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News 4/20/16

April 19, 2016 News 7 Comments

Top News

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Federal prosecutors launch a criminal investigation of Theranos, seeking to determine whether the lab company misled regulators and investors about its technology. Founder Elizabeth Holmes said during her squirmy and somewhat creepy “Today” show appearance on Monday (sans her trademark black turtleneck, but sporting her equally common deer-in-the-headlights look) that she was “devastated” to learn of extensive company failings of which she was previously unaware.

Holmes confidently told “Today” that the company will survive because the world needs it, although I wouldn’t be so sure. She says Theranos will “rebuild this entire laboratory from scratch.” Maybe the show’s label of Holmes as “billionaire” (on paper, anyway) was correct before the hydrogen-filled Theranos zeppelin went down in flames, but I doubt anyone would buy the entire, permanently tarnished Theranos for anywhere close to $1 billion at this point.

The mistake Holmes made in starting Theranos as a rich, Stanford dropout (at 19) was proclaiming it to be a high-valuation, disruptive Silicon Valley tech startup rather than a tiny entrant into the boring back office lab system business that is dominated by Quest and LabCorp, failing to put reasonable clinical oversight in place and competing with them mainly on price (although the sustainability of even that business model has yet to be proven). It’s  OK and maybe even desirable to be quirky, obsessively focused, publicity-shy, and inexperienced when you’re starting a faddish website for easily amused 20-somethings, but less so when you’re running a federally regulated medical business with lives on the line.


Reader Comments

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From CarrolltonObserver: “Re: Greenway Health. Tee Green is stepping away and another 100 employees were let go last week. My guess is that Tee is slowly stepping away to get into politics.” See  my mention in the People section below. The company says Tee “will remain in an active, full-time role as executive chairman, focusing on innovation and growth initiatives,” which sounds like work more appropriate to the position he left than the one he’s taking. 

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From Blue Horseshoe MD: “Re: cholera in Haiti. This article that describes the US implications is mind-blowing, but it also demonstrates the power of data visualization in epidemiology and thus in medicine.” Haiti’s cholera epidemic, which has killed nearly 10,000 people and infected 775,000 others, was apparently caused by UN peacekeepers from Nepal who brought the disease with them and from whom it spread due to negligent sanitation practices. The article says the CDC and the US administration are trying to hide the outbreak’s source by using questionable public health tracking measures. No cases of cholera had ever been reported in Haiti until the peacekeepers arrived and geo-mapping of reported cases points directly to the UN facility, with a CDC official going on record in unscientifically characterizing its response as, “We’re going to be really cautious about the Nepal thing because it’s a politically sensitive issue for our partners in Haiti.”

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Speaking of the value of data visualization, the Johns Hopkins Bloomberg School of Public Health launches a fully online, part-time masters in spatial analysis for public health.

From How EMRya?: “Re: the EMR replacement market. All the vendors thought the high EMR dissatisfaction rate would keep the market going with replacements. I don’t think it evolved that way. Physicians burned themselves out with their selection process within the past five years and don’t want to go through it again with vendors that seem about the same. Companies like NextGen and Greenway are retooling their business to an EBIDA strategy of just holding onto the base in running a profitable company in a saturated market.” I agree that it’s not likely that large numbers of physicians will want to go through choosing and implementing a new EHR no matter how unhappy they are with their current one. Even if they do eventually switch, it would be tough to build a stable business based on what they might do and when they might do it. I predicted early in the HITECH days that vendors would scale up to meet temporary demand, but then find it hard to shrink back down once they had blown through their share of the taxpayer billions. Maybe that’s why everybody from Allscripts to EClinicalWorks is trying to pivot into something fresh that’s outside their historic core competency, which usually ends up being population health management for lack of alternatives.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor PokitDok. The San Mateo, CA-based company (its name is pronounced “pocket doc”) offers a healthcare API ecosystem that meets consumer-driven healthcare market demands. APIs include clearinghouse (enrollment, eligibility, authorizations, claims, claims status, referral – all of those X12 APIs are free); patient scheduling (across all major PM/EHR systems); identity management (EMPI queries); payment optimization (medical financing qualification tools); and a Private Label Marketplace for provider search (scheduling, eligibility, payments).  Customers use these APIs to connect doctors to patients, to help payers and providers develop new business functions, and to connect EHRs and other digital health services. PokitDok’s APIs allow startups to scale immediately with lower cost, encouraging innovation and connectivity. Thanks to PokitDok for supporting HIStalk.

Here’s an overview video of PokitDok that I found on YouTube.

My latest pet peeve: people who say “pop health,” apparently challenged to find time in their day to enunciate the three additional syllables. They probably mean “population health management technology” anyway, so maybe their 10-syllable avoidance is worth it. 

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Mrs. Ulhaque from Texas is happy that we funded her DonorsChoose grant request for a single classroom iPad that is shared by her 24 students. She says they love playing educational games and she is rewarding students who show academic improvement with extra time on it.

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Also checking in is Ms. Munoz, who teaches Grade 5-6 math and science for special education students (intellectual disabilities, Down syndrome, brain injury, autism, etc.) We provided four tablets and cases, which she says have helped the students complete lessons they couldn’t previously tackle before because of their disabilities and motor skills problems.  The students who can’t write or speak are using a communications app that allows them to interact with their teachers and fellow students. Just to give you an idea of how little it costs to fund such a significant classroom project, HIStalk readers paid for half of the $363 total and Google matched that amount.


Webinars

April 26 (Tuesday) 1:00 ET. “Provider-Led Care Management: Trends and Opportunities in a Growing Market. ”Sponsored by HIStalk. Presenter: Matthew Guldin, analyst, Chilmark Research. This webinar will provide a brief overview and direction of the provider-led care management market. It will identify the types of vendors in this market, their current and longer-term challenges, product capabilities, partnership activity, and market dynamics that influence adoption. It will conclude with an overview of key factors for vendors and solutions moving forward.

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


Acquisitions, Funding, Business, and Stock

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A reader provided details on the lawsuit brought by the MetroChicago HIE against Sandlot Solutions. The HIE says Sandlot took away its data access one day after warning it that it would be shutting down but then provided a database copy. The HIE said that was unacceptable since any technical snags in restoring the information could cause the HIE itself to shut down. The lawsuit says Sandlot was insolvent and was closing following a failed merger attempt. Santa Rosa Consulting, listed in the lawsuit as Sandlot’s owner (which I’m not sure is exactly true – the parent of both is Santa Rosa Holdings), was a co-defendant in the lawsuit. Sandlot announced its only funding round ($23 million) about 18 months before it shut down (it’s always a red flag when a company fails to raise new money unless it’s doing so obviously well that it doesn’t need it). Interestingly, the HIE says Sandlot’s actions violated HIPAA since the company is a business associate of the HIE. Also interestingly, the lawsuit claims that Sandlot refused to provide the HIE with its data because the database would contain previously deleted data from other Sandlot customers.

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UnitedHealth Group makes good on its earlier threat to stop offering policies on Affordable Care Act marketplaces as it loses $1 billion on those policies over the past two years. The company will offer exchange policies in only a handful of states in 2017, saying that the market isn’t growing and it’s being stuck with sicker patients as younger, healthier ones don’t see the value in buying health insurance. UHG’s policies are rarely the least expensive and it holds only a 6 percent market share.


People

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Scott Zimmerman (TeleVox / West Interactive) joins Greenway Health as CEO, according to his LinkedIn profile. He apparently replaces Tee Green, who is now listed on the company’s site as executive chairman.

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Voalte hires Adam McMullin (SFW Capital Partners) as chairman and CEO.


Government and Politics

A study finds that nearly 3 percent of physicians who provide Medicare Part B services billed CMS for work that would require more than 100 hours per week, with optometrists, dermatologists, and ophthalmologists leading the pack. Those same providers also submitted more high-intensity billing codes than average. The authors suggest using Medicare’s utilization and payments data to flag potential fraud, although they probably underestimate the complexity of how providers use their National Provider Identifier to bill Medicare for services they don’t necessarily provide personally.

Florida becomes the second state to prohibit hospitals from balance-billing patients treated in their network for services rendered by the hospital’s out-of-network practitioners — such as surgeons, ED doctors, and anesthesiologists — for which the patient can’t seek an in-network alternative. The patient will pay the in-network rate, leaving the insurance company and provider to negotiate any additional payments.


Privacy and Security

The computer systems of Newark, NJ’s police department are taken offline for four days following a ransomware attack.


Other

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The board of Massena Memorial Hospital (NY) approves $1 million to upgrade its “ancient” Meditech system (or “metatech,” as the local paper spells it) in contracting with CloudWave for cloud-based hosting. The CEO warned the board that their current implementation runs on Windows Server 2003, which he describes as “a big garage door somebody could hack their way through and steal everything.”

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A brilliant article in London’s “The Guardian” says unlearned movie stars should stick to pretending to be someone else on screen rather than taking positions on medical science, referencing “Vaxxed,” the new movie about Andrew Wakefield, the widely discredited anti-vaccine doctor who eventually lost his medical license. Robert DeNiro included the film in his film festival with a vague rationale that the documentary “is something people should see,” only to pull it when scientists complained. The Guardian notes:

If “Vaccinating With the Stars” looks a little inappropriate where public health is concerned, so too is the prospect of children falling ill because an actor clearly hasn’t read Wakefield’s Wikipedia entry. Unless, worse still, he has.

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An LA Times article quotes University of Michigan’s Karandeep Singh, MD, MMSc, who says unregulated and sometimes poorly design healthcare-related apps can be “like having a really bad doctor.” It points out a recent study of Instant Blood Pressure, a $4.99 app marketed without FDA approval that correctly diagnosed hypertension only 25 percent of the time, with the company hiding behind the excuse that it isn’t intended for diagnosis and treatment, thus rendering its raison d’être questionable.

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A New York jury awards $50 million to a woman who says she has become incontinent after her obstetrician performed an unnecessary episiotomy during the birth of her healthy child in 2008. The woman says she was forced to quit her job, has to wear panty liners, and can’t have sex with her husband. The doctor, who insists he did nothing wrong and that the woman never complained about any issues, says, “Someone can just make up a story, cry to the jury, and they will ignore all the records and give her a big award.”

Sparrow Health System (MI), bowing to pressure from the National Labor Relations Board and the state nurse’s union, rescinds its policies that prohibited employees from talking about health system policies on social media and to the press. NLRB says the health system’s policies related to social media, cell phone use, the wearing of unapproved buttons, and gossiping are overly broad and are discriminatory.

Minnesota hospitals report that their emergency departments are becoming “holding pens” for sometimes violent mental health patients, forcing other patients to wait for hours or to be sent elsewhere as up to half of their gurneys are occupied by patients who require levels of oversight and security that few hospitals can provide. One hospital psychiatrist reports, “This is supposed to be a place of peace and security. Instead, we have acute psychiatric patients banging on windows, throwing feces, and assaulting people. It’s deeply unsettling to other patients in the ER.”

In Canada, Alberta Health Services will spend $316 million over the next five years to replace 1,300 mostly non-interoperable clinical systems with a single system that can maintain a single medical record. It will issue an RFP shortly. The College of Physicians and Surgeons termed existing systems “woefully inadequate” in late 2014, with a government official adding that after spending nearly $300 million, Alberta “really got nothing more than electronic isolated file systems. Do we realize we need to have data exchange standards before we start adding systems? We need systems to talk. It blows my mind.”

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A study of those Dyson Airblade hand dryers with which business replace paper towels (while claiming unconvincingly that their motivation is your health rather than reducing their restroom expenses) finds that they blast germs onto anyone within 10 feet of the bathroom wall, so you’d better hope the person using it washed their hands well first. Dyson disputes the study, claiming the paper towel cartel is behind it.


Sponsor Updates

  • Aprima will exhibit at the Boulder Valley Individual Practice Association meeting April 26 in Lafayette, CO.
  • Catalyze CEO Travis Good, MD will speak at the HITRUST Annual Summit April 25-28 in Grapevine, TX.
  • Besler Consulting releases a podcast on “IME Shadow Billing.”
  • Crossings Healthcare Solutions will exhibit at the Cerner RUG April 20-22 in Charlotte.
  • Cumberland Consulting Group Managing Director Tom Evegan guest blogs for Revitas.
  • EClinicalWorks will exhibit at the California MGMA 2016 Annual Conference April 22-23 in Sonoma.
  • Isthmus Magazine features Healthfinch and its data partnership with Beekeeper.

Blog Posts


Contacts

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

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April 19, 2016 News 7 Comments

Monday Morning Update 4/18/16

April 17, 2016 News 10 Comments

Top News

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Epic’s trade secrets lawsuit against India-based Tata Group concludes with the Wisconsin jury awarding Epic $940 million in damages. The verdict calls for Tata to pay Epic $240 million for the benefits received by its subsidiary (Tata Consultancy Services) from stealing Epic’s trade secrets plus another $700 million in punitive damages. The lawsuit said employees of Tata posed as Kaiser Permanente employees to gain access to client-only Epic documentation that Tata planned to use to develop a competing product.

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Tata says it will appeal, claiming it did not use Epic’s information in the development of its Med Mantra system. The company says its developers never saw Epic’s materials.

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The $940 million judgment will certainly be reduced by the presiding judge, who chided Epic’s damage claims before the hometown jury’s verdict was announced. He observed:

  • Epic didn’t provide the court with the method it used to calculate its damage claims until after the trial began, which could cause those claimed damages to be excluded.
  • Epic hasn’t proved that it was damaged to the extent claimed or that Tata benefited to that degree, explaining, “The complete lack of evidence tying the costs of Epic’s research and development efforts to any commensurate benefit to TCS dooms its methodology.”
  • Epic claims that the biggest benefit to Tata wasn’t stealing development secrets or source code, but rather then value of “what not to do” that is “spread throughout the enterprise.”
  • The only evidence provided of how Tata used Epic’s information was a side-by-side marketing graphic comparing Epic’s products and Tata’s Med Mantra, with the claimed damages “based on Epic’s speculation that the confidential information is sitting on a shelf somewhere to be used immediately after this trial ends.”
  • The judge says such “future use” assumptions are more appropriately addressed via injunction to prevent such use  rather than a speculative damage award. He also noted that Tata has mostly failed in its attempts to penetrate the US market and that an injunction would reduce its chances even further.

Reader Comments

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From Verisimilitude: “Re: HealthTap access on Facebook Messenger. I’m not sure how much privacy protection people are given. I’m no HIPAA expert, but my guess is there’s a big fat release and arbitration clause buried in a EULA someplace.” Video visit vendor HealthTap offers a free chatbot Q&A service using Facebook Messenger rather than real-time access to actual human doctors. HealthTap’s terms of service are indeed voluminous and include an arbitration clause. I tried the Facebook service and it was worthless – all I received within several hours of asking a simple question was a list of previously answered similar questions (that weren’t similar at all) and a link to HealthTap’s site.

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From Nasty Parts: “Re: NextGen. A major re-org was announced as Rusty Frantz continues the Pyxis-ization. It has dissolved its silos into ‘One NextGen,’ and as a result, multiple senior execs are transitioning out.” Unverified. Nasty Parts named several VPs who are leaving and says there’s “much more change to come.” I’m not sure that’s a bad thing. Frantz has been CEO at Quality Systems for almost a year, so he’s had time to think through what needs to be done.

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From Maury Garner: “Re: Sandlot Solutions. You reported their closing. I ran across this lawsuit filed by one of their customers to prevent Sandlot from destroyer their data immediately after copying it for them. The article describes Sandlot Solutions as insolvent and closing.” I don’t have a Law360 subscription to see the details, but your description of their article seems accurate.

From Rebuttal: “Re: IT departments. In the last 5-6 years, I’ve noticed that organizations I’ve interviewed with seem to care more about what I can bring rather than having a balanced interest in our mutual needs. It seems that complex vendor systems have turned IT departments into sweatshops.” It may well be that the high cost of vendor systems has raised provider expectations that new hires will immediately pay off in task-specific, product-specific ways with implementation and optimization. It’s also probably true that for-profit companies in particular aren’t as interested in investing in mutually satisfying long-term relationships with new hires who might bolt once they’ve built their resumes. Lastly, I would speculate that the rise of the 1099 economy has redefined the work environment on both sides to a “what have you done for me lately” mindset. I’ll invite readers to weigh in.

