a fundraising and marketing organization than a disaster relief or charity group.”


Sponsor Updates

  • Perigen wins an innovation award in clinical information management.
  • Black Book ranks Nuance as the leading vendor for clinical documentation improvement solutions.
  • DataMotion releases a free Dr. Seuss-like electronic book titled “A Healthcare Holiday Tale: Horace & the Messaging Miracle.”
  • Medicat will integrate terminology management software and patient education content from Wolters Kluwer Health with its college health service software.
  • PatientPay customer Kids First Pediatrics Group in the Atlanta area reports that it is successfully using the company’s solutions to address the shift from 90 percent insurance-paid claims to 50-percent patient responsibility due to more widespread high-deductible health plans. 
  • KLAS names Divurgent as the top-rated vendor in go-live support delivery.
  • EClinicalWorks client HealthNet is awarded the 2015 HIMSS Ambulatory Davies Award of Excellence.
  • Healthwise’s Catherine Serio publishes “Alone, Adrift, and Hoping for Health.”

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 15, 2015 News 2 Comments

Morning Headlines 12/15/15

December 15, 2015 Headlines 1 Comment

Top health industry issues of 2016 Thriving in the New Health Economy

PwC publishes its annual report on health industry issues, in which it predicts 2016 will bring expanded patient engagement through mobile technologies, heightened cybersecurity threats, and expanded adoption of non-relational databases.

Digital Health Funding: 2015 Year in Review

$4.3 billion was invested in digital health startups in 2015, matching 2014’s funding levels, according to Rock Health’s annual VC funding report.

CMS expands quality data on Physician Compare and Hospital Compare

CMS updates both its Physician Compare and Hospital Compare websites, adding quality metrics for individual health care professionals and updating performance scores for ACOs and several hundred provider groups.

Where Are STDs Rampant? Google Wants To Help Researchers Find Out

Researchers at the University of Illinois are mining Google search data to create a Flu Trends-like map that will track the spread of STDs.

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December 15, 2015 Headlines 1 Comment

Curbside Consult with Dr. Jayne 12/14/15

December 14, 2015 Dr. Jayne 2 Comments

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In my experience, this time of year is always a mixed bag in health IT. Sometimes it can be extremely busy, with groups trying to frantically spend any remaining budget before the end of the year if their fiscal year follows the calendar. Those are always interesting clients to work with because some of them just want to book the work and not really do anything until after the holidays, while others want to try to cram the work in as well as getting it on the books. I try to avoid the latter since I typically plan for a lull at the end of the year so I can enjoy some downtime.

Then there are other kinds of clients who have either run out of money (often long before the end of the year) or are short on staff and are trying to figure out a way to complete projects before the end of the year. I also try to avoid these clients if possible since it’s often someone’s bonus requirements that are driving the work. There is typically a lack of planning (hence the end-of-year approach) and the team is often not resourced correctly to get the work done even with support. The handful of times I’ve done consulting engagements around projects like this, I’ve always made sure that I have enough backup resources to just do the work for the client rather than with them.

I was approached by a client last week who was clearly desperate and fell into multiple categories. It’s a small practice that has been working on Meaningful Use. They attested to Stage 1 in 2013 and planned to attest to Stage 2 in 2015, but their project went way off the tracks. They have four providers and about 10 staff members, but have not been able to figure out how to dedicate anyone on the staff to shepherding a Meaningful Use project.

They spent the first half of the year knowing that they needed to upgrade their EHR to a version that would support MU2, but doing everything possible to avoid it. Much blame was placed on the vendor despite the practice not having adequate servers to support an upgrade. They had worked with another consultant to get through the upgrade, which luckily included a migration to a hosted platform so that servers won’t be an issue moving forward.

Despite having upgraded over the summer, the practice hasn’t done much to further their MU efforts. They haven’t been running reports to see how they are doing on their quality metrics and haven’t really checked their workflows against the best practices recommended for MU documentation. They also haven’t yet purchased (yet alone installed) a patient portal. They were under the impression that all they had to do was to get the portal installed, which is why they called me. It never crossed their mind that they would actually have to have patients live on the portal or actually using it. They just thought they could hire me to run interference with the vendor, get a proposal, get the contract signed, and then “turn it on.”

I know the vendor is more than happy to send them a contract immediately, but scheduling an installation during the holidays never goes well. Not only do many vendors have people taking time off, but usually people who work in a medical practice also hope to take time off to spend with family and friends. Not to mention that hurrying this through isn’t going to help their cause with Meaningful Use since there are many other requirements that they are not meeting.

I’m not typically one to turn down work, but in this case I elected to take a pass. Not only would it add a lot of stress to my planned downtime, but I just don’t think it’s the right thing to do for the client.

What the client really needs is a solid sit-down with the owner to actually create a strategic plan for the practice. He needs to figure out whether he really wants to participate in the Meaningful Use program and if so whether he is willing to dedicate resources (either a single staffer who can own the project or money to hire someone outside to do the job) to create a comprehensive plan. If he is agreeable to that, then he needs to commit to dedicating time for staff members to receive training and adapt their workflows for success.

In addition, he will need to get the employed providers in line with the expectations. He needs to agree to a plan that not only covers the installation of a patient portal, but also a campaign to engage patients and get them to sign up and to incorporate the use of the patient portal into the daily workflow of his office.

I tried to schedule a meeting with him to discuss all of this, only to find out that he has taken the rest of the year off. The fact that a practice owner would just hand off a task to staff such as, “Hey, let’s do a patient portal” and leave town is just shocking.

As a consultant, it’s also a key indicator of marked unhealthiness in the practice. It’s unlikely that I’ll be doing any work with them even as much as I like a good challenge. The longer I’m in this business, the less interest I have in total train wrecks regardless of how well they pay.

I’m going to maintain my planned downtime and continue contemplating my career plan. Although my clinical employer’s offer was somewhat open-ended, I don’t want to keep them waiting if that’s the way I’m going to go. During the lull, I have some craft projects planned and of course some pastry therapy.

What are your end-of-year plans? Email me.

Email Dr. Jayne.

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December 14, 2015 Dr. Jayne 2 Comments

HIStalk Interviews Gerry McCarthy, President, TransUnion Healthcare

December 14, 2015 Interviews 1 Comment

Gerry McCarthy is president of TransUnion Healthcare of Chicago, IL.

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I’ve been in healthcare IT since 1991. I landed a job at HBOC right out of college, working as an installer on the Star system. HBO was eventually acquired by McKesson, where I spent the majority of my career with roles in services, sales, product management, and operations.

I left twice in the 1990s to join startup organizations, Automated Healthcare and Abaton, both of which were sold back to McKesson. McKesson has been very good to me and my family over the years. After I left McKesson, I was the chief strategy officer for HealthMEDX, a long-term, post-acute care EMR vendor. I then joined TransUnion two years ago as the president of healthcare.

Most people know TransUnion as a credit bureau, but that’s really only one aspect of the company. We have three key divisions representing consumer, financial services, and healthcare. In healthcare, TransUnion focuses on the patient access and reimbursement area of revenue cycle management. Our main solutions are eligibility, ID, propensity to pay, charity care determination, payment plan recommendation, and insurance coverage discovery.

What kind of financial pressure are consumers feeling as the health insurance model changes?

From the Affordable Care Act, there’s been a lot of unintended consequences associated with underinsured. Now that more people have access — which is a great thing — we’re starting to see that people are struggling with being able to pay their bills and understanding what they need to pay and when. From a consumerism perspective, people struggle with how they make clinical and financial decisions based on the care that needs to be provided.

Medical bankruptcy makes up a significant percentage of personal bankruptcies. How do you see that changing over the next few years?

We see it increasing, back to that under-insured component. People think about the indigent and lower income. If you look at even the Baby Boomer generation, there was this perception that Medicare is free. All of these plans, whether it’s Medicare or these high-deductible insurance plans, are causing a significant churn within the marketplace.

Because we are TransUnion, we understand the credit bureaus. For example, the average household income is roughly $60,000. Some of these high-deductible plans are reaching $5,000 for a family. If something happens in January or February, people are immediately under water from a payment perspective against their current income.

This has been a struggle for people. We’re going to continue to see a rise in medical bankruptcy.

Not only are networks getting narrower, but some insurers have quietly eliminated out-of-network coverage completely. What will the impact be?

We see more and more movement towards consumerism in healthcare in general. It has a significant impact on our business and is an opportunity. If you look at what patients are demanding, they’re demanding not only the access to care, but they want to know what it’s going to cost before services are rendered. 

Whether it’s value-based care, where there’s potentially a flat rate on a risk-based model, more and more organizations are saying, "There has to be some level of estimation and transparency up front so the patients are educated." That’s a key component of what we do.

