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Morning Headlines 5/9/16

May 8, 2016 Headlines No Comments

American College of Physicians: Sylvia Mathews Burwell

In a speech given at the 2016 ACP Internal Medicine Meeting, HHS Secretary Sylvia Burwell assures providers that Meaningful Use complaints are being taken seriously and that the department is “working to address things like burdensome reporting and inflexible requirements.”

Saint Agnes Medical Center victim of data breach

Hackers running a phishing scam steal the W-2s of 2,800 Saint Agnes Medical Center (CA) employees.

Cerner (CERN) Q1 2016 Results – Earnings Call Transcript

During its Q1 earnings call, Cerner President Zane Burke reports that the company has reached an all time win rate against competitors, primarily Epic, driven by software improvements, lower cost of ownership, and open platform capabilities.

Allscripts Healthcare Solutions (MDRX) Paul M. Black on Q1 2016 Results – Earnings Call Transcript

During its Q1 earnings call, CEO Paul Black notes that the company is building a precision medicine hub, “bringing together clinical, genomic, and consumer-based information to a centralized database.”

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May 8, 2016 Headlines No Comments

Monday Morning Update 5/9/16

May 8, 2016 News 5 Comments

Top News

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HHS Secretary Sylvia Burwell tells the American College of Physicians that not only do some EHRs lack interoperability, but health systems sometimes don’t want to share information and providers aren’t paid in a way that rewards information sharing. She acknowledges that Meaningful Use has been hard on doctors with its “burdensome reporting and inflexible requirements.”

Burwell says HHS will set common interoperability standards, chane the culture in hospitals and practices regarding the right of patients to access their own information, and make sure its rules and regulations support the smooth movement of healthcare data.


Reader Comments

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From Frank Poggio: “Re: MACRA. Dr. Halamka’s assessment isn’t surprising. The federal government’s objective is to control healthcare costs even though most of the escalation is due to societal failings like obesity and smoking. The provider is stuck in the middle and the middle gets squeezed every time. Providers play ball with payers and government trying to keep impending regulations from going off the track, and when the changes don’t meet the cost savings goal the feds sold to Congress, the bureaucrats have no choice but to go off track, blaming it on providers and promulgating even more onerous rules (remember that HITECH was supposed to pay back $800 billion over 10 years). This bureaucratic insanity will continue as the government continues to ignore the basic issues that drive healthcare costs. Unfortunately, that guarantees there will be many versions of the good Dr. Halamka over succeeding decades.”

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From Skitch Henderson: “Re: medical error deaths. How many of those were IT-related, I wonder?” We in healthcare unfortunately kill some patients with the best of intentions but the worst of execution, but nobody really knows how many, much less how those deaths break out by individual cause. Keep in mind that the widely-quoted recent study (with obligatory clickbait headlines, including that of the Washington Post above that inserts the incorrect “now” in falsely suggesting a fresh trend) doesn’t represent new information or signify a rising trend – the authors merely used a different calculation method to create a new estimate from old data using massive extrapolation. Even the authors seem embarrassed that their results have been so overblown in trying to put a new number on an old problem using questionably useful methods. We simply don’t know when medical treatment causes a patient’s death – you can bet that a lot of death certificates say “heart attack” only because nobody knows for sure.


HIStalk Announcements and Requests

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Two-thirds of poll respondents think MACRA’s Advancing Care Information is better than Meaningful Use. Meltoots says it’s just more of the same for physicians who are already burned out, adding new measures that haven’t been proven to improve care, cost, efficiency, safety, or interoperability. New poll to your right or here: who is most responsible for physician dissatisfaction? Like those dissatisfied physicians, I am interested in your personal narrative and not just your check-the-box answer, so click the poll’s Comments link after voting to document your story.

It occurs to me that the acronym-obsessed healthcare industry hasn’t yet abbreviated the new program, so I hereby dub it MACI (MACRA Advancing Care Information). You are welcome.

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Mrs. R from Ohio says her third graders ask every day if it’s a tablet day, referring to the iPad Mini and case we provided in funding her DonorsChoose grant request. Her students are using it to practice their math skills, perform research, and teach each other to use the iPad.

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Also checking in is Mr. Willet from North Carolina, who says the faces of his elementary school students light up with pure joy when he brings out the programmable robot kit for his digital lab program, which he says enhances not only their math skills, but their communication and critical thinking. A surprising 15 percent of the students in his school are homeless, so the only technology access many of them have is at school, and quite a few students go home on Friday with donations from the local food bank in their backpacks. It’s interesting that schools are better than hospitals at identifying social determinants of health and connecting those in need with resources.

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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Last Week’s Most Interesting News

  • BIDMC CIO John Halamka criticizes proposed MACRA rules, saying that nobody can understand them and that it’s time for physicians to consider leaving their profession if the government’s trajectory doesn’t change.
  • Siemens Healthcare renames itself to Siemens Healthineers.
  • IMS Health and Quintiles announce plans to merge in creating a pharma services business with $7 billion in annual revenue.
  • Joint Commission reverses its 2011 decision that prohibits sending orders by text messaging, provided that the messaging platform meets specific technical requirements.

Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

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

Here’s the recording of a recent Webinar, “Provider-Led Care Management: Trends and Opportunities in a Growing Market.” Our presenter had audio problems during the live Webinar, so we recorded a new version.


Acquisitions, Funding, Business, and Stock

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From the Allscripts earnings call:

  • President Richard Poulton says the Netsmart transaction will allow patients to be managed across acute and chronic illness to health maintenance.
  • CEO Paul Black says the company is building a precision medicine knowledge hub.
  • Allscripts offers 135 certified solutions in its application store and developers are using its APIs to work on 1,550 applications.
  • Black quoted a recent study that found that 87 percent of financially challenged hospitals regret changing IT systems, 90 percent of nurses say EHRs impede their ability to deliver care, 63 percent of executives say their jobs or those of their peers were threatened by an EHR replacement, and 78 of physicians say replacement EHRs didn’t deliver the expected clinical buy-in.
  • Responding to an analyst’s question about rumored loss of market share in the independent physician segment, Black said that every vendor has churn but that of Allscripts is within expectations.
  • Black expects MACRA to cause some of the nearly 500 certified EHR vendors to leave the market, creating replacement opportunity.
  • Asked about the NantHealth partnership, Black says that two or three Sunrise customers will be going live on integrated Eviti protocols soon and that he expects to gain EHR business from the partnership.
  • Black says the physician complaints in South Australia got more press than either the client or Allscripts wanted, but haven’t damaged the relationship.

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From the Cerner earnings call:

  • The company says its win rate against Epic is at an all-time high, which it attributes to product improvements, predictable delivery, lower cost of ownership, population health capabilities, and an open platform.
  • Cerner says the number of hospitals moving from the former Siemens products to Millennium is ahead of expectations, while the overall financial and operational objectives of the acquisition are on track.
  • The company says its HealthIntent population health management product is a differentiator when competing for new EHR business, with most new customers choosing it.
  • Cerner’s go-forward product for patient accounting remains Millennium, but the company will continue to offer the Soarian product to the 25 percent of the market that wants a standalone patient accounting product.

I checked the five-day share price performance of a few companies that recently announced earnings: Cerner (down 4.5 percent), Allscripts (down 1.7 percent), Athenahealth (down 2.8 percent), McKesson (up 0.2 percent), CPSI (down 12.4 percent), and Imprivata (up 0.4 percent).

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I’m enjoying the savagely clever commentary about Siemens changing the name of Siemens Healthcare to Siemens Healthineers, as the company apparently intends to spin it off (Siemens says the “eers” part refers to “pioneers” rather than “engineers” like you might expect). Much of the scorn involves an employee-posted video (with 450,000 YouTube views) of the obviously expensive yet hilariously awful employee kickoff event that Siemens held in its home town in Germany, which to many typifies everything that’s wrong with big companies — cluelessness, mandatory employee attendance at morale-boosting events that actually kill morale, spending money on frivolity while laying people off, and inadvertently emphasizing the multi-faceted chasm between the richly compensated executives and the trudging masses who do the actual work. Some of my favorite comments from a Reddit topic titled “Siemens embarrasses 44,000 employees with new ‘Healthineer’ mandatory dance concert”:

  • Can confirm – this killed all productivity at our newly-christened Healthineers office today. It was hard to get any work done in between the fits of laughter and moments of dumbfounded shock that anyone, anywhere, thought this was going to be a step in the right direction.
  • Siemens made ovens at Auschwitz. I think they will regret this more.
  • Hawaiian Shirt Friday.
  • Siemens: we’ll lay off 12,000 employees to keep profits up. Now show us how much you love your job! Dance, puppets, dance!
  • First, do no harmineering.
  • This event was probably a huge success. Nothing brings people together quite like hating something together.
  • Look at all those people watching this " concert" in dead silence. That pretty much tells they were forced to attend this s&^%. Besides, this reeks of brainwashing and reminiscent of propaganda videos that dictators release un-ironically.
  • When the camera pans across the crowd … wow. It’s like a bunch of KISS fans who accidentally showed up at a gospel festival, or vice-versa.
  • After this presentation, Hermann von Siemens was exhumed and charged with war crimes for a second time.
  • The balding, middle-aged engineers in the audience seem to be as horrified and bewildered as we are, so we can at least have some faith that the people who do the actual work at Siemens have their s&^% together despite upper management’s cluelessness.
  • I was waiting for one of the blue morph suit guys to tear their mask off, revealing a Michael Scott glowing with so much pride it hurt to look at.
  • It really pains me to know that this is what our healthcare dollars are being spent on.
  • I think the world is finally getting over giggling at the pronunciation of our company’s name. We need to up the ante with something else embarrassing.
  • This is great marketing material … for GE and Phillips. How can a company be taken seriously if they are so out of touch to think this was a good idea?
  • I feel like there must be some elderly Germans left around who would be more than willing to tell you that this is, in fact, a very clear sign of things about to go very, very wrong.
  • It is cringingly awesome how they have the lyrics highlighted as if they thought everyone would want to sing along.
  • Suffering through that pap is one thing, but having to tell people who ask that you work for Siemens Healthineers? That’s torture.

Sales

Grace Health System (TX) selects Patientco for its patient-focused payments solution.


People

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Imprivata hires Aaron Miri (Walnut Hill Medical Center) as CIO and VP of government relations.

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Allscripts hires Tess Coody-Anders (Resolute Health) as SVP/GM of consumer health.


Announcements and Implementations

Centura Health (CO) went live on Epic at five hospitals and their clinics on May 1.


Privacy and Security

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A hacker steals the W2s of all 2,800 employees of Saint Agnes Medical Center (CA) when one of them falls for a phishing email.


Other

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The Irish government gives initial approval to a nine-year, $1 billion plan to provide all patients with a digital health record. The one-year product selection will start at the end of 2016. The first go-live will be the new National Children’s Hospital in Dublin.

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Allegheny Health Network (PA) blames an unexpected operating loss on the one-time costs of implementing Epic.

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The local paper notes that St. Charles Health System (OR) will implement Epic, creating 100 jobs in reversing their late-2014 decision to stick with McKesson Paragon. This will be the health system’s fourth EHR, having previously chosen to move from McKesson Horizon to Paragon.

