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News 7/18/14

July 17, 2014 News 8 Comments

Top News

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CVS Caremark signs a clinical affiliation agreement with four healthcare providers (ProHealth Physicians, Texas Health Resources, Palmetto Health, and The Baton Rouge Clinic) whose patients will gain access to clinical support, chronic disease monitoring, and wellness programs at CVS drugstores and MinuteClinic retail clinics. MinuteClinic will send electronic medical histories and visit summaries to each patient’s PCP and CVS will share messages and alerts. CVS announced in February 2014 that its MinuteClinic division would move from its homegrown EHR to Epic’s EpicCare, saying it needed a platform that would allow it to share information with other providers more quickly and give it patient portal and analytics capabilities.


Reader Comments

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From Pop Counter: “Re: EHR vendors counting patients. Epic touts 50 or 60 percent coverage of the US population. How do they arrive at that number and how does it align with market share?” It’s an arguably flawed SWAG that doesn’t have a lot to do with market share, but it is a great marketing point from a company that claims to employ no marketing people, where huge marketing billboards magically appear on its HIMSS booth walls without human intervention. The “percentage of the US population” claim is also being used to impress the Department of Defense in its EHR selection. I’ve heard that Epic simply asks its customers (even the non-live ones) to estimate the number of patients they serve, applies some mysteriously derived percentage of potential overlap with other Epic sites, and then just adds it up. But let’s look at it from the point of view of an EHR company engineer being asked by the marketing department to arrive at such a number. Being objective and pedantically pragmatic as engineers often are, you would point out these challenges:

  • We don’t host every client system, so we can’t just run some super-query of unique medical record numbers. We have to ask the hospitals to report the number back to us.
  • Even though an individual health system may have successfully applied the one-patient, one-record rule, there’s no easy way to de-dupe overlapping patients across multiple clients without some kind of master person index algorithm. As a vendor with multiple health system clients in the same geographic area, we can’t easily account for patients who have information in all of them.
  • We would be counting imported CCD record from someone else’s system. Should we really count that as a complete patient record in our system when it wasn’t even created there?
  • We have a massive number of old patient demographics that we imported from our legacy system during conversion and we haven’t seen some of those people for 10 or more years.
  • Some patients in our database have died, quite likely elsewhere so that we don’t have a record of it.
  • Since we have an ambulatory system, we get an easy “credit” for a patient who merely drops by for a one-time ophthalmology consultation or lab test with no plans to return. The “record” in our system is minimal, containing (if we’re lucky) allergies, chronic conditions, and medication reconciliation. Almost everything of value is stored by other providers.
  • We as a vendor who sells primarily to large academic medical centers can boast of more patients because of higher churn from referrals, specialty clinics, and large ambulatory practices, all of which see patients who are also in the EHR databases of many other providers. Ambulatory visit patients greatly outnumber hospital inpatients, so the numbers are artificially skewed to favor vendors with many active sites in both, and in fact a large ambulatory EHR vendor may have more unique patients than any hospital vendor.
  • It’s not a zero-sum game. The market-leading system might claim 50 percent of US patients, the runner-up could have 45 percent, the third-place vendor might count 40 percent, and so on. That doesn’t mean we’ve sold more systems, have more users, process more active patients, or house complete data on more patients than anyone else.
  • As an engineer, I think we need to be careful about implying that having a high percentage of the population covered reflects attributes of our system or our company that are important to prospects. It’s more accurately a reflection on the size and patient diversity of our existing customers.

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From The PACS Designer: “Re: BlackBerry. It’s not seen much in the healthcare setting, but that could change if it becomes a takeover candidate. With its shares selling below $10, BlackBerry might soon become a division of Apple since consolidation in the mobile space is starting to happen. The real question is would that be practical for Apple to pursue.” BlackBerry’s market capitalization is down to around $5 billion after a big drop following the Apple-IBM enterprise announcement, which threatens BlackBerry’s one bright spot of mobile device management revenue. However, the company has $3 billion in cash, an enterprise user base that has no instantly appealing alternative, and a bunch of patents, so someone should be interested.

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From Point Taken: “Re: GE Healthcare. Any idea of substantive outcomes from the bold 2012 aspiration from GE, saying that it will invest $3 billion in R&D in the Healthymagination program to foster at least 100 innovations to lower healthcare costs by 2015?” I will leave it to GE to respond if they like. I know they’ve done a lot specifically to develop lower-cost medical technology (not IT) in India, but I haven’t heard otherwise. The few press releases on the Healthymagination site are old, the most recent annual report posted is from 2012, and the newest video on their YouTube channel is from 2012.

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From Sext Machine: “Re: doctor sexting during surgery. Thanks for the post – we got a kick out of that at our company. Do you know of other physicians who have gotten in trouble for using SMS messaging to share patient data?” I will defer to readers since the “trouble” involved is likely to be more related to internal discipline rather than being formally charged with violating HIPAA. I will say that I talked to a CIO today who implemented a secure messaging system to avoid users sending PHI via text messaging, but then found additional benefit in using the system to coordinate care among physicians.

From CEO: “Re: social media. We’ve been writing a weekly company blog but haven’t gotten Twitter and LinkedIn followers. How can we get better social media visibility?” I should mention that this was an actual (paraphrased) question I received today from the CEO of an HIStalk sponsor. Here was my excerpted answer, which I figured I might as well share in case anyone else is interested:

Company blogs rarely say anything fresh or insightful, often being cranked out by a marketing person or ghostwriter. They also try to appeal to every kind of reader, from newbie to old pro, programmer to CEO, with content that nobody hates but that nobody loves either. As a result, they aren’t going to get a lot of social media attention because they don’t say anything new. I don’t think your tweets will be all that compelling to Twitter users since they are infrequent, mostly link back to company material on your website, and don’t have much personality. People with big Twitter followings tend to be passionate about a subject other than their employer and that enthusiasm shines through. However, the question is whether that even matters. Companies tend to get wrapped up in the number of followers or retweets without having any idea whether that translates into more business.


HIStalk Announcements and Requests

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Reminder: you can nominate a non-management employee, co-worker, or vendor person for the HIStalk BOSS (Beacon Of Selfless Service) award. It’s for people who went above and beyond during a specific incident, such as downtime, an IT crisis, bug fix all-nighter, or anything else in which your nominee sacrificed their own self-interest to fix a problem.

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We like Niko Skievaski, the former Epic guy who produced “Struck by Orca,” an entertaining book about ICD-10 (he dropped off autographed copies at our HIMSS14 booth). He’s working on a new book, MU2i (MU2 Illustrated), which will ship in September. Artistic types who are willing to contribute a picture can contact Niko.

This week on HIStalk Practice: Mostashari’s Aledade venture works to set up an ACO in Arkansas. Healthcare IT sees its first billion-dollar acquisition quarter. CVS announces new clinical affiliations and a $1.5 million community health center grant program in partnership with IBM. A new independent practice study finds EHR workarounds are used for three main problems. Takeaways from the recent eHI webinar on ONC’s 10-year vision for interoperability. Providers and consultants are welcome to share an “Idea of the Day” with the HIStalk Practice audience. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers the growth of ZocDoc, benchmarking its success against his early predictions for the company. Google announces that it will commercialize its glucose monitoring contact lenses through a partnership with medical device manufacturer Novartis, which hopes to have the non-invasive glucose reading lenses on shelves within five years. Apple teams up with IBM to target the enterprise mobile markets. 

Listening: new from the 60-something metal gods Judas Priest, who sound great even with the album’s horrible production. Also: new Linkin Park.


Acquisitions, Funding, Business, and Stock

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Athenahealth announces Q2 results: revenue up 27 percent, adjusted EPS $0.32 vs. –$0.08, beating expectations for both.

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Microsoft announces that it will cut 18,000 jobs in the next year – 14 percent of its workforce – with the former Nokia unit taking most of the hit. Like all companies desperately ditching headcount to keep Wall Street happy, the Bill-less and Balmer-less Microsoft says it will simplify processes, increase accountability, reduce management layers, and make itself faster and more agile. I don’t recall hearing the announcements when it made processes more complicated, reduced accountability, added management layers, and let itself get slower and fatter. Microsoft paid $7.2 billion for Nokia in September 2013, which was probably the polite thing to do given that Nokia’s demise was hastened by hitching its teetering wagon to Windows Phone.

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Behavioral EHR vendor Valant Medical Solutions receives an $11 million private equity investment.

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Medical image exchange platform vendor DICOM Grid gets $6 million in funding from Mayo Clinic and Canaan Partners.

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Online doctor search vendor BetterDoctor closes $10 million in Series A funding.


Sales

Texas Health Resources (TX) chooses LogicStream Health’s Intelligence Platform to manage and optimize its clinical decision support. I’ve pored over the company’s site for several minutes and I still can’t figure out how its product works given the maddeningly high-level non-detail it provides in abundance.

Desert Imaging (TX) chooses IDS AbbaDox RAD to manage its radiology workflow.

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Children’s Hospital Los Angeles (CA) and Wisconsin Statewide Health Information Network sign four-year contracts for Orion Health’s Rhapsody integration engine.

The FHP Health Center (Guam) selects the eClinicalWorks EHR.

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University of Kansas Hospital selects Health Catalyst’s data warehouse.


People

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Susannah Fox (Pew Research Center) is named as an entrepreneur in residence at the Robert Wood Johnson Foundation.

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Informaticist and former ONC Deputy National Coordinator Charles Friedman, PhD is promoted to chair of the Department of Learning Health Sciences at the University of Michigan Medical School. 

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Paient satisfaction and physician reputation vendor SayAh names Warren Dodge (Creekside Healthcare Consultants, Altos Solutions) as CEO.


Announcements and Implementations

TeraMedica completes the implementation of its Evercore VNA for the public health system of New South Wales, Australia, saying it’s one of the world’s largest VNAs in covering 7 million patients, 110 facilities, and nine PACS that process 3 million imaging procedures each year.

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The Central Texas division of Baylor Scott & White Health goes live on API Healthcare’s ShiftSelect.


Government and Politics

Two subcommittees of the House Energy & Commerce Committee held a joint meeting Thursday to discuss the use of technology to advance medicine. Above is Rep. Phil Gingrey, MD (R-GA) calling out Epic for selling a “closed platform” whose users have received more than half of the $24 billion in HITECH payouts, asking if taxpayers should be subsidizing the purchase of products that are supposed to be interoperable but aren’t. Gingrey says it may be time for the committee to look at the practices of EHR vendors, saying “fraud may be perpetrated on the American taxpayer.”

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Three Arkansas Medicaid patients sue the state for refusing to pay for a cystic fibrosis drug that costs $300,000 per year. The patients meet FDA’s treatment criteria, but the state says the patients must first prove that older and cheaper drugs don’t work for them. According to the executive director of the National Association of Medicaid Directors, “We have this public health mentality that all people have to be cured no matter what the cost, and also let the innovators charge whatever they want. Those are fine theories independently, but when you combine them together in a finite budget environment, it’s not sustainable.”


Innovation and Research

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In Canada, Telus Health opens an innovation center in Toronto.


Technology

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A physician reviews a $3.99 iPhone app that claims to measure blood pressure using only the iPhone, with the developer suggesting it’s a Johns Hopkins product. The physician reviewer  talked to the CEO (who graduated from Hopkins but is otherwise unaffiliated) who says the app is “for entertainment purposes only” and shouldn’t actually be used to measure blood pressure. He says he’ll consider adding that disclaimer, which should not exactly boost sales.


Other

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Medscape surveys 18,000 self-selected physicians about their EHRs. My observations:

  • The survey asked, “Are you using an EHR?” which is a horrible question given that (a) it doesn’t distinguish between a practice EHR and a hospital EHR and most physicians practice in both settings, and (b) it doesn’t define “using.” All but 7 percent of respondents said they’re using an EHR or planning to do so within two years.
  • The most widely used EHRs (again subject to the limitations of failing to distinguish between practice vs. hospital) are Epic (23 percent), followed by Cerner, Allscripts, eClinicalWorks, and NextGen. Three percent or fewer reported using well-known systems such as Practice Fusion, the VA’s VistA, athenahealth, Greenway, and McKesson.
  • The top-rated system was the VA’s VistA, which also had the highest reported user satisfaction. However, the VA’s physician users are all employed and use only that EHR, so they’re probably going to be happier than a community-based doctor who has an EHR in the office plus different EHRs at each hospital in which he or she sees patients.
  • VistA and Epic were top rated for connectivity.
  • Only 42 percent of respondents said they are satisfied with their EHR vendor, and 16 percent say they’ll be replacing their system (it’s not clear how the hospital-based doctors could have answered this since it’s not their call).
  • Overall, the survey’s results are questionable in its failure to distinguish among the multiple settings in which the average physician uses EHRs and its lack of definition of “using” (Entering orders? Having a clerk create a bill? Looking at a hospital rounds list on an iPhone?) For that reason, I would characterize its conclusions as entertaining but hardly authoritative. However, I doubt that will stop vendors and lazy writers from crafting clickbait headlines and swaggeringly wordsmithed stories about the results.

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In the UK, Homerton University Hospital NHS Foundation Trust goes live with RFID technology that will track the movement and location of paper charts within the facility. The hospital says it won’t even bother to file patient notes alphabetically since they can just be shelved and located later by RFID. Paper records were tracked previously using Cerner Millennium.

An article in Health and Human Rights Journal profiles New York City’s jail system, which tweaked its eClinicalWorks EHR to help protect the rights of high-risk inmates (the article fails to note the difference between jails and prisons, the former being local facilities housing both those awaiting trial as well as those serving short sentences, so calling their occupants “prisoners” isn’t correct). EHR templates were created to identify injury patterns in vulnerable populations (LGBT, mental illness, injured, held in solitary confinement) consistent with inmate wrongdoing, officer misconduct, sexual assault, and self-harm.

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Weird News Andy simply titles this story as “Smile.” Police arrest an upstate New York man for flying a $1,300 video-recording drone in front of the windows of a medical facility’s exam rooms. “Front Row Dave” says he made a mistake but won’t stop “droning.” His Facebook page has a picture of his drone, which appears to be a DJI Phantom 2 Vision+ Quadcopter with FPV HD Video Camera and 3-Axis Gimbal. The video above was made by a guy on a cruise using that same drone, which must be a voyeur’s delight. I’m thinking about flying one over HIMSS conference airspace in Chicago, or perhaps in the exhibit hall.


Sponsor Updates

  • Orchestrate Healthcare posts a blog entry, “Healthcare Business Intelligence: Harness the Power.
  • PerfectServe’s VP/Chief Clinical Officer Leigh Ann Myers, RN writes a blog post, “Changing the Culture for SBAR Communications.”
  • Kareo opens an operations center in Las Vegas, NV.
  • Regenstrief Institute joins ConvergeHEALTH by Deloitte’s real-world evidence and analytics consortium.
  • AirWatch by VMware opens registration and lineup of analyst speakers for the Airwatch Connect Global Tour 2014 in Atlanta, London, and Sydney.
  • McKesson launches Benchmark Analytics, which provides reports and consulting services to optimize performance.
  • GetWellNetwork’s CEO Michael O’Neil discusses the CDC Morbidity and Mortality report on the cost of cancer survivorship with a local journal.
  • Kareo and Falcon EHR partner to provide cloud solutions to nephrology practices.

EPtalk by Dr. Jayne

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HIMSS15 is looking for proposals for preconference symposia. We’re returning to Chicago this year, so dig out your winter boots and scarves. I’m not convinced that moving to April is going to allow the meeting to escape winter’s wrath. I seem to be cursed any time my travel remotely involves Chicago, so I’m not sure I’m looking forward to it.

Continuing the Open Payments saga from earlier this week, I was finally confirmed as a real, live physician so that I could access my data. I don’t have any data listed for the 2013 program year and that’s probably accurate, plus or minus a martini. I know I provided my NPI to one device manufacturer when we had drinks, but the reporting threshold is $10 and I’m not sure I topped that even though the cocktail in question was good.

Speaking of money, AMDIS released its annual report on CMIO salaries. There were 120 respondents and average compensation was up, according to the report. Based on the compensation of CMIOs I know well, the range isn’t terribly reflective of our reality in the trenches. The report also noted that although salaries have increased, job satisfaction is on the decline. I would agree that job satisfaction is an issue. It could be that my role has matured or perhaps it’s all the government regulations, but the job isn’t as much fun as it used to be. I’m the kind of CMIO that enjoys rolling up my sleeves and digging into cool projects, so every time I have to sit on another committee or address another regulation, it sucks a little bit of my life away.

I was surprised to see that more than 70 percent of respondents maintain a clinical practice. It’s getting harder and harder to do so. I’m one of the CMIOs whose own organization doesn’t support administrators who want to continue seeing patients. My clinical opportunities are cobbled together at a variety of facilities, which makes scheduling a bit of a challenge.

It’s hard to interpret the data with the relatively small sample size, however. I’m not sure how many CMIOs there are in the US, but there are many more people doing CMIO-type roles without the title and often without the compensation. Of respondents, 25 percent are certified in the subspecialty with another 25 percent considering it. Unfortunately many of my strongest colleagues are unable to sit for the exam since they didn’t maintain a primary board certification. I’m somewhat ambivalent about that personally and hope that those physicians who are certified but don’t see patients any more aren’t required to keep up a primary certification for no reason.

On the other hand, I had an email this week from a recruiter looking for a board certified physician to fill a locum tenens job in the US Virgin Islands, so maybe that primary certification is a good thing after all. They actually said “soaking in the sun with beverage in hand” in the opening paragraph, so they get full credit for that one. Doubtful that the actual experience would live up to the hype, like so much in healthcare these days.

I love some of the headlines I see: recently “MU drives patient savings” has been my favorite. Based on the duration of the program and what was actually involved in Stage 1, coupled with the relatively small numbers of providers attesting for Stage 2, I’m not sure we can arrive at this conclusion. Did they factor in the time cost of visits running late because providers were playing catch-up with the ever-increasing and burdensome requirements? Interestingly, the study in question had data provided by HIMSS.

Another great one cited Stage 2 EHRs as not being ready for data sharing. I don’t disagree with this one, although I think they focused too much on the technical problems of CCDA exchange and not enough on the philosophical problems. Some of the documents I see coming into our system are technically correct, but really don’t tell the clinician what he or she needs to know. For example, a patient who was seen in the emergency department for a laceration. I’d rather have the physician’s pen-and-ink sketch of the wound than any syntactically correct description, but there’s no room for that in the game of data exchange.

It’s probably a good thing that I can’t keep up with all the news that hits my inbox because it would just aggravate me. If I’m going to be aggravated, I’d rather be annoyed by the challenges of my latest pastry therapy project. For those playing along at home, this week’s specimen is the Blueberry-Lemon Bundt Cake from my good friend Martha Stewart. And thanks to YouTube for videos on how to zest a lemon without going insane. The picture doesn’t do it justice, but I loved the cake pan.

