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Monday Morning Update 2/23/15

February 21, 2015 News 5 Comments

Top News

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In Canada, an IBM/Deloitte-led, $670 million British Columbia Cerner EHR project is delayed with no new timelines announced. Reports say arbitration over a software dispute is a possibility.


Reader Comments

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From Jude Lawless: “Re: 23andMe. They’re excited to receive FDA approval to publish ONE new genetic health report. At this pace, I’m not sure what they’re hoping to accomplish for individuals. For researchers, I’m sure that all their genetic information plus all of their surveys are accomplishing a great deal.” The FDA has loosened its rules covering direct-to-consumer carrier screening tests, allowing 23andMe to market its test for Bloom syndrome. It’s a rare condition, but the company makes money based on (a) the number of people who want to find out if they carry it, and (b) the value of selling the genetic data of its opt-in purchasers to drug companies.


HIStalk Announcements and Requests

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Poll respondents are evenly split on whether biometric security should be mandatory for protecting PHI. Glen commented that biometric consensus standards are inconsistent, while Clark added that infection control solutions make smart cards and RFID better solutions in clinical areas. New poll to your right or here: why is Epic creating an App Exchange? Click the “Comments” link after voting to explain yourself.

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HIStalkapalooza registration has closed and I’ll send out invitations shortly. Every year I get dozens of complaints about the event long before it happens, with these being the most common (and all of which I’ve already heard for 2015):

  • “I read HIStalk religiously and didn’t see the signup notice.” I ran the large graphic and notice several times starting January 29 and ending February 18, so anyone who reads HIStalk even casually couldn’t possibly have missed it.
  • “My boss is an industry big shot and you can’t turn him away if he shows up uninvited.” I can, and in fact, I will. It’s not that hard for even completely self-absorbed executives to put their name on the list or order some flunky to do it for them. Attendance is nobody’s entitlement.
  • “We’re an HIStalk sponsor and didn’t think we had to register our people individually to attend.” I made it clear that every person who wants to attend needs to sign up. The names and emails of the chosen folks populate an Excel worksheet row that is then turned into a badge (and hopefully a door-checked barcodes if I can work that out). I’m still explaining eight years after the first event that this isn’t just a come-one, come-all party – sponsors foot the bill for around $200 per attendee and we can’t just throw open the doors like it’s a fraternity kegger.
  • “I’m bringing a guest.” Answer: that’s great if you signed them up and you each receive an invitation.
  • “We’re sponsoring the event and will be sending you our attendee list.” This actually isn’t a negative comment – it’s how the sponsorships work. Each company gets a specific number of invitations and they manage those, sending me their worksheets once they’re finished.

Speaking of the HIMSS conference, it was fun having celebrity guests in our microscopic 10×10 booth last year. Contact Lorre if you are famous, notorious, or fun and want to hold court there for an hour.


Last Week’s Most Interesting News

  • Shares of Castlight Health dove 31 percent Thursday after an analyst’s downgrade, but rallied almost 10 percent Friday.
  • Epic confirms its plans to open an App Exchange for customers and third-party developers.
  • Rumors say Apple Watch will be missing several planned monitoring capabilities because they weren’t reliable or would have triggered FDA interest.
  • A think tank’s report says the Department of Defense shouldn’t lock itself into a long-term agreement with a commercial EHR vendor, although it also noted the DoD’s hugely expensive and marginally successful efforts at having big contractors develop its current AHLTA system.

Webinars

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.


Acquisitions, Funding, Business, and Stock

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CompuGroup Medical acquires South Africa-based practice management vendor Medical EDI Services.

Credit information provider TransUnion plans an $800 million IPO.

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Community Health Systems announces Q4 results: revenue up 54.1 percent, adjusted EPS $0.87 vs. $0.30, missing expectations slightly on revenue and meeting on earnings. The for-profit hospital operator’s massive August 2014 data breach wasn’t mentioned in the earnings call.


Sales

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St. Luke’s Hospital (MN) chooses perioperative and anesthesia systems from Surgical information Systems.


People

11-2-2011 7-38-46 PM

Patrick Hampson (HM3 Partners) joins the board of Canada-based Logibec Group.

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MGMA names Halee Fischer-Wright, MD (St. Anthony North Medical Center) as president and CEO. You might think that MGMA would know better than put “Dr.” in front of her name and “MD” after, but you’d be wrong.

Huron Consulting Group names Joe Mauro (Siemens Medical) as managing director in its healthcare practice.


Announcements and Implementations

Black Book modifies its EHR survey methods after finding that some hospitals that provide EHRs to physicians and other hospitals were also completing surveys posing as system users. The company says nearly half of the 800 survey responses it audited from community practices and hospitals of under 100 beds were actually scored by their large-hospital partners, which the company likened to “soliciting a salesman to rate his own merchandise” to boost sales.

In Australia, cancer facility Chris O’Brien Lifehouse goes live with Oneview’s patient engagement solution.

Two Oregon organizations — a behavioral services provider and a health center — exchange patient CCDs via their respective Netsmart and Epic systems.

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Employee scheduling software vendor Intrigma launches a free version of its product.


Government and Politics

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Kenya’s first lady opens a medical conference by urging medical professions to use IT to solve the continent’s high maternal mortality rate.


Innovation and Research

University of Pittsburgh and UPMC sign a non-exclusive collaboration agreement that will speed up commercialization of medical technologies.


Technology

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It’s always annoying to buy a new PC and finding it loaded with bloatware that hardware vendors are paid to install, but Lenovo takes it to another level by pre-installing the hack-prone Superfish adware that not only hijacks search results, but supports a man-in-the-middle attack that can expose all browser-based information to hackers. Lenovo’s CTO starts off with a refreshingly blunt apology (“we messed up badly”) but then ruins it with a bald-faced lie in claiming that the company’s only purpose in pre-installing adware was “to supplement the shopping experience” rather than Lenovo’s income. You can test your laptop here and Lenovo and antivirus makers are providing removal programs. The many forms of crapware that the California-based Superfish is responsible for has earned it $20 million in VC investments. It’s sad when the first thing you have to do after buying a new PC is to reformat the hard drive and reinstall everything to make it usable.

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An interesting article on technology in 1.3 million-citizen Estonia brings up interesting points:

  • The country’s president is a technology geek, tweeting regularly after honing his skills at expressing himself concisely by writing one sonnet per day.
  • Half of Skype’s employees work in the capital of Tallinn.
  • The country offers an electronic identity program that citizens use to participate in 3,000 public and private services and to vote in elections, saving an estimated two weeks per citizen each year. It is available to e-residents, in which non-residents can obtain a state-issued, microchip-powered digital identity for digital document signing and transacting business with Estonian firms, or as the government says, “to make life easier by using secure e-services that have been accessible to Estonians for years already … we are moving towards the idea of a country without borders.”
  • Estonians sign 50 million documents electronically each year.
  • The government has developed a contingency plan to upload its entire digital infrastructure to the cloud if Russia were to invade the country.
  • The country created a “maximum coverage, maximum use” 4G broadband policy in giving the winning bidder for the frequency spectrum 21 days to provide country-wide 4G coverage, with the next goal being 300 Mbps LTE-Advanced coverage. 

Other

Federal prosecutors charge a Texas medical technology company owner with impersonating a Cerner employee in selling a $1.3 million MRI machine to Dallas Medical Center (TX) claiming he was representing Cerner. The man was also charged with perjury related to a previous legal case in which he allegedly falsified documents claiming a relationship with Cerner in winning a $25 million judgment against another company for breach of contract, theft of trade secrets, and several other charges. 

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Montreal’s Jewish General Hospital urges patients to stay away after a power surge takes its computer systems down.

Healthcare IT Leaders posts a pretty funny “5 Apps We Want to see in the New Epic App Store.” Here are mine:

  1. A personalized countdown timer that shows Epic employees how long it will be before they’re old enough to rent a car.
  2. A Verona-optimized weather app for Epic educational attendees that in September through May adds 30 degrees to the predicted daytime high.
  3. A “Buy Epic Now” button for the health systems that haven’t already implemented Epic, which is all that’s needed since the company doesn’t negotiate prices or contract terms anyway.
  4. A real-time map of patient records being exchanged between Epic and non-Epic systems so we can settle this “is Epic interoperable or not?” thing one way or another.
  5. A real-time National Debt Clock-type display of how many billions Judy Faulkner is worth.

Sponsor Updates

  • Black Book Research names Medicity a top-ranking “Core Private Enterprise HIE Solutions Vendor.”
  • Five Versus clients will present on RTLS at HIMSS15.
  • Jim Morrow, MD shares his experience with Shareable Ink’s Patient Xpress Solution.
  • SRSsoft’s Scott Ciccarelli writes about “Dreams vs. Reality.”
  • T-System’s Molly Golson, RN shares “How I Got into Healthcare.”
  • Valence Health is featured in a Trustee Magazine article on the role of the attribution process in population health.
  • Verisk Health’s Lee Stephenson describes “How Population Health Management Becomes Self-Management.”
  • Voalte client Boulder Community Health’s transition to smartphones is featured in the local paper.
  • WeiserMazars employees raise over $5,500 for the American Heart Association’s “Go Red for Women” campaign.
  • ZeOmega’s Ron Wozny writes about “The Key to Delivering Healthier Babies.”
  • Sentry Data Systems outlines seven basic steps to annual 340B FQHC recertification.
  • Qpid Health will exhibit at HealthIMPACT East February 27 in New York City.
  • PMD’s David Cote advises readers, “Don’t Buy a Porsche if You Want an iPhone.”
  • PeriGen will exhibit at the AWHONN California Section Conference February 27-28 in Napa.
  • Quest Diagnostics makes Fortune magazine’s list of “Most Admired Companies.”
  • Tony Kanaan will pilot the No. 10 NTT Data Chevrolet in this year’s Verizon IndyCar Series.
  • Nordic’s Scott Gierman offers advice on how to “Prepare for a Successful Season with EHR Spring Training.”
  • The New York eHealth Collaborative will exhibit at the ePharma Summit February 24-26 in New York City.
  • Navicure Founder and CEO Jim Denny will speak at a panel during National Health IT Day at the Georgia State Capitol.
  • MEA / NEA launches a free website facelift contest for physician practices.
  • MedData’s Sean Biehle introduces patient engagement to billing in a new company blog.
  • McKesson releases a new case study on “Evidenced-based Care Management across the Continuum.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 21, 2015 News 5 Comments

HIStalk Interviews Mike Jefferies, VP/IS, Longmont United Hospital

February 20, 2015 Interviews 1 Comment

Michael Jefferies is vice president of information systems at Longmont United Hospital of Longmont, CO.

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Tell me about yourself and the hospital.

I started off as an intern way back when with McKesson. I started with their support center, answering the phones and doing support tickets. That grew into doing technical administration work. I had my roots in technical work and then grew into business leadership and started doing some outsourcing and consulting work with ACS Xerox. From there, I felt strongly that I’d like to get closer to the delivery of care.

T hat’s how I found myself at Longmont United Hospital. The hospital is a 201-bed facility. It’s a community, not-for-profit hospital Longmont, Colorado, which is in Boulder County.

 

As someone who previously worked for McKesson and is now a Horizon customer, how has the company handled the Horizon product and trying to get its users to migrate to Paragon?

I have a lot of respect for McKesson as an organization. I got my start there and they have some wonderful people working there. The Horizon product got its start as a startup in Boulder. It was a great product to start. It grew organically in some great ways.

As McKesson rushed to be first to market with a comprehensive, integrated solution, they used an acquisition strategy, which led to not achieving that goal of having an integrated product. While they were first to market, they came to the conclusion with their Better Health 2020 announcement that the acquisition strategy created technical, geographic, and personnel challenges. Making an integrated product through an acquisition strategy was not a feasible way to go about it. That was unfortunate because it was a product that early on had great promise.

I would agree with their decision that they’ve made in Better Health 2020. It was no longer an integrated solution. They were right to shift their strategy towards an integrated solution.

I’ve had the fortune of being a product manager and leading the implementation of the Paragon solution, It was a KLAS market leader for smaller community hospitals. They had good satisfaction. For a lot of customers, it was their first EMR.

The idea of trying to get folks that were Horizon customers with higher expectations to move to the Paragon product was premature. It was something that most of the customers did not see as a feasible solution or alternative. That’s what you’ve seen. The vast majority of Horizon customers have gone elsewhere.

The other thing working against Paragon is that the healthcare market, due to other forces, needs economy of scale. You’ve seen a huge consolidation in healthcare. That consolidation has favored EMRs that can handle a large scale, which in our market means Cerner and Epic. When a larger organization consolidates smaller hospitals and organizations, they certainly aren’t going to uptake that smaller community EMR. They’re going to continue to deploy Cerner and Epic. That has contributed to their market dominance.

 

Do Paragon and Meditech have significant problems that would prevent them from being successful in large academic medical centers?

Yes. Paragon right now doesn’t have an ambulatory solution, so people that are making the jump to Paragon right now are putting faith into that product developing into a comprehensive solution. Their ED product is brand new and their ambulatory product does not exist yet. That’s a major limitation for Paragon right there.

With Meditech, they’ve made some great changes in strategy recently. They’re very strong in the market. But a colleague accurately described Meditech as, “The EMR that your materials management department would choose.” It hits all the checkboxes on everything you need, but when it comes to the end user experience, there’s something wanting there. They’re a great organization, they fill a market niche that is needed, and they are moving in the right direction with listening to their customers. They have a lot of great really satisfied customers as well.

 

Will Athenahealth be able to compete with Cerner and Epic via its RazorInsights and BIDMC WebOMR acquisitions?

I would love to see that. Athenahealth’s approach to the private practice or ambulatory market has been that customers want to be health providers, not IT organizations. We’re not in the IT business, we’re in the healthcare business, and I think Athenahealth supports that. Their fundamental makeup gives them the chance to make a run for it. Now if they’re actually going to be successful — that’s yet to be seen. I would love to see a different competitor come in because we know that while Cerner and Epic are dominating the market, they each have their own blights as well.

 

What are the most important initiatives that you see happening in your hospital over the next several years?

One thing that’s come to the forefront has been IT security. This is one that I’m pleased to see has gotten traction, but all of us in healthcare IT have very suddenly gotten large targets drawn on our backs and we need to move quickly. When I see the percentage of organizations out there that don’t have liability insurance for IT, that’s concerning. 

It’s also concerning that a lot of the security incidents that have been reported are around theft or loss. It’s really under-reported because a lot of people don’t know that their systems have been breached. There’s an ignorance factor there as well. As we ramp up that, that’s going to be a major IT initiative — protecting our borders and raising our awareness around protecting our information. I was pleased to see that appear in the State of the Union address.

My other personal belief is that IT security — not just in healthcare, but in all industries — needs to start being addressed as a governmental issue. We have national security protecting our borders. We have a lot of protections out there. Our local municipalities have firemen and policemen. Yet hospitals essentially have to put guards at their doors and bars on their windows when it comes to IT security. We’re on our own to defend ourselves. Something that’s as critical to the US infrastructure as healthcare, financial, and other industries needs to be a larger governmental conversation.

Other than security, we’re looking at the desktop experience for our users. Having a greater awareness and a better experience for those users, especially the clinical users, to be able to roam from PC to PC and carry their session. We were an early adopter of something called Symantec Workspace Corporate and we’re now moving to an Imprivata and VMware combination solution. We’re going to be focusing on improving that end user experience with regards to speed, with regards to single sign-on, and maintaining security while making it easy for the user to carry their session throughout the hospital and for that delivery to be seamless. That also comes into location awareness and the other technologies that can be ahead.

The other item that we’re doing is working with Hill-Rom, which also comes into location awareness with our nurses. For tracking what they’re doing, but also giving them greater communication tools and greater meaningful alerts with some of the smart beds. That’s been an important strategy for us as well.

 

Integration between nurse call systems and IT systems for clinical alert management, communications, bed status reporting, and patient education has been a quiet change. How will that play out as bed manufacturers move into IT and the IT side of the house has the technology they need?

It’s fascinating that the bed management people are trying to figure it out. I had the pleasure of being in a focus group at the last CHIME conference with Hill-Rom. What I understood from them is they’re trying to figure out where there’s going to be overlap and not overextend their business where they’re not going to be welcome or where they’re not going to be able to make progress. 

Longmont United Hospital has been a market leader in throughput and bed management and visibility solutions. We use what I’d call a command center in our shift manager office that has a view of every unit of the hospital. At a glance, you can see the occupancy of every single one of those beds. Over the next year, that will tie into our smart beds that will be connected. You’ll be able to know whether or not the patient is in the room.

It’s also tied into our CPOE system. When new orders are placed on the units, monitors show a map of the unit and there will be an alert showing that there’s new orders on the patient. Or perhaps it would show an alert that this patient is a fall risk or some other identifier for that patient without violating their privacy.