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Kaiser Family Foundation tweets out a timely graphic showing the primary role mothers have in keeping their children healthy.

This interesting video shows how Cedars-Sinai is using virtual reality to reduce the boredom of hospitalized patients. I would be happy just to get fast WiFi since my one and only night in a hospital for observation was like spending a night in jail – I didn’t get dinner because they didn’t find me a bed in time and all they had was fruit juice, there was no WiFi, my bed was missing the TV remote/call button combo, and I was in the dreaded “semi-private” room (meaning separated by only a paper-thin curtain that allowed every sound, smell, and silhouetted image to pass freely) with a guy who was a lot worse off than me. I was also awakened frequently by the nurse charged with writing down what the gadgets around me displayed, which must have required a lot of her focus because she didn’t notice that my IV ran dry and didn’t give me the meds that were ordered. This was the hospital that refused to give me an electronic copy of my medical records with the excuse that “we only do that for doctors.”

Here’s Part 3 of Vince and Susan’s vendor review. It’s fact-filled and entertaining as always.


Sponsor Updates

  • TeleTracking will host an executive forum on transforming patient access May 10 in Long Island.
  • Midmark closes its acquisition of Versus Technology.
  • WeiserMazars #BestAdvice campaign wins the Association for Accounting Marketing’s National Social Media Campaign of the Year.
  • Optimum Healthcare IT is ranked among the top two Epic consulting vendors for overall broad performance by KLAS.
  • ZirMed will exhibit at the Zoll Data Summit May 17-20 in Denver.
  • Experian Health will exhibit at the HFMA/MO Joint Conference May 11-13 in St. Louis.
  • PeriGen offers a National (OB!) Nurses Week Appreciation Toolkit.
  • Streamline Health will exhibit at the 2016 National Rural Health Association Innovation Summit May 10-13 in Minneapolis.

Blog Posts


Contacts

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

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May 8, 2016 News 5 Comments

Morning Headlines 5/6/16

May 5, 2016 Headlines 3 Comments

A Deep Dive on the MACRA NPRM

BIDMC CIO John Halamka, MD publishes his analysis of the recently released MACRA proposed rule.

Cerner Reports First Quarter 2016 Results

Cerner reports Q1 results: revenue grew 14 percent to $1.14 billion vs. $996 million during the same quarter last year, adjusted EPS $0.53 vs. $0.45, missing revenue projections. Share prices fell four percent in after hours trading.

Allscripts announces first quarter 2016 results

Allscripts reports Q1 results: revenue grew three percent to $346 million but fell short of projections, adjusted EPS $0.13 vs. $0.08.

Ns1ghter Launches Free and Unlimited Doctor Visits

An Austin-based startup launches offering free, unlimited telehealth visits and free second opinion case reviews.

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May 5, 2016 Headlines 3 Comments

News 5/6/16

May 5, 2016 News 6 Comments

Top News

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BIDMC CIO John Halamka, MD dissects the nearly 1,000-page MACRA NPRM and makes interesting points:

  • It’s a zero-sum redistribution rather than a stimulus program –  some clinicians will be paid more while others will be paid less based on performance.
  • MACRA doesn’t impact hospitals or Medicaid EHR incentive participants. For them, Meaningful Use and quality reporting continue.
  • ONC in March gave itself more authority over how EHRs are used in the field, with the proposed MACRA wording requiring clinicians to sign off that they have cooperated with ONC and that they haven’t disabled the interoperability capabilities of their EHRs. He says a lot of people are going to see ONC’s self-proposed surveillance role as overly intrusive.
  • Clinicians can meet the secure messaging and view-download-transmit measures by having a single patient participate.
  • Clinicians must participate for the full 2017 year, use a 2014 or 2015 certified EHR, and report to either eight Stage 2 or six Stage 3 measures in the Advancing Care Information objectives that replace Meaningful Use.
  • Halamka also dryly notes a requirement that clinicians “continue to practice medicine” and that “listening to each patient’s story, being empathetic, and healing are optional.”
  • He concludes that “sometimes when you remodel a house, there is a point where additional improvements are impossible” and says that nobody can understand the 962-page MACRA document, concluding that clinicians probably only have two choices – become a salaried employee or take a hospital job to avoid the complexity.
  • The usually-optimistic Halamka summarizes darkly, “As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.” That’s a significant development since he called for rolling Meaningful Use into a less-prescriptive quality measurement program, but he’s not happy with how it turned out.

Reader Comments

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From EMR Expert: "Re: King Khaled Eye Specialist Hospital in Saudi Arabia. It will become the first hospital in the Middle East to reach HIMSS EMRAM Stage 7.  That’s very good news for InterSystems, hard luck for Cerner and Epic.” Unverified. The InterSystems TrakCare-using hospital, a Johns Hopkins partner, reached Stage 6 in December 2014.

From Compressed Coal: “Re: Quintiles-IMS Health merger. Quintiles acquired Envoy in 1998 to create a competitor to IMS. It didn’t work and Quintiles eventually sold the business to Healtheon / WebMD. Envoy is one of the core assets of Emdeon, which is now Change Healthcare. I guess Quintiles finally got what it wanted all those years ago.” I wince remembering those irrational dot-com days of 2000, when Quintiles sold Envoy to Healtheon / WebMD for $2.7 billion after acquiring it in a $1.4 billion stock swap just a year earlier.

From Chili Dog: “Re: SPARC. CMS has notified the winners of its 10-year, $24 billion Strategic Partners Acquisition Resource Contract (SPARC). Here’s the small business winner list that CMS hasn’t announced yet.” I wasn’t familiar with SPARC, but the RFP description says it’s a multiple award, indefinite delivery / indefinite quantity contract divided into two pools – small business and unrestricted – with a $25 billion ceiling. It is described as, “This contract will provide strategic, technical, and program management advice, guidance, and support services to CMS to facilitate the modernization of business processes and supporting systems and their operations. These systems will include the Federal Healthcare Exchange and Medicare / Medicaid information technology systems. Other Department of Health and Human  Services Operating Divisions (HHS OPDIVs) may place orders under this contract as well.”


HIStalk Announcements and Requests

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Mrs. M from Pennsylvania is using the three iPad Minis, cases, and document camera we provided in funding her DonorsChoose grant request to challenge her second graders with STEM skill exercises and games. She adds that the students who don’t have access to technology at home are especially excited about learning and working hard.

Listening: new from reader-recommended Purson, an inexplicably obscure female-led British psychedelic band that sounds like all the best musical parts of the trippy early 1970s (Deep Purple, Jefferson Airplane, and The Doors come to mind). The female lead singer-songwriter, Rosalie Cunningham, can and does shred it on guitar. They just started a small-venue US tour. They are outstanding, including their choice of name.

This week on HIStalk Practice: CMS, AMA offer resources for physicians struggling with MACRA. Jonathan Bush sounds off on Athenahealth’s trajectory, gives thanks for Obamacare. DAS Health acquires EHR/PM assets of Jackson Key Practice Solutions. "HIPPA" loses its luster thanks to a fraudulent letter to patients. Tandigm Health rolls out virtual visits courtesy of TouchCare. Warburg Pincus acquires DocuTap. Dr. Gregg channels Prince in his ode to MACRA.

You can rekindle your (hopefully) fond memories of HIStalkapalooza in Las Vegas by checking out Elsevier’s great video. Thanks to Elsevier for creating the video, sponsoring the event, and sponsoring HIStalk for several years. I guess I need to decide soon whether to do it again in Orlando since venue booking is always the first step, but it’s also the scary one where I sign on the line which is dotted an agreement to pay many dozens of thousands of dollars in hopes that sponsors will step up to keep me financially solvent.


Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

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


Acquisitions, Funding, Business, and Stock

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DocuTap, which offers an urgent care PM/EHR, is acquired by private equity firm Warburg Pincus.

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Envero Health, which offers care management and analytics systems, raises $14 million. CEO Dan Neuwirth was previously president and CEO of MedCPU Americas. The company’s website is irritatingly vague and artsy in failing to explain exactly what they’re selling, but a news search turns up its recent acquisition of two other Richmond, VA firms owned by local health systems, one that offers an HIE and another selling call center services. 

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McKesson reports Q4 results: revenue up 7 percent, EPS $1.97 vs. $1.69, meeting revenue expectations but falling short on earnings. Technology Solutions wasn’t mentioned much in the earnings call except to say that margins are improving and hospital revenue is decreasing. Stock analysts didn’t even ask any technology questions as they focused exclusively on McKesson’s core drug business.

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CPSI announces Q1 results: revenue up 51 percent, EPS –$0.07 vs. $0.49, missing expectations for both with the company blaming the timing of its $250 million January Healthland acquisition closing. From the earnings call, Healthland CEO Chris Bauleke has left CPSI well before the 12 months he agreed to stay on to help with the transition.

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Cerner reports Q1 numbers: revenue up 14 percent, adjusted EPS $0.53 vs. $0.45, meeting earnings expectations but falling short on revenue.

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Allscripts reports Q1 results: revenue up 3 percent, adjusted EPS $0.13 vs. $0.08, beating earnings expectations but falling short on revenue.

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The Advisory Board Company reports Q1 results: revenue up 12 percent, adjusted EPS $0.46 vs. $0.30, beating earnings expectations but falling short on revenue.

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The dour German engineers that run the gray metal conglomerate Siemens inexplicably turn their marketing people loose to justify their existence in creating a forcibly fun new identity for the healthcare business, with the end result being that Siemens Healthcare will now be known as – it’s making me retch as I type it – Siemens Healthineers, which sounds overly cheery for a company best known for supporting the Third Reich and bribing government officials. Feel free to sing along with the video above that celebrates the “innovators and family of friends” who mostly seem embarrassed by the corporate misstep that is exploding with mandated joviality around them, with the Disney-esque song running way too long before it finally ends to stunned, half-hearted applause. The only people who seem to be actively engaged in the white-bread proceedings are two on-stage suits, who I assume were in charge since their beaming faces and stiff dancing are the exceptions among an otherwise borderline hostile crowd who would clearly rather be anywhere else. They should have passed out the faux Blue Man Group costumes at the door to prevent the friends and families of employees from recognizing them. Surely the out-of-touch executives that approved the name without thinking it through are horrified by the scorn it is generating, leading to my prediction that it will be quietly retired within a few weeks and everybody who was involved will claim they didn’t know anything about it or were just following orders.

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Startup Ns1ghter offers free, unlimited online access to its board-certified doctors. It boasts of a machine learning platform whose contribution is not described, but that appears to be intended for developing care algorithms. The “free” part is made possible by “funding and marketing partnerships.” The choice of name is bizarre without being memorable (they apparently pronounce it “insighter” without acknowledging the presence of the numeral) and the company’s address on its privacy policy page is a residence in Austin, TX.


Sales

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Salem Regional Medical Center (OH) selects Meditech 6.1 to replace McKesson Horizon.


People

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Rock Health Founder and Managing Director Halle Tecco announces via Twitter that she is leaving the venture capital firm for unstated reasons and destination.

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Kaleida Health (NY) hires Cletis Earle (St. Luke’s Cornwall Hospital) as VP/CIO.

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David Chou (University of Mississippi Medical Center) joins Children’s Mercy Hospital (MO) as VP/CIO.


Announcements and Implementations

Optum, Medecision, and TriZetto launch a set of software and service offerings for state Medicaid Management Information Systems, taking advantage of a CMS change that provides federal funds for states to modernize their Medicaid enrollment, eligibility, and claims systems incrementally.


Government and Politics

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Farzad Mostashari tweets out this CMS actuary’s graphic that shows the expected impact of MACRA on physician payments, which he describes as “financial suicide” for small practices. It suggests that 87 percent of solo practices will be paid $300 million less, or about $3,400 less per doctor. It’s interesting that the bigger the practice, the lower the expected rate of negative adjustment (dropping to just 18.3 percent for practices of 100 or more clinicians). The inevitable consolidation might sound like a good thing economically, but note that hospital consolidation has raised rather than reduced prices and patients are dealing with an even larger indifferent bureaucracy.


Privacy and Security

A hacker called “The Collector” offers 1.7 billion email passwords for sale, stolen from all of the most popular online email services. The hacker is selling the entire package for $1, asking only that positive reviews be posted on a hacker forum. Experts recommend changing passwords for email as well as any other sites where the same password was used.

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Privacy advocates question Sharp Grossmont Hospital’s (CA) use of OR video surveillance in trying to determine which team members were stealing drugs. The hospital hid motion-activated cameras inside the computer monitors of anesthesia machines, thereby capturing video of every delivery and tubal ligation over a year without patient consent. The hospital says the videos show the doctor they suspected pocketing drugs, but the doctor says he was just keeping them handy and other videos show the doses being used on patients. The hospital doesn’t want to give the doctor’s lawyers access to the videos, saying they would invade the privacy of Sharp HealthCare, employees, and physicians.


Other

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The mainstream press picks up an FDA MAUDE database adverse event report filed by Merge Healthcare in which an unnamed hospital customer ignored the company’s antivirus configuration instructions for its Merge Hemo cath lab documentation system, failing to exclude huge medical imaging and data files. The hourly scans caused an incident described as, “A customer reported to Merge Healthcare that, in the middle of a heart catheterization procedure, the hemo monitor PC lost communication with the hemo client and the hemo monitor went black … there was a delay of about five minutes while the patient was sedated so that the application could be rebooted.”

A TransUnion Healthcare survey finds that three-quarters of consumers are worried about increasing healthcare costs as they watch their premiums, co-pays, and deductibles increase even before the 2017 rate increases. I have to assume that the 25 percent who don’t care about healthcare costs are funded in some way by taxpayers who do.

Study authors determine that medical mistakes kill more Americans than all other causes except heart disease and cancer. The study involves quite a few assumptions since death certificates don’t include codes for medical errors and BMJ seems awfully promotional in touting the article, but regardless of methodology, all of us working in healthcare know that patients die because of our screw-ups. Still, it’s hard to say definitively that a given medical error killed a patient, just like it’s hard to say that a given patient died of cancer rather than of chemotherapy complications.

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An LA Times investigative report finds that Purdue Pharma, which has sold $31 billion worth of the narcotic OxyContin, knew that the drug didn’t really offer 12-hour relief as its packing claims, but it  stuck to those claims because the 12-hour dose was the only advantage the patented drug had over older, cheaper alternatives. The company instructed sales reps to tell doctors to increase the dose rather giving it more often, causing many patients to be ordered dangerously high doses and to go into withdrawal even while failing to achieve pain relief, feeding a cycle of addiction in which seven million Americans have abused the drug. Meanwhile, the company’s owners (the Sackler family whose name adorns several art museums) have amassed a $14 billion fortune.


Sponsor Updates

  • Ingenious Med launches a year-long bus tour to offer guidance to providers on how to lower costs through improved care.
  • Influence Health announces the 2016 EHealth Excellence Award winners.
  • Cumberland Consulting Group is rated by KLAS as the top-performing targeted Epic consulting firm.
  • InstaMed sponsors the 21st annual Taste for a Cure at UCLA Health.
  • PokitDok joins CommonWell Health Alliance.
  • Visage Imaging will exhibit at ACR 2016 May 16-17 in Washington, DC.
  • Netsmart will exhibit at the Decision Coordinated Health Care Summit May 9 in Baltimore.
  • Obix Perinatal Data System will exhibit at the Philadelphia Pregnancy Center Prenatal Summit May 5-7 in Philadelphia.

Blog Posts


Contacts

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

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May 5, 2016 News 6 Comments

EPtalk by Dr. Jayne 5/5/16

May 5, 2016 Dr. Jayne No Comments

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Most of my colleagues are lamenting the proposed rule for MIPS and APM, citing the control that CMS is going to have over their day-to-day practice of medicine. I didn’t know until Wednesday, though, that the reach of CMS went even farther into the realm of fire safety. A newly-released final rule applies to hospitals, long-term care facilities, critical access hospitals, inpatient hospices, ambulatory surgery centers, religious non-medical healthcare institutions, programs for all-inclusive care for the elderly, and intermediate care facilities for individuals with intellectual disabilities.

The rule adopts provisions from 2012 fire codes. Unlike the MIPS rules, which require all kinds of work prior to January 2017, this rule gives facilities 12 years to come into compliance with sprinkler requirements. It also regulates the kinds of home décor items allowable in long term care facilities.

NCQA has weighed in on the proposed rules to implement MACRA, coming out in support, which is not surprising. They specifically cite independent third-party validation of Patient-Centered Medical Homes and Specialty Practices as a plus. If there is one thing that does make sense about the proposed rule, it is that patient-centered care is a winner. Practices that aren’t sure what they should be doing might want to consider a serious look at the models if they haven’t already.

I’m doing quite of bit of work lately with a customer who is switching EHRs. It always amazes me how easy people think this is, before they actually dig into it. The receiving vendors tend to over-promise on their ability to lift the data from the old system and place it into the new system in a usable fashion. Of course, they don’t mention that this often depends on the willingness of the legacy vendor to participate. Sometimes the legacy team will perform the data extract and sometimes a third party is used, but there is at least some baseline cooperation needed, especially if the legacy system is hosted.

Depending on the quality of the source data, there may be some degree of massaging of values to map to new data formats. Sometimes this requires clinical input, which can be extensive. When organizations look at the cost of physician time needed, it may impact decisions on how much data an organization decides to bring forward.

In this particular situation, the client is using a third party to perform the extract and manipulate the data so that the receiving vendor can perform the database insert. My client was concerned about some of the proposed mappings, so they asked me to take a look. I immediately identified some issues, and when I asked about them, the extract vendor became evasive. That’s never a good sign.

Working on behalf of the client, I asked to be put in touch with their clinical resources who were processing the data. It turns out they are using people who aren’t necessarily clinical. The extract vendor is actually operating from his home in a resort town in Thailand. On one call, I’m pretty sure I heard waves lapping in the background.

I asked the client to also reconsider their scope for the extract. They had been planning to move all the clinical data, but given that they have more than 15 years of data in their legacy system, it might not be the best clinical decision. If there are issues with data, it’s a lot easier to correct the most recent three to five years of data than trying to manipulate decade-old data that might involve drugs that no longer exist or diagnoses that are no longer valid.

We had already had a very difficult conversation about using the new system as their archive. They had originally planned to migrate all their patients, even if they were expired. It remains to be seen how this is going to work out, but the extract vendor is supposed to be working on another data pull for the client to review with me. I hope they’re successful, but in the immortal words of Han Solo, I’ve got a bad feeling about this.

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AMIA has announced its InSpire 2016 event, which is specifically dedicated to informatics educators. Expanding beyond the Academic Forum, the conference is seeking submissions around education innovation. Additional topics include academic career advancement, informatics for curriculum developers, research, and data science.

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DocuTap is hosting its annual user group June 15-17 in Sioux Falls, SD. It should be an interesting meeting since they were just acquired by private equity firm Warburg Pincus. The event is free for clients and includes sessions on telehealth, analytics, and target-marketing to payer specific patients. I got a kick out of their “20 reasons to attend” document which included the ability to take extra time off to visit Mount Rushmore and the Black Hills, noting that it is an additional five-hour drive across the state.

Next week is National Nurses Week, held May 6-12. Being in clinical informatics, I’m proud to work with quite a few informatics professionals who are nurses, as well as nurses who specialize in nursing informatics. I’m also eternally grateful to the nurses at St. Somewhere who saved my backside repeatedly during my first rotation in the coronary care unit as a resident physician. They taught me a tremendous amount of real-world medicine.

They also taught me the value of respect – they knew I respected their judgment and knowledge, so they batched their questions for me throughout the night so I could get a little sleep (unlike my counterparts who got paged every 15 minutes because they were jerks).

Has a nurse made a difference in your career? Email me.

Email Dr. Jayne.

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May 5, 2016 Dr. Jayne No Comments

Morning Headlines 5/5/16

May 4, 2016 Headlines 1 Comment

Email from insider led to Epic Systems’ $940 million legal win

A disgruntled Tata Consultancy employee working at Kaiser Permanente alerted Epic that the company had been illegally downloading trade secrets through Epic’s UserWeb. The employee had reportedly been passed up for a promotion.

IBM Gives Free Storage to ResearchKit Users

IBM announces that it will host ResearchKit apps on its Watson Health hosting platform for free.

Acting Administrator Slavitt Speech at the American Hospital Association’s Annual Membership Meeting

During the AHA Annual Membership Meeting, CMS Acting Administrator Andy Slavitt called on doctors to engage in the rule writing process while MACRA was in its public comment period.

Medical Errors Are the Third Leading Cause of Death: Study

A BMJ study estimates that medical errors kill 250,000 Americans each year, making it the third leading cause of death in the US.

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May 4, 2016 Headlines 1 Comment

HIStalk Interviews Travis Good, MD, CEO, Catalyze

May 4, 2016 Interviews 2 Comments

Travis Good, MD is co-founder, CEO, and privacy officer of Catalyze of Madison, WI.

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Tell me about yourself and the company.

My background is technology — focused specifically on cyber-security — clinical medicine, and the business of medicine. All converging in the arena of healthcare technology, which is where I’ve been for the past eight or nine years.

Catalyze is a three-year-old company that we built. The name is intentional. We help catalyze the shift within the industry from volume to value. We did it, not by building a specific type of application, but by building infrastructure that enables a thousand flowers to bloom within digital health.

How much of a startup’s efforts to get to scale are impeded by compliance or integration issues?

Obviously our thesis is that it’s a significant amount. From a previous venture, we estimated somewhere around 40 percent of product effort is spent on those two areas.

What kinds of companies seek you out and what help do they need?

It’s probably helpful to split it into two buckets. On the smaller side, there are vendors that are just getting started, signing and onboarding their first one to three hospital customers. In those cases, they’re fresh. They’re looking for a solution. They haven’t really tried that much themselves. They’ve done enough research to know that it’s something that they don’t want to try to do themselves.

The larger vendor side has companies that are pretty well established and are getting pushed by their hospital customers to integrate with the EHR. A lot of those customers have looked around. Some have tried to do it themselves using different tools and ended up coming to us because they just don’t want to manage those tools and that process themselves.

For those customers that had something in place and decided to replace it, what was the value to them of turning that over to Catalyze to manage?

With larger vendors and anybody who’s scaled beyond probably five or 10 hospitals – and we have vendors that have hundreds of hospital customers — there’s significant value at that scale in having a consistent partner, where they don’t have to tweak their application for each one of their hospital customers. Essentially, we manage the different endpoint connections for them across, 10 to 50 or maybe a couple of hundred hospitals.

They have just one consistent endpoint from Catalyze. They don’t need to do a lot of custom development on their application for each subsequent hospital that they onboard. In a lot of respects with those larger vendors and in terms of integration at scale, there’s a lot more value than at just a handful of hospitals.

What would be the challenges for a company new to healthcare to build that infrastructure themselves?

Compliance and integration raise the bar in healthcare. They’re unique to healthcare. They definitely raise the bar compared to building and selling technology into other industries.

I think that there’s two core value propositions that they get from using Catalyze. One, it is a significant amount of work from a technical perspective to set up and manage infrastructure that is secure and compliant and does things like monitoring and intrusion detection and vulnerability scanning and all of those different pieces.

Then the secondary value in healthcare is that increasingly — especially with all the recent high-profile security breaches — there’s the requirement not just of saying that you’re in compliance, but being able to prove it. Those components that we offer — intrusion detection, logging, and backup and disaster recovery — have all been fully audited and are HITRUST certified. Our customers inherit not just that technical work from us, but also the proof and the audits from us to help expedite their sales process.

Some of those breaches involved business associates. How can covered entities protect themselves better with regard to their business associates?

Those things definitely changed a few years ago with the HIPAA Omnibus rule that expanded who was covered under HIPAA and who had to participate in the form of business associate agreement. It remains challenging for covered entities because they work with a myriad of business partners, business associates, and vendor customers or partners. The major challenge is that business associate agreements aren’t really standardized. Comparing business associate agreements is an additional level of work. Covered entities have to deal with that across all of their partners and business associates. That is a challenge for them.

A lot of large payers have standardized on HITRUST as a framework and as a more true certification, which goes beyond the business associate agreement. It certifies a lot of the different technical pieces and organizational requirements of HIPAA. It standardizes it across NIST, PCI, and a bunch of other frameworks. To expedite that process — not just through these business associate agreements, but also to assess the security of a partner or business associate — HITRUST is becoming the accepted standard in the industry.

Will we see more componentization or segregation of technical capabilities as cloud-based systems extend the functionality of EHRs?

Two or three years ago, every answer was, “Our EHR vendor is going to get around to it." Increasingly, that has changed. It has opened the door to telemedicine solutions, bundled payment platforms, and clinical communication solutions. All these other tools. 

The same is true of interoperability. CommonWell was announced. FHIR has been in the works for some time now. Increasingly, EHRs have not made it any easier to integrate. If you don’t have this middle layer, this componentry,  every company ends up reinventing the wheel. That is incredibly inefficient, both from the company’s perspective as well as from the hospital or health system’s perspective.

Increasingly, there is a need for that middle layer. There is a need to secure that connectivity and standardize it from the EHRs to the digital health tools, solutions, and services that are increasingly serving healthcare customers.

Healthcare is not unique. A company called Clever in education frees data from educational systems and standardizes it so that health applications can be created and distributed for schools. Healthcare is in need of much of the same thing. EHRs have been too slow to cover those things themselves. They’re not meeting the timelines that now the government has mandated things like MACRA and MIPS. There is a need for that middle layer componentry.

Are EHR vendors still trying to protect their own interests or are they now open to the idea that customers need third-party solutions?

Healthcare customers are demanding it. EHR vendors like Athenahealth have been out ahead with their More Disruption Please program in terms of creating an ecosystem. Increasingly, healthcare or EHR customers are demanding it. You saw the trend where consolidation on a standard platform was the epic stage of growth in the industry.

Now as we shift, we see new technologies coming into healthcare to deliver value that is needed by the health system customers. I mentioned some examples like bundled payments or virtual care solutions that then direct people to the appropriate levels of care and reduce costs. All of those different pieces.

Those are things that health systems desperately need to start implementing across increasingly large portions of their population. They are now saying that the EHRs aren’t necessarily going to get there. It’s not that EHRs aren’t going to remain the hub of clinical data and the hub of clinical workflow within the health system, but we will increasingly see these EHR add-ons, digital health solutions, and ecosystems.

Kaiser has already tested, piloted, and is starting to scale a lot of different solutions. Kaiser is a little bit different,  but it does reflect the direction the industry is going. I think we’re going to see a lot more with a lot more health systems.

What challenges will vendors experience in trying to open their systems up with APIs?

They should look at standards like FHIR. It’s gaining a lot of interest and "adoption," quote-unquote. “Adoption” because it’s  hard to find FHIR in the industry that’s actually implemented in production. Looking at something like that is probably a good guidepost for how to think about enabling access to your EHR. Cerner and Epic are the two big beasts, but increasingly, practice-based, specialty-based, all these other EHRs need to also be thinking about it. Looking at something like FHIR is probably the right approach. At least from the organizations that are promoting FHIR, it seems to meet the requirements in terms of accessing EHR data.

What have you learned from creating a company?

One of the biggest things is saying no and not pursuing certain things. When you look at healthcare, there’s a lot of opportunities and a lot of things that seem broken, inefficient, not optimized for care, and all the things you assume healthcare should be built around. But you can very quickly go down a rabbit hole if you don’t have focus. 

A second thing is being  very open about what you’re doing, even if it’s early stage. Getting feedback, finding mentors, finding people at organizations that may be customers down the road, getting their feedback. Not being too what people call "stealthy" or a "stealth" type of startup, but being open about what you’re doing. 

Success is ultimately going to come down to execution. Scaling a company is going to come down to execution. You have to be much more open about the idea and what you’re doing if you want to be successful.

Do you have any final thoughts?

Having spent time at HIStalk writing about digital health and companies that were building solutions for the next wave of healthcare and then jumping to the other side of building a company that then helps those vendors and those different technologies of scale has been incredibly exciting. I get to work with a lot of companies that I used to write about and I was excited to see their history.

The industry has moved much faster than I expected in  embracing these digital health solutions and EHR add-ons. It’s exciting to see some of these digital health solutions start to scale and then get research and data about how they actually work. It’s very, very cool.

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May 4, 2016 Interviews 2 Comments

Morning Headlines 5/4/16

May 3, 2016 Headlines No Comments

IMS Health and Quintiles to Merge

Quintiles, the parent company of Encore Health Resources, will merge with IMS Health, resulting in a company with $7 billion in annual revenue.

Imprivata Announces First Quarter 2016 Financial Results, Revenue Growth of 23%

Imprivata reports Q1 results: revenue climbed 23 percent to $25.6 million, adjusted EPS –$0.21 vs. $-.24.

How a tiny hospital has imperiled Mass. Medicare funds

Hospitals in Massachusetts face a potential ten percent drop in Medicare funding after consultants hired by the state’s only rural hospital, 19-bed Nantucket Cottage Hospital, miscalculate annual wage costs which are used by Medicare as a baseline for all hospitals in the state.

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May 3, 2016 Headlines No Comments

News 5/4/16

May 3, 2016 News 4 Comments

Top News

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Pharma services firm Quintiles – which acquired Encore Health Resources in 2014 – will merge with drug data and marketing firm IMS Health, creating a drug data behemoth with 50,000 employees and $7 billion in annual revenue.

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Quintiles founder Dennis Gillings, PhD was a biostatistics professor at University of North Carolina at Chapel Hill when he founded Quintiles in 1982, eventually making him a billionaire.  IMS Health is mostly known for selling drug prescribing and dispensing information to drug manufacturers to allow their salespeople to aggressively market their products to physicians.


Reader Comments

From Spiffy Duds: “Re: [vendor name omitted]. Glassdoor reviews say the place is imploding, running scared about Epic threat, losing customers and employees, late on software, new platform released with huge issues. The new president runs a fear-based shop and can’t stick to a strategic decision. The owner knows nothing about healthcare and is an incurable narcissist who believes the company is saving lives and doing things that no one else can do.” Unverified. I’ve omitted the company name since anyone can say anything on Glassdoor, plus Glassdoor now allows full viewing of comments only to those who write a review or submit a salary, of which I’ve done neither.  

From Publius: “Re: Coast Guard and Epic. It’s quite the coincidence that Leidos deleted the Coast Guard’s Epic SAN while working with Cerner on the DoD project.”


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mr. S from New Mexico, who asked for electronic circuitry to help Zack, a student in his high school class who has set his sights on obtaining a Harvard math and engineering PhD. Zack reports, “I thank you for empowering me to use electronic circuitry components to create Arduino circuits that I code and assemble. This is most exciting because I can use circuitry components that I previously was unable to access. Thank you for allowing me to do this.”

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Also checking in is Ms. W from Arizona, whose preschoolers are learning “sight words” in the 10 minutes per day she has set aside for using them. She reports, “These tools may be small to some, but to my students who do not have the opportunity to have these things, it is a great essential. I can’t wait to continue using these tools for the years to come in my classroom and see the great learning that happens.”


Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

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


Acquisitions, Funding, Business, and Stock

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Healthcare managed services vendor MedData acquires patient engagement software vendor Duet Health.

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Behavioral health telemedicine software vendor WeCounsel closes its $3.5 million Series A funding round. The company offers practices unlimited use of its platform for $15 per month.

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NIH awards ID Genomics a three-year, $3 million grant to continue development of its 30-minute test that identifies the bacteria causing an infection and matches it against a profile of antibiotic resistance to help doctors choose the right antibiotic.

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Cotivity, which sells payment accuracy solutions to payers in healthcare and retail, announces plans to launch an IPO.

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Investor Warren Buffett, asked a question about board member diversity at Berkshire Hathaway’s annual meeting, uses Theranos as an example of what not do do when choosing a board:

You know, one organization recently, the one that did the blood samples with small pricks, they’ve got some very big names on their board. Theranos. I mean, the names are great, but we’re not interested in people that want to be on the board because they want to make two or three hundred thousand dollars a year for 10 percent of their time. And we’re not interested in the ones for whom it’s a prestige item and who want to go and check boxes, or that sort of thing.

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Imprivata announces Q1 results: revenue up 23 percent, adjusted EPS –$0.21 vs. $-.24, beating analyst expectations for both. 


Announcements and Implementations

England’s West Suffolk NHS Foundation Trust goes live on Cerner.

CommonWell and NATE (the National Association for Trusted Exchange) will join each other’s organization as members.


Government and Politics

A study finds that citizens of states that spend more on social and public health services vs. healthcare services have better outcomes for several chronic and debilitating conditions.

The federal government will require the DoD’s Defense Health Agency to issue IT contracts through the General Services Administration.