Got a favorite Bundt cake pan or recipe? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 17, 2014 News 8 Comments

News 7/16/14

July 15, 2014 News 9 Comments

Top News

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IBM and Apple announce a partnership to develop business applications for iPhones and iPads. IBM will also sell Apple products and provide on-site services to business clients, while Apple gains business credibility and a tie-in to IBM’s big data capabilities that will make its devices decision-making tools. The deal also gives Apple’s iOS more enterprise credibility against the more widely used Android operating system. The companies say more than 100 business apps will be available by fall.


Reader Comments

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From Baron Schkinn: “Re: Siemens. The rumor is surfacing again that Cerner will buy the health IT division of Siemens and close the deal by the end of the summer, coming from an inside source who I trust. That would give Cerner a replacement for its failed ProFit, a backup center in another earthquake zone, a shot at selling to the significant number of Invision and MedSeries4 clients, and would make Cerner the #1 vendor over McKesson in revenue. They would still be left with two poor ambulatory solutions that would make them non-competitive with Epic.” Unverified, other than the seemingly solid rumor that Siemens is shopping the business it describes on its website in a predictably confusing fashion as “the Siemens Healthcare Information Technology business of Health Services, Siemens Healthcare” (which offers several humorous acronym-powered punning opportunities.) Cerner might be willing to pay the rumored $1.4 billion just to get the Siemens customer base and a few worthwhile niche-filling nuggets (MobileMD, although nothing else comes to mind given Soarian’s minimal-and-dropping competitiveness) but it would seem to be a better fit for private equity. Cerner doesn’t do a lot of acquisitions and one that size might spook Wall Street, which Cerner doesn’t like doing, but anything can happen when it comes to acquisitions.

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From BadBuy: “Re: Sunquest. Significantly behind full-year sales target, with the top two reps at just over 50 percent. Vista/Huntsman Gay made out like bandits.” Unverified. Roper Industries acquired Sunquest in July 2012 for $1.42 billion after what I’ve heard was shockingly minimal due diligence. I would assume that former owners Huntsman Gay Global Capital and Vista Equity Partners did indeed do quite well for themselves given that the former paid only $208 million to acquire 51 percent of Sunquest in December 2010, with Vista holding on to 49 percent. That means Roper paid more than three times that valuation just 19 months later. Roper executives talked up Sunquest’s revenue growth and implementation improvements in the company’s most recent earnings call, adding that Sunquest will have “quite an exceptional year in 2014.” Roper’s diversified growth is steady – share price has more than tripled in the past five years. The longer you work in this or any other industry, the more you realize it’s the generic money guys, not the deep subject matter experts or passionate advocates, who do really well. “Owning” has more potential reward (and risk) than “doing.”

From Binge and Purge: “Re: Johnathan Samples. You’ve probably already heard, but he has left Greenway after 13 years and started a new company.” Samples, who was Greenway’s chief innovation officer through last month, threw in with former Greenway Chief Product Strategist Jason Colquitt at Across Healthcare, which offers what appears to be an unfocused array of consulting and software development services.

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From Yalie: “Re: Yale-New Haven. Anything in writing about their hard Epic downtime system-wide for two days last week?” The local paper says a network switch went down Friday for a handful of hours, requiring the hospital to cancel elective surgeries. Epic information was still available from cached copies.


HIStalk Announcements and Requests

I’ve confirmed that Epic’s FDA 510k submission was for a bedside matching system, not a blood bank system.

We hear a lot about the suits in the healthcare corner offices, but not enough about the cube-dwellers who perform the actual work that pays for them. I am offering the HIStalk BOSS (Beacon of Selfless Service) Award to recognize those trench warriors (provider or vendor) who toil without bonuses, reserved parking spaces, or the ever-present validation of company-paid butt kissers. The BOSS Award isn’t a trophy or cash, but rather recognition in HIStalk of a non-management employee who went above and beyond during a specific event (downtime, sales demo, screaming surgeon demanding a new laptop, etc.) to save the day. Anyone who observed the individual’s laudable effort firsthand can nominate someone – a supervisor, peer, or customer. Submit your candidate here.

We like to keep in touch with HIStalk’s sponsors and we just sent an e-mail to all the contacts on our list. Let Lorre know if we missed you.


Acquisitions, Funding, Business, and Stock

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The US Bankruptcy Court approves MModal’s reorganization plan, allowing the company to emerge from bankruptcy in August as it had originally announced.

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The Teamsters Union urges McKesson’s shareholders to approve its proxy proposal to eliminate the company’s change-of-control terms that will give its top executives $283 million if new owners fire them, including $140.5 million for John Hammergren alone.

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Craneware announces $70 million in sales in the first half of 2014, up 80 percent year over year.


Sales

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Saint Mary’s Hospital (CT) selects Wellsoft’s EDIS.

Wheeling Hospital (WV) adds Sunrise Financial Manager to its Allscripts systems.

Carrus Hospitals (TX) will deploy Medhost’s clinical and financial solutions via the company’s hosted Medhost Direct platform.


People

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Rob Lipowski (Cleveland Clinic) joins Perceptive Software as director of healthcare solutions.

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Perry Lewis (McKesson) is named VP of industry relations of CoverMyMeds.

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“Inc.” profiles Beyond Lucid Technologies Founder and CEO Jonathon Feit, who has Tourette Syndrome. It points out the difficulty he has in performing company pitches and recorded videos without the characteristic twitching. His company sells an electronic patient record system for first responders.


Announcements and Implementations

Summit Healthcare announces that 26 facilities are live on its Summit Care Exchange technology, which allows providers to send CCDs to a Health Information Service Provider via Direct to meet Meaningful Use requirements.  

EHNAC and WEDI launch an accreditation program for practice management systems, announcing GE Healthcare, Medinformatix, and NextGen as pilot participants.

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Elsevier Clinical Solutions announces its Clinical Documentation Improvement Reference App, which provides clinical term look-up and medical necessity information with an emphasis on ICD-10.

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New Orleans-based startup Clinicate launches its clinical file-sharing solution for providers and patients. It also contains some unrelated tools such as drug lookup. It’s free for patients and a single provider can use the system free for up to 100MB of storage.

Healthcare Data Solutions announces availability of the HealthcareData360 EHR market intelligence database, which allows looking up EHR decision-makers both within and across connected provider organizations.


Government and Politics

NIST and OCR will co-host “Safeguarding Health Information: Building Assurance through HIPAA Security” on September 23-24, 2014 at the Grand Hyatt in Washington, DC. Onsite attendance runs $345, while Webcast attendees will pay $200.

The FCC’s 17-year-old system crashes under the weight of 800,000 comments filed regarding net neutrality, forcing it to extend the comments deadline until midnight Friday. Comments can be filed (and read, in the case of the most recent 10,000 comments) here.

Eighty-nine House lawmakers sign a letter requesting that CMS remove penalties for clinical laboratories that perform tests for Medicare patients, explaining, “Pathologists have limited direct contact with patients and do not operate in EHRs. Instead, pathologists use sophisticated computerized laboratory information systems (LISs) to support the work of analyzing patient specimens and generating test results.” CMS granted pathologists a hardship exception for 2015, but the College of American Pathologists wants the requirement to be eliminated permanently.


Innovation and Research

Three computer scientists who developed the first program that passed the Turing test — convincing a human that they are interacting with another human rather than a computer — have joined startup Wholesale Change, which will develop online tools to help consumers choose Medicare insurance plans.

@Cascadia tweeted about Israel-based Tyto Care, which offers a handheld device and cloud platform that allows patients to do their own physical examination while being guided remotely by their doctor.

Chicago-area researchers query the EHRs of 23 primary care practices to identify patients likely to have undiagnosed hypertension based on their historical pattern of in-office blood pressure readings, inviting those patients to follow up with a more comprehensive series of readings. The practices not only alerted patients, but also turned their work into a quality improvement project by continuing to remind both patients and physicians of the need for follow-up until an ICD-9 code was entered indicating that hypertension had been either confirmed or ruled out.


Technology

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The Alcon division of Novartis AG licenses Google’s smart contact lens technology that will measure and report blood glucose levels. Meanwhile, the former Google X director who led the development of the contact lens as well as Google Glass announces his departure from Google and his excitement at going to work for Amazon. He made headlines last week by saying that Glass is “not necessarily the definitive answer” for wearable technology.

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Welch Allyn adds customizable patient scoring to its Connex vital signs monitor, allowing hospitals to use their own Early Warning Score to identify deteriorating patients. The company’s clinical surveillance system can send the results wirelessly to the hospital’s EMR and can also monitor for falls, pressure ulcers, and respiratory distress.


Other 

A new HIMSS Analytics report says “germ-related hospital applications” have high growth potential. That oddly phrased category (clinicians never say “germs” unless talking slowly to laypeople who possess limited medical comprehension) includes systems for infection surveillance, patient acuity, and laboratory outreach.

HIMSS14 is named the fourth-largest medical meeting of 2013 with its 36,5325 attendees, following the FIME (Florida International Medical Expo) trade show in Miami, the Greater New York Dental Meeting, and RSNA.

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Two surgeons from UNC Hospitals (NC) open a burn center in Malawi, which has 14 million people and only 20 surgeons. One of the UNC surgeons added that UNC’s new Epic electronic medical record and potentially the addition of telemedicine services will help it treat patients in their local areas of North Carolina rather than transporting them to Chapel Hill.

Let’s hope Massachusetts isn’t the national healthcare model everybody brags on: healthcare will eat up almost a third of the new state budget vs. the 20 percent it consumed in 2001.

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An article describes how 25-bed Cottage Hospital (NH) became one of the first hospitals to attest for Meaningful Use Stage 2. It’s a Medhost facility and hired an informatics nurse to keep things moving along.

“US News & World Report” lists its “Best Hospitals 2014-15”: (1) Mayo Clinic; (2) Mass General; (3) Johns Hopkins; (4) Cleveland Clinic; (5) UCLA Medical Center; (6) New York-Presbyterian; (7) HUP; (8) UCSF; (9) Brigham and Women’s; (10) Northwestern Memorial; (11) University of Washington; (12) Cedars-Sinai, tied with UPMC; (14) Duke; (15) NYU Langone; (16) Mount Sinai; and (17) Barnes-Jewish. 

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“The Wall Street Journal” reports that the ambitious $54 million biotech facility created from the converted Brooklyn Army Terminal stands nearly empty, reportedly because of squabbles between its two developers, SUNY Downstate Medical Center and the city’s Economic Development Corp. The project’s former executive director, who left last year, said public agencies are lousy at running speculative developments because they have too much bureaucracy behind them and lack the mindset to get it done. The project is limping along by renting space to non-biotech companies at a discount despite its mission of boosting the city’s biotech presence.

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Madison, WI’s weekly hippie newspaper covers Epic’s purchase of wacky artwork at the summer art fair run by the Madison Museum of Contemporary Art, saying that Judy Faulkner brings an employee team armed with a “generous budget” (some of it in cash) to find big, bold, and whimsical pieces.

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A father whose six-week-old daughter died of a liver tumor after spending her entire life in the hospital posts a request on Reddit asking for help to Photoshop the only photos he had of her, all of them showing her with tubes in place since she had never been without them. His post generated 2,700 comments of support and many photographs and drawings. He called attention to “Now I Lay Me Down to Sleep,” whose volunteer photographers take portraits of families with their dying or deceased child.


Sponsor Updates

  • The Sunquest User Group conference is being held this week at the JW Marriott Desert Ridge Resort in Scottsdale, AZ.
  • HealthMEDX sponsored the “Prescription for Change” technology discussion for long-term and post-acute care providers, with CEO Pam Pure and Medical Director Charles Rogers, MD participating.
  • Laura Argauer of CTG co-presented “Using Transformational Data Analytics to Improve Care Valuation, Management and Outcomes of Chronic Kidney Disease Patients” at the Healthcare Analytics Symposium & Expo 2014 this week.
  • Health Catalyst shares a case study on Crystal Run Healthcare (NY), explaining why they bought rather than built a data warehouse.
  • Predixion CEO Simon Arkell will discuss the explosion of connected devices and predictive analytics challenges in healthcare during the Microsoft Worldwide Partnership Conference in Washington, DC this week.
  • Kari Bunting, RN of MedStar Franklin Square Medical Center (MD) will present her research on reducing excessive uterine contractions aided by PeriGen’s PeriCALM Patterns EFM at the Summer Institute in Nursing Informatics in Baltimore, MD this week.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 15, 2014 News 9 Comments

Monday Morning Update 7/14/14

July 12, 2014 News 7 Comments

Top News

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Former health system CEO Joe Swedish, now CEO of WellPoint, says he’ll focus the company on technologies such as telemedicine, kiosks, and smartphone-based instruments (he didn’t mention the company’s partnership with IBM to develop Watson-powered applications). Swedish is also driving use of WellPoint’s databases that are populated from processing 581 million medical claims each year. It’s good to work for an insurance company – Swedish’s shares are worth $15 million and he’s paid $7.5 million per year. I remember him way back when he was CEO of Winter Park Hospital (FL).


Reader Comments

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From A Concerned Customer: “Re: NantHealth. We as a customer are hearing of extensive layoffs of the iSirona people. Almost all of the account executives were let go.” Unverified.

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From LISPro: “Re: Epic. I’ve heard the company has submitted to the FDA for 510k certification of their new blood bank module.” Unverified.

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From Not From Me: “Re: Intermountain. The short-term choice (three or so years) would have been Epic, but we went with Cerner because of Epic’s dated technology, Cerner’s openness, and the feeling that we would be more of a partner than a customer with Cerner. The partnership is more than words. We’re working closely with Cerner and their horde of sharp, dedicated people on the implementation. We have some pieces they don’t and those are being built into the Cerner system, while some of our own development efforts have been redirected since Cerner already has that functionality. The first rollout is scheduled for December and I think it will go well due to the way the teams are working together.” Unverified.


HIStalk Announcements and Requests

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Two-thirds of poll respondents have used their PCP’s patient portal in the past six months. New poll to your right: what contributed most to your present success? Young people will be interested to learn what worked for their more experienced healthcare IT peers. Click the “comments” link in the poll to elaborate further.

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

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Acquisitions, Funding, Business, and Stock 

Epic says that it has 7,400 employees, 600 more than it reported in February, probably boosted by the college graduation of its latest round of hires.

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QPID Health will move its offices to Federal Street in Boston to accommodate expected growth.


People

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Brad Holcomb, RN (St. John’s Health System, First Consulting Group, BHL Consulting Group) died on May 14 at 47. His wife Lucretia said it would be OK for me to mention the donations page a family friend has set up for their children.


Announcements and Implementations

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Valence Health announces its Further 2014 conference, September 10-12 in Chicago. It’s open to anyone and the cost is amazingly low: $500 includes registration, meals, entertainment by Second City, and two nights’ accommodations at the Drake Hotel ($400 per night on the hotel’s site for those dates.) If you’re local to Chicago, you can go for $199 without hotel. Some of the agenda is specific to customers, but a lot of it isn’t, covering value-based care, clinically integrated networks, patient engagement, and predictive risk. I would attend myself if I didn’t have a conflict , and may yet in fact, since it looks worth juggling other stuff around.


Technology

A hospital in Spain is using the Oculus Rift virtual reality gaming headset in the OR for nervous surgical patients. The immersive device provides calming scenic movies with music that minimize the patient’s perception of the OR’s noises and bright lights. Facebook must have been impressed since it bought the company for $2 billion in March even though the headset won’t be available to consumers until next year. The founder of Oculus is a 21-year-old California college dropout.

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An article profiles the use by Duke Medicine (NC) of a geographic information system tied to its homegrown clinical database query tool, allowing researchers to study medical issues by neighborhood, socioeconomic indicators, and even proximity to fast food restaurants, all in real time.


Other

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In England,the Health & Social Care Information Centre reports that Summary Care Records have been created for 41 million patients, with only 1.4 percent of them opting out of the program. The SCR program was intended to give off-hours providers fast access to a patient’s medications and allergies using information from practice-based EHRs. Around 5,500 practices have created SCRs for patients. SCR was until recently a floundering part of the now-defunct National Programme for IT. A British Medical Association IT committee chair called for its shutdown in early 2013, saying that while 23 million SCR records had been created, only 100 hospitals and after-hours providers were using them.

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An article by former FDA Deputy Commissioner Scott Gottlieb, MD says existing policies don’t encourage researchers to develop high-priced cures for diseases that would reduce overall lifetime patient cost for chronic conditions. He suggests a system in which payers can finance their longer-term benefit through government-backed guarantees and accounting rule changes.

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I found a cool heart rate app that  works sort of like a pulse oximeter – you put your finger on the phone’s rear-facing camera, the app turns on its flash so it shines through your finger, and then it measures and displays your heartbeat as a real-time graph. It seems to be quite accurate, making it useful for people who exercise or who have atrial fibrillation. The developer claims 25 million users and offers others for cardio exercise, sleep cycle analysis, biofeedback stress reduction, and blood glucose logging.

Weird News Andy sniffed out this story: a woman who received experimental treatment for paralysis eight years ago in which cells from her nose were injected into her spine grows another nose from the injection site. WNA also suggested taking the stairs in hospitals after a study finds that elevator buttons have more germs than restrooms.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 12, 2014 News 7 Comments

Morning Headlines 7/11/14

July 11, 2014 Headlines No Comments

HIT Policy Committee DRAFT Summary of the June 10, 2014 Virtual Meeting

During Tuesday’s HIT Policy Committee meeting, CMS reported that only 972 providers and 10 hospitals have attested for Stage 2 of Meaningful Use.

Cerner ups campus cost to $4.45B, will seek $110M TIF bump

Cerner increases the budget on its new Kansas City campus by $160 million, to $4.45 billion, and is asking the local and state government to cover $110 million of that through tax breaks.

The Experience of Young Adults on HealthCare.gov: Suggestions for Improvement

A study published in the Annals of Internal Medicine concludes that Healthcare.gov’s user interface was perceived as confusing and unintuitive by millennials.

Moody’s Assigns AA3 To Providence Health & Services Series 2014B Bonds; Outlook Stable

Moody’s gives Providence Health’s bonds a strong, stable Aa3 rating, something that is not always the case for health systems in the midst of an Epic implementation. The rating notes, “PHS has nearly completed its system-wide implementation of the Epic electronic medical record (EMR) system. Implementation has spanned many years, and has occupied a significant portion of the system’s capital budget. Outsized operating expenses related to Epic have suppressed margins but are now expected to reach a steady state going forward.”