If you look at the transparency component, what we’re seeing more and more is it’s not just the hospitals providing this information. You’re starting to see payers provide the information with both clinical and financial data to their membership so they can make the best clinical decision with the best financial outcome based on their individual plan. That’s really the goal — to get that transparency in front of the patient so they can make those decisions.

You can ask someone at the point of service what you owe and they can’t tell you – they don’t know how the encounter will be coded and everybody pays a different price based on the insurance contract. How can that transparency logjam be broken?

You’ve hit the nail on the head. You have to be able to model the actual plan information and the contract that will impact that individual. It costs more money and it’s more time-consuming to implement and do those types of solutions and services, but that’s the first piece.

The second piece is that as the patient enters the system, things change. It’s not always straightforward that this is the DRG from start to finish and this is how we’re going to code that claim. There has to be financial counseling throughout. You have to make sure that you are being transparent with that patient. As they are going through the system and the solution, financial counseling is becoming a key component of what’s happening in the care delivery model during the care as well.

Both sides want something new to happen at the point of care. The patient wants to know what they owe and the provider wants to be paid before the patient leaves. Can those interests be reconciled?

I don’t think it’s ever going to be 100 percent accurate just because of the nature of how healthcare is delivered, but based on certain procedures or certain disease states, we can get much closer. When you think about heart and ortho and standard visits are happening within the physician practice, there’s no reason why we can’t get to that level up front, where everybody can understand and ensure that you have the right patient, we’ve checked for fraud, ID, we understand the credit history of that patient, the clinical history of that patient, and we can put forth a payment plan recommendation so everybody understands that entire process all the way through.

It’s not just an eligibility check any more. It’s the ability to take all of those things into account and then also look for 501(r) charity determination. These are things that our customers in the marketplaces are talking about right now.

It’s less likely that the patient will pay once they’ve left the provider’s premises. What are providers doing to increase point-of-service collections as patient responsibility increases while also knowing that people don’t make paying medical bills a priority?

That’s key right there, to make sure that up front you’re actually providing some level of cost estimation so they clearly understand exactly what is going to happen, the care that’s going to be provided, and the potential cost associated with it.

Studies show that the patient is seven times more likely to pay the total bill on time if you receive at least $1 at the point of patient access. That whole entire step of financial counseling up front with that transparency and estimation is what drives the patient behavior.

So if a patient pays anything at all up front, they feel engaged enough to be more likely to pay the remainder?

That’s correct.

You also make a very good point that patients look at healthcare bills differently than they do everything else in their lives. Being TransUnion with our financial background and history as a company, it’s interesting to see how people pay mortgage versus cell phone versus any other prioritized account. The number one reason of whether or not people will pay their healthcare bill is if they’ve paid a bill in the past.

In the ranking of what a consumer actually will pay for, surprisingly, the cell phone ranks higher than the mortgage.

Will consumer satisfaction with providers decrease as their insurance pays less for services, leaving the patient to personally pay the provider more?

Yes. We’re starting to see for the first time within our customer base and within the market that patients are starting to shop. That does influence. They will leave a provider and go to a new provider if they’re not offering tools. For example, the ability to pay online.

The point that you’re hitting on is very valid. Patients who are dissatisfied because they’re receiving a bill that they didn’t expect to get are more likely to search out a new provider in the future for medical care.

A broader concern for me is those patients who are looking at that bill and then putting off care. It’s not even the fact that they go search for another provider. They feel that they can’t afford it, which leads us to a longer-term problem that it will be more expensive to treat that patient down the road, especially if they have some level of chronic illness.

Are some of your revenue cycle customers finding the process changing so much that they will consider selling out or, in the case of small practices, closing?

What we’re seeing right now is a trend that’s growing substantially at a 20 percent CAGR is the outsourcing of revenue cycle management services, both in physician practices as well as in the hospital setting. Many organizations are stepping back and saying, is this really core to our mission and who we are, which is truly providing the best care for the community and the health of that community? Many organizations are looking to vendors like TransUnion and others, partners of ours like Conifer and MedeAnalytics, that are growing their customer base by outsourcing their core competency of revenue cycle management.

Thinking back to the case of Accretive Health, do outsourced revenue cycle vendors have to be careful to avoid embarrassing their provider customers by using overly aggressive collections practices even as collecting the money owed becomes harder?

It is a fine line for hospitals to turn around and walk when it comes to collections. That’s why it really begins on the front end of patient access.

There’s two things that hospitals can be doing. Number one, working with your collections team at the patient access level up front and using transparency to make sure that the patient understands fully what the costs are and beginning that financial charity and propensity to pay education immediately. That’s the first step.

The second step is, before it even goes to some level of collections, we’re seeing more and more organizations … if you look at uncompensated care, one of the key components of uncompensated care is that almost 5 percent of accounts that go to bad debt have some level of insurance that neither the hospital nor the patient is aware of. Our eScan solution goes and finds all of that data and information and allows hospitals to bill that back. I was just at a hospital last week where a CFO thanked us for finding $4 million in billable claims that they were going to write off to a collection agency to go find. Our goal is to make sure that that happens before it ever becomes a collection issue where you have to involve the patient.

Will a lot of hospitals run afoul of the 501(r) charity regulations that will become a condition of their non-profit status?

We just did a seminar that you helped us put on last week. We had over 250 organizations represented on that webinar. We’ve been surprised at how much hospitals have embraced and wanted to be educated on 501(r).

We do believe that they’re extremely nervous about their tax-exempt status and making sure that they’re following up on everything to follow that law to keep that tax exempt. There’s been a couple of cases recently where hospitals had to write large checks back to counties or states or even the federal government. 501(r) is here to stay and we believe hospitals are paying attention to it.

The company offers data breach-related services. What trends are you seeing?

You can’t have a conversation with anyone in healthcare today without talking about data breach services. First and foremost, we get the first phone call when it’s almost too late, when people are calling and saying that we need to provide credit protection services that TransUnion offers to the affected population. It’s more important, obviously, to have those controls up front to manage that data and lock that down.

You’re seeing a significant spend that’s happening within healthcare being shifted away from EMR and even revenue cycle opportunities as people are investing in their data centers and their policies and controls to make sure that you do not lose access to that data.

Is is sustainable to use HIPAA to fine breached providers even when they followed reasonable standards and the type of breach they experienced could have happened to anyone?

HIPAA is actually a very solid approach, we believe, to make sure that you can maintain patients’ data rights and integrity of that information that we’re supposed to be great stewards of. When you look at, though, some of the impact of HIPAA, this information of going to — whether it’s quality indicators from a clinical perspective or getting after the right financial information — some of these are onerous and put us in a position where we know we could solve some of the problems within healthcare, but some of the regulatory components are actually holding us back from being able to do it because we can’t share and utilize the data in the way we want.

I think finding the right balance between how we manage and maintain that data for information for good versus some of the bad things that are happening out there from the hacker perspective needs to be taken into account.

How do you see the short-term future playing out?

Consumerism is going to continue to grow and influence how care is delivered and paid for. Consumers really must go through the exchanges. They’re struggling with the decision on which plan to choose with little insight as to what the plan will cost them in reality. This is similar to how hospitals are making decisions on risk-based contracting models. They’re shifting that all the way down to the patients. Payers and providers are pushing that cost out.

Patients struggle with the high-deductible plans. The reality that Medicare and ACA aren’t free is setting in. More and more we’re going to start seeing the consumerism play, where patients will want to be educated on outcomes both clinical and financial. When you look at these new “payviders,’’ when you look at health systems that are offering insurance plans, and you look at the large commercial payers, everyone’s trying to get back directly to the patient.

I think there’s going to be a huge shift towards consumerism, where we start providing more and more data and information to them from a clinical and financial perspective so they can make the decisions. Because they are the persons who are ultimately going to be responsible for their healthcare spend.

Do you have any final thoughts?

I’m very thankful for the opportunity to be with TransUnion Healthcare with its great employees and focus. We have very quietly become a leader in the RCM space. We look forward to seeing how this continues to unfold and how we can support it.

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December 14, 2015 Interviews 1 Comment

Morning Headlines 12/14/15

December 13, 2015 Headlines 1 Comment

Johnson & Johnson Announces Formation Of Verb Surgical Inc., In Collaboration With Verily

Google’s newly renamed life sciences division, Verily, partners with Johnson & Johnson to build a new, independent robotic surgical solutions company.

Connect for Care

In an ONC blog post, National Coordinator Karen DeSalvo, MD, MPH calls on health IT stakeholders to back her vision for a connected health information ecosystem by focusing on consumer access, information blocking, and adopting national interoperability standards.