Innovation and Research

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A study finds that the most profitable hospitals (based strictly on operating income) are for-profit, have higher markups, have regional prestige that allows them to dictate terms to insurers, and are located in states (interestingly enough) with price regulation. The most profitable hospitals in the 2013 data studied were 268-bed Gundersen Lutheran Medical Center (which made $300 million in profit from patient care), Sutter Medical Center, and Stanford Hospital. I checked Gundersen’s federal tax forms, which show 2014 profit of $95 million, down from $312 million in 2013. To its credit, the hospital paid its executives comparatively modestly, with the CEO earning $910K and the CIO $385K.

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Half of surveyed teens say they are addicted to their smartphones, with 78 percent of them checking their devices at least hourly and 72 percent believing they must respond immediately to texts and social networking messages. More parents than teens (56 percent) check their devices while driving, while a big chunk of both groups think the other ignores them and plays with their phones when they’re together. 


Technology

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Microsoft’s SQL Server 2016 will launch on June 1, with speed and security enhancements, support for the R analytics tool, the ability to query both structured and unstructured data, and the ability to query encrypted data without decrypting it first.

Google donates $250,000 toward Flint, MI’s water problems, of which $150,000 will fund a University of Michigan data project to identify homes with likely high levels of lead. UM will also develop a mobile app and website that will allow residents to visualize data and communicate with the city.


Other

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As reported here earlier in quoting Shriners CMIO Richard Paula, MD, the Joint Commission confirms in an emailed newsletter Monday that it has reversed its 2011 policy that prohibited sending orders via text message, effective immediately. Joint Commission says it changed its mind because messaging platforms have improved.

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The only rural hospital in Massachusetts — 19-bed, Partners-owned Nantucket Cottage Hospital – may cause all state hospitals to lose $160 million in Medicare funding in the next year after consultants make mistakes in calculating the hospital’s labor costs. The hospital’s high-cost location makes it the state’s most expensive and Medicare sets the labor payments to all other hospitals based on its costs. Some hospitals could lose 10 percent of their Medicare payments due to the mistake.

An interesting article describes Mid-Atlantic Permanente Medical Group’s hepatitis C screening protocol, which has these components:

  • An EHR alert recommends to providers that patients born between 1945 and 1965 undergo hepatitis C screening if they haven’t already had it.
  • Patients who test positive for the hepatitis C antibody are automatically ordered confirmatory testing.
  • An assigned hepatitis C coordinator manages the follow-up activities and educates the patient.
  • A liver damage assessment is automatically ordered.
  • Patients are connected to physicians to make sure ongoing care occurs.

A Kaiser Health News article concludes that hospitals are not good at coordinating post-discharge care with home health agencies and nursing homes, particularly when it comes to medications. The article notes that none of the $30 billion in HITECH EHR bribes went to nursing homes, rehab facilities, or home care providers. The article failed to note equally sobering problems in coordinating the care of patients with behavioral problems, which have a similar genesis.

The Chinese government will investigate search engine company Baidu following the death of a student who searched online for a treatment for his rare form of cancer. The student claimed that his search turned up a hospital that lied about a high rate of success with an experimental treatment he was given. Before he died, the student accused Baidu of promoting false medical information and called out the hospital for false advertising.

Two large employers who offered a healthcare price transparency tool found that only small percentage of employees used it and healthcare costs actually increased slightly.

A study finds that the price of oncology drugs is steadily and illogically increasing, as drugs whose initial high price was justified by expected narrow usage get more expensive even when new indications are discovered.


Sponsor Updates

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  • KLAS recognizes Sagacious Consultants (now part of Accenture) as a top-performing Epic consulting firm.
  • AdvancedMD releases a new ebook, “Advanced Practice Training: Changing the Game in Financial Reporting.”
  • Extension Healthcare releases a video showing how its Engage Mobile solution integrates with AirStrip One live waveforms.
  • AirWatch launches the Echo One Podcast.
  • Aprima will exhibit at the ACP Internal Medicine Meeting 2016 May 5-7 in Washington, DC.
  • KLAS recognizes Nordic’s Epic implementation support and staffing services, also ranking the company for the first time in the IT Advisory segment with a 92.6 score.
  • Besler Consulting releases a new podcast, “What Hospitals Should Do Regardless of Who is Elected President.”
  • DrFirst’s Rcopia e-prescribing platform wins the Surescripts White Coat of Quality Award for the fourth time.
  • CapsuleTech celebrates National Nurses Week May 6-12.
  • The Advisory Board Company features Carevive Systems in a presentation during its Oncology Roundtable series May 5-6 in Washington, DC.
  • CompuGroup Medical will exhibit at the Rural Health Care Conference May 10-13 in Minneapolis.
  • CoverMyMeds will exhibit at the 2016 New England Regional MGMA Conference May 5-6 in Bretton Woods, NH.
  • Wellcentive develops a free tool to calculate the cost of delaying the shift from payer volume to value-based care and reimbursement.
  • Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
  • ECG Management Consultants will present at the MGMA New England Regional Practice Management Conference May 5 in Bretton Woods, NH.
  • EClinicalWorks will exhibit at the IMGMA Spring Conference May 5-6 in Indianapolis.
  • Healthwise will exhibit at the EClinicalWorks 2016 Health Center Summit May 11-13 in Boston.

Blog Posts


Contacts

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

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May 3, 2016 News 4 Comments

Curbside Consult with Dr. Jayne 5/2/16

May 3, 2016 Dr. Jayne 3 Comments

Since the release of the proposed rule for MACRA, many of my colleagues have been heads down trying to digest the content and figure out how to operationalize the requirements. While some organizations are taking the proposed rule and running with it, others are adopting a “wait and see” approach given the anticipated volume of negative comments from the public. They’re hoping that things will change prior to it becoming final, which is always a possibility given this crazy environment in which we all now operate.

Although CMS talking heads have said MU is dead, it must be zombie-dead. It’s just been reinvented as “Advancing Care Information,” which although more flexible than MU, is still too daunting for many practices. Physicians will not be accountable for cost category measures from claims data as well as being pushed towards further tracking and reporting on PQRS.

There are two tracks for physicians, with CMS expecting that most providers will be in the MIPS track vs. Alternative Payment Models. The numbers I saw estimated were 700,000 vs. 60,000, respectively. Unfortunately, providers will have to decide wither to submit under MIPS before they know whether they qualify for the APM track. Many organizations will be doing a belt and suspenders approach.

Several of my friends that work at vendors are extremely stressed out, realizing that federal requirements will dominate development efforts over the rest of the year. Just when they had breathing room to work on usability and customer-requested enhancements, they’re going to be forced back to the grindstone to crank out code that may or may not be what their customers want or need. Vendors have to walk a fine line between speculating on what will be dropped from the final rule and running full speed to get it all done.

Some vendors will start working on the requirements whether or not they think they’ll be modified. Given the way the last few rulemaking cycles have gone, even if a particular element gets taken out of the final rule, it will likely rear its head in a subsequent rule or in another program, so this might be a wise approach. On the other hand, if the rule is substantially modified, there is a risk of significant wasted development efforts. Once the comment period closes, it will be several months before we have a final rule. My friends with crystal balls tell me we’ll have the final rule in October with it taking effect in January. If that timeline holds, there won’t be much time for vendors to shift gears if the modifications are significant.

In the provider space, there is a tremendous amount of chatter about this being the last straw for small or independent practices. The requirements are daunting, especially for practices who haven’t been at the forefront of payment reform efforts. Just trying to read and understand all the rules and keep track of all the FAQs we’ll undoubtedly see could be a full-time job. As CMS goes, so go the commercial payers, and I expect we’ll see them ratcheting down on physicians as well. I’m still trying to fully absorb how this will affect my own practice given that we opted out of MU and haven’t looked back.

One of my colleagues brought up a good point. Although providers may not be ready to go to a direct model practice or all the way to a concierge / retainer model, providers have been slowly transitioning out of Medicare. It’s tricky for these non-participating providers when they want to continue to care for Medicare beneficiaries. Another option is to opt out of Medicare entirely. The complexity of the choices make it difficult for providers to consider leaving, especially when they consider that commercial payers will have matching requirements of their own that the providers will still have to deal with. The seemingly-onerous nature of the proposed rules might be a catalyst for providers to consider moving to direct models.

When you think about it, direct payment models would go nicely with some of the goals of all these efforts. If the goal is to put the patient at the center of their own care and to engage them, what better way to engage them than with their pocket books? Patients who start to see the true cost of care (rather than being shielded by their co-pays) might start choosing their therapies more wisely. Perhaps the generic drug that’s been around forever but doesn’t have sexy marketing will start looking more attractive.

We’ve experimented with that to some degree with tiered co-pays and that has driven patients to ask about cheaper alternatives. I’ve seen some patients question their hospital-employed physicians when the patients start getting bills from both the provider and the facility through provider-based billing arrangements. A couple of organizations in my region have done away with the practice based on negative community feedback.

Understanding the cost of care may encourage patients and families to make end-of-life choices that are ultimately more compassionate – choosing palliative care or hospice rather than expensive interventions that may not prolong life and may even damage the quality of life. Patients may begin to analyze whether the expensive (and life-altering) cancer treatments that may only extend life a few months are really worth it for them or for their families. Maybe we’ll stop ordering CT scans for things that really could be diagnosed with a good history and physical exam.

Of course, this wouldn’t solve all our problems. The cost of care is still prohibitively high for many treatments. Patients would still need insurance against catastrophic medical bills and we would still need safety net facilities and arrangements for patients who have limited ability to pay.

It also doesn’t address the real origins of healthcare costs. Lifestyle and behavior-related factors are 40 percent of the pie compared to medical care, which is a mere 10 percent. Human biology is 30 percent, with social determinants of health at 15 percent and environmental factors at 5 percent. Although patient engagement may help the lifestyle and behavior-related category, there’s still much more work to be done.

I still have several hundred more pages to get through, but I’m not sure I’ll make it. It’s too depressing.

Have you finished the proposed rule? What do you think? Email me.

Email Dr. Jayne.

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May 3, 2016 Dr. Jayne 3 Comments

Morning Headlines 5/3/16

May 2, 2016 Headlines No Comments

CHIME Letter to FDA on Interoperable Medical Devices

The College of Healthcare Information Management Executives submits comments to the FDA calling for assurances that medical devices will be interoperable with EHR software.

Not-for-profits dominate top-10 list of hospitals with biggest surpluses

Seven of the 10 hospitals with the largest surplus from patient care services in 2013 were not-for-profits, according to Health Affairs.

Hospital discharge: It’s one of the most dangerous periods for patients

The Wall Street Journal profiles problems that can arise during transitions of care, with a focus on the hospital to home transition.

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May 2, 2016 Headlines No Comments

ResearchKit Unlocks the Power of Real-Time Clinical Research

May 2, 2016 News No Comments

New studies at Boston Children’s and RWJF highlight the evolving role of Apple’s mobile research technology.
By
@JennHIStalk

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It’s been just over a year since Apple introduced ResearchKit, an open source framework that enables researchers and developers to design apps for healthcare research. In that time, participation has soared. The platform now boasts 100,000 users who are submitting data to studies sponsored by hospitals and non-profits, including ones focused on asthma, breast cancer, diabetes, heart disease, hepatitis C, melanoma, Parkinson’s, post-partum depression, prostate cancer, and sleep apnea.

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Even the NFL Players Association has gotten in on the act, partnering with Harvard University researchers to use ResearchKit in a joint investigation into the long-term effects of football injuries on 3,000 former NFL players.

The platform has also made accommodations for personal genomics via integration with 23andMe’s module. Researchers can enable 23andMe customers to contribute their genetic data to a study or offer genotyping services from the company to study participants. It’s a timely move given the industry’s White House-driven focus on precision medicine and cancer moonshots.

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Apple, having realized the escalating potential of its own creation, decided earlier this year to start collecting ResearchKit data for its own internal purposes. Study participants who submit data to the Mole Mapper Study app and Parkinson’s mPower study app now have the option of also submitting that data directly to Apple. The company no doubt plans to use the data to further refine the platform and to impact future iterations of HealthKit and the new CareKit, corresponding apps that help power and further ResearchKit’s capabilities.

Real-World, Real-Time Research

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Studies leveraging ResearchKit continue to be introduced, evidence that the platform is well on its way to changing the face of medical research. “It’s the most evolved mobile platform to run studies,” says Paul Tarini, senior program officer at the Robert Wood Johnson Foundation, which has taken an interest in ResearchKit from the beginning. “We’ve been interested in what we call real-world, real-time data for a number of years now, especially what that data can tell us about our health, how it can be used for research, and how it can be used to improve care. ResearchKit was the first formal platform developed to conduct research by taking advantage of the IPhone’s native capabilities to collect real-world, real-time data.”

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Tarini and his team began talking about what kinds of apps might be useful within the ResearchKit library not long after its debut. “In discussions with Apple staff and industry experts, we ended up settling on mood and what helps influence mood,” Tarini explains. The result of that decision – RWJF’s Mood Challenge – launched earlier this month.

“We’re hoping the winning app could be used in part or in whole by another study that’s interested in including some aspect of mood or variable in its focus – something that other researchers can pick up, use, and plug in as they build their own apps,” Tarini adds. “We’re also interested in apps that use a mash-up of data, such as data from the phone and other sources, to shed light on mood. In this case, we’re particularly interested in data on social context. What are the graduation rates in your neighborhood? The income rates, family structures, crime rates, weather patterns? How do these influence health, if at all? We’re really focusing on building a culture of health in this country, and social context is certainly a reflection of culture.”

Uncovering the New Normal

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Researchers at Boston Children’s Hospital have also been ResearchKit fans from the beginning. “We are proud to be the first academic institution to launch our second ResearchKit app,” says Jared Hawkins, director of informatics and innovation and of the hospital’s digital health accelerator. The hospital launched its C-Tracker app last year to collect data on the effects of hepatitis C and debuted the Feverprints app last month.

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“One of the major lessons we learned from C-Tracker was how best to link anonymized data from ResearchKit to our servers at the hospital, securely and at scale,” Hawkins explains. “There are a number of commercial solutions for this, but none of them offered the flexibility that we needed. Fortunately, the C-Tracker team developed open-source software, C3-PRO, to accomplish this, which we have leveraged for Feverprints.”

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The Feverprints study and ResearchKit-powered app will help Boston Children’s researchers better understand what a “normal” temperature looks like, how fever patterns can be used effectively to diagnose disease, and how fever-reducing medications affect the course of an illness.

“The standard notion that a normal temperature is 98.6 and a fever is anything above 100.4 is based on questionable research from a few hundred years ago,” says Hawkins. “This study seeks to leverage modern technology, including smartphones and continuous temperature monitoring, to revisit this historical research and collect temperature from tens of thousands of participants to reassess what is normal.”

Form Factor Makes the Difference

The enthusiasm Hawkins has for Feverprints can be largely attributed to ResearchKit’s form factor. “It transforms how we can do clinical research by addressing some of the biggest hurdles we face as researchers – recruitment and long-term engagement,” he explains. “ResearchKit allows us to consent exponentially more users than would be possible traditionally, at minimal cost. These users have the power to enroll themselves, giving them a more direct role in the study and increasing engagement.

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“Overall user experience is improved because ResearchKit makes it easier to share health data,” Hawkins adds. “If the user allows it, data from any connected smart thermometer can automatically be loaded from HealthKit. Even if data is entered manually, the whole process takes less than a minute. We hope that the data collected will allow us to identify distinct ‘feverprints’ that may aid clinicians in patient diagnosis in the future. For this, continuous data from a wearable device may prove to be the richest, although temperature data captured at any granularity will be helpful.”

Hawkins add that Feverprints app developers plan to add additional engagement features in the near future that will, for example, allow users to see how their data has specifically helped researchers better understand normal and elevated temperatures, and how they compare to the population as a whole. “We don’t have to wait until the study is over to begin to feed our results back to the user,” he says, “which really drives home the power of participatory real-time research.”

Tarini and his colleagues at RWJF also see immense value in ResearchKit’s data delivery methods. “We like the creativity, the flexibility, and the democratization,” he notes. “More people can enroll in the studies. We also like the fact that the platform is able to turn more results around more frequently to participants.”

Changing the Research Game

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While there’s general consensus on ResearchKit’s ability to transform the way clinical studies are conducted, the verdict is still out on it being a bona fide “game changer.” It is, after all, available only to Apple users, which leaves the much larger Android user base without the means to participate. (an Android alternative called ResearchStack became available earlier this month.)

“I wouldn’t call ResearchKit a game-changer,” Tarini says, “because that means we’ve done it. I would say changing. ResearchKit is changing perspective on the importance of returning results to people. It’s producing greater engagement from the people who are participating.”

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“We’re also excited about CareKit and the opportunity for more seamless integration of research data with regular care,” he adds. “You can repurpose the data that was collected by the research study and inject it into the processes of care so that a provider can see the data that’s coming in from the study. Previously, that was really hard to do, if not impossible. ResearchKit is changing the relationship between research studies and their participants, and the relationship between the research enterprise and the care delivery enterprise.”

Hawkins is more optimistic about the role ResearchKit has thus far played in the evolution of clinical research. “It’s absolutely a game-changer for health research because it addresses some of the biggest hurdles we face as researchers – recruitment and long-term engagement. We are looking for other projects at the hospital that would benefit from ResearchKit as well as the newly announced CareKit. Apple has built some truly exceptional platforms to enable health research.”

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May 2, 2016 News No Comments

Morning Headlines 5/2/16

May 1, 2016 Headlines No Comments

Medical Information Technology, Inc. Form 10-Q

Meditech reports its Q1 results: revenue grew 4.3 percent to $117 million vs. $113 million during the same quarter last year, EPS $0.51 vs. $0.53.

Athenahealth Jonathan S. Bush on Q1 2016 Results – Earnings Call Transcript

During its earnings call, Athenahealth CEO Jonathan Bush says that the small-hospital market has experienced a borderline collapse of established technologies, resulting in huge unmet demand that will benefit its expansion into inpatient software.

Revealed: Google AI has access to huge haul of NHS patient data

In the UK, an investigative report finds that Google has been given access to 1.6 million patient records, with visit details going back five years.

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May 1, 2016 Headlines No Comments

Monday Morning Update 5/2/16

May 1, 2016 News 5 Comments

Top News

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Meditech releases Q1 results: revenue up 4.3 percent, EPS $0.51 vs. $0.53. Product revenue rose 3.2 percent, with 78 percent of that coming from services. The company generated $23.1 million in total cash flow, all of which was paid to shareholders as dividends.

Meditech Director Dan Valente, 85, has resigned as director and was replaced by CFO Barbara Manzolillo.


Reader Comments

From Dixie Chicken: “Re: Epic. Verona, WI will collect taxes based on an Epic campus value of $393 million, but Epic has spent billions on it. If that’s the basis of property taxes, is Verona celebrating when they should feel ripped off?” Verona will close the special tax district it created to get Epic to relocate there from Madison 14 years ago when the company had only 550 employees, cashing in the district’s financial surplus and making Epic’s campus taxable. The property’s value is established at the time the tax district is created, meaning Epic’s massive campus growth (from 550 employees to nearly 10,000) returns only a partial benefit as companies pay only lower, construction-related taxes when they expand.


HIStalk Announcements and Requests

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Forty percent of poll respondents think that EHR redesign offers the best hope for reducing the time physicians spend entering data into EHRs, while 25 percent say the capture of non-clinical information is the real problem that should be addressed. Tech MD wonders if those readers who chose EHR redesign or reduced data capture burdens believe the other choice is a lost cause, while Mobile Man says it’s futile to expect EHRs to be redesigned because they are intended to be big filing cabinets. Curious (along with a least one person per poll I run) expresses an unrequited lust for surveys that allow shades-of gray answers, which of course means that he or she must also prefer capturing EHR narrative rather than easily interpreted check-boxes for precisely the same reason  — I would rather force respondents to choose the “best answer” rather than leaving me to wade through 431 free-text comments and abstract their thoughts into a collective opinion.

New poll to your right or here: is the proposed replacement of Meaningful Use with MACRA positive or negative?

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Ms. Ahrstrom says the math books we provided to her South Bronx, NY third graders in funding her DonorsChoose grant request have eliminated the boredom using the limited selection of books available in the school’s library, as students can’t wait to finish each book and start the next one.

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Also checking in is Ms. B from Minnesota, whose students are still talking about the field trip we provided to the Wildlife Science Center even though it was weeks ago.

Listening: Nico Yaryan, of whom I know basically nothing except he’s a newcomer and I like his music. He sounds like he could make it big. Here’s another of his songs.


Last Week’s Most Interesting News

  • HHS issues a Notice of Proposed Rulemaking that spells out details of MACRA, the value-based payment model for providers who accept Medicare. MACRA will replace the Meaningful Use program with less-prescriptive measures called Advancing Care Information.
  • Joint Commission announces that it will permit clinicians to send orders via secure messaging, provided that the system they use supports specific message management and EHR integration standards.
  • Epic gives its side of the story on why the Coast Guard cancelled its EHR implementation plan.
  • NextGen confirms employee layoffs, immediate cessation of development on its NextGen Now cloud-based PM/EHR, and a strong focus on the HealthFusion PM/EHR it acquired for $165 million in January.
  • Apple releases the CareKit developer’s framework and announces availability of the first four apps that will use it.
  • The FDA rejects the “digital pill” drug application that would have used technology from Proteus Digital Health.
  • Nokia acquires consumer health device vendor Withings for $192 million to create Nokia Digital Health.
  • CMS releases the minimally redacted warning letter it sent to Theranos last month in which it accused the lab processing company with a lack of knowledge of CLIA standards and diluting finger-stick samples so they could be run on standard Siemens analyzers.
  • Verisk Analytics announces that it will sell its Verisk Health services business to Veritas Capital for $820 million.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

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


Acquisitions, Funding, Business, and Stock

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A small reference in Caradigm’s announcement of a new CEO last week says that Microsoft has sold its 50 percent interest in Caradigm the holder of the other 50 percent, GE Healthcare. The company didn’t explain why the change wasn’t otherwise announced.

