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News 10/10/14

October 9, 2014 News 1 Comment

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ONC hires RTI International to plan its national health IT safety center. Several lawmakers have questioned ONC’s legal authority to create and run such a center, particularly the part of its original plan that involved charging vendors fees.


HIStalk Announcements and Requests

This week on HIStalk Connect: Facebook investigates new healthcare-focused services, including disease-specific social media groups and Facebook-connected health apps. Healthcare billionaire Patrick Soon-Shiong’s startup NantHealth raises a $320 million Series B led by the Kuwait Investment Authority. Startup Health welcomes 13 new digital health companies to its three-year incubator program.

This week on HIStalk Practice: Virginia Women’s Center implements Keona Health tech. NHS patients are assigned non-muggle names at check-in. United Physicians rolls out Wellcentive solutions. DHMSM bidders get two more weeks. Community Health Centers of Arkansas goes with eClinicalWorks. The artist formerly known as Dr. Gregg pens a new tune. Thanks for reading.

Listening: new from Hozier, a creative Irish musician who tells lyrical stories in a variety of genres. I like it.


Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

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Box acquires medical imaging collaboration platform startup MedXT. Meanwhile, healthcare startup investor and Box CEO Aaron Levie (centimillionaire; college dropout; healthcare background or previous interest zero) posts a self-congratulatory USA Today opinion piece (it’s not very well edited with quite a few misspelled words, so it may be a paid promotion) extolling the virtues of the companies in which he holds a financial interest, saying, “There’s already an explosion of start-ups in Silicon Valley and beyond tackling healthcare, ready to transform the industry from the outside in … The Obama administration has taken the lead on pushing through legislation to increase access to care, and there’s far more that can be done on the policy side. But there’s a major role for the technology sector to play in transforming our health care system from one that lags behind its peers, to one that defines the future of health care innovation worldwide.” That’s what Google thought, too.

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NantHealth raises $250 million from Kuwait’s sovereign wealth fund, adding to the $100 million the fund invested earlier this year. The company also announced that Steve Curd (CareInSync) has joined as COO and KLAS co-founder Scott Holbrook has been named to the company’s board.

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HIMSS and the Avia provider-driven accelerator announce HX360, which will facilitate adoption of next-generation technologies. I don’t really understand what the buzzword-laden announcement is saying the new organization will actually do. Or, for that matter, why HIMSS would partner with a for-profit that collects dues and invests directly in companies that may compete with the vendors that provide HIMSS with most of its income.


Sales

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Maury Regional Medical Center (TN) selects VisionWare’s MultiVue platform.

University of Virginia Health System selects Strata Decision’s StrataJazz for decision support and cost accounting.

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Hugh Chatham Memorial Hospital (NC) chooses Medhost’s Advanced Perioperative Information Management System with Anesthesia Information Management System.


People

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Hearst Corporation promotes Charles Tuchinda, MD to president of First Databank.

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Anthony J. Principi (US Department of Veterans Affairs) joins GetWellNetwork’s board.

Vince Ciotti reports that former SMS VP Jim Carter, who he profiled in the above HIS-tory segment a few years ago, has passed away. Vince adds, “I’m sure his hundreds of friends at SMS share my sad feelings tonight at this news. The good things we all share are the many memories of his ever-smiling face, infectious laugh, and always positive attitude. He will be sorely missed.” 


Announcements and Implementations

Allscripts announces GA of the FollowMyHealth Achieve care management solution for Touchworks and Sunrise users.

Visage Imaging announces a new release of its Enterprise Imaging Platform, which includes increased scalability to tens of millions of images and Epic integration. The company will exhibit at ACR’s Imaging Informatics Summit on October 29-30.


Government and Politics

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HHS Secretary Sylvia Burwell says in a interview question about the Meaningful Use program, “Once we get these systems interoperable, that’s when we get the real value. You get the real value as a practicing physician, you get the real value as a consumer, and that’s the next step. At the same time, as we’re trying to move forward, we’re receiving comments and pressure to slow the implementation. This is a push-pull as we’re going through change.”


Technology

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Wearables vendor Fitbit says it has no plans to integrate with Apple’s HealthKit.

