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HIStalk Interviews Ogechika Alozie, MD, CMIO, TTU Health Sciences Center-El Paso

March 9, 2015 Interviews 1 Comment

Ogechika Alozie, MD, MPH is CMIO at Texas Tech University Health Sciences Center in El Paso, TX.  

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Tell me about yourself and your work.

I’m chief medical informatics officer at Texas Tech University Health Sciences Center in El Paso. That’s a mouthful. We became an independent campus last year. We were part of the Texas Tech system, which includes Lubbock, El Paso, Amarillo, Odessa, and Dallas. We’re a separate entity legally. We’re doing a lot of separation things that happen when two organizations have been together for tens of years.

The biggest thing of interest for our environment is that El Paso is about 70 to 80 percent Hispanic and we’re also on the border. It creates some unique challenges in terms of language, socioeconomics, a lot of things that big cities have anyway, but they don’t have them in the magnitude that we probably have them. We’re a new medical school as well, so that creates some of unique challenges of financing. We’re just moving forward with the challenges of healthcare, academic healthcare, and academic education that a lot of other people are dealing with at the same time.

 

You’re probably the only informatics person I know whose background is infectious disease with an ID fellowship. Does that impact how you think about informatics?

I hope it that it changes it a little bit. I hope I think of things in a more of a public health manner.

How I got into ID and then informatics … I was born in Nigeria, but grew up in the Twin Cities. I went back to Nigeria to go to medical school. I did a lot of public health work while I was post-medical school in Nigeria. I realized that I had no idea what I was doing in terms of the skills of basic statistics and epidemiology. I came back to Minnesota, got my MPH from there, and then did residency and fellowship.

It was during residency that my mentor, Kevin Larsen, who’s at the ONC now … we started flipping to Epic. We were one of the first hospitals in the Twin Cities to go to Epic. That whole process of EMR and notes and things being digitized for me just seemed really cool. I hated writing, so for me, it was very selfish in that it was just easy.

I’ve taken that going forward as I think about things like HIV and hepatitis C, which are my clinical specialties. I hope that I think about things at a more population level. Instead of thinking about it as one patient at a time, every encounter is important. When I talk to our president and CFO and CIO, I try to look at, how is this going to affect the organization as a whole? Not only the organization — how’s it going to affect the El Paso population as a whole?

I’ve sometimes said that public health in a sense mirrors in a way some of the thinking in clinical informatics. You have to think about populations and how it will change the effect of a population. Payment is always important to whether you’re thinking of public health or informatics. I think I’m cognizant of the fact that the public health background and the infectious disease background lets me think about that a little bit better.

 

We’ve always exported our public health expertise to other countries while here we just cranked out encounters. Is public health thinking now essential for practicing physicians?

I’m not sure it is necessarily essential to be a practicing physician. A lot of providers across the country, especially in Texas, do not look at healthcare IT as a good thing. They don’t look at it in an improvement in care. No matter how much information you give them about reduction in drug-drug interactions, drug-allergy interactions, cost, or sending a patient off to get five x-rays in under a week just because a couple of providers were too lazy to go get the chart from their next door neighbor …  think that’s kind of crazy. But I do think that as Meaningful Use and PQRS and a host of other quality measures start to actually measure bits and pieces of what we do as providers or as health systems, it starts to build a case whereby doctors for the first time have to look at, "Oh, wow, this is how I’m doing on a global scale."

As part of my job, we have private practices that we either own or help them or do technical assistance with. It’s always amazing to me when you put just the PQRS numbers in front of a provider and they say, "I do excellent diabetes care" … we can argue about whether A1C is a process or outcome, but the fact is this: it’s what we use for parts of diagnosis and parts of monitoring, so if you haven’t ordered one in three years and you say you’re a great diabetes manager, I’m not really sure what you’re looking at. If you haven’t done a foot exam or an eye exam or any of those basic things that are outcomes of having long-term, uncontrolled diabetes, it’s really hard to make that case.

When I put it in front of some providers who are private practice guys, one or two docs who probably have four or five thousand patients, it’s always amazing to see the shock on their faces. For the first time, public health has intersected with their lives in terms of their practice and what they have to do to change their process to hopefully give their patients better care.

 

What systems have you worked and what do you think of the technology that’s available?

For Nigeria, I worked with a pen-and-paper technology [laughs] It was what it was. When I was at Hennepin County Medical Center in Minneapolis, we initially had a homegrown system. When I was an intern, we switched over to Epic, so we were the first residency in the Twin Cities to have Epic. By the time I became a fellow at the University of Minnesota, it was switching over to Epic. As a fellow, you know how it is — you go from the university hospital to a private hospital to the VA. I used CPRS at the VA. We had Allscripts at that point in time at the University of Minnesota. We eventually switched over to Epic.

When I came to El Paso, our county hospital, University Medical Center, uses Cerner on the inpatient side and NextGen on the outpatient side. We used CPRS for about a year and now we’re on GE on the ambulatory side. In my private practice, I have Athena, so [laughs] seven or eight different EMRs. 

At one time right now, I have to understand at least four of them, which is as you can imagine, kind of a pain after a while. One of my biggest pushes to our president and our CFO is that we really need to be on one platform — to improve our interoperability, to improve the efficiency of training, a host of other things that I think it will bring to us. That’s one of the biggest pushes that we’re having right now.

 

Having seen those systems and thinking about population health aspects, are those systems going to be appropriate for where the payment model is shifting?

My personal take on it right now is that none of them are adequate to really do what we need to do. If we’re going to leverage data to change the way we treat patients and bend the cost curve, I don’t think Epic or Cerner or anybody on their own has the ability to do that. They’re getting into that space after the whole MU debacle and trying to get certified, but I just don’t think they have the tools right now.

There are a lot of other organizations or vendors out there that probably do it a little better. At some point in time, the big players are just going to have to collaborate or cooperate with some of the other smaller population health vendors that are out there to make it a better system because I don’t think any of them owns enough pieces right now to make it work from one end of the spectrum to the other.

 

What are the key projects you’re working on?

We have a pretty amazing lady who works on medical education cartoons, which you’ll say, "OK, so?" But especially for us in our region, where English is not a first language or even a language of a large percentage of our patients or clients that come into our system, it’s important that we give them ways to understand what’s going on in the healthcare system, whether it’s by pictorials that explain that one to two tablets Q4 hours is not necessarily one tablet or two tablets, you make the decision.

We as providers take a lot of things for granted. We write all these prescriptions and we never really explain it to the patient because that’s not our thing. We just send the patient off to the pharmacy, and if the line at the pharmacy is 30 people deep, it never gets explained. That’s one of the things we’re trying to put on our portal right now — some of that pictorial education and cartoons and some animations that will help patients understand their medical issues and some of their medications.

We’re in the process of aligning ourselves with Tenet Healthcare out of Dallas. They have three hospitals here in El Paso. We’re in the process of aligning ourselves with them to create a clinically integrated network. We’re just starting to look at how our data exists in each hospital and how we can create a data warehouse and start to look at our payment data and our patient data and outcomes data, things like that. For us, it’s staffing. We use a lot of that information to determine how many doctors we need in a certain specialty or a certain space over the next two to three to four years.

On the education side, we’re probably behind the curve a little bit in what some of the other places have done, but we’ve just started using secure messaging with Imprivata Cortext. The residents are really excited about that. It was interesting to me how much we pushback we had from some of the more mature physicians in the organization regarding secure texting. But the people that were doing most of the patient care and the visiting in the hospital — if you look at counts of who puts in the labs and the orders and the images — it’s all the residents. If you talk to them, they were all excited about it. That basic information of a simple count of who’s actually doing work within the EMR to justify finally to security and compliance that we really needed the secure texting process. We’re about to go live with that in our PCMH.

Those are some of the big things that we’re looking at. You know how it is. It feels like there’s always a million things going on at the same time and you’re just trying to keep abreast of them so that you don’t drown. But then you have some of the fun projects. The secure text messaging project is really cool. I’m excited about that.

We have an external referral management process that we built in-house. It’s a web-based tool that our clinics use to track referrals, see who it’s going to, and send transition of cares, so we’re excited about that, too. Those are the main things we’re working on right now.

 

You’ve done quite a bit of work with HIV. Are you finding ways that technology can help improve the lives of people with HIV?

Yes. One of the things that I really enjoy about being CMIO and also in practice is that I was able to get some advanced toys or to move things along quicker in my clinic. It’s kind of sad, but because politically it was a marginalized population and I had really young patients … the average age of the patient in my HIV clinic was about 24 to 26, so that’s the range. They just allowed a lot of things to happen. If you look at my HIV clinic for example, about 70-80 percent of them were already on the portal. That’s probably the highest adoption rate throughout the organization.

For me, it’s fun to be able to get — I call them my kids — my kids on the portal and have those conversations back and forth. I have two full-time case managers whose job is just to respond on the portal and get people information and access and a whole bunch of other things. We set up a system with Google Voice about two or three years ago where we were sending text messages to our patients — this was before we had the portal — that gave them reminders 72 and 24 hours before an appointment and allowed them to respond to the Google Voice message as an anonymous text from them if they weren’t going to make it. We saw our no-show rates drop from almost 40 percent to about 20 percent, which is about 50 percent improvement, so that was kind of cool to us, too.

We do Google Hangouts once in a while. I haven’t done any this year, but once a quarter we would just send out a Hangout link to people on the portal and say, "Hey, free-for-all, come online, either myself or the case manager, the pharmacist, will be online for 30 minutes to an hour and we’ll answer any of your questions." Unrestricted, talk about sex, drugs … marijuana is always the biggest question clients have, not surprisingly. We would just go at it like that, which was fun.

I also do hepatitis C and a lot of my patients are co-infected, so just getting that education out to them on the portal or using our text messaging system for me has just been really cool. You have clients come back maybe a month or two later and they say, "Hey, I read this on the portal,” or, “Thanks for sending me the reminder about my appointment. I wasn’t able to make it because I was in Las Cruces or Juarez or whatever, so I responded and rescheduled it." Just a lot of missed opportunities that we would have had before that I hope we’re reducing with some of those … I call them the little technology pieces, but they seem to have a big effect on our clients.

 

Do you have any final thoughts?

It’s just exciting work. I enjoy being at that intersection between public health and ID and health informatics. It’s really exciting for me, looking at work I’ve done in TB and some other stuff globally, to start to think that now we can start to measure what our providers are doing. And hopefully what our patients are doing as we talk about the bring your own device, not just from a tablet standpoint, but from a consumer trackables standpoint, be it a Fitbit or a Jawbone, I’m beginning to get clients asking me, "I have this thing, what should I do with this data?" We don’t have anywhere to ingest it yet, so we’re starting to think about that.

Even though there’s a lot of angst in the overall healthcare community about where health IT is right now, I do think that we’re going in what is sort of the right direction. We’ll probably have to branch off as time goes on, but eventually that will get us to a place where we’ll have a better idea, or at least better transparency about what our healthcare really is.

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March 9, 2015 Interviews 1 Comment

Morning Headlines 3/9/15

March 8, 2015 Headlines No Comments

St. Mary’s: Patient information compromised in Email hack

St. Mary’s Medical Center (IN) is informing 4,400 patients that their personal information was compromised when hackers gained access employee email accounts in January. The exposed information included names, date of birth, gender, date of service, insurance information, health information, and Social Security numbers.

Clayton County’s Southern Regional Medical Center Lays Out Long-Term Plans For Hospital’s Financial Success

Southern Regional Medical Center (GA) lays off 80 employees after implementing a productivity benchmarking system that shows how other hospitals around the nation of a comparable size and case mix are staffing their own departments.

On the Case at Mount Sinai, It’s Dr. Data

The New York Times profiles Jeffrey Hammerbacher, a 32-year old Harvard trained data analytics expert that started out in finance before moving to Facebook to build their data analytics team, and is now a professor at the Icahn School of Medicine at Mount Sinai working with computational biologists to apply data analytics in medicine.

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March 8, 2015 Headlines No Comments

Monday Morning Update 3/9/15

March 8, 2015 News 5 Comments

Top News

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St. Mary’s Medical Center (IN) notifies 4,400 patients that their information was exposed during a January phishing attack. It’s yet another example of securing the cyber-perimeter only to have it blown wide open by unwitting employees duped by fake “click here” emails.


