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HIStalk Interviews Marc Probst, VP/CIO, Intermountain Healthcare

February 1, 2016 Interviews No Comments

Marc Probst is VP/CIO at Intermountain Healthcare of Salt Lake City, UT.

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You have a history of speaking out about Meaningful Use. How has your opinion of it changed over the last several years?

Meaningful Use came out as a stimulus package. Did it stimulate the economy and health IT? It clearly did. If that was the plan, it was successful. Did it get more EHRs in physicians’ offices and in hospitals? It clearly did.

Did it move healthcare dramatically to lower costs, or even incrementally, to lower costs and higher quality? It has not. It has a long way to go, and because of the way we approached it, with check-the-box certification and achievement of Meaningful Use, it just didn’t deal with the underlying challenges of things like standards of interoperability.

The last point on that is simply how much money we’ve spent for the value that we’ve gotten. It’s minimal. All along, I felt we should have dealt with that and that’s why I’ve been so outspoken, a thorn, probably, in the side of my colleagues at ONC.

What was your reaction to Andy Slavitt’s remarks at the JP Morgan Health Care Conference, and then in the follow-up CMS blog?

On one hand, it’s disappointing because we’d like to see the end of Meaningful Use. I don’t speak for every CIO, but the ones I know were kind of excited to see it end. It wasn’t achieving necessarily all the objectives we want to achieve, so that was the negative.

The good side is that the national conversations picked up around what is the value of Meaningful Use and how the program should be changed to become more effective. I think that’s positive. The water under the bridge is how much money we’ve spent and the steps we’ve taken to this point.

The optimist in me things we’re going to have a good conversation about it. We’re going to talk a lot more about outcomes and how organizations can achieve outcomes that are better with technology. If properly done, properly incentivized by the government or not disincentivized by penalties, I think we can make some really important strides.

How would you like to see Meaningful Use transition into something truly beneficial?

I’d like to see it become outcomes-driven. If I can prove to you that I have lowered the incidence of diabetes or some of the clinical outcomes that are associated with diabetes because I’ve used information systems and data to do that, that’s a good thing. It lowers cost for the country and improves healthcare.

If we can do that with diabetes, let’s go to heart disease. Let’s go to incidence of jaundice in or around birth. There’s so many areas we could focus on, and if we turned it to that direction, you’re going to have clinicians and technologists working together to leverage these tools we’ve put in place to improve care and lower cost.

That ought to be our outcome, not whether or not we placed 60 or 90 percent of our orders through CPOE. If we can shift that conversation and then the incentives around that, I can just see massive innovation and much more benefit come out of these systems.

Intermountain is just over two years into its contract with Cerner. How is the partnership going?

It’s going very well. I think like every other organization, our very first go-live was a learning experience. Having to help physicians and other clinicians understand how to use the system was a tad painful. It wasn’t easy. We were Intermountain Healthcare. We thought we knew everything, but we had a few things we had to learn.

We did that last March. We went live with our first two facilities on clinical and rev cycle. That was two hospitals and about 20 clinics. Then we went live in late October with two more hospitals much larger in size, one of them our second-largest hospital.

Then probably 60 more clinics and rev cycle and everything surrounding it. That one went much better because we had learned so much from our first implementation and we’re now ready to go much more quickly. We’re going to probably bring up probably 12 to 15 more hospitals in 2016. We know how to do it better now, so I would say it’s going very well.

If you had to pinpoint one lesson learned that you’d like to share with other CIOs and IT teams, what would that be?

Adequate resources on the clinical side to help physicians adopt their work flows, without a doubt. It wasn’t technical issues. Technically, this thing went swimmingly. It’s all around adoption, use of the system, and changing work flows.

Did you bring in any consultants to help with those initial implementations?

The second one we did. The first one we did all on our own with Cerner’s help. The second one we brought in Leidos, primarily, to really help us get it done. They were very, very helpful. We’ll use them going forward.

What’s the biggest lesson you think your end users have learned or are in the process of learning?

Just how involved they have to be. You must have leadership on all levels. We’re divided into regions and then those regions have multiple facilities in them. That local leadership has to participate. This isn’t something that can be done to them. It has to be done with them. As they participate, our success rate goes way up.

What sort of ROI are you looking to get from your partnership with Cerner?

I don’t think any of us have fooled ourselves into thinking it’s going to be cheaper than our self-developed systems. What we’re getting with Cerner is a much more comprehensive solution. That’s been really positive.

Given that we’ve built systems very unique to the needs of Intermountain, our concern in transitioning to a system we didn’t build was, would we be able to retain that level of … I hate to use the word interoperability … tightness between what we’re doing from data analytics and what we’re trying to do from a process and workflow perspective to obtain those levels of best practice care and cost that Intermountain is known for. It’s actually what drove us to Cerner, because we thought we had a much better chance of doing it with them than we might with one of their competitors.

To date, that’s become much less of a concern. We’ve achieved a lot. We’ve done a lot of work in enhancing the core Cerner model system to have more of those capabilities, so I think our ROI is with this more comprehensive system and the greater amount of data that it provides.

We can go to the next level of best practice care. We don’t think we’ve gotten there. We think we can build in a lot more activity-based procedures and cost mechanisms so that we can even better understand where we’re spending money and where we can lower our costs and improve our quality. That’s really been our focus and that’s where we see the ROI.

The expense of doing something like this … did we lower IS costs or workforce costs? We haven’t really focused on that and we won’t. We know the benefit comes from providing better care and doing it at a cost that’s lower than what we’re doing today.

What is Intermountain looking to accomplish from a population health management standpoint this year?

We’re building a digital health strategy, and so this year we’ll be looking at how to engage patients with portals, mobile, that kind of thing. We’re really building out the strategy on how to do that. To suggest in 2016 we’ll accomplish a ton, I don’t think so. We’re just getting our ducks in a row this year as to how we’ll pull it off.

However, from the data side, we’re looking at understanding where our opportunities are around population health. How do we get to value-based payment and how do we contract with physicians that are going to be moving to population health and value-based care? We’re working with Cerner with HealtheIntent to support that exercise, but we’re also depending upon our legacy electronic data warehouse and traditional analytics.

What will you be looking at on the HIMSS show floor this year?

Security’s going to be a big issue. In fact, I just got out of a meeting to have this call, an all-day meeting that’s got some big players in town talking security.

Also, I think anything around population health and more visible things like portals, mobile, and wearables, that kind of thing. That’ll be pretty interesting to me.

Plus, I’m looking forward to connecting with old friends. I’ve been in the industry a long time and it’s a pretty small one, all things considered. It’s a great industry.

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February 1, 2016 Interviews No Comments

Monday Morning Update 2/1/16

January 31, 2016 News 9 Comments

Top News

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CMS proposes a rule that would allow qualified entities – of which 13 have been approved so far — to provide or sell Medicare and private claims data to providers to support quality improvement. Only two of the qualified entities report provider performance nationally — Health Care Cost Institute and Amino. Physician practices (or employers paying for their services) would be able to review all-payer data for their patients.


Reader Comments

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From Eddie T. Head: “Re: CHIME’s patient identifier challenge. A 100 percent match is unrealistic. Even in countries with a national medical identifier the accuracy is about 95 percent. The 100 percent goal will get in the way of creating a real solution nationwide.”

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From AthenaAscending: “Re: Florida Hospital. Is replacing Epic’s PM/EHR with Athenahealth.” Unverified.

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From Unintended Consequences: “Re: AGH in Pittsburgh. Its Epic acute go-live has created medical care havoc in peripheral LTAC and SNF facilities that had relied on Allscripts Sunrise for order entry and results retrieval. They are not on Epic and have resorted to a 1980s paper requisition and lab retrieval system. Doctors cannot see a list of their patients. AGH’s command team has informed doctors that stat orders must be called in and cases ordered as consultations won’t appear on the consultant’s patient list.” Unverified. 


HIStalk Announcements and Requests

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A reader asked me to post a single summary of my unsuccessful quest to obtain an electronic copy of my hospital stay information, which I’ve done here.

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A surprising 80 percent of poll respondents aren’t fans of the idea of the ONC-published EHR star rating that Congress is considering. Jacob Reider commented that it’s a terrible idea and is outside of the government’s role. Ross Koppel says summarizing complex systems with a single star rating is simplistic. Barbara Hillock thinks such ratings would be misleading since they would be driven by the expectations of customers who don’t always follow the vendor’s implementation recommendations. Meltoots commented that ONC and CMS need to stop getting in the way of patient care with new programs.

New poll to your right or here: how have recent statements from CMS affected your perception of HHS/CMS/ONC?

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

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Mrs. Johnson from Illinois sent photos of her kindergarten class using the math tools we providing in funding her DonorsChoose grant request. She says, “It was so generous of you to help us succeed in getting some of the tools we need to make learning math engaging and fun! The look in these kids’ eyes when I tell them we have something new that will help us learn is motivation for me. I couldn’t have provided these materials on my own and appreciate the support you have given.”

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Epic consulting firm BlueTree Network donated $1,000 to secure a spot at my CIO lunch at the HIMSS conference, which allowed me to fully fund these DonorsChoose teacher grant requests with the help of matching funds:

  • Science activity tubs for Mrs. B’s first grade class in Richfield, NC.
  • Three iPad Minis, cases, and a document camera for the second grade class of Mrs. Mann of West Newton, PA.
  • Electricity and magnetism activity tubs for Ms. Anderson’s fourth grade class in Phoenix, AZ.
  • Two Osmo gaming systems for Mrs. Boyd’s elementary school class in Chocowinity, NC.
  • Three programmable robots and engineering components for the new middle school robotics club started by Mr. Rector in Beebe, AR.
  • STEM challenge kits and for Mrs. May’s special education classes in Edgewater, FL.

HIStalkapalooza

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I have received over 1,200 requests to attend HIStalkapalooza, so I’m closing signups Monday. Sign up now or never. I’ll be able to invite most of the people who signed up. We’ll be handling invitations, RSVPs, reminders, and electronic check-in through Eventbrite this time and I expect the invitation emails will go out this week. This is where the annoying part of throwing a free party begins as it does every year when I vow that this year’s event will be the last because of the time and energy it requires:

  • People will email me asking if they can bring a guest. If you didn’t sign up your guest like the form clearly states, then they can’t come – it’s like going to an Adele concert or traveling on American Airlines –everybody needs a ticket, with the only difference being that HIStalkapalooza tickets are free.
  • I’ll hear from folks who claim to be the most loyal and careful readers who swear they mysteriously missed the dozens of times I’ve provided signup instructions and wanted to be added after the fact. Sorry, no, it’s only a party and your life won’t be ruined if you miss it because you couldn’t follow the rules everybody else figured out.
  • Vendor administrative assistants who don’t read HIStalk and who signed up bunches of their executives (who rarely actually show up) will start bugging us about why they haven’t received invitations. That’s actually already happened as the admin of one company keeps asking why her 23 executives haven’t been invited yet. This isn’t a company outing and we have more important things to do than swap party-related emails, so I’m hitting “delete” on those.

Last Week’s Most Interesting News

  • CMS warns Theranos that its California lab practices are dangerous to patients and that it has 10 days to fix the problems or face suspension from Medicare.
  • Leidos announces that it will acquire the IT business of Lockheed Martin for $5 billion.
  • Cerner Chairman and CEO Neal Patterson notifies shareholders that he is being treated for soft tissue cancer.
  • A Texas hospital regains access to its EHR after being locked out for more than a week by ransomware.
  • Flint, MI-based Hurley Medical Center says it was hit by a cyberattack by hacker group Anonymous, which is protesting the city’s water crisis.
  • Big Bucks Equals Big Interest in CHIME’s National Patient ID Challenge.
  • McKesson’s Paragon Dilemma.

Webinars

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


Acquisitions, Funding, Business, and Stock

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Capital BlueCross orders Theranos to stop performing blood draws in Capital’s storefront in Hampden Township, PA following a CMS investigation that found deficiencies in the California lab of Theranos that “pose immediate jeopardy to patient health and safety.”

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Xerox will split itself into two companies, responding to pressure from activist investor Carl Icahn to separate its $11 billion document imaging business from its $7 billion business process outsourcing. Xerox, which acquired Affiliated Computer Services for $5.6 billion in 2010 and will now basically spin it back off, has 104,000 employees who will be part of the new BPO company. Xerox announced Q4 results with the announcement: revenue down 8 percent (its 15th consecutive quarter of declining sales), adjusted EPS $0.32 vs. $0.31, beating earnings expectations.

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WeiserMazars acquires Lion & Company CPAs, which includes healthcare consulting among its offerings.

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Quality Systems (NextGen) announces Q3 results: revenue down 1.7 percent, EPS $0.16 vs. $0.16, missing on revenue but beating on earnings. Shares dropped nearly 20 percent Friday on the news. Above is the one-year share price of QSII (blue, down 20.7 percent) vs. the Nasdaq (red, down 1.34 percent). Five-year performance looks a lot worse, as Quality Systems shares dropped 67 percent as the Nasdaq gained 67 percent.

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The HCI Group acquires Houston-based Expert Technical Advisors.

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Philadelphia-based orthopedic practice The Rothman Institute and the University of Virginia Health System participate in a $4 million funding round for Locus Health, a remote care management company of which both organizations are customers.

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Meditech publishes its FY2015 annual report. Revenue was down 8 percent for the year (“primarily due to lower product bookings”) and net income dropped from $124 million to $70 million. Neil Pappalardo owns about $450 million worth of shares.  


Announcements and Implementations

Recondo Technology launches MySurePayHealth, which allows patients to estimate their out-of-pocket cost for a given procedure.

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An emerging technology site profiles Valdic co-founder and CTO Drew Schiller as part of its “Today’s Entrepreneur” series, in which he lists his top three lessons learned:  (a) if someone isn’t interested in paying for your product, ask them what they would pay for; (b) reputations follow you, so treat everyone well; and (c) we are so fortunate to be living in an era where it is this easy to start a new company and iterate on ideas.


Government and Politics

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Ashkan Soltani, senior advisor to White House CTO Megan Smith on loan from the Federal Trade Commission, announces that he has effectively been fired after just six weeks on the job when the Office of Personnel Security denies his security clearance. Soltani, whose White House assignment involved privacy, data ethics, and recruiting technologists for government service, previously won a Pulitzer prize as part of the Washington Post investigative team that revealed the extent to which the National Security Agency spies on American citizens.

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This might be the highest-profile bungling of the HIMSS acronym. Pedantic grammarians such as myself smugly note that HIMSS and HIPAA are “acronyms” as opposed to “initialisms” (acronyms are sounded out as words, while initialisms are pronounced as their individual letters, as in “CIA” or “IBM”).


Privacy and Security

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Scientific American’s “How Data Brokers Make Money Off Your Medical Records” contains no new information, but gives the public a glimpse at how companies are buying and selling their de-identified medical information. It mentions IMS Health, which takes in $2.6 billion per year by combining and repackaging information on 500 million people worldwide and then selling insights to drug companies and other to help them target sales. It repeats the now-obvious concept that it’s not hard to re-identify people by linking multiple databases. Drug company Pfizer spends $12 million per year to buy health data, but even its own analytics director says patients own their data, should be told how it’s being used, and should be given the ability to opt out of data that’s being collected for purely commercial purposes.


Technology

A Fast Company article describes the use of robots in long-term care, giving as an example Luvozo’s SAM “robotic concierge” that uses remote care staff. 


Other

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A good interview with WebMD’s dethroned founder Jeff Arnold, now CEO of Atlanta-based Sharecare, describes how the company uses individual results from its acquired RealAge health questionnaire to push content to users. Sharecare also offers personal health consultations via its AskMD app and publishes a voice-analyzing app to detect stress. On the downside, the company’s co-founder is the pseudo-medical huckster Dr. Oz.

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Kaiser Health News describes the enthusiasm patients of Newport Orthopedic Institute are expressing for the empathetic, automated post-surgery daily emails they receive from the practice’s HealthLoop system. The article provides an example of a knee surgery patient who responded to a system-generated, emailed question about calf pain, which triggered his doctor to see him immediately and diagnosis his dangerous blood clot.

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The Hurley Medical Center pediatrician who uncovered the human effects of the Flint, MI water crisis credits the hospital’s Epic system and EHRs in general for allowing her to quickly discover the increasing number of children with high levels of lead in their bloodstream. “If we did not have Epic, if we did not have (electronic medical records), if we were still on paper, it would have taken forever to get these results,” says Mona Hanna-Attisha, MD, MPH. She cross-referenced the abnormal blood levels to home addresses using geographic information system software to prove what was happening despite the denials of state officials. She is also adding an Epic flag to allow doctors to track those children for lead poisoning symptoms that can take years to emerge. Note once again the key involvement of a doctor trained in public health when discovering and responding to a regional crisis.

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Chester County, PA commissioners proclaim January 29 as R. James Macaleer Day, honoring the recently deceased local charitable benefactor and founder of Shared Medical Systems on his birthday.

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The US Army Reserve highlights the actions of three members of the 345th Combat Support Hospital of Jacksonville, FL who are deployed to Kosovo and who saved the life of a motorcycle accident victim while on leave in Greece. Those involved were Major David Whaley, who is a doctor of pharmacy; Colonel Edward Perez-Conde, brigade surgeon; and Major Kirk Shimamoto, a doctor of dental surgery. Perez-Conde says he considered using a pocketknife and ball point pen to relieve the victim’s pneumothorax, but, “we didn’t know how the police would react to a medical procedure using a pocketknife and we certainly didn’t want to go to jail.”

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Flint-based McLaren Health Care (MI) will centralize its 13 billing and collections offices, saying it lags in standardizing its revenue cycle processes but hopes it can increase revenue by $30 million by reducing denials and increasing collections. The health system also says it is working on integrating Cerner’s EHR and patient billing systems.

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An article describing how ad-supported publishers are “freaking out” over their readers using ad-blocking software provides an example in Modern Healthcare. The Interactive Advertising Bureau calls AdBlock Plus, which has been downloaded 500 million times, “unethical” and “immoral,” declining to note that publishers are producing content that few people are willing to pay for in any form, including by the viewing of ads.

A New Hampshire jury awards $32 million to a former Walmart pharmacist who claims she suffered gender discrimination in being wrongfully terminated for notifying the state’s board of pharmacy about the large number of errors the pharmacy was making, some of which the store manager inappropriately blamed on her. Mauren McPadden, who had worked for the company for 18 years, also says Walmart violated her HIPAA rights by accessing her PHI and telling co-workers that she had suffered a nervous breakdown. Walmart claims it fired her because she lost her pharmacy keys.