The Health of Obamacare

The Wall Street Journal dissects the impact ACA has had on the cost of care in the US and its resulting benefit to patients. The article highlights a reduction in the overall number of uninsured citizens but also points out that the ACA establishes a financial system that looks “more like welfare for the medical-industrial complex than support for the needy.”

Introducing OpenAI

A group of Silicon Valley entrepreneurs donates $1 billion to establish OpenAI, a non-profit artificial intelligence research company that will work on projects that are “most likely to benefit humanity as a whole, unconstrained by a need to generate financial return.”

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December 13, 2015 Headlines 1 Comment

Monday Morning Update 12/14/15

December 12, 2015 News 9 Comments

Top News

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Alphabet’s Verily – the just-renamed Google Life Sciences – launches Verb Surgical, which will develop surgical robots in conjunction with Johnson & Johnson.


Reader Comments

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From Dickey Ascot: “Re: CareTech Solutions. COO Pat Milostan resigned last week. He follows the resignations of CFO Rob Johnson and Controller Dan Lincoln. Karl Graham, formerly in charge of its service desk, has been reassigned. Since the company was acquired by HCT Global Services of Chennai, india, six executives have resigned as its operation focus has been cost cutting and relocating customer services offshore.” Unverified. The company’s executive page still lists Milostan, Johnson, and Graham in the same roles, as do their individual LinkedIn profiles.

From Bill Duck: “Re: occupations. What would you have been if not a hospital IT person?” I wish I had the skill and personality to be a band manager like Shep Gordon, but since I don’t (and besides, I don’t tolerate prima donnas well), I would probably fall back on some solo endeavor that involves creativity, working mostly alone, a lack of convention, and not working for people or causes I don’t respect. My early days as a clinical analyst hit all of those except the last one, which was a partial match. Actually I guess I have that with HIStalk, which is maybe why I’ve stuck with it for so long. I would probably be a pretty good book editor, especially for non-fiction books.

From All R. Base: “Re: mHealth News. HIMSS Media is shutting it down in favor of recently acquired MobiHealthNews.” I don’t have a reaction since I don’t read either site. As far as I can tell, none of the folks involved have any healthcare or technology background, which is fine when they’re just rewording press releases to sound like expert reporting, but not so fine when they forget that they’re just watching the actual athletes perform as nacho-eating fans.

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From Schmarbitration: “Re: arbitration clauses. There was a great series of articles several weeks ago in the NY Times diving into arbitration agreements. The main reason companies do this is to make class actions go away and that has been upheld in pretty much all courts. Sounds like Cerner did this in response to associates being classified as exempt. Epic did the same a few years ago, but with no carrot and a very large stick. People mock frivolous class action suits, but ultimately, they are one of the only tools to keep companies in line when a small amount of damage is spread over large numbers of people.” The article says big companies are eliminating their lawsuit risk by adding a one-sentence arbitration clause (so-called “get out of jail free” cards for corporations) to their agreements, with examples being cable companies, cell phone providers, and online stores. Their customers are unlikely to have the money to pursue arbitration individually rather than signing up with an existing class, so the company gets its way, just like the Wall Street-led credit card companies and retailers intended when they masterminded their protective loophole. A federal judge concludes, “Ominously, business has a good chance of opting out of the legal system altogether and misbehaving without reproach.” An example is Cerner’s Kansas City neighbor Sprint, which charged $20 roaming fees to customers who never left home, but pocketed the millions because each customer would have been required to hire an expert witness at up to $1 million just to get back their $20. The Supreme Court upheld arbitration clauses starting in 2011, led by Chief Justice John Roberts, who as a private attorney for Discover Bank had been involved in creating them in the first place.


HIStalk Announcements and Requests

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It was just about a 70-30 poll respondent split as to whether their job is a significant part of their identity vs. just a way to pay the bills. Two percent said the most important part of their life is their employment. Furydelabongo would love to become a patient advocate but keeps working as a “disruptive innovator” after realizing that his/her employers in care delivery and healthcare IT don’t keep patient interests foremost. Mobile Man says his need to support the most important thing in his life – his family – has overemphasized his work as part of his self identity. Cassie admits that she associates the majority of her personal value with her work, but wishes she could stop and move into the “it just pays the bills” group.

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New poll to your right or here: What is your reaction to Cerner employees becoming ineligible for future pay raises if they refuse to sign an arbitration agreement? Answer and then click the poll’s Comments link to explain, especially if your employer already has such an employment clause in effect. Tick, tock.

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Ms. Catoire sent photos from her urban Virginia high school earth sciences class, for which we provided a Chromebook and printer supplies via her DonorsChoose grant request. Her school can’t earn accreditation because it lacks supplies for interactive and hands-on learning, with our donation allowing her to improve individual learning by supporting individual learning styles. She adds, “Just a few of the activities that I use in my class include having the students create animated presentations, movies, mock assessments, and virtual labs, all which have been made possible by your donation … it is because of your generosity that both the students and myself find the teaching and learning process to be so exciting and fulfilling.”

I was thinking about the ridiculous situation where a patient’s in-network hospital has all kinds of out-of-network people running around sending them bills their insurance doesn’t cover. Instead of those “not this one” markings surgeons make to ensure that they don’t amputate the wrong leg, patients need to write in Sharpie on their foreheads, “no out-of-network providers.” Or, perhaps bring their own single form (vs. the mountain of them the hospital requires them to sign) in which the hospital agrees to provide no out-of-network services without prior authorization. It’s pathetic that hospitals take no responsibility for using providers who bill separately without accepting the same insurance. It’s like paying for a pricey restaurant meal and later finding your credit hard hit for charges from the chef, florist, and exterminator.


The Meaningful Love Program

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I hereby propose that the federal government turn over responsibility for managing the IRS’s “married filing jointly” tax break. Couples can expect these changes.

  • Couples who want to file jointly will be required to participate in the Meaningful Love program, in which they will document the quality of their relationship using  government-certified software called Electronic Marital Records (EMRs).
  • Conversations and other intimate encounters must be documented via a series of EMR checkboxes and predefined text strings as entered on ever-present computers positioned between them at all times, with the administrative burden estimated at eight distracted minutes of the average 12-minute encounter.
  • Heartfelt handwritten cards and murmuring phone calls will be eliminated in favor of email templates (CPOE, or Computerized Partner Outlook Entry) composed by choosing from a series of government-approved drop-down phrases to improve legibility and standardization.
  • Marital decision support will be used to provide evidence-based recommendations such as anniversary reminders, suggested behavioral changes based on menstrual cycle tracking, and time-since-last-sex alerts.
  • Each couple must maintain a marital problem list that they reconcile during each encounter.
  • EMR records must be sent electronically upon request to anyone with whom either partner might wish to arrange an outside dalliance or in the case of divorce where the new partner would benefit from having the old partner’s EMR data. This will improve the urgent “unconscious person in my bed – what do I do without a history?” scenario as long as all US couples participate despite a lack of incentive for doing so. Future program enhancements will provide the other partner a real-time alert when the tryst has been scheduled.
  • The amount of the tax break will be pro-rated based on mutual attestation that the relationship is loving, the surveyed satisfaction of both people, and their romantic performance as benchmarked against other couples.
  • The Eligible Pair (EP) must submit their EMR-generated marriage quality data to the appropriate state and federal agencies and for the benefit of unmarried researchers who are trying to understand how relationships work.

These requirements are being protested by the American Marital Association and the EMR vendor-sponsored social media campaign #LetLoversBeLovers, but in the mean time, couples who are unwilling to share their marital bed with Uncle Sam just to avoid a few dollars in penalties can opt out by filing individual tax returns.


Last Week’s Most Interesting News

  • Cerner tells employees to sign away their right to sue the company or else they will never be given pay increases.
  • Ascension Health buys almost half of Accretive Health and signs a 10-year revenue cycle agreement with the company.
  • UL acquires IT accreditor InfoGard, which certifies EHR and EPCS systems.
  • National Coordinator Karen DeSalvo, MD tells a group that public health receives only 3 percent of federal health expenditures vs. 97 percent paid to deliver medical services even though 80 percent of health doesn’t involve doctors and hospitals.

Webinars

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

December 16 (Wednesday) 2:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

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


Sales

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Kaleida Health (NY) chooses Ascend Software for accounts payable document imaging.


People

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Baptist Memorial Healthcare (TN) adds CIO to responsibilities of Beverly Jordan, RN, its VP/chief clinical transformation officer.


Announcements and Implementations

Versus Technology announces a new Wi-Fi locating platform and asset tags.


Government and Politics

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National Coordinator Karen DeSalvo, MD, MPH calls for health IT stakeholders to commit to providing consumer access, avoiding information blocking, and following standards to support her vision of a connected health system that includes an app store of FHIR-based consumer tools.