Reader Comments

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From EpicAlready Won: “Re: DoD. Did they really just say they expect to have their EHR — the contract for which hasn’t even officially been awarded — up and running by EOY 2015? Do they have any idea what they are getting into? What does this imply in terms of the likely winner?” DoD says it hopes to have the infrastructure in place by December 31, 2015 for a Pacific Northwest test site.

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From Oh Nant: “Re: NantHealth. Bob Watson lives up this his reputation by firing the entire sales team at NantHealth. All sales will be done through Allscripts.” Unverified, but the companies signed a partnership agreement last week.


HIStalk Announcements and Requests

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One-third of poll respondents say provider CIOs are always more believable than vendor VPs, although some added clarifying comments suggesting that they would have voted yes had the word “never” been replaced with “most often.” Anonymouse elaborates that both provider and vendor executives put the best possible spin on their organizations, while HIS Junkie opines that “you can’t tell a CIO from a vendor without a score card.” New poll to your right or here: do you feel welcome and appreciated when you make contact with your preferred hospital by calling, emailing, or driving to their facility? Vote and add your comments because I’m sure you have some great stories that add color to your Boolean response.

I haven’t sent out HIStalkapalooza invitations yet, so there’s no need to email me to inquire (and thus no need for me to respond, which is my real motivation in saying so). I will probably get them emailed out in a week or so, plus having learned from years past that emails don’t always get through spam filters, I’ll post an encoded list — like the upgrade list at the airport with some combination of name letters — so you’ll know you’re invited.

I’m about to close down registration for our sponsor-only networking reception that will be held Sunday, April 12. Those who sign up (and show up) will mingle with their normally competitive peers, eat and drink at my expense, and enjoy a low-pressure evening in which nobody is either selling or buying anything. I suppose those who don’t have will chosen an equally invigorating alternative. Contact Lorre.

Listening: Denmark-based Volbeat, whose hard rock music lies somewhere in the continuum between Metallica and Johnny Cash but still sounds fresh.


Last Week’s Most Interesting News

  • A group of five Republican senators says HITECH hasn’t provided taxpayer return on investment, EHRs aren’t useful to physicians, and ONC’s interoperability roadmap is too vague to guide EHR vendors.
  • Five healthcare IT vendor founders make the Forbes list of billionaires.
  • The AMA says CMS should release more ICD-10 testing details and develop a contingency plan for the upcoming switchover.
  • Truven Health Analytics is rumored to be planning a $3 billion IPO.
  • A Wall Street Journal article questions the appropriateness of drug company-paid alerts and reminders sent to patients whose doctors use Practice Fusion’s free EHR.
  • Allscripts says in its earnings call that it is disappointed in 2014 revenue and it should not have allowed overly optimistic Wall Street expectations to go unchallenged.
  • A reporter’s posthumous editorial urges that every willing cancer patient’s information be loaded to a database that both patients and doctors can access as a one-person clinical trial.

Webinars

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.

Here is the recording of Zynx Health’s recent webinar, “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions


Acquisitions, Funding, Business, and Stock

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Golub Capital provides a $250 million senior credit facility to support Netsmart’s recapitalization by its owner, private equity firm Genstar Capital.

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Lenovo will launch a healthcare division (for the second time in four years) on April 1, probably hoping that cybersecurity-sensitive providers will forget about its recent Superfish preinstalled spyware debacle. The company’s 2011 healthcare push tanked quickly and probably could have been easily predicted given its self-stated motivation in reviewing the healthcare market: “I know we want a piece of that, I know our partners want a piece of that, and we want to go get it with them together.” There’s not a whole lot they can do except take a few off-the-shelf products that seem interesting for healthcare users, market them separately, and train partners to sell them.

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Apple will live stream the announcement of its Apple Watch today (Monday) at 1:00 p.m. Eastern, although Apple says the video will work only on specific Apple hardware and software combinations. Several Internet wags remarked that they lost an hour Sunday morning due to the DST time change and then will lose another three staring at Tim Cook and company on their screens.


Sales

Baltimore-based Emocha Mobile Health signs a one-year, $65,000 contract with Harris County, TX to monitor medication adherence in TB patients by having them record themselves taking their prescriptions and sending the smartphone video to their doctors via the company’s app (maybe nobody ever looks at it, but the fact they might could make patients more diligent, I guess). The seven-employee company, which licenses technology from Johns Hopkins, is trying to raise $1.8 million in seed funding. None of the folks involved have any apparent healthcare experience.

Depression solutions vendor SunSprite chooses Validic to collect information from its bright light exposure tools.


Announcements and Implementations

SRS will offer its users SurgiMate surgery scheduling software.

340B pharmacy platform vendor Sentry Data Systems partners with Avella Specialty Pharmacy.

Agfa Healthcare launches a patient and physician portal to display images from its system, which should be wonderful news to those patients and physicians who love logging on to separate portals for each system a hospital uses.


Government and Politics

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The Illinois HIE, having blown through $19 million in HITECH money in four years and still running at a loss, doesn’t have funds allocated in the proposed state budget that will take effect July 1.

The Washington Post profiles telemedicine and other technology services offered to veterans through charity groups and the VA itself.


Technology

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The New York Times profiles 32-year-old Jeffrey Hammerbacher, a Mount Sinai medical school data analyst and assistant professor who previously made fortunes working as an equities analyst, creating Facebook’s data team, and founding multi-billion dollar company Cloudera. He’s married to Rock Health co-founder Halle Tecco. His Mount Sinai team is applying data science to chronic disease for the development of personalized medicine. When at Facebook, he famously said not long before he quit knowing he was leaving IPO money on the table, “The best minds of my generation are thinking about how to make people click ads. That sucks.”


Other

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LA County’s Department of Health Services is using clinical decision support software developed by Chief Research and Innovation Officer Jeffrey Guterman, MD that applies clinical rules to encounter data to manage chronic diseases. He’s modest about his work: “It’s pretty sophisticated for healthcare, but it’s pedestrian for any other industry … As a large governmental bureaucratic organization. I think people are happy to say, ‘The providers look happier, the patients look happier, no one is complaining, this is a great change.’”

Ed Marx is writing a book called “Voices of Innovation” and invites readers to contact him about being part of it.

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Medical school dean Art Kellermann, MD tweeted out this graphic created by Daniella Meeker, PhD of Rand Corporation.

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Struggling Southern Regional Medical Center (GA) lays off a bunch of employees after realizing from benchmarking software reports that it was overstaffed. I always have the same question after reading stories like this: was management too stupid to notice lack of productivity until they found out that similar hospitals have fewer employees? We might as well have just one national hospital since none of them can take any action without seeing what the others are doing, with that lack of competence and/or confidence fueling an entire industry of conferences, software, and consulting services.

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Unrelated, but bizarre enough to worth mentioning since it made me laugh out loud even if I did feel guilty afterward. A judge dismisses a lawsuit against Applebee’s in which a patron claimed the restaurant’s waitress should have warned him that his platter of sizzling fajitas was hot. The waitress sat the fajitas down, at which time Hiram Jimenez decided to take his brother’s hand and bow to say grace, causing his face to get splattered with hot grease. It just got worse: the man claims he pushed the platter away as a reaction but instead it ended up in his lap, which caused him to injure his arm. His attorney, Dick Weiner, is unhappy that the judge ruled that it shouldn’t have been necessary for the waitress to warn anybody that a furiously sputtering skillet full of meat might be hot. The man was fine, with no scarring, permanent injury, or financial windfall.


Sponsor Updates

  • The SSI Group will exhibit at the VA/DC 2015 Spring Education Conference March 11-13 in Richmond, VA.
  • TeleTracking offers insight into how RTLS is enabling high-visibility health.
  • T-System’s blog focuses on “Nurse Debate: Communication Silos.”
  • Verisk Health will exhibit at the 15th annual Employee Healthcare Conference – East March 12-13 in New York City.
  • Truven Health Analytics releases its annual study identifying the 100 top U.S. hospitals based on their overall organizational performance.
  • Vital Images will exhibit at the ACC 15 Annual Scientific Session & Expo March 14-16 in San Diego.
  • Voalte discusses the challenges healthcare facilities face when moving to a new facility.
  • The Chicago Sun-Times features Huron Consulting Group’s Arshia Wajid and her work as founder and president of the nonprofit American Muslim Health Professionals group.
  • ZeOmega offers the second part in its blog series on defining population health management.
  • The latest ZirMed blog offers “Fresh Insight into Predictive Analytics … and Renewed Focus on ICD-10 Contingency Planning.”
  • The Daily Practice blog from Navicure asks, “The Times They Are a Changin’ … So How Do You Get Ready for Value-Based Modifier Payment Models?”
  • NTT Data offers a blog on “The Counter Effect of Mobile and How to Avoid It.”
  • Patientco posts “Beat Patient Debt, One Payment at a Time.”
  • The latest MedData blog advises, “Don’t limp towards the ICD-10 finish line. Finish strong.”
  • ScImage releases updated echo reporting based on new ASE 2015 quantification standards.
  • PatientSafe Solutions discusses the case of the frustrated phlebotomist in the second part of its quality care and mobility blog series.
  • The PMD “Charge Capture” blog discusses “Increasing Team Productivity with Paired Programming.”
  • Orion Health offers insight on “Integrating Device Data with EMR for Better, Safer Care – A Case Study.”
  • Perceptive Software lists “Four Reasons You Need an Enterprise Capture Strategy.”
  • Nordic launches a video on its successful affiliate extension project with ThedaCare.
  • Passport Health will exhibit at AAHAM South Florida March 11-13 in Cocoa Beach.
  • The latest nVoq blog covers speech-recognition solutions for mobile physicians.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 8, 2015 News 5 Comments

Startup CEOs and Investors: Michael Burke

Working with Startups: Assessing Viability
By Michael Burke

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In a previous article about accelerators and incubators, I made an argument for why it can be advantageous for purchasers of healthcare IT solutions to strike up vendor relationships with emerging startups. A drawback, however, is that more startups fail than survive.  

In this article, we’ll take a closer look at the prospect of long-term viability for startups. To make it mildly entertaining (and to pay homage to Mr. H’s eclectic musical interests), we’ll compare it to a band trying to make it big in the music business.

What Are The Odds?

The stats related to long-term viability for a startup are not great. The rule of thumb popularized by the National Venture Capital Association is that 25 to 30 percent of venture-backed businesses fail.

However, this stat may be misleading and a little self-serving. Research from Shikhar Ghosh of HBS says that 75 percent of venture-funded enterprises never return cash to their investors, while 30 to 40 percent of them liquidate assets such that investors lose all their money.

The stats for a band trying to make it big are similarly grim. In 2009, only 2.1 percent of the albums released sold more than 5,000 copies. Of the lucky few bands that sold 5,000 or more albums, most didn’t make any money. The reasons most bands don’t make money are oddly similar to the reasons most venture-funded startups fail.  

Winning the Lottery

When a band signs a deal with a major label, they feel like they won the lottery and that their success is guaranteed. They often get a big advance. However, they use a lot of that advance for recording the album and paying professional fees to lawyers and managers.  

When the record is released, they may get lucky and sell a bunch of albums, but there are huge “recoupable” costs for video production, tour support, radio promotion, and other odds and ends. Even after selling a million records, they could still end up owing the label money.

When a startup signs a deal with a venture capital company, they feel like they, too won the lottery and that their success is guaranteed. They get a big cash injection (think “advance”). However, the cash doesn’t go in the shareholders’ pockets — it is used to fund and grow the business (just like a band uses the record company money for recording, promoting, and touring).

If the company gets lucky and folks start buying their product, things are looking good for the founders, right? Maybe. Maybe not.

When the startup signed the deal with the VC, it probably included a number of terms that are immensely preferential to the VC.  The deal probably included terms that allowed the VC to exert considerable influence (if not outright control) over key decisions. The deal probably included  “participating preferred” shares that allow the VC to recoup all their money (sometimes several times their original contribution) before the founders get a dime.  

This means that in order for the founders to earn any money, they have to be able to sell the company for quite a bit more than they may have originally expected just to pay the “recoupable costs” (like in our band example). They are clearly motivated to swing for the fences. Because they gave up control, they can’t choose to focus on organic growth or on operating a great business. Instead, they have to go for the grand slam exit strategy.

For better or worse, raising venture capital moves the goal line for an exit, both in terms of time and value. It changes the responsibilities and objectives of an operator / founder. They must grow bigger and faster, with everything that approach includes. This may require a completely different skill set than the existing team can offer.