Gartner identifies its “Top 10 Strategic Technology Trends for 2015”:

  1. Computing everywhere
  2. Internet of Things
  3. 3D printing
  4. Advanced, pervasive, and invisible analytics
  5. Context-rich systems
  6. Smart machines
  7. Cloud/client computing
  8. Software-defined applications and infrastructure
  9. Web-scale IT
  10. Risk-based security and self-protection

Other

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An eHealth Initiative survey of HIEs finds them concerned about the cost and challenges involved with interfacing with EHRs, but happy that Meaningful Use and regulatory requirements have sent providers their way. Nearly half of the HIEs that charge membership fees say that income doesn’t cover their expenses.

Weird News Andy titles this story “Fallopian Tubers.” Doctors investigating a woman’s abdominal pain remove a germinating potato from her reproductive tract, which she explained as, “My mom told me that if I didn’t want to get pregnant, I should put a potato up there, and I believed her.” 


Sponsor Updates

  • Beckie Cosentino, director of privacy and compliance at Etransmedia, discusses HIPAA-compliant email.
  • Orchestrate Healthcare posts “Strategies for Effective Healthcare Systems Integration Are Changing”
  • Clinovations shares a Q&A with Brian Morton discussing the business side of medical practices.
  • CitiusTech will participate in the NAHC Annual Exposition, MGMA, and the IBM Insight in October.
  • Connance and the University of Rochester Medical Center will discuss how the medical center was able to increase charity care dollars and reduce bad debt during HFMA Region 2 Fall Annual Institute October 22-24.
  • Innovative Healthcare Solutions shares how PeaceHealth (AL/WA/OR) was able to alleviate challenges and meet expectations for its Epic implementation by engaging IHS for support.
  • Sunquest announces its November anatomic pathology summit agenda.
  • Craneware will sponsor the Hospital 100 Leadership and Strategy Conference October 19-21 in California.
  • CoverMyMeds partners with Prodigy Data System to provide faster prior authorization approvals within long-term care facilities.
  • ShareCor selects Sandlot Solutions’ Sandlot Dimensions for its Louisiana Health Information Network.
  • Imprivata will showcase its single sign-on and authentication management solutions during VMworld 2014 in Europe October 14-16.
  • Premier shares a video overview by Stacey Counts at Heartland Health/Mosaic life Care (MO) of the PACT Collaborative and Premier’s PopulationFocus after participating in the first Medicare Shared Savings Program by CMS.
  • Orion Health launches eReferral province-wide in Alberta, Canada for lung cancer, breast cancer, and hip and knee joint replacement surgery referrals.
  • Besler Consulting explores the implications of the elimination of the Common Working File for acute care hospitals in a recently published issue brief.
  • The Nova Scotia Department of Health and Wellness PHR project, powered by RelayHealth, receives second place in the 2014 Canada Health Infoway Accelerate Challenge.
  • ScImage achieves DIACAP accreditation for its hybrid cloud medical imaging solution PicomEnterprise 3.x.
  • ZeOmega CEO Sam Rangaswamy is named to Dallas Business Journal’s “Who’s Who in Health Care.”
  • Strata Decision publishes the agenda for its summit and leadership symposium October 21 in Chicago.

EPtalk by Dr. Jayne

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ONC opens a public comment period on the Draft 2014 Edition Release 2 Test Procedures. I can confidently say that most of the public has no idea what this is, let alone a comment on it. I imagine most comments will come from individuals associated with a vendor or who have a vested interest in the testing process. Anything that takes my vendors’ time and effort away from improving usability and ensuring patient safety is a problem, so I hope people who have more free time than me add some helpful comments.

In other news, CMS is reopening the hardship exception application process with a new deadline of November 30. We submitted a number of applications prior to the original July 1 deadline and still have not received determinations on about half of those providers, despite their reason for hardship all being identical. I’m not sure why the rest are delayed, but I hope CMS addresses the backlog before they start processing new applications.

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I’m continuously entertained by the emails I receive as a result of being on LinkedIn. This week I’ve had no fewer than 10 requests to connect with international medical students with whom I have no connections in common. The pick of the week is one from a recruiting firm searching for a CMIO with experience using a particular vendor. Had she bothered to look at my profile, she would have seen that vendor listed exactly nowhere.

Additionally, she states that the client requires the new CMIO spend 70 percent of his or her time in clinical pursuits “to establish credibility with the medical staff and garner Physician respect.” Anyone who thinks that you can do the non-clinical work of a CMIO in 12 hours a week doesn’t understand at all what it is that we do.