This has been an amazing success for us. It has reached every corner of the hospital. Our environmental services team is using this system where the beds get marked as no longer occupied to quickly identify that the beds are in need of cleaning. During busy periods of time, we can then quickly get patients from the ED into beds. We’re seeing an increased throughput and increased patient satisfaction. It integrates into our EMR. That visibility system has displays on all the units that our environmental services team looks at. if someone in a room has C. Diff, there will be a flag for the environmental services team so they know to use special cleaning precautions for that room. Through that simple alert, we’ve eradicated C. Diff as a hospital-acquired condition here at LUH.

With the smart beds, when a rail drops and a patient is a fall risk, you can have an alert that’s appropriate go to the nurse. We’re seeing a lot of opportunity. We’re also seeing a lot of overlap.

It will be interesting to see where the EMR vendors end and where those bed manufacturers like Hill-Rom and Stryker end. The bed manufacturers are trying to figure that out themselves because they have a lot of great technology that can be helpful, but I think they also know that they might not be welcomed into some markets that the EMR vendors own.

 

Tell me about your palm vein scanning project.

We were looking at how to improve the patient check-in experience. We started exploring kiosks similar to the airline check-in. From there, it evolved into how we would identify the patients as they checked in.

We started exploring the ability to use palm vein scanning technology as a biometric to identify patients. It uses near infrared light to looks at the vein pattern within your palm, which is 100 times more unique to an individual than a fingerprint. It also doesn’t have that criminology sort of connotation that some people associate with fingerprinting, so it has a higher patient adoption rate.

That palm vein pattern is developed in the womb and it’s even unique between twins. It’s a really unique and useful biometric that has high adoption rates among patients where you might not get it because a retina scan is pretty uncomfortable and fingerprinting has the criminology connotation. With palm vein scanning, you can get better adoption.

We’ve rolled that out where the patients need to initially enroll in the program. They go through the normal registration process, provide a form of identification, and then place their palm down onto the scanner. It’s a very simple process. That biometric is saved, so from then on when they put their palm down, we know who they are.

We no longer need to ask them sensitive information. The next time they come in, they have a better experience, because by just simply placing their palm down, they can avoid having to share sensitive information that can be within the earshot of someone else. They don’t have to show their ID every time.

The other places I’ve seen this technology used has been in test-taking, like the GMAT and the SAT, so that when people leave to go the restroom and come back, that they’re not switching for someone else to take their test. It’s also used in some other countries in banking. But I think the use in healthcare has extremely great promise. 

Now that we have people enrolled, we’ll be able to use that as the identifier in the kiosks. In the next few months, we’re going to be installing these kiosks so that when patients come to check in at our hospital, they can simply put down their palm on the kiosk and then immediately be identified. It will ask them for some of their information to verify that it is accurate. If there are updates, they can correct that with the registrar. It will also know if they have a payment due — they can quickly swipe their credit card and we can accept payment there, which makes that more convenient for the patient as well. The purpose here is around improving the patient experience.

The other benefit is something that plagues hospitals and health systems nationally — duplicated and overlaid medical records. We spend a lot of time merging records because of minor differences when they come in. In large metropolitan areas, it is quite common that you have people with the same name and the same birthday whose medical records might be accidentally shared. That can be extremely dangerous since you have clinicians that are making medical decisions for those patients potentially based on someone else’s medical history.

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February 20, 2015 Interviews 1 Comment

Morning Headlines 2/20/15

February 19, 2015 Headlines No Comments

Most Admired 2015

Fortune Magazine names Cerner to its 2015 Most Admired Companies list.

Castlight Health Announces Fourth Quarter and Full Year 2014 Results

Castlight Health announces Q4 and 2014 year end results: Revenue for 2014 closed out at $45.6 million, a 252 percent increase over 2013, but still resulting in an overall $86.2 million operating loss, EPS -$1.16 vs. -$6.28. Stock prices dropped 31 percent Thursday following an analyst’s downgrade.

Oregon Sues Oracle Over Health Insurance Site

Oregon has filed another lawsuit against Oracle, seeking to bar the company from doing business in the state, over claims that Oracle is preparing to pull the plug on hosting Oregon’s state insurance exchange.

U.S. FDA approves 23andMe’s genetic screening test for rare disorder

After a long regulatory battle with the FDA, genetic testing service provider 23andMe earns regulatory approval to market its personal genome testing service. The company is only approved to test for a genetic mutation associated with Bloom syndrome, a rare disorder that leads to an increased risk of cancer.

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February 19, 2015 Headlines No Comments

News 2/20/15

February 19, 2015 News 9 Comments

Top News

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Epic will launch App Exchange, which will publish Epic-compatible software developed by both customers and vendors, in the next few weeks.


Reader Comments

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From Pima Pundit: “Re: Cerner. Saw this on the wall of a Carondelet Health Network office. They’re moving from Greenway Intergy to Cerner.”

From CC Ryder: “Re: Skycare. We implemented their EHR in 2014 to meet Meaningful Use requirements but found out today that the company has ceased operations. They told us that all employees were let go Friday and no further support is available. I’m the EHR champion at our small family practice and could use help understanding how to switch EHRs and any advice on what will happen for our 2015 attestation year.” I will forward information from anyone who can help.


HIStalk Announcements and Requests

This week on HIStalk Practice: Walmart mulls over mobile and telehealth. Laguna Beach Community Clinic and Village Family Practice implement new HIT. A new study finds that the cost of ICD-10 conversion for a small practice is just over $8,000. EHR company adds some robotic sizzle to its 5K. SHIN-NY’s connection costs hamper physician participation. University of Miami Pediatric Mobile Clinic implements new telemedicine IT. Dr. Gregg shares this year’s collection of “Top 10 Dubious HIT Bumper Stickers.” Thanks for reading.

This week on HIStalk Connect: A systematic review of patient portal studies finds few correlations with improved outcomes. Walgreens partners with PatientsLikeMe to embed crowdsourced feedback on medication side effects on its health app. Breakout Labs welcomes its next three startups, all focused on healthcare research. HIStalk Connect interviews Aterica CEO Alex Leyn, founder of a digital health startup building smartphone-connected EpiPen cases.

@JennHIStalk joined Eric Topol, MD and Geeta Nayyar, MD, MBA in a Xerox-sponsored Google Hangout covering patient engagement.

I was helping a friend find a primary care provider for her new UnitedHealth insurance obtained via Healthcare gov. My suggestions, based on having worked in hospitals for nearly forever, was to look for a doctor with these criteria: (a) educated at a decent US-based medical school and reasonably good residency; (b) board certified in internal or family medicine; (c) graduated from medical school no more than 25 years ago since studies seem to show that mortality rates increase with each year after a doctor’s graduation. Extra points for good Healthgrades reviews and an affiliation with a good hospital. We called one doctor and group after another and the answer was always the same – not a single physician who met these criteria is accepting new patients. Nearly every available doctor graduated from a foreign medical school, while some were old enough to make you realize how hard it is to retire from primary care (one graduated from medical school in 1961, which must put him in his late 70s). UnitedHealth’s online provider directory incorrectly listed many doctors as accepting new patients when in fact they aren’t, making for a frustrating couple of hours of calls and web searches figuring out how to make undesirable compromises despite having a top-of-the-line medical plan. I’m beginning to realize that while it’s challenging to find and afford medical insurance, the battle isn’t won once you do.


Webinars

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.


Acquisitions, Funding, Business, and Stock

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Castlight Health reports Q4 results: revenue up 182 percent, adjusted EPS –$0.17 vs. –$1.79, beating estimates for both. Shares dropped 31 percent Thursday following an analyst’s downgrade, dropping the company’s market capitalization to $591 million. Above is the share price chart of CSLT since its March 2014 IPO (blue, down 84 percent) vs. the Dow (red, up 12 percent).

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The Wall Street Journal names as one of its 73 startups valued at more than $1 billion Proteus Digital, whose smart prescription pills report back to doctors and drug companies when patients take their medicine. 

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Fortune places Cerner among its “World’s Most Admired Companies 2015.”


Sales

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Mission Health (NC) chooses Qlik for enterprise-wide visual analytics.


People

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Park Place International names Bob Green (EMC) as VP.

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Anthony Lancia (TriZetto) joins ClaimRemedi as VP of sales.


Announcements and Implementations

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University of Missouri-Kansas City’s Center for Health Insights and Truman Medical Center (MO) will conduct research using de-identified patient data provided by Cerner. The company’s Health Facts Reporting extracts and de-identifies information from its customer databases that sells to drug companies as “the industry’s only data source offering a comprehensive clinical record, with pharmacy, laboratory, admission, and billing data from all patient care locations time-stamped and sequenced.”

ZeOmega launches a maternity management offering for its Jiva population health management solution.


Government and Politics

Oregon sues Oracle and seeks to permanently bar the company from doing business with the state, claiming Oracle reneged on its promise to continue running the state’s Medicaid enrollment system and instead plans to shut the system down at the end of February. Oracle says it made no such promise and the state should have developed a contingency plan, adding that Oregon defamed the company in saying its system isn’t working, then claiming that same system is essential. The state previously sued Oracle over its failed health insurance exchange.


Privacy and Security

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A “CBS Evening News” segment quotes a security expert who says, “Digitized health records are jet fuel for medical identity theft. The healthcare system built a digital record system without building the corresponding privacy-security safeguards.” It points out that HHS has audited only 115 of 700,000 healthcare providers.

NPR’s “All Things Considered” finds Medicare IDs being openly sold on the Internet, with a set of 10 costing $4,700. An expert says healthcare providers have grown to the point they often don’t even know how large their networks are, much less that those networks are secure. A comments says it’s surprising that many providers don’t realize that a Medicare number is just a Social Security number with the letter “A” at the end, while another says she opted out of her physician’s patient portal because the consent form said the company running it isn’t responsible for hacking or even if its own employees steal patient information.

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I Googled how Medicare numbers are created and the comment above is correct: CMS came up with the idea of placing SSNs on cards that 50 million people carry in their pockets, claiming that it would cost nearly a billion dollars to reprogram its systems to use a different ID. GAO wasn’t buying CMS’s excuses, saying it should have considered options to print only the last four SSN digits on the cards or to switch to barcodes or magnetic stripes.


Technology

Automated Assembly Corporation will market its InfoSkin near field communication (NFC) skin stickers to the healthcare industry. NFC allows a smartphone app to communicate with an inexpensive RFID-like tag over distances of a few inches, most commonly to make payments but with potential for identifying patients and communicating with implanted medical devices.


Other

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Chuck Feeney donates another $100 million to UCSF — part of the money earmarked for hospital construction and aging research — raising his total donations to the school to nearly $400 million. The 83-year-old billionaire philanthropist made his money running duty-free shops. Reports say he’s frugal: he doesn’t own a house, uses public transportation instead of owning a car, flies coach, and wears a $15 watch. His motto: “If you want to give it away, think about giving it away while you are alive because you’ll get a lot more satisfaction than if you wait until you’re dead. Besides, it’s a lot more fun.”

Rice University and the Baylor College of Medicine offer a free, four-week online course called “Medicine in the Digital Age” that begins on May 5.

A Forbes article about chief innovation officers says they have 16 months to shake things up radically or risk being fired, providing as an example an unnamed health system CINO who lasted less than three years because he played it safe by choosing board-pleasing, low-impact projects.


Sponsor Updates

  • Greenway Health signs a strategic referral agreement with Orion Health.
  • Park Place International launches a Meditech disk defragmentation solution.
  • NextGen releases the results of its practice revenue cycle management survey, which finds that practices are faring poorly at managing denials and that 35 percent of incoming patient calls involve billing issues.
  • Caradigm announces a solution package to support DSRIP participation.
  • PatientSafe Solutions President and CEO Joe Condurso posts “Reimbursement Continues to Drive Strategy.”
  • Iatric systems integrates its Security Audit Manager with incident response software from ID Experts.
  • Orion Health is ranked as the top “Government Payer and Commercial Insurer HIE” vendor and is a second-place finisher in “Core HIE Systems Enterprise Centric Solutions” in a Black Book Rankings report.
  • Logicworks points out that “Healthcare’s New ‘Anthem’ is Encryption, but Not Everyone Sings from the Same Hymnal.”
  • Intelligent Medical Objects will exhibit at Hack Illinois February 27-March 1 in Urbana, IL.
  • InterSystems talks with Dave deBronkart (“e-Patient Dave”) in its latest blog, “Seeding the Growth of Patient Engagement Through Innovative Interoperability.”
  • InstaMed will present at the World Health Care Congress on February 26 in Orlando.
  • Annie Meurer of Impact Advisors focuses on telehealth in the second part of the company’s blog series on unified communications.
  • Extension Healthcare and Holon Solutions are exhibiting this week at the 2015 Texas Regional HIMSS Conference in Austin. 
  • Healthwise will exhibit at Preventive Medicine 2015 on February 25 in Atlanta.
  • Hayes Management Consulting’s Paul Fox offers “4 Ways to Improve Your End User Systems Testing.”
  • Max Stroud of Galen Healthcare Solutions asks “Are Electronic Notes a Pain Point for Your Physicians?”
  • DocuSign focuses on the Internet of Things in its latest blog.
  • The HCI Group offers “Best Practices to Achieving HIMSS Stage 7.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 19, 2015 News 9 Comments

Monday Morning Update 2/16/15

February 14, 2015 News 6 Comments

Top News

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A national security think tank’s report on military health system reform — written by former government officials General Hugh Shelton, Stephen Ondra, and Peter Levin, all of whom now work for corporations — says the DoD’s $4 billion AHLTA system has a “tortured history” of poor design and lack of interoperability with the VA, and despite President Obama’s specific instructions in 2009 for the departments to develop a joint EHR, “DoD has spent billions of dollars and still not fielded any newly integrated clinician-facing software.” The report adds that the DoD will spend more billions to buy a commercial system that may not serve it well, explaining:

Given the fast pace of technology changes, we hope that DoD will not repeat the mistaken multi-billion dollar decision that will hold it captive to the innovations of any single company or the services of a solitary vendor …DoD is about to procure another major electronic (health records) system that may not be able to stay current with – or even lead – the state-of-the-art, or work well with parallel systems in the public or private sector. We are concerned that a process that chooses a single commercial “winner,” closed and proprietary, will inevitably lead to vendor lock and health data isolation.

Hugh Shelton was formerly chairman of the Joint Chiefs of Staff and is now chairman of Red Hat. Stephen Ondra, MD was a White House health information advisor and is now SVP/chief medical officer of insurance company Health Care Service Corporation. Peter Levin was CTO at the VA and now is CEO of Amida Technology Solutions, which offers applications built around Blue Button.


Reader Comments

From Camino Real: “Re: OpenNotes. Cerner will also be using it as the default.” I’m still interested to learn more about the technology changes required by EHR vendors and how the patient interacts with the EHR.

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From Back to School: “Re: master’s in health informatics. I’m considering the online programs of UCF and USF, but neither is CAHIIM accredited and therefore I can’t sit for the RHIT exams. I’m not sure if that’s a necessary certification when pursuing a career. I would be interested to hear from someone who graduated from an online program.”


HIStalk Announcements and Requests

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Eighty-one percent of poll respondents are skeptical that Athenahealth can turn BIDMC’s homegrown WebOMR into a competitive commercial product. Ann commented that it’s hard to commercialize a system that was built for a specific organization and wonders how much effort Athenahealth will spend on requirements, design, and testing. Reluctant Epic User says the value to Athenahealth will be in using BIDMC’s intellectual property to turn its RazorInsights acquisition into a more capable offering, adding that the big winner is BIDMC, who gets cash for an asset they weren’t willing to monetize and a free 20-year license to whatever Athenahealth develops if they like it. New poll to your right or here: should biometric security protection be mandatory for systems that contain patient information? I would also be interested in hearing from biometric security experts – how reliable is it and why isn’t it more widely used for IT systems in general?

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HIStalk “I want to come” registration will close soon, so it’s your last chance to avoid non-buyer’s remorse in a few weeks.


Last Week’s Most Interesting News

  • The IPO of analytics vendor Inovalon values the company at more than $3 billion.
  • A private equity vendor acquires marketing company BrightWhistle and will merge it with Influence Health.
  • Legislators agreed in a congressional hearing that ICD-10 implementation should not be delayed again and a GAO report finds no major issues with CMS’s readiness for it.
  • Premier announces strong quarterly results and hints at further acquisitions.

Webinars

February 17 (Tuesday) 1:00 ET. Cloud Computing – Cyber-Security Considerations. Sponsored by Sensato. Presenter: John Gomez, CEO, Sensato. This webinar will examine the security challenges involved when healthcare organizations implement cloud-based services.


Acquisitions, Funding, Business, and Stock

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HealthStream will acquire San Diego-based credentialing software vendor HealthLine Systems for $88 million in cash, announcing plans to combine its business with that of Sy.Med Development, a credentialing systems vendor that HealthStream acquired in 2012 for $7 million.