If you are a music fan, you may have heard of a number of bands going a different route lately. Instead of working with a major label, they release records on their own or work with a smaller label. They may not gross as much, but they’re far more likely to have a higher net. Possibly more importantly, they get to control their own destiny. Similarly, a startup may choose to bootstrap the endeavor on their own or they might take smaller investments from friends, family, or angel investors. This is the path we’ve taken with Clockwise.MD.

Either path is valid. It really depends on the goals and the circumstances.  

What Really Matters for Customers

Based on what we’ve learned about the risks of working with a startup, what should purchasers of health IT do? That depends.

A health system that has its own early stage fund ostensibly knows the risks and probably doesn’t expect all of its portfolio companies to succeed. Even without a captive fund, most health systems can control the environment to some degree by leveraging their network to boost the success of the startup through referrals. The basic goal should be to avoid the 30 to 40 percent of startups that end up liquidating assets.

If they’re simply trying to solve a problem with technology and are considering a startup’s offering as a possible solution, they can mitigate risk through some simple reflection and investigation:

  • Do they want to influence or control the feature set of the product? If so, they should jump in early. Companies often work hardest to serve their early adopters. Those adopters can have great influence in product development and pricing, which can serve everyone well over the long term.
  • Does the startup have traction? Has it achieved critical mass in the marketplace? Sometimes a startup has a compelling solution but lacks market traction or reference sites to get the customer comfortable with investing time and money. In this case, vendors can enter into a beta agreement to gain the opportunity to prove their value. This can de-risk the relationship.
  • How is the startup funded? What does its financial picture look like? Don’t be afraid to ask. Venture capital support certainly may not hurt a startup’s viability, but it should not be a requirement.
  • Talk with current customers to get an idea of how well the solution works and the level of support and flexibility at the company. For vendors, reference sites are worth their weight in gold.

Working with a startup doesn’t have to be a nail-biting adventure. It largely depends on understanding clearly what you hope to accomplish and doing your due diligence.

I’ll close with a quote from Mark Zuckerberg, founder of Facebook:

"The biggest risk is not taking any risk. In a world that’s changing really quickly, the only strategy that is guaranteed to fail is not taking risks."

Michael Burke is an Atlanta-based healthcare technology entrepreneur. He previously founded Dialog Medical and formed Lightshed Health (which offers Clockwise.MD) in September 2012.

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March 6, 2015 Startup CEOs and Investors 1 Comment

HIStalk Interviews Bob Dudzinski, EVP, West Corporation

March 6, 2015 Interviews 1 Comment

Robert Dudzinski is EVP of the healthcare practice of West Corporation of Omaha, NE.

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Tell me about yourself and the company.

I came to West via an acquisition. I was a CEO and founder of a company that it acquired about five years ago.

I’m a pharmacist by background with a doctorate. I owned, operated, and sold a prescription benefit management company and a mail-order pharmacy. I kept out of healthcare for a little bit and opened up a chain of baseball and softball stores. I had a great time with that. I got back into healthcare and started a company called SPN, Specialty Pharmacy Network, in 2004. That ultimately became an acquisition of West in 2010.

West is a publicly-traded, technology-driven communication company. We participate in about every industry — retail, finance, banking, and certainly healthcare. We’re about $2.2 billion, about 15,000 employees, and we have a full plethora of communication assets. We take a vertical approach, moving from products and services to value-added solutions in the healthcare space.

 

Providers for years have gotten away with hiding behind phone trees and doing anything to avoid putting a human on the line. Does that need to change?

Absolutely. The rallying cry in the market today is patient engagement and activation. To your point, that’s never been a primary initiative for provider systems. Today that’s very different. It ultimately ties back to reimbursement and now there’s a great emphasis going on in that area.

 

Now that providers are expected to manage populations, they have to reach out to patients instead of just waiting for them to call or show up. How can technology help?

There’s all kinds of initiatives that are going on today in trying to do outreach at scale and capacity. That’s been the big challenge for health systems and those are the solutions that they’re looking for. In other words, as providers have moved to managing larger populations, the challenge is, how I’m going to touch those people effectively? How am I going to personalize it? How am I going to change a behavior and improve an outcome? Technology can provide some of that success in doing that if it’s purposed correctly and there’s a good strategy and plan behind it.

 

Everybody has their own preferred way of being communicated with – text message, email, or phone call. How does a provider choose the best medium for each person?

The provider needs to start with an overarching strategy of how they’re going to approach engagement and activation. We here at West always gravitate to the notion of a unified communicate environment where you are providing preference and choice to that patient. When you do that, you provide contextual awareness amongst those channels and you have a sophistication around content that’s being delivered. Is it relevant? Is it non-redundant? All of those things start to roll up and start to create what we would call an enhanced experience. That’s what the provider is actually looking for.

 

Providers haven’t had much incentive to getting on the phone or email with patients because nobody was paying them to do so. Are you seeing the demand change now that there is reimbursement for keeping contact with patients and not just having them drive to the office?

Yes. Most certainly as payer organizations look to value-based pricing — we’ve heard that term ad nauseum in the marketplace today — it’s going to be a challenge and edict for the providers to reach not just the chronic patient, but those that have yet to become chronic patients. Having a strategy of addressing that population in totality is going to be an imperative for providers. No longer will they just simply have to be reactive. They’re going to need to be proactive in their approach.

 

I wrote about the free nurse hotline in New Mexico that is keeping thousands of people out of the ED. Is it hard for hospitals to think about being paid to keep people out of their facility?

They have to have a whole new mindset approaching population health and what it means to implement the Affordable Care Act. In your example the nurse line, we have a nurse on the line doing outreach or at least trying to promote a call prior to an ED visit. That’s a great also application for technology.

We have programs here written against our IVR systems that do a couple of things. They do a reminder on a Friday to make sure that the patient’s got their meds filled so that they’re not going to the emergency room because of a need for a refill. Number two, technology that could actually nudge the patient and remind the patient that if they have floss stuck in their teeth, that’s not an appropriate ED visit — they should be reaching back to the care coordinator or to the case manager. 

Technology could play a role in facilitating, as you’ve described, that nurse line. We can do that at scale and capacity, that constant nudge and connection with the patient, allowing them to know there are alternatives to some of the thinking that they have today.

 

If a hospital calls you wondering what they should do both short and longer term to get more engaged with their patients, what do you recommend?

Historically, providers haven’t had a need to engage the patient and what’s expected of them today. Because of the complexity of health systems and hospital systems, we’ve put an assessment process together. It’s very simple. This usually is our first recommendation. It’s a way to give them clarity as to where they’re heading, the assets they have, what is possible, and a road map to that end.

That strategy has worked well for us. No commitment. It’s just a matter of allowing them to see outside of healthcare what organizations have done to achieve either a world-class call center persona or an understanding of the communication technology that could play a role in their discrete objectives.

 

As a pharmacist, are you impressed with what Walgreens and CVS are doing to engage with their customers using technology?

Absolutely. Pharmacy has always had a need to engage the patient. Pharmacy by its very nature sees the patient more often, and they also have to do it not only from a healthcare perspective, but from a retail perspective. 

Pharmacy and the strategies that the pharmacies are promoting today are great models for other provider systems to look at and engage against. I like what pharmacy is doing and I think we’ll see more of that from pharmacy on a go-forward basis.

 

We talked about the barricades providers seem to have put up to prevent people from reaching out to them. You could argue that hospitals do that physically as well, where parking is inconvenient and departments are hard to find. Could non-physical patient interaction allow them to work around the huge disadvantage of being located on campuses that are consumer-unfriendly?

We hear that consistently across the country as we’re out there with our offerings. The mere fact of trying to navigate the ever-changing environment of a health system has been a challenge for patients. To be honest, it’s also been a challenge for the patient to call into a health system and intelligently get navigated to where they need to be.

We did a roundtable with a group of patients at a health system. One of the comments that came from the patient was, "I would rather walk to this institution than call it." That was an indictment of the fact that there is a real immaturity around how best engage patients and the importance of that engagement. 

The mindset needs to change in the provider market and I think it is. They are shifting to a very different approach. We see it also even in how they present themselves and how they organize themselves. Now we have VPs of engagement. We have VPs of consumerism. We have VPs of population health that now are charged with creating an experience and recognizing all of the touch points that a patient could have. Then obviously the need to translate that into how that will either generate revenue or reduce costs.

 

Do you have any final thoughts?

It’s a great time to be in healthcare. The provider community has never played a more important role and I don’t think they’ve ever taken on more responsibility. The need to address consumerism, the need to think through engagement and activation strategies, the notion of gravitating to unified communication environment s going to be critical for success and not only in the provider systems. Any healthcare organization that’s looking to manage a population needs to be thinking in those terms.

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March 6, 2015 Interviews 1 Comment

Morning Headlines 3/6/15

March 5, 2015 Headlines 1 Comment

Where Is HITECH’s $35 Billion Dollar Investment Going?

Five Republican senators co-author a Health Affairs piece questioning what value EHRs and the governments $35 billion HITECH investment have returned to taxpayers.

Anthem Refuses Full IT Security Audit

Anthem has been refusing to let the Office of Personnel Management’s inspector general perform "standard vulnerability scans and configuration compliance tests" since 2013, before the recent cyber attack on its network that compromised 80 million medical records. The insurer still won’t allow the IG’s office to conduct its tests, citing a corporate policy that bars outside agencies from accessing its network.

FDA launches drug shortages mobile app

The FDA has launched a mobile app, its first, that identifies current drug shortages, resolved shortages, and recent discontinuations. It is available for both iOS and Android devices.

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March 5, 2015 Headlines 1 Comment

EPtalk by Dr. Jayne 3/5/15

March 5, 2015 Dr. Jayne 1 Comment

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As a CMIO, I’ve spent most of my time working for hospitals and health systems. The bulk of my experience has been in with face-to-face using a “train the trainer” model. Our in-house trainers learned from the vendor’s trainers; our trainers in turn deliver the training curriculum to end users.

As healthcare has evolved, many organizations have wanted to get away from traditional classroom training, whether due to facility, logistic, or cost issues. Having users participate in at least some kind of online or self-directed learning prior to in-person training is highly desirable.

We created this kind of training at my organization last year and it’s been fairly successful. I haven’t really been able to judge it as objectively as I’d like, however, because I already have a deep knowledge of our system and had been previously trained in the old methodology. I’m glad that my employer allows me to moonlight at other facilities.

I mentioned last month that I was going to start at a new site. Since I’m clearly a health IT geek at heart, I was actually excited to receive the email today with my password to their learning management system.

It’s clearly a vendor-driven system – my new employer didn’t go out and code this on its own. It’s branded with the vendor name and the graphics are fresh and inviting. Maybe I was looking for a reason to procrastinate, but it made me want to put aside the HL-7 specs I was reading and dive right into training. I think I was most excited about experiencing what online training might be like in a situation where I wasn’t involved with designing or maintaining it.

The system was ridiculously easy to navigate, with both a traditional navigation bar and a more graphical representation. That made me smile since I spent a lot of time arguing with some of our developers about the need for “old school” navigation when we configured our system. People have different learning styles – some are abstract thinkers and others concrete – and often seem to do better with one approach over the other. I’m more of a traditional girl, so I dove right in with the top-down navigation.

The introduction was handled with a video presentation. What struck me first was that it had background music. I haven’t seen that much in the training content I’ve used previously, but it was somewhat spa-like and unobtrusive, so I decided I liked it, although it kind of made me want to get up and light some scented candles to match the mood. Once I completed the introduction, it released me to view the courses in which I had been enrolled.

Many organizations assume providers don’t care about the practice management aspects of the system, so I was excited to see that I had been enrolled for training on the billing system as well as the clinical system. Knowing my background, they may want to revoke my enrollment in the EHR Configuration section but I am looking forward to seeing how things work with a new and different vendor.

Once I moved into the provider training, I was glad to see that it had option for both video/spoken content as well as turning off the audio and just reading. Putting myself in a typical physician’s shoes, I found it to be a little heavy on the technical jargon as it discussed virtualization and thin-client delivery. I don’t know that I need to be told that 100 million users have experienced “the promise of proven application compatibility” that is Citrix XenApp, but you can bet I’m going to use that factoid in our next office trivia contest.

I’ve spent most of my career using enterprise-class EHRs that attempt to support every specialty under the sun. This is the first time I’ve used a specialty-specific EHR. I have to admit it’s significantly different than my past experiences.