An essay in the Wall Street Journal says the Affordable Care Act is “neither the triumph trumpeted by its proponents nor the disaster suggested by its critics.” ACA’s positives include reducing the number of uninsured patients, its possible effect on slowing healthcare spending growth, the upcoming Cadillac tax that encourages employers to control low-value spending, and the creation of a more cost-conscious market than existed with employer-provided insurance. Its negatives are rising numbers of insured thanks to Medicaid expansion that is “more like welfare for the medical-industrial complex than support for the needy” and being promoted as budget-neutral when it isn’t. The article concludes, “Both sides also need to recognize that the changes in incentives necessary to bend the cost curve will be highly unwelcome to many Americans. Markets for health care are the perfect example of the old saying that ‘every dollar of waste is someone’s income.’”


Technology

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Several high-profile Silicon Valley technology entrepreneurs, including Tesla’s Elon Musk, donate $1 billion to launch non-profit OpenAI, which will develop artificial intelligence technologies that benefit humanity without worrying about profit. They might be surprised to find that healthcare’s use of AI and other technologies always has profit first and foremost, with benefit to patients coincidental.

The Chicago Tribune observes EHR-caused doctor burnout, focusing on doctors turned into data entry clerks and patient visits that emphasize clicks and drop-downs rather than paying attention to what patients tell them.


Other

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Turing Pharmaceuticals CEO Martin Shkreli is getting the publicity exposure of his life and not just for raising Daraprim prices 5,000 percent and buying $2 million rap albums. Shares in the failing biotech company he bought a few weeks ago for $1.50 are now trading at $28 as investors express confidence that newly named CEO Shkreli will figure out a way to rape the system. Apparently he has – the company has exclusively licensed a drug not available in the US that is used to treat an uncommon parasitic disease. The drug sells for $50 per course of therapy and Shkreli says he’ll raise the price to the $60,000 to $100,000 range. About 300,000 people in the US have the disease, almost all of them Latin American immigrants who entered the country with it, and Shkreli estimates that 3,000 to 7,000 of them will need treatment each year. Even if the market doesn’t pan out, Shkreli has another path to quick profits – he is petitioning the FDA to grant him a fast-track research voucher that he can resell to another drug company for up to $350 million, which benefitted Shkreli’s previous drug company that sold one of the free FDA vouchers for $245 million. I admit that I would invest in his companies since his entire focus is on enriching himself and his investors without letting altruistic emotions interfere with his lust for profit.

A new Missouri law addresses the physician shortage by eliminating residency requirements, allowing newly graduated medical students to start practicing immediately. Medical associations don’t like the law, saying medical schools aren’t set up to prepare their graduates to start practice immediately, perhaps forgetting that residencies were neither mandatory or common for non-specialists outside of urban areas in the early 1980s. So far no new graduates have taken advantage of the change, however, probably realizing that it’s a career gamble that won’t pay off if other states don’t follow suit.

A former part-time employee of New York cardiologist Hussain Khawaja, MD sues him, claiming he fired her looking up her computerized hospital records to determine that she was pregnant. She says the doctor told her while recruiting for other positions that he doesn’t hire applicants with children.

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New York’s tax department notifies 1,900 taxpayers who worked for Erie County Medical Center in 2012 that they owe the state money because miscoded hospital W2 forms gave them a pension deduction to which they weren’t entitled. The hospital found a bug in its payroll system and says it will pay the interest, fees, and penalties for those affected and will even provide up to $200 to those who hire a tax preparer to amend their 2012 tax forms.

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Medical helicopters seem to crash a lot given their small numbers, with 78 deaths in the past decade. In a new example, a patient and three rescue personnel die when a SkyLife air ambulance goes down in fog and rain in California. I’ve known folks on hospital helicopter teams and it’s a funny business, with such high cost for so few deployments that ROI (other than for dramatic hospital photos) is tough to justify. I would guess in the vast majority of countries where healthcare is a service rather than a private industry the number of such helicopters is low. As was eloquently stated in “The Right Stuff” even though it wasn’t talking about insurance companies or taxpayer subsidies, “no bucks, no Buck Rogers.”

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Magician Penn Jillette turns into a pitchman for Withings after using the company’s smart scale and blood pressure monitor to lose 120 pounds in switching to a plant-based diet.  He explains, “It’s just making it automatic and instant. It doesn’t allow a guy like me to spin information — something I’m normally very good at. A little tool, a little bit of a nudge, can make a huge difference.” Penn will be all set if Withings invents a scale to monitor his still-overweight obnoxiousness.


Sponsor Updates

  • TransUnion Healthcare identifies more than $1 billion in insurance payments for hospitals.
  • Versus joins the Cisco solution partner program.
  • Freakonomics author Stephen Dubner will keynote Zynx Health’s Care Guidance 2016 event May 23-26, 2016 in New Orleans.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 12, 2015 News 9 Comments

Morning Headlines 12/11/15

December 10, 2015 Headlines 6 Comments

Maryland fires firm upgrading Medicaid technology, may seek money back

Maryland fires and then sues CSC for unacceptable performance during a $300 million Medicaid computer system upgrade contract.

Cerner Corporation offers US employees tough choice: Agree to arbitration or give up merit raises

Cerner is asking employees to sign an arbitration agreement that bars them from filing lawsuits against the company for any reason. Those that refuse are being told they will give up merit-based raises, while those that comply are being given $500 in stock options.

LabMD Loses Sanctions Bid Against Tiversa Over Info Leak

A judge denies LabMD’s request for sanctions against Tiversa, the cybersecurity firm that illegally breached its network and then reported the breach to the FTC.

Patient data compromised after cyberattack hits MaineGeneral Health

The FBI notifies MaineGeneral Health that an undisclosed number of patient records has turned up online after a cyberattack on its network last month.

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December 10, 2015 Headlines 6 Comments

News 12/11/15

December 10, 2015 News 2 Comments

Top News

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Maryland fires Computer Sciences Corp. from a $300 million Medicaid computer contract for unacceptable performance and may sue the company to recoup some of the $30 million it has already spent. It had suspended the contract in February. The state’s track record for health IT projects isn’t so good: it also threatened to sue Noridian Healthcare Solutions, the contractor of its health insurance exchange that failed within minutes of its October 1, 2013 go-live, but instead settled for $45 million in July 2015. Most of the wasted money for both Maryland projects, more than $200 million, came from federal taxpayers, although Maryland’s tally is less impressive than Oregon’s squandering of more than $300 million of federal money for an insurance exchange that never even went live. CSC’s record isn’t great, with state Medicaid system problems in North Carolina and a key role in the massive failure of NPfIT in England.


Reader Comments

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From Rude Boy: “Re: Greenway. Taking direct aim at NextGen in this mailing sent to customers.”

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From Clam Chowdah: “Re: Brigham and Women’s. Apart from cost overruns, the main operational issues have been because of radiology and one of their legacy systems. Overall, Epic has performed well.”

From Memphis Hank: “Re: executives of big software companies who not only studied, but also taught software engineering or computer science. Along with Epic, there’s also Adobe, SAS, and ESRI. An interesting follow-up analysis would be: what happens to products and customers when geek founders are replaced by private equity and other finance-centric executives?” Big companies run by technologists are about as rare as big health systems run by clinicians.

From Hot Tub Club: “Re: funny video. Remember this one you wrote up years ago?” I remember the dry-humored, four-part video from 2009 in which a slick but clueless salesperson (“I’m not really familiar with what our software things do”) meets with an annoyed and sometimes profane CIO. I was trying to recall the animation tool used and finally remembered that it was Xtranormal, which shut down in 2013.


HIStalk Announcements and Requests

I took my car in for an oil change and got a rare look at daytime TV with a laugh-inducing sight: Dr. Oz wearing scrubs on a talk show as though he might be called upon to perform an impromptu, on-screen surgery on one of the incessantly chatty hosts.

Watching: Jane the Virgin, a witty, fast-paced, and non-profane comedy that has Season 1 on Netflix. I had to give up on American Horror Story because of its overreliance on profanity and graphic violence in Season 2, but that’s OK since I rarely watch TV anyway.

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Nick van Terheyden followed up on his observation that HIStalk is blocked by the government in United Arab Emirates, which I thought might be a technical issue instead since several of my Dubai readers say they can read it just fine.  Dr. Nick asked the Emirates Integrated Telecommunications Company to unblock it, but they said it’s intentional per Telecommunications Regulatory Authority. Beats me why.

Last chance to nominate your choices for the HISsies awards. I’ll be emailing ballots to the people who have signed up for HIStalk updates in the next few days. It’s easy to spot the company-encouraged employee responses because the respondents skip most of the categories except Best Vendor and Best Leader and enter their company and CEO names there.