“Fortune” profiles eClinicalWorks , which has grown without venture capital and is run by co-founders who placed their ownership in trusts so that none of them can cash in their shares or try to take the company public. CEO Girish Navani told the reporter, “I don’t need to be the richest man in Massachusetts,” adding that employees like profit-sharing cash even more than stock options since “they can buy stock in Apple.”


Government and Politics

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A McClatchyDC article calls attention to the fact that emails older than six months are fair game for warrant-free US government snooping because the 29-year-old Electronic Communications Privacy Act categorizes anything older than 180 days as “abandoned.” Several bills have been proposed to change the law, one of them by Rep. Kevin Yoder (R-KS), who explains, “The government is essentially using an arcane loophole to breach the privacy rights of Americans. They couldn’t kick down your door and seize the documents on your desk, but they could send a request to Google and ask for all the documents that are in your Gmail account.”

A same-sex married Indiana couple sues the county health department for refusing to list both their names on their child’s birth certificate. The couple changed the “Father” field on the submission form to “Mother No. 2,” but hospital’s software couldn’t handle the change, so the resulting birth certificate listed only one of the women. The county’s health administrator says his department sympathizes, but state law is clear that birth certificates are intended to list only biological parents.

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The title of a Medscape article “House Hearing Dampens Hope of ICD-10-Delay” obviously sees the other side of the ICD-10 argument. It quotes the one negative testimony from the hearing, which came from an Alabama urologist representing the American Urological Association. He said, "Physicians have to have a guarantee that we’re going to get paid if we don’t code right. You’re not going to pay me because I code it wrong? Some doctors won’t be able to do it. Do they deserve the death sentence and be put out of business?” He says doctors have been too busy with Medicare cutbacks and Meaningful use to deal with “another expensive distraction with little demonstrated value to improving direct patient care.”He suggests another delay or a dual reporting option that allows doctors nearing retirement or having hardships to keep using ICD-9.


Privacy and Security

Re/code’s Kara Swisher (the separated wife of White House CTO Megan Smith) interviews President Obama, who says that state-sponsored cyberhacking is too sophisticated for the private sector to defend against without government help, adding that companies within a given sector need to work together to share information since any one of them could be the weak link that exposes the others. Asked how the US government can condemn state-sponsored hacking when it is guilty of the same thing, the President said that international standards should be developed, adding that industrial espionage should never be allowed. Silicon Valley companies that passed on attending the White House’s cybersecurity summit in protest of the National Security Agency’s heavy-handed citizen spying included Google, Facebook, Microsoft, and Yahoo. The President added that he’s looking at wearable fitness trackers and is leaning toward an Apple Watch as his first.

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In England, a 16-year-old hacker publishes a list of vulnerabilities in NHS sites that includes SQL injection flaws, cross-scripting bugs, and administrative logins. The same hacker live-streamed some of his recent attacks, inviting people to watch as he broke into the sites of a travel insurance company and an Illinois university.

A Texas judge dismisses a patient’s lawsuit against a hospital whose systems were hacked early this year, saying that she suffered no injury as a result since her credit card didn’t bill her for the resulting fraudulent charges and use of her Yahoo Mail account to send spam stopped once she changed her password.


Other

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A Florida jury finds that concierge medicine firm MDVIP falsely identified its doctors as superior in the 2008 case of a now-deceased patient whose leg had to be amputated after poor care coordination, awarding her husband $8.5 million. The jury found that the patient’s MDVIP-provided primary care doctor misdiagnosed her circulatory condition and referred her to an orthopedist without providing her medical records. The industry-dominating, 700-physician MDVIP was purchased by Proctor & Gamble in 2009 and sold again in 2014 to a private equity firm that also holds positions in Wellcentive, Modernizing Medicine, Infor, and Meditech. The company does not hire physicians, but instead charges them a franchise fee. MDVIP’s chairman and CEO is also chairman of work site health provider Crossover Health, whose CEO is former Medsphere co-founder Scott Shreeve, MD.

Novant (NC) connects its EHR to the federal health information exchange, allowing it to exchange records with the VA if the patient approves.

“Father of the Internet” Vint Cerf says the loss of medical records in a recent Brooklyn warehouse fire could happen again if priceless original documents are stored only in electronic forms. He worries that the digitized versions of photos or documents are of inferior quality compared to the originals and that software companies may stop supporting those file types, creating “a forgotten generation” of material that can’t be viewed. I immediately thought of all the family memories from the 1990s that are sitting in closets around the world on now-obsolete and decomposing videotape.

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The Toronto Star finally admits it was wrong in running an anecdote-filled, science-light article titled “a wonder drug’s dark side” in implying that HPV vaccine is dangerous and then insulting the scientists who pointed out the article’s many flaws. The publisher now concedes that the headline was misleading, the front-page hysterics were inappropriate, and the story’s emphasis on emotional stories rather than the medical literature was wrong.


Sponsor Updates

  • Medicity puts together “A Year in Review” that offers a snapshot of its 2014 accomplishments.
  • TransUnion Healthcare President Gerry McCarthy writes about “Revenue Cycle Management Solutions: A Shift to Value-based Care.”
  • The SSI Group and T-System will exhibit at the HFMA Dixie Institute February 17-20 in Charleston, SC. ZirMed will present there.
  • Stella Technology launches a company e-letter.
  • VisionWare updates its Resource Library.
  • Verisk Health’s Matt Siegel is profiled in this month’s edition of “Predictive Modeling News.”
  • Voalte CNO Candace Smith, RN writes about her work as co-chair of the 2015 Manasota March for Babies in Florida.
  • Surgical Information Systems will exhibit at the OR Business Management conference February 16-18 in Orlando.
  • Zynx Health’s Siva Subramanian writes in the company blog that, “To Achieve My Vision for Improving Healthcare, We Have to Focus.”
  • Xerox Healthcare will host a February 17 Google + Hangout on patient engagement with Eric Topol, MD, Geeta Nayyar, and Jennifer Dennard.
  • Lynn Schep asks in the SRS “EMR Straight Talk” blog if the MU prayers of providers will be answered thanks to a potentially shortened reporting period.
  • April Truelove of Sagacious Consultants writes about her experience at the ONC Annual Meeting.
  • Perceptive Software’s “In Context” blog features a piece on “Hybrid Cloud: Concept vs. Market.”
  • PDS will exhibit at the February 20 IT United CIO Forum in Milwaukee.
  • Patientco client Grinnell Regional Medical Center’s AVP of Finance, Kyle Wilcox, pens an article on “How compassionate payment collection boosted Grinnell Regional.”
  • PatientSafe Solutions offers a sneak peek at its plans for HIMSS15.
  • Passport Health and RazorInsights will exhibit February 17-20 at the HFMA Dixie Institute in Charleston, SC.
  • Boston-based Jennifer Crowley writes about her “love” of snow and expecting the unexpected in healthcare in the latest MedAptus blog.
  • Navicure VP of Product Management Jeff Wood is featured in an article on “7 Ways to Manage High Medical Bills.”
  • MBA HealthGroup offers “4 Tips to Get Through the New MU Reporting Period.”
  • Nordic’s Abby Polich offers tips on “Extending Your EHR: Preparing for Success.”
  • Netsmart’s Matthew Arnheiter is featured in an article on giving voices to people with speech impairments.
  • Orion Health’s Harish Panchal writes about “Investing in Integration Engines.”
  • PMD’s Clayton Hoeffer offers insight into “Dog-Driven Development.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 14, 2015 News 6 Comments

Readers Write: A Healthcare Tale of Two Continents

February 13, 2015 Readers Write No Comments

A Healthcare Tale of Two Continents
By Ted Reynolds

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An interesting byproduct of growing up American is that we tend to view everything from one perspective – our own. That’s not surprising given our standing in the world and the influence our culture seemingly has.

Over the last year, I had the unique opportunity to work on a significant electronic medical record (EMR) implementation in Europe that forced me to look beyond my singular, American view. What a revelation! During my time working on this engagement, I learned to view healthcare differently and gained knowledge that has proven invaluable to my ongoing work stateside.

While there are some similarities, there are also striking differences in how the US and Europeans approach and deliver healthcare. I thought it might be interesting to compare and contrast these approaches so you can benefit as well from my journey across the pond.

Let’s start with the similarities. My main observation is that change is certain and swift in both the US and Europe. The status quo on both sides is giving way to new ways of thinking, partly driven by technology.

We have greater access to larger amounts of data today, and as a result, the unprecedented opportunity to improve care and outcomes while reducing costs. With healthcare costs continuing to climb in the US and economic recovery slow worldwide, we simply cannot afford to continue with the old models of care delivery.

My experience working in Europe gave me a unique “outside looking in” perspective on American healthcare.

For instance, the big US EMR wave has passed. According to the December 2014 HIMSS Level 7 survey, nearly two-thirds of hospitals now have computerized provider order entry (CPOE) and an EMR implemented. In this area, the US is well ahead of our European counterparts, so we have more patient data than ever before.

However, many organizations have yet to recognize the promised results out of these systems despite significant investment. The focus for US healthcare today has turned towards reducing costs, improving quality through performance improvement and optimization efforts, and making better use of the available data through analytics.

Another US trend is increased merger, acquisition, and affiliation activity among providers. I believe this will most probably affect the one-third of organizations that have not yet implemented new EMR technology. They will likely seek to join with (or at least establish an extended EMR relationship with) stable organizations in order to remain competitive and control costs. IT issues surrounding these new arrangements are enormous. Among the top concerns we’ve seen in these arrangements are the initial loss of control and resulting service levels from the hosting organization.

Finally, call it what you will — accountable care, population health, value-based care, pay-for-performance, etc. — rising healthcare premiums and deductibles will continue to drive the migration from fee-for-volume to fee-for-value. This change will have substantial IT implications – some known, others yet to be seen. Some of the most visible are:

  • Health information exchanges (HIEs) or other forms of data interchange between disparate systems will no longer be a “nice to have.” The downside of our EMR implementation wave is that we now realize the problems associated with absence of real data interchange. This issue must be addressed if we are to recognize the full potential of electronic data.
  • Data analytics become essential. The healthcare industry must unravel the data to information to knowledge to real action transformation in order to demonstrate value. Data analytics will help hospitals and health systems better understand and apply best practices to enable care standardization among providers – a key step necessary to thrive in a landscape heavy on bundled payments and other shared risk plans.
  • Revenue cycle technology replacement and optimization will become an increasing priority as many were originally implemented in reaction to Y2K. These outdated systems cannot adapt to the variations and requirements that new risk-based contracts bring and must be upgraded to new, more flexible systems.

Conversely, the EMR wave in Europe has just begun.

Several large American integrated vendors are starting to work their way across the pond and into new markets. It will be interesting to see if they take some of the lessons learned in the US market (especially around interoperability) and apply them there.

Some of these transitions may be eased in a socialized medicine environment, which has one reimbursement model for an entire country – as opposed to the large variety of complex reimbursement models in the US. A single reimbursement model has the opportunity to significantly streamline billing.

Although the revenue cycle and financial applications in Europe vary greatly from those here in the US, the clinical workflows are very similar. On one of the large EMR implementations I worked on in Europe, the hospital used 90 percent of the American vendor’s clinical model workflows as-is.

On the other hand, Europe’s procurement cycle is extremely long, similar to that of US federal and state organizations. Given the rapid pace of change in healthcare today, I would expect to see Europeans accelerate that process over time.

Many European countries are ahead of the US in establishing national health identifiers and national provider registries. This puts them in a much better position to share data about patients across providers. They are also doing a better job of delivering high quality outcomes at lower costs.

Finally, due to the size of the various national markets, you do not see the proliferation of large, homegrown software vendors as observed in the US. This has made these countries targets for established American EMR vendors such as Cerner and Epic.

My takeaway from my time working in the European healthcare market and the opportunity to attain an “outside looking in” perspective on the US market is quiet simple. We both have much to learn and can learn a lot from each other.

Ted Reynolds is senior vice-president of CTG and is responsible for CTG Health Solutions

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February 13, 2015 Readers Write No Comments

HIStalk Interviews Tim Elliott, CEO, Access

February 13, 2015 Interviews No Comments

Tim Elliott is CEO of Access of Sulphur Springs, TX.

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Tell me about yourself and the company.

We started the company about 15 years ago based on some needs that a customer had. It was with another one of our companies at that time. It grew into what it is today. We deal with enterprise forms management.

I grew up in a family that was in the multifunctional hardware business. The need for forms came out of that.

 

What’s going on with electronic forms in healthcare?

It has changed a lot. When we first started, everyone needed the ability to get rid of pre-printed forms. So we first started, it was all about output of forms — current forms, forms with barcodes, and that sort of thing. That’s been the legacy piece that we’ve been dealing with for probably the last 10 or 12 years.

About five years ago, we bought another company called Formatta out of Virginia and it changed what we’re able to do. So many of our customers were wanting to go completely paperless. Everything we do now is dealing with paperless, web-based forms.

 

What are some creative things customers have done outside their core EHR functionality?

We’re gap fillers. A facility buys Epic, Cerner, Siemens or Meditech. Every facility has most of the same needs, but they all have different workflows and processes. The big EMRs are good at addressing all the big stuff. We go in and help deal with the little stuff.

Some systems don’t have great procurement systems. We have the ability to have automated purchasing systems, where you’re signing off on POs and requisitions. We have a customer in Kansas City who runs a lot of their HR — their customer-facing or their employee-facing stuff — directly off our solutions. They’re using some pretty big EMRs and some pretty big HR systems.

Every customer does something a little bit different. Our customers have driven some interesting solutions that we never thought of. A lot of things that we market came from our customers. They didn’t necessarily come from our minds.

That’s really what’s fun about what we do. We go into every healthcare facility with some specific things we know that are issues, but we get a lot of, “Wow, that’s really neat, but wouldn’t it be cool if we could do this?” or, “We’ve been trying to solve this problem for five years and this might do that.” We began discussions around that and the light bulb goes off. They start seeing how something like this could fix some of those things. We fix it electronically instead of with paper or additional processes.

We’ve worked over the three to four years on integration. It’s one thing to have a paperless front end, but what happens to the data? What happens to the forms at the end? We’ve gotten really good at the integration — where do these things reside, where do they go, where do they attach, what records do they go into?

 

When you’re talking to CIOs, what seems to be worrying them most these days?

Cost. Dollars. Most of them have spent so much on investing in IT solutions or trying to get some of the money coming in. It’s not as much about the solutions that fulfill the daily needs, but how can we get by and how can we get everything in place in order to meet the regulations? 

The people who are working out in the departments are aware of that and that’s important to them as well. But they’re really concerned with, how do I keep this from being a three-day process? How can we make this a one-day process or a one-hour process?

Someone pays many millions for Epic, Cerner, Siemens, Meditech or whatever it may be. About two to three years down the road, they start addressing some of those things. They all think it’s going to be paperless and everything’s going to be great with the world and it’s going to solve all their problems. Then the paper starts seeping through the concrete a little bit to the top. They’re starting to see those gaps and we’re able to address those.

 

Once your system is installed, do super users create the applications or does IT have to do it?

It depends on the facility. Usually we’ll go in and implement based on a need. They have a particular need or problem they’re trying to fix. We’ll go in and help and implement around that. Our professional services people will help them solve that. But then we’ll train a super user on how to replicate that, or how to fix the problem. 

We have different types of customers. We have some that have incredible admins that are doing an incredible job of understanding what it does. We’ll call them in three months and they will have fixed four other things that we weren’t even aware of when we first started with their work flows. Then we have some users that need our help and we push them a little bit here and there. Then we have some that just say, come in every six months, look what we’ve got, find our gaps, and help us fill those. But most of our clients do a lot of it themselves.

 

Are you using newer technologies such as web-based forms and smartphone form entry?

We’re doing a lot. In the last year and a half, we’ve done a lot of development on the app side where we can use iPads and iPhones. It’s a question of which is the best platform to do certain things on. How do you do it on the iPad screen or a Surface screen or an iPhone screen or a Samsung Galaxy screen? All those are different. How can you make that experience right for all of them? That’s what we’ve worked on the last two years. 

We’re getting there and we have customers using it now. We have a couple of international customers that are going to do some incredible stuff with it with the iPad. Patient-facing forms, patient-facing stuff on the web or on an iPad or a Surface there in the facility.

 

As a gap filler, do you worry that other companies will widen their reach and step on your turf?

They do. We’re partners with a couple of EMR vendors. Their goal is to try to fill all the needs of their clients. The reality is that, at the beginning, they can’t. As they build a new version, they push that out to their clients. Those clients see holes and they ask for those to be filled. They can’t fill all those immediately. I takes four, five, or six years before they can meet all of those. That’s where we fill those gaps until their vendors can fill those. By that time, there’s other gaps that we fill.

We’ve been doing that for 15 years. We don’t try to take the place of their EMR. All we try to do is fill those gaps until they can be served by that vendor. We’re usually finding other things around it. Once our customers install our solutions, they keep them there a long time. It’s just not always the same solution at the end that it was at the beginning.

 

Where do you take the company from here?