There were other exciting non-specialty features as well. In contrast to the system in place at our hospital, patients can pre-register and check in online. Instead of jumping right to the physician part, the module then walked me through the basics flow of a visit, including what the front desk staff would see and do. Not at the level where I could perform the tasks, but just to give me an idea of the features. I often think that physicians would be more forgiving of a lengthy check-in process if they understood what really went on in the front office.

This will also be the first time I’ve used an EHR that is optimized to run on an iPad. Although it looks cool, it was kind of jarring to keep looking at a screen in portrait layout rather than the landscape layout we’re all so used to. As I went through the initial training session, I saw a couple of things that raised my EHR developer hackles: inconsistent use of color and blood pressure fields where systolic and diastolic were combined are examples I noted. I know I’m more discerning than the average user, but I had thought vendors were well past those entry-level design flaws.

I have to admit, though, I drooled a bit when I saw how the system handles approximate dates. My primary vendor has struggled with this for quite some time. Maybe the way my new EHR is handling it isn’t glamorous, but it gets the job done much better than I’ve seen other vendors do it. Unfortunately, that was just a teaser during the EHR overview, and I’m going to have to wait to dig into it a little more. Each module shows the length of time allotted and most look like they’re 20-25 minutes. Since my eyelids were already drooping from a long day at the office followed by yet more snow shoveling, I decided to call it a night.

Do you have a passion for online training? When is the last time your CMIO learned a new EHR? Email me.

Email Dr. Jayne. clip_image003

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March 5, 2015 Dr. Jayne 1 Comment

News 3/6/15

March 5, 2015 News 3 Comments

Top News

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A Health Affairs article written by five Republican senators says their 2013 question of what value Americans have received in return for their $35 billion HITECH investment hasn’t been answered. They say EHRs “are not meaningful for physicians,” interoperability remains elusive, the $12.5 billion CBO-predicted EHR savings haven’t been realized, and ONC’s interoperability roadmap doesn’t provide enough specific details for vendors to work from. It criticizes ONC for releasing its interoperability roadmap well after Stage 2, which “was promised to be the stage when health providers were interoperable.” The article finishes on a slightly positive note in complimenting Karen DeSalvo:

In listening to the concerns from EHR vendors and EHR users from across the care continuum, ONC has taken an important turn under the leadership of Dr. Karen DeSalvo. The previous ONC leadership did not understand the difficulty and enormity of creating government-approved products in a market that struggled to exist before government incentives arrived. As a result, our nation’s health care providers are stuck with the huge cost of unwieldy systems trying to conform to government mandates. They are stuck adopting EHR systems which don’t fit into their established workflows. And if they actually want to share their patients’ data, they are stuck with even more costs imposed by vendors. At the center of all this is the patient who must sit quietly in the exam room looking at her physician use a computer instead of directly talking with her, who likely has seen no better access to her own data, and who is struggling to understand why her doctor has such a difficult time getting her lab results.

HIStalk Announcements and Requests

I was thinking today about the kind of reader who probably shouldn’t be reading HIStalk because I won’t be able to meet their expectations. I’m not offended by losing readers who:

  • Assume there’s a direct relationship with how important a story is and how much space is used to describe it.
  • Need repeated mentions of the same story over several days, with no new information, to make sure they understand they should pay attention to it.
  • Enjoy catchy headlines (especially those click-desperate, frothy ones that include a number as in a “listicle”) with cartoonish action verbs that sit atop stories that fail to deliver anything insightful.
  • Don’t mind stories that fail to link to the source document with the hopes you’ll mistake the story as containing original reporting.
  • Require pictures even if they have nothing to do with the story, like generic shots of stethoscopes or smart phones, or who value slick design over substance.
  • Are convinced that keeping up with the industry requires spending a lot of time each day reading several sites.
  • Enjoy reading opinion pieces written by people who have never worked in either health IT or healthcare.

 

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Quite a few people are writing about the study that found little overlap in the “best hospitals” lists of four organizations that create them. It’s a lost cause in my opinion – any “best” list, whether it be restaurants or plumbers, is situationally subjective and even medical experts can’t provide a definitive answer. Go to an academic medical center when you have a tricky diagnosis or need a rare surgery performed by someone who does a lot of them, but expect to have privacy and restfulness compromised by rounding teams made up of everybody and his brother popping in at all hours, expect more mistakes to be made (especially in July, on holidays, on weekends, and at night), don’t mind the happy indifference of employees who aren’t afraid of being fired, and expect to have a lot more tests done because that’s the research culture (no pun intended). Community hospitals are fine for most medical situations, but they don’t always have high volumes in what you need done, the employees they attract are probably friendlier but maybe less accomplished, and if you crash you might be a long way from somewhere better equipped to save you. I would rather see a list of the worst 30 percent of hospitals (as measured by mistakes, poor outcomes, low-quality medical staff) and then feel safe in choosing any of the others as long as you bring someone to watch everything done to you like a hawk. It also won’t matter which hospitals are “best” if you aren’t willing or able to travel halfway across the country and possibly go out of network, and for many mid-sized cities, consolidation has left only one or two choices anyway. I think for most people, long-term health is driven more by the choice of PCP and specialists rather than the big, bureaucratic building with the lights on all night that often makes things worse instead of better. The “best” hospital is the one you stay out of.

Welcome to new HIStalk Platinum Sponsor HCTec Partners. The Nashville-based HIT/HIM solutions and staffing provider offers services related to EHRs (build, implementation, training, optimization, go-live support), clinical transformation, revenue cycle and ICD-10, data migration, data warehouse, and HIM and coding. I was happy to see prominent mention on their site of the extensive benefits they offer consultants as well as the company’s “giving back” activities, such as working with Habitat for Humanity. Testimonials from clients and consultants are here. Thanks to HCTec Partners for supporting HIStalk.

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I had a sign made to commemorate Atlanta’s convincing HIStalk reader poll win as healthcare IT capital of America that Jenn presented it to the folks at Metro Atlanta’s Bioscience-Health IT Leadership Council on Thursday. Receiving the award from Jenn were Council Chair Robert Hendricks of McKesson and Pat Williams, chair of the Institute of Health Information Technology and TAG Health.

This week on HIStalk Practice: Palm Medical Group picks HealthFusion as its VoC. KVC Nebraska turns to telemedicine for behavioral health services. Hospital employment loses luster with Ohio physicians. CHESS and Chase Brexton Health Care implement new pop health management tools. ClickAClinic CEO discusses telemedicine business model outlook. The Consultant’s Corner takes a look at primary care networks.

This week on HIStalk Connect: Google and Stanford University publish a paper on the use of deep learning neural networks to expedite drug discovery research. During the Mobile World Congress conference in Barcelona, Jawbone announces that it will partner with Huawei to provide access to Jawbone’s UP fitness ecosystem for the company’s growing portfolio of smartphones and wearables. Rock Health invests $100,000 in Chrono Therapeutics, a startup building a wearable device that supports smoking cessation programs by administering nicotine at strategic intervals based on the time and intensity of each user’s actual cravings.


Webinars

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.

Here’s the recording of the “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care ” webinar.


Acquisitions, Funding, Business, and Stock

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I mentioned that the Forbes list of 2015 billionaires omitted Terry Ragon of InterSystems, with my speculation that his net worth should be in the same $1.5 billion neighborhood as Cerner founders Cliff Illig and Neal Patterson. Turns out he’s actually on the list at #1190 at $1.6 billion, but categorized under “technology” rather than “healthcare,” which is technically correct (no pun intended) since the company’s Cache’ database has at least some use outside of healthcare.  

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Stanford Health Care and GE Ventures launch Evidation Health, which will pair digital health companies with possible provider customers to define product value.


Sales

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Greenville Health System (SC) chooses Caradigm’s population health management products.


People

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CareCloud clarified a reader’s rumor report that CEO Albert Santalo was asked to step down. Per the company, he’ll be “focusing his time almost entirely on advancing our products for the next several months,” with an emphasis on meeting the needs of large-practice customers, but will remain chairman and CEO.


Announcements and Implementations

First Databank will distribute Polyglot’s Meducation simplified medication patient instructions.

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Physicians at Community Memorial Health System (CA) are entering 98 percent of their orders and notes electronically into Meditech after implementing PatientKeeper’s CPOE and NoteWriter systems.

Agastha and Axon HCS add the CompletEPA electronic prior authorization solution from Surescripts to their systems.


Government and Politics

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FDA releases its first mobile app, which identifies drug shortages.

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HHS Secretary Sylvia Burwell publishes an article on HHS’s move to value-based payments, but reading it involves another type of payment – sending $20 to the New England Journal of Medicine for the privilege of seeing the comments of the government official whose salary is paid by your taxes. It should be law that elected officials should not publish paywall-protected articles or appear at conference sessions that require a fee or that are invitation-only. They represent all of us, so they should speak to all of us.

Here’s Karen DeSalvo’s keynote and comments from a Wednesday session on health IT at Brookings Institution. 


Privacy and Security

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The Australian radio station whose “morning zoo” hosts called a London hospital in 2012 claiming to be the Queen and Prince Charles and were given information on the condition of the Duchess of Cambridge may lose its license for airing the call without consent. The India-born nurse who didn’t recognize the “ridiculous comedy accents” transferred the call to the floor. The nurse committed suicide three days later, leaving a note blaming the shame of the call for her death. British prosecutors declined to press charges against the two DJs even though they probably broke Britain’s privacy and malicious communications laws, explaining that they weren’t likely to be extradited from Australia and their action was intended to be a harmless prank.

Texas Health Resources, responding to a negligence lawsuit brought by its nurse Nina Pham over her exposure to Ebola, says in an email to employees that despite her claims, it had her permission to release information about her and that it followed HIPAA rules.

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The federal government’s Office of Personnel Management  OIG says Anthem twice refused to allow it to perform security testing of Anthem’s systems as part of a routine OIG security audit. Anthem told the OIG that its policies don’t allow external entities to connect to its networks (Chinese hackers excluded).

An Oregon TV station uncovers an interesting privacy law: universities are allowed to dig into the health records of any student who sues them without running afoul of HIPAA. They’re covered under a separate law called FERPA.


Technology

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A JAMA Internal Medicine case study profiles the case of an occasionally symptomatic patient whose tachycardia was diagnosed only after his PCP suggested he buy an AliveCor smartphone-based cardiac monitor.

RxRobots delivers four of its pain management robots to the Alberta, Canada hospital where they were developed. The robot distracts children who are undergoing painful procedures.


Other

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Garen Sarafian from Citigroup sent over the company’s analysis of the most recent Meaningful Use data titled “Stage 2 Clingers: Weak Vendors Try Holding On.” While I would be cautious about reading too much into the skimpy number of EP Stage 2 attestations, the report’s conclusions feel about right:

  • Cerner and Epic are increasing their Stage 2 market share (somewhat at the expense of Meditech, which is sliding a bit) and Athenahealth is succeeding on the EP side.
  • Provider EHR difficulties should drive a robust replacement market that will benefit those same three companies.
  • Low EP attestation rates should benefit quickly implementable products from Athenahealth and Practice Fusion.
  • A dropoff on Stage 2 attestations by users of Allscripts and NextGen could indicate declining market position, especially given their acknowledged problems with reduced client spending and satisfaction problems, respectively.

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The BBC finds that the US is the most expensive place in the world to give birth, drily adding that, “there is no publicly financed health services as in most developed countries.” A Johns Hopkins professor summarizes our healthcare mess succinctly: “If you can make more money as a doctor by ordering more tests, you are going to order them and therefore patients end up getting more tests … If you don’t have health insurance in the US, hospitals and doctors will ask you to pay three to four times what someone with insurance will pay for the same service because no one is negotiating rates on their behalf.”

The AMA, seemingly unable to find anything to whine about these days other than technology and the EHRs its members bought of their own free will, twists CMS’s latest ICD-10 testing results to suggest that “the claims acceptance rate would fall from 97 percent to 81 percent if ICD-10 was implemented today.” AMA and other physician groups want CMS to develop contingency plans “to save precious heath care dollars” (the Medicare ones that arrive in the pockets of doctors) and to describe how PQRS and Meaningful Use reporting will work given that the calendar year will straddle ICD-9 and ICD-10 (that part is valid). Meanwhile, AMA’s online newsletter wraps up a supportive article with a link to its online store, where those cash-strapped doctors are invited to buy AMA’s ICD-10 data file. AMA makes a good point: CMS should release more specific testing details. It also makes a bad one: CMS should pay doctors in advance in case they have billing problems.