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July 11, 2014 Headlines No Comments

News 7/11/14

July 10, 2014 News 5 Comments

Top News

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National Coordinator Karen DeSalvo reorganizes the HIT Policy Committee. Also announced by ONC: only 972 EPs and 10 hospitals have attested to Meaningful Use Stage 2. Athenahealth users lead the EP Stage 2 attestation by far. Clearly ONC’s budget and influence are shrinking as disenchantment with the Meaningful Use program grows and providers focus on more strategic goals than lapping at Uncle’s Sam’s ever-distancing carrot.


Reader Comments

From McLayoffs: “Re: McKesson. Decimated their ranks last week, so I wouldn’t be surprised if they sold off that business. It’s not one that John Hammergren ever wanted to be in, but inherited when he took over. All non-essential implementation teams were dissolved and upgrades are rumored to be handled by national support. A lot of good people were lost last week. I’m not surprised that Siemens is calling it quits as well, with Epic dominating the market. I’m even seeing Cerner to Epic conversions now.” Unverified.

From Punch Bowl: “Re: Nuance. Acquiring Notable Solutions, Inc.” Unverified. NSI offers solutions for document capture and forms processing to a variety of industries.

From Kites Away: “Re: research question for your audience. Is strategic planning a useful exercise? Why or why not?” I will let readers weigh in. My opinion is that it’s a good exercise even though the assumptions and predictions often turn out to be wildly off. It makes people focus on the current state and to consider the array of possible future states.


HIStalk Announcements and Requests

This week on HIStalk Practice: Key takeaways from the 2015 proposed physician fee schedule. The ONC Health IT Policy Committee presents the latest round of Meaningful Use attestation numbers (and notes the vendors leading the pack). Cigna creates 100 collaborative care arrangements with large physician groups. The Accountable Care Coalition of Greater New York uses new grant money to launch a medication adherence program, while Milwaukee Health Services uses new funds to upgrade its EHR. Online consumer service providers and the DMV pilot a patient identity management program. Thanks for reading.

This week on HIStalk Connect: Dr. Travis breaks down Rock Health’s recent “Mid-Year Digital Health Funding Report.” In Europe, the $2 billion Human Brain Project is under threat of boycott from the scientific community over its hard line stance on funding out-of-scope projects. Syria is getting international support through an ICU telehealth program that is helping resolve the country’s physician shortage. AdhereTech raises a $1.25 million Series A for its connected pill bottle. 

I received two items from readers that I’m going to decline to run because I don’t think it’s fair to the companies involved, but I want to explain why. First was a healthcare IT vendor CEO who was arrested for battery, which I don’t think is fair game because it’s personal and being arrested isn’t the same as being found guilty. Second is a lawsuit brought against a company that alleges it broke its contract with an offshore development shop, which has the same problem in being just an allegation so far. I like good rumors and gossip as much (probably more) than the average person, but both of these documents name people who shouldn’t be tried on the pages of HIStalk. I’ll report the final legal decisions once they are out.


Acquisitions, Funding, Business, and Stock

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Revenue cycle vendor RevSpring acquires Talksoft, which offers an automated appointment reminder service.

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Allscripts acquires UK-based Oasis Medical Solutions and will implement its Oasis Patient Administration System as a single-source solution for the UK market.

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USA Mobility, along with its previously acquired Amcom Software, changes its name and Nasdaq ticker symbol to Spok (pronounced “spoke”).

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Oncology data analysis vendor Syapse raises $10 million in a Series B funding round. Its product integrates genomic information with the EMR to display data for decision-making, suggest treatment plans, and track outcomes.


Sales

Centegra Health System (IL) adds revenue performance improvement solutions to its existing MedAssets agreement.

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Carrus Hospitals (TX) will deploy Medhost’s clinical and financial solutions via the company’s hosted Medhost Direct platform.

Memorial Sloan Kettering Cancer Center will implement Allscripts dbMotion and continue its use of Sunrise EHR.


People

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Health Data Specialists promotes Chad Jones to Cerner practice director.

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Harold Paz, MD (Penn State Milton S. Hershey Medical Center) is named EVP/CMO of Aetna.

George Murillo (Leidos Health) is named western area VP of Orchestrate Healthcare.


Announcements and Implementations

Awarepoint announces the availability of awareAssets V3.0 for RTLS-based asset tracking and workflow optimization.

Lexmark’s Perceptive Software launches Perceptive Cloud Share, a cloud-based content management system for video, images, and other rich media.

DSS adds real-time abnormal lab results alerts to the VA’s VistA CPRS Version 31.

Elsevier launches PolicyNavigator, a knowledge management tool for healthcare policies and procedures.

Healthcare Engagement Solutions launches the Uniphy clinician communications platform.

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MediSafe releases its medication adherence app for Google’s Android Wear smartwatch technology.


Government and Politics

The HIMSS EHR Association weighs in on HHS’s proposed Meaningful Use changes, saying pretty much the same thing as other groups before it: (a) turn the proposed rule into a final rule quickly and without changes since providers are otherwise forced to make decisions blindly; (b) define the types of delays that are acceptable for not implementing 2014-certified EHRS – vendor delays, lack of provider resources, lack of local interoperability options, etc.; (c) simplify the combinations stages, objectives, and EHR certification year; (d) simplify the proposed CQMs; (e) delay MU Stage 3 to avoid the same rush and confusion that accompanied the rollout of Stage 2.

A tiny observational study published in Annals of Internal Medicine finds that the government failed in its attempt to make Healthcare.gov as easy for millennials to use as popular websites. Its recommendations: (a) allow clicking on health insurance terminology to bring up a definition; (b) make it clearer that preventive care is included in all plans offered; (c) make the dental insurance option clearer; (d) improve sorting and filtering of available plans; (e) explain the available tax credit and cost-sharing options that reduce cost; and (f) call “catastrophic” plans something else, such as “minimal” or “value.”

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CMS designates non-profit Health Care Cost Institute as the first national Qualified Entity, meaning it can merge Medicare claims data with commercial payer data to provide price and quality transparency.

CMS gives Tennessee 10 days to fix its $35 million Medicaid eligibility system, saying it is preventing people from signing up for insurance on Healthcare.gov. CMS says state workers ignored requests to assign more people to the project and failed to help new users navigate its system. The state blames Northrop Grumman for missed deadlines and has paid the company only $5 million so far.

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A GAO report says the VA-DoD integrated EHR (iEHR) plan met only one of six required conditions in FY2013. The VA and DoD abandoned their two-year-old plan to develop a single EHR in February 2013 due to cost and timelines, leading Congress to threaten to cut off 75 percent of the iEHR budget unless six conditions were met (define a budget, set a timeline, break out annual and total spending, define how costs would be shared, establish data standardization, and comply with government acquisition policies.) The only fully satisfied condition was creation of a cost-sharing schedule. The joint oversight group says the plan has changed to the point that the original goals no longer measure the program’s success, leading GAO to recommend holding the VA and DoD responsible for publishing accurate budgets, maintaining a deployment schedule, developing data standardization rules, and proving that they are indeed compliant with federal purchasing policies.


Other

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Cerner increases the estimated cost of its new 16,000-employee campus to $4.45 billion and wants Kansas City’s tax commission to chip in an additional $110 million in tax breaks, boosting the total taxpayer support to $1.745 billion.

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Quick — who’s the CEO of Microsoft? No, it’s Satya Nadella, and he plans to rejuvenate the company by moving from “devices and services” to “platforms and productivity,” emphasizing mobile-first and cloud-first.

Partners HealthCare seeks a $145 million loan to help it pay for a new building, raising its total debt to $4 billion. Part of that money was targeted for its $1.2 billion Epic implementation.

A Florida lawsuit questions whether release of information companies can charge lawyers more than patients for copies of their hospital medical records. An attorney became upset at being charged $1.00 per page by HealthPort for a client’s medical records when state law specifies $0.25 per page, but HealthPort says the lower rate only applies to patients even though it recently lost a case using that argument.

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A new bond issue for Providence Health & Services (WA) gets high, stable rating, with its ratings agency noting that, “PHS has nearly completed its system-wide implementation of the Epic electronic medical record (EMR) system. Implementation has spanned many years, and has occupied a significant portion of the system’s capital budget. Outsized operating expenses related to Epic have suppressed margins but are now expected to reach a steady state going forward.”

Weird News Andy likes the idea of “virtual gastric banding” described in this article, where hypnotists convince patients they’ve had weight loss surgery, sometimes even causing them to lose weight afterward from the power of suggestion alone. Of course WNA questions the $1,500 cost in  wondering, “Can the patient then hypnotize the hypnotist to induce memories of payment?” WNA also likes a rare case in which a man suffers a blood clot in his brain after head-banging at a Motorhead concert, leading WNA to suggest renaming the band “Subdural Hematoma.”

Bizarre: city police charge a 17-year-old boy with child pornography for sending explicit photos of himself to his 15-year-old girlfriend and then ask a judge’s permission to inject him with arousal drugs in a local hospital so they can snap new pictures to compare to those he allegedly sent. I immediately thought of the “sketch artist” principal’s office scene in “Porky’s,” not safe for work or for those with a non-warped sense of humor but possibly the funniest four minutes (shot straight through with no edits) in movie history.


Sponsor Updates

  • PatientSafe Solutions’ Cheryl Parker shares how informatics nurses contribute to products roadmaps through analysis, compliance, consultation, coordination, facilitation. and integration.
  • Lucca Consulting Group offers post-implement feedback and testimonials.
  • MedData will participate in the Annual MI Emergency Medicine Assembly July 27-30 in Mackinac Island, MI.
  • A report by Imprivata and the Ponemon Institute says pager inefficiency and the inability to use text messaging costs the average hospital approximately $1.75 million per year.

EPtalk by Dr. Jayne

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One of the things I enjoy least about my work in the CMIO trenches is keeping up with the ever-present stream of new rules, proposed rules, and all the supporting documents that go with them. It shouldn’t be a surprise that only a very small percentage of Eligible Providers have attested to Stage 2 Meaningful Use. As of May 1, only 50 Eligible Providers were on the books. Although the individual measures are not that difficult, keeping up with the voluminous documentation on all of them is a chore, as is preparing the documentation needed for attestation and potential audits.

CMS hasn’t disappointed in releasing its proposed rule to update the Medicare Physician Fee Schedule in 2014. I didn’t have time to read the 600-plus page rule myself, but luckily one of my vendors digests the information for its customers and sends out the highlight reel. As we always suspected, parts of MU are becoming mandatory independent of the actual MU program. Physicians billing for chronic care management would be required to use an EHR certified under 2014 criteria.

I was excited to see that Medicare is considering coverage for telemedicine services, including psychotherapy and wellness visits. I question, however, exactly how the digital prostate exam (and I don’t mean high-tech digital) or other sensitive exam maneuvers can be done via telemedicine, although I agree that a lot of the preventive counseling aspects of an annual visit don’t require a face-to-face visit if you already have a good relationship with your patient. Although those services aren’t specifically part of the Medicare “Annual Wellness Visit” paradigm, they are recommended services.

Are we setting ourselves up to have different kinds of wellness visits for patients, such as the Medicare Annual by phone, the Medicare Annual in person, the “G-Code Special” for those physical exams that have to be performed in person, and more? Patients can barely keep track of the services they need at present without having to worry how they’re delivered. And you can bet that if we try to bundle any of them into other in-person services, we won’t get paid. The Medicare Annual Wellness visit does recommend biometric assessment. I’m not sure I trust my patients to report what the scale actually says and we’re not yet in the Star Trek world of the medical tricorder. Although coverage for telemedicine sounds great in person, it just goes to show that the devil is in the details.

One of the other things I enjoy least about my work is dealing with difficult physicians. Although I’m not responsible for physician discipline per se, I do have to provide input when physicians are creating issues during implementation and training. I had mentioned a few weeks ago that we would start deploying new practices after Independence Day. This week has not disappointed for sheer magnitude of “stuff you just can’t make up.”

One of our surgeons decided to book two elective cases at the same time as his prearranged EHR training, then demanded that we train him later that evening. What do you even say to that? They weren’t emergencies. Although our trainers are happy to accommodate evening sessions when requested in advance, they can’t do it on short notice due to family and other obligations. I really think that he hopes to stall his go-live by staying untrained.

His power play failed, however, and he only ended up short-changing himself since his partner showed up and training was delivered. He’s just going to have to play catch-up because we have 22 go-lives teed up behind this cohort and there’s no room for game playing. His partner was an absolute joy to work with and decided to move his own go-live forward. I’m betting the practice dynamic is going to be pretty interesting in the coming weeks. Hopefully positive peer pressure will win the day.

One of the things I enjoy most about my work is the people I have gotten to know over the years. Although it seems like there’s a lot of movement around the industry, especially among the sales force, there’s still a sense that we’re all in this together and a willingness to help out whether you work directly together or not. I was able to meet up with a friend who used to work for one of my vendors and learn about his adventures in a different part of the industry. Another consultant I worked with early in my career turned up on a project I’m peripherally attached to. It’s definitely a small world and I’m glad to have people with whom I can commiserate. Maybe if I’m lucky though one will read the 600 pages of federal regulations and give me the Cliffs Notes version.

Will trade wine for summaries – email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 10, 2014 News 5 Comments

News 7/9/14

July 8, 2014 News 1 Comment

Top News

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Siemens AG is reportedly considering the sale of its healthcare IT unit (potentially worth over $1.4 billion) to focus on its industrial and energy businesses. The company considered selling its microbiology unit earlier this year, and is already spinning off its hearing-aids unit in an effort to give its healthcare businesses “operational independence.” A HIStalk reader familiar with these types of M&A scenarios notes that this rumbling is “sort of like rumors of McKesson selling off its IT division. They both keep losing customers, so who would want to jump on that mess? But, Siemens probably feels it’s best to sell now before it is worth less.”


Acquisitions, Funding, Business, and Stock

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CliniWorks announces a strategic alliance with Pfizer in which the companies will work to develop a population health management platform that will enable large medical groups and IDNs to improve patient engagement, and deliver more efficient and effective quality healthcare in nearly real time.

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Blackberry announces plans to open a healthcare services platform in India that will enable the integration of medical devices to aid in the early detection of illness. Blackberry India has several trial projects underway at local hospitals, all of which include integration with health information systems and medical equipment. A presence in India will likely serve Blackberry well, as providers there are expected to spend $1.08 billion on IT products and services in 2014. It seems likely the company will introduce those providers to the clinical operating platform from NantHealth, which it acquired a minority stake in earlier this year.

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Blackberry’s interest in niche markets may just help it stand out from larger players like Samsung, which expects to post second-quarter earnings that fall $1.4 billion short of analyst expectations. The company attributes its loss to low demand in a saturated global market, and cannibalization of tablet sales by “phablet” phones. No word yet on whether a heist in Brazil affected Samsung’s earning predictions. Thieves held hundreds of factory employees hostage while they stole $36 million worth of Samsung tablets, mobile phones, and laptops.

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N.C.-based Validic acquires Infometers Inc., a California-based technology company that connects remote healthcare monitoring devices to healthcare organizations. As a result, Validic has opened a Silicon Valley office and seems well on its way to achieving its goal of 300 clinical and wellness device and application integrations this year.

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Following a disappointing second quarter, Royal Philips announces it will implement a new management structure within its healthcare sector, with all healthcare business groups reporting directly to Philips CEO Frans van Houten. Philips Healthcare CEO Deborah DiSanzo has decided to leave the company.

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Capsule Tech announces it will open a Singapore subsidiary to support its growth in the region. Capsule Singapore will provide medical device integration implementation, technical and commercial support, pre-and post-sales assistance, and customer service.


Sales

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Southern Illinois Health System expands its use of Ascend Software, selecting the company’s SmartTouch HR Imaging technology to create a paperless environment in its HR department. The 20-facility health system already uses Ascend solutions in its accounting department.

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Holy Name Medical Center (NJ) selects Wolters Kluwer Health Language Workflow-Enhancing Search solutions. HNMC will use the solution to support encoding its problem lists in SNOMED-CT for Stage 2 Meaningful Use and the transition to ICD-10.

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Cumberland Medical Center (TN) implements DataMotion’s Direct Secure Messaging with its Meditech EHR, resulting in successful attestation for Stage 2 Meaningful Use. The 189-bed hospital is a member of the East Tennessee Health Information Network, for which DataMotion provides Direct addresses.


People

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T-System names Roger Davis (Accenture) president and CEO.

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IPC The Hospitalist Company appoints Jeffrey Winter (Correctional Medical Services/Corizon Health) senior vice president of sales and marketing.

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ESD names Richard Armstrong (Leidos Health) Cerner practice director.

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HealthTrust appoints Kent Petty (Wellmont Health System) as CIO.


Government and Politics

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FDA officials are likely starting to sift through the 158 submitted comments addressing the FDA Safety and Innovation Act draft report. Several health IT industry groups seem to have reached a consensus, citing the need for limited regulation of clinical decision support software, and a desire for the FDA to dig deeper when it comes to specifics. The EHR Association noted in its comments that “the limited number of examples of applications in each category provided in the report is not sufficient to determine the risk categories for the many existing and new applications being developed, and we urge their expansion as this proposal is finalized.” Concerns around the proposed Health IT Safety Center were also raised, though recent media coverage suggests that the ONC’s policy advisory committee has endorsed workgroup recommendations for the center.

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The Health Care Cost Institute announces that CMS has certified it as a “Qualified Entity,” making it the first organization to have full access to national Medicare claims data for reporting on the costs and quality of healthcare services. The Qualified Entity program, created as part of the ACA, permits certain organizations to combine Medicare Parts A, B, and D claims data with other payer data to evaluate the performance of healthcare providers, services, and suppliers. HCCI plans to pursue a research agenda using the combined dataset containing information on over 100 million individuals.


Research and Innovation

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A study finds no evidence to suggest that hospitals are systematically using EHRs to increase reimbursement. Hospitals that adopted EHRs increased billing to Medicare at a rate comparable to that of non-EHR adopters. Detractors of the study, which only looked at inpatient records, think the real billing problem is more likely to be found in EDs and outpatient clinics, which are increasingly run by hospitals.

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Results from a new international study highlight four myths about the future of healthcare IT, particularly as it pertains to helping global healthcare organizations transition to all-digital environments:

  • People don’t want to use digital services for healthcare – 75 percent of patient respondents expect to use digital services in the future.
  • Only young people want to use digital services – Digital-service use is expected to increase across all age groups.
  • Mobile health is the game changer – Awareness and process execution are in fact core drivers of digital-service adoption for patients.
  • A comprehensive platform of service offerings is a prerequisite for creating value – The services that Singaporean patients request most show it’s not always necessary to start big (good news, no doubt, for Capsule Tech).

Other

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Sensationalist headlines aside, The Bill & Melinda Gates Foundation is in fact backing development of wireless, implantable birth control that could be effective for up to 16 years. Massachussetts-based MicroCHIPS is working on the implant, which can be turned on and off via remote control. The device will begin pre-clinical testing in the U.S. next year, during which the company will no doubt work with the FDA to overcome hacking concerns.