This week on HIStalk Practice: Physicians in rural West Virginia feel the effects of high-speed broadband connections. Hattiesburg Clinic and HealthNet receive HIMSS accolades for their use of health IT. Performance Physical Therapy CEO Michelle Collie outlines the health IT challenges faced by PT practices. Allscripts breaks ground on a new office tower. MediKey partners with Teladoc and EDocAmerica. WebPT expands into new Phoenix digs. Brazilian physicians lead the way in communicating with patients via WhatsApp. Everseat CEO Jeff Peres details the impact of unfilled practice seats.


Webinars

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

December 16 (Wednesday) 2:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

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


Acquisitions, Funding, Business, and Stock

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Express Scripts will invest $25 million in revenue-generating health IT companies related to drug adherence and personalized care. Actually the announcement says the investments will focus on “prescription drug adherence,” so I assume those who are addicted to street drugs are already adhering just fine on their own.

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India-based Tata Consultancy Services will join Vanderbilt University Medical Center’s CTTC commercialization group to develop products related to bioinformatics, care management, and analytics.

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Goldman Sachs and other investors provide $41 million in funding for doctor search site Vitals, raising its total to $86 million.


Sales

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Adventist Health System chooses Athenahealth’s EHR, PM, and patient engagement services for its 1,600 employed physicians.

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Ascension Health signs an exclusive, 10-year revenue cycle agreement with Accretive Health and will invest $200 million in the company. That’s an interesting development given that Ascension tried to buy Accretive this past June, was turned down by Accretive, and then announced that it would not renew its contract with Accretive that was to expire in 2017, forcing Accretive to “undertake a review of strategic alternatives” at the prospect of losing a customer that represented 50 percent of its business. Accretive shares jumped around 50 percent following the latest announcement, but are trading at 90 percent less than their mid-2011 price and at about half the share price at the time Ascension offered to buy the company. Accretive’s market cap is $300 million, so a $200 million investment must represent at least a 50 percent stake.


People

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LogicStream Health names Jack Hauser (Ability Network) as CFO.

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Scripps Health (CA) names Andy Crowder (MaineHealth)  as SVP/CIO.

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Gurpreet Singh (MD Revolution) joins CareSync as VP of interoperability. The company says it has hired 60 employees since it announced $18 million in Series D funding in October.

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HIMSS and CHIME name Craig Richardville, SVP/CIO of Carolinas HealthCare System, as John E. Gall, Jr. CIO of the Year.


Announcements and Implementations

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SCL Health (CO) offers $40 physician video visits via Doctor On Demand.

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Orion Health launches Amadeus, a data platform that offers predictive modeling and machine learning to support precision medicine. It also features open APIs for developers to create additional services.

Idaho HIE goes live on a clinical portal from Orion Health.


Government and Politics

CMS says that 2.8 million people have signed up for insurance via Healthcare.gov, one million of them first-timers. Healthcare.gov CEO Kevin Counihan say 80 percent of consumers can find coverage for less than $75 per month after government subsidies.

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The White House announces mental health hackathons and data sprints on Saturday, December 12 in Boston, Chicago, New York, San Francisco, and Washington, DC.


Privacy and Security

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A federal judge denies LabMD’s request for sanctions against security vendor Tiversa, which LabMD said intentionally breached its systems and then threatened to report the company to the government if it didn’t buy Tiversa’s security services, resulting in LabMD’s eventual shutdown after a long Federal Trade Commission fight. Meanwhile, Tivera’s CEO, stung by accusations of extortionate sales practices in LabMD’s case, writes a Wall Street Journal letter titled, “Tiversa Was a Good Samaritan, Not a Bully” in which he states that the company sent LabMD a services proposal at the company’s own request without any threat that it would otherwise tell the FTC about the exposed information. He blames a former Tiversa employee turned whistleblower who has “a history of not telling the truth.” He says Tiversa is suing LabMD and its former employee for defamation. 

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The FBI finds patient information from MaineGeneral Health online and alerts the health system, which says radiology patient information is at highest risk. Employee and prospective donor information was also taken.

A hospital employee and his wife are charged with stealing the information of 80 patients to take over their credit card accounts and fraudulently charge $300,000 worth of upscale fashions and accessories.


Technology

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A study finds that two-thirds of doctors in Italy and nearly 90 percent in Brazil communicate with their patients via the WhatsApp messenger app.

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Shriners Hospital for Children (UT) tests its new telemedicine system by offering children video chats with Santa Claus.


Other

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A Mayo Clinic Proceedings article looks at physician burnout, which it unsurprisingly concludes is getting worse. It should have added a third axis of average income by specialty, which would have shown that internal medicine and family medicine have high burnout paired with lower incomes compared to their equally burned out but higher-earning peers in orthopedic surgery and radiology.

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A Kansas City TV station reports that Cerner is requiring its employees to sign an arbitration agreement that prevents them from suing the company for any reason, offering them $500 in stock options if they signed by December 8 but denying them future merit pay increases if they didn’t. Employees had previously filed two class action lawsuits claiming they were incorrectly classified as salaried employees and thus were denied overtime pay. The arbitration clause would eliminate the possibility of such lawsuits. An anonymous Cerner employs speculates on Reddit (not entirely convincingly) that Cerner is trying to work around terms of its Siemens HS acquisition that require it to use Siemens service years to calculate severance pays in the case of Malvern layoffs.

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Regina Holliday is running a GoFundMe campaign in hopes of raising $10,000 toward her expenses in creating The Walking Gallery jackets. I should also mention her excellent book, “The Writing on the Wall,” that came out earlier this year. I see it’s now available for Kindle as well as softcover. I thought it was superb and I strongly recommend it.

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The mystery buyer of the one-of-a-kind Wu-Tang Clan rap album — the most expensive in history at $2 million for the only copy that will ever be sold — is revealed to be the most-hated man on the Internet, Turing Pharmaceuticals CEO, pharma bad boy, and aspiring rap producer Martin Shkreli. Shkreli says be bought it hoping he can hang out with celebrities who want to hear the album (he’s hoping for Taylor Swift), but when asked if will stream it free for Wu-Tang fans, he replied with the same logic that’s behind his 5,000 percent price hike for Daraprim, “Why would I pay millions of dollars just to let everyone listen to it for free?” He says he may commission more bands to make albums for his ears only just because he can.

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Weird News Andy predicts “Sold Out in Chicago,” as FDA approves commercial sale of a former military-only device that injects sponges into a bullet wound to stop bleeding in 20 seconds. The sponges are tagged with radiopaque markers so they can be detected and removed later.


Sponsor Updates

  • PerfectServe adds Robert Rinek of Paper Jaffray and Brant Heise of Memorial Care Innovation Fund to its board.
  • Health Catalyst is named a “best place to work” on three lists, two national and one regional.
  • PeriGen’s Emily Hamilton is published in the American Journal of Obstetrics & Gynecology.
  • Streamline Health Solutions signs a reseller agreement with outsourcing solutions provider Himagine Solutions.
  • InterSystems receives the HIMSS Middle East Integrated Health Innovations Award 2015 – mHealth category.
  • MedCPU will host four US-based hospital CIOs December 14 in Israel as part of a CHIME/Israel Export & International Cooperative Institute event.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

 

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December 10, 2015 News 2 Comments

EPtalk by Dr. Jayne 12/10/15

December 10, 2015 Dr. Jayne 2 Comments

A couple of reader comments on my piece about employer wellness programs caught my attention. I have to thank Al Lewis, who provided my laugh of the day when he asserted that, “There is no adult supervision in this field, so vendors can do things that doctors would get sued for doing.” He goes on to call out a vendor who provides carotid artery disease screening even though the US Preventive Services Task Force (USPSTF) specifically recommends against screening the general adult population. I didn’t know this was creeping its way into employee wellness programs, so thanks for the warning.

I have, however, seen mass carotid artery disease screening in a promotional offering for senior citizens that I can only describe as predatory. For an upfront cash fee, it touts the benefits of multiple “screening” tests that aren’t recommended. In addition to the carotid artery test, it also offers abdominal ultrasound screening (only recommended for men aged 65 to 75 who have ever smoked, and selectively recommended for men in this age group who have never been smokers). It also offers screening for peripheral arterial disease via an ankle brachial index (insufficient evidence to assess) as well as multiple blood tests that aren’t necessarily recommended for average-risk individuals.

When looking at the flyer and the number of tests offered, it may be easy for some to come to the conclusion that it’s a good deal based on the sheer volume of diseases they talk about. However, no test is without risk and just getting them because they’re cheap and available is a bad idea. Although we did tend to “shotgun” batteries of tests on our hospitalized patients when I was in medical school, by the time I reached residency training, the focus had shifted to doing fewer tests and only those that were evidence-based. That was good, because I can’t even count how many wild goose chases we went on due to abnormal labs that should never have been ordered in the first place.