Sponsor Updates

  • T-System offers free tool to providers for documentation and diagnosis of influenza patients.
  • Valence Health will exhibit at the HFMA First Illinois Managed Care Meeting February 4 in Chicago.
  • Huron Consulting Group releases a new clinical research management briefing.
  • ZirMed will exhibit at the AAPAN Annual Forum February 1-2 in Laguna Niguel, CA.
  • Aprima launches its redesigned website. 
  • Caradigm completes the ConCert by HIMSS interoperability testing and certification program.
  • Sandlot Solutions will exhibit at the Louisiana Hospital Association’s Winter Leadership Symposium February 2-3 in Baton Rouge.
  • Surescripts will exhibit at the EHealth Initiative 2016 Annual Conference February 3-4 in Washington, DC.

Blog Posts


Contacts

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

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January 31, 2016 News 9 Comments

Morning Headlines 1/29/16

January 28, 2016 Headlines 1 Comment

2015/2016 Best in KLAS Winners: Software and Services

KLAS publishes its annual list of Best in KLAS winners. Epic takes the Acute Care EMR category. Cerner wins Acute Care EMR for community hospitals, while MEDITECH wins the community HIS category.

No patient records involved in possible NCH computer breach

NCH Healthcare System (FL) notifies its employees that two servers being hosted at Cerner’s Kansas City data center have been breached, exposing employee and medical staff credentialing information.

CPSI Announces Fourth Quarter and Year-End 2015 Results and 2016 Guidance

CPSI announces Q4 and year-end results:revenue of  $44 million for the quarter, down 4.5 percent from last year, EPS $0.30 vs. $0.60, missing estimates on both.

MidMichigan Health investing $55M for electronic medical record system

MidMichigan Health selects Epic to replace its existing Cerner and Allscripts EHRs, for a total project cost of $55 million that the health system expects will pay for itself within six years.

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January 28, 2016 Headlines 1 Comment

News 1/29/16

January 28, 2016 News 2 Comments

Top News

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CMS warns lab company Theranos that its December inspection of the company’s California laboratory found deficient practices that “pose immediate jeopardy to patient health and safety.” CMS has given the company 10 days to prove that it has corrected the problems, threatening to revoke its Medicare certification otherwise. Theranos respondes that 90 percent of its lab work is done in its Arizona facility and says it has already fixed some of its California lab problems, including hiring a qualified lab director.

Walgreens, which seems anxious to wangle out of its deal with Theranos, has told Theranos it doesn’t want its samples processed in the California lab and has closed its Theranos Wellness Center in Palo Alto, CA. Walgreens admits only that it is “currently in discussions about the next phase of our relationship.”


Reader Comments

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From The PACS Designer: “Re: better cancer detection. Researchers at the University of Tokyo Graduate School of Engineering have developed haptic gloves that can more easily detect potential types of breast cancer lumps through a new type of bendable sensor. The gloves cling more tightly to your fingers, thus improving the feel aspect of detection.”

From Pale Imitator: “Re: KLAS report on Soarian. You didn’t mention how Soarian is seen as an orphan product.” KLAS has stopped sending me anything about their reports, so I don’t mention them since I don’t even have a summary to review like other sites apparently get. For example, I noticed KLAS’s tweet that talked up Medicity’s “most improved vendor” performance in its year-end awards and clicked the link, but goes to a sign-up page that doesn’t even mention Medicity’s award, so I’m left with nothing. Back to your original comment, Soarian is an orphan product, of course, with only the timeline in question.


HIStalk Announcements and Requests

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FlexPrint donated $1,000 to attend my CIO lunch at HIMSS, which funded these DonorsChoose teacher grant requests:

  • A programmable robot for Mr. Fess’s elementary school class in Port St. Lucie, FL.
  • A programmable robot for Mr. Jewell’s  sixth grade engineering class in Beebe, AR.
  • Headphones for Ms. Garris’s elementary school class in Fayetteville, NC.
  • Math tools for Ms. Reynolds’s elementary school class in Springfield, MO.
  • Electronic circuitry kits for Mr. Shawver’s career pathways high school class in Taos, NM, in a project led by sophomore Zack, who wants to earn a Harvard doctorate in math and engineering.
  • Math games for Mrs. Dlouhy’s elementary school class in Las Vegas, NV.
  • STEM activities for Mrs. Newman’s second grade class in Indianapolis, IN.
  • A document camera and wireless printer for Mrs. Garcia’s elementary school class in New Haven, CT.
  • Dry erase boards and markers for Ms. Hughes’s elementary school class in Marietta, SC.

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QPID Health also donated $1,000, which funded these requests:

  • A Chromebook, mouse, and case for Mrs. Williamson’s English language learner class in Rentz, GA.
  • Science reading books for Mr. Beeler’s high school class in Houston, TX.
  • Two trumpets for the area’s first band program led by Ms. A in Dallas, TX.
  • Science learning centers for the kindergarten class of Ms. Estes in Franklin, TN.

This week on HIStalk Practice: Mississippi taps Teladoc for virtual firefighter care. Emerge Urgent Care opens as the "first telemedicine-based urgent care center in the US." Amazing Charts President John Squire lays out his vision for the problem-oriented medical record. RetraceHealth raises $500,000. AMA convenes disgruntled physicians for a town hall vent session in Seattle. PCPSs in Arkansas, South Dakota, and Iowa have it made – unless they’re female. Riverside Medical Group opts for an "always-open" model.

This week on HIStalk Connect: In England, the NHS partners with IBM, GE, Phillips, Google, and others to roll out several digital health pilot projects designed to objectively evaluate the benefit of introducing new technologies to care delivery. CMS sends a public letter to Theranos after discovering deficiencies during a routine lab inspection that could put patient safety in "immediate jeopardy." Texas Medical Center welcomes 13 startups to its TMCx accelerator program. Neurotrack raises a $6.5 million Series B to roll out an Alzheimer’s disease diagnostic tool that can detect cognitive impairment six years before symptoms present.


HIStalkapalooza

HIStalkapalooza Sponsor Profile – Clinical Path Consulting

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Clinical Path Consulting is dedicated to optimizing the benefits of digital healthcare. Our team of industry experts help healthcare providers take advantage of technology to make operations more efficient, meet regulatory requirements, and improve the overall quality of patient care. Our professionals have extensive experience with, and an in-depth understanding of, healthcare business processes and industry technologies. Our services range from EMR implementation, optimization, upgrades, and training to specialized services, including our Healthcare Reporting Lab and our Clinical Concierge Program.


Webinars

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


Acquisitions, Funding, Business, and Stock

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McKesson reports Q3 results: revenue up 3 percent, EPS $2.71 vs. $2.04, missing revenue expectations but beating on earnings. Revenue in its Technology Solutions business dropped 8 percent on the sale of its nurse triage service and “anticipated revenue softness” in Horizon Clinicals. From the earnings call, John Hammergren says he’s pleased with the operating margin trends in the Technology Solutions business, citing the company’s focus on peer solutions, transactional offerings, imaging, and revenue cycle management. The transcript makes it seem that stock analysts tremble in Hammergren’s telephonic presence since they can’t seem to string together coherent sentences without Tourette’s-like verbal crutches. The Morgan Stanley analyst said “kind of like” a record 16 times in just three questions, such as, “It’s kind of like up 7 percent in the last kind of like 18 months, we’ve seen this growth in kind of like low to mid and even high teens,” while the ISI Group’s analyst, not to be outdone, used “sort of like” five times in his two questions.

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HCA announces Q4 results: revenue up 6.4 percent, EPS $1.40 vs. $1.19. The hospital operator made over $2 billion in profit in FY15.

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Anthem announces Q4 results: revenue up 7 percent, EPS $0.68 vs. $1.80, missing earnings expectations. The company says its insurance exchange policy volume ran 30 percent lower than it planned.

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CPSI announces Q4 results: revenue down 4.5 percent, EPS $0.30 vs. $0.60, falling short of expectations for both. 

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Telemedicine technology vendor SnapMD raises $5.3 million in Series A funding.


Sales

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The Ohio Department of Mental Health and Addiction Services expands its use of Netsmart’s clinical and financial systems across its six psychiatric hospitals.

Orion Health signs two pilot project contracts with the French Ministry of Health.

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MidMichigan Health chooses Epic in a $55 million project that it says will pay for itself within six years. They went live on Cerner in early 2011 and choose Allscripts for ambulatory that same year. The change was most likely due to its 2013 affiliation with University of Michigan Health System, which invested in the Midland-based system with plans to undertake joint projects in telemedicine, clinical data analysis, and IT.

The Cal INDEX HIE selects Wolters Kluwer’s Health Language for terminology management.

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Steward Health Care Network (MA) expands its use of behavioral health access technology from Quartet Health, which has former US Representative Patrick Kennedy on its board.


People

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Joshua Lee, MD (Keck Medical Center) joins Loyola University Health System (IL) as VP/chief health information officer.


Announcements and Implementations

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Oracle announces Oracle Healthcare Precision Medicine, which it says connects genetic testing information to EHRs “for seamless clinical workflow and adoption.”

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Continuous wearable vital signs monitoring technology vendor Sotera Wireless’s database of de-identified monitoring data reaches 1 million hours, supporting evidence-based alarm management.

University of Michigan launches MS and PhD degrees in Health Infrastructures and Learning Systems, which will focus on IT-driven innovation and continuous improvement.

DrFirst releases a new version of its Rcopia system for e-prescribing, controlled substance e-prescribing, electronic prior authorization, medication history, and medication adherence.


Government and Politics

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ONC has a proposed rule in front of the White House that is described only as, “ONC Health IT Certification Program: Enhanced Oversight and Accountability.”


Privacy and Security

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NCH Healthcare System (FL) notifies employees that two of its servers hosted at Cerner’s data center have been breached, exposing employee and medical staff credentialing information. 

Fitbit will add security measures to its fitness trackers after hackers brag openly about stealing user account information that they use to scam the company. The hackers sell Fitbit login credentials online for between 50 cents and $5, explaining to buyers how to convince Fitbit support reps to send them a replacement for a claimed defective device they never actually bought using a Photoshopped Amazon receipt as proof of purchase. They then sell the devices.

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A short report by cloud security vendor Bitglass reminds us that one in three Americans were affected by a healthcare breach in 2015, with hacking and IT incidents making up 98 percent of the total. The big problem last year was loss of employee devices, but that was before the huge Anthem and Premera insurance company breaches that represented 80 percent of the affected individuals.


Other

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A doctor in Canada warns the public of physician rating site RateMD, claiming the company’s salespeople offered him extra-cost options to hide up to three suspicious reviews and display his banner on the pages of other doctors. To be fair, the company is straightforward about that (and its business in general) on its FAQ page. The real challenge for ratings sites is that the small number of self-selected people who post have had either a great or terrible experience that may not be representative. That plus the fact that anonymous posts can’t be verified, allowing anyone to post a review.

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KLAS announces its Best in KLAS winners for 2015/16. Epic won best Overall Software Suite, Impact Advisors won Overall IT Services Firm, and Medicity earned most-improved recognition. Some notable category winners:

  • Acute care EMR: Epic
  • Ambulatory EMR small practice: CureMD
  • Ambulatory EMR medium practice: Athenahealth
  • Ambulatory EMR large practice: Epic
  • Business intelligence/analytics: Dimensional Insight
  • Community EHR: Cerner
  • Community HIS: Meditech
  • ED: Wellsoft
  • HIE: Epic
  • Laboratory: McKesson
  • Patient accounting/patient management: Epic
  • Patient portal: Epic
  • Population health: IBM (Phytel)
  • Surgery management: Epic

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Dear Healthcare IT News: your ad-filled junk email pitches for HIMSS16 are using a “from” email of “Destination HIMSS15.” Thank you in advance for your prompt attention in this matter.

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The crack investigative team of a Louisiana AM radio station smugly discloses photographic evidence that doctors are wasting time using computers with an “absurd number of diagnoses and codes that total more than 18,000,” adding expert editorial comment opining that, “Remember that our tax dollars are going to buildings filled with bureaucrats who spend their days making rules and regulations that run our lives!” My question is this: does AM radio still exist?

A survey of doctors in Canada finds that 73 percent use office-based EHRs vs. 23 percent in 2006.

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The Orlando paper notes the swelling but untaxed annual profits of Florida Hospital ($330 million) and Orlando Health ($247 million) as “the hospital chains gobbled up what were once taxpaying businesses and property and brought them into the non-profit, tax-exempt fold.” The systems would have paid $50 million in property taxes alone if they weren’t non-profits. Both organizations not only avoid state income tax, federal income tax, and sales tax, but they also receive taxpayer money in the form of taxing districts in three counties. The article notes that Florida Hospital parent Adventist Health System “trades $4.5 billion in securities, mostly through bonds, hedge funds, and money market funds.”

Hospitals in China require non-emergent patients take next-number type tickets, providing a lucrative market for ticket scalpers. A woman who complained on state TV about offers to sell places in the hospital line for $700 says she was harassed afterward by the scalpers and is afraid to take her mother back to the hospital. Her summary would work equally well here even in the absence of scalpers: “My God, for average people to see a doctor takes so much money, so much energy.” 


Sponsor Updates

  • Ingenious Med’s Scott Pierce describes the company’s new consulting practice.
  • NTT Data is sponsoring the Northern California Chapter of HIMSS reception at HIMSS16 on March 1.
  • Iatric Systems takes the Best in KLAS top spot for patient privacy monitoring.
  • MedData will exhibit at the American Society for Anesthesiologists Practice Management Meeting January 29-31 in San Diego.
  • Premier recognizes Inova (VA) with its 2016 Premier Excellence Award.
  • InterSystems TrakCare wins Best in KLAS for Global (Non-US) Acute Care EMR.

Best in KLAS 2015/2016 Winners

Segment Leaders: Software
Cardiology: Merge
Claims and Clearinghouse: ZirMed
Emergency Department: Wellsoft
Global (Non-US) Acute Care EMR: InterSystems
Patient Access: Experian Health
Radiology: Merge
VNA/Image Archive: Merge

Segment Leaders: Professional Services
HIT Implementation Support & Staffing: Galen Healthcare
IT Advisory Services: Impact Advisors
Technical Services: Galen Healthcare
Value-Based Care Advisory Services: Premier

Category Leaders: Software
Cardiology Hemodynamics: Merge
Charge Master Management: Craneware
Clinical Decision Support – Care Plans: Zynx Health
Clinical Decision Support – Order Sets: Zynx Health
Clinical Decision Support – Surveillance: Wolters Kluwer
Decision Support – Business: Strata Decision
Enterprise Scheduling: Streamline Health
Labor and Delivery: Clinical Computer Systems/Obix
Medical Device Integration Systems: Capsule
Patient Flow: TeleTracking
Patient Privacy Monitoring: Iatric Systems
Quality Management: Nuance
Secure Messaging: Imprivata
Single Sign-On: Imprivata
Staff/Nurse Scheduling: GE Healthcare

Category Leaders: Services
Business Solutions Implementation Services: Xerox

Blog Posts


Contacts

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

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January 28, 2016 News 2 Comments

News 1/27/16

January 26, 2016 News 5 Comments

Top News

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Leidos Holdings will acquire Lockheed Martin’s Information Systems & Global Solutions business — which includes its health IT offerings — for $5 billion, confirming earlier rumors.

Lockheed Martin is known in health IT circles as having created the first CPOE system in the early 1970s when the company was operating as Lockheed (it merged with Martin Marietta in 1995 and changed its name to Lockheed Martin) but the company sold the product to Technicon in 1971, when it was named TDS. Lockheed Martin recently won the VA’s appointment scheduling system contract, bidding Epic through its recently acquired Systems Made Simple subsidiary.

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With the acquisition, Leidos will become the #1 government IT contractor by revenue, with annual sales of more than $10 billion.


Reader Comments

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From Smartfood99: “Re: Frisbie Memorial Hospital (NH). Cerner couldn’t flip a MedSeries4 hospital – they are going with Meditech 6.1.” Frisbie’s CEO says they wanted a system that would work for their 112-bed hospital sold by “a vendor we could trust.”

From Eddie T. Head: “Re: integration with Epic’s hosted systems. I would be surprised if Epic ever agrees to host third-party products. As far as I know they have always maintained that they will host the Epic infrastructure of servers, but they will not take on the role of a customer’s IT department for anything else. If the server-to-server integration comment is correct, then it sounds like sabotage (either by malice, or by incompetence) on the part of McKesson.”


RxNorm Follow-Up

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A reader asked us to find out what’s going on with RxNorm updates and code changes, which they say is causing quality measures to fail because CMS has not updated its eCQM value sets with the new codes. Jenn asked the NIH/National Library of Medicine what happens with VSAC and quality measures when RxNorm is updated:

The short answer is, nothing. But it really has nothing to do with RxNorm or any other code system. ONC/CMS (back in 2012) statically bound all of the CQM value sets to their respective code systems, so the content of those value sets is legally locked to whatever versions of code systems specified by an update. So for example, the last CQM update back in 2015 used Feb 2015 RxNorm I believe. Thus, the problem for implementers who want to use the newer, better content (Lovenox as injectable heparin) to meet the treatment criteria for a measure, but are bound to use an earlier version of RxNorm. This has been a known problem for years. The real issue is providers vs. implementers. Providers, of course, want the new content as it benefits them meeting the care goals. Implementers see too much risk in updating/floating value sets dynamically, especially those that are authored as list (extensional) to begin with rather than as rules (intentional).

Julia Skapik, MD at the eCQI Resource Center adds:

This topic is known to CMS and ONC—the use of a static value set associated with each measure means that dynamic code system changes post-publication will not be reflected in the value set. To this date, we have provided the guidance that it is permissible to map where appropriate to a similar code. Where there are no similar codes, however, there will be a gap in the measure. Rob McClure, cc’d above, has been working on a proposal with CMS to provide an interim update to the value sets in the middle of the measurement period with additions only that will fill out dynamic code changes (and potentially correct errors) that affect real-world value set and measure performance.

In response to the reader’s example of CMS not updating the code sets for Lovenox as an injectable heparin that causes the VTE measure for anticoagulant therapy to fail, ONC/NLM consultant Robert McClure, MD responded:

Her defining example is confusing. Enoxaparin (Lovenox) has been included in the VTE measure anticoagulant value sets, such as "Anticoagulant Therapy" OID: 2.16.840.1.113883.3.117.1.7.1.200 and "Low Molecular Weight Heparin" OID: 2.16.840.1.113883.3.117.1.7.1.219 (and there others), from the very first release in October 2012. So if this is a good example of what ever her concern is, I’m afraid I don’t get the problem. 

If I was to wildly guess (a dangerous thing to do with you playing man-in-the-middle) perhaps she is not familiar with the expectation that data submitted in support of meeting an eCQM may at times require mapping, say from a code representing a branded drug (like Lovenox) to the “general form” (Enoxaparin) using RxNorm as the submitted code system. Or some entity that she’s relying upon is not getting this job done well.

There is the possibility that Sanofi (they make Lovenox) has come out with a brand new formulation of enoxaparin that did not get into the value set. If that is the problem, then this is exactly the sort of thing we are working to determine a better solution for implementers then simply “mapping to something close that is in the value set." If she is aware of such things then I encourage her to provide very specific evidence of this so we can design solutions that really work. She should do this by participating, like thousands of her colleagues have done, in the CMS/ONC eCQM JIRA site (http://jira.oncprojectracking.org) and report the specific issues so we can get to specifics.


HIStalk Announcements and Requests

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The HCI Group donated $1,000 to participate in my CIO lunch at the HIMSS conference, with which I funded these DonorsChoose grant requests:

  • A document camera, speakers, and dry erase lapboards for Ms. Hardy’s elementary school class in Upper Darby, PA
  • A document camera for Mr. Martinez’s high school math class in Delano, CA
  • Three tablets for Mrs. Haley’s elementary school class in Waycross, GA
  • Model rockets for Mrs. Elliott’s sixth grade class in Indianapolis, IN
  • Electronic circuit kits for Ms. Mills fifth grade science classes in Spring, TX
  • An iPad and gaming system for Mrs. Swords’ fourth grade class in Douglas, GA
  • Machining tools for the robotics team of Mr. R’s high school class in West Covina, CA

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Ms. Osborne says her South Carolina elementary school class is using the math games and materials we provided in their math centers.

I was excited about Black Sabbath’s final tour, but video from their “The End” tour stop in Chicago shows Ozzie singing so wildly off key that he ruins all the songs they otherwise played excellently. I think they’re making the right decision to hang up their inverted crosses after nearly 50 years.


HIStalkapalooza

HIStalkapalooza Sponsor Profile – Healthwise

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Amplify the impact of your patient touch points with Healthwise health education, technology, and services. Easily integrated into episodic care, care coordination, automated programs, and patient portals, Healthwise solutions give you the ability to deliver tailored, meaningful experiences. Since 1975, Healthwise has been driven by our non-profit mission to help people make better health decisions. Visit us on the HIMSS show floor in booth #3617 and at our kiosk in the Population Health Knowledge Center. To find out more about Healthwise or to schedule a one-on-one meeting, visit www.healthwise.org/himss16.


Webinars

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


Acquisitions, Funding, Business, and Stock

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CMS inspectors have found problems at the Northern California laboratory of Theranos, according to unnamed insiders. Meanwhile, a Wall Street Journal investigation finds that not only is Theranos using its fingerstick technology for just one test, it’s also sending some of its samples out to reference labs instead of running the tests itself, apparently losing money on each (Theranos sells patients a test for $7 while paying UCSF $300 to run it). The article also reports that Walgreens has met with the company several times since October to discuss concerns about the Theranos stations in its California and Arizona drugstores and isn’t satisfied by the company’s responses. The since-fired CFO of Walgreens approved a loan of $50 million to Theranos without involving the drug company’s senior clinical executives and signed an agreement that Walgreens can’t easily escape from, although a negative CMS report might give them reason.

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Specialty EHR vendor Nextech acquires SupraMed, which offers a PM/EHR for plastic surgeons.

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Medical image exchange platform vendor LifeImage acquires its mammography-specific competitor Mammosphere.

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Enterprise integration vendor Jitterbit, which offers a platform for developers to build and expose APIs, raises $20 million in a Series B funding round. It lists among its customers Dignity Health, Eisenhower Medical Center, and ZirMed. Prices range from $2,000 to $6,000 per month.

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Kaiser Permanente will open an 800-employee customer service center and a 900-employee IT center in metro Atlanta.

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The Milwaukee paper profiles Epic with a potpourri of recycled facts:

  • The company has 9,500 employees, up from fewer than 400 in 2000.
  • The Verona campus has cost $1 billion and construction continues.
  • The article claims that Epic departments don’t have budgets, there’s little hierarchy and few middle managers, and use of job titles is minimized.
  • The company won 127 contracts in 2014 vs. 19 for Cerner.
  • The article says the company is poorly equipped to deal with the criticism that goes hand in hand with its success, noting that its in-house communications team consists of one person and the company is run by limelight-shunning CEO Judy Faulkner, who has asked reporters not to run photos of her for fear that people will bug her at her favorite Madison ice cream shop.

Sales

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Pikeville Medical Center (KY) chooses Medsphere’s OpenVista EHR.

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Trinity Mother Frances Hospitals and Clinics (TX) chooses Stanson Health’s point-of-care recommendation system for appropriate use of medications, imaging, and lab tests.

Phynd Technologies announces sales of its provider management system to Premier Health (OH), Duke University Health System (NC), and Children’s Health (TX).

University of Iowa Health Care selects Oneview Healthcare’s interactive patient care system.


People

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Cerner Chairman and CEO Neal Patterson notifies shareholders via an SEC filing that he was just diagnosed with a “treatable and curable” soft tissue cancer and will therefore be traveling less and attending fewer meetings as he undergoes treatment.

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For-profit hospital operator Capella Healthcare promotes Vishal Bhatia, MD, MBA to SVP/CMIO.

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Nashville healthcare entrepreneur R. Clayton McWhorter, who served as CEO of HCA in the 1980s, died Saturday at 82.


Announcements and Implementations

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The California HealthCare Foundation will cease publishing its iHealthBeat daily technology news digest as of February 1 because “its exclusive focus on health IT no longer aligns with the programmatic focus of our work.” The newsletter was managed by The Advisory Board Company under contract to CHCF. I’m surprised that HIMSS didn’t buy it and fold it into its vendor-friendly publishing arm.

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EHealth Ireland announces that available funding will allow it to increase its 288 FTE headcount by 47.

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Vermont’s Depart of Labor notifies former and present employees of the South Burlington, VT office of Allscripts that they are eligible to apply for re-employment services if laid off.

Liaison Technologies launches its bone marrow transplant registry that includes one-click CIBMTR reporting.

CareSync joins Athenahealth’s More Disruption Please program, offering CMS Chronic Care Management program support services to providers.

Research software vendor Pulse Infoframe will use InterSystems HealthShare for interoperability.


Government and Politics

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CMS encourages development in state Medicaid claims processing systems by permanently extending a 90 percent federal funding match for those systems. CMS is spending $5 billion per year on state Medicaid IT and estimates that 30 states are redesigning their Medicaid eligibility or claims processing systems. Cedars-Sinai CIO Darren Dworkin tweets that it’s a much bigger vendor opportunity than any population health app although it’s likely open only to large government contractors.

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Blue Cross Blue Shield of Vermont calls for an independent review of the state’s Vermont Health Connect insurance exchange as errors force it to once again turn off the ability to enter “change of circumstance” situations. The state blames original contractor CGI and a consulting firm it hired that has since gone out of business. BCBS says exchange problems have prevented some of its customers from renewing their policies and doesn’t allow the company to reconcile its customer accounts. The exchange cost over $200 million to develop, nearly all of that paid by federal taxpayers.

A New York Times article describes the security-required modifications that are required before government officials (including the President) can bring mobile devices into the White House. A general who bought one of the first iPads in 2010 says DARPA technicians removed the device’s cameras, wireless chips, location sensors, microphones, and on-board storage capabilities, leaving him with “a pretty dumb iPad.” The article recounts a 2013 interview in which former VP Dick Cheney revealed that when his replacement defibrillator was implanted in 2007, his cardiologist insisted on disabling its wireless capability for fear someone might use it to assassinate him.

A Congressional Budget Office report finds that the federal government spend $936 billion last year on Medicare, Medicaid, and ACA subsidies vs. $882 billion on Social Security. The report warns about increased spending on mandatory programs and predicts that the federal deficit will increase.

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CMS posts its 2017 Medicare EHR Incentive hardship exception application, due March 15 if EPs are involved or April 1 for just eligible hospitals, with these allowable reasons:

  • Lack of Internet access.
  • An EHR destroyed by natural disaster.
  • Practice or hospital closure or bankruptcy.
  • Problems with EHR vendor certification delays, decertification, or other vendor-caused delays.
  • Lack of control over locations that fall short of 50 percent of patient encounters.
  • For EPs, a practice that does not offer face-to-face interaction.

Privacy and Security

Insurance company Centene announces that it can’t find six hard drives containing the information of 950,000 members.

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NIST invites companies to provide products and technical expertise to help develop use cases for IV pump security.

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Titus Regional Medical Center (TX) finally regains access to its EHR more than a week after its servers were locked by ransomware. The hospital says it did not pay the money demanded and that the FBI is investigating. The Dallas Area Rapid Transit Authority was also recently infected with ransomware that demanded payment of $63,000 to restore access to encrypted files. DART declined to pay and was able to recover most files from backup copies, but some information was lost and some online services remain unavailable. The FBI stated a few weeks ago that it might make sense for some businesses to pay the ransom demanded, which was the case with at least one police department and a sheriff’s office that have paid to get their files back. The hackers behind the CryptoWall ransomware creation tool recently upgraded their product with a redesign of the ransom note.

Two organizations — New Jersey Cybersecurity and Communications Integration and Cell and National Health Information sharing and Analysis Center — create a third-party reporting and notification system in which the state’s hospitals can share cyberattack information anonymously.


Other

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Apparently the unnamed health IT vendor who ran this ad in the Las Vegas Craigslist values its customers about as much as it does women in seeking a “booth girl” whose primary attribute is appearance.

The inquiring mind of Weird News Andy wonders whether a drug that can cure fear will work in cases of pharmacophobia, iatrophobia, and phagophobia.


Sponsor Updates

  • Burwood Group packs 100 winter coats, hats, and gloves for the Boys & Girls Club of America during its annual company retreat.
  • The local paper features CareSync in its roundup of local entrepreneurial ventures.
  • The local paper features Healthfinch in its feature on “Madison startups to watch in 2016.”
  • Qpid Health’s quality reporting solution achieves ONC HIT 2014 Edition Modular Ambulatory EHR Certification.
  • Huntzinger Management Group hires Jay Boylan and Bill Ehrman as regional sales directors.
  • EClinicalWorks is recognized as having the highest market share among cloud-based EHR vendors.
  • Versus creates a dedicated clinical solutions department of RNs. 
  • Stella Technology is supporting ConCert by HIMSS and conducting demos of the Interoperability Test Tool (ITT) at the IHE NA Connectathon this week in Cleveland, OH.
  • Elsevier Clinical Solutions will host the New England HIMSS Social March 1 at HIMSS16.
  • Frost & Sullivan recognizes the EClinicalWorks cloud-based EHR for highest market share.
  • FormFast will sponsor the HIMSS Midwest Gateway Chapter networking event January 28 in St. Louis.

Blog Posts


Contacts

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

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January 26, 2016 News 5 Comments

Morning Headlines 1/26/16

January 25, 2016 News No Comments

Deficiencies Found at Theranos Lab

The Wall Street Journal reports that a damaging inspection report on Theranos’ California lab testing facility will be made public soon. The article says that investigators found “serious deficiencies” that could compromise its standing with Medicare and existing corporate clients.

Cerner CEO Neal Patterson being treated for cancer

Cerner CEO Neal Patterson files an SEC update announcing that he has been diagnosed with a “treatable and curable” soft tissue cancer. He reports that he will reduce his travel and work schedule while he receives treatment, but notes that “it will not be a big change compared to how we run Cerner day to day already.”

Kaiser Permanente says website woes, now on third day, weren’t caused by cyber attack

Kaiser Permanente’s website, including its patient portal, went down last week due to server issues. Kaiser has confirmed that the outage was not the result of a cyberattack, and has confirmed that all systems are back up.

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January 25, 2016 News No Comments

McKesson’s Paragon Dilemma

January 25, 2016 News 3 Comments

The bumpy road McKesson and its users have found themselves on in the transition from Horizon to Paragon.
By @JennHIStalk

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It’s been four years since Atlanta-based McKesson announced its decision to shift resources away from its Horizon Clinicals product line — known for serving several hundred large facilities of 300 beds and up — and to make Paragon its centerpiece hospital IT system.

The move — part of the company’s broader Better Health 2020 initiative of increased investment, research, and development of Paragon — was seen by the industry as an attempt to streamline McKesson’s technology solutions to better serve a customer base that was becoming increasingly vocal in its need for an integrated offering.

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McKesson has faced an uphill battle in its attempts to convert Horizon customers to Paragon. Changes in leadership, rumored employee discontent, and user push-back have all played their part in McKesson’s attempt to remain competitive with scalable technology that can keep up with federal regulations, evolving payment models, and a customer base that seems to be jumping ship to Cerner and Epic in numbers the company didn’t anticipate.

The Evolution of Industry Reaction

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Initial reactions to McKesson’s decision were tempered, with analysts and industry insiders coupling their wait-and-see attitudes with a healthy dose of skepticism regarding the company’s financial stakes. “On one hand, I laud MPT for coming clean on the challenges it has had with the development and support of the Horizon product,” Aspen Advisors (now part of The Chartis Group) Founder and Managing Principal Dan Herman said in a 2011 year-end assessment. “However, it appears that [McKesson’]s go-forward strategy is ‘déjà vu’ – a poorly thought-out approach to integrate disparate platforms, enhance a product that has experienced success in a focused marketplace (Paragon), and promise to customers that [McKesson] is committed to delivering a ‘fully integrated core clinical and revenue cycle IT system.’”

The situation wasn’t as positive after a few years and a few Horizon to Paragon migrations, both from an end user and company perspective. “As a customer, we have noticed that support and services have steadily declined since the Better Health 2020 announcement …. The average tenure of support employees supporting us has dropped severely with resignations,” noted one HIStalk reader and McKesson Horizon customer in 2013. “We have to run a gauntlet of triage and bottom-tier support before most of our issues are escalated to a rare senior resource. They are exerting pressure for us to migrate to Paragon while failing in their commitment to support us on Horizon. Actions speak louder than words and customers have been left to deal with the fallout.”

Fewer than one-fourth of respondents to an HIStalk reader poll in December 2011 said they had a positive reaction to McKesson’s Better Health 2020 plan. Three-quarters of respondents to a September 2012 reader poll said McKesson’s healthcare IT position had worsened in the past year, with one respondent commenting that the plan to move Horizon users to Paragon was, “Nothing more than puff-piece marketing. There was no tangible follow-up with their closest clients to show them concrete plans. The traditional, ‘Trust us because we’ve worked so hard together all these years’ and the implications of ‘we are too big to fail’ just do not hold water.”

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The corporate side of the story correlated with user frustration, as McKesson leadership shuffled and Horizon employees were urged to take jobs at RelayHealth, which expanded to over 1,000 employees in 2013. McKesson’s February 2015 earnings call offered a slightly rosier picture of the company’s migration attempts. Chairman, President, and CEO John Hammergren mentioned that the Technology Solutions division’s seven percent drop in revenue was in line with expectations of lower Horizon Clinicals revenue, and that the company was “in [the] middle of the game” in trying to migrate customers.

He added that, “As you think out two or three years, the EMR space and the transition away from Horizon will be more complete or complete, and we’ll see more results, we think, in terms of this pay-for-performance priority.”

Fast forward almost a year. Hammergren’s prediction of a transition away from Horizon seems to be coming true, though not necessarily with the outcome he had hoped.

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“The move from Horizon to Paragon has actually been pretty painful for McKesson and for their customers,” says Coray Tate, vice president of clinical research at KLAS Enterprises. “That’s not a secret. It’s a little bit of a perfect storm that Paragon got caught up in.”

Paragon, Tate explains, has suffered not only from a Horizon customer base that was unenthusiastic about switching systems and wary of Paragon’s ability to scale to larger facilities, but also from bad timing. The leader in KLAS customer satisfaction rankings for small community hospitals was caught up in the rollout of Meaningful Use and the prospect of a switch to ICD-10. Toss in high-level leadership changes and the “perennial leader” found itself falling behind.

“They took a product that had really struggled,” says Tate. “They reset expectations and have actually done a really good job of developing on that. But now you’ve got all these external pressures that they haven’t been able to meet. Meaningful Use made EHRs become a physician tool, and so that part has been the biggest gap and they are having a hard time getting to the point where physicians are happy with it. That’s not unique to Paragon, but that is definitely one of Paragon’s struggles and one of the reasons why you’ve seen their scores drop in the small market.”

End-User Fallout

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Tate’s insight into market forces have been playing out in Horizon facilities. Mike Jefferies, a former McKesson technical advisor who is now vice president of IS at McKesson customer Longmont United Hospital (CO), agrees with the Better Health 2020 strategy. However, he questions whether big Horizon customers are comfortable with the idea of migrating to Paragon.

“You’ve seen a huge consolidation in healthcare,” Jefferies explained in a February 2015 HIStalk interview. “That consolidation has favored EHRs that handle a larger scale, which in our market means Cerner or Epic. What a larger organization consolidates smaller hospitals and organizations, they certainly aren’t going to uptake that smaller community EHR.”

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Vanderbilt University Medical Center (TN) is one such customer. It announced its move from Horizon – much of which it had self-developed as WizOrder and then licensed to McKesson in 2001 to create Horizon Expert Orders — to Epic in December 2015, with an anticipated go-live in 2017.

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VUMC Chief Informatics Officer Kevin Johnson, MD, MS, who is spearheading the effort, says that its decision was certainly strategic, though the IT team was understandably disappointed to hear the Horizon/Paragon news. “We realized that McKesson was focusing on a different segment of the healthcare market with the Paragon system,” he explains. “Therefore, we had begun surveying the landscape to be proactive about the move at the same time that McKesson sent us the announcement.”

“We have enjoyed a long history with Epic as one of their first revenue cycle clients, dating back to 1995,“ Johnson adds. “We had made a decision to upgrade our revenue cycle and billing system to a more recent Epic version for inpatient and outpatient billing. We also have Cerner’s lab system. Our decision, therefore, was to migrate our revenue cycle/clinical/lab environment to Epic/Epic/Cerner or Epic/Cerner/Cerner. Paragon is a system constructed with a different size and complexity health system in mind. Both Cerner and Epic were good choices for us, and after a thorough evaluation, we chose Epic for our clinical system.”

The Consultant’s Perspective

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Mike Lucey, founder and president of Paragon consulting firm Community Hospital Advisors, paints a more intimate picture of Horizon end user reaction. ”I work with the IT folks and the doctors, nurses, therapists, and revenue cycle folks that actually use the product. They take it personally. This is their product,” he explains. “It’s very hard for the users to get around the idea that McKesson is taking something away that they like and works for them and giving them something that for years and years has been pitched as not good enough for their needs. They feel like they had the rug pulled out from under them.”

In Lucey’s best estimation, between 50 and 60 Horizon customers are still evaluating their options and  “a couple hundred” are on Paragon, with half of those being migrations.

“It’s important to remember that frustration has a half-life,” he says. “People get frustrated, they get angry, they stomp their feet. They run around and they put out RFPs and they get their responses back. Then the reality of money sets in. I think that’s where we are now. How many phases are there to grief? You know, you have denial. They kind of get stuck on anger for a while. Then somewhere along the way there’s acceptance. I think that’s the phase this market has gotten to. Folks are recognizing that they need to make a rational decision with good information.”

The Positives of Paragon

It’s not all doom and gloom, as Lucey’s current Paragon customer estimates attest. He is quick to emphasize that Paragon works, though the definition of “works” is, as with all IT systems, at the discretion of the implementing organization.