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The New York Times profiles Kevin Tracey, MD president and CEO of the Feinstein Institute for Medical Research for the North Shore-LIJ Health System (NY). Tracey shares his view on great leadership in the operating room: “It’s about clearly stating the purpose and asking people how they’re doing and really listening if someone needs something different that day. If the operating team can accommodate the needs of that person without deviating from the plan, that person will be a better member of the team.”

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The New York Attorney General files suit against Beth Israel and St. Luke’s-Roosevelt hospitals, and Continuum Health Partners, accusing them of accepting over $1 million in Medicaid payments they were not entitled to, and had in fact received as a result of a known computer error in 2009 and 2010. (Continuum owned both hospitals prior to a recent merger with Mt. Sinai.) A Mt. Sinai representative has firmly stated it intends to argue the case “vigorously” in court.


Sponsor Updates

  • HealthTronics signs a distribution agreement with HS Medical to provide HS Amica microwave ablation apparatus to providers.
  • Arcadia Healthcare Solutions client Carlos Olivares, CEO of Yakima Valley Farm Workers Clinic, is named CEO Visionary of the Year.
  • A.D.A.M.’s SmartCare V1.2 receives MU certification with eClinicalWorks V10.0.
  • The Advisory Board Company profiles the new Medicare patient in a recent research brief, offering five ways they’re different and how to engage them.
  • LifeImage’s Hamid Tabatabaie discusses transparency and OpenTable for medical imaging in a recent blog post.
  • Hennepin County Medical Center (MN) details how it was able to save almost $11 million after working with Leidos Health on a revenue cycle optimization plan.
  • LDM Group provides an overview of what population health management’s purpose and goals within healthcare actually are (and what they are not).
  • GetWellNetwork is profiled for starting GetWell Labs to assistant fledgling health technology companies develop their software.
  • Divurgent shares how pharmacists and pharmaceutical companies assist in remaining relevant as an ACO and CIN in a new white paper.
  • AirWatch by VMware launches Partner University and updates its Academy Certification Program.
  • BCBS of North Carolina integrates with CoverMyMeds to streamline the prior authorization process.
  • Leeds Teaching Hospitals NHS Trust uses InterSystems HealthShare for its regional master patient index.
  • Hayes Management Consulting explains the details of decision support extracts.
  • Emdat explains the benefits of dictating documentation within the EHR in a fun, informative video.
  • CareTech Solutions achieves ONC HIT 2014 Edition Modular EHR Certification from ICSA Labs for its iDoc solution.
  • Western Medical Associates (WY) is live on its eClinicalWorks patient portal.
  • Wolters Kluwer Health partners with Logical Images to offer VisualDX to its Lexicomp clients.
  • Quintiles completes the acquisition of Encore Health Resources, which will now be known as Encore, a Quintiles Company.
  • DrFirst announces in a new briefing that there are now over 28,000 pharmacies nationwide that accept electronic prescriptions for controlled substances.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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July 8, 2014 News 1 Comment

News 7/2/14

July 1, 2014 News 10 Comments

Top News

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Bloomberg profiles InterSystems founder and owner Terry Ragon, net worth $3.1 billion, and the connections he has with other early healthcare IT companies such as eScription and IDX.


Reader Comments

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From Illinois Blago: “Re: Riverside in IL. Moving from McKesson to Epic.” Unverified.

From GhostofEclipsys: “Re: Allscripts. In an effort to reduce costs as sales continue to wane, the company is considering outsourcing its client education and training group this fall. This has not worked well for other HIT companies and is an often quoted reason for not selecting a vendor during RFP. Clients want training by experts from inside the four walls who have critical relationships with engineering, not the B-team outsourcer. The Allscripts education team has won several awards for client education nationally.” Unverified.

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From Block and Tackle: “Re: Self Regional Healthcare. Has had three days of Allscripts Enterprise downtime due to a known issue involving a patch. I’m curious if readers have had similar experiences with Allscripts Enterprise.” Unverified.

From Nasty Parts: “Phytel laid off a large number of people today. Rumor has it that the primary VC wants their $40M investment back and that Premier backed out of a deal to buy Phytel. I hear Phytel wants $225M and Premier wants to only pay $165M. So, today’s layoffs are to help the company get to a more profitable number that can justify the larger purchase price.” Unverified.

From Furydelabongo: “Re: athenahealth. The Belfast, ME office is bringing in a local primary care practice, Searsport Family Medicine,  to serve as the clinic practice for their employees as well as be a test site for new functionality.” Unverified.


DoD EHR Update from Dim-Sum

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DHMSM status and latest rumors in the halls of bedlam, located “just to the right” of K Street. Sorry about he delay, I have been rather busy.

  • June marked the date where the DHMSM vendors will finally peruse a more comprehensive assessment of what each and every vendor will have to endeavor.
  • Great job Captain W and your respective team – The REAL RFP will be dropped September 2014.
  • One can only hope that your DHMSM team’s work will allay the fears and will fuel the excitement of those that are crazy brave and yet confident to move forward with this unique EHR experience
  • Rumors are ringing about the Womack ousting. In all sincerity, I believe that all three impact solution teams could improve safety across the DoD HIT environment, be it Cerner, Siemens/athena, or Epic (have yet to decide if Allscripts can compete with their sub-mundane acute solution). Good news, DoD, all of these solutions will improve workflows, enable true integration and interoperability, and will be focused on clinician adoption. In the immortal words of the DoD, “There is no such thing as too much training?” COTS love to train the trainer (for a nominal fee) and perhaps that mentality will be a bright spot in a bleak environment.
  • Six site visits by DoD to Epic sites, one gratis for McKesson, Meditech, and Cerner. I guess Siemens/athena and Allscripts missed the boat?
  • Can anyone explain how with two media submissions (one article, one announcement) the DHMSM solution price went from $5.5B to $11B? Perhaps it is the Watson effect?
  • In that same way of thinking, I believe that the first decade in a half of amateur DoD HIT design cost tax payers a trillion dollars give or take a half a billion!
  • Claims rumors abound. Wondering how much of the claims processing debacle including collections will be handled by one of the big three. This is an essential component, and since ABACUS is having FISMA issues, I figured that maybe Mr. Miller will see value in pushing claims in the DHMSM deal – more than revenue cycle, so sorry, Epic, you will have to actually find a third-party system (feel the fear!)
  • Industry Day – interesting, not as interesting as the RFP team read. Telehealth, asset tracking, real enterprise scheduling, military styled healthcare logistics (COTS, this is more of a challenge than most realize – hope there are some real discussions to understand what it means to be a functional ERP+ system).
  • Cerner, you are not ranked in the top five to install your own system. Good thing you have Accenture to pick up the slack – Leidos “as is” is your key to victory – Theme “transition, transition, transition”
  • Siemens, be happy athena is a very competitive ambulatory care solution. Teamed with your SOA your co-hosting maturity in acute and ambulatory settings make a lot of sense. I believe it might be appropriate for Tibco to lend a hand in the technology story that is truly a differentiation for the Lockheed team.
  • BTW, Lockheed, I could have sworn you had more than a part-time employee working your public relations program – is it difficult to state your intentions? CSC passed you as though you were riding a moped on the autobahn.
  • Allscripts, CSC, and HP — what a combination. You only need a population health solution and have to press the fact that Eclipsys is not archaic – good luck with that. Great announcement, short, succinct, and made people scratch their head.
  • McKesson is rumored to be in deep negotiations with themselves – so far no progress.
  • Cerner is the closest COTS to try to emulate what Epic has done, stating proudly that they are a monolithic solution, built on a myriad of frameworks they are competitive and can hold their own (however, I do not like the ambulatory solution, but the RFP will not have a weighted value assessment on features and functions, merely a check box that allows a team to state “YES we CAN"). Cerner should also utilize the Oracle story as they did in Utah for a win.
  • Accenture “good on you” for the Henry Schein relationship. If my teeth were falling out of my mouth, the first and most exciting dental EHR solution I would want managing my episode of care would be Dentrix!
  • GE Healthcare is missing in action. Perhaps an upcoming announcement will be made about their acquisition by SAIC? OK, maybe that is pure rumor :-)
  • VistA – we all know your solution is awesome, everyone loves it, adoption in a monopoly environment is 110 percent. However, do you really think after the debacle that is VA, informatics should try to be proliferated across the DoD? Methinks NO.
  • NOTE: After several “as is” and “to be” meetings, the EHR vendors real fears have more to do with two things: (a) Legacy solutions that were so poorly designed and the manner in which they were integrated requires duct tape and glue – can any vendor that programmed the old solutions actually stand behind their solution?  Did anyone within 50 miles of the beltway ever read anything about HIT standards? (b)How does a real EHR maintain parallel operations with a variety of poorly designed systems? These two thoughts are constantly on the minds of the EHR vendors – it haunts their dreams!
  • There is a sobering thought I had with a colleague over a cigar — that Leidos (SAIC in general) and Grumman should not be allowed to bid as a member of any team, but instead be enlisted as enablers to access the “stuff” they created. Perhaps they should be relegated to provide 100 percent support for all transitions, migrations, parallel synchronization, and conversions for the new EHR solution team. This time using real standards, ones that people can understand, would be refreshing. In essence they should act as Switzerland so they can actually do something that emits value over the next 5-7 years associated with rollout. Think of it as penance.

Webinars

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Sales

Arkansas Methodist Medical Center (AR) chooses T-System’s ED documentation and coding solutions.

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Children’s of Alabama extends its contract for Allscripts Sunrise and adds dbMotion, Sunrise Ambulatory Care, and Sunrise Emergency Care.


People

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Voalte promotes Trey Lauderdale to CEO and appoints a new board of directors: Tom Johnson (Global Imaging Systems), Nico Arcino (Kaiser Permanente), William Gish (Cerner Corporation), Isobel Harris (PeopleFluent), Jeffrey Lozon (Revera), Michael Marvin (MapInfo). 

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SRS names Scott Ciccarelli (GE Healthcare) as CEO. He replaces Evan Steele, who will become senior advisor.

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AirStrip promotes Matt Patterson, MD to president and hires Nancy Pratt, RN, MSN (St. Joseph Health) as COO.

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Robin Raiford, RN-BC (The Advisory Board Company) died on June 26 at 62. The visitation and service will be held Wednesday, July 2 in Springfield, VA. Details and guest book are here.


Announcements and Implementations

PatientKeeper adds a rules engine to its charge capture solution that allows billers and coders to manage code edits.

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QSI subsidiaries NextGen and Mirth announce NextGen Share, a Health Information Service Provider (HISP) that will connect NextGen and non-NextGen EHR users via Direct.

Albany Area Primary Health Care (GA) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.


Innovation and Research

Researchers develop the capability to create blood vessels using a 3D printer and then growing cells around them, leading to the possibility of “printing” a full organ.


Other

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An Ars Technica article written by an early Google Glass Explorer  says Android Wear smart watches make Google Glass obsolete. Reasons: (a) Google is developing more technology for Android Wear than for Glass; (b) Glass will always look weird and raise suspicions that the wearer is secretly recording them; (c) Google disabled live video streaming on Glass because it didn’t work well; (d) Glass doesn’t fold, so it takes up a lot of room wherever you place it other than on your face; (e) it’s easier to look at a watch than upward to Glass; (f) Android Wear watches cost $200 vs. Glass at $1,500 and do more; (g) Android Wear is being run by Google’s powerful Android team while Glass is a skunkworks project that hasn’t even exited beta; (h) Android Wear is faster and less buggy; and (i) Google has no plans to add augmented reality or facial recognition to Glass to make it something more than just a computer built into a pair of glasses.

Weird News Andy wonders “retail or wholesale” when an ED patient is charged with walking out with $300 worth of medical supplies that included bed sheets, 47 latex gloves, a bloody syringe, oxygen tubing, washcloths, alcohol wipes, lubricant, and pulse oximeters. WNA concludes, “The list price on a pulse oximeter on Amazon is $199. A single aspirin might be a hospital charge of $25. Seems like the perp might have gotten off cheap.”


Sponsor Updates

  • Aventura releases the latest in its “This is Aventura” video series, seasonally appropriate in being set to the “1812 Overture.”
  • EDCO Health Information Solutions publishes an article, “Solve Patient Indexing Errors Once and for All.”
  • Liaison Healthcare will offer its EMR-Link laboratory and radiology integration solution to members of GNYHA Services.
  • Beacon Partners offers an article, “Four Key Components for Building a Sustainable mHealth Strategy” and publishes a blog post “Are You Ready for Change? Four Questions to Ask Before Launching a Healthcare IT Project.”
  • Truven Health Analytics reports that 300 hospitals have integrated Micromedex patient education and clinical decision support with their EMRs so far in 2014.
  • QPID CEO Mike Doyle will participate in the “Big Data and Decision Making” panel at the Connected Health Symposium 2014 October 23-24 in Boston.
  • ADP AdvancedMD introduces integrated fax with a short video clip.
  • ICSA Labs certified products from First Databank, Iatric Systems, Juniper Networks, Orion Health, Quest Diagnostics and The Advisory Board Company in June.
  • Health Catalyst explains the anatomy of healthcare delivery model in a recently published white paper.
  • Maury Regional Medical Center (TN) selects Nuance services for its medical transcription needs.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 1, 2014 News 10 Comments

Morning Headlines 6/30/14

June 29, 2014 Headlines No Comments

Report Finds Health Unit of V.A. Needs Overhaul

A review of the Veterans Health Administration conducted by Rob Nabors, deputy chief of staff to President Obama, finds that VA leadership “is not prepared to deliver effective day-to-day management.” The report says that inept managers and a corrosive and non-transparent culture across the system have eroded the VHA’s ability to accomplish its mission. Nabors concluded by recommending that the VHA be completely restructured with a focus on transparency and accountability.

Obama to nominate former Proctor & Gamble CEO as Veterans Affairs secretary

In related news, former Proctor & Gamble CEO Bob McDonald will be nominated to take over as the secretary of the VA. McDonald graduated from West Point and then spent five years in the Army before getting out and moving into the corporate world. He was ousted from Proctor & Gamble last year, after a 33-year career, following a string of disappointing quarters that drove stock prices down and eventually attracted activist investor pressure.

Cerner is going after a huge government contract

Cerner announces that it will partner with Leidos (formerly SAIC) and Accenture in its bid for the DoD EHR contract.

Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative

A JAMIA study finds that many Meaningful Use Stage 2 certified EHR vendors have failed to properly implemented the interoperability standards outlined within the MU2 Consolidated Clinical Document Architecture (C-CDA) specifications. Researchers found 615 errors within 91 sample C-CDA documents provided from 21 different certified EHR platforms.

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June 29, 2014 Headlines No Comments

Monday Morning Update 6/30/14

June 28, 2014 News 22 Comments

Top News

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White House Deputy Chief of Staff Rob Nabors delivered his review of the VA to President Obama Friday. The report’s high points:

  • The VA is the country’s largest health system with 1,700 sites and $150 billion per year in funding.
  • The 14-day patient scheduling standard was unrealistic and encouraged inappropriate behavior.
  • The Veterans Health Administration needs to be restructured because it has little accountability, isn’t responsive, and can’t communicate effectively.
  • One-fourth of all federal government whistleblower complaints involve the VA.
  • Individual VA facilities often ignore VHA’s directives and sometimes express their disagreement via the press.
  • Employees know that the federal government rarely fires anyone, so they don’t try to solve problems.
  • The VA’s VistA system is “cumbersome and outdated,” but is state of the art when it comes to capturing patient documentation to form an integrated health record. The real problem with scheduling patients is a lack of clinicians, support personnel, and space, not deficiencies in IT systems.
  • The VA hasn’t planned well and hasn’t tied its budget requests to specific outcomes.

Reader Comments

From Mcklayoffs: “Re: McKesson layoffs. There were huge ones in April. I heard it happen again on Thursday. I heard even some of the Paragon folks were let go from services. You have to wonder if that’s their go-forward solution.” Unverified.

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From Lt. Dan: “Re: cyberwarfare visualization. This real-time map of hacker attacks shows that the US is getting bombarded by pretty much everyone.” The extremely cool display from cybersecurity firm Norse, which looks like one of those 1960s US-Soviet World War III doomsday scenario illustrations, shows who’s being attacked and from where. Some of the information is surprising: at this moment, attacks are being launched from the domain of drug maker Merck in New Jersey as well as the University of Michigan and Cal Berkeley, quite a few attacks are originating from military domains, and the US is by far the most popular intended target with 10 times as many attacks as #2 Hong Kong.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Ivenix. The Amesbury, MA-based company offers the Ivenix Infusion Management System, a smart IV pump that combines information technology with new smart pump design to reduce errors and improve patient safety. It measures and adjusts IV flow rate in real time and manages patient-specific infusion information via a secure, wireless, Web-based architecture that lets clinicians make decisions by viewing remote dashboards that display infusion information, alerts, alarms, and cross-pump drug alerts. Its analytics capability supports organization-wide quality and cost projects. IV orders are sent to the pump with nurse verification via open, pluggable EMR integration and drug library and software updates are delivered transparently. Thanks to Ivenix for supporting HIStalk.

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Six percent of poll respondents said they participated in a video-based visit as a patient in the past year. New poll to your right: which EHR package should the DoD choose – Allscripts, Epic, or Cerner? Click the Comments link on the poll widget after voting to defend your decision –  you never know, maybe the DoD is looking for your insight.

Listening: Austin-based Ume, who I saw live awhile back. Singer/guitarist Lauren Larson shreds it on stage with monstrous distorted guitar licks, passionate vocals, and a head-pounding mane of blonde hair, but I met her after the show and she’s a tiny, sweet Texas cheerleader type who decided to take a break from working on her PhD to focus on music along with her bass-wielding husband Eric. Ume is on tour with Circa Survive, which will play in Riot Fest in Chicago in September with some of my favorite bands: Jane’s Addiction, The Cure, Weezer, Metric, Failure, Superchunk, Dandy Warhols, and Mastodon.


Webinars

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


People

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ONC’s Director of the Office of Consumer eHealth Lygeia Ricciardi announces on Twitter that she has resigned effective July 25.


Announcements and Implementations

ZirMed announces enhancements to its Analytics solution that include a customizable dashboard and drill-down interactive KPIs for key business metrics.