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From the Athenahealth earnings call:

  • The company has partnered with Intacct to offer its hospital customers an ERP solution and says it will seek additional partnerships to expand its service capabilities.
  • Jonathan Bush said in answering a stock analyst’s question, “In the small-hospital market, there is a borderline collapse of the established technologies, so there is a huge demand … with the exception of Epic and Cerner, most of the HIT companies appear to be just not able to make a go of it.”
  • Bush added that Athenahealth won population health management system deals at Dignity and Providence because those health systems trialed products from their existing vendors and found them unacceptable (Dignity is a Cerner shop, while Providence uses Epic).
  • Bush said of the company’s efforts to move users of systems from the acquired RazorInsights to those of Athenahealth, “It’s very hard … in order to be that fast, the architecture was more client-centric than network-centric. Every single table — the drug list, the provider directory, the pharmacy supply, the medical supplies — every single one of them is a separate table that only works for each individual customer. That is not the point of Athenahealth … we are taking back those tables, taking back the administration of them and connecting them to great little Web services that connect to national tables that are always current, always correct because they’re maintained by us. That work involves moving the cheese of people that have worked very hard on their tables for years. So, it’s painful.”
  • Bush replied to an analyst’s question about an unnamed competitor moving to a cloud-based product, “You need to double-check on the idea that anybody that you’re thinking about is cloud-based. That somebody will host your data center and run backups does not make them cloud-based. I just described the agony we’re going through centralizing the remaining tables that are being maintained by clients. These are companies where 100 percent of tables are maintained by clients. This is just rental software and 99 percent of the code is running on the servers in the client side. So let’s be clear — those guys are not cloud-based.”
  • When asked about the credit-worthiness of hospital prospects, Bush said, “We used to joke in selling to doctors in the early days that we restrict our sales team to doctors that have a pulse. That was an interesting comment at the time because a lot of the doctors’ pulses that we originally signed were quite thready at best … not only are the HIT companies dying, but a lot of the hospitals are dying … . You have very, very low bed occupancy in this segment, a need to dramatically change strategy from kind of end provider of inpatient and acute care to front-end of the larger health system for the ill … if you took the imaging margins out of every hospital right now, more than half the hospitals in the country would close. Some of the best names in healthcare with the best institutions in healthcare have the majority of their profits coming just from an anomaly where the cost of the imaging equipment is going down because of digital equipment faster than Medicare can figure it out and chase them down.”
  • Bush explained the company’s More Disruption Please program as, “It’s too bad that Epic and Cerner and Meditech and all these guys can’t build open enough platforms, because we don’t really want to do Athena dietary management systems. But if it doesn’t come out of MDP and if Epic and Cerner and Meditech don’t open up their API so that they could be used by responsible developers, what can you do?“
  • Bush replied when asked about adding billing capabilities to the former RazorInsights product, “The front desk for the hospital is the front desk for AthenaNet. It’s the same front desk, same work flow, same insurance capture, same portal registration … one of the big arbitrage opportunities for AthenaOne for the inpatient is, we get all the doctors around the hospital. We don’t have to register them when they show up at the hospital. We already know what their deductible utilization is, we already know their eligibility, we know their medical records, et cetera, et cetera  … there has been a product we’ve been dying to release for years, for a decade, called AthenaController, which basically takes on the same approach to the cost cycle as we have to the revenue cycle. We are now pregnant with that baby. We have to do it.”

People

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Ryan Nellis (Optum) joins Stanson Health as SVP of sales and marketing.


Announcements and Implementations

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Clinical Architecture launches its SIFT Services product line, which uses natural language processing to extract coded data from free-text documents for specific data targets. The company offers a free trial of the first offering, SIFT for Meds. 

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Nordic hires its 600th consultant.


Government and Politics

Political differences aside, President Obama might offer Ronald Reagan a challenge for the title of funniest American president ever. Above is the video, “Couch Commander,” released by the White House and presented at the White House Correspondents’ Association Dinner. The Obamacare references at 1:33 are interesting.


Privacy and Security

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A science magazine analysis finds that the agreement between the UK’s NHS and Google’s artificial intelligence company DeepMind gives the company full electronic information on 1.6 million patients treated annually by three hospitals of Royal Free NHS Trust. Google says it needs complete information on all patients because NHS can’t provide a subset just for the kidney patients who will be monitored by Google’s Streams system. The agreement also calls for Google to develop a clinical decision support and surveillance system called Patient Rescue that will use real-time data streams from the hospitals. Critics are not only worried about Google keeping the patient information secure, but also that Google is the only company with access to the data.

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The American Dental Association notifies subscribers to its Dental Procedure Codes that some of its thumb drive updates contain malware. The ADA speculates that one of the duplicating machines used by ADA’s China-based manufacturer were infected with data from a previous customer, meaning that only the drives produced by that specific machine contain malware.


Other

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Here’s a nice quote from Farzad Mostashari, MD in responding to a tweet saying that non-profit Minnesota HIMOs (like most health systems everywhere) insist that what’s left when income exceeds expenses is a “surplus” rather than a “profit,.” although they seem to love the word “loss” when things aren’t so rosy. Perhaps Farzad can weigh in on “payment” vs. “reimbursement” and “invested” vs. “spent.”

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Dear Health Data Management, please spell company names correctly, not like the actual word is spelled. Thank you.  While I’m quibbling journalistically, I would to ask newspapers to stop saying that someone “checked himself in” to a hospital since that just doesn’t happen.

Here’s the next HIS Vendor Review from Vince and Susan, which this time looks at high-end vendors.


Sponsor Updates

  • T-System will exhibit at the CHIMA Annual Meeting May 5-6 in Denver.
  • The local news interviews TeleTracking President Michael Gallup about the company’s sponsorship of the Walk MS Pittsburgh 2016 event.
  • Fortune profiles Validic.
  • Vital Images will exhibit at the McKesson User Group May 2-4 in Atlantic City, NJ.
  • Huron Consulting Group will exhibit at the MAGI Clinical Research Conference 2016 East May 1-4 in Boston.
  • Wellsoft will exhibit at Emergency Medicine Update 2016 May 3-5 in Toronto.
  • ZeOmega offers the Jiva Consultant Certification Program.
  • PatientPay extends the $10,000 healthcare billing challenge.
  • Streamline Health will exhibit at the 2016 DCHIMA/MDHIMA Annual Meeting May 6 in Hanover, MD.

    Blog Posts

Blog Posts


Contacts

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

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May 1, 2016 News 5 Comments

Morning Headlines 4/29/16

April 28, 2016 Headlines No Comments

Medicare’s new plan for paying doctors: 10 key takeaways

The Advisory Board Company recap’s yesterday’s MIPS and APM incentive proposed rule.

Leidos Holdings, Inc. Reports First Quarter Fiscal Year 2016 Results

Leidos reports Q1 results: revenue grew five percent to $1.31 billion vs. $1.25 billion in the same quarter last year, adjusted EPS $0.72 vs. $0.67. Executives announced that

Athenahealth, Inc. Q1 Profit Rises 47%

Athenahealth reports Q1 results: revenue climbed 24 percent to $256 million vs. 206 million in the same quarter last year, EPS $0.34 vs. $0.24, beating expectations on both.

FDA rejects antipyschotic drug/device combo

The FDA has rejected Proteus Digital Health’s request to embed smart sensors designed to track medication compliance into Otsuka’s antipsychotic medication Abilify.

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April 28, 2016 Headlines No Comments

News 4/29/16

April 28, 2016 News 5 Comments

Top News

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HHS issues a Notice of Proposed Rulemaking for the long-awaited Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will replace the Meaningful Use program in moving clinicians to payment based on value starting in 2017. The Merit-Based Incentive Payment System (MIPS) sets Medicare payments based on quality, use of technology, clinical practice improvement, and cost. Physicians participating in alternate payment models such as CPC+ and the Next-Generation ACO will be eligible to receive bonuses without participating in MIPS.

A CMS blog entry from CMS Administrator Andy Slavitt and National Coordinator Karen DeSalvo says Meaningful Use boosted EHR usage, but adds, “We remain a long way from fully realizing the potential of these important tools to improve care and health.” HHS says incorporating Meaningful Use in the MIPS program in a program called Advancing Care Information will “make it more patient-centric, practice-driven, and focused on connectivity.”

Slavitt and DeSalvo’s article says Advancing Care Information will:

  • Simplify physician reporting by eliminated all-or-nothing measures.
  • Provide flexibility for doctors to choose the most applicable measures.
  • Emphasize interoperability and the right for patients to access their own information through APIs.
  • Reduce the number of measures from 18 to 11.
  • Exempt doctors from reporting if EHR technology isn’t applicable to their practice.

The article sheds light on the technology focus going forward:

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.

The proposed HHS changes would affect only Medicare payments to practices. Nothing will change for hospitals and Medicaid program participants.

The full text of the 962-page proposed legislation is here. The Advisory Board Company posts a good summary.

Here’s a new three-minute HHS video for consumers that describes delivery system reform.


Reader Comments

From Richard Paula: “Re: texting of orders. The May 2016 Joint Commission Perspectives will contain a revised statement on texting orders, ending the ban enacted in 2011. It reinforces the fact that texting can be an expedient method of patient care. The secure texting platform must have:

  • A secure sign-on process
  • Encrypted messaging
  • Delivery and read receipts
  • Date and time stamp
  • Customized message retention time frames
  • Specified contact list for individuals authorized to receive and record orders

It requires text orders to be complete, dated. timed, confirmed, authenticated, and documented in the medical record.” Rich is CMIO of Shriners Hospitals for Children. This is a pretty big deal as companies whose messaging product can’t integrate with EHRs to complete the order loop now find themselves at a significant competitive disadvantage.

From Marshal: “Re: Meditech. Delta Regional in MS has signed to replace Cerner with Meditech. Salem Regional Medical Center in OH has signed with Meditech to replace their McKesson Horizon system. Cerner was the other finalist in that bid.” Unverified. 

From Graham: “Re: Coast Guard EHR. I saw that Politico just replayed your coverage from last October. The Coast Guard won’t say if a particular provider’s software caused the issues. What’s your take on where accountability resides? Sounds like mismanagement at a project level by USCG themselves, but Epic paying back $2.2 million on a $14 million award isn’t immaterial, either. It gets even fuzzier with the InterSystems component coming in later and then Leidos / Apprio / Lockheed.” The Coast Guard cited unstated problems with the implementation, seemingly blaming itself for a lack of consistent workflows and ongoing scope expansion, while outsiders speculate that it handled the product selection poorly and that Epic and Leidos may have bid too low to  meet the Coast Guard’s expectations.

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Meanwhile, Epic uncharacteristically posts its side of the Coast Guard story, saying its software was originally ready for go-live in 2011, but Coast Guard changes such as hardware procurement delays, vendor changes, data center changes, and a government accounting investigation of the Coast Guard’s method of payment threw the schedule off. The Coast Guard’s storage area network was also lost twice, once from corruption and once after someone from Leidos deleted it. Epic says the go-live was rescheduled for October 2015 and was on track until the Coast Guard cancelled it the month before for unstated reasons. Epic says it was paid in full and the Coast Guard did not ask for a refund.