“The underlying technology and the functionality of Paragon is effective. It can get the job done for hospitals and multi-facility organizations, but it has to be put in well. It’s an issue of accountability. You can find many instances of Paragon implementations where the product is working very, very effectively. The difference between where it’s effective and ineffective is ownership. If the hospital owns it, it works well. If they don’t, it usually stinks.”

Paragon’s Success Hinges on McKesson’s Commitment

Both Lucey and Tate believe that product development and overall quality will make or break Paragon. “They’re going to have to be able to get code out to increase the physician experience,” Tate explains. “The code quality of the releases has got to get better. There have been reports of things being buggy as releases have come out. Overall, it’s going to have to mature to more of a clinical solution, meaning that it’s easier and faster for physicians to use.”

Lucey agrees that McKesson needs to show its commitment to Paragon by improving code quality within a few months. He adds that the company will have to deal with employee challenges. “A lot of them are the same people that were previously doing that for Horizon. A lot of them are still upset. Can they change uniforms from Horizon to Paragon, pick up the mantle, and advocate for it? Make it better, support it well, and sell it effectively? I don’t think a lot of them can, quite frankly.”

Lucey’s insight into McKesson’s internal struggles is shored up by several HIStalk reader reports that McKesson has turned to offshore resources to tackle Paragon’s development and that the company has begun pitching its technology division to venture capitalist firms, reported privately to HIStalk by someone who claimed to have been present in one of the meetings. McKesson President Nimesh Shah was unavailable for comment due to the company’s pre-earnings quiet period through April 1.

McKesson’s commitment to Paragon will determine whether it will continue to meet user needs, remain competitive, and capture a significant share of the Horizon customer base that is being forced to seek an alternative from McKesson or its competitors.

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January 25, 2016 News 3 Comments

News 1/20/16

January 19, 2016 News 4 Comments

Top News

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A CMS blog post by Administrator Andy Slavitt and National Coordinator Karen DeSalvo, MD says the administration has been “working side by side with physician organizations” to change the EHR incentive program. They will propose MACRA-based regulations that will:

  • Reward providers for patient outcomes
  • Allow providers to use IT in the way that works best for them
  • Promote open APIs
  • Focus on real-world interoperability goals while not tolerating data blocking.

Slavitt and DeSalvo warn that, despite their seemingly inadequately planned and oddly timed exuberant comments:

  • Existing standards are still in effect as required by law
  • MACRA covers only Medicare Eligible Providers and not hospitals or the Medicaid program
  • MU Stage 3 remains in effect

Reader Comments

From See Me CMIO: “Re: NEJM article on intrusive, standardized patient visit requirements and EHR checklists. Cerner with Dynamic Documentation returns us to the old-school way and away from the tyranny of physician documentation templates. Our go-live of Cerner Ambulatory created angst by physicians using template- and list-driven EHRs from NextGen and eClinicalWorks (especially younger ones who never knew pre-EHR documentation) who were uneasy with a system that instead presented them with basically a blank sheet of paper. Dyn Doc allows the open-ended interview style described in the article, with the need for reminders accomplished on the health maintenance section, the best of both worlds. However, template-driven systems may work better for specialists such as colorectal surgeons and orthopedists who would be slowed down by an open-ended interview.” 

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From EMR Expert: “Re: Cerner. Bid $23 million for the EMR tender of 1,095-bed King Fahad Medical City in Saudi Arabia vs. Epic’s $126 million. Only Epic’s price was similar to what it would have bid in the US. Why is Cerner overcharging its US customers compared to oil-rich Saudi Arabia?” “Oil rich” is an oxymoron these days as the barrel is almost worth more than the oil it contains, but I don’t know why Cerner would so significantly undercut Epic’s apparently predictable bid in a two-horse race. Going back to the petroleum theme, it’s like my local gas station whose price is 20 cents per gallon less than everyone else’s – why not go only five cents lower in undercutting competitors while still pocketing the difference?

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From Not from Monterey: “Re: Centra Health of Central Virginia. A good source tells me they’ve chosen Cerner, ditching McKesson if my memory serves me correctly.” Unverified. They are a Horizon and Pathways shop going back many years.

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From NantWatch: “Re: NantHealth. Patrick Soon-Shiong says he intends to ‘merge’ NantOmics and NantMobile (the recently rebranded NantMobileHealth) into NantHeath the first half of this year as a part of the ‘Moonshot 2020’ initiative, though he has a tendency to change his mind on a whim, so who knows if this will happen. Predictable internal power struggles have begun.” Unverified.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mrs. Nelson, who asked for science kits for her Alabama elementary school class (her “highest poverty” school has only old, outdated books). She reports, “When they heard the news that we were getting funded, they all cheered in excitement! They were counting down the days until they could see our science kits come in by mail. When they finally arrived to our classroom, my students chimed in perfect sync, YESSSSSS! We opened them immediately to see all of the contents inside. As I read the descriptions of the science kits and showed them the parts, they smiled, cheered, and gleamed with anticipation!” The students are using the electrical activity tub to study and build circuits and next week they will use that knowledge to begin studying renewable and non-renewable energy sources.

An anonymous reader sent $50 for my DonorsChoose project. I couldn’t find any projects that amount would fully cover even with matching funds, so instead I completed the donations already received for Mrs. Azorr’s elementary school class request for dry erase markers, pockets, and earbuds for math practice and, in a second project, printing supplies for Mrs. P’s class in Roanoke, VA.

Listening: new from The Strumbellas, a six-piece band from Canada whose music is somewhere between spare, catchy alternative and pop bluegrass. It didn’t seem promising, but I ended up liking it. I’ll note the untimely passing of Glenn Frey (even though I’d take a root canal over listening to the Eagles any day) as well as the death of another 60-something musician, glam band Mott the Hoople drummer Dale Griffin. It was all Nektar for me at the gym today and those guys are in their late 60s as well. One might argue that 1970s-era musicians were our Greatest Musical Generation and we’re losing them way too fast.  


Webinars

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


Acquisitions, Funding, Business, and Stock

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Digital Reasoning acquires mobile clinical documentation vendor Shareable (formerly known as Shareable Ink). Digital Reasoning vaguely describes its work as “cognitive computing,” of which I could learn no more since its horribly designed website takes several minutes to load, vastly exceeding the limits of my curiosity.

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UnitedHealth Group beats Wall Street expectations for Q4 revenue and earnings despite losing $720 million in the fiscal year selling insurance on federal and state exchanges, a much bigger loss than it originally expected. The company warns again that it may stop selling policies on the exchanges next year. Meanwhile, UHG’s Optum business generated earnings that were up 50 percent.

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Three-month-old Malaysia-based doctor appointment booking startup BookDoc takes an unspecified investment from the royal family of Brunei. The company says it has “the highest pre-seed and seed funding valuations ever in the technology start-up history of Asia.”

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Public relations firm Weber Shandwick acquires Nashville-based healthcare marketing firm ReviveHealth.

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Johnson & Johnson will eliminate 3,000 positions in its medical device business, an action it optimistically euphemizes as, “to strengthen its go-to-market model, accelerate the pace of innovation, further prioritize key platforms and geographies, and streamline operations while maintaining high quality standards.” In other words, the little people it will fire are the problem, not the still-employed executives who hired them in the first place and then apparently mismanaged them to the point that the company is better off with 3,000 empty chairs.

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In Spain, NTT Data will work with Everis Health and local hospitals to develop a new medical analytics service technology that will apply knowledge to ICU patient data streams.

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Sentry Data Systems will acquire Agilum Healthcare Intelligence. Both companies offer data analytics solutions.


Announcements and Implementations

Divurgent and General Dynamics partner to offer security solutions to healthcare providers.

Ireland’s Health Service Executive announces that within a few months all of the country’s hospitals will be able to receive electronic referrals, 95 percent of physician practices will be able to send them, most hospitals will be capable of sharing x-rays electronically, all 19 maternity units will run a single computer system, and all of Ireland’s 43 medical labs will share information via an electronic network.

AdvancedMD launches AdvancedEPCS for electronic prescribing of controlled substances.

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CHIME launches the year-long, $1 million prize National Patient ID Challenge to develop some kind of technology workaround to the lack of a national patient identifier. I have a lot of questions: (a) where did CHIME get $1 million to spend on an R&D project? (b) can any algorithm truly hit 100 percent accuracy without requiring patients to sign up for something new? and (c) if the best submission still isn’t commercially feasible with 100 percent accuracy, does the submitter get the million dollars anyway? Not to mention (d) who has the deep pockets to fund a possible solution with only the hope of earning a winner-take-all prize? (actually there’s a $30,000 prize after the second round, but still …) Perhaps CHIME is actually hoping that someone will launch a third-party registration service since a national health ID isn’t illegal – it just can’t be funded using federal money. I admire the initiative, but I would be somewhere between surprised and shocked if the winner’s solution earns broad adoption.


Government and Politics

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The VA pays the director of its Danville, IL system $86,000 to resign and keep quiet after he complains to the Merit Systems Protection Board about being charged with threatening to fire a co-worker who reported him for doing little work, having sex with a female VA employee, and then bragging about his conquest to the female employee’s daughter, who also works for the VA. The daughter complained that she didn’t want to hear details about her mother, after which the director sent her a letter that said, “Would you like to live the rest of your life without a mom to be there for you and (redacted word) or would you prefer to have (her) available and happy in my company?’

New Jersey Governor Chris Christie kills a bill that would have required the state’s non-profit hospitals to pay city fees to help cover the cost of municipal services. Oddly enough, the New Jersey Hospital Association collaborated on the bill, hoping to avoid individual lawsuits brought against its member hospitals from cities demanding they pay their fair share. Or as the association’s CEO phrased it while comically avoiding saying the word “tax” in the same sentence as “hospital,” “for hospitals to support their host municipalities with added community contributions.”


Technology

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The Rite Aid drug chain rolls out proximity beacons to its 4,500 stores in the largest such implementation in a retail setting. The app sends advertisements and offers (“contextual experiences”)  to the smartphones of in-store shoppers. I bet HIMSS will have it running by next year’s conference.


Other

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I’m not sure what the British reporter (its political editor, of all things) who wrote a newspaper story titled “Strike all you like, doctors – technology will soon take away your power” expected, but he seems to be whining that doctors disagreed with his highly questionable conclusions, including his belief that people running around wearing Fitbits (which he spelled wrong) will upend “a profession reluctant to give up its position as the keepers of knowledge.”

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Former Allscripts CEO Glen Tullman provides an interesting career bio to the Chicago Tribune. I wasn’t as interested to read about his investments in vendors of shoes, tea, and solar roofs as I was his recap of  his Allscripts days:

Then I went to a company called Enterprise Systems, which was in the healthcare business. Privately held. They asked me to come in as CEO. I took it public a year after arriving, and then a year later we sold it to the medical information company HBOC at a wonderful valuation … after we sold, I went to a company called Allscripts. Allscripts got to Series J financing [that is, the 10th round], which very few living people ever do. You have a lot of enemies, and you’ve burned through a lot of cash, and that’s when I arrived. We bought just over 60 percent of the company for $6 million … Then we went to work creating the first electronic business that prescribed at scale. We became the leading electronic health record provider in the country on the ambulatory side. Two years later, I took the company public at a $2 billion valuation.

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In Australia, the pathology department of Royal Melbourne Hospital goes to manual processing when malware infects its computers running Windows XP, whose support and security updates ended on April 8, 2014. Given the infected location, I would bet that those PCs were running software that is regulated as a medical device and therefore can’t be upgraded without the software vendor’s approval.

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A Health Affairs study identifies the 50 US hospitals with the highest markups, of which 49 are for-profit and 20 are in Florida. Their list prices averaged 10 times their reported costs, meaning out-of-network or cash-paying patients get stuck trying to cobble together enough money to pay bills inflated with a 90 percent profit margin. The authors suggest policy changes that could include: (a) requiring hospitals to publicly post their charge-to-cost ratio; (b) forcing hospitals to apply the same markup to all services rather than selectively jacking up areas like anesthesiology; (c) setting a maximum allowed markup for a given patient; (d) requiring hospitals to offer their lowest negotiated rate to everyone; or (e) requiring insurers to use the same payment method (such as DRGs) but allow the actual payment to vary by insurer based on negotiated rates. 

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A BMJ blog post from a palliative care doctor and David Bowie fan thanks the late musician for leaving an allegory-laden final album, for dying with dignity at home instead of in a hospital, and for inspiring patients to strive for a good death as the end of a good life.

I was thinking about NASA’s use of telemedicine for space station astronauts, which I assume must not involve Houston-based Johnson Space Center since the Texas Medical Board would otherwise find a way to shut it down.


Sponsor Updates

  • PeriGen publishes a white paper titled “The Future of Electronic Fetal Monitoring.”
  • Health Facilities Management publishes a Field Report detailing how Trinitas Regional Medical Center reduced the severity of injuries due to assault with Versus Staff Assist.
  • Bottomline Technologies will sponsor Leadership Seacoast, a nonprofit that educates and informs future community leaders. Vice President of Services and Operations Jill McFarland will participate in the organization’s 2016 class.
  • ZeOmega’s Jiva PHR earns ONC HIT 2014 Edition Modular EHR certification.
  • Capsule Tech will participate in the IHE Connectathon January 25-29 in Cleveland.
  • The local business paper features CareSync in an article on venture capital funding.

Blog Posts


Contacts

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

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January 19, 2016 News 4 Comments

Morning Headlines 1/19/16

January 18, 2016 Headlines No Comments

Privacy experts say Coburn op-ed misses the mark

Privacy experts respond critically to an op-ed published in the Wall Street Journal last week by former Senator Tom Colburn, MD’s in which he argues that “HIPAA makes it difficult for researchers to tap into large caches of clinical and genomic data shared across multiple institutions or firms, and then share their findings more broadly.”

50 hospitals charge uninsured more than 10 times cost of care, study finds

A Health Affairs study analyzing Medicare-certified hospital data from 2012 and 2013 finds that 46 of the 50 hospitals with the highest overall markup on care delivered to out-of-network or uninsured patients are members of for-profit health systems, and that 20 of 50 operate in Florida.

Cerner again teams up with KC-area startup

Cerner partners with local Kansas City startup Infusion Express, an outpatient IV therapy company, to reduce IV treatment costs among its employees and reduce absenteeism by a forecasted 5,000 hours annually.

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January 18, 2016 Headlines No Comments

Monday Morning Update 1/18/16

January 17, 2016 News 1 Comment

Top News

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The New York Times takes public the recent OCR clarification for providers whose patients request copies of their medical records. An American Hospital Association SVP says the guidelines are “a helpful reminder,” the need for which she didn’t mention – that most of AHA’s members do everything they can, including citing non-existing policies or legal requirements, to avoid giving patients copies of their own information.

The statement was welcome, but areas of concern might be:

  • The law was already in effect and was being widely ignored by doctors and hospitals, with no announcements of any resulting fines or enforcement actions.
  • Patients will need to understand their rights and how to complain to OCR, which 99.99 percent do not.
  • The effort required to file a complaint – and the potential for disrupting the provider relationship for doing so — will discourage most people from notifying OCR even if they know how.
  • Providers still have a ridiculous amount of time to provide records that are most likely stored electronically.
  • Many hospitals use release-of-information companies to handle patient records requests, allowing those companies to bill high per-page charges. It’s not clear to me whether that practice will be abolished since OCR’s requirements affect providers, not third parties.
  • It would be nice if insurance companies, which have a lot more clout with providers than patients, would accept and manage records requests of their insured patients.
  • OCR will have to respond to an increasing volume of complaints, which given their lack of response to a complaint I filed in July 2015 for exactly this situation from either the hospital or OCR, seems unlikely.
  • OCR hasn’t done much to stop HIPAA violations, rarely using its power to levy fines.
  • The only positive outcome for a patient who files an OCR complaint is finally getting the records, probably after a long delay in which their clinical value has been greatly reduced.

Reader Comments

From MU Later: “Re: your comment that CMS might be disappointed by how ONC has run Meaningful Use. ONC does not manage the program – that is solely done by CMS. ONC provides certification parameters and feedback to CMS, which is free to do whatever it wants.” I admit that I incorrectly think of ONC as being in charge of Meaningful Use since I’m not all that knowledgeable about the inner workings of ONC, CMS, and HHS or how much of ONC’s effort involves MU. Reading about the initial implosion of Healthcare.gov and the political differences between federal “agencies” and “offices” with their sometimes dueling fiefdoms and competing CIOs made me glaze over.

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From Pustular Exudate: “Re: CareCloud. Of the 10 leadership positions listed on their website, nine are held by men. The one female is the head of HR.” CareCloud’s executive team is therefore 90 percent male, compared to Cerner (80 percent), McKesson (78 percent), Allscripts (92 percent), Athenahealth (90 percent), Meditech (62 percent), and Nordic (54 percent), just to list a few companies that I chose randomly.

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From Gettin’ Jiggy: “Re: Becker’s Hospital Review. I wondered who is doing those clicky, empty stories. New grads, that’s who. Checked their LinkedIn employee list.” Reviews on Glassdoor say things like, “This is not journalism … editors suggested that writers rerun quotes and portions of old features and cobble them together to create new content” and “recapping real reporters’ healthcare news to spit out on our sites … working on a feature story with some sort of catchy, click-friendly title like ‘7 Ways to Make More Money.’” They are the industry’s Buzzfeed, cranking out click-baiting headlines and mindless lists from content reported better elsewhere, read by folks who can’t resist the temptation of journalistic junk food. I can’t fault it – it apparently has quite a few readers and its employees say it makes a fortune for the owner.


HIStalk Announcements and Requests

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Two-thirds of poll respondents aren’t interested in company funding announcements. New poll to your right or here: what impact will providers see from CMS’s planned changes to the EHR incentive program?

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Mrs. Perez is a new teacher in the gifted program of her Florida school and reports that her students are using the portfolios we provided via her DonorsChoose grant request to organize and present their materials when they attend their gifted class. She isn’t allowed to send photos that include student faces, but was nonetheless creative in having them pose with their “thank you” signs attached to their brand new portfolios.

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Ms. B checked in from her Illinois kindergarten class, for which our grant provided STEM exploration kits. She provides some background: “Thank you for providing my little scholars with the opportunity to experience the STEM activities from this proposal. You may say, ‘why linking monkeys?’ Well, just look at the joy on my students faces when they’re using the linking monkeys to learn the standard of number representation… What about the classifying chart? My scholars love to size up the various pictures and debate on who has it correct. Is a bus larger or smaller than a ball?”

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Recruitment and consulting firm Healthcare IT Leaders donated $1,000 to DonorsChoose to secure a presenter spot at my CIO lunch at HIMSS (contact Lorre if you would like to do the same or to volunteer as a CIO attendee). I’ve exhausted the matching funds from my anonymous vendor executive, but I was still able to use dollar-for-dollar matching funds from third-party foundations to fund these teacher grant requests from their donation:

  • Five tablets and three headsets for Ms. Johnston’s elementary school class in Aurora, CO
  • Math manipulatives for Ms. Krieg’s fourth grade class in Round Lake, IL
  • Math center games for Ms. Yoder’s first grade class in Jacksonville, TX
  • A library of 13  literacy and numeracy DVDs for Ms. White’s kindergarten class in Phoenix, AZ
  • Two Osmo gaming systems for Mrs. Jochum’s elementary school class in Norfolk, NE
  • Math games for Ms. Medel’s fifth and sixth grade classes in Indianapolis, IN

My new dentist offers a $400 per year plan for patients without dental insurance that includes two cleanings, a whitening treatment, annual exam with x-rays, and a 30 percent discount on other services. I was running the numbers to decide whether I’d be better off dropping dental insurance and paying him directly when I realized that the most valuable contribution of insurance companies is to negotiate pricing in their contracts. His list price for a filling is something like $240 vs. the insurance-negotiated price of just over $100, so his 30 percent member discount would leave me paying $168 ($240 x 0.7) vs. $40 with insurance ($100 x 0.4 since insurance covers 60 percent of the negotiated price). I’m back to my never-ending question – why do providers charge so much more for cash-paying patients as a “cash surcharge” rather than a “cash discount?” Maybe it’s naive to think that they should offer the same rate to everyone, but that’s how it seems to me. It’s easy to understand why ever-expanding big health systems are increasing prices through pricing power rather than decreasing them through efficiency – because they can.


HIStalkapalooza

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About 900 folks have signed up to attend HIStalkapalooza, so the window will soon close on your opportunity if you aren’t one of them. Barry and Jennifer will host again, the red carpet is set, and at least three HISsies winners will appear on stage. The good news is that unless I get swamped with additional requests, I’ll be able to invite everyone who signs up, same as last year. 

If you haven’t attended previous HIStalkapaloozas and are wondering why so many people rave about the band, here’s a video of Party on the Moon, who fills the dance floor literally from their first note to their last. As a music snob, I’ve never seen anything like them, which is why I keep bringing them back. They love the HIStalkapalooza crowd and are rewarded with reciprocation.


Last Week’s Most Interesting News

  • A House committee review finds that the VA’s self-developed claims processing system is being used only as a document repository despite a budget that is running double the original estimate of $580 million.
  • CMS Administrator Andy Slavitt announces the end of the Meaningful Use program in its current form in favor of “something better” in remarks delivered at the JP Morgan Health Care Conference, where he also warns that “data blocking will not be tolerated.”
  • The National Center for Policy Analysis criticizes the Texas Medical Board’s “protectionist” restrictions on telehealth, noting that the state is worst in the country in providing access to care.
  • The American Medical Association gets into the for-profit incubator business by spending $15 million to launch Health2047.
  • OCR clarifies provider responsibilities in giving patients copies of their medical records, noting that they can’t require patients to physically visit their premises, can’t refer them to an online portal, and must provide electronic copies if patients want their records in that form.

Webinars

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


Sales

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Duke University Health System chooses Phynd’s Unified Provider Management platform.


Announcements and Implementations

TierPoint appoints four former executives of its acquired Windstream Hosted Solutions to key leadership roles. The company offers cloud, co-location, and managed services.


Privacy and Security

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In Canada, Alberta Health Services drops disciplinary action against 24 of the 48 employees it had accused of inappropriately accessing patient records in a high-profile case, including rehiring the one employee it had fired and paying any missed wages that resulted for all of them. The nurse and public employee unions successfully argued that hospital’s policies weren’t clear.

Montana health plan New West Health services says a stolen, unencrypted laptop full of PHI covering 25,000 people has inspired it to install “additional security on all company laptops.”


Other

I just noticed that Epic has been running job ads for Epic Hosting as “we enter the realm of multi-tenant hosting and create a data center with a cloud-based approach.” The way it describes the employer as “Epic Hosting” suggests that it’s a separate company.

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In England, a doctor shortage is blamed for delays in returning patient calls to the non-emergency 111 service that’s run by a private company, with patients waiting up to 12 hours to hear back. Employees say they were told to falsify records to make the service appear more efficient.


Sponsor Updates

  • The Salt Lake City television station features Health Catalyst in a report on the cost of healthcare.
  •  T-System, VitalWare, and ZirMed will exhibit at the HFMA Region 11 Healthcare Symposium January 24-26 in San Diego.
  • Valence Health will exhibit at the South Dakota HFMA Winter Meeting January 21-22 in Chamberlain.
  • Verisk Health’s Sam Stearns and Jon Edwards pen a guest column on on-site clinics for Employee Benefit News.
  • Versus real-time location solutions receive Novation’s Innovative Technology designation.
  • Huron Consulting Group President and CEO James Roth shares his 2016 predictions with Consulting Magazine.
  • The local business paper profiles WeiserMazars Digital Marketing Manager Gabrielle Chwazik-Gee.
  • YourCareUniverse releases the latest edition of The Navigator newsletter.

Blog Posts


Contacts

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

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January 17, 2016 News 1 Comment

News 1/15/16

January 14, 2016 News 5 Comments

Top News

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WebMD shares rise on the rumor that the company is up for sale, with Walgreens and UnitedHealth Group named as possible acquirers. The share price dropped back to previous levels when the company denied the rumors.


Reader Comments

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From Lax It Is: “Re: CareCloud. Missed 2015 revenue numbers wildly and its strategic partnerships have fallen apart. Sales execs are being axed and a high-level executive is being let go although the company is trying to keep it under the radar.” Unverified. I reached out to the company but haven’t heard back.

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From Darned Kids: “Re: Cerner. I’m CIO at a health system implementing Cerner. We’re having trouble with resources, mostly leadership. A Department of Defense halo effect that I am battling with.”

From Beautiful Loser: “Re: Quality Systems/NextGen. Following its purchase of Health Fusion, the company is ceasing development of its next-generation ambulatory product and is laying off the entire Austin office. Everyone is seeking jobs at Mirth and other QSI divisions. What a waste of time and money to scrap the new system after three years of work.” Unverified. The company has so far not responded to my offer to comment.

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From Pushing Daisies: “Re: Leidos Health. They are definitely recruiting for Epic people.”

From CMIOHio: “Re: CMIO lunch at HIMSS. Are you having another one this year?” I’m not opposed to the idea, but it won’t be as easy since the Bistro HIMSS lunch service program right on the exhibit floor isn’t offered in Las Vegas. I’m open to suggestions.

From NantWatch: “Re: NantHealth. The head of sales and business development has abruptly quit.” Unverified. His LinkedIn profile remains unchanged and there’s no executive page to check on NantHealth’s site since the only person listed has always been founder Patrick Soon-Shiong, not that he has a outsized ego or anything.

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From Justa CIO: “Re: Denver Health. How many CIOs will have their careers either tarnished or blown up due to Epic? The body count continues and adds credence to the not-so-funny joke of how many CIOs does it take to do Epic? Three: (a) the one who was there when it was picked; (b) the one who implements it; and (c) the one who comes in after the financially driven bloodshed after the install. What is the cause of this effect? I would love to see thoughts other than my own.” I’ll hopefully be able to provide a bit more insight shortly as I’ve been working on a report with the Peer60 folks about Epic sites, in which we surveyed a bunch of CIOs, CEOs, CFOs, chief medical officers, and chief nursing officers to get their candid assessment of their Epic projects. I asked some blunt questions and got some great answers that I’ll make available for free once we’ve written everything up.

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Here’s what one health system CEO said in my Epic customer survey: “Epic has increased our operating cost at a time when we had no ability to absorb that cost. The Epic EHR, at least until now, has not added an strategic advantage or underlying improved operations.” In contrast, a CIO said, “Epic has been a great vendor and partner of ours for over 10 years. I continue to get more impressed with them in most things through time and have yet to find another vendor (for any application) that is even close to matching up with them in quality, support, and future viability.” By the way, thanks to the many folks – including around 100 Epic-using CIOs — who responded to the survey.


Reader Gripes

  • New CIOs who come into a hospital IT department that has had relative success for many years and the first new package they want to install is employee productivity software. Or worse yet, manual logging of time spent on every activity. How much good ever comes from this morale-busting practice?
  • The VA system. The latest news of the Phoenix employees surfacing elsewhere in the system is just BEYOND outrage but wait, it’s the government—screwing the people that laid down their lives to keep us free.

You can sound off about your gripe or you can even say something positive if you’d rather.


HIStalk Announcements and Requests

Thanks to Nordic, Xenergy Healthcare, BlueTree Network, XL Health Partners, and Dak Systems Consulting, all of which offered to run the check-in table at HIStalkapalooza. It’s gratifying to mention a need and have so many people volunteer. Santa Rosa Consulting offered quickly and is taking charge admirably, even reviewing the possibility of using electronic invitations and barcode-powered check-in to shorten the line, something I’ve always wanted to do.

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I’m declining to comment on the President’s so-called “cancer moon shot” because I think that concept is well-intentioned but naive, this perception that cancer is a single, curable disease that can be defeated by throwing money at research, having technology geeks lovingly stroke their Watson or NantHealth computers, or encouraging people to run around while wearing pink in October. Americans in general and non-scientist politicians in particular love the idea that bold innovation and taxpayer money can fix specific problems, but what we really need in US healthcare isn’t diagnostic supercomputers, gene editing, and yet another data-spewing wearable that benefit a small percentage of the population at best. We need to embrace the public health approach to improve the health of the most people, which involves far less sexy work such as:

  • Focusing on the 80 percent of health that has nothing to do with impressive buildings containing people wearing scrubs. “Healthcare services delivery” is a small subset and a not necessarily major determinant of “health” despite its budget-busting cost.
  • Making healthcare services affordable and accessible to everyone since we’re going to pay collectively for the consequences.
  • Reducing the prescription and non-prescription drug epidemic that has a big chunk of the population stumbling around in a mind-altered haze, pocketing cash for fueling it, or being expensively supported by taxpayers while incarcerated because of their role in it.
  • Turning healthcare into something other than profit center for drug and device companies, supposedly non-profit hospitals, insurance companies, and procedure-cranking specialists.
  • Addressing obesity and physical inactivity as the only exercise more and more Americans get is lifting their forks and their phones to their faces.
  • Dealing with mental health problems that cause expensive overreliance on EDs and community organizations.
  • Increasing patient engagement responsibly, allowing patients an equal say in how their health is managed  while committing to education to stop their irresponsible requests for narcotics, antibiotics, and over-advertised prescription drugs.

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We funded the DonorsChoose grant request of Ms. Carbo in Georgia in purchasing an iPad Mini and programmable robot to teach programming to her first graders and to allow them to participate in the Hour of Code. She sent some photos, including the one above.

This week on HIStalk Practice: Dr. Gregg thinks HIT might benefit from a little rock-n-rollness. GE Healthcare relocates to the US. Teladoc reports record revenue and visits, while American Well touts its top-app ranking. CMS releases its latest round of MU EP payment figures. Fitbits become one university’s link to student fitness and academic performance. Lyft gets into healthcare.

This week on HIStalk Connect: Flatiron Health raises a massive $175 million Series C to further develop its oncology EHR and clinical decision support platform. Researchers from multiple labs are working to change the way cancer screenings are conducted. Higi raises $40 million to expand its health and wellness platform. AiCure, backed by $7 million in NIH grants and a fresh $12 million Series A, works to solve medication non-adherence with an artificial intelligence platform.

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It’s odd that Andy Slavitt from CMS moved so quickly from MU Stage 3 cheerleading to distancing himself from it in proudly announcing that it will be going away via Twitter this week. Maybe HHS is unhappy about how ONC has managed the program, or it could be that the endless whining of provider organizations about it was wearing thin, or perhaps it relates to the upcoming elections. Surely John Halamka’s call for its demise must have rattled the federal folks given his long and constructive involvement with the federal programs. I asked John what he thinks and he expanded on his Thursday blog post:

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This is a general consensus among healthcare systems in the US that prescriptive regulations will not work. My feeling from speaking with many stakeholders in industry and government is that MACRA will offer incentives (not penalties) for achieving an outcome without mandating a workflow or requiring certified technology. Instead of “reconcile medication lists 80 percent of the time for transactions sent 50 percent of the time and incorporated 40 percent of the time,” the outcome might be, “Improve patient compliance with medications.” If you do that with Apple Watches and a patient-facing medication administration app, great. If you send high school students with a clipboard to inventory a patient medicine cabinets (with their consent), that’s OK too.


HIStalkapalooza

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Signups are still open for HIStalkapalooza, which promises to spice up the otherwise mundane Monday (the equivalent of Sunday in non-Las Vegas HIMSS days). The HIMSS conference opening reception won’t have the fabulous Party on the Moon band, stage show, and the HISsies.

Sponsors of HIStalkapalooza 2016 are:

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HIStalkapalooza Sponsor Spotlight

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Validic provides the industry’s leading digital health platform connecting providers, pharmaceutical companies, payers, wellness companies, and healthcare IT vendors to health data gathered from hundreds of in-home clinical devices, wearables, and consumer healthcare applications. Validic was named to Gartner’s “Cool Vendors” list, received Frost & Sullivan’s “Best Practices and Best Value in Healthcare Information Interoperability” and was recently featured as a “Top 10 Healthcare Innovating Disruptor” in Forbes. Its scalable, cloud-based solution offers one connection to a continuously-expanding ecosystem of consumer and clinical health data, and reaches more than 223 million lives in 47 countries. Check them out at validic.com, on Twitter @Validic, or at their HIStalkapalooza Cabana on the House of Blues dance floor.

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The CIO lunch to raise money for DonorsChoose will be Wednesday, March 2 from 11:00 a.m. until 1:00 p.m. at Maggiano’s Little Italy, just down the street from the convention center. A $1,000, tax-deductible vendor donation will provide admission to one person who will provide a company overview and then socialize with volunteer CIOs such as Dana Moore (Centura), Ed Marx (NYC Health + Hospitals), Drex DeFord (freelance consultant), Ari Entin (Natividad Medical Center), Chuck Podesta (UC Irvine Health), Steve Hess (UCHealth), and others helping out for a good cause. I’m paying for lunch, so all the money goes to DonorsChoose. Contact Lorre to sign up, either as a CIO or donating company. I’ll announce everyone who is involved.


Webinars

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


Acquisitions, Funding, Business, and Stock

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GE will move its global headquarters from Connecticut to Boston to avoid high Connecticut taxes and to gain access to technology organizations and talent. Boston and Massachusetts are providing up to $150 million in incentives.

Practice Fusion says its 2015 revenue grew 70 percent.

CVS Health announces affiliations with John Muir Health, University of Chicago Medical Center, Novant Health, and University of Michigan Health System in which it will exchange EHR information and offer services from its MinuteClinic locations. All of the organizations, including CVS, use Epic.


Sales

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Parkland Health & Hospital System (TX) expands its use of Kaufman Hall’s products to include cost accounting and capital planning software.

In Australia, St. George Hospital chooses Spok for radiology result notification to smartphones.


People

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WEDI President and CEO Devin Jopp, EdD resigns to start a consulting firm.

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Tim Kuebelbeck (NantHealth) joins LogicStream Health as EVP of sales.

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Stuard Hammond (SCI Solutions) joins Forward Health Group as VP of sales.


Announcements and Implementations

HIMSS Analytics launches Logic, a more personalized, dashboard-driven version of its HIMSS Analytics Database. It will offer demos, not surprisingly, at the HIMSS conference.

Health plan MDwise will extend its use of ZeOmega’s Jiva population health management solution to monitor medication adherence and safety.


Government and Politics

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The House Committee on Veterans Affairs reviews the VA’s “over budget and underachieving” self-developed claims processing system system, the cost of which is running double the original $580 million estimate at $1.3 billion and counting. Committee Chairman Congressman Jeff Miller (R-FL) says the Veterans Benefits Management System (VBMS) was supposed to fully support disability claims and pension applications but is only being used as a document repository for appeals. Testimony from the GAO says the system was designed only to serve as that document repository and delayed timelines are due to scope creep in extending its capabilities. GAO also concludes that the VA’s agile development methodology has prevented it from setting firm completion estimates, timelines, and deliverables.

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In England, the NHS posts a job opening for the newly created position of CIO/CTO.

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Florida eliminates decades-old quality standards for pediatric heart surgery following big political donations from for-profit hospital operator Tenet, which owns a hospital that had earned widespread media coverage for its poor outcomes. Death rates for pediatric heart surgery at Tenet’s St. Mary’s Medical Center were triple the national average while performing only 27 cases per year, information CNN had to obtain through Freedom of Information Act requests since the hospital refused to publish the data publicly and tried to block CNN’s investigation. CNN’s report aired in June 2015 and the state dropped the standards in July, claiming that the Department of Health didn’t the Legislature’s approval to implement them in  1977. The hospital closed the program and the CEO resigned in August.


Technology

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Oral Roberts University will track the physical activity of all of its incoming students, who will be required to purchase Fitbits. The university had previously required all students to log their exercise in a fitness journal as part of its Whole Person Education program.

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TechCrunch profiles Medal, which claims its software can be installed on a doctor’s computer in 60 seconds and can then move EHR information around to other providers. “We’re hoping to create true interoperability for the first time in this country,” says the founder. 


Other

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Athenahealth CEO and former emergency medical technician Jonathan Bush elbows observers aside outside the JP Morgan Healthcare Conference to perform CPR on a man who had collapsed on the sidewalk. Bush did mouth-to-mouth as another good Samaritan handled compressions. Bush describes, “It was like the US healthcare system. Everybody was standing there, nobody was helping.” It’s a public relations bonanza for Athenahealth, which just happened to have a camera on hand to snap an action photo.

An opinion piece in NEJM decries the forced, efficiency-driven “one best way” standardization of the physician-patient encounter that is causing dissatisfaction and burnout as patients find themselves answering EHR-driven checklist questions instead of being allowed to speak freely. It adds,

Encounters have been restructured around the demands of the EHR: specific questions must be asked, and answer boxes filled in, to demonstrate to payers the “value” of care. Open-ended interviews, vital for obtaining accurate clinical information and understanding patients’ mindsets, have become almost impossible, given the limited time allotted for visits — often only 15 to 20 minutes. Instead, patients are frequently given checklists in an effort to streamline the interaction and save precious minutes. The EHR was supposed to save time, but surveys of nurses and doctors show that it has increased the clinical workload and, more important, taken time and attention away from patients.

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In South Australia, technology vendor Global Health wins the EHR business of Adelaide Primary Health Network despite the company’s ongoing legal battle with the South Australia government, which refuses to stop using a 1980s Global Health application that the company insists has been sunsetted.

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An Oregon health news site reports that PeaceHealth’s former president was fired in 2014 because of declining profit margins and problems with its implementation of Epic.

Bizarre: drug companies are chasing underage hemophilia patients like colleges pursue star high school athletes — hiring their relatives, taking them to dinner, infiltrating disease support groups, and paying recruiters (often patients themselves) a percentage of drug sales in hoping to convince the patients and their families to use drugs that cost up to $1 million per year (paid by insurance companies and taxpayers, of course, not the patient or families being courted).

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Weird News Andy says that a good cleaning was apparently “out of scope” as a Senate investigation determines Olympus knew that the design of its duodenoscopes made them hard to clean, which caused at least 141 patients to become infected while undergoing procedures. WNA concludes that, “Clarence Darrow would not monkey around, he’d just win this trial.”


Sponsor Updates

  • Leidos Health will exhibit at the Meditech Executive Institute January 17-19 in San Diego.
  • Medecision CMO Ellen Donahue-Dalton discusses the consumer healthcare experience at the Atlanta CMO Breakfast series.
  • Nordic representatives will attend the HIMSS Dallas/Fort Worth Chapter event January 22 in Arlington, TX.
  • Recondo recaps 2015 and offers 2016 RCM predictions.
  • PeriGen CNO Becky Cypher, RN contributes to a study on the effect of elective induction on C-section delivery rates published in Obstetrics & Gynecology.
  • Summit Healthcare will exhibit at Meditech’s MUSE Executive Institute January 17-19 in San Diego.

Blog Posts


Contacts

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

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January 14, 2016 News 5 Comments

HIStalk Interviews William Winkenwerder, MD, Chairman, Winkenwerder Strategies

January 11, 2016 Interviews 2 Comments

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William Winkenwerder, MD, MBA is chairman and founder of Winkenwerder Strategies. He was formerly president and CEO of Highmark, Inc.; assistant secretary of defense for health affairs for the United States Department of Defense; and has held leadership positions with Blue Cross Blue Shield of Massachusetts, Emory University, Prudential Healthcare, Kaiser Permanente, and the Department of Health and Human Services. He serves on the boards of health IT vendors CitiusTech, Cureatr, and Accreon.

Tell me about yourself and what you do.

I am the chairman and founder of Winkenwerder Strategies. We’re a healthcare advisory and consulting firm. I focus my efforts currently — and our firm does — on innovative healthcare companies. In that vein, I work with a number of leading private equity firms who are investing in healthcare companies, serve on the boards of these portfolio companies, and invest in these companies. In addition to that, I have a group of advisory clients in the healthcare industry.

Prior to this, I served as the CEO of Highmark Health, one of the largest health insurers in the United States. I also served as assistant secretary of defense for health affairs with responsibility for all the healthcare for the US military and the Tricare program. My background prior to that was about 20 years in the healthcare industry working in the managed care sector, both on the health plan side and the provider side.

I’m an internist by background and training, board certified. I also have a business degree from the Wharton School.

What are the biggest challenges and opportunities in healthcare IT?

There are tremendous opportunities today in the area of health information technology. Healthcare continues to pose tremendous challenges for corporate budgets, personal budgets, and our federal budget, not to mention state budgets.

We continue to spend more money each year. We thought for three of four years that the healthcare cost growth might have been tamed, but it appears that it’s taking off again this year. We are spending now over $3 trillion a year on healthcare in the United States, representing about 17-18 percent of our entire economy. What is a really amazing fact is that over the next 10 years, we will spend many trillions of dollars on healthcare, and within 10 years, we’ll be spending over $5 trillion in a single year.

There are tremendous challenges with all of that cost growth to provide healthcare and pay for healthcare in more efficient ways. I firmly believe that health information technology as an enabler of better business solutions and better care processes is critical to that task.

Where do you think we’re spending too much and getting too little return in terms of overall population health?

We’re spending too much inside of institutions, principally in hospitals. The hospital sector is the most single expensive sector of the entire healthcare economy. More recently, we’ve been concerned about pharmaceuticals, especially because of price increases these last two or three years, but pharmaceuticals just represent 10 or 11 percent of the entire healthcare dollar. We’re spending a lot of money in the area of long-term care in caring for people with chronic conditions.

It’s difficult to put your finger on a single sector or single area within the entire healthcare economy that is responsible for most of the problem. It really cuts across all the sectors.

We can do things so much more efficiently. But in order to accomplish that task, there have to be the right financial incentives in place and the right information, not just for clinicians and administrators in the healthcare system, but also the right information for consumers to choose and make decisions about their healthcare in order to create more of an economy for healthcare services.

Until just the past few years, there has not been, in many areas, sufficient information for people to make decisions. There has not been sufficient engagement by consumers. That’s beginning to change. People are beginning to take healthcare decisions more into their own hands, principally because they are now experiencing some of the costs directly themselves through the changes in the benefit designs, which have more high deductibles and more co-insurance and cost sharing.

The individual and the family have a vested interest in getting value for their dollars. Even though that creates some pain right now, it’s a good thing in the sense that it’s going to force more economical provision of care.

You just called out the elephant in the room. Are people realizing that their despite non-profit status and source of community pride, hospitals are looking out for their own interests as they integrate to command more market power?

There are lots of shared and conflicting interests when it comes to the local community hospital or even the regional hospital system of today. The problem is that in many markets — in fact, probably most at this point — there is just one hospital system,  two, or potentially as many as three. This leaves in place a situation where there’s not sufficient competition. This is especially the case when the hospitals and doctors have come together in a community and really are just one force.

It reduces the number of choices that people have. Frankly, I think it creates a situation where there’s not sufficient room for innovation and change in the way that care can be provided. Being a physician, I think some of the most innovative models of care are through physicians driving change. I hope that, in the future, we’ve got physician-driven systems that are able to compete on equal footing with big hospital-based systems.

You worked in the Pittsburgh market, which was a bellwether for what was about to happen everywhere as providers became insurers, insurers became providers, and competition got ugly. You had UPMC as a national and even international brand. Will that also become common, where we’ll see the emergence of regional or national provider brands?

I do see the emergence of regional and national provider brands. To be clear, I don’t believe that this is all bad by any stretch. There are many great organizations that provide great care and that have developed a great brand because of their quality, their service, and their capability.

The problem comes when that entity acquires many of the resources, the assets for care within a given geographic region. Because healthcare is local, that creates a situation where there’s not choice, because people typically can’t drive hundreds of miles to receive services. It’s not like you can get your healthcare on Amazon or get the service delivered through UPS. You have to go to a local institution, a local doctor and so forth.

It’s important that regardless of who owns the assets, the rule book allows healthy competition to take place. In the absence of that, the only vehicle for control, if you will, of pricing is the government. The government typically has not been reluctant to step in to set prices or influence pricing where they can. I would expect that there will be a push to do that in other ways in other ways, pharmaceuticals, for example.

What has been the impact of the Affordable Care Act and what will it be going forward?

The Affordable Care Act has got, at best, a mixed set of results associated with it. On the positive side, we have more Americans who are insured, principally through the expansion of Medicaid, and to some extent, through the creation and operation of exchanges in most states.

The total number of additionally insured people, I think now is in the range of 16 to 18 million. Much of that is through Medicaid. I think the breakdown on that is like 10 to 12 million through Medicaid and six or seven million through exchanges. The target for the Affordable Care Act was in the range of 32 to 35 million. It’s fallen far short of the target. 

At the same time, it’s introduced a lot of requirements and burdens on employers that have not made a lot of employers happy. It’s also created a bureaucratic regulatory infrastructure that I worry introduces unnecessary costs as well as a potential for limiting innovation.

On the positive side, in addition to the newly covered lives, you do have some benefits from the introduction of products on these exchanges that take advantage of things like narrow networks or higher-deductible benefit plans that do, in fact, save costs. These, ironically, are the same things that many people complain about, but they are — from an insurance perspective — the best way to limit the cost to the individual. There’s really a Catch-22 going on with some of these developments.

Certainly this is a highly political issue. It’s been that for six years now, since 2010, and it’s going to be a factor in the 2016 elections. We’ll see where all of that goes. My expectation is that there will be a continuance of certain elements of the Affordable Care Act regardless of who becomes president, but there could be a lot of change to the Affordable Care Act depending upon who gets elected.

The middle class is being hit hardest financially with higher premiums, deductibles, and co-insurance because lower-income families receive federal insurance subsidies and high-income families can afford the higher costs. One ED visit could bankrupt the average family even with insurance. What do you think the average voter wants to happen?

You have to read lots of different polls and you get different answers. People seem to want, in my reading of all of this, coverage to be available that’s affordable, on the one hand. On the other hand, they like to have choice and they would like protection against some of these high costs of healthcare.

It’s really a double bind. There’s no way to provide a really highly affordable coverage plan, for example, in a market where there’s consolidation of providers and not much insurance competition. The cost of care is just going to be expensive.

My hope is that we set the conditions and the incentives into place such that cost of care can be driven down, not just held at bay or made to grow at a slower rate of increase. There’s evidence that care can be delivered at a lower cost than it is today, many times using good technology solutions and putting information into the hands of individuals and providers.

People talk a lot about patient engagement and consumer involvement.  Do consumers have more influence as customers and are providers recognizing that they must operate differently as a result?

I do believe that consumes are more engaged, have more influence on their care, and want more influence on their care. They are able to get their hands, if they’re reasonably educated and interested, on information about their particular condition. That’s available on the Internet. That’s available through information sources that people can easily access. People are driving decisions at a consumer level today in ways that just weren’t happening a decade ago.

People think insurance companies are the bad guys, but what are their challenges in trying to create and manage a risk pool?

This is where CitiusTech comes into the conversation. CitiusTech is a highly innovative health information technology company solely focused on healthcare and working across all sectors, providers, health plans, life sciences, pharmaceutical, and also working even with other technology companies.

What’s needed, as you try to develop new kinds of risk- and performance-based arrangements between the payers, between the health plans and the providers, and even the pharmaceutical companies, you need really good information. You need large databases. You need to be able to integrate the data. Ideally, you’re using the capabilities of the cloud. You’re delivering great information.

That’s what I found so attractive about CitiusTech that caused me to want to work with them. We started out our relationship about a year ago in an advisory capacity and then I was asked to join their board about six months ago. They’re a great example of a new kind of company that’s totally focused on healthcare and as deep knowledge of not just the bits and the bytes of the technology, but of clinical issues, clinical information, and clinical operations. When you take that and marry it to the financial side, the health plan world, you begin to create some tremendous capabilities and the kind of capabilities that people need today.

What kind of health IT companies would get you excited about either advising them or investing in them?

CitiusTech would be one for sure. I love what they do. I’m excited with what they’re doing. I think their focus is great. It’s not just the technology, it’s the services and solutions and great talented people. That’s one example.

Another great company that I’ve had a relationship with in the past, serving as a board director, is Athenahealth. Again, a cloud-based company that is on the leading edge of change in how they do things.

There are some newer companies that are focused in specific areas. Say, for example, companies like Vitalz and ZocDoc that are focused on things like the consumer and consumer choice. They’re companies that are focused on even things like personalized genetic information. That’s going to come into the lexicon and come into people’s consciousness in terms of things they want to know about themselves that may be predictive of their future healthcare issues and needs.

There are just a lot of great companies out there. Cerner is a great company, in my opinion. They just recently won the contract to create the next-generation electronic healthcare record system for the military, partnering, by the way, with Accenture and Leidos. I served as an advisor to them in their effort to win that contract, which they did.

There’s a long list. There’s just a lot of very interesting and exciting companies out there today. Obviously, if you go to HIMSS, you’ll get to see all of them and more. It’s an interesting time.

You led the Department of Defense in building their EHR that’s now being replaced. What was your reaction to its decision and the never-ending pressure on the DoD and VA to integrate their systems?

It needed to. The system that was implemented in 2003-2004 — that’s 12-13 years ago — was an earlier-generation system. It worked, but it was really clunky. It was not sufficiently meeting the needs of the Military Health System on a global basis.

It was a big step forward at the time. It was, at the time, the largest global electronic health record system in the world. People there can be proud of what was accomplished then, but rightly in my opinion, there was a focus on creating a next-generation system utilizing the resources of a world class consulting firm like Accenture along with Cerner and along with Leidos, which was formerly SAIC and had a lot of legacy relationships and had done legacy work for the Military Health System, and so knew and understood a lot of the ground-level issues. When you put those three entities together, I think you’ve got the best-of-breed total solution.

If you were king of healthcare for a day, what would you do to fix it?

Boy. It would take more than a day [laughs]. That’s my first response.

I think of the healthcare challenge in the United States on multiple levels. One is at a political level. The politics of healthcare have to be addressed and navigated. One is at a government level. We have existing government programs in place. They need reform, including Medicare and Medicaid. Then we have a private sector system that is connected to, partly governed by, and heavily influenced by government. They are moving parts and they’re connected. Any solution or set of solutions needs to take all of that into consideration.

At the end of the day, I think that what most needs to happen is policy change at the federal government level to set the Medicare and Medicaid programs on a course of financial sustainability. They’re not sustainable right now. There are policy changes that need to be undertaken, things like extending the age of eligibility to get into Medicare, other changes with Medicare and Medicaid, etc. I won’t go into all of them, but there are important policy changes that need to happen within those federal programs.

On the private side, we have to work to create a competitive system, as I’ve alluded to earlier, where there is competition between and among providers and providers and insurers. A system in which individuals can be engaged financially themselves, but at the same time, it’s a system that people of low income and little means have support and protection. When healthcare is costing $10,000 a year per person, or for a family, $18,000 or $20,000, somebody who makes $30,000 a year literally is not going to be able to afford healthcare. We need a support system for those individuals. We just must be very careful that we don’t create something that is not sustainable. Right now, we’re on a non-sustainable track.

The politics need to take ideas from both parties and it needs to be clear-eyed in its movement forward. One of the biggest faults of the Affordable Care Act is that it did not have a single vote from one member of a party that represents half of the people. It actually had votes against it from within the Democratic party. That’s not a good thing. When you want to make big changes, you really need some level of bipartisanship. I hope, as we look at 2016 and beyond, that there will be more of that mindset applied to try to solve those problems.

I’m ever the optimist. I like to believe that America is an innovative place and we want to do right by everybody, but we need to continue to develop solutions that can provide high-quality care to most or all of the people and do that at a reasonably affordable price. That’s the goal. I believe that health information technology is central to that objective.

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January 11, 2016 Interviews 2 Comments

Monday Morning Update 1/11/16

January 10, 2016 News 4 Comments

Top News

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The Office for Civil Rights declares that it won’t tolerate providers who refuse to give patients copies of their medical records, publishing clarifications of what providers must do, with these examples:

  • Covered entities must provide designated record sets to patients or their designee.
  • They can verify the requester’s identity however they like as long as the verification process doesn’t delay the delivery of the information.
  • They cannot require patients to physically visit their premises or mail a paper form to submit their request.
  • They must offer records delivery by email if requested.
  • They cannot withhold records copies just because the patient hasn’t paid for their services.
  • They must provide requested electronic copies of paper documentation if they have a scanner.
  • They cannot tell patients that, “We have a patient portal, so log in and print your own information.”
  • The patient has a right to obtain all information about them, not just EHR data. That includes images, billing and payment records, claims data, and any information the provider used to make decisions about their care.
  • They must provide electronic copies of information they store electronically if the patient requests electronic instead of paper. They cannot insist that the patient accept paper copies instead.
  • Fees charged must be “cost-based,” which includes the labor required to make paper or electronic copies, supplies, and postage. The fee cannot include the cost of retrieving and verifying the information. This is a big deal since providers impose absurd per-page charges – often through their third party release of information vendor – even when providing information in electronic form. OCR is clear that federal law overrides state law in this case, so extra fees are not allowed even if state law says they are.

The question is what OCR does now that it has clarified the rules. Patients most likely don’t know how to file complaints despite widespread lack of provider compliance with these guidelines.

From my own experience in having filed an OCR complaint six months ago about a hospital that refused to give me an electronic copy of my electronic records resulting in no response, I doubt they are geared up to take fast action even when patients are knowledgeable enough to contact them.


Reader Comments

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From Little Buddy: “Re: President Obama. This quote sounds like someone very much out of the loop who happens to have the solution to healthcare woes with Obamacare.” The President said, “I don’t have a Fitbit yet, but I work out hard. Word is these Apple Watches might be a good companion for my workouts. So I’m gonna see, I’m gonna test it out.” I actually think it’s kind of cool that he’s not afraid to drop some pop culture references and that he takes care of himself with technology help. Speaking of the Watch, I got stuck behind an older lady in the airport security line the other day who was confused about which items to place on the scanner belt, oversharing with the TSA agent, “I have an iWatch.” People apparently don’t even know the name of their expensive, short shelf life gadget, which is not called the iWatch because smart companies had already trademarked the name before Apple.

From Apollo Creed: “Re: health IT companies. Which ones do you like?” I don’t think my opinion is relevant, or if it is, it’s not available. It’s best that prospective investors and employees perform their own due diligence, especially since I’m not an investor or employee of any of them.

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From DC VA Insider: “Re: VA CTO Marina Martin. Will be leaving soon.” Unverified.

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From Rowdy Roddy: “Re: Leidos. I heard a Leidos ad on a Madison classic rock station. They are looking for Epic and Cerner help. Is the world that short of Cerner expertise that they have to find Epic folks, which themselves are in short supply?” I can’t imagine that many Epic youth spend their commute gramps-moshing to “Sweet Emotion” and “Sultans of Swing” in between Leidos commercials. There’s a business opportunity for you: launch an Internet radio station just for Epic or Cerner employees – including company gossip, the cafeteria menu, and customer news interspersed with Justin Bieber and Adele songs — and sell ads to consulting firms that want to poach them.

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From The PACS Designer: “Re: iPhone 7. With Apple reducing the price of iPhone 6 Plus S by 30 percent, soon there had to be a reason. Now,we know why. The iPhone 7 leaks have started and sales will drop as everyone waits for the new model.” The cell phone and services market are changing quickly as competition heats up (thanks, Google, for creating Android). The major carriers are getting better and cheaper as they worry about upstarts and companies selling unlocked phones that use their networks at a discounted rate. A new Consumer Reports survey found that the worst-rated carriers for value are Verizon, AT&T, and Sprint, as smaller providers like Consumer Cellular and Ting top the customer satisfaction scale.


Reader Gripes

  • “Epic’s #6 list of principles says they don’t do deals, yet it’s hard to imagine Mayo wasn’t swayed by Epic’s $46 million offer to buy its data center.”
  • “When I am alone with a patient, one on one, in an exam room and try to show caring and compassion, as I have always done over these many years as a clinician, it gets harder knowing that everyone and everything around this patient is treating them like the latest gold rush or oil boom. Their insurance company, hospitals and their administrators, pharmacies, medication manufacturers, many of my colleagues with their over-testing, etc. I do the best I can. I still think medicine is a noble profession and am proud that both my children wish to become doctors.”
  • “It bothers me that you’ve created yet another forum to complain, like the comments section wasn’t enough. No one comes to HIStalk to hear people crap on companies or news, much less co-workers. I would rather see a Great Box, stories of awesome stuff people are doing in this industry. We don’t hear enough about the outcomes of our work.”
  • “CommonWell members Cerner and McKesson, who claim to be in favor of interoperability, won’t allow us to interface to their systems even if we match the spec of one of their existing interfaces. Even though they interface to our competitors. Even though their own clients request it. Hypocrisy is alive and well.”
  • “People that are more interested in building their fiefdoms than great companies.”

You can sound off about your gripe or you can even say something positive if you’d rather.


HIStalk Announcements and Requests

Thanks to the CIOs who volunteered to raise DonorsChoose funds by making themselves available to donating vendors at a lunch on Wednesday, March 2 at the HIMSS conference. CIOs interested in raising money for education by spending a couple of hours socializing with vendors can contact me.

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About half of poll respondents will attend the HIMSS conference next month. A few more folks who attended in 2015 won’t attend vs. those who will attend, but I don’t think that necessarily portends lower overall attendance. New poll to your right or here: do company funding announcements make you curious to check them out?

Listening: Blackstar, the new album from David Bowie. The Thin White Duke is 69, but he eschews the profitable victory tour of mindlessly mumbling moldy hits in favor of creating complex, fresh music that throws down the gauntlet in setting the pace rather than wheezing to keep up with it. The album came about because Bowie saw a jazz band he liked and decided to perform some musical experimentation them. He just keeps doing his own thing, emerging from obscurity only when he has something new to say musically. The music is among his most experimental, the lyrics are hard to comprehend yet poetic and chilling (especially the title track), and it sounds like a real band with occasional boluses of electronica just to challenge the listener. It won’t change your mind if you don’t like Bowie, but it’s a gift if you do. UPDATE: a few hours after I posted this review, I was shocked to hear that David Bowie has died.

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Mrs. K’s middle school science class in Brooklyn is using the iPad Mini we provided in funding her DonorsChoose grant request for researching STEM projects. She reports, “On behalf of my students, I want to thank you for your generous donation of an iPad mini. This gift will provide our students with real world connections to current research that will support all our ongoing investigations in our classroom. Curiosity and access to technology is the key to our success as productive Americans. Thank you for your support!”

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My Christmas present to myself even though I don’t travel all that much is Global Entry, a known traveler program powered by fingerprint scan that lets you skip the line when entering the US by plane or car. It also includes TSA’s Pre-Check (shorter line, shoes and belt left on, laptop left in bag, metal detector instead of scanner), which is newly important since the days of free “upgrades” to Pre-Check often are about to end. Global Entry costs $100 for five years, only $15 more than Pre-Check alone. Every road warrior should (and probably does) have it. One might quibble that Department of Homeland Security is charging a premium to bypass its intentionally created inefficiency, but arguing that point with everybody else stuck in long lines doesn’t make sense unless you can’t spare $20 per year to save a lot of time and frustration.


HIStalkapalooza

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Sign up to request an invitation for HIStalkapalooza. I have only about 400 requests so far, but I just announced it Friday.


Last Week’s Most Interesting News

  • Henry Schein Practice Solutions pays $250,000 to settle FTC charges that it overstated the database encryption technology used in its Dentrix G5 dental practice management system.
  • Oncology software vendor Flatiron Health raises another $175 million, increasing its total to $313 million.
  • The Rochester, MN paper reports that Mayo Clinic will run Epic hosted from Epic’s Wisconsin data center, while the data center Mayo sold Epic for $46 million will be used only for failover. The organizations will also work together to create new products.
  • Health kiosk vendor HealthSpot shuts down.
  • NantHealth acquires NaviNet to create a payer-provider collaboration network. 
  • Navigant acquires 70-employee consulting firm McKinnis Consulting Services for $52 million.
  • “Brain training” app vendor Lumosity pays $2 million to settle FTC charges that it made unproven claims that its software can reduce age-related cognitive decline.
  • A local paper reports that Epic’s headcount has grown to 9,400, increased by 1,400 in the past year.

Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

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


Acquisitions, Funding, Business, and Stock

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UltraLinq Healthcare acquires Cardiostream as the companies combine their medical image management expertise.

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Several  Fitbit users sue the company, saying that its fitness trackers cannot accurately record heart rates during intense exercise even though the company markets them for that purpose. One of those users said her Fitbit showed a heart rate of 82 beats per minute when it was actually measured at 160, making the trackers “worthless.” In an interesting response, Fitbit stands by its technology but adds that its trackers “are not intended to be scientific or medical devices.”


Sales

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Mount Nittany Medical Center (PA) chooses paperless electronic forms on demand from Access.


Announcements and Implementations

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MedStar Health adds a “Ride with Uber” button to its home page that will hopes will make it easier for patients to keep their scheduled appointments on time. They should do something similar with discharged patients since, as bizarrely as it sounds, a top reason for extended length of stay is patients who can’t get a ride home and calling 911 for a free ambulance ride only works for those headed to – not from – the hospital.


Government and Politics

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Two Phoenix VA executives who were suspended over scheduling wait times surface in new VA jobs 19 months after they were suspended with full pay and given a notice of termination that never happened.

The IRS says that 1.4 million households may lose their Healthcare.gov insurance subsidies because they they took government tax credits in advance last year but didn’t account for them in their federal tax returns. That means that 30 percent of households that received insurance subsidies handled the tax implications incorrectly. The announcement was made late Friday, when the federal government often releases unflattering information about the administration’s pet projects.


Other

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@Cascadia caught this: Amazon is recruiting for a Leader, Global Healthcare for Amazon Business, the business-to-business supply marketplace it is building.

Nemours is considering IT as one of this areas in which it may reduce headcount.

Donna Walters, CIO of Sharon Regional Health System (PA), is hit by a car as she crosses the street in a crosswalk in front of the hospital. She is apparently OK, suffering a broken wrist. The driver, who was driving with a suspended license, was charged with a felony.

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In bizarre healthcare news:

  • Workers partially demolish a hospital in China that is still being used with patients inside, with locals suspecting that a company working on nearby roads ordered it removed (photo above left).
  • In Russia, hospital security cameras capture a doctor killing a patient in the ED admitting area with a blow to the head after accusing the patient of touching a nurse, the most recent of several incidents in which the doctor used physical force on patients (photo above right).
  • In New York, a patient commits suicide by jumping off a building and lands on Mount Sinai St. Luke’s Hospital’s oxygen tank, forcing its ED to be evacuated.
  • In South Sudan, 10 patients – including premature babies – have died because its main hospital has run out of money to fuel its electrical generators.
  • In Cincinnati, the parents of a recovering seven-month-old baby overdose on heroin in the hospital. The mother died in the baby’s hospital room, while the father was arrested after being found in a hospital bathroom with a heroin needle in his arm and a loaded pistol in his pocket.
  • A San Francisco group sues to halt construction of a new professional basketball arena near UCSF Benioff Children’s Hospital, saying, “Some people will die trying to get to the hospital if this stadium is built next to the emergency room.”

Sponsor Updates

  • Extension Healthcare lists its 2015 awards and achievements.
  • Caradigm publishes an infographic on electronic prescriptions for controlled substances.
  • Valence Health CEO Andy Eckert will present at the JP Morgan Healthcare Conference, taking place January 11-15 in San Francisco.
  • ZeOmega ranks number 54 on the 2015 SMU Cox Dallas 100.
  • Strata Decision Technology publishes “Margin + Mission: A Prescription for Curing Healthcare’s Cost Crisis.”
  • YourCareUniverse receives national recognition for innovative patient engagement tools.

Blog Posts


Contacts

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

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January 10, 2016 News 4 Comments

News 1/6/16

January 5, 2016 News 3 Comments

Top News

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NantWorks and NantHealth acquire eligibility and benefits management software vendor NaviNet, explaining that, “we are now poised to be the nation’s leading healthcare collaboration network by transforming the payer-provider relationship to evolve from transactions to interactions and finally to collaboration,”adding that NaviNet Open will serve as a web portal for cancer patients and providers. NaviNet sold its PM/EHR customer base, which was using rebranded versions of CureMD products, to CureMD in 2013 in continuing its focus on payer-provider collaboration tools. NaviNet was in 2012 acquired by Silicon Valley investor John Doerr’s Essence Healthcare, which I believe still owns ClearPractice and Lumeris.


Reader Comments

From Walter: “Re: health systems moving to Epic or Cerner. If you want to predict those, start with a list of McKesson Horizon and then Paragon clients.” I haven’t seen the numbers of Horizon customers who have followed McKesson’s hopeful suggestion that they replace their now-retired system with Paragon, but I’m guessing they are negligible.

From The PACS Designer: “Re: WiFi HaLow. At the Consumer Electronics show this week, the WiFi Alliance announces a new service called WiFi HaLow. It will bring a longer-range, low-power WiFi application that could benefit the patient engagement initiatives in healthcare as well as applications in other healthcare areas.” HaLow also penetrates walls better, which coupled with longer ranges and less battery drain should make device connectivity (including wearables) more practical. Unlike Bluetooth, HaLow connects devices directly to the Internet, not just to a smartphone.


HIStalk Announcements and Requests

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Quite a few folks in health IT-land like this recent Dilbert, which might be the perfect preview (or replacement for) the HIMSS conference techno-blather.

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Ms. Brown from Michigan sent photos of students in her K-3 special education resource room using the math puzzles and learning centers we provided by funding her DonorsChoose grant request.

I was thinking about the HIMSS conference and that my least-favorite US city — Las Vegas — has the perhaps unique distinction in that its residents indignantly scorn tourists who pronounce its state name correctly as “nev-AH-dah” instead of the local version “nev-AD-ah,” which is probably an ongoing challenge given that 75 percent of the state’s residents were born elsewhere. I suppose it’s like cities whose names we Americanize (i.e., we say it wrong) as we scorn those who say the name correctly (Los Angeles, St. Louis, New Orleans, and probably a bunch more). My go-to example for the odd-but-universal pronunciation is the Empire State Building, which you and everyone else say as “empire STATE building” even though New York is the Empire State and therefore the name should be pronounced “EMPIRE state building.”

Listening: the new and first EP from Cado Young, a couple of young guys (one of whom I’ve met) who have created some polished, hard-edged alternative music that deals maturely with the human condition.


Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

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


Acquisitions, Funding, Business, and Stock

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Mayo Clinic sells its data center to Epic for $46 million and will lease it back from its EHR vendor. That’s news everywhere except here since reader Sturges said exactly that in as a perfectly accurate Rumor Report from April 6, 2015.

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Navigant acquires 70-employee McKinnis Consulting Services for $52 million to expand its revenue cycle management consulting practice.

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Healthfinch raises $7.5 million in a Series A funding round, planning to use the money to complete development of its EHR “extender tool” that will expand its business beyond automated prescription refill management technology. The 30-employee Healthfinch was founded by biomedical engineer Jonathan Baran and Lyle Berkowitz, MD.

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Minneapolis-based virtual care technology vendor Zipnosis raises $17 million in Series A funding, with Ascension Ventures and Fairview Health Services participating. The company offers a white-label virtual care portal for provider groups in which patients answer online questions and are then triaged to an appropriate clinician.

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Pre-surgery patient portal software vendor One Medical Passport receives a $4 million Series A investment.

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Smart pill bottle manufacturer SMRxT, whose name veers off the “distinctive” roadway into the “utterly unpronounceable as written” swamp, moves its headquarters from New York to Orlando. The company pronounces its name “Smart” in ignoring its own un-clever “Rx” pun and incorrect capitalization that renders the entire nomenclature exercise baffling, making me question whether it employed too much or too little marketing expertise.

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Imaging technology vendor Sectra acquires Sweden-based RxEye, which offers a medical imaging collaboration platform.


People

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Healthwise promotes Adam Husney, MD to chief medical officer.

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Microsoft senior director of worldwide health Bill Crounse, MD retires from the company.


Privacy and Security

Hackers take down three electric power substations in the Ukraine by installing malware packaged as Microsoft Office document macros, with the resulting blackout sure to cause concern that similar actions could affect healthcare facilities if careless employees (was that redundant?) open documents from unknown sources.


Technology

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Twitter will expand the 140-character Tweet limit to as many as 10,000 characters as it had already done for private messages. The downside is that plenty of Tweeters were already stretching the limits of their appeal within their allotted count of 140, now giving them the opportunity to move from “dull” to “insufferable.” On the upside, people were already kludging around the limit by taking screenshots of text anyway. Maybe a compromise would have been to expand the character limit while imposing a tweets-per-day cap.


Other

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Critics question whether BMJ (the cute name that replaced British Medical Journal) has turned itself into a populist magazine rather than a scientific journal with its sometimes poorly researched editorial campaigns. The editor in chief acknowledges that it’s a fine line, explaining, “Some people would say we have gone too far down the magazine route. But we have no doubt that we’ve increased our influence and increased our readership among clinicians.”

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“Brain training” games vendor Lumosity will pay $2 million to settle FTC charges that it made unfounded claims that its software can help reduce age-related cognitive decline.

The bad news is that a year’s worth of a new drug for pulmonary artery hypertension will cost a patient’s insurance $170,000, based on the price set by its manufacturer that expects to sell more than $1 billion worth per year. The good news is that it’s still cheaper than existing drugs for the same condition. The more-bad-news is that insurance companies will surely pass the cost along to the rest of us because that’s how insurance works, meaning everybody is happy except the majority of Americans who don’t have the condition who are paying big premiums without getting much in return.

The New York Times observes that millions of Americans are declining to buy medical insurance since it’s more expensive than the penalties involved in not buying it, capturing some interesting logic from the folks they interviewed:

  • One woman says it’s better to die if something catastrophic happens, defying the government to collect the $1,500 fine she will owe in electing not to buy insurance.
  • A man who doesn’t like poor out-of-network coverage comments, “I’m just going on the hope that nothing bad is going to show up until I get a full-time position somewhere or there’s better choices.”
  • An artist who dropped his $455 per month plan that covered “zero medical expenses” says, “You’re asking a bunch of people to basically just give money into the system when they have an option not to,”
  • A woman who says she just keeps antibiotics in her home rather than buying insurance says, ““I do not believe it serves the public good to entrench private insurance programs that put actual care out of reach for those they purport to serve,” adding that she hopes any disaster happens while driving since her auto insurance covers personal injury.

Sponsor Updates

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  • AdvancedMD staff donates 4,402 pairs of socks to The Road Home, a social services agency that helps the homeless in Salt Lake City.
  • VentureBeat profiles AirStrip’s work with the University of Michigan and IBM to predict when a patient will become ill.
  • Aprima Medical Software donates a record eight tons of food to needy families in the Dallas area as part of its annual food drive.
  • CareSync CEO Travis Bond will speak in March at the South by Southwest Interactive Festival in Houston.
  • The Times of India features CitiusTech HR VP Sowmya Santhosh and her thoughts on accommodating different personalities in the workplace.
  • Divurgent releases a white paper, “Population Data: Healthcare’s Critical Success Factor for Health Management.”
  • E-MDs selects Dell Children’s Medical Center for its 2015 holiday giving program.
  • The local business paper profiles new GE Healthcare CEO Lee Cooper.
  • Greencastle Associates Consulting recounts the part it played in Einstein Medical Center’s EHR rollout.
  • The Huntzinger Management Group ranks number 10 in Consulting Magazine’s list of fastest growing firms of 2015.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

 

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January 5, 2016 News 3 Comments

Monday Morning Update 1/4/16

January 3, 2016 News No Comments

Top News

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The Madison paper reports that Epic’s headcount has increased to 9,400, up 1,400 in the past year. Campus 4 and Campus 5 are under construction and will add 3,500 offices and the company is sharing the cost of expanding Nine Mound Road to four lanes to handle Epic employee traffic. The company also announces that it has 360 healthcare organization customers in 10 countries and booked $1.8 billion in 2014 revenue.


Reader Comments

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From Crank Caller: “Re: McKesson. I agree with your prediction that it will divest its health IT business. I’ve heard from two reliable sources within McKesson that Paragon is for sale, not that anyone would want to buy it.” Unverified, but the company seems to be constantly apologizing for its health IT business, it hasn’t produced great numbers, the Better Health 2020 initiative doesn’t seem to get much airplay after an initial big splash, and the company has shut down product lines like Horizon. With the retirement of Jim Pesce, anything could happen.

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From Simmering Stock: “Re: 2015 share price performance. Some vendors are traded on non-US exchanges.” I intentionally limited my list to companies whose shares trade on US exchanges, but some that don’t are:

Pro Medicus (parent company of Visage Imaging), Australian Securities Exchange: up 191 percent
Craneware, London Stock Exchange: up 68 percent
Orion Health, New Zealand Stock Exchange: down 45 percent

From HIPAA Shake: “Re: your medical records request. Did you ever hear back from the Office for Civil Rights?” I filed a complaint in July with both OCR and the hospital that refused to provide me with an electronic copy of my medical records (the hospital claimed it is required to do so only for providers and patients can only get printed copies). I haven’t heard back from either organization. Good thing I haven’t been comatose for the six months with my doctor anxiously waiting to see what happened during my one-day stay in early 2014.

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From EHR Product Manager: “Re: LA Times op-ed piece on physician working conditions. I left a faith-based academic medical center to work on the vendor side, which definitely has a better work environment. The AMC emphasized work-life balance but I couldn’t get them to let me work remotely even one day a week, which is a given in the vendor world. Is healthcare seeing a brain drain due to perceived lack of perks?” The Stanford medical student’s article says it’s easy to understand why the school’s graduates often forego residency to jump straight into industry in contrasting their environments: the working conditions for low-pay medical residents involve fluorescent lights, endless pages, and cell-like on call rooms, while business school students ride fancy buses to tech companies that provide free gourmet meals, gyms, massages, and on-site services such as bike repair and yoga classes. I would hope that those who choose to pursue professions such as medicine or the ministry don’t expect the eye-popping perks awarded to a tiny percentage of the young workforce who are chosen to work at Google or Facebook (or Epic, for that matter) — I’d rather see the folks who are torn between patient care and Silicon Valley just hire on with Google instead of naively wasting a medical school spot. Excluding poor working conditions for residents, hospital jobs are a mixed bag, especially for non-executives who aren’t eligible for bonuses, fancy offices, and expense accounts. Sometimes the time-off policy is pretty generous and layoffs are less frequent, but otherwise the rewards of hospital work mostly involve the satisfaction of helping people rather than helping yourself. It’s also not a given that people have a choice between the two worlds – hospitals hire lots of people who overestimate their own capabilities in failing to realize that nobody else would want them. My only conclusion is that medical schools should paint a realistic picture of what it’s like being a doctor before offering admission to a student who might have unreasonable expectations, but that’s not their business model — university tuition coffers are filled by students who are destined for a rude awakening when they realize that their expensive degree has little market value or has prepared them for a job nobody would really want.


HIStalk Announcements and Requests

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Cerner and Epic share the lead as the companies for which poll respondents lost the most respect for in 2015. New poll to your right or here: what are your HIMSS conference plans?

I hope everyone enjoyed their most-of-December industry slowdown. The industry rocket is about to blast off now that New Year’s is behind us and HIMSS is just eight weeks away. News was understandably slow last week, so today’s post won’t consume too much of your first-day-back output.


Last Week’s Most Interesting News

  • ProPublica launches a searchable database of health data breaches and privacy complaints.
  • A new law takes effect that allows CMS to fine insurance companies for publishing incorrect provider databases.
  • AMA President Steven Stack, MD names EHRs as the top cause of physician frustration.
  • A New York non-profit rolls out an app that alerts volunteer first responders of nearby medical emergency 911 calls.

Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

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


Acquisitions, Funding, Business, and Stock

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South Carolina-based Singular Sleep offers $249 home-based sleep apnea studies and $69 online consultations for patients in 13 states.

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The Chicago business paper profiles Prepared Health, which offers a care team communications platform. The company was started by folks formerly with Medicity.


People

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Bruce Matter (AMC Health) joins Banyan Medical Systems as EVP of sales.


Other

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In England, problems with the implementation of CSC/iSoft Lorenzo at Hull and East Yorkshire Hospitals NHS Trust cause extended patient waitlists and short appointment time notices.

ProPublica covers Denmark’s 1992 elimination of medical malpractice lawsuits, replaced by a national compensation program in which patients file claims that are reviewed by independent experts who set compensation in return for gaining access to the details for ongoing improvement. The two most-used criteria there are: (a) was care of substantially lower quality than a specialist would have provided; or (b) did the patient experience a rare medical event, such as an unusual drug reaction. The average paid claim is $30,000, but citizens there file seven times the number of claims as in the US and four times more patients per capita receive awards. Doctors there are also legally required to tell patients when they’ve been harmed during medical care. The president of a US association of malpractice lawyers hates the idea, of course, fretting that “those with economically viable cases would take pennies on the dollar when their case is worth substantially more.” He left unstated the obvious two last words of the sentence that motivates him: “to me.”


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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January 3, 2016 News No Comments

News 12/30/15

December 29, 2015 News 10 Comments

Top News

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ProPublica launches HIPAA Helper, which allows searching government data to see if a given provider or insurer was named in privacy complaints, breaches, or violations. The organization calls out frequent offenders , none of which have been assessed penalties by the Office for Civil Rights. 


Reader Comments

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From The PACS Designer: “Re: fluorescent camera pills. As we get smaller technology in the form of camera pills, the innovations become exciting. Florescent technologies are now so small that they can be inserted into a swallowed form that includes a camera that can now detect cancer without using an endoscope. The sensor used is called the single photon avalanche detector (SPAD) and it can detect single light photons given off by the molecules in human tissue.”

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From Dorm Fridge: “Re: saying ‘no problem.’ I say it to indicate that whatever I did wasn’t a burden. It makes just as much sense as ‘you’re welcome.’” “You’re welcome” indeed doesn’t make much sense (nor does “thank you,” for that matter – why not “I thank you?”) but at least it’s traditional. Just about everybody I’ve heard say “no problem” — or its even more annoying variant, “not a problem” — is under 30, so I certainly wouldn’t use the phrase when trying to sell something to curmudgeonly older executives. I’ve also noticed that younger folks have unnecessarily raised the gratitude gamesmanship by embracing “thank you SO MUCH,” oddly pronouncing the “so” more like “soul.” Here’s a compromise: expressions of gratitude don’t require a reply, especially the call-and-raise response of thanking that person back, so just let it ride unchallenged or give a slight smile or nod. It’s all weird, of course, just like saying “goodbye” or “bye,” which originated as a shortened version of “God be with you,” which technically a non-believer shouldn’t be saying. I’m also intrigued that non-Texans are using “howdy” for some reason.


HIStalk Announcements and Requests

RIP Motorhead and Hawkwind singer Lemmy, who has died of cancer at 70.

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A reader who wishes to remain anonymous donated $250 to my DonorsChoose project, which was matched by the Bill & Melinda Gates Foundation and then again by my anonymous vendor executive. That allowed me to fund $1,000 worth of teacher grant requests, all of which carried additional matching funds to stretch the donation value to fund $2,000 worth of projects:

  • Three sets of ear buds and wireless mice for Mrs. Steele’s kindergarten class in Huntland, TN.
  • Two programmable robots for Mr. Willet’s elementary school digital lab in Asheville, NC.
  • Five MP3 players to form a listening center so that Ms. Johnson can read books for her first grade class in Oklahoma City, OK, in which the student poverty rate is 100 percent and 98 percent are English Language Learners.
  • A Chromebook, case, six sets of headphones, and a wireless mouse for Ms. Johnson’s third grade class in Philadelphia, PA.
  • An iPad Mini, Apple TV, case, and display adapter for Mrs. Robles’ middle school math class in Phoenix, AZ. She replied almost immediately, “Oh my God! Because of you, all my underprivileged students will be beaming with smiles and their brains full of knowledge that they will be eager to engage in and learn. It is because of wonderful people like you that our children have equal access to success and in becoming someone in this world! The kids have had to deal with the lack of the proper tools to learn. This will definitely be a game changer. They will not feel left out in the technological world and will be super proud to come and learn in my room. Over 150 students will now feel part of a new era of learning.”
  • A laptop and Ethernet switch for a student-led project in which the West Covina, CA school’s robotic team will recruit new members by demonstrating their robots to fellow students and parents on Saturdays. As the students who made the request summarized, “This year, our robotics team won the 2015 Chezy Champs Competition and we are ready to win it again! Just like a football team, after high school seniors graduate, we have to rebuild the team. Without enough team players and support, we are at risk of losing our robotics program … With a new notebook and Ethernet switch, we will be able to showcase our previously built robots! We want to be able to show how exciting robotics is, and be able to present this without having any embarrassing hiccups.”

Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

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


Acquisitions, Funding, Business, and Stock

I took a look at how publicly traded health IT-related stocks fared in 2015 from best to worst. For the year to date, the S&P 500 was up less than 1 percent, Nasdaq around 7.5 percent, and the Dow down less than 1 percent.

  1. MedAssets: up 56 percent
  2. Nuance: up 43 percent
  3. Aetna: up 38 percent
  4. Leidos: up 34 percent
  5. Allscripts: up 21 percent
  6. UnitedHealth Group: up 19 percent
  7. Vocera: up 18 percent
  8. Cognizant: up 17 percent
  9. Athenahealth: up 13 percent
  10. Teladoc: down 8 percent (since its June IPO)
  11. Premier: up 4 percent
  12. Quality Systems: up 4 percent
  13. McKesson: down 3 percent
  14. The Advisory Board Company: up 3 percent
  15. Cerner: down 5 percent
  16. Imprivata: down 14 percent
  17. CPSI: down 17 percent
  18. Evolent Health: down 34 percent (since its June IPO)
  19. Castlight Health: down 64 percent
  20. Streamline Health: down 68 percent

Government and Politics

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A new law that goes into effect this week allows CMS to fine insurance companies whose provider directories contain mistakes that can cause patients to inadvertently receive out-of-network care. California fined Anthem Blue Cross and Blue Shield of California last month after discovering that 25 percent of the doctors in their directories either didn’t accept their insurance or had moved, while Blue Shield has paid $38 million to cover out-of-network bills that were caused by its inaccurate doctor listings. Critics say the provider directories are full of doctors who are dead, moved, retired, no longer accepting insurance, or not accepting new patients. Insurance companies say directory management is a nightmare since doctors often don’t return their calls and 30 percent of them change affiliations in a given year. CMS originally required insurance companies to call every doctor monthly to verify their listings, but changed that to quarterly since as MGMA says, “The last thing physicians want is for hundreds of health plans to call them every month.”


Privacy and Security

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This won’t help the argument for a national patient identifier: the TSA may stop accepting driver’s licenses issued by several states that refuse to comply with federal standards. Federal law requires states to check documents that verify the identity of applicants, equip the license with a chip or magnetic stripe containing the information collected, and to share information with other states and the federal government. The Department of Homeland Security wants to implement the $3.9 billion program to more carefully check travelers and to prevent identity theft, while critics say it’s the equivalent of a national ID card and the recent hack of the Office of Personnel Management raises concerns about storing too much personal information in one location.

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Mainstream media have picked up on a Financial Times report that simply added up the number of hacked US medical record records for 2015 and reached the unsurprising total of 100 million, nearly 80 million of which resulted from the Anthem breach alone. FT repeats the hacker motivation in which a credit card record fetches only $1 on the black market, while a complete medical record is worth $2,000.


Technology

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The first non-beta release of Google Glass will occur in mid-2016, says a newspaper that ran purportedly leaked photos of the device obtained from FCC filings. It will now be sold only to businesses under the name Google Glass Enterprise Edition, available only from companies that will pre-load their software on it. Features include a sturdier hinged design, an external battery pack, a larger screen but at least one model that won’t include a screen at all, and eventually a clip-on model for people who wear glasses. Excited Glassholes who paid $1,500 for the previous version – most of whom abandoned it quickly due to limited functionality and unlimited public scorn — probably aren’t thrilled that the Glass development team now refers to their premature technology investment as “little more than a scuba mask attached to a laptop.”

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St. Jude Children’s Research Hospital scientists develop ProteinPaint, a free Web application and dataset that allows scientists to analyze and contribute information on genetic mutations that cause pediatric cancer.


Other

An interesting article questions the AMA’s interest in requiring competency testing for aging physicians. Some experts say evidence is scant that older doctors are less competent or less likely to follow modern standards and therefore any new competency testing should be applied to all doctors. This is a brilliant quote: “It’s a growing concern now that 26 percent of active physicians in the US — about a quarter million docs — are over 60. Fears they will soon go running for the exits and create a physician shortage are competing with fears that they will stick around forever and create a quality performance gap.”

In Pakistan, a government official angry at the IT department of a local hospital gives it until February 15 to go live with its computer system after the project was delayed for five years.

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The $1,000 per pill hepatitis C drug Sovaldi costs only $4 in India after Gilead Sciences licenses 11 India-based companies to produce generic versions that aren’t available here. You’re welcome, India (or should that be “no problem?”) That nicely illustrates how product pricing that would be entirely reasonable in every other industry (charge whatever people are willing and able to pay) is infuriating when being an un-wealthy citizen of a purportedly wealthy (but deeply in debt) country means you can’t afford to get something that would make you healthier.

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Researchers find that contrary to perception, Britons have better teeth than Americans, mostly because they have access to publicly funded medical and dental care and we don’t. We’re mid-pack in global dental health, which is a lot better than we fare in overall health in every category other than spending.

A senior manager at a company that specializes in “changing health behavior” (meaning being paid to push paid advertising at doctors) urges colleagues that “we must rely in EHR technology to capture data and use it to target our messages effectively … Our promotion can be just as successful as [wrestling promoter] WWE.” You can bet that sort of nonsense will neither raise physician EHR satisfaction nor lower US healthcare costs, but the fact is, it works, because doctors aren’t nearly as smart as they think in resisting the siren song of billion-dollar industries willing to do anything to wrest control of their prescribing pen or keyboard.

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It’s puzzling to me why some experts – doctors, CIOs, and health IT people – seem to structure their entire professional lives around Twitter and Facebook as though whatever they do there constitutes a professional accomplishment worth including on their LinkedIn profile. As evidence, note the unconvincing “7 Social Media Platforms Every Urologist Should Use,” which suggests that “it’s becoming essential for every healthcare professional to cultivate an online presence” and adds that following lame conference tweets is as good as actually attending. The author says every urologist should use Facebook, LinkedIn, Doximity, Twitter, Figure1, Instagram, and Periscope. I think it’s probably an uncommon urologist whose social bleatings would prove entertaining or informative, so perhaps the blanket recommendation that all of them take to the airwaves should be tempered with the reality that not all of them are well suited for it. Self-proclaimed “King of the Urology Twitter World” Ben Davies, MD  (@daviesbj) is an obvious exception, although he shares stuff that patients might not need or want to see.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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December 29, 2015 News 10 Comments

20 Top Stories of 2015, 20 Predictions for 2016

December 28, 2015 News 3 Comments

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It’s not too hard to choose 2015’s big stories, but I’m annoyed by people who make obvious “predictions” that are intentionally vague enough to evade accountability, like psychics who boldly proclaim that their client will have “a change in fortune” or “family developments, some good and some bad” in hoping desperately not to lose business by being proved clearly wrong. My predictions will be specific and I’ll publicly recap them this time next year even if they make me look silly.

What are your predictions for 2016? Send them my way and I’ll list them here.

Stories

  1. The Department of Defense chooses the team of Leidos, Cerner, Accenture, and Henry Schein for its $4.3 billion EHR project.
  2. High-flying Theranos and Turing Pharmaceuticals go down in flames, at least temporarily.
  3. NantHealth continues its acquisition streak and PR push, but temporarily shelves its IPO plans.
  4. ICD-10 finally goes live with barely a ripple thanks to the in-the-trenches folks who modified systems to accommodate it.
  5. The Supreme Court upholds the Affordable Care Act, but poor-performing state exchanges, increased insurance company costs, and increasingly higher deductible and narrower networks leave the middle class footing the bill for a bold experiment that has mostly helped providers gain paying patients without improving overall health.
  6. Just about everybody pushes back on Meaningful Use Stage 3, either by complaining to Congress or exiting the program, and doctors increasingly say their EHRs are the top source of their dissatisfaction.
  7. Industry mergers increase dramatically at all levels – health systems, health IT vendors, drug companies, and insurance companies.
  8. Epic CEO Judy Faulkner pledges to donate her multi-billion dollar fortune to a charitable foundation upon her death or direction.
  9. Epic and Cerner continue to dominate the inpatient systems market at the expense of their only significant competitor, Meditech.
  10. Data breaches become commonplace, including hackers who accessed the identities of 80 million people associated with Anthem.
  11. Cerner completes its acquisition of the former Siemens Health Services, but sees its financial results tarnish slightly immediately following.
  12. Athenahealth acquires software from RazorInsights and Beth Israel Deaconess Medical Center as it increases its push into the inpatient market.
  13. CVS and Walgreens continue to lead health IT with innovative apps and services.
  14. Epic wins several impressive customers, but struggles in the UK, loses the DoD contract, and will be displaced with Cerner following Banner Health’s acquisition of financially strapped University of Arizona Health Network.
  15. The OpenNotes project to allow patients to review clinician documentation gains ground with positive study findings and new funding.
  16. Expectations increase for the FHIR standard as the best way to integrate EHR information with other systems.
  17. ONC releases its Interoperability Roadmap that calls for EHR vendors to expand their API support and for the government to streamline privacy and security policies.
  18. Mobile apps show considerable promise for diagnosing and monitoring mental health conditions, especially depression.
  19. Apple announces ResearchKit for clinical study enrollment.
  20. Major healthcare systems and payers pledge to migrate most of their business to value-based payments by 2020.

Predictions

  1. The cooled-off IPO and funding markets will leave nearly all of the unprofitable startups that graduated from the overabundance of accelerators and incubators in the past few years struggling to gain or maintain momentum and customers. Companies with IPO intentions will postpone their plans due to market conditions, but Health Catalyst will do so anyway with decent but comparatively unspectacular initial share price results as wary investors wait for a couple of good quarters to convince them.
  2. Healthcare costs will become a contentious topic in the 2016 presidential elections as the millions of Americans who purchased health insurance are stung by low utilization and high costs due to high deductibles and co-insurance, leaving them both poorer and less healthy than before. Medical bankruptcies will increase significantly and hospitals in particular will find it difficult to collect the money owed by under-insured patients. At least one presidential candidate will timidly suggest cost controls – both provider and pharma – as the only remaining option in trying to manage the increasingly damaging costs of healthcare in the US. Provider mergers will continue and national brands such as Kaiser Permanente that combine insurance and care delivery will gain prominence.
  3. Consumers will lose interest in fitness trackers and wearables as 2015’s Christmas presents gather January dust just like they did last year.
  4. The CEOs of Epic, Cerner, and Meditech will start to pull back from day-to-day company involvement as they approach retirement.
  5. ONC and Meaningful Use will become increasingly less relevant and more contested as ONC replaces Karen DeSalvo with a new National Coordinator who lacks her experience and bipartisan support.
  6. Several mid-tier consulting firms will be downsized or acquired as their implementation and advisory business dries up.
  7. At least three big health systems will experience a data breach that results in exposure of the information of 100,000 or more their patients. The industry will realize that collaboration to identify and mitigate breach threats is essential and of mutual benefit. The government and organizations such as HIMSS will attempt to create and manage an information sharing and risk assessment platform.
  8. The VA will announce plans to eventually replace VistA with a commercial product. Congress will push Cerner since the Department of Defense will be implementing it, but the VA will favor Epic just to be different.
  9. At least one Epic and Cerner customer will switch to the other company’s product in trying to get a better deal on crippling software maintenance fees. Epic will also expand its hosting service to compete with Cerner’s successful offering.
  10. The terms “telemedicine” and “mobile health” will become antiquated as they simply become another accepted aspect of care delivery. “Information blocking” will also fade away as a hot term when everybody realizes the concept involves speculation without proof, but consumers will increasingly demand that their providers share their information – both with their other providers and with themselves – without charging per-page fees for information that exists in electronic form.
  11. IBM Watson will continue to produce mostly hype. No convincing studies will demonstrate its value, but newly announced, high-profile partnerships will keep IBM shareholders hopeful.
  12. The dark horse publicly traded company best positioned to succeed in health IT and related areas without a lot of fanfare will be Premier.
  13. Athenahealth won’t get much inpatient traction with the former RazorInsights and BIDMC’s WebOMR.
  14. McKesson will consider packaging and divesting its many health IT offerings as non-core business.
  15. Epic will not join CommonWell, but will leapfrog its competitors in offering APIs and slowly building a carefully controlled third-party ecosystem.
  16. Software for population health management and analytics will enter Gartner’s Trough of Disillusionment as providers implement it poorly and without a commitment to truly change their profitable business models.
  17. Cerner and Epic will continue to poach the business of Meditech, CPSI, and best-of-breed vendors whose small-hospital customer bases are being acquired by larger health systems.
  18. “Big data” will support a few meaningful clinical studies performed using only aggregated electronic information, but “little data” will provide more impressive but less-publicized results as doctors design the treatments of individual patients by reviewing the outcomes of similar patients.
  19. Consumer healthcare apps will continue to be plagued by inconsistent use, questionable design, and an unremarkable impact on health or outcomes.
  20. CHIME and AMIA will follow the HIMSS model of increasing conference attendance and revenue by catering to high-paying vendors willing to buy access to prospects.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

 

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December 28, 2015 News 3 Comments

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  • Dave Newman: Oh my gosh, that is a lot of bloviating buzzwords, even by Hammergren's standards. ..."reduce complexity, lower costs, a...
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  • Amused: What a joke. What a mess. This reminds me of Microsoft and GE spinning off their (failing) HIT businesses into a joint v...

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