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Cerner, not surprisingly, joins Epic and Allscripts in throwing its hat into the DoD’s EHR replacement ring. Cerner will bid along with partners Accenture and Leidos. Someone asked me on Twitter how I saw it playing out and I gave the odds at 80 percent Epic, 20 percent Cerner, and zero percent Allscripts. Epic has a big advantage in covering a huge chunk of the US population, having the only comparably sized implementation in Kaiser Permanente, winning just about every large-system bid, having implemented its system with the Coast Guard, having IBM as a partner, and having powerful members of Congress like Paul Ryan who have previously demonstrated willingness to use their clout to push Epic. Cerner’s advantages are the comfort level of being a large, publicly traded company with increasing healthcare reach outside of IT, strong government-savvy partners in Accenture and Leidos, good hosting experience, and a potential willingness to beat Epic on price in what will be the biggest deal in healthcare IT history. I don’t see Allscripts having a chance since large hospitals aren’t buying Sunrise, its biggest client North Shore-LIJ is keeping whatever enthusiasm it has quiet, its offerings are narrow compared to Epic and Cerner, and memories of its corporate stumbling  haven’t faded yet, but it does have the strongest set of partners in CSC and HP, the latter being important since the much-touted $11 billion bid value is a 10-year cost including maintenance and infrastructure where HP shines.


Technology

3M announces ePrivacy Filter, $50 software that uses webcam-powered facial recognition to limit screen viewing to the authorized user, warn them if someone is looking over their shoulder, and blur their screen when they step away.


Other

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Implementation of the C-CDA (Consolidated Clinical Document Architecture) semantic interoperability standard needs work, according to a JAMIA-published study by a group that found many errors in documents submitted from 21 systems. Meaningful Use Stage 2 requires using C-CDA, but the samples provided to the authors often included missing or incorrect information. The authors made four recommendations: (a) create a site with public C-CDA samples and scenarios since vendors say they don’t always know how to represent their data; (b) require EHR certification testing to include validating terminology such as SNOMED and RxNorm; (c) add a certification requirement that EHR vendors provide all of the data elements they capture instead of making many of them optional; and (d) electronically monitor the quality of real-world C-CDA documents being produced and report results. The authors conclude that further effort will determine whether C-CDA documents “can mature into efficient workhorses of interoperability.”

A study finds that patients discharged from hospitals that use an advanced EHR cost $731 less than those from non-EHR using hospitals. The methodology isn’t convincing: (a) the data is from 2009 and simply matched up a discharge database to what the article says is the HIMSS annual survey (which really means the HIMSS Analytics database);  (b) the “cost” figures were the nearly worthless cost-to-charge ratios that everybody uses because hospitals don’t track individual unit costs well; (c) the analysis seems to have looked only at overall cost rather than for comparable diagnoses or treatments, but I’m not clear on that from the methodology provided; (d) correlation isn’t causation, so any jumping to conclusions that plugging in an advanced EHR will reduce hospital costs is ridiculous.

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Here’s how disintermediated San Francisco cab drivers are competing with ride-sharing service Uber (valued at $18 billion): they’re using an app that lets people pay them for the public parking spots they intentionally occupy for that purpose. The city has ordered the app’s Italy-based developers to cease operations, saying its excuse of selling convenience rather than parking spots is “like a prostitute saying she’s not selling sex — she’s only selling information about her willingness to have sex with you.” The developer of a competing app is paying people $13 per hour to tie up high-demand evening spots in the Mission District and then resell them, give the company working inventory to promote its app.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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June 28, 2014 News 22 Comments

News 6/27/14

June 26, 2014 News 5 Comments

Top News

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Philips will deploy clinical applications in a Salesforce.com-powered cloud environment that’s centered around patient relationship management. Two applications will be launched this summer, eCareCoordinator and eCareCompanion, which are collaboration platforms for monitoring chronic condition patients at home.  Philips says future offerings will incorporate information from EMRs, medical devices, home monitoring, and wearables. The platform will be open to developers to create add-on products.


Reader Comments

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From Otto Complete: “Re: HTRAC East conference in Leesburg, VA. I attended this week and found it to be amazingly enlightening! Limited vendor involvement, zero exhibitors, and passion for IT improvement in our space, along with tremendous information sharing – these are just a few of the compliments I would give the conference. As you are a thought leader in our field, I wanted to be sure this group was on your radar.” I hadn’t heard of the group or conference, but they get points from me for being non-profit and for bundling meals (and an open bar) with the registration fee. The write-up says it’s invitation-only and limited to around 200 attendees, with minimal vendor participation and no exhibit hall.

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From Demon Deacon: “Re: Wake Forest Baptist IT department. The CMIO and VP of clinical applications positions were eliminated and will be replaced with a chief clinical information officer.” Unverified, although a search of Google’s cache turns up the now-removed job posting that I assume they filled. They’ve had a lot of IT turnover after their horrific Epic implementation.


HIStalk Announcements and Requests

This week on HIStalk Practice: Avecinia Wellness Center CEO Unaiza Hayat, MD shares the details of successfully attesting for S2MU and the role good physician leadership plays in any implementation. HIE merger creates largest in Michigan. Nashville physicians show no love for Epic. Verizon gets into the telemedicine game. Maine Primary Care Association goes live with new pop health technology. Thanks for reading.

This week on HIStalk Connect: researchers with Sandia National Laboratory make headway on their work developing non-invasive ways of monitoring electrolyte levels. Google unveils Google Fit, a digital health developers’ platform that promises the same basic functionality that Apples HealthKit offers. San Francisco-based startup Grand Rounds raises a $40 million Series B round to expand its growing network of physician thought leaders who offer remote second opinions on complex cases.

Listening: Chicago-based Eleventh Dream Day, probably the best and hardest-rocking Midwestern band that nobody’s heard of thanks to their record label’s incompetence. Also: Queens of the Stone Age.

My latest reading peeves: (a) cutesy reporters who start off a healthcare technology story with, “The (technology name here) will see you now.”; (b) using “there” as the subject of a sentence; (c) clickbait headlines, tweets, and lame slide shows that will do anything to get you to click even though you will regret it almost immediately; (d) referring to doctors as Dr. John Smith, which doesn’t tell us what kind of doctorate John earned; (e) surveys that try to hide low participation by giving results only as percentages; and (e) as I try to ignore the flood of World Cup chatter, people who confuse spectating with exercising in referring to someone else’s athletic team as “we.” I’ll keep the porn analogy that popped into my head to myself.


Webinars

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

We’ve decided to post the recorded videos of our HIStalk Webinars on YouTube to avoid the playback problems some viewers were having. The webinar, Cloud Is Not (Always) The Answer, ran live this past Wednesday. Not only did Logicworks do a great job in taking our suggestions and input from two CIOs into account to perfect their content and delivery, running the recorded version from YouTube is cleaner and faster, with no signup required to start watching.


Acquisitions, Funding, Business, and Stock

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CareCloud borrows $25.5 million from a growth capital lender. I’m never cheered by a company taking on debt just like I wouldn’t be thrilled about a relative signing up for a home equity loan, but I guess it’s good news to be found credit-worthy and to have your plan for using the money vetted by someone whose objectivity is inarguable given their interest (no pun intended) in being repaid.

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Physicians Interactive, which markets life sciences products to physicians, acquires consumer health information site WebHelp.

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Imprivata’s raises $66 million in its Wednesday IPO.


Sales

Central Florida Health Alliance (FL) chooses MModal for transcription technology and document insight.

Sutter Health (CA) selects Orion Health to build and deploy its HIE.


People

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Mark Caron (Capital BlueCross) is named CEO of population health and analytics systems vendor Geneia, which is owned by Capital BlueCross.

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The Jersey Health Connect HIE names Judy Comitto, VP/CIO of Trinitas Regional Medical Center (NJ), as its board chair.  

Secure email vendor DataMotion appoints Kathleen Ridder Crampton (United HealthCare Group) to its board.


Announcements and Implementations

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Ivenix announces that it is developing a new smart IV pump that will feature a smartphone-like user interface, enhanced IT capability that includes Web-based EHR integration and analytics, and new pump technology.

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Telehealth solutions provider AMC Health says it has integrated its system with Epic.

Verizon announces Virtual Visits, a secure video technology platform that allows consumers to connect with doctors. The company hopes to license the technology to health plans (i.e. doctor not included.)

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The non-profit CCHIT, which exited from what it said was the unprofitable EHR certification business in January 2014, announces its new mission of selling developers advice on how to get their EHRs certified.

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Biometric Signature ID announces its handwriting-powered identity authentication system for Epic. It seems that handwriting would not be reliable given that users would be “writing” with their fingertip on a small screen while standing up in most cases, but maybe they’ve figured it out. You can try cracking a “Go Verify Yourself” signature-powered access page on their site.


Government and Politics

A Bloomberg editorial says that the Affordable Care Act is drawing a disproportionate number of people with chronic conditions to sign up for health insurance, which could possibly drive insurance companies out of the market or force the President to try to bail them out (with questionable legality) as he promised upfront to get them to participate.

CMS claims that its much-maligned Medicare fraudulent claims detection system prevented $210 million in payments in 2013, its second year of operation. That works out to something like 0.02 percent of total payments, a fraction of the government-estimated $50-60 billion that CMS improperly pays each year, and less than a monkey throwing darts could turn up before hitting the Beltway by noon on the Friday before Independence Day.


Other

A Wisconsin high school loses its track coach to Epic, where he will become a project manager. He says, “I’ll be working to implement software, and going out to hospitals and clinics, visiting with doctors and nurses, and discuss their ideas and concerns with the developers at Epic … I’m no computer whiz. They say they want people who are able to distinguish themselves through their careers, and they’ll teach the rest. There will be a lot of learning.”

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An editorial in Applied Clinical Informatics says that specifying advance directives should be easy and the resulting preferences should be stored by HIEs and shared via interoperability. It proposes an input sheet that looks like a US tax form in making the analogy that advance directives should be as easy as electronic filing of taxes. Misusing the term as “advanced directives” drives me crazy (you make them in “advance,” not “advanced”) so it was disappointing that “advanced” made an unwelcome appearance three times in the mostly-correct article. Note the subtle humor in identifying the form as 419, the police code for a “dead body found.”

A small (120 responses) AMDIS-Gartner survey of CMIOs finds an average annual salary of $326,000 in a range of $206,000 to $550,000. Respondents reported slightly less job satisfaction than last year, higher CMIO turnover, and an overwhelming preference for reporting to the chief medical officer rather than the CIO.

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In Canada, a $300 million privacy lawsuit is filed against Rouge Valley Health System that alleges two hospital employees sold the names of 8,300 mothers of newborns to an investment who cold-called them to sell education savings plans.

Google CEO Larry Page says yet again that 100,000 lives would be saved each year by more healthcare data mining. He’s made that claim (without backing it) several times.

A Bloomberg article says that hospitals are starting to use consumer information from big data sources to target their at-risk patients for interventions, such as finding out which asthma patients are buying cigarettes or whether heart patients are allowing their gym memberships to lapse. Patients say hospitals making cold calls about health habits is intrusive, but hospitals say they need to aggressively manage their patients under new payment models.

A new KLAS report reaches an obvious conclusion: only Epic, Cerner, and Meditech are expanding their hospital EMR client bases. Actually I was surprised that Meditech was included since my perception is that they are falling behind rather than gaining, but I assume KLAS has hard data suggesting otherwise.


Sponsor Updates

  • Validic will be featured by TEDMED 2014 as one of its chosen “transformative startups and the inspiring entrepreneurs that power them.”
  • Optimum Healthcare IT will be featured in a June 29 episode of “21st Century Television” on Bloomberg Worldwide.
  • Jeanette Ball, RN, PCMH CCE of CTG Health Solutions shares her experience working with western New York providers to create a PCMH framework in the Journal of Clinical Engineering.
  • CareTech Solutions launches its website built on CareWorks CMS v4.1.
  • ESD shares how to implement automated testing.
  • Navicure partners with Acculynk to launch a customized payment platform for providers.
  • Netsmart posts a white paper exploring the similarities and difference in PC and behavioral health.
  • Allscripts receives 23 commitments for expanded Allscripts Sunrise solutions such as Ambulatory Care, Emergency Care and Surgical Care.
  • Practice Fusion partners with Emdeon to offer automated health plan eligibility check in its EHR.
  • Juniper Networks announces the capabilities and enhancements of its Next-Generation Firewall and SRX Series Services Gateways.
  • The Advisory Board Company is profiled by a local news station for its community volunteer projects.
  • Extension Healthcare discusses how EHR alerts have contributed to alarm fatigue and offers a two-part white paper on managing alarms to improve patient safety.
  • Wellcentive client Children’s Health Alliance (OR) receives the Analytics All Stars Award for Population Health Project of the Year award.
  • Albany Area Primary Health Care (GA) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.
  • Divurgent offers a series of free conference calls on big data and analytics.

EPtalk by Dr. Jayne

It’s been a completely random week at work. Most of the practices we acquired earlier in the year have stabilized from a revenue cycle perspective, so it’s time to bring them up on EHR. Once the Independence Day holiday rolls by, it will be full steam ahead.

There have been a couple of last-minute glitches though, mostly involving providers behaving badly. There are always challenges when a practice has to change its culture, but I’ve not seen this many employed providers who don’t seem to remember that they’re employed.

Some of our operational leaders try to soften the blow by referring to them as “partners” or “associates,” but the bottom line is that they are employees. If we were partners, there would be shared decision-making and give and take. There would not be top-down leadership with requirements that must be adhered to. There would not be contractual obligations that require compliance with a host of regulatory items. There would not be penalties for failure to adhere to documented policies.

I’m fortunate to have an implementation team that’s well-seasoned and grateful for its manager and her solid leadership. Since the team has had a couple of months without active deployment cycles, we front-loaded the calendar with some of the most difficult providers. That way they can get them done while they’re still fresh. The majority of the team agreed they’d rather save the best providers for last rather than having to look forward to all the difficult ones at the end.

From Stay Glassy San Diego: “Re: Dr. Chrono’s Glass app. Did you see it? They’re referring to it as the first wearable health record.” I did see, it but I’m not sure it’s actually a wearable record as much as a different way to interface with the record. Physicians can store a video of an office visit in the EHR but it’s not clear how that translates to discrete data or the other hoop-jumping we need for payers and incentive programs. I did find it interesting that media reports cite 300 of the 60,000 drchrono clients as users of the Glass app. They may have downloaded it, but given psychosocial and privacy concerns around use of Glass, I’d be surprised if that many were actually using it. According to the company website, users can sign up to be beta testers, which doesn’t exactly sound like widespread adoption to me. If there are any readers who have actually used it, I’d be happy to share your stories.

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From App-e-tite for Destruction: “Re: Open Payments, did you look at any of the other government apps that were available? Some are amusing.” I was on a pretty focused expedition the other day but did have some time tonight to check out the Mobile Apps Gallery at USA.gov.  In addition to Apple and Android, they still offer content for BlackBerry. There’s an app to help you through the National Gallery of Art as well as one to locate alternative fueling stations for electric, biodiesel, CNG, and other non-gasoline vehicles. I spent some time playing with the FDA Mobile app, which has medication recalls and safety alerts as well as consumer updates. There’s also a radiation emergency app, one that manipulates census data, a rail crossing locator, and a ladder safety app to boot.

What’s your favorite government app? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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June 26, 2014 News 5 Comments

HIStalk Interviews Davin Lundquist, MD, CMIO, Dignity Health

June 25, 2014 Interviews 1 Comment

Davin Lundquist, MD is VP/CMIO of Dignity Health of San Francisco, CA.

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What systems are you using on the ambulatory side and what are your priorities there?

In California, we have laws that prevent corporations from hiring physicians directly. The structure that Dignity Health primarily uses in California is a medical foundation. We have Dignity Health Medical Foundation, for which I practice at one of their sites in the Ventura market. Camarillo, California specifically. I’m a family medicine physician, a PCP. 

In our medical foundation, which has about 600 physicians plus several hundred radiologists, we use Allscripts Enterprise for our ambulatory EMR. Dignity Health has nearly 40 hospitals crossing California, Arizona, and Nevada. We are moving to the Cerner platform in the hospital.

Outside of the foundation, we also have some employed medical groups in Nevada and Arizona. The large one in Arizona is using Allscripts Enterprise. Then in Nevada and a lot of our clinics that are not part of the foundation … many hospitals have community-based clinics. There’s a hodgepodge of systems that are being used there. We are in the process of looking to maybe consolidate or figure out if there’s an enterprise solution that we can roll out to all of those sites.

 

Are you having any challenges to tie in Allscripts ambulatory with Cerner inpatient?

In some of our markets, we’ve done a better job than in others with creating the integration. I would guess that a lot of health systems have this challenge of integrating data and having it be seamless. Integration tends to be very costly. There are issues around patient matching. 

We have one of the largest private HIEs in the country. We use MobileMD, which was acquired by Siemens a few years back. We have nearly 7,000 of our physicians that have an account with that HIE. Primarily we’ve used that as a way for doctors out in the community to get information from Cerner, the hospital. Both the Cerner and the Meditech hospitals will feed data into MobileMD and then those physicians and offices in the community can access that. 

Leveraging that integration platform, we’ve been able to, for our own providers that are on Allscripts, create a pretty good integration. A lot of our Allscripts providers in Sacramento will get automatically delivered to their Allscripts platform discharge summaries and radiology reports and labs and things that are done in the hospital.

 

Are most of the physicians attesting for Meaningful Use?

Yes. Of the providers who are on a system that is up to speed with Meaningful Use, we’ve had a nearly a 100 percent rate of Meaningful Use attestation. The clinics where we don’t run them from a foundation standpoint, then those doctors tend to work in clinics where he hospital staffs it, but the doctors are independent contractors. There’s a lot more variability there because a lot of those doctors may be specialists who have their own practice and just come in a few days a month. We believe a lot of them are attesting in their own practices.

 

Are you looking at any specific Meaningful Use Stage 2 challenges?

Yes. For Stage 2, the biggest challenge for us is the patient portal. We’ve been working with a company called Medseek to customize a portal for our Allscripts users. We’ve made a lot of progress, but there’s still challenges in getting patient enrollment, in getting doctors to feel comfortable sharing the amount of information that needs to be shared to achieve Meaningful Use. We’re still working through a lot of those issues, but we feel like we’re on a trajectory to make that happen by the end of the year.

 

Did you make that decision before Allscripts acquired Jardogs and FollowMyHealth? I’m just curious why you wouldn’t have chosen it.

We did. Without getting into the specifics, there was a very detailed RFP that went out and Jardogs was part of that. There were, I think, some specific limitations that Jardogs had, not necessarily related to function, but more around privacy and security and the way that Dignity Health approaches those things that I think made it incompatible with our setup. That was all pre-date of the acquisition by Allscripts.

 

Describe the pilot that you’re doing with Google Glass and Augmedix.

I practice in a clinic in Camarillo. We have several other primary care doctors there. We learned of the Augmedix solution. As you heard me describe some of the other technologies that we’re using at Dignity Health, you probably didn’t hear a lot of excitement in my voice. [laughs] I try not to reveal my true feelings.

Technology for physicians, while we understand and we know that it’s where we need to go, it hasn’t always been easy to adopt. If you talk to most physicians, they probably wouldn’t say that the EMR has made them more efficient. Again, I think we all understand that it’s important and having access to that data will eventually be more important.

