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Morning Headlines 4/7/14

April 6, 2014 Headlines No Comments

IMS Health raises $1.3B in 2014′s second-biggest IPO

IMS Health completes its IPO, selling 65 million shares at $20 and raising $1.3 billion for the company. Stock prices closed at $23 Friday, up 15 percent, at the end of its first day of trading.

5 Things About States With Problem-Plagued Health Exchanges

Oregon, Maryland, Massachusetts, Nevada, and Hawaii are named as having the worst health insurance exchange marketplaces in the country.

Oversold Conditions For Athenahealth

In trading on Friday, analysts watching key financial indicators warned that Athenahealth’s stock had entered into oversold territory. The stock closed down 11 percent by the end of trading Friday.

Beebe rolls out $33 million electronic records system

Beebe Healthcare (DE) goes live on its $33 million Cerner system, concluding a nine-month implementation and a two-year vendor selection process.

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April 6, 2014 Headlines No Comments

Monday Morning Update 4/7/14

April 5, 2014 News 4 Comments

Top News

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Thoughts on the months-late FDASIA report (based on an earlier work group report) that proposes minimal FDA oversight of healthcare information technology:

  • Vendors should be breathing a sigh of relief. The report contains nothing new and in fact takes FDA further away from having health IT responsibilities.
  • The report proposes that IT vendors continue to be self-regulated without FDA’s involvement, turfing any new responsibilities to ONC rather than FDA.
  • The report is intended to stimulate discussion about what other parties might do. FDA’s only to-do is to “actively engage stakeholders” to implement the framework the report proposes. In other words, the report doesn’t impose responsibilities on anyone.
  • The report seems uncomfortable addressing the issue that an IT system may or may not be safe depending on how its users implement and maintain it, which is a clear distinction compared to single-purpose medical devices approved for use in specific ways. That may have been the overriding factor – vendors could product a perfectly safe IT system that is rendered unsafe by how a customer does with it.
  • Products will be regulated only if they post significant risk to patient safety. FDA does not propose regulating anything it isn’t already regulating. If it’s not a medical device, FDA won’t regulate it. The FDA’s definition is above, although it is more appropriate for distinguishing a medical device from a drug than for determining whether a given information technology is a medical device.
  • The report proposes grouping products into three categories, but that’s irrelevant from a regulatory standpoint since the medical device category would continue to be the only one regulated.
  • FDA’s recent Class 1 recall of an anesthesia information system that displayed the wrong patient information seems at odds with the draft, which says that FDA will focus only on the medical device portion of such a system.
  • It’s still user beware when it comes to clinical decision support systems, order entry, and results reporting since FDA proposes no change in their current unregulated state.
  • The report suggests that ONC create a Health IT Safety Center in collaboration with FDA, FCC, and AHRQ, which in effect puts IT patient safety under ONC’s purview rather than FDA’s.
  • The report says that while ONC’s certification program addresses only EHRs, it has the authority to certify other health IT systems. That’s an interesting observation given that “certification” as it exists today only affects providers interested in collecting government handouts, but the implication seems to be that such certification should address all vendors and users. 
  • Better interoperability standards and testing criteria are needed, the report says.
  • The report urges adoption of practices for healthcare IT implementation that address installation, customization, training, contracting, and downtime, suggesting the use of ONC’s SAFER Guides as a starting point.
  • The report proposes that vendors and products undergo “conformity assessment” that could include product certification, testing, inspection, or vendor attestations. It suggests private industry conformity assessments except in situations where patient safety is critical, in which case government assessments would be appropriate. It mentions NIST’s usability standards.
  • The report notes that vendor contract terms and customer fear of liability impede the free flow of information.
  • The report agrees with IOM in suggesting that vendors be required to list products that include any degree of patient risk with ONC. That’s a new suggestion, that ONC require software vendors to register products that meet specific criteria.
  • The report has a 90-day comment period, although I could find no stated process for submitting comments.

The FDASIA’s original work group whose recommendations from last summer were incorporated into this report contained an industry-friendly mix of members. By my count, 15 of the 30 members represent vendors or investors, six come from government or associations, four are academics, three are providers, one is from a testing organization, and one is a consumer.


Reader Comments

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From Jack: “Re: John Muir Health. It has been a long time coming, but we’ve arrived: our state-of-the-art electronic health record (EHR) and revenue cycle system are now live within John Muir Health! With today’s go-live, all of our hospitals, outpatient clinics, Home Health, John Muir Medical Group practices and several IPA practices are on our single, integrated EHR, as are our patients’ health records. This is great news for John Muir Health, and even better news for the patients and communities we serve. With the entire health system up and running on Epic, all patients will benefit from improved service and care coordination.”


HIStalk Announcements and Requests

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Only 12 percent of respondents say they’ve benefitted as a patient from an HIE. New poll to your right: what force is to blame for the delay in ICD-10 enforcement? Clicking a radio button alone doesn’t provide much insight, which is why it would be swell if you’d click the “Comments” link at the bottom of the poll after voting to explain your position.

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

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Listening: San Diego-based No Knife, apparently defunct since 2003 other than a few reunion shows. The were kind of emo-indie with quite a bit of complexity. Also: the re-formed and touring Zombies, with Rod Argent and Colin Blunstone (both 68 years old) sounding amazing on new stuff as well as “Time of the Season,” “She’s Not There” and Argent’s “Hold Your Head Up.”

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I added my Twitter support to the Thunderclap project of OpenNotes. As a patient, I should able to see the notes providers have made about me. The fact that this is a controversial issue tells you how paternalistic and patient-unfriendly healthcare is.

The Twitter word that signals someone is about to do some stealth bragging: “honored” (us when humbly but firmly announcing their recent success in being published, featured as a speaker, or given a high-visibility role.)


Upcoming Webinars

April 9 (Wednesday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 1 – Avoiding Analysis Paralysis. Sponsored by Premier. Presenters: Kristy Drollinger, senior director of population health analytics, Fairview Health Services; J.D. Whitlock, corporate director of clinical and business intelligence, Catholic Health Partners; Sean Cassidy, general manager of information technology services emerging business unit, Premier, Inc. Are you ready to invest in an integrated data platform? Do you have a strategy to make the information accessible and actionable? How will enterprise data warehousing transform care delivery? There’s more to data analytics than simply deploying an EDW. Learn what goes into becoming an information-driven enterprise in the first webinar in this series.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.


Acquisitions, Funding, Business, and Stock

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Interesting points on the big IPO of IMS Health. The company was taken private a few years ago and its three main private equity investors (who bought in for $5.2 billion) will nearly triple their money by taking it public again. As often happens when the private money guys take control, IMS has loaded itself with debt along the way, jumping from $1.3 billion in debt before they got involved to a current $4.9 billion. It will use the IPO proceeds to pay the debt down to $3.95 billion. Annual revenue is $2.5 billion.

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Shares of athenahealth plunged 11 percent on Friday, with shares dropping 28 percent in the past month.


Sales

Etransmedia Technology licenses its Connect2Care patient engagement platform to Merge Healthcare.


People

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Gary Lakin (Microsoft) is named CEO of Australia-based oncology vendor charmhealth.


Announcements and Implementations

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Scanadu starts distributing its wildly hyped $199 tricorder-type diagnostic to its Indiegogo backers, but has to stop when it finds a several problems, including algorithm errors, incorrect temperature readouts, and breakdown of the machinery that creates the device’s case. The Scanadu Scout can’t be sold until approved by FDA, so the backers had to sign up as study participants. With those kinds of problems, it’s a long shot that FDA will ever approve the device.


Government and Politics 

US CTO Todd Park has been minimally visible since the Healthcare.gov rollout fiasco and the ensuing Congressional subpoena, but he shared celebratory champagne with contractor QSSI early Tuesday morning after the site exceeded its goal of enrolling 7 million people.

The Wall Street Journal recaps the five states with the most problem-plagued health insurance exchanges, all covered here previously: (1) Oregon (still not working); (2) Maryland (dumping its dysfunctional system and moving to the one Connecticut developed); (3) Massachusetts (still not working); (4) Nevada (carriers are being sent incorrect information); and (5) Hawaii (not being used because state law already required employers to provide insurance).

Influential House lawmakers continued Thursday to press the Department of Defense and VA for failing to create a single EHR that would follow service members during and after their service. According to Rep. Rodney Frelinghuysen (R-NJ), who chairs the committee that funds the DoD, “It’s enormously frustrating. It makes us angry. … This is way beyond the claims backup VA has. It’s pretty damn important.” Rep. Pete Vicslosky (D-IN) added, “We fought a world war in four years. We’re talking interoperability of electronic medical records from 2008 to 2017, and I’m appalled.” The DoD’s assistant secretary of defense for health affairs says the current approach is to allow the two separate systems to talk to each other, which is says has been a problem nationally and why DoD wants to buy its own commercial product for $11 billion instead of using the VA’s VistA for free.

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The State of Connecticut says that Windows XP, which finally goes off support Tuesday after Microsoft replaced it in 2008, still runs 20 percent of its computers, including all of the Department of Corrections and 43 laboratory instruments. The state is planning to pay Microsoft $250,000 to continue receiving Windows XP security patches, which may or may not keep it safe from potential HIPAA violations for running an unsupported and potentially compromised operating system. According to Microsoft, “Businesses that are governed by regulatory obligations such as HIPAA may find that they are no longer able to satisfy compliance requirements.” Another report finds that 77 percent of British companies still run XP and only a third of those surveyed plan to upgrade.

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The Missouri House sends a bill to the Senate entitled the “Second Amendment Preservation Act” that would make it illegal for a healthcare professional to use an EMR that requires information about a patient’s access to firearms.


Innovation and Research

Maybe we really do need Amazon to get into healthcare. Check out its new Dash device that allows easy ordering through its AmazonFresh grocery delivery program (only available in Southern California, San Francisco, and Seattle for now.)


Technology

Billionaire AOL founder Steve Case decides on a whim to invest $100,000 each in all 10 startup teams pitching at the inaugural Google for Entrepreneurs Day. Among the companies funded is Nashville-based InvisionHeart, a Vanderbilt spinoff that is developing technology that converts EKGs to digital form for sharing in the cloud.


Other

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The local paper covers the $33 million Cerner go-live at Beebe Medical Center (DE), featuring CMIO Jeff Hawtof, MD.

The two HIEs located in Columbia, MO (Missouri Health Connection and Tiger Institute Health Alliance) say they may talk about sharing information despite disagreements that arose when Missouri Health Connection demanded that Tiger Institute pay it. The current setup means that two Columbia hospitals could be close together but unable to share information because each participates in a different HIE.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 5, 2014 News 4 Comments

News 4/4/14

April 3, 2014 News 4 Comments

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HHS releases a draft report from its FDASIA work group that includes a proposed strategy and recommendations for an HIT framework for maintaining appropriate patient protections and avoiding regulatory duplication. It reaffirms FDA’s position that its regulation is appropriate only for medical devices and not clinical software (including clinical decision support tools.) The report ponders the question of how a conformity assessment program (product testing, certification, and accreditation) might work and whether the government should play a role. It also recommends creating the Health IT Safety Center, seeking input on how it should be operated to share incidents, lessons learned, and user experience, also suggesting that third-party tests or reviews might play a role. The report describes three categories of health IT products:

  • Products for admin HIT functions, such as software for billing, scheduling, and claims management  that pose little patient risk. No FDA regulation is proposed.
  • Clinical software for health information and data management, medication management, physician order entry, electronic access to clinical results, and most clinical decision support software. No FDA regulation is proposed.
  • Products with medical device functionality, such as computer-aided detection software, software for beside monitor alarms, and radiation treatment software. FDA would continue to regulate products falling into this category.


Reader Comments

From Harry-O: “Re: NTT Data-supported Indy car. I’m pleased that we are no longer a client. While I understand that vendors need to market their products, those of us in the trenches are struggling to survive and pay their (for the most part) exorbitant support fees. Wouldn’t it be nice if they could find a way to market and reduce costs at the same time? What a waste, paid for by a hospital near you.”

inga_small From Perky: “Re: ICD-10 delay. Does anyone have an inkling as to how things are going to proceed with such things as CQM reports and MU 2 demonstration/certification with the delay of the ICD-10?  As I try to think this through, my head sort of explodes. If they are going to continue to require ICD-10 codes for the CQM, PCMH, and MU 2 reports, then how are the codes going to get entered if we are not using them for billing? If they decide to stick with the ICD-9 for CQM, PCMH, and MU 2 reports, what happens with the certification process? If we are not allowed to use ICD-10 until after October 1, 2015, what happens with all of the products that are already certified to use ICD-10? Are they expected to rewrite their reports using ICD-9? Do they then need to go through the certification process again?” Unfortunately Perky just hits the tip of the iceberg with his list of questions and CMS may not have enough disk storage to adequately address all the new FAQs. CMS has been been oddly silent on the whole issue all week, suggesting that  no one at the agency saw the delay coming. One of the first steps towards clarity will be the issuance of a final rule for the new ICD-10 deadline. If anyone wants to stab at Perky’s questions, please share.


HIStalk Announcements and Requests

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Assuming this isn’t your first time reading HIStalk, you contributed to the 8 million visit milestone. Thanks.

inga_small A few highlights from HIStalk Practice this week include: AMA remains tight-lipped about the ICD-10 delay. Physicians in academic settings report higher compensation when more time is spent seeing patients versus performing research. Specialists who are late in adopting EHRs may struggle to meet Stage 2 patient portal requirements. European Union GPs report that interoperability issues, a lack of regulatory framework, and inadequate resources are the biggest barriers to adopting ehealth tools. The GAO recommends CMS expand its benchmarks for assessing Medicare physicians. Dr. Gregg contends that HIT’s next big role is to motivate change in consumers that will drive transformation in providers. Thanks for reading.

This week on HIStalk Connect: IBM partners with the New York Genome Center to research genetics-driven brain cancer treatments with Watson. Rock Health’s digital health funding report recaps a record-breaking $700 million in funding in Q1, its strongest investment quarter to date. Airstrip acquires San Diego, CA-based Sense4Baby, a startup from the West Health Institute that markets wireless fetal monitors.


Upcoming Webinars

April 9 (Wednesday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 1 – Avoiding Analysis Paralysis. Sponsored by Premier. Presenters: Kristy Drollinger, senior director of population health analytics, Fairview Health Services; J.D. Whitlock, corporate director of clinical and business intelligence, Catholic Health Partners; Sean Cassidy, general manager of information technology services emerging business unit, Premier, Inc. Are you ready to invest in an integrated data platform? Do you have a strategy to make the information accessible and actionable? How will enterprise data warehousing transform care delivery? There’s more to data analytics than simply deploying an EDW. Learn what goes into becoming an information-driven enterprise in the first webinar in this series.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.


Acquisitions, Funding, Business, and Stock

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GE Healthcare will acquire CHCA Computer Systems, the Canada-based developer of the Opera software application for OR management and analytics, of which GEHC Is a distributor.

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MModal reaches an agreement with the majority of its bankruptcy creditors to cut its debt by over 55 percent, which is about $350 million. Investor’s Chair sitter Ben Rooks provides some financial perspective about the company in answering a reader’s question in his “Health IT from the Investor’s Chair”.

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IMS Health Holdings, which sells de-identified patient prescription information, goes public in an IPO that values the company at over $6 billion.

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Practice software vendor edgeMED acquires revenue cycle management company Physician’s Billing Alternative.

ZirMed acquires the payment processing, patient eligibility, and patient estimation business owned by TransEngen.

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Pharmacy automation vendor Aesynt, which operated as McKesson Automation until its November acquisition by Francisco Partners, acquires Italy-based pharmacy IV technology vendor Health Robotics.

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TreeHouse Health makes a six-figure cash investment in LogicStream, a provider of clinical decision support tools.


Sales

A healthcare quality collaborative headed by San Jose Clinic (TX) selects CompuGroup Medical’s CGM Enterprise suite for community health practice management.

Memorial Health Care System (TN) and St. Vincent Health System (AR) select MedAptus Professional Charge Capture for automated coding and billing.

Visiting Nurse Service of New York chooses Crescendo from Delta Health Technologies for homecare business management.

VNA of Albany and Visiting Nurses Home Care (NY) choose Homecare Homebase.

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Oconee Medical Center (SC) adopts PeraHealth’s PeraTrend platform as its real-time clinical decision support tool.

The Center for Diagnostic Imaging (NJ) will implement Healthec’s HIE platform.

Craneware signs multi-year contracts with two unnamed hospitals in the Eastern US for about $6.9 million.


People

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PatientSafe Solutions names Cheryl D. Parker chief nursing informatics officer.

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Nextech appoints Ron Kozlin (Pilgrim Software) CFO.

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CareCloud names Lee Horner (Eliza Corporation) chief sales officer.

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Baylor Scott & White Health appoints 11 new members to its senior leadership team, including Matthew Chambers (Scott & White Healthcare) as CIO.

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Aaron Karjala, CIO of the troubled Cover Oregon online marketplace, becomes the fourth top manager to resign his post.


Announcements and Implementations

Cherokee Regional Medical Center (IA) goes live on its $2 million Epic system.

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Qatar’s Al Khor Hospital and Al Daayan Health Centre go live on Cerner.

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Hudson Valley Hospital Center launches its MyHVHC patient portal.

Emory Healthcare and Grady Health System join the Georgia HIN.

The Spanish Catholic Center (DC) implements Forward Health Group’s PopulationManager and The Guideline Advantage. 


Government and Politics

4-3-2014 6-39-02 AM

CMS issues a Daily Digest Bulletin that summarizes the newly passed Protecting Access to Medicare Act of 2014, Noticeably absent is any mention of the ICD-10 delay. The Bulletin notes that “more information about other provisions will be forthcoming.”


Innovation and Research

The New York eHealth Collaborative and the Partnership Fund for NYC call for applications for the second class of the New York Digital Health Accelerator, a program that will give up to 10 early- and growth-stage companies $100,000 each to advance their digital health technology efforts.

Children’s Memorial Hermann Hospital (TX) offers patients a chance to virtually visit the Houston Zoo, located across the street from the hospital, from their hospital beds using Google Glass.


Other

4-2-2014 7-16-11 PM

inga_small I suppose this constitutes a bad day at the office, at least if you are the tree trimmer who is recovering after the chainsaw he was operating kicked back into his neck.

The local paper covers the plight of a 25-bed critical access hospital in Arkansas, whose February computer fees of $63,000 contributed to a loss of $142,000. Administrators expect a $1.2 million EHR incentive check in May, but those funds will be used to pay off  EHR vendor Healthland, which did not require the hospital to pay until it received its MU check.

Mercy Technology Services, the information backbone of the Mercy healthcare system, will market its services to other Epic users as the first provider accredited in the Epic Connect program.

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A KLAS report on ICD-10 consulting services (with the unfortunately timed subtitle “Who Can Help in the Eleventh Hour”) ranks The Advisory Board highest for overall ICD-10 consulting performance, followed by Aspen Advisors. Optum and 3M earned the highest scores for on-site training.

The majority of health organizations participating in a HIMSS Analytics survey report having a formalized EHR governance structure in place with a structure that involves a cross-functional, multi-disciplinary advisory board or committee. The biggest EHR governance challenges are physician engagement and adoption.


Sponsor Updates

  • 3M completes its acquisition of Treo Solutions, a provider of data analytics and business intelligence to providers and payers.
  • Analyst firm IDC names Covisint a “major player” in worldwide federated identity management and single sign-on.
  • Medworxx Solutions and Leidos Health will offer providers help with patient flow performance and analytics.
  • Allscripts recognizes its customer Citrus Valley Health Partners (CA) for being one of the first organizations in the country to meet the 2014 MU Stage 2 requirement for electronic transitions of care, which it accomplished using Allscripts dbMotion.
  • Wellcentive will demonstrate is population health management platform at this week’s AMGA meeting in Grapevine, TX.
  • Biztech profiles ICSA Labs and its work certifying security products.
  • The Health Catalyst team explains how population health management solutions lead to overall better health care.
  • MedAssets president and CEO John Bardis headlines the SEMDA 2014 Conference as the Gala speaker May 7-8 in Atlanta.
  • A local paper interviews Summit Healthcare founder and CEO Ted Rossi, who shares details of the company’s history and growth.
  • A KLAS report on HIEs finds that 100 percent of InterSystems HealthShare customers have made HealthShare part of their long-term plans and say they would purchase HealthShare again.
  • Craneware conducts its annual Executive Industry Leadership Survey to measure revenue integrity priorities.
  • ADP AdvancedMD, Intelligent Medical Objects , The SSI Group and NextGen issue statements following the passage of the ICD-10 delay legislation.
  • Kit Check adds Medi-span integration to its Trusted Pharmacist Medication Checks software.

EPtalk by Dr. Jayne

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I seem to be rounding up lots of federal issues this week. Monday opened with an extremely heated discussion involving a hospital laboratory director, our medical group operations VP, and me. To make a long story short, one of our hospitals is refusing to play nicely in bringing a bidirectional interface live for our employed physicians. Although many of our physicians use a large national reference laboratory (mostly due to payer requirements) we have a handful of physicians who are being held captive because they are located in the hospital medical office building. The terms of their lease prohibit external vendors from picking up samples at the office after hours, which basically locks them out of the market. Since the practice specializes in OB/GYN and has a high volume of office-collected specimens, they’re stuck using the hospital’s lab and pathology services.

