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News 4/23/14

April 22, 2014 News No Comments

Top News

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Continua Health Alliance, mHealth Summit, and HIMSS launch the Personal Connected Health Alliance to represent the consumer voice in personal connected health to ensure that technologies are user-friendly, secure, and can easily collect, display, and relay personal health data.


Reader Comments

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From Less Disruption Please: “athenahealth. Friday was a tough day. Their outage was apparently due to catastrophic loss of power. It took out email, production, and backup sites. At least they apologized.” Unverified.


Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.



Acquisitions, Funding, Business, and Stock

4-22-2014 11-36-25 AM 

AdverseEvents, a healthcare informatics company focused on drug safety and side effects, closes $2 million in Series A financing.

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Informedika changes its name to Health Gorilla.

Lexmark reports that revenues for its Perceptive Software division grew 38 percent in the first quarter.


Sales

4-22-2014 11-44-46 AM

Evangelical Community Hospital (PA) selects dbtech’s eFolder solution for enterprise content management.

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Griffin Hospital (PA) will implement athenaCoordinator Enterprise.

UMass Memorial Health Care (MA) will integrate Luminat’s end-of-life directives platform into its EHR.

Alder Hey Children’s Hospital (UK) selects Summit Healthcare’s interface engine technology.

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Missouri Baptist Medical Center will deploy the Vocera Communication System.



People

4-22-2014 11-21-15 AM

EHR/PM provider Pulse Systems appoints Richard Ungaro (RU Investment) SVP of operations.

4-22-2014 11-22-32 AM   4-22-2014 11-23-32 AM

NoteSwift hires Stan Swiniarski (Nuance) as VP of products and Art Nicholas (Nova Dynamics) as VP of sales and business development.

4-22-2014 12-20-58 PM

MediTract, a provider of automated contract management solutions, appoints Ed Caldwell (Emdeon) SVP of sales and marketing.

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CMS Principal Deputy Administrator Jonathan Blum, the administration’s top Medicare official, will resign effective May 16.

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Cancer Treatment Centers of American names Kristin Darby (Tenet Healthcare) CIO.


Announcements and Implementations

Athenahealth reports that 95.4 percent of its participating providers successfully attested for MU Stage 1 in 2013. The company also resigns from the HIMSS Electronic Health Records Association (EHRA) trade association saying it “never really belonged” since it is neither an EHR company nor a software vendor.

Maine’s HealthInfoNet HIE offers providers access to the state’s Prescription Monitoring Program through the HIE’s portal, giving clinicians a single sign-on to both systems.

Children’s Hospital of Philadelphia and Virtua (NJ) integrate their imaging systems as well as CHOP’s Epic and Virtua’s Siemens EHRs to give both health systems access to each other’s radiology reports and diagnostic images.

4-22-2014 12-34-36 PM

Prince Mohammed Bin Abdulaziz Hospital in Saudi Arabia deploys Cerner after a nine-month implementation.


Government and Politics

CMS officials are considering whether to keep Accenture as its long-term prime contractor for the the HealthCare.gov website or seek a potential replacement. A “sources sought” notice posted by CMS says the agency is looking to see if any small businesses owned by veterans or minorities might be suitable candidates.


Other

Use of Epic’s Care Everywhere HIE tool helped four EDs within Allina Health (MN) reduce duplicate tests and procedures, according to a study published in Applied Clinical Informatics.

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Boston Children’s Hospital (MA) partners with Etiometry to analyze information from ICU patient monitors to display a Stability Index.

Weird News Andy says patients have to pay for expensive ICU stays, but maybe this isn’t the best way. Police arrest a female ICU patient after a tip from hospital staff that she was receiving many visitors who stayed only 1-2 minutes. She was dealing heroin from her bed.


Sponsor Updates

  • Kinetic Data names CareTech Solutions its Innovator of the Year for its innovative use of Kinetic Data products.
  • Craneware enhances its supply management solution Pharmacy ChargeLink to include additional worklist functionality, benchmark pricing, and automated dosing tools.
  • PaySpan will integrate MEA|NEA’s electronic claim attachment capabilities into its healthcare reimbursement platform.
  • McKesson observes Earth Day with a Green Week celebration that focuses on informing employees about the company’s efforts to reduce its environmental footprint and engaging employees in environmental efforts.
  • Wolters Kluwer Health releases the Medi-Span Medicare Plans File, which provides indicators to designate coverage under Medicare Part B and/or Part D.
  • Holon explains why HIE implementations in rural healthcare can trump those in urban settings in a company blog post.
  • The Advisory Board Company shares an infographic  that highlights how progressive organizations are focusing on primary care providers to achieve volume and quality goals.
  • Surgical Information Systems updates its industry, client, and anesthesia events calendar.
  • Aperek will participate in the SMI Spring 2014 Forum in Phoenix April 29-May 1.
  • Halim Cho, Covisint’s director of product marketing will discuss the cloud’s disruptive power to transform enterprises at the May 5 Forrester Forum for Technology Management Leaders in Orlando.
  • John Marshall, SVP and GM for AirWatch by VMware, offers his enterprise mobility market perspective in an interview.
  • Shareable Ink’s founder and CTO Stephen Hau organized a Boston Marathon team that raised over $750,000 for last year’s bombing victims.
  • Netsmart opens registration for its CONNECTIONS2014 conference October 6-9 in Anaheim, CA.
  • The Orion Health Patient Portal v.4.0 achieves ONC HIT 2014 Edition Complete EHR Certification through ICSA Labs.
  • Navicure adds 300 new clients representing 1,225 providers in the first quarter and posts a 19 percent increase in revenues versus a year ago.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 22, 2014 News No Comments

HIStalk Interviews Jim Prekop, CEO, TeraMedica

April 16, 2014 Interviews No Comments

Jim Prekop is president and CEO of TeraMedica of Milwaukee, WI.