The Google Glass technology was something that intrigued me. How is this going to impact healthcare? Where will this fall? You can imagine lots of potential use cases for it, but what we liked about the way Augmedix was deploying it, it seemed to be something that added value to physicians that would improve their ability to interact with patients, to do their job more effectively and not feel like they were getting bogged down with technology.

The way that it works is we wear the device as we’re seeing patients. The audio and video are being streamed to the Augmedix team. Through a combination of humans and technology that’s proprietary to them, the progress notes are being completed. As a practicing physician, the ability to feel like you’re getting back to that doctor-patient interaction has been a tremendous experience.

 

I assume they use some type of back-end speech recognition with human review and correction and that information is placed in the EMR?

I would encourage you to reach out to the Augmedix people and have them explain it to you. I want to protect their proprietary endeavors there. But I would guess that there’s probably some combination of human and technology going on there.

My experience would tell me that it has to be different than just voice recognition. You would understand this better than people that have interviewed me that when you use Dragon or even traditional dictation, you as a physician have to summarize the encounter for that voice-to-text to happen. In this case, Augmedix has partnered with us. They came and observed our workflow, observed the physicians that are using it beforehand, they met with us, they understood how we like to document, how we like to capture our physical exam and other things. They’re summarizing in real time for us. The true medical elements of that conversation are making it into the chart.

 

That’s not customized for each physician, right? It’s somewhat of a templated formula of how you speak to Glass to get it to understand what you’re doing at that point?

It’s not fully customized. I don’t want to imply that you can have it any way you want, but there is some customization. They do take time to learn how we like our notes to look. Also things like as I’m examining the patient, they can’t hear what I’m hearing, so I have to be able to communicate that to them in some way. Things like, if someone’s exam is normal, then in the absence of me verbalizing what I found, they may use a normal exam template that we agreed upon.

Then other times, if I miss something, one of the great and nice things about Google Glass is they can send me a little message that shows up on the Glass device and says, hey, you forgot to tell me what you saw in their ear exam. So there’s some two-way interaction that goes on.

 

Did Augmedix have to interface into Allscripts or did Allscripts have to participate in the setup to get your progress notes into their EMR?

Our version of Allscripts is hosted internally by Dignity Health. The Dignity Health IT team worked closely with Augmedix to sort that out. We ran everything through the privacy and security and compliance people so that the way it’s set up, everyone’s very comfortable with.

 

The release used the word “partnered.” There’s no financial interest either by you personally or Dignity Health with Augmedix, right?

Correct.

 

This is a three-physician pilot. What are the plans to roll it out further?

We’re currently looking in negotiations with Augmedix to expand to other physicians in Ventura. We’re excited about that opportunity. Then depending on how that goes, we may look to roll it other sites within Dignity.

 

What’s the patient reaction to using Glass in their encounters?

Overwhelmingly it’s been very positive. That’s definitely a question I had going into this — whether or not patients would accept it. I don’t wear glasses normally, so I was kind of curious what my patients would think of me wearing something like this. 

One of the most surprising things is how many of my patients don’t even seem to notice. I think that probably has to do with patients coming in not feeling well or looking for help and focused on their concerns. When they come in now and see that I’m not typing, that I’m just sitting there, looking at them, waiting and listening and asking pointed questions about what’s happening — they almost don’t even notice that I have it on there.

There’s another group, obviously, that’s more tech savvy. They recognize that it’s a Google Glass and they’re interested in that because they haven’t seen one yet and they want to know what is it like. But even that, too, is a really short conversation. I explain to them what’s happening, that the information is being transmitted, and that this is helping us to document so that we can spend more time with them. 

Across the board it’s been very well received. They even get a little excited about the fact that their doctor is using a new technology. It gives them confidence that we’re looking to whatever it takes to provide better care for them.

 

Are there still things in an encounter that you have to use a keyboard or a tablet for, or are there things that you would like to see added to what Augmedix can do to make it complete so that you don’t have to use any other device?

In this first phase, we still have to do our orders. We didn’t feel comfortable yet turning over the keys to that CPOE engine given that there’s a lot more important things going on there, like we should get the right medicine ordered, right labs ordered, those kinds of things. 

Usually that happens at the end of a nice interaction with the patient, though, where we say, “OK, this is what I’m going to do for you.” That’s when I can turn and enter in some orders. But I think that’s a much more accepted thing for patients because they feel like they’ve had their time and now you’re actually doing something for them. When you do have to turn to your computer to do that, I think that’s an appropriate thing.

We are looking and hoping that as the technology matures, both the EMR and the Augmedix technology, that maybe at some what point we can verbalize those orders and that our voice can be recognized and authenticated. Who knows what that will turn out to be? But I am optimistic that we can push the limits of that.

 

Is it storing video or audio or both from the encounter?

At this point, no. I think our compliance people and everybody wasn’t comfortable with that yet, is my understanding. It’s an interesting thought, though. I think I saw an article recently where someone else was looking to maybe record video and audio right into a medical record, which I thought was an interesting concept. But we’re not doing that.

 

People always say technologies don’t preserve the patient’s story or the full richness of the encounter, so it would be pretty cool to say, “I want to see this whole visit over. I want to hear what I said, what the patient said.” That would be interesting documentation, although certainly there’s privacy and litigation concerns on both sides.

Absolutely. Once people feel comfortable that there’s technology out there that would really keep that safe, then I think we’ll move in that direction.

 

Dignity recently formed an accountable care organization. What lessons are you learning about the need for data and analytics tools?

ACO is kind of a broad term. There are several ACO-type contracts throughout Dignity Health in both California and Arizona. Some of them are more along the shared savings route and others are maybe more along just some metrics and other things. Clearly we understand the need for having access to data across the continuum of care. We need to be able to see longitudinal view of a given patient in order for us to really understand what it’s going to take to care for that patient and partner with them in helping them achieve their health goals.

 

What other projects are taking the most of your time and energy?

I’m working on projects with population health. We are looking to create what we call our population health management technology stack. You described the need for data — we’re looking at getting the data gathered for the first phase, then getting into the analytics layer, care management, what we do with that data, the clinical and patient portal-type interactions. 

Related to pop health, we’re looking at collaboration tools, secure messaging tools, video visits … the list goes on and on. I think there’s probably a common list that you would hear from any big health system that is trying to anticipate what might be needed as we turn the corner on healthcare reform.

 

You’ll be buying and implementing quite a lot of systems over the next several years.

Yes. We are in the process of looking for vendors who, in some cases, have the maturity for us to buy them and purchase. But in most cases, especially in the population health space, we’re looking to either build or partner to co-develop solutions. I think it would be naive of us to invest too much money in a "solution" when nobody really knows what’s exactly going to be needed. We’re going to be very busy for a few years on that front.

 

Do you have any final thoughts?

I just want to say that I’m excited to be a part of Dignity Health. I’ve only been here for a couple of years. I came on at a really good time. I arrived right about the time that they were changing their name from Catholic Healthcare West to Dignity Health. I’ve seen a trajectory in this company that seems to really understand where things are headed, but not losing sight of the mission and value, this campaign around human kindness. 

This particular Google Glass pilot and project has demonstrated that Dignity Health is willing to put their support and invest in projects that go in line with that. I’ve done a lot of technology stuff over the years, but this is one of the first that seems to excite every physician that comes around it, which is different from a lot of technology. I think the reason is because it really does get us back to why we got into medicine, which is that patient interaction, making a difference and feeling like you’re using something that’s more transparent and that is helping you as opposed to getting in your way.

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June 25, 2014 Interviews 1 Comment

News 6/25/14

June 24, 2014 News 1 Comment

Top News

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Emdeon will acquire Capario for $115 million in cash from its private equity owner Marlin Equity Partners, with Emdeon announcing plans to incorporate the CaparioOne revenue cycle management product into its Intelligent Health Network.


Upcoming Webinars

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Acquisitions, Funding, Business, and Stock

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KPMG acquires Cincinnati-based Zanett Commercial Solutions, an Oracle partner and health IT consulting firm.

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A new $152 million funding round for doctor-finding site ZocDoc values the company at $1.6 billion.

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Second medical opinion site Grand Rounds raises $40 million in funding. The company charges $7,500 for an online review by a nationally recognized physician, while arranging an appointment with a specialist costs $200. The company says that its second opinion finds the original doctor wrong 60 percent of the time, giving employers more than a threefold benefit to their investment, which for companies of fewer than 1,000 employees is $10 each per month. The company also offers physician-to-physician consultation for hospitalized patients who demand a review by a recognized expert. It would be interesting to know how they choose the “top 3 percent of specialists in the nation.”   

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IMS Health will acquire some product lines of Cegedim, which sell life sciences marketing solutions, for $520 million in cash. Cegedim’s Pulse Systems products for medical practices (PM/EHR, RCM, patient portal, patient kiosk) weren’t mentioned as being part of the deal.


Sales

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St. Luke’s (MN) chooses Strata Decision’s StrataJazz for Decision Support.

Cerner signs a 10-year deal with existing customer Mission Health (NC) to work on unspecified innovation and population health projects.

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University Health Shreveport (LA), UMass Memorial Medical Group (MA) and Baptist Memorial Health Care (TN) select Infor Healthcare financial solutions.

RegionalCare Hospital Partners (TN) will deploy Agilum Healthcare Intelligence’s BI solutions and services across its eight hospitals in seven states.

Verizon will provide AirWatch by VMware to its US enterprise clients.


People

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M. Bridget Duffy, MD (Vocera) joins the board of scribe and EHR consulting vendor Essia Health, formerly known as Scribes STAT.

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Athenahealth names Kristi Matus (Aetna) to the newly created role of EVP/chief financial and administrative officer.


Announcements and Implementations

Premier, Inc. launches PremierConnect Price Lookup, which will allow members and vendors look up pricing information for nearly 7 million contract items.

CSC will partner with Allscripts and HP in vying for the DoD’s $11 billion EHR replacement. CSC wastes no time in playing the card of Robert Wah, MD, its chief medical officer and newly installed AMA president.

The newly merged Great Lakes HIE and Michigan Health Connect choose Great Lakes Health Connect as their new name.


Government and Politics

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Janet Woodcock, MD, director of FDA’s Center for Drug Evaluation and Research, says the agency’s Mini-Sentinel drug surveillance system that’s being piloted combines claims and EHR dispensing data from 18 large healthcare organizations in a common data model that its safety scientists can query with drug safety questions. It covers 153 million people, 4 billion drug dispensing episodes, and 4 billion patient encounters.

A South Dakota newspaper points out that small claims collection lawsuits for medical expenses often violate patient privacy since they list the services for which the patient owes the provider. One collections agency requests that each of its lawsuits be sealed to prevent casual electronic observers from prying into a given patient’s procedure codes.

Above is video from Tuesday’s 21st Century Cures digital health roundtable convened by the US House Energy & Commerce Committee. Among those speaking are Jonathan Bush (athenahealth), Jeff Shuren (FDA), Martin Harris (Cleveland Clinic), and Brian Druker (OHSU).


Other

Seven-bed Reagan Memorial Hospital (TX) says it was unable to pay its vendors after the only employee who knew how to issue checks from Meditech quit. They’re back on track after having Meditech train more people.

Above is Deborah Peel, MD of Patient Privacy Rights at TEDxTraverseCity on “Designing Technology to Restore Privacy” from a few weeks ago. She’s also starting a campaign, #MyHealthDataIsMine.

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Fitch Ratings holds the rating on bonds of Beebe Healthcare (DE) at BBB-, one step above junk status, with EHR implementation contributing to its losses.

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The State of Montana starts notifying 1.3 million people — more than the entire population of the state — that hackers got into a state health department server containing their medical information. A surprising amount of medical information was stored on the server, including “health assessments, diagnoses, treatment, prescriptions, and insurance.” Also on the same server: the bank account information of 3,100 department employees and contractors and 50 years’ of birth and death certificate information.

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Parkview Health (IN) pays $800,000 to settle an OCR HIPAA investigation in which a retiring independent doctor who was transferring her patients to new practices found 71 boxes of medical records dumped in her driveway when she got home. The hospital says it has since replaced its insecure paper records with an EHR.

On Computerworld’s “100 Best Places to Work in IT 2014” in the “Large Organizations” category are Sharp HealthCare (#7), Texas Health Resources (#8), OhioHealth (#10), Carolinas HealthCare System (#20), Cedars-Sinai Health System (#21), Cancer Treatment Centers of America (#27), Children’s Hospital of Philadelphia (#33), Cerner (#37), Ascension Health (#39), HCA (#42), Kaiser Permanente (#45), and McKesson (#50). On the “Midsize Organizations” list are Miami Children’s Hospital (#8) and Genesis HealthCare System (#12). UHC takes the #2 spot in the “Small Organizations” category.  

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A small (111 hospitals) AHA-sponsored survey finds that a third of the responding organizations don’t feel they have the right executive team in place to execute their strategy, with their biggest talent shortfall being in creating non-traditional partnerships, managing community and population health, and managing change. Just half have a CIO/CTO on the executive team, and only 20 percent say the CIO is always involved in making decisions. The report predicts the emergence of new executive titles that include chief population health manager, VP of cost containment, chief patient engagement officer, and VP of clinical informatics.

“No Matter Where,” a movie about HIEs in Tennessee, has a limited premiere in Nashville. The executive producer is Kevin Johnson, MD, professor of pediatrics and biomedical informatics at Vanderbilt University School of Medicine.


Sponsor Updates

  • Black Book Rankings names Streamline Health’s Looking Glass ECM system as #1 in the “Document Improvement” category of “Financial Products and Services.” Also #1 in its category is PatientKeeper in the “Charge Master” and “Charge Capture” categories.
  • Netsmart is providing CareManager to the Early Connections Network in Tennessee.
  • Levi Ray & Shoup announces its MFPsecure pull printing software that enables secure delivery for Ricoh devices.
  • Craneware earns HFMA Peer Review Designation for five products for the tenth consecutive year.
  • Agilum Healthcare Intelligence introduces its new website and BI solutions.
  • Health Catalyst posts a video demonstration of its new Financial Management Explorer.
  • MedAssets introduces the first module of it revenue cycle analytics suite Contract Analytics during the 2014 HFMA National Institute in Las Vegas.
  • Vital Images releases VitreaExtend advanced visualization solution that supports up to three simultaneous users.
  • Navicure launches BillingBetter.com to connect medical billing companies and practices and provide education resources on billing.
  • MedAssets unveils the next generation of Decision Support Costing and Contracting this week at the 2014 HFMA National Institute in Las Vegas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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June 24, 2014 News 1 Comment

Monday Morning Update 6/23/14

June 22, 2014 News 2 Comments

Top News

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HHS Secretary Sylvia Burwell reorganizes the staff of Healthcare.gov in preparation for the next open enrollment period that starts in November, hiring Andy Slavitt of Optum (above) as CMS principal deputy administrator. Optum helped fix Healthcare.gov after its disastrous rollout. Slavitt fills the vacant position that places him as second in command to CMS Administrator Marilyn Tavenner, replacing Jonathan Blum, who left the agency in April. Burwell also announced plans to hire a Healthcare.gov CEO and CTO.


Reader Comments

From Dingo Boot: “Re: HIStalk Practice. I took a break from reading but I’m back. A double dose of industry news there and on HIStalk gives me an edge, I think.” Thanks. Jenn is doing an amazing job on HIStalk Practice. She is contributing in other less-obvious ways and will most likely become more visible on HIStalk.

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From The PACS Designer: “Re: the bionic pancreas. A new concept to help with Type 1 diabetes has been announced by Boston University. The bionic pancreas device uses uses a smart phone, glucose monitor, and insulin pump to automatically control blood sugar levels.” Quite a few groups were working on the concept, including University of Virginia, but what’s different about this device is that it can manage both high and low blood glucose because it is loaded with both insulin and glucagon. This one’s getting coverage because it was mentioned in a NEJM article describing results from a tiny study of 52 patients over five days. It avoids finger sticks by using a continuous glucose monitor and lets the patient describe what they just ate, such as a “typical breakfast” or “small bite.” Most interesting is that the system doesn’t know or care what type and dose of insulin the patient has been administering since it’s measuring blood glucose continuously – all it needs is the patient’s weight and their descriptions of meal size.  


HIStalk Announcements and Requests

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Epic supports interoperability as well or better than its competitors, according to 75 percent of a large number of poll respondents (630). Quite a few thoughtful and informed comments were left on the poll, many of them non-anonymously. I’ll excerpt a few that are from real-life experience rather than the more common sideline Epic bashing or cheerleading:

I’ve worked with several vendors over the years and plenty of HIEs. At the end of the day, Epic connects to other Epic facilities or to non-Epic just fine. Epic to Epic is priceless and effortless. More than 50 percent of the patients in the US today are or will be using Epic when the current Epic pipeline is implemented. For organizations that are not Epic, we expect them to connect to a commercially available HIE or to the federal level HIE (eHealth Exchanged managed by Healtheway). We have no plans to connect our Epic system to other EHRs directly, not when the states and fed are encouraging and incenting us to connect to HIEs.

Epic has already built and tested connections to a wide variety of other vendors, so that implementation is rather easy. Epic notifies us when a new vendor connection is available and we are eager to proceed based on prior success. When configuration changes are found, Epic promptly addresses and tests changes, so there is no finger pointing or project delays. Epic is dedicated to interoperability in a way that I don’t see from a variety of other EHRs. Interoperability projects with Epic will be delivered in a fraction of the time and at a fraction of the expense of many other vendors

My experience with Epic and Direct messaging to date is less robust than some other vendors. At this point in time, Epic can only send and receive CCDA documents — other enclosures like notes, radiology reports, discharge summaries, .wav files — are unable to be sent from Epic to other EMRs. I have seen other EMRs be able to send us different types of information, including free text notes (like an email) and we cannot process them. So in this regard, Epic has lower performance than other vendors.

Our hospital connects with other Epic facilities, local, state and national government organizations and we are currently working on connecting with non-Epic entities. Whether we connect via Query/Retrieve or interfacing, Epic has always been extremely knowledgeable and helpful in assisting us to link to Epic or non-Epic entities.

Very impressed with Epic interoperability. They do it the best of any vendors we’ve had to work with. If we are frustrated its the lack of real standards across the industry. Id like to see true semantic interoperability.

Epic has the ability, but not the will to interface with other vendors. As one of those vendors, our customers are not getting what they need to support their workflows in specialty areas when Epic declines to provide interfaces to vendors supporting specialty areas.

New poll to your right (or here): have you as a patient had a video-based “visit” in the past year? Vote and then click the “Comments” link to describe.

Listening: new from Mali Music, also known as 26-year-old Kortney Jamaal Pollard from Savannah, GA. His heartfelt lyrics are always uplifting and often religious, while musically it’s mostly neo-soul with some light rap thrown in. It’s likely to polarize people who react strongly to some aspect of his work, which I did: I loved it. Coincidentally sticking with the Georgia theme, I’m also listening to the defunct, Athens-based Magnapop.

firsthistalk

Saturday was the summer solstice, which means it had more hours of daylight than any day of the year. It also reminded me that Friday marked 11 years since I wrote the first HIStalk post. Several of the folks who have recently recommended me on LinkedIn have been readers since the beginning, or at least nearly so, with quite a few going back to 2005 or 2006. Thanks for reading regardless of how long you’ve been doing so. I’m lucky to be doing something that gets me so excited every single day that I can’t wait to get started.


Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Sales

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Centegra Health & Wellness Network chooses Valence Health to provide infrastructure and support for its clinically integrated network.


Government and Politics

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FDA publishes draft guidance stating that won’t enforce regulatory controls on Medical Device Data Systems (MDDS) because they pose low risk to the public and are important for advancing digital health. MDDS are medical devices that transfer data electronically (such as from a ventilator to an EHR), store and retrieve data (blood pressure readings), convert data using preset specifications (pulse oximeter data to printed form), display data (displaying a patient’s EKG), or store or communicate medical images. Only apps that control other medical devices would continue to be regulated. The 60-day comment period is open.

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ONC will present a webinar on Thursday, June 27 at 1:00 ET on how to implement digital privacy notices on websites. PatientPrivilege won ONC’s contest to create compelling, easy to implement online NPPs – its example shows how one might look.

A Huffington Post article talks up Blue Button (and Humetrix’s iBlueButton) as a way for veterans to work around the never-ending DoD-VA EHR fighting, saying it’s easier for veterans to just download their own information and take it to whoever they’re seeing, including private practice doctors.


Other

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Niko Skievaski, the guy behind “Struck by Orca: ICD-10 Illustrated” (you have more time to buy it now that ICD-10 is delayed) has made the Breadcrumbs knowledge management software available for free. Users can ask questions and receive answers from the health IT community, members of which earn reputation points from the moderators.

A BMJ essay says evidence-based medicine is having a crisis, postulating that its promise isn’t being met because: (a) drug and device vendors have hijacked the process by manipulating clinical trials and publishing only favorable research to create “evidence”; (b) the amount of available evidence is unmanageable for practicing physicians, even with technology help; (c) the low-hanging fruit of managing established diseases has already been picked and the emphasis has moved to industrial-scale screening that may involve unexpected opportunity costs or unintended consequences; (d) less-skilled or lazy doctors may treat by template rather than by using experience and judgment; (e) EBM gives bureaucrats a way to impose rules that marginalize the physician’s skill and eliminate the opportunity for the patient to be involved in the decisions made about them; and (f) EBM works best for a single condition, which isn’t usually the case. The authors plea for a return to “real” EBM that uses the physician’s judgment, involves the patient, resists the use of “evidence” created by special interests, and places ethical care as its highest priority.

I’m fascinated that Google just bought home security and camera vendor Dropcam for $555 million in cash. The Wi-Fi video service offers live streaming, two-way talk, alerts, and night vision. Naturally I was thinking about healthcare uses, such as monitoring processes (like in the OR, pharmacy, etc.) or as a patient advocate wisely unwilling to leave a loved one lying in a hospital bed surrounded by potential misadventure. The company has lots of competitors, but their product looks simple to set up and my interest was more in the concept rather than the specific product. On the Big Brother side of the argument, I can just see a clueless, overly controlling Dilbertesque IT director demanding that work-from-home employees have the camera trained on their chairs at all times.

A video from Missouri Economic Development highlights Cerner’s program to hire military veterans.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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June 22, 2014 News 2 Comments

News 6/20/14

June 19, 2014 News No Comments

Top News

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The American Hospital Association urges CMS and ONC to quickly adopt plans that were identified in its Notice of Proposed Rulemaking that would give hospitals flexibility in the combinations of EHR certification and Meaningful Use stages that are permitted for 2014. AHA observes that the proposals are last minute given that the last FY2014 reporting period is July through September 2014 and the NPRM’s comment period won’t be finished until that reporting period is underway, meaning that “hospitals are essentially being asked to act on faith that the agencies will finalize these proposals as written while risking that they may not.” AHA also wants the 2015 reporting period shortened to 90 days and to avoid setting a firm October 2016 start date for MU Stage 3 given that “fewer than 10 hospitals and 50 EPs had attested to Stage 2” as of mid-May.


Reader Comments

From Clueless About HIT: “Re: magazine’s Top 100 ‘HIT’ vendors. Many represented their revenue from payers, life sciences, and government health as ‘HIT.’ This includes Cognizant, Optum, Infosys, TriZetto, Syntel, and Edifecs. Either these vendors are clueless about what ‘HIT’ means or they are deliberately misreporting. It also speaks volumes about publications that come up with these lists.” I never even look at those lists, to be honest. They’re great for the magazines who make them up to sell ads, but even if the numbers are accurate (and that’s obviously dependent on interpretation), who cares? Bigger vendors aren’t necessarily better vendors, and anyone who would make a buying decision based on a company’s annual revenue is likely to be disappointed. I think I’ll sell spots on a “Coolest Vendor” list and donate the proceeds to charity – at least some good would come from it.


HIStalk Announcements and Requests

This week on HIStalk Practice: ARcare CIO Greg Wolverton talks agility and mandatory EHR training. Virginia’s "people problem" gets in the way of HIE. Mobile access to EHRs takes a back seat to workflow. Physicians may be the biggest barrier to HealthKit’s success. Dr. Gregg pontificates on the inevitability of change. The Brookings Institution highlights the top challenges of Medicare ACOs. ONC leadership changes have some questioning the longevity of the Meaningful Use program. Thanks for reading.

This week on HIStalk Connect: Former National Coordinator Farzad Mostashari, MD, launches a startup that will focus on optimizing EHRs for primary care practices interested in joining an ACO. Dr. Travis discusses the promising but very new telecharting market. In an effort to keep up with Apple and Samsung, Google will unveil its new health data platform at next week’s Google I/O developers conference. Mr. HIStalk interviews Colin Konschak, CEO of Divurgent.

Listening: Birdy, the 18-year-old singer-songwriter from England who has recorded several international hits and contributed a track to “The Hunger Games.”


Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Acquisitions, Funding, Business, and Stock

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BlackBerry reports a surprise quarterly profit and announces the Passport, which CEO John Chen says is either the world’s smallest “phablet” or its largest phone. It features a hardware keyboard at a 4.5-inch square display. The device will be marketed to healthcare users, which is a key target of the struggling BlackBerry.

Vocera opens an office in Dubai, UAE.


People

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Fraser Bullock (Sorenson Capital) is elected chairman of the board of Health Catalyst, replacing David A. Burton, MD.  

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Valence Health names Tony Gutierrez (Missouri Care) as VP of operations of its health plan division and Jack Risenhoover (Napier Healthcare) as VP of business development.

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Kryptiq hires Jacquelyn Hunt, PharmD, MS (Bellin Health System) as chief population health officer.

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AirStrip appoints Orlando Portale (Palomar Health) as chair of its newly created Innovation Advisory Board.


Announcements and Implementations

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Aprima will offer dashboardMD’s performance management and BI reporting tools.

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Kareo offers medical practices a guide for registering for the VA’s “Accelerating Access to Care Initiative,” which allows them to serve VA patients who can’t get appointments for primary or specialty care.

In England, Cerner launches a SaaS version of Millennium for smaller NHS trusts (under 500 beds) that can’t afford its system otherwise. The company says it’s similar to a US version used by 70 hospitals.

Athenahealth announces that its users account for 59 percent of the 485 providers who have attested for Meaningful Use Stage 2 even though its market share is les than 3 percent.

Hartford HealthCare’s Integrated Care Partners goes live with High Line Health’s Visual Analytics Platform for population health management and value-based care.

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California Telehealth Network chooses HealthFusion’s MediTouch as its first EHR partner.


Government and Politics

Governors of several New England states say they will explore sharing prescription data to thwart doctor-shopping drug seekers who cross state lines. 

ONC will present a webinar on the FDASIA draft report on Friday, June 20 at 3:00 p.m. Eastern.

The US House Energy & Commerce Committee’s 21st Century Cures seeks guidance on how the vision of a digital health ecosystem (mobile apps, EHRs, cloud, and big data) can be realized to create new treatments and cures. Public input is solicited to cures@mail.house.gov. The group will convene a roundtable in Washington, DC on Tuesday that includes Jeffrey Shuren, MD, JD (director, FDA’s Center for Devices and Radiological Health), Martin Harris, MD (CIO, Cleveland Clinic), Jonathan Bush (president and CEO,athenahealth), and Joseph M. Smith, MD, PhD (chief medical and science officer, West Health.)


Innovation and Research

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Apple files patent applications that include an iPhone receiving sensor data — including from at least one that’s worn and not part of the iPhone — and calculating a “personal scorecard” and triggering alarms.


Other

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The Wall Street Journal profiles Flatiron Health, which gathers de-identified treatment and outcome data from cancer centers to give doctors visibility into how treatments are working for the 96 percent of patients with cancer who aren’t enrolled in a clinical trial. The 28-year-old co-founder, who with his Flatiron Health co-founder sold their advertising technology company to Google in 2010 for $81 million, says it was hard to get the cancer center CIOs and doctors to contribute information they considered proprietary. The company has 105 employees, has 200 cancer centers on board, and received a $130 million investment from Google in May 2014, using some of the money to acquire oncology EHR vendor Altos Solutions.

A survey by FICO (the former Fair Isaac) finds that 80 percent of people want to communicate with their providers via smartphone, while 76 percent would like medical appointment reminders and 69 percent say they want appointment scheduling and medication reminders.

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Rady Children’s Hospital (CA) exposes the information of 14,000 patients when employee accidentally attaches a worksheet to emails sent to six job applicants.

A Huffington Post report calls out for-profit hospices that make up nearly 60 percent of the total, including 6,100-employee Vitas, which was bought out for $406 million in 2004 by the parent company of Roto-Rooter. Companies are accused of upcoding, sending marketers to find dying hospital inpatients to sign up quickly, enrolling patients at Medicare’s expense who were healthy enough to play golf, treating patients against their will, and having a high rate of safety and patient care violations. Experts say the problem is that Medicare pays set day rate, encouraging hospitals to enroll patients who don’t require their services and provide higher levels of services than the patient needs. Medicare’s data shows that non-profit hospice had an average length of stay of 69 days vs. 105 days for for-profits.

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Fletcher Allen Health Care (VT) will change its name this fall to The University of Vermont Medical Center.

A North Carolina business paper mentions the status of EHR deployment in the state. Wilmington Health is about to go live with NextGen, New Hanover Regional Medical Center is expanding Epic to give inpatients access to MyChart, and Novant is expanding Epic use throughout its facilities. Tad Dunn, CIO of New Hanover, says 70 percent of the citizens of North Carolina now have a chart in Epic.


Sponsor Updates

  • Connance announces the Analytically Optimized Revenue Cycle, predictive analytic and workflow strategies to increase cash 10-30 percent and reduce cost up to 25 percent.
  • Elmhurst Clinic (IL) shares how its use of healthfinch RefillWizard has led to happier doctors.
  • Nuance announces that Valley Medical Center (WA) gained $2.2 million in revenue by using its Clintegrity 360 clinical documentation improvement program.
  • Fujifilm Medical Systems USA will demonstrate the latest version of its Synapse Cardiovascular and it Synapse Mobility mobile ap, which will allow viewing of non-DICOM information from its vendor-neutral archive in EHRs such as Epic, at the American Society of Echocardiography meeting in Portland, OR starting this weekend.
  • Sagacious Consultants will participate in the HFMA ANI 2014 in Las Vegas June 22-24.
  • Predixion is recognized as a Challenger in the Advanced Analytics Market by Hurwitz & Associates.
  • Texas Pulmonary & Critical Care Consultants is experiencing increased doctor collaboration since going live on pMD Messaging.
  • Texas Children’s Hospital shares how it improved appendectomy outcomes using Health Catalyst’s analytics solutions.
  • InterSystems expands its New York City office.
  • Aspen Advisors celebrates its eighth anniversary, adding 10 clients this year.
  • Divurgent announces the addition of Cost to Collect service to its Revenue Cycle Management Practice solution.

EPtalk by Dr. Jayne

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Quite a few readers responded to my recent Curbside Consult regarding a telemedicine solution a potential part of an employee benefits package. One made a very good point:

I read your recent op piece on the new “benefit” your HR department is trying to roll out to employees. I wondered what issue they were trying to solve, other than be on the “bleeding” edge of offering this service? If the employees have an access issue, seems like the first step would have been to meet with medical staff leadership and brainstorm alternatives. I’m just a CIO with no clinical background so I can’t bring a clinical perspective to the discussion, but the one that I always tell my colleagues I do have is that of a patient and how our decisions are viewed through those “lenses.” In this case, I wonder how someone I don’t know and have never met will understand me within the full context of my medical history and current environment and can deliver better quality and outcomes than someone who does.

That’s a very good point and one that was brought up to some degree in our committee’s discussion. It also makes a good point about IT solutions. In general, it’s good practice to understand the business problem you’re trying to solve prior to looking at vendors. In our case, the business problem is that we’re notoriously cheap. Our employees haven’t had raises in years (blamed on MU-induced belt tightening). Many of us suspect they’re trying to use this as a way to make up for what we’re lacking in salary or other retention perks. Another reader wrote:

As a long-time practice administrator in hospital systems, I totally agree with your reaction. The med exec committees will have a heyday and make life miserable for the hospital administrators. Aren’t we all trying to keep care within our own “families?”

Another physician reader referred to the story as, “Almost Dilbert material, except there are too many layers of absurdity.” I almost spit coffee on my keyboard as I read that because I had to withstand the pointy-haired boss in a previous life. The need for patient privacy was also a recurring theme:

At our facility, we have an aggressive strategy to significantly incent our employees to receive care within our network. The loudest noise we hear on this topic is what you alluded to – patient confidentiality. It is cited as the #1 barrier to our employees seeking care with us.

Readers also sent plenty of tips about nice seaside locations where I could consider practicing. It’s looking awfully tempting. Another travel-savvy reader sent me this article about the urgent care clinic that recently opened. Since the airport already has a liquor store in the baggage claim area, it was only a matter of time. They do offer hangover remedies including intravenous fluids, vitamin B12, and oxygen. I wonder if Chicago O’Hare will offer the same options for HIMSS15 travelers? Not likely.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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June 19, 2014 News No Comments

Morning Headlines 6/16/14

June 15, 2014 Headlines 5 Comments

Cumberland Consulting Group Acquires Cipe Consulting Group

Nashville,TN-based Cumberland Consulting Group acquires Cipe Consulting Group, a Seattle-based firm that specialized in EHR and Revenue Cycle projects.

Is Meaningful Use Becoming the Next ICD10?

Eric Boehme, associate director of informatics at Vanderbilt University Medical Center, questions the future of the EHR Incentive Program after MU Stage 2 is delayed, ONC National Coordinator, Farzad Mostashari, CMS Administrator, Marilyn Tavenner, and the HSS Secretary, Kathleen Sebelius all resign, and ONC’s stimulus funding begins to dry up.

Lack of input, training created problems with Athens Regional electronic records system

A local paper reports that two Cerner VP’s and the hospital’s own CMO are blaming the IT department at Athens Regional Health System for its failed $31 million implementation, saying that IT-led installs are atypical and that the clinicians that would ultimately be the primary end users should have made many of the decisions that were being made by IT leadership.

Beware Bad Data About Hospitals

Johns Hopkins’ patient safety expert Peter Pronovost, MD, PhD publishes an editorial on the unregulated and often confusing state of hospital quality data.

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June 15, 2014 Headlines 5 Comments

Monday Morning Update 6/16/14

June 14, 2014 News 3 Comments

Top News

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Cumberland Consulting Group will announce Monday that it has acquired Cipe Consulting Group, a 50-consultant, Seattle-based EHR and RCM consulting company. Franklin, TN-based Cumberland has 230 consultants.


HIStalk Announcements and Requests

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Responses to my poll about meeting attendance in the next year indicate that it’s the HIMSS conference (33 percent) and vendor user groups (26 percent) well out front, followed by CHIME (9 percent) and then a scattershot of other meetings with low percentage numbers. New poll to your right: how well does Epic support interoperability compared to other EHR vendors? After you vote, click the “Comments” link at the bottom of the poll to explain why you think so.

Things you can do to help me with HIStalk: (a) read HIStalk Practice and HIStalk Connect; (b) support my sponsors by checking out their ads, reviewing the listings in the Resource Center, and using the RFI Blaster for any consulting needs; (c) review the archived educational material on HIStalkU; (d) send me anything readers would find useful – people I should interview, conferences I should attend, and of course news, rumors, and fun stuff; and (e) tell people you know about HIStalk since I don’t advertise and nobody will hear about it otherwise. Thanks for reading HIStalk even though I started writing it in 2003 just for myself and it was mostly that way for years.


Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Acquisitions, Funding, Business, and Stock

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Streamline Health Solutions reports Q4 results after a delay involving an auditor change and an internal controls audit: revenue down 3 percent, EPS –$0.14 vs. –$0.63.


Announcements and Implementations

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IT gets the blame (at least from non-IT people looking for a scapegoat) for the failed $31 million Cerner implementation at Athens Regional Health System (GA). The hospital’s chief medical officer says users weren’t well trained and the CIO was holding back information, while Cerner claims IT was running the project without getting users involved. The CEO and CIO were forced out after physicians protested.  My suspicion is that the medical staff docs were already mad at administration over something unrelated, refused to participate, then capitalized on go-live challenges to get the CEO fired. The CIO was probably collateral damage since an IT system was the claimed problem.


Government and Politics

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Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA) ask unnamed stakeholders for ideas on how the use of government healthcare databases can be expanded. Chuck asks a lot of questions and writes a lot of letters, but that’s usually the last you hear about it.

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Vanderbilt University Medical Center’s Eric Boehme, associate director of informatics, worries that the already-complicated Meaningful Use timetable could take an unexpected turn between the recent Notice of Proposed Rule Making and the actual rule, as in what happened with ICD-10. He also takes an interesting long view: “This is all too late and too little. MU is in trouble. Two powerful committees in Congress asked for a pause for MU to evaluate the success of the program and to emphasize the lack of true interoperability. ONC has lost a significant portion of its funding as the stimulus money dries up. Recently, some members of Congress questioned how much ONC should regulate HIT. ONC National Coordinator, Farzad Mostashari, CMS Administrator, Marilyn Tavenner, and the HSS Secretary, Kathleen Sebelius have all resigned.”