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From Vince Ciotti: “Re: Bill Childs. Just to make sure readers appreciate how progressive Bill and the pioneering team at Lockheed were, they also came up with:

  • CRTs (cathode ray tubes). They called them VMTs (Video Matrix Terminals) in an era when most systems relied on keypunch cards and green bar paper reports for input and output.
  • Light pens. The precursor (punny?) to today’s mice, an idea Jobs and Wozniak copied from Xerox PARC. Clinicians using MIS only had to click on the VMT screen instead of trying to learn touch typing.
  • Screen building. Lockheed (later TDS) called it matrix coding, but teams of clinicians designed their own order screens rather than implementing a model designed by programmers who never saw a patient.

Feeling nostalgic? You can read more in Vince’s HIS-tory series that ran on HIStalk for several years. I immersed myself back into them over the weekend as a guilty pleasure.

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From Rocket J. Squirrel: “Re: Erlanger. A rocky start to the Epic project. The consultant evaluation ignored the lowest-cost option and the CTO who made the decision is gone after eight months. Totally behind on project staffing and already six months delayed.” Unverified.

From Alpha Surfer Dude: “Re: Dr. Brink’s article on radiology benefits managers. See what’s going on in Hawaii if you want to learn why this is so topical.” A Readers Write article by James A. Brink, MD, vice chair of the American College of Radiology and Mass General radiologist in chief, criticized plans to require pre-authorization of advanced imaging. He says electronic guidelines can help ensure the appropriateness of such orders in real time. Insurer Hawaii Medical Service Association (HMSA) made outpatient imaging pre-authorization mandatory in December 2015, leading doctors to complain that care is delayed and that tests are often denied. Newly proposed legislation would hold insurance companies rather than providers liable for any civil damages resulting from pre-authorization delays. HMSA requires doctors to contact Arizona-based radiology benefits management company National Imaging Associates (a subsidiary of publicly traded Magellan Health), leading one Hawaii doctor to complain, “Do you want those decisions to be made by offshore non-experts?” Taking the counterpoint, it was widespread ordering of medically questionable imaging studies – sometimes by doctors with a financial interest in the machines used to perform them — that created the need for such restrictions in the first place. As they say, one person’s excess cost is another’s livelihood.


HIStalk Announcements and Requests

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Only 12 percent of poll respondents have had a virtual visit in the past year, although 81 percent of those who did were satisfied. New poll to your right or here: would you be worried about your privacy if you were being treated for depression by an EHR-using provider? Please explain after voting.

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Mrs. May, a first-year teacher from Florida, says her special education classes are using the STEM and engineering kits we provided in funding her DonorsChoose grant request not only to learn about science, but also “how important communication is to get to the finish line.”

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Also checking in is Mrs. Johnson from Oklahoma, who says her elementary school students “are loving the hands-on materials that you have provided for us. I no longer hear any complaints when I ask them to go to their math stations because they are not only enjoying them, but they are practicing their skills.”


Last Week’s Most Interesting News

  • CMS threatens to ban Theranos CEO Elizabeth Holmes from the blood testing business for failing to correct problems that CMS had previously called to the company’s attention.
  • Kaiser Permanente launches a database of data contributed by its members that researchers will use to study how genetic and environmental factors affect health.
  • CMS announces a five-year pilot of CPC+, a medical home model that requires the use of a certified EHR, and for one of the two tracks, a signed agreement from the practice’s EHR vendor that it will support the capabilities needed.
  • Kaiser Permanente releases a summary of what it has learned from having a large number of its patients use a portal, disclosing that one-third of its PCP encounters are now conducted by secure email with expectations that the percentage will increase significantly.

Webinars

April 26 (Tuesday) 1:00 ET. “Provider-Led Care Management: Trends and Opportunities in a Growing Market. ”Sponsored by HIStalk. Presenter: Matthew Guldin, analyst, Chilmark Research. This webinar will provide a brief overview and direction of the provider-led care management market. It will identify the types of vendors in this market, their current and longer-term challenges, product capabilities, partnership activity, and market dynamics that influence adoption. It will conclude with an overview of key factors for vendors and solutions moving forward.

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


Acquisitions, Funding, Business, and Stock

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Cardinal Health-owned NaviHealth, which offers post-acute care utilization management services, will acquire care transition software vendor Curaspan Health Group.

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Behavioral health software vendor Quartet Health raises $40 million in a Series B funding round led by GV (the former Google Ventures), increasing its total to $47 million.


People

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Mark Cesa, whose long healthcare IT sales career included stints with Baxter Healthcare, GTE Health Systems, Eclipsys, Tamtron, QuadraMed, Allscripts, and Napier Healthcare, died of cancer April 1. He was 61.


Announcements and Implementations

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Voalte announces that it signed 125 hospitals in its fiscal year ending March 2016, increasing its customer base by 83 percent.

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Imaging IT expert Herman Oosterwijk posts the Digital Imaging Adoption Model that was announced a few weeks ago by the European Society of Radiology and HIMSS Analytics.


Government and Politics

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VA CIO LaVerne Council says in Congressional testimony that the VA needs “a new digital health platform” and seems to suggest it will pursue a custom-developed system rather than buy a commercially available product or upgrade VistA. Council says a working prototype will be available in a few months that “is aligned with the world-class technology everyone’s seen today and using in things like Facebook and Google and other capabilities. But it also is agile and it leverages what is called FHIR capability, which means we can bring things in, we can use them, we can change them, we can respond.” Lawmakers are justifiably concerned that the history of the VA specifically and government agencies in general suggests a high likelihood of expensive failure and lack of interoperability with the DoD, but Council says the cost-benefit analysis is solid. She also reiterated previous statements that the VA is putting its $624 million Epic patient scheduling system rollout on hold while it tests its own self-developed system that will cost just $6.4 million. The VA and Congress, anxious to deflect bad publicity about the VA’s wait time scandal, quickly threw IT money at the patient scheduling problem last year despite scant evidence implicating technology as the problem.

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CMS Administrator Andy reiterates that EHR certification will require vendors to provide open APIs for interoperability.


Privacy and Security

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The Department of Homeland Security’s US-CERT urges Windows PC users who have Apple’s QuickTime installed to de-install it immediately after a security firm finds major vulnerabilities and Apple quickly drops QuickTime for Windows support. It’s fine on Apple devices.

A federal appeals court rules that a healthcare company’s general liability insurer must defend it against security breach claims even when the policy doesn’t specifically include cyberbreach wording. .


Other

Jenn covered for me Thursday and mentioned the JAMIA-published study that found missing information about patients with diagnoses of depression or bipolar disorder, about which I will opine further. The authors try to make the case that primary care EHRs suffer from “data missingness” that indicates that “federal policies to date have tilted too far in accommodating EHR vendors’ desire for flexible, voluntary standards” that “can lock providers in to proprietary systems that cannot easily share data.” Underneath that big (and preachy) conclusion is a little study with a lot of problems:

  • It analyzed data from 2009 only, eons ago in HITECH years (in fact, that was the same year that HITECH was passed, well before it had significant EHR impact).
  • It covered patients from a single insurance plan’s patients, treated by a single medical practice, using a single EHR (Epic).
  • The “data missingness” it claims involves only two behavioral health diagnoses that were likely treated by specialty providers (LCSW, PhD, psychiatrists) who weren’t HITECH-bribed to adopt EHRs and who often don’t use them because of privacy concerns and lack of benefit.
  • The study matched EHR information to claims data in finding that 90 percent of acute psychiatric services were not captured in the EHR. The authors should have noted that many patients seeking behavioral health services pay cash to avoid creating a claims history, seek help from public services, or travel out of their own area for them to maintain privacy, all of which could impact their conclusions.
  • It’s likely that some or even most of the patients with missing information would have opted out of automatic sharing of their behavioral health information given the chance.
  • The authors blame EHR vendors for the lack of interoperability, but give the organization they studied a free ride in assuming that it freely exchanges information with any other provider who expresses interest.
  • The study seems to state an expectation that every primary care provider’s EHR have a complete patient record from all sources of care, which is a nice dream, but as they correctly conclude is not today’s reality for many reasons, most of them unrelated to EHR vendors. That doesn’t necessarily mean the information isn’t available (via an HIE, records request, patient history, etc.) but only that it isn’t updated in real time across EHRs everywhere.
  • Lack of information doesn’t necessarily change the treatment plan or outcome. Doctors have never had that information, electronic or otherwise, so it’s not like EHRs caused a new problem.
  • The best conclusion is this: if you want the most nearly complete patient information available, use both EHR information and individual patient claims data across all commercial and governmental payers and present it from within the patient’s EHR record. That’s not how the system works for most PCPs, however.

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Kansas City tax authorities approve reimbursing Cerner for $1.75 billion of the $4.45 billion construction cost of the company’s new The Trails campus. Cerner says the new space will allow it to add 16,000 jobs within 10 years and  the increased post-construction assessment should generate $2.6 million of additional property taxes per year.

In Canada, Nova Scotia has spent $30 million on incentives for practices to use EHRs, but faxing is still the most common way for practices to communicate with each other because the government-approved systems aren’t interoperable.

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Lee Memorial Health System (FL) comes up with creative excuses for earning a one-star quality rating from CMS: (a) the hospital converted to Epic just three years ago; (b) incomplete EHR coding caused the health system to be compared unfairly; (c) CMS doesn’t take into account tourist-driven seasonality; and (d) CMS doesn’t take socioeconomic factors into account and therefore penalizes hospitals that treat poor patients who are sicker (a minor variant of the “our patients are sicker” explanation). The hospital didn’t suggest that it will actually treat patients any differently even though its largest customer gave it the lowest possible quality score.

Weird News Andy notes that “even junkies are logical” as evidenced by this story, in which drug abusers are injecting themselves in the bathrooms and parking garages of Massachusetts General Hospital so they can get medical help quickly if they overdose. MGH says people are even tying themselves to the emergency pull cords in its bathrooms so the alarm will go off if they keel over in a narcotic stupor.


Sponsor Updates

  • A Spok case study describes the 50 percent of University of Utah Health Care’s incoming residents and medical students who choose to communicate using Spok Mobile for secure text messaging.
  • Medecision President and CEO Deborah M. Gage is named as one of the most powerful women in healthcare IT.
  • T-System will exhibit at the UCAOA National Urgent Care Convention April 17-20 in Orlando.
  • Huron Consulting Group is named by Forbes as one of America’s Best Employers for the second consecutive year.
  • Wellsoft will exhibit at TCEP Connect 2016 April 21-24 in Galveston, TX.
  • ZirMed will exhibit at the California MGMA Conference April 21-23 in Sonoma.
  • Zynx Health will exhibit at the ANIA 2016 Conference April 21-23 in San Francisco.
  • PatientPay shows commitment to rid paper from healthcare billing in support of The Nature Conservancy.
  • QPID Health CMO Mike Zalis will speak at the North Carolina Association for Healthcare Quality Annual Conference April 21-22 in Durham.
  • Huffington Post interviews Red Hat CEO Jim Whitehurst.
  • The SSI Group will exhibit at the Healthcare Finance Institute April 17-19 in Tysons Corner, VA.
  • Streamline Health will exhibit at the 2016 California MGMA Annual Conference April 21-23 in Sonoma.

Blog Posts


Contacts

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

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April 17, 2016 News 10 Comments

Morning Headlines 4/18/16

April 17, 2016 Headlines No Comments

Epic Systems wins $940 mln U.S. jury verdict in Tata trade secret case

Epic wins its trade secret lawsuit against Indian IT firm Tata Consultancies. A judge awarded Epic $240 million in compensatory damages and $700 million in punitive damages after concluding that Tata employees illegally accessed Epic’s customer website and accessed proprietary information.

VA teases plans for new ‘state-of-the-art’ digital health platform

VA CIO LaVerne Council says she will unveil plans for a “new digital health platform” to replace VistA.

Nova Scotia spends $39M on electronic medical records push

After spending $39 million in incentive payments to encourage EHR adoption, Nova Scotia continues to rely on faxes to communicate between facilities.

Kansas City TIF Commission approves financing agreement for huge Cerner redevelopment

Kansas City approves a reimbursement plan to repay Cerner $1.75 billion of the $4.45 billion it is spending to build its new campus.

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April 17, 2016 Headlines No Comments

News 4/13/16

April 12, 2016 News 8 Comments

Top News

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CMS announces a five-year, 5,000-practice test of Comprehensive Primary Care Plus (CPC+), a new medical home model that moves payments further away from fee-for-service. Eligible practices can apply to participate in one of two tracks, both of which require use of a certified EHR.

Track 1 practices will be paid $15 per month per Medicare patient plus performance-based incentives in return for providing 24/7 patient access and supporting quality improvement activities. Track 2 practices will be paid $28 per Medicare patient plus performance-based incentives and must also follow up after ED or inpatient discharge, connect patients to community resources, and have their EHR vendor sign an agreement that “reiterates their willingness to work together with CPC+ practice participants to develop the required health IT capabilities.”

CPC+ will begin in January 2017. 


Reader Comments

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From Bob: “Re: Meditab. Any news? Emails are bouncing and phone numbers are disconnected.” I’ve barely heard of the ambulatory EHR vendor, so I don’t have a lot of interest or knowledge about whether they are defunct or not. I tried to contact sales and got into an endless PBX loop.

From Lance Carbuncle: “Re: Vocera. Lawsuits are flying after an infringement on the privacy (and dignity) of a patient. A mother whose baby passed away was subjected to an open communication between the transplant team and the nurse wearing her Vocera badge. Then the worst part was the care team disclosed that the mother has HIV to the family over a ‘speakerphone’ Vocera badge.” Unverified. A patient sues Tampa General Hospital (FL) for disclosing HIV test results without authorization, claiming that a nurse spoke to the transplant team on speakerphone. The hospital has announced its intention to replace Vocera with Voalte.

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From Portobello: “Re: Arkansas Children’s Hospital. Is walking away from its Meditech 6.1 implementation for Epic. I am wondering if the hospital is being acquired by a larger health system and it just hasn’t been announced yet or if the ambulatory product was so poorly implemented that it pushed them away.” Sources tell me the hospital is not happy with Meditech’s new ambulatory system, to the point they had to halt its rollout. Ambulatory has been the Achilles heel of Meditech and lack of a competitive offering is further marginalizing company as the choice of small hospitals that would rather have Epic or Cerner but can’t afford them. It’s a shame because we really could use more inpatient EHR competition. Meditech’s executives and directors average 65 and 77 years of age, respectively, and while I admire that the company has rigidly stuck to its knitting for 50 years, sometimes it feels like the rich, Boston-society guys in charge are no longer fully engaged enough to successfully run a technology company in the face of better competition than they had in 1990. It would have been interesting if Athenahealth had bought Meditech in its effort to penetrate the inpatient market, but that would have probably been a $1 billion acquisition loaded with legacy baggage and a customer base of small hospitals that are being bought out by larger health systems who want everybody running the same system.

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From Diametric: “Re: Bill Childs. He published this document in April 1968 when he was at Lockheed. I’ve always kept this document to remind me what’s important. While the technology has changed, I think this can still serve as a supplemental guide for rational development. I have interacted with perhaps 200 vendors over the years and found those that held close to this philosophy made the best partners.” I set up the document for downloading here. It’s a remarkable manifesto written nearly 50 years ago that spells out the still-valid requirements for hospital clinical systems. Bill started at Lockheed doing missile programming, then in 1968 moved over to the company’s new project of building a hospital information system. He later joined Technicon Data Systems. Not only was he a healthcare IT technology pioneer, he then started what became Healthcare Informatics magazine and ran that from 1980 to 1995 before getting back into the vendor world. Somehow he hasn’t yet won the HIStalk Lifetime Achievement Award despite being amply qualified. Thanks for sending over the document – it made my day.


HIStalk Announcements and Requests

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I uncharacteristically funded a non-STEM DonorsChoose project from Ms. A from Texas, whose grant request asked for two trumpets for her music classes that are creating the area’s first school band. She reports, “While many of our scholars have very little material possessions, I truly believe we are providing them with something that cannot be purchased with money. We are offering them something that goes beyond what they can buy, which is confidence, creativity, and self-expression.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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GE Ventures and Mayo Clinic create Vitruvian Networks, which will offer software and manufacturing capabilities to support personalized medicine in the treatment of cancer, specifically those blood diseases that can be treated by reengineering the patient’s own blood cells.