The worst wild goose chase of my career still haunts me and I wonder if a different attitude (and better interoperability) would have prevented it. The patient was a delightful lady with significant and complex medical problems who had been my patient for three years during my residency. When I decided to stay in town and open a practice, she asked if she could follow me. Although I said yes, I cautioned her that there would be a two-week period between when I graduated from the training program and when I hung out my shingle when I would have no malpractice insurance and could not be her doctor. I advised her to remain with the residency clinic for continuity until my doors were open.

Unfortunately, one week into the gap (while I was cramming for my board exam) I received a call from the emergency department of my “new” hospital where the patient’s caretaker had taken her, not realizing I could not yet care for her. She was admitted and placed in the care of a hospitalist and three specialists who were working up her problems, unaware that they had been worked up thoroughly in the past. Because the patient was non-verbal, her ability to consent to the evaluation was limited. She had abdominal pain and her exam was challenging due to her other conditions, so someone ordered a cancer antigen test, which was positive. They didn’t realize it had been positive for some time with a completely negative workup and a previous informed consent decision to stop pursuing it.

I attempted to reason with one of the house doctors, begging them to request the chart from the residency program so they could provide good care. Unfortunately the goose chase persisted and the patient remained hospitalized, developing a life-threatening problem with her platelet function. This was in part due to the blood thinner injections she was given in the hospital to prevent blood clots due to her immobility. Oddly enough, the patient has been immobile for the better part of 50 years and survived without blood thinners, but the doctors were just following the hospital protocol for giving heparin to immobile patients.

The cancer workup was completely repeated, including several invasive procedures. By the time I assumed care of her barely a week later, she had suffered multiple complications, including a heart attack, and was being considered for bypass surgery.

Thank goodness I was able to corral things before that happened because the patient and I had previously discussed her surgical prospects and she had clearly indicated that she didn’t want anything like that done. I realized that for most of the hospitalization, she had been without the computer she uses to communicate with people (she has mobility of one hand and creates computer-generated speech using it) and probably hadn’t consented to most of what she had been through.

At that point, my goal was just to get her out of the ICU, and then out of the step-down, and then to the regular floors, and then home – one day at a time. Eventually we accomplished all of those and she did well despite the “care” she received. Even years later, just thinking about this scenario wants to make me track down whoever ordered that initial (inappropriate) blood test and give them a good talking-to. Whenever one of my students or supervisees orders an unnecessary test, they hear this story. I hope it sinks in.

Another comment was from John Lynn, who asks that if a patient showed up in my office and said they were healthy and wanted to stay healthy, what would I do? I agree with him that some doctors would offer a physical and try to find something wrong. However, many physicians (especially those trained in family medicine and other primary care specialties in the last two decades) would know exactly what to do. We’re well trained in health promotion and disease prevention, but many of us don’t get to use those skills often enough. My personal recipe includes the following:

  • Find out if the patient has any concerns about their health, even if they think they’re generally healthy. Those concerns should be addressed through additional history and a targeted exam and a specific workup if warranted.
  • Take a detailed family history to review the patient’s risk factors and discuss ways to mitigate those risks or avoid developing additional risk factors.
  • Discuss general health behaviors (diet, exercise, tobacco, alcohol, caffeine, sexual behaviors, seat belt use, etc.) and advise accordingly in line with current evidence. Refer to appropriate resources as needed (nutritionist, smoking cessation, psychology, social work, etc.)
  • Assess psychosocial and other determinants of health as needed (social supports, financial ability to get care if needed, etc.)
  • Targeted physical exam as recommended for evidence-based screenings and to establish a baseline rather than “looking for” something.
  • Recommendation for additional screening tests and preventive services as appropriate based on evidence-based recommendations. This may include in-office services such as vaccines or external testing such as mammograms, colonoscopies, etc.

There are more things involved, but you get the idea. It’s about the doctor and the patient sitting down and talking about things. Which in our system doesn’t get you paid very well, and because of that, we don’t have anywhere near the time we need to do it right.

Add in the fact that patients often have to change doctors every year or two due to insurance changes and it’s hard to develop the rapport needed to work together on some of the more challenging situations that come up when you actually talk to people and get to know them. I’d love to be able to have a solid hour with patients to do a wellness visit and to leverage proven techniques such as motivational interviewing, but that’s just not how it works.

In my ideal world, I’d not only have the time to do it right, but the resources – access to other clinical professionals as needed (psychologist, social work, nutritionist, health coach, etc.) at times that work for the patient so they don’t have to take off work. I’d also like to see these preventive services fully covered by insurance. Although the Affordable Care Act mandates coverage for preventive services recommended by the USPSTF, patients on so-called “grandfathered” plans may still not have coverage. Until recently, I was on one of these plans so know exactly what is involved.

I’d love to see all preventive services fully covered. Not only because it’s the right thing to do, but also because they have been proven to be cost effective. I remember the first time I realized that Medicare wouldn’t pay for blood sugar monitoring supplies for certain diabetic patients but they would pay for amputations. I was appalled.

If that ideal world existed, I’d likely still be a primary care physician rather than a mercenary CMIO and part-time emergency doc and blogger. It’s something for the politicians and pundits to think about when they talk about the shortage of primary care physicians and wanting to bend the cost curve. But unfortunately, I don’t think it’s anything I’m going to see in my lifetime.

What’s your ideal care paradigm? Email me.

Email Dr. Jayne.

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December 10, 2015 Dr. Jayne 2 Comments

Morning Headlines 12/10/15

December 10, 2015 Headlines 1 Comment

Athenahealth Reaffirms Fiscal Year 2015 Guidance and Initiates Guidance for Fiscal Year 2016

Athenahealth forecasts a FY16 EPS of between $1.65 and $1.85 on $1.13 billion in revenue, topping analyst estimates on earnings but forecasting a lower than expected revenue. In a statement ahead of its investor day, the company explained that it planned to scale its operations to increase revenue and improve margins.

ACA Update: Effects On Ability To Pay Medical Bills And Labor Supply; Enrollment Snapshot; And More

Health Affairs recaps a number of ACA-related reports, one from the CDC finding that the percent of adults struggling to pay medical bills is steadily declining, another from the CBO forecasts a 1.7 percent decline in labor supply caused by ACA coverage expansions, and a third from CMS announcing that one million new Healthcare.gov users have selected plans this year.

Tufts Medical Center Is Bringing Virtual Reality to Patient Care

In an effort to alleviate pre-surgical anxiety and improve patient education, Tufts Medical Center (MA) will begin using virtual reality headsets to help prepare patients for surgery, giving them a 360-degree tour of the facility and introductions to the staff.

Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between

A report on physician job satisfaction between 2011 and 2014 finds that burnout is increasing across the board, but at rates that vary heavily between specialties. Burnout rates in the general population have remained flat over the same period.

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December 10, 2015 Headlines 1 Comment

EHR Design Talk with Dr. Rick 12/9/15

December 9, 2015 Rick Weinhaus 9 Comments

Designing a New EHR User Interface: Telling a Story on a Timeline

In January of this year, my wife Karen — who is an artist and illustrator — and I came across an illustration from a children’s book for early readers which she had illustrated back in 1980.

The book tells the adventures of the very nice Brown family (Mr. and Mrs. Brown, Sam, Jane, and Grandpa) who somehow manage to accomplish and thoroughly enjoy their daily activities despite the fact that, or perhaps because, they are incapable of abstract reasoning.

In the chapter about bedtime, Sam explains his plan for the night:

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About the same time we came across this illustration, I had been thinking about how to display EHR events visually on a timeline (see my posts from 11/09/2015 and 11/25/2015 for a description of the EHR TimeBar design). I was struck by how both Sam and I wanted to use length in order to measure time.

I started doing some reading in the cognitive psychology literature. It turns out that it’s not just Sam, but all of us (including the MIT undergraduates who were the subjects of some of the experiments and whose capacity for abstract reasoning is presumably better than that of the Browns) who use length and other spatial metaphors to think about time.

When we use expressions like “a long time ago,” “a short time later,” “back in time,” “the distant past,” “spring is far away,“ and so forth, they come to us so naturally that we don’t realize we are using our concepts of space to describe time.

To what extent we have to rely on spatial metaphors when we think about time turns out to be a hotly debated topic in cognitive psychology. According to the “strong version” of one theory, the human brain just can’t intuitively grasp the concept of time. This theory holds that the human brain, like the brains of all other animals, evolved to help us perceive and interact with the physical world.