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Weird News Andy notes what he calls a “kidney kidney kidney kidney kidney kidney” transplant. A San Francisco hospital performs six paired donation kidney transplants, using software developed by a technology executive (who underwent a kidney transplant himself years ago) that performs the number-crunching that matches unrelated donors and recipients using their medical characteristics.


Sponsor Updates

  • VisionWare CEO Paul Roscoe provides thoughts as part of Health Data Management’s “Visionaries for 2015” special edition.
  • Bill Kinsley, enterprise architect for NextGen, will chair the HIMSS EHR Association’s privacy and security workgroup. 
  • Galen Healthcare Solutions posts “Health Management Plans: A Better Way to Care for Patients.”
  • Extension Healthcare creates a new infographic on the “Evolution of Clinical Alarms and Text Messaging in Healthcare Communications.”
  • Etransmedia Technology Chairman Vikash Agrawal summarizes his experience at the Pacific Crest 10th Annual Emerging Technology Summit.
  • LifeImage posts “Medical Image Sharing for Neurological Care & Research.”
  • Holon Solutions CEO Mike McGuire explains the company’s rebranding strategy.
  • Healthwise offers a blog on how it helps its customers get the information they need.
  • HealthMEDX will exhibit at LeadingAge Oklahoma March 10-11 in Midwest City.
  • Iatric Systems exhibits at the Privacy & Security Forum through March 6 in San Francisco.
  • Logicworks posts a new blog on the Internet of Things security.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 5, 2015 News 3 Comments

Morning Headlines 3/5/15

March 4, 2015 Headlines 1 Comment

The Next Marketing Frontier: Your Medical Records

The Wall Street Journal covers freeware-EHR vendor Practice Fusion and its decision to embed big pharma-funded vaccine reminders into its EHR. Practice Fusion CEO Ryan Howard explains “For every project we do that drives forth public health or gives data away, we need to make sure it’s balanced out by a monetizable exercise.”

100 medical societies warn about possible ICD-10 problems

The American Medical Association and 99 other professional associations are calling on CMS to improve its ICD-10 transition plan following recent end-to-end tests that resulted in 19 percent of submitted claims being kicked back, almost all due to errors made by the submitting organization.

Supreme Court justices split in key challenge to Obamacare subsidies

The Supreme Court hears arguments on King v Burwell, a case that could undermine the Affordable Care Act by stripping subsidies from any consumer that purchased health insurance through Healthcare.gov. Defendants of the ACA argue that withholding subsidies from states that did not launch an insurance exchange would be tantamount to the federal government applying illegal ”coercive pressure” on states.

Despite The Spread Of Health Information Exchange, There Is Little Evidence Of Its Impact On Cost, Use, And Quality Of Care

Health Affairs publishes a literature review of 27 studies finds little evidence that health information exchanges reduce costs or improve outcomes.

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March 4, 2015 Headlines 1 Comment

Readers Write: Understanding the Importance of Prioritizing e-Prescribing

March 4, 2015 Readers Write 1 Comment

Understanding the Importance of Prioritizing e-Prescribing
By Louis Hyman

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As the industry awaits confirmation of a compliance deadline delay for the New York State e-prescribing mandate—which will require electronic prescribing of controlled and non-controlled substances—it’s important that providers don’t delay their preparation efforts, as this process can be time- and resource-consuming.

Under provisions of the New York State e-prescribing mandate and subsequent regulations (such as amendments to Title 10 NYCRR Part 80 Rules and Regulations), all prescriptions in the state must be transmitted electronically by authorized prescribers unless an exception exists. However, as many providers are struggling to meet compliance by the original March 27, 2015 deadline due to a myriad of challenges beyond their control, the New York legislature is working to pass a law to delay implementation of the mandate to March 27, 2016.

No matter the timing of the deadline, this mandate serves to be a game-changer for how providers share prescription information, and they should be aware that other states are closely watching New York’s rollout, with several already considering following suit.

The scope is intensified because the law covers both controlled and non-controlled medications and applies to all providers in New York State, including long-term and post-acute care organizations (LTPACs) and senior living facilities. Providers must start transitioning to the new requirement now to avoid significant penalties including fines, imprisonment, and/or professional license suspension or revocation.

As such, providers must make e-prescribing a priority in the midst of other major industry initiatives such as ICD-10 and Meaningful Use. However, e-prescribing easily can be incorporated into these efforts if organizations are already leveraging technology and staff training in their preparation.

To comply with the new mandate, healthcare organizations first must fully comprehend its scope. They need to look at its impact on provider, practice, and facility workflows, as well as how it ultimately affects patient or resident care. The following four best practices can help healthcare organizations engage providers and create a smoother transition:

  1. Generate physician awareness of the implications. Regardless of the care venue, it’s important to meet with physicians to raise their level of awareness and engage them in understanding the law’s full scope. Providers need to be clear on what is expected from them within the new e-prescribing workflows, just as they adapted workflows for EHR implementations to meet Meaningful Use requirements. Building physician awareness is even more critical among those organizations that have not yet implemented an EHR and may therefore require standalone computerized order entry or electronic prescribing technology. These providers may not be accustomed to any form of e-prescribing.
  2. Evaluate the workflows of all clinicians involved in the traditional prescribing process. This step is especially important in regard to the complex workflows in hospitals, skilled nursing facilities, and other senior living care settings. Because the law applies to both controlled and non-controlled medications and does not allow physicians to delegate the final steps within the prescribing process, four basic workflows need to be reviewed to understand how they will be impacted by e-prescribing. These workflows include: orders generated in-house for controlled medications, orders generated in-house for non-controlled medications, orders generated upon discharge for controlled medications, and orders generated upon discharge for non-controlled medications. Additionally, providers should examine specific workflows for nurses, physicians, and other clinicians. For instance, because telephone orders will no longer be accepted, healthcare organizations need to plan for physician availability during off hours and periods of high admission and discharge volumes.
  3. Engage caregivers in decisions. Because caregivers are key stakeholders, they should be included in the workflow evaluation to gain accurate insight into the overall impact of e-prescribing. It’s important for organizations to involve these individuals in any technology selection as well to ensure the appropriate tools are in place to support necessary workflows. As part of the selection process, engage caregivers in active testing of how their workflows are accommodated on a day-to-day basis. Beyond supporting workflows, healthcare organizations also should confirm the selected technology performs on a variety of platforms used by caregivers – such as tablets, smartphones, laptops, and PCs, as the physician may not always be on site.
  4. Train and practice e-prescribing. With workflows and technology in place, it’s now time to employ a robust training program to support efficiency and compliance by all caregivers. Providers should begin actively practicing e-prescribing as soon as possible to identify and resolve any issues prior to the compliance date.

Even with the possible New York State e-prescribing mandate deadline delay to March 27, 2016, New York providers need to make e-prescribing a priority. By focusing now on an e-prescribing strategy, healthcare organizations and providers across all care settings – including LTPACs and senior living providers – can realize the benefits to medication management and patient/resident safety while also maintaining compliance.

Louis Hyman is chief technology officer for SigmaCare.

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March 4, 2015 Readers Write 1 Comment

Meet the HIMSS Conference Patient Advocate Scholarship Winners

March 4, 2015 News 2 Comments

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HIStalk is funding five, $1,000 scholarships for patient advocates to attend the HIMSS conference, with conference registration credentials provided by CTG Healthcare. Applicants provided their biographies and a statement of what they hope to achieve by attending, with the winners chosen by Lorre and Regina Holliday.

I have another motive. I’ve often pondered what our patients would think of the over-the-top excesses and unchallenged claims of both providers and vendors at the HIMSS conference. I hope these attendees, clearly identified by tee shirts bearing Regina’s artwork above, will serve as neutral observers keep us all focused on the people who we say we work for, but who we may rarely see face to face.

Each attendee will attend whatever educational sessions they choose along with having access to the exhibit hall in representing the patient’s point of view. Each will provide ongoing social media commentary during the conference as well writing a summary HIStalk article afterward. We’ll announce a time where the attendees, along with other members of The Walking Gallery, will be available to meet people in the HIStalk booth.

I created a contact form for each attendee to avoid publishing their personal email addresses. Please don’t spam them, but you can get in touch about anything related to their conference goals. It’s up to each person to respond if they so choose.


Kim Witczak

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I became involved in pharmaceutical drug safety issues after the death of my husband, Tim “Woody” Witczak in 2003 as a result of an undisclosed drug side effect. I have taken my personal experience and launched a national drug safety campaign through www.woodymatters.com. My work has been featured in major news media such as Fortune, Readers Digest, Consumer Reports, Wall Street Journal, New York Times, and Star Tribune. I have testified before US Senate on PDUFA/FDA reform issues as well as numerous FDA Advisory Committees. In 2008, I was appointed to the FDA’s Psychopharmalocgic Drug Advisory Committee as a Patient Representative. In 2013, I co-organized the Selling Sickness: People Before Profits international conference held in Washington, DC bringing academic scholars, healthcare reformers, consumer organizations and advocates, and progressive health journalists to develop strategies and solutions challenging the “selling of sickness.” I am an active member of the Consumer Union Safe Patient Project as well as a part of the DC-based Patient, Consumer, and Public Health coalition making sure the voice of patients and consumers is represented in healthcare/FDA related legislative issues. In addition, I was just appointed to the National Physicians Alliance Board of Directors. 

Professionally, I am an advertising and marketing professional with 25 years of experience in a variety of industries (e.g. airlines, automotive, fashion, and retail). I am one of the founders of Free Arts Minnesota in 1996, a non-profit dedicated to bringing the healing powers of the arts to over 4,000 abused and neglected children in Minnesota. I earned a BA in Business and Economics at Lake Forest College in Lake Forest, Illinois.

I am excited to be granted the scholarship to attend HIMSS in Chicago. It’s a great opportunity to network with leading healthcare providers and learn about the new healthcare solutions on the horizon. I also hope to be able to infuse the patient perspective with those I meet. Oftentimes others are speaking for what “patients" want and it’s not always in alignment with the real world patient / public voice.  

As someone who has spent my entire career in advertising and marketing, technology is at the core of communicating with the public. Communication is also at the center of healthcare, not only between companies, staff, hospitals, but also between provider and patients and their families.  I truly believe the only way we will advance healthcare is by working together, collectively.  

Since I have a unique perspective of having foot in both advertising and communications AND patient safety worlds, it will be interesting to see HIMSS through this lens.

Contact Kim.


Amanda Greene

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I am looking forward to attending HIMSS in Chicago this April. As one of the lucky HIS-talking Gallery Patient Scholarship recipients, as well as a woman who lives with Lupus, I am excited about the opportunity to meet and connect with stakeholders and businesses that believe including patients in the process is vital to the creation of successful partnerships within the healthcare and wellness industries.

Currently, I co-host and moderate @LupusChat, which leads a bi-monthly Twitter Chat (#LupusChat). I am a healthcare activist and recently was the host of WEGO Health’s #HAChat on the importance of Self-Care for Healthcare Activists. I am also a Creator of POPULOVE.net, which “redefines what fans can accomplish through music,” where I write and curate some of the content for the Pop Ed. and Causes sections of the community.

Being a part of the HIS-talking Gallery Patient team at HIMSS will be an informative adventure. My enthusiasm as a passionate healthcare activist and patient voice is loud and clear. If there is a chance to meet and engage with HIMSS attendees so that together we can gain insight to how the patient experience can be incorporated into their practice and businesses I am happy to share. I hope to connect and create an open dialogue with today’s change-makers.

Contact Amanda.


Carly Medosch

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Why do I want to attend HIMSS? It’s the biggest event of its kind — so big that most convention halls cannot contain it. My involvement in health IT has expanded in recent years, as this is the field most likely to include patients and one of the more innovative spaces in healthcare today. HIMSS is the preeminent health IT event — it’s the place to be! So it’s critical that patients are there, too.

It is crucial that patients attend healthcare events. We are in a transitional time where patients are recognized as more important than ever, but the reality is that there may not be a single patient on stage in the course of a multi-day event. 

Who am I, as I patient? I have been living with chronic illness for 21 years, since I was diagnosed with Crohn’s disease at age 13. I’ve never been able to experience life as a healthy adult, but have enough medical education to warrant an honorary doctorate. More recently I’ve developed some secondary complications from the Crohn’s disease, and also Fibromyalgia. Because of this grab bag of conditions, I am in pain and discomfort (physical or emotional) at all times, but the levels vary.