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Diabetes management software vendor Livongo Health, founded by former Allscripts CEO Glen Tullman, raises $44.5 million in a Series C round, increasing its total to $77.5 million. 


Sales

North Memorial Health Care (MN) goes live on the VitraView enterprise image viewer from Vital Images. 

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Tift Regional Health System (GA) chooses Cerner’s clinical and financial systems.

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University of Kansas Hospital (KS) will replace Cisco phones and Vocera voice badges with Voalte’s clinical communication and alert notification system.

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The State of Vermont will offer PatientPing to all state providers to give them real-time alerts when their patient is being seen by another provider.


People

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Susan Pouzar (Versus Technology) joins H.I. S. Professionals as SVP of sales and marketing.

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NIH hires Eric Dishman (Intel) as director of its Precision Medicine Initiative Cohort Program.

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Adrienne Edens (Sutter Health) joins CHIME as VP of education services.

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Forward Health Group hires Subbu Ravi (Amphion Medical Solutions) as COO.

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Streamline Health Solutions names Shaun Priest (Influence Health) as SVP/chief growth officer.

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GetWellNetwork hires Scott Filion (Digital Health Innovations) to the newly created role of president.


Announcements and Implementations

Kaiser Permanente launches Research Bank, where volunteer KP members will contribute their genetic information as well as behavioral and environmental factors to allow researchers to study their effect on health. 

Presbyterian Homes of Georgia (GA) goes live with the HCS Interactant EHR.

Logicalis will offer its healthcare clients single sign-on and biometric ID solutions from HealthCast Solutions to support e-prescribing.


Technology

Boston Children’s Hospital (MA) launches cloud-based parent education for Alexa-powered devices such as Amazon Echo. KidsMD will be packaged as an Alexa “skill” that can be enabled by saying phrases such as, “Alexa, ask KidsMD about fever.”


Other

A former Michigan house majority whip who is also a physician is charged with healthcare fraud for providing nerve blocks for patients he hadn’t examined, then billing for his services although nurse practitioners staffed his clinics. Paul DeWeese is accused of storing his signature electronically in the EHR and then giving employees his login credentials to falsely indicate that he had met the insurance company’s requirement of reviewing the clinical documentation before being paid. He lost his medical license last summer for writing narcotics prescriptions for patients he hadn’t examined.

Former University of Missouri Chancellor R. Bowen Loftin, forced out of his job and into a newly created position with the joint MU-Cerner project called Tiger Institute for Health Innovation, never took the promised job after Cerner complained that the university didn’t consult them before announcing it. 


Sponsor Updates

  • PatientKeeper will exhibit at the 2016 International MUSE Conference in Orlando, May 31-June 3.
  • AirStrip will exhibit at the Regional CEO Forum April 13-15 in Chicago.
  • Frost & Sullivan recognizes Bernoulli with the 2016 North American Frost & Sullivan Award for Product Leadership.
  • PatientPay will plant a tree through The Nature Conservancy for every patient payment the company receives on Earth Day, April 22.
  • Besler Consulting is named a finalist in several B2B Marketer Awards categories.
  • CapsuleTech will exhibit at the 2016 American Nursing Informatics Association Conference April 21-23 in San Francisco.
  • CoverMyMeds will exhibit at the North Carolina HIMSS Annual Conference April 20-21 in Raleigh.
  • Direct Consulting Associates will exhibit at the Health IT Summit April 19-20 in Cleveland.
  • EClinicalWorks joins the National Patient Safety Foundation’s Patient Safety Coalition.
  • Form Fast, Health Data Specialists and Healthwise will exhibit at the Cerner Southeast Regional User Group Meeting April 20-22 in Charlotte, NC.
  • Galen Healthcare Solutions wins the #HITMC 2016 Best Content Marketing Award.
  • Healthfinch CEO Jonathan Baran will serve as a judge during Madison Startup Weekend April 22 in Wisconsin.

Blog Posts

Contacts

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

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April 12, 2016 News 8 Comments

Monday Morning Update 4/11/16

April 10, 2016 News 6 Comments

Top News

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Dell’s security business finds that the going rate for hiring a hacker to penetrate Gmail, Hotmail, or Yahoo email accounts is $129, while breaching a corporate email account runs $500. They will hack into a Facebook or Twitter account for $129, provide a complete US identity (driver’s license, Social Security Card, and utility bill) for $90, or provide a Visa or MasterCard for $7. They’ll even turn over a US bank account with a $1,000 balance for just $40.

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The enterprise price list is even more sobering – hackers will launch a denial-of-service attack for as little as $5 or will install a remote access Trojan for $5 to $10. Security sites have noted that hackers are selling Ransomware as a Service for $50 plus a 10 percent commission on the ransom money paid, allowing non-technical criminals to easily and immediately launch their own extortion business.


Reader Comments

From Twidiots: “Re: [publication name omitted]. Stole your story about the DoD’s EHR project name without giving credit. I’m going to email them.” It’s common for sites to miss subtle but significant news items until they read about them on HIStalk, but it’s obvious this time because I ran the Tuesday evening announcement in my Thursday night news and suddenly everybody’s running it first thing Friday, pretending they found the days-old announcement themselves. That’s OK, but it’s still lazy to reword the DoD’s announcement without linking to it and to cite the published quotes as “US Department of Defense officials said” like some general called them up with a scoop. I guess they get lots of readers, just like those clueless “9 things you need to know” sites that rarely contain anything you might actually need to know. I think HIStalk readers are smarter than that, so there’s no need to email the publication.

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From Vince Ciotti: “Re: Leapfrog’s tests that showed CPOE systems missed 39 percent of harmful drug orders and 13 percent of potentially fatal ones. That means they flag 61 percent and 87 percent, respectively – great progress since paper charts caught none of them!” Leapfrog took a measured approach in describing its findings as it does every year during Medication Safety Awareness Week, noting that CPOE warnings are doing a pretty good job. It’s nice that we’ve moved from questioning whether such warnings work at all to urging that it work 100 percent of the time.

From boyfrommer: “Re: Decision Resources Group. CEO Jim Lang quit and will be replaced with Jon Sandler of IndUS Group, the private equity arm of the group that purchased (and overpaid for) DRG in 2012. Jon has no operating experience and neither does his COO, who also comes from IndUS.” I’ve never heard of the company, which appears to provide medically related research reports.

From The PACS Designer: “Re: ICD-10-PCS. It’s an exciting time for healthcare as the ICD-10-PCS Procedure Codes will be updated with 3,651 additions by CMS to further enhance it starting October 1. Here’s a sample: 0273356 Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc (abbreviated version) or Dilation of Coronary Artery, Four or More Arteries, Bifurcation, with Two Drug-eluting Intraluminal Devices, Percutaneous Approach.”


HIStalk Announcements and Requests

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Poll respondents would fell safest having their medical information in the hands of Apple and an EHR vendor, placing the least trust with Microsoft and an HIE. My suspicion is that the spate of health system breaches of many kinds has cause people in general (and healthcare IT people in particular) to lose faith that their information will remain confidential. New poll to your right or here: have you had a virtual visit in the past 12 months?

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Ms. Chestnut from Indiana says her fourth graders are becoming better world citizens by studying the library of nearly 100 books we provided in funding her DonorsChoose grant request.

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Also checking in is Mrs. P from Virginia, who says she has “been laminating like a mad woman and our new printer is SO FAST” in describing some of the supplies that we provided, from which her elementary school students are creating their own math and reading games that they play independently.

Listening: The Raconteurs, the possibly defunct Detroit-Nashville supergroup foursome that includes Jack White, formerly of The White Stripes. It’s catchy, has big horns, and pushes into acid rock/Led Zeppelin in its experimentation. That sent me back (as happens frequently) to one the greatest (and most intelligent) live rock and roll bands in the world, Sweden’s Howlin’ Pelle Almqvist and The Hives.


Last Week’s Most Interesting News

  • The Department of Defense gives its Cerner project the name MHS Genesis.
  • MedStar Health (MD) disputes reports that its ransomware attack was made possible by unpatched server software.
  • HHS asks for suggestions for interoperability measures that it should incorporate into MACRA objectives.
  • Massachusetts General Hospital (MA) and two hospitals of NYC Health + Hospitals go live on Epic.
  • At least two more hospitals are taken offline by ransomware attacks, this time in California and Indiana.

Webinars

One of the best (and most timely) webinars we’ve done was last week’s “Ransomware in Healthcare: Tactics, Techniques, and Response” by Sensato CEO John Gomez. We had a big, engaged crowd that asked John so many questions that we didn’t have time to address them all in our scheduled one hour. It’s worth watching — we asked John to put this together purely as a public service, so there’s zero pitch or commercial influence involved.

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


Acquisitions, Funding, Business, and Stock

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Medical equipment and workflow vendor Midmark Corporation will acquire RTLS vendor Versus Technology to enhance its clinical workflow offerings.

Asset, facilities, and real estate management software vendor Accruent acquires Mainspring Healthcare Solutions, which offers equipment maintenance and asset management systems.

Oncology EHR vendor Flatiron Health announces strategic partnerships with its drug company customers Celgene and Amgen, both of which participated in the company’s $175 million funding round in January 2016.


People

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St. Peter’s Health Partners (NY) promotes interim VP/CIO Chuck Fennell to the permanent position.


Announcements and Implementations

IBM and drug company Pfizer will collaborate to remotely monitoring sensor data from people with Parkinson’s disease to look for new diagnostic and treatment insights.


Privacy and Security

Einstein Healthcare Network (PA) notifies 3,000 people who filled out a web form requesting information that their entries were exposed when the form’s underlying database was inadvertently opened up to the Internet.

Target says in a securities filing that it has spent $300 million cleaning up the mess from its 2013 data breach, of which it expects only $90 million to be covered by cyberinsurance.

Adobe urges computer users to upgrade to the latest level of Flash released last week after finding flaws that allow delivery of ransomware. Steve Jobs was right when he said in 2010, “Symantec recently highlighted Flash for having one of the worst security records in 2009. We also know first hand that Flash is the number one reason Macs crash. We have been working with Adobe to fix these problems, but they have persisted for several years now. We don’t want to reduce the reliability and security of our iPhones, iPods, and iPads by adding Flash.”


Other

Want to make it obvious you don’t really know healthcare IT? Refer to inpatient drug “orders” as “prescriptions.”

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Wired profiles artificial intelligence technology vendor Sentient Technologies, which has raised $143 million in funding since 2008 to create financial applications. The company is developing an “AI nurse” that can predict patient condition changes. The co-founder describes how such a system can teach humans:

One of the good things about evolutionary AI is that — if you know how to read it — you can actually see the rule sets. In the case of traders or of AI nurses (on which we are working, too), they are fairly complex beings. A trader may have up to 128 rules, each with up to 64 conditions. Same thing for an AI nurse. So, they are pretty complex systems and the interplay among these rules is not always linear. But if you spend some time on it, you can still understand what this thing is doing, because it’s declaratory — it says what it is doing, in other words. So we can certainly take this and learn from this what works and what doesn’t work when it comes to solving a certain problem. AI can teach people to make better decisions.

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Authors from Kaiser Permanente describe what the organization has learned from having many of its patients use its patient portal over several years.

  • Seventy percent of KP’s eligible adult patients, 5.2 million people, have registered to use its Epic MyChart-powered portal called My Health Manager.
  • KP providers and patients exchanged 23 million secure emails in 2015, representing one-third of all PCP encounters in the first half of 2015.
  • Use of secure email was associated with a 2 to 6.5 percent improvement in HEDIS measures and a 90 percent approval rate by users with chronic conditions.
  • My Health Manager users are 2.6 times more likely to remain KP members.
  • KP is studying the disparities introduced by e-health technologies after its studies found that a disproportionate number of users are white, older, and better educated.

Weird News Andy says he’s a sucker for stories like this. Wichita, KS police arrest a 36-year-old man for child abuse after the two-year-old son of his 21-year-old girlfriend is brought to the ED not breathing due to a two-inch dead octopus blocking his throat. The boyfriend claims the child swallowed the octopus while the mother was at work. Police say it wasn’t a pet – it was intended for sushi. The child is OK.


Sponsor Updates

  • DrFirstwill exhibitat the 2016 International MUSE Conference May 31 – June 3 in Orlando, FL.
  • T-System will exhibit at the UCAOA National Urgent Care Convention April 17-20 in Orlando.
  • TierPoint will host a seminar on Emerging Threats & Strategies for Defense April 13 in Liberty Lake, WA.
  • TransUnion CMO Julie Springer is inducted into Direct Marketing’s 2016 Marketing Hall of Femme.
  • Valence Health will exhibit at the First Illinois HFMA Spring Symposium April 11-12 in Chicago.
  • Visage Imaging will exhibit at the 2016 Spring Radiology & Imaging Conference April 13-15 in Atlanta.
  • VitalWare will exhibit at the 2016 Vizient Supplier Summit April 11-13 in Las Vegas.
  • Huron Consulting Group will exhibit at the 2016 AAPL Annual Meeting and Spring Institute April 11-17 in Washington, DC. 
  • West Corp. will exhibit at the World Health Care Congress April 10-13 in Washington, DC.

Blog Posts


Contacts

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

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April 10, 2016 News 6 Comments

Morning Headlines 4/8/16

April 7, 2016 Headlines No Comments

MHS Genesis rolls out as name for new electronic health record

The DoD brands its Cerner implementation project MHS Genesis.

Hospitals’ Computerized Systems Proven to Prevent Medication Errors, but More is Needed to Protect Patients from Harm or Death

A new report finds that CPOE systems fail to flag 39 percent of potentially harmful drug orders and 13 percent of potentially fatal drug orders.

MedStar disputes report it ignored warnings that led to attack

MedStar disputes recent allegations that the ransomware attack it suffered exploited known security flaws from 2007 and could have been prevented with a simple software update.

As hospitals go digital, human stories get left behind

A physician at Massachusetts General Hospital (MA) argues that EHRs fail to capture a meaningful patient story, arguing that EHRs mask “how one symptom relates to another, the emotional context in which the symptoms or events occurred, or the thought process of the physician trying to pull together individual strands of data into a coherent narrative.”

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April 7, 2016 Headlines No Comments

News 4/8/16

April 7, 2016 News 9 Comments

Top News

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The Department of Defense christens its Cerner-centered EHR project as MHS Genesis. The functional project champion explains, “We want people to know MHS Genesis is a safe, secure, accessible record for patients and healthcare professionals that is easily transferred to external providers, including major medical systems and Department of Veterans Affairs hospitals and clinics. When our beneficiaries see this logo or hear the name, they’ll know their records will be seamlessly and efficiently shared with their chosen care provider.”

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I might quibble that the DoD’s new logo incorrectly contains all capital letters in spelling GENESIS and looks like something a Photoshop newbie might design, but at least it uses the correct Greek mythology symbol of the wingless Staff of Asclepius – which denotes healing and medicine –rather than the oft-mistaken winged Staff of Caduceus, which is symbol of commerce. Still, I  can understand how the latter is more appropriate than the former in our convoluted healthcare system, where the lines at the financial trough are often serpentine.


Reader Comments

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From ZenMaster: “Re: Sandlot Solutions. Website down. Phone not working. Clients frantic. A cautionary tale for all the start up Population Health Analytics companies out there. HIE / Healthcare Data Aggregation / Population Analytics is hard. Proceed with caution.”

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From A Vendor That Also Finds Email Tracking Slimy: “Re: vendors being informed when you open their spam email and then contacting you directly. Most of these programs function by embedding a one-pixel image into emails and tracking when that image is loaded. Disable the automatic download of images in your mailbox settings or contact your organization’s IT team about blocking or filtering items that are created using similar methods like Tout, Sidekick, Yesware, Streak, etc.” Promos for the Yesware tracker shows why aggressive companies keep using it for “prescriptive analytics” to pester prospects – unfortunately, it works, just like other sales techniques that range from cold calling to outright lying.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Ms. S in Texas, who asked for five animation studio kits for her elementary school class to produce STEM-related movies.

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Also checking in is Mrs. S from Connecticut, whose middle schoolers are using the Chromebooks we provided to publish and discuss their writing, with some of the most active participants being those students who don’t otherwise engage.

