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Curbside Consult by Dr. Jayne 6/19/17

June 19, 2017 Dr. Jayne 6 Comments

I received some sad news from a friend this week whose employer recently migrated to a single vendor platform. She’s worked for her health system’s IT team for years, primarily supporting the ambulatory practices on the practice management application. When the group initially decided to migrate to a new platform, all IT employees were given the opportunity to either transition to the team that would be supporting the migration, or to remain in their current positions with the understanding that following the migration, they would move to positions supporting the new application. She’s developed deep relationships with her customers over the years, and agonized over the decision. She finally decided to stay where she was, keeping the lights on for the legacy application users while everyone else focused on the shiny new thing.

Plans changed along the way, however, but the leadership didn’t give any hints to the support teams. Literally five days after cutover she was given notice that her employment would be ending in two weeks. She of course is welcome to apply for any of the new support positions, however, all of them were posted as requiring current certification on the new system. Having been a CMIO, I understand how these decisions are made, but it seems like a gutless way to get rid of people. I’m not aware of this particular vendor being willing to accept freelance people off the street to train and certify on their products, nor would it be reasonable to expect a full-time employee to try to train on a new system on the side and at their own expense.

It’s not about reducing headcount, because they actually have more posted open positions than the number of people they’re laying off. More likely, it was seen as a way for the health system to get out of paying for training. Not to mention, getting rid of people with 15 to 20 years experience and replacing them with people earlier in their careers is generally cheaper in its own right. The problem, however, is that they didn’t just jettison the employees, but they also got rid of the relationships and history they have built with their customers. They’ve given no weight to the fact that these support workers know their customers, know how the offices run, and understand the dynamics at play. One might think that could be part of the strategy, if they were worried about the “old guard” creating complications with new processes and policies, or being a barrier to effective change.

However, I know enough people at her employer to understand that they didn’t do hardly any work on people or process, but rather treated this migration simply as a technology swap-out. Based on their outreach to me to see if I’m available for some consulting work, I suspect they’re reaping what they sowed as far as failing to use the opportunity for further standardization and clinical transformation. I hate, though, to see good employees negatively impacted by lack of executive strategy and will. Fortunately, my schedule doesn’t allow me to get involved with them right now, because I’m not sure I could do it in good conscience. Although they may think this was strictly a financial decision, when you factor in the loss of “soft skill” expertise, such as knowing how best to handle Dr. Frazzled’s high-maintenance billing team, and the ramp-up time for new technical employees who don’t know the landscape, I bet there is a negative financial impact.

One could argue that there is also a larger domino impact, looking at a health system that provides a large volume of uncompensated care. They’re about to release quite a few workers in their 50s and early 60s, and based on IT hiring needs in the city, they’re going to struggle to find jobs. Eventually COBRA runs out, assuming former employees can afford it in the first place, and depending on what happens with healthcare legislation, they may not be able to afford individual plans. They may wind up needing uncompensated care, with ultimately greater cost to the system in the long run. Although the logic may be a leap, it’s something to think about especially when you’re talking about a non-profit organization that advertises the breadth of their community-mindedness.

Those of us who have seen the balance sheets for those kinds of organizations know the numbers are a little different from what they advertise. They can afford nearly half a billion dollars for an EHR migration, but they’re going to cheap out on training a couple dozen seasoned employees who have been loyal workers, some for decades. They can afford hundreds of millions in capital expenditures but don’t even provide cost of living wage increases to their low-paid clinical employees, let alone to the support teams like IT. Especially for nonprofits, shouldn’t charity begin at home? As a small business person, I understand that businesses need to make money. Even the not-for-profit ones need money to further their missions. Too often, however, that mission is keeping up with the proverbial Joneses rather than being good stewards. It reminds me of when I was in the hospital this winter, when I didn’t get scheduled medications on time due to a staffing shortage. Is it really cheaper to risk a poor outcome? When did people become less valuable of an asset than mammoth IT systems or another outpatient imaging facility or ambulatory surgery center? And do we really need another glass and marble temple to healing when the actual patient care suffers? Every time I think about going back to a health system or large hospital, these are the kinds of issues that keep me up at night.

Fortunately for my friend, there are plenty of opportunities in her area that use the system on which she is proficient. She has a great work history and strong references, so hopefully she will find something quickly. I’d be happy to bring her on to do some projects, but not enough for a full-time position. I’ll help her however I can though, until she finds something permanent. I’m sure her story is representative of those that happen every time a hospital or health system makes a big change. But just because it happens, it doesn’t make it right.

Email Dr. Jayne.

Morning Headlines 6/19/17

June 18, 2017 Headlines No Comments

Fostering Medical Innovation: A Plan for Digital Health Devices

FDA Commissioner Scott Gottlieb, MD describes his plans for regulating digital health innovation, saying that the FDA “should carry out its mission to protect and promote the public health through policies that are clear enough for developers to apply them on their own, without having to seek out, on a case-by-case basis.”

On AHCA, CMS Actuary Finds Smaller Coverage Losses, Smaller Spending Reductions Than CBO

The Office of the Chief Actuary of CMS forecasts a 13 million reduction in insured patients by 2026 if AHCA is passed, 10 million less than the CBO’s prediction.

What Health Systems, Hospitals, and Physicians Need to Know About Implementing Electronic Health Records

Kaiser Permanente Medical Group CEO Robert Pearl, MD outlines the lessons he learned while working on the health system’s $4 billion Epic implementation.

Baby Genome Sequencing for Sale in China

Boston-based DNA sequencing company Veritas Genetics is offering full genome sequencing to parents in China. The sequencing report addresses 950 inherited diseases, as well as 200 genes connected to drug reactions, and 100 physical traits the child is likely to have.

White House task force echoes pharma proposals

STAT reports that behind-the-scenes discussions being held by the Trump administration on how to reign in drug prices are being influenced by lobbyists for the pharmaceutical industry.

Monday Morning Update 6/19/17

June 18, 2017 News No Comments

Top News

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FDA Commissioner Scott Gottlieb, MD outlines his digital health plans for the agency, which include the development and launch of a third-party certification program for low-risk digital health products that it deems “software as a medical device.” He adds that using “a unique pre-certification program for SaMD could reduce the time and cost of market entry for digital health technologies.”


Reader Comments

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From Peg Leg Pete: “Re: Problems at Baptist Health. As a group concerned with how EHR implementations are affecting hospitals and their financial situations, we are currently seeing some problems in Florida. Baptist Health in Pensacola is having delays and cost overruns on their Allscripts implementation. The hospital may face layoffs. As it’s a private hospital, this news isn’t reported publicly.” The 492-bed Baptist Health selected Allscripts in 2015, deciding to implement Sunrise plus a number of other financial and population health management technologies. The provider’s bond ratings agency noted in April of last year that it had taken on a $22 million loan from Allscripts to fund the roll out.

From Potato, Tomato: “Re: VA Cerner vs. DoD Cerner. There seems to be some debate at the VA and in Congress as to whether Cerner will use an ‘identical’ system to the DoD or a ‘similar’ but separate system. (I’ll bet 10 out of 10 HIStalk readers know the answer.) No doubt Cerner’s PowerPoint experts are frantically focus-grouping which line style looks the most ‘seamless’ when you draw it between a VA box and a DoD box.”

From Gordon Gecko: “Re: Cerner financials. I read somewhere (was it HIStalk?) that Cerner’s stock price didn’t pop on the VA announcement because it was already expected/baked in. More likely, the street is aware that … if you take out the DoD and one deal that bundled 30 micro-hospitals … Cerner has actually lost more hospitals as customers (96) than it has added new (92) in the last two years. Not confidence-inspiring, especially when coupled with a late and scope-reduced DoD pilot.”

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From Eagle Eye: “Re: Middle Eastern HIT. Ministry of Health Saudi Arabia is about to sign a $1.5 billion dollar deal with GE. GE will be developing an HIS that consists of its specialty modules (maternity, cardiology, etc.), and combine it with two very basic health information systems – one locally-developed billing solution and a Turkish HIS. The MOH is in for a major mess as the solution has not been even built. It is not clear whether GE is planning to re-enter the HIS market after exiting it a long time ago, or if it’s a one-off thing taken on for the money.”


HIStalk Announcements and Requests

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The “Noes” have it when it comes to considering research studies before purchasing health IT or signing up to participate in private or public clinical programs. Pragmatist puts the role of such studies during decision-making in perspective: “Research results are very important from many standpoints, but generally provide minimal insight into commercial systems that are not readily subjected to research comparisons due to intellectual property considerations.”

