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EPtalk by Dr. Jayne 3/24/16

March 24, 2016 Dr. Jayne 4 Comments

Several readers responded to my recent request for information on EHR vital signs data entry alerts. Epic has not only color changes that indicate an out-of-range value, but the possibility of a hard alert that forces the user to address the value. I got a chuckle out of the warning for our erroneous pulse of “13270,” which read as follows:


I’m fairly certain that a pulse of 500 is incompatible with life, which makes me wonder if this is a vendor value or something the customer configured.


This week has been a veritable news roundup of interesting articles and newsy tidbits. Popular Science featured a wearable patch that can not only monitor blood glucose, but also deliver medication. Using the pH of sweat along with temperature changes that align with a high blood glucose level, when certain conditions are reached, a micro heater in the patch dissolves a layer of coating, releasing the drug metformin via microneedles. Commentary on the recent publication notes that it’s not clear whether the device can last a full 24 hours and whether it will withstand exercise and increased sweat. Its ability to deliver human-scaled drug doses is also an issue. From the physician standpoint, I’m not sure about metformin as the choice of drug due to its mechanism of action, but it’s certainly an interesting technology to think about.


Engadget reviewed a business card with built-in electrocardiograph capability from MobilECG. The card is open source and schematics are posted online, so I’m thinking perhaps my nephews would like to try their hand at building one.

Content vendor Wolters Kluwer has made its Zika Virus order sets available for download. The World Health Organization has declared it a global threat and there have already been nearly 200 cases reported in the United States. The order sets include one for infants to assess for congenital infection, as well as those for emergency department and outpatient settings. Other freely available order sets include Ebola evaluation, ischemic stroke, low back pain, myocardial infarction, pneumonia, and more.

Even though I’m behind the scenes at HIStalk, I still rely on it for healthcare IT news. I was glad to see mention of the AHIMA petition in support of a voluntary unique patient safety identifier program. Being in the healthcare trenches, I’m more worried about incorrect data matching than I am about people misusing my data, so it’s a risk I’m willing to take. It’s not the complete answer, but I can’t help but think that it would be better than what we have.


I also appreciated Mr. H’s mention of the retirement of Groupwise at BJC. I remember using Groupwise fondly – my favorite feature for scheduling recurring appointments, when you could just pick dates off the calendar rather than having to follow a straight formula. It was an absolute necessity when I had to schedule physician advisory board meetings – we alternated Tuesdays and Thursdays so that conflicts would be shared throughout the group. Also great for meetings that occurred the first and third Wednesday, etc. Much easier than sending multiple appointment series. Users can’t convince Microsoft to get rid of the unholy “Clutter” folder in Outlook, so it’s doubtful Microsoft would ever consider this type of enhancement.

HIStalk is also a place where readers can ask for feedback and advice. One emailed me asking if I knew of any companies that might have a “lab” of EHR vendors to connect to. He’s trying to test some integrations but frustrated dealing with individual vendors. If anyone knows of that kind of arrangement, leave a comment to pass along the information.

I mentioned in this week’s Curbside Consult that our practice is seeing an increase in volume that we’re at least partially attributing to the shift towards high-deductible health coverage. Price transparency is one of our talking points. Reader Intrigued asks, “For those of us who missed it or are search challenged, where did you discuss this before? Definitely interested in learning more about your experience.”

I’ve mentioned it a couple of times in passing over the last few months. As for data, we have referral tracking and patient satisfaction survey data which shows the trend. We can capture who has a high-deductible plan from our practice management system and can see who chose us for "cost" in post-visit surveys. We also can see trends on the number of patients who visit us because they can’t access their PCP or don’t have a PCP. There are definitely multiple drivers fueling our growth, but I continue to be impressed by the number of patients who are paying attention to cost.

A reader asked about my recent mention that Institute for Health Improvement courses have been approved for ABPM LLSA credit. I clarified with my source that the approved courses include: Quality Improvement Curriculum, Graduate Medical Education, and the Patient Safety Curriculum. Too bad I already took my mandatory Patient Safety course through the National Patient Safety Foundation, because it sure would have been nice to also get the LLSA credit.


I enjoy reading scholarly articles, although some are best left for bedtime. “Do You Smile with Your Nose? Stylistic Variation in Twitter Emoticons” was perfect for a mid-day break, however. Analyzing the 28 most used emoticons in American English tweets, it demonstrates “that the variants correspond to different types of users, tweeting with different vocabularies.” I shared it with a friend who edits journals for a living and she responded back with this gem, “20 PhD Students Dumb Down Their Thesis.” I’m fairly certain that #5 might have been submitted by one of my medical school classmates.


Chocolate cake as the new breakfast of champions? Thanks to Dr. Lyle Berkowitz for sharing this article summarizing research on the benefits of chocolate. Morning chocolate consumption has been found to have positive influences on weight loss and improved performance on cognitive function. I think I’m going to make chocolate part of my complete EHR implementation plan from here on out.

What’s your favorite vehicle for chocolate consumption? Email me.

Email Dr. Jayne.

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March 24, 2016 Dr. Jayne 4 Comments

Morning Headlines 3/24/16

March 23, 2016 Headlines No Comments

Allscripts is buying stake in Netsmart Technologies

Allscripts and private-equity firm GI Partners will pay a combined $950 million to acquire behavioral health software vendor Netsmart Technologies as part of a new joint venture. Allscripts will pay $70 million in cash and merge its home health software business into the new venture, resulting in a company with an annual revenue of $250 million.

Opportunities and Challenges in Advancing Health Information Technology

During testimony before the House Committee on Oversight and Government Reform, National Coordinator Karen DeSalvo, MD discussed ONC’s interoperability roadmap and the agency’s efforts to help expand the use of alternative payment models.

New HIPAA audits will target healthcare industry’s business partners

The HHS Office for Civil Rights announces that the next round of privacy and security audits will target business associates and insurers.

In Its First Year, Has Apple’s ResearchKit Revolutionized Medical Research?

Fast Company recaps ResearchKit’s first year in operation, highlighting some of the successes and barriers to growth researchers are seeing with the framework.

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March 23, 2016 Headlines No Comments

Readers Write: Time for Providers to Lead the Price Transparency Revolution

March 23, 2016 Readers Write 5 Comments

Time for Providers to Lead the Price Transparency Revolution
By Jay Deady


With ICD-10 in the rear-view mirror, providers now face a new challenge – answering the public and media call for consumer price transparency. High-deductible plans now cover nearly a quarter of those Americans with commercial insurance, raising the ante on patient financial responsibility. Yet large numbers of patients remain confused about how much they will owe for hospital services—a full 36 percent, according to one survey.

This problem, unheard of in other consumer industries, not only endangers patient satisfaction scores, but threatens to increase the bad debt load of organizations already struggling with severely low margins.

While insurance companies and employers have deployed some pricing tools, they have done a poor job of accurately representing multiple providers’ fees within a geographic area. New technologies are available from a handful of companies that let providers take the price transparency bull by the horns and lead themselves.

These technologies transcend the usual approach of mere compliance with a state’s price transparency laws. Posting a list of charges on a provider’s website may satisfy the letter of the law, but it fails to give consumers an accurate picture of what they will owe for services. Knowing this, providers have struggled to come up with an alternative that does not reveal proprietary information to their competitors. Most have concluded there is no way for them to easily accomplish this and they refer questions to patients’ insurance companies.

But it turns out the path to truly efficient, accurate, and accessible price transparency is one that healthcare consumers can take themselves—directly from the provider’s website.

Healthcare consumers want – and deserve – an accurate understanding of what they will owe for services before they are rendered. The operative word here is “accurate”—as in an estimate based on the consumer’s current levels of insurance coverage. Or, in the case of a self-pay patient, an estimate based on the provider’s discounted fees for consumers that pay fully out of pocket.

Either way, with self-service pricing, healthcare consumers generate the estimates themselves, typically from an online calculator on the provider’s website. The process is quick and hassle-free. A consumer simply inputs their name, insurance plan number, and perhaps two or three more data elements. Within 10 to 45 seconds, a complete and accurate estimate appears, giving consumers immediate, line-item insight into what they will owe.

The process is powered by rules-based engines that automatically query, retrieve, and combine data from payer portals with the hospital’s charge master data and payer contracts. Analytics plays a critical role in assuring the estimate is accurate, including analysis of previously adjudicated claims to identify variances.

Such a tool neatly solves one of the most persistent challenges with implementing price transparency: the pitfalls of making proprietary financial information public. As a provider-facing solution, and because patient-unique information needs to be entered to generate an estimate, not just anyone can use the calculators. This is vastly preferable to putting a list of total charges or paid amounts out there for all competitors to see, which neither reflects negotiated rates with payers or the patient’s accurate out-of-pocket costs.

At the same time, self-service price calculators appeal to today’s information-driven patients and nicely align with how they already seek pricing on other purchases, from airfare to mortgages.

One of the most promising advantages of a self-service price calculator is its potential to engage consumers in multiple ways. After generating a price estimate, for example, the calculator could prompt high-deductible and self-pay consumers to view payment plan options. It could even engage those patients with concerns about their ability to pay and schedule time with a financial counselor. Realistically, we can only expect such concerns to grow along with the increasing number of high-deductible health plans. Since these plans were introduced in 2006, they have increased from 4 percent to a whopping 24 percent.

A deductible payment and co-insurance spread out over a year, or whatever the time span the provider and patient agree on, is clearly more manageable than a lump sum payment. Armed with clear, accurate information about how much they will pay—and how—healthcare consumers can better plan for paying their medical bills. This in turn will help reduce a hospital’s bad debt or charity write-offs.