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Tell me about yourself and the company.

I’ve been in health IT for about 30 years. The last 10 have been with TeraMedica. Before that, I was in the EMR space and companies like PeopleSoft and Dun & Bradstreet software.

TeraMedica is middleware. The industry term is vendor-neutral archive. We collect clinical objects and are responsible for making them available to the source system, but also making them available in a patient-centric view to additional consumers of that data, whether they’re outside in institutions, exchanges, or new technology that gets adopted by the provider. We perform that role in the healthcare architecture.

 

How has the unbundling of PACS from single-solution vendors changed the demand for vendor-neutral archives and what’s the end result for the provider and the patient?

It’s a natural progression. With systems, historically, the new idea is a more or less a closed-loop answer. It’s the same way with accounting systems going back decades. 

What was a box has now become a layer in the architecture, the process of acquiring and managing an image and then making it available down the road to new consumers or later in my lifetime. The solution has had to evolve. The VNA, or the ability to seamlessly have the interaction with departmental activity but yet be the conduit into the enterprise, it’s a natural progression. It’s not to say that PACS is bad, just that the focus going forward on PACS will be different, just as the responsibility for the VNA will change over time as well.

 

What about universal viewers?

The universal viewer is interesting. They’re approaching this through the lens of the physician, whereas the VNA approaches it from the infrastructure up. 

The advantage for the enterprise viewer is that they can combine data from multiple sources. But the other thing that has to be kept in mind is that there is response time and there is certainty that is needed in what is delivered to the enterprise viewer. You get into a federated discussion of going after 20 different data sources, combining that answer, and then delivering it in one view to the clinician versus the ability to have all of that patient matching resolved by the VNA. It’s one-stop shopping. It goes to any consumer of the VNA.

We see the consumers being an EMR. We see the consumers being an enterprise viewer. Going forward as more adoption comes into the United States, it will be different exchanges that imaging will become part of. So to us, it’s just a consumer. We optimize its ability to be confidently assured that they’ve asked for and gotten the right information and that all the information is there. If you have a federated view and make a request and one of those systems is down, you might not get the answer.

 

Enterprise viewer implies that there’s behind the scenes fetching going on that then presents a unified view, as opposed to the VNA where it’s actually stored in a single system.

Yes. It’s already stored and normalized and you’re having one conversation behind the scenes. 

Unless somebody’s invented something new in IT that I haven’t seen, you pretty much have to ask the same question across multiple systems or go to some sort of index and find out all the Jim Prekops and then go and find out where they’re located, go get them, and then present it to me in an organized way. Can those enterprise viewers do that? Absolutely, and we have great partners in that space. Is it the best experience for the provider or the clinician? Maybe not.

 

What are the optimal ways to integrate a variety of images into Epic or Cerner?

I call it a landing page. EMRs address all the departments in the organization and rightfully so. But if I want to go look at all the different clinical objects that Jim Prekop created in a facility, chances are the links to that information are within various locations within the EMR. 

One of the advantages that TeraMedica brings to the table to leverage the investment that the provider has in the EMR is to give a patient-centered view of all the clinical objects, should they want that. That’s an option in our system. We can be tied to a report and just show that image, or we can present a complete inventory of what we have in the VNA, so that in one location, a clinician can see things that might be related to other departments. I don’t necessarily have to navigate over to that section of the EMR to see those objects.

 

It’s probably important to note that all images are objects but not all objects are images. Are you seeing demands for new object types?

Absolutely. When I first got here, I had to get an education on DICOM and all the nuances and it was a big education. But not everything is DICOM when it comes to clinical objects. 

Our customers asked us very early to not just manage DICOM. It’s a wonderful thing and is the heavy lifting in our business. But to be truly patient-centric, you have to address all different types of file types, whether it be JPEGs, MPEGs, PDFs, a Word document, or in the case of cancer care, lots of calculations are done using Excel and other types of planning systems.

To represent that an image is just a DICOM object is not fair. It’s usually one of the arguments when you try and decide what a VNA really is. There are lots of folks that manage DICOM and they do a good job, but they declare themselves as the VNA. That doesn’t meet our definition of a VNA.

 

What’s the distinction between storing non-DICOM data in its native format instead of using a DICOM wrapper?

Unlike other industries where you can create data marts and if there’s a problem you just snap another copy of the data, we’re into terabytes and hundreds of terabytes of data. As you acquire that information as the VNA, you have to be clinically responsible to the source system. If I go get a PDF of Jim Prekop from a clinical system and I wrap it in DICOM and that system wants it back, I either have to create duplicate storage — which is not cost productive — or I have to be able to unwrap it from that DICOM and enter that as a PDF to that source system.

The overhead of doing that simply doesn’t work and it doesn’t scale. To believe that you have to wrap everything in DICOM so it follows how your system works … I would suggest you have the wrong system if it only works with DICOM.