New poll to your right or here: Given the latest round of industry speculation around Apple’s healthcare efforts, do you think it is truly capable of moving the patient-centered interoperability needle? I know it’s a loaded question, and so I’m hoping you’ll expound on your “yes” or “no” by leaving a comment.

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Welcome to new HIStalk Platinum Sponsor PatientPing. The Boston-based, Silicon Valley-backed company is building a network of providers who are notified via real time "pings" when their patients receive care elsewhere, allowing them to share care instructions for better care coordination. The network includes physicians, nurses, case managers, and care coordinators in hospitals, EDs, ACOs, physician practices, SNFs, home health agencies, and payers, all of whom rely on PatientPing’s network to support their delivery of high-quality, cost-effective care with improved patient outcomes and experience. I interviewed CEO Jay Desai earlier this year and he did a great job explaining the company’s lightweight technology, the resulting workflow, and its business model. Thanks to PatientPing for supporting HIStalk.


This Week in Health IT History

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One year ago:

  • Reuters reports that McKesson is discussing a merger of its Technology Solutions IT business with Change Healthcare (the former Emdeon).
  • An independent investigation recognizes Healthcare.gov as the second-most secure consumer website, while Twitter took top honors.
  • Doctors at the University of Pennsylvania are seeking approval to use CRISPR gene editing technology on humans for the first time.
  • Federal agents have arrested 300 suspects in the largest ever crackdown on Medicare fraud, with suspected losses totaling $900 million.
  • VA Undersecretary of Health David Shulkin, MD says during testimony before the Senate Committee on Veterans Affairs that its EHR modernization plans are “not dependent on any particular EHR.”

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Five years ago:

  • CMS reports that more than 110,000 EPs and over 2,400 hospitals have been paid a combined $5.7 billion in EHR incentives from Medicare and Medicaid.
  • The VA establishes a goal of conducting more than 200,000 clinic-based telemental health consultations in fiscal year 2012.
  • An FDA report finds that software problems cause 24 percent of medical device recalls.
  • The US Supreme Court refuses to consider an appeal by former McKesson Chairman Charles McCall to overturn his 10-year prison sentence for scheming to inflate company revenue.

Ten years ago:

  • Richard Granger, head of NHS Connecting for Health in the United Kingdom, has announced that he will leave the program at the end of the year.
  • Pro basketballer Dikembe Mutombo buys a smartcard-driven EHR for a hospital in the Congo.
  • Athenahealth announces IPO plans.

Weekly Anonymous Reader Question

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Last week’s survey: What characteristics made the worst doctor you’ve ever had so bad?

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This week’s survey: What is the best practice you’ve seen for a company to encourage gender equity?


Last Week’s Most Interesting News

  • Rumors circulate that Apple wants to store health information on the IPhone, and work with EHR developers to allow users to export information to providers as needed.
  • The House Appropriations Committee approves a $65 million down payment toward the VA’s Cerner procurement, with the stipulation that it will integrate with both DoD and private EHR systems.
  • Omada Health raises $50 million in a round led by Cigna, which will offer the company’s digital chronic disease management technology to its members.
  • Kieran Murphy is named president and CEO of GE Healthcare, succeeding John Flannery who has been promoted to CEO and chairman elect of GE.
  • An OIG report concludes that CMS inappropriately paid eligible providers $729.4 million in EHR incentive payments.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

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ChartSpan Medical Technologies raises $16 million in a venture round led by Cypress Growth Capital, bringing its total funding to $22.15 million since launching five years ago. The Greenville, SC-based chronic care management-focused technology vendor plans to create 300 jobs over the next 18 months and expand beyond its Appalachian borders.

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Inspira Health Network (NJ) announces plans to open the Inspira Innovation Center to develop and commercialize patient-focused health IT.


Government and Politics

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TIAG will customize its Warrior Performance Platform to meet the needs of US Navy sailors. Originally developed for training programs for Special Operations forces, the WP2 will evolve into the Human Performance Self-Service Kiosk, enabling sailors to log fitness, training, and nutritional goals, plus sync them with data from select wearables. No word on whether the data will eventually link with the DoD’s MHS Genesis EHR from Cerner.


Decisions

  • Wadley Regional Medical Center At Hope (AR) will go live with Cerner in December.
  • Sartori Memorial Hospital (IA) will switch from McKesson to a Cerner inpatient EHR in October. (Its clinic will remain with an Epic ambulatory EHR.)
  • Hereford Regional Medical Center (TX) will switch from Healthland (a CPSI company) to Cerner next month.
  • Select Specialty Hospital – Danville and Gainesville (PA) plans to switch to Epic.
  • Regency Hospital Of Central Georgia will go live with Epic in 2019.

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


Privacy and Security

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In New York, prescription eligibility check vendor CoPilot Provider Support Services agrees to pay $130,000 to settle a case with the state attorney general after waiting more than a year before notifying affected patients that a hacker had accessed its system and stolen 220,000 patient records.

A Global Cyber Alliance survey finds that US hospitals have, for the most part, not yet invested in cybersecurity tools at an enterprise level – a statistic that bodes well for hackers looking to take advantage of organizations that have made themselves sitting ducks either through lackadaisical attitudes on the part of upper management or lack of funds. Just six of the 50 largest public hospitals have adopted an email authentication, policy, and reporting protocol known as DMARC. Presumably bigger budgets have enabled 22 of 48 for-profit hospitals to implement DMARC; only one of those has implemented it to the level that it prevents suspicious emails from hitting inboxes.


Innovation and Research

Researchers from the University of Miami Miller School of Medicine and the California Pacific Medical Center will use a $300,000 grant from the Muscular Dystrophy Association to develop and integrate an ALS Toolkit with Epic. The kit will consist of a set of smart forms within the EHR that will help MDA ALS Care Center providers collect and access standardized health data for clinical and research purposes.


Sponsor Updates

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  • Summit Healthcare helps raise money for The Gatehouse, this year’s MUSE conference’s selected charity.
  • QuadraMed, a division of Harris Healthcare, will exhibit at the Wisconsin Rural Health Conference June 21-23 in Wisconsin Dells.
  • Salesforce will accept applications for its incubator program through July 15.
  • The SSI Group renews its HFMA Peer Review designation for the sixth consecutive year.
  • SK&A publishes a “US Elder Care Market Summary.”
  • Versus Technology offers its RTLS for wayfinding initiatives using Bluetooth Low Energy networks.
  • Zirmed will exhibit at the CAPG Annual Conference June 22-28 in San Diego.
  • LogicStream Health will exhibit at the 2017 AMDIS Physician Connection Computer Symposium June 20-22 in Ojai, CA.

Blog Posts


Contacts

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

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Reader Survey Results: What characteristics made the worst doctor you’ve ever had so bad?

June 18, 2017 Uncategorized 2 Comments

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I asked readers what characteristics made the worst doctor they’ve ever had so bad.


Poor personal hygiene.


Seems otherwise occupied; rushes visit.


One who makes me feel their time with me is inconvenient.


Arrogance is a huge problem. Refusal to learn about new programs is a huge roadblock.


That’s easy – his inability to ask questions and listen. The result? Several misdiagnoses.


Two of my PCPs stand out as the worst in my experience:
1. One asked for candor but didn’t seem to want it. In my early college days, I disclosed during a social history check that I did, in fact, have a few drinks per month. The doctor was distinctly colder to me throughout the rest of the checkup.
2. Another decided that it was easier to assume I was lying about my symptoms than do the due diligence. This doctor actually told me that what later turned out to be a legitimate respiratory problem was “all in my head” and probed me for what might be “going on in my life” that I was lying about this problem to avoid.


Arrogance, cockiness, thinking they know your own body better than you, unwilling to listen to or quickly dismissing questions of serious concern to the patient, rushing the visit because the last guy took too long and patients are waiting in the lobby.


She made snap judgments about my health state. Continually ignored data that didn’t match her snap diagnosis and then put a pregnancy at risk because she didn’t ask better probing questions to figure out I was having gallbladder attacks.

I was willing to forgive this and a long, fear-ridden pregnancy because to some degree my symptoms were asymptomatic, BUT she then instituted a rule after years of delayed, long waiting times that if you as a patient were late for an appointment, that she would not  give you your full time slot. At my very first appointment after giving birth and having post-partum gallbladder removal, the first time she’d seen me since missing a year’s long series of gallbladder attacks, she had a very embarrassed nurse tell me that because I was 10 minutes late I wouldn’t get my full annual appointment check up. I got dressed, left the room, and changed doctors.


Two separate doctors who told me that my (very real) pain was all in my head and that I needed to "relax." This kind of disregard and automatic dismissal of the patient is chronic in treatment (or I guess non-treatment) of "women’s issues." If something I’m experiencing is bad enough that not only am I going to take a day off to go to your office, but I’m going to get my feet up in stirrups … you better not call me a liar.