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Speaking of Chromebooks, I decided to round out my little technology arsenal of everything I use to research and write HIStalk (a $300 Toshiba laptop and a $200 iPad Mini) with a Chromebook. The Asus C201 has an 11.6-inch monitor (perfect for traveling), 4 GB of memory, a 16 GB solid state drive, a very nice Chiclet keyboard (I’m not a fan of on-screen and tiny Bluetooth keyboards), and a battery life of around 10-12 hours. It weighs about 2 pounds and is 0.7 inches thick. It powers on and off almost instantly and took almost no time to set up, automatically updating itself as needed in the background with no third-party antivirus needed. The learning curve is pretty much zero – the only workaround I had to look up was how to regain Delete-key function since that key is omitted from most Chromebooks for space reasons. Best of all, it was only $200 complete with a nice padded sleeve and a wireless mouse with nano receiver. Chromebooks use the Chrome OS operating system instead of Windows or Linux, so they won’t run most desktop apps, but the Chrome browser is very fast (as are Google Docs and Gmail), Dropbox works fine, and thankfully my most valuable program LastPass works great on it for automatically logging me in password-protected sites I’ve saved, like Amazon. I even installed the Chrome OS version of Teamviewer in case I need to remote back into the laptop to do something. It’s not for everyone – for example, folks who rely on desktop versions of Office – but you might be surprised at how much of your work is online once you think about it and this is an inexpensive, lightweight, headache-free alternative to Windows or Apple laptops. 

This week on HIStalk Practice: KAI Innovations acquires Trimara Corp. Family physician Kim Howerton, MD stumps for direct primary care in Tennessee. DuPage Medical Group expands relationship with PinpointCare. Cable and home security business Connect Your Home gets into the telemedicine business. Culbert Healthcare Solutions VP Johanna Epstein offers advice on improving patient access (and ROI to boot). Kaiser Permanente Northwest puts medical record access at patient fingertips. Tribeca Pediatrics founder details the drastic steps he took to revitalize his failing practice. Biotricity CEO Waqaas Al-Siddiq offers his take on what’s holding physicians back from making the wearables leap.


Webinars

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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


Acquisitions, Funding, Business, and Stock

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Andover, MA-based National Decision Support Company opens a research and development headquarters in Madison, WI.

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Population health management systems vendor Lightbeam Health Solutions acquires Browsersoft, which offers an HIE solution built with open source tools.

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Digital check-in vendor CrossChx raises its second $15 million round in two years, increasing its total to $35 million.


Sales

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Tampa General Hospital (FL) will implement the Voalte Platform for caregiver communication.

Universal Health Services will replace the former Siemens Invision revenue cycle solution with Cerner’s revenue cycle solution, integrating with UHS’s existing Millennium products. For-profit hospital management company UHS operates 25 hospitals.

The Department of Defense awards a five-year, $139 million contract to McKesson’s RelayHealth for patient engagement and messaging solutions. I assume that’s an extension or expansion since the military was already using RelayHealth.

Ernest Health (NM) will expand its use of NTT Data’s Optimum Clinicals suite in four facilities. The organization uses Optimum RCM in its 25 locations.

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Queensland, Australia’s Metro North chooses the referrals management system of Orion Health.


People

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Influence Health names Michael Nolte (MedAssets) as CEO. He replaces Peter Kuhn, who remains as president, chief customer officer, and board member.


Announcements and Implementations

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Franciscan Alliance (IN) uses InterSystems HealthShare to create a vital signs viewer for legacy data that can be accessed from inside Epic by its 140-physician group.

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India-based doctor finding and appointment scheduling app vendor Practo begins answering medical questions from India, the Philippines, and Singapore at no charge via Twitter using the @AskPracto account.


Government and Politics

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National Coordinator Karen DeSalvo, MD, MPH says of information blocking in a Wall Street Journal interview, “We don’t have all the authority we need to really be able to dig into the blocking effort. We have put forward a proposal to Congress asking for more opportunities to address the issue.” She says that it’s a big step that the major inpatient EHR vendors have pledged to not participate in information blocking vs. a year ago when “people said blocking is a unicorn and not happening.” She adds consumers are interested in third-party apps that can extract data from elsewhere to create their own longitudinal health record and says that person-centric medical records will shift “very deliberately away from the electronic health record as being the source or center of the health IT universe.”

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HHS asks for ideas about how to measure interoperability within MACRA objectives, with responses due June 3. The most interesting part of the information published in the Federal Register is that ONC is considering analyzing the audit logs of EHR users to determine how often they exchange information.

AMIA says proposed HHS changes that would give drug and alcohol abuse patients more control over their medical records aren’t adequate and fail to address electronic information exchange. AMIA wants HHS to revisit the idea of giving patients granular sharing control over their entire medical record, saying that managing substance abuse data differently is “a dated concept and flawed approach.” Doug Fridsma, MD, PhD, AMIA president and CEO, said in a statement, “Clearly, the trend in healthcare is to make patients first-order participants in their care. This means giving them complete access to their own medical records, and it should mean giving them complete control over who sees their medical information.”


Privacy and Security

MedStar Health (MD) disputes earlier Associate Press reports indicating that an unpatched JBoss server allowed hackers to take its systems down with ransomware. MedStar says Symantec, which it hired to investigate the attack, has ruled out unapplied 2007 and 2010 JBoss patches as the problem. The AP stands by its earlier report and adds that experts say that the Samsam ransomware that infected MedStar can be prevented by keeping updates current.

Google’s Verily Life Sciences biotechnology company comes under fire for awarding a research contract to a company its own CEO owns and for failing to tell its Baseline health study volunteers that it is planning to sell their data to drug companies for a profit.

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Metropolitan Jewish Health System (NY) announces that an employee of one of its participating agencies responded to a phishing email in January 2016, with the unidentified hacker gaining access to the email account that contained PHI.


Other

Leapfrog Group  finds that CPOE systems still miss a significant number of drug ordering errors, failing to warn the prescriber of potentially harmful orders 39 percent of the time and also missing 13 percent of potentially fatal orders. Leapfrog collects voluntary CPOE test results from hospitals that use its testing tool.

The AMA publicly supports AllTrials, a global campaign that calls for every past and present clinical trial to be registered with their methods and summary results reported. The campaign says it’s not fair to study participants to hide study results that are inconclusive or unfavorable to the sponsoring organization, such as a drug company buying a study that finds one of its products ineffective. Commendably, the AMA’s involvement came from a proposal from its Medical Student Section. 

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The COO of BCBS of North Carolina, promoted from CIO four years ago, resigns abruptly after the botched rollout of a billing and enrollment system last November during Healthcare.gov’s open enrollment period. The company is scrambling to rewrite the system in time the next open enrollment that starts November 1. It found an unspecified “fatal problem” in its software before last year’s open enrollment began, but continued anyway thinking it could fix problems as they arose, causing 147,000 customer calls on November 1 alone and 500,000 in the first week. The company imposed emergency measures in January 2016 after projecting that it will lose $400 million in North Carolina Healthcare.gov business, turning off the ability for consumers to apply online since they had no way to determine whether the applicant was actually eligible to purchase insurance.

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The always-hustling Newt Gingrich pens an editorial criticizing his home state of Georgia for proposing to outlaw people doing their own eyeglass exams at home via a company’s app. USA Today got the assurance of Newt’s people that he had no financial interest in any related firms before running his op-ed piece, only to find out afterward that he’s running a $100 million tech fund with a private equity firm.

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I missed a great April Fool’s prank by MedData, who announced the April 1 hiring of Hayden Siddhartha "Sidd" Finch as chief experience officer, slyly referencing a 1985 George Plimpton April’s Fool fake story in Sports Illustrated involving a Tibetan pitcher with a 168 mph fastball. The brilliant Plimpton even led off the 1985 story with a clever clue in spelling out “Happy April Fool’s Day” with the first letters of each word in the opening sentence, but still duped a significant number of people who should have known better (including a Senator, reporters, and Mets fans looking for hope).

An article questions whether it’s OK for sexting-comfortable teens to send genitalia photos to their doctors for diagnosis, wondering whether those images should be sent securely or whether the doctor receiving them might even be charged with possessing child pornography.

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A woman who recorded her hernia operation with a hidden recorder captures OR staff making fun of her belly button and calling her “Precious” from the movie about an overweight teen. Harris Health System (TX) declined to comment citing HIPAA, but told the woman they had reminded OR staff to watch their comments and that was enough. She says she was racially profiled and is considering suing.

A primary care physician at Massachusetts General Hospital (MA) says the lack of patient narrative in EHRs dehumanizes patients and hampers the diagnostic abilities of physicians, noting that the story of Cinderella, if entered into the hospital’s newly implemented Epic system, would be a problem list consisting of “Poverty, Soot Inhalation, Overwork, and Lost Slipper.” She describes Epic (and thus EHRs in general) as:

Epic features lists of diagnoses and template-generated descriptions of symptoms and physical examination findings. But it provides little sense of how one event led to the next, how one symptom relates to another, the emotional context in which the symptoms or events occurred, or the thought process of the physician trying to pull together individual strands of data into a coherent narrative. Epic is not well-suited to communicating a patient’s complex experience or a physician’s interpretation of that experience as it evolves over time, which is to say: Epic is not built to tell a story.

A Boston Globe article ponders why the medical schools of Harvard and nine of its prestigious peers like Yale, Johns Hopkins, and Columbia don’t have a department of family medicine. Harvard blames lack of costly participation by its affiliate hospitals to support a residency. However, a Harvard medical student says doctors specializing in internal medicine and pediatrics often bolt for more lucrative subspecialties while most family medicine practitioners remain in primary care, adding that Harvard Med thinks, “You’re less competitive or you’re less rigorous if you’re interested in primary care.” Ironically, Harvard launched one of the first family practice residencies in 1965, but the federal government ended its funding 10 years later due to poor quality. The chair of the recently created family medicine program at Icahn School of Medicine says bluntly, “It’s bizarre to me that you have these institutions that don’t really feel that there’s a requirement to introduce their students to the second-largest specialty in the United States.”

The department of physical and occupational therapy at Massachusetts General Hospital (MA) create a video just before its April 2 go-live with Epic.


Sponsor Updates

  • CloudWave joins the Microsoft Cloud Solution Provider program.
  • Experian Health will exhibit at the SE Managed Care Conference April 7-8 in Charleston, SC.
  • PeriGen publishes its annual review of labor and delivery malpractice awards.
  • Red Hat announces the winners of its 2015 North American Partner Award Winners.
  • The SSI Group will exhibit at the Texas Ambulatory Surgery Center Society 2016 Annual Conference April 7-8 in San Antonio.
  • Streamline Health will exhibit at the 2016 HASC Annual Meeting April 13-15 in Dana Point, CA.
  • Surescripts announces its 2015 White Coat of Quality Award winners for excellence in e-prescribing quality.
  • Iatric Systems will exhibit at the Hospital & Healthcare IT Reverse Expo April 13-15 in Atlanta.
  • RTLS technology from Versus earns Cisco Compatible Extensions certification.
  • A record number of attendees gather at InstaMed’s annual user conference.
  • InterSystems will host its annual Global Summit April 10-12 in Phoenix.
  • Intelligent Medical Objects will exhibit at HealthCon2016 April 10-13 in Lake Buena Vista, FL.
  • Netsmart will exhibit at the Texas Public Health Association Conference April 11 in Galveston.
  • Obix Perinatal Data System will exhibit at the SSMHealth Annual Perinatal Nursing Conference April 14 in Fenton, MO.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.

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April 7, 2016 News 9 Comments

HIStalk Interviews Paul Brient, CEO, PatientKeeper

April 6, 2016 Interviews No Comments

Paul Brient is CEO of PatientKeeper of Waltham, MA.

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Tell me about yourself and the company.

I’ve been CEO of PatientKeeper for almost 14 years. Our company is focused on automating physicians, primarily in an inpatient setting. We offer an overlay solution that allows doctors to automate their entire days, regardless of the back-end system that they are working on in their hospital.

Given the data entry that’s expected of physicians, is it possible to make usability better?

Certainly usability has come to the forefront as we have gotten past the adoption question and people are using it. But now the question is, can people use it in a way that saves them time? Clicks and keystrokes are the enemy of saving time. Lack of intuitiveness is as well. If you have to puzzle over a screen and figure out what is being asked of me, or how do I find that order that I’m looking for, those things all kill productivity.

Clearly we think it’s possible to create systems that save physicians time, but it requires a very thoughtful set of work. Not only on software design, but also on, what are we going to ask the physician to do? 

Obviously in our current healthcare environment, there are a lot different people in different organizations that have very legitimate things they would like physicians to do. Unfortunately, without some sort of filter or prioritization of them, you end up with all of them being thrust on the doctors. That just kills their productivity.

How do you go beyond the technical definition of usability to design software that physicians will at least tolerate and maybe even enjoy using?

In healthcare, that is a particularly challenging question. If you go back to the days of Hewlett-Packard, they were engineers building software or systems for engineers. They had this next-bench idea, where literally they would be building a tool for an engineer at the next workbench at Hewlett-Packard. They had this great environment for design.

In the healthcare world, that’s just not practical. You can’t just go sit in a hospital and have doctors write software while they are taking care of patients. That would be a bad thing for lots of reasons.

We think the best approach is get as close to that as you can, though, which is to have full contact with practicing providers to get feedback on what the real world is in healthcare delivery. Not a theoretical world, a theorized world, or a world they way we would like it to be. The actual world of all the crazy data patterns and situations that occur.

Then, get experienced designers who have usability training who understand how to build good software. If you don’t expose them to the chaotic and complicated world that physicians face every day, they just can’t build software that works for them. It’s really hard. It’s a difficult challenge to get access to that environment and then also to digest it in a way that makes sense.

The handful of significant inpatient EHR vendors are running decades-old code. Are they challenged to meet customer demands without rebuilding their products from the ground up?

Cerner Millennium — which I think is the most modern of the systems — was released before the millennium, in 1997. They certainly all have some legacy aspects to them in terms of technology. They weren’t built yesterday. You couldn’t have built them yesterday, because it takes a long time to build these systems. They’re big and complicated and they have many, many elements to them.

But I do think that some of the vendors — with the move towards interoperability and some of the standards that are being proposed, the FHIR concept if not the standard — pressure is starting to get applied that will allow these systems to become more open and allow innovation to occur that hasn’t before. Even a system as old as Meditech Magic can be made very open. It’s not a technological limitation, it’s a philosophical limitation. The push towards interoperability is helping to get the philosophy aligned more where we would like the technology to go.

When we talked three years ago, you said that healthcare is the only area left where it’s OK to have a monolithic, closed system that doesn’t support interoperability or an ecosystem. Where do you see that going?

Certainly in the last three years it has improved a lot. The FHIR standard has come out. At HIMSS, we saw Cerner demonstrating applications running against Millennium and moving across and running those same applications against Epic or even PatientKeeper, since we support it as well.

That’s a big change. That’s awesome. But it’s not yet sufficient. Even if you make the software interoperable, the data underneath in many hospitals isn’t yet. It’s not LOINC encoded and all that stuff like it would be if you started from scratch. But they did their implementations 30 years ago as well.

There’s still a lot of work to do as an industry. It’s a little bit chicken-and-egg. The more we open stuff, the more people can innovate and invent and other vendors can create cool applications that motivate people to want to exercise interoperability. That says, we’ll make more interoperability. It becomes a virtuous cycle. Without that pull, it’s just theoretical, “Hey, you should be interoperable and make some new APIs available” and no one really uses them. That isn’t going to drive it.

I think we’re starting to see that cycle start a little bit. You see a variety of organizations — like xG health, for example — taking some products that Geisinger has written for in-house and trying to bring them out to the market. It’s starting. It will be really cool to see that happens over the next three or four years.

How will that impact your business? PatientKeeper has been connected to these systems for more than a decade and new entrants will then have the bar lowered to do the same.

We had to spend a tremendous amount of money building all these integrations, but we would just as soon not have to build them. We built them so that we could build the software that we expose to physicians and that they use.

We embrace it. We’ve implemented the FHIR standards on both ends of our application. Somebody can run FHIR on top of us. We can run using FHIR on top of something that is FHIR enabled.

We think openness is philosophically the way to go. That means if someone finds a better application than we have, well then, shame on us. Our job is to have the best applications, and if we don’t, then someone should buy one that is different from ours and have it work with ours that they do think are best.

That’s the way innovation works. That’s the way it works in the tech world. That creates a great ecosystem, an ecosystem that has all ships rising because it puts competitive pressure on everybody. I’m a huge fan, philosophically. I think it can do nothing but good things for us and for other vendors like us.

You just added imaging appropriate use criteria to your product. Are you seeing more interest in having point-of-care systems offer guidance, reminders, or other features that keep providers on the best practices track?

Hopefully it’s the tip of the iceberg. I believe the reason that we as a country spent $40-plus billion getting doctors onto electronic systems isn’t so that we can just get rid of paper, although that was nice. It’s so that we can take this next step of improving healthcare and making the computer an essential tool for physicians.

The analogy I like to use is if you go to most doctors today and say, "Would you write this order on paper instead of putting it into the computer?" Depending on what kind of computer they have, they might gladly say, "Yes, please give me that paper. I can’t wait to write it on paper." If we do our job right as informaticists and as healthcare IT providers, the answer to that should be, “No. I would never write it on paper, because that’s dangerous. I get so much good information and so much help from the computer to do my job that I would never consider practicing without the computer.”

We’re not there yet. PatientKeeper isn’t there. I don’t think anyone is there. But that is the ultimate test. Imaging criteria is one small step. As we start to deploy more advanced techniques, with all the big data analytics techniques, we’ll have computers that know everything about that patient that is all codified. 

The computers aren’t really helping the doctors that much. In some cases, the computer asks the doctor questions the computer knows about. Did you give aspirin to this patient? Well, yes, because I put the aspirin order in the system — why are you asking me? It’s even worse.

The next four, five, six years is going to be that renaissance, helping the physicians with what they do in a way that works for them. Interoperability is such a key to that because it’s going to require the entrepreneurial horsepower of an industry. It’s not going to be one company that solves that problem.

We’re seeing early steps in using little data, where instead of waiting years for big clinical studies to be completed, doctors are getting immediate data analysis from their own systems, such as, “If I have 10 patients in my database who are somewhat like this one, how many of them benefited from this treatment option I’m considering?” Is that concept ripe for development?

I am so excited about that concept. If you think about clinical trials the way they have existed to date, we have a molecule or we have a procedure or a hypothesis. We go out and recruit people, we do all kinds of stuff, and we see whether it works or not.

But every day, there are millions of clinical trials being done. Patients are seeing providers. Things are happening. Outcomes are happening. If we can learn from all of that, even in the smaller cohort, that here are patients like you and and let’s observe how they work. Here are different protocols.

Our parent company HCA has been doing clinical research essentially by just observing different practice patterns across their hospitals. They have done groundbreaking research around sepsis prevention and what things worked and what things didn’t work around preventing infection. Just by observing that there are three or four different ways people do this in terms of washing hands, prophylactic antibiotics, et cetera. They figured out which ones work better without a clinical trial — just by observing the data they have.

That is the future. It might even change the clinical trials industry. At some point you still have to come up with new molecules, but when you start getting into these practices and procedures and off-label use, there is a lot we can learn.

I haven’t heard much about the HCA acquisition since it was first announced. What has changed since?

Certainly the goal of the acquisition was to have exactly what you just described happen, which is business as usual for PatientKeeper from a customer perspective and from an organization perspective. I’m pleased to report that we have achieved that goal. We’re a year and a half in to the acquisition. I’ve talked to some of our customers and they didn’t even know we were acquired. That’s awesome.

The big thing that has changed, which our customers will start to notice over time, is that we’ve made some very big investments in our R&D organization and our hosting center operations. We now have a world-class hosting operation. We had a pretty good one before, but we have a much better one now.

That’s really the big change that we have made. We’ve accelerated R&D efforts and accelerated a variety of projects that we had on the back burner. We’re in the pipeline that we’ve now pulled forward. We haven’t gotten those out to the market yet, so if you are a customer of ours, you haven’t seen the benefits of that. But in the next six to 12 months, you’ll start to see those things hitting the release cycle.

Otherwise, it is just business as usual for us. We’re deploying our advanced clinical software throughout the HCA hospitals and having a great time continuing to go against our original vision.

Do you have any final thoughts?

We’re at the beginning of a new era in healthcare IT. Up until now, it’s been, get rid of paper, get stuff automated. We’ve mostly done that. I wouldn’t say we’re complete, but that phase is coming to an end, where you’re taking processes that have never been automated and automating them.

Now it really is about that next generation. If you think of the evolution of the Internet, we now have concepts like Facebook and EBay that were not possible on paper. They are new concepts. What we’re going to find is a whole new set of innovation in healthcare IT around concepts that were not possible until everybody is electronic. As a company, we’re excited to participate in that. We’re excited to see the ecosystem and the healthcare IT industry itself blossom as that occurs.

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April 6, 2016 Interviews No Comments

News 4/6/16

April 5, 2016 News 8 Comments

Top News

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A study of scripted standardized patient encounters performed by physicians of six virtual visit companies finds significant clinical variation. Remote physicians didn’t ask the right questions or didn’t perform the correct examination steps in 30 percent of visits and gave the wrong diagnosis or no diagnosis at all 23 percent of the time. They ordered urine cultures for only 34 percent of recurring urinary tract infection patients and failed to order the recommended X-rays for ankle pain 84 percent of the time. The authors conclude that while virtual visits may involve lower rates of inappropriate testing, remote physicians often don’t order even medically indicated tests, possibly because of the complexity involved in following up on test results from the patient’s home location or concerns about insurance coverage.

The authors also note that some of the companies performed better than others and suggested they share best practices. The virtual visit companies tested were Ameridoc, Amwell, Consult a Doctor, Doctor on Demand, MDAligne, MDLIVE, MeMD, and NowClinic.

While the virtual visits weren’t perfect, they were not compared to face-to-face visits. Those probably have a similar lack of conformance to best practices, but there’s no good way to send standardized (i.e., fake) patients into an exam room to serve as mystery shoppers.


Reader Comments

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From PHE: “Re: Sandlot Solutions. Has ceased operations. They were down to a skeleton crew as of last week, looking for last-minute funding to maintain core operations, but I was told that the board had already voted to close down if nothing came through as of Friday. No evidence of ongoing operations this morning.” Unverified. However, the logo of Sandlot Solutions was recently removed from the banner of parent company Santa Rosa Holdings – it was there in a March 13, 2016 cached copy but is gone now.

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From Luxardo: “Re: NYC Health + Hospitals going live on Epic. Reports say it went OK, but 900 Epic installers were on site at the two facilities whose combined census was 700. No wonder these installs cost a small fortune – that has to be at least $2 million per day to have a tech person standing next to each clinical person all day. The real test will be 30 days from now when all those installers have gone back to Wisconsin.”

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From Concerned Customer: “Re: Vocera. Do you put in any stock into this?” SkyTides, which sells “deep due diligence” to hedge funds in “targeting over-hyped stocks and outright frauds,” calls Vocera and Chairman Robert Zollars “purveyors of fraud and obsolete, defective products.” It says Zollars previously ran two companies that paid $591 million to settle fraud charges (Neoforma alone paid $586 million, it says) and claims Vocera strong-armed customers into accepting early product shipments so that the resulting revenue could help the company hit forecasts. It says insiders have been aggressively selling their shares and that Vocera’s one product hasn’t had a major upgrade since 2011 and “appears to be inferior” even though it’s the most expensive. SkyTides accuses Vocera of committing accounting fraud in the three of 16 quarters it reported a profit, says the company has lost $110 million, and predicts that Vocera will have to cut prices to compete. Vocera shares had little reaction to the announcement and have risen 29 percent in the past year vs. the Dow’s decrease of nearly 2 percent. A federal judge gave initial approval a month ago for Vocera to pay $9 million to settle securities class action litigation that accused it of telling investors during its March 2012 IPO that the Affordable Care Act would boost its business, then admitting in May 2013 that ACA was actually hurting sales, sending shares down 37 percent. I’ll be interested to see if Vocera responds, although since it’s an analysis firm making the claims rather than a regulatory agency or litigant, they wouldn’t have much to gain and would instead call attention to the unflattering charges.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mr. Cho in providing 15 scientific calculators for his Bureau of Indian Affairs high school math classes in South Dakota, replacing the 99-cent models he was using. He reports, “These calculators have made it easier for us to do more in the 47 minutes I’m allotted each day per class. The students are now able to move into higher level math. We just started 4th quarter on Monday and your calculators have, over the past three months, allowed us to go into pre-calculus in my Algebra 2 class. My Algebra 1 students were able to use the calculators and fly through it and are now starting Algebra 2! We will continue to use these calculators weekly for many years.”

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Also checking in is M. Feeley from New York, whose pre-schoolers are experimenting with the light kits and games we provided.


Webinars

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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


Acquisitions, Funding, Business, and Stock

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Sunquest acquires GeneInsight, a genetic testing software firm created by Partners HealthCare (MA). Sunquest had previously invested in the company. which will operate as a wholly-owned subsidiary from its Boston office.

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Cumberland Consulting Group acquires 50-consultant  Oleen Pinnacle Healthcare Consulting, expanding the company’s payer market capabilities.

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Credentialing software vendors Symplr and Cactus Software merge.

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Healthcare software vendor Ability Network acquires EHealth Data Solutions, which offers software for senior living providers. Minneapolis-based Ability, whose chairman and CEO is former McKesson President and CEO Mark Pulido, has made four other acquisitions in the past two years following a $550 million investment by Summit Partners.


Announcements and Implementations

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St. Luke’s University Health Network (PA) goes live on Bernoulli’s medical device integration and connectivity in six of its hospitals as part of its Epic implementation.

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NYC  Health + Hospitals goes live on Epic at its Elmhurst and Queens hospitals, reporting no major problems.

Massachusetts General Hospital and two other Partners HealthCare (MA) facilities go live on Epic, with 1,000 Epic employees participating in Boston.

ESD celebrates its 26th year in the consulting business, noting that its implementation team members worked 30,000 hours in March.

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McKesson signs up 2,111 of its employees to the Gift of Live Bone Marrow Foundation’s donor registry.


Government and Politics

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The Federal Trade Commission creates an online tool for developers of health-related software that asks questions about how their software works and then suggests specific federal laws and regulations (such as HIPAA and the FDA) that might apply to them.


Privacy and Security

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The Associated Press reports that MedStar Health’s ransomware attack exploited known flaws in the Red Hat’s JBoss Application Server that date back to at least 2007. Red Hat and the federal government have for years urged JBoss users to apply patches that correct a common configuration error that allows external users to take control of the server. The article notes that MedStar may be fully exposed to lawsuits or sanctions if it (or its vendors) failed to apply the patch and therefore could be construed as not having exercised reasonable diligence in protecting its systems and data. MedStar criticized media coverage of its attack, saying the publicity will encourage copycat hackers.


Other

Epic’s trade secrets lawsuit against India-based Tata Consultancy Services goes to trial in federal court.

A Wall Street Journal op-ed piece called “How Not to End Cancer in Our Lifetimes” says the White House’s proposed changes to patient consent policies may impede research. The author, dean of Weill Cornell Medicine, says proposed HHS regulations will limit the number of patients who consent to having their leftover medical samples de-identified and stored for future research. It would also require providers to obtain new specimens from each patient every 10 years and to manage their consent documents.

Hospital executives surveyed by The Advisory Board Company state their top concerns as minimizing clinical variation, retooling for population health management, meeting rising consumer expectations, developing patient engagement strategies, and controlling avoidable utilization.


Sponsor Updates

  • AirStrip will exhibit at the Health Evolution Summit April 13-15 in Dana Point, CA.
  • Besler Consulting will exhibit at the HFMA Hudson Valley Annual Institute 2016 April 7 in Tarrytown, NY.
  • Crossings Healthcare Solutions will attend the Cerner Southeast RUG April 20-22 in Charlotte, NC and the Great Lakes RUG May 31-June 2 in Chicago.
  • Crain’s Chicago Business names Burwood Group as one of the Best Places to Work for Women Under 35.
  • Caradigm will exhibit at the Care Coordination Institute April 7-9 in Greenville, SC.
  • Clockwise.MD will present at the 2016 Spring Healthcare Tour and Conference April 5-6 in Nashville, TN.
  • CompuGroup Medical will exhibit at G2 Lab Revolution April 7-8 in Phoenix, AZ. 
  • Direct Consulting Associates will exhibit at Health Connect Partners – Hospital & Healthcare IT Conference April 13-15 in Atlanta.
  • Divurgent will exhibit at the Health Information Technology Summit April 10-13 in Washington, DC.
  • EClinicalWorks will exhibit at the NCCHC Spring Conference on Correctional Health Care April 10-12 in Nashville, TN.
  • HCI Group CEO Ricky Caplin earns recognition from Consulting Magazine, KPMG, and the University of Florida Entrepreneurship & Innovation Center.
  • Healthgrades releases its 2016 Outstanding Patient Experience Award and 2016 Patient Safety Excellence Award recipients.
  • HealthMEDX will host its annual user group meeting April 12-14 in St. Louis.
  • Healthwise will exhibit at the Allscripts Central Region User Group April 13-15 in Minneapolis.

Blog Posts


Contacts

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

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April 5, 2016 News 8 Comments

HIStalk Interviews Rick Adam, President, Stanson Health

March 30, 2016 Interviews 1 Comment

Rick Adam is president and COO of Stanson Health of Los Angeles, CA.

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Tell me about yourself and the company.

I’m a serial entrepreneur and have done several different startups in healthcare IT. I’ve been with Stanson about 15 months.

The company was founded by Dr. Scott Weingarten, who was the founder of Zynx. Scott wanted to do something new and different. He wanted to put clinical advice in front of physicians who are ordering. Scott got the company started and then I was hired to help Scott scale it up.

What’s the connection between the company and Cedars-Sinai?

Scott was at Cedars 20 years ago when he came up with the idea for order sets. Cedars funded what became Zynx. Then Scott left and was CEO for Zynx for 16 years. It ultimately ended up as part of Hearst Publishing.

About four years ago, Scott wanted to do real-time CDS as docs order. Hearst didn’t want to do it, so Scott went back to Cedars with two hats on. He’s SVP for clinical transformation at Cedars-Sinai. They also wanted him to go ahead and start this new company to launch point-of-care CDS. Scott is founder and chairman of our board. Our primary funding source so far has been Cedars-Sinai.

How do you tie your product into EHRs?

It’s a little different from vendor to vendor. We’re operational in Epic. We’re developing a system in Cerner. We’re working with Athenahealth and Meditech on integration.

Epic has a Best Practice Alert rules engine. We write Epic rules that our customers then load into their Epic BPA engine. When an order meets the criteria to fire the alert, we trigger the alert and it shows up inside the physician’s order entry screen. Then they either accept it or reject it and can cancel the order right inside their natural workflow. We’re operating in 80 hospitals and 25,000 docs that use Epic.

External to Epic is our analytics facility. We outload the log every night and then wrap it back around analytics so the medical management of health system can see how their clinicians are reacting when they see alerts. The analytics system is in the cloud, but the actual interaction with the clinicians is native inside Epic.

Someone told me that at least two vendors asked to license your analytics and dashboard to improve what happens after their own alerts have fired and been acted on.

The popularity of our analytics has been a little bit of a surprise to us. We understood that it was valuable so we could see the efficiency and effectiveness of our own clinical recommendations. We outload everything in the log.

What surprised us was the customers were interested in seeing what other alerts were happening and behaving. For example, their drug-drug, drug-allergy alerts which typically have very low followed rates, they could see that. Most large Epic clients have written some best practice BPA alerts on their own. There’s no real tool to see how they’re performing. For example, Henry Ford likes our content, but I’d say they probably like our analytics better.

Are hospitals following up on alerts that are constantly overridden even though they are clinically appropriate given evidence-based guidelines?

For the alerts we’ve written, we continuously refine them and make then more pertinent and more likely to be on target.

We had a client-written alert that fired 2,500 times and was followed once. Once they saw that, they just turned it off. The issue of alert fatigue is really serious. All of us need to be much more careful what we put in front of a clinician in order to improve efficiency and safety.

With our tool, you’re going to see a lot of curation of what alerts are out there — emphasize the ones that are helpful and start shutting down the ones that don’t do any good. They just clutter up the doctor’s workflow.

In the medical management process in these health systems and in the government system, it’s common to take our reports and go to a clinician. In the old days, you would go to a clinician and say, “You use too many CTs.” They would say, “My patients are different.”

Now we say, “There’s a recommendation from Choosing Wisely and the American College of Radiology that says don’t CT headache first-time presentation. You overrode that 50 times. Why are you doing that?” That’s the dialogue between clinical leadership and the physicians. It’s patient-specific and  order-specific. It only fired if the patient met the criteria. It’s a much more targeted conversation with clinicians now.

In many cases the clinicians like the feedback. They’ll say things like, “I want to do the right thing. Help me figure out what the right thing is.” When you wrap back around, you say, “You’re a really good follower of clinical advice.” That’s one thing. You have another guy and you say, “You’re on the low end of followed rights. Why is that?” It’s a more targeted, more clinically oriented discussion.

What outcomes are properly presented Choosing Wisely recommendations having on clinical practice?

We have inpatient ones and outpatient ones. It varies pretty widely over the recommendation. I’d say on the low end, we get followed rates of, let’s say, 15 percent. On the high end, we get followed rates as high as 60 percent. This compares to other CDS, where a one or two percent followed rate is considered adequate.

If these things are coded properly and presented properly, the Choosing Wisely recommendations get a lot of uptake. They came from the American Board of Internal Medicine and their 70 sub-societies, like cardiology and radiology. It’s not the government telling you what to do or the payer telling you what to do — it’s advice from your colleagues and your sub-society. It’s a lot easier for the docs to look at that and conclude that it’s good advice.

How do see the role of societies in creating guidelines like these going forward?

I think there will be more. However, I would say that, in terms of influence, we’re getting lots and lots of recommendations from CMS and Medicare now. For example, the PQRS series. Choosing Wisely mostly doesn’t do recommendations. PQRS, Physician Quality Reporting System — which is going to morph into MACRA – is “do,” “do in addition,” or “do instead.”

For example, you’ve got a heart failure patient — I’d like you to prescribe a beta blocker and ACE inhibitor. If we look in the medical record and we see it’s not there, we can alert the doctor that it’s missing. That ties to physician reimbursement, both bonuses on the upside and penalties on the downside. Then there’s a huge push for bundled payment starting this year with hips and knees. Most of the clinical advice that’s going to come out in the next year will be driven by CMS.

What are the most important lessons that you’ve learned in your career?

Most of my experience is on the provider side. The people who run health systems are dedicated, smart, hard-working, credentialed people. But they have a lot going on and there’s a lot of distraction going on. A lot of noise in the system.

The hardest thing to get IT projects moving is that you have to come up with a good enough explanation and a good enough value proposition for what you’re proposing. You have to come up out of the noise and get the leadership’s attention and give them a really good ROI — both financially and quality-wise — on why they should consider doing your project.

The technology is plenty hard enough, but getting onto the health system’s priority list is even harder. The hardest thing is to come up with a great communication program where the decision-makers and health systems understand your offering as one they should take a hard look at.

What are the most important factors that impact whether a startup will succeed or fail?

Assuming they’re trying to get customers out of the provider set, they’ve got to understand what the provider’s strategy is and how their tool, their offering, or system, or whatever helps the health system meet its strategy.

From our point of view specifically, as we move into payment reform and fee-for-value instead of fee-for-volume, it’s critical that you get the clinicians to shift their clinical practice. Eighty percent of the cost in healthcare is the result of a physician making a decision. You’ve got to get into that decision-making and get them to make a better decision or the right decision given where the health system is trying to go.

For anybody trying to bring health IT into the marketplace, you’ve got to match what you’re reasonably capable of doing as a vendor and what’s on the A-list for the decision-makers in the health system. That’s the trick.

Where do you see the company in five years?

We’re early in this market of putting information in front of physicians and having it change their mind. It’s going to be a valuable line of work for us and other people. It has a chance to be a big business and to make a meaningful difference in the way healthcare gets practiced.

I saw an interview with Paul Ryan. They were talking about how hard it is to attack entitlement. They said, do you think you could do Medicare reform? Ryan said Medicare is going to go bankrupt, which is in nobody’s interest. We’ve got to do something different in Medicare to preserve the system.

In some small way, Stanson helps clinicians get a higher quality clinical outcomes for less resource. The driving force behind that is Medicare driving the fee-for-value. In our own small way, we’re going to help preserve Medicare and everybody is going to be better off. I think we’ve got a chance to be a really big company because we add a lot of value.

Do you have any concluding thoughts?

We’re in a really great time. The country has paid the bill for putting in all these electronic health records. The government subsidized $31 billion and health systems have paid way more than that to get these things up and running. Essentially, the railroad tracks are down.

On average, we look at 30 elements in the medical record before we give the physician advice. We look at their medications, we look at their lab results, we look at their age, their presenting symptoms. Ten years ago, you couldn’t do that, because the stuff wasn’t digitized.

To get the Meaningful Use money, you have to get clinicians entering their own orders. We now have the point of attack where the clinician is ordering something. We have a rich amount of digitized medical records. We finally have the infrastructure to start giving people intelligent clinical advice.

The technology is there. The payment reform is the driver for change. There’s never been a better time to be in healthcare technology. We’re going to see huge advances in the next five years. It’s an exciting time to be in the business.

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March 30, 2016 Interviews 1 Comment

Morning Headlines 3/30/16

March 29, 2016 News No Comments

Statement from MedStar Health Regarding Computer Downtime

10-hospital system MedStar Health is hit with a computer virus that has restricted access to its network and EHR system, forcing users back to paper documentation. Officials from the hospital have not confirmed whether a ransom has been demanded.

Banner to invest $1 billion for facilities in Tucson, Phoenix

Banner Health will implement Cerner at the recently acquired University of Arizona Health Network by 2017, replacing Epic.

Contracts: Defense Logistics Agency

DoD signs a one-year, $77 million extension with Philips Medical Systems to continue using its “patient monitoring systems, subsystems, accessories, consumables, spare/repair parts, and training.”

Security alert! New ransomware found inside Microsoft Word

A new healthcare-focused ransomware package is being passed around within Microsoft Word macros that uses Microsoft’s PowerShell framework to download malicious code and initiate the ransomware attack.

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March 29, 2016 News No Comments

News 3/30/16

March 29, 2016 News 15 Comments

Top News

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Ten-hospital MedStar Health, the largest health system in the Baltimore-Washington corridor, shuts down its electronic systems and turns away elective patients and after what appears to be a ransomware attack that began Monday morning. The systems remain down. The FBI is investigating.

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Despite MedStar’s assertion that it is unaware of any demands for ransom, some of its employees reported seeing a pop-up window demanding payment in bitcoin.

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Senate HELP Committee Chair Lamar Alexander (R-TN) says the MedStar attack proves that HHS should quickly implement requirements from the Cybersecurity Information Sharing Act of 2015, which calls for HHS to:

  • Appoint a cybersecurity leader.
  • Create a healthcare cyberthreat report.
  • Create a task for to submit recommendations and to disseminate federal cyberintelligence threat information.
  • Publish voluntary best practices.

Reader Comments

From MD Prof: “Re: NY e-prescribing. You mentioned an exemption for patient-requested paper prescriptions. Can you provide a link to the regs?” I had run across a source that said patients can request paper prescriptions, but upon reviewing the regulations and the stated exceptions, I don’t see such language, so I don’t believe patients have that option after all. Patients and prescribers could see some problems:

  • Patients may want to price-shop multiple pharmacies and can’t without having a paper prescription.
  • They might not have a particular pharmacy in mind at that moment.
  • They may want to send some prescriptions to one pharmacy and others to a different one to save money and new electronic prescribers may struggle with how to do that.
  • If the requested pharmacy doesn’t have the medication in stock, the prescriber will have to issue a new electronic prescription to a different pharmacy.
  • Patients might choose a pharmacy that is closed for a holiday or for normal hours of operation.

All of these are especially problematic for ED physician prescribers, who would be hard to reach if prescription changes are needed. I’m also not clear of pharmacies can still transfer prescriptions among themselves, which I assume they can once it has been created electronically. MD Prof also notes that it’s a pain for doctors to perform the required manual patient lookup on the I-Stop website to identify possible doctor shoppers and suggests further integration of that database with prescribing systems.

From Circular Logic: “Re: site. I wasn’t able to get on for part of Monday.” Me neither, at least for a few minutes mid-morning. It was really busy yesterday for some reason, with more daily page views than even during the HIMSS conference. In fact, it was the busiest day since July 30, 2015 when the DoD contract winner was announced and when I decided I needed to upgrade to a bigger dedicated server. Maybe it’s time again.

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From C. Cortez: “Re: rumors. I hope you don’t listen to the comments of people complaining about running industry rumors. Those rumors are usually correct.” My survey shows that only 1.3 percent of readers don’t enjoy reading rumors on HIStalk, which is not really surprising given that I’ve been running them since 2003 and therefore the audience is somewhat self-selecting. What I’ve learned in that 13 years is that nearly everybody loves reading well-placed “rumors” until they hit too close to home, at which time the indignant commenter suddenly proclaims them to be “gossip.” Many big stories have been broken here from reader rumors, while the rest are still entertaining.

From Sue Veed: “Re: interoperability. Judy Faulkner is still describing technical problems and calls for national standards. The problem is now 40 years old with no resolution in sight. The banking industry adopted MICR check standards in no time and healthcare is still dithering. Why?” I heard a keynote years ago by Dee Hock, a local banker who almost single-handedly created what was then BankAmericard (now the Visa credit card system after which competitors are modeled). He explained that it was tough to convince banks (which were local and regional rather than national back then) that it was in their best interest to work together in a decentralized way to create a nationally available electronic credit card network for their shared customers, which he later described as the prototype for “chaordic” organizations that “blend competition and cooperation to address critical societal issues.” Healthcare IT is stuck in the mid-1960s with no heir apparent to Dee Hock available to convince providers and IT vendors that everybody wins (especially the customer) if they share information.


HIStalk Announcements and Requests

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We provided Mrs. Openlander from Missouri with several sets of math and reading flash cards for her K-5 school in funding her DonorsChoose grant request. The cards are placed in high-traffic areas so that hallway waiting downtime can be used for extra instruction.

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Also checking in is Ms. Wilson from Virginia, who passes along to HIStalk readers that the five human anatomy models we provided are being used for class demonstrations and “center time,” where the teachers have created add-on learning exercises such as an interactive anatomy whiteboard game. She concludes, “Our students have grown so much in the short time we have had the new materials. I cannot tell you how good it makes us feel to watch them interacting and striving to learn in ways that before you gift we never thought possible … your gift has changed the lives of our students and us forever.”

A quote I can’t get out of my head: “There’s no such thing as a cloud. It’s just someone else’s server.”

Listening: Built to Spill, Boise-based indie rockers who start a small-hall tour in late May as they approach 25 years of bandom. Also, new Italy-based symphonic metal from Rhapsody of Fire.


Webinars

March 30 (Wednesday) 1:00 ET. “Coastal Connect Health Information Exchange: Igniting the Power of Events-based Notifications Webinar.” Sponsored by Medicity. Presenters: Cory Bovair, application specialist. CCHIE; Andy Biviano, director of product management, Medicity. Wilmington, NC-based CCHIE, which covers 800 physicians and 1.4 million patients, implemented Medicity Notify for real-time clinical event notifications to help reduce ED utilization, improve care quality, and enhance patient satisfaction. In the first 30 days, physicians and care managers received more than 3,000 admission and discharge notifications.

April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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


Acquisitions, Funding, Business, and Stock

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Dell will sell its IT services business, the former Perot Systems, for $3.05 billion to Japan’s NTT Data to help pay for Dell’s planned $60 billion takeover of data storage vendor EMC. Dell bought Perot Systems for $3.9 billion in 2009. NTT Data, a subsidiary of Japan’s national telephone company, acquired IT systems and services vendor Keane for $1.2 billion in 2010, giving it the Optimum hospital product suite.

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Alphabet’s (Google) Verily Life Sciences is losing top executives and its governmental connections with FDA and HHS due to the abrasive management style of CEO Andrew Conrad, STAT reports. The company has apparently abandoned its project for connecting medical devices to the cloud, with all of its team members departing the organization. Also gone is the co-founder of the project to develop a glucose-monitoring contact lens. A biotech consultant who previously worked for a research institute Conrad founded describes him as, “We used to joke and call him the seagull of science. He used to fly in, squawk, crap over everything, and fly away. You couldn’t engage him for more than 10 minutes. It was sort of the overpromise, under-deliver.”


Sales

The Department of Defense issues a $77 million, one-year contract extension to Philips for “patient monitoring systems, subsystems, accessories, consumables, spare/repair parts, and training.”


Announcements and Implementations

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Boston Children’s Hospital (MA) launches Feverprints, an iPhone app powered by Apple ResearchKit that will use crowdsourcing to explore normal temperature variation and evaluate the effectiveness of fever medications.

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Carolinas HealthCare (NC) will implement Epic at Southeastern Health (NC) via a shared services agreement. I believe Southeastern runs McKesson Horizon for inpatient and eClinicalWorks for ambulatory.

AARP Health Innovation@50 announces the ten finalists for its April 27 pitch event:

  1. Cake (end of life planning)
  2. Medvizor (patient instructions)
  3. Penrose Senior Care Auditors (senior check-up app)
  4. PicnicHealth (personal health record)
  5. Savor Health (nutrition)
  6. SeniorHabitat (senior care facility selection)
  7. SensaRx (wandering sensor)
  8. SingFit (music as medicine – video above)
  9. UnaliWear (fall detection and medication reminder watch)
  10. Well Beyond Care (non-medical assistant finder)

Privacy and Security

A new ransomware variant called PowerWare is discovered to be targeting healthcare specifically in spreading itself via macros embedded in Microsoft Word documents posing as email-attached invoices. It’s smarter than similar types of ransomware, invoking the “fileless” native automation tool Windows PowerShell to download a script and then encrypt the PC’s files. This would be another great reason to demote users who have Administrator privileges or who can run programs with elevated permissions.


Other

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Peer60 releases “Trends in Revenue Cycle Management.” Some of its findings: (a) cost is the top criterion for selecting a RCM vendor; (b) collections is the most-outsourced provider service; and (c) the most-unmet RCM needs are denials management, contract management, and value-based reimbursement.

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A 60-patient study finds that the fingerstick blood tests previously offered directly to Arizona consumers by Theranos give results that vary significantly from results obtained from venipuncture samples that were sent to Quest and LabQuest.

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Banner Health (AZ) will complete by fall of 2017 the replacement of Epic by Cerner at the two Tucson hospitals formerly owned by University of Arizona Health Network, which it acquired in 2015. Banner says the switch will provide “significant savings” to the hospitals, which spent an unbudgeted $32 million and a total of $115 million on their 2013 Epic project, causing a $29 million fiscal year loss that was followed by the sale of UAHN to Banner.  


Sponsor Updates

  • Aprima will exhibit at the Texas MGMA Annual Meeting March 30-April 1 in Dallas.
  • The Baltimore Business Journal lists Audacious Inquiry as one of the five largest software developers in the Baltimore area.
  • Catalyze publishes a new e-book, “Innovation Doesn’t Follow Rules.”
  • Besler Consulting will exhibit at the HFMA Hudson Valley Annual Institute 2016 April 7 in Tarrytown, NY.
  • Burwood Group Justin Flynn will present at the Palo Alto Networks Ignite 2016 Conference April 4 in Las Vegas.
  • Carevive Systems shares its latest presentation, Survivorship Care and Care Plans: Transforming Challenges into Opportunities.
  • Direct Consulting Associates sponsors the HonorHealth Charity Golf Classic in support of the HonorHealth Military Partnership.
  • Divurgent will exhibit at the AEHIS/CHIME Cyber Security Lead Forum April 4 in San Francisco.
  • EClinicalWorks will exhibit at the 2016 Health Care Symposium April 1 in Costa Mesa, CA.
  • Healthwise will present at the Society of Behavioral Medicine meeting March 30-April 2 in Washington, DC.

Blog Posts


Contacts

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

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March 29, 2016 News 15 Comments

OpenNotes: From Grassroots Effort to Nationwide Movement

March 28, 2016 News No Comments

We look at the evolution and future of OpenNotes — from the impact it has had on patient engagement, medication adherence, and physician workflows to the technological challenges of implementing a truly vendor-agnostic tool.
By @JennHIStalk

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Six years ago, the notion that patients could have electronic access to their doctor’s notes was almost unheard of. The note was a safe, private place where providers could document a clinical encounter without worrying about a patient’s reaction to their accompanying commentary. The note was for internal use only, which no doubt gave providers a certain poetic license to describe patient ailments and mindsets in the bluntest of terms. Enter OpenNotes, now a national movement that encourages providers to adopt open access to clinician notes as a standard practice of care.

A Grassroots Beginning

The movement began in 2010 as a year-long study funded by the Robert Wood Johnson Foundation that tested the OpenNotes concept with 105 PCPs and over 13,000 patients at Beth Israel Deaconess Medical Center (MA), Geisinger Health System (PA), and Harborview Medical Center (WA). The trial was considered a success, with patients reporting that access to physician notes helped them feel more educated about and in control of their care. They were also more apt to take their medications, share their notes with other caregivers, and communicate and collaborate more with their physicians.

Participating physicians experienced similar positive results, with just a handful reporting longer visits and taking extra time to address patient questions outside of regular visits. While a larger percentage reported taking more time to write notes and change documentation content, none of them stopped providing access once the trial ended.

As RWJF President and CEO Risa Lavizzo-Mourey, MD said at the trial’s conclusion, “The evidence is in. Patients support, use, and benefit from open medical notes. These results are exciting and hold tremendous promise for transforming patient care.”

Growth Gets Underway

Since results from the initial OpenNotes trial were published in 2012, the movement has expanded almost exponentially across the country. Twenty-six healthcare organizations — including the VA and most recently Duke Health (NC) — are now providing open-note access to over 6 million patients.

The movement shows no signs of slowing down thanks to an additional $10 million in funding from RWJF, Cambia Health Foundation, Gordon and Betty Moore Foundation, and Peterson Center on Healthcare that will be used to roll out OpenNotes access to 50 million patients across the country.

The investment doesn’t stop there. We Can Do Better, a nonprofit OpenNotes advocacy group that works alongside the NorthWest OpenNotes Consortium, received a grant earlier this year from the Oregon Health Authority Office of Health IT to help spread OpenNotes to small to medium-sized physician practices in Oregon, and to work with healthcare IT vendors on making OpenNotes easy to access via their EHRs and patient portals.

CHIME has also thrown its support behind the initiative, announcing last month its intent to collaborate with the OpenNotes movement on accelerating health data sharing as part of its participation in the Precision Medicine Initiative.

Change Management Trumps Technical Necessity

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“There is very little funding needed for OpenNotes rollouts,” says Amy Fellows, MPH, executive director at We Can Do Better and an OpenNotes team member. “The main effort is around change management – convincing providers that this is going to be a good thing and something that won’t add to their workload. We hear that OpenNotes is a much easier and smoother rollout process than many previous facility implementations. It really is all about the upfront change management, then ripping the Band-Aid off and getting it turned on. In some cases, a small number of skeptics can delay or moderate an implementation. The issues are cultural, not technical.”

Technical requirements do, of course, need to be taken into consideration. According to Fellows, facilities using Epic and Cerner should be able to easily configure their systems to support OpenNotes. “We attended HIMSS16,” she adds, “and spoke to many other vendors about their capability to offer OpenNotes, including EClinicalWorks, Allscripts, and NextGen.”

Fellows adds that OpenNotes is working to develop a best-practices sheet with recommendations for vendors on how to configure OpenNotes so that it is patient and physician friendly.

Digging Into Provider Best Practices

Fellows and her OpenNotes colleagues in the Northwest have had ample opportunity to discuss provider best practices at Northwest Open Notes Consortium quarterly meetings. “OpenNotes seems to be an evolutionary process, so even those that have done it come to learn about national efforts bringing it to mental health, inpatient, and other specialties,” she explains. “We know about 1 million patients [in the Northwest] have the ability to access their notes, but it is dependent on each organization’s strategy in promoting their patient portal, and how easy they make it to access the note, i.e. do they send an email tickler inviting patients to access their notes with a link taking them directly to that part of the patient portal after log in?”

“We believe best practice includes internal and external promotions, reminders, and easily accessible notes,” Fellows adds. “Initial implementation should include some time spent with clinicians on avoiding documentation practices that can confuse patients – acronyms, cut-and-paste approaches, confusing medication lists or problem lists. Avoiding jargon can also be helpful, i.e. ‘patient denies,’ or ‘patient complains.’ Sensitizing clinicians to terms that activate patients, like ‘obese’ or ‘addicted,’ is worthwhile, too.”

Geisinger Sets the Bar

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Geisinger, an original OpenNotes trial participant, has expanded its involvement with the program by rolling it out to new physicians as part of best practices. “Right now, we’re looking at 1,700 providers including advanced practitioners and case managers across the system who access OpenNotes as part of their care,” says Rebecca Stametz, senior director of clinical innovation at Geisinger. “Looking at it from mobile utilization, we have gone from 2,005 unique users to about 150,000 with about 550,000 unique hits off of our portal.”

“Since the trial, we’ve rolled it out as a best practice across care settings, with the exception of pockets across our system like psychiatry, maternal-fetal medicine, and EENT,” Stametz says. “We’ve decided to pause on areas where we were unsure of any implications and where we felt we needed to take a deeper look. That being said, new physicians that get on-boarded, especially those in ambulatory, have access to OpenNotes. It’s now part of our care process.”

Serving up OpenNotes to patients is as easy as a visit to Geisinger’s patient portal. “It’s really one of the benefits that [they] have when enrolling with MyGeisinger or our patient portal, both Epic,” she explains. “It’s really about word of mouth – marketing it as a best practice and utilizing it via internal systems. There really isn’t anything to purchase outside of the EHR and maybe a patient portal, which most of the systems who are implementing OpenNotes already utilize.”

Measuring Success Now and Later

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Given Geisinger’s track record with OpenNotes, Stametz is well poised to offer what success with OpenNotes means to the organization. “Success means that patients feel more connected to their care,” she explains. “They want OpenNotes. They feel like there’s open communication and they have confidence in their ability to manage their own care. Studying the long-term implications of end users is something that we’re going to begin to tackle now with our national partners.”

Stametz adds that little to no impact on physician workflow is also a part of Geisinger’s definition of success. “We were wondering about disruption to workflow and whether or not people actually utilize those notes if they became open,” she says. “We know that 99 percent of those patients wanted the practice to continue, so there were benefits we didn’t anticipate. We observed that some patients began to gravitate towards physicians that offered note access. I think one of the big things from a Geisinger perspective is that there was little concern or complaints from providers or patients.”

OpenNotes is just beginning to reach a maturity level that will enable researchers to determine its effect on outcomes. Thus far, the only hard data available is a paper published last fall in the Journal of Medical Internet Research that shows patients with open-note access have better blood-pressure control than those who don’t.

Fellows adds that several implementers have evaluated their efforts with surveys similar to the original OpenNotes research surveys. “Patient-reported outcomes have been very similar in each one,” she explains. “All of the implementations we are aware of have gone well with no physician workflow disruptions. Email traffic has been flat, and when made available, portal traffic has increased.”

“The most revealing metric,” Fellows adds, “has been the rate of patients opening notes and the rate of physicians hiding notes. Patients viewing notes are highly dependent on patient reminders and internal/external promotion. Hiding notes is unusual and mostly done by a small number of physicians. The incidence of hiding notes decreases with time.”

Moving Beyond Primary Care

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Many OpenNotes participants are venturing into new territory. Several organizations, including BIDMC, have launched mental health pilots to gain a better understanding of how increased transparency could potentially benefit psychiatric care. Vancouver Clinic is exploring the value in allowing adolescents to view their notes with or without parental proxy access. Fellows also foresees eventually rolling out OpenNotes to more vulnerable patient populations, such as non-English speakers, those with health literacy issues, and underserved and safety net populations.

For Geisinger, the next phase of OpenNotes is about expansion and better understanding what patients want to get from its access. “What are the long-term implications for end users who have been using OpenNotes for the past five or six years?” Stametz asks. “We don’t know those answers, but we’re beginning to work with national partners like BIDMC to find out. For example, if patients and family caregivers were able to write their own narrative within the note, what would that do for goal setting, treatment planning, communication, encounter time, etc.? We’re at the tip of the iceberg with the ways we could leverage the impact OpenNotes has had and its potential in other areas.”

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March 28, 2016 News No Comments

HIStalk Interviews Matt Patterson, MD, President, AirStrip

March 28, 2016 Interviews 2 Comments

Matt Patterson, MD is president of AirStrip of San Antonio, TX.

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Tell me about yourself and the company.

I’m a physician by training, with a background in head and neck surgery and as a Navy physician. I spent some time with McKinsey before joining AirStrip.

I’ve been here for four years. I was with the company during the transition from making the first FDA-cleared mobile applications for waveform-based data into a full platform called AirStrip One, which can accommodate essentially any clinical data source in a single workflow to enable a variety of care collaboration and innovation workflows.

Mobile health was a specialty niche when AirStrip was started, but now it’s a given that any software has to work well for mobile users. How is the industry is doing in that regard?

What we’ve seen is the continuation of a pattern that was around when we first started. There certainly is a push to provide a mobile extension of health IT stacks. What we are ahead on still to this day is the ability to aggregate across multiple, disparate sources of data and to stream that data to analytics, third-party, and decision support platforms, in addition to providing just the essential elements that are important for decision-making in a clinical workflow. I think that is quite distinct. We’re ahead on that, but in general, most people recognize that having a mobile extension of the software stack is a valuable addition to healthcare.

Is the Apple-like ecosystem of third-party healthcare apps real or is it just wishful thinking?

It’s more the latter. As a physician myself, I’m always skeptical about having to have too many applications to go to. It’s akin to having too many pagers on my belt walking around the hospital. Most clinicians are not necessarily looking to segment their workflow experience if they can avoid it.

That said, no single vendor is going to be able to accomplish all the things that any one clinician needs to do at any given point. You’re always going to have a number of different applications out there that are each trying to satisfy certain elements of the clinical workflow. But the concept of having a clearinghouse or a hosted environment that somehow corrals all these beasts is missing the one key point, which is, how do all of these things work together? It’s the interoperability piece that the industry is way behind on. 

We have dedicated our entire mission and product evolution around solving for the interoperability. I’m OK with whatever it takes to address the clinical workflow. Different vendors and different applications can lift different parts, but it needs to feel like a singular, unified, coherent, and elegant workflow for the clinician. Otherwise, you’ll never get adoption.

What steps are needed to open up EHRs to those third-party applications?

The most powerful lever in my mind is to make the ask with a powerful health system client at your side. What’s become very, very clear is that, despite the numerous promises of these large EMR vendors that either they can do what the health system wants them to do or that another smaller innovative company is already doing today, most health systems are waking up and realizing, "You’ve been telling me this answer for 10 years and you still haven’t delivered on the things that are already out there in the marketplace that more nimble companies are accommodating.” 

The time is now to open up complete, bi-directional APIs to allow these innovative firms to plug and play nicely with the EMR environment. That’s the most important thing. The reason I focus on that is that the typical answer that you’ll hear stems around technology standards, policy, government, and all that type of stuff. I can tell you right now the tools exist today to do complete, effective, bi-directional, Web-based APIs to all the major EMR vendors in the market.

I applaud things like FHIR and other standards. They’re a step in the right direction, but they are years and years away. The tools already exist. It’s simply the blocking that is getting in the way. The data blocking can manifest in not only technical ways. It can manifest in political ways, and it can manifest in financial ways. We’ve experienced all three.

How do you approach that issue? Are you all set in dealing with Cerner and Epic, or is it a battle every time you need to connect a new client?

It gets easier and easier. The work that we’re doing today, I never would have even imagined possible three years ago. It is absolutely moving in the right direction, albeit it much more slowly than we would like to see. 

What we have done is always use our clients as the voice, because it is the client’s voice. It’s not just AirStrip that’s out there asking for this and looking to monetize it. This is really about our clients coming to us trying to solve the problems that they have and AirStrip having a willingness to innovate through providing interoperability and workflow solutions.

We have developed very, very important strategic relationships with large IDNs across the spectrum of large healthcare IT vendors. Not just EMRs, but also on the monitoring side. We absolutely are side by side with our clients in the requests that we make, which are quite reasonable and are based on sound clinical and business cases for workflows that are in demand in the marketplace.

Are people distinguishing between interoperability as in sharing patient data among sites vs. snapping applications together within the same health system?

I don’t really see much of a distinction. Increasingly where I’ve seen the conversation turn is a patient-centered approach to interoperability. The answer is all of the above. The more that we take a more consumer and individual orientation towards data ownership and stewardship, that should be the North Star. All things should bow to that.

All efforts to monetize simple movement of data from Point A to Point B should be eliminated. The only thing that deserves monetization these days is adding value, creating workflows, and doing things with the data that are meaningful for patients.

If you take a patient- or consumer-centric view of the world, you recognize that there are challenges not only in connecting all the existing stacks within a particular health system together and making them work seamlessly, but it also includes situations like you describe where you have different facilities on different platforms and those need to communicate effectively as well.

What is the right level of FDA oversight for IT systems that have a biomedical component?

The FDA aligns themselves in the spirit of patient safety. That is appropriate, and that should be their mission and guiding force. It’s interesting when you get into things like what happened recently with the non-binding guidelines around interoperability, that the focus was on devices and how they communicate with the outside world. Interoperability was the focus. Somehow, that came under the realm of patient safety. I have a lot of things that I could go into on that topic, but I’ll pause there and not do that now.

Sticking with the question, there just needs to be a certain degree of risk that you cross, regardless of what you do from an application standpoint or device standpoint, where the FDA should regulate and should provide guidelines in the interest of public safety. I think that that’s appropriate. Most importantly is just to be very clear about what those situations are and then to make it as efficient as possible for innovative companies to submit their applications when appropriate and get approval.

Do you think the government climate supports innovation in healthcare IT?

I have been incredibly encouraged by what I’ve seen come out of the Capitol recently. In particular, I’ve been very encouraged with the work being done by Senator Alexander and the HELP Committee. We were referenced in a recent letter to Secretary Burwell by several members of the House of Representatives in an urgent plea to address interoperability and data blocking. There’s a lot of very, very positive momentum towards opening things up and allowing innovation to take place.

That’s another reason why just the timing of the release of the FDA’s non-binding guidelines recently on interoperability is very, very interesting to me. In some ways, I see it as a potential foil on the good conversations that have been taking place. I certainly don’t fault the FDA for wanting to address patient safety. I think that’s what they should do. But the timing is interesting. Similar to the way that HIPAA and Stark have been misused and misunderstood and that has stifled innovation, I could see almost safety blocking – that’s the only way I can put it — stifling innovation. “In the name of safety” type of thing, that the recent guidelines might have an unintended effect.

How has your experience as a Navy surgeon shaped your career?

Gosh, it did in so many different ways. I was fortunate enough to be an undersea medical officer while I was in the Navy. That allowed me to work with the fast-attack submarine group. It also allowed me to work with the Special Forces. I was the medical director at the Naval Special Warfare Center, which is the first training area for the Navy SEALs.

Navy medicine shaped my career in a few important ways. One, the concept of a flat team structure is prominent, particularly in the Special Forces community. I know that may come as a surprise when thinking of the Navy as a hierarchical place, but it’s surprisingly flat when it needs to be. There’s just an incredible esprit de corps and sense of teamwork that can happen in crisis. That gave me quite a bit of perspective on what’s important and what’s an emergency. You learn relative degrees of emergency very, very quickly in Navy medicine.

A second big thing is that it was my first introduction to telemedicine. It’s uncanny that I find myself in the situation I’m in right now, because AirStrip is obviously used a lot in various telehealth scenarios. My very first experience with telehealth was working up patients preoperatively remotely, even using scopes and some pretty advanced technologies, and never laying hands on the patient. The very next time seeing that patient was when they showed up to get an operation. Being that confident in my pre-surgical exam remotely had a profound effect on what I envisioned could be possible with application technology in healthcare. Both of those things I carry with me to this day.

Do you have any final thoughts?

We are at an important turning point when it comes to interoperability and innovation in healthcare. It’s going to take more than government regulations in order for us to get to where we need to be in the marketplace. I’m very, very encouraged that interoperability is a prominent part of the conversation coming out of HHS and coming out of the Senate and the House of Representatives. I’m very encouraged by work being done by interested parties like the Center for Medical Interoperability, because I think that what you’re seeing now is a much more patient-centered approach to the problem. When we focus on the patient, when we focus on the individual consumer, we cannot be wrong.

I envision a world very soon where consumers will essentially be allowed to hit the virtual “record” button on their medical data any time that they want to. Then have the ability on the fly, using plain English opt-in and opt-out types of scenarios and technology, to subscribe their data to anyone they want — vendor, health system, payer, provider, innovative company, you name it. Not only for their own benefit, but for the benefit of society at large. The only way we get to that place is by allowing wide-open interoperability among all of the technology players out there. We’re privileged to be a part of that ecosystem.

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March 28, 2016 Interviews 2 Comments

Monday Morning Update 3/28/16

March 27, 2016 News 7 Comments

Top News

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New York’s mandatory e-prescribing mandate took effect Sunday despite a questionable level of prescriber readiness even after the one-year postponement a year ago. Allowed exceptions are drug items that require pharmacy compounding, parenteral drugs, items requiring lengthy patient instructions, or non-patient specific prescriptions. Paper or call-in prescriptions can be issued upon patient request or given technology failure, which then requires the prescriber to report the prescription to the state’s Department of Health, but the department has not implemented such reporting technology and suggests that prescribers just note it in the EHR instead.


Reader Comments

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From No Flipping: “Re: ransomware. I searched HIStalk and there was an example from 2012, so it’s not a new problem.” I wrote about a clinic in Australia whose files were encrypted by ransomware in December 2012. I don’t recall hearing if the clinic paid the demanded $4,000 ransom, but I expect it did. Meanwhile, a ridiculously useless Wall Street Journal article manages to ask the wrong questions (or perhaps fails to understand the answers) of those it interviewed in claiming to share healthcare security best practices to prevent ransomware. The pearls of wisdom provided are: (a) assume malware will get through; (b) perform backups; (c) apply patches; and (d) educate employees. CIOs who learn anything from this breezy waste of time should probably just go ahead and quit or at least attend our webinar described below.  

From The_Epic_Guy: “Re: Epic. The company is having their implementation consultants put their Starbucks coffee into non-labeled containers to avoid reminding customers that its inexperienced people are costing a small fortune.” Unverified. I would have expected contracts to specify a per diem rate rather than individual charges so that Starbucks vs. McDonald’s coffee wouldn’t matter, but maybe that’s not the case.

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From MCK Auto Pilot: “Re: McKesson. This site has interesting layoff rumors. All are unsubstantiated from employees who have been laid off, but in every exaggeration there is a kernel of truth.” Comments from claimed current or former McKesson employees complain about clueless upper management, the failed Better Health 2020 initiative, the cold manner in which employees were informed that their services would no longer be required, offshoring to India, and the likelihood that MCK will sell off what’s left of its IT business and whether anyone would want to buy it.

From Nasty Parts: “Re: Greenway layoffs. Four sales VPS have been downsized. Looks like the company is moving into a ‘protect the install base’ mode of operation.” Unverified. The four named VPs still list Greenway as their employer on LinkedIn, but most people don’t rush there first after they’ve been forcibly re-workforced.


HIStalk Announcements and Requests

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Half of poll respondents work for a company that has laid people off in the past 12 months. New poll to your right or here: do you personally admire and respect the highest-ranking executive of your employer? I’ve divided the answers out into not-for-profit and for-profit choices to see if that makes a difference (which I should have done on the previous poll, too). Click the Comments link on the poll after voting to explain.

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FHIR Family donated $500 to my DonorsChoose project, explaining, “HL7 has a big deadline on Monday, March 28 and I am in awe of all the work Grahame Grieve does in the background. This donation is in his name.” Through the magic of matching funds, the donation fully satisfied these teacher grant requests:

  • An iPad and case for Ms. Markussen’s first grade class in Dallas, TX
  • A laptop and document camera for Mrs. Lark’s middle school class in Brooklyn, NY
  • Math games for Ms. Burkett’s elementary school class in Independence, MO

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Mrs. Hale from Indiana says her third graders were so excited about the kid-friendly biographies we provided in funding her DonorsChoose grant request that they finish their other work early so they can work on biography projects.

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Also checking in is Mrs. Ortego, who says the headphones we provided for her Louisiana special needs elementary school class not only allow students to work without distraction, but also, “One of my greatest joys is that I have a hearing impaired student and he is able to put the headphones over his ears with no feedback from his hearing aids. This is the most amazing thing to experience. There is no frustration for this student.”


Last Week’s Most Interesting News

  • Allscripts and a private equity firm form a joint venture to acquire post-acute care EHR vendor Netsmart for $950 million.
  • The CEO of NYC Health + Hospitals denies rumors that he will be fired if the organization doesn’t go live on Epic on April 1 and dismisses reports by the former CMIO of one of its hospitals that a lack of readiness will endanger patients.
  • Three more hospitals report ransomware attacks.
  • AHIMA petitions the White House to allow HHS to work on a national patient identifier.
  • Apple announces CareKit, which will allow developers to create person health apps for the iPhone.

Webinars

April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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

Here’s the recording of last week’s webinar, “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.”


Sales

Dell Services announces recent big contracts that Dubai Health Authority and BCBS of Rhode Island.


Government and Politics

The president of the New York State Medical Society politely asks for two changes to the just-implemented requirement that all state prescriptions be issued electronically rather than on paper or by telephone. He would like to see an exemption for those doctors who write fewer than 25 prescriptions per year and a reduction in documentation requirements when technical issues require issuing a paper prescription. Both seem reasonable to me.


Privacy and Security

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Hackers steal and offer for sale the information of 1.5 million customers of Verizon Enterprise Solutions, whose services (including an extensive set of security offerings) are used by 99 percent of Fortune 500 companies.


Other

Epic removes regular and diet soda from its vending machines and cafeterias to promote health, so bring your own supply from a local convenience store if you’re a Diet Coke fan taking classes in Verona.

Another medical transport helicopter goes down, killing all four occupants (including the patient) in Alabama. The for-profit company’s site boasts that it has a “proven clinical tract record.”

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An interesting article describes the online problems experienced by people with unusual names: those who go by a single name, those with very long or short names that don’t pass field edits, and most interesting to programmers, people whose last name is Null. These folks often have to resort to telephone calls or snail mail to do tasks everybody else can accomplish online.


Sponsor Updates

  • Forward Health Group shares the wall-sized, hand-drawn graphics created in its UnBooth at the HIMSS conference, including population health management questions posed by visitors. 
  • EClinicalWorks releases a podcast recapping EClinicalWorks Day.
  • Extension Healthcare and FormFast will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
  • The Upstate Business Journal recognizes Glytec as an Upstate biotech player.
  • The Boston Globe features Healthwise CMO Adam Husney, MD in an article on how perks from pharmaceutical companies influence prescribing medicine.
  • Cumberland Consulting Group expands its business processing outsourcing services to pharma in a partnership with revenue acceleration software vendor Revitas.
  • Recondo Technology will exhibit at the HFMA Texas State Conference on March 29 in Dallas.
  • Experian Health will exhibit at NAACOs March 28-30 in Baltimore.
  • PatientSafe Solutions and PerfectServe will exhibit at the AONE Annual Meeting March 30-April 2 in Fort Worth, TX.
  • The Doctor Freedom Podcast features PatientPay founder and CEO Tom Furr.
  • Point-of-Care Partners ECare Management Practice Lead Michael Solomon discusses optimizing EHRs.
  • Streamline Health will exhibit at the 2016 WV HIMA Annual Convention March 30-April 1 in White Sulphur Springs, WV.
  • T-System awards its Client Excellence Award to Dosher Memorial Hospital (NC) for excellence in sustainable outcomes.
  • TeleTracking, Versus Technology, and Zynx Health will exhibit at the AONE 2016 annual conference March 30-April 2 in Fort Worth, TX.
  • TeraMedica will host a healthcare IT symposium April 7 in San Francisco.
  • Huron Consulting Group releases 2016 Healthcare CEO Forum report.

Blog Posts


Contacts

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

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March 27, 2016 News 7 Comments

Morning Headlines 3/25/16

March 24, 2016 Headlines No Comments

Raju to explain financial plan to Council, defend records system

NYC Health + Hospitals President and CEO Ram Raju claims the April 1 Epic go-live was a self-imposed deadline that he would be comfortable moving if needed, clarifying that he would not be fired for making that decision.

The Evolving EPCS Landscape 2016: A Prescription for Stopping Opioid Abuse

DrFirst publishes a paper on e-prescribing of controlled substances in the US, noting that while 82 percent of retail pharmacies are EPCS enabled, only 5.8 percent of providers are setup for EPCS.

Providers must release all of patient data to patients, families

The Ohio Supreme Court rules that any patient data kept by a health care provider must be released to patients and family members on request. Officials at Aultman Hospital argued that only patient data held within the medical records department was required to be turned over.

Thomas Health System Selects Parallon as its Meditech 6.1 Partner

Thomas Health System (WV) selects Meditech 6.1, upgrading its legacy Meditech Magic system and replacing its Cerner/Siemens Soarian system.

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March 24, 2016 Headlines No Comments

News 3/25/16

March 24, 2016 News 1 Comment

Top News

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Allscripts and private equity firm GI Partners form a joint venture to acquire human services and post-acute care EHR vendor Netsmart, which will be combined with the homecare software business of Allscripts. Allscripts also contributed $70 million to the joint venture, which will pay $950 million for Netsmart. The company’s name and management team will remain in place. Allscripts says the JV will have an annualized revenue of $250 million and operating income of $60 million.

Netsmart has gone through several name changes, ownership changes, and acquisitions in its 20-year direct history and earlier connections going back to 1968. It went public in 1996, sold itself to private equity buyers for $115 million in 2006, and then was then sold for an unspecified price in 2010 to another private equity firm, Genstar Capital, which is rumored to be making 4.4 times its investment in the newly announced sale.


Reader Comments

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From PM_From_Haities: “Re: Allscripts paying $70 million for a joint venture. It’s hard to imagine Allscripts giving up assets with out corresponding liabilities (debt). I’m looking forward to their audited financial results since they might require certain items to be disclosed, such as whether one customer represents more than 10 percent of revenue. The other item of interest with audited results is mark-to-market accounting of the Allscripts investment in NantHealth, which delayed its IPO due to unfavorable market conditions. Allscripts’ debt covenants contain asset-to-liability requirements and an unanticipated decline in asset value could seriously impact their delicate financial picture. The bright side of this JV is that Allscripts may be allowing a product that would languish with its other zombie EHRs to blossom into something good for home health.” Unverified. MDRX shares didn’t react much following the announcement, meandering down a bit Wednesday and then down a bit more Thursday.

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From Green about the Gills: “Re: Greenway. Starting a layoff cycle this week. Right-sizing post the Vitera purchase and the EHR land grab of the MU era.” Unverified. However, I do see the company has “rebranded” itself.

From The PACS Designer: “The ICD-10-CM Clinical Modifications has a code J62 for silica related disease, and under this classification falls the longest word in the English dictionary. Silicosis is a form of occupational lung disease and within this category is the 45 letter word ‘Pneumonoultramicroscopicsilicovolcanoconiosis.’”


HIStalk Announcements and Requests

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Mrs. Pryor from Oklahoma says her kindergartners love the programmable robots we provided in funding her DonorsChoose grant request, adding that they are a “huge motivator” that she has integrated into her reading and math curriculum.

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Also checking in is Mr. Jewell of Arkansas, who says his sixth graders have gotten a lot more excited about engineering after working with the Lego Mindstorm kits we provided. He has conducted two enrichment classes that involved building and programming the robots and now there’s a waitlist for the next class.

This week on HIStalk Practice: Signallamp Health adds CCM jobs in Scranton. Mend wins big at SXSW. PCAST advocates for the advancement of telemedicine. Wearables earn dubious accolades for their inconsistencies. Telerehabilitation startup RespondWell celebrates a $2 million funding round. Night Nurse COO Stuart Pologe offers tips on balancing HIPAA compliance with efficiency across EHRs and paper records. GAO brings Healthcare.gov cyberattacks to light on the ACA’s sixth anniversary. OneCare Vermont selects care management software from Care Navigator. The US Oncology Network’s David Fryefield, MD lays out the strategy behind empowering value-based technologies.


Webinars

April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

Contact Lorre for webinar services or for one final chance at her post-HIMSS discounts. Past webinars are on our HIStalk webinars YouTube channel.


Sales

Statewide ACO OneCare Vermont chooses Care Navigator’s care management software.

Thomas Health System (WV) will implement Meditech 6.1, replacing Cerner/Siemens Soarian and Meditech Magic.

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Palomar Health (CA) chooses Ascend Software for accounts payable electronic imaging automation.


People

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Lane Regional Medical Center (LA) hires Paul Murphy (Geocent) as CIO.


Announcements and Implementations

DrFirst publishes “The Evolving EPCS Landscape 2016: A Prescription for Stopping Opioid Abuse,” which finds that most pharmacies can accept electronic prescriptions for controlled substances while only 5.8 percent of prescribers are similarly EPCS-capable.

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Boehringer Ingelheim Pharmaceuticals will offer users of its asthma inhalers the chance to sign up for health system studies to determine the effectiveness of Propeller’s usage tracking inhaler sensors.


Privacy and Security

Rep. Ted Lieu (D-CA) may propose a modification to the HITECH act that would require healthcare organizations to notify patients if they’re hit by ransomware.

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The New York Times, explaining how it “decoded the NFL database” to debunk the National Football League’s concussion studies, admits that it was able to re-identify many of the 887 players that were listed only by an NFL-assigned code by reviewing the concussion date, whether the game was home or away, and whether it was being played on natural or artificial grass. The paper seems pretty pleased with itself for working around the method used to protect the privacy of the players.

Walmart confirms that a programming error caused the prescription records of 5,000 of its online pharmacy customers to be displayed to the wrong user.

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Do this now to help prevent having your PC infected with the Locky ransomware: allow only digitally signed macros to run. Instructions are here.

The Ohio Supreme Court rules that patients are entitled to receive all information stored about them by providers, not just those data elements the provider intentionally filed in the medical record. A hospital that was involved in a wrongful death lawsuit unsuccessfully argued that it was not required to release the deceased patient’s EKG strips because they had been stored by its risk management department.


Technology

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Google registers two healthcare-related images that may or may not have something to do with new medical apps.


Other

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NYC Health + Hospitals President and CEO Ram Raju, MD says the organization’s April 1 Epic go-live date is flexible and he won’t be fired for missing the date if the system isn’t ready. He says former Elmhurst CMIO Charles Perry, MD, MBA, who resigned in comparing the upcoming go-live with the Challenger disaster, took a parting shot as a “disgruntled” employee. Raju says previous CIO Bert Robles left shortly after the Epic project started because, “I didn’t want someone learning on the job,” leading him hire Ed Marx, who was recommended by Epic CEO Judy Faulkner. NY Health + Hospitals, which is projecting a $2 billion deficit, is rumored to be spending $1.4 billion on the Epic project.

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Lancaster General Health (PA) investigates a 12-hour EHR outage of unspecified origin.


Sponsor Updates

  • Medicity CEO Nancy Ham writes for the HFMA blog on “Determining the ROI of Clinical Care Technology.”
  • A record number of providers, payers, and partners gathered at the InstaMed 2016 User Conference.
  • Live Process will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
  • Navicure will exhibit at the Office Practicum User Conference March 31-April 2 in Atlantic City, NJ.
  • Obix Perinatal Data System will exhibit at the Sanford Health Perinatal, Neonatal, and Women’s Health Conference March 31 in Sioux Falls, SD.
  • The Irish Times profiles Oneview Healthcare founder Mark McCloskey.

Blog Posts


Contacts

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

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March 24, 2016 News 1 Comment

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Reader Comments

  • TheAlchemist: I apologize to HIStalk. Did not realize that the HIT community was such a left-wing advocate group, i.e., 57.52 %. Tha...
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  • ICU Nurse: We are going from bad to worse. HHS is focused on mu and macra, while the data is being compromised. HHS has failed...
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