HIStalk Announcements and Requests

I’m interested to learn what sort of EHR prototype the VA is creating in exploring the idea of replacing VistA with what sounds like another self-developed product. Let me know if you can provide information, on or off the record.

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The vast majority of 514 poll respondents (92 percent overall, including 90 percent of the females and 93 percent of the males) think it’s a bad idea for HIMSS to publish a separate website and newsletter for women in healthcare IT. Sandra says the goal is to be separate but equal rather than separate but separate, while NoHorseInThisRace says its a disservice for HIMSS to be “peddling its clickbait drivel” specifically at women. Lisa says she might take an occasional look but since the issues and concerns are the same for everyone, the choice of content the site will promote will be interesting. Long Disappointed by HIMSS adds that, “The comment made on HIStalk is appropriate – look no further than the board.” The women’s interest stories so far is lame – it’s anything related to Karen DeSalvo, third-party stories on gender pay gap, and mentions of people who have been promoted who happen to also be female.

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Ms. Anderson’s Arizona fourth graders, especially her special education students, have used the electricity and magnetism kits we provided in funding her DonorsChoose project to complete her standards-based assignments while having fun.

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Also checking in is Ms. Isaacs, whose Indiana second graders are using the 16 sets of headphones we provided to participate in an online literacy program, which she saves “gives our class the opportunity to focus on what we are learning rather than the other students around us.”

This week on HIStalk Practice: Thirty-six practices sign up for CancerLinq’s oncology analytics. Raleigh Orthopaedic Clinic settles with OCR to the tune of $750,000. AMA partners with IDEA Labs to support student entrepreneurship in healthcare IT. The American Telemedicine Association aims to broaden the Rural Health Care Connectivity Act. Reliance ACO COO Gene Farber highlights the role of CCM in coordinated care. UniVision gets into telemedicine. Vice President Joe Biden set to spice up Health Datapalooza. CDW’s Jonathan Karl offers advice on how to promote positive outcomes with communication and technology.


Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

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


Acquisitions, Funding, Business, and Stock

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A RBC Capital Markets analysis says Quality Systems / NextGen issued investor updates Wednesday indicating that it will focus on streamlining management, building up the business of the HealthFusion PM/EHR it acquired in January for $165 million, and cutting costs furthers. Analyst Dave Frances expresses skepticism on the downbeat business changes announcement given a shrinking market share in QSI’s core business, adding that, “We remain unconvinced that HealthFusion and Mirth are the answer.” Quality Systems says it will stop development on its NextGen Now product immediately, taking a $32 million charge and confirming that it will reduce headcount by 150 as I previously reported from reader rumor reports. The cloud-based NextGen Now PM/EHR was announced in November 2014 and was supposed to be launched in 2015.

A New York Times op-ed piece says Theranos wasn’t a product of Silicon Valley hype – the company pitched to top life sciences venture capital firms whose doctorate-heavy investment teams were put off by Theranos trying to appear cool while keeping the technical details intentionally vague. Those VCs also noted that Theranos hadn’t published in peer-reviewed journals and that the company’s board was made up of mostly old politicians with zero healthcare experience. The company’s investors were non-Silicon Valley types who were apparently less discerning.

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Leidos announces Q1 results: revenue up 5 percent, adjusted EPS $0.72 vs. $0.67. Chairman and CEO Roger Krone says in the earnings call it’s on track to bring the DoD’s MHS Genesis Cerner project live at two facilities in the Northwest by the end of the year, but Leidos will also continue making money supporting the old system for another 8-10 years until the Cerner rollout is finished.

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Athenahealth announces Q1 results: revenue up 24 percent, EPS $0.34 vs. $0.24, beating analyst expectations for both. ATHN shares are up 13.3 percent on the year.

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Spok reports Q1 results: revenue down 6 percent, EPS $0.17 vs. $0.18. The SPOK share price is down 12.9 percent compared to a year ago.

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Vocera announces Q1 results: revenue up 12 percent, EPS – $0.14 vs. –$0.17, beating analyst expectations for both. VCRA shares are up 7.8 percent in the past year.


Sales

MedStar Health (MD) chooses provider data management and scheduling software from Kyruus.

UK Healthcare selects Voalte for caregiver secure messaging.


People

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Medfusion hires John Juzaitis (ZirMed) as chief revenue officer and Michelle Murray (EDM Americas) as VP of marketing.

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Brigham and Women’s Health Care (MA) promotes Adam Landman, MD to CIO.

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Caradigm promotes Neal Singh to CEO. He replaces founder Michael Simpson, who has left the company.

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Anita Pramoda (Owned Outcomes and former Epic CFO) joins the board of Health Catalyst, replacing EVP/Co-Founder Steve Barlow, who remains on the executive team.


Announcements and Implementations

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The first four apps that use Apple’s CareKit developer’s framework are released to the Apple Store as the open source CareKit itself is also released to GitHub. The apps are Glow Nurture (fertility tracking), Glow Baby (maternity), One Drop (diabetes monitoring), and Start (depression medication tracking).


Other

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Here’s a cute “Take Our Daughters and Sons to Work Day” photo from Karen DeSalvo’s office from @Commanda4aCure.

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The FDA rejects the application for a drug-device combination, or so-called “digital pill,” to monitor drug adherence. FDA had already cleared the use of Proteus Digital Health’s technology in existing drugs, but wants to see more data before allowing Otsuka Pharmaceutical manufacture it as part of its Abilify antipsychotic medication. Proteus has raised $334 million in 10 rounds of funding, adding $50 million earlier this month.

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A man sues Snapchat and the 18-year-old driver who rear-ended his car at 107 miles per hour while taking a selfie, leaving him with brain damage. The teen admitted that she was speeding while posting to earn a Snapchat “speed filter” trophy icon for recording her speed with her photo. After the crash, the teen took a photo of her bloodied face and labeled it “lucky to be alive.” Snapchat says it gives users a warning not to use its speed filter option while driving.

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This TV screen grab will resonate with everyone annoyed by poorly timed Windows 10 update nagware messages.


Sponsor Updates

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  • Employees of Impact Advisors attending the company’s annual meeting in Orlando delivered 150 teddy bears to patients at Florida Hospital for Children.
  • Florida Hospital (FL) reports decreased mortality and a $72.5 million increase in appropriate reimbursement after rolling out Nuance’s Clinical Documentation Improvement embedded, with the next step being to embed Nuance Clintegrity CDI within Cerner Millennium.
  • Bernoulli will exhibit at the at the American Association of Critical-Care Nurses’ 2016 National Teaching Institute & Critical Care Exposition (NTI), May 16-19 in New Orleans.
  • Intelligent Medical Objects will exhibit at the IHealth 2016 Clinical Informatics Conference May 4-7 in Minneapolis.
  • MedData will exhibit at the Louisiana Chapter HFMA Annual Institute May 1-3 in Lafayette.
  • Orchestrate Healthcare will help Pertexa integrate its Radekal physician productivity tool for hospital use. The tablet-based product expedites the clinical encounter, reducing visit time by up to 30 percent.

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April 28, 2016 News 5 Comments

EPtalk by Dr. Jayne 4/28/16

April 28, 2016 Dr. Jayne No Comments

My phone started going into shock Wednesday afternoon with the release of the 962-page proposed rule for the Medicare Merit-Based Incentive Program (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models.

Vendors and providers alike have been eagerly awaiting the details hinted at by MACRA when it was passed last year. Providers were hopeful about the potential for consolidation of the alphabet soup of PQRS, VBM, and Meaningful Use.

It starts with the customary glossary of acronyms, which numbers nearly three pages. It also includes an overview of current reporting programs and regulations. For people who haven’t been immersed in the federal regulatory stew for the better part of a decade, it must seem like so much gibberish.

The provisions regarding the “Sunsetting of Current Payment Adjustment Programs” starts on page 35. A section on “information blocking” caught my eye on page 41 despite the fact that information blocking as defined by Congress seems much more theoretical than actual for most of the organizations I’ve encountered. Page 44 brings nearly three pages of new terms which require definitions. I gave it my best effort, but I couldn’t make it more than 100 pages. For those with longer attention spans, the comment period is open through June 27.

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Registration is open for the AMIA 2016 Symposium, to be held at the Chicago Hilton. The Student Design Challenge, now in its fourth year, will focus on engaging providers and patients in precision medicine. Proposals are due by June 30 with notifications to authors on August 15.

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For those who can’t wait until the fall for your next informatics meeting fix, the 2016 ONC Annual Meeting will be held May 31 through June 2, with the last day being focused on consumers. Agenda details are still forthcoming, so I’m not quite ready to commit just yet.

I enjoy attending conferences and connecting with colleagues across the country to discuss best practices and innovative ways to move healthcare forward. In my own world, though, I’d settle for healthcare that met the bare minimum.

I’ve been in a downward spiral, with several negative ophthalmology experiences over the last several years, but this week’s visit took the cake. My physician (the third in that I’ve seen in the practice) recently went on an indefinite medical leave, so I was called to reschedule with one of her partners. I always book the first appointment of the day so that I can be on time for the rest of my schedule. Unfortunately, my new physician was stuck in traffic.

He phoned the office five minutes after my appointment started. The practice has an open front desk, so I could hear the receptionist talking with him. I was dumbfounded when she told him that he didn’t have any patients in the office yet, especially since I had been checked in with my co-pay posted for 15 minutes.

About five minutes after she finished the call with him, she called me up to tell me what was going on. After another 10 minutes, a technician took me back to an exam room to get things started so I’d be ready when he arrived. She asked my reason for visit, and when I told her, she promptly asked why I was seeing Dr. X because he doesn’t treat patients with my chief complaint.

I reminded her that the practice is the one that scheduled me for the physician and should have known from my original appointment reason in the scheduling system what I was coming in for and that it was going to be a problem. I then got to hear through the open doorway as the staff called the physician in his car to ask what to do about me.

He agreed to see me, which I thought was odd if it was outside his area of expertise, but I decided to keep the appointment so I could get my prescription, which had expired due to the rescheduling with my previous physician’s departure.

When he arrived, he was apologetic, and told me “How great that was that the office was able to get in touch with you and have you come in later so you didn’t have to wait for me?” That’s certainly a creatively editorialized version of what happened, but by this point, I wasn’t surprised by anything. He performed only part of a typical exam, pronouncing my eyes “healthy” and then sending me to the front desk with a paper superbill that included charges for services he didn’t actually render.

I hadn’t mentioned that I was a physician. I wonder if he would have performed the way he did had he known that I was? It shouldn’t matter, though – the things that happened during this visit shouldn’t have happened to any patient anywhere. The fact that this occurred at a major academic medical center was particularly distasteful. Although the office manager was appropriately horrified, I’m still waiting for a call back from the department chair.

I have no idea whether his behavior was a result of his being late or generally poor practice. I’m waiting for a copy of my visit note to see what he documented in comparison to what he actually did and what he attempted to bill. In the meantime, I have an appointment across town to see another physician.

If we can’t even get basic medicine right, what hope is there? Email me.

Email Dr. Jayne.

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April 28, 2016 Dr. Jayne No Comments

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