Other

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A Wall Street Journal editorial by patient safety expert Peter Pronovost, MD, PhD of Johns Hopkins Medicine urges consumers to “Beware Bad Data About Hospitals” in the current “Wild West” environment in which “there are greater protections about what claims we can make about toothpaste than a hospital or measurement organization can make about quality of care.” He recommends creating the equivalent of a Securities and Exchange Commission to oversee development and use of quality indicators. Until then, he suggests that consumers use only composite scores such as those from The Leapfrog Group and Consumer Reports. He concludes with a simple plea: “There really is very little useful information on pricing. There should be.”

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An unnamed IT system goes down at Fletcher Allen Health Care (VT) Friday morning, forcing the hospital to go to paper.

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The Detroit newspaper profiles Sorie Kanue, a former Michigan State football standout and team captain (playing safety) who worked in IT after college and then went to nursing school. He has been named nurse of the year twice at Detroit Medical Center’s Heart Hospital and is working on his MSN.

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Fortune profiles Elizabeth Holmes, who as a Stanford sophomore in 2003 founded blood diagnostics company Theranos, which now has 500 employees and a valuation of $9 billion. When questioned by her professor about why she wanted to start a company, she answered, “Because systems like this could completely revolutionize how effective healthcare is delivered and this is what I want to do. I don’t want to make an incremental change in some technology in my life. I want to create a whole new technology, and one that is aimed at helping humanity at all levels regardless of geography or ethnicity or age or gender.” The company’s product can run dozens of tests from a single, tiny sample of blood drawn via pain-free finger stick, and the company’s app supports its pledge that “we believe you have the right to your own health information” and “answers at the speed of digital.” Test cost is as little as a tenth of what hospitals charge. Walgreens will put the company’s labs in many of its drugstores, but Theranos is also working with UCSF, Dignity Health, and Intermountain. Holmes says patients don’t have 40-60 percent of lab test orders drawn because of the pain or inconvenience involved.

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”The Daily Show” invites a group of Google Glass fans to defend their worship of the technology, include one woman who claims that she was a victim of a hate crime because she wore Glass into a bar and filmed fellow patrons without their permission, eliciting their angry taunts as she cursed at them and announced while recording, “I want to get this white trash on tape for as long as I can.” The same woman’s neighbors had previously filed a restraining order against her for recording their private conversations. She and her fellow Glassholes probably should have stayed home: after hearing that Glass early adopters are called Explorers, the host responds, “Magellan was an explorer. Chuck Yeager was an explorer. You guys have a %&@! camera on your face.”


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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June 14, 2014 News 3 Comments

News 6/13/14

June 12, 2014 News 13 Comments

Top News

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ONC announces that Chief Privacy Officer Joy Pritts, JD has resigned after four years on the job.


Reader Comments

From Anonymous Tipster: “Re: Wayne Tracy on VistA. I agree it would be a tragic shame to see VistA replaced. Unless Epic were to make some dramatic changes in its approach to interoperability, this could be a disaster for the VA. Anyone who has ever suffered through a migration to Epic could tell you how difficult this can be from a workflow perspective (not to mention cost overruns). You think there’s backlog now? Remember the iEHR project that died? It’s an election year and the money is rolling in big time from lobbyists  — maybe Epic will even begin to divert some of its campaign dollars to Republicans).” The DoD’s IT efforts have been financial disasters, with AHTLA and its predecessors rumored to have cost $10 billion. The VA has done very well with VistA, but its more recent efforts involving government contractors (BearingPoint’s CoreFLS at Bay Pines) were spectacular failures, so there’s no guarantee that VistA wasn’t a one-trick pony. It’s also true that DoD and VA don’t agree on anything despite their common responsibility in caring for active service members who eventually (hopefully) become veterans. Kaiser had to pull the plug on its IBM-developed system that cost hundreds of millions of dollars and replace it with $4 billion or so worth of Epic, so that’s an interesting IBM-Epic partnership (I can’t imagine Epic letting IBM tell its 25-year-olds how to implement.) Add replacing VistA to DoD’s $11 billion project and you’re probably talking about $30 billion worth of overruns, delays, and potential patient harm as the VA and DoD are forced to smoke their first-ever HIT peace pipe – that number has substance since the DoD walked away from iEHR because it was going to cost $28 billion and nothing involving the federal government ever comes in on budget, especially if the military is involved. Britain’s failed NPfIT has been called one of the most expensive government IT projects in history at around $17 billion, so we’ll beat that for sure. One final thought: Epic’s Judy Faulkner and InterSystems’ Terry Ragon are already healthcare billionaires as sole owners of their hugely successful private companies — an IBM-Epic DoD deal would certainly raise the numeric placeholder in front of their billions.

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From Expandable Beltway: “Re: DoD bid. Cerner is teamed up with Accenture.” Unverified. I am getting anxious to hear what Dim-Sum has to say. Lorre would love to get him or her to present a webinar on the DHMSM topic, for which I would even arrange one of those voice-changing gadgets.

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From Cool Runnings: “Re: Benefis EHR RFI. They use Meditech inpatient and replaced LSS with NextGen a few years ago. NextGen is taking a hit in Montana – a small hospital sued them, Bozeman Deaconess is rumored to be switching from Meditech/NextGen to Epic, and Community Medical Center in Missoula is merging with Billings Clinic, which very likely means a move from NextGen to Cerner Ambulatory.  I’ve heard that Benefis is talking to athena, but may be leaning toward looking for an integrated solution instead of just an ambulatory switch.” Unverified, but I should have checked Meditech’s online customer list, which would have told me that Benefis runs its soon-to-be-gone systems.  


HIStalk Announcements and Requests

It’s time to say goodbye to Inga, who has moved on to greener pastures after seven years of contributing to HIStalk and HIStalk Practice. She finished working on the sites in April and has finally tied up her last loose ends. Rumors that she is launching a healthcare shoe division of Christian Louboutin may or may not be unfounded, but we will wish her well in any case. Jennifer Dennard took over writing HIStalk Practice several weeks ago, while Lorre is happily handling the non-writing HIStalk chores.

This week on HIStalk Practice: ONC’s 10-year vision statement on interoperability prompts CommonWell to up its game. Several trade associations line up with telemedicine-related requests for new HHS head Sylvia Burwell. ARcare receives the HIMSS Analytics Stage 7 Ambulatory Award. Epocrates ranks number one again. HIT Policy Committee meeting numbers show $24 billion in MU incentive payments so far. Jim Morrow, MD gives healthcare IT its due as an independent physician. Wesley Medical Center docs face employment ultimatums. Northern Virginia launches the HeaLiXVA HIE. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the concept of patient ownership of health data, its benefit to public health in general, and the role that Apple and Samsung will play in advancing the concept. ZocDoc expands its business model to include corporate wellness services. Autism Speaks signs a deal with Google to create a database that will store 10,000 fully sequenced genomes in the cloud, where researchers across the globe can access the data.


Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.


Acquisitions, Funding, Business, and Stock

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Imprivata sets terms for its $75 million IPO that values the access management company at around $400 million.

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KeyBanc downgrades shares of CPSI, saying that Healthland is strong in the small-hospital market and that Epic’s Community Connect program is making it a competitor there as well.

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Elsevier acquires Amirsys, which offers clinical decision support and learning tools for radiology, pathology, and anatomy that will be integrated with the Elsevier Clinical Solutions suite.

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Mediware acquires Harmony Information Systems, whose systems help state and local agencies track long-term care policies.


Sales

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The State of Vermont signs a six-month $5.69 million contract with OptumInsight for evaluation, remediation, and operations support for its health insurance exchange.

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In England, Oxford Health NHS Foundation Trust awards a five-year, multi-million pound contract to Advanced Health & Care to develop an EHR that up to 3,500 clinicians will use on iPads. Oxford Health provides services for mental health, home care, children and family, and substance abuse.

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Irving, TX-based USMD chooses the population health management platform of Lightbeam Health Solutions for its ACO and other risk-based programs. I interviewed Lightbeam CEO Pat Cline three weeks ago.


People

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IMDsoft names Lars-Oluf G. Nielsen (Epic) CEO.


Announcements and Implementations

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Estes Park Medical Center (CO) goes live on Medhost EDIS.

UPMC (PA) will deploy 2,000 Microsoft Surface Pro 3 devices to deploy its Convergence app, which UPMC says it first tried to roll out on the iPad without success. Convergence, developed by UPMC and Caradigm, gives clinicians a single view of UPMC’s Cerner and homegrown applications and suggests and monitors compliance with clinical pathways.

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Nevada, MO, Cerner’s testbed for healthy communities, gets a new playground courtesy of the company and the Nevada Parks and Recreation Department.


Government and Politics

CMS reassures taxpayers that the workers who were sleeping on the job at the call center of Serco (which has a $1.25 billion Healthcare.gov contract) are busier now that the site is actually working.

Jon Stewart makes fun of the June 9 testimony of Assistant Deputy VA Under Secretary Philip Matkovsky, in which Matkovsky says in in the deadest of deadpans, “Our scheduling system scheduled its first appointment in April of 1985. It has not changed in any appreciable manner since that date.”

It isn’t just the VA that has an appointment problems. England’s NHS backlog hits three million patients who are waiting for appointments, not even counting six trusts that couldn’t report data because of computer problems. Still, NHS squeaked by in meeting the requirement that it treat 90 percent of patients within 18 weeks. As with the VA, increasing demand could cause NHS to start missing its goals routinely.

OpenFDA was possible only because the agency used a startup’s technology to turn its document backlog into discrete data. Captricity uses a combination of optical character recognition and crowdsourcing the unreadable parts by giving human reviewers “shredded” sections so they don’t see entire Social Security numbers or full names, preserving confidentiality. Pricing runs around 15 cents per page.


Innovation and Research 

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Device maker Medtronic says every person will eventually want sensors implanted in their bodies that will generate data for self assessment, remote monitoring, and disease management. The company is testing a pill-sized cardiac pacemaker and has already released the Linq insertable cardiac monitor that’s the size of a AAA battery and uses cell technology for remote cardiac monitoring.


Other

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Via Christi (KS) asks for patience as it tries to recover from slowdowns caused by its Cerner Millennium go-live, with one patient reporting a 12.5-hour wait to get from the ED to a bed.

A McKesson-sponsored report predicts that value-based payments will double within five years, to two-thirds of the total.

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AMA approves guidelines recommending that limitations on physician payments for providing telemedicine services be removed as long as a valid patient-physician relationship has been previously established, the physician is licensed in the patient’s state and follows that state’s laws, and standards are followed the same as for in-person encounters.

CHIME and AMDIS announce an alliance in which CHIME will provide health IT support to AMDIS and AMDIS will provide physician informatics advice to CHIME. The organizations recently jointly offered the CHIME/AMDIS CMIO Boot Camp, modeled after CHIME’s longstanding CIO Boot Camp.

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Georgia Regents University will host the week-long NLM Georgia Biomedical Informatics Course September 14-20 at the Brasstown Valley resort in Young Harris, GA. Applications are due July 7. The nationally known faculty will teach change agents (biomedical educators, medical administrators, faculty, and others who don’t have knowledge of the field but who can spread the word) how to apply informatics solutions such as clinical informatics, big data, and telemedicine to their delivery, research, and education challenges. Enrollment is limited and competitive since the National Library of Medicine will pay for the registration, travel, housing, and meals of those accepted.

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For $2,500, you can buy a report containing a SWAG at the size of the EHR market over the next four years in which the authors clearly don’t have a clue about data precision and presentation. Either that or they are very good at estimating the market to within 0.004 percent. I don’t see them trumpeting proof of previous accuracy.

A hospital in France blames a drug delivery robot’s computer bug for sending $15 million worth of drugs to the incinerator in the past five years.

An English hospital apologizes for the death of an 11-month-old baby whose acute appendicitis was not diagnosed because the samples for ordered tests were not delivered to the lab. A Trust spokesperson said that the pathology computer system has been upgraded to flag specimens ordered but not received.

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Castlight Health co-founder Giovanni Colella, MD (formerly of RelayHealth), says big data rather than government intervention is needed to fix healthcare. He recommends: (a) companies should analyze the claims data from their health plan to see what they’re paying for; (b) gag clauses prohibiting the release of price contracts between insurance companies and providers should be abolished; (c) the government should allow the private sector to use Medicare claims data and physician quality data; and (d) price, utilization, and quality data should be made publicly available in the absence of a compelling reason not to.

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More from Castlight Health: the company releases interactive maps showing national in-network pricing for lipid panel, PCP visit, head CT, lower back MRI (above, which ranged from $676 in Fresno, CA to $2,635 in Sacramento, CA, just 171 miles away by car.)


Sponsor Updates

  • Healthland will offer its hospital customers Meaningful Use Manager of Iatric Systems to help with their Meaningful Use attestation.
  • Grinnel Regional Medical Center (IA) reports a seven percent increase in cash collections, 79 percent of payments made via self-service, and 124 saved hours per month in a two-year review after its go-live with Patientco’s payment automation solution.
  • Impact Advisors and the Scottsdale Institute publish a report from the CIO Summit on IT Cost Management and Value Realization.
  • Sixteen medical innovations were showcased at Premier, Inc.’s Innovation Celebration in San Antonio, TX this week.
  • Quest Diagnostics certifies MedicsDocAssistant EHR v. 7.0 from Advanced Data Systems as a Silver Quality Solution under its Health IT Quality Solutions Program.
  • Janssen Diagnostics collaborates with Halfpenny Technologies to provide specialized reporting for HIV/AIDS healthcare.
  • GetWellNetwork recognizes several providers for using its solutions to improve care at GetConnected 2014 in Chicago, IL.
  • Hills Health Solutions signs a distribution agreement to make Lincor’s interactive patient engagement technology available in Australia and New Zealand.
  • Craneware and Centura Health (CO/KS) will co-present best practices of charge capture during HFMA ANI 2014 in Las Vegas June 24.
  • InstaMed shares how its Premium Payments solution has changed the consumer payment process.
  • Medfusion publishes a white paper on creating patient value through portals.
  • Gartner names Covisint a Leader in Identity and Access Management as a Service.
  • PeriGen CNO Rebecca Cypher will discuss fetal heart rate interpretation at AWHONN 2014 in Orlando June 14.

EPtalk by Dr. Jayne

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This has been a rough week in the healthcare IT trenches. Our medical group has been in acquisition mode again, resulting in the addition of several new specialties. Unfortunately, this time around our EHR vendor doesn’t have content for any of them.

Luckily we’ve been through this enough to have a process in place. Our implementation team sends out a staffer or two to observe the practice’s current state workflow and documentation style. This is essentially a reconnaissance mission. We try to blend in and to avoid having the practice ask us a lot of questions while we gather data.

The team then comes back and makes a presentation to the implementation manager, the application team manager, and me to talk about what their current process looks like and how much we’ll be able to handle with the EHR as-is, without any additional development. Depending on the specialty, it’s hit and miss.

For example, when we added vascular surgery, we were able to handle 95 percent of their needs because we have both general surgery and cardiovascular content. On the other hand, when we’ve added certain pediatric subspecialties, we’ve had to get creative with what we choose to offer them. Vendors haven’t quite figured out that children are not just little adults and it’s not as easy as just having them use adult content with the same specialty name.

For example, pediatric cardiology deals with care for children who have had a variety of surgical procedures that are largely unspoken of in the adult cardiology world. On the flip side, there isn’t very much coronary artery disease or many triple vessel bypass surgeries among the pre-adolescent set.

Often we’re working with physicians who are used to dictating their notes and having them transcribed. We’ve had good success at putting them in our EHR “core” templates for documenting histories, assessments, and plans, but we augment the “story” part of the visit with voice recognition. It’s a hybrid approach, but it prevents us from doing costly development that will only be used by a handful of physicians. It also provides for physician satisfaction in that they’re used to being able to include a detailed narrative in their visit documentation.

We encountered a rare bird this week, however: a subspecialist who seriously believes she’s going to be happy with point-and-click documentation. She wants us to build a whole herd of custom screens for her. She dictates on the hospital system at present and has no previous experience with discrete data.

In our experience with other physicians of the same subspecialty, it’s generally not worth building custom screens. They tend to change their minds before the content is even built. If they don’t change their minds, once they see it, they decide it’s too “clicky,” and 90 percent of the time they end up dictating anyway.

We had our follow-up meeting with her today. We ran through the options and asked her to try some typical click-by-click workflows in the general medicine templates just to get a feel for what it would be like. She wasn’t terribly proficient, so we had her try voice recognition within the system. She did fairly well with that. It was clear to the team that she’ll likely do better with that kind of hybrid approach. The subspecialist was unconvinced, however.

We moved to our next tactic,  which is to ask the physician to use our recommended workflow for a couple of months and then decide if we still need custom content. It was obvious that she was not buying what we were selling. She told us we were just being difficult and didn’t want to do what she asked. She then accused us of trying to skimp on her content for budgetary reasons.

We explained the history with other physicians in her specialty, even trying to show her the content we had previously built that her peers had abandoned. She didn’t want to see that either, but made it completely clear that she expected us to build custom content for her alone. I knew we weren’t going to win this discussion, so we agreed to go back to the office, brainstorm other solutions, then meet up in a few weeks.

In debriefing with the team in the car, we’re not sure what to do for her. We have more than a decade of experience doing this. We know what works and what doesn’t work. However, we have a physician with no EHR experience (and no track record as an end user – she won’t even use the hospital system) who is demanding a certain course of action. My team asked what we should do.

My thoughts went into doctor mode. It feels like the scenario where a patient is demanding an antibiotic where none is indicated, or insisting on a procedure that could potentially be more risky than it is worth. The patient in this case is arguing with the IT-equivalent of our professional medical opinion as to the course of care. In the medical world, we wouldn’t be bullied into doing something that is not of benefit. Not to mention that building clicky screens for a provider who has never been exposed to that documentation style is a recipe for unhappiness.

Our plan is to bring some of her soon-to-be colleagues in the same subspecialty with us to our next meeting and hope that their shared experiences will steer her in the right direction. We’d like her to make the choice herself without us having to flat out reject her request, but I’m not sure how we’ll handle it if she doesn’t start to get on board with our advice. Being new to the group, we know her level of trust of our team is low and her experience with EHR is minimal, so that seems like a logical approach.

I never like disappointing people. It’s always difficult to have those conversations with patients when you deny their requests. It’s doubly challenging when you’re dealing with a peer who might be more senior than yourself, and particularly difficult when they’re in a seemingly more prestigious subspecialty than your own.

In other parts of the physician universe, we’re also dealing with some significant Meaningful Use issues where physicians are requiring retraining and a lot of hand-holding. This was just one more thing to add to the mounting heap of stress.

I polled a couple of my CMIO peers on how they handle these situations. They didn’t have too many better answers. For all our readers on the implementation and content side, what’s your take? Is there a silver bullet solution? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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June 12, 2014 News 13 Comments

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