The email goes on to say that eventually the role will transition to 20 percent, but doesn’t list a time period. From experience, it doesn’t matter how much time the CMIO spends in clinical pursuits, it will never be enough for some physicians. Unless you’re seeing as many patients who are as sick as their patients (who are undoubtedly the sickest patients on the planet), you are inferior.

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The end of the month really heats up with healthcare IT events. First MGMA kicks off in Las Vegas on the 26th, with the CHIME Fall Forum starting the next day. The Cerner Health Conference starts November 2 along with NextGen’s One User Group Meeting. Las Vegas, San Antonio, Kansas City, Las Vegas. If you’re a best of breed CIO (and I can think of a few), you could really rack up some frequent flyer miles. If you’re attending any of them, we love to have reader feedback.

Got photos? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 9, 2014 News 1 Comment

News 10/1/14

September 30, 2014 News 5 Comments

Top News

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UnitedHealth Group’s Optum division acquires MedSynergies, which offers physician practice billing and quality services. MedSynergies was founded in 1996 by a group of Texas ophthalmologists. Its board chair is Joe Boyd, whose history includes being GM of the healthcare practice of Perot Systems, board chair of Healthlink until it was sold to IBM in 2005, and board chair of Encore Health Resources until it was sold to Quintiles earlier this year. I interviewed him in 2012.


Reader Comments

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From CloudedCare: “Re: CareCloud. Recently laid off a number of their implementation team and the senior leader running that department. The venture debt must be creating pain or their onboarding process needs a revamp.” The company provided this response to my inquiry: “CareCloud is increasingly gaining traction among larger medical group clients, and optimizing our organization to best support their needs. This includes an expansion of professional services offerings and realignment of the team to deliver them.”

From Bloomington Onion: “Re: health system bond downgrades following EHR implementation. They always blame billing issues and reduced productivity due to revenue loss. I wonder how many of them expect it going in?” I would imagine most health systems expect a short-term jump in AR days, but not to the extent that would cause bond raters to question their financial outlook. Hospitals can’t seem to survive without constantly borrowing money and downgrades mean they pay higher interest rates.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Zynx Health, healthcare’s pioneer and leader in evidence-based clinical solutions. Solutions include ZynxAnalytics (pinpoints opportunities to reduce care variation), ZynxOrder (evidence-based order sets), ZynxCare (patient-focused plans of care), ZynxAmbulatory (evidence-based order sets for primary care), and ZynxEvidence (online library of clinical evidence guidelines, and quality measures). A brand new product is ZynxCarebook, a mobile platform that connects care team members and guides them to best practices with clinical evidence while making communications more efficient (the “virtual huddle” capability is a cool idea) and eliminating HIPAA concerns related to text messaging. ZynxCarebook stratifies discharge risks and suggests interventions as it supports care transition plan collaboration – clients have experienced a 22 percent reduction in 30-day readmissions, an 18 percent improvement in HCAHPS scores, a LOS decrease of 0.5 days, and a 40 percent increase in referrals of high-risk patients to post-discharge care management. Zynx is part of Hearst Health, which also includes First Databank, MCG, and Homecare Homebase. Learn more by signing up for a demo. Thanks to Zynx Health for supporting HIStalk.

I found this new Zynx Health video on YouTube, which features customer testimonials.

Listening: new from Sloan, an underrated Canada-based power pop band that’s been around for almost 25 years with no lineup changes and with all four members writing hook-heavy songs that sometimes sound like the Beatles (and still sound good even when they don’t).


Acquisitions, Funding, Business, and Stock

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Hospital financial management software vendor Healthcare Insights will merge with NOMISe Systems, which offers hospital cost accounting and analytics software. Business will continue under the Healthcare Insights name.

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Forbes names its 400 richest Americans, with Microsoft’s Bill Gates leading the list at $81 billion of net worth. Facebook’s Mark Zuckerberg jumps to #11 as the company’s share price increase boosts his wealth to $34 billion, while the founder of the GoPro wearable video camera clocks in with $3.9 billion. New to the list is Elizabeth Holmes, the 30-year-old Stanford dropout who founded lab testing company Theranos and owns half of the company, which is valued at $9 billion. Patrick Soon-Shiong of NantHealth is #39 with $12 billion, while Epic’s Judy Faulkner is listed at #261 with an estimated worth of $2.4 billion. Cerner’s Neal Patterson comes in at #395 with $1.55 billion.