We’re looking at a lot of interesting things. We’ve had more change in our customer base in the last two years than we’ve had in the last 15 and that’s good. We’re focusing on is the integration part, integration directly inside of some of the EMRs. With a lot of our web-based solutions, we’ve found some really nice niches. I’m sure that everyone will hear more about this in the next year or two. But really doing some neat things around trying to make the experience better not only for the patients in the facility, but also all the team members inside of the facility, giving them an ability to do things easier, faster, better, and paperless.
What you’re going to see from us in the next year or two is a lot of integration directly with the EMRs, a lot of integration with the data back into multiple places so that it can be analyzed, used, played with, understood, all those things. That’s where our focus has been the last two years and what you’re going to see from us the next two.

 

Do you have any final thoughts?

Access is a development company. We do a lot of fun things, but our favorite thing is listening to what our customers are saying and filling those gaps they have. They’re the ones that make us better. This healthcare thing that we’re all in is really about users and customers and what they want. We’ve been very, very blessed to be able to have team members on our side who listen well and develop around that. We’re excited to see what the next two or three years have for us.

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February 13, 2015 Interviews No Comments

News 2/13/15

February 12, 2015 News 3 Comments

Top News

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Shares of analytics vendor Inovalon (renamed from MedAssurant in 2012) started trading on the Nasdaq Thursday with a first-day price increase of just under 10 percent. The Bowie, MD-based company’s market capitalization is $3.3 billion. Chairman and CEO Keith Dunleavy, MD, who founded the company, holds 44 percent of the shares, valuing his stake at nearly $1.5 billion.


Reader Comments

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From Rude Boy: “Re: Epic. They are adding OpenNotes capability to their system.” Verified. Epic will not only add OpenNotes capability to its base product and to MyChart, it will turn the capability on by default. Providers can still choose which notes the patient can see. I’m interested in what other EHR vendors are doing to support OpenNotes since I hear a lot about the concept, but not much about how vendors are retooling their products to support it.

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From Chill Wills: “Re: Deloitte. MedCity News blew this story.” Indeed they did, and all they had to do was reword the press release to look like real reporting (i.e., practice normal healthcare IT journalism). Not only did they misinterpret a routine Deloitte announcement about a new EHR consulting package in thinking that the company built and released an actual EHR, they also misspelled “Deloitte” in the article body as well the name of Deloitte’s Mitch Morris. MedCity just sold out to another company, so maybe they were over-celebrating.

From Chiaprism: “Re: HIPAA violations. A hospital nurse claimed I couldn’t stay overnight in my inpatient boyfriend’s room because that would be a HIPAA violation.” It is surprising at how often HIPAA is invoked incorrectly in an attempt to bolster an losing argument. A friend recently tried to make a doctor’s appointment for her 90s-age grandmother and was told by the barely-legal receptionist that it’s a HIPAA violation for someone to make an appointment who doesn’t have the patient’s power of attorney, which is clearly ridiculous. They wanted a faxed copy of the document sent to their fax number, which turned out to be disconnected, so my friend just called up pretending to be her grandmother and the receptionist violated HIPAA herself in providing patient details such as her conditions and medications.

From Matthew Holt: “Re: HIStalkapalooza. I was the one who requested you bring the band from Orlando and am ecstatic they’re back. My first and last time influencing anything on HIStalk! Now I just have to hope I get a  party invite!” I was skeptical when Imprivata chose the band as sponsors of last year’s event since I don’t usually like pop cover bands, but Party on the Moon was a big hit and filled the dance floor.  I probably would have misguidedly chosen a Finnish death metal band whose lead singer would have crashed hard to the floor as mosh-averse IT-type audience members scattered away from his stage dive landing zone instead of catching him.


HIStalk Announcements and Requests

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Signups are still open to attend HIStalkapalooza on Monday evening of the HIMSS conference. Submit your information if you want to attend – even if you’re a sponsor, long-time supporter, or VIP, I still can’t invite you if I don’t know you want to come. The priority order for invitations is providers in hospitals or physician practices (I generally invite every hospital employee who signs up) and then Platinum-level HIStalk sponsors (they’re guaranteed two tickets each). That still leaves the majority of invitations for other folks who sign up, and if I have enough capacity to invite everyone on the list, I will.

This week on HIStalk Connect: Blueprint Health unveils its newest class of startups. VisualDx rolls out a global emerging diseases tool designed to help doctors diagnose infectious conditions. Noom partners with Viridian Health to advance diabetes care.

This week on HIStalk Practice: DigiSight Technologies raises a new round for ophthalmology. Frontier Behavioral Health goes with CoCentrix EHR. Vermont governor takes VITL to task for its Super Bowl ad. Michigan’s REC achieves MU goals. Azalea Health and Imprivata launch new services. Burgeoning physician social networks highlight healthcare’s fascinating "ick" factor. KiddoEMR CEO Joe Cohen, MD shares frustrations, challenges of private-practice HIT. Brad Boyd offers insight into gauging patient access performance. Thanks for reading.

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Welcome to new HIStalk Platinum Sponsor Cureatr. The New York City-based company, founded by a group of physicians, offers the nation’s leading mobile care coordination solution. It provides real-time care transition notifications (including group messaging and photo sharing), cross-platform secure messaging, and clinical workflow tools (including best practice checklists) to eliminate interruptions in care, saving time and money in the process. Providers use an organizational directory to check team member availability and to send urgent messages. One hundred percent of clients report faster response time and improved coordination, with physicians saving an average of 90 minutes per day and nurses saving 60 minutes. Hospitals use it to expedite clinical decision-making and streamline care delivery, specialty care providers benefit from connecting with referring providers and extending their services, and physician groups use it to navigate patient care and influence care decisions. I interviewed founder and CEO Joseph Mayer, MD a year ago, when he said, “The next 12 months is really about what’s coming after messaging. Optimizing the care team mapping side of things, i.e. routing of messages to the right person at the right time, or routing information at the right time beyond messaging, task management.” Thanks to Cureatr for supporting HIStalk.


Webinars

February 13 (Friday) 2:00 ET. Inside Anthem: Dissecting the Breach. Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. The latest intelligence about the Anthem breach will be reviewed to provide a deep understanding of the methods used, what healthcare organizations can learn from it, and how to determine if a given organization has come under similar attacks. Attendees will be able to ask questions and put forth their own thoughts. 

February 17 (Tuesday) 1:00 ET. Cloud Computing – Cyber-Security Considerations. Sponsored by Sensato. Presenter: John Gomez, CEO, Sensato. This webinar will examine the security challenges involved when healthcare organizations implement cloud-based services.


Acquisitions, Funding, Business, and Stock

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The Advisory Board Company reports Q3 results: revenue up 15 percent, adjusted EPS $0.26 vs. $0.26, beating expectations on earnings and meeting on revenue. Above is the one-year ABCO share price chart (blue, down 13 percent) vs. the Nasdaq (red, up 14 percent). The company’s market capitalization is $2.2 billion.

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Advisory Board Chairmen and CEO Robert Musslewhite announces in the company’s earnings call that it has acquired clinically-focused advisory firm Clinovations.  

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Vocera reports Q4 results: revenue down 14 percent, adjusted EPS –$0.10 vs. $0.03. Above is the one-year VCRA share price chart (blue, down 46 percent) vs. the Dow (red, up 11 percent). The company’s market capitalization is $234 million.

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From the Cerner earnings call:

  • Bookings for the quarter hit a record $1.16 billion, with 28 percent coming from outside the Millennium customer base.
  • Expenses involved with the $1.37 billion Siemens Health Services acquisition will reduce margins by a few percentage points until 2017.
  • The company says early purchasers of niche population health solutions are already kicking those products out just 18-24 months later as they look for tools that can aggregate data from multiple systems and insert real-time information into clinician workflow.
  • The company’s Siemens-related work will be focused this year on (a) migrating those customers who want to move to Cerner products, and (b) selling the former Siemens customers services such as process optimization and performance improvement.
  • Cerner will continue to sell Soarian Financials as a standalone product, saying surprising demand exists for standalone patient accounting applications.
  • Cerner plans to go live with some of its Intermountain work in Q1.

 

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Private equity firm Silver Lake acquires Atlanta-based healthcare marketing technology vendor BrightWhistle, which it will merge with its existing portfolio company Influence Health (the former Medseek).


Sales

Ocean Health Initiatives (NJ) chooses Forward Health Group’s PopulationManager and The Guideline Advantage.

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Hospital CIMA San Jose (Costa Rica) chooses Allscripts Sunrise for its 62 beds.


Announcements and Implementations

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Epic announces on Open.epic.com that its FHIR testing sandbox is live, with formal FHIR production support planned for a June release.

PerfectServe signed 29 new client contracts and had 260 go-lives in 2014, with 45,000 clinicians using its communications platform.  

Saint Francis Medical Center (MO) begins its Epic implementation, with an expected go-live in July 2016.

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Stanford Health Care releases its self-developed iOS 8 mobile app that connects with Epic and Apple’s HealthKit.


Government and Politics

Legislators and providers agreed in a congressional hearing Wednesday that ICD-10 implementation should not be delayed further. Video of the meeting is here. Chairman Fred Upton (R-MI) commented, “The United States is one of the few countries that has yet to adopt this most modern coding system. Australia was the first country to adopt ICD-10 in 1998. Since then, Canada, China, France, Germany, Korea, South Africa, and Thailand – just to name a few – have all also implemented ICD-10. In the United States, Congress, through one vehicle or another, has prevented the adoption of ICD-10 for nearly a decade.”

GAO is accepting nominations through February 27 for openings on the HIT Policy Committee in the areas of consumers, providers, health plans, and quality reporting.

The VA says its Janus viewer, which visually merges a patient’s VA and DoD EHR records on the screen, will be made available to third-party care providers in about a year. The VA will send a service member’s doctor a link rather than attaching full records to an email.


Privacy and Security

A 60-year-old man sends a phony recruiter $4,300, scammed into thinking he was being offered a job with Cerner by email, not finding it unusual that the recruiter demanded that he send money to pay for his company PC before starting work.


Innovation and Research

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AHRQ-funded researchers at UCSD roll out a “lab in a box” that uses a camera, microphone, keystroke monitor, and Microsoft Kinect sensors to measure how EHR use affects patient encounters, such as analyzing how much time doctors spend looking at the screen instead of the patient. The researchers plan to compare distraction levels across practice settings, provide data to help EHR vendors write less disruptive software, and possibly even warn doctors in real time that they aren’t paying enough attention to their patient.


Technology

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Techcrunch profiles CliniCloud, which has launched a Bluetooth-connected stethoscope and non-contact thermometer kit. Its app is integrated with Doctor On Demand, which provides video chats with doctors to discuss the results. The device will ship in July and can be pre-ordered for $109.

In Chicago, the MedEx ambulance service rolls out 10 ambulances equipped with Google Glass to allow paramedics to live-stream hands-free audio and video to hospitals.


Other

Two Epic technical writers file lawsuits against the company that claim they should have been paid overtime, with both suits seeking class action status. The technical writers say they should have been categorized as hourly rather than salaried employees since their jobs don’t require advanced knowledge or computer expertise. Epic has offered to settle a previous similar suit brought by its quality assurance employees for $5.4 million.

A market research firm says that health IT jobs are harder to fill in New York than anywhere else in the country.

A South Florida “doctor and entrepreneur” launches ClickAClinic, which he says is the state’s only telemedicine services provider that’s licensed as a clinic. I suspected from the use of the title “Dr.” without further explanation that the “doctor” wasn’t an MD, which turned out to be true – he’s a chiropractor. I would never engage any service from someone who uses the title “Dr.” in front of their own name instead of their actual degree since they’re either egotistical or trying to hide something. A lot of MDs (and particularly the wives of male MDs) introduce themselves in purely social situations as “Dr. John Smith” as though the guy at Home Depot or the neighbor down the street really cares.

Facebook rolls out an option that will allow a user to name a “legacy contact” who can explain to breathless followers that the stream of cute videos, quiz results, and click bait “likes” has been sadly interrupted by their faithful curator’s demise.


Sponsor Updates

  • Nuance’s Clintegrity 360 Facility Coding topped the “Best in KLAS Awards” in the Medical Coding category that had been dominated by another vendor since 2008. Clintegrity 360 Quality Management Solutions also was named a category leader.
  • PatientSafe Solutions President and CEO writes “Prepare for Post-EHR Era with Actionable Data Delivered in Clinical Context.”
  • Stella Technology offers “HIE Implementation Tips & Tricks.”
  • Healthwise wins international awards for two of its health videos. 
  • Lifepoint Informatics opens up registration for its User Conference March 18-19 in San Diego.
  • LifeImage’s Mike Murphy writes about “Medical Image Exchange for Cancer Care: More Collaboration and a Better Patient Experience” in the latest company blog.
  • Kathleen Aller of InterSystems explains that “You CAN Get There from Here: Navigating Interoperability.”
  • Intellect Resources President and CEO Tiffany Crenshaw explains in the latest company blog that “Hiring Top Tech Talent Requires an Investment in People.”
  • InstaMed asks healthcare payers to participate in its Healthcare Payments Annual Report survey.
  • IngeniousMed’s Brian Vice is featured in a “CBS Evening News” segment on job growth.
  • Impact Advisors Principal Robert Faix shares insight into how hospitals are getting hacked.
  • Healthgrades sponsors the inaugural Special Olympics dual slalom race at the Winter X Games in Aspen, CO.
  • Healthcare Growth Partners advises Keais Records Service on its recapitalization by CapStreet.
  • HCS will participate in the February 19 HFMA event – “Emerging Management Challenges in the Physician and Hospital Arena” – in Philadelphia
  • The HCI Group is named to the University of Florida’s inaugural 2015 Gator 100.
  • Clara Hocker of Hayes Management Consulting offers tips on “Building a Better Billing Office: What You Need to Know” in the latest company blog.
  • DocuSign offers digital best practices for digital business success. 
  • Erin Michaud asks, “Why is a Project Manager Important to Your Clinical Data Conversion?” in the latest Galen Healthcare Solutions blog.
  • Extension Healthcare will exhibit at the Texas Regional HIMSS Conference February 19-20 in Austin.
  • Greythorn Managing Director Richard Fischer shares insight into the shortage of “right skills” in IT.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 12, 2015 News 3 Comments

Morning Headlines 2/11/15

February 10, 2015 Headlines No Comments

Cerner Reports Fourth Quarter and Full Year 2014 Results

Cerner announces Q4 results: revenue up 16 percent to $1.16 billion, adjusted EPS $0.47 vs. $0.39.

Premier, Inc. Reports Fiscal 2015 Second-Quarter Results

Premier, Inc. announces Q2 results: revenue is up 19 percent to to $294 million, EPS $0.36 vs. $0.31.

Is Your Doctor’s Office the Most Dangerous Place for Data?

ABC News cover the rise of hackers migrating toward the healthcare space, an industry that finds itself 10-years behind financial services in terms of protecting consumer information.  

WakeMed posts $3M Q1 income, goes live with electronic records

WakeMed goes live with its $100 million Epic install.

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February 10, 2015 Headlines No Comments

News 2/11/15

February 10, 2015 News No Comments

Top News

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Premier, Inc. announces Q2 results: revenue up 19 percent, adjusted EPS $0.36 vs. $0.31, beating analyst expectations for both. President and CEO Susan DeVore says the company will make more technology acquisitions following its recent buys of TheraDoc, MEMdata, SYMMEDRx, and Aperek, noting an interest in supply chain analytics, alternate site, ambulatory data, and population health.

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DeVore adds that HHS’s fee-for-value push will increase the need for the company’s technology related to quality and clinical analytics, labor analytics, infection surveillance, and population health. Above is the one-year share price chart of PINC (blue, up 0.6 percent) vs. the Nasdaq (red, up 14 percent). The company’s market capitalization is $1.32 billion, with DeVore holding shares worth $7.3 million.


Reader Comments

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From Smartfood99: “Re: Ohio Valley in Wheeling, WV. Chose to upgrade to Meditech 6.1, beating out other finalist Ohio State University’s farm out of Epic.” Unverified.

From Webejammin: “Re: patent trolls. They’re using ONC’s list of certified EHRs to file suits using old patents that never should have been issued. This will dampen innovation and increase the cost of EMRs.” It’s not hard to get a list of EHR vendors from ONC’s list or elsewhere. Nor is it hard to find an old, intentionally vague patent and use the threat of an expensive legal defense to coerce EHR vendors into paying settlements or licensing arrangements whose cost is intentionally placed at the extortionate sweet spot between “annoying” and “profit-threatening.” Thank your lawyer-heavy Congress for its resistance to embracing the “loser pays” frivolous lawsuit policy that would increase unemployment among our vastly superior US force of ambulance chasers.

From Dingman: “Re: companies in financial trouble. You probably see some of that firsthand when they either are slow to pay their sponsorship or don’t renew because of financial issues.” I could indeed, although I usually lose sponsors instead because (a) they get acquired, or (b) a new marketing person who doesn’t even know what HIStalk is decides to wield their low-level decision-making power in deciding not to renew, which sometimes gets them in trouble down the road with their executives who wanted to support HIStalk in the first place. Sometimes I do hear directly from companies that their budget has been cut or executive upheaval is so extensive that they can’t even figure out who has purchasing authority, which might involve more transparency than customers get.


HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Galen Healthcare Solutions. The Grosse Pointe Farms, MI-based professional and technical services consulting firm also offers products for Allscripts TouchWorks  — remote patient monitoring, integrated health calculators, downtime chart review, note form reporting, and reporting. Technical services include EHR conversions, integration, technical consulting, and contract programming, with experience in Epic, eClinicalWorks, Allscripts, Meditech, Orion, Medfusion, and others. Galen helped Citizens Memorial Hospital (home of one of my favorite CIOs, Denni McColm) convert an acquired Allscripts-using practice to its Meditech system, bringing over 1.5 million documents and 3.5 million test results. Galen’s full (and huge) client list is available freely online along with client testimonials. Thanks to Galen for supporting HIStalk.

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Sign up now to attend HIStalkapalooza on April 13. The “I want to come” form is still open, but that won’t be true for much longer. Every year I get annoyed at people who email after signups close to insist that they weren’t aware that it had taken place and demand special treatment, which generates little sympathy from me because that tells me they don’t really read HIStalk. On the other hand, I’m amused by some of the creative uses of the comments field on the form from the responses so far:

  • On a Cerner life raft in an ocean of Epic. Would love to come and party with the smartest, coolest people on this blue planet.
  • Is there a more senior VC in HCIT? What do I gotta do?
  • I figured since even you were filling out the "I want to go" form, so should I! ;)
  • I went two years ago and loved it!!! I didn’t get an invite last year :( I hope I am still a cool kid!
  • [enter pithy/witty comment that guarantees entry here]
  • Often watched the big party bus roll out without me while I searched the conference town for tourist food. I had the HIMSS blues, man.
  • Can we get the band from last year? They were brilliant!

I took over running the event myself this year with the support of multiple sponsors so that I could invite more people, and so far it’s looking good for covering the cost of a big guest list. House of Blues is an amazing venue and I will indeed be bringing back last year’s musical entertainment, Party on the Moon, America’s #1 private party band. I’m hoping the winner of the “Healthcare IT Lifetime Achievement Award” will accept the award on stage. I’m also contemplating whether the individual named as “Industry Figure in Whose Face You’d Most Like to Throw a Pie” would be willing to receive delivery of said pie in public, possibly delivered by the second-place vote-getter (I might be able to mount a charitable fundraising campaign rivaling the Ice Bucket Challenge to shame both parties into participating).

One more HIMSS-related event item: we’ve emailed HIStalk sponsors about our networking reception on Sunday, April 12. Email Lorre if you’re a sponsor and you want to come because sometimes we don’t have good company contacts.

I could use some help from folks willing to critique the recorded rehearsals of our webinars, suggesting to the presenter what they might change for the live event. Provider CIOs, CMIOs, or other hospital IT types are ideal given the topics often covered. I’ll send a $50 Amazon gift card in return for the 45 minutes or so it takes to watch the video and fill out the eval sheet. Email me if you’re interested.


Webinars

February 13 (Friday) 2:00 ET. Inside Anthem: Dissecting the Breach. Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. The latest intelligence about the Anthem breach will be reviewed to provide a deep understanding of the methods used, what healthcare organizations can learn from it, and how to determine if a given organization has come under similar attacks. Attendees will be able to ask questions and put forth their own thoughts. 


Acquisitions, Funding, Business, and Stock

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Hitachi Data Systems will acquire Orlando-based business analytics tools vendor Pentaho, which has some healthcare-related customers and partners, for $500 to $600 million.

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Aventura raises $14 million in an oversubscribed Series C funding round and will use the proceeds to expand its awareness computing services and product development.

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Image-sharing cloud vendor LifeImage raises $2.6 million in funding, increasing its total to $68 million.

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Shares of Merge Healthcare jumped substantially in the past week in hitting a 52-week high Monday, doubling in price since October. Above is the one-year share price chart for MRGE (blue, up 101 percent) vs. the Nasdaq (red, up 14 percent).

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Cerner announces Q4 results: revenue up 16 percent, adjusted EPS $0.47 vs. $0.39, meeting earnings expectations and beating on revenue.


Sales

Frontier Behavioral Health (WA) chooses the CoCentrix Coordinated Care Platform as its EHR and care management tool.

Quintiles signs a five-year contract with the National Football League to track player injuries using the league’s EHR data.


People

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AMC Health names Jonathan Leviss, MD (WiserCare) as SVP/medical director.

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HIMSS names Michelle Troseth, MSN, RN, chief professional practice officer of Elsevier Clinical Solutions, as  the recipient of its Nursing Informatics Leadership Award.

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Joe Miccio (ESD) joins Impact Advisors as VP.

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Brigham and Women’s Hospital promotes David Bates, MD to SVP/chief innovation officer.

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Adam Wright, PhD, who leads a biomedical informatics team at Harvard Medical School, is promoted to associate professor of medicine.

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Kaiser Permanente names interim CIO Dick Daniels to the permanent position. He was previously SVP of enterprise shared services.

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Personalized medicine analytics vendor Kyron names Jacob Reider, MD (ONC) as chief strategy officer.

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Cumberland Consulting Group names board member Brian Cahill (LifeImage) as CEO. His predecessor, founder Jim Lewis, moves into the board chair role.

Surgical Information Systems names John Spiller (Origin Healthcare Solutions) as CFO.


Announcements and Implementations

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WakeMed (NC) goes live with Epic.

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Imprivata launches Confirm ID, which supports DEA-mandated policies for electronic prescribing of controlled substances.

The US Patent and Trademark Office awards DR Systems seven imaging-related technology patents.

Divurgent and Sensato will jointly offer healthcare cybersecurity and privacy services and will host Hacking Healthcare 2015 in March.

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Cone Health (NC) issues easy-to-read patient bills using Patientco’s PatientWallet.

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PatientSafe Solutions expands its clinical communications tool and renames it PatientTouch Clinical Communications.


Government and Politics

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A GAO report seems satisfied that CMS is ready for the ICD-10 implementation date of October 1, 2015, although it seems to have looked more at CMS’s responsiveness to suggestions than its actual technical readiness.

The New York Times calls out little-noticed White House budget language that urges Congress to eliminate the financial incentive for hospitals to buy physician practices so they can charge more for delivering the same services to patients.


Privacy and Security

The largest insurer of the Lloyd’s of London insurance marketplace says that breaches — such as the one just experienced by Anthem — involve financial risks that are too large for insurance companies to cover, suggesting that only governments have the resources to manage those liabilities. Insurance companies worry that multiple cybersecurity insurance customers could be hit by the same exploit simultaneously.

ABC News asks, “Is Your Doctor’s Office the Most Dangerous Place for Data?” citing the FBI’s warning that healthcare organizations are being targeted and quoting a security expert who says healthcare is 10 years behind the financial services sector in protecting consumer information such as Social Security numbers.

A Swedish biohacking group offers to replace the security key fobs used by a high-tech building’s employees with a palm-embedded RFID chip that allows them to wave their hand to unlock doors, activate the photocopier, and pay their cafeteria bill. The group says the chips could be used to make payments and replace fitness trackers.

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Reporters are trying to create a story around whether Anthem was irresponsible in not encrypting its customer records. I’m not an expert, but my minimal exposure to encryption involves three types: (a) encrypting a secure online session connection such as with SSL; (b) encrypting a storage device so that nobody can dig into its contents without logging on with the appropriate credentials; and (c) encrypting individual database elements so that they can’t be queried without logging on with the appropriate credentials. The only relevant form in Anthem’s case would seem to be (c) and that wouldn’t have helped since the attackers stole a database administrator’s credentials via a phishing attack. Encrypting data at rest is great for physical protection (a stolen disk drive or a physically breached data center) but otherwise the system doesn’t know that the correct login was used by an unauthorized person, short of using biometrics or privileges tied to IP address. I think the story is misleading, but I’ll defer to any experts who care to respond.

Anthem’s hackers knew that database credentials would give them access to everything, so perhaps the immediate health system to-dos would be (a) review users who possesses DBA credentials; (b) monitor the use of those credentials for irregularities, such as large queries that are run off hours or that involve outside that individual’s normal job scope; (c) monitor for large data transfers outside the firewall; (d) enlist DBAs to help watch for problems since they were the ones who detected the Anthem breach; and (e) put efforts into anti-phishing technology and user education rather than worrying about encrypting databases on the off chance that someone will physically steal a server. I really don’t understand in this day and age why we haven’t moved to biometric security instead of the easily pilfered “what you know” password – our data center doors are more technically secure than the systems they house.

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Several Atlanta-area businesses fall victim to ransomware, where malware encrypts the files on a user’s PC and demand anonymous payment to restore access. A Secret Service representative says that physician offices are targets since their often-unsecured wireless networks can be hacked from their parking lots, although I would have assumed the method of infection would be via other methods.


Technology

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Google will incorporate Mayo Clinic-curated information into its medically related search results, providing symptoms and treatments via its Knowledge Graph and Now personal assistant (which I’ve never heard of).

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Medical device manufacturer DexCom will release an app that will display readings from its implanted continuous glucose monitor on the Apple Watch when the latter goes on sale in April. Dexcom already offers such monitoring on its own hardware with Bluetooth-powered iPhone data sharing.

Merge Healthcare announces that users of its iConnect Network will be able to transmit and receive imaging orders and results to Emdeon Clinical Exchange users.


Other

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The local newspaper covers the migration to Epic by two Lehigh Valley, PA competitors, Lehigh Valley Health Network and St. Luke’s University Health Network. Epic replaces GE Healthcare at LVHN and McKesson and Allscripts at St. Luke’s.

Health system consolidation continues: Emory Healthcare and WellStar Health System are discussing merging into a single Atlanta-area system, while in New York, North Shore-LIJ is talking to Maimonides Medical Center about a “partnership” that sounds more like the former acquiring the latter.

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Why do reporters feel qualified to interpret scientific information and render related opinion without consulting experts? The Toronto Star runs a self-proclaimed investigative article on the dangers of HPV vaccine Gardasil, dramatizing the 60 potential cases of side effects out of 800,000 doses administered. Expert physicians called out the poor reporting, to which one of the paper’s otherwise uninvolved left-leaning, American-hating columnists (best known for calling Sarah Palin a “toned-down porn actress” and insisting that male conservatives make bad decisions because of impotence) responded with a bizarre rebuttal that invokes government secrecy, Twitter, the US Tea Party, and her own self-study of statistics. The physician author of a book the columnist cited immediately blasted out a series of tweets calling out the paper’s “appalling, ignorant, irresponsible journalism” in running a “scare story.” The exchanges were summarized and brilliantly titled as “When ‘Teaching Yourself Statistics’ is No Match for Being a Doctor.”


Sponsor Updates

  • Craneware enhances its Supplies Assistant solution to make it easier for hospitals to add new devices and supplies to their chargemaster.
  • Dental software vendor Curve Dental incorporates DrFirst’s e-prescribing technology into its product, which will allow users to comply with New York’s I-STOP mandatory e-prescribing regulation that takes effect March 27, 2015.
  • Meditech will add more products from Truven Health Analytics’ Micromedex Patient Connect Suite to its EHR platforms.
  • Clockwise.MD announces that nearly 1 million patients have been seen through its Web-based appointment reservation tool.
  • Clinical Architecture offers the third installment of its blog series on “The Road to Precision Medicine.”
  • Certify Data Systems validates the interoperability of its HealthLogix solution at the IHE North American Connectathon.
  • Anthelio renews its contract with Saint Mary’s Health System (CT).
  • Besler Consulting latest blog post covers “Optimizing Communications to Reduce Readmissions.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 10, 2015 News No Comments

Monday Morning Update 2/9/15

February 8, 2015 News 2 Comments

Top News

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Experts say hackers can sell the patient information exposed in Anthem’s 80 million member breach for up to $1,000 per record (or a staggering potential payout of $80 billion for the thieves) since it forms a “complete identity theft kit” that includes insurance and Social Security numbers (stored unencrypted, in Anthem’s case). A stolen credit card number is worth only $1 and insurance credentials alone fetch just $20. Anthem admits that hackers used the credentials of at least five of its IT employees for up to a month before the attack, which the company detected only when a database administrator noticed someone running queries under his user ID. Investigators are looking into evidence suggesting that China-sponsored hackers launched the attack to obtain information to be used in espionage-related phishing, which seems to be the standard, non-verifiable post-breach excuse.

Meanwhile, scammers pile on by sending bulk spam using Anthem’s logo (above) and cold-calling people claiming to offer credit monitoring trying to get recipients to divulge their own confidential information.

The healthcare- and privacy-related background of Anthem CIO Thomas Miller: zero. He came from Coca Cola just eight months ago, hired because of his background with digital marketing and loyalty programs. 


HIStalk Announcements and Requests

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Nearly 80 percent of poll respondents think the federal government should issue a national patient identifier, about the same percentage that answered positively in my 2013 poll asking the same question. They added some thoughts: (a) an opt-in version would be more acceptable; (b) the VA could use the identifier to provide information needed to process Social Security disability claims; (c) the ID should be used only for healthcare, employers can’t ask for it, and the individual owns the information associated with the number; (d) use Social Security number as the patient identifier; (e) since nobody wants their Social Security number used for fear of hacking, instead create an ID consisting of date of birth, first three letters of the last name, and the last four digits of the SSN; and (f) a private company’s solution is available now and they’re looking for partners.

New poll to your right or here: will Athenahealth be able to create a competitive, large-hospital information system by rewriting BIDMC’s internally developed WebOMR? Vote and then click the poll’s “Comments” link to elucidate further.

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Welcome to new HIStalk Platinum Sponsor CoCentrix. The Sarasota, FL-based company’s Coordinated Care Platform, built on the Microsoft Dynamics CRM solution, optimizes the behavioral health continuum for the benefit of state and local government agencies, providers, and consumers. Components include a certified HHS EHR for state agencies and community providers (intake, assessments, treatment plans, orders, documentation, billing, dashboards, and data mining), enterprise-level case management, a managed care solution, and the rather cool Caretiles integrated mobile app marketplace for consumers. The 32-year-old company has 500 customers in 42 states. Thanks to CoCentrix for supporting HIStalk.

Here’s a patient-centered overview video of CoCentrix that I found on their site.

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Sign up now if you want to come to HIStalkapalooza on April 13. I’ll have to shut the page down once I get too many requests to accommodate. I can’t necessarily invite everyone who wants to come, but I can say for sure that you won’t be invited if you don’t sign up (which is true for me as well, so I’ll register today).


Last Week’s Most Interesting News

  • Roper Industries acquires two health IT companies, including the leading laboratory middleware vendor as a complement to its Sunquest business, for $450 million following its recent acquisition of Strata Decision Technology.
  • Insurance company Anthem announces that a cyberattack exposed the information of 80 million of its customers, but says no medical or credit card information was stolen.
  • Athenahealth acquires rights to Beth Israel Deaconess Medical Center’s self-developed WebOMR hospital information system, announcing plans to rewrite it to sell to large hospitals.
  • ONC requests $92 million for its FY2016, budget, with $5 million of the 50 percent increase set aside to create a Health IT Safety Center.
  • Cerner completes its $1.3 billion acquisition of Siemens Health Services.
  • ONC publishes the draft version of its 10-year interoperability roadmap that includes a goal of allowing most patients and providers to exchange and use a common set of electronic clinical information by the end of 2017.

Acquisitions, Funding, Business, and Stock

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From Friday’s Athenahealth earnings call:

  • Chairman and CEO Jonathan Bush says the company “fell short of the finish line” in 2014 due to “over dependence on one channel partner, over focus on ambulatory medicine, and limited experience with turnaround situations.” He says those were “admission tickets to new levels of adulthood” that will allow the company to get back to 30 percent growth.
  • Bush admitted that the company’s enterprise prospects have balked at solutions that don’t address inpatient.
  • He says that the acquired RazorInsights product, built for hospitals under 50 beds and priced at around $250,000 to $500,000 per hospital, is “the multi-tenant platform we need to manage most hospitals in the country,” while BIDMC’s WebOMR can handle the more complicated hospitals. Those will be merged together to form Athena Inpatient Clinicals.
  • Bush says the company failed in missing its Net Promoter goal of 52.5 in hitting only 42 for Q4.
  • The company hired 1,300 employees in 2014, raising its total to 3,700, and will add another 1,000 in 2015.
  • Athenahealth’s CFO says RazorInsights produces “a very small amount of revenue at a loss” and that WebOMR is not immediately commercializable, so she recommended that analysts view the acquisitions as ways to eventually enter the inpatient market rather than as revenue-contributing products.
  • The company “tried to stop the bleeding on the nervous prospects” who were passing on Athenahealth to choose Epic.