When humans subsequently acquired the capacity for abstract reasoning, we had to use our existing sensory and motor systems – the ones we use for seeing, hearing and touching things and moving around in the real world – in the service of understanding abstract concepts. In other words, according to this theory, we are mentally incapable of understanding the concept of time without thinking of it in concrete terms. For instance, by visualizing it as a physical path.

If this theory (or even a weaker version of it) is true, it has profound implications for designing EHR user interfaces. If we can present a sequence of clinical events as points in space along a visual timeline, we should be able to grasp this time-based data with little cognitive effort.

In other words, we can “co-opt” the parts of our brain — including our high-bandwidth visual processing system — that have been finely honed by millions of years of evolution to intuitively grasp the physical world in the service of grasping abstract concepts. In doing so, we spare our finite cognitive resources for patient care issues.

Consider two alternate ways of representing the sequence of clinical events (documents) in my data set for the months of March and April, 2014. Note that for clarity, in both views only the time-based (temporal) information about the documents is represented; the subject matter of the documents has, for now, been omitted.

Chronological List of Events – Numeric Format

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Timeline View of Same Events – Graphical Format

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We can then begin to ask which view better supports the following tasks:

Accurately shows the precise date of each event

Here, the numeric chronological list does better. In the timeline view, an interactive gesture such as a mouse hover would be required to cause the precise date to display. On the other hand, if the precise date is not important, the numeric list of precise dates can cause visual clutter.

Shows the events in the correct temporal order

Both views show the events in the correct temporal order.

Makes it easy to see how events are clustered

Here the timeline view does better. We can intuitively see how events are clustered and the time intervals between them. In contrast, with the chronological list, it takes cognitive effort to get this same information.

Makes it easy to see how many events occurred on the same day

Again, the timeline view does better. To get the same information using the chronological list requires cognitive effort.

Makes it easy to see how events relate in time to the present

In one sense, the present – that is, “today” – is always the most important point in time when taking care of a patient. The timeline view incorporates a symbol for today. In this example, it is as if we are viewing the timeline on April 30. Of course, today could just as easily be inserted into a numeric chronological list, but most EHRs do not support this option.

It’s important to remember that this comparison makes a huge presupposition. It assumes that your EHR is, in fact, capable of providing you with a single chronological list of all clinically relevant documents (notes, labs, reports, imaging, procedures, and so forth) regardless of their category.

As I discussed in my last post, many major EHRs, both ambulatory and inpatient — at least as they are usually configured — do not provide this option. Without such a view, some of the tasks above become nearly impossible cognitive challenges (see my very first post, Human-Centered versus Computer-Centered Design).

In summary, both the chronological list of events and the timeline view have advantages and disadvantages. We are so used to working with chronological lists of EHR events in numeric format that the advantages of timeline-based views remain largely unexplored.

Note: I would like to thank Stephen Few, whose article, Data Visualization for Human Perception, published in the Encyclopedia of The Interaction Design Foundation, inspired the comparative format of this post.

Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

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December 9, 2015 Rick Weinhaus 9 Comments

Morning Headlines 12/9/15

December 9, 2015 Headlines 1 Comment

Public health gets least money, but does most

Karen DeSalvo, MD and acting assistant secretary of health discusses the need for increased public health funding, noting that 97 percent of funds are spent on care delivery, while 80 percent of people’s health needs are influenced by what happens outside of the doctor’s office.

Debunking common myths about healthcare consumerism

A review of McKinsey studies focused on healthcare consumerism finds that patient satisfaction is most influenced by nurse empathy and keeping patients informed about their treatments.

Hospitals Face Budget Woes With Switch To Electronic Records

Brigham and Women’s Hospital falls $53 million short of its projected 2015 surplus, blaming in part its Epic implementation, which was expected to cost $47 million but ultimately ran $27 million over budget due to lower patient volumes and coding issues.

Startups ZocDoc, Oscar to Help Obama Advertise Obamacare

ZocDoc and Oscar Health have both been contracted to begin running Healthcare.gov ads in hopes of bolstering sign ups as the final weeks of open enrollment wind down.

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December 9, 2015 Headlines 1 Comment

News 12/9/15

December 8, 2015 News 4 Comments

Top News

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Acting Assistant Secretary for Health and National Coordinator Karen DeSalvo, MD, MPH tells a group that US public health is “marginalized and under-funded” as 97 percent of available federal money is spent on delivery of medical services even though 80 percent of health factors don’t involve hospitals and doctors’ offices. She adds, “The notion of population health doesn’t end with a geographic boundary … it’s everybody in the community,” giving the example that parts of Baltimore have worse health than North Korea.


Reader Comments

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From The Freshman Whisperer: “Re: Hour of Code. I was at a ninth-grade career fair last week telling students the story of technology and how the healthcare industry needs help. As a part our booth, we had students try Hour of Code. I was happy to hear that many students had tried coding before (lots even enjoyed it) and were considering a career in computer science. I wasn’t offered any coding classes in high school. Thumbs up for teachers teaching young coders. My company can’t hire enough of them!”

From Health Dataphile: “Re: HCA’s inpatient and outpatient facilities in the Southeast. Meditech went down over the weekend and, as far as I know, is still down as of Monday morning.” Unverified. Usually an outage of that magnitude would be related to data center communications or some type of network failure, which HCA might be prone to since it deploys Meditech and other systems regionally. That might be a lesson for everyone anxious to get out of the operations business and move to a cloud provider – cloud systems are probably better architected, but they can still go down or you can lose access to them if something happens to your real-world connectivity. A reader in an HCA hospital in Florida says the ICU nurses didn’t know the downtime protocol they were supposed to be following, but on the bright side, doctors fell back to writing and dictating orders instead of entering them into the computer, allowing them to leave for home earlier than ever. The nurses were worried about medication reconciliation between the MARs and Pyxis machines.

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From This Is Just Silly: “Re: Judy Faulkner’s letter on exhibit at the Smithsonian. I would have rather seen the letter or email she sent to George Halvorson at Kaiser Permanente when she turned down KP’s interest in buying Epic.” The National Museum of American History’s just-opened “Giving in America” exhibit includes the letter Faulkner wrote in pledging that she will donate 99 percent of her $3 billion fortune to charity. I was just thinking that Epic must be one of very few hugely valued companies where both top executives studied computer science.

From Unscheduled: “Re: McKesson’s scheduling software. I’m hearing it is ending support. Do you know if that’s true?” I don’t, but anyone who does is welcome to comment.

From Ground Pounder: “Re: salary survey. Cute infographic hides terrible methodology.” It’s puzzling why reasonably smart people will believe a dumbed-down graphic instead of paying attention to what it’s based on, although far less puzzling why crappy “news” sites run the graphic as clickbait. The members-only report is based on a survey of only 700 people who were apparently self-selected, meaning any conclusions it attempts to draw are not believable, especially when it tries to segment the responses into subcategories. Here are some headlines the self-promoting report drew by sites that simply reworded the press release, with extra points for the first entry (which turned it into a “listicle” like you’d see on celebrity gossip sites) and the last entry (which seems to attempt a Donna Summer song pun):

  • Health IT professionals think they’re underpaid: This and 9 more findings on IT salaries
  • Average healthcare IT salary tops $87,000, job tracker survey finds
  • Average Health IT Salary Down, but Job Satisfaction Up, Report Finds
  • Health IT Professionals Report High Salaries, Job Satisfaction
  • Survey: HIT workers get lower salaries than desired
  • Infographic: Health IT workforce paid well, but perhaps not enough
  • Health IT Pros See High Salaries Due to Increased HIT Needs
  • Working Hard for the Money

HIStalk Announcements and Requests

HISsies nominations will remain open for a few more days. The best nomination I’ve received so far is in the “smartest vendor action taken” category, where someone offered, “Hiring hookers to seduce my COO.” Athenahealth has obviously put the word out to employees as indicated by both boilerplate nominations in several categories and repeated IP addresses that are dominating the responses, but that’s OK since the final ballot will be delivered by the unstuffable ballot box of direct email.

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Ms. Lam from California says she assigned her first graders, most of whom are from immigrant families in which English is their second language, to work with fourth-grade partners using the hands-on Make Wonder programming and robotics kit we provided by funding her DonorsChoose grant.


I wrote earlier this week about a friend who keeps working for her vendor employer even while fighting the cancer that will almost surely kill her because she’s worried she isn’t replaceable at work. It resonated with a reader who sent me an internal executive email exchange from a few years ago. An employee of a large health IT vendor was determined to keep working despite having cancer (of which she died shortly after) so that her retirement plan could vest for her surviving family. I’m paraphrasing the exchange below:

[Executive to CFO]: The employee thinks she needs to push through and keep working even though it will be one of the last things she will do on this Earth. Without being too nosy, can we vest the retirement even though the dates haven’t arrived?

[CFO] I want to make this happen and will approve the change under my board-delegated authority. Consider this as my approval. This is the only time I have ever approved such an action, but it seemed appropriate. A great example of why it feels great to work at [vendor name omitted].

[CEO] I am in complete agreement. Today is a gift – that is why they call it the present. 


Webinars

December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.

December 9 (Wednesday) 1:00 ET. “The Health Care Payment Evolution: Maximizing Value Through Technology.” Sponsored by Medicity. Presenter: Charles D. Kennedy, MD, chief population health officer, Healthagen. This presentation will provide a brief history of the ACO Pioneer and MSSP programs and will discuss current market trends and drivers and the federal government’s response to them. Learn what’s coming in the next generation of programs such as the Merit-Based Incentive Payment System (MIPS) and the role technology plays in driving the evolution of a new healthcare marketplace.

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

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


Acquisitions, Funding, Business, and Stock

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San Diego-based MD Revolution raises $23 million. It offers a patient engagement platform that allows providers to bill Medicare for delivering chronic care management services.

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UL acquires InfoGard, an IT accreditor whose offerings include certification of EHRs and electronic prescribing of controlled substances systems.

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EClinicalWorks will spend $30 million in India to build a data center and increase its 1,000-employee headcount there by at least 300 in the next three months. The company will offer consumers in India an app to view lab results, find doctors, maintain personal health records, and schedule appointments. The company has already signed 40 hospitals and 20 practices in India.

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The Wall Street Journal summarizes the strategy behind the turnaround of Valeant Pharmaceuticals that has brought criticism as well as a 4,000 percent share price increase that gave its CEO $2 billion in holdings:

  • Cut research and development expense.
  • Take over dozens of drug companies.
  • Buy undervalued drugs and raise their prices.
  • Focus on skin treatments, mostly just redesigning old ones rather than researching new ones, knowing that dermatologists are responsive to drug salespeople and prescribe by habit.
  • Sell its dermatology products through a now-closed mail order pharmacy that used aggressive sales tactics.

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Twine Health, which offers health coaching software developed at MIT, raises $6.75 million.

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San Francisco-based concierge medicine provider One Medical Group raises $65 million to expand its service area and to further develop its enterprise and mobile technology solutions, increasing its total to $182 million.

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Google has renamed many of its business and does the same with Google Life Sciences medical device group, now known as Verily. Meanwhile, GV (formerly known as Google Ventures) says it is less interested in seed-stage investing and will instead pursue more mature companies, with an ongoing emphasis on healthcare and life sciences firms.

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Harris Computer Systems relocates its QuadraMed EMPI Solutions business to a high security office in Plano, TX that can house up to 100 employees.


Sales

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Weirton Medical Center (WV) chooses Besler Consulting’s Transfer DRG Revenue Recovery Service.

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Scripps Health (CA) chooses the Health Gorilla Clinical Network to provide patients with access to imaging and lab information.


Announcements and Implementations

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Intelligent Medical Objects announces GA of its 2.0 release that includes silent terminology updates, support for natural language processing, quarterly refreshes of major dictionaries, and a CQM dashboard.

PatientPay announces that customer Greenwood Pediatrics (CO) reduced its billing costs by 47 percent by switching from paper to the company’s online bill review and payment.

Cloud hosting provider Infinitely Virtual announces that it has passed the HIPAA audit that allows it to offer health IT hosting plans, including a $10 per month option for full-disk encryption for each virtual machine.

Telemedicine services company Virtual Radiologic announces that it has applied artificial intelligence to data from the 90,000 head CTs it performs monthly to create a real-time warning to its teleradiologists that a patient might be experiencing intracranial hemorrhage.

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A Finland-based software vendor licenses a web-based geriatric assessment system developed by the University of Queensland in Australia. The software records and monitors the progress of elderly patients before, during, and after hospital stays and can be used to deliver telehealth services. The CeGa Online system is already offered by Queensland Health. The same researchers have also developed a residential care version.

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SAP announces software for medical data analysis and clinical trials recruitment.


Government and Politics

The White House enlists ZocDoc and Oscar Health Insurance Corp. to provide free advertising that will urge uninsured people to buy insurance via Healthcare.gov in the final week of open enrollment. ZocDoc will target customers who have paid cash for the appointments they booked through its scheduling service, while Oscar chas reated an explainer video that it will distribute in the handful of states where it sells plans.


Privacy and Security

A physician-written editorial in the Journal of American Physicians and Surgeons says that patient privacy is an illusion because of electronic medical records that make data available without patient consent for oversight and research. The psychiatrist, Susan Israel, MD, wants EHRs redesigned to give patients control of their information via consent requirements “regardless of cost and complexities involved.” 


Innovation and Research

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Google patents a needle-free blood draw system that uses compressed gas to pierce skin and then draw the resulting blood into a collection chamber. The patient covers two possible devices, one for diabetic finger-sticks and the other worn as a wristband. Companies seem to be enchanted with the idea that patients need an alternative to needles and the collection volume of standard blood draws, but for me, that’s far less important than avoiding the inhospitable long waits at LabCorp and Quest drawing centers full of people whose NPO stomachs growl as they watch awful TV shows that working people rarely see.


Technology

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Carequality releases its interoperability framework (legal terms policies, technical specifications, and governance processes) that allows organizations to quickly establish data sharing agreements with partners.


Other

Brigham and Women’s Hospital misses its budget surplus target for FY2015 by $53 million, which it blames on weather, employee retirement costs, and the cost of transitioning to Epic. The hospital had budgeted $47 million for its Epic conversion, but instead spent $74 million. Revenue also fell short by $13.5 million as employees didn’t code cases correctly on Epic.

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A summary of McKinsey’s previous healthcare consumerism studies concludes that while patients say their outcome is the most important factor in their satisfaction with providers, it’s actually clinician empathy (especially from nurses) and the information they are given before and after treatment that is most closely correlated to satisfaction. Access to medical records wasn’t all that important and neither was the perception of value received. A study also found that while 40-50 percent of patients aged 18-34 want to use technology to speak to their provider by phone, schedule appointments, and check health status, the percentage drops sharply for those aged 35-55. Respondents are also willing to share health monitoring data capture with their PCPs, but not very many would do so with friends, family, insurance companies, and employers.

Researchers mine EHR databases at two hospitals to detect a previously unknown correlation between the use of androgen deprivation therapy and later development of Alzheimer’s disease. The study used text-based data mining methods developed by one of the authors that were patented by Stanford University. The hidden value of a study like this is that researchers can look at the entire patient population of a health system rather than just individual patients who opt in for a study that was designed to test a particular theory.

A study in England proves that patients are as clueless about antibiotics as doctors keep saying. Two-thirds of them expect to get an antibiotic prescription for a cold or flu, one-third think they should stop taking antibiotics once they feel better, and three-quarters believe it’s the human body rather than bacteria that grow resistant to the drugs. Doctors who apply sound science to writing antibiotic prescriptions are seeing their patient satisfaction ratings fall, with a 3- to 6-percentile drop for every 25 percent reduction in prescriptions. The other GPs just keep cranking them out to keep patients happy, with half of those patients receiving an inappropriate antibiotic prescription. 

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A Florida woman is jailed for hit and run when her car’s crash-triggered electronic monitoring system automatically calls 911. The operator, suspicious of the woman’s insistence that nothing had happened when the device clearly showed that it had, dispatched police, who found her car damaged with the airbag deployed.


Sponsor Updates

  • Forrester Research ranks AirWatch as an enterprise mobile management leader.
  • TransUnion Healthcare announces that its eScan product has found patient insurance coverage worth $1 billion in hospital payments that would have otherwise been written off to bad debt and charity care.
  • Sixteen Influence Health clients receive eHealth Leadership Awards.
  • LiveProcess exhibits at the National Healthcare Coalition Preparedness Conference through December 4 in San Diego.
  • Oneview Healthcare launches an internship competition.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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Reader Comments

  • Oh Lordy: Agree with the above comments. This feels much more blatantly self promotional than what I used to seeing. I could pr...
  • Matt Levin, MD: I was sadly struck by your statement below -- "I was recently at a site where providers were seeing 16 patients a day...
  • The wisdom of inexperience: Niko, you're "blaming the customer for being dumb". Seriously? Why don't you go to med school or run a hospital or c...
  • IfIRememberCorrectly: I thought this author was banned for submitting content posted elsewhere. [From Mr H] He was apologetic and blamed a ...
  • FLPoggio: Ok Niko, here's some feedback... This piece sounds like the classic entrepreneur's healthcare lament. I know because ...

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