New patient visit with physician who had little interest in hearing what the patient had to say and didn’t perform any type of exam. She read the MA intake notes, told me what labs she would order, and that she’d see me back after the labs were received. She then advised that the problems that prompted the visit were, in her expert opinion, generally due to poor diet and she highly recommended I purchase the diet supplements sold in her practice. She billed the visit to my insurance as a comprehensive new patient examination (something that requires a complete physical exam!). I never returned and filed a complaint with my insurance company regarding her fraudulent billing (which unfortunately went nowhere because apparently patient complaints to the insurance company don’t matter).


Thinking they are always right.


He was infuriated that after spending a good half hour with me discussing my needs, I decided to have my surgery and care provided by another physician. He practically threw me out of his office and threatened to call security if I didn’t immediately leave.


Physical: unclipped fingernails on a dentist.


Cold. Conversation was awkward. On a follow-up visit, she entered the room and just stared at me, as if it was up to me to initiate the discussion. So … last time you saw me …


An unwillingness to listen and an attitude that he knew everything and was always right, which was not true!


Would not listen,acted liked I was bothering him, and then seriously misdiagnosed me on top of it all. It was the beginning of me looking to alternative medicine for at least some problems.


Lack of respect for me and my problems.


Disinterest in patient, deferential attitude, otherwise preoccupied, feeling like patient was wasting doctor’s time.


Not explaining the pros and cons of recommended medications to me during labor and generally being dismissive of my questions. This was not my regular OB but the hospitalist who happened to be on call when I was triaged with my first child.

Morning Headlines 6/16/17

June 15, 2017 Headlines 1 Comment

Apple is quietly working on turning your iPhone into the one-stop shop for all your medical info

Christina Farr reports that Apple wants to store health information on iPhone and work with EHR developers to allow users to export information to care providers as needed.

Coming to ONC – One Informaticist’s Journey

In his first blog post as National Coordinator for Health IT, Don Rucker, MD discusses the challenges facing the health IT industry, and his background as an informaticist.

Congress offers $65M as down payment on Vista replacement

The House Appropriations Committee approves a $65 million down payment toward the VA’s Cerner procurement, with the stipulation that it will integrate with both DoD and private EHR systems. The DoD’s Cerner implementation will cost $4.3 billion in total, and estimates suggest that the VA’s final cost could climb as high as $16 billion.

A.G. Schneiderman Announces Settlement With Healthcare Services Company That Illegally Deferred Notice Of Breach Of More Than 220,000 Patient Records

In New York, prescription eligibility check vendor CoPilot Provider Support Services agrees to pay $130,000 to settle a case with the state attorney general after waiting more than a year before notifying affected patients that a hacker had accessed its system and stolen 220,000 patient records.

News 6/16/17

June 15, 2017 News 8 Comments

Top News

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Rumors related to Apple’s healthcare takeover abound, with CNBC reporting that the company is working behind the scenes to develop an Iphone-based repository of health data that users can share from at will. Lab results and allergy lists seem to be first on Apple’s pick list of data points to tackle. Tied in with that is the recommendation of a Citigroup analyst that Apple buy up Athenahealth in a move that would give it access to the EHR vendor’s 83 million patient records and its Epocrates physician end users and technology. Apple is certainly a force to be reckoned with when it comes the ubiquity of its mobile devices (though some have lately challenged that notion), but it seems the issue of interoperability with other competing platforms – as seen so often with healthcare – would raise its ugly head sooner rather than later. It would be fun to see how Apple fanboys would take to Jonathan Bush’s cult of personality.


Reader Comments

From First Fruits: “Re: App Orchard. Prices have gone up by $5,000 for the top two tiers effective May 25th from what I can tell. And they have taken away benefits, i.e. the number of included support hours, free app listings, and registrations to events. You don’t get any indication of available APIs until after you pay your annual fee. Does anyone consider this a pay-to-play interoperability?”

From Chip Hart: “Re: Larry Weed, MD. Larry passed away at the age of 93 earlier this month. Arguably the great-grandfather of EHRs, and certainly of the organized medical record. (He invented the SOAPM and POMR concepts.) His lectures are famous. I believe you’ve linked to them in the past. The stuff from the 70s is still relevant today. Here’s one.”


HIStalk Announcements and Requests

This week on HIStalk Practice: The FBI looks into Zoom’s falsified risk-adjustment payments. Community Health and Wellness Center of Greater Torrington leans on Stone Health Innovations for CCM expertise. Several cancer care practices select Flatiron Health software and support. Digital Noema Telehealth adds EazyScripts e-prescribing to virtual consult software. The Medical Society of the State of New York expands partnership with DrFirst. Spry Health raises $5.5 million. Dermatologist Stacia Poole, MD discusses the role health IT plays at a practice with older patients. Thanks for reading.


Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

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Omada Health raises $50 million in a round led by Cigna, which will offer the company’s digital chronic disease management technology to its members.

Cleveland Clinic and Oscar Health will offer co-branded insurance plans to people in northeastern Ohio. The move is a first for both organizations, marking Oscar’s entry into the state and the health system’s first time offering an insurance product bearing its name.

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Weirton Medical Center (WV) sues Cerner and its Siemens subsidiary for their failure to provide adequate support and service related to a $30 million contract extension for Soarian in 2013. A trial by jury has been requested. WMC’s end goal appears to be termination of its contract with Cerner, and Cerner’s free-of-charge assistance in switching the hospital to a new vendor.

PokitDok acquires the software and pharmacy assets of Oration, a prescription management and savings app developer. PokitDok plans to make Oration’s commercial pharmacy benefit data available through its DokChain network.


Announcements and Implementations

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JD McCarty Center for Children with Developmental Disabilities (OK) implements Evident’s Thrive EHR. The center enlisted the consulting services of TruBridge to assist with the roll out. Evident and TruBridge are both subsidiaries of CPSI.


Technology

Physician’s Computer Company adds FDB’s MedsTracker e-prescribing tool to its EHR for pediatricians.

MModal’s CAPD tools now support Epic’s NoteReader CDI module.

Salesforce adds new communications features to its Health Cloud CRM, enabling caregivers outside of the doctor’s office to communicate via mobile device, and to share care plans across different organizations.


Sales

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Community Medical Centers (CA) will implement LogicStream Health’s Clinical Process Improvement solutions.

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Neighbors Emergency Center selects Presidiohealth’s FSEC Foundation software, which combines T-System’s EDIS with Presidio’s PM technology.


People

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Clinical Computer Systems, developer of the Obix Perinatal Data System, promotes Cindy Bell to VP of customer services.

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Cambia Grove founder and executive director Nicole Bell will join Amazon Web Services as principal business development manager, serving as a healthcare industry liaison.

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Erin Jospe, MD (PatientKeeper) joins Kyruus as CMO.

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Citing closer proximity to family, Vancouver Island Health Authority President Brendan Carr, MD plans to step down to take over as president and CEO of the William Osler Health System in Ontario. His five-year tenure at Island Health has included oversight of the rocky rollout of the IHealth EHR, which still has physicians up in arms over its risk to patient safety. “I’ve learned immensely from that experience,” he explains, “sometimes painfully so. It’s been a challenging thing, and I think it’s something that will absolutely allow this organization to do great things in the future.”


Privacy and Security

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Microsoft releases a bevy of security updates to protect users from WannaCry-like attacks. In addition to automatic updates, the company is making the updates available for manual download and installation for unsupported software versions including Windows XP and Windows Server 2003.

Sensato Cybersecurity Solutions will focus on the attacker’s perspective during its Hacking Healthcare Workshop, set to take place September 13-14 in Asbury Park, NJ.


Government and Politics

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A GAO report finds that pharmacists at the VA have trouble accessing patient data via its pharmacy system, and often run into trouble when transferring or refilling prescriptions from non-VA facilities. Recommendations include updating the system and taking a deeper look at barriers to interoperability.


Innovation and Research

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Colorado’s UCHealth launches the virtual Applied Decision Science Lab through its CARE Innovation Center to collaborate with entrepreneurs on healthcare technology. Researchers are particularly interested in using AI and machine learning to enhance EHR workflows and clinical decision support.


Other

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Bloomberg reports that nearly half of the $2 billion raised on popular crowdfunding platforms like GoFundMe are being used to pay medical expenses. Facebook has gotten in on the action, adding a health category to a new feature that lets users set up fundraisers for personal causes.