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Google Glass healthcare telepresence vendor Pristine raises $5.4 million in Series A financing.

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The state of Ohio offers CoverMyMeds $482,000 in incentives to execute its plans to add 116 jobs, move to a larger Columbus office, and create a $2 million training program for software engineers.


Sales

Christopher Rural Health Planning Corporation (IL) selects eClinicalWorks EHR for its 13 locations.

In England, Wrightington, Wigan and Leigh NHS Foundation Trust chooses Allscripts Sunrise.


People

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Connie D’Argenio, RN, MSN (Philips Healthcare) joins Huron Consulting Group as managing director of its healthcare practice.

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PerfectServe names Travis Hiscutt (CRI) as sales director for the southeast.

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Bimal Shah, MD, MBA (Duke University Health System) joins Premier Research Services as VP.

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Katherine Schneider, MD (Medecision) is named president and CEO of the Delaware Valley ACO (PA).

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The Cal Index HIE announces two new board members: Mark Savage (National Partnership for Women & Families) and Beth Ginzinger, RN, MBA (Anthem Blue Cross – above).

Morris Collen, MD died last week at 100 years old. He was the last of the seven original partners who created Permanente Medical Group, founded its Division of Research more than 40 years ago, and later embraced a second career as an a medical informatics expert after developing a health assessment tool in the 1950s that was automated as a patient screening tool. He said on his 100th birthday that his proudest accomplishment was his involvement with Kaiser’s EHR. AMIA’s annual excellence award is named after him.


Announcements and Implementations

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Cerner announces that its HealthyNow app with newly added Apple HealthKit integration is available to Sharp Health Plan members. It allows users to set health goals, earn rewards, share information with providers, and manage medication schedules.

MModal announces availability of computer-assisted physician documentation for its Fluency Direct speech recognition system. The cloud-based solution gives physicians feedback about possible documentation deficiencies as they type or dictate. 

Beaumont Medical Group (MI) goes live on Wellcentive’s PQRS Enterprise Solution, aggregating information from its Epic EMR.

Nuance expands its consulting services to include coding and abstracting compliance monitoring.

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HCA International will distribute physical therapy and pathology images using Picsara from Sweden-based Mawell. A pilot project found savings of up to an hour per day per clinician when physical therapy sessions were recorded and reviewed using video instead of writing and reading notes.

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Two North Carolina-based HIEs, Carolinas HealthCare System CareConnect and Mission Health Connect, will share their 3.5 million patient records. They will fill a need in the western part of the state since North Carolina’s first HIE, WNC Data Link, will shut down on September 30 after running out of money.

AirWatch debuts AirWatch Video, an enterprise application integrating content delivery network operators to secure companywide video initiatives.


Technology

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Dartmouth College will use a telehealth robot from Dartmouth-Hitchcock’s Center for Telehealth on the sidelines of home football games as part of a remote concussion assessment program.

HITRUST warns that the newly discovered Shellshock Unix shell vulnerability could be even more dangerous than Heartbleed since it gives hackers complete control of a server and thus the network on which it resides.

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Intel introduces the Basis Peak smartwatch that includes step counting, an optical heart rate sensor, sleep tracking, and smart phone notifications. It has a Gorilla Glass touch screen, works with both iOS and Android, is waterproof, claims a four-day battery charge life, and costs $199.

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Bizarre: Microsoft decides to name the new Windows release Windows 10, skipping a number. Every other Windows version is problematic, so maybe it’s hoping to dodge the bullet even though Win 8 was the disappointing follow-up to Win 7. The new version downplays the much-reviled Metro tile interface, brings back the start menu, and finally shows evidence that Microsoft understands that few users have or want touch screen laptops and desktops no matter how convenient it might be for Microsoft to design one OS for all platforms.


Other

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Alabama’s medical association registers its displeasure with ICD-10 with its “Top 10 Craziest ICD-10 Codes” social media campaign.