Although the hospital initially agreed to a bidirectional interface so the practice could meet its requirements for both structured data and CPOE, it is now balking under the excuse that a bi-directional interface isn’t “required” for Meaningful Use. They want the practice to figure out some way to create magic with electronic ordering that prints to paper requisitions and an unsolicited results interface. The orders can’t match up automatically, which makes a mess of all the numerators and denominators unless staff manually matches the results. I explained to the lab director in my best primary care voice that a bi-directional interface isn’t entirely about MU, but rather actually has a great deal to do with patient safety.

He didn’t seem to care that it would help close the loop on orders, making sure results were received and catching misses through electronic reporting. He actually suggested providers should use an accordion file and duplicate copies of the requisition. What century is this person living in? I understand competing priorities and limited budgets, but these are our employed physicians that we placed in the hospital building in good faith.

I thought at one point I was going to have to perform a stroke assessment on the operations VP. He made some threats about calling the hospital CEO to discuss breaking the lease and the lab guy still didn’t flinch. It was brinksmanship like I haven’t seen in a long time. I know the hospital CEO well and would love to be a fly on the wall when he calls the lab director and tells him to get it in gear. The bigger picture includes hundreds of newborn deliveries and even more GYN surgeries. Given the practice’s revenue boost to the hospital, I would bet money that the lab director will be singing a different tune by next week.

I’ve also been wrangling entirely too many consultants and administrators regarding the now-approved ICD-10 delay. We’re breathing a sigh of relief on the inpatient side because our hospital vendor still hasn’t delivered decent software. On the ambulatory side, I’m just aggravated, though. Our vendor worked extremely hard to deliver solid product and we’re upgrading very soon. I think of all the “real” enhancements they could have done to the software with the development dollars that they pumped into getting ICD-10 ready and out to the client base with ample time for everyone to upgrade.

Speaking of the legislation, did anyone read the whole thing? I did read the “Protecting Access to Medicare Act of 2014” and there were a couple of other gems that snuck in under the cover of the SGR patch. I love the fact that the Government Printing Office uses an old-school type face for the header on legislation. Check out Section 111, which gives hospitals some relief from the so-called “two-midnight rule” through March 2015. Of course “evidence of systematic gaming, fraud, abuse, or delays in the provision of care by a provider” can trigger an audit regardless.

Sections 205 and 206 include abstinence education and funding for the PREP personal responsibility education program. I know there are some sassy seniors out there, but I fail to see how throwing this in with the “Protecting Access to Medicare Act” makes logical sense. They should have called it the “Protecting Medicare, Serving Special Interests, and Tidying Up Odds and Ends Act.”

Fifteen million dollars for pediatric quality measures is in section 210. One of my favorite add-ons is section 216, “Improving Medicare policies for clinical diagnostic laboratory tests.” It requires laboratories to report their private payer contractual rates and test volumes to assist in establishing Medicare rates. So much for a free market (although we knew that was long gone with Medicare already.)

Another favorite (which I almost missed because of the mind-numbing and sleep-inducing effects of federal legislation) is section 218, which promotes evidence-based care by requiring physicians to use clinical decision support before they order certain radiology imaging studies. CDS modules can be part of certified EHR technology or independent. Eventually outlier physicians will require prior authorization before they can order studies. Just when you thought it was safe to go back into the water after MU2, there are more sharks circling. I hope the EHR vendors can code fast enough to keep them at bay.

The ICD-10 delay is in section 212, if anyone is interested. I gave up after page 31. A reader gave me my laugh of the day about the delay:

Dear Dr. Jayne,

I have three young boys and one of them is always winding up in the ER. This year alone we’ve already had boy vs. coffee table, boy vs. Evel Knievel bicycle jump, and boy vs. monkey bars. Every time our insurance pends the claim and sends me a letter asking for verification that the injury was not work-related or due to a motor vehicle accident. I wish they could figure out that if the boys are 4, 7, and 10 they’re probably not on the job. A quick skim of the ER note would give them the rest of the information. I was looking forward to ICD-10 because maybe the more specific codes would give the insurance company what it wanted in the first place. I guess I’ll have to wait another year to find out. Hopefully we’ll be less accident prone by then.

Those descriptions remind me of Struck by Orca and I’m thinking maybe a companion volume is in order. What’s your reaction to the ICD-10 delay? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 3, 2014 News 4 Comments

News 4/2/14

April 1, 2014 News 7 Comments

Top News

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Implementation of ICD-10 will be delayed until at least October 1, 2015 (it’s up to HHS to set the exact date, apparently) as the Senate approves (64 to 35, with 60 votes required) a hastily assembled bill intended to once again delay the SGR-mandated 24 percent physician pay cut for another year, the 17th time it has been delayed rather than repealed and replaced. Nobody claims to know how the one-sentence ICD-10 language ended up in the otherwise unrelated bill. Sen. Jeff Sessions (R-AL) declares that the “doc fix” violates the just-passed Bipartisan Budget Act since there’s no money to pay for it. The patches have cost taxpayers an estimated $150 billion. The President signed the bill Tuesday. Several organizations expressed disappointment that ICD-10 was delayed and the AMA says it is “deeply disappointed” that the Senate kicked the can down the road again rather than repealing SGR instead of addressing Medicare physician payment reform. HIMSS didn’t announce a position on the delay, but CHIME said it wasn’t happy about the industry’s wasted efforts and the unknown aspects of the delay. A few sages predicted this could happen: the HHS big wheels declaring at the HIMSS conference that ICD-10 would not be delayed further are civil servants, not legislation-making members of Congress.


Reader Comments

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From Minnesotan at Heart: “Re: Mayo Clinic in MN, AZ, and FL. Looks like they are looking at Epic and Cerner from this article in the employee newsletter.” According to the March 28 newsletter, Mayo will implement a single-instance EMR at all campuses and has narrowed the field to Cerner and Epic for demos.

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From Vince Ciotti: “Re: Indy Car Grand Prix in St. Petersburg, FL. I took this picture of the NTT DATA car.” Many readers would have been jealous of the obviously great weather in Florida had spring not finally kicked off in some places.

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From Todd Hatton: “Re: Saint Luke’s Health System. We have gone live on Epic inpatient clinical applications on March 28 at our seven metropolitan hospitals in a big-bang fashion. Applications implemented are ClinDoc, Stork, Rover, Haiku, Cantu, Orders, ASAP, Willow, Radiant, OpTime / Anesthesia. SLHS implemented on the Linux database platform. New wrap-around applications are Perceptive Software integrated document imaging, Nuance eScription partial dictation integration, Perigen fetal strip integration, and iSirona medical device integration for anesthesia, ventilators, and bedside monitors in ED, surgery, ICU, and NICU. Things are going well.” Congratulations to the Kansas City area SLHS, where Todd is associate CIO and is no doubt proud of the team that made it happen. A seven-hospital big bang Epic go-live is quite an accomplishment.

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From Plausibility: “Re: Meditech. We are looking a vendor-agnostic solution that pulls contextual information from the patient’s record. I am concerned that Meditech will block access to its data. Has anyone used a solution like this without having Meditech block the information or have advice on encouraging them not to?”

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From The PACS Designer: “Re: iPhone 6. Rumor has it there will be two designs, a 4.7-inch phone and a 5.7-inch phablet.”


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Navicure. The Duluth, GA-based company offers worry-free clearinghouse and payment solutions built for physician practices, supporting expanding health systems by accelerating and protecting practice cash flow, decreasing A/R days, providing enhanced eligibility verification, improving staff productivity, and giving patients tools to manage online statements and payments. The company serves over 50,000 providers, offering them a “3-Ring Policy” guaranteeing that support calls will be answered within three rings. Thanks to Navicure for supporting HIStalk.

I found this YouTube video overview of Navicure. 

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I sent $50 Amazon gift cards to three randomly chosen readers who responded to my annual survey, but Lorre noticed that two other readers had written in that if they happened to win (they didn’t), they wanted their prize donated to my favorite charity, DonorsChoose. I was touched, so this is for you, Andrew Gelman of PDR Network and Pam Landis of Carolinas HealthCare. I funded an amazing DonorsChoose project with your $100. I found a grant program underwritten by Autodesk that helps pay most of the cost for certain classroom equipment, and your $100 bought – you won’t believe it – a $2,669 MakerBot 3D printer, supplies, and support package for Mr. Fraustro’s architecture, engineering, and construction classes at high-poverty John A. Rowland High School in Rowland Heights, CA.


Upcoming Webinars

April 2 (Wednesday) 1:00 p.m. ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

April 9 (Wednesday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 1 – Avoiding Analysis Paralysis. Sponsored by Premier. Presenters: Kristy Drollinger, senior director of population health analytics, Fairview Health Services; J.D. Whitlock, corporate director of clinical and business intelligence, Catholic Health Partners; Sean Cassidy, general manager of information technology services emerging business unit, Premier, Inc. Are you ready to invest in an integrated data platform? Do you have a strategy to make the information accessible and actionable? How will enterprise data warehousing transform care delivery? There’s more to data analytics than simply deploying an EDW. Learn what goes into becoming an information-driven enterprise in the first webinar in this series.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.


Acquisitions, Funding, Business, and Stock

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Imprivata files for a $115 million IPO, planning to list its shares on the NYSE. According to the SEC filing, the company lost $5.5 million on revenue of $71 million for the year ended December 31, 2013, with 83 percent of its revenue driven by the OneSign single sign-on product that has 2.6 million licensed healthcare users and another 740,000 outside of healthcare. The S-1 registration statement also notes that the company uses a development firm in Ukraine with obvious exposure as Russia threatens. The fine print notes that BIDMC CIO John Halamka was given options worth $140,700 as a company director.


Sales

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Florida Hospital Memorial Medical Center (FL) chooses Authentidate’s InscrybeMD telehealth solution to manage chronic disease patients in a partnership with Bethune-Cookman University.

ViaQuest’s Clinical Services Division (OH) will use Netsmart CareManager for its planned Health Home.

Ministry Health Care (WI) selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.


People

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Patty Griffin Kellicker (Humedica) joins Hayes management Consulting as VP of marketing and communications.


Announcements and Implementations

St. Francis Hospital’s (CT) use of ReadyDock’s storage, charging, and disinfecting system for mobile devices gets coverage on the local TV station.

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Brigham and Women’s Hospital (MA) will expand its use of scribes to operate its EMR, at least until that system is replaced. According to CMIO for Health Innovation and Integration Adam Landman, MD, MS, MIS, MHS, “It lets me sit next to the patient and focus 100 percent of my attention on the patient. There are a few patients who don’t want the scribe involved in their care, and then I ask the scribe to leave.”

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TigerText says it will cover up to $1 million in fines if its customers are charged with violating HIPAA secure messaging requirements.


Government and Politics

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A GAO audit finds that Department of Defense is lousy at estimating long-term system costs, with its TMIP-J battlefield EHR (which includes the frontline portions of the AHLTA, CHCS, and DMLSS systems) being by far the most wildly underestimated. DoD estimated its cost at $68 million in 2002, but they’ve spent $1.58 billion on it so far.

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Indiana’s professional licensing agency asks the state’s ethics commission to review a Board of Pharmacy decision that allows Walgreens pharmacists to use workstations that aren’t located behind counters in its “Well Experience” program. The pharmacy board’s president at the time the request was approved was a Walgreens manager. Consumer groups expressed concerns that pharmacists might leave the area and expose confidential computer or label information to customers.


Technology

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Retired Akron, OH cardiologist Terry Gordon, who advocated placing automated external defibrillators in public areas, is working on a scavenger hunt-type game app that would encourage high school students to locate and report the AED locations to a central database so emergency responders can direct 911 callers to them in a cardiac emergency.


Other

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In New Brunswick, the government’s $16,000 subsidy of the $24,000 Velante EMR sold by a for-profit venture of the New Brunswick Medical Society ended Monday. Expected physician enrollment was running well behind expectations through the end of February. The medical society partnered with a vendor who then contracted out system development to a New Zealand company.

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Epic offers its usual April 1 merriment, declaring that it will immediately discontinue Meaningful Use support to allow clients to claim Stage 2 hardship exemptions, KLAS realizing that it has always spelled CLASS incorrectly, and Epic funding research into how to pronounce the name of its business intelligence suite Cogito but advising to just call it “ree-POR-ting” for now.

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A new JAMA-published study finds that 19 of the 50 largest drug companies have at least one academic medical center leader on their boards, paying them an average of $313,000.

The chairman of an England-based CMIO-type organization says his organization can’t say anything negative about their software systems because vendors will sue them. “Our pockets are not deep enough to confront the legal departments of the suppliers,” he says, suggesting that instead trusts contact each other before buying.  

Weird News Andy titles this story “To Make You Feel Better.” Hearing-impaired California consumers who called the listed 800 number to receive help signing up for health insurance are surprised to hear, “Welcome to America’s hottest talk line.” The site’s incorrectly listed number was for a sex chat line. A Covered California spokesperson denied that its site listed the wrong number despite the local TV station’s screenshot clearly showing it. A Sacramento newspaper had made the same mistake previously, running a number that was one digit off and sending prospective subscribers to the same service.


Sponsor Updates

  • Brad Levin, GM of Visage Imaging, contributes an AuntMinnie.com post titled “The Time is Now for Deconstructed PACS.”
  • SyTrue is selected to present at the Healthcare Documentation Integrity Conference in Las Vegas, NV July 23-26, offering “Your ‘Hitchhiker’s Guide’ to Medicine’s ‘Tower of Babel.’”
  • PerfectServe discusses clinician exhaustion and offers three steps to eliminate the problem.
  • Harris Corporation’s FusionFX Patient Portal earns 2014 Edition Modular Ambulatory and Inpatient Certification from ICSA Labs.
  • Health Care Software posts its event calendar through October.
  • ESD celebrates 24 years in healthcare IT.
  • Etransmedia Technology’s Direct Care Coordinator receives ONC-ACB certification.
  • DrFirst and Insight Software partner to offer e-prescribing to eye care providers.
  • First Databank will summarize research findings on drug pricing benchmarks at two pharmaceutical conferences in April and May.
  • WebInterstate Inc partners with Liaison Healthcare to integrate its MediMatrix mobile imaging solution to multiple EMRs.
  • MedAssets continues to support clients in preparation of ICD-10, saying the transition is “when” rather than “if.”
  • Deloitte Analytics senior advisor Tom Davenport expounds on the findings of the strategic planning required for big data to be of use.
  • Wellcentive will demonstrate its population health management platform during the AMGA conference in Dallas, TX April 3-5.
  • Perceptive Software creates a blog to recap Inspire 2014 in Las Vegas April 4-9.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 1, 2014 News 7 Comments

Morning Headlines 3/31/14

March 30, 2014 Headlines No Comments

Maryland set to replace troubled health exchange with Connecticut’s system

Maryland’s $125 million health insurance exchange website is being called “broken beyond repair” and will be shut down and replaced by the Deloitte-built system that Connecticut is successfully using.

Morgan Stanley Reveals Stocks on Takeover Target

Cerner is included in a Morgan Stanley report which looks at financial and market sector data to predict which companies are acquisition or takeover candidates this year.

Big data: are we making a big mistake?

A Financial Times article explores the state of ‘big data,’ warning that building larger datasets does not guarantee that statisticians will unlock exciting new answers from them. To illustrate that ‘big data’ comes second to good data, the article cites two presidential polling surveys from the Landon vs. Roosevelt 1936 election. One poll surveyed 3,000 voters and correctly predicted that Roosevelt would win, while the other surveyed 2.4 million voters and incorrectly predicted that Landon would win. The 3,000 sample-size survey called the election correctly because the researchers focused their efforts on building a clean and unbiased sample set, rather than building a massive sample set and assuming its size would correct for any statistical bias.

Medical First: 3-D Printed Skull Successfully Implanted in Woman

A 22-year-old woman in the Netherlands is the first person to receive a 3D plastic scull implant. The woman suffered from a condition that was causing her skull to thicken, leading to severe headaches and total loss of vision. Once the replacement skull was implanted, the woman’s vision returned and her and headaches stopped.

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March 30, 2014 Headlines No Comments

Monday Morning Update 3/31/14

March 29, 2014 News 7 Comments

Top News

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The Washington Post reports that Maryland has such little hope that its $126 million health insurance exchange will ever work that it will be shut down permanently and replaced by Connecticut’s system. Nobody’s willing to talk about what the new system will cost, especially the politicians who botched the first one that crashed minutes after it was turned on. The only refreshing aspect about Maryland’s folly is that it was Noridian Healthcare Solutions that it had to fire instead of CGI and it’s also the first state to admit defeat and start over. Connecticut’s system was developed by Deloitte, which seems to be the only company that consistently delivered for those states that decided they couldn’t use the federal exchange.


Reader Comments

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From Bruce Kee: “Re: patient privacy case. It’s a sticky situation.” Wisconsin Governor Scott Walker, while a county executive running for governor in 2010, received and shared information about a patient who was sexually assaulted at a county mental health facility as he and his political consultants tried to deflect criticism of four deaths that had occurred there. The attorney hired by the county explained in the draft response why the patient’s information should not be released to the newspaper, saying, “They and I are bound by laws and regulations governing, among other things, the confidentiality of certain information. What should we do? Should we disregard the rights of patients? The legal and ethical obligations imposed upon us? Please — please consult with someone familiar with the laws and regulations governing the disclosure of the information you seek.”  

From Vas DeFerence: “Re: cloud EHR vendors. A know of a practice that wants to switch systems ASAP, but can’t get their data even though their contract gives the practice ownership of it. The SaaS-based vendor won’t provide it or give the practice access, so the practice is actually thinking about manually printing out 80,000 charts to PDF. How are other practices and vendors dealing with SaaS-based database lock-in?” The obvious answer would be to sue the vendor, but that takes time and money the practice probably doesn’t have. The second would be to call the vendor out publicly and hope the possibility of negative publicity action heightens their data export enthusiasm. I’ll offer to be the intermediary if the practice wants to give me details on the record so I can get the company’s response. My pessimistic expectation is that the vendor doesn’t really know how to deliver on its promise and has little incentive to figure it out until the seat it occupies gets a bit hotter. Mass export capability should be part of certification given ONC’s push for interoperability, the practice’s equivalent of Blue Button that allows them to move to a new system without endangering patients by losing their information.


HIStalk Announcements and Requests

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The huge amount of taxpayer money spent on dysfunctional health insurance exchanges is more the fault of bureaucrats rather than of contractors such as CGI, poll respondents said 51 percent to 29. New poll to your right: have you seen personal benefit from an HIE as a patient / consumer? I understand that maybe you wouldn’t necessarily know, but even then that’s the marketing challenge of HIEs.

My latest grammar peeve: specifying times as “EST,” which is wrong through November 2. Just say “Eastern” or “ET” year-round if you don’t want to be bothered with the seasonal intricacies of “EDT.” The only “standard time” in the summer is in Arizona, which confusingly but sensibly doesn’t observe Daylight Saving Time and therefore remains on MST all year.

Listening: ReVamp, operatic metal from the Netherlands featuring my favorite female singer, Floor Jansen (After Forever, Nightwish).


Upcoming Webinars

April 2 (Wednesday) 1:00 p.m. ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.


Acquisitions, Funding, Business, and Stock

Morgan Stanley places Cerner on its list of 44 companies whose stock fundamentals make them attractive for being acquired. 

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TrueVault, which offers a programming API allowing software developers to store and use patient information in a HIPAA-compliant manner, raises $2.5 million in seed funding. The Mountain View, CA-based company charges $0.01 per programming call to its service. 


Government and Politics

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A consultant hired to review Vermont’s insurance exchange lists problems that include changing federal expectations, inexperienced consultants provided by CGI, and putting political cronies in charge. It’s a well done and easily understood report, although I suspect that engaging a consulting firm to evaluate even a successfully executed project would result in a similar list.

A proposed California referendum that would increase the state’s $250,000 limit on non-economic malpractice awards adds two unrelated items added to make it more enticing to voters based on focus group response: requiring stringent drug testing of hospital-based doctors and mandatory use of a doctor shopping database that is already available but that nobody uses because it’s clunky. The special interests will be out in force: trial lawyers love the prospect of higher awards that will encourage them to represent injured patients instead of just turning them down as not being worth the effort, hospitals say the change will cost billions, and the guy pushing the database nobody uses was upset that he got only $250,000 when a doctor-shopping drug abuser ran over and killed his two children.

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Check out C-Span video of the doc fix/ICD-10 delay being approved by voice vote, suspending the House’s own rules and skipping the recorded vote that would indicate who voted yes and no. The “no” votes sounded louder than the “yes” votes to me but the Chair gets to decide, not to mention that voice votes require legislators to be physically present, which isn’t common, and are usually used only for non-controversial issues for which support is nearly unanimous. The voice vote means the two-thirds majority wasn’t required, leading experts to say that both parties feared it wouldn’t pass otherwise by the April 1 deadline, the day after Monday’s Senate vote. Since the one-sentence ICD-10 delay got tacked on for some reason, it also passed without any kind of discussion or thoughtful process. An example of the political motivations comes from Minority Leader Nancy Pelosi (D-CA), who explained her support as, “The Republicans will say this is because of the Affordable Care Act, and I just don’t want to give them another opportunity to misrepresent what this is about.” Democrats want the SGR repealed, but Republicans say they haven’t offered a proposal on how the country will pay for it, leading in the regular “patches” that have prevented what would have been $160 billion in taxpayer savings over the past 10 years as the law requires.

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HHS releases a security risk assessment tool for small to medium physician practices. It’s available for the desktop, iPad, or as Word documents.