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ATHN shares closed Friday down 0.8 percent. Above is the one-year chart of ATHN (blue, down 17 percent) vs. the Nasdaq (red, up 15 percent).

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From the McKesson earnings call, which had few mentions of its Technology Solutions business:

  • Technology Solutions revenue was down 7 percent due to lower revenue from Horizon Clinicals and the exited UK workforce business, in line with projections.
  • John Hammergren says McKesson is “in middle of the game” in trying to move Horizon customers to Paragon.
  • He adds, “There’s a bunch of interesting places that we’re placing bets, including CommonWell Health, that we think will pay off” as the company sells data-related products.
  • Asked about the future Technology Solutions product line, Hammergren said, “I would say though that as you think out two or three years, the EMR space and the transition away from Horizon will be more complete or complete, and we’ll see more results, we think, in terms of this pay-for-performance priority. I mentioned that HHS and others believe that the market has to move more towards a value-based reimbursement methodology. That’s going to require additional investment.”

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Crain’s Chicago Business profiles 73-year-old, near-billionaire investor Dick Kiphart, who says of his investment 10 years ago in healthcare communications company Emmi Solutions, which he sold two years ago to Primus Capital, “It stumbled for a long time. I kept my money in, and it looks like it will be a two- or three-bagger.”


People

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Jennifer Haas (Microsoft) joins Aventura as VP of marketing.

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John Hallock (CareCloud) joins Imprivata as VP of corporate communications.

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Tony Scott (VMware) is named chief information officer of the United States, replacing Steve VanRoekel.


Announcements and Implementations

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Facebook founder Mark Zuckerberg and his wife, Priscilla Chan, MD donate $75 million to San Francisco General Hospital (CA), where Chan did her pediatrics residency. The city will name the expanded facility Priscilla and Mark Zuckerberg San Francisco General Hospital and Trauma Center, which is pretty much the opposite of creatively and succinctly naming a social media website “Facebook.”


Government and Politics

The Defense Health Agency says its top 2015-2016 priorities will prepare it for its EHR implementation: continuing to work with the VA on interoperability, consolidating infrastructure, and standardizing configurations.  The agency’s director explains that, “This is an $11 billion procurement. When you think about that, this infrastructure piece is huge. So we have to think about what we’re going to do to make sure we get the best performance out of that EHR."


Technology

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A CNN report says the Apple Watch will fail (at least in compared to typically blockbuster Apple offerings) because: (a) for $350, all it does is allow users to perform existing iPhone functions from their wrists; (b) rumors are that the battery life will be awful at just 10 hours; (c) it’s rectangularly chunky compared to sleeker products already on the market; (d) it doesn’t do anything particularly compelling; and (e) it’s likely to be improved in a year, forcing users to buy it all over again.


Other

Grant-funded Vermont Information Technology Leaders pitches its new HIE to consumers by running regional Super Bowl ads on local TV stations at a cost of around $13,000 of its $195,000 marketing campaign.

University of California’s 10 campuses will require students to be vaccinated for measles starting in 2017, with students expected to enter their vaccination records into UC’s electronic system. Religious and medical exemptions will be honored, UC says.

Forbes notes the “emerging bull market” for “digital healthcare journalism,” with examples being Politico’s three-reporter subscription-only eHealth launch in 2014 and its plans to expand to an overall healthcare team of 16, the recent sale of Med City Media, and establishment of a five-reporter health and science department at BuzzFeed.

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Patients of Reid Hospital (IN) complain when the hospital tries collect debts from as far back as 2011. The hospital has apologized, saying that some patients didn’t receive the usual three monthly bills before their accounts were turned over to collection agencies by a former contract company.

The gutted healthcare system of cash-strapped Greece requires hospitalized inpatients to hire their own nurses for even basic inpatient care, but lack of money and insurance leads many of them to retain poorly trained and illegal phony nurses – often immigrants — provided by temp agencies that cruise the hospital halls handing out business cards. Hospitals say they are too understaffed to expel visitors who offer to rent TVs, bedding, and chairs to patients, adding that even the state doesn’t have the legal authority to issue fines to violators.

Weird News Andy never eliminates stories about fecal transplants, titling this one “Does this bacteria make me look fat?” Researchers suggest not using gut bacteria from overweight fecal donors to treat infections since a case study found that the recipient gained 34 pounds in the 16 months following the procedure.


Sponsor Updates

  • Medicity offers a recap of the HL7 conference that showcased FHIR as the “next big thing” in healthcare.
  • Sandlot Solutions writes about “Interoperability: Making the ONC’s Vision a Reality.”
  • Courtney Patterson asks, “Could Your Reporting Team Structure be Helping or Hurting Your Organization?” in the latest Sagacious Consultants blog.
  • RazorInsights will exhibit at the Rural Healthcare Leadership Conference February 8-11 in Phoenix.
  • Qpid Health’s Amy Krane summarizes the company’s recent webinar on how Partners Healthcare eliminated prior authorization.
  • Siavosh Bahrami rants about the importance of simplicity in a new pMD Charge Capture blog.
  • PatientKeeper offers a post on “The Interoperability Non-Controversy.”
  • Park Place International offers advice on “Getting Ready for the Meditech Patient and Consumer Health Portal.”
  • Patientco posts an article titled “The Importance of Payment Plans in Your Revenue Cycle Strategy.”
  • NVoq Director of Healthcare Industry Solutions Chad Hiner, RN explains why “EMR adoption will require more than financial carrots.”
  • In the latest Phynd blog, Thomas White asks, “How many employees does it take to enroll a new provider in a hospital’s EMR?”
  • Ryan Reed offers “5 Tips to Prepare for Cloud Migration” in the latest NTT Data blog.
  • Netsmart will exhibit at the Open Minds Best Management Practices Institute meeting February 12-13 in Clearwater Beach, FL.
  • MBA Health Group Consultant Nicholas Bocchino writes about the possible changes to Meaningful Use this year in its latest blog.
  • PeriGen launches its Five-Minute Challenge for labor and delivery managers.
  • Medfusion will introduce its Help Center in an event on February 12.
  • Nandini Rangaswamy asks “What works? EHR-based PHM or PHM-based EHRs?” in the latest ZeOmega blog.
  • WeiserMazars releases its Group Annual Report.
  • T-System shines a spotlight on staff member Javariah Khan in its latest Informer blog.
  • General Manager of Clinical Solutions Eric Brill writes about Voalte’s work with UCSF Medical Center Mission Bay in a new blog.
  • Stella Technology Founder and SVP of Business Development Salim Kizaraly discusses HIEs past and present in a Relentless Health Value podcast.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 8, 2015 News 2 Comments

News 2/4/15

February 3, 2015 News 5 Comments

Top News

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Cerner completes its $1.3 billion acquisition of Siemens Health Services as announced in August. Cerner reiterated in the announcement that it will continue to support Siemens core systems for an unspecified period, with Soarian maintenance guaranteed for 10 years. Former SHS CEO John Glaser has joined Cerner as SVP and a member of the company’s executive cabinet. Julie Wilson, Cerner’s chief people officer, says Monday was “the biggest single hiring day in Cerner history” as its employee count jumped from 16,000 to 22,000 with the acquisition. CERN shares rose 0.57 percent Monday on the news, giving them a slightly better performance (blue, up 20 percent) than the Nasdaq as a whole (red, up 17 percent) over the past year.


Reader Comments

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From Lemmy: “Re: Athenahealth’s purchase of BIDMC’s WebOMR. Not sure why Athenahealth would be interested – WebOMR is a complete piece of crap being held together with gum.” I mentioned the acquisition in last weekend’s post as a rumor provided by reader InTheKnow, although I left out specific details since ATHN is publicly traded. More discussion follows below – I got details from John Halamka that go well beyond the announcement and invalidate some incorrect assumptions I had.

From Mr. Smith: “Re: national patient identifier. HHS and ONC are prohibited by law from even discussing anything related to an NPI even though they are acutely aware of the challenges posed by not having one. The legislative branch should address the issue, but HHS and ONC are trying to create a workable solution.”


HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor West Corporation and its healthcare practice. The Omaha, NE-based company processes billions of voice-related transactions each year. Its West Engagement Center drives patient engagement, care coordination, and provider collaboration using a variety of technologies (voice, text, email, mobile, contact center). Available solution sets include telehealth, patient access, prevention and wellness, and chronic disease management. It is used by providers, payers, and employers that are transitioning to value-based care, managing populations,  creating chronic disease care coordination programs, or adding patient engagement capability to existing population health management technologies. Sign up for an online tour here. Thanks to West Corporation for supporting HIStalk.

Here’s a YouTube video that shows how patients report their daily blood pressures using the West Engagement Center.

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We’ve received just a handful of requests from real-life patients who want to take advantage of our HIMSS15 conference scholarship ($1,000 in travel cash plus registration). We’re accepting applications through February 9 and will choose the five based on their patient stories and their writing ability. See Regina’s description and send entries to Lorre.


Acquisitions, Funding, Business, and Stock

Athenahealth makes its second recent  push into the inpatient EHR market by acquiring the WebOMR system that was developed by Beth Israel Deaconess Medical Center (MA). Terms were not disclosed. The company will integrate WebOMR with its AthenaNet system. The internal announcement from BIDMC CEO Kevin Tabb says that BIDMC will do a “trial implementation” of “some of athena’s current products” in “select areas of our network.” BIDMC’s only obligation to Athenahealth is to help its engineers understand how WebOMR works “so they can try to expand its use beyond our walls” as “the days of self-built information systems will not last forever.” Athenahealth acquired small-hospital EHR vendor RazorInsights on January 14. Athena shares ended the day up just over 1 percent, the same daily gain as the Nasdaq composite.

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I spoke to BIDMC CIO John Halamka, MD for clarification about the agreement:

  • BIDMC originally developed WebOMR as an ambulatory application, but it has been extended to include all BIDMC-developed automation – a certified inpatient EHR, OR management, oncology, laboratory, radiology, electronic medication administration record, and bedside barcoding. The only external dependency is First Databank for drug information. The only excluded module is the ED information system (which had been previously commercialized as Forerun) and the agreement doesn’t cover billing (which is performed by a McKesson application). BIDMC has done work with Google Glass and Apple Health and those components are included as well.
  • Athenahealth is buying BIDMC’s intellectual property, but it will not use BIDMC’s programming code, which was developed by a 25-member team using Cache’ and Cache’ server pages. Athenahealth will instead rewrite the entire product (or at least the parts they want to commercialize) using their own workflow, user interface, and business logic to create a new platform.
  • BIDMC will not act as Athenahealth’s development partner. What Athenahealth bought for an unstated cash investment is the intellectual property, one BIDMC FTE for two years to help them understand the applications, and access to an alpha site in BID-Needham, which has a 29-bed medical-surgical ward running Meditech (which will not be replaced there).
  • BIDMC gets a 20-year license to use the code that Athenahealth develops, but they do not have to move to Athenahealth’s version and are not precluded from replacing WebOMR with a commercial product, which Halamka says may happen at some point.
  • Halamka estimates that it will take Athenahealth 18 months to rewrite the product.
  • Athenahealth and BIDMC signed two agreements. The first covers the intellectual property as described above. The second is an agreement in which three practices within 38-site BIDMC Healthcare will begin phased implementation of Athenahealth’s ambulatory product, but BIDC has no further obligation to continue or extend the trial beyond those three practices that are participating in the trial.
  • Halamka says in a blog post that BIDMC won’t necessarily choose Athenahealth products when they consider replacing WebOMR since “we are a meritocracy and the best services at the lowest cost will win.” He adds, “Just as Mayo chose Epic to reduce the number of different IT systems, BIDMC will pursue a parsimony solution – the fewest moving parts possible. That might be one vendor, but hopefully it will not be more than two … While we want to continue to innovate, we know that commercial vendors will be able to leverage their knowledge and capabilities to build future platforms at larger scale.”

 

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Cerner rang Nasdaq’s opening bell Tuesday.

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Voalte lays off 25 percent of its staff, or around 40 employees, in a reorganization.

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Canada-based consulting and services vendor Accreon is acquired in a leveraged buyout funded by its management team, its founders, and Mansa Capital. As part of the deal, the company gives up its 49 percent ownership in Velante, which ran a controversial e-heath project in New Brunswick, and turns it over to the other partner, the New Brunswick Medical Society.


Sales

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Yale New Haven Health (CT) chooses Mobile Heartbeat’s clinical communications system.

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Boulder Community Health (CO) chooses Voalte’s smartphone caregiver communication for its newly expanded facility.

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Pocono Medical Center (PA) selects Authentidate’s telehealth solution.


People

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Murray Reicher, MD is named CEO of DR Systems, which he co-founded in 1992. He replaces co-founder Rick Porritt, who has retired.


Announcements and Implementations

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Vancouver, WA-based patient monitoring systems vendor OSTAR launches a cellular network-powered blood pressure monitoring system to reduce CHF readmissions.

Mediware announces CareTend, which combines its home care solutions into a single platform.


Government and Politics

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HHS Secretary Sylvia Burwell announces a $28 million ONC-funded HIE grant program, described as, “Grantees will address interoperability workflow challenges, technical issues, and improve the meaningful use of clinical data from external sources. Providers will be engaged from across the entire care continuum, including those who are not eligible for the Medicare and Medicaid EHR Incentive Programs such as long term care facilities, to be able to send, receive, find, and use health information both within and outside their care delivery systems.”

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ONC requests $92 million for its FY2016 budget, up from $60 million. ONC wants $5 million to establish a Health IT Safety Center that will go live in FY2016.

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This is a great quote from former National Coordinator David Blumenthal, MD, tweeted by ONC annual meeting attendee @PharmDJD: “It is cognitive dissonance to want cutthroat competitive markets but to expect healthcare players to share valuable data.” It would be great if hospitals, retail stores, quick lube stations, and hair salons shared customer information freely for the benefit of their shared customers, but only healthcare providers are being (unsuccessfully) shamed into doing so.

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Health IT equities researcher Jamie Stockton of Wells Fargo Securities provides a slice and dice of CMS’s Meaningful Use Stage 2 data. Hospital attesters included 97 percent of eligible Epic users, 63 percent of Allscripts, and 60 percent of CPSI, with everybody else falling under that number (Medhost and NextGen trailed the pack at under 40 percent). Physician Stage 2 rates were predictably abysmal, with Athenahealth out front at 58 percent and Epic at 26 percent, but vendors such as Allscripts, Greenway, Cerner, NextGen, and McKesson (the latter at 0 percent) having less than 5 percent of users attesting. Obviously it’s dangerous to read too much into the vendor vs. the customer, especially given the mass EP Stage 2 bailout.


Privacy and Security

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Paper records from several New York City hospitals are lost when a Brooklyn document warehouse is destroyed in a seven-alarm fire that scattered charred patient charts over several blocks. Cleanup crews attempted to retrieve partially burned papers that contained patient clinical and financial information. New York City Health and Hospitals Corporation is among the organizations that stored documents in the warehouse, but says that as early EHR adopter, it expects no operational impact.

The creator of PGP encryption software (now owned by Symantec) says the Sony Pictures breach highlights the need for companies to redirect efforts from security to privacy by encrypting emails and documents and retaining less information online. “If you look at all the things that have been developed – firewalls, intrusion detection systems, all these things put in place to protect computers? They haven’t really hit a home run: they keep getting breached. But if you look at the Snowden material, the one thing that does seem to do well is strong encryption. Of all the things you see getting broken into, it’s conspicuously absent from that list … In the 90s, if you were using strong encryption, you’d have to defend yourself and justify what you were doing: ‘What, are you a terrorist or a drug dealer?’ Now, if you aren’t using strong encryption, you have to justify it. You’re a doctor? What do you mean you’re not encrypting your patient records? Or you left your company laptop in a taxi with 2,000 customer names on it? You better hope that data is encrypted or you’re in trouble.”


Other

Researchers at Penn State College of Medicine suggest 10 situations where it would be acceptable for doctors to Google a patient, boiled down to (a) if they suspect the patient is lying to them about their history; (b) if the patient could be a doctor-shopping drug user; and (c) if the patient seems to have the capacity to harm themselves.

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I received the email above from a well-known B2B spammer who apparently got an email list of HIMSS15 exhibitors and is offering to sell a database of full attendee details. The fraud clues are numerous: (a) the email purporting to be from “Tracy Nixon” was clearly not written by a native English speaker; (b) the company’s website is just a placeholder full of “lorem ipsum” text; (c) the domain owner’s name is blocked in its registration records; and (d) clearly a 7,500-record HIMSS conference attendee database is at best incomplete given the 40,000 or so attendees. The same company has scammed companies in other industries by selling them junk lists at high prices and then refusing to give refunds.