My illness is not a blessing, but I do consider it a credential, along the same lines as my MBA or project management certification. I don’t primarily identify as a person with Crohn’s disease. Rather, I identify as a patient, in general, and if pressed, as a chronic illness or invisible illness patient. For a long time I did not know about many opportunities for patients, except for volunteering with my disease-specific non-profit, or fundraising for research.

My early experiences with disclosing my illness were so traumatic and dangerous that I was in the closet for most of my life. It was not until I started using social media to find and connect with other patients that I began to learn of ways to be involved on a different scale. In my professional life, I went from a graphic designer, to an MBA student, to a project manager, to a program analyst. I started off as a small cog in a large system, but slowly began to understand, and be excited by, working as a larger system. Recently, I realized that my advocacy evolved in a similar way.

I am excited about all the awesome people I will meet at HIMSS. To improve the health care system, we must understand the challenges and motivations of all the stakeholders. I need to understand why the doctor only has eight minutes to talk to me during my appointment. I need to understand why my pharmacy can’t accept refills on certain types of medicines. I need to understand how reimbursement works, and the regulations that hospital face. I need to understand why the timelines for improvements are so far out. I need to meet pharma employees and insurance CEOs and understand that they are not the enemy. I need to tell my story to all of these people, and yes, I need to listen to theirs.

We cannot solve problems by considering a single cog, we must see the whole machine and we must understand that it’s made of human beings, all with hopes, dreams, frustrations, and solutions.

Contact Carly.


Melanie Peron

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My name is Melanie Peron of Paris, France. I am the founder of the Butterfly Effect. In September 2011, I decided to make a career transition and create the Butterfly Effect after my personal experience as a patient supporter for my companion. During this time I discovered the social exclusion and all the difficulties of families and patients have to face up.

I deeply believe that little actions can bring great consequences and that is why I chosen this name. The idea was to bring sweet moments for patients and families and allow people to live normal moments in difficult times.The Butterfly Effect has several missions : providing supportive care (art therapy, aesthetics, relaxation therapy, writing workshop), a 3D social network application (Bliss), cultural action (shows in patients’ bedrooms) and research (evaluation of the supportive care and the quality of patients lives).

Some numbers: more than 1,000 patients and families received 20 shows of music and storytelling in their rooms, over 200 people received collective and individual sessions (aesthetic, relaxation therapy, art therapy, writing workshop) and a pilot study evaluating of the well-being of patients treated with chemotherapy was conducted with a team of oncologists in Victor Hugo Le Mans [April 2014-January 2015].

I’m delighted to participate to HIMSS because it will allow me to connect with people who share the same dream as me: make health policy move forward for the benefit of patients and citizens. It will also be the opportunity to meet other walkers of the Walking Gallery and that is something very meaningful for me.

Whether we live in France or in the United States, thanks to our experiences as patients, supporters, and careers, we can improve our health and I deeply believe that it is by being together we can make a real and concrete impact ! I also will be happy to show Bliss, our 3D social network, to professionals. Maybe one day Bliss will be available in the US?

Finally, six years after the first idea of The Butterfly Effect, I’m very happy and honoured to come to Chicago to live this experience and to share it all over the world.

Contact Melanie.


Tami Rich

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Thank you for the generous scholarship to attend HIMSS as a patient and family advocate. My overall goal for attendance is to deepen my knowledge about HIM and current trends. It is also most important for me to understand the gap between what hospitals and healthcare companies provide for EHR / EMR and HIT support to patients, such as what patients receive via patient portals vs. what we need, which is fuller access to our chart’s medical history, test results, and even the chance to review notes and visit summaries about us. Why is it so hard for us to get our own data? And why is our data not fully portable?

As the mom case manager to Jameson, a young adult with complex congenital heart disease, we need all of his data, both to make informed decisions and also to help him become knowledgeable about his medical situation. Along with most parents of children with special healthcare needs, we share the larger mission to raise young adults who are as health confident and as medically independent as possible. For most of my son’s life I’ve had no other choice but to collect and track his data on my own. I’d like to know how to help hospitals to better engage with us, to serve us and to meet our needs as key customers, by fully understanding our experience and the role we play in managing our own and our family’s healthcare.

Another problem I’ve experienced is that HIPAA rules are often applied unevenly, leading to yet another barrier that inhibits my ability to partner with and teach my son. These challenges only strength my resolve to find new and innovative ways to break down the silos between us and open the path to access our health information.

I’m very much looking forward to attending and absorbing all I can at HIMSS, not only to further my own learning but to inform my advocacy work. I’m happy to share my perspective on HIMSS15 by blogging or writing about the event; I also hope to present to other parents in my advocacy networks back at home. Perhaps most importantly, as a HIMSS first-timer who has been repeatedly warned by seasoned past attendees, I already have my comfortable shoes at the ready!

Contact Tami.

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March 4, 2015 News 2 Comments

HIStalk Interviews Frank Nydam, Senior Director of Healthcare Solutions, VMware

March 4, 2015 Interviews No Comments

Frank Nydam is senior director of healthcare solutions in the office of the CTO of VMware.

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Tell me about yourself and the company.

I’ve been with the company for just over 12 years. The last seven have been dedicated to our healthcare provider market. My team and I develop solutions along with our customers and ISV clinical application partners to help healthcare make that jump from yesteryear to tomorrow.

 

CIOs have to deal with infrastructure issues such as security, mobility, and cloud computing. What worries CIOs the most?

Top of mind in the last couple weeks has been security. I’d like to touch on that, but prior to that, it’s the overwhelming complexity that healthcare CIOs are dealing with.

If you think about the last 20 years of the applications and the infrastructure they needed to build to support the hospital, they still need to support that infrastructure and application set today, yet some of those technologies are pretty old and brittle. If you look at some of the new services, EMRs, and new mobile services, it’s almost a collision between the old world and the new world. That’s on top of their mind. That’s a lot of complexity to try to fit those two worlds together.

Number two is definitely security. With the recent breaches out there, I’ve had several CIOs say to me that the only thing the board would like to talk to them about is keeping their names out of the paper. That is definitely a big issue now. Obviously with so much complexity, it’s very hard to secure assets like that. That’s been our main talking point when I’ve been on the road meeting with our customers.

 

Everybody was worried about external hacking against their domains, but the big problem seems to be phishing attacks used to steal administrator credentials. Do any solutions look promising for that problem?

A good analogy would be that if you look at a hard-boiled egg, it’s very secure on the perimeter. It’s got a hard shell. If you look at healthcare security, we do a good job of securing the perimeter of the hospital from intrusions. But once somebody gets in and breaks through that proverbial egg, they have the full run of the infrastructure. Once they’re in, they can start snooping around, picking up passwords, data, what have you.

We have been focused on what happens once you get through that perimeter security. We purchased a company just about two years ago called Nicira. It was a startup out of Stanford. Our goal here is to do for networking what VMware has done to the compute side, to provide policy-based network services. Not at just at the perimeter, but for every workload, and make it really intelligent that regardless of the location of that virtual machine, it’s always protected by that security policy. It can only ever talk to its web server or its client.

We  feel that’s going to help what we call the east-west communications. Going back to the egg analogy, if somebody does get through the perimeter, how are we going to protect the inside of that? We’re bullish on that. It’s a solution we have been working with in our enterprise customers. We’re trying to bring that into the healthcare industry right now.

 

Maybe hackers are using phishing attacks because perimeter security is working and they had to look for other weaknesses. Could there be a virtual firewall for the desktop since you have control of each VMware session and also AirWatch for mobile sessions? Can you protect users similarly to the way firewalls and antivirus software work?

Absolutely. If you walk through that from a virtual desktop perspective, we created a solution called AlwaysOn Point of Care. Right off the bat, the patient records never leave the data center. We present that desktop out to the clinician, whether it’s on a mobile device, on a desktop, what have you. That first step of security is not even having the patient records outside the perimeter. 

You hit it on the head. Our product called NSX provides a distributed firewall in every single ESX server that’s out there. Whether it’s a VDI desktop, a server application, what have you, we put a virtual firewall around that device, around that application. If you think about trying to do that in the physical world, it would be nearly impossible to put a physical firewall in front of every single desktop device and application out there. It’s physically impossible as well as financially impossible. That’s one of the benefits and disruptions of our technology, that ability to have a firewall in front of everything and protect it. A term out there that’s emerging for that would be called micro-segmentation.

 

It’s been just over a year since VMware acquired AirWatch. What are hospitals doing with it?

If you look at healthcare, there’s not only an external generational issue with patient population, but it’s internal as well. The younger physicians want that same experience that they have outside the hospital inside the hospital. Call it BOD, call it what you wish. AirWatch allows us to provide that consumer-like experience to that physician so they can take their patient records home with them and work from home. We often get, “It’s really changed my family life because I can start doing charting from home rather than being inside the hospital. It has really been a revolution for us.”

But we’re just scratching what we’re going to be able to do with the AirWatch product. If you think about higher-level features, imagine geo-fencing to be able to contextually say, the doctor is outside of the hospital, they’re at home, they want to do e-prescribing. Let’s enforce two-factor authentication so they can do e-prescribing. But if they’re inside the hospital on that specific network on that specific device, let’s make it easier for the physician to do their job and take some clicks out of that workflow.

We feel that’s that next stage. We’re calling it the next-generation clinical workspace. How do we move from the technology of 20 years ago and give that physician that workspace, that device, regardless of their location application, to get their job done?

 

Is a point coming where hospitals can get away from running physical data centers and managing servers and infrastructure and get back to their core mission of using rather than maintaining technology?

Absolutely. We believe it’s going to be a hybrid world, meaning that we’re going to see hospitals continue to hold on to some of their infrastructure and applications where they feel its  core value to the hospital. They’ll run that on-premise in a private cloud.

But for applications that no longer fit the mission but are required for the hospital to run, we’re starting to see those applications move out to a hybrid cloud. In our world, we want that private cloud and public cloud to be connected, and that’s what we call hybrid.

Probably the biggest use case we see for hospitals right now is something we’re calling legacy decommissioning. If you think about all the mergers and acquisitions that are going on in healthcare today, hospitals are saddled with a lot of old data and old applications that may not be core to their mission any longer, but they need to take it forward for merger acquisition or for read-only. We’re allowing our customers to decommission that legacy data and those applications to a cloud that looks, feels, smells, has all the security of their private cloud, yet it sits in a VMware vCloud — what we call VMware vCloud Air. We believe that’s a great first step for a lot of these hospitals who may be wary of putting PHI in the cloud or older applications or even newer applications. That has been a big hit for us.

 

In medicine it’s not that we don’t have enough medical experts, they’re just not spread out equally, so Boston has a lot and North Dakota doesn’t. The same is true with technology support talent, where small, rural hospitals don’t have the same technical resources. Will a move to cloud access better distribute the technical expertise needed to keep applications running?

That’s absolutely correct. I’m personally passionate about rural healthcare. I think it’s something we as an industry need to keep an eye on, making sure that these rural community hospitals, physicians, and caregivers are getting access to the right data, new applications, what have you. The ability to run some of this in the cloud and let a developer that’s really good at MUMPS in Boston support a physician or a small community practice of North Dakota — that’s a perfect use case for helping retain our rural community healthcare centers.

It’s almost like a democratization of healthcare IT talent in the same way that you can be a C++ developer sitting in Germany working for an American company. We need to bring the same type of democratization of skill sets into healthcare.

 

What are small and medium community health systems doing with the cloud?

It’s funny — there’s been so much “cloud washing” over the last five or 10 years that we had found ourselves stopping using the word “cloud.” I’ve seen some CIOs actually putting in a spam filter that says any email with the word "cloud," send it to the junk bin.

We took a different approach. We sat back with our customers and focus groups and said, at the end of the day, what are you trying to get out of that? What’s the outcome you’re trying to get from going to a cloud? They came back to us with about eight outcomes that any cloud should provide. That allowed us and our customers to focus on the outcome they’re trying to get rather than this fluffy computing term called cloud.

We built a framework called vCloud for Healthcare that defines the outcomes that a hospital can consume, whether they be application delivery services like virtual desktop or AirWatch to analytical, financial, and continuity services. That has allowed the smaller hospitals to consume and find value out of it quicker. Because again, there has been so much cloud washing that some vendors were walking and saying, “We can do anything with the cloud.” It was slowing down progress and innovation. Defining the outcomes and not being too concerned about the big fluffy name has helped us move along.

I’ll give you a great example. I had mentioned earlier legacy decommissioning. It’s a great opportunity for a small community hospital to see and feel what it looks like to use the same tools that they use internally and externally and relieve some pressure — regulatory pressure, data center pressure, and financial pressure. You hit it on the head — there is a big disparity between larger IDNs and academic research centers versus the community hospitals. This has really helped them.

 

Do you have any final thoughts?

When I started here, we were about a 300-person company. We’re about a 17,000-person company now. It has been quite a journey over the last seven years focusing on a specific customer set. I have been able to attract some of the most passionate and talented healthcare IT professionals. I have former CIOs, CEOs across the country, and heck, some folks even have patents out there in smart room technology.

This has been not only rewarding personally and professionally, but I’d like to look back on my career to be able to say we’ve left healthcare with something positive. Not from a sales perspective or a revenue perspective, but that we can look back five or 10 years from now and say we made healthcare a little bit better for you, my family, what have you. Some would say that’s a pretty idealistic view of the world, but it’s a great way to get up every day and help our customers. I just am so jazzed about the future of what we’re going to be able to do.

We need to help healthcare IT industrialize itself. For too long it’s been a piecemeal of this part and that part. I’m excited about how we can help healthcare industrialize, to make them look, feel, and act a little bit more like financial services so they can go innovate.

I do a lot of traveling and I see a lot of frustration out there among customers just trying to keep the lights on all day. We’ve got to get you guys away from just keeping the lights on and get back to your day job so you can innovate. That’s what gets me going in the morning.

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March 4, 2015 Interviews No Comments

Morning Headlines 3/4/15

March 3, 2015 Headlines No Comments

Truven Health Analytics prepares for IPO

Reuters reports that Truven Health Analytics is preparing for an IPO that will value the company at $3 billion. Truven was acquired by Veritas Capital Fund Management in 2012 for $1.25 billion.

Review of Alleged Misuse of VA Funds To Develop the Health Care Claims Processing System

The OIG investigates the VA Chief Business Office, concluding that it violated appropriations laws when it spent $92 million on a new IT system from a fund that was only authorized to cover medical, construction, supply, and research costs.

Free of Ebola but not fear

Nina Pham, the Texas Health Resources nurse that contracted Ebola while treating a patient last fall, is suing her former employer, claiming that a lack of training, established policies, and proper equipment led to her exposure.

What Are the Best Hospitals? Rankings Disagree

The Wall Street Journal compares four hospital ranking sites (US News & World Report, Consumer Reports, Leapfrog Group, and Healthgrades) and finds that there is virtually no consensus among the lists. 27 percent of the hospitals listed among the nation’s best were rated among the nation’s worst on one of the other lists.

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March 3, 2015 Headlines No Comments

News 3/4/15

March 3, 2015 News 3 Comments

Top News

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Reuters reports that Truven Health Analytics is planning an IPO that will value the company at $3 billion. Veritas Capital Fund Management LLC bought the company from Thomson Reuters in 2012 for $1.25 billion.


Reader Comments

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From DejaVuAllOverAgain: “Re: Leidos Health. Laid off over 50 people last Friday, the third round of layoffs since Q3 2014. SAIC bought two $400M consulting companies (Vitalize Consulting and maxIT Healthcare) thinking they’d get $800M annually. Revenues now less than $300M. The typical acquisition story.” Unverified.

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From LL Cool J: “Re: Allscripts and NantHealth partnership = desperate.” The wordy announcement wasn’t very clear on who’s doing what, but NantHealth seems to be signing up a bunch of partners and Patrick Soon-Shiong is drawn to TV cameras like a mosquito to a bug zapper.

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From RutRoh: “Re: CareCloud. It was announced at the CloudUp corporate meeting that CEO Albert Santalo has been asked to step down.” Unverified. He’s still listed on the executive page and I assume that even if the rumor is true that he’ll remain as board chair. Update: CareCloud says Santalo will remain chairman and CEO but will be focusing his time over the next several months on advancing products, with emphasis on optimizing operations for larger practices.  

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From Dysf(n): “Re: microbiology interfaces. CAP Today puts out an annual review of laboratory middleware. New version is due in June 2015, I think. Here’s last year’s in PDF format. Data Innovations is in there, along with another six or seven. If that doesn’t cover the specific instruments / systems you’re looking to integrate, it may be a good start — search elsewhere through CAP Today online.”


HIStalk Announcements and Requests

Here’s a fun fact that everybody who orders HIMSS-related giveaways already knows: China-based manufacturing shuts down for two weeks each February for Chinese New Year. Last year we had to settle for inferior quality lapel pins because the factories where the good ones are made were closed.

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Divurgent is offering all HIStalk readers the chance to attend summitHIT15 in Chicago’s best rooftop lounge on the 27th floor of theWit hotel on Sunday, April 12. RSVP here.

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

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Webinars

March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.


Acquisitions, Funding, Business, and Stock

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Becton Dickinson acquires CRISI Medical Systems, with which it co-developed a wireless, EHR-integrated electronic checking system for drug identification, dose, and allergies for drugs given by IV push.


Sales

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Memorial Sloan Kettering Cancer Center will use PeraHealth’s Rothman Index health scoring system throughout its system to provide an early warning for patients whose conditions are deteriorating.

Cornerstone Health Enablement Strategic Solutions (NC) chooses Lightbeam Health Solutions for population health management.


People

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T-System names Janie Schumaker, RN, MBA (Heartland Regional Medical Center) as chief nursing officer.

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Rick Toren (Qpid) joins healthcare analytics vendor Atigeo as president of its healthcare division.


Announcements and Implementations

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ScImage updates its PICOM365 systems to support the new ASA 2015 echocardiography cardiac chamber standards that were released in January.

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NantHealth and Allscripts announce their collaboration on development of precision medicine solutions for cancer patients.

Spectrum Equity makes an unspecified investment in healthcare database vendor Definitive Healthcare.


Government and Politics

A Connecticut bill would require insurance-related companies to encrypt consumer information, introduced in response to the Anthem breach by politicians who clearly don’t understand that encryption is rendered instantly worthless once hackers obtain administrator account information by phishing (as they did in Anthem’s case).

The VA’s Office of Inspector General finds that the VA’s chief business office knowingly violated appropriations law by using $93 million in medical support and compliance money to help pay for development of a claims processing system to avoid going through the VA’s IT process.


Privacy and Security

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ProPublica plans another article in its series about medical privacy and invites readers to contribute stories about problems they’ve had.

The New York Times runs pro-con arguments about genetic testing data. Negative arguments: drug companies are paying 23andMe big money to get their hands on test results, genetic testing is a minor disease predictor compared to lifestyle choices, DNA information could be hacked for manipulating crime scenes or medical records, and laws against genetic discrimination need to be strengthened. Positive arguments: shared data speeds up healthcare research, technology can protect the data, companies making millions from selling data should buy insurance of $500,000 per user since they claim the breach likelihood is low and if that’s true the insurance should be inexpensive.

Patient information in Minnesota’s doctor shopper prescription database was accessed hundreds of times by a former insurance company nurse after the state forgot to revoke his credentials when he was reassigned. The nurse was previously disciplined by the state nursing board after admitting to stealing narcotics from two hospitals, a fact the state says they were unaware of even though his record is in a public database. He still works for Blue Cross Blue Shield.


Technology

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Antivirus maker AVG debuts prototype infrared LED privacy-protecting glasses that prevent facial recognition systems from identifying their wearer. The company says “invisibility glasses” are a valuable privacy tool because candid smartphone photos are often posted to Facebook, Google’s StreetView puts identities in the public domain, and Facebook’s DeepFace can match up different photos of the same person with human-like accuracy of greater than 97 percent. 


Other

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Texas Health Resources nurse Nina Pham, who contracted Ebola in the Thomas Duncan case, sues her employer for negligence, claiming lack of training and violations of her privacy that made her “a symbol of corporate neglect – a casualty of a hospital system’s failure to prepare for a known and impending medical crisis.” She says she told THR not to release information about her when she was hospitalized, but a doctor recorded her on video using a GoPro body-worn camera and released it publicly, with her attorney claiming THR “used Nina as a PR pawn.”  She also claims THR announced her condition as “good” while simultaneously counseling her on end-of-life decisions as documented in the EHR. Her attorney has a history of successfully suing THR and other hospitals for her $750 per hour fee and has hit defendants with $675 million worth of settlements and verdicts in the past five years.   

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Named to the Forbes list of 2015 billionaires from healthcare IT are Patrick Soon-Shiong of NantHealth (#96, $12.2 billion, although he made his money from pharma), Judy Faulkner of Epic (#663, $2.8 billion), Neal Patterson of Cerner (#1006, $1.9 billion), and Cliff Illig of Cerner (#1605, $1.2 billion). The list omitted Terry Ragon of InterSystems, who should be worth about the same as Patterson and Illig based on previous reports. Elizabeth Holmes, founder of lab provider Theranos. is the youngest self-made woman at 31 years old (#360, $4.5 billion). Your best chance by far of being one of the world’s richest people is inheriting $40 billion each in Walmart money as did the four Waltons who hold spots in the top 12.

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A note to PR people: they say there’s no such thing as bad publicity, but that might not hold true when a press release misspells the company’s name.

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Chuck Denham, MD, the former co-chair of a National Quality Forum patient safety panel charged with taking $11 million in CareFusion bribes to have its product added to national standards, settles with the Department of Justice for $1 million. At least he sold his integrity for a great price, netting $10 million after expenses. Meanwhile, briber CareFusion settled last year for $40 million and it’s still a $12 billion market cap company whose shares have risen 50 percent in the past year. Anyone who says crime doesn’t pay needs to get into healthcare.

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A Wall St. Journal article titled “The Next Marketing Frontier: Your Medical Records” highlights the alerts and reminders sent to patients in Practice Fusion’s EHRs, with some of those messages paid for by drug companies. Practice Fusion’s CEO defends the practice, saying that with regard to the alerts and presumably the company’s free EHR, “someone has to pay for it” and adds that new agreements have been signed to deliver sponsored alerts from Aetna and another drug company. He also states, “For every project we do that drives forth public health or gives data away, we need to make sure it’s balanced out by a monetizable exercise.”

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The Wall Street Journal highlights a Health Affairs-published study that found major inconsistencies in the “best hospitals” lists published by four sources (US News & World Report, Consumer Reports, Leapfrog Group, and Healthgrades). Only 10 percent of the hospitals that were highest rated by one service received an equally high ranking from even one of the other three, while 27 hospitals that were named among the nation’s best by one service were named as among the worst by another (UCLA’s Ronald Reagan Medical Center being an obvious example). Lead author Peter Pronovost, MD, PhD says just about every hospital tops somebody’s list and urges better methods “so it isn’t just a beauty pageant.”


Sponsor Updates

  • Impact Advisors publishes a white paper titled “Selecting a Population Health Management Vendor: Taming the Wave.”
  • PatientSafe Solutions posts “Quality care and Mobility: Case 2.”
  • Caradigm is participating in the iHT2 CHIME & Health IT Summit through March 4 in San Francisco.
  • Aventura and Bottomline Technologies are exhibiting at the Spring Hospital and HealthCare IT Conference through March 4 in Orlando.
  • CareTech will host the New England HIMSS & Social Networking event March 10 in Warwick, RI.
  • AirStrip writes about “Bringing Up Baby: the Value of Remote Monitoring for High-Risk Pregnancies.”
  • AtHoc writes about its work with the Red Cross.
  • Besler Consulting looks at the “State-by-State Impact of Readmissions Penalties for 2015.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 3, 2015 News 3 Comments

Morning Headlines 3/3/15

March 2, 2015 Headlines No Comments

CMS announces release of 2015 Impact Assessment of Quality Measures Report

CMS publishes a report measuring progress made on quality measures since 2006, finding that improvements have been made in 95 percent of the 119 publicly reported performance measures reviewed.

NantHealth and Allscripts Join Forces to Develop Precision Solutions at Point of Care in This Era of Genomic Medicine

Allscripts and NantHealth will partner to develop genome-based clinical decision support features within Allscripts’ EHR that will help oncologists create  personalized cancer treatment plans.

VA boosts telehealth budget for 2016

The VA has requested $1.2 billion for telehealth services in its 2016 budget request, up $126 million over last year.

AMA continues push for MU changes

AMA applauds CMS’s decision to extend the MU attestation deadline for eligible providers, but complains that even with the extension the program is too rigid and still needs to be overhauled.

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March 2, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 3/2/15

March 2, 2015 Dr. Jayne 1 Comment

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I received an email from ONC on Thursday that they were extending the deadline for nominations to the HIMSS Interoperability Showcase, citing “feedback that organizations needed more time to submit nominations for participation.” From the time the email arrived, that’s a whopping three business days until the deadline. It made me wonder exactly why the deadline was extended and what their current applicant pool looks like. If they were delaying because they didn’t have many applicants, then they hardly gave much of a window for organizations that weren’t already prepared. Was the announcement a way to raise awareness about the Showcase rather than being designed truly to solicit participants?

Perhaps organizations didn’t apply because they didn’t want to spend $8,000 to participate. That’s just for the kiosk at the Showcase, which includes a monitor, keyboard, mouse, power, and Internet connectivity as well as two exhibitor badges. Travel, meals, and lodging will be on top of that. We’re doing some cool things with interoperability at my health system, but they’re not about to spend upwards of $12K for developers to go show it off at HIMSS.

Whatever the reason, I can’t help but think about the ongoing list of government initiatives that have to be delayed, extended, or otherwise modified because they don’t seem to be achieving the desired results. Being a process improvement person, I’m always looking for the root cause when outcomes are not achieved or when projects run off the rails. Recently, we’ve had delays in ICD-10, Meaningful Use, and Healthcare.gov. Some of us, however, remember delays in the implementation of the 5010 claim standard and those of us deep in the weeds know about dozens of lesser-known parts of HIPAA and other omnibus legislation that are virtually unimplementable.

In medicine, we have a doctrine about ordering laboratory and diagnostic tests: don’t order it if it’s not going to change your plan for the patient. I do a lot of work with reporting from our EHR data and we have a similar dictum: don’t run the report if you’re not equipped to act on it. You’d think there would be a similar mantra about not making rules that people can’t actually follow, but that doesn’t seem to be a factor for those happily engaged in rulemaking. Only in healthcare do we come up with creatures like the “Two Midnight” rule and other similar nonsense.

My extended family is always asking about some of the wacky things that go on, such as provider-based billing, which allows hospital-owned practices to charge both a professional fee and a facility fee for outpatient visits. I’ve become as expert at explaining the Medicare Part D “donut hole” as I am at teaching patients to use a home blood glucose monitor. In trying to find some method to the madness, I stumbled on an article that attempts to explain why healthcare regulation is so complex. The first paragraph opens with a perfect summary: “Health care professionals may feel that they spend more time complying with the rules that direct their work than actually doing the work itself.”

The author contends that “regulation arises largely from a set of confrontations between opposing interests that created the system.” I agree that there are clashing agendas and learned that first hand as a young physician when the hospital’s chief of staff wanted to know why he wasn’t getting my referrals. It felt more than a little like a shakedown. He wasn’t aware that I sent nearly all of my referrals in his specialty to one of his partners, so at least his practice was seeing volume if he wasn’t personally. It didn’t matter, though, since it was apparently all about his ego. These conflicting agendas are ongoing, and “Doctored: The Disillusionment of an American Physician” talks about one physician’s struggle.

Although there are certainly turf wars at play, the regulatory soup includes rulemaking at so many levels that it’s nearly impossible to keep track of what needs to be done. I have to follow the rules of multiple hospital medical staff organizations, two state licensing boards, two specialty certification boards, one professional society, dozens of payers, the city, the county, the state, and the federal government. These rules (and non-rules that often have the force of law) sometimes conflict each other and often fail to make sense.

Several times in the last few decades, studies have looked at everything a primary care physician should be doing for his or her patients and how long that would take. An article in the Washington Post summarized the most recent data from the Annals of Family Medicine, which found that for a typical panel of 2,300 patients, the physician would have to spend nearly 22 hours a day to provide all the recommended care. That’s just delivering the care itself – it doesn’t factor in the time needed to comply with everything else a physician does such as arguing with payers, managing staff, dealing with regulations, worrying about compliance with programs, and trying to stay current with medical knowledge.

That’s what we’re dealing with in the ambulatory setting. Hospitals and health systems deal with many more rules and countless regulatory bodies. Similarly their IT departments are trying to keep the systems up and running, prevent breaches, avoid breaking something that’s required for Meaningful Use, and so on. It’s no surprise that people are not coming out of the woodwork to sign up for the Interoperability Showcase.

What regulations keep you hamster wheel spinning? Email me.

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March 2, 2015 Dr. Jayne 1 Comment

HIStalk Interviews Phil Kamp, CEO, Valence Health

March 2, 2015 Interviews No Comments

Philip H. Kamp is CEO of Valence Health.

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Tell me about yourself and the company.

We’ve been around since 1996. The vision of the company is that providers should be in charge of how healthcare is delivered, and for them to be in charge, they have to be at risk financially. Our job is to help provider organizations decide on the level of risk, help them figure out how to organize around the risk, and then manage the risk.

We have products around analytics. We operate all the way to a provider-sponsored health plan. We manage those things, so we pay claims, we do care management, customer service … all the functions you would do to run a health plan. It’s moving groups through the value-based care spectrum to any level of risk that they want to be.

 

How do you think HHS’s seemingly ambitious goals in moving quickly toward value-based payment will go?

I think it’s good. The general issue for us has been that their approach to doing training wheels was a problem. The old version of the shared savings models — we don’t think they were good enough or strong enough. They tried getting into risk, but what’s happened is those organizations –  from funding it and actually operating — are finding they are not being successful, most of them, and they just need to assume more risk. We would like to see more risk in those rather than less risk. We think the moves that they’re making now make a lot more sense.

 

Insurance companies and doctors have always been blamed for healthcare costs, but people are recognizing that hospitals and their increasing clout in driving favorable contract terms are a lot of the problem. Do you see HHS or CMS addressing the cost role of hospitals?

It’s interesting because the hospitals can play a major role in this if they do it right. You’re right that if they get market share, they certainly can drive pricing from that perspective. But I think if you get into more risk, where you’re actually getting a PM/PM amount, the hospitals are a large part of the cost and they’re going to be the organizers.

Hospitals should play a major role, but it’s not on a fee-for-service basis. They’re the ones who can organize the doctors and pull together an organization that can assume the risk, so I see hospitals having a major role. The market share issue is an important one, but if you’re getting into competitive PM/PM insurance-type rates, that’s where you need to go with this.

 

Back in the HMO days and attempts at moving to a capitated model, assembling risk pools that made actuarial sense was also politically awkward because you had to decide who you could afford to cover. If you’re a hospital and you’re trying to figure out the steps toward accepting risk, how do you define and measure your risk for the population that you have?

We still have conversations with some insurance companies that are saying, I get a PM/PM and I want the healthy people, I don’t want the sick people. I think that’s what you’re getting at. From a risk entity perspective, as provider groups get into risk, the population that really needs to be taken care of are those more expensive people. 

What we need to do is make sure that the PM/PM that we’re getting for that population is the right PM/PM. That was a problem in the old models. You had in a market where say the commercial PM/PM was $200 and you had an academic medical center taking in a population and got adverse selection, their cost might have been $300 PM/PM. We need to make sure that for the population that you’re responsible for, we’re looking at the dollars that are being spent on that population, then managing for that as compared to the old insurance model. That’s an important element of this.

 

Nobody wants the high-cost patients, but it’s not usually acceptable to charge those patients more. How many ways can the buck be passed?

Somebody is paying for it now, right? Those people are getting coverage, or they’re not getting coverage and they’re just using the ERs and hospitals to get their care. It’s recognition of that population and making sure that they have coverage. There’s great opportunity to manage that population better than it’s being managed now and the overall dollars will go down.

You just need to make sure you tie the actual expense for an individual, so if X-person costs $1,000 PM/PM, that should be the basis for the risk of that particular patient or that particular population. You need to tie the cost of the person to the actual risk that you take, or the cost of the population to the risk that you take, as compared to saying, “The overall population is $200 PM/PM, so let me try to get all the people that are $100 and leave the $300 people out.” 

Somewhere, that $300 person is getting healthcare. We just have to do a much better job of making sure that the dollars that we’re spending per person is where you take on the risk for that population at that dollar base.

 

As health systems and insurance companies start looking more alike, what technologies and information do each have that the other needs?

From a health system perspective, very few have the technology and the information to actually manage the population. A hospital has its information and each individual physician may have his or her information. The hard part has been aggregating the data for a population. 

If you take any given market, you probably have some physicians that are employed by a hospital, you have independent physicians … they all have different EMRs and different practice management systems. One of the keys is data aggregation. Maybe 10 years from now it will be different, but right now the key is tying all those systems together into one platform. It sounds like an HIE, but it’s the analytics behind that data that becomes important. There’s got to be ways of collecting that data from everybody and then doing the analytics around that. It’s the pharmacy data, it’s the lab data. There may be 300 different practices that may have 70 different practice management systems and EMRs.

You’ve got to be able to tie that data together to do the analytics. To me, that’s the biggest gap that exists today — pulling that data together, figuring out what it’s actually costing for that population, and managing that data to manage the care better for that population.

 

What health system metrics will be important to monitor for long-term success?

Today they’re focused on a patient entering their system and how they manage that patient who’s sick. They have to move to a higher level of managing the population as a whole. They’ve got to get a whole different level of data.

Once you’re within a system and you’ve determined how care should be provided for that population, you now have to determine if the services that are needed are actually getting done within that village. If you have multiple health systems in a marketplace, which is usually the case, how do you make sure that the services are all getting done, especially if people leave the system? The physicians in that particular organization have agreed on how care should be provided. You need to push those services to within that organization and make sure that you’re tracking it and making sure things are getting done. 

If a diabetic is supposed to get an eye exam, we need to make sure that the eye exam is done by the ophthalmologist that’s in the network and not outside the network, because if it’s done outside the network, we probably don’t have that information. It gets back to the data aggregation piece and managing the population as a whole.

 

Explain what “narrow network” means.

I think of it as a village of hospitals and physicians that have come together to agree on how care should be provided and agree on the level of risk that they’re going to take. Do they become a health plan, do they just do risk contracting with health plans, do they do a combination of things? It’s that organization that’s made that decision and then it’s got it technology that it needs to manage that in its operation.

What’s really important is that you don’t separate the technology from the operations. There are a lot of smaller technology firms or single-source technology firms that are doing one piece of this thing. But there really needs to be an overarching perspective on how the technology relates to the actual performance on these risk contracts. There’s operational pieces, there’s technology pieces, and then there’s just network development pieces.

For people on the IT side, the biggest thing is around data aggregation, the management of that data overall, and how that helps the operational people succeed in making sure that you’re caring for that population as best you can so you’re managing that population and the best quality of care is given at the lowest possible cost. Getting that information that’s not just from the hospital, but from these other independent sources, and getting it on a daily basis so that you can track what’s actually going on and manage the population going forward and helping your physicians and their practices figure out what needs to happen in the next six months with a population of people.

 

Do you have any final thoughts?

The main thing to me, and one of the things that I hear in the marketplace, is that as a health system doing this, you have to be really big. I don’t think that’s the case at all. There is a certain life threshold that you need to manage and there’s no question about that, but that life threshold doesn’t require you to be a mammoth system at all.

Groups, provider organizations coming together to cover a state is certainly an approach to do this, but again, I don’t think you need to be a 5,000-bed system in a particular marketplace. You don’t want to be a 50-bed hospital. There’s a certain size that you need to be to do this, but it’s not huge. 

The level of risk for a provider assuming risk is very different than the level of risk for an insurance company to assume risk. If you’re UnitedHealthcare and you have a patient in a hospital and that patient cost $50,000, UnitedHealthcare has a direct expense of $50,000 for that patient. Now you take a health system that has that same patient in their hospital, what does it actually cost that health system to provide care for that patient? Eighty percent of the costs in a hospital are fixed. It’s much less costly for them to assume that risk as long as the care stays within that network. If it leaves the network, they have the same situation as United has. But as long as they stay within the network, it is much less risk for a health system to assume risk. 

Another way to say that would be, if you’re a billion-dollar health system and I told the CFO tomorrow they were going to get a billion dollars in revenues next year, would they assume that’s more risk or less risk? I would say that everyone would say that it’s less risk. That’s full capitation from that standpoint. The concept of risk on the provider side is much less risky.

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March 2, 2015 Interviews No Comments

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