A well-known VNA consultant who comes from a PACS mentality is adamant that everything should be wrapped in DICOM. We needed to get him to sign an updated non-disclosure agreement, so I had my engineers wrap our NDA in DICOM before I sent it to him. His asked me what I had sent him since he operates on a Macintosh that doesn’t understand the file type, which is a .UCM. He didn’t even recognize that I had sent him a DICOM file. He didn’t understand that he was essentially justifying the reason why we believe that it’s DICOM and non-DICOM.

 

Who are your main competitors and how do you differentiate your product from theirs?

Since the VNA term was adopted — I prefer Vendor-Neutral Architecture — lots of folks put their hat into the game. As you would expect, a lot of PACS vendors have begun to open up and allow multiple DICOM systems to enter data in there.

It’s usually TeraMedica and Acuo that end up being the finalists in any evaluation. There are some other ones that are out there that do some of the things that we do. There’s some newcomers — Mach7 is out there, but I think they have more activity outside the US than they do within the US. But there are others that are coming into the space, and rightfully so. It’s a competitive market.

 

Hospitals acquiring medical practices and each other have left them trying to figure out how to get their systems to talk to each other. Is that true of imaging systems or other systems that would populate a VNA?

There’s two aspects of that. We’re having organizations that are buying us because they’re strategically positioning themselves to acquire other entities. They know that they can’t rip out those clinical systems, so they will use us as part of their strategy to get control of the data and share it across the enterprise.

As far as the other way, we have sites that are established either because of acquisitions or because of differences on campuses that have multiple EMRs. Our technology allows, again using myself as the example, Jim Prekop to be referenced, and if I know the request is coming from Epic, I’ll behave one way to put it properly in Epic. At the same time, I can put it into Cerner. There’s one source of the truth.

One of the value propositions that we bring as a VNA is that we can identify consumers and react accordingly. We can also respond to multiple consumers, but yet give them the exact data that they’re looking at, whether they come in through the physician’s office with one EMR or they come in through the hospital with another EMR. It’s one source of the truth with multiple consumers.

 

Where do you see the company going in the next three to five years? 

I think it’s based around being a good partner with our customers and bringing to them more use cases, more managing the data. As you would expect, we can sit behind a PACS, but the thing about VNAs is we’ve had to come around the curtain. We’ve always considered doing the plumbing behind the scenes. But now we’re very active in different departmental workflows.

We’re getting involved with our iPad app, as an example, in departments like wound care and dermatology, where the clinicians are actually interacting with our software and we are part of the EMR, but the clinician doesn’t even know we’re there. A lot of times when someone says, “I didn’t know you were there,” that’s a bad thing. For us, that’s a good thing, because we want seamless integration into these different systems. I can see us doing more of it.

I can see us taking responsibilities for more functions of a generic nature in the provider space so that they can optimize the platform that they’ve invested in. Clearly the leading investment is the EMR. But the VNA is also a strategic investment, and we need to do more for them when it comes to clinical workflow.

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April 16, 2014 Interviews No Comments

Monday Morning Update 4/14/14

April 12, 2014 News 3 Comments

Top News

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The New York Times says the White House decided that Kathleen Sebelius needed to go as HHS secretary after her “wooden” appearance on “The Daily Show with Jon Stewart” in October (during which Stewart speculated openly that Sebelius was lying to him about Healthcare.gov) and the pressure she was getting from Republican members of Congress. The President waited until last week until the Healthcare.gov crisis was over to give her the hook, with the Times calling it a “slow-motion resignation.” It may be a first that a Cabinet member was forced out because of a TV show appearance and for antagonizing the other party. Even her carefully orchestrated Rose Garden farewell speech was marred by technical difficulties – she stumbled because her notes were missing a page. I don’t expect much to change with her replacement – Congress and the White House can’t keep their hands out of what HHS is doing, so the Secretary’s job is to announce big changes rather than to propose them (and to be the President’s unusually obedient lap dog in Sebelius’s case.)


Reader Comments

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From Anon: “Re: Wipro. Remember how they were going to save the day with low cost IT managed services? Won a $200m contract with Catholic Health Initiatives? Big problems. They can’t even keep Microsoft Exchange running, service applications, HR system, let alone CHI’s various EHRs. Unplanned downtime is becoming a daily occurrence.” Unverified. CHI signed the deal with the India-based Wipro in March 2013, saying it expected to save $42 million over five years.

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From NoPicis: “Re: Picis. Just been in a meeting where complaints were ventilated on Picis not being MU2 certified. Nobody at Picis took the time to let their customers base know about their non-compliance.” Unverified. I contacted Picis/Optum but didn’t hear back. ONC shows Picic products as being certified under 2011 criteria.

From Pokey: “Re: Cerner-Intermountain partnership. The baby has a name!” The project will be called iCentra, which is how I would picture Brits pronouncing “eye centre” based on how they spell it.

From Biller: “Re: 1500 format. On April 1, 2014, CMS has required the use of new formats to submit bills, replacing the 1500 format. Our vendor was desperately unprepared and did not have the code to make the change.  And when they did, systems were crashing like cars in a sleet storm. Were the other vendors of billing systems so unprepared?” Readers: if you had this problem, leave a comment and name your vendor if you like.

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From Mark: “Re: Oconee Medical Center (SC). A Paragon site, about to be absorbed by Greenville Health System, which is moving to Epic.”


HIStalk Announcements and Requests

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It was political maneuvering that caused the ICD-10 delay, according to more than half of poll respondents. Anydoc had a good comment: “For sure, the lack of both provider and vendor readiness in an election year. One could easily imagine the backlash in November elections after a year of debating at nauseum the failures of Healthcare.gov compounded by providers frustrations with payment delays, lost productivity, etc. only one month before going to the polls.” New poll to your right: who is most responsible for the ACA failures like Healthcare.gov that led Kathleen Sebelius to step down?

Saturday is my grammar pet peeve day. Topping my list this week: people who write “it’s” as a possessive. Please, I know it isn’t logical, but the possessive form is “its” so just live with it, OK? Also driving me crazy: people who say “thanks but no thanks” thinking it’s cute, which requires double the number of syllables to say precisely the same thing as just “no, thanks.” OK, one more: using the word “very,” which when used often is either superfluous (“very interesting”) or incorrect (“very unique.”)

Listening: Superdrag, a decent, defunct alterna-pop band from Knoxville, TN. Not to be confused with my favorite Superchunk, which is better, non-defunct, and in fact celebrating their 25th anniversary.

I had HIStalk and the other sites migrated to a much larger server this weekend. It’s a dedicated one running a four-core Xeon processor, 16GB of DDR3 memory, a terabyte of 7,200 rpm disk, an identical second drive just for backups, MySQL databases running on a 120GB solid-state drive for extra speed, and 20TB of premium transfer. OS is CentOS Linux 64 bit and Litespeed. HIStalk keeps growing and response time was slowed at times when hundreds of readers were on at the same time, so the new server should be fast with plenty of capacity for continued growth.


Upcoming Webinars

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


Acquisitions, Funding, Business, and Stock

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A lifeIMAGE blog post says Nuance will enter the image sharing market in a Monday announcement that it will acquire “a small, Atlanta-based company.” I hear (unconfirmed) that company is Accelerad. KLAS ranked the company’s SeeMyRadiology.com #1 in image sharing in November 2013. It’s an odd business for Nuance to be entering, but shareholder pressure to deliver better results may have made diversification attractive for either strategic or accounting reasons even though it strays from the company’s traditional core mission of speech recognition and consumer apps (Dragon, Siri, and software for scanning and PDF editing.)

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Medical cart maker Enovate Medical will expand its Murfreesboro, TN headquarters, with plans to create 410 jobs in the next five years.


People

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Vermont Commerce Secretary Lawrence Miller, who was tapped to rescue the state’s Vermont Health Connect health insurance exchange after a rocky rollout, is named as the governor’s point person for healthcare reform. His previous background: he founded a brewing company and ran a business that sells pewter jewelry. Meanwhile, the state auditor will investigate Vermont Health Connect and its struggles with vendors Oracle and CGI after a consultant blamed the site’s problems on politics and inexperienced leadership. Vermont has up to $170 million in federal money to spend, gave CGI a contract worth $84 million, and has paid $54 million so far for a crippled site.


Announcements and Implementations

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Penn Highlands Healthcare (PA) goes live on its patient portal, or actually “portals” in the plural since the some are Cerner, some are NextGen, and others don’t appear to be from either vendor.


Government and Politics

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HIMSS loves Kathleen Sebelius and any other politician who helps divert taxpayer money into HIT vendor and provider pockets, so naturally they gave her a laudatory send-off, saying “the health IT community was blessed” to have her running the department overseeing HITECH payments (and plugging its own EMR Adoption Model in its praise.) I’m suspicious of anybody who refers to a “community” without defining it or explaining how they know what that “community” thinks, especially since most members of the health IT community are citizens paying the ever-rising taxes needed to fund HITECH, Healthcare.gov, and Medicare. Personally, I’m not feeling all that blessed.

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The State of Maryland threatens to sue Noridian Health Care Solutions, the $85 million prime contractor of its health insurance exchange.


Technology

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April 15 is more than just tax day for nerds jealous at their peers wandering around wearing Google Glass: anybody can buy a $1,500 Glass for that day only without being part of the Explorer program. The downside: it could go into commercial production soon at a lower price and possibly with better features.

The Heartbleed bug in OpenSSL that has exposed web server information (including passwords, credit card numbers, and potentially patient information) for years on two-thirds of the world’s websites was caused by programming error that wasn’t caught by the QA review of the small, open source project, according to the German developer who identified the exploit.


Other

The American Medical Association releases a laundry list of warnings about correlating Medicare payments information to physician incomes. A subset:

  • The information could contain errors and CMS doesn’t allow doctors to report inaccuracies.
  • Claims filed under a given National Provider Identifier can include services rendered by residents or other healthcare professionals.
  • Payments include the cost of physician-administered drugs, which are low margin for doctors.
  • Physician payments are actually practice payments that must also cover practice overhead – the physician doesn’t just pocket the Medicare check.
  • Medicare’s coding and billing rules vary over time and even by location.
  • Doctor’s don’t make all their income from Medicare.

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A JAMA editorial by Farzad Mostashari, MD and colleagues from The Brookings Institution says that each primary care physician is in essence a CEO in charge of $10 million in annual revenue, that being the overall annual healthcare spending of the average practice’s 2,000 patients. It concludes that PCPs are underused and that physician-led ACOs will work better than those run by hospitals, but that success has been limited because practices haven’t spent enough on IT or on practice transformation services. It warns PCPs that they will lose control if they just continue with business as usual or sell out to hospitals. I’ll go with that: if you want to encourage efficiency, save money, and improve health and not just episodic healthcare services delivery, the last group you’d want to talk to would be hospitals.

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Cleveland Clinic, which anyone who has walked its halls can tell has always treated a cash-paying Middle Easterners, will open a 364-bed hospital in Adu Dhabi, with CEO Toby Cosgrove, MD saying, “We look at it as our petrodollars coming home to Cleveland.”

I missed this announcement from earlier this month: ECRI Institute Patient Safety Organization launches a partnership to identify and learn from health IT safety issues. Among the collaborating organizations are HIMSS, AHIMA, AMIA, ISMP, and AMDIS. Several experts serve on its advisory panel, including David Bates, MD (Brigham and Women’s), Peter Pronovost, MD, PhD (Johns Hopkins), and Dean Sittig, PhD (UT Health Science Center at Houston.)


Contacts

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

More news, HIStalk Practice, HIStalk Connect.

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April 12, 2014 News 3 Comments

News 4/9/14

April 8, 2014 News 6 Comments

Top News

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Minneapolis-based Medicare billing technology vendor Ability Network (formerly VIsionShare) will receive a $550 million strategic investment from Summit Partners. The company characterizes the investment as a recapitalization rather than an outright sale. CEO Mark Briggs has spent time with Carefx, NaviNet, and QuadraMed.


Reader Comments

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From Smartfood99: “Re: Meditech. First it was a 400+ hospital in NJ, now an even larger academic hospital in GA. Does Epic not control this space any more?” Phoebe Putney Hospital (GA) will upgrade from Meditech Client/Server to Meditech 6.1, with the 691-bed hospital choosing that system because of its integration and lower cost of ownership. It would be fun to talk to someone there to find out what Epic and Cerner put on the table.

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From Chris: “Re: OneReach Health. What do you hear about them?” Chris is a hospital guy and not a company shill, so I took a look. The Denver-based company offers Web-based VoIP phone solutions: inbound IVR-powered call management, text messaging, appointment confirmation, reminders, smart inbound call routing based on previous calls, and integration with EHRs. They were in the Startup Showcase at the HIMSS conference. That’s all I know.  

From Reluctant Epic User: “Re: eating your own dog food. I don’t see us doing that in my own IT shop. On the desktop side, we give our users a poorly configured, un-optimized desktop image and strip them of administrative rights so the machine that they have to use each day is so locked down it becomes unusable. Outside of the IT shop, the majority of us get our healthcare elsewhere, too.  IT users should be forced to use the same desktop image as everyone else. I would be curious to hear if others are attempting any sort of dogfooding.” I’ve often railed against IT shops that lock down PCs without regard to individual user expertise, solely to reduce  support desk calls, with IT and usually the finance departments being exempt. Readers are welcome to chime in – do IT department users get treated the same as the rank and file whose technology they oversee? 

From For Real: “Re: [PM / EHR /secure email vendor name omitted]. Word is they are finished. Layoffs and not paying vendors. No loss to the industry.” Shares dropped 23 percent Tuesday to $0.01, valuing the company at $6.5 million. For the last fiscal year, it reported revenue of $106,000 and a net loss of $7.2 million. As a comment on a stock message board questions, “Why does this thing even trade?” I omitted its name because it’s publicly traded, although at a penny a share nobody probably cares much.

From Dim-Sum: “Re: Defense Department EHR. DHMSM is rounding out their final RFI, but the DoD is wondering, ‘Did we ask the right questions?’ Vendors are scratching their heads wondering what am they are signing up for, and where is the ‘assumptions’ section? Do COTS vendors really want to sift through almost synchronized-archaic pre-Aramaic scribe data from CHCS – CHCS II, and AHLTA? Do they know the agony of making AHLTA data useful? Could the incumbent purveyor of AHLTA actually spell ONTOLOGY?  You are going to have to embrace the pain of migration and conversion. If you think that is bad, wait until you meet ‘Mr. MODS’ (Military Operational Deployment System) designed by a firm that cannot spell HealthKare. Rumor has it that the DoD wants to consolidate the solutions from Air Force, Army and Navy. As the SIs finalize their wooing of COTS vendors, we wonder will CSC announce that they are partnering with an outfit from Overland Park, KS? Will Leidos keep searching for a tenable partner or are they running on the fear that they may lose the re-compete? I guess Accenture and Leidos are not sure if they want to go to the prom together? Will IBM convince the DoD that once in for all a hardware company can install ‘Badger State’ software? Could anyone have predicted that the incumbent would have bowed out after a few phone calls to HCA Healthcare references? Where did McKesson go? Did the Allscripts Eclipsys ever come to fruition? Is it true that the Greek Goddess of Wisdom, Warfare, Divine Intelligence, and Service Oriented Architecture actually find their acute companion in Malvern, PA? And what about the VistA cult? Expect the RFP to drop Q4 2014 and your dreams should resonate on Q3/Q4 2015 when the prize will be rewarded to the team that approaches DHMSM from a practical, methodical, and sound technological foundation (as well as a sense of humor.)”

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From FDASIA Work Group Member: “Re: FDASIA report. I’m not sure it’s fair to describe the work group members as pro-vendor. Much of the discussion was about increased regulation in certain domains, but unfortunately due to time limits, that didn’t make it into the report because we couldn’t come to agreement on what that would look like. I would have guessed the FDA would have regulated more given our discussion, but they also have to consider how practical enforcement would be as well as politics.”

From Epic Consultant: “Re: Epic post-live problems. I have worked with four relatively large places with consistent themes of failures in physician productivity, poor revenue cycle performance, and inability to manage patient navigation. It’s not news that later adopters are having issues given the sheer number of installed clients, but for every vendor that got to be Epic’s size, there was a rise in post-live problems where productivity never made it back to the baseline. I’m not sure if this is a general trend.” Readers are welcome to describe their experience.

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From Graham Grieve: “Re: CDA security issues. Readers might be interested.” HL7-provided style sheets that display C-CDA documents have made 2014 Certified EHRs vulnerable to attacks from maliciously composed documents, according to ONC’s SMART project. If you are a vendor of a Web-based EHR, you should pay attention.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Validic. The Durham, NC-based company offers the healthcare industry’s premier technology platform for connecting health systems, providers, drug companies, payers, and health systems to 80 mHealth apps and devices (in-home monitoring, wearables, and apps) all with one easy connection. Its mobile ecosystem delivers standardized, FDA Class I MDDS, HIPAA-compliant consumer health data covering 30 million lives. Customers use it for monitoring patient engagement, monitoring patients remotely, collecting clinical trials data, and monitoring medication and preventive wellness adherence. Thanks to Validic for supporting HIStalk.

I learned something from this recent YouTube video about Validic that I found: Mark Cuban is an investor and talked up the company at SXSW a few weeks ago.

A tweet from an attendee of a healthcare marketing conference says that a survey by Agency Ten22 found that HIStalk is the most-read blog of hospital C-suite readers. Thanks if you are one of them.

Listening: new from Austin, TX-based Ume, a female-led melodic, guitar-heavy rock band (they sound a bit like Metric) that should be wildly popular but isn’t.


Upcoming Webinars

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

April 9 (Wednesday) 1:00 p.m. ET. The Path to Shared Savings With Population Health Management Applications. Sponsored by Health Catalyst. Presenters: Eric Just, vice president of technology, Health Catalyst; and Kathleen Merkley, clinical engagement executive, Health Catalyst. The presenters will look under the hood at several advanced applications built on a Late-Binding Catalyst data warehouse, showing how to identify care variability, define populations, report key indicators, apply flexible risk stratification models, and measure process metrics.

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


Acquisitions, Funding, Business, and Stock

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Wellframe, developer of a mobile care delivery and management platform, secures $1.5 million in seed funding from multiple investors, including Jonathan Bush (athenahealth), Russ Nash (Accenture), and Carl Byers (Fidelity Biosciences).

Care management software developer Bjond raises $3.25 million in Series A funding.

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Allscripts CEO Paul Black made 22 percent less income in 2013 than in 2012 because he didn’t earn a bonus, giving him $7.1 million in compensation for the year. CFO Richard Poulton’s total compensation was $3.9 million.


Sales

Antelope Valley ACO (CA) selects eClinicalWorks Care Coordination Medical Record for population health management.

The Defense Logistics Agency awards GE Healthcare’s Datex Ohmeda division a $19.8 million contract for patient monitoring systems and services.


People

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Trace Devanny joins Nuance Communications as president of the company’s healthcare division after spending 30 months as chairman and CEO of TriZetto, leaving that company a month after it relocated its headquarters to Colorado.

4-8-2014 9-42-25 AM

EDCO Health Information Solutions promotes Andy Williams from director of field operations to VP of business quality and process improvement.

4-8-2014 11-51-58 AM

Huron Consulting Group hires Rob Schreiner, MD (Kaiser Permanente Georgia) as managing director of its healthcare practice.

4-8-2014 12-09-00 PM

Cumberland Consulting Group names Amy VanDeCar (Compliance Implementation Services) senior principal of its life sciences practice.

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Freeman Health System (MO) names Thomas Glodek, MD (The Physician Advisory Services Group LLC) as CMIO.


Announcements and Implementations

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Quest Diagnostics launches the MyQuest by Care 360 portal to provide patients direct access to their lab test reports. The release coincides with a federal rule going into effect this week that allows patients to view test results without physician approval.

Nine health systems and medical groups will adopt the OpenNotes movement in making clinician notes available to their patients Washington and Oregon, including Kaiser Permanente Northwest, which starting providing its information to members on Tuesday.

The Canadian Intellectual Property Office awards EDCO Health Information Systems a patent for its Solarity medical record scanning and indexing technology.


Government and Politics

4-8-2014 10-47-48 AM

CMS paid 367,228 eligible professionals $168 million under the PQRS program in 2012 and $335 million to 227,447 EPs under the e-Rx incentive program. Payments under the PQRS program decreased 35 percent from the previous year with EPs earning an average of $457. Under the eRx program, incentive payments jumped 18 percent and the average incentive payment was $1,474 per provider.

CMS releases Bonnie, a tool for testing implementation of electronic clinical quality measures (eCQMs) in EHRs. CMS also posts updated specifications for the Eligible Hospital eCQMs under Stage 2 MU.


Other

4-8-2014 1-08-10 PM

Lexicode, Anthelio, and KForce earn the top overall performance scores in a KLAS report on outsourced coding. Two-thirds of providers say they plan to keep or expand their current service.

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A Computerworld IT salary survey finds that application development is the most sought-after skill in the IT world, followed by help desk and IT support. In 2013, IT salaries grew 2.1 percent and bonuses increased less than one percent. 

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I love this list of things to look for before trusting the conclusions of an article or survey. Pay attention to these and you’ll ignore nearly every loudly trumpeted study or survey that earn simplistic headlines from sites too lazy to read beyond the executive summary:

  • The headline may hype a conclusion that the research doesn’t deliver.
  • The authors work for vendors or otherwise stand to benefit.
  • It may conclude that A caused B rather than the actual fact that A was correlated to B without necessarily causing it.
  • The sample size may have been too small, or even more importantly, may not have been carefully chosen as a proxy for the group it claims to represent.
  • The authors focus on one aspect of a study and ignore the less-favorable findings.
  • The publisher doesn’t have high review standards.

A low-income clinic requests that commissioners of  Durham County, NC give it $1 million to pay for an Epic implementation, with Duke University Health System offering to pick up the remaining tab of the $2 million project. Commissioners were surprised that the money was requested immediately in preparation for an implementation and go-live in three months.

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Voters soundly defeat a $9 million property tax levy that would have allowed 40-bed St. Bernard Parish Hospital (LA) to replace its dysfunctional billing system and to implement electronic medical records. 

Crain’s New York Business reports that for former CEO of Barnabas Health (NJ) was paid $22 million when he retired in 2012, while the CEO of Atlantic Health made $10 million in the same year.

Beth Israel Deaconess Medical Center (MA) launches a pilot project in which it will share clinician notes with psychiatric patients,

Weird News Andy calls this article “New Organs from Old,” suggesting its use for giving a diabetic patient a new pancreas or a CIO a new liver. Stem cell scientists rebuild a functional mouse thymus by reversing age-relating shrinking.



Sponsor Updates

  • Summit Healthcare and S&P Consultants partner to provide an enterprise-wide Cerner downtime solution.
  • e-MDs adds PDR Brief to its EHR, giving users enhanced drug information and alerts from PDR Network.
  • Borgess Health (MI) reports a $9 million increase in appropriate revenue within a year of implementing the Nuance Compliant Documentation Management Program.
  • Health Data Specialists will attend the Cerner Pacific West Regional Users Group meeting in San Diego, CA on April 22-24 and will also attend the 2014 Texas Regional HIMSS Conference on April 22-23 in Dallas, TX.
  • Cornerstone Advisors will offer two presentations at the 2014 Texas Regional HIMSS Conference on April 22-23 in Dallas, TX.
  • The American Board of Internal Medicine uses Truven Health Treatment Pathways 3.0 to help identify wasteful healthcare as part of its Choosing Wisely initiative.
  • Levi, Ray & Shoup introduces Independent Document Bundling, a document automation solution to automate the retrieval and merging of documents in different formats from various sources.
  • Navicure posts its April and May events calendar.
  • BlueTree Network co-founder Ted Gurman offers tips for making the most of the ICD-10 delay in a company blog post.
  • Acadiana Center for Orthopedic and Occupational Medicine (LA) shares details of the benefits it has realized since implementing Greenway’s Intergy EHR and Practice Analytics.
  • RazorInsights releases its April conference schedule.
  • Deloitte seeks applications for its 20th annual ranking of the Technology Fast 500.
  • Wolters Kluwer Health releases Lippincott Advisor App for Android and Apple smartphone and tablets.
  • Perceptive Software launches its hybrid cloud foundation Perceptive Evolution at this week’s Inspire 2014 in Las Vegas.
  • Bottomline Technologies announces the general availability of its Healthcare 5.1 platform, which includes enhanced functionality for eCapture, eSignature, and On-Demand forms.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 8, 2014 News 6 Comments

Morning Headlines 4/7/14

April 6, 2014 Headlines No Comments

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

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

5 Things About States With Problem-Plagued Health Exchanges

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

Oversold Conditions For Athenahealth

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

Beebe rolls out $33 million electronic records system

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

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April 6, 2014 Headlines No Comments

Monday Morning Update 4/7/14

April 5, 2014 News 4 Comments

Top News

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

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

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


Reader Comments

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


HIStalk Announcements and Requests

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

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

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

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

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


Upcoming Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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


Sales

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


People

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


Announcements and Implementations

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


Government and Politics 

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

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

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

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

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


Innovation and Research

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


Technology

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


Other

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 5, 2014 News 4 Comments

News 4/4/14

April 3, 2014 News 4 Comments

Top News

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

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


Reader Comments

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

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


HIStalk Announcements and Requests

8 million

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

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

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


Upcoming Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

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


Sales

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

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

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

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

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

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

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


People

4-1-2014 7-09-34 AM

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

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Nextech appoints Ron Kozlin (Pilgrim Software) CFO.

4-2-2014 4-50-14 PM

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

4-3-2014 1-39-53 PM

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

4-3-2014 1-48-52 PM

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


Announcements and Implementations

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

4-3-2014 8-29-21 AM 

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

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Hudson Valley Hospital Center launches its MyHVHC patient portal.

Emory Healthcare and Grady Health System join the Georgia HIN.

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


Government and Politics

4-3-2014 6-39-02 AM

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


Innovation and Research

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

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


Other

4-2-2014 7-16-11 PM

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

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

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

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

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


Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

Dear Dr. Jayne,

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 3, 2014 News 4 Comments

News 4/2/14

April 1, 2014 News 7 Comments

Top News

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


Reader Comments

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

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

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

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

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


HIStalk Announcements and Requests

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

I found this YouTube video overview of Navicure. 

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


Upcoming Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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


Sales

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

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

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


People

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


Announcements and Implementations

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

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

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


Government and Politics

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

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


Technology

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


Other

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

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

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

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

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


Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 1, 2014 News 7 Comments

Morning Headlines 3/31/14

March 30, 2014 Headlines No Comments

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

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

Morgan Stanley Reveals Stocks on Takeover Target

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

Big data: are we making a big mistake?

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

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

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

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March 30, 2014 Headlines No Comments

Monday Morning Update 3/31/14

March 29, 2014 News 7 Comments

Top News

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


Reader Comments

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

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


HIStalk Announcements and Requests

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

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

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


Upcoming Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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


Government and Politics

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

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

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

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


Innovation and Research

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


Other

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

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

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

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

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

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

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


Contacts

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

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March 29, 2014 News 7 Comments

News 3/28/14

March 27, 2014 News 12 Comments

Top News

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

 


Reader Comments

3-27-2014 11-22-52 AM

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

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

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

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

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

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


HIStalk Announcements and Requests

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

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

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


Upcoming Webinars

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

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


Acquisitions, Funding, Business, and Stock

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


Sales

3-27-2014 10-15-05 AM

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

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


People

3-27-2014 12-42-12 PM

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

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

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


Announcements and Implementations

3-27-2014 8-34-30 AM

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

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


Government and Politics

3-27-2014 1-49-32 PM

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


Technology

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


Other

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Continua Health Alliance announces availability of its 2014 Design Guidelines.

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

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

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


Sponsor Updates

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

 


EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect

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March 27, 2014 News 12 Comments

Monday Morning Update 3/24/14

March 22, 2014 News 11 Comments

Top News

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


Reader Comments

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

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

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

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


HIStalk Announcements and Requests

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

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

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

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


Upcoming Webinars

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


Acquisitions, Funding, Business, and Stock

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


People

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

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CHIME promotes Keith Fraidenburg to EVP/chief strategy officer.


Announcements and Implementations

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


Government and Politics

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


Technology

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


Other

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

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

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

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

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


Sponsor Updates

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

Exhibitor Costs at the HIMSS Conference

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

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

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

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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March 22, 2014 News 11 Comments

News 3/21/14

March 20, 2014 News 5 Comments

Top News

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


Reader Comments

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

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


HIStalk Announcements and Requests

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

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

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

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


Upcoming Webinars

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


Acquisitions, Funding, Business, and Stock

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

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

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

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Social health management vendor Welltok acquires wellness game developer Mindbloom.

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


Sales

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

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

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

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


People

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Clinovations promotes Kevin Coloton from COO to president.


Announcements and Implementations

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

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

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

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

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

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

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


Government and Politics

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

3-20-2014 10-47-09 AM

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

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

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


Innovation and Research

3-20-2014 11-31-49 AM

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

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


Other

3-20-2014 1-38-00 PM

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

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

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

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

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

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

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

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


Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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March 20, 2014 News 5 Comments

News 3/19/14

March 18, 2014 News 2 Comments

Top News

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


Reader Comments

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

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

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


HIStalk Announcements and Requests

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

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


Upcoming Webinars

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

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


Acquisitions, Funding, Business, and Stock

3-18-2014 1-32-20 PM

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

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

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

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


Sales

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

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

3-18-2014 1-34-07 PM

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

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

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

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

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

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


People

3-18-2014 10-06-09 AM

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

3-18-2014 9-03-10 AM

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

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NexTech names Eric Nilsson (Surgical Information Systems) CTO.

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

3-18-2014 1-39-39 PM

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

3-18-2014 1-40-50 PM

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

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

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

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GetWellNetwork appoints Bart Witteveen (Matrix Medical Network) CFO.


Announcements and Implementations

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

3-18-2014 9-15-41 AM

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

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

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


Government and Politics

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


Innovation and Research

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


Technology

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


Other

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

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

3-18-2014 1-03-53 PM

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

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

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


Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect 

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March 18, 2014 News 2 Comments

HIStalk Interviews Bill Anderson, CEO, Medhost

March 17, 2014 Interviews No Comments

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

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Tell me about yourself and the company. 

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

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

 

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

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

 

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

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

 

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

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

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

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

 

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

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

 

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

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

 

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

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

 

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

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

 

Where does the company’s future lie?

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

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

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

 

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

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

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

 

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

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

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

 

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

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

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

 

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

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

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

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

 

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

 

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

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

 

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

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

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

 

Do you have any final thoughts?

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

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Morning Headlines 3/14/14

March 13, 2014 Headlines No Comments

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

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

MMRGlobal and Cerner Announce Patent Agreement

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

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

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

Wearable Computing at BIDMC

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

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March 13, 2014 Headlines No Comments

News 3/14/14

March 13, 2014 News 1 Comment

Top News

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


Reader Comments

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


HIStalk Announcements and Requests

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

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

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


Upcoming Webinars

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


Acquisitions, Funding, Business, and Stock

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

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

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

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


People

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

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

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

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

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


Announcements and Implementations

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

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

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


Government and Politics

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


Other

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

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

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

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

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

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

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

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


Sponsor Updates

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

EPtalk  by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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March 13, 2014 News 1 Comment

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