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The local TV station covers the rollout of the MedaVet app by Washington State University’s veterinary hospital, which allows pet owners to have around-the-clock access and review their care plans. The company’s site says the cloud-based service includes a customized site for the veterinary practice, creation of templates and health plans, incorporation of promotional and wellness information, a calendar of daily tasks with learning material and appointments, a shared health journal that shows task status with an optional photo, and a social support network. It costs $239 for up to three vets. What’s interesting is that the same company – MedaNext – offers care plans for humans, too.

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The local paper highlights the implementation by Floyd Memorial Hospital (IN) of CrossChx, a fingerprint-based biometric solution for spotting patient identity theft. Founder and CEO Sean Lane was an Air Force captain and NSA Fellow, serving five tours of duty in Afghanistan and Iraq before founding Battlefield Telecommunications Systems. CrossChx, which is based in Columbus, OH, says its solution is live in 28 health systems (of 61 signed) and that it has verified 6 million identities. 

The New York Times interviews Epic CEO Judy Faulkner in covering the challenge of EHR interoperability. She says the government should “do some of the things that would be required for everybody to march together,” adding that Epic created Care Everywhere only when it became clear that the government wasn’t going to go far enough.

A Toronto study finds that assigning patients to a post-discharge “virtual ward” (at-home care coordination, visits, care plans, home care, and follow-up) failed to improve the rate of readmission or death compared to just sending the patients home as usual. The authors suggest these issues caused the surprising failure of all that clinical attention to make any difference: (a) it was hard to get in touch with the patient’s PCP and their in-home support workers; (b) the variety of EMRs used made it hard to figure out who was doing what; and (c) the intervention was started after discharge instead of before.
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Amazing Charts apologizes for long customer support wait times, blaming a Meaningful Use services rush. Users unhappy after the company’s 2012 acquisition by Pri-Med are venting their frustration on the company’s discussion boards, with one summarizing, “AC has created these logjams by being unable to prioritize what is important, continuing to partner with NewCrop, releasing buggy new versions, and offering unlimited support for a flat price which may create abuse.” Users are also upset that the company is charging them to watch Meaningful Use webinars.

Beth Israel Deaconess Medical Center CIO John Halamka tells a local business group that, “The academic medical center is a dying beast,” urging those systems to reinvent themselves in the face of competition from retail clinics and community-based hospitals and practices.

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Walgreens CIO Tim Theriault, speaking at Oracle OpenWorld this week, says the company has distinct IT strategies for the retail and healthcare sides of its business. The retail initiatives are focused on a customer loyalty program, determining what items each store stocks, and using analytics and personalization to connect more closely with customers. For its healthcare business, the company plans to perform in-store lab tests and to exchange information with doctors and hospitals collected through its health cloud.

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Former Kaiser Permanente CEO George Halvorson says in a Health Affairs interview by healthcare expert Jeff Goldsmith that the organization spent $6 billion implementing Epic:

Halvorson: When I got to Kaiser Permanente, one of the things that I told the board was that we were going to do what I did when I helped build health plans in Uganda. We were going to have every single element of the care system connected electronically, so there would be no paper record.

Goldsmith: So you told them you wanted to catch up to Uganda?

Halvorson: I’m not kidding.  I actually learned in Uganda that to strip the whole process down to its most elegant essence was to have no paper anywhere. In Uganda, we couldn’t afford to pay a claim or for patients to show an ID card.

A New York Times article highlights hospitals that use out-of-network ED physicians who stick patients with huge bills even when the patient is careful to use an in-network hospital’s ED in a crisis. Texas lawmakers found that the state’s three largest insurance companies had no in-network ED doctors at all. The article points out that 1980s emergency medicine board certification pushed hospitals to contract out their ED coverage and bill the physician services separately. One patient observes, “It never occurred to me that the first line of defense, the person you have to see in an in-network emergency room, could be out of the network. In-network means we just get the building? I thought the doctor came with the ER.”

Weird News Andy says he plays golf like this, too. A previously profanity-hating grandmother recovering from a stroke finds herself swearing involuntarily when things upset her, including poor performance on the golf course. WNA also notes this story, in which coroners are determining whether high chlorine levels in the water supply of England’s second-largest hospital caused the deaths of two dialysis patients. Meanwhile, an anonymous WNA-wannabe contributes this story, in which surgeons saved a teen whose hair-eating psychological disorder caused her digestive system to be blocked by a world record nine-pound hairball.


Sponsor Updates

  • DataