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News 10/11/17

October 10, 2017 News 4 Comments

Top News

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Pharmacy benefits manager Express Scripts will acquire care management vendor EviCore Healthcare for $3.6 billion.

Private equity firm General Atlantic formed EviCore in 2014 in merging its acquisitions CareCore (acquired in January 2014 for an undisclosed price) and MedSolutions (acquired in November 2014 for a reported $1 billion). The company renamed itself to EviCore in June 2015. 

EviCore was rumored to be seeking a buyer in May 2017 in hoping for a valuation of more than $4 billion, but was simultaneously planning an IPO in case no acceptable offers were made.

EviCore Chairman and CEO John Arlotta has worked for General Atlantic and was previously president of Express Scripts competitor Caremark RX (now CVS Caremark).


HIStalk Announcements and Requests

Every October Lorre offers a deal for new HIStalk sponsors – sign up now and get the rest of 2017 free. Contact her if you want in before the usual pre-HIMSS rush that, shockingly, will be here before we know it.

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I wanted to buy a baby monitor for some relatives who are new parents and ran across this IP-based camera that was so cool I had to get myself one afterward. The TenVis HD camera features two-way audio, rotation, night vision with 32-foot range, a micro SD card slot for recording, optional emailing of a snapshot or a telephone alert when it detects movement, and an app that allows viewing real-time video from anywhere. That’s a lot of technology in a $40 device. Setup was nearly instantaneous over WiFi, although I had to throttle back my router to 2.4 GHz for configuration and then switch it back to 5 GHz afterward because of some quirk. I don’t need to monitor babies, but it’s fun to check out what’s happening in the living room from anywhere in the house or anywhere in the world, while other Amazon reviewers love it for keeping an eye on elderly parents or driving their dogs crazy by talking to them from afar. My gift recipients report an added benefit that I hadn’t thought of – they’ve given the far-away grandparents access so they can take a wistful look at the little one whenever they want.


Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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Telahealth technology vendor Avizia acquires Seattle-based virtual clinic operator Carena.

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Pittsburgh-based AI vendor Petuum — which  is developing  products for several industries including an EHR-powered disease and treatment module — receives a $93 million investment, increasing its total to $108 million. Two of the three founders earned PhDs from Carnegie Mellon University in computer science and machine learning, respectively.


Sales

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Aetna selects Stanson Health to automate its clinical prior authorization process by integrating with provider EHRs to collect both discrete and free-text information.

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Southwestern Health Resources (TX) chooses Phynd’s provider management system that will integrate with its Epic and credentialing systems, managing 50,000 providers in 31 hospitals.


People

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Chris Mathia (Hyland) joins Innara Health as EVP of sales.


Announcements and Implementations

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Clinical Architecture releases version 2.0 of its Symedical enterprise terminology management platform.

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EClinicalWorks announces that its EHR now supports the OpenNotes initiative in allowing clinicians to share visit notes with patients via its patient portal.

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Nokia will cease development of its $45,000, 360-degree Ozo virtual reality camera for filmmakers, saying that the VR market is developing more slowly than the company expected. Nokia will focus on digital health, enabled by its June 2016 acquisition of France-based consumer medical gadget vendor Withings for $191 million.

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HIMSS Analytics launches a mobile version of its Logic database, giving health IT salespeople access to information about provider organizations and their technology-related activities.

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Switzerland-based Ascom releases Digistat Vitals, which allows bedside EHR entry of vital signs and clinical scores in eliminating double entry and paper transcription.

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PatientKeeper announces a hosted version of its physician charge capture solution.


Government and Politics

A study finds that the FDA‘s requirement that direct-to-consumer drug advertisements list side effects paradoxically increases sales of potentially dangerous drugs. The “argument dilution effect” leads consumers to assume that the mandatory long list of possible side effects – some of them included because of frequency of occurrence rather than severity – misleads them into thinking a drug isn’t likely to harm them.

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A former Missouri nursing home company CEO is sentenced to 41 months in prison and ordered to pay $667,000 in restitution for using Medicaid payments to pay for strippers, casinos, and country clubs as residents of his facilities were given clear broth as meals and did not receive their meds because the company failed to pay its pharmacy provider.


Privacy and Security

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Security researchers find an unsecured Amazon Web Services S3 file containing the medical information of 150,000 people, apparently patients of anticoagulant monitoring company Patient Home Monitoring Corporation.

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In a related item, another security firm finds four unsecured, Accenture-owned AWS S3 buckets holding customer decryption keys, passwords, and certificates. Ironically, the exposed information includes software for Accenture Cloud Platform, the company’s enterprise cloud offering.


Technology

A Wall Street Journal review of scientific studies confirms my suspicion that smartphones make their users stupider. Not only do phones distract people from real-world tasks (the average phone user whips theirs out 80 times per day), keeping a phone “nearby and in sight” diminishes the ability to learn, reason, and solve problems even as users suffer from “delusions of intelligence” in confusing what they actually know vs. what they can look up on their phones. The article notes,

It isn’t just our reasoning that takes a hit when phones are around. Social skills and relationships seem to suffer as well. Because smartphones serve as constant reminders of all the friends we could be chatting with electronically, they pull at our minds when we’re talking with people in person, leaving our conversations shallower and less satisfying … The evidence that our phones can get inside our heads so forcefully is unsettling. It suggests that our thoughts and feelings, far from being sequestered in our skulls, can be skewed by external forces we’re not even aware of … A quarter-century ago, when we first started going online, we took it on faith that the web would make us smarter: More information would breed sharper thinking. We now know it isn’t that simple. The way a media device is designed and used exerts at least as much influence over our minds as does the information that the device unlocks.

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In England, the local paper covers the use by King George Hospital of Vitalpac, an iPad-based vital signs documentation system from System C Healthcare that has reduced hourly rounding time by 75 percent. McKesson bought England-based System C for $140 million in 2011, then sold it to private equity form Symphony Technology Group in 2014 as McKesson began its health IT exit.


Other

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Two Northern California hospitals – Santa Rosa Memorial and Queen of the Valley Medical Center — evacuate patients after Wine Country wildfires spread to 100,000 acres, burning down 1,500 buildings and killing a least 11 people. If there’s such a thing as wine futures, now would be a great time to load up.

A. James Bender, MD, medical director for clinical informatics at Virginia Mason (WA) and his Virginia Mason Center for Health Care Solutions co-author write in Harvard Business Review that the EHR is increasing innovation, with these examples:

  • Alerting clinicians about possible omissions in care based on evidence.
  • Adding transparency to patient and family engagement with ICU electronic patient scoreboards to prevent blood clots.
  • Providing intelligence, such as auto-ordering of labs when specific drugs are ordered.
  • Blocking orders for high-cost imaging studies that are not supported by evidence.

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The local paper reports that three-hospital Maui Health System (HI) has experienced a few technology problems in the first 100 days of turning over operation of the to Kaiser Permanente. Community-based doctors say they don’t automatically receive faxed information about the hospital visits of their patients like they used to, causing billing delays.

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The Salt Lake City, UT police chief fires the detective who handcuffed an ED nurse who refused to allow him to draw a blood sample from a patient without obtaining a warrant as hospital policy requires.

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The work of Richard Thaler, who just won the economics Nobel  prize, has healthcare implications. His specialty is behavioral economics, which studies why people act irrationally when it comes to money, why they fail to stick with their plans, and how they choose whether to act selfishly or selflessly. He says people segregate money in mental accounts and it’s easier for them to spend someone else’s money. He also urges organizations and government to nudge people to help them make good decisions, which would make his observations on the US healthcare system interesting. He said previously that employer healthcare insurance sites are too complicated, such as displaying deductibles as a full-year sum while pricing premiums by the paycheck. One of his significant contributions involved 2006 federal retirement savings plan changes that encouraged employers to make participation opt-out rather than opt-in, which doubled participation, although he’s disappointed that companies encourage under-contribution by setting the default contribution at the minimum amount instead of escalating it over time.

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A woman in Japan posts Instagram-worthy photos of the hospital meals she was served following the birth of her child, making it obvious that they do things differently there. 


Sponsor Updates

  • Colquitt Regional Medical Center (GA) describes the benefits it has seen from its summer 2016 go-live on Meditech 6.1.
  • Fortified Health Security President Dan Dodson will present “Out of the Dark: Seeing and Securing Network-Connected Medical Devices” at the Raleigh Health IT Summit on October 20.
  • Aprima will exhibit at the American Academy of Home Care Medicine Annual Meeting October 13-14 in Rosemont, IL.
  • Besler Consulting will present at the SC HFMA Fall Institute October 12 in Greenville.
  • Black Book publishes the results of its annual outsourced coding and HIM market client experience surveys.
  • CoverMyMeds partners with Pelotonia to raise over $100,000 for cancer research.
  • CTG will exhibit at the Northwest Arkansas Technology Summit October 17 in Rogers.
  • Direct Consulting Associates, Imprivata, and InterSystems will exhibit at the Health Connect Partners Hospital & Healthcare IT Conference October 18-20 in Chicago.
  • Dimensional Insight will exhibit at the HFMA Region 2 meeting October 18 in Verona, NY.
  • FormFast will exhibit at the ASHRM Annual Conference & Exhibition October 15-18 in Seattle.
  • Healthwise will exhibit at Philips Connect2Care October 16-18 in Los Angeles.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 10/10/17

October 9, 2017 Headlines No Comments

Amazon is on the brink of deciding if it will make a big move into selling drugs online

CNBC’s Christine Farr reports that Amazon is in the final stages of planning its move into the healthcare space, and is considering selling prescription drugs as an entry point. The tech giant is expected to make a decision on its next steps by Thanksgiving.

Governor Brown Announces Precision Medicine Advisory Committee

California Governor Edmund Brown Jr. announces the formation of the Governor’s Advisory Committee on Precision Medicine. The committee will advise the governor on  the use of data-driven tools and analysis to help the State improve health and health care.

Trump to Sign Order Easing Health Plan Rules, Official Says

The Wall Street Journal reports that President Trump will sign an executive order this week rolling back health insurance regulations governing ACA’s individual marketplaces.

Federal prosecutors launch investigation of prominent surgeon who double-booked operations

Federal prosecutors are investigating Lenox Hill Hospital’s (NY) Chairman of Urology and Chief of Robotic Surgery at for simultaneously running operating rooms on hundreds of occasions, a practice patients did not know about.

Curbside Consult with Dr. Jayne 10/9/17

October 9, 2017 Dr. Jayne No Comments

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I spent another weekend seeing patients, the by-product of a practice that is expanding physically faster than it can expand its staffing. In an environment where various organizations are grappling for market share, there’s good business justification to grow quickly, but it can create pressure on the people, processes, and technology needed to support the growth.

I mentioned last week that we had a mini-release from our EHR vendor that added some clunks to the documentation workflow. The clunks are still there, with no end in sight as far as streamlining around them. They were added to facilitate document upload to a health information exchange, but we’re not connected to one. Based on some of the patients who arrived at my location, I could really have used the HIE.

The day started pretty slow, allowing me to catch up on some journal reading and continuing education. I read an interesting article on physician burnout from the state medical society in one of the states where I’m licensed but don’t practice. In addition to physician burnout, it talked about how physicians receive healthcare in general, which is to say poorly at times. There are many physicians who feel like seeking care is a burden, either to their schedules (having to cancel office days or move patients for a sick visit) or to their colleagues, who have enough on their plates.

This leads to physicians often treating themselves, which is generally a bad idea. It’s hard to be objective about your own symptoms and examining yourself isn’t the most productive diagnostic activity. Nevertheless, it happens, with studies estimating the prevalence of self-treatment from 52 to 90 percent. Physical illness can impact how we render care, as can psychological problems like burnout. The article mentions that in the particular state, licensure applications require physicians to self-report any conditions that limit or impair judgment or affects the ability to practice medicine in a safe and competent manner.

I’d argue that burnout can affect the ability to practice medicine in a competent manner – loss of empathy, loss of patience, tunnel-vision, and more – but physicians aren’t likely to self-report because that triggers the need for a sheaf of documentation and an investigation from the licensing board. The article goes on to mention a 2009 study that found that 69 percent of state medical licensing applications ask questions that would be considered “likely impermissible” or “impermissible” based on the Americans with Disability Act and relevant case law. Other countries have fewer barriers to physician care, with Norway leading the pack with a group of physicians trained by the Norwegian Medical Association to specifically care for other physicians.

It was in the context of having read this article and been thinking about physician stress and burnout that I cared for a couple of challenging patients. The first had some drug-seeking behavior that was validated by a query to my state’s Prescription Drug Monitoring Program. It’s not integrated with my EHR, but rather is a separate website, but I was happy to do those extra clicks to confirm what I suspected. Score one for technology assisting the physician, although the technology doesn’t make the conversation with the patient any easier, especially when you’re denying them the care they’re seeking. Fortunately, this was a patient who accepted her situation rather than one who became angry when I refused to prescribe oxycodone, because as an urgent care, we’re not well equipped to handle angry or potentially violent patients.

That happy technology-enabled bubble burst a few patients later, however, when I was confronted with a medically complex patient with difficult social circumstances. She had issues following a transplant for over a year, largely related to changes in her insurance and inability to get new coverage. Transplant patients need coordinated care that has many inputs, including the surgical team, organ-specific team, pharmacists, social workers, and more. Being disconnected from your team and having to rely on episodic care can result in organ rejection and serious complications. She had bounced around due to the insurance issues and then was further impacted by a recent hurricane, which displaced her to another state.

At least in her previous city, urgent care or walk-in clinic providers might be willing and able to call the transplant team for advice, regardless of the insurance coverage situation. However, providers in another state aren’t going to necessarily have that willingness to try to make that connection, especially if they’re in a stressed healthcare system. The patient realized that and had been trying to connect with a transplant group in her new state, but began to have signs of organ failure before establishing that connection.

Due to some family issues, she traveled to yet another part of the country, and several weeks and a 30-pound weight loss later, she wound up in my urgent care an hour after we closed, halfway across the country from either of her previous residences, feeling terrible and looking very ill. As soon as I heard the basics of the story from my triage nurse, I was wishing that clicky HIE popup was actually connected to something. I can log in separately to a regional HIE, but it’s a fairly immature repository that rarely contains anything useful for my local patients, so I wasn’t hopeful about finding anything on this interstate traveler. Regional HIEs often have web access for people like me, but I doubt they’d be too keen on a request from out of state, and even if they were, it’s not like that request is going to get validated and turned around at 11:00 on a Sunday evening.

After seeing the patient and dividing her concerns into short-term and longer-term categories, I started to work on a plan. One concern for transplant patients is the sensitivity of their medication regimens and their relatively immune-compromised status. In general, you can’t rely on the “bread and butter” medications we use every day because they can have serious consequences. I maximized my use of drug interaction checking but was still unsure about my plan, and had to turn to a quick literature search to see if I could get the answer. The search was fairly silent about what I was considering in my plan of care, and without documentation of safety, I couldn’t use it.

As a community physician, I don’t have any transplant colleagues I can just call up and ask questions. The hospital I’m most closely affiliated with doesn’t have transplant services, so that was a dead end as well. Since this was after closing time, we were paying overtime to our staff, and as an hourly employed non-partner physician, I couldn’t authorize more overtime to have them start to call around to the local academic centers and hope we could track down a transplant fellow on call as it approached midnight.

I was left with providing simple and supportive advice to the patient for her short-term problem, with the hopes that she could reach her original transplant team in the morning and that they would be able to offer definitive advice despite the lapse since her last visit with them. I can’t begin to describe the feelings of helplessness that these situations evoke for caregivers. We are wired to help people and our training supports that. But when we’re placed in situations like this, it’s hard to not internalize that sense of failure or the feeling that you should have been able to do more. Especially when there are multiple and ongoing situations like this, they contribute to physician burnout and further stress our healthcare system.

In thinking back through it with my CMIO hat, would a true national HIE have helped? Maybe a little. If I could have looked through past records and seen how her previous physicians handled similar symptoms, that might have given me a clue. If I could have accessed past medication lists (older than the year I could get from our Pharmacy Benefit Manager link) that might have helped. Direct messaging to providers wouldn’t have helped given the time of day or the acuteness of the situation, but at least I would have felt more like I was doing something. Direct messaging might have been tricky though, because she didn’t know the individual names of her physicians, but rather listed the transplant program as her primary care provider.

Health information technology has so much promise, but most of us are working with only bits and pieces of it and it’s not in an integrated fashion. The care we’re giving isn’t worse than it was in the paper world, but how we feel about it has changed. We feel like we should be able to do more with the technology or that we could have done better if we were fully connected along with the rest of a patient’s caregivers. There’s a certain psychic load to knowing what could be and comparing it to where we are.

I don’t know what the answers are, but hope that the people who are making healthcare policy and deciding how and if we are going to fund different healthcare initiatives think about situations like this. It’s not only how it impacts the patient, but also how it impacts the caregivers and their ability to stay resilient. In my area, losing a physician from active practice can result in between $200K and $300K in replacement and ramp-up costs, not to mention the lost patient accessibility during the transition time.

We’ve got to find a better way to ensure the available technology makes it to caregivers across the country, not just those in academic medical centers or large cities. We have to figure out how to help those who are in backwards states that don’t adequately fund PDMP or HIE efforts. We have to figure out how to get past hospitals and health systems that are actively engaging in information blocking and refuse to share patient information with the greater clinical community.

Do you see a solution in your crystal ball? Email me.

Email Dr. Jayne.

Readers Write: Interoperability and Standards Will Be Areas of Focus Through Year End

October 9, 2017 Readers Write 4 Comments

Interoperability and Standards Will Be Areas of Focus Through Year End
By Michael Burger

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Michael Burger is practice lead, EHRs and EDI, for Point-of-Care Partners of Coral Springs, FL.

While there are many uncertainties in healthcare, interoperability and standards will undoubtedly be areas of focus through the end of 2017. To that end, the government and industry will continue to refine existing standards and address interoperability challenges. This involves activities by the Office of the National Coordinator (ONC) and ongoing efforts by standards development organizations (SDOs) and electronic health record (EHR) vendors.

Despite potential severe budget cuts, ONC says it is committed to interoperability and standards as main areas of emphasis. For example, ONC is putting the finishing touches on its Proposed Interoperability Standards Measurement Framework, the final document for which will be issued this fall. It also is accepting comments through November 20 for the Interoperability Standards Advisory, which is a stakeholder-informed catalog of the standards and implementation specifications that can be used to meet interoperability needs in healthcare. The newly created Health Information Technology Advisory Committee will also be influential with regard to standards and interoperability. Its recommendations to ONC doubtless will be translated into rulemaking and policy.

The next few months also should see continued progress by SDOs in refining standards for interoperability with a focus on practical use cases by EHR vendors.

One example is FHIR (Fast Health Interoperability Resources), which is one of the newest standards from Health Level 7 (HL7). Vendors are beginning to embrace the most recent iteration of the standard for various clinical use cases and FHIR is being used to extract relevant clinical data from EHRs.

Also, the National Council for Prescription Drug Programs (NCPDP) is refining the SCRIPT standard to facilitate the transition to electronic prescribing of specialty medications. Today, specialty prescribing is largely a manual process that isn’t easily adapted to existing electronic prescribing workflows. An NCPDP task group is looking at ways in which new data elements could be added to the SCRIPT standard to handle enrollment for specialty medications, which accompanies the prior authorization that is required for nearly all such medications. The goal is to enable enrollment and electronic prior authorization (ePA) for specialty medications. Changes to the standard will enhance the ePA functionality, which EHR vendors have already built for non-specialty medications.

There are still obstacles that must be overcome to move health IT interoperability down the field. Three come to mind:

  • Lack of a national patient identifier. One of the biggest interoperability challenges is the lack of a national patient identifier. While industry solutions are being developed, they are one-offs that are not totally standards based. True interoperability cannot be achieved unless this problem is solved.
  • Changes in business models. There is much talk around data-blocking by EHRs, but this is not so much a technology challenge as a business one. The competitive nature of healthcare delivery is primarily what prohibits the exchange of clinical information, as competitors don’t want to make it easy for patients to seek care outside of their networks. When there is demand among customers to connect systems, software vendors respond by building and selling connectivity solutions. The most successful of these solutions rely on standards that have been created and vetted through SDOs.
  • Variations in standards implementation. Other interoperability challenges are created by variations in how standards are used in application program interfaces (APIs) with EHRs. Sometimes these APIs rely on technology that is not standardized, thus adding to the complexity and inconsistency in how data are exchanged among EHR platforms. The goal of using standards to achieve interoperability can only be met when standards are interpreted, implemented, and used consistently.

These are but some of the opportunities and challenges we see in the waning months of 2017 when it comes to standards and interoperability. These issues are not going away anytime soon and will continue to occupy stakeholders’ attention in 2018.

Readers Write: The Untapped Data That Can Improve Lives and Lower National Healthcare Spending

October 9, 2017 Readers Write No Comments

The Untapped Data That Can Improve Lives and Lower National Healthcare Spending
By Kurt Waltenbaugh

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Kurt Waltenbaugh is founder and CEO of Carrot Health of Minneapolis, MN.

Ask 10 mechanics which costs more — preventive or corrective maintenance — and each will likely give the same answer. It’s cheaper to change a car’s oil regularly than to repair a seized engine. The same principle holds true for healthcare.

In 2015, US healthcare spending reached $3.2 trillion. More than half of that went toward hospital care and physician / clinical services, which increased by 5.6 percent and 6.3 percent, respectively, according to the Centers for Medicare and Medicaid Services (CMS). The surge in payouts for these services was due to “non-price factors,” specifically an increase in “use and intensity of services.”

This makes sense given that the coverage expansion under the Affordable Care Act (ACA) gave more Americans access to healthcare than ever before. But at a time when the public and healthcare professionals have centered their focus on reducing insurance premiums and the cost of care, there is one question missing from the debate. Could the need for some of these services have been prevented?

The answer lies in a well of big data that has, until recently, been untapped by the healthcare industry.

In the health insurance market, there exists a disconnect between medical costs and an individual’s health quality. Behavioral and socioeconomic factors determine roughly 60 percent of their overall health, yet 88 percent of the country’s healthcare spending goes towards medical services, which impacts merely 10 percent of a person’s healthiness.

A study entitled “Health and social services expenditures: associations with health outcomes” compared spending by 11 nations on medical care against social care and the impacts on health outcomes. The findings showed that not only was the US the only country to spend more on healthcare than social services as a percentage of GDP, but that a higher ratio of spending on social services was also associated with better outcomes in infant mortality and life expectancy.

Access to this socioeconomic and behavioral data gives payer organizations a clearer picture of a member’s health risks. For example, detailed knowledge about where a person lives — such as neighborhood crime rate, average household income, and availability of healthy food — provides more predictive information than higher-level information on the coverage region, data that delivers far more accurate insights into quality of life. Environmental factors like “walkability” can help determine how easy it is to exercise, while air quality can indicate a person’s risk for lead exposure. For individuals living in a low-income, high-risk area, education and local job opportunities can determine their probability for upward mobility and, by extension, how likely they are to improve the socioeconomic factors impacting their health.

On the surface, proponents of data privacy might argue that these companies would push to use this information to raise premiums for those whose socioeconomic and/or behavioral patterns make them more susceptible to life-altering medical conditions. A deeper examination, however, reveals an opportunity for payers to cover more individuals with less-costly interventions without losing any competitive ground. By connecting these individuals with services that help address social and behavioral determinants of health, payer organizations help them improve their lives while also reducing the potential need for higher-cost care interventions, such as emergency room visits or hospitalization.

In fact, this approach has the potential to change the way insurance operates throughout the country. Rather than balancing enrollment with enough low-risk members into a health plan to cover the care costs for high-risk members, a strategy centered on preventive care through social and behavioral interventions means payers become more invested in their members’ total quality of life, thereby creating a healthier population.

Morning Headlines 10/9/17

October 8, 2017 Headlines 2 Comments

eClinicalWorks Announces Strong Sales Growth

eClinicalWorks reports $130 million in Q3 revenue and the addition of 3,750 new providers. It claims to now be “the second most widely used EHR in the country.”

West Suffolk Hospital patient records checked after discharge letter software error

In England, West Suffolk NHS Foundation Trust stops using Cerner-generated patient discharge letters after a software bug leads to incorrect medication reconciliation information making its way into the letters.

112 Degrees With No Water: Puerto Rican Hospitals Battle Life And Death Daily

NPR profiles the three-quarters of Puerto Rico’s hospitals that remain on emergency power.

PatientKeeper Charge-Note Reconciliation

PatientKeeper announces reconciliation tools to help hospitals find unclaimed inpatient professional fee charges. The company estimates that hospitals typically fail to charge for 10 to 15 percent of their inpatient professional fee charges.

Monday Morning Update 10/9/17

October 8, 2017 News 6 Comments

Top News

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EClinicalWorks says at its annual user conference in Grapevine, TX that it had Q3 revenue of $130 million. The company notes that its EHR is the second-most widely used in the US.

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ECW’s migration statistics for 2017 to date show that the EHRs it most often replaces are those of Greenway (by far), Allscripts, and Athenahealth.

EClinicalWorks also announces December 2017 availability of an interoperability development platform that allows developers to connect to ECW’s API-enabled EHR.

Also announced: a voice-powered Virtual Assistant called Eva, Healow Virtual Room for telemedicine, and v11 of the company’s core product.


HIStalk Announcements and Requests

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Two-thirds of poll respondents think customers that are featured in a vendor’s product sale announcement should be required to indicate whether they hold a financial interest in that vendor. The “required” part of that assertion is the problem, of course, since the obvious remaining issue is, “Required by whom?” Still, the idea that a provider’s purchase of a product wasn’t made using purely objective criteria is troubling to some since the announcement may influence others, especially in health IT-land where “I’ll have what he’s having” purchasing behavior is not uncommon.

New poll to your right or here: who among the rumored candidates would you like to see appointed HHS secretary? I can’t say I’m enthused about any of them except at least they aren’t Tom Price.

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Welcome to new HIStalk Gold Sponsor CenTrak. The Newtown, PA-based company’s real-time location system has been installed in 850 healthcare facilities, with its Clinical Grade-Visibility providing certainty-based location accuracy; rapid location and condition updates; easy installation without requiring patient rooms to be closed; and an open location platform that can be integrated with EHRs, nurse call, and other systems. Its app is available for both iOS and Android devices. CenTrak is KLAS’s 2017 Category Leader for Real-Time Location Systems, receiving the highest performance score among ranked RTLS vendors. The company offers a free Enterprise Location Services Handbook and an RTLS RFP template. Thanks to CenTrak for supporting HIStalk. 

I found this video describing how CenTrak is used at Our Lady of Lourdes Regional Medical Center (LA).

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

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Listening: the amazing alt-acoustic Jamestown Story, which I’ve mentioned before since it’s a project of independent singer-songwriter Dane Schmidt, whose dad Mark is a consultant with Navin, Haffty & Associates. Mark reports that his other son Jordan is one of the top songwriters in country music and has three songs on the charts right now. I’m also listening to former Porcupine Tree singer and guitarist Steven Wilson, justifiably recommended by a reader who also suggests Wilson’s older work with the tragically underappreciated Porcupine Tree as a “modern Pink Floyd.” I’m tracking Porcupine Tree while I’m writing HIStalk today and it is stunningly perfect, even in live recordings. Video from Wilson’s live 2013 performance gives me prog chills, to the point that I just now bought tickets for his US tour that starts in April, where I’ll be silently thanking the reader who showed great insight in recommending Wilson’s music.


This Week in Health IT History

One year ago:

  • Theranos announces that it will close all of its clinical labs and lay off half of its employees in pivoting from running labs to commercializing its MiniLab testing system.
  • ICU monitoring technology vendor Sotera Wireless files for Chapter 11 bankruptcy.
  • Xerox, preparing to split itself into two publicly traded companies, chooses Conduent as the name of the business process services segment.
  • HHS publishes the final MACRA rule.

Five years ago:

  • Allscripts offers MyWay EHR customers a free upgrade to Professional as it begins the product’s retirement.
  • Allscripts files a protest against New York City’s hospital system for choosing Epic.
  • The developer of Nashville Medical Mart shuts down the project for lack of leasing interest.

Ten years ago:

  • Misys Healthcare re-forms under new private equity owner Vista Equity Partners and returns to its old name of Sunquest Information Systems, with Richard Atkin as president and CEO.
  • Microsoft’s healthcare head predicts that the company’s HealthVault personal health record and Azyxxi data aggregation platform will generate a billion dollars in annual revenue.
  • Word leaks out that Epic is developing its own PHR called Lucy.
  • Sage fires its North American executives as the company’s US performance continues to lag.

Last Week’s Most Interesting News

  • France-based IT consulting firm Atos acquires three US EHR-focused consulting companies.
  • The US Supreme Court hears arguments on the legality of Epic’s requirement that employees agree to arbitration rather than lawsuits to settle employment issues.
  • Several names are floated as possible replacements for fired HHS Secretary Tom Price.
  • A Wisconsin court reduces the $940 million awarded to Epic in its intellectual project lawsuit against Tata Consultancy to $420 million.
  • Canada’s Alberta Health chooses Epic.

Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for informat


Acquisitions, Funding, Business, and Stock

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Medecision acquires 58 client contracts of AxisPoint Health’s retired CCMS and Vital software platforms, making it the largest independent provider of care management applications in the country. AxisPoint Health has retained its services business. 

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A fascinating profile of the richest man in Florida — an immigrant from Hungary who made his many billions from the electronic stock brokerage he created — contains his deceptively simple business strategy: “My strategy has always been to try to focus in on a product or service where you can create a dollar of value for 20 cents and sell it for 40 cents. The only way to do that is to use technology that has not been used before in producing that product or service. If I can create that dollar, then I’m already ahead 20 cents of earnings, and I’m going to keep way way way ahead.” Thomas Peterffy said when he introduced hand-held computers to Wall Street trading floors in the 1980s, “I think the way a CEO runs his company is a reflection of his background. Business is a collection of processes, and my job is to automate those processes so that they can be done with the greatest amount of efficiency.” Some other quotes that may be applicable to healthcare IT:

  • “Some traders still think that a computer could not trade as well as they can.”
  • “I always preferred computer programmers because I knew how to talk to them. I never knew how to talk to salesmen because I never believed them.”
  • “I moved to a commodity trading firm and my job was to figure out how to price options. That was a very, very interesting job because in those days people were trading options by the seat of their pants because nobody understood the mathematics. And after a very long period of ruminating and running simulations on my computer, I eventually came up with a model that is very similar to what today is known as the Black-Scholes formula. Given the fact that I was the only one at the time who had that formula, I saved my money. I bought a seat at the American Stock Exchange and I became a market maker.”
  • “Given that the market is very complex and our strategy is to give our customers an advantage over the customers of other brokers, we cannot do that with just a simple system, so unfortunately the system has to be complex. The only way we can do that is to provide a facility just like your Apple iPhone. People who only use it to make phone calls and send texts don’t know about all the other things that it can do … As to onboarding, that’s been a hassle forever … The regulators tell us that we have to know our customer rules. We have to know many things about our customers to make sure that they will not do certain trades, because even though we don’t give any recommendations, we are liable. We have to make sure that they do not do trades that they are not fit for. I don’t really know how to judge that.”

Decisions

  • Palmetto Health (SC) will switch from McKesson Star to Cerner revenue cycle management in October 2018.
  • Cape Fear Valley Health System (NC) will replace Cerner revenue cycle management with that of an undecided company.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

Health Catalyst promotes Patrick Nelli to CFO. He replaces Dan Strong who, unlike his replacement, has experience taking companies public.


Announcements and Implementations

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PatientKeeper announces Charge-Note Reconciliation, which automates the reconciliation of clinical notes and inpatient charges to find the 15-20 percent of typically unsubmitted professional charges. It’s available immediately in the company’s charge capture solution.


Other

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NPR covers the three-fourths of Puerto Rico hospitals that are still running on emergency power and no air conditioning. An Arecibo hospital’s cardiac unit registered 112 degrees, requiring patients to be moved by HHS’s Disaster Medical Assistance Team to air-conditioned tents. 

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Eric Topol, MD posted this about patients owning their data.

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A terminal cancer patient expresses frustration with feel-good healthcare marketing that spreads false hope of miraculous recoveries with endless pink ribbons and catchwords like “thrive” and “smile out,” with the implication that people like herself who are dying maybe just aren’t being positive enough. Experts say that hospitals market themselves against their competitors by tugging at emotions, while drug companies are prohibited by FDA from running “this is where miracles happen” type messages that aren’t backed by rigorous studies or outcomes results.

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Arizona funeral homes are left unable to bury their customers due to problems with the state’s new death certificate processing system that went live October 2. Bodies can’t be buried or cremated until doctors have acknowledged the cause of death and many doctors didn’t sign up for the new system, requiring some funeral homes to go back to paper.

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In England, West Suffolk Hospital stops using discharge letters after doctors complain that they contain errors in medication doses, a problem the hospital blames on a Cerner software bug. One doctor says a patient collapsed after following the incorrect dose listed in the letter.

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Congratulations to the 10 people (out of 252) who scored a perfect 100 percent in Dean Sittig’s informatics terminology quiz. The mean score was 68 percent, with the most-missed terms being “structural alignment” and “syncytium.” Biomedical informatics professor Dean just published “Clinical Informatics Literacy: 5,000 Concepts That Every Informatician Should Know.”

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Bizarre in mass hysteria, sad current events sort of way, especially if you thought you were the only one sick of the fall “pumpkin everywhere” craze. A Baltimore high school is evacuated, dozens of students are triaged by Hazmat teams, and five students and adults are hospitalized for breathing problems after reports of a strange smell. Firefighters discovered the cause in a classroom – someone had plugged in a pumpkin spice air freshener.

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In England, a hospital’s power goes off during electrical system testing, leaving the delivery suite in darkness just as midwives are cutting the new mom’s umbilical cord. Her mother whips out her smartphone and turns on its light to allow the delivery to be completed. The new mom reports, “There was just no dignity because I had people pointing their phones at me. It was so surreal. I was thinking, what is my mum doing? Is she filming this?”


Sponsor Updates

  • LifeImage and National Decision Support Co., Experian Health, the SSI Group, Summit Healthcare, Surescripts, and ZirMed will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.
  • LogicStream Health will host a reception during the Cerner Health Conference October 10 from 5:30-7:30 at Cleaver & Cork in Kansas City, MO.
  • Meditech releases a video on its Sepsis Management Toolkit featuring Capital Region Medical Center Clinical Analyst Marlene Stiefermann, RN.
  • Navicure will exhibit at the US Women’s Health Alliance October 12-14 in San Antonio.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the National Association of Neonatal Nurses October 11-13 in Providence, RI.
  • Harris Healthcare and Versus Technology will exhibit at the ANCC Magnet Conference October 11-13 in Houston.
  • Qpid Health will host “Artificial Intelligence (and More) in Healthcare” at its offices in Boston October 11.
  • Consulting Magazine includes Huron in the top 10 of its 2017 list of best firms to work for.
  • ZeOmega will exhibit at the California Association of Health Plans Annual Conference October 9-11 in Huntington Beach.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 10/6/17

October 5, 2017 Headlines No Comments

Atos acquires 3 key healthcare consulting companies in the US

France-based Atos acquires three US health IT consulting firms: Pursuit Healthcare Advisors, Conduent’s Healthcare Provider Consulting business, and Conduent’s Breakaway Group business.

IBM to Congress: Watson will transform health care, so keep your hands off our supercomputer

IBM is actively lobbying Congress to minimize regulatory oversight of artificial intelligence.

HCH replacing Electronic Health Records system

Hiawatha Hospital Association announces plans to migrate from McKesson Paragon to Athenahealth for its hospital EHR.

Willis-Knighton Health System statement: Board supports CEO James Elrod

Willis-Knighton Health System (LA) Chief Cardiologist Michael G. Futrell, MD resigns following a failed vote of no confidence in the hospital’s 52-years-long CEO James Elrod. The board voted to keep the embattled CEO in place, despite criticism that he has shown “resistance to changing with the times and refusal to upgrade the hospital system’s information systems.”

News 10/6/17

October 5, 2017 News 2 Comments

Top News

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France-based IT consulting firm Atos acquires three US healthcare consulting firms that focus on EHRs: Pursuit Healthcare Advisors, Conduent’s Healthcare Provider Consulting, and Conduent’s Breakaway Group.

The acquisition gives Atos 400 new consultants. The company expects its healthcare revenue to increase to $1.2 billion.

Atos acquired Anthelio Healthcare Solutions a year ago for $275 million in cash.


Reader Comments

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From Kyle Armbrester: “Re: Givenchy’s rumor report from Tuesday. The statement that ‘about 20 hospitals are cancelling scheduled go-lives’ is false. It’s unfortunate that a few, CPSI in particular, persist in seeding and spreading misinformation about Athenahealth and our in-market momentum and success. Some facts: Earlier this year, KLAS reported that only three vendors achieved net gains in the hospital space—Cerner, Epic, and Athenahealth. Our clients are realizing improved financial and clinical results; four out of five of executives who we work with are seeing real positive impact on bottom lines (KLAS). We have plenty who would love to do a Q&A for HIStalk. We are building true partnerships across the community hospital space which are directly attributed to addressing the needs of an underserved segment. We offer low up-front costs, no maintenance fees, and aligned incentives. It’s our cloud-based, results-oriented platform model that gives us our edge and sets us apart from traditional software players that now seem to be kicking-up some in-market desperate and unsavory behavior. Givenchy, would love to talk further.” Kyle is chief product officer at Athenahealth. Givenchy also named three specific (but still unverified) hospitals that have returned to CPSI, not including Jackson Medical Center (AL), which a CPSI-issued press release says went back to Evident Thrive after its collections dropped 75 percent after a few months running Athenahealth. I’m happy to talk to folks from hospitals that have either gone live on Athenahealth in the past 6-12 months or that have returned to CPSI after trying Athenahealth, which is about as fair and direct as I can make it.

From Cheap Seater: “Re: cavorting on the UGM stage. What about so-called journalists who make the mistake of letting vendors court them at user meetings and conferences?” I think that happens only rarely since most of those folks don’t have a lot of influence to be worth courting, but I do picture most industry writers as introverted, inexperienced with frontline healthcare or IT, and easily swayed by token vendor executive attention, so I agree that their reporting might be suspect at times. It’s like reading an online review from Yelp or elsewhere – be wary of starry-eyed accounts that don’t contain at least one negative observation. I like staying anonymous because that removes even the possibility of vendors trying to apply schmooze in return for positive commentary. It’s like fake news – the problem isn’t that it exists, it’s that Facebook users aren’t smart enough to recognize it or are so anxious to validate their beliefs that they suspend whatever objectivity they once had.

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From Lazy Crazy AZ Days of Summer: “Re: Banner Health. Went big bang in replacing Epic at the former University of Arizona Health Network on October 1. A colleague says ED lab turnaround is six hours and they had to divert patients.” I reached out to Banner, whose PR contact said the hospital was briefly on diversion for some ED patients, but remained open for trauma and walk-ins. They are now off diversion.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor CarePort. The Boston-based company – acquired by Allscripts a year ago – offers a care coordination platform that bridges acute and post-acute EHRs, providing visibility into the care that patients receive across post-acute settings so that all providers and payers can efficiently and effectively coordinate patient care. Starting at discharge, CarePort Guide enables patients to choose the best next level of care based post-acute quality scores, services, and geography. Post-discharge, CarePort Connect helps the care team to track patients as they move through the continuum by pulling real-time data from acute and post-acute EHRs. Finally, CarePort Insight aggregates data across providers to deliver the insights needed to manage a high-performing post-acute network. A spokesperson from customer Cleveland Clinic says, “We are giving patients all the information they need to make an informed decision that best suits their needs and preferences.” Co-founder and CEO Lissy Hu – who earned her MD and MBA degrees from Harvard – previously worked on a Medicare demonstration project involving transitions in care for complex patients. Thanks to CarePort for supporting HIStalk. 

Listening: a new live album from The Magpie Salute, which carries some Black Crowes DNA in offering straight-ahead rock. They’ll play in Madison next week and Kansas City the week after.

Music I won’t listen to: young female singers who start every vocal phrase with a dramatically loud intake of breath even though it’s obvious they’re using vocal improvement software that could have removed even trendy extraneous bodily noises. You would not enjoy hearing most of those musically enhanced warblers on “MTV Unplugged,” which is probably why that program went away.

I know little about guns (even though I have a satisfyingly hefty .357 Magnum revolver that I used to love shooting at the range) and was curious about the inexpensive and entirely legal “bump stock” used by the Las Vegas shooter to turn a semi-automatic rifle into a poor man’s machine gun, turning up this video that illustrates a product that is either ingenious or terrifying depending on which end of it you expect to be on. I was amused only by the portion showing the product’s schematic in which the gun is throbbing in a phallic-like manner in time with heavy metal music that suggests a stereotypically swaggering target audience (notwithstanding this unfortunately accented female customer). The device is likely to be banned quickly because it’s made by a small family business (it shut down all competitors via copycat lawsuits) rather than a big gun manufacturer. The company owner should go out rich, though, since sales have gone off the charts since the massacre.

This week on HIStalk Practice: California IPAs merge as they expand Epic utilization. DuPage Medical Group fills physician pipeline with new resident incentive program. WebPT acquires Strive Labs. CareCloud launches patient intake, payment system. Practices outpacehospitals on healthcare pricing transparency. Former US Surgeon General Vivek Murthy, MD highlights loneliness epidemic. EHR investment makes up good chunk of Q3 digital health funding. MGMA President and CEO Halee Fischer-Wright, MD previews upcoming annual conference, addresses role companies outside of healthcare will play in EHR development. HIStalk’s Must-See Exhibitors Guide for MGMA 2017 goes live.


Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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ECG artificial intelligence analysis vendor Cardiologs raises $6.4 million in a Series A round, increasing its total to $10 million. The company’s ECG analysis platform earned FDA clearance in July 2017. Cardiologists upload a digital ECG from a Holter monitor, smart watch, or personal monitoring device and the system reviews the often-long recordings to alert the doctor if it finds one of 10 types of cardiac events, most of them related to atrial fibrillation.


Sales

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The board of Hiawatha Hospital Association (KS) approves the replacement of Allscripts/McKesson Paragon with Athenahealth.

Seven Hills Foundation (MA) chooses Netsmart as the care coordination and population health management provider for the Massachusetts Care Coordination Network.


People

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James Murray, MS (CVS/Minute Clinic) joins Culbert Healthcare Solutions as CIO.


Announcements and Implementations

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IVantage Health Analytics, part of The Chartis Group, launches Performance Manager, which allows health systems to benchmark performance, identify opportunities for improvement, manage initiatives, and share best practices in a peer-to-peer community.


Government and Politics

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Stat reports that IBM is using its lobbying clout to shield its Watson system from medical scrutiny. A former IBM executive (Janet Marchibroda) helped draft legislation that removed some kinds of health software from the FDA’s oversight; IBM hosted an event to introduce Watson to high-powered members of Congress; and the company has deployed lobbyists to argue that Watson should be exempt from medical device law. It’s an interesting piece, but it seems obvious that IBM Watson Health, like most other clinical decision support or medical knowledge systems, does not fall under FDA regulation because it is not a closed-loop system since the clinician is free to accept or reject the advice it offers. The real scrutiny should come from Watson’s customers and I’ve seen little positive commentary in that regard.

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An Oracle executive applauds the federal government’s move to the cloud, its data security efforts, and IT service consolidation in a letter to the White House’s American Technology Council and Jared Kushner, but makes these observations:

  • The federal government should emulate the best practices of Fortune 50 customers rather than Silicon Valley vendors that often fail even though they know how to deploy products at scale.
  • The government should focus on procurement and program management, not IT development, a lesson long since learned by large companies. It says that the most important CIO skills are choosing commercial products, implementing them efficiently, and maintaining those systems to prevent cyberattack.
  • The federal government should focus on open data instead of open source software development in recognizing that nothing requires the federal government to give citizens systems it builds or buys for free.
  • The most important driver of cost and complexity is customization, with code written by 18F, USDS, and other agencies creating a support tail that drives unbudgeted costs.
  • The government should modernize its processes across agencies since government-specific processes drive IT cost overruns.
  • The government is using technology preferences and vendor-favoring standards instead of competition, which “places the government at substantial risk of failing to acquire the best, most secure and cost effective technology, even if those de facto standards are proposed by well-meaning government employee who ‘came from the private sector.’”

Privacy and Security

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Brilliant satire – as usual – from The Onion. Substitute “hospital employee” for “mom.”


Innovation and Research

The NIH issues a $2.3 million grant to the chief epidemiologist at Maryland’s VA system to study why physicians overuse lab tests in believing they are more useful than evidence suggests.


Technology

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Major League Baseball – which prohibits the use of Internet-capable devices in the dugout during games because of concerns about stealing or relaying signs — launches an investigation as to why a Diamondbacks coach was captured in a photo taken during a Wednesday wild-card game wearing a smart watch.


Other

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Western Australia’s coroner blames Fiona Stanley Hospital’s lack of follow-up for the death of a 41-year-old patient who died of septic shock on March 2015 after being ordered a contraindicated drug. The patient had inflammatory bowel disease and was prescribed mercaptopurine after clinicians failed to notice a red-flag lab result on his electronic chart. The coroner noted that the hospital now watches patients who are ordered the drug more closely and has developed new requirements for reporting abnormal results, but also recommends that the hospital install better patient tracking systems and send lab results to the physicians overseeing treatment.

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The chief cardiologist of Willis-Knighton Hospital System (LA) resigns as part of a no-confidence vote in the hospital’s CEO, who has run the hospital for a record 52 years. Critics say he has been too slow in making changes and refuses to upgrade the hospital’s computer systems. The system wasn’t mentioned, but Googling suggests that the hospital has run Meditech and Siemens/Cerner Soarian in the past.

A Utah neurology clinic that was previously sued for unpaid wages and investor fraud leaves patients without access to their MRI results when it shuts down without notice. The owner blames the clinic’s closure on an electrical surge that damaged its computers, but says he sent its electronic records to Salt Lake Regional Medical Center (UT), which was able to recover those of a patient quoted in the newspaper article.

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A jury finds that a hospital’s collection agency isn’t meeting legal notification requirements when it sends a collection letter via a secure PDF email link since, unlike reliable postal mail,  there’s no strong likelihood hat the intended recipient will read the letter. The collection company’s own software proved that the intended recipient did not open the letter. The judge summarized, “She was required to open an email and then click through over the Internet to an unknown web browser inviting her to then open a ‘Secure Package’ … modern consumer practices are not conducted this way. Although a consumer may regularly open e-mails from persons and companies she knows and to which she has given her email address for communications (like a recognized email from the utility company or the bank one does business with), there is no evidence that Ms. Lavallee should have recognized as safe an email from Med-1 Solutions.”

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This is fascinating: one of 12 companies that were awarded medical marijuana growing permits by Pennsylvania’s Department of Health in June is offering the never-used permit and its 47,000 square foot cultivation facility for sale at $20 million. The company, run by a former candidate for governor, wants to obtain an even more lucrative clinical research (CR) license that would allow it to investigate the medical benefits of marijuana in partnering with a teaching hospital, which would also let it open another growing facility and to operate six storefront dispensaries. Six of the eight Pennsylvania CR permit holders have already signed research agreements with medical schools —  Penn, Drexel, Thomas Jefferson, Temple, UPMC, and Lake Erie College of Osteopathic Medicine. The company’s chief medical officer is the recently retired president of MedStar’s medical group.


Sponsor Updates

  • Influence Health announces its 2017 EHealth Excellence Award winners.
  • The Chartis Group publishes a white paper titled “Solving the IT Investment Paradox.”
  • Black Book names Nuance as the leading vendor for end-to-end healthcare coding, clinical documentation improvement, transcription, and speech recognition technology.
  • McLaren Flint (MI) implements an RTLS-smart pump interface between Versus and B. Braun, allowing clinicians to see on a real-time floor plan where pumps are located and whether they are actively infusing to improve re-distribution. 
  • A Health 2.0 conference demo shows how FDB’s Meducation solution, previously available only to providers, can now be viewed and shared by a patient-controlled app.
  • EClinicalWorks will exhibit at the Louisiana Primary Care Continuing Education Conference October 10-12 in Lake Charles.
  • FormFast and Iatric Systems will exhibit at AHIMA October 7-11 in Los Angeles.
  • Healthwise, Image Stream Medical, and Imprivata, and Intelligent Medical Objects will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.
  • Influence Health announces its 2017 EHealth Excellence Award Winners.
  • ConnectiveRx will exhibit at the IPatientCare’s national user conference October 6-7 in New York City.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 10/5/17

October 5, 2017 Dr. Jayne 1 Comment

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This week is National Health IT week, with events being held across the country. The “points of engagement” for this year’s events include: supporting healthcare transformation; expanding access to high-quality care; increasing economic opportunity; and making communities healthier. I’m particularly fond of the point regarding healthcare transformation, as so much of my work revolves around helping healthcare organizations make sense of the changing delivery environment and payment models. Many organizations are transforming for the right reasons, such as patient and community health, and those efforts make me feel energized and that I’m doing valuable work.

However, I still see far too many organizations that are on the “stick” end of transformation, only changing because they feel they are being forced to. Many of these groups are fighting themselves as they move through the change, with the C-suite saying change is here while allowing some of their more vocal (and often more profitable) physicians and subspecialties to basically opt out. I watched one group mandate that primary care physicians enter all data through discrete template fields, while allowing their orthopedic surgeons to dictate because they were afraid the surgeons would leave the group. This kind of behavior doesn’t do much to engender collegiality or build professional rapport. The most successful groups I work with are transforming because they believe in their ability to deliver care more efficiently and effectively, but trying to spread that enthusiasm continues to be a challenge.

It feels like there is considerably less buzz around Health IT Week than there was even just a few years ago, let alone what it was like in the heyday of excitement around Meaningful Use. Even Google seemed a bit lackadaisical, with my “national health IT week 2017” search bringing up an article about the 2016 events as the fourth item in the search. Let’s face it, healthcare IT isn’t as sexy as it once was and there aren’t as many so-called rock stars out there doing the moving and shaking, but it’s something in which every single one of us is a stakeholder. Having gone through yet another round of medical adventures this week, I’m grateful to have care with physicians that continue to use technology to its fullest and who enable me to be a more educated and engaged patient.

Despite the relative lack of buzz, healthcare IT continues to be of interest to young physicians and those still in training who have decided that clinical medicine may not be right for them. Maybe it’s the rigors of the schedule, the stress of feeling responsible for so many outcomes, or lack of resilience to deal with the chaos that can be modern medical practice that are raising interest. I’ve been mentoring a young resident who is considering whether he should pursue a clinical informatics fellowship or give practice a try. It’s hard to watch a once-idealistic trainee talk about his level of burnout before he’s even made it out of training. Primary care salaries continue to lag behind other subspecialties and doing something other than going straight into the trenches has a certain appeal. He’d like to stay in our metropolitan area for family reasons, so I’m encouraging him to try some moonlighting shifts in the urgent care setting to see if that’s a better fit.

One of the reasons he’s so burned out is that his residency program hasn’t truly embraced the model of team-based care. The faculty physicians are still in the mold of doing things how they were trained, which means a lot of work rolls downhill to the trainees. They have to do all their own patient callbacks and aren’t allowed to leverage staff to manage routine patient requests or to do care management activities – everything must be done by the resident physicians. I don’t dispute that this gives them a lot of knowledge about managing patients, but it doesn’t teach them how to work effectively with other members of the care team or how to lead the care team. The residents don’t get assistance with chart prep or morning huddles, leaving them to try to address gaps in care as part of the routine office visit. Worst of all, when patient-facing work is delayed by other clinical rotation activities, the patients aren’t getting good care. I’m trying to help him arrange some elective work in a setting where he can see clinical transformation in play, along with a rotation with a clinical informaticist in the academic setting. He needs to see first-hand that healthcare IT isn’t all that glamorous either, and depending on where you wind up, you may not escape patient care.

I’m still waiting to see if all this talk about the shift to value-based care will increase primary care salaries, but I’m not holding my breath. I do have a number in mind for which I would hang up my frequent flyer card and go back to primary care, but it would also require some addressing of the details of physician autonomy and practice structure. The wait for a new patient appointment with a primary care physician in my community is upwards of two months if you have commercial insurance, three months for Medicare, and four to six months for Medicaid. When people complain about the potential for rationing in healthcare, they don’t understand that in all practicality, it’s already here. These issues are daunting to new physicians (and old alike) and aren’t doing much to increase enthusiasm among physicians in crisis.

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I’m always on the lookout for new vendors and found one this week in the form of CampDoc. The product is positioned as an electronic health record system for camps and they’ve been doing some epidemiologic research looking at the camp population. In addition to injuries, heat-related illness, insect bites, and allergic reactions, camp physicians also have to contend with head lice, infectious diseases, and disaster preparedness. They’ve partnered with the University of Michigan to broaden their research, which has been presented at the American Academy of Pediatrics, the Society of Academic Emergency Medicine, and other groups. Upcoming studies will focus on head injuries and concussions during summer camp activities. Interested parties can visit their website or reach out to CampDoc for more information.

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For all you IT road warriors out there, join me in saluting Southwest on their retirement of the Boeing 737-300 series planes. The last of the fleet without Wi-Fi or exit windows that open like a DeLorean vs. having to be thrown out, they officially ended service September 30. I was pleased to see that several will be turned into firefighting tankers and others are in the process of being brokered. I’ve spent many hours in its confines, usually on time. I’m looking forward to its replacement, the 737 MAX 8 ,which has enough range for destinations in South America and the South Pacific. If SWA ever heads to OGG or HNL, I’ll be cashing in my points faster than you can say humuhumunukunukuapua’a.

Email Dr. Jayne.

Morning Headlines 10/5/17

October 4, 2017 Headlines No Comments

Scott Gottlieb rocketed to the top of FDA. He may keep rising

STAT reports that FDA Commissioner Scott Gottlieb, who has earned bipartisan praise of his work thus far, may replace Tom Price as secretary of HHS.

Warren, Hatch, Whitehouse, Baldwin, Cassidy Request that GAO Consider Steps for Federal Agencies to Improve Patient Matching in Upcoming Report

Senators Elizabeth Warren (D-MA), Orrin Hatch (R-UT), Sheldon Whitehouse (D-RI), Tammy Baldwin (D-WI), and Bill Cassidy (R-LA) write a bipartisan letter to the GAO outlining topics they would like addressed in the 21st Century Cures Act-mandated report on improving patient matching.

In digital health’s biggest year of funding, women CEOs emerge as Q3 2017 winners

Rock Health publishes its Q3 2017 digital health funding report. 2017 has been a record-breaking year for startup investments, with Q3 funding raising $1.2 billion, bringing the year-to-date total to $4.7 billion.

In Puerto Rico, Health Concerns Grow Amid Lack of Clean Water, Medical Care

The Wall Street Journal covers worsening conditions in Puerto Rico as the healthcare delivery network on the island struggles to return to operations.

Readers Write: Sepsis Risk Intervention: You May Be Doing It Wrong

October 4, 2017 Readers Write No Comments

Sepsis Risk Intervention: You May Be Doing It Wrong
By Jennifer Knapp

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Jennifer Knapp is director of strategic partnerships and solutions for Vocera of San Jose, CA.

September was Sepsis Awareness Month. Many hospitals and health systems, propelled by CMS penalties for avoidable hospital-acquired infections, have made important investments in sepsis risk intervention. But these efforts have introduced new challenges.

As nurses are put on high alert for a growing number of risk factors—including falls, drug interactions, etc.—they are struggling to attend to and prioritize all of these different alerts. For long-term success against the scourge of sepsis, the health IT industry must work to mitigate and manage the negative impact of alarm fatigue on our frontline healthcare providers.

Sepsis is an important target of hospital quality and safety programs. It is a leading cause of death in the U.S., claiming 750,000 lives annually. With $24B spent annually, it is the costliest medical condition to treat in this country. Luckily, strong evidence shows that early, tailored intervention can significantly reduce the likelihood of sepsis-related complications and death.

To this end, many hospitals have deployed EHR-based pop-up advisories to identify patients at risk for sepsis. But there are three problems:

  • Nearly half of these alerts are false-positives.
  • They get mixed in with the routine pop-ups nurses have learned to quickly click through.
  • Nurses will only see these alerts if they are working in the EHR. Since nurses can walk up to five miles a day during a 12-hour shift, they are often away from the EHR.

Sepsis rates will not fall dramatically unless risk intervention alerts are accurate, reliable, and actionable. Alerts must give nurses the right information at the right time in the right way.

The algorithm used to detect sepsis must include nursing and provider documentation, in addition to data from the EHR, to improve the precision of risk determination. Alerts should only be delivered when they provide new information to the staff or when appropriate treatment steps have not been completed. Sending only actionable alerts will significantly reduce alarm fatigue.

Move sepsis alerts out of the routine flow of EHR notifications where they are likely to get lost in the shuffle. Instead, deliver them to caregivers on mobile devices at the point of care. The bottom line is that if you don’t use a mobile alert solution, you are leaving sepsis detection to chance because caregivers may not check the EHR for long periods of time.

Don’t just tell the nurse there’s a septic patient in Room 101. Provide more detailed information about the level of his or her condition (such as severe sepsis), why the alert was triggered (for example, hypotension), and what to do next. Consider functionality that would automatically alert another group, such as the rapid response team, after the alert is accepted by the frontline nurse on duty.

Hospitals are more committed than ever to reduce sepsis rates and intervene early to save lives. Health IT solutions should support, not stymie, these efforts. Deploying the right workflows and technology, driving care team engagement, and managing performance improvement against goals are keys to a successful sepsis program. Do it right and you can significantly improve patient outcomes.

Readers Write: Centralized or Decentralized Revenue Cycle After an Acquisition? Maybe There’s Another Option

October 4, 2017 Readers Write No Comments

Centralized or Decentralized Revenue Cycle After an Acquisition? Maybe There’s Another Option
By Jim Denny

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Jim Denny is founder and CEO of Navicure of Duluth, GA.

According to a recent AMA survey, for the first time, there are as many hospital-owned providers as there are physician practice owners. As this acquisition trend continues to grow, health systems are evaluating the best way to coordinate and consolidate revenue cycle management (RCM) across the entire organization. Typically, to streamline patient billing, healthcare data analytics, and reporting, organizations take one of the following approaches:

  • A centralized approach. All RCM processes are combined across all entities into a single revenue cycle with a central billing office.
  • A decentralized approach. All billing remains separate across all entities.

The path chosen often varies depending on the organization and its structure.

However, in many cases, neither option may be the perfect approach. Instead, organizations may choose to employ a customized billing approach, leaving a majority of each acquisition’s processes, technologies, and best practices separate and in place, which are evaluated over a defined time frame.

A short-term, slower, methodical approach allows the health system and acquisition time to get to know more about each other and can be much less disruptive. A slower integration, perhaps a year or year-and-a-half, allows both to understand how the other works and to work as a team to come up with a plan as how to grow together.

During this period, it is important to establish a common electronic data interchange (EDI) solution so data and reports can be standardized and summarized across all organizations. Then, the health system can review standardized performance data to better understand each acquisition’s approach to RCM, working to identify each one’s uniqueness, strengths, and challenges. From there, they can determine the best way to proceed for the long term. A customized approach is considered a hybrid because it allows the health system to decide whether centralization or decentralization is the right option, and choose from the best of existing RCM approaches, or determine that it’s time to incorporate new ones.

Here are three reasons why a customized approach can make sense for your organization following an acquisition:

This hybrid approach provides time to assess the acquired practic.e

Customized RCM can give leadership the time needed to evaluate the success of a newly acquired practice, while enabling the practice to maintain productivity and conduct business as usual. Questions to ask can include the following:

  • What’s working and what’s not?
  • Does the practice need guidance to improve their efforts? This includes looking at the statistics – days in accounts receivable (A/R), denial rate, and success in patient collections.
  • What IT systems and vendor relationships are yielding the best results across claims management, patient payments, and reporting?

A customized approach allows a health system to choose from best-in-class vendor partnerships.

It benefits both the practice and the health system by allowing practices to maintain their own systems without having to conform to a billing office’s mandate immediately, while enabling the health system time to evaluate a number of systems and vendors and then making a best practice recommendation that fits the health system’s strategic roadmap. This is the time to assess what’s involved in streamlining and integrating technology from a process, people, and data perspective, regardless of whether the organization ultimately chooses a centralized or decentralized strategy.

This method provides breathing room to evolve over time while establishing a strong foundation for future growth.

Using a hybrid model for the short term can offer an organization the opportunity to mesh with other groups in an optimal way. With this approach, health system leadership does not need to force physician practices within the system to conform to the organization’s existing processes immediately. Instead, practices are given flexibility at a critical time that can ultimately lead to a successful merger. Even more importantly, it allows for necessary breathing room for the health system so it can prepare to adapt to industry shifts – such as building a bridge to move from fee-for-service models to value-based care, or in defining the best ways to evaluate when and where to participate in taking on risk-based contracts.

Choosing a short-term hybrid approach yields the opportunity to create a transition plan based on thorough evaluation to help ensure the health system capitalizes on the right processes, technology, and vendor relationships. And while there’s no easy answer, ultimately, the decision to centralize or decentralize an organization’s revenue cycle can be made together with buy-in from each organization, which is the best way to ensure long-term success.

Readers Write: Value-Based Healthcare Drives “Left of Bang” Approach for Risk Management and Compliance

October 4, 2017 Readers Write No Comments

Value-Based Healthcare Drives “Left of Bang” Approach for Risk Management and Compliance
By Mark Crockett, MD

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Mark Crockett, MD is CEO of Verge Health of Charleston, SC.

In 2007, the Marine Corps deployed to Iraq and Afghanistan had a problem: how to identify an enemy that blended in with the population. They developed a behavioral approach to helping teams sharpen their tactical awareness skills to remain “left of bang,” or to fend off hostile actions before they culminate in the “bang” of conflict. In 2017, healthcare needs to deploy the same approach to managing risk and improving outcomes.

Healthcare is currently focused on right of bang, or the future correction of adverse events. Too much effort is expended to react to problems that have happened, and aren’t directed to preventing failure. The military (and other industries) expect that more than 80 percent of efforts should be spent left of bang to reliably prevent failure. A shift to a balanced approach is beginning to happen in top health systems for the first time, and it’s critically important for healthcare leaders to understand the how and the why.

How we got to the current right of bang problem is pretty clear. As a physician, I see failure all the time. Kidneys fail, hearts fail, and ultimately people fail. Dealing with that compassionately and professionally is part of the territory. Financial models have not helped at all. Under straight fee-for-service medicine in the past, if I gave someone an infection, it was quite possible I could bill them for a follow-up visit and perhaps even the antibiotics. In that kind of model, preventing failure is working against your economic model, making success in prevention just that much harder.

Times are changing fast. In the last few years, an array of accrediting bodies, regulatory entities, and payment model changes have made failure punishing to a health system’s finances and reputation. It’s now possible to see quality and adverse events on a dozen web sites, and more every day. Readmission prevention, Healthcare-Acquired Conditions, MACRA, MIPS, etc. are all ways of demanding reliable and efficient care. Health systems fail to execute on quality and safety at their risk: competitors across town that are doing it well are looking to expand and acquire patients and even facilities.

For one California-based hospital system, their timeline-oriented thinking – and solutions – needed to become left of bang. One of their hospitals had implemented a Six Sigma plan to reduce central line infections. Six Sigma is a popular methodology that takes a data-driven approach to eliminate defects in any process. The approach aims for six (or fewer) standard deviations between the mean and the nearest specification limit.

Using Six Sigma, the hospital system found a catheter that was superior in their opinion and a skin sterilization technique they knew worked. That single hospital then worked through the purchasing process, the stocking of the catheter, the sterilization procedures, and finally, implemented a process that ensures no one touches the catheter until the surgeon is ready to insert it into the patient. These improvements eradicated central sepsis at that hospital for more than five years. It was an amazing feat compared to industry standard. This completely redefines the concept of “expected complication” to “zero complications,” and unequivocally saved lives.

It’s a great thing when you can eliminate sepsis in central lines. But five years later, the multiple-hospital system still had a small number of hospitals using the technique. They had no means of assessing system-wide compliance with the Six Sigma process design, which at best was being implemented inconsistently. They simply have not organized left of bang. They admitted they lacked the ability to bring about system-wide change from what was learned at one hospital.

“We know how to prevent central line infections,” said one team member. “But without strong leadership, and the technology to implement the safety procedures system-wide, we find ourselves fixing the same problem every three years. We get serious about a problem, design a solution, and implement it. Then institutional inertia takes over. Two years later we are seeing adverse events, or worse, and ask ourselves ‘Where is that folder on the way we prevent catheter infections?’ It’s just not good enough.”

Getting hospitals to look for patterns in identifying adverse events, and working to identify them before they occur, keeps clinicians and staff in perpetual left of bang mode. But process improvement through Six Sigma isn’t going to enable this essential shift to a safety-first culture. Neither will the latest software or the best management training. It’s going to take all of these approaches – and more – for healthcare to truly see the results and outcomes that payers demand from providers.

Morning Headlines 10/4/17

October 3, 2017 Headlines No Comments

Argument analysis: An epic day for employers in arbitration case?

Epic’s Supreme Court case is split over whether employers should be able to force employees to sign arbitration clauses as a condition of employment.

Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data

A Health Affairs study of EHR interoperability data from broken down into the sub-domains of finding, sending, receiving, and integrating electronic patient information, concludes that at the end of 2015 only 29.7 percent of acute care hospitals are engaged in all four domains.

2017 HIMSS Congressional Asks

HIMSS asks Congress to elevate the role of HHS CISO to that of the CIO, expand telehealth services, and increase funding needed to implement the 21st Century Cures Act.

Announcing Cityblock: Bringing a new approach to urban health, one block at a time

Alphabet’s Sidewalk Labs unveils Cityblock Health, a neighborhood-level approach to improving care coordination for Medicaid beneficiaries through technology.

News 10/4/17

October 3, 2017 News 4 Comments

Top News

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The Supreme Court in it its first day of the new 2017 term hears opening arguments over companies that require employees to sign away their right to sue them over employment issues and force them into arbitration instead. Epic was one of three companies whose attorneys argued their positions Monday.

Liberal justices expressed concern that allowing such agreements rolls back employee rights by decades and discourages expensive individual employee lawsuits, while the court’s conservative members opined that mandatory arbitration clauses are legal and that employees can as a group hire the same attorney to reduce litigation cost.

The Obama White House had initially asked the Court to hear the case in support of the NLRA, but the new administration now sides with the employers as represented in the proceedings by its Deputy Solicitor General.

The main issue is whether arbitration agreements are legal under the Nation Labor Relations Act, which gives employees the right to take collection action. The attorney representing the companies argues that the NLRA guarantees the right of employees to have a forum convened, but once that has happened, employers can present defenses that include previously signed arbitration agreements, an argument to which one justice took exception in interpreting NLRA as covering all workplace issues.

A decision in favor of the employees would invalidate the employment agreements of up to 60 million Americans. Two courts have ruled that Epic’s arbitration clauses are illegal, while another ruled that they are legal.

The court will render its decision later in the term.


Reader Comments

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From Stella Overdrive: “Re: Allscripts. Black Book’s survey finds that 96 percent of McKesson Paragon customers are optimistic that Allscripts will improve their satisfaction, but it reads like an Allscripts commercial. Similar studies by Reaction and KLAS found high levels of skepticism among Paragon customers, with KLAS reporting that only 29 percent were favorable and Reaction saying that the acquisition would actually be a deterrent to attracting new customers. Do you know if Allscripts underwrote the Black Book study, and if so, was there appropriate disclosure? Seems like it might have been commissioned as damage control given negative market reaction to the acquisition.” A Black Book spokesperson says the company did not break from its strong stance against allowing vendors to participate or influence the survey  process – no company or payment was involved in the Paragon user survey. I read the more detailed survey notes and came up with these points:

  • The survey response rate was 23 percent, with 280 respondents representing 66 facilities. I don’t know how many hospitals are running Paragon to know if that’s a significant percentage of sites.
  • Black Book wisely focused on hospital decision-makers rather than end users.
  • The survey found that none of the respondents have developed new plans to replace Paragon, although that’s not surprising since the acquisition was announced only a few weeks ago.
  • The report says that 96 percent of boards are “confidently optimistic” (I would have expected “cautiously optimistic”) that Allscripts will do a better job than McKesson, which might not be a high bar to clear. There’s also the question of how knowledgeable board members would be on IT topics.
  • Two-thirds of the hospitals say they don’t have the money to replace Paragon in the next two years and will instead focus on revenue cycle management, population health management, and analytics. That’s probably the most important finding of the survey. 
  • Eight-one percent of IT leaders representing 58 facilities say they are receptive to the Allscripts takeover.

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From Gideon: “Re: Allscripts. Layoffs in the former McKesson’s professional services area on the day the merger was finalized – PMs, tech, and interface resources. The words used in the termination letter were, ‘’Unfortunately, the new organization structure doesn’t include your position.’” Unverified, but reported by several readers. Layoffs by either company are, unfortunately, hardly newsworthy, and certainly an acquiring company will nearly always – immediately or eventually – start trimming costs involving any assumed redundancy to help pay for the acquisition’s cost.

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From Givenchy: “Re: Athenahealth. Hospitals are retreating. Following the failed implementation at Jackson Medical (AL), about 20 hospitals are cancelling scheduled go-lives. At least three have returned to their previous systems after collection and cash flow issues and clinician dissatisfaction. Veterans Memorial Hospital (Waukon, IA), Kimball Health Services (Kimball, NE), and Appleton Municipal Hospital (Appleton, MN) have returned to CPSI owned-products.” Unverified. 

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From Publius Tullius: “Re: KLAS at Epic’s UGM. In the ‘photo is worth 1,000 words’ category, KLAS’s VP in wizard garb. I can’t think of worse optics for two organizations that are already intrinsically linked amidst concerns of bias. People in the industry joke that KLAS is Epic’s marketing arm and this doesn’t help.”

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From Corny Collins: “Re: NYC H+H. NYC tax dollars hard at work as officials played dress-up with Epic employees at UGM.” I disagree. Their attendance (I’ve blurred their ID since it felt creepy otherwise) is reasonable and taxpayer accountability doesn’t require frostiness with their vendor. I agree, however, that healthcare people attend a lot of questionable conferences and thereby increase patient costs questionably, although a vendor’s user group meeting when you are spending hundreds of million dollars to implement their product doesn’t spring to mind as an obvious excess. Those of us with health system experience struggle with appeasing valuable employees whose self-worth is defined by running around like a big shot at conferences of questionable ROI, but the employer has to set the parameters and assess the value they receive in return for the cost and out-of-office time. A better target is the HIMSS conference, where people who clearly have no good reason to attend dutifully pack the exhibit hall because they like the attention and networking and can convince their employer to foot the bill. Meanwhile, NYC H+C may need some wizardry as it says it’s down to 18 days of cash on hand.

From Journomaniac: “Re: HIStalk. You must have had partnership or acquisition interest that you haven’t mentioned but should in the interest of full disclosure since you criticize other sites.” Three health IT sites (that I recall – maybe there were more over the years that I’ve forgotten — have approached me unsolicited wanting me to partner with them, sell out to them, or go to work for them. All three said they would render HIStalk obsolete because of their superior technology, deeper corporate pockets, or more insightful approach, thus leaving me no choice but to throw in with them. I dismissed their inquiries quickly because I like working alone in a way I can be proud of. All three of those sites have folded up their health IT tents while I’m still here doing what I’ve been doing since 2003. That’s all I have to disclose. I’d rather quit than let someone else tell me what to do.

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From Abraxas: “Re: VistA. The Indian Health Service uses the VA’s product at no charge. With the VA’s move to Cerner, they haven’t been told whether they will continue to get free access and they have no budget for a replacement EMR. I wonder what will happen to other VistA users once Cerner replaces it in the VA?” I would expect VistA to become an orphan product now that the VA’s attention has been diverted to the Cerner shiny, no-bid object, leaving VistA’s other users without access to the VA’s expensive development. VistA is used by hospitals all over the world as a free public domain product, although some of those are supported by third-party companies like Medsphere and WorldVistA. I invite those with more knowledge about VistA than I have to weigh in on its future outside the VA. Above is part of a 2015 slide I found from the VistA Software Alliance listing VistA’s users.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor ChartLogic, a division of Medsphere. The Salt Lake City, UT-based company, founded in 1994, offers a complete ambulatory EHR solution (EHR, PM, RCM, ERX, patient portal). Providers can create a complete patient note in less than 90 seconds, supported by intelligent voice commands, specialty-specific content (vocabularies, templates, flowsheets, and macros) and a single-page layout. Its practice management system includes a preference-based appointment scheduler, eligibility checking, an automated Collection Center, and quick claims entry and one-click payment posting that reduces claims rejections to less than 5 percent. The company’s browser-agnostic patient portal offers appointment scheduling, mobile intake forms, SMS patient reminders, and online payments to improve patient engagement and experience. ChartLogic also offers services for billing, revenue cycle management, and managed IT and service desk. The Department of Defense recognized the company a few weeks ago for its support of the National Guard and Reserve, a program led by ChartLogic EVP and former Army Ranger Chris Langehaug. Thanks to ChartLogic for supporting HIStalk. 

I found this ChartLogic EHR overview on YouTube.


Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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First responder software vendor ESO Solutions acquires the Firehouse emergency management software business of Conduent Government Solutions.

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Kiio — whose platform screens for low back pain, joint replacement, and rehabilitation and offers exercise guidance — raises $1 million from Wisconsin-based not-for-profit insurer WEA Trust.


Sales

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Olmsted Medical Center (MN) chooses Epic to replace the former McKesson (I think they were on Series, but I’m not positive). UPDATE: readers say Olmsted was using Cerner CommunityWorks for inpatient, with which it has reached HIMSS EMRAM Stage 6, and McKesson for ambulatory despite undated information I saw mentioning that it was running McKesson Series and McKesson-acquired MED3OOO.


People

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Robert Barras (The Advisory Board Company) rejoins CTG as VP of healthcare sales.

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Seattle Children’s (WA) hires Zafar Chaudry, MD, MSC, MIS, MBA (Cambridge University Hospitals NHS Foundation Trust)  as SVP/CIO.

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Senior living community software vendor Caremerge (Merge Healthcare) hires Nancy Koenig as CEO. She replaces founder Asif Khan, who remains as board chair.

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Larry Wolf (Strategic Health Network) joins MatrixCare as chief transformation officer.

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MedeAnalytics hires Tyler Downs (TriZetto) as CTO.

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Julie Mann (Optum Analytics) joins Holon Solutions as SVP of sales.

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ViTel Net hires Richard Bakalar, MD (KPMG) as VP/chief strategy officer.


Announcements and Implementations

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A new Reaction report on telemedicine finds that physicians overwhelmingly support the use of telemedicine to replace the 20-30 percent of visits that don’t require physical examination. A surprising two-thirds of respondents either contract as a telemedicine provider or have considered such moonlighting. Hospitals are mostly using telemedicine for population management or follow-up care rather than for primary care visits as only 14 percent say such services have boosted their revenue. The biggest telemedicine platform vendor by far is “homegrown.”

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Sidewalk Labs, an urban innovation group within Google parent Alphabet, announces Cityblock, which will offer residents of low-income communities who are covered by Medicare or Medicaid a care team that provides doctors, coaches, technology tools, and a health plan. The service will launch next year.

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HIMSS Analytics adds the former CapSite vendor contracts database to its Logic platform, renaming it Logic Source.

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EClinicalWorks adds a self-service option for customers to connect with CommonWell and Carequality.

A Black Book survey finds that while hospitals and medical practices are increasing their IT outsourcing and like the prospect of increased efficiency at a lower cost, their satisfaction with outsourcing companies is decreasing. Most of that dissatisfaction involved IT managers who are forced to manage an inexperienced health IT outsourcing vendor. The top-scoring EHR vendors were Cerner, Meditech, and Allscripts.

A small Dimensional Insight hospital CIO/CMIO survey concludes that less than half of hospitals have implemented enterprise-wide data governance, causing problems with data integrity and access.

Infor launches Cloverleaf Consolidator for data aggregation and exchange in a multi-EHR environment.

JAMA will launch a broad-topic, open access journal in early 2018. 

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Fujitsu announces a new palm vein biometrics sensor for its PalmSecure F-Pro Suite authentication solution.


Government and Politics

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HIMSS asks Congress to:

  • Elevate the HHS chief information security officer role to be equivalent to its CIO and make that position responsible for creating a cybersecurity plan.
  • Pass the CONNECT act that would remove geographic restrictions for telemedicine.
  • Increase funding for rural healthcare broadband coverage discounts and adopt CDC electronic information flow for case reporting, lab reporting, disease surveillance, and death reporting.

Technology

A home care provider in Australia launches a “holographic doctor” in which physicians can participate in a home nurse consultation via mixed reality technology that uses Microsoft HoloLens. Both doctor and patient wear a virtual reality headset that allows them to see each other in real time along with the patient’s healthcare data.


Other

A Health Affairs article finds that hospital interoperability didn’t improve much from 2014 to 2015 as less than 20 percent of them reporting that they “often” use outside patient information to make clinical decisions.

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A hospital in Scotland cancels surgeries after going back to paper following flooding of its basement data center.

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Ohio National Guard Captain Michael Barnes develops a veteran suicide prevention program as part of his coursework at The Ohio State University to attain a master’s degree in nursing.


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  • Employees of The Chartis Group held a community service event at its annual retreat in New Orleans, supporting Boys Town, Covenant House, Raintree, Salvation Army, and YMCA.
  • A Spok case study describes the use of Care Connect by Union Hospital of Cecil County (MD) to reduce communication breakdown.
  • Casenet will exhibit at the Change Healthcare Inspire Conference in Philadelphia this week.
  • Ability Network is named a finalist in the Tekne Awards that recognizes technology innovation in Minnesota.
  • Nordic posts a podcast titled “How do I plan for a successful EHR go-live?”
  • AdvancedMD will exhibit at the American Society for Dermatologic Surgery October 5-8 in Chicago.
  • Aprima will exhibit at the American Osteopathic Association Conference & Exhibition October 7-9 in Philadelphia.
  • Datica publishes a new report, “Public and Private Cloud Computing within Healthcare.”
  • Besler Consulting will exhibit at AHIMA October 7-11 in Los Angeles.
  • Carevive and Crossings Healthcare Solutions will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.
  • CoverMyMeds will exhibit at the American Association of Medical Assistants Annual Conference October 6-9 in Cincinnati.
  • The Nashville Business Journal includes Cumberland Consulting Group on its Fast 50 list for the third consecutive year.

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Morning Headlines 10/3/17

October 2, 2017 Headlines No Comments

US Emergency Department Visits For Firearm-Related Injuries, 2006–14

Health Affairs publishes findings from an aptly-timed study conducted by researchers from Johns Hopkins University School of Medicine that aimed to quantify the clinical and financial burden of firearm-related injuries. Researchers concluded that in the US, firearm-related injuries claim 36,000 lives and account for a financial burden of approximately $2.8 billion, annually.

Iasis Healthcare’s sale closes, CEO Whitmer departs

Steward Health Care (MA) completes its $2 billion acquisition of 16-hospital Iasis Healthcare, expanding Steward’s network to include 36 hospitals spread across 10 states.

Three US scientists win Nobel Prize for uncovering inner workings of the biological clock

The 2017 Nobel Prize in medicine was awarded to Jeffrey Hall and Michael Rosbash, of Brandeis University, and Michael Young, of Rockefeller University, for their discoveries of the underpinnings of the circadian rhythms that help organisms adapt to our 24-hour days.

Authority of Health Care Providers To Practice Telehealth

The VA proposes a rule that would allow employed VA providers to offer telehealth services to veterans across state lines.

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Reader Comments

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