Most important, patients who clearly understand their financial responsibility are more likely to schedule rather than delay urgently needed care. This reason, above all others, is why providers would be wise to take control of the price transparency issue now.

Jay Deady is CEO of Recondo of Greenwood Village, CO.

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March 23, 2016 Readers Write 5 Comments

Advisory Panel: HIMSS conference, ransomware

March 23, 2016 Advisory Panel 1 Comment

What were the most interesting things you learned or saw at the HIMSS conference?

  • I met a number of CIOs from hospitals and health systems that either have already completed or were in the process of implementing Cerner financial and ambulatory products to result in integrated clinical and financial systems across inpatient and ambulatory. Cerner appears to continue gaining momentum and building some critical mass in their competition with Epic. VNA products continue to develop nicely. It appears there are good product options that are positioned to upset the traditional, monolithic PACS products.
  • I did not attend the HIMSS conference this year. If I attend the one in Orlando next year, it would be merely to see how off the wall they can be and how obscene and disconnected from the reality of practicing medicine today they have become. HIStalkapalooza may be the only reason for even flying there or paying for a hotel room since they are not even offering CMEs.
  • I was mostly impressed with the booths downstairs and in the side rooms. I saw some interesting applications of big data analytics finally starting to bloom. Check out Ayasdi (I have no relationship with their company). Generally it felt like there was a lot less energy and excitement than in previous years. I saw very few of my provider-side colleagues — mostly just vendors talking to other vendors (or consultants).
  • I focused on meeting with clinical decision support vendors and several that are building CDS data analytics tools, e.g., LogicStream, Stanson Health, MedCPU, Zynx, Appervita, Wolters Kluwer. Seems everyone is trying to figure out how to create some sort of dashboard that can help organizations manage their CDS alerting process. So many organizations have turned on way too many alerts and no one wants to, or perhaps is able to, make the decision to turn off excessive alerts that are overridden upwards of 95+ percent of the time. We really need to get this fixed soon or everyone will be ready to shoot their EHRs. LogicStream and Stanson Health’s data analytics platforms are both outstanding. Both appear to capture a significant amount of the data and display it in several different and useful ways. Stanson also offers their clients actual CDS content, whereas LogicStream is just the analytics platform. I heard several people asking Stanson to just sell them their analytics platform, but so far they only want to sell content and you get the platform to help you manage their content.
  • I spent the pre-conference day at the EHR-related patient safety symposium sponsored by AQIPS and ECRI among others. It was interesting to hear everyone talking about EHR-related safety issues and what we need to do to improve EHR safety. Seems that most orgs are still struggling with basic implementation and utilization and only the very mature orgs are worried about EHR-related safety. Heard a good talk by Joe Schneider on ways to avoid and manage EHR downtime that focused heavily on the ONC’s SAFER guides. If the ransomware problem doesn’t kill the EHRs, then I think EHR-related safety issues will become much more important over the next five years.
  • I didn’t go to HIMSS — it is less and less valuable each year. One long-time colleague went to his first this year and doesn’t plan to return.
  • Disappointing meeting — poor topics of education, too many vendors with chotchkeys, lack of enthusiasm for educational aspects and more towards having fun in Vegas was our perception.
  • I didn’t go to HIMSS and really haven’t heard anything (other than your posts, of course) about it from others, including vendors. I get the feeling that I didn’t miss a lot this year.
  • Population health is starting to fall into some discrete strategies, with products to match. I expect the diffuse "population health" to become several more discrete somethings like "narrow network strategy," "quality management (analytics and registries),” etc. Still looking for someone who really does it well. Interestingly, there were a lot of people talking about serious security, which I thought was excellent.  About dang time. Also, many organizations with a real cloud model getting traction with hospitals. When asked, it seems that the hospitals figure the data may well be safer with the vendor than with their own systems. Good way to get rid of liability is to not have the data stored on site?
  • The most interesting thing I saw was AccendoWave at the AT&T booth. In short, the equivalent of a thermometer for pain (based on EEG waves detected through a non-invasive headband). Even if you only differentiate drug seekers and malingerers from legitimate pain, that’s some great tech. I’m not sure what the most interesting thing I learned was. I got through about 19 hours of the education sessions this year, most of which had CME attached and were legitimate rather than vendor pitches, for which I was grateful.
  • I suppose the most entertaining things I learned might be worth mentioning: Halamka really emulates Steve Jobs and is almost as invested in brinksmanship as Eric Topol. Presenters from academic centers have an incredible degree of hubris and a pride in their “big data” volumes that is astounding. I guess “big” is a matter of perspective, but come on, folks, you’re talking about having data from one or a few facilities.
  • Themes this year seemed to be: usability, patient engagement, population health, and analytics/BI/big data. It was almost humorous how many different vendors were pitching solutions for “population health” and “value-based reimbursement” all doing different things and using different definitions.

Is your organization taking any steps related to ransomware?

  • This past year, we’ve had seven individual episodes of ransomware infections resulting in user and departmental network shares being encrypted. Luckily, we’ve been able to recover through simple data restores with little to no loss of data. These incidents, along with all of the other security news items in the industry, has our leadership more focused than ever on security. I still wonder if it’s enough. IS has been attempting to raise awareness amongst our leadership about the importance of developing a broader security program and I believe we make some relatively small progress every year. However, we still need more resources to move fast enough to keep up with the threats.
  • Reputation-based blocking of malicious links embedded in emails. Ransomware often infects the user’s computer after the user is tricked into clicking on a malicious link in a phish email. We subscribe to ProofPoint to analyze all email embedded links and attachments and then stop the malicious ones. This DOES NOT protect against malware downloaded via personal Web-based email, such as Hotmail, Gmail, Facebook, etc. We are considering blocking such services, but that is a tough row to hoe considering the culture.
  • Blocking of suspicious Web advertisers as much as we can. We plan to do more of this in the future. Malvertising is another way with which unsuspecting users browsing legitimate sites get hit with ransomware.
  • User education and awareness programs to make our community less susceptible to phishing emails. We plan to start using targeted awareness campaigns facilitated by products such as PhishMe in the future to increase user awareness. 
  • Things that we’re doing to address the infection payload: overlapping antivirus software. We have three different AVs on the email system, server environment, and desktop/laptop environment to hunt for and stop malware to include ransomware. Unfortunately, traditional AV is not super effective in detecting zero-day malware. Behavioral-based next generation AVs such as Cylance are not mature yet and are fantastically expensive, but we’re watching this space.
  • Robust backup process. We don’t pay ransom when we get hit with ransomware. We restore from backup. We use Crashplan to back up desktops and laptops.
  • Can we do more? Yes, but it would make our environment stricter. It’s a balancing act.
  • We are pretty much maintaining our patches, but we are as vulnerable to phishing as the next guy. You do what you can.
  • We are raising awareness from our board level down to the associates. The message to our board includes information about industry events and the outcome, what we are doing to minimize our risk, and how we would respond if infected with ransomware. Our associates are much more aware of the possible consequences of clicking bad email. We had an email phishing attack that resulted in an organizational-wide password expiration. This allowed for education of supervisors and managers as to why they were having them coordinate all associates changing their passwords. That level of awareness has already resulted in a more informed workforce and an increased number of reports of suspicious email.  We use real stories from other health systems to communicate our risk and it seems to work. Also, we have begun adding to our communication around events not only what IT will do to avoid a recurrence, but what our end users can do to help.  As far as technical prevention, we continue to strengthen our monitoring and blocking tools to protect our assets.
  • We’re constantly improving our security posture here, but it’s not like we’ve targeted ransomware specifically. However, we actually did see some within our organization. While running some scans from one of our newly deployed technologies, we found some ransomware on a handful of really old files (from 2002 and 2003). I’m not sure when it came in, no one was actually using those files so no one noticed the ransomware or inability to get to them. But, we just deleted them and restored them from backup and they open fine now. Not sure we needed them at all, but that’s another issue altogether.
  • We have a security vendor that provides us tools and accounting and as I understand it there have been layers of security improving in strength and coverage in IT. Also the organization is messaging to the physicians and employees how to avoid phishing and other types of targeted email based attacks.
  • We have a very aggressive information security and privacy protection strategy and always have. That said, when the bad guys really are out to get you (and they are out for all of healthcare), there is never enough precaution / preparation or defense-in-depth that’s deep enough. It’s a continuous race uphill. There are many key steps we are taking based on the latest round of evolving threats (ransomware being just one of many).
  • We are not taking any specific steps due to the recent activity. However, I have pressed our security team pretty hard on ensuring we are doing what we should be doing for our overall security program.  Our weaknesses were identified long before this latest publicized event, so we have a roadmap for all things infosec. We are covering this event in our next board meeting to remind them of our efforts and that even with a good program, we will always have risks.
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    March 23, 2016 Advisory Panel 1 Comment

    HIStalk Interviews Roger Davis, CEO, T-System

    March 23, 2016 Interviews No Comments

    Roger Davis is president and CEO of T-System of Dallas, TX.


    Tell me about yourself and the company.

    I’ve worked for over 30 years in healthcare in variable roles, including being on the provider side in academic, not-for-profit, and for-profit medicine. I’ve held a number of leadership roles companies including Accenture, GE Healthcare, Perot Systems, and Dell Computer, among others. I’ve spent a lot of time in healthcare in a lot roles on the provider side, the vendor side, and the consulting side.

    With regard to T-System, I’m very proud to be here. Our marketing people gave me a note indicating that we’ll have our twentieth birthday in June of this year, which is remarkable for a company like ours. We have domain expertise in emergency medicine and a longevity that exceeds anybody else in our market. I’m very proud to be here in this great organization.

    What are the biggest issues in the practice of emergency medicine in hospitals?

    Maybe just a slight correction in that regard. We certainly have a large component of our practice that supports hospital-based emergency departments, but it’s important to know that we are also a very strong market presence in the freestanding emergency department space, as well as in the urgent care space. We have a very broad application across that unscheduled care environment and significant footprints in each one of those.

    Having said that, there probably is a common set of challenges within that organization set, things that they share and challenges they face together. Perhaps the most important is the obligation to more actively deliver on outcomes in those healthcare spaces. Those clinical events are largely unscheduled and the outcomes can be challenging because they’re not quite sure what’s going to walk in the door at any given time. They have a unique clinical environment to deliver within. Associated with that are the challenges that the technology supporting it has to meet.

    Our business, our mission is to support that clinical delivery in that unique environment. You enhance those challenges with the things that everybody else in healthcare sees, like ICD-10, regulatory requirements, and additional burdens with regard to capacity for providers. All of those are challenges. All of those are issues which we bring a technology solution to in that urgent care ED space.

    What impact have your customers seen from the passage of the Affordable Care Act?

    Because of the evolution of this space, sometimes the metrics are a little bit challenged depending on who you’re talking to. What we think we see in the footprint in the folks that we serve is that the overall count of hospital-based emergency departments is probably slightly declining. Having said that, while there are fewer hospital-based emergency departments, the capacity or the volume of patients they’re seeing is increasing, based on the fact that there is an increasing funded base of patients now.

    They’re seeing more patients in fewer environments on the hospital-based ED side. That compression of capacity we think is forcing, or at least accelerating, these alternate care sites. They include freestanding emergency departments and urgent care centers. A lot of increase both in number and capacity in those two care settings, based in part on the pressures of the hospital-based EDs with regard to capacity.

    How are the needs of freestanding EDs and urgent care centers different from those of the hospital ED?

    This is one of those classic answers … if you’ve seen one, you’ve seen one. There are certainly some commonalities with regard to freestanding EDs and urgent care centers. There are multiple business models and some are unique.

    Having said that, the freestanding emergency departments, as I’m sure most of your readers know, are fully functional emergency environments, where they are able to deliver radiology and laboratory and complex care for life-threatening clinical scenarios.

    Urgent care centers more typically are a high-access, high-availability, more primary care sort of environment. They are characterized by the ability of a patient to simply walk in and receive care when they choose to and where they choose to. Urgent care centers may be the best manifestation of the scenario of converting to retail medicine that people have described historically. Urgent care centers really are that model. Freestanding EDs are a version of that model that is more focused on acute medicine and higher degrees, or higher orders, of severity.

    Your customers have a greater need than anyone to be able to quickly see a patient’s medical records from wherever they’ve been treated. Has their access to that information improved in the past few years as people focus more on interoperability?

    You’ve touched on one of the things that we spend most of our time thinking about, and certainly more recently with some of the announcements from CMS and the discussions at HIMSS — this notion of interoperability and its importance. The availability to access patient records historically is very important, certainly in our care setting as well as others.

    Maybe even more importantly, though, when we talk about interoperability from a T-System perspective, we’re more interested in what that looks like as a next version. In terms of real-time capabilities of moving data between applications in order to optimize both the provider’s capability as well as the patient outcomes, we’re really thinking more about the velocity of data movement as it supports true clinical interoperability at the care setting and for providers and patients.

    T-System joined CommonWell last year. What are you seeing as either the current or future benefit?

    We think CommonWell, together with some other organizations, represents a forward-looking view of what the relationship between application vendors should be in support of clinical care.

    In that context, I will say that early in the year, Andy Slavitt spoke at the JP Morgan Healthcare Conference. He delivered a very important viewpoint from our perspective. That speech on January 11, together with the follow-on paper they produced called “The Future of EHR,” sets the tone for organizations like CommonWell and how we think about how organizations should be interactive.

    He was very specific in terms of a requirement for “leveling the technology playing field.” He talked about a requirement for vendors to interchange data. He used the term "deadly serious" when he referenced interoperability and data exchange. He talked about referencing open APIs as a specific model for integrating data and moving it seamlessly between technologies.

    Our hope and expectation is that much of what Andy talked about in that view is reflected in organizations like CommonWell and in the behavior of our vendor peers in the healthcare space.

    Has your business been affected as health systems move from best-of-breed systems to a single-vendor approach?

    In any business vertical, there are cycles between enterprise and specialty solutions, whether that’s in finance or ERP or other. Most business verticals see this transition over time between enterprise solutions and specialty solutions.

    You could take a view that Meaningful Use at some level drove more enterprise-type behavior, as there was incentive simply to adopt a platform. Our growth was relatively level over that period of time. We were still meaningful and remained meaningful through that period.

    If you go back to what we talked about with interoperability and you think about a next cycle in that enterprise to specialty model, where organizations are looking for next levels of performance and higher tiers of technology capability, that’s where organizations like ours are primed to participate and meaningfully contribute.

    We see that, on a go-forward basis given the levels of interoperability we’re talking about, the decisions that are going to be made going forward are much more around outcomes and provider enablement as opposed to the fact that it’s nice to have a single platform.

    How have you addressed your audience’s need for usability?

    This clinical environment, this emergency environment, has to be the most challenging and demanding of providers. The technology that they utilize similarly has to behave in a way that is probably disproportionately capable to a traditional EHR because of the pressures and demands associated with that emergency environment.

    T-System, from a solution perspective, has over the last 20 years defined its value relative to that requirement. The notion of complex care delivery in a high-pressure setting is exactly what T-System was formed on 20 years ago and the value that we continue to enhance today. That includes not only the notion of a per-click model, but much more importantly, we spend an inordinate amount of effort and time and talent to refine the user interface of our products, such that they make sense clinically, but they deliver clinical value and that they support physician thinking, nurse thinking, and management of workflow within the ED. That optimizes that environment and supports the complex sorts of outcomes that they have to deliver.

    What are the ED opportunities to deliver better outcomes at a lower cost?

    At its core, beginning 20 years ago, T-System solutions were developed on clinical templates which carried embedded clinical intellectual property. All of the learning that we have developed and aggregated from an emergency perspective is collected and combined within the views that we present to clinicians. That clinical learning directly translates to optimizing clinical outcomes because it is an aggregated clinical IP set. We deliver those over each one of our clinical views. That substantially advances clinical outcomes.

    Where do you see the company going in the next five years?

    You used the term best-of-breed. We love that term. We love being best. Being best means enhancing those things that differentiate us and enhancing those things that provide value differently from a more traditional EHR vendor.

    We see ourselves moving in that space in a couple of different ways. First, back to Andy Slavitt’s comment, we began in 2015 to make a significant development commitment towards open API models and developing both Web delivery and open API capabilities. We have doubled down in that space given where we think the market is moving. We think our ability to interoperate and to be a leader in participating in that model is substantial and significant for us in an area where we’re focused on a go-forward basis.

    The second thing we’ll do is continue to enhance our clinical content, continue to aggregate our domain expertise and awareness, such that we will enhance outcomes as CMS and others have indicated as a priority.

    The third thing is, again beginning last year, we understood that because of the complexities of EHR environments and because of the different requirements in each of those clinical settings, we could better serve our clients by looking at a modular delivery capability as opposed to one solution, take it or leave it. In the context of developing more actively in a Web-delivered, API-enabled solution, we’re moving more toward modularizing capabilities within our solution set that we could interoperate and deliver more flexibly than we do today. A significant direction for us going forward in that five-year horizon is that modular capability with aggressive interoperability.

    Do you have any final thoughts?

    Your questions have touched on nearly every single value message we like delivering. From a personal perspective, I can’t imagine being at a better place with a better organization. The legacy here in the ED space is remarkable. I was at HIMSS talking with someone I had never met before who was an ED physician. As soon as I introduced myself and the company I was from, she couldn’t speak highly enough about T-System and her experience with our products and how it had enabled her clinically. For the almost two years I’ve been here, that scenario is played out over and over again. It makes me very grateful to be here.

    We feel positively about how our company is positioned. Our opportunity in this new season of interoperability is to be extremely meaningful across a variety of care settings, interoperating with anyone from a legacy EHR, enterprise EHR perspective. We’re excited about that. We’re glad we are where we are.

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    March 23, 2016 Interviews No Comments

    Morning Headlines 3/23/16

    March 22, 2016 Headlines No Comments

    Methodist Hospital Contains Cyber Attack

    Methodist Hospital (KY) contains the ransomware attack on its network and restores access to end users. Hackers were not paid a ransom, and an FBI investigation is ongoing.

    Hackers Take Aim At Two More Southern California Hospitals

    Hackers attack two Prime Healthcare Services hospitals in Southern California hospitals, Chino Valley Medical Center and Desert Valley Hospital. Administrators refuse to say whether a ransom was demanded, but say patient safety has not been compromised and that steps are being taken to restore full user access.

    23andMe Enables Genetic Research for ResearchKit apps

    Apple partners with genetic testing vendor 23andMe to integrate consumer genome information into ResearchKit apps.

    Call for Papers: Special Focus Issue on Safety of Health IT

    JAMIA publishes a call for submissions about the safety of all types of healthcare IT systems for an upcoming special issue.

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    March 22, 2016 Headlines No Comments

    News 3/23/16

    March 22, 2016 News 6 Comments

    Top News


    AHIMA petitions the White House to support development of a voluntary national patient identifier. Patients who opt in would be able to choose their own identifier. The petition will earn an official White House response if it gets 100,000 signatures by April 19. It calls for removing a late-1990s HHS funding restriction that prohibits the department from working on a national patient identifier.

    Reader Comments

    From Suzie HR: “Re: Cerner. A 20+ year SMS/Siemens/Cerner employee gets terminated after six months of personal leave taken for treatment of stage 4 colon cancer. Wonder if Neal Patterson is worried what will happen to him during his cancer treatment?” Unverified.

    From Helium: “Re: Epic 2015 upgrades being delayed. Not true here. We’ve discussed the fixes coming out from Epic with our technical lead at Epic and will take them when released. We are still on track for our mid-May upgrade to their latest version (v2015).” Unverified, but this is from a non-anonymous CIO who asked not to be named.

    From A Friend: “Re: Epic. Notified their customers Friday that they have become aware of a major security hole and would be distributing emergency SU’s (Epic jargon for patches) soon.” Unverified.

    From Dueling Banjos: “Re: your comment about flame-related FHIR puns. It hit my funny bone as I was reading your news update while riding BART. I was having such a good, hearty laugh over that comment that the man next to me thought I was crying and asked if I was OK. Thank you for making my day!” 

    HIStalk Announcements and Requests


    Welcome to new HIStalk Platinum Sponsor HealthCast. The Boise, ID-based company offers enhanced sign-on solutions that provide fast, secure access to EHRs and other software. That includes enterprise single sign-on that has a 100 percent success rate in integrating with applications; proximity card-based VDI access; and two-factor authentication for DEA-compliant electronic prescribing of controlled substances via biometrics or tokens. Physicians report that they save up to 45 minutes per day with fast-user switching, click-reducing automated workflow, and remote and roaming access to their systems. The company’s patented Qwik-Start helps community-based physicians who admit patients infrequently and therefore don’t necessarily remember their user IDs and passwords to log on to hospital systems using biometrics-activated proximity badges. Thanks to HealthCast for supporting HIStalk. 

    image image

    Vivian, who is a member of Mr. Chen’s robotics team in Massachusetts, emailed her thanks for funding their DonorsChoose grant request for pizza gift cards for feeding the team on evenings and weekends while they prepared for competition. She says, “We are so grateful that you helped us out! We needed energy to keep us going as we were very charged on getting the robot built for our competition. We have learned so much about mechanical engineering, software engineering, teamwork, and how to run the club as if it is a small business. Your donation has enhanced our learning and made it so much more enjoyable!”


    None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

    Here’s the video from last week’s webinar, “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado,” sponsored by Spok.

    Acquisitions, Funding, Business, and Stock


    Denver-based CirrusMD, which offers a white label app that allows consumer users to send messages to on-call and ED doctors, raises $1 million.


    Practice Unite and Uniphy Health will merge to offer secure messaging and collaboration solutions under the Uniphy Health name.


    In the UK, Wirral Partners chooses Cerner’s HealtheIntent for population health management.



    Indiana University Health names Mark Lantzy (Gateway Health) as SVP/CIO.


    Andy Grove, the former CEO and chairman of Intel, died Monday at 79.

    Announcements and Implementations



    Apple announces CareKit, a developer’s framework for creating personal health apps for the iPhone. Its first four modules will support health to-do lists, symptom logging, a dashboard to map symptoms to the to-do lists, and an information sharing function. The company says early adopters are using CareKit to build apps for Parkinson’s patients, post-surgery progress, home health monitoring, diabetes management, mental health, and maternal health.

    23andMe integrates with Apple’s ResearchKit, allowing developers to create apps in which study participants can upload their genetic testing results from their iPhones. It also allows researchers to offer 23andMe testing at their own expense to expand study access to non-23andMe customers. 

    Privacy and Security


    A cybersecurity firm finds that the public website of Ontario, Canada-based Norfolk General Hospital has been infecting its visitors with the TeslaCrypt ransomware. Hackers gained access to the site via an exploit in its outdated Joomla content management system.

    Methodist Hospital (KY) recovers its systems from a ransomware attack that lasted several days, saying that it was able to regain access without paying the demanded ransom.

    Two California hospitals owned by Prime Healthcare Services have been hit by an unspecified cyberattack that sounds like ransomware. The hospitals are working to restore their systems and the FBI is investigating.


    Ruby Memorial Hospital (WV) goes into lockdown mode for several hours after unspecified malware affects its clinical and security systems.


    A doctor in Canada is punished for overbilling and for keeping inaccurate electronic medical records, the latter of which he blames on not understanding the EHR of the practice he joined. He told the tribunal that he failed to change a pre-populated EHR template, but later switched EHRs.

    JAMIA issues a call for articles on the safety of health IT, with manuscripts due June 1.

    Expedia offers patients of St. Jude Children’s Research Hospital the chance to experience their “Dream Adventures” in which Expedia dispatches teams carrying live-streaming 360-degree cameras to display the adventures the children request in a virtual reality room installed at the hospital. 

    Sponsor Updates

    • Besler Consulting releases a new podcast, “Compliance pitfalls and how to understand RAC findings on your discharge status.”
    • Burwood Group will exhibit at the AONE 2016 nursing leadership conference March 31 in Fort Worth, TX.
    • Elsevier launches a history of medicine site to celebrate the 100th anniversary of its Medical Clinics clinical review publication.
    • CTG will exhibit at the 2016 Annual Health Care Symposium April 1 in Costa Mesa, CA.

    Blog Posts


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


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    March 22, 2016 News 6 Comments

    Morning Headlines 3/22/16

    March 21, 2016 Headlines No Comments

    CareKit Is Apple’s Ambitious New Health Monitoring and Tracking Tool

    Apple unveils CareKit, an open-source app development platform that extends functionality found in ResearchKit and HealthKit, but designed to help hospitals and patients track medical treatments and share medical information between providers.

    FCC auction will scramble patient-monitor airwaves

    Despite objections from the medical community, the FCC will move ahead with plans to auction off rights to airwaves within the 600MHz spectrum, a frequency band once reserved almost exclusively for wireless medical telemetry systems.

    Petition Calls for Unique Patient Identifier Solution

    AHIMA starts a petition calling for the development of a voluntary national patient ID system and the removal of the federal budget ban prohibiting HHS from participating in this effort.

    Scripps Health moves to reduce workforce, expenses

    Scripps Health (CA) reports a 12 percent increase in operating costs for fiscal year 2015, and announces cost saving measures that includes cutting 100 jobs and restructuring its management team.

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    March 21, 2016 Headlines No Comments

    Curbside Consult with Dr. Jayne 3/21/16

    March 21, 2016 Dr. Jayne 4 Comments


    At my clinical practice, many of my partners have been out for spring break. Since the local school districts have staggered break schedules, nearly everyone wanted the overlap weekend off, so I was happy to work the whole thing.

    Although Friday’s shift had more than its share of patients bearing the complaint of, “I just started getting sick and I’m going to Cancun and can’t be sick for break,” Saturday trended more towards, “I just got back from Cancun and am sick / hung over/sunburned.” I was starting to question my sanity until Sunday, when some “typical” patients started coming in.

    I’ve mentioned this before, but with the shift to high-deductible health coverage, we’re seeing a tremendous increase in volume. Our pricing is transparent and we’re conveniently located and provide quick service, so the business is experiencing exponential growth.

    With that comes some growing pains, however, which for me has been felt in the number of new staff members working on the teams. We have a really great training program – new staff members have formal training shifts and each shift has a different focus. One day may be clinical interview skills, another may be labs, and another may be procedures, etc. They work directly with a trainer whose only focus for the day is to train them – it’s not someone already on the care team who is training on the side.

    Even after the formal training, some staff may be more green than others. I ran across a scenario yesterday where the staff failed to notice some nonsensical entries in the EHR. Although it should have been reviewed before addition to the chart, the patient care tech missed the errors:

    • Pulse of 13270
    • Respirations of 99/minute
    • Temp of 15

    It turned out that the tech had entered the data quickly, was just tabbing through the data entry fields, and was off by one field. The blood pressure field (which should have shown 132/70) was blank and he entered those numbers without a slash in the pulse field. The error then compounded as he tabbed. He was apologetic and immediately fixed the error.

    Being in the health IT industry, I quickly flagged it as not only a human error, but also a software problem. Most of the EHRs I’ve worked with have restrictions on various data fields to prevent these kinds of errors. For example, a pulse field might only be able to hold three digits. Active or passive alerts might display for values outside the normal range.

    Although the tech should have caught it, my bigger concern is that this happened in a Meaningful Use Certified EHR. I’ve asked the practice’s technology liaison to open a ticket with the vendor and see if it’s functioning as designed or whether there is a defect. If it’s functioning as designed, I have to wonder about the certification standards. I don’t beg to have a command of the details and I know there are hundreds of pages of requirements that must be met.

    Knowing that some of the elements that are requirement for certification may not be something that physicians need or want, I’m surprised if there isn’t something in there to require safety checks for straightforward data entry like this.

    I first dealt with an EHR that handled data like this in a conversion project more than a decade ago. We had vast amounts of data that couldn’t easily be brought into our new system because the blood pressure field was a single field that would accept numbers, letters, and symbols. Assuming a sample BP of 140/90, users had entered it as:

    • 140/90 sit (meaning taken seated)
    • 140/90 R (meaning taken on the right)
    • 140/90 RA (meaning taken on the right arm)
    • 140/90 RALC (meaning taken on the right arm with a large cuff)
    • 140-90
    • 140.90
    • 140s/90d

    And so on. Our new system had separate fields for the systolic BP (top number) and diastolic BP (bottom number) as well as discrete fields for position, side, site, and cuff size. Due to the work needed in trying to cleanse the data, we quickly decided that we would just not bring any values into the new system and would start from scratch.

    Since that conversion project was so long ago and I haven’t run across the issue since, I assumed that such handling of data had gone the way of the dinosaurs. I guess it hasn’t, or I’ve just been spoiled by more sophisticated systems. But I would have hoped that with all the focus on patient safety and regulations, that we would have moved past this and that consistent handling of essential data such as vital signs would be a requirement for vendors seeking certification. How in the world can you be truly interoperable with data like this?

    We’ll see what happens with the vendor ticket and what my practice decides to do about it otherwise. If I was the CMIO, CMO, or medical director and this was my system, I’d be tracing it all the way through to find out what is being sent to the patient portal and what appears on transition of care documents and how extensive the problem might be.

    Although this particular scenario was a pretty significant and obvious error, I’m sure I could have missed less significant errors during the last couple of years. Since I’m wearing my hourly staff physician hat in this scenario, though, I’ve notified our leadership and have to let them work it as they see fit. I’ll be spending extra seconds reviewing my vitals going forward, however.

    This should be basic functionality, but I guess it’s not. I’m interested in hearing how other certified systems handle this type of data – whether they have field restrictions that would have prevented these errors, and whether they have active or passive alerts to create additional patient safety support. Consider adding a comment and sharing what you’re seeing in the trenches.

    Got screenshots? Email me.

    Email Dr. Jayne.

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    March 21, 2016 Dr. Jayne 4 Comments

    HIStalk Interviews Madelyn Herzfeld, CEO, Carevive Systems

    March 21, 2016 Interviews No Comments

    Madelyn Herzfeld, RN is CEO of Carevive Systems.


    Tell me about yourself and the company.

    I am an oncology nurse by background. I am also an entrepreneur. Prior to starting Carevive, I had an accredited oncology continuing education business, where I worked with thousands of oncology professionals all around the country who helped disseminate education to oncology clinicians.

    About three years ago, I started Carevive. It is a healthcare information technology company where I am leveraging all those relationships of those experts all around the country who are helping me to develop both clinical workflow and patient engagement software which interfaces with the enterprise EHRs. The primary deliverable of the software are patient care plans, treatment plans, symptom management care plans, and survivorship care plans. All intended to improve the clinical outcomes and quality of life of cancer patients.

    Oncology emphasizes the importance of patient-reported symptoms and patient perception of well-being. Is that unusual compared to other medical areas?

    Oncology has several uniquities. There are over 300 diseases within oncology, which in itself makes it a complicated disease. Then, of course, it is the big C. When you have cancer, it’s very important to be balancing survival and quality of life. Patient engagement and making sure that patients are involved and educated about their disease, prognosis, and treatment is very, very important because it is life or death.

    What are the most important characteristics of an oncologist who works with sophisticated technologies while managing the psychological aspects of a patient with cancer?

    Being an oncologist is part scientist and part clergy. That relationship between an oncologist and his or her patient is the most sacred. Somebody puts their life into your hands. I feel the stress and the burden today of oncologists. The healthcare technology industry has not kept up with the rest of the world. Patients have access to all of this information, which may or may not be relevant.

    The oncologist doesn’t have those tools — the clinical decision support, the data analytics tools — to be able to help that patient process that information. It’s a whole new world. There is some light at the end of the tunnel with changes in cancer care and value-based reimbursement. The healthcare IT market is mobilizing to better support oncologists, but it’s a struggle.

    We’re beginning to accumulate a lot of electronic treatment data and outcomes data. Will that increasingly used to evaluate the risks and benefits of treatments as well as their value?

    Absolutely. As I mentioned, there are hundreds of diseases within oncology and very limited data sets. Everything is based on very small clinical trials data. The NCCN guidelines are based on expert panel discussions, again, with very little evidence. You’re starting to see a number of companies that are trying get real-world treatment practice pattern data and symptom experience data to better inform clinicians and patients moving forward — which they have never had before — to guide practice.

    Do oncologists recommend or manage treatments for their patients the same way they would for themselves?

    One of the important changes — a consistent quality measure — is the need for oncologists to document a patient’s goals of care prior to making a treatment decision. It seems so intuitive, but oftentimes those conversations weren’t being had. Making sure the patient understands whether their disease is curative or palliative. That conversation has to be documented, as well as documenting what the patient’s goals of treatment are. Those are two very important first steps in treatment planning.

    Oncology drugs are among the most expensive. Does that create difficult decisions for the oncologist who has to balance their potential benefit with the fact that their cost could financially drain the patient?

    There are some areas, some diseases, where there is a plethora of choices. The routes of administration are different. The costs are different. In terms of routes of administration, some are given orally, some are given intravenously. Some will require that the patient is frequently going to the clinic versus others where a patient can self-administer a drug. That’s an important consideration, as are costs, as are toxicity profiles.

    The perfect example is that some drugs can cause significant peripheral neuropathy in your fingertips. If you are a pianist or somebody whose profession requires them to work frequently with their hands, they probably would not be a good candidate for that option. All those things come into play. The oncologist and their patient are very thoughtful about all of those risks and benefits when treatment planning.

    What types of engagement do oncology patients want?

    It goes back to that conversation that you and I had when we first started. There is this sacred relationship between the patient and the person that they are putting all of their faith in to save their life. There are meta-analyses of data that point to, as frequently as the care team can touch that patient and the patient can touch the care team, those patients have far better outcome. There are a couple of examples of that.

    There is a quality measure now that you have to screen all patients for distress. You’ve got to manage their distress, because distressed patients have poorer outcomes. You want to keep that relationship close. A big problem in cancer care is that because patients have such a will to live, sometimes they will push through a number of symptoms until they get really severe and not want to talk about them or report them because they want to maximize that therapy. Making sure that there are mechanisms, be it technology or just simple care coordination, where you’re in active communication and dialog with patients. Part of what we do is the technology and part of it is workflow and coordination, making sure that there are those frequent touch points and follow through with the patient.

    Number two is making sure that the patient is educated and realistic and doing all that they can to maximize the benefits of treatment.

    A lot of talk recently, including from the White House, is about patients donating their genomic and EHR data to cancer researchers who are looking for patterns and ways to identify similar patients. Will that concept be difficult to explain to oncologists and individual patients?

    As part of our license agreement, you have to discuss data rights. I’ve seen the oncology community be overwhelmingly positive so long as the spirit of the data collection is good and to progress the science. You get buy-in from clinicians and patients because they’re dying for this information. They know it will improve patient care.

    Specifically what I’m referring to here, at least in our case, is when you’re collecting patient-reported data on the patient experience and being able to understand and compare quality of life on different regimens. Those are datasets that they don’t have right now. Those are important datasets when you’re talking about the risks, the benefits, and the value of treatments.

    Does the simplistic idea of cancer as a single disease that can be cured via a cancer moon-shot send the wrong message?

    We have to be really careful. Today’s cancer moonshot … Several years ago, it was targeted therapies. Now it’s a little bit of immunotherapy. Just making sure that we are keeping it real. There has been incredible amounts of progress, but there is much, much, much more progress to be made. This concept of 2020 — that’s just a few years away. We owe it to patients to just set realistic expectations.

    Do you have any final thoughts?

    It’s very exciting to see resources being mobilized to our industry. I’ve been doing this a few years. Even seeing the small changes in the interoperability between EHRs and all of the interest that has gone into this market is exciting. I’m glad to be part of the journey.

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    March 21, 2016 Interviews No Comments

    Morning Headlines 3/21/16

    March 20, 2016 Headlines No Comments

    FBI investigating cyber-attack at Methodist Hospital in Henderson

    Methodist Hospital (KY) is the latest victim of a ransomeware attack, forcing the hospital to operate on a backup system while the FBI investigates and administrators decide how to restore access to patient records.

    Poor Country, Top Doctors

    India-based 32-hospital chain Narayana Hrdayalaya is profiled for its efforts to bring down the cost of healthcare so that quality care is accessible to all, not just the wealthy. The health system performs CABG’s for just $2,600 and insurance for just $3.60 per year.

    Private Dell mostly makes PCs – and its sales of those are down

    Analysis of Dell financial records shows that the company still makes 65 percent of its revenue from hardware sales, and that the company booked a net loss of $1.1 billion.

    Cerner Trails campus construction reaches top of first two towers

    Cerner holds a “topping out” ceremony as the first of two towers in its new $4.45 billion campus reached its peak height Friday.

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    March 20, 2016 Headlines No Comments

    Monday Morning Update 3/21/16

    March 19, 2016 News 5 Comments

    Top News


    Methodist Hospital (KY) is hit by ransomware, forcing it to run from a backup system while it decides whether to pay an unspecified ransom to regain access to its patient records. The hospital has declared an internal state of emergency and warns that it has “limited access to Web-based services and electronic communications.” The FBI is investigating.

    Reader Comments

    From Certifiable: “Re: Epic 2015. All upgrades are being delayed for 1-2 months until fixes can be delivered. Unusual!” Unverified.

    HIStalk Announcements and Requests


    It’s easy to describe the HIMSS keynoters that poll respondents want to see – they are the ones HIMSS doesn’t invite. The least-attractive speakers are government officials (HIMSS16 — Sylvia Burwell), authors (HIMSS16 — Jonah Berger), celebrities or athletes (HIMSS16 – Peyton Manning), and for-profit business leaders (HIMSS16 – Michael Dell). Topping the most-desired but rarely offered list are public health experts, patients, and not-for-profit provider leaders. Furydelabongo wants to hear from inspirational people who remind us of why we’re connected to healthcare and who can convey urgency, while Tracy wants to be inspired by what’s possible in transforming healthcare rather than hearing from a celebrity.

    New poll to your right or here: has your employer laid anyone off in the past 12 months?

    I was thinking about how the most prevalent form of healthcare ransomware is being distributed by hospitals – the kind that holds your own medical information hostage unless you’re willing to pay to get it back.

    image image

    We fulfilled the DonorsChoose grant request of Mr. Blachly in Indiana, whose high school advanced placement calculus and physics students experience “abysmal conditions and poverty” that cause them to miss classes. The video camera and accessories we provided has allowed him to archive his lectures so that absent students can watch them online, allowing them to return to class fully caught up. It also frees up his time for questions rather than re-teaching missed lessons.

    image image

    Also checking in is Mrs. Beggs from Maryland, who teaches a middle school math class for students with educational disabilities. She says of the math tools we provided, “My students could not believe that people that have never met them were willing to purchase items for them. We had a wonderful conversation about giving to others and why its so important. We are currently working on integers and absolute value. We will continue to practice our basic math facts while we learn integer skills. These skills are essential for the every day world and are helping prepare my students for life.”

    Last Week’s Most Interesting News

    • HHS OCR settles two lost laptop HIPAA incidents for $5.4 million, one of them involving a non-hospital employee whose employer hadn’t signed a business associate agreement with the hospital.
    • The CMIO of two NYC Health + Hospitals hospitals resigns, warning that the system isn’t ready for its April 1 Epic go-live and that patients will be harmed if it isn’t moved back.
    • St. Joseph Health (CA) settles for $15 million a privacy class action lawsuit involving a 2012 incident in which a PHI-containing server was inadvertently opened up to the Internet. It states the total cost of the incident at $40 million.
    • Dell appears close to be selling its services business to Japan’s NTT Data for $3.5 billion.
    • The Senate’s HELP committee passes the MEDTECH act that exempts several types of health-related software from the FDA’s oversight.


    March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

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

    Acquisitions, Funding, Business, and Stock

    An analysis of privately held Dell’s financial forms finds that sales are down across most of its divisions and it’s still largely a PC company, with 65 percent of its revenue coming from hardware sales. Revenue for the services business it is trying to sell was down 5 percent for the fiscal year.


    Staffing and services firm HCTec Partners acquires Colorado-based professional services firm HIMS Consulting Group.

    McKesson will take a $300 million charge for its cost-cutting restructuring plan that involves 1,600 layoffs.

    Privacy and Security


    Developers of the TeslaCrypt ransomware toolkit update their product to remove the ability of cybersecurity firms to use a known exploit to restore the encrypted files without paying the ransom. The FBI warned last month that ever-smarter ransomware can now search a network to locate and delete backups, leaving the victim with only one choice if they want their systems back. I’ll repeat my prediction that hospitals will have no choice but to block access to Web-based email services like Gmail that employees use to check personal email, bypassing IT security.



    Cerner holds a topping-out ceremony for its $4.45 billion Cerner Trails campus in Kansas City, MO. The 16-building, 4.7 million square foot complex with two, 15-story towers will house up to 16,000 employees. Kansas City will pay $1.1 billion of the project’s cost.

    The two surviving original members of The Who, Roger Daltrey and Pete Townshend, open a teen lounge at Memorial Sloan Kettering Cancer Center (NY). The space was created using $1 million raised by a concert in which Daltrey and Townshend performed via Teen Cancer America, a charity they founded in 2012.

    A profile of India-based 32-hospital chain Narayana Hrudayalaya describes its mission to “dissociate healthcare from affluence” in proving that “the wealth of the nation has nothing to do with the quality of healthcare” in a country where most residents can’t afford drugs or surgery. It offers CABG surgery for as little as $2,700 and surgery insurance for $3.60 per year. Some of its cost-cutting methods:

    • Do as much as possible in an outpatient setting.
    • Focus on high-volume procedures to gain economy of scale. Its 16 cardiac surgeons each perform 400-600 procedures per year.
    • Minimize facility expense by not investing in fancy buildings, artwork, or even air conditioning.
    • Competitively bid for drugs and medical equipment.
    • Use top-of-license practices to shift less-critical work to junior employees.
    • Use iPad-based ICU monitoring software called iKare to update patient records and provide alerts.
    • Connect all hospitals via a cloud-based information system that includes ERP and EHR.
    • Teach patient families to deliver post-op care at home.
    • Offer free telemedicine services via Skype, including consultations, radiology reports, EKG, and second opinions.

    An anesthesiologist in England faces dismissal for having sex with a prostitute in a maternity hospital. He was blackmailed by the woman’s “associates,” who threatened to tell his wife if he didn’t pay them $15,000. He worked with police to set up a sting operation to capture the blackmailers, and as it was underway, he showed officers an X-ray showing a patient with a bottle lodged his most private of areas.

    Sponsor Updates

    • TierPoint will exhibit at the Boston Premier CIO Forum March 22-23.
    • VitalWare will exhibit at HFMA Dixie 2016 March 20-23 in Nashville, TN.
    • PatientMatters will exhibit at the HFMA Northern California – Spring Conference March 20-22 in Sacramento.
    • Sagacious Consultants publishes the March 2016 edition of its Sagacious Pulse newsletter
    • The SSI Group and Streamline Health will exhibit at the Region 5 Dixie HFMA meeting March 20-23 in Nashville.

    Blog Posts


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


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    March 19, 2016 News 5 Comments

    Morning Headlines 3/18/16

    March 17, 2016 Headlines 2 Comments

    Improper disclosure of research participants’ protected health information results in $3.9 million HIPAA settlement

    OCR announces two breach settlements stemming from stolen, unencrypted laptops. The Feinstein Institute for Medical Research will pay a $3.9 million fine, while North Memorial Health Care of Minnesota will pay $1.5 million.

    Hospital exec quits, compares $764M upgrade to Challenger disaster

    Charles Perry, MD, the CMIO of Queens and Elmhurst Hospital Centers resigns over concerns about the upcoming NYC Health + Hospitals Epic go-live. He compared the project to the Challenger space shuttle launch of 1986 and called for a delay to prevent patient harm.

    McKesson Falls After Saying It Will Cut 1,600 Jobs in US

    McKesson lays off 1,600 employees, or four percent of its US workforce, after losing several key customers.

    Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds

    A ProPublica report finds that doctors who receive payments or gifts from pharmaceutical companies are two to three times more likely to prescribe a brand-name drug instead of a generic alternative.

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    March 17, 2016 Headlines 2 Comments

    News 3/18/16

    March 17, 2016 News 1 Comment

    Top News


    HHS OCR announces two big HIPAA violation settlements for years-old incidents, both involving the theft of unencrypted, PHI-containing laptops.

    North Memorial Health Care (MN) will pay $1.55 million to settle charges involving the 2011 theft of an PHI-containing, unencrypted laptop from an employee of Accretive Health. HHS OCR says the system violated HIPAA rules by failing to require Accretive to sign a business associate agreement and for not performing a security risk analysis.


    Feinstein Institute for Medical Research (NY), a non-profit sponsored by Northwell Health, will pay HHS OCR $3.9 million to settle charges that it lacked of security management processes, detection of which was triggered by OCR’s investigation of an unencrypted  PHI-containing laptop that was stolen in 2012.

    Reader Comments


    From Dockside: “Re: Novell GroupWise. BJC HealthCare began its Outlook rollout using Microsoft hosting services. The rollout is going well and will be finished in stages over a couple of months. Makes me wonder how many GroupWise shops are left.” I was involved with that same conversion at my hospital many years ago and thought we were probably one of the last holdouts then. Users weren’t clamoring for Outlook, but our GroupWise version was so old that it couldn’t handle long file names and its inline document viewers didn’t work with newer file formats. The product is still around, with the 2014 edition being the most recent version. Most of us in the hospital missed a few GroupWise features that Outlook didn’t have, but nobody had any interest in going back since we had already moved away from Novell Office. BJC is the first-listed success story on the GroupWise site. I also notice that the screen shot included in the Wikipedia entry for GroupWise is from someone in healthcare since the pictured inbox contains emails from HIStalk and HIMSS.


    From Legally Blonde: “Re: Hardee County, FL. The grand jury in January 2015 investigated the director of the county’s economic development department for spending $7.25 million to fund creation of what is now CareSync. The jury found that nobody monitored the project or whether it returned benefit to county taxpayers. A member of the economic development board had financial interest in the approval of the money. The jury found that projections of 400,000 users and $26 million in annual revenues were ‘mere smoke and mirrors and not even close to being met.’ The interesting thing to me is that surely that indictment was in play before the investors of CareSync (Merck Global Health Innovation Fund ) invested. There was a Series B raise of 18M in early October 2015. Certainly there were clauses about there being no legal proceedings in the terms of the funding.” The full grand jury report is here. I found a March 2015 story in which the development authority ignored the grand jury’s recommendations. I’m not a legal expert, but it looks like the grand jury was focusing on the county’s economic development board and not CareSync and I saw nothing involving indictments or anything more than recommendations to the county. CareSync said its October 2015 fund raise would enable the hiring of 500 workers, although it didn’t indicate how many of them would be working in Hardee County.

    From Empowered Patient: “Re: obtaining medical records. Thank you for sharing Deven McGraw’s excellent explanation in Jenn’s HIStalk article. The HIPAA Omnibus Rule clearly spells out the right that a patient has to receive an electronic copy of their protected health information if the entity is capable of producing it. Further, the electronic copy must be provided in a readily producible form and format, including unencrypted email if that is the patient’s desire. I have argued with CIOs and security professionals who should know better, but denial of these rights is a violation of HIPAA. The American Bar Association has a great overview for anyone who still doesn’t understand.”

    From MS Clippy: “Re: HIStalk articles. Which one is the most-read ever?” I don’t have tools that track how many times each post has been read, which would be pretty cool. It’s been busy the last couple of weeks, though, with nearly 10,000 page views Monday and 8,000 on Tuesday and Wednesday. Those are pretty big numbers for the post-HIMSS lull with no blockbuster news.


    From Tawdry Tale: “Re: Memorial Hermann. Has been hit by ransomware from the Nemucod Trojan dropper.” Unverified.

    HIStalk Announcements and Requests

    image image

    Ms. Medina says her California first graders are using the engineering kits we provided in funding her DonorsChoose grant request to learn about simple tools and machines.


    I also heard from Mrs. Sickle, whose Missouri first grade classroom is filled with charts the students are making from the chart paper we provided.

    This week on HIStalk Practice: Complete Family Foot Care informs patients of a Bizmatics EHR breach. St. Clair Specialty Physicians implements Medical Design Technologies charge-capture software. CTO Prakash Khot brings Salesforce ethos to Athenahealth. Morris Heights Health Center goes with EClinicalWorks EHR and population health management software. Atlantic Spine Center launches virtual consults. Xerox’s Tamara StClaire addresses the population health management equation. Physician burnout may lead to a surge of ninjas promoting "warlord tourism."

    This week on HIStalk Connect: Researchers unveil a new sensor capable restoring a sense of touch for prosthesis wearers. Personal assistant apps fail to offer clinically relevant results when queried with health questions. AliveCor introduces an Apple Watch band that can capture an ECG. The NHS will expand the use of e-referrals through a $78 million grant program.


    March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

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

    Acquisitions, Funding, Business, and Stock


    McKesson lays off 1,600 people, 4 percent of its US workforce, after losing some of its key pharmaceutical customers. 


    Cash-strapped Toshiba, struggling after an accounting scandal, sells its Toshiba Medical Systems business to Canon for $5.9 billion. Canon’s healthcare offerings include digital radiography and fluoroscopy systems.


    Ireland-based Oneview Healthcare raises $45 million in its Australian Stock Market IPO, valuing the company at $160 million. Shares rose 3 percent on their opening day.


    Predictive analytics care coordination systems vendor Pieces Technologies raises $21.6 million in Series A funding.



    Riverside Medical Center (IL) chooses Glytec’s eGlycemic Management System and its Glucommander algorithm-based software for insulin management and glycemic control in its diabetes management program.



    Charles Perry, MD, MBA, CMIO of Elmhurst and Queens Hospital Centers (NY), resigns in protest, comparing the Epic project of NYC Health + Hospitals with the Challenger space shuttle disaster of 1986. He says his hospitals aren’t ready for their go-live and patients will be harmed if the April 1 date isn’t moved back. He had been in the CMIO role since June 2014.


    Impact Advisors promotes Michael Nutter to VP.


    Accenture hires retired Army Surgeon General Lt. Gen. Patricia Horoho, RN, MSN to lead its Accenture Federal Services defense health practice, which includes its work on the DoD’s EHR project.

    Announcements and Implementations

    Wolters Kluwer migrates three customers of the sunsetted Olympus EndoWorks to Provation MD Gastroenterology, the first of 86 facilities that have contracted for the replacement.

    Medsphere launches a mobile version of its OpenVista EHR, which includes its NoteAssist template-based patient documentation system. 


    ID Experts launches the first complete identity protection program for health plan members, which includes protection against all nine types of identity theft. The company offers services for identity monitoring, identity recovery, health fraud, and breach response.

    Government and Politics

    The VA will attempt to fire three executives from its Phoenix hospital over the 2014 wait times scandal. Two of them were placed on leave nearly two years ago but are still employed, and all three will be able to challenge their termination, which in the VA usually means they’ll just be reassigned. The VA previously fired the hospital’s director, but she got to keep her bonus despite pleading guilty to a felony charge for accepting $50,000 in gifts from a lobbyist who was her former supervisor. She had worked at four VA facilities in five years.

    Privacy and Security

    Premier Healthcare (IN) breathes a sigh of relief when a stolen laptop containing the PHI of 200,000 people is anonymously returned by mail, with IT forensics showing that it had not been powered on since the theft occurred in January.


    UNICEF is testing the use of drones in Malawi to carry the blood samples of babies born to HIV-infected mothers to a hospital laboratory, hoping to cut down on the two-month turnaround time between drawing the blood and receiving the result. Ten percent of the country’s population has HIV.



    A physician leaving the medical profession to work for a medical device company she founded explains her decision:

    The phenomenon of patients as customers, the cultural rise of entitled incivility, and trusting Dr. Google more than their doctor has eroded some of the pleasure of patient care … In Kurt Vonnegut’s dystopian gem [Harrison Bergeron], to promote equality, the best and brightest were interrupted by technology that slowed thought. Much as the concept of the EHR makes sense in today’s peripatetic world, the required computer interface currently is right out of Vonnegut. Five minutes of patient contact necessitates 10 of charting, documenting discharge, signing scripts, and all must now be done with a mouse and click box. So many of my heroes have stopped seeing patients, so many years of productive practice lost to the interface. The part of the medical equation that solves the problem shouldn’t be doing data entry. Scribes? Real time dictation? While a portable electronic record is a necessary iterative step to longitudinal map that follow patients through life, the EHR kills joy.


    Broward Health (FL) demotes its CEO and places its general counsel under review after executives complain about lack of leadership and a prolonged contracting process with doctors that may leave it without specialists who can treat trauma or stroke patients. The hospital’s chief of staff says the former Broward General Medical Center is 30 days away from being forced to shut down. SVP/CIO Doris Peek told the board that employees look to it to provided leadership. The hospital district’s former CEO committed suicide on January 23, followed by a state investigation into the district’s contracting practices.


    Boston Medical Center (MA) will offer the digital sleep training app Sleepio as an employee benefit. The UK-based vendor claims hospital employees sleep 4.5 hours per week longer using its cognitive behavioral therapy program. Consumers can sign up directly for $300 per year.

    Data analysis by ProPublica may dispute the claims of doctors that payments they receive from drug companies don’t influence their prescribing habits. Doctors who received money or meals from drug and device makers were 2-3 times more likely to prescribe brand name drugs. The study found that 90 percent of cardiologists who wrote at least 1,000 Medicare prescriptions received such payments, as did 70 percent of internists and family practitioners. Reporters contacted three doctors who prescribed high rates of brand name drugs. The first doctor claimed the drugs are of higher quality, the second said he can’t make a living without taking drug company payments, and the third threatened to call the district attorney about reporters questioning the $53,400 in drug company payments he received.

    Eleven-hospital Presence Health (IL) announces that it lost $186 million in 2015, blaming one-time charges that include a $53 million write-off of uncollectible debt, a change in accounting policies, and the cost of implementing unstated software (presumably Epic since they’re implementing it).


    The systems development group of the IT department of Arkansas Children’s Hospital will host Camp WannaCode, a free, week-long day camp for students aged 14-18 interested in computer programming. The June 7-10 camp in Little Rock will offer classes on Raspberry Pi development, data analytics, SQL databases, JavaScript, and Android development.

    In Canada, a Winnipeg doctor loses his license for a variety of professional misconduct offenses including failing to install medical records software as ordered in a 2000 disciplinary hearing for poor recordkeeping. A 2014 forensic audit of his computer found no trace of the EHR software, but records suggested he had copied and pasted blood pressure readings over multiple visits. The doctor had submitted in his defense the results of a peer group analysis and an independent audit of his practice, but he later admitted that he just wrote both documents himself.

    Friday is Match Day, where graduating medical school students find out where they’ll be spending the next few years working endless hours for low pay. The always-talented University of Chicago Pritzker School of Medicine Class of 2016, led by the musically gifted Beanie Meadow, provides this amusing tribute to their graduating peers everywhere.

    Attention, all you witless punsters who think flame-related FHIR jokes are clever: research suggests that you might have a neuropsychiatric disease beyond just being annoying.

    Sponsor Updates

    • KLAS rates InterSystems HealthShare a top HIE technology in the EMR-independent category.
    • PDR will exhibit at CBI e-Rx & EHR-1 March 21-22 in Philadelphia.
    • Navicure will exhibit at the MGMA/AMA Collaborate in Practice event March 20-22 in Colorado Springs, CO.
    • Nordic sponsors the Southwest Region User group Meeting at Maricopa Integrated Health System March 18 in Phoenix.
    • Orion Health CEO Ian McCrae discusses precision medicine on a New Zealand morning show.

    Blog Posts


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


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    March 17, 2016 News 1 Comment

    EPtalk by Dr. Jayne 3/17/16

    March 17, 2016 Dr. Jayne 5 Comments

    I’ve been spending a lot of time this week on strategic planning for the next wave of healthcare reform. For those of you who thought Meaningful Use being “dead” meant we would be able to catch our breath, there’s an even more challenging sequel. I’m talking about alternative payment models and yet more acronyms – specifically MACRA and MIPS. In a recent blog, John Halamka describes the future:

    Providers will be responsible for the care that their parents receive throughout the community — inpatient, outpatient, urgent care, post-acute care, and home care all contribute to total medical expense and wellness. Some of the care may be delivered by people and organizations outside the control of primary care. The only way they can succeed is by aggregating data from payers, providers, and patients/families in an attempt to provider “care traffic control.”

    When I first saw it, I thought it was catchy – yet another way to try to describe what primary care providers do. We’ve been gatekeepers, quarterbacks, and now care traffic controllers.

    But thinking about the analogy to air traffic control, it couldn’t be farther from reality. Commercial aircraft and their owners are required to obey certain rules across the board. There is a central body making those rules — we don’t have subsidiaries across the nation coming up with their own “local coverage” determinations. The rules are governed by logic, physics, statistics, and experience.

    In healthcare, it seems that sometimes we have none of those forces at play. Humans are often irrational (stroll through the intensive care unit sometime and watch the futile and sometimes cruel treatments forced on the elderly by “loved ones”) and our behaviors are determined by a complex interplay of biological, social, and other factors.