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A US District judge sentences Wilbert Veasey, Jr. to pay over $23 million to CMS and serve 17 years in prison for his part in what authorities call the biggest home health fraud in the history of Medicare and Medicaid. Veasey, along with four conspirators, convinced already vulnerable Medicare patients to sign up for unnecessary home health services, after which they then filed for reimbursements for via a number of shell companies. The racket ultimately ran up $374 million in fraudulent claims.

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The Michigan Attorney General charges HHS Director Nick Lyon and Chief Medical Executive Eden Wells in the latest round of criminal charges related to the Flint water crisis in 2014 and 2015 that resulted in 12 deaths and dozens more sickened by contaminated drinking water. Lyon’s actions were particularly reprehensible. According to court documents, he “willfully disregarded the deadly nature of the Legionnaires’ disease outbreak, later saying he ‘can’t save everyone,’ and ‘everyone has to die of something.’”


Sponsor Updates

  • Meditech releases a new podcast, “Home Care & Population Health.”
  • Liaison Technologies will host an IT Leaders Forum on data strategy June 21 in London.
  • Meditech will host the 2017 Revenue Cycle Summit June 20-21 in Foxborough, MA.
  • Navicure will exhibit at the Florida MGMA 2017 Annual Conference June 21-22 in Orlando.
  • Experian Health publishes a new case study featuring Yale New Haven Health.
  • Health Catalyst adds Duncan Gallagher (Allina Health) to its Board of Directors.
  • The Medical Society of the State of New York will offer its members complimentary access to DrFirst’s e-prescribing and medication management app.
  • InterSystems customers Northwell Health and Mount Sinai Health System connect their private HIEs to the New York-based Healthix public HIE.
  • ROI Healthcare Solutions will present at Inforum 2017 July 10-12 in New York City.

Blog Posts


Contacts

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

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Readers Write: Top 10 Takeaways From the EClinicalWorks Settlement

June 15, 2017 Readers Write No Comments

Top 10 Takeaways From the EClinicalWorks Settlement
By Colette Matzzie

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1. The federal False Claims Act provides an effective way to hold EHR vendors accountable for failing to meet Meaningful Use standards.

Many customers had complained to EClinicalWorks about major problems with its software, but little changed. It took a knowledgeable healthcare IT implementation specialist and the might of the US government to get the software problems fixed. They used a powerful whistleblower law known as the False Claims Act, which encourages whistleblowers to fight fraud by filing “qui tam” lawsuits, to force ECW to take action. Anyone who “causes” false claims to be submitted to the government is liable under the False Claims Act. Customers of ECW relied on representations that ECW’s EHR technology was properly certified and therefore, unknowingly submitted tens of thousands of claims for government incentive payments that falsely attested MU requirements had been met.

2. The federal Anti-Kickback Statute forbids EHR vendors from paying or rewarding users to promote or refer others as customers.

Many healthcare providers, pharmaceutical companies, and medical device manufacturers have been penalized for violating the Anti-Kickback Statute, but the ECW case is the first time it has been applied in the EHR industry. The government cited payments totaling almost $300,000 through ECW’s “referral program,” “site visit program,” and “reference program,” in addition to unknown amounts for consulting and speaker fees paid to influential users, as evidence of alleged violations of the Anti-Kickback Statute. The law prohibits providing money, gifts, or other remuneration intended to get referrals for services or items paid for by federal healthcare dollars except under very limited circumstances.

3. The accuracy of representations made to certifying bodies will be a factor when the DoJ reviews the liability of an EHR vendor under the False Claims Act.

Certification by a government Authorized Testing and Certification Body has been a prerequisite to successful sales because buyers can obtain federal incentive payments only for certified EHR technology. The government cited EClinicalWork’s decision to modify its software to “hard code” the drug codes needed for testing without meeting the certification criteria as evidence that ECW had “falsely obtained” its certification. This gave rise to its liability under the False Claims Act. Accurate and truthful information will remain a requirement for certification, despite the debate over whether the certifications adequately ensure software reliability and patient safety.

4. The Office of Inspector General crafted an innovative Corporate Integrity Agreement requiring ECW to fix deficiencies, notify its customers, provide customers with free upgrades, and permit customers to transfer clinical data without penalty.

As part of the settlement, ECW signed an expansive, state-of-the-art Corporate Integrity Agreement that the OIG put together to ensure that providers and patients are protected going forward. ECW is required to take significant remedial steps, which included sending out a series of notifications and advisories to customers that advise them of patient safety risks with its software, giving customers an opportunity to obtain updated (and presumably remediated) software free of charge; and offering the opportunity to transfer clinical data to another vendor free of onerous penalties or other restrictions. Software vendors should consider the agreement a guide to understand the risks they will face if their software does not meet federal requirements or if other misconduct occurs.

5. The government deems data portability and audit log requirements to be essential to proper EHR functioning.

EHR systems are required by the government to be able to export clinical information on patients electronically, including by batch exports, and reliably and accurately record user actions in an audit log. In its complaint-in-intervention, the government faulted ECW for allegedly misrepresenting these capabilities, and made clear that these omissions from the software were not acceptable.

6. EHR vendors need to respond in a timely and effective manner to customer reports of software defects, usability problems, or other issues that may present a risk to patient safety or that may violate federal law.

The Corporate Integrity Agreement requires ECW to notify OIG of certain reportable events that involve patient safety, certification, or a matter that a reasonable person would consider to be a violation of law. The government wants all EHR vendors to report significant problems or violations of law, especially when patient health or safety may be at issue.

7. EHR vendors should have persons and procedures in place to ensure compliance with federal law, just as healthcare companies do.

ECW’s Corporate Integrity Agreement requires the company to establish a compliance program with a compliance officer and a written code of conduct, similar to what many healthcare companies have. That’s something all EHR vendors should consider doing, as it’s wise to offer employees clear avenues to report concerns internally. Most employees prefer to address concerns internally before blowing the whistle by filing a qui tam lawsuit – unless the company has shown it is not responsive to legitimate concerns or will retaliate against employees who speak up.

8. The government will hold managers personally responsible for activities of the EHR vendor company.

The ECW settlement holds both the company and its three founders (the CEO, CMO, and COO) liable for payment. The settlements reinforce the DoJ’s commitment to individual accountability for corporate decisions in a very tangible way.

9. EHR vendors must ensure that all contracts and agreements with its customers do not restrict disclosures of information about the performance of the software or reporting of patient safety concerns (the “anti-gag” rule).

ECW’s Corporate Integrity Agreement requires that contracts between the company and its customers do not restrict customers from disclosing concerns about the performance of its software. This includes concerns related to patient safety, public health, and product quality. Other vendors should consider adopting similar “anti-gag” practices.

10. Whistleblower rewards may be paid for information that leads to successful resolution of a federal qui tam action against an EHR vendor.

The ECW case shows the government welcomes whistleblowers who have information about significant problems with EHR software. Under the False Claims Act, the government will pay whistleblowers a reward of 15 to 25 percent of the proceeds recovered by the government as damages and civil penalties, if the government joins the “qui tam” case filed by the whistleblower. The government awarded the ECW whistleblower $30 million.

Colette Matzzie is a whistleblower attorney and partner at Phillips & Cohen LLP, which represented the whistleblower in the EClinicalWorks case.

EPtalk by Dr. Jayne 6/15/17

June 15, 2017 Dr. Jayne 1 Comment

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Congratulations to the University of Arizona College of Medicine – Phoenix for receiving full accreditation from the Liaison Committee on Medical Education. The school was created more than 10 years ago to help address Arizona’s physician shortage and was originally a branch campus of the UA College of Medicine – Tucson. Now, UA joins the ranks of only a few universities with multiple accredited medical schools. Starting up a new medical school is a daunting process, whether it’s a branch of an existing school or not. I had the pleasure of speaking recently with one of the faculty members at the Dell Medical School at The University of Texas at Austin who shared some of their trials and tribulations. Becoming fully accredited is quite an accomplishment.

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While EHR vendors are working on their certification testing, many are expanding the incorporation of user testing. NCQA is also getting into the act with a website usability and navigation study. I appreciate the fact that they’re trying to make the website easier to use, but I wish they’d make their recognition programs less cumbersome and more affordable for primary care practices. I’ve been contacted by multiple clients who are struggling with the transition from their 2014 program to the updated 2017 program. One of my staffers is attending the course in Washington, DC this week, and at nearly $900 for one day it’s certainly not cheap. Tack on some hotel and travel, and it’s a lot for a small practice to spend for training.

Fortune recently released its list of the 500 companies that generated the most revenue in the last year. Multiple healthcare systems made the list, including HCA Holdings, Community Health Systems, Tenet Healthcare, DaVita, Universal Health Services, LifePoint Health, Kindred Healthcare, and Genesis Healthcare. Health insurers made it on the list as well, with UnitedHealth Group ranking at number six. Other payers making the cut include Anthem, Aetna, Humana, Centene, Cigna, Molina Healthcare, and WellCare Health Plans.