Innovation and Research

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Doctors in the Netherlands save the life of a 22-year-old woman by replacing most of her skull with a plastic one they created using 3-D printer. It’s refreshing that among all of the wildly overhyped technologies, 3-D printing has come out of nowhere and is solving big problems cost effectively.


Other

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I thought this subject line of the promotional email from Next Wave Connect described either late-breaking news or fresh emanations from their in-house psychic related to Monday’s scheduled Senate vote (who also irrationally capitalized “Delayed”). Nope, it was just “click here’ bait for people who require assistance in comprehending what a one-year delay would mean to them (is it really that hard to figure out?)

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Northern Berkshire Healthcare (MA), which operates 36-bed, 129-year-old North Adams Regional Hospital and its affiliates (visiting nurse service, hospice, and three practices) files Chapter 7 bankruptcy and shuts down the hospital due to declining revenue. The state’s attorney general, who is from the same town, has announced an investigation of the hospital’s board. Protestors showed up at the empty building, seemingly more interested in the loss of union jobs than any immediate danger to public health triggered by closing a facility short on patients. A court ordered competitor Berkshire Medical Center to take over the ED on Friday, but shortages of supplies and staff led it to delay the ED re-opening until Monday. The CEO of the state hospital association summarized the situation as, “Changes are taking place both in how care is paid for, and also how care is delivered. Not all hospitals will continue to operate as they used to. Possible solutions for this could include redefining what a hospital is to maintain basic services for a community, or cross-subsidization within a larger health system.” He didn’t mention the more Darwinian solution that needs to be on the table given healthcare costs: if you’re not providing a service the market demands or someone else is doing it better, shut down.

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I saw a few mysteriously belated tweets about a 2013 Accenture study (complete with the usual cartoonish infographs for people too busy to actually read words) of what patients expect of drug companies, which concluded that: (a) patients want to hear directly from drug companies, preferably as they begin taking a new drug; (b) they want free stuff, like discounts or rewards; (c) two-thirds are willing to trade their personal information to get the aforementioned free stuff. The conclusion is that pharma has not met expectations for more actively engaging with its customers. What’s wrong with the study: (a) it was an online survey that is by definition skewed toward heavy online users who don’t have anything better to do than fill out surveys; (b) Accenture didn’t include the actual survey questions, which I expect were heavily suggestive of demonstrating unmet demand since Accenture sells consulting services to drug companies panicking that their Facebook page isn’t clever enough; (c) it didn’t compare non-online communication options (telephone or mail, for example) but instead just asked respondents to choose from several online technologies;  and (d) surveyed consumers almost always express an interest in something that’s free that they end up ignoring completely when it’s actually made available in response to questionable survey results (see: personal health records). My unscientific conclusion of what consumers want from drug companies: (a) discounts; (b) notice of any new information about the drugs they take; and (c) follow-up information about use, side effects, warnings, etc. a few weeks after starting a new chronic medication. They don’t want drug companies bugging them on Facebook and Twitter.

Sunday, March 30 is National Doctor’s Day, which means that hospitalists and ED docs will be about the only ones who get thanked directly since their peers won’t be working.

A Financial Times article warns that the concept of “big data” has consultants, entrepreneurs, and governments drooling, but Google Flu Trends is a good example of putting too much faith in easily collected data of unknown meaning. Everybody focuses on correlation rather than causation — just because people with the flu Google the word “flu” more often doesn’t mean that everyone who Googles “flu” has it. It also points out a common misperception: bigger data sets of uncertain selection bias aren’t as predictive as smaller data sets that are free of sampling bias, with an example being the prediction that Landon would convincingly defeat Roosevelt for President in 1936, which was based on 2.4 million mailed survey responses that turned out to be wildly wrong compared to 3,000-respondent survey that was more carefully designed. The article concludes that giant databases have people clamoring for information that statistical methods can’t always deliver.

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Two ED registrars at Jamaica Hospital Medical Center (NY) are arrested for selling information from electronic patient files to rehab centers and personal injury attorneys, with one patient receiving a call from an ambulance-chasing lawyer while still sitting in the ED.

The founder of sexually transmitted disease testing app Hula says he won’t change the company’s name despite protests from Hawaiians, but he now understands the cultural insensitivity of company marketing materials that refer to “getting lei’d.”


Contacts

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

More news: HIStalk Practice, HIStalk Connect

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March 29, 2014 News 7 Comments

News 3/28/14

March 27, 2014 News 12 Comments

Top News

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The House of Representatives approves, by an unusual voice vote, a hurriedly presented bill that would delay the mandatory implementation of ICD-10 until at least October 1, 2015. The bill, presented Wednesday and approved Thursday, primarily addresses a Sustainable Growth Rate fix that would prevent the 24 percent reduction in physician Medicare payments that will otherwise occur on April 1. The ICD-10 date change was contained in a single sentence in the bill, which will become law if it’s approved by the Senate on Monday and then signed by the President. HHS has been insisting the deadline wouldn’t change after two previous delays, providers and vendors should have been ready given the generous lead time and remaining six months, and most organizations agreed that it was time to rip the Band-Aid off and just do it. Now a delay gets snuck into an unrelated bill and pushed to approval in less than 24 hours, most likely by politicians who didn’t have a clue about what they were voting for. The bill proves how ineffective Congress can be – they can’t figure out how pay for fixing SGR, so they delay its implementation, and despite HHS claims that ICD-10 is vital, it’s easier to keep delaying it than to reach an actual decision about its merit.

 


Reader Comments

3-27-2014 11-22-52 AM

From The Reverend: “Re: another MU question. Thanks for posting question about the exemption letter. I’m also confused by the statement at the top of the exemption form that, ‘If you successfully met Meaningful Use in 2013, you will be excluded from the payment adjustment and do not need to submit a Hardship Exception Application for Payment Year 2015.’ I betcha this is a brilliant tactic to bring costs for the program under control. Providers current with MU will see an opening to ignore this year’s reporting period since the one percent penalty is off the table and ultimately fewer providers will get that final year payment.” I’m not sure what CMS’s intentions were with its handling of the exemption process, but I bet plenty of providers will take advantage of the reprieve.From Seymour Bush:

“Re: Atlantic article series on EHRs. This gentleman’s comments are a fun counter to industry hype.” According to Nebraska-based family practice doc Creed Wait, MD:

The saying is, “Build a better mousetrap and the world will beat a path to your door.“ The saying is not, “Build a different mousetrap, pay out 19 billion dollars in incentives to use the mousetrap, mandate its use by law and punish those who fail to adopt it. Then shove the world kicking and screaming against their will through your door” … For the federal government to mandate the use of EMRs by every physician out there just because it works at the VA would be like telling the entire world, “OK, we made it to the moon. Now it is your turn. Any country that has not put a man on the moon within the next five years will be bombed. Every country that complies with this mandate will get a check for $1B. For those countries who fail to comply with this mandate, shelling will begin at 1:00 a.m, five years from today.” …The EMR had become the primary influence in the interview. The dynamic had changed. The patient and I were now both in the room to feed the hunger of the software … Physicians used to write their orders and clerks would enter these data into the computer. Under the new mandates, the physician is now a data entry clerk. What’s next? Is each hospital CEO going to be required to spend two hours a day manning the switchboard?

From Dim-Sum: “Re: DoD EHR. DoD looked at Judith’s big Kaiser win, calculated additional funds for development of a down range medicinal solution, and added a chunk for COTS vendors to certify their teams for Tier 1,2 & 3 support. That figure, for all practical purposes, is $5.5 billion USD. The SI prime wants 40 percent of the pie. COTS EHR vendors will want $1.8 billion USD . Does anyone see the math does not add up? To add to the confusion and muffled numbers is the fact that a CMMI 3 firm will come in and state that COTS can’t create or engineer a down range solution, so they will want $500M – are we seeing a trend here? COTS EHR vendors cannot fathom Agile Scrum, let alone CMMI 3 mediocre results, Everyone forgets that software vendors in the US usually charge 16-20 percent of original software list for ongoing annual support — those numbers are included, so the hopes and dreams of the average EHR vendor is shattered. They will have to come down by $0.5 billion, round down their fee so they can recoup recurring revenue of 20 percent ($200 million a year) of the leftover amount to secure a more realistic number of $800 million. Your SI buddies want COTS vendors to be realistic, stop your silly dreams – you never heard of SPAWAR (Latin meaning “Beltway ONLY.”) SIs deserve the cash because they have no idea how to develop competitive software, so they want your knowledge on the cheap, they are program managers, they are the conduit in to the psyche of the DoD. The DoD does not value software, they value stability and sustainability and salute predictability. That is why it is so hard for COTS vendors to believe that the DoD blew $10+ billion USD for the monstrosity they have today and are hoping COTS EHR vendors can save the day.”

From Bill O’Sayle: “Re: FDA recalling McKesson’s anesthesia software. Both Cerner and Epic (for example) now have products to consume medical device data straight into their EMRs (i.e. Cerner iBus). Do you think this means then that EMRs with such capability are now at risk of such a recall? I can’t see Cerner putting their PowerChart install base at risk of a recall just so they (Cerner) can claim medical device integration. But if this is the logic of the FDA, then that seems to be the case, no?” The lab software model is that the instrument interface requires FDA’s approval, but the system that uses its information doesn’t (except for blood banking systems). I’m speculating, without knowing the details, that McKesson’s anesthesia product may have medical device integration built in, which puts the whole product within FDA’s purview. But given my “without knowing the details” disclaimer, I’d be interested to hear from someone who knows more than I.

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From HIMSS EHR Association: “Re: EHR Developer Code of Conduct. A correction to Mr. H’s thoughts on the McKesson/FDA matter. The EHRA  strongly recommends that all vendors developing EHR products, regardless of membership in the EHRA, adopt the Code of Conduct. However, it is not a condition of membership in the EHRA. The 17 vendors that  adopted the Code of Conduct as of February were recognized at HIMSS14. Since then, three additional vendors have adopted the Code. The EHRA is hosting a webcast on Friday, March 28 to educate more vendors on the elements included in the EHR Developer Code of Conduct and the benefits of adoption.”


HIStalk Announcements and Requests

inga_small Highlights from HIStalk Practice this week include: Dr. Gregg asks if being OK is OK and notes that the hard part isn’t achieving perfection but learning to be OK with OK. CMS warns EPs of possible system delays as providers submit MU attestation data by the March 31 deadline. The American Academy of Ophthalmology launches IRIS Registry, a centralized data repository that aggregates outpatient clinical data from EHRs. Epic, eClinicalWorks, and Allscripts claim the biggest shares of the ambulatory EHR market. Naval Branch Health Clinic Albany (FL) offers secure messaging services through RelayHealth. AHIMA warns that the use of copy and paste functionality in EHRs should be permitted only in the presence of strong technical and admin controls. While checking out these stories, why not sign up for the spam-free email updates so you won’t miss something important? Thanks for reading.

This week on HIStalk Connect: Six senators send a letter to the FDA seeking clarification over medical app regulation. Beth Israel Deaconess Medical Center will expand the use of Google Glass by ED clinicians after finishing a successful three-month trial. Reflexion Health raises $7.5 million to expand development of a Microsoft Kinect-based platform designed to support physical therapists and their patients.

I had some site problems over the weekend through Wednesday, which caused some downtime and the temporary disappearance of some posts and comments. Hopefully it’s all fixed now. Geek details: the webhost monitors web traffic and noticed IP traffic containing HIStalk’s server password, leading them to discover a root trojan that would have allowed its creator to take control of the server. That required building a new virtual server and migrating all the settings and large MySQL databases over to an environment containing fresh installs of PHP and Litespeed, which often brings up odd permissions and database problems. It’s been quite a pain – I watched the site and the open support ticket for 15 hours on Saturday alone and slept only a couple of hours, but problems delayed the actual migration until Tuesday evening.


Upcoming Webinars

April 2 (Wednesday) 1:00 p.m. ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.


Acquisitions, Funding, Business, and Stock

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AirStrip acquires the assets of wireless fetal/maternal monitoring provider Sense4Baby and licenses the technology from the Gary and Mary West Health Institute.


Sales

3-27-2014 10-15-05 AM

Southern Illinois Healthcare selects CPM CarePoints, ExitCare, Mosby’s Nursing Consult, and Mosby’s Skills from Elsevier.

Gracepoint Management (FL) will implement the Plexus Revenue Cycle Management service from Netsmart across its network of 48 behavioral health and drug and alcohol treatment centers.


People

3-27-2014 12-42-12 PM

TeleTracking Technologies hires Susan Whitehurst (Joint Commission Resources) as managing director of consulting services.

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Innovative Consulting Group names David Kissinger (Leidos Health) regional VP.

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Wellspring hires Matthew Joyce (Stout Risius Ross) as SVP of sales.


Announcements and Implementations

3-27-2014 8-34-30 AM

Bradley Healthcare and Rehabilitation Center (TN) begins transitioning to PointClickCare EMR.

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Henry Ford Health System (MI) joins the Michigan Health Connect HIE.


Government and Politics

3-27-2014 1-49-32 PM

The HHS OIG finds that a federal database for tracking Medicaid fraud isn’t working as intended, with 17 states and the District of Columbia failing to provide information on providers banned from billing Medicaid. The database also contains missing National Provider ID numbers and  names of “terminated” providers who are actually dead.


Technology

Medicity earns a patent for its technology for connecting referral networks and another for its technology to centralize communications between providers and patients using cloud-based mobile technology.


Other

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Continua Health Alliance announces availability of its 2014 Design Guidelines.

The eHealth Initiative launches its 2020 Roadmap to guide the transformation of the nation’s healthcare system by 2020. The roadmap will focus on recommendations tied to Meaningful Use, system interoperability, care delivery transformation, and a balance of innovation and privacy.

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Online second opinion service Best Doctors launches the Medting medical exchange.

Weird News Andy calls this story “dueling paramedics.” A woman being transported by ambulance for possible stroke gets out of the ambulance after the two paramedics started arguing bitterly about a personal issue. WNA also observes the skyrocketing healthcare salaries in Cuba, where huge percentage boosts will give nurses an income of $25 per month, while physician specialists will earn $67 per month, up from $26.


Sponsor Updates

  • HealthMEDX hosts its user group meeting next week in Branson, MO.
  • CommVault publishes a white paper highlighting findings of a nationwide survey of healthcare IT managers, which suggest that healthcare data from a variety of sources could overwhelm the healthcare delivery system.
  • HCS announces that all of its Interactant modules meet ICD-10 standards.
  • Craneware hosts a series of one-day user group meetings in advance of its October Revenue Integrity Summit in Las Vegas.
  • PDS provides details of its 2014 Tech Conference October 22-23 in Madison, WI.
  • Nordic Consulting CEO Mark Bakken will deliver the keynote address at Madison’s startup incubator Gener8tor’s winter premiere night on April 3.
  • Wolters Kluwer Health enhances its UpToDate App for the Android mobile platform.
  • Kareo CEO Dan Rodrigues discusses his company and the power of cloud computing for small- to medium-sized practices.

 


EPtalk by Dr. Jayne

Everyone at the hospital is buzzing about the possibility that ICD-10 will be delayed as part of the legislation addressing the Medicare physician payment cut. Both CHIME and AHIMA have come out against the ICD-10 provision, stating that delaying it would negatively impact innovation and health care spending.

Athenahealth’s VP of government affairs, Dan Haley, quickly blogged about it in response. His main assertion is that a delay would only reward vendors who didn’t work hard enough to meet deadlines which have been published well in advance. His secondary point is that for the legislature to delay ICD-10 after the head of CMS has said multiple times that there will be no further delays is akin to a child receiving dessert after his parent had previously told him no.

As much as I’d hate to see my colleagues and their employers suffer when their vendors are not ready, it may take something this dramatic to really thin out the vendor herd. We’ve known this deadline was coming for a very long time and for vendors to still be unable to meet it is inexcusable. We can blame it on MU and the fact that we have a perfect storm of governmental requirements massing to hit us all at once. We can blame it on all kinds of things but the bottom line is that many vendors have delivered despite all those factors.

I don’t have a crystal ball to see how this is going to morph as it works its way through Congress, but it just goes to show that there’s never a dull moment in health IT. Many of my colleagues are already using it as an excuse to stop working on ICD-10 even though the legislation hasn’t been signed. In the words of Julia Roberts as Vivian Ward: “Big mistake. Big. Huge.”

Speaking of mistakes, several readers have written about the issues mentioned in Monday’s Curbside Consult. One of the problems I encountered was an issue with having multiple aliases in a hospital’s patient portal. A reader pointed out that issues like this are not only patient safety issues, but can also play into national safety:

I’m sure you’ve seen the articles about the so-called “Boston Bomber” entering the US undetected because he spelled his name differently than what was on the official watch list (Tsarnayev v. Tsarnaev). Seriously? The CIA was confounded by the unexpected insertion of the letter “y” into a person’s name … a person on a monitored watch list?  Seems incredible. If the CIA can’t figure out how to address probable name variances, then I’m not so surprised that your large academic medical center can’t figure out how to fix an alias name in its EMPI.

Other readers sent their own stories of IT systems run amok not only in healthcare, but in other industries as well. The pace of change is so great that little things like accuracy and completeness can’t seem to keep up. As long as the majority of people think technology is the solution to everything, I don’t see things slowing down.

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I haven’t mentioned shoes or wine in a while, so I was excited to find this piece about a way to remove the cork from a wine bottle using only a man’s dress shoe.  The article contains an engineering explanation of the fluid dynamics responsible for it working. Unfortunately ladies’ heels don’t work well due to the angle of the sole, so Inga and I are out of luck. If you’re looking for a few good laughs, however, make sure you check out the comments section.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

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March 27, 2014 News 12 Comments

Monday Morning Update 3/24/14

March 22, 2014 News 11 Comments

Top News

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Three Detroit hospital systems – Beaumont, Oakwood, and Botsford – announce plans to merge into an eight-hospital, $3.8 billion system, citing shared electronic medical records as one of their four goals.


Reader Comments

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From Tom: “Re: McKesson’s FDA Class 1 recall. The description of their product Anesthesia Care could generically be applied to almost any EMR/EHR/CIS vendor’s AIMS product and yet the FDA’s decision-making clearly does not apply to vendors equally. Also I wonder how the regulation of CDS would affect a hospital who develops their own CDS?” FDA’s highest-level recall of McKesson Anesthesia Care may be sending a message that the agency considers even software-only clinical decision support to be high risk. McKesson defines its product as an anesthesia information management system, which it also calls an “anesthesia EMR.” McKesson sought and received FDA premarket clearance apparently because the system collects data from physiologic monitors. McKesson did a voluntary recall of its product in March 2013 after a customer reported that the software pulled up the wrong patient’s information, with two other customers reporting later that it had lost medical history comments and misconnected to a physiologic monitor, affecting one patient in each instance. Some thoughts:

  • McKesson Anesthesia Care is a software-only system that does not control medical devices. It collects and uses information from patient monitors. Other than that, it’s like any other high-acuity, unregulated EHR (surgery, ICU, ED, etc.)
  • FDA would not have been involved if the patient monitor connection hadn’t pushed the product into its regulatory arena. FDA regulates software that makes independent patient decisions or connects to regulated devices, with the idea being that those systems are devices working on their own rather than simply providing guidance to users.
  • Software vendors usually hide contractually behind the “professional judgment” test that says even if their software gives incorrect information or bad advice that harms patients, the clinical professional who uses the system makes the final decision and is solely responsible for the result.
  • The danger to patients is the same as for any other clinical decision support or even EHR software. Mixing up information between patients could be disastrous any time software is presented information or recommending actions. However, high-acuity systems give users less time to make important decisions, so that probably should be a consideration in determining patient risk.
  • McKesson planned to announced a Class II recall (meaning the problem wasn’t likely to cause patient harm) but FDA overrode that proposal and initiated a Class I recall indicating that patients could be harmed.
  • McKesson notified users almost immediately when the first problem was reported in March 2013, but FDA’s recall didn’t go out until a year later.
  • It’s not clear what users of the system should do as an alternative, or what action they may have taken since the original McKesson notification last year.
  • Vendors of systems that perform equally critical functions that aren’t connected to medical devices can take whatever action they want if they are faced with the same problem since their software isn’t regulated by FDA. Other than to avoid legal exposure, they could arguably not inform customers at all.
  • McKesson is a member of the HIMSS Electronic Health Record Association, a trade group that requires them to sign the EHR Developer Code of Conduct asserting, “We will notify our customers should we identify or become aware of a software issue that could materially affect patient safety, and offer solutions.” The other inpatient EHR vendor members are Allscripts, Cerner, Epic, GE, NextGen, and Siemens.
  • McKesson backed legislation introduced last month (along with athenahealth, IBM, and trade groups) that would reduce “unnecessary regulatory burdens” by limiting FDA’s oversight of “low-risk health IT, including mobile wellness apps, scheduling software, and electronic health records.” 
  • FDA is running late in producing a report that it says will explain its position on regulation of clinical decision support systems.

From LochnessMonster: “Re: McKesson. Reduction in force 3/20/14, roughly 300 under Pat Blake organization (uncertain number).” Unverified, but reported by multiple readers, one of them saying that the targeted areas were Horizon and Paragon.

From Bootay: “Re: vendor-convened panels. You should participate or report the results.” I don’t think so. I’ve seen many times where properly objective people turned into fawning, attention-starved glad-handers just because some company tries to buy their love by inviting them to be a speaker or advisor. It makes my skin crawl to see the obvious mutual sucking up as mutually expectant backs wait to be scratched.


HIStalk Announcements and Requests

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A slight majority of respondents don’t think patients should have a greater role in the HIMSS conference. New poll to your right: who’s most responsible for the problems with health insurance exchanges?

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Welcome to new HIStalk Platinum Sponsor ScImage (pronounced sye-image). The Los Altos, CA-based imaging and informatics company offers solutions that include enterprise imaging, radiology, cardiology, Echo PACS, ECG, cloud PACSEMR content management, vendor-neutral archive, and a Web-based DICOM exchange. Case studies include Missouri Baptist Medical Center’s cardiology PACS, Blessing Hospital’s enterprise PACS, and US Air Force’s cardiology consultation program. The privately held, employee-owned, debt-free company says it has never sunsetted a product or required a forklift upgrade. According to a physician at Cedars Sinai Heart Institute, the company’s products are the “ultimate value proposition” to its cardiology practice. Thanks to ScImage for supporting HIStalk.

Here’s ScImage PACS consolidation overview I found on YouTube.

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Teach for America teacher Ms. A sent pictures of her students using the Chromebook that we as HIStalk readers provided to her first grade classroom in Maryland via DonorsChoose. They’re using it to access online reading and math programs.


Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.


Acquisitions, Funding, Business, and Stock

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WelVU, which offers a personalized patient education application, raises $1.25 million in an initial seed round.


People

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Effingham Health System (GA) promotes Mary Pizzino to CIO.

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CHIME promotes Keith Fraidenburg to EVP/chief strategy officer.


Announcements and Implementations

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Physicians at Jupiter Medical Center (FL) are piloting the use of email alerts and status updates when their ACO patients are seen in the ED or urgent care center. The press release is poorly written and the product has a confusing name: MicroBloggingMD. I saw their booth at HIMSS and thought it was yet another doctor writing a blog.


Government and Politics

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Connecticut officials say Massachusetts owes the state $10 million of the $45 million in federal money it received to build its struggling Massachusetts Health Connector. The original grant called for Massachusetts to share its technology plans with other New England states, but those other states realized they could get their own federal money for building exchanges and went their own way, with Connecticut receiving $140 million, Rhode Island $113 million, Vermont $168 million, and Massachusetts a total of $179 million. Massachusetts says the money wasn’t intended for the other states – they were added on to the grant application at the last minute after pressure from the White House and Governor Deval Patrick to make Massachusetts a model for the rest of the country. Access Health CT’s CEO says that unlike the dysfunctional, CGI-built Massachusetts exchange, their Deloitte-created one works fine, adding, “Some states were trying to build a Maserati. We built a Ford Focus. It might not be as glamorous, but it runs. It can get you to the store.”


Technology

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Google is a bit touchy over Google Glass, having previously urged its users to avoid the “Glasshole” label by not being “creepy or rude.” Now it shares “The Top 10 Google Glass Myths,” the one above being notable considering that people (some of them Glassholes, no doubt) are already using it in patient care. Google published the statement on Google Plus, which means almost nobody other than its own employees will see it.


Other

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Duke University Health System (NC) will pay $1 million to settle charges that it overbilled the government by unbundling claims and billing for PA services in heart surgery. Duke says its mistake wasn’t intentional, but instead “resulted from an undetected software problem and through possible misapplication of certain technical billing requirements.” A former Duke employee had filed the whistleblower lawsuit.

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In England, the local newspaper reviews the 2012 Meditech go-live at Rotherham NHS Foundation Trust that caused delays in cancer treatment, lost appointments, and cost the hospital $2 million in revenue. It mentions the project review, which found that delivery targets weren’t specific, penalties clauses were vague, and the 18-month timetable was unrealistic given that the system had never been implemented in the UK. Taxpayers got stuck with $17 million in cost overruns on top of the budgeted cost of $49 million.

A two-doctor cardiology practice in Texas will pay $3.9 million to settle Medicare fraud charges for conducting unneeded procedures. Authorities requested data from 100 nuclear tests that had been performed, but the doctors provided only 37, saying their computer had crashed and the other results were lost. The investigators found that 19 of the 37 tests had been interpreted incorrectly and 75 percent of them were performed wrong. The same foreign-born doctors were part of a group that settled for $27 million in a 2009 Medicare fraud case.

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Stanford Hospital & Clinics and its former collections agency are expected to pay $4.1 million to settle charges that the information of 20,000 ED patients was posted online for nearly a year. Stanford says it encrypted the information sent to the agency, but that company forwarded it to get help creating a graph and the worksheet ended up on a student homework site.

A Motley Fool review of mobile health in China, which a Brookings Institution report says will be worth $2 billion per year by 2017,  says the three publicly traded companies that will benefit most are IBM, Microsoft, and Lenovo. It says the market won’t behave as it does here because Chinese medicine has different workflows, the language is hard, cloud-based security is a tough sell, and Apple’s mobile devices are much less popular than Android ones. It misses some facts: (a) most mHealth companies aren’t publicly traded; (b) those three companies are so large that whatever happens with mHealth in China isn’t going to move the share price; (c) it touts Microsoft as having implemented “a single, cloud-based system” that turns out to be the nearly forgotten HealthVault; (d) it predicts Lenovo’s success because it makes hybrid devices (laptop/tablet) that run Windows 8 and because it bought Motorola and found itself owning 11.8 percent of the smartphone market in China, although the article fails to mention Lenovo’s huge benefit: it’s a Chinese company.  


Sponsor Updates

  • Health Data Specialists will exhibit at the Cerner Southeast Regional Users Group March 30 – April 4 at the Sheraton Sand Key in Clearwater Beach, FL.

Exhibitor Costs at the HIMSS Conference

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Readers had asked for details on what it costs a company to exhibit at the HIMSS conference. I greatly appreciate the vendor executive (let’s call him “Larry,” just to keep things anonymous) who provided complete information from last month.

Booth construction: $132,000
Booth space (20×40): $26,000
Booth power and connectivity: $20,000
Breakfast briefing: $11,000
Hospitality suite: $15,000
Printing: $6,000
Giveaways: $4,000
Booth graphics: $2,500
Buying the attendee list: $1,800

Including some other smaller costs, the company’s total expense was $222,000. That doesn’t include employee salaries or travel costs.

Larry says he’s happy with the outcome. The company had 400 people visit the booth for meetings or to see a demo. About half of those had been scheduled in advance, which is an efficient way to meet with prospects, and the other 200 were walk-ups who might become prospects. He also sees value in the employee bonding experience and being able to learn from attendees.

It’s the same as for attendees, in other words: HIMSS benefits from putting interesting people in the same place at the same time. The attendees derive their value from each other.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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March 22, 2014 News 11 Comments

News 3/21/14

March 20, 2014 News 5 Comments

Top News

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Transcription and software vendor MModal files for Chapter 11 bankruptcy protection less than two years after being acquired by One Equity Partners for $1.1 billion. The company, which lists its assets and its liabilities between $500 million and $1 billion,  says it is in “constructive discussions” with its lenders and bondholders regarding the terms of a consensual financial restructuring plan and expects to continue normal business operations throughout the restructuring process.


Reader Comments

From Experienced CIO: “Re: reader survey. I had to write to admire how many ways you politely declined to go down rabbit holes and chase information that is not within your (broad) span of knowledge. You are great at delivering what you know and show a comprehensive understanding of the business. Thus, I welcome your personal opinions and commentary. I also recommend that you discontinue HIStalkapalooza, which is a wonderful gesture when you were smaller, but has become unmanageable. Just invite everyone to get together at a cash bar and it will take care of itself in a year or two. Good job, well written, and you stick to your knitting. That is why your publication is so popular.” I appreciate the comments. I like the idea of a simpler, cheaper HIStalkapalooza, having initially envisioned a big parking lot or park with kegs of beer, grill-your-own hot dogs, and a band. Dr. Travis from HIStalk Connect wanted me to put something like that together for startups at HIMSS, but the idea didn’t come up until too late. I’m considering options for next year. Party planning isn’t my core competency.

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From Arcanity: “Re: your poll about professional certifications on your business card. I think this guy takes the cake.” Looks like either a big ego or a small … well, you know. Diplomate-ically speaking, his business card must be the size of a poster board.


HIStalk Announcements and Requests

inga_small A few of the stories you may have missed this week on HIStalk Practice: CMS offers a free online tool to help small practices transition to ICD-10. Over 60 percent of practices don’t plan to participate in an ACO. A reader suggests that Practice Fusion, CareCloud, and ZyDoc might follow Castlight’s IPO lead within the year. The potential costs associated with information loss during the ICD-10 transition could be substantial. Four major insurance carriers tell the AAFP they’ll be ready for ICD-10 by October 1. NCQA intends to raise its PCMH recognition standards in 2014. Thanks for reading.

This week on HIStalk Connect: Castlight Health shares soar 149 percent on the day of its IPO. Physician-only social networking site Doximity reaches 40 percent market penetration with US physicians. SharePractice launches a mobile app designed to let doctors use crowdsourcing to collaborate on and rank the best approaches to treating specific conditions. Dr. Travis dissects the recent failings of Google Flu Tracker and its implications on big data at large.

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Welcome to new HIStalk Platinum Sponsor NYeC (New York eHealth Collaborative). NYeC is New York State’s not-for-profit public resource for healthcare IT, facilitating the EHR transition for providers and improving healthcare for all New Yorkers. Its activities include the SHIN-NY HIE; NYeC Regional Extension Center serving the upstate region and Long Island; the multi-state EHR-HIE Interoperability Workgroup; and the Patient Portal for New Yorkers that will go online this year. It runs the New York Digital Health Accelerator along with the Partnership Fund of New York City, supporting early- and late-stage digital health companies working on care coordination, patient engagement, predictive analytics, and workflow management. Chosen companies, which are required to have a New York presence, receive $100,000 in upfront funding and participate in a leadership program of healthcare leaders, entrepreneurs, and investors for the five-month term. Applications for the 2014 class are due April 11. The class of 2013 included ActualMeds, Aidin, Avado, CipherHealth, Cureatr, MedCPU, Remedy Systems, and SpectraMedix. Thanks to NYeC for supporting HIStalk.

Here’s my free “how not to look stupid” tip of the week: don’t reply to business emails on your phone. I see this constantly: the sender doesn’t notice incorrect spellcheck changes, they write barely intelligible terse text that makes little sense, and the tiny keyboard makes it too much trouble to make desirable changes to the subject or to the “Sent from my iPhone” email signature that indicates they are dashing off a reply on the fly while doing something else. You would be better composing a more thoughtful reply on a real computer later unless it’s an emergency.


Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.


Acquisitions, Funding, Business, and Stock

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Augmedix, a startup building clinical applications for Google Glass, secures $3.2 million in venture funding.

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CitiusTech announces an investment partnership with General Atlantic. The company, which works with 50 healthcare organizations worldwide, reported 2013 revenue growth of 51 percent.

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HIMSS acquires Harrogate, England-based conference promoter Citadel Events, renaming it HIMSS UK.

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Social health management vendor Welltok acquires wellness game developer Mindbloom.

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Procured Health, which offers software that manages hospital purchases of medical devices, raises $4 million in a Series A round.


Sales

The New England Healthcare Exchange Network will implement the Ability Secure Exchange Platform across its member hospitals and provider sites.

Mercy Orthopedic Hospital Springfield (MO) selects Emmi Solutions for patient engagement.

Adventist Health Hospitals (CA) will deploy Aperek Ellipse for real-time anytime spend visibility and analytics.

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BJC Healthcare (MO) selects Health Language to assist with its transition to ICD-10.


People

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Clinovations promotes Kevin Coloton from COO to president.


Announcements and Implementations

Methodist Healthcare (TN) deploys MedAptus Professional Charge Capture for inpatient coding and billing.

La Clinica del Pueblo (DC) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.

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The Nashville paper profiles RoundingWell, the patient engagement software company launched by the founder of bulk email software provider Emma. It uses EHR-generated information to send patients questions, education, and guidance from a proprietary content library developed with Vanderbilt University School of Nursing and The Center for Case Management. A tiny study found that patient engagement rates were at 60-70 percent over 90 days, with the average patient having eight risks identified that it says wouldn’t have been addressed otherwise.

Aprima offers Etransmedia customers running Allscripts MyWay a conversion to Aprima Patient Relationship Manager, hosted by either Aprima or Etransmedia.

HealthEast Care System (MN) goes live with an early intervention program for heart failure patients that uses patient engagement technology from Pharos Innovations.

Catholic Health System (NY) deploys Juniper Networks Meta Fabric, an open standards-based architecture for data centers. 

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Sanford Health (ND) completes the installation of  RTLS technology from Sonitor Technologies and Intelligent InSites at Sanford’s soon-to-be-opened Moorhead clinic.


Government and Politics

OIG testing of the 28-hospital Indian Health Services computer network reveals inadequate security and significant network vulnerabilities. OIG hackers were able to gain unauthorized access to the IHS web server and an IHS computer, as well as obtain user account and password data and records in the IHS file system.

3-20-2014 10-47-09 AM

The HHS Office of the Assistant Secretary for Preparedness and Responses and ONC launch an initiative to promote the use of HIT in emergency medical services.

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ONC announces that its open source popHealth tool to process electronic clinical quality measures has been certified as a 2014 edition EHR module.

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Oregon Governor John Kitzhaber fires the head of the state’s health authority and asks Cover Oregon to replace its senior management team, including the CIO and COO, following an independent investigation. Cover Oregon remains the only state whose exchange, which cost $200 million, hasn’t enrolled a single person after its planned October 1 rollout failed. The report concluded that the state’s managers had too much confidence that Oracle, which has been paid $160 million so far, could deliver what it promised.


Innovation and Research

3-20-2014 11-31-49 AM

Harvard University Medical School researchers find that use of the EarlySense monitoring system on a medical-surgical unit was associated with a significant decrease in length of stay, code blue events, and ICU stay times. EarlySense uses a sensor that is placed under a patient’s mattress to detect potential adverse events, as well as monitor heart and  respiratory rates and movement.

A study finds that facial recognition software beats humans at detecting patients who are faking pain, with accuracy of 85 percent vs. 55 percent.


Other

3-20-2014 1-38-00 PM

An ONC-commissioned review of nine RECs finds that their most difficult challenges are poor EHR product usability and the “unsavory” business practices of some vendors. Other struggles include physician resistance to EHRs and the MU program, sustainability of RECs once federal funds are depleted, and difficulties communicating often confusing details of the MU program. The authors also note three best practices that emerged for helping providers achieve MU:

  • Maintain strong partnerships with the community
  • Hire technical employees who that have a mix of IT skills, clinical understanding, and general business understanding
  • Work with a physician champion.

The Business Journals names its “10 Markets with the Strongest Brainpower”: Washington DC, Madison, Bridgeport-Stamford, Boston, San Jose, Durham, San Francisco-Oakland, Raleigh, Minneapolis-St. Paul, and Colorado Springs.

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Supply chain software vendor Global Healthcare Exchange, acquired by private equity firm Thoma Bravo a week ago, reportedly lays off 130 of its 500 employees.

Google CEO Larry Page, speaking at a TED conference in Vancouver, touts the sharing of medical records, saying, “Wouldn’t it be amazing if everyone’s medical records were available anonymously to research doctors? We’d save 100,000 lives this year. We’re not really thinking about the tremendous good which can come from people sharing information with the right people in the right ways.” He described losing his voice because of an undocumented condition and finding thousands of people with the same problem after posting a description online.

St. Luke’s Health System (ID), which lost an antitrust lawsuit filed when it attempted to buy a physician group and used its Epic system as one of the benefits, receives a $10 million legal bill from the the hospital, surgery, center, and attorney general that successfully sued it.

Cerner is among 23 Kansas City-area employers recognized for their commitment to lesbian, gay, bisexual, and transgender equality.

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Doctors in England using Skype to check on a home dialysis patient notice her husband collapsing in the background and send an ambulance to help the 70-year-old man, who was later found to have bowel cancer.


Sponsor Updates

  • ScImage will deliver its PICOM365 PACS with Cedaron’s CardiacCare.
  • Direct Consulting Associates joins the HIMSS Innovation Center in Cleveland as a Supporting Collaborator.
  • CommVault will add 250 jobs in the next three years at its 275,000 square foot headquarters under construction in Eatontown, NJ.
  • Pandodaily.com spotlights Validic and its data pipeline solution for healthcare.
  • GetWellNetwork sponsors the 28th annual National Disabled Veterans Winter Sports Clinic March 30-April 4 in Snowmass, CO.
  • Emdeon CEO Neil de Crescenzo tells the Nashville Business Journal that his company has hired 100 people in the last six months.
  • AdvanceNet Health Solutions will add the CoverMyMeds ePostRx automated prior authorization solution to its enterprise pharmacy management platform.
  • Summit Healthcare partners with Indigo HIT to offer complimentary services to enable clients with streamlined and scalable CCD integration.
  • Kareo adds Rignadoc to the Kareo Marketplace to help physicians with phone triage.
  • ICSA Labs certifies First Databank’s MedsTracker as a 2014 Edition Ambulatory and Inpatient Modular EHR.
  • The Ethisphere Institute names Premier a 2014 “World’s Most Ethical Company” for the seventh consecutive year.
  • Angela Hunsberger, senior consultant for Hayes Management Consulting, discusses the need to balance security and usability in patient portals.
  • Healthcare services firm Accreon partners with identity management solution provider NextGate to deliver services and technology for enterprise data awareness and exchange.
  • RelayHealth Financial releases RelayClearance Plus 5.0, a pre-service financial clearance solution that includes an eligibility benefits detail viewer.
  • Clinithink launches its suite of CLiX Online Solutions to translate unstructured clinical narrative for real-time use.
  • TeleTracking Technologies names Hill-Rom a licensed reseller of TeleTracking’s asset and temperature tracking software, while Hill-Rom extends re-sale rights to TeleTracking for its hand hygiene compliance solution.

EPtalk by Dr. Jayne

I spent all day Tuesday at yet another continuing education class to recertify a life support certification. This is the last one until summer, so I’m glad to have a break.

I understand why they require us to stay certified, but the odds of my actually having to participate in a code situation in the hospital are pretty slim based on my clinical practice patterns. I’m more likely to have to use basic CPR at the supermarket than any of the other skills, which I guess is a good thing. This year I took the “independent study” course, which included an online pre-course as well as the in-person practice and skills testing sessions using a computerized mannequin.

In some ways, the certification seems like a racket. This week confirmed my thoughts. The health system I work for has a master license to be able to train staff on adult cardiac life support because they require most of the clinical staff to maintain certification. I have no idea how much that master license costs, but I know that the individual certification fee is $220 because I had to pay it out of pocket.

In a quirk of rule-making, since I’m not employed by the hospital in a clinical service line (my Emergency Department work is through a third-party contracting firm), there isn’t a department to cost it back to. Apparently neither the administration or IT cost centers are valid for the education department to use, which makes me nervous that someone thinks administration and technology don’t need continuing ed.

At other hospitals (such as the one where I take my pediatric course) the fee for the all-day course includes the textbooks and lunch, but ours doesn’t. I’m a girl who knows how to brown bag and I don’t mind not being allowed to keep the books because I’m never going to look at them again. Neither of those are that big of a deal, but the twist at the end of this course was unbelievable. When we turned in our evaluations at the end of the day expecting to pick up our certification cards, we were asked to pay an additional $2.25 (in cash) for the actual card. Talk about unbundling!

Hospitals are infamous for nickel and diming patients. I suppose I shouldn’t be surprised that they’re now doing it to the medical staff and the independent contractors who fill the positions they can’t staff on their own. When I registered for the course, I had to wait until my check had cleared to actually schedule it and borrow the text books. I thought that was a little weird, especially since I’ve been on staff for more than a decade and they know where to find me if the check bounced, but I understand not everyone is that reliable. Incidentally, the pediatric hospital takes online payments for their courses, so they don’t have the check cashing issue.

My suggestion to the education department was to just raise the course cost to $222.50 (or even $225) so that they’d have the full payment up front and not ask for cash at the end of the course. I was told that the clinical departments only allowed $220 for the course and the reason they charge for the card was because the “regular employees” don’t actually need the card, they just need a statement from the education department that they had passed the course. Only “external” attendees need the card, hence the extra charge.

I guess external is a nicer way to say that I’m an irregular employee, or to possibly admit that our hospital is so cheap they won’t pay $2.25 for the 20 or so “external” attendees who take the course each year. Or that they’re ignoring the cost savings of recycling textbooks that they’re charging individuals for.

I’m afraid that as healthcare reform evolves, this is only going to get worse. Our hospital has hired a fleet of financial staffers to micromanage every facet of patient care (without admitting they’re telling physicians how to practice medicine) at the same time they’re cutting positions for nurses and patient care technicians. They were already in the business office, where I did battle over the fact that I can only order one printer cartridge at a time (despite the fact that they’re cheaper in a two-pack) due to new purchasing rules. They were already on the hospital floors, where we have to bar code scan every gauze pad and bandage we touch. Now they’re even in CPR class.

We are the embodiment of penny-wise and pound-foolish. I’m curious about the trends our readers are seeing in the hospital or clinic. Has everyone gone as mad as my employer seems to have gone? Are we headed towards the level of care seen in other parts of the world, where patients are expected to provide their own bandages and meals? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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March 20, 2014 News 5 Comments

News 3/19/14

March 18, 2014 News 2 Comments

Top News

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The comment period opens for a CMS proposal that would allow it to recoup improper PQRS and e-prescribing incentive payments in a four-year project that would look for errors, inconsistencies, and gaps related to data handling, program requirements, and clinical quality measure specifications.


Reader Comments

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From Cupola Dogs: “Re: Epic Emeritus Program. Interesting.” Forwarded documents describe a program in which Epic will offer vetted, independent “Epic Emeriti” (Epic-experienced retirees who are least 55 years old) who will help customers as Epic subcontractors. It’s an interesting concept, especially considering that the average Epic employee is probably under 30. Obviously most of the Emeriti will come from hospitals, where experience is considered an asset rather than a liability. Maybe Epic is finally acknowledging that while industry newcomers can follow a carefully documented project plan, sometimes it’s nice for nervous customers to have someone who has walked in their shoes standing beside them.

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From TooMuchCoffee: “Re: Mass Health Exchange. Cuts ties with CGI Federal. There has been a lot of finger-pointing over the poor-performing sites, but the one common factor in the lousy sites is the lousy contractor CGI Federal, period. WA state was done by Deloitte and is doing fine.” My cynical suspicion is that the combination of governmental and contractor incompetence creates a lot of dysfunctional software that neither party wants publicized. The insurance exchange sites just happened to be public-facing and political, ensuring that their problems make the papers.

From Parker: “Re: McKesson. Still struggling to find a major health system on their Horizon product to convert to Paragon in order to prove to the naysayers that Paragon can manage complex systems. Atlantic Health was going to, but now is not going to move until they see more progress before making a final decision.” Unverified. It’s tough to get customers to switch to a different product offered by their incumbent vendor without their at least going out to the market first, so that may be causing indecision. It’s also tough to convince them to stick with a vendor who’s retiring the product they bought, which will require a painful new implementation no matter whose product they choose. That’s not a reflection on Paragon, just the reality of why most customers aren’t going to be thrilled, especially the larger ones that can afford to buy another system instead of accepting a free one.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor VisionWare. The Newton, MA company provides a healthcare-focused data management platform that provides world class operational and analytical integrity. Its Master Data Management solutions address data management, integration, and data visualization. VisionWare’s Patient 360 brings in information from a variety of enterprise systems (including retired ones) to provide providers, payers, and HIEs a 360-degree view of a person (patient, member, or customer) and meet the needs for Meaningful Use Stage 2, ACO reporting, and fee-for-value reporting. Provider 360 manages provider engagement, credentialing, referral management optimization, and relationship management. Specific solution components include an EMPI, provider registry, data verification, data visualization, and data governance. Long-time friend of HIStalk Paul Roscoe joined the company as CEO in January after running The Advisory Board Company’s Crimson analytics unit and Microsoft’s Health Solutions Group. Thanks to VisionWare for supporting HIStalk.

Listening: reader-recommended Lake Street Dive, skilled jazz/soul featuring amazing vocals and a female upright bass player who rocks it. They even sound great in a driveway.


Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.


Acquisitions, Funding, Business, and Stock

3-18-2014 1-32-20 PM

AbilTo, a provider of behavioral health telehealth services, closes a $6 million Series B round.

Castlight Health signs a deal to turn Leapfrog Group’s 2013 hospital survey information into report to help consumers understand hospital performance.

Varian Medical Systems will acquire the oncology team imaging collaboration software product of Atlanta-based Velocity Medical Solutions.

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Bloomberg Businessweek profiles CrowdMed, where patients whose unusual conditions have stumped their local doctor post their the symptoms and offer a reward for a correct diagnosis. The site says 180 people have gone through the process, with 80 percent of them reporting that they received a useful diagnosis.


Sales

The Veterans Health Administration Midwest Health Care Network will deploy Lexmark’s Perceptive Software Acuo VNA to consolidate medical image storage.

Meridian Health Systems ACO (CA) selects Halfpenny Technologies to provide analytics modules and an interface engine for exchanging lab information.

3-18-2014 1-34-07 PM

Capital Regional Medical Center (MO) selects Summit Healthcare’s Exchange technology to enable CCD integration and Direct messaging.

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Saint Peter’s Healthcare System (NJ) selects athenahealth’s athenaOne EHR, PM, and communication system.

Health Choice (TN) selects Valence Health to build a clinically integrated network for population health management and clinical integration.

UNC Health Care (NC) chooses FrontRange HEAT for its newly consolidated service desk, replacing ServiceNow.

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New Hanover Regional Medical Center (NC) chooses Strata Decision Technology’s StrataJazz for cost accounting, budgeting, planning, forecasting, management reporting, and productivity improvement.

Valley Hospital (NJ) will upgrade to Meditech 6.1, including the company’s new CCU/ICU application.


People

3-18-2014 10-06-09 AM

R. Andrew Eckert (CRC Health Group/Eclipsys) joins TriZetto Corporation as CEO.

3-18-2014 9-03-10 AM

CynergisTek hires Erin Fulton (T-System) as VP of operations.

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NexTech names Eric Nilsson (Surgical Information Systems) CTO.

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Home health and hospice EMR provider HealthWyse appoints Graham Barnes (HealthyCircles) CEO.

3-18-2014 1-39-39 PM

Lois Rickard (Press Ganey Associates) joins Streamline Health Solutions as SVP/chief people officer.

3-18-2014 1-40-50 PM

Deloitte names Sarah Thomas (NCQA) director of research for the Deloitte Center for Health Solutions.

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Box appoints Aneesh Chopra (Hunch Analytics) and Glen Tullman (7WireVentures) as advisors for its healthcare and life sciences practice.

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SSM Health Care (MO) SVP/CIO Tom Langston will retire on July 3 after 33 years with the health system.

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GetWellNetwork appoints Bart Witteveen (Matrix Medical Network) CFO.


Announcements and Implementations

Three teams share $85,000 in prize money for winning NewYork-Presbyterian Hospital’s InnovateNYP, a two-day hackathon to develop patient engagement ideas for its patient portal. The winning concepts were: (a) a platform that allows inpatients to connect with each other for games, communication, and education; (b) an app that allows patients to connect with other patients, mentors, friends, and families; and (c) a tool that streamlines appointment check-in and rewards patients for healthy activities.

3-18-2014 9-15-41 AM

The Boone County Health Center (NE) and clinics go live on Cerner.

Grady Memorial Hospital (GA) implements RTLS from Intelligent InSites to track mobile assets and tissue and blood samples.

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InstaMed launches InstaMed Go, which allows providers to collect patient payments via smartphones from any location with the payments posted automatically to their practice management systems and receipts emailed to patients.


Government and Politics

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A salary review of Colorado’s health insurance exchange finds that its 36 employees are paid generously with mostly federal tax dollars, with 20 percent of them making more than $100,000 per year and all of them receiving a  10 percent contribution to their retirement plan. The executive director makes $191,000 per year and was given a $18,500 bonus within nine months of being hired. According to a healthcare policy expert for the Independence Institute think tank, “This is a bunch of people really responsible for nothing other than getting government grants.”


Innovation and Research

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Inpatient EHR information can be used to predict sepsis, according to a study published in JAMIA. Researchers are working on a sepsis risk algorithm that an EHR can automatically calculate.


Technology

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Google beats Apple to the smartwatch punch by announcing Android Wear, available later this year. The watches, which will be tethered to Android-powered phones, will offer voice control, a Siri-like personal assistant, Google Maps, and fitness-tracking sensors. Android Wear may eventually power other wearables, such as a smart jacket.


Other

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UNC Health Care System-owned Rex Healthcare (NC) will pay $28 million this year for its portion of UNC’s Epic implementation, which is scheduled for a summer go-live.

CDC’s flu tracking data is better than Google Flu Trends even taking its lag time into account, with Google Flu Trends overestimating flu prevalence by more than 50 percent in the past two flu seasons.

3-18-2014 1-03-53 PM

AHIMA, CHIME, and other ICD-10 stakeholders urge Congressional leaders to continue to move forward with the October 1, 2014 ICD-10 implementation deadline and ask for support for the Medicare Audit Improvement Act, which addresses challenges with the RAC program.

A doctor in England is caught by fraud investigators for falsifying electronic medical records to earn NHS quality care bonuses. He enlisted the help of an IT person to enter fraudulent data, but after getting caught, blamed the technician and then computer coding errors for the falsified records. Some of the patients he claimed to have treated were imprisoned, abroad, or dead at the time. 

Weird News Andy titles this, “Lungfish?” Student engineers program at Rice University (TX) enrolled in a program that addresses the problems of hospitals in developing countries create an affordable bubble CPAP device (it helps newborn breathe by pushing air into their lungs) made from two aquarium pumps and a Target shoe box. The device has been deployed in hospitals in Malawi and is being rolled out to other countries. One of the students visited a hospital in Malawi and was told by a nurse there that their device had saved her own baby’s life.


Sponsor Updates

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  • Nuance will host a free “Art of Medicine” panel discussion on Thursday, March 27 from 9:00 to 11:00 a.m. at the W Hotel in Boston, MA that features Beth Israel’s John Halamka, MD; the AMA’s Steven Stack, MD; and Mass General’s Keith Dryer, DO, PhD discussing demands that take doctors away from patients. Email to register.
  • SyTrue is chosen to participate in the first Wharton DC Innovation Summit on April 29-30, which will bring together investors, innovators, entrepreneurs and academic leaders. CEO Kyle will present a session on “Innovation Tools.”
  • Gartner positions NTT in the Challengers Quadrant of the 2014 Magic Quadrant for Global MSSPs.
  • Canon USA introduces Nuance eCopy ShareScan v5.2, which features an email and folder-watching service to simplify electronic workflows.
  • The Drummond Group certifies Kareo EHR for MU 2014 Stage 2.
  • Truven Health Analytics reports that its Treatment Cost Calculator tool for estimating out-of-pocket medical costs now reaches 20 million consumers through its client base of employers and health plans.
  • Culbert Healthcare Solutions VP Brad Boyd and Oschsner Health System medical director of accountable care Philip M. Oravetz,MD will discuss strategies for extending EHR technology to affiliated practices at next month’s AMGA conference in Dallas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect 

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March 18, 2014 News 2 Comments

HIStalk Interviews Bill Anderson, CEO, Medhost

March 17, 2014 Interviews No Comments

Bill Anderson is chairman and CEO of Medhost of Franklin, TN.

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Tell me about yourself and the company. 

I’ve been in business a long time, more than 40 years now. This is my first foray into the healthcare IT business. My background has generally been in the financial area and financial technology. I was about 20 years in consulting, went to be CFO of a large public company, and ended up doing the Internet with a company called Bankrate.com. As I got into technology, I got more and more interested in different types of technology and ended up in healthcare.

We’re a diversified technology company, an HCIT company with enterprise software and some innovative new products. We’re just finishing up our audit, but we think we’ll be around $180 million this year. We’re really proud of the fact that we’ve grown in excess of 20 percent a year over the last five years. We have about 1,000 customers, about 60 percent of in general acute care, but with significant market share in some specialty areas like LTACs, inpatient behavioral, and inpatient rehab.

 

Even experienced industry people were confused about HealthTech’s multiple product brands until the names were changed to Medhost in December. What took so long to consolidate?

We realize the importance of consistent branding. We had a couple of choices, and so we had to sort through the situations where we could actually get good title to names as well as having the URLs and all the other type of connectivity that you’d like to have. We settled upon the fact that Medhost was the best choice for us. We’ve been very happy with the reception from that so far.

 

I don’t think I ever noticed HealthTech’s booth at previous HIMSS conferences, but with the Medhost name this year, it was a nice presence and the booth had a lot of activity every time I went by. Did you notice a change?

We did, and thank you for the compliment on the booth. I think that many HCIT buyers did not realize what a comprehensive line we had. When we pulled our different product lines together in the Medhost booth and did some promotion around the new branding, we got some much higher response rates or levels of interest than we had in the past. We were very pleased with the HIMSS conference.

 

I would assume most people know the company from the EDIS product line that provided the company’s new name. But you have a variety of products, many of them from acquisitions. How do you portray the company’s identity now and how hard is it to support a fairly diverse and extensive product line?

We do have a diverse and extensive product line. It’s come about principally through acquisition, but also some significant organic growth.

We acquired a company called HealthCare Management Systems, which was an enterprise software business, because two of the most important departments in a hospital are the perioperative and the ED. We acquired a company called Acuitec, which essentially was selling the Vanderbilt surgery and anesthesia system. And Medhost, with EDIS.  Today we think we’ve got leading products in these very important areas. Those came in by acquisition, as three pieces.

There are also two product lines that you may have noticed that we’ve built internally. One being our YourCareCommunity platform with our first app that runs on that platform, which is our patient portal. Also, our profitability solutions.We call those solutions because they’re a combination of our patient flow product, our business intelligence product, and a consulting group. We have the full range of the products necessary to deliver a higher profitability to our customers.

 

Is there sales synergy across these products or do they each have to be sold on their own?

Oh, absolutely. You know, we view ourselves as a distribution company. One of the things that has characterized Medhost is that about 60 percent of our customers are associated with a multi-facility organization. Over the years, we’ve demonstrated an ability to distribute products into our customer base, who are growing rapidly themselves. We have tried to tailor our products — acquisitions and the parts we’ve developed — to meet the needs of that customer base. That’s been a successful strategy for us.

 

Who are your biggest competitors and what advantages do your products offer?

We view our sales as being a middle market provider in the HCIT business. I would say our principle competitors in the general acute care space would be McKesson’s Paragon and probably Meditech. We obviously see Cerner, who comes down into the middle market with a hosted solution, as well as CPSI, who comes up market with their product line. But as far as direct competitors, we would probably identify those two as the most directly comparable.

 

What are you seeing as the key drivers of the decisions made by that market?

In our customer base, we think we’ve got customers for which ROI really makes a difference. We have a heavy concentration in the for-profit healthcare business. What we view is that for our customers, a combination of market-appropriate features plus ease of use results in a low total cost of ownership. As a result of that, that’s what differentiates us in the marketplace.

 

It’s always interesting that for-profit hospitals buy and deploy differently than the not-for-profits. Why do you think that is?

Our customers are not only good at delivering healthcare, but they are very good at running businesses. As a result, I think they’re looking for the effectively the right product for the facility they have. In many cases, we’re in customers that have segmented their bases, and we tend to be in the hospitals and other facilities where our features match up  with what that facility’s doing. And again, we offer what we believe is a low total cost of ownership.

 

Where does the company’s future lie?

We’re pretty happy with our menu of products for the inpatient world right now. We think we’ve covered bases with that. We would like to do additional acquisitions, because we think our customers have needs, and we’d like for them to be able help serve those needs.

We would be looking at areas like post-acute care. Many of our customers are going to be more and more involved in dealing with patients outside the four walls of a hospital. Also in services, because again those are becoming more and more important to both our corporate customers and our standalone customers. Things like revenue cycle outsourcing, some other types of services like that, we think are going to be very important to these customers as margins are squeezed and they need to be able to control their costs.

Probably the biggest area that we are interested in either building products or acquiring products or partnering with customers is in this YouCareCommunity platform. Essentially what we’ve done is combined an HIE with an enterprise master patient index to allow people to pull records from both ambulatory and inpatient EHRs into the cloud. Using that platform, we’ve launched some initial applications, being our patient portal, and we’re working on a disease management product and some other products. But we’re also looking for partners and acquisitions that add additional applications to that platform.

 

Is this product the answer to the HIMSS buzz around population health management or analytics, or do you have other strategies or do you even want to be in those markets?

Yes, we absolutely want to be in that market. This would be the platform that we use to address the needs of our customers in that marketplace. 

Population health has a number of different facets. The really important thing, though, would be to help manage the patient, or even better to help the patient manage themselves, to prevent things like readmission, disease management, things of that nature. We think that with our cloud-based platform and our strategy to engage the patient on a regular basis, even when they are not currently in the hospital or have recently been in the hospital, will allow our customers to help affect their downstream cost on those customers.

 

What are your customers telling you about their state of readiness or state of interest in Meaningful Use and ICD-10?

Everyone is very focused right now on the Meaningful Use program. I think that’s been a challenge, particularly to our smaller, standalone customers. They’re interested in trying to attest as quickly as possible and move on to other things, one of those things being ICD-10.

We view this as being a very difficult transition for many of our customers, and one that we hope we’ll be able to assist them with. We believe we have the right tools in place for them to do that, but it will be a significant change in training and how a facility has to deal with some of their billing and coding issues.

 

Evidence suggests that smaller hospitals may be walking away from Meaningful Use money after the first couple of years. Do you see that happening?

That’s going to be difficult to do. There will be some in the very small end of the hospitals. We have less than a 100 critical access hospitals in our more than 1,000 customers, and with many of those really small facilities, the economics are not going to work for them.

The cost of attesting and maintaining the Meaningful Use progression is going to be more than the potential penalties or the rewards. That is going to be an issue globally for healthcare, because it is in the best interest of the healthcare delivery system in general for those customers — our customers — of that size to participate, as well as other facilities of that size. That will be an issue that ultimately the government will have to address — how to pool those customers into the system. Because it is going to be difficult.

 

You are emphasizing a touchscreen user experience in the keystroke-heavy world of healthcare. Do you think that is the market changing to now accept and even demand a touchscreen experience?

Absolutely. While we think of our users as healthcare professionals, they’re also consumers. Every day they use mobile platforms. They use consumer software. Healthcare professionals, like other consumers, are going to be more demanding about the quality of their software.

As a result, we’re making and are continuing to make significant investments in things like workflows, usability of the product, and making it mobile agnostic. Our belief is that tablets will be very important in the medical area. We do have some phone apps and some others that are in process, but inherently the phone apps or smartphone apps are going to be more difficult to use.

Tablets, however, will give the clinician much better access to data and the ability to kind of process data without being tied to a particular workstation or having to sign in and sign out. The convenience and the ability to increase productivity will make that important for all software providers.

 

Many of the early claims vendors made about mobile access involved Citrix running a desktop session on an iPad. How is the industry is progressing in creating a true mobile experience?

 

The industry in general has had a lot of demands upon it and has been distracted from some of the work flow and ease-of-use type of objectives that I think are shared by most vendors. Everyone will have to cycle back to that.

Almost four years ago now, we started a renovation of our enterprise systems to put an HTML 5 interface layer on top of it. The reason for doing that is that the combination of wanting to have a more inexpensive hosting solution as well as being mobile agnostic. You can do that an HTML 5 interface as long as you’re paying attention to form factors and how you design a page. Then the same page I can view on a computer, I can view on my tablet and get a very satisfactory experience. Those types of solutions are going to be very important in the future.

 

What are you priorities for the company in the next three to five years?

Our priorities are to continue to grow our base and our enterprise business, but also at the same time, to take these new product lines that we have in our profitability solutions and YourCareCommunity and to try to meet more the needs of our customers in those areas.

We think in particular, our ability to provide a patient portal in both the ambulatory and inpatient area that is certified and can pull together the care community is going to be a really important thing. We are out trying to talk to as many of our customers as we can about the advantages of being able to build this community in terms of improving patient care, giving the patient better ability to manage their own care, as well as keeping revenues within the network.

 

Do you have any final thoughts?

There’s a lot of changing coming and has been coming in both the healthcare provider industry and in the healthcare IT industry. With change, there’s always opportunity. Our goal is to try to take advantage of that opportunity and return as much benefit to our employees and shareholders as we can.

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March 17, 2014 Interviews No Comments

Morning Headlines 3/14/14

March 13, 2014 Headlines No Comments

Validic Secures $1.25 Million in New Funding, Adds Key Executives

Durham, NC-based Validic closes a $1.25 million convertible note to support expansion for its mHealth integration engine.

MMRGlobal and Cerner Announce Patent Agreement

Cerner signs a confidential agreement with MMRGlobal over MMR’s Personal Health Record patents.

Unique Database Collaboration Will Enable Improved Care for Heart and Lung Surgery Patients

The Society of Thorasic Surgeons will link its database with CMS to provide researchers a means of tracking long-term outcomes.

Wearable Computing at BIDMC

John Halamka, MD, CIO at BIDMC, writes about his hospital’s trial use of Google Glass in the ED.

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March 13, 2014 Headlines No Comments

News 3/14/14

March 13, 2014 News 1 Comment

Top News

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Validic, which offers a platform for accessing data from mobile health devices and wearables, secures a $1.25 million convertible note.


Reader Comments

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From Professional Zac: “Re: Mat Kendall. Has given ONC exemplary service in leading its workforce, REC. and rural programs as director of the Office of Provider Adoption Support. He is leaving.” Mat is one of those people who gets a lot done, not only running those ONC programs, but before that working for New York’s EHR program and before that leading a FQHC. Like everybody who works for ONC, he sacrificed income and lifestyle for public service since it’s generally true that only low-level government employees fare better than they might in the private sector. I haven’t heard where he’s going.


HIStalk Announcements and Requests

inga_small This week on HIStalk Practice: Practice Wise CEO Julie McGovern addresses EHR users who refuse to admit they might be causing their own system problems. Users of drchrono’s free EHR will be rushing to apply for MU hardship exemptions after the company announces that its Stage 2 certified release won’t be ready until  “later this year.” A Rand study finds that physicians recognize the value of EHRs in concept but believe they undermine professional satisfaction and can negatively impact patient care. Between 2011 and 2012, the percentage of EPs participating in  Medicare’s MU program dropped 16 percent and the percentage dropping out of Medicaid’s program fell 61 percent. CareCloud CEO Albert Santalo discusses a possible IPO, company growth, and how its offerings differ from athenahealth’s. While you are checking out the latest in ambulatory HIT news, take a moment to subscribe to the email updates so you’ll never miss a post. Thanks for reading.

This week on HIStalk Connect: Proteus Digital Health announces large-scale trials and plans for a new manufacturing plant in the UK. Nintendo will refocus its strategic direction to capitalize on the growing health and wellness market. Validic raises $1.25 million to expand its mHealth integration engine.

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Last chance to help me out plus be entered into a drawing for three $50 Amazon gift certificates: complete my reader survey before I close it Saturday. I appreciate it.


Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.


Acquisitions, Funding, Business, and Stock

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Telus Ventures invests $3 million in PatientSafe Solutions and becomes the exclusive reseller of the PatientTouch point-of-care mobile system in Canada.

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Covisint announces preliminary Q4 revenue of $24-$25.5 million, short of estimates, and appoints Sam Inman (Comarco Wireless Technologies) as interim CEO.

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Accretive Health says it will probably not meet the SEC’s deadline to file restated financial results from the last three years, which will likely cause its stock to be delisted from the NYSE next week. 

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General Atlantic is said to be the frontrunner to make a $100 million investment for a 30 percent stake in 1,400-employee healthcare IT services firm CitiusTech, which seeks capital to fund growth in Europe and the Middle East.


People

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Validic hires John Turnburke (MedFusion) as SVP of business development, Chris Edwards (Allscripts) as VP of marketing, and Ben Clark (Allscripts) as VP of operations.

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Janet Dillione, executive vice president and general manager of Nuance’s healthcare division, will step down on March 21, according to an SEC filing.

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Richard Paula, MD (Tampa General Hospital) is named CMIO at Shriners Hospital for Children (FL).

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Brian Ahier (Advanced Health Information Exchange Resources) is named director of standards and government affairs for Medicity.

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Connance names Michael Puffe (Huron Consulting Group) SVP of sales.


Announcements and Implementations

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MMRGlobal announces a confidential patent agreement with Cerner relating to MMR’s MyMedicalRecords PHR portfolio, including the one above submitted in 2005.

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OCHIN and Health Choice Network launch Acuere QOL, a data aggregation, analytics, and quality solution powered by the Caradigm Intelligence Platform that will help CHCs and PCAs manage populations and improve quality.

PatientsLikeMe launches a media campaign urging people to share their medical information. How the for-profit PatientsLikeMe makes money: selling the medical information people share to drug and device manufacturers.


Government and Politics

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A GAO report recommends that HHS pay more attention to the reliability of EHR data used for quality measures and use them to measure progress.


Other

BIDMC CIO John Halamka reports that the ED has been beta-testing Google Glass since December to view the patient dashboard during examinations. He says its greatest strength is being able to provide real-time updates at the bedside and will become valuable when tied to location services.

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Executives of three Madison, WI-area healthcare IT companies were among the 35 invitees who were briefed by White House and HHS officials on healthcare innovation and entrepreneurship last week, including a session with National Coordinator Karen DeSalvo, MD.  The companies were Nordic Consulting, Forward Health Group, and healthfinch.  

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Speaking of the White House meeting, HIStalkapalooza winner and Nordic Consulting President Drew Madden broke out socks appropriate to the occasion. It’s apparent that he has worn them before, with the obvious question being, “To where?”

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I recently mentioned that I rarely complete a HIMSS member survey because the are so long and poorly designed. I just received one asking for feedback on the annual conference that ran eight online pages and 1,100 words. Needless to say my incompletion record remains intact.

A Fitch Ratings report says hospitals may face weakened credit ratings as a result of their ICD-10 conversion.

The Department of Homeland Security warns users of the now-unsupported Windows XP that they should at least replace Internet Explorer with a more secure browser for which security updates will be issued.

The Society of Thoracic Surgeons will connect its clinical database to CMS claims data, allowing researchers to track readmissions, second procedures, and long-term survival.

Weird News Andy wonders if the hospital gets a commission on tickets as local police install a red light camera near the ED of University Hospital of Tamarac (FL), snaring at least one patient experiencing chest pains. WNA quotes a related story in which most people with chest pain in Northern Utah drive themselves to the ED, slowing their treatment since ambulances can run ECGs during transport and alert the cath lab team to be ready at the door.


Sponsor Updates

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  • Shareable ink Founder/CTO Steve Hau will run in the Boston Marathon on April 21 and will personally match up to $10,000 in donations for victims and survivors of the 2013 bombing. 
  • Capsule Tech will showcase Capsule SmartLinx Medical Device Information System at the American Organization of Nursing Executives annual meeting in Orlando.
  • Fujifilm Medical Systems and Fujifilm SonoSite will participate in the National Consortium of Breast Center Meeting in Las Vegas March 15-19.
  • Perceptive Software launches v10.3 of its Enterprise and Workgroup Search.
  • Holon Solutions and Texas Organization of Rural & Community Hospitals (TORCH) will build a health information exchange (HIE) that will connect North Texas Medical Center (TX) to local clinics.
  • HealthCare Anytime offers two-minute video overviews of their enterprise and SaaS portals.
  • NTT Data is doubling the size of its US headquarters in Plano, TX.
  • Seven healthcare CIOs shared strategies for managing IT cost while maximizing its value at the CIO Summit in Chicago co-sponsored by Impact Advisors.
  • NexxRad Teleradiology Partners selects Merge PACS to integrate with its NexxRIS.
  • ZirMed partners with Precyce/HealthStream to offer client ICD-10 education to the ambulatory market.
  • WiserTogether and Truven Health Analytics partner to help consumers make better healthcare decisions.
  • Porter Research President Cynthia Porter shares her thoughts on the Health IT Marketing and PR Conference in Las Vegas April 7-8.
  • pMD announces that all of its new mobile charge capture implementations will be ICD-10 compliant.

EPtalk  by Dr. Jayne

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I was pleasantly surprised in my personal Yahoo mail account this morning when they returned a feature that was taken away with its redesign last fall. Although I’m glad I can now see my folders and their contents, I still wish they would bring back the tabs across the top that allowed multiple emails to be open at the same time. They also followed up with an email response to my original complaint letting me know. After the original annoyance of the upgrade, I moved most of my real email activity to Gmail, so pretty much all I use Yahoo for anymore is coupons and shopping promotions.

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Inga tipped me off to this piece regarding physician professional satisfaction. The study showed multiple factors as having a positive impact on physician professional satisfaction:

  • Perception of whether high-quality care is being delivered
  • Control over work environment, pace, and content
  • Common values shared with leadership
  • Respectful professional relationships
  • Fair and predictable incomes

Not surprisingly, these have more to do with how practices and physician organizations run rather than with EHR. Although there are problematic EHRs and other IT systems out there, my sense over the last few years is that physicians often use them as a scapegoat. My local colleagues have voiced the thought that they can have some degree of control over EHR (refusing to use the system, demanding de-installation, blaming the vendor) but that some of the other factors (control over work environment, salary issues) are simply untouchable.

Thinking about this from a pure behavioral health standpoint, this is classic behavior. When people experience trauma, they tend to cling to the things they can control even when the rest of their lives are out of control.

Although the timing of the study didn’t allow assessment of the impact of the Affordable Care Act, I see a lot of physicians ready to use it as a scapegoat even though the majority of its changes have not yet impacted anything other than the access issue. I liked the fact that the study had a qualitative portion, which included open-ended interviews rather than just survey-type items. Those types of questions allow respondents to share direct responses without feeling the need to fit them into a predefined response box.

Unfortunately, the responses may also fail to allow full understanding of or exploration of the results. Physicians stated that “their EHRs required them to perform tasks that could be done more efficiently by clerks and transcriptionists.”

Since I spend a lot of time working on efficient clinician workflow, I would have wanted a follow up question. Is it really the software that is requiring the workflow, or is it also impacted by organizational policies that require physician data entry where it is not necessary? Is it impacted by continued administrative cost cutting that forces work onto physicians because they are perceived as “free labor” since the hospital doesn’t bill for their services as community physicians? Of course those would be rather leading questions, but that’s what I see a lot of in our metropolitan area.

Due to my CMIO responsibilities, I cobble together my clinical experience at several different hospitals. Two of them have the same EHR vendor, yet the user experience difference is night and day. One system has been configured to require endless busywork. The order sets are poor, in a confusing order, and missing seemingly key components. Physicians are required (by administrative decision) to key a PIN for each individual order rather than being able to authenticate a cohort of orders at once. That kind of thing is fixable through educating the decision makers and ensuring that physicians are part of that decision-making process.

Don’t get me wrong, there are a lot of bad EHRs out there. It’s hard to sort that out though when poor leadership, incomplete training, and lack of understanding can cripple a perfectly good system. We need to remember that there are plenty of “causal” factors to go around, In order to truly deliver physician usability, we have to address both the hardware/software issues and how the system is implemented and governed.

In addition to EHRs, physicians cited multiple sources of dissatisfaction:

  • Obstacles to care, such as unsupportive practice leadership or payers refusing to cover recommended services
  • Income instability
  • Burdensome regulations, including Meaningful Use

Unfortunately, these aspects of physician practice are mostly outside our control. We can’t control payers and spend countless hours of uncompensated time trying to get care for our patients. We can see more patients, but we can’t control the wide variation in payments for the same service that we see across payers. We certainly can’t control the regulatory environment.

So what do we do? We circle back to the EHR as something we think we can have some control over.

I don’t have any good answers here and wish I did. I’d love to have a magic wand or even a sparkly Band-Aid to make it all better. How do we empower physicians to be part of the solution? How do we help administrators make rational decisions around system selection and implementation? How do we get them to share the reins with providers? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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March 13, 2014 News 1 Comment

HIStalk Interviews Mark Bakken, CEO, Nordic Consulting

March 12, 2014 Interviews 3 Comments

Mark Bakken is CEO of Nordic Consulting and an investor in several healthcare IT startups.

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How’s Nordic’s business these days?

Our business is booming, like everybody else in healthcare IT right now. We’re doing a lot with optimization, helping a lot of Epic customers as they figure out how to leverage their investment in Epic and the EMR to not only improve care, but reduce costs at the same time. 

It’s been pretty fun to be able to send in experts to quickly do an assessment and say, hey, if you enabled all these features and other things, you could most likely make your co-workers very, very happy by saving them some time, and at the same time, get better results or hone in on a cure a little faster, leverage the technology you have while at the same time get more done with less. It’s like the equivalent of robots for manufacturing. It’s fun to do these. 

These organizations are so large. Nobody likes to eliminate positions or let people go if they don’t have to. But since most of them are so big, they can reduce the number of staff they need relative to them growing. If they do acquisitions and mergers, they don’t need to hire as many. The net effect is their efficiency gets better from a cost perspective, or they could do it through attrition if they say we no longer have to do registration, for example. Customers and patients are doing it automatically, so we need a lot of people. That person can then take a new career opportunity within a healthcare organization.

It’s fun to be on the forefront, to see organizations starting to leverage their initial investment into that second wave.

 

The company just moved to a new headquarters location. Epic is known for some interesting and fun buildings. What’s yours like?

[Laughs] It’s nowhere near as Disney or Google-like as Epic’s, but it’s nice and open and airy. We pride ourselves on transparency. We made it nice and professional looking, but within reason, I would say.

 

What’s the overall state of healthcare IT innovation and the business climate in Wisconsin?

Obviously with Epic in Madison — and I’m in Madison — there’s a lot going on here. There’s a lot of really sharp people that either come to the University, work at Epic, and then they have some ideas. Epic’s road map isn’t going to get around to building those into their core products for a few years, so they say, hey, maybe I can do it, grab some friends, and give it a shot at the new American dream — starting your own company and making it big some day. There’s a lot of that going on.

There’s a lot of support around that from the investment community here. Madison, Wisconsin was one of the leaders in the whole biotechnology wave that started taking off with stem cell research and everything else. Not to mention all the providers in Wisconsin were some of the early adopters, especially with Epic in our back yard, where they tried some things and are benefitting from some of those early advances with healthcare IT. We’ve got a lot of the good raw ingredients here.

 

Neither you nor Judy Faulkner would have fit my mental model of what education a founder would have since you both have degrees in computer science. Is there something different about being educated at University of Wisconsin or does Epic just create things that are like Epic?

It is interesting because usually that isn’t the background. We’ve taken different paths. Judy has been at it obviously for a long time. Trying to figure out the right mix and perseverance is a big piece of it and you do find that in computer science people that gravitate towards that. There’s always a problem you’re trying to figure out and there’s many different ways to go about it. 

Maybe there’s something to that. Who knows? It might just be coincidence or maybe it is one of those things, as computers and technology are becoming much more relevant in a services-based economy, where you can use computers to automate things. That’s a good question.

 

What are you doing with your investing and what kinds of things you look for in companies?

What I look for, like most people, is a great management team, leadership, and passion. People that can inspire people, whether it’s people that follow them or just believe in their vision and their dream, whether it’s customers, or potentially investors. Then other employees that have the same desire or vision to do that. 

With healthcare and IT and everything going on right now, all the pressure and all the change and everything else, there’s lots of ways you can use technology to not only get the patient more engaged and more accountable and figure out how to do that from the Fitbits, smart scales, to the whole continuum of care that say, it’s all about responsibility. It’s not just the physician, it’s not just the healthcare organization. Let’s all try to leverage technology to be healthier and live longer and find things sooner so we can find a cure.

Learn from each other. I heard a stat that says something like an average 40 percent of physicians’ initial diagnoses are incorrect. If that’s true, we can definitely do better than that by leveraging data. If we can leverage technology, leverage data to find things, to hone in on things sooner before they’re uncurable or unfixable, that ends up being a good thing. That’s basically what you look for. 

Epic, Cerner, athena, Meditech, McKesson, AllScripts — the list goes on and on. They’ve got a really good platform and a good foundation, but healthcare and driving down costs and improving care is much more than just the clinical data. You got to take everything into account and there’s lots of different ways to do that. There’s a lot of bolt-ons.

I saw a ton of this with the whole Microsoft wave and revolution in 1990s and early 2000s where Microsoft has a platform, and then there’s lots of other companies out there like, hey, we can build on it and we can make something better for what you specifically need. The thing is, the bigger the companies get, they can’t come out with that specific module or niche. It might take them three to five years, and by the time they come out with it, the market may have moved on. They might have a different need or something else came up. 

Young, small startups that are agile and can get things done quickly … it’s fun to be part of that.

 

What are some companies you’re investing in?

I would probably start with Catalyze.io. They’re creating repeatable platforms for healthcare IT. It’s HIPAA compliant. Instead of reinventing the wheel, there’s a lot of things that we could learn from each other. We can share that framework to do quick custom development stuff.

Forward Health is a great analytics company, population health, medical intelligence organization. Great way to slice and dice information easily. Not just clinical data, but when you look at RX data, claims data, consumer data, or anything else that you need in order to make better decisions faster for actuaries and statisticians as well as physicians.

Wellbe.me is another organization. Patient engagement before they come in for a surgery or when they leave, making sure they do all the things ahead of time and they fill out all the forms and all the checklists. They do it in a very easy way that’s a nice wraparound any of the EMR programs out there. Very affordable, works very, very well. Lots of interest from everybody to say, hey, when you come in, if you do all these things ahead of time, the odds of you not having to be readmitted greatly increase. Then afterwards, make sure you do all the follow-ups. It makes it easier for a healthcare organization to manage tons of people before they come in and after they come in and leverage their social network to do so.

Moxe Health, which is the connection and interfaces. Just think of all the different things you have to connect out there. Instead of paying someone to customize all those at the end of the day, maybe there’s 50 different systems that someone has to connect to, why do you have to custom build all those things over and over and over again? They’re making reusable app store type connectors out there.

Healthfinch is another one that makes a great way to save physician time. That’s their whole goal in life is to reduce the number of clicks. Right now there’s a lot of frustration on the physician side saying, hey, I just want to do what I do. Trying to find the best use of their time, finding that right mix without making them all hire scribes to follow them around. There’s some clever things they’ve done with prescription refills, which is interesting. On average, physicians spend seven percent of their time doing that. They have a way they can get it down to one percent. For every 100 physicians, if you can free up six physicians’ time doing things that could be automated, that’s a good thing for everybody.

 

What’s your vehicle for investing? Do you just make a personal investment or do you have a fund of some sort?

It’s all new territory for everybody. It’s either go to friends or family, which is tough because you don’t want to mix friends and family. It’s to try to do a round, or do a convertible note is what they would call it, where you can do a loan and then down the road, if they raise money, once they have more customers and more success than the valuation.

The trick is, you want to make sure the people actually doing the work have some substantial stake in the outcome and some motivation to make sure they can create something that’s creating value out there. If they do, they benefit and that would be good for me, too.

I just am a huge, huge fan of entrepreneurs. I know how tough it is to get going. You need the right mix of everything. You need the stars to all align and a little bit of guidance from “don’t do this” or “how do you do that?” Everywhere from how do you work with large organizations, how do you contract with them, how do you get insurance, how much insurance, to payroll, to taxes, to a lot of little things that everybody needed despite what they’re doing. If I can help point them in a direction that will save them a bunch of time so they can focus on what they really are good at, then I think that’s a good thing.

 

Is there a way the average person can invest now that some of the rules have loosed up, such as for crowd funding, for instance?

Not as easily as you would hope yet. You read all about the crowd funding. Some of the laws in Wisconsin, thankfully, have changed. You can actually get them some equity instead of some kind of token gift or something. It’s going to be easier without having to be accredited and all this other stuff and all these hoops. 

There’s some other things I’m looking at personally trying to do. Change the business lending laws to be more in line with America’s economy, which is more of a services-based economy. The business lending laws that were set up 70 years ago were based on America being a manufacturing-based economy. You need inventory, you need all these other things, assets, you need buildings that a bank could repossess in order to get a line of credit or a loan. If we can make that easier for people so they don’t have to spend a bunch of time trying to get people to invest in their idea and everything else, I think that would be a good thing. It would be good for them, good for America.

 

What do the companies you’re investing in need most, other than money?

They need a mixture of things. You’ve got to have a customer that is willing to work with you, to at least do the pilot, to work out the kinks, to figure out how to price it, how to package it, how to deliver it. That’s one.

They need mentors from every angle, from lawyers, from LLCs or S corp to C corp to some other structure, and then all the other mentor types around like that. In Madison, we have something called 100health, which is geared towards helping people figure out where they can go for different resources and packages to get their idea off the ground in the most efficient manner.

I do have to say, there is a lot of other interest in investment in healthcare IT right now from the venture capital community, even down to the tens or hundreds of thousands of dollars, whether they’re from Chicago or all over the country. I just was in an advisory board meeting where they said that VC funding has more than doubled in the last four years in healthcare IT space. The rest of the world’s starting to take notice, to say, hey, I think there’s something to this whole EMR and healthcare IT technology wave that will be good for everybody.

 

Money comes at a price and companies give away their equity too early or get taken in a direction that seems to be the quickest path to profitability and not really what their vision was. Do you see that as a challenge?

Yes, absolutely. There are strings attached. Part of it is finding the right way to do that. Typically in Wisconsin and other states around the country, there’s a lot of older money. They don’t quite understand this new world economy; the Silicon Valleys and WhatsApp be worth $18 billion, not to say healthcare IT is going to go that kind of crazy.

It is basically trying to find that right balance. That’s why I think I can, because I know the healthcare IT space. Me personally making some kind of investment of faith at some kind of valuation to at least set the bar that is fair. Then other people can piggyback on that and do things at the same ratio with the entrepreneurs and the people doing all the work feel like, OK, that’s fair, I don’t feel like I’m getting held over a barrel.

 

What are the start-ups most naive about?

Most of them really, really get excited about their idea and their program or whatever they’re going to do without 100 percent going to the market and knowing are people willing to pay for this, and if so, how much, and is it enough where they can actually make a good living by providing that value to a customer. People can think great thoughts, but if the market isn’t ready, if there isn’t a budget, if it really doesn’t make sense, if it’s a nice to have instead of a need to have, then it’s one of those lessons learned type things.

 

How do you think healthcare IT will look different than it does today in five years?

It will be hugely different in a very, very good way. There was another study that came out like one in eight hospitals had an EMR back in 2009, five years ago. Five years from now, I think almost everybody will. With that, hopefully we’ll be able to analyze that data to be able to find other Patients Like Me type thing, where physicians, nurses, everybody in the healthcare world can use that data to hone in on a cure faster or to diagnose something before it’s unsolvable. I think we really, really, really will be using data a lot more so to make care better so people can live longer, healthier, happier lives.

 

Do you have any final thoughts?

It’s pretty fun to be part of it right now, the whole healthcare IT revolution that’s going on. The one thing I look at is saying roughly 18 percent of our economy is spent on healthcare and it’s basically flying blind. We’re using data for everything else, so it would be nice to actually use this data to make care safer and better. It’s fun to be part of it.

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March 12, 2014 Interviews 3 Comments

News 3/12/14

March 11, 2014 News 6 Comments

Top News

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The HIT Policy Committee submits its Meaningful Use Workgroup’s Stage 3 recommendations.


Reader Comments

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From Pointy Toes: “Re: CEHRT Hardship Exception Guidance. This is a joke. All you have to say to qualify for the Medicare hardship exemption to avoid the 2015 payment adjustment is say you  had ‘2014 Vendor Issues.’ Tavenner previously said some ‘narrow’ hardship exemptions would be granted. Sounds like anyone wanting an exemption can request it and presumably one will be granted one. Why not just push the deadline back for everyone instead of requiring providers to jump through an extra hoop?” CMS issued guidance Tuesday for EPs and hospitals worried about being hit with penalties, even going so far as to provide instructions to choose “2014 Vendor Issues” no matter what their actual issue. It is ridiculous – setting the bar high officially, then accepting a wink-wink rubber stamp excuse for anyone who can’t make it. Maybe someone should track the vendors whose non-compliant yet certified products forced their users to claim hardship.

From Canuck: “Re: rumore that UHN in Toronto is replacing QuadraMed EHR with Cerner. I believe instead it came down to Cerner and Epic and Epic won.” Unverified.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor SyTrue. The Chico, CA-based company offers a business and clinical intelligence platform that tells hospitals how their clinical objectives are being deployed; what physicians are doing; and who in the market is providing services at a given cost and outcome. It integrates and structures disparate EHR information for predictive and clinical analytics used for data analysis, electronic abstraction, outcomes analytics, operations, population management, clinical research, and patient engagement. Thanks to SyTrue for supporting HIStalk.

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Here’s one final mug shot featuring Tammi’s office de-stresser, which must have traveled furthest from Orlando while still not leaving the continental US (the UFO on a stick in the background should give a strong hint of her location).

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Thanks to the 355 folks who have completed my reader survey so far. That number provides respondents with good odds of being randomly drawn for one of three $50 Amazon gift cards, but represents only around 1 percent of HIStalk’s 30,000+ readers. Spend less than five minutes completing the survey and you’ll help me plan the next year of HIStalk and earn my appreciation besides.

I’m always looking for interesting people to interview. Know someone who would be stimulating, fun, and a straight shooter? Let me know.


Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.


Acquisitions, Funding, Business, and Stock

First-half results from Scotland-based Craneware: revenue up five percent, pre-tax profit up seven percent.

CompuGroup Medical acquires three European HIT providers: lab software provider vision4health Laufenberg & Co and office-based physician software vendors Imagine Editions and Imagine Assistance.

Quest Diagnostics completes its acquisition of Solstas Lab Partners Group and raises its full-year 2014 financial guidance.

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Employer benefits platform provider Castlight Health raises the price range of its IPO to $13-15 per share, up from the $9-11 range it set just a week ago. The company, which lost $62 million on $13 million of revenue in 2013, would receive proceeds of $140 million, valuing it at $1.5 billion. The company’s founders are Todd Park (US CTO and co-founder of athenahealth); Bryan Roberts, PhD (chairman and co-founder of venture capital firm Venrock); and Giovanni Colella, MD (founder of RelayHealth).

 


Sales

The Royal Free London NHS Foundation Trust selects OpenText to manage its scanned legacy case notes.

The Community of Hope (DC) is implementing Forward Health Group’s PopulationManager and The Guideline Advantage.

The VA awards Leidos three contracts worth $16 million to support blood bank software and the MyHealtheVet program.


People

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TeleTracking Technologies names Diane Watson (Tilt, Inc.) COO and Joseph Tetzlaff (inVentiv Health) CTO.

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Michael Hart is promoted to VP of IT applications at Arkansas Children’s Hospital.

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Craig Joseph, MD (Agnesian HealthCare) is named ICD-10 and EHR physician advisor at Texas Children’s Hospital (TX).


Announcements and Implementations

Cox Health (MO) deploys Phytel’s population health and patient engagement platform.

McKesson announces QICS for Cardiology, a CVIS-based workflow and critical results communications platform. OSF Healthcare (IL) is piloting.

QuadraMed announces GA of its QCPR 6.0 enterprise EHR, which includes bar code medication administration, a comprehensive problem list, a Web-based patient portal, the ability to create a CCD, and Canada-specific architecture requirements.

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In Canada, Bluewater Health will roll out patient flow software from Oculys.

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University of Colorado Physicians goes live on the DocASAP self-scheduling system.


Government and Politics

Office of Civil Rights fines the public health department of Skagit County, WA $215,000 for HIPAA violations involving information on 1,581 people exposed in its public web server, the first time a HIPAA fine has been levied against a local government.

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The White House launches #GeeksGetCovered, encouraging technology entrepreneurs who can now buy their own non-employer health insurance because of the Affordable Care Act to start their own businesses.

President Obama riffs hilariously with comedian Zach Galifianakis, appearing on “Between Two Ferns” to plug Healthcare.gov (“I wouldn’t be with you here today if I didn’t have something to plug … Healthcare.gov works great now.”)

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The phrase “healthcare exchange” always seems to be preceded by “troubled,” so add Maryland’s $200 million version to the list.  Like other states, it decided to create its own site, hired a contractor that it later said underperformed, missed its go-live date, and had to create a backup plan to accommodate people who wanted to enroll but couldn’t. HHS announces that it will investigate.

Hillary Clinton’s financial disclosure forms for 2012 reveal that her husband Bill took a $225,000 speaking fee from the struggling, non-profit Washington Hospital Center as it was laying off employees. The hospital also brought in George W. Bush to speak, but since his wife isn’t running for office, his fee remains confidential. Bill made a bunch of money in 2012 for addressing money-losing non-profits. Somewhere in those records is the payment he received from HIMSS if anyone knows how to locate them. I’d bet $400K.


Innovation and Research

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A NIST report says that inadequate workflow integration forces users of ambulatory EHRs to develop system workarounds, suggesting that EHR vendors develop these capabilities:

  • At-a-glance physician views of patient schedules
  • Task reminders from previous patient visits
  • Redacting and summarizing lab results
  • Draft creation of patients orders in advance
  • Conversion of working diagnoses to formal diagnoses
  • Skip or defer tasks when workload requires
  • Role-based views of progress notes
  • Visually differentiate copied-and-pasted progress note text from newly entered documentation
  • Manage referral and consultation messages with specialists
  • Track scheduled consults and lab results review

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The Charlotte, NC newspaper says that Carolinas HealthCare System will use innovative (unnamed) software and the information collected by its multiple EMR systems to identify ED patients who are likely to be readmitted, allowing team-based intervention and remote management. The system’s chief medical officer weighs in on hospitals that don’t use electronic medical records: “You don’t know how bad it is until you actually go back. It was like a time warp. The care is unsafe, it’s uncoordinated. It’s a nightmare…The system was absolutely stupid, and frightening.” I interviewed SVP/CIO Craig Richardville in September 2013. It might be time for a follow-up to talk about analytics.


Technology

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Wellocracy provides a well done comparison chart of wearable activity trackers.


Other

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A column by InfoWorld’s executor editor says a disconnect exists between complex government EHR requirements and the stubbornness of the healthcare industry to embrace them, summarizing, “We have a mess of proprietary EHR systems with highly customized processes, a set of HIEs that use different standards and protocols to connect them, and a mandate to provide human-readable data from these disparate systems. What could possibly go right?”

In England, University Hospital of North Staffordshire plans to conduct video consultations via Skype, saying the service will reduce outpatient appointments by 35 percent.

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The Gainesville, FL newspaper profiles Shadow Health, whose founder licensed avatar technology from the University of Florida to create nursing school education tools that students buy for $89.

A study finds that incorrectly flagging patients as being allergic to penicillin increases overall inpatient days by 10 percent and increases resistance to broad-spectrum antibiotics. Up to 95 percent of patients who say they are allergic to penicillin really aren’t.

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New York-Presbyterian Hospital will host a hospital hackathon this weekend in which teams will design apps for its portal that improve patient access to care. The hospital is offering $85,000 in prizes and has filled all of its slots with 120 participants. Dr. Oz provides the video introduction.


Sponsor Updates

  • Kinetic Data names CareTech Solutions “Innovator of the Year” for realizing $4.7 million in cost savings by implementing Kinetic Request.
  • Premier enhances its OperationsAdvisor labor management solution to give healthcare organizations the ability to analyze labor efficiency across multiple care settings.
  • Ryan Uteg, senior advisor for Impact Advisors, is named to Consulting Magazine’s “35 Under 35.”
  • Allscripts Sunrise is selected by Black Book as top inpatient EHR.
  • Iatric Systems will deploy integration in the EDIS and vital sign monitors as Southeast Alabama Medical Center (AL) upgrades its McKesson Paragon HIS.
  • MedAssets’ National Sourcing Collaborative cumulatively saves providers $135 million over the last three years.
  • Wolters Kluwer Health launches Bates’ Visual Guide demonstrating evidence-based physical exam techniques.
  • Santa Rosa Consulting’s Fred L. Brown is inducted into Modern Healthcare’s “Health Care Hall of Fame 2014.”
  • Kareo announces that its ICD-10 Success Checklist is available on a write-on poster.
  • NextGen Healthcare’s CMO Sarah Corley is elected to serve on the EHR Association Executive Committee.
  • Medical Economics spotlights e-MDs customer John Bender, MD of Miramont Family Medicine (CO) for expanding his practice while 30 percent of local practices have sold or closed.
  • Health Catalyst publishes a free white paper with a candid 12-point review of population health management software vendors.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

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March 11, 2014 News 6 Comments

News 3/7/14

March 6, 2014 News 1 Comment

Top News

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The Defense Health Agency, established in October 2013 as a successor to TRICARE, requests $1.6 billion to support its health IT systems in 2015. It also wants $91 million for R&D to develop a new EHR by 2017 and $68 million to integrate its systems with those of the VA. Meanwhile, the VA’s 2015 budget requests include $269 million for EHR development.


Reader Comments

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From TooMuch Coffee: “Re: WA state healthcare insurance exchange. You mention that 15k applications are stuck in limbo. I agree that’s not great, but they have signed up around 500k successfully. The site basically works, unlike OR and HI sites.” I’ve written about Oregon’s struggling exchange, so here’s the story on Hawaii’s: it received $204 million in federal funding, went live two weeks late due to software problems, has enrolled fewer than 5,000 people (at a cost of about $46,000 each), and has already been declared unsustainable without ACA rule changes since few potential customers and insurers are interested and it’s supposed to be self-funding its $15 million annual operating budget with 2 percent of the take. Meanwhile, the US Government Accountability Office says it will audit Oregon’s exchange, which cost $304 million and hasn’t enrolled a single person without manual help.

From Concerned: “Re: UHN in Toronto. Can anyone confirm that they are replacing QuadraMed EHR with Cerner?”

From Nobody Knows: “Re: value-based risk contracts. Is there a resources that details which payers and providers are engaging in them vs. those doing fee-for-service? I’ve tried AIS, HIMSS Analytics, and Billian’s and so far, no dice. Even a high-level report would be nice.”


HIStalk Announcements and Requests

inga_small This week on HIStalk Practice: You won’t want to miss the summary of my chat with eClinicalWorks CEO Girish Navani, who shares his thoughts on the MU program, population health, and health information exchange, plus provides an estimate of the company’s valuation if it were to go public. Despite the growing number of  employed physicians, work still needs to be done to integrate physicians and develop performance-based reward programs. The pay gap between primary care providers and specialists narrowed in 2013. I recap some vendor announcements from last week and muse on various HIMSS sights and sounds, including the future of Practice Fusion; Allscripts and its new tag line; what’s driving Aprima’s recent growth; and, the hot topic of ICD-10. Thanks for reading.

This week on HIStalk Connect: Samsung unveils the Galaxy S5, which integrates with both its two new smart watches and its new activity tracker. Basis, the maker of the B1 activity tracker, is acquired by Intel for a rumored $100 million. The FDA is looking for a vendor to develop social media analytics tools.

On the Jobs Board: Chief Market Strategist – Healthcare, EHR Tester, Epic Activation Consultant.

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Welcome to new HIStalk Platinum Sponsor CompuGroup Medical. You see the count of big global customer numbers in their graphic above and the owner-led and publicly traded company is expanding its US sales. Offerings include CGM Clinical (integrated PM/EHR), CGM DAQbilling (PM), CGM webEHR (EHR), CGM webPRACTICE (PM), and CGM Enterprise (PM/EHR for community health centers); LIS, outreach, and reference lab solutions; the eSERVICES Patient Portal, EMEDIX Reimbursement Solutions, and the SAM disease management platform. The new CEO of CGM US is Norbert Fischl, who has an interesting background as leader of the company’s Northern European region, managing director of a software company, McKinsey consultant, and an Internet entrepreneur. Thanks to CompuGroup Medical for supporting HIStalk.

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Here’s another update on one of our DonorsChoose projects that was paid for by the top-of-the-page ads. The 35 freshman girls in the Illinois high school taught by Teach for America teacher Ms. Schwartz are using the notebooks and colored pencils we provided to create College Bound Journals. They will fill them with goals, thoughts about their futures, and information they gather about college campuses and majors. You can see in the photo sent by the teacher that they’ve already started.  

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More remote mug sightings.

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Anne-Marie wasn’t able to get way from the family medicine practice she manages to attend the HIMSS conference, so she made her own mug. She says it’s not nearly as cool as the original, but I disagree.

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It’s time for the once-yearly HIStalk Reader Survey. It’s quick and I use the results to plan the entire next year of HIStalk, so I would really appreciate your taking five minutes or less to give me some guidance. I’ll sweeten the pot by randomly drawing three responses to receive $50 Amazon gift cards. Thanks in advance – most of the good ideas I’ve put in place came from responses to this survey.


Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.


Acquisitions, Funding, Business, and Stock

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MedAssets reports Q4 results: revenue up 4.1 percent, adjusted EPS $0.28 vs. $0.25, beating estimates on both.

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Clinical prediction software vendor Health Outcomes Services completes a $5 million financing round. CEO Jim Wilson has worked for McAuto, EDS, and Cerner and was president of Craneware before joining HOS.


People

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ArborMetrix appoints former CMS administrator and FDA commissioner Mark McClellan, MD, PhD (Brookings Institution) to its board.

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Idea Couture hires James Aita (Medicomp) as head of healthcare solutions.

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Bart Foster, founder and CEO of self-service medical kiosk maker SoloHealth, is replaced by Chairman Larry Gerdes (both above.) The company’s CFO has also resigned and an undisclosed number of employees have been laid off. Gerdes sold transcription vendor Transcend Services to Nuance for $300 million in 2012. One of SoloHealth’s investors is healthcare IT long-timer Walt Huff, the “H” in HBOC, where Gerdes was an executive from 1977 to 1991.   

Tamyra Hyatt (McKesson) joins Azalea Health as VP of marketing.


Announcements and Implementations

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The New York eHealth Collaborative and the Partnership Fund for NY call for applications for participation in the second class of the  NY Digital Health Accelerator, where 10 early- and growth-stage companies will each receive mentoring and $100,000 of investment capital.

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North Dakota officials announce the official rollout of the state’s HIN, which will connect all of North Dakota’s hospitals by the end of the year.

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The US Army deploys a software upgrade to its battlefield Medical Communications for Combat Casualty Care EMR, also known as the MC4 system, that includes an upgraded operating system, enhanced security, and patient safety improvements related to allergies and medication history.


Government and Politics

HHS includes $75 million in its 2015 budget for ONC, a $14 million increase over last year.

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ONC updates its Health IT Dashboard to include a Rand Corporation-prepared review of literature on the impacts of HIT, with a focus on MU functionalities.

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Analysis of full-year 2013 MU attestation data by Wells Fargo Securities finds that 92 percent of hospitals stuck with the same vendor for at least two years. Meditech, Allscripts, and Siemens topped the list of hospitals that stayed the vendor course, Cerner and CPSI were average, and Healthland, McKesson, and HMS lagged. It also finds that small hospitals seem to be dropping out in big numbers by the third year, perhaps because they’ve paid their EHR costs in the first two years and don’t want to deal further with MU complexity.


Innovation and Research

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Hospitalization rates declined at nursing homes that used after-hours telemedicine services, according to a Commonweath Fund-sponsored study. Researchers estimate that the use of telemedicine services could net Medicare a $120,000 savings annually per nursing home.


Technology

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Azoi announces Wello, a $199 case that turns an iPhone into a monitor for blood pressure, ECG, heart rate, blood oxygen, temperature, and lung functions.


Other

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Epic, Orion, and Siemens earn the highest customer satisfaction scores in a KLAS survey on HIE solutions. Overall provider satisfaction with HIE solutions has dropped an average of eight percent since last year.

Becker’s Hospital CFO looks back at hospitals whose bond ratings have been downgraded by Moody’s Investors Services because of EHR-related budget problems: (1) Health East Care System (MN), which is spending $145 million on Epic; (2) Community Medical Center (MT), which is having cash flow problems after installing Cerner and NextGen; (3) Saint Luke’s Health System (MO), implementing Epic for $200 million; (4) Scott & White Healthcare (TX), seeing increasing costs with Epic; (5) Washington Hospital Healthcare (CA), having increased costs and a negative margin after implementing Epic; (6) Robinson Memorial Hospital (OH), with losses partially attributed to its Allscripts Sunrise implementation.

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Bloomberg News calls Mount Sinai Hospital (NY) “a heart surgery factory with obscene levels of pay,” claiming the hospital coaches patients to feign heart attack symptoms in the ED to get their stents covered by insurance, earns referrals from doctors with financial ties to the hospital, and pays its head of interventional cardiology $4.8 million per year. The head of another New York interventional cardiology program summarizes, “You essentially have physicians combing the streets of Staten Island, Queens, Brooklyn, and Bronx looking for patients they can screen on a treadmill to feed into the cath lab, where the big reimbursement comes.”

In Canada, Pierre Le Gardeur Hospital cancels all elective procedures after experiencing an unspecified computer system problem.

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Weird News Andy has his ear to the UK ground in noticing this story, in which the British public reacts to news that a marketing company used a 47 million-record hospital data extract to target Facebook and Twitter ad campaigns. Another company was found to have loaded the entire database to Google’s servers to create interactive maps. The Hospital Episodes Statistics database had been made available by the government to researchers and approved private companies. The government has a PR nightmare on its hands because de-identification is hard to describe to laypeople who react to “my hospital records are on the Internet.”


Sponsor Updates

  • Vonlay concludes an Epic engagement with Aspirus (WI).
  • Physicians Interactive and McKesson Patient Relationship Solutions will jointly deliver Coupons on Demand, which will provide clinicians access to online cost-saving offers for medications.
  • Kinston Pulmonary Associates (NC) will implement NextGen PM and EMR from TSI Healthcare.
  • InterSystems joins the Global Alliance for Genomics and Health.
  • Gastroenterology-specific EHR provider gMed will add medical content from Health Language to its system.
  • E-MDs releases details on its June 5-7, 2014 User Conference and Symposium in Austin, TX.
  • CIO profiles ICSA Labs, which is now the largest government-approved EHR testing and certification body.
  • Hardin Memorial Hospital (KY) reports improved clinical response times since integrating telemetry alarms with Voalte smartphones.
  • Divurgent raises $5,000 during HIMSS for the Florida Hospital for Children.
  • RazorInsights ONE-Electronic Health Record achieves Stage 2 ONC certification.
  • Daniel Flanagan, executive consultant for Beacon Partners, discusses in the company’s blog his recommendations to ensure a clearinghouse is ready for the ICD-10 transition.
  • MedAssets estimates that its latest National Sourcing Collaborative event will drive $5 million annually in added value for its participating clients.
  • Connance expands its patient-pay solution to include predictive analytics and additional platform reporting and consumer engagement functionality.
  • On the company’s blog, MEA | NEA CEO Lindy Benton explains the significance of electronic submission of medical documentation (esMD) and health information handler (HIH).

EPtalk by Dr. Jayne

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One of my fondest memories from medical school is working the ER during Mardi Gras. I sewed up more than one reveler who didn’t really need anesthesia because they were already feeling no pain. I chuckled when one of my former classmates sent me this story about the germs residing on Mardi Gras beads. Who would have thought that beads that have been thrown around in the midst of public drunkenness might have germs? I wonder if there’s an ICD-10 code for that? Maybe there’s one for choking on the baby in the King Cake as well.

One thing I found lacking at HIMSS was the presence of wearable devices (other than on attendees). I didn’t see much vendor promotion or anything cool enough that I’d consider it (although watching people try to interact with Google Glass was pretty funny). I don’t have any experience with Fitbit, but after reading this article I heard about on Twitter, I might consider one just to have this app. The Sleep Tracker Hack, which emerged from the recent Netflix Hack Day, helps a viewer find her place after sleeping through streaming media. I just might know someone who has fallen asleep in the middle of re-watching “Grey’s Anatomy” for the last several weeks. Unfortunately the hack was part of an internal hackathon, so it may never see the light of day.

I believe in patient engagement and making health-related technology accessible to patients, but there’s such a thing as going too far. I was reading a piece about the Bellabeat Connected System that turns a smart phone into a fetal heart monitor. It also mentioned the Huggies “TweetPee” that sends a tweet when the baby wets its diaper. Seriously? Unless your infant has a urologic problem, I’m not sure tracking urination on social media will do much more than drive followers crazy.

One of my favorite HIMSS connections reached out earlier this week to ask if I would be willing to help mentor a physician who would like to join the CMIO ranks. When I first started out, I had no one to look to for advice, so I was happy to oblige. One of his questions was what I think is the most important CMIO function. I’m not sure I can pin down a single one, but one of the most important in my book is being able to be the peacemaker among IT, the operations folks, and the physicians. Certainly there are other constituencies, but those are the three that tend to be the most contentious.

I’m still surprised that nearly a third of health systems still don’t have a CMIO. The organization where my mentee works falls into that category, but at least they understand that they need to work towards filling that role even if they aren’t ready to admit they need an honest to goodness CMIO. Whether we’re called Medical Directors or Directors of Informatics or Physician Champions, we can still help organizations move forward.

His hospital is currently struggling with physician engagement and clinical oversight, so it makes sense that a physician would be uniquely positioned to assist. He’s not highly techy, but I think that’s OK – if we can master anatomy and pathophysiology, we can learn enough about networks and software to be meaningful participants. The key is knowing who our experts are and being willing and able to leverage them appropriately.

He’s worried that his hospital isn’t really ready to formalize physician leadership in the IT space. There have been comments made about fears that the CMIO “will come in and boss IT around because he’s a physician” or that he will preferentially take the physicians’ side in arguments. I’m encouraging him that even though his role is emerging,  he should ensure that  it’s well defined and that leadership is prepared to support him. Without those elements, the risk of frustration will be fairly high for all involved.

At this point, I think he’s wise to negotiate for a formal position, but I’d recommend going for something part time that lets him dip his toes in the waters of clinical informatics without locking in at an organization that might not be as ready to move forward as he thinks they might be. That will buy him some time to work on professional development and to build the skills he’ll ultimately need if he wants to make a career of this. I’ll keep you posted as I hear from him. I’m looking forward to remembering what it was like to be young and idealistic before the CMIO life started beating me down.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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March 6, 2014 News 1 Comment

News 3/5/14

March 4, 2014 News 7 Comments

Top News

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FCC Chairman Tom Wheeler announces the formation of a task force that will seek ways to increase use of broadband to deliver telehealth, mobile apps, and telemedicine. Heading up CONNECT2HEALTHFCC will be Michele Ellison, a lawyer who runs the agency’s enforcement bureau. Wheeler said in the announcement, “We must leverage all available technologies to ensure that advanced health care solutions are readily accessible to all Americans, from rural and remote areas to underserved inner cities. By identifying regulatory barriers and incentives and building stronger partnerships with stakeholders in the areas of telehealth, mobile applications, and telemedicine, we can expedite this vital shift.”


Reader Comments

From Just Tim: “Re: MU stages beyond stimulus payments. What is the legislative basis to extend the MU program? MU requirements were supposed to run in conjunction with years in which payments were made, not years after penalties kick in. I’d certainly agree that if someone never got to Stage 3, they could reasonably be penalized on an ongoing basis. Otherwise, we’ve just created a large bureaucracy with the power to continue to push unfunded mandates.” Legal scholars and political junkies, the less legislative among us are calling.

From Dim-Sum: “Re: military EHR replacement. Word on the street is that the vendors of choice and partners are as follows. Six service integration (SI) firms will bid Epic. The team that is getting the most news is Leidos/Accenture/Harris. Cerner has a single exclusive SI partner (still doing research to see who that SI is). Allscripts cannot find a partner for their Sunrise. Meditech has the incumbent Northrop Grumman. McKesson walked away from GDIT/Vangent. Siemens has a yet to be named DoD giant. Competitive bids will require an investment by prime and sub software solution firm of about 1.5-2 percent of the total contract value. That means that to win a $5B deal with the DoD, the investment for resources, capabilities, compliance, and regulatory wherewithal (see FISMA, FedRAMP, DIACAP, 508, JITC etc) is $50 million USD. Good Luck beltway bandits and COTS EHR dreamers.” Unverified.

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From Brenda: “Re: Washington’s insurance exchange. Add it to the list of those having issues. By the way, I’ve recommended HIStalk to countless people and I’m glad our company has been a sponsor for about a year now.” The Healthplanfinder exchange has 15,000 applications that are stuck because the user-entered information can’t be matched to the state’s Medicaid benefits database or contain incomplete information (hello, programmer edits?) I speculate that the state incurred the wrath of the grammatical gods when it combined “health plan finder” into a single word.  

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inga_small From Charger: “Terrific correspondence from Orlando; much appreciated since I could not attend! I’m sure you have been deluged with coffee mug requests and are out of stock, but may I place an order for one upon receipt of any new inventory? I will gladly swap you one of my local Karl Strauss Brewery pint glasses in return.” Thanks for the generous offer, but sadly all the coveted coffee mugs are gone. Lorre and I are trying to convince Mr. H that the timing is perfect for the opening of an online store featuring HIStalk swag. Beauty queen sash, anyone?

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More mug sightings: Investor’s Chair contributor Ben Rooks, who obviously works standing up while looking at green ivy outside his San Francisco office; and Mike Jefferies of Longmont United Hospital, whose Spotify-HIStalk two-monitor setup looks a lot like mine. I still have a few more photos to run next time.

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From Dr. Travis: “Re: Nordic’s new office. Thought this was very cool.” I had to clarify with Travis since this is a Midwestern, tailgating, and college thing that much of the country won’t understand: it’s a cornhole platform.  

From Ion Exchanger: “Re: HIMSS booth. You had traffic in your booth back in the hall. You should get another exhibitor to give you space free in return for drawing people.” That idea has come up on occasion, although not usually from people offering space. Our first-time exhibitor experience was good, especially since it was a low-rent, homebrew operation designed solely to give Lorre a way to say hello to interested readers and sponsors. I think I’ve decided to do it again in Chicago.

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From Dr. Matt: “Re: QlikView. First there’s an Epic partnership and now I find at HIMSS that Health Catalyst offers QlikView on top of their data warehouse. Why are these big players using it?” I’ll let those organizations speak for themselves.

From Doctor N: “Re: HIMSS conference. It was my first one. Only the HIStalk people made me feel valued as a practicing physician. The insults, lack of humility, time away from my clinic, and the lack of vendor understanding of how medicine really works will keep me from returning soon. The sessions could have been done online and the networking conversations were shortened because everyone was in a hurry to get somewhere else. I believe I have seen the American medical industrial complex at its worst. I was surprised at the number of vendor folks who are physicians and how little they know about how we pay for healthcare: SGR (which will worsen matters for providers) and $156 billion being cut from Medicare Advantage plans. They have no clue that I’m not paid for population health and most docs in my community hardly even know the meaning of the term. It is like we are buying the horseshoe, barn, and saddle in the hope that we’ll get a horse for a present. HIStalkapalooza, however, did not disappoint!”

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From Spelling CMIO: “Re: a tech solution to HIT spelling problems. As technology professionals, we ought to be able to bring our expertise to bear on the current plague of spelling confusion. I suggest we start to use regular expressions, like: HIM*S* and HIP*A* so that all variants can be brought under the welcoming umbrella of mediocrity. Heck, we could even bust out CM*S to obscure the failure to include ‘and Medicaid’ in the name of our favorite bureaucracy. We could even try E[Pp][Ii][Cc] to free the caps-lock crowd from their yoke of humiliation.” Scanning for “HIMMS” news stories turns up 56, which is pretty sloppy.

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From Frank Poggio: “Re: ONC. Issued new 2015 test criteria while at HIMSS last week. They kept repeating that this new (and extensive at 242 pages) test criteria is ‘voluntary’ for vendors. Here comes another wolf in sheep’s clothing. Do you really think the 2015 Criteria will be ‘voluntary’? How can they generate a revised list of criteria that fixes bugs and not make it required? How can they add something critical to patient safety such as UDI and not make it required? Breaking out CPOE components has been something niche vendors have been asking for since the start. So will those vendors ignore it and stick with 2014 criteria? I have worked through dozens of tests with clients since the inception of ONC and every time they expand or make a test update it soon becomes mandatory by the authorizing testing labs … and with some ATLs sooner than others. I give the 2015 version at most four months before it becomes mandatory.”


HIStalk Announcements and Requests

Listening: new from the all-female, LA-based spacey rock quartet Warpaint, which sounds a bit like Cocteau Twins (and that’s a good thing). I’m also enjoying defunct, brilliant Irish pop band The Thrills.

Some random thoughts I had regarding the HIMSS conference:

  • I was surprised and happy that the vendors of much-hyped analytics and population health management products were restrained in their pitch. Many companies talked about those products, but I didn’t hear a lot of wild claims.
  • The terms “big data” and “cloud” weren’t repeated reverentially and annoyingly to the extent that might have been expected.
  • What is population health management, exactly? It will be whatever payers say it is, no different than “quality.”
  • I’m not impressed with “big data” when healthcare is woefully indifferent to “little data.” We ignore evidence-based medicine, warnings for inappropriate or duplicate tests and drugs, and quality measures. We are sloppy about monitoring our supply chain and controlling our labor and materials costs. We pay little attention to the free exchange of information we hold about patients. We don’t like the idea that patients themselves should see our digital secrets. We should be using the information we have to its fullest before trying to tackle giant databases containing even more insights that we’ll ignore. Speak up if your hospital is different.
  • I’m not sure if patient engagement was just a token HIMSS nod or a real movement. I don’t see stretched providers getting excited about engaging patients unless government or competitive pressures force them to. It was nice to see patient advocates at the podium, even if only sporadically.
  • People are beginning to realize that EHRs aren’t necessarily the center of the universe. Small vendors are creating specific applications that use the EHR, which makes them easier to develop, cheaper, easier to use, and easier to buy since any buyer’s remorse will be several zeroes cheaper than the EHR itself. A question to ask of the dwindling number of EHR vendors might not be what their system does, but what does it allow to have done by other sources? Those companies were in the hall.
  • The government has taken a lot of innovation out of the system with Meaningful Use and ICD-10. I said from the beginning that taking MU money means making the federal government your incessantly nagging partner, but with penalties following rewards it wouldn’t have mattered anyway. I got the sense that attendees were more interested in what HHS and ONC say than what vendors were telling them.
  • Financial uncertainty as well as a big implementation and optimization ramp-up business has increased the willingness of providers to pay a premium to use consultants since they don’t want to get locked into salaried employees for specific short-life tasks. Consulting companies seemed to be generating a lot of interest.
  • Hospitals, like every swollen, inefficient, and political bureaucracy, will do whatever it takes to protect their own interests. They have money and clout and they aren’t just going to happily reduce their profits, headcount, or ambitions to reduce overall healthcare spending. Integrating their acquisitions will be a target market.
  • HIMSS is always like a boat show, but this year I’m not sure many boats were sold.

Acquisitions, Funding, Business, and Stock

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Telus Health acquires Med Access, a British Columbia-based vendor that claims its EMR is #1 in Canada with 4,000 users.

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Clinicient, a provider of RCM and clinical solutions for rehabilitation therapy, raises $15 million in Series C funding from Catalyst Investors and names Rick Jung (Medsphere) chairman and CEO.

Castlight’s IPO could raise up to $140 million based on a revised filing made this week.


Sales

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PatientPoint awards Xerox a $28 million contract to work with hospitals and physician practices to introduce PatientPoint’s digital check-in and population health management software and to provide training and support.

Denver Health selects Besler Consulting to assist in the identification of Medicare and Medicare Advantage Transfer DRG underpayments.

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UCSF Medical Center will implement Oneview Healthcare’s patient empowerment program at three Mission Bay hospitals.

The University of Miami Health System selects Lockheed Martin to manage its healthcare data, develop predictive models for risk identification, and build automated systems to give providers data at the point of care.

Florida International University’s faculty practice chooses PatientKeeper Charge Capture.

Citizens Medical Center (TX) selects MModal for transcription services and front-end speech recognition.

West Florida ACO will implement eClinicalWorks Care Coordination Medical Record.

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Forbes names Epic’s Judy Faulkner as #520 on its list of “The Richest People on the Planet,” estimating her net worth at $3.1 billion.


People

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Accretive Health appoints Patrick Funck (Segwick) SVP/CIO.

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HCI Group names Bill Bria, MD (Shriners Hospital for Children) as CMIO and Robert Steele (Sterling Healthcare Initiatives) as SVP of delivery operations.

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Greater Houston Healthconnect CEO Jim Langabeer, PhD resigns to return to his previous employer UT Health Science Center, with CTO Phil Beckett, MD named acting CEO.

Carolinas HealthCare System hires Nancy Olson, RN-C, MBA, PhD (Providence Health & Services) as its first chief nurse informatics officer.


Announcements and Implementations

inga_small WEDI, in partnership with EHNAC, will create a Practice Management Accreditation Program to review PM vendors in the areas of privacy, security, mandated standards and operating rules, and operational functions. While I am all for having minimum performance standards, is this really the best time to ask vendors to jump through one more hoop to remain competitive in the marketplace? It’s no surprise that we are seeing limited advances in product usability and innovation.

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The local business journal profiles St. Francis Hospital (CT), which goes live on Epic next month following a two-year, $120 million transition. Above is VP/CIO Linda Shanley.

Summit Health (PA) implements Wellcentive’s population health management solutions and services.

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Ontario’s Group Health Centre goes live on Epic.

Wellmont Health System (TN) transitions to Epic in its physician offices and hospitals.

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North Oaks Medical Center (LA) goes live with a two-way interface between Epic and the Masimo Patient SafetyNet remote monitoring and clinician notification system.

GetWellNetwork debuts GetWellNetwork Ambulatory, which is available on mobile and stationary devices and integrates with EHRs to provide personalized information, healthcare tools, and patient pathways.

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CoverMyMeds launches an API that enables providers of EHRs, e-prescribing systems, and PM systems to offer an NCPDP standards-compliant electronic prior authorization solution.

John Gomez launches Sensato, which will offer healthcare privacy and security assessments, guidance, and tools.

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UC Irvine Health deploys WANdisco and Hortonworks Hadoop data technology to provide real-time information for patient care. They run Allscripts Sunrise, I believe, and an unnamed data warehouse technology described in the announcement as one that “struggles with availability issues as well as the volume and variety of data it can handle.”


Government and Politics

inga_small The FDA is seeking a contractor to monitor social media chatter about drugs, medical devices, and other regulated products in order to track conversation shifts following FDA warnings. I found this move especially interesting in light of the heavy Twitter traffic during HIMSS and my realization of  the potential value of mined Twitter data. Now I’m wondering if anyone has figured out a way to combine data from social media chatter with old-school opinion polls from phone and mail surveys. That could be powerful.

ONC releases additional draft electronic clinical quality measures for review and testing for the possible inclusion in the MU and other federal programs.

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The front-page story of the March 10 issue of Time says that Healthcare.gov had so many problems that the White House was ready to shut it down and start over right after its launch. It says that it’s not clear even now who was supposed to be in charge of the launch and that people knew upfront that the site’s design was flawed.

Speaking of Healthcare.gov, HHS says it will need $1.8 billion in FY2015 to run the federal health insurance exchange.


Other

A three-year study finds that patient-centered medical homes do little to reduce costs, decrease utilization, or improve care, leading researchers to conclude, “Medical home interventions may need further refinement.”

The use of patient portals for secure messaging does not significantly change the frequency of face-to-face visits, according to a Mayo Clinic study. Weakness of the study are that portal messages were studied in a vacuum rather than in the context of all provider communication, it looked only at the number of visits rather than patient outcomes, and most of the study subjects were Mayo Clinic employees.

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Baylor Regional Medical Center announces that it will not accept the Malcolm Baldridge National Quality Award following allegations that it improperly managed a neurosurgeon who is accused of botching surgeries while under the influence of drugs. An extensive profile in the Dallas Morning News paints a disturbing picture of a physician who was labeled a sociopath and serial killer by colleagues. We featured the story in September 2013 with this summary:

A Dallas news magazine recounts the fascinating tale of a newly licensed MD-PhD neurosurgeon whose incompetence left several patients maimed or dead while the state’s medical board couldn’t stop him from practicing. Colleagues called the doctor the worst they had every seen and said his skill level was no higher than a first-year resident as he kept inadvertently slicing arteries causing patients to bleed to death, and in one case the OR team had to forcibly remove him from the OR to prevent him from killing his patient. His marketing team and his 4.5 star Healthgrades.com rating brought in plenty of new patients to his loftily named practice, Texas Neurosurgical Institute. Surgeon readers will be horrified by this recap by a peer who had to clean up one of his messes: “He had amputated a nerve root. It was just gone. And in its place is where he had placed the fusion. He’d made multiple screw holes on the left everywhere but where he had needed to be. On the right side, there was a screw through a portion of the S1 nerve root. I couldn’t believe a trained surgeon could do this. He just had no recognition of the proper anatomy. He had no idea what he was doing.” The article blames the situation on malpractice caps, laws that hold hospitals liable for damages only if their intentions are provably malicious, and a nearly powerless medical board charged more with keeping licensure records and counting CE hours than watch-guarding patient safety.

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Mike “PACSMan” Cannavo summarizes HIMSS14 from the imaging perspective in an Aunt Minnie article (simple registration is required.) He tells me that HIMSS rules even though RSNA is a bigger conference because, “The balance of power has definitely shifted from departmental solutions to facility-wide ones and IT and the CIO/CTOs make those decisions here.” Another of his observations:

HIMSS may, and probably will, command the lion’s share of the trade show budgets for VNA and cloud companies from now on. Considering there were more than two dozen vendors playing in this arena alone, plus the majors who showed various central data repository (CDR) solutions, this can affect other trade shows in terms of booth size and revenue. Given that attendance at most radiology-specific shows has been flat or declining and time spent at the shows has declined each year, HIMSS poses even more of a threat.

A group of former senators (Tom Daschle, Trent Lott, John Breaux) forms the noble-sounding Alliance for Connected Care, which will lobby Congress to protect the interests of its big-company members (Verizon, WellPoint, CVS, and Walgreens) as well as patients who benefit from telehealth services. In addition to seeking friendly governmental consideration, the group wants to lift geographic treatment limitations and build the case for telehealth as an effective care delivery mechanism. Surprisingly, HIMSS isn’t among its lengthy list of advisory board organizations. I’m always suspicious of the motivations of retired politicians anxious to make up for the income they lost while holding office, but in this case their announced intentions seem appropriate.

Brian Ahier got a one-on-one interview with National Coordinator Karen DeSalvo at the HIMSS conference. She says everybody has been focused on collecting information via EHRs, but now it’s time to allow patients to participate and acknowledge that “health is more than getting people to a doctor” since only 10-20 percent of outcomes can be attributed to the healthcare system. She clearly has a public health mindset as did her predecessor and she gets a “bravo” for that.

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The CFO of Wake Forest Baptist Medical Center (NC) lists reduced Epic expenses as one element of its improved financial performance in which six-month operational losses were reduced from $49.8 million to $23.5 million. The hospital still has high expectations for Epic, saying in a bond ratings agency report, “Management believes that future financial performance must be improved from current levels, and continues to aggressively pursue both short- and long-term strategies to drive growth, reduce cost and leverage our investment in Epic.”

In England, a three-year-old cardiac surgery patient dies when the scheduling system of the hospital to which he was transferred fails to generate his follow-up appointments. According to the hospital’s pediatrics manager, “Samuel’s appointment request must have fallen through the cracks between the old and new system. The new system is now up and running as best as it can be, but as long as there is still humans entering the information there will always be room for error.”

Weird News Andy notes that Banner Health didn’t have a banner day when it inadvertently printed subscriber Social Security numbers on its health magazine’s mailing labels.


Sponsor Updates

  • Greenway Medical names Phreesia its Marketplace Partner of the Year.
  • Aprima Medical announces that over 1,500 former Allscripts MyWay customers have migrated to its platform.
  • PerfectServe introduces automatic electronic PHI filtering capabilities that remove ePHI from the body of messages sent to non-secure mobile devices.
  • Lisa Reichard, director of community healthcare relations for Billian’s HealthDATA, writes a fun blog post that includes her top 10 tales and takeaways from HIMSS14.
  • Extension Healthcare will participate in the AONE 2014 Annual Conference in Orlando March 12-15.
  • The Tennessean interviews Cumberland Consulting Group CEO Jim Lewis about the company.
  • Boston Software Systems offers a white paper that examines three steps to a successful migration. 
  • An HCS case study highlights Christian Health Care Center (NJ) and the benefits it realized following the implementation of HCS Interactant.
  • TriZetto Provider Solutions advises customers that it will continue to accept claims in print image, NSF, and legacy formats even after the ICD-10 implementation deadline.
  • E-MDs publishes video testimonials from multiple providers.
  • Clinithink’s VP of solutions Russ Anderson suggests leveraging the use of Clinical Natural Language Processing to control patient leakage.
  • Health Catalyst offers a white paper with keys to a successful data warehouse and analytics implementation.
  • Vital Images experiences significant growth across Europe, the Middle East, and Europe.
  • CommVault achieves certified integration with its Simpana 10 software and the SAP HANA platform.
  • TeleTracking Technologies, Hill-Rom, and GOJO will co-market integrations with the Hill-Rom Hand Hygiene Compliance solution.
  • Cornerstone Advisors reports that its staff has grown to 39, a 25 percent increase in the past year.
  • Divurgent will provide support to Medsphere clients in their MU, ICD-10, and value-based purchasing initiatives.
  • Gartner positions Qlik in the Leaders Quadrant of the 2014 BI and Analytics Platform Magic Quadrant report.
  • HIMSS Analytics names Allscripts its first Certified Educator of the EMR Adoption Model.
  • The Cleveland Clinic and Dell will offer Epic EMR consulting and implementation services to other health systems and practices.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

 

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March 4, 2014 News 7 Comments

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Reader Comments

  • Glenn Reph: Great thinking! Being in the payment space for 30 years, Healthcare needs to leapfrog into new technology. EMV and NFC ...
  • Just a Nurse Analyst to be demoted: Jeez - look at you, trying to blame, blame, blame. It was an empty chart with one page of data in the EHR. THR did...
  • HIS Junkie: Re: 2009 after pushing the usual date back several weeks to avoid blizzards (which didn’t work Aw common Mr H. ..th...
  • Perspective: Um, not to be a Negative Nancy, but if I were an Epic consultant, the first thing I'd do would be to fill out that surve...
  • Just a Nurse Analyst: Multiple times THR has stated they modified the clinical system as corrective action for this disastrous event. If they...

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