    Planes in the skies are required to not only identify themselves, but to broadcast their intentions regularly. They have to file a flight plan — they’re not allowed to come up with a confidential or proprietary flight plan, then spring it on the passengers at the last minute. Planes have to be inspected regularly and certified for safety. Pilots are retired for certain medical conditions and after certain ages. Additionally, airliners are required to have onboard tools to help determine what went wrong in the case of a failure. Such failures are scrutinized and the findings broadcast for everyone’s learning. This is far from how healthcare operates.

    Lastly, the air traffic controllers aren’t punished for the actions of pilots who don’t play by the rules or airlines who cut corners. They’re not punished when passengers are kept on the tarmac for hours or when flights run late or are cancelled. They’re not personally liable for “oversold situations” or forced to compensate passengers for lost or mangled luggage. Under the “care traffic control” theory of healthcare, we’re asking front-line physicians (particularly primary care providers) to assume the equivalent responsibilities.

    It was in that frame of mind that I started trying to work out some strategy for how my partner and I can assist physician and practice clients in navigating yet another seemingly dysfunctional scheme that is coming their way. It was also in that frame of mind that I received word that three more of my former partners from Big Medical Group had taken or were about to take the jump to either cash-only care models or concierge models.

    One has been in practice for nearly half a year and interviews all her patients, taking only those who agree to her model of care. She has very little overhead due to her non-involvement with payers and the government, so she doesn’t have to see many patients at all to make ends meet. Additionally, she’s doing a time-share out of another physician’s office and is only paying for fractional use of his staff. But most of all, she’s practicing the way she wants to and finds her work satisfying again.

    Not everyone can practice this way, and if we all did, “disruption” would not be a strong enough word to describe what was happening. But it’s an interesting thought and was a nice distraction as I worked through scores of analyses and discussions of where we believe policy and legislation will take us over the next two to three years.

    Among all this deep thought, I’ve still been trying to get caught up after HIMSS. Given some of the changes to my business model and our plans to expand our offerings, I’ve been following up with contacts and reading proposals. I still have over 1,000 emails to deal with, and unfortunately, they seem to be coming in as fast as I can dispatch them.

    One from today was a notification from Microsoft that they’ve released a fix for the pen issue I’ve been having with Office 365 and tablets. Although it’s only available to their Microsoft Insider group at present, they estimate it will be available to the general user base in a week or two. Although I’m eager to receive it, I’m not eager enough to sign up for the Insider program, which seems like an ongoing beta program with a high potential for workflow disruption.

    I was happy to receive a couple of reader emails, including one with photos of the limbo portion of HIStalkapalooza. She managed to capture several people I know in the pics and I’m debating whether to share them with the respective parties or hold them for future blackmail.

    I asked last week whether interoperability is really the answer to all our problems and was happy to receive a detailed reader response:

    In my mind, not until we find a way to retire faxing. MU didn’t account for the value of narrative and so it left faxing as a safety net, therefore increased faxing. It’s a 40-year-old technology that is still the backbone of communication between practices and from hospitals to providers. Healthcare is wasting millions of dollars in time, money, and hours better used elsewhere dealing with faxing. My organization sends 35,000 faxes a week. Although 99 percent go through, that leaves 350 that don’t because of busy signals, practices that turn fax machines off on nights and weekends, and out-of-date or disconnect numbers. Still 10-20 fax issues come in daily, with the most common being:

    • Provider left practice and no one told the hospital.
    • Patient isn’t mine. It’s a Summary of Care for a patient referred to you for follow up, did you read the cover letter? Or maybe registration entered the wrong referring, ordering, or PCP?
    • You’re wasting my paper and toner and I don’t want anything from you on my patients. (my favorite)

    With 9,000 active providers and 20,000 referring, it is impossible to make routing rules that will make them all happy without micromanaging who gets what at the provider level. Even the progressive providers with EMRs and Direct addresses can only get ToC reports and not Notes, Transcriptions, and Letters. Why? Because it’s not in the locked down MU XML specifications. Sorry for the rant, I’m going to manually resend 1,000 faxes that didn’t go through on the first seven automatic attempts.

    He bid me a good night, and so I pass it on to you. Sleep well with visions of fax machines dancing in your heads. Or perhaps you had a nightmare? Email me.

    Email Dr. Jayne.

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    March 17, 2016 Dr. Jayne 5 Comments

    Morning Headlines 3/17/16

    March 17, 2016 Headlines 1 Comment

    VA moves to fire three hospital executives in Phoenix scandal

    Two years after the Phoenix VA scheduling scandal came to light, the VA has formally proposed firing three more executives from the hospital: Darren Deering, MD,  the hospital’s chief of staff; Lance Robinson, the hospital’s associate director; and Brad Curry, chief of health administration service.

    Organizations urge 90-day MU reporting period for 2016

    CHIME and 32 other organizations ask CMS to shorten the MU reporting period for 2016 from 365 days to 90 days.

    Google vet Alan Warren is Oscar Health’s new CTO

    Allen Warren, former Google CTO and senior VP of engineering leaves his position to take a job as the CTO at tech-savvy insurer Oscar Health.

    CHIME, HeroX Patient ID Challenge Gains Momentum

    More than 200 companies have registered to participate in the $1 million CHIME National Patient ID Challenge.

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    March 17, 2016 Headlines 1 Comment

    Providers Prep for a New Age of Patient Record Access

    March 16, 2016 News No Comments

    HIStalk follows up its coverage of OCR’s new HIPAA guidance with a look at provider reaction and preparation.


    OCR’s new HIPAA guidance has the industry on high alert. The office’s clarifications on reasonable fees, timeliness, and a patient’s right to electronically transmit their health data to third parties have many providers and their release of information (ROI) vendors rethinking workflows and technology needs – all in the name of ensuring that patient medical records requests are handled in a timely and cost-effective manner.


    As OCR Deputy Director for Health Information Privacy Deven McGraw explained in a previous HIStalk article, “People shouldn’t put their heads in the sand about this. We’re quite serious.”

    OCR has made its case clearly and is making an effort to help providers understand their role in helping to empower patients with the ability to access their health data in a non-burdensome manner. But are providers listening? Are they – and their ROI vendors – ready for this new age of patient medical-record access?

    Huge Culture Change

    HIM leaders at Oakland Regional Hospital (MI) and Piedmont Healthcare (GA) have been keeping a close eye on OCR’s HIPAA updates, working in tandem with their ROI vendors to ensure compliance with minimum disruption to patient care.


    “Some providers are a bit skeptical with the move towards more patient involvement and control over their health record,” says Stephanie Tatum, director of health information and informatics management at Oakland Regional, a multi-site health system that focuses on hand, joint, orthopedic, and sports medicine. “I believe it’s a huge culture change that providers are having to adapt to. The younger generation of providers view this movement as a positive for the patients because it allows them to feel more involved. On the other hand, other providers believe patients will become overwhelmed with the amount of information that is available to them.”


    Oakland Regional’s ROI vendor, Bactes, has already made changes to its records request process to maintain compliance with the updated guidance. “Our facility follows the guidelines of our ROI vendor, so our workflows will remain the same at this time. [Bactes] does a really good job of processing the requests in a timely manner, and they also provide great statistical reports that allow us to track the number of requests as well as the type of requests processed over time.”

    Tatum adds that while Bactes — a Sharecare subsidiary that made news a few years ago for overcharging patients for copies of their medical records — is working to bring its clients up to speed with HIPAA, the ROI vendor community as a whole is not necessarily ecstatic about the changes, especially with regard to the transition to more reasonable fees. “I have heard that the updated OCR guidance will cause some vendors to lose money on processing requests, so it’s being viewed as a negative.”

    Gaining Clarity into New Fees


    Piedmont’s ROI vendor, Healthport, also made similar news several years ago for overcharging. The Atlanta-based company, which acquired medical record retrieval company ECS last September, is working diligently with Piedmont to ensure its compliance as the health system begins to roll out patient medical record access through its Epic MyChart patient portal.

    Pamella Marshall, senior director of HIM at Piedmont, did a little digging into the difference between the state of Georgia’s take on record access fees and OCR’s guidance, ultimately contacting Healthport for clarification. “They came back and had actually reduced their per-page fee and eliminated the retrieval fee that was allowed by the state. They also eliminated the certification fee.”

    Marshall isn’t so sure that reducing or eliminating fees will empower patients to go after their records more than they already are, given that requests are “usually made as a follow-up to care. But I do know that the change in copy fees will make a difference for everybody.”

    Satisfaction Scores will Benefit

    Piedmont has been working on making medical records access easier even before OCR released its latest clarifications. Access via patient portal will be key. “I suspect we’ll probably have the complete patient medical record access feature up and running by the end of this fiscal year … maybe by the end of the third quarter. We are about to upgrade to the 2015 version of Epic, and so everyone is tied up with that.”

    Marshall adds that the patient portal strategy will be a win not only for patients, but for Piedmont’s patient satisfaction scores, too. “One of the things I’m looking at is adding not only the ability to release the entire record through MyChart, but also to give patients the ability to request their records through MyChart,” she says. “For those patients who are computer savvy – and not all patients are – this is a really good patient satisfier. Our goal is to make a complete, downloadable, and shareable copy available to the patient – all free of charge. Those are a couple of things we have to work on over the next several months.”

    Marshall believes that giving patients easier, less burdensome access to their complete medical record will be a win for population health in the long run. “We as a population of people are becoming more health conscious, looking at things like genetics and our ancestry.” As the momentum behind this trend escalates, she adds, especially in light of the 1 million patient Precision Medicine Initiative, “people may be more inclined to get copies of their records so they can compare them and make sure they are leading a healthy lifestyle.”

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    March 16, 2016 News No Comments

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