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Weird News Andy titles this story “Heaven Scent” and adds that the device should be worth the cost of at least 1,000 Fitbits. A smartphone-powered cancer detection system called the SniffPhone detects the odor of lung cancer on the breath with 90 percent accuracy


Sponsor Updates

  • SyTrue CEO Kyle Silvestro posts “The Secret Life of your Healthcare Data.”
  • Verisk Health’s HEDIS measures are certified by NCQA for 2015.
  • Nordic publishes a blog post titled “Optimizing My Birkie and Your EHR.”
  • Four Medicity HIE customers are named in “Survivor: Edition HIE"–Can Statewide HIEs Achieve Sustainability?”
  • Dan Hamilton, COO of Nor-Lea Hospital District (NM), writes an article titled “Handling the Demands of a Population Boom: Using RTLS to Improve Patient Care and Workflows” about its use of Versus Advantages Clinic RTLS.
  • ADP AdvancedMD asks, “Has the ICD-10 Delay Hurt Provider Preparedness?” in its latest blog.
  • Bottomline Technologies will exhibit at the NAMIC Claims meeting February 10-12 in Phoenix, AZ.
  • Divurgent offers a new white paper entitled, “From the Trenches: Leadership Strategies from the US Navy SEALs Applied to Healthcare.”
  • Clinical Architecture’s Charlie Harp posts the second installment of the company’s blog series on “The Road to Precision Medicine.”
  • Caradigm will exhibit at the iHT2 Health IT Summit February 10-11 in Miami.
  • Matt Patterson, MD asks “What stage of Meaningful interoperability are you?” in the latest AirStrip blog.
  • CareTech Solutions will exhibit at the Health Forum Annual Rural Health Care Leadership Conference February 8-11 in Phoenix.
  • Amber Harner blogs about her trip to Costa Rica to help build houses with Habitat for Humanity, courtesy of the CoverMyMeds 2014 CoverMyQuest competition.
  • Michael Passanante writes about the physician’s role in lowering hospital readmission rates in the latest Besler Consulting blog.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 3, 2015 News 5 Comments

Morning Headlines 2/3/15

February 2, 2015 Headlines No Comments

Cerner Completes Acquisition of Siemens Health Services

Cerner announces the completion of its acquisition of Siemens Health Services. The new merged organization has a combined customer base of 21,000 facilities and an annual R&D budget of $650 million.

Community Health Systems Professional Services Corporation and Three Affiliated New Mexico Hospitals to Pay $75 Million to Settle False Claims Act Allegations

For-profit hospital chain Community Health Systems will pay $75 million to settle False Claims Act charges with the DOJ. Three New Mexico hospitals are accused of making illegal donations to county governments. The funds were used to pay the state’s share of Medicaid payments to the accused hospitals, in an effort to drive up local spending and take advantage of a federal program that reimbursed New Mexico $0.75 for ever dollar spent on rural Medicaid services.

ONC Annual Meeting, February 2 – 3

ONC’s Annual Meeting kicked off in Washington DC today. Tomorrow morning Karen DeSalvo, MD will join the former National Coordinators for an hour long round table on the state of the HIT nation.

Cost Comparison Between Home Telemonitoring and Usual Care of Older Adults: A Randomized Trial

Researcher compare the total cost of care for 205 patients over the age of 60 and find that, over the course of a 12-month period, traditional care costs the same as care supplemented with remote patient monitoring services.

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February 2, 2015 Headlines No Comments

HIStalk Interviews Alan Weiss, MD, Director of Medical Informatics, Memorial Hermann Medical Group

February 2, 2015 Interviews 3 Comments

Alan Weiss, MD, MBA is director of medical informatics with Memorial Hermann Medical Group of Houston, TX.

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Tell me about yourself and the organization.

I’m a general internist by training. I have a computer science background and an MBA. I’ve been involved in the development of EMRs for about 15 years. I practiced at the Cleveland Clinic for about 10 years doing EMR implementation and practicing.

I’ve been at Memorial Hermann for about a year and a half. It’s a 10-hospital system, about to become a 12-hospital system, with an outpatient medical group directly affiliated with about 170 providers. We’re a GE shop on the ambulatory side and a Cerner shop on the inpatient side. We also have an affiliated group of physicians, about 600 to 700, on a whole different group of EMRs, with our biggest one probably being eClinicalWorks. We are the largest healthcare provider here in Houston.

 

What is the state of EHRs and in what areas should they be better?

EHRs need to improve. When people talk about the current state, I always think about what the basics are of EMR — what does it have to do? It has to be able to allow providers to look at data, to enter orders, and to write notes in a clean and efficient manner. A lot of the EMRs don’t allow for this. Each EMR has its benefits and its drawbacks, but if you can do those three simply and easily, that’s when providers can use the tool as best as possible.

 

What is the place for the doctor’s true narrative and rather than text generated from click boxes?

I think we’re going to see a throwback away from the computer-generated text and back into true narrative. It’s gone too far. It doesn’t have a whole lot of meaning and notes are way too long. It doesn’t convey the clinical impression, which is what we need to provide the best care we can.

 

It wasn’t doctors who originally wanted to click boxes to create text. Do they have enough voice to turn the EHR back into a record that’s for them and not for someone else?

There are providers out there who love the being able to do all the clicking of text and checking the boxes to get things done. But it’s more to get things done, not to create the narrative. The problem is that the narrative that’s created through clicking boxes becomes a hard to read mess.

I think we’re going to see everything change back into a much better narrative. A better way of actually describing what providers want from the EHR, which is an easy way to document, but also a way that gives their notes meaning to them.

 

What parts of the note could give clinicians an immediate sense for what’s going on with that patient?

There’s a whole movement of trying to get the notes to be meaningful again. One of the best ones is to change your SOAP note — Subjective, Objective, Assessment, Plan — into an APSO note, where your assessment and plan are at the top. If you want additional information, you can go through and see the rest of the information. 

Many organizations have changed from SOAP to APSO as a way of making sure that the assessment and plan, which is what you really want, is right in your face with the supporting documentation later on. I think we’re going to see more of that as time goes on.

 

What do you think about the OpenNotes initiative and the new plan to allow patients to contribute to the notes?

It’s probably going to be the way of the future. I think we’re going to see open notes. I don’t see anything wrong with having patients see the notes the providers have written. It’s actually very good, and especially for patients who are very concerned about their own health, seeing what the providers write will help them. I think it will also help some providers write better notes in the process of providing care. That’s going to be great.

It’s interesting that in the whole notion of having the patients come in and add to the notes themselves; we have started looking at ways of taking some of the surveys that patients are filling out and incorporating those into the notes. It can have some very positive effects, especially when it comes to patient engagement.

 

Will the least technically savvy patients do that?

The technical savviness of patients versus physicians is interesting. I tend to think that patients right now are more technically savvy than a lot of physicians. They want more apps, they want more access to their data, and they want to be able to access their physicians all the time in as many ways that they possibly can. 

The technical savvy aspect is extremely important. The patients,though, who are least technically savvy also have some of the greatest health problems. For that population, we still need a better strategy.

 

What are some system-agnostic EHR changes you might recommend to improve care?

I’ve worked ambulatory and I’ve worked inpatient. You have to really distinguish between the two.

On the inpatient side, certainly order sets and standards are a lot easier to implement than on the ambulatory side. The ambulatory side is more of people doing whatever they want to do. It’s much easier to create rewards to get people to do either the right thing or to stop ordering the wrong thing. That’s much easier on the inpatient side.

On the ambulatory side, sometimes the right thing to do is actually not to change your EMR, but to give reports. For instance, we’ve got a very simple report that shows providers their top 20 medications, the ranking, and the amount. When we show it to the providers, they start to see patterns. We have one provider who saw their pattern with  very high antibiotic prescribing, lots of Zithromax, lots of Z-Paks prescribed. In fact, she was providing about one or two Z-Paks a day on average to her patients. When she realized that that was the most common medication and not the most appropriate medication for what she was seeing, she changed her behavior. She has reduced her prescribing of Z-Paks by two-thirds.

That’s the kind of thing you may do outside of the EMR itself. If you can provide those simple reports showing behaviors, they can often have a bigger effect than making huge changes in the EMR itself.

 

As more physicians who practice in ambulatory setting are acquired or are working more collaboratively on the patient as a whole via new payment models, will they see EHRs as the bad guy that enforces rules that they didn’t follow when they were on their own?

I don’t think it’s going to be EHRs. I think it’s going to be the medical practice itself. When you’re in large groups, you’re being held accountable for all of the costs. At the same time, you’re going to have a natural progression where everybody is going to be seeing that they have to be responsible for every single order they put in.

 

What is the medical group doing with managing populations and not just encounters?

We’re doing a huge amount of population health. We’re doing a lot of analytics, looking at gaps in care where we can better provide care for diabetics who are falling outside the ranges of desired HbA1C and other testing. We’re trying to make sure all the screens are being done.

We have a great population health program that is doing some wonderful things. We are part of ACO, and as part of that ACO and the analytics that it provides, we’ve become one of the highest savings ACOs in the country.

 

How are people reaching out to the patients who might need an intervention or education? They aren’t necessarily used to getting a call from a medical practice.

A lot of patients want it. They want people to be involved in their care, but certainly there are ways of making sure that the patients have access to the things they’re missing.

For instance, we have a patient portal that provides a way for our patients to check the things that are due for them. At the same time, the diabetics who haven’t been in for a while or who need testing done tend to like it that we’re reaching out. It makes them feel like we care about them, and in fact, we do care about them. It gives them a way of closing the loop in some of the testing that they need. Most patients are reacting very positively to it.

 

What opportunities and challenges do you see with being paid for value instead of volume?

Part of the problem is that what patients often want are more tests and more medications. The conflict that I see is that the advertising that’s out there, what’s on the Internet, seems to get patients to want to have all those tests done. It’s more testosterone testing, thyroid testing, checking this and checking that.

If anything, if you look at all of those news articles about the tests you should have, a lot of it is creating almost like a culture of fear. You have to get certain tests done in order to make sure you are healthy. Those are the kind of things that are coming out of the general advertising. Yet at the same time, all of the data shows we should be doing less testing.

For instance, there’s no reason to check for kidney problems in an otherwise healthy person without high blood pressure. There’s no reason to check for urine or chest X-rays or EKGs unless you have a reason for doing it. But the common practice often is that those things are checked and the patients demand them and want them.

It’s the same kind of thing with antibiotics. When patients come in for a URI, they want and they expect antibiotics because that’s what they think the medical practice should be giving them. They’ve taken time off from work or school and they feel like they need something to justify them being there. I’ve had friends who have said to me that if they don’t give them something, the patient has threatened to go see other doctors.

Certainly there are patient satisfaction scores that are part of this whole issue, the need to satisfy the patient and give them what they want. We have to divorce that. We have to start thinking about what we should be doing. What is good evidence and what do the patients really need. That’s going to be the big conflict that we are going to have in the next five to 10 years to try and rein in some of the healthcare costs.

 

Do you have any final thoughts?

EHRs are just one great tool to help us. If anything, it makes it easier to provide care in the EHR. I’ve been on EHR since I finished my residency almost 15 years ago and I would never go back to a paper system. There’s just absolutely no way. For me, it’s the way things should get done.

What I look forward to being able to do is to optimize EHRs to create a healthcare system that helps you to provide the best care possible. If we do it the right way, we can rein in costs. We can provide better care. We can take care of those gaps. It will work its way through, but the EHR has to be the backbone. It has to be the new tool for us.

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February 2, 2015 Interviews 3 Comments

News 1/30/15

January 29, 2015 News 7 Comments

Top News

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CMS announces plans to shorten the 2015 EHR reporting period to 90 days and to change hospital reporting to be calendar year in a new rule it expects to be approved in spring 2015.


Reader Comments

From Information Dirt Road: “Re: Practice Fusion. Earlier this month they interfered with all lab results traffic during peak business hours and now are having another outage. All who work with PF are cursed by the absurd spectacle of PF being the clueless center of their own special universe.” They have a scheduled weekly maintenance window of Thursdays from 9 p.m. to 1 a.m. Pacific, which seems sensible to me. I followed the link to their EHR status page, which appears to be rarely updated.

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From HIS Junkie: “Re: HX360. I thought this was supposed to get people going on a new interoperability phase of HIT, but HIMSS has created a new meeting program for it right in the middle of its conference. It’s amazing how fast HIMSS jumped on this to make another buck.” I’m not a fan of co-located conferences, but you can watch a just-posted interview with HX360 CEO Roy Smythe, MD for more on what they’re doing. The HX360 exhibit hall is included with normal HIMSS15 registration, the full track is an extra $225, and the executive sessions are invitation-only.   

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From Deli Meat: “Re: electronic signature pads. Thanks for an amazing website. We are trying to reach Topaz Systems about problems with their signature pads that we use in registration with Epic. Emails are bouncing, phone calls aren’t returned, and their website seems to be down. Please assist with any insider information you may have.” The website is up for me and I got a live salesperson when I called their number, so I passed along your email address and said you needed help as a live customer.


HIStalk Announcements and Requests

I forgot to include a link to the the now-separate Dr. Jayne post in the email update, but it’s right here.

If your company sponsors HIStalk and didn’t receive our email in which we’re taking RSVPs for our HIMSS sponsor networking event and collecting information for our HIMSS guide, contact Lorre. Sometimes the information we have for contacts is incorrect or even missing entirely.

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We’re still accepting applications through February 9 from real patients who want to attend the HIMSS conference with a $1,000 scholarship and registration provided. These are for non-healthcare IT folks who have a compelling patient story to tell and who want to attend the HIMSS conference and write about their experiences on HIStalk afterward. Email Lorre with your story and why you want to attend – we’ll judge on both motivation and writing ability.

This week on HIStalk Practice: Telehealth takes over the headlines, with state licensing issues and vendor compliance making the news. GE Ventures looks to HIT to the potential tune of $40 million. Community Eye Center Optometry goes with VersaSuite. Doximity offers interactive physician salary data by state. Premedex launches new chronic care management solution for physician practices. Clinicient secures $7 million. Customer satisfaction with government services reaches a new low. Google Fiber heads southeast.

This week on HIStalk Connect: Google partners with Biogen Idec in a multi-year project focused on researching multiple sclerosis. The FDA approves the first smartphone-connected continuous glucose monitors, technology that diabetics have been demanding for years. Researchers from the University of Pennsylvania find that Twitter data analytics can be used to create highly accurate maps depicting the prevalence of heart failure at the county level. 

Welcome to new HIStalk Gold Sponsor CenterX. The Madison, WI company’s next-generation e-prescribing network improves medication adherence by closing the physician-pharmacist loop. It offers enterprise medication authorization, formulary management, pharmacy benefit eligibility, and medication profiles. Doctors are notified when the prescription is picked up and flat rate pricing eliminates the per-transaction penalty that discourages communication. Physicians benefit from electronic refill requests and automated prior authorization. Only about 40 percent of patients nationally pick up their prescriptions and use them correctly, but CenterX users have up to 90 percent adherence. The company just announced that it has fully integrated its Enterprise Medication Authorization solution with Epic. Thanks to CenterX for supporting HIStalk.


Acquisitions, Funding, Business, and Stock

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Lexmark turns in anemic Q4 results, but its Perceptive Software business books a solid quarter.


Sales

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Penebscot Community Health Care (ME) chooses Forward Health Group’s PopulationManager and The Guideline Advantage.

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St. Joseph Health (CA) selects Clinical Architecture’s Symedical for terminology management, semantic normalization, and interoperability.


People

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St. Tammany Parish Hospital (LA) promotes Craig Doyle to VP/CIO.

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Impact Advisors promotes Jenny McCaskey to VP.

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Richard Holada (IBM) joins Truven Health Analytics as chief data and technology officer.


Announcements and Implementations

First Databank announces GA of FDB Cloud Connector, an Amazon Web Services-powered web API solution that reduces development time and IT overheard required to deliver FDB’s drug knowledge. Meditech was an early adopter, and interestingly, the company mentions that future pharmacogenomics decision support may be impractical to deliver by traditional means.

Medsphere announces OpenVista Population Health, a Windows-based enhancement developed by the Indian Health Service for its RPMS ambulatory EHR version of the VA’s VistA. The company signed a $15 million contract in 2011 to support and enhance RPMS.

Epic wins Best in KLAS 2014 for overall software suite, acute care EMR, HIE, patient accounting, patient portal, surgery management. Epic Beaker beats the best-of-breed LISs as the #1 lab system (although one might argue that Epic Care Everywhere as the #1 HIE is equally surprising). Epic also wins best physician practice vendor and several EHR/PM categories. Athenahealth wins for practice management in the two larger practice size categories (11 docs and up), while Impact Advisors takes the top spot in overall IT services and clinical implementation principal.


Government and Politics

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New ONC Meaningful Use Stage 2 numbers show that 88 percent of hospitals that are MUS2 eligible have attested so far with an April 2015 due date, with 25 percent of those using the Flexibility Rule. EP attestations are much less robust, with only 15 percent of MUS2 eligible providers attesting so far with a February 28 due date and nearly half of those using the Flexibility Rule.


Privacy and Security

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The psychologist who pioneered the study of facial expressions in the 1970s fears that companies will use his work to infringe on privacy. Software can measure consumer reaction to ads, but is being extended to detect shoplifters and to interrogate suspects, leading him to worry that facial expression algorithms will be used in public spaces without consent. On a positive note, the technology is being testing for measuring post-operative pain and to detect stress levels.