A friend sent me this piece about “Perfect Non-Clinical Income Ideas for Doctors.” I had to laugh at some of the suggestions, especially considering the time pressure that many physicians face. I don’t imagine that many physicians would be up for multilevel marketing, peddling insurance, or renting out their cars. Not to mention, the author fails to appreciate the concept of “passive” income. The only side businesses I see my colleagues involved in are in the property ownership realm, and none of them are personally managing their properties.

My practice opened two new locations in the last 30 days, so I’m working more clinical shifts than I usually do. Unfortunately, that increased schedule came right when my vendor is experiencing an ongoing problem with API errors. The impact is worst when we’re trying to use the e-prescribing functionality or when staff is trying to search for the patient’s preferred pharmacy, which means it impacts pretty much every patient when it happens. Although I appreciate the communication, receiving an email every two hours that essentially says “yes it’s still going on, and no we don’t know how to fix it yet” becomes annoying. Even while I scowled at my inbox, however, I did get a kick out of a marketing email that popped in from our friends at EClinicalWorks. Apparently they’re offering an ill-timed promotion called “Make the Switch” that includes free data migration to the system. I wonder how many takers they’re getting.

A reader sent me this piece about workplace wellness programs. It references some interesting statistics that I wasn’t aware of, such as the fact that 50 percent of companies that have more than 200 workers either offer or require employees to complete biometric screenings. Of those companies, more than half offer financial incentives to employees to participate. Others mandate the screenings for employees who elect company-provided health insurance plans. I’m sure wellness programs will continue to expand, as employers try anything they can to try to control rising healthcare costs.

I’ve written about my concerns around wellness programs before, namely that programs often aren’t compliant with screening recommendations. They may require employees to participate in screenings, such as blood glucose and cholesterol, that are not recommended for their age group and that may lead to distress and interventions that ultimately do more harm than good. Another tidbit I wasn’t aware of is the fact that modifications to regulations around employee wellness programs were nestled into the Affordable Care Act, allowing employers to shift 30-50 percent of employee-only healthcare premiums onto employees who fail wellness tests. I haven’t had to participate in biometric screening since I left Big Hospital, although when you compare the hassle, invasion of privacy, and dubious science against the premiums paid by small businesses, it doesn’t seem so bad.

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I’m always on the lookout for stories of adventures in healthcare, and today I had one of my own. I was calling to make an appointment for a procedure with a provider who has multiple offices. Even though I haven’t been seen there in a couple of years, they were willing to schedule the procedure without a consultation first, which seemed unusual given the opportunity to not only collect an updated history and physical but to also generate some extra charges in a procedure-based specialty. The scheduler then paused and said, “Let me write all this down” and I assumed that she was going to take my request to a surgery scheduler, who would get back to me for the actual scheduling. She “wrote” for over a minute, and apparently used the information as a reference while she looked at the computerized scheduling system. As a process improvement person, I can’t imagine how that works given an average office’s phone volume. I can’t wait to see it in person in a couple of weeks. Needless to say, I won’t be surprised if they call me back and ask to schedule a consultation first, but you never know.

Email Dr. Jayne.

Morning Headlines 6/15/17

June 14, 2017 Headlines No Comments

American Health Care Tragedies Are Taking Over Crowdfunding

Bloomberg reports that half of the $2 billion raised on popular crowdfunding platforms like GoFundMe are being used to pay medical expenses.

Ron Peterson retiring as Johns Hopkins Health System president after 44 years

Johns Hopkins Health System President Ron Peterson announces that he will retire at the end of this year. Peterson arrived at the health system in 1973, starting as an administrative assistant.

5 people, including Michigan health chief, charged in Flint

Nick Lyon, the former director of Michigan’s Health and Human Services department, is charged with involuntary manslaughter along with five other officials as a result of the 2014 Flint water crisis.

Your Doctor’s Office Is Vulnerable to Hackers, but Congress Could Change That

MIT Technology Review weighs in on legislative changes that could improve cybersecurity for smaller health care facilities.

Morning Headlines 6/14/17

June 13, 2017 Headlines No Comments

Kieran Murphy Appointed CEO of GE Healthcare, Succeeding John Flannery

Kieran Murphy is named president and CEO of GE Healthcare, succeeding John Flannery who has been promoted to CEO and chairman elect of GE.

MEDITECH Signs 16 More Hospitals in Q1 2017

Meditech signs five new health systems, with 16 combined hospitals, to its 6.1 Web EHR in Q1.

Drones carrying defibrillators could aid heart emergencies

Researchers launched drones carrying defibrillators from a fire department to see if drones could deliver a faster response time than an ambulance, and found that drones arrived at the scene of 18 cardiac arrests within about 5 minutes of launch, almost 17 minutes faster on average than ambulances.

New Mexico Physician Chosen as AMA President-elect

At the Annual Meeting of the American Medical Association, Barbara McAneny, MD, an oncologist from Albuquerque, NM, is elected as the next president of AMA.

News 6/14/17

June 13, 2017 News 4 Comments

Top News

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An audit reveals that CMS may have paid out nearly $729 million in improper Meaningful Use incentives between 2011 and 2014. OIG auditors based their estimate on the review of 100 payments – 14 of which were made for incorrect reporting periods, or were based on incomplete verification documentation, and totaled just over $290,000. Auditors also found that CMS should not have paid out $2.3 million to providers who switched between Medicare and Medicaid incentive programs during that timeframe. OIG recommends that CMS recoup the money and undertake a more thorough review of all payments made.


Reader Comments

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From OITNB: “Re: Athenahealth/Medhost deal. I think you may have it wrong or that Medhost may have multiple suitors. Allscripts CEO Paul Black was at the Medhost office on the executive floor a few weeks back.”


Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Announcements and Implementations

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Torrance Memorial Medical Center (CA) rolls out Mobile Heartbeat’s smartphone-based clinical communications system to its 2,700 team members.


Acquisitions, Funding, Business, and Stock

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Genetic testing company Invitae acquires Ommdom, developer of the CancerGene Connect risk assessment and family history analysis tool.

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Cognizant plans to acquire TMG Health, a subsidiary of insurer Health Care Service Corp., later this year. TMG, which caters to government-sponsored health plans, will continue to provide IT and business process services to HCSC business units. Cognizant’s largest publicized acquisition was TriZetto in 2014 for $2.3 billion in cash.


People

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Erin Trimble (Athenahealth) joins Redox as VP of business development.

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GE promotes healthcare lead John Flannery to CEO and chairman elect. GE Healthcare Life Sciences CEO Kieran Murphy will take over Flannery’s role. Murphy will likely devote much of his time to strengthening GE Healthcare’s technology with the relocation of hundreds of tech workers to its office in Boston, as well as with a planned $500 million software spend over the next several years.

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Patientco hires Alan Nalle (Accenture Strategy) as chief strategy officer.

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The American Medical Association names New Mexico Oncology Hematology Consultants CEO Barbara McAneny, MD president-elect at its annual meeting. She will succeed newly sworn-in Mercy Clinic VP David Barbe, MD.

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Tycene Fritcher (Solutionreach) joins health system-focused telemedicine company Avizia as CMO.


Sales

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Greater Baltimore Medical Center (MD) selects Phynd’s Enterprise Provider Data Management solution tool to help it manage the data of 15,000 credentialed and referring providers.

Meditech signs up 16 hospitals in the first quarter of 2017.


Technology

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Caradigm releases a trio of population health tools to help Medicare ACOs understand clinical and financial risk and utilization patterns, and to identify high-risk patients who may need clinical intervention.

Glytec integrates AgaMatrix’s wireless blood glucose monitoring app with its EGlycemic Management System, giving providers the ability to offer patients more mobile and tailored insulin dosing management between appointments.


Government and Politics

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Vice President Pence stresses the president’s focus on repealing the Affordable Care Act during remarks to HHS employees. His main points focused on rising premiums, reduced coverage options due to payers leaving the exchanges, and the number of people dropping out of ACA insurance plans – figures that some have called into question. He emphasized that the Republican-crafted American Health Care Act quietly working its way through the Senate will “transition our healthcare economy away from the regulations and mandates and taxes of Obamacare to a patient-centered healthcare system built on personal responsibility, free-market competition, and state-based reform.”


Innovation and Research

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A survey of just over 1,000 consumers finds that only 17 percent believe health-related industries are the most innovative compared to sectors like consumer electronics, telecommunications, and media. Respondents have high hopes for healthcare innovation, though; 70 percent believe health IT will eventually make the biggest impact on their personal health management. They cite wearables, robotics, 3D printing, smart home devices, and AI as technologies likely to make the most waves.

Vanderbilt University Medical Center (TN) researchers create an algorithm based on hospital admissions data that is “80-90 percent accurate when predicting whether someone will attempt suicide within the next two years, and 92-percent accurate in predicting whether someone will attempt suicide within the next week.”

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Drones carrying defibrillators to the scenes of heart attacks arrive five minutes after launch – 12 minutes faster than local ambulance services, according to a study featured in JAMA. Drones were launched from a fire station within six miles of where previous cardiac arrests had occurred.


Other

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The New York Times looks at the growing role the Dark Web plays in helping opioid-pushing drug dealers sell and ship their products. Thanks to increased potency and decreased size, “enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope.”


Sponsor Updates

  • The Millenium Alliance advisory firm interviews Arcadia Healthcare Solutions VP Michael Meucci.
  • Besler Consulting releases a new podcast, “Completing your Medicare Occupational Mix Survey.”
  • CareSync publishes an infographic on annual wellness visits.
  • Docent Health will participate in Boston TechJam June 15.
  • EClinicalWorks will exhibit at The Private Healthcare Summit 2017 June 20 in London.
  • FormFast joins the Salesforce AppExchange.
  • HCS will exhibit at the Texas Hospital Association Behavioral Health Conference June 15-16 in Austin.
  • The HCI Group customer St. Luke’s University Health Network achieves HIMSS Analytics EMRAM Stage 7 status.
  • InterSystems will exhibit at the HIMSS NY Chapter Annual Conference June 20 in the Bronx.
  • Meditech South Africa celebrates 35 years.
  • InstaMed releases its Trends in Healthcare Payments Annual Report.

Blog Posts


Contacts

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

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Morning Headlines 6/13/17

June 12, 2017 Headlines No Comments

Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements

An OIG report concludes that CMS inappropriately paid eligible providers $729.4 million in EHR incentive payments who did not meet meaningful use requirements.

FBI is investigating an Oregon health care startup

Oregon-based health insurance startup Zoom is under FBI investigation for retrospectively altering medical claims to make its patient population look sicker in an effort to avoid paying into risk adjustment pools.

Iowa Seeks to Revamp Affordable Care Act

Iowa state officials are seeking permission to make signification changes to its ACA marketplace in an effort to protect residents at risk of losing their insurance due to payers backing away from the exchanges.

CRISPR May Cure All Genetic Disease—One Day

CRISPR pioneer Jennifer Doudna, PhD. discusses the future of genetic editing, saying “I think it’s really likely that in the not-too-distant future it will cure genetic disease.”

Curbside Consult by Dr. Jayne 6/12/17

June 12, 2017 Dr. Jayne 2 Comments

Last week, CMS kicked off a multi-pronged outreach program to help providers prepare for the transition to the new Medicare Beneficiary Identifier (MBI). New Medicare cards, to be issued starting in April 2018, will have a new identification code for each beneficiary, which is not based on the Social Security number. Congress mandated that all cards be replaced by April 2019, and vendors have been working on adding functionality to hold the new identifiers for some time. There will be a nearly two-year transition window where providers can use either the MBI or the old Medicare number, as well as secure lookup tools for both providers and patients. The ID will include both numbers and letters – along with many others, I’ll probably still call it a “Medicare number” regardless of the presence of letters.

There are nearly 58 million people on Medicare, and the goal of the program is to fight identity theft, fraud, and illegal use of SSNs. Unfortunately, this doesn’t help the rest of us who are constantly asked to provide our SSNs across the rest of the healthcare space. I checked with a couple of my clients to see if they have plans to phase out use of the SSN in general and they haven’t really thought about it. I’ve had quite a few adventures in healthcare this year, and every single one has asked for not only my SSN but also had fields on their patient data forms to gather the SSN of a guarantor where one exists.

Even with a Congressional mandate, this process has taken years. It was in the works prior to the passage of MACRA, but that law accelerated the timetable. Although CMS has had a website about the project for some time, it’s unclear how much providers understand at this point. Providers and their office leaders have been through a lot of federally-induced change in the last few years, including the prolonged ICD-10 transition and now the distraction of MIPS, along with continued Meaningful Use pressures for our Medicaid friends. It could be that people just aren’t planning to pay too much attention until it gets closer. The other piece of it is that vendors aren’t entirely ready yet, so it’s not yet “real.” Once the new ID field starts appearing in systems, then perhaps it will be worth thinking about. I searched my email archives and found a notice from our vendor a few months ago, mentioning that it will be added to the system towards the end of 2017. One of the benefits (and sometimes challenges of) a vendor-hosted, cloud-based system is that features just appear after a brief announcement, so we’ll have to see what other communication we receive as it gets closer.

The migration to the new MBI is not just a digital change but one that will require operational and process changes as well. Practices may want to consider proactive outreach to their patients to educate them about the new cards and the need to bring them to the office, as well as to allow for additional check-in time on their first visit after they receive their new cards. Sites will need to educate staff about their cutover plan and the need to maintain both identifiers during the transition, and the fact that they can’t simply remove the old IDs from the system since claims may still be working their way through the system. Everyone should be readying a plan, even if it’s just high level at this point. I’d be interested to hear what organizations of varying sizes are doing at this stage in the game.

In other CMS news, Tuesday is the last day to submit formal comments on the FY18 Inpatient Prospective Payment System and Long Term Acute Care Hospital proposed rule. The rule also includes language around Indian Health Service and other Tribal facilities. Most notably, it modifies the EHR reporting period from full calendar year to 90 days, which many of us are eagerly awaiting. Other nuggets include a new exception from the Medicare payment adjustments for eligible professionals, hospitals, and critical access hospitals if they demonstrate that they can’t comply with being meaningful users because their EHR has been decertified. There’s always a path for no payment adjustments for EPs who furnish all their covered services in the ambulatory surgical center setting. Even if you don’t have any comments to offer, the closure of the comment period is a milestone in the countdown to a final rule, which many of us are eagerly awaiting.

I spent some time this weekend at a continuing education conference at one of the local medical schools. I was looking forward to it, since it was targeted towards community physicians and was an opportunity to engage with some of the leaders in the field about the best ways we can co-manage patients. The content was outstanding, with concise presentations offering real-world advice rather than the more esoteric academic discussions I’ve seen in some of their sessions in the past. However, it was marred by attendees behaving badly. The worst example was a physician who was clearly responding to emails and/or transcribed phone messages, and who was using the voice recognition features on his phone to do so. If you have to multitask, you need to either do it non-verbally or you need to step out of the room.

The first couple of times he did it, I’m not sure people understood what was going on, because it looked like he might be having a sidebar conversation with the person next to him and was just being loud. As it continued, it was more obvious what he was doing, yet no one close to him said anything although there were plenty of people giving him dirty looks. Finally, one of the CME door monitors came forward to address the situation and he quit. Still, you have to wonder in what universe someone thinks that’s OK and how we’ve arrived at a place where people’s need to try to do it all interferes with them being a considerate member of society.

Email Dr. Jayne.

Morning Headlines 6/12/17

June 11, 2017 Headlines 1 Comment

Cost of HSE’s €35m IT system continues to rise

Ireland’s countrywide Maternal and Newborn Clinical Management System project, which includes Cerner clinical software and Deloitte project management and implementation staff, is reportedly overrunning its budget at every site that implements it.

Artificial intelligence can now predict suicide with remarkable accuracy

Researchers at Vanderbilt University Medical Center have created an algorithm that was “80-90% accurate when predicting whether someone will attempt suicide within the next two years, and 92% accurate in predicting whether someone will attempt suicide within the next week.”

Amazon poised to deliver disruption in medical supply industry

Amazon plans to use its massive distribution network to enter the medical supply distribution market.

Opioid Dealers Embrace the Dark Web to Send Deadly Drugs by Mail

Drug dealers selling opioids are turning to the Dark Web to move their products as potency increases, as the New York Times reports “enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope.”

Apple just hired the star of Stanford’s digital health efforts

Apple hires Sumbul Desai, MD and former executive director of Stanford Medicine’s center for digital health, to its healthcare team.

Monday Morning Update 6/12/17

June 11, 2017 News No Comments

Top News

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Cork University Maternal Hospital and University Hospital Kerry in Ireland report significant added expense as a result of their implementations of the nation’s first Maternal and Newborn Clinical Management System. The initial $39.2 million price tag has increased by $785,000 in Deloitte consultancy fees, with millions more expected as 17 additional hospitals prepare to go live on the Cerner-powered system over the next several years. Ireland’s Health Service attributes the over-budget, delayed implementations to a lack of expertise on the part of its clinical and business staff.

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Ireland experiences similar woes with its eHealth project, which is “not in a good place,” according to Chief Scientific Adviser Mark Ferguson, adding that the project is moving forward with several initial pilots to help alleviate patient concerns about  the digital storage of PHI. The project will ultimately include the launch of a nationwide EHR, unique identifiers for patients, and capacity for genome-sequencing.

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Providers at University Hospital Limerick are particularly depressed with projections that eHealth implementation at their facility could take up to 10 years. The hospital uses a number of different data-sharing systems, and is still plagued by an inefficient paper record-keeping system. “We have many, many computer systems in the health service,” says the hospital’s founding president, Ed Walsh, “but they don’t talk to each other. [The health service is] consumed by inefficient bureaucracy, which is based on a Victorian paper system. And until we move that, we won’t be able to move the resources necessary to provide the healthcare that the patient requires.”


Reader Comments

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From Kiwi: “Re: Orion Health’s financials. It seems to be letting an error by HCIT go uncorrected. Their Healthcare Informatics 100 listing cites $193 million in revenue in 2016, but reported financials show a different story (and the company is publicly traded). If my math is correct, the New Zealand dollar has moved between being worth about $.68 to $.74, making their earnings anywhere from $140M to $152M in 2016 and even less this for FY 2017.”


HIStalk Announcements and Requests

The anonymous vendor who donated $500 to my project to fund DonorsChoose teacher grant requests in return for mentioning a survey they’re interested in tells me they’ve almost hit the 100-response mark, which will trigger a second donation even bigger than the first. Providers, please click here and spend just a few minutes to help a classroom in need. Thank you.

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Over 75 percent of survey takers would consider switching systems if their vendor became involved in a situation akin to that of EClinicalWorks. It’s All Good contends, however, that “the basis of the allegations/settlement is not a reason to switch. There were defects. They’ve been fixed. But …  a switch could be considered because such a settlement could force the company into insolvency. Or at least support and innovation will suffer as the company tightens its’ proverbial belt so it can pay the fine.” Ross Martin wonders if this will be the tip of the health IT iceberg – one that’s similar to finding out VW wasn’t the only carmaker to game the emissions compliance system. He suspects that, “in the context of the Great Meaningful Use Land Grab of 2009 and the spend-stimulus-fast development of certification criteria, we will find a good amount of fudging among the vendors. Even vendors who complied with the letter of the reg are nowhere near enabling the plug-and-play level of interoperability we need.”

New poll to your right or here: Do you take research studies into consideration when making health IT purchasing or clinical programming decisions? Given the Washington Post’s piece last week on the tendency of journalists to make headlines out of studies they don’t truly understand and/or that are poorly designed in the first place, I’ve been wondering if hospital executives look at them with the same skeptical eye that I do. Your comments, as always, are appreciated.

I decided early on to have only two HIStalk Founding Sponsors, spots held by Medicity and Nuance since around 2007 or so. Nuance’s new marketing crew has decided that sponsoring HIStalk doesn’t interest them, meaning that their Founding spot is therefore available to the first company who commits to taking it over. Contact me at mrhistalk@gmail.com to grab Nuance’s premiere ad position on the page along with the usual Platinum sponsor benefits. Thanks to Nuance for supporting HIStalk for 10 years.

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Welcome to new HIStalk Gold Sponsor ZappRx. The Boston-based company solves the inefficient workflow and time drain involved with prescribing specialty drugs. Its platform modernizes the multi-step, manual prescribing process – often involving multiple platforms – to automatically populate prior authorization information, obtain digital patient consent, track prescriptions, and communicate bi-directionally with the specialty pharmacy, reducing administrative burden and improving team collaboration without resorting to phone calls. Patients get their critical therapy faster and more accurately with complete transparency. Practices can estimate their time savings using the company’s online calculator – the average prescription order requires just three minutes of provider time with ZappRX. Thanks to ZappRx for supporting HIStalk.


This Week in Health IT History

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One year ago:

  • Connecture, a technology company that builds online health insurance marketplaces, acquires ConnectedHealth, a benefits technology platform that helps employers choose health plans.
  • Cerner launches a one-year pilot study that will help determine whether patient’s genetic data can play a motivating role in promoting behavior change.
  • The VA fires three more administrators within the Phoenix VA Health Care System for “negligent performance of duties and failure to provide effective oversight.”
  • In light of voided test results and potential CMS sanctions, Walgreens ends its relationship with Theranos, closing all 40 of its Theranos Wellness Centers in Arizona.
  • South Australia looks for a spokesperson to reassure the public that its over budget, behind schedule 80-hospital Allscripts EHR implementation is still a worthwhile investment.

6-12-2012 9-34-40 PM

Five years ago:

  • Private equity firm TPG Growth acquires critical care systems vendor iMDsoft.
  • NIH and the National Cancer Institute announce grants to fund development of tools that empower consumers, patients, and/or their providers.
  • A CareFusion site from which medical equipment firmware updates are distributed is found to be loaded with malware, triggering a Department of Homeland Security investigation.
  • Steve Larsen, the federal government’s most powerful health insurance regulator responsible for consumer protection and insurance exchanges, quits to become EVP of Optum.

Ten years ago:

  • IBA is considering suing CSC and Connecting for Health after CSC blocked its bid to acquire ISoft.
  • The Northeastern Pennsylvania RHIO shuts down.
  • DoD’s AHLTA EMR system (formerly CHCS II) is running in 138 military treatment facilities.
  • Henry Schein tries to expand its medical software line with an offer for Australia’s Software of Excellence International.
  • The South Australian Department of Health launches big upgrades of its patient and nursing systems.

Weekly Anonymous Reader Question

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Last week’s results: Would you recommend to someone that they switch careers to health IT?

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This week’s survey: What characteristics made the worst doctor you’ve ever had so bad?


Last Week’s Most Interesting News

  • The VA announces it will shut down its VistA EHR and join the DoD in implementing Cerner Millennium.
  • HHS appoints Bruce Greenstein CTO.
  • Athenahealth acquires Praxify Technologies for $63 million.
  • The Health Care Industry Cybersecurity Task Force releases its report to Congress.
  • HHS alerts providers that the WannaCry ransomware attack is still causing problems for several US hospitals.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


People

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Michael Hyder, MD (Southcoast Health) joins Clearsense as president. He will also take on the role of EVP of healthcare delivery at sister company Optimum Healthcare IT.

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Apple hires Sumbul Desai, MD (Stanford Center for Digital Health) to join its healthcare team in an unidentified role.

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Arik Anderson (Terumo Cardiovascular Systems) joins smart inhaler company Adherium as CEO.


Government and Politics

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In a first for the FDA, it asks Endo Pharmaceuticals to stop selling Opana ER – an opioid that has become a favorite among drug users who have taken to crushing it and injecting it or snorting it. If Endo fails to withdraw the drug voluntarily, the FDA will force its removal by revoking its market approval. “We will continue to take regulatory steps when we see situations where an opioid product’s risks outweigh its benefits,” says FDA Commissioner Scott Gottlieb, MD “not only for its intended patient population but also in regard to its potential for misuse and abuse.”

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The Secretary of the Navy recognizes Naval Hospital Bremerton (WA) sailors for the parts they played in an ongoing process-improvement program that has so far reduced the Patient Administration Medical Records Division workload by 40 percent, and saved $156,400 and 7,300 man hours a year. In their downtime and with little prior coding know-how, the sailors developed a Medical Records Data Automation Program that now automates the daily operations of the hospital’s medical records department. MRDAP will soon serve as a transition program between the hospital’s Composite Health Care System and the forthcoming Cerner-powered MHS Genesis system. Cmdr. Robert McMahon, Director for Administration, refreshingly adds:

“What is most impressive is these young sailors had no fear of failure and despite no personal or monetary gain they continued to capture the ideas of their coworkers to improve workflows in their department that benefited everyone. Promoting innovation is like growing grass. Sometimes you already have the soil, water and sun. All that is needed is a safe and supportive environment to grow.”


Technology

Healthcare app development company Medable creates Synapse, a cloud-based tool that enables providers to launch CareKit apps for their care teams.


Privacy and Security

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After Bronx-Lebanon Hospital Center (NY) and its contractor IHealth sent threatening cease-and-desist letters to the author of DataBreaches.net (who let them know that their PHI was exposed due to an improperly configured server), the hospital tucks tail and asks her to go through the 500 mb of data she used in her original investigation to let them know which patients were affected. The audacity of the request, which did not come with an apology and with which she refuses to comply, prompts her to offer this advice:

  • Don’t rush to send legal threat letters. What your mother taught you about catching more flies with honey than vinegar appears true here, too.
  • If you wouldn’t send a legal threat to the New York Times over their reporting, don’t send one to me. This site may be small, under-funded, under-staffed, and under-appreciated, but with the support of great law firms like Covington & Burling, this site will always fight back against attempts to erode press freedom or chill speech.

Decisions

  • St. Mary Corwin Medical Center (CO) switched From Meditech to Epic in April 2017.
  • Perry Memorial Hospital (OK) will switch from Evident to Athenahealth in August 2017.
  • Jefferson Regional Medical Center (PA) is switching from Omnicell to BD Automated Dispensing Cabinets. The conversion process started last month.

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


Innovation and Research

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A survey of executives from 104 healthcare organizations points to AI as the next big thing when it comes to transforming the way the industry interacts with patients: 84 percent believe AI will “revolutionize” their encounters with healthcare consumers, while 72 percent report already using virtual assistants. Their interest in AI will likely fuel their near-term efforts to better understand what consumers want even before they articulate it. Eighty-one percent feel organizations should shape digital health tools based on patient preference rather than their own. A similar percentage believe those that understand the motivations behind consumer behavior will ultimately win the day.


Other

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McKesson CEO John Hammergren drops the price of his $22 million compound in San Francisco by $6 million after watching it sit on the market for a year. The solar-powered estate consists of a main house with six bedrooms and 10 bathrooms; a sports complex with tennis, bocce, racquetball, and squash courts, plus a gym, rock climbing wall, steam room, sauna, yoga center, and spa; and a carriage house with a five-car garage, car wash station, and banquet hall. The accompanying pool and spa have their own pool house.


Sponsor Updates

  • QuadraMed, a division of Harris Healthcare, will exhibit at the MaHIMA Annual Conference June 11-13 in Boston.
  • Salesforce publishes its “2017 Connected Patient Report.”
  • Kyruus wins the “Best Healthcare Big Data Platform” Award from MedTech Breakthrough.
  • CRN names Impact Advisors to its 2017 Solution Provider 500 list.
  • Senator Cory Booker (D-NJ) helps to christen Conduent’s new global headquarters in New Jersey.
  • Gartner names AdvancedMD a leader in its FrontRunners for Mental Health Quadrant.
  • Encore publishes a new white paper discussing the role of data governance in the shift to value-based care.

Blog Posts


Contacts

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

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Reader Survey Results: Would you recommend to a relative or colleague that they change careers to health IT?

June 9, 2017 Uncategorized No Comments

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I asked if readers would recommend to a relative or colleague that they change careers to health IT.


As I approach retirement, I enjoy having this debate with colleagues my age and with 30-somethings. I was initially involved in healthcare delivery, graduating to healthcare IT over time. My observation is that most of the senior workers recall what we would call a "good job," where you left work at a reasonable time, valued your home life, and were active enough that you didn’t have to pay huge fees to a gym in an effort to stay in shape.

It does not appear the majority of younger staff have ever experienced a job where they felt valued, where the company invested in them, where there were true career paths. Few report a job where a sense of loyalty was engendered. At a certain point, healthcare IT (and IT in general) evolved into this organism that demands 24/7 availability and accessibility, freely doles out periods of excessive hours, covertly considers a commitment to family an impediment to success, provides minimal mentoring and training, and where the management mantra boils down to "do more with less," "work smarter," or some similar analog. The question we deliberate: Which of the groups is happier with their career?

I would not recommend a career in health IT, with a few specialized exceptions.


Why: growth industry. Also the ability to be creative. Room to innovate, or coast or dabble, whatever fits your interests.


My wise old Italian immigrant father told me long ago when I started this crazy ride in healthcare IT that "people will always be sick and people will always need computers". Job security, there’s that. Although the ride has been bumpy at times, I look back fondly at my 25+ year career in this industry. I’ve met some fantastic people (and some not so fantastic people), and some really smart people. I’ve learned a lot, travelled a lot, and am passionate about what I do.

Went to school for finance/accounting and made the switch myself after chatting with a neighbor who was a healthcare IT guy. I thought he was pretty smart and he got me my first interview, and off I went from there. So yes, I would, but only if people were looking for something new.


An IT career professional needs to transcend any primary allegiance to IT and become a healthcare professional with an IT specialty, and become customer-focused. Depending on the person, that may be a stretch – especially mid-career.


Yes, I would. There are significant opportunities for those, particularly with a healthcare background, to contribute to on-going needs of health IT. As a licensed pharmacist who worked in retail for 18 years, then moved to the IT space, I’m finding much more satisfaction and sanity in working in the IT space than I ever found working the bench in McPharmacy. As data sharing continues to develop, it will be amazing to see what population health details will develop over the coming years.


Maybe. I enjoy working in the field because I love feeling like I can make a difference in peoples’ health even though I am not a clinician, and of course, it’s exciting to be in a growth industry. That said, it can be frustrating that not having a clinical background can mean always being seen as less credible, no matter how long you’ve been in the industry.


I just did, actually, to a friend who’s studying to be a software engineer (and who had previously considered healthcare). I told him it was an interesting and ever-changing field with enormous breadth, and that it was a way to be paid well while still doing something truly important.

My caveats: It will also make you want to rip your hair out, and possibly ruin most of your faith in doctors. (#NotAllDoctors)


No – I got in 22 years ago and having been trying to get out ever since! It’s like The Godfather III …


No. The demands are outrageous, the funding for IT initiatives takes the back seat to clinical initiatives, and healthcare is in the middle of a major upheaval based on budget and governmental initiatives. I would suggest something more stable.


Yes, absolutely. Health IT is and will continue to grow. Given how behind the times we are with regards to so many of the technologies available, there is ample room to jump in and make a big difference. Also, it just feels good to know you are making a meaningful difference to people doing good work. I’m not just clocking in to help people find a good restaurant, respond to the latest Internet meme, or play the cool new game. We are making a difference in the health of our communities.


I don’t know that I would recommend a career change, but I would encourage recent graduates to explore health IT as a career option. My own daughters have had the pleasurable (torturous) experience of my 20 years in HIT, they aren’t so impressed with my career choices. I remind them that it kept a roof over their heads, and computers in their rooms.


There is nothing wrong with changing careers to a specific industry. It’s not like it hasn’t been done before with other industries. We all at one point reinvent ourselves. Why should healthcare be any different?


YES: You will always have a job/career where you know it matters whether or not you come to work. You will be busy beyond your wildest imagination. And if you are good, there is never a day when you will be unemployed, wonder where you will work next, or not have the ability to be challenged.

NO: In the 30 years I have worked in this industry, I have had few days “off.” The pace is grueling, the management short-sighted or not focused on the mission, and the initiatives are always under-resourced.


Nope. It’s just a negative, stressful industry. Doctors resent EHRs and hate being forced to use technology, practices are overworked and understaffed, vendors haven’t been able to add too many cool features because they need to keep up with government regulations, and now all the hacking and ransomware scares …


Not in a traditional health IT role because of the constant pressure to cut costs and shave corners. One area I would recommend as a viable opportunity would be any position related to health analytics, artificial intelligence, and machine learning.

Morning Headlines 6/9/17

June 8, 2017 Headlines No Comments

athenahealth Agrees to Acquire Praxify Technologies to Advance Cloud Platform and Mobile Innovation

Athenahealth acquires Palo Alto-based EHR optimization vendor Praxify Technologies, which analyzes the way doctors interact with EHRs and uses machine learning to optimize workflows.

One Person-One Record Clinical Information System

Nova Scotia narrows the list of vendors that will compete to implement its province-wide “one person-one record” system to Cerner and Allscripts.

Epic, Allscripts and Cerner Signal Paradigm Shift in Population Health Management

A Black Book Report lists Epic, Cerner, and Allscripts as mindshare leaders in the growing population health software vendor marketplace.

Bruce D. Greenstein: Chief Technology Officer

HHS names Bruce Greenstein as CTO. Greenstein leaves his role as President at Quartet, a data integration company working in behavioral health.

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Reader Comments

  • FYI: It is Epic not EPIC....
  • John: First off, thx to HIMSS Analytics for the chart/data share - aligns closely with our own research. What these charts...
  • PM_from_haities: This New York Times profile seems to ignore Dr. Mostashari's "real' innovation. Population health approaches are a form...
  • Bsaun76: EPIC is installed in the Central Region (Temple/ Scott & White) and with the Physician Network in the Dallas area. ...
  • Bigdog: Re: Baylor Scott White Isn't Epic already installed at this organization?...

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