Technology

A New York Times editorial by a Mayo Clinic anesthesiologist warns that despite President Obama’s call for heavily funded research for precision medicine, it won’t make most people healthier. He says that genes can’t predict the most common and expensive chronic diseases, but we can already do that with simple tests, while the treatment is decidedly non-technical: eat better, exercise more, and don’t smoke. He concludes that “moonshot medical research initiatives” such as the “war on cancer” usually fail and that efforts would be better directed to studying human behavior.

Bloomberg Business says IBM has lobbied Congress for two years to pass the 21st Century Cures bill that would keep Watson-powered medical capabilities free of FDA oversight. The bill, which also includes the Software Act and addresses several health IT issues, was drafted by the House Energy & Commerce Committee, whose Democrat members just pulled their support of the bill.

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AliveCor’s smartphone-powered heart monitor earns FDA approval for new algorithms that assess an ECG as normal and that warn users that interference makes the ECG unreliable. The just-introduced third generation model costs $75, creates readings from a two-finger touch, and includes an algorithm to detect atrial fibrillation.


Other

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A group of health systems – including Advocate, Ascension, Atrius, Dartmouth-Hitchcock, Dignity, OSF, Partners, Providence, and SSM — and other healthcare players unite under the name Health Care Transformation Task Force in committing to put 75 percent of their business into value-based payments by 2020.

A NEJM study suggests that while the Affordable Care Act prohibits insurance companies from excluding coverage for pre-existing conditions, they may be using high drug co-pays to keep people with expensive diseases such as HIV from signing up in the first place.

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The bonds of Einstein Healthcare (PA) are downgraded due to financial losses that are partly attributed to a drop in employee productivity caused by its Cerner EHR.

Massachusetts General Hospital (MA) used telemedicine virtual visits during the recent snowstorm when clinics closed.

A physician’s editorial in NEJM called “Death Takes a Weekend” ponders the age-old question of why — in this age of high-acuity admissions and fast discharges — hospital services shut down on weekends. “It seemed callous on the hospital’s part — expecting very sick patients and very worried family members to understand that the doctors’ convenience had to come first. They need the weekend off, so you’ll have to wait till Monday. Even in good hospitals, weekends had a decidedly makeshift feel, with a constant refrain of ‘I’m just cross-covering, we’re short-staffed, the person you need will be here Monday.’”

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Weird News Andy researches scam online medical journals that charge authors to publish their work. A doctor tests their editorial review process by submitting an article composed of randomly generated phrases titled “Cuckoo for Cocoa Puffs?” with primary authors Pinkerton LeBrain and Orson Welles. Seventeen of 37 journals accepted it within the first two weeks and offered to publish it upon submission of a processing fee. One of the journals shares an address with a strip club. I checked out Global Science Research Journals, which publishes dozens of journals such as “Global Journal of Neurology and Neurosurgery” and “Global Journal of Pediatrics” and charges a $500 per article fee. The Nigeria-based publisher’s US office is in a Brooklyn apartment.

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Another WNA find he calls “My Doctor the Car”: Mississippi’s medical board investigates an 88-year-old doctor whose practice consists only of house calls, saying they don’t like the idea that he writes prescriptions from his 2007 Camry. In the TV station video, a guy walks right up to the car window to explain his medical issues. WNA proposes a solution: he should upgrade to an RV.


Sponsor Updates

  • Named as KLAS Category Leaders for 2014 are Sentry (340B management inpatient), SIS (anesthesia), Merge (cardiology hemodynamics), Zynx Health (CDS care plans), Wolters Kluwer (CDS order sets), Premier (CDS surveillance), Optum (computer-assisted coding), Strata Decision (decision support business), Emdeon (eligibility enrollment), NextGate (EMPI), Allscripts (global acute EMR, Northern America), Encore (go-live support), GetWellNetwork (interactive patient systems), Capsule (medical device integration), Nuance (medical records coding, quality management), Ingenious Med (mobile data systems), Nordic (other implementation), TeleTracking (patient flow), Iatric Systems (patient privacy monitoring), Craneware (revenue cycle charge capture), SSI Group (revenue cycle claims management), and GE Healthcare (staff/nurse scheduling, time and attendance).
  • Named Best in KLAS 2014 are Merge (cardiology), ZirMed (claims and clearinghouse), Impact Advisors (overall IT services, clinical implementation principal), Wellsoft (emergency department), Streamline Health (enterprise scheduling), McKesson (ERP), Allscripts (global acute EMR), CareTech Solutions (IT outsourcing extensive), Orchestrate Healthcare (technical services).
  • Logicworks publishes the eighth installment in its DevOps Automation series, entitled, “Improving the End User Experience with Amazon Web Services.”
  • Orion Health earns accreditation as a HISP.
  • William Seay of Lifepoint Informatics writes a new blog entitled, “Get Your Laboratory & Anatomic Pathology Results in Real-Time, When You Want, How You Want & Where You Want.”
  • LifeImage’s Mike Murphy blogs about saving time, increasing referrals, and improving orthopedic patient care via medical image sharing.
  • PDR will exhibit at the NACDS Regional Chain meeting in Naples, Florida on February 2-4.
  • Ivenix Medical Advisor and anesthesiologist Matt Weinger, MD shares his views on infusion pump technology at the Association for the Advancement of Medical Instrumentation’s blog.
  • Kathleen Aller writes about looking for meaning in mounds of data in the latest InterSystems blog.
  • HealthMEDX offers insight into its full EHR implementation at Lexington Health System (KY).
  • Jim Blanchet, associate management consultant at Greencastle, blogs about “The Valley of Despair” and asking yourself the right questions.
  • The HCI Group offers five tips on meeting the ICD-10 implementation deadline.
  • Pepper McCormick writes about the four healthcare trends that will shape 2015 in the latest Healthwise blog.
  • Greythorn will exhibit at this weekend’s Geek Wire Startup Day in Seattle.
  • Health IT Outcomes profiles e-MDs and its work to exchange provider data directly with the new Kansas infectious disease registry.
  • DocuSign announces that over 50 million people in 188 countries now use its technology.
  • The Healthfinch team offers a new blog on healthcare IT assumptions versus reality.
  • Cynthia Ethier of Hayes Management Consulting offers advice on how to create an ACA front desk.
  • HDS takes a look at the growing phenomenon of walk-in clinics at local malls in its latest blog.
  • Ingenious Med Mobile Product Manager Brannon Gillis posts a new blog entitled, “Useful and Usable: Basic Mobile Development Philosophy in Action.”
  • ICSA Labs participates in the IHE North America Connectathon today in Cleveland.
  • Extension Healthcare will exhibit at the Association of California Nurse Leaders Conference in Anaheim from February 1-4.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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January 29, 2015 News 7 Comments

Startup CEOs and Investors: Bruce Brandes

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld”: Part I – Do The Opposite
By Bruce Brandes

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In my continued efforts to learn from progressive healthcare thought leaders, I recently read Eric Topol’s new book “The Patient Will See You Now.” I was heartened to see Dr. Topol’s opening chapter illustrate his first point with an intellectual / cultural equilibrium I can appreciate … through an amusing story from “Seinfeld” about Elaine’s medical record woes. That anecdote caused me to reflect on how my favorite iconic TV show about nothing is instructive for the entrepreneurs who strive to reinvent our healthcare delivery system.

Cautionary note:  my comments in this series will assume that HIStalk readers have at least a baseline knowledge in all things “Seinfeld.” I apologize in advance to the two or three folks out there who have not seen (or heaven forbid, did not like) “Seinfeld.”

Do The Opposite

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If you are relatively new to healthcare (and missed Vince Ciotti’s insightful HIStalk series on the history of healthcare IT), you may have asked yourself how Epic became so epic. Like George Costanza’s approach in landing a job with the New York Yankees, Epic did the opposite of what every other healthcare information systems vendor did.  

Most enterprise clinical systems originated as either hospital-centered extensions of patient billing systems, intended to capture just enough clinical information to get the bills out the door (SMS and HBOC) or as an expansion of a niche departmental system (Cerner and Meditech). Epic, on the other hand, began as an ambulatory system focused on winning the hearts and minds of the physicians. Those same physicians would later have significant influence over hospital decision-making. 

Rather than deploying armies of salespeople, Epic let their customers sell for them. Rather than making shortsighted decisions to placate quarterly earnings reports, Epic remained privately held. Rather than growing by multiple acquisitions, Epic expanded organically and built their own software on a common database. Epic had successfully broken down the departmental silos of laboratory, radiology, and pharmacy as well as ambulatory and inpatient records so that the health system could be unified on a singular platform.

However, the radical changes underway in our healthcare system now create an interesting parallel from Epic’s history lesson. Hospitals that are lauded for successfully unifying on a single EMR are as limited today in an Accountable Care Organization or Clinically Integrated Network as the historical single hospital was limited by the siloed departmental systems. To achieve population health, information must be openly shared across disparate systems and organizations. The sky-high costs, antiquated technology, and limited interoperability inherent in these legacy healthcare IT investments may prove to be the Waterloo for hospitals struggling for economic viability and competitive relevance in need of flexibility and agility in a value-based care world.

Emerging, disruptive companies should learn from history – and do the opposite. What might “opposite" look like from the traditional vendors with whom healthcare organizations have become accustomed? Some ideas and examples:

  • Free vs. expensive (Zenefits, Practice Fusion)
  • Payments aligned with benefits vs. massive capital outlays with vague ROI promises (Athenahealth)
  • A better experience at a lower cost vs. causing customer dissatisfaction at higher additional costs (Theranos)
  • Simple vs. complex to buy, implement, and use (Apple)
  • Openly shared, interoperable data vs. closed, proprietary systems (anything built in the last few years)
  • Mobile-first (information to you) vs. desktop (you go to the information) (AirStrip, Voalte)
  • Cloud-based SaaS vs. installing and maintaining software (Salesforce)

But beware, big-bang industry disruptors. Over the last several decades, the healthcare IT road (except a certain one-mile stretch of Arthur Burkhardt Expressway) has been littered with major international corporations that saw gold, Jerry, GOLD, in healthcare and failed (American Express, McDonnell Douglas, Alltel, etc.). Healthcare is indeed a “bizarro” industry – almost the opposite of every industry you’ve ever encountered. 

That said, the underlying economic, technical, and clinical restrictions that have historically hindered change are lessening. New mainstream technologies that we all use in our everyday lives are resetting expectations of the tools we use in our healthcare workplace.  

Now is the time for innovative entrepreneurs to consider jumping into the healthcare pool – but make sure your target market’s water isn’t too cold in order to avoid “shrinkage” of your investment.

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"My life is the complete opposite of what I want it to be. I should’ve done the complete opposite of whatever I’ve done up till now.”

Is this quote from George Costanza or a healthcare system you may know?

Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

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January 28, 2015 Startup CEOs and Investors 2 Comments

News 1/28/15

January 27, 2015 News 8 Comments

Top News

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HHS Secretary Sylvia Burwell announces an ambitious plan to tie 30 percent of Medicare provider payments to alternative payment models by 2016 and 50 percent by 2018, and also to link 85 percent of Medicare fee-for-service payments to quality and value by 2016. The announcement was received positively, although with guarded enthusiasm due to the lack of details and the mixed results of early adopters.


Reader Comments

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From Nihilist: “Re: BJC. Rumor is that the Epic install will be run out of a yet-unnamed holding company as a partnership with Washington University School of Medicine, which employees the academic hospital faculty. That’s why no job postings have appeared.” Unverified.


Acquisitions, Funding, Business, and Stock

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Huron Consulting will acquire Pensacola, FL-based, healthcare leadership consulting firm Studer Group for $325 million. The 235-employee company was founded by former hospital CEO and author Quint Studer in 1999 and was reported to have had 2013 revenue of $67 million.

China-based Alibaba Group, one of the world’s most valuable technology companies, partners with a medical software company to develop cloud-based services for physician practice, payment systems, e-prescribing, and drug tracking.

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Roper Industries reports Q4 results: revenue up 7 percent, adjusted EPS $1.85 vs. $1.65, falling short on revenue expectations but beating on earnings. Chairman, President, and CEO Brian Jellison says the company will be making at least one more Q1 acquisition that relates to its Sunquest business. He adds that Roper paid $140 million for Strata Decision Technologies, which has $30 million in annual revenue, but Roper gets an immediate $40 million in tax benefit because the company was operating as a limited liability corporation.


Sales

Eastern Idaho IPA chooses Valence Health’s vElect contract administration system to allow physicians to compare fee schedules to Medicare benchmarks in selecting and declining payer contracts.

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Two hospitals in Dubai will use Oneview Healthcare’s interactive patient engagement and clinical workflow system.  

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University Medical Center Health System (TX) extends its agreement with Cerner.

MedConnect chooses clinical interface terminology from Intelligent Medical Objects for its EHR.


People

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Biotechnology company Biogen Idec hires Naomi Fried, PhD (Boston Children’s Hospital) as VP of medical information, innovation, and external partnerships. She was Kaiser Permanente’s VP of innovation and advanced technology from 2006 to 2009.


Announcements and Implementations

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Georgia’s GRAChie HIE – founded by Cerner, GRHealth, and Navicent Health — reports increased numbers of data sources and system usage.

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The DEA approves EHNAC as the sole certifier of applications for electronic prescribing of controlled substances.

The Anesthesia Quality Institute recognizes Shareable Ink’s newly released ShareQuality mobile quality capture product as Quality Clinical Data Registry ready, allowing practices to use CMS’s preferred reporting mechanism.

CoverMyMeds announces that its electronic prior authorization system has been integrated with Epic.

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Decisio Health earns FDA marketing approval for its EHR-powered bedside clinical decision support and triage dashboard that was beta-tested by Memorial Hermann Hospital (TX).  

The Apple Watch will begin shipping in April.


Government and Politics

An HHS OIG report says CMS should coordinate its multiple quality improvement programs to reduce duplication of effort and to make it easier to attribute results, adding that CMS awarded Quality Improvement Organizations a new $4 billion contract just after spending $500 million to roll out two other programs.  


Privacy and Security

St. Peter’s Health Partners (NY) warns that a manager’s stolen, unencrypted cell phone contained emails with patient scheduling information for its physician practices. I think I read that iOS 8 encrypts everything on the iPhone by defauult.


Innovation and Research

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Samsung engineers create a smartphone-powered early warning stroke detection headset that analyze brain waves, expressing hope that the sensors may also be useful for other brain-related conditions. The engineers add that while the prototype model is a headset, the rubber-like sensors could be attached to less-obtrusive eyeglass temples.


Technology

Logitech announces a $500 portable videoconferencing solution for medium-sized rooms, which might be interesting for remote teams and IT meetings. ConferenceCam Connect works on any device that has a USB port and includes both battery and AC power.


Other

Weird News Andy says it’s like deja vu all over again. A doctor describes his patients’ constant deja vu as being trapped in a time loop. “As he walked in, he got a feeling of deja vu. Then he had deja vu of the deja vu. He couldn’t think of anything else.”

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Western Missouri Medical Center’s COO gives its Meditech-to-Cerner conversion a B+ grade, saying that continuity, integration, and data collection improved markedly, but getting data from Meditech was hard. They say they “never new when upgrades are coming” with Meditech.

Weird News Andy says it’s like deja vu all over again. A doctor describes his patients’ constant deja vu as being trapped in a time loop. “As he walked in, he got a feeling of deja vu. Then he had deja vu of the deja vu. He couldn’t think of anything else.”


Sponsor Updates

  • Nordic suggests five areas that should be part of a 2015 health IT plan.
  • Beacon Partners explains Business Intelligence Competency Centers and how to implement them.
  • PatientSafe Solutions CNIO Cheryl Parker, PhD, RN publishes “Smartphone-Based Mobility for Nurses.”
  • Besler Consulting participates today in the HFMA Florida Chapter Mid-Winter Conference and the Tri-State Winter Institute in Mississippi from January 28-30.
  • Caresync CEO Travis Bond asks, “What’s it Really Going to Take to Have Personalized Medicine?” in the latest company blog.
  • Brian Mitchell of CommVault, asks if “2015 is the Year of Data Dystopia?”
  • Clockwise.MD is nominated as a finalist in the inaugural Georgia’s Top Startup Awards.
  • AirStrip’s Alan Portela writes about “The Healthcare Dinner Party” at the company’s Mobile Health Matters blog.
  • Craneware lists the “Top Five Reasons for Denials” in a new blog post.
  • Awarepoint posts a new article, “The ROI in RTLS for Hospital Asset Management.”
  • Divurgent writes about “The ABCs of Ambulatory EMR Training and Acceptance.”
  • Clinical Architecture’s Charlie Harp writes about “The Road to Precision Medicine” in a new company blog.
  • Jaffer Traish of Culbert Healthcare Solutions writes about data sharing.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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January 27, 2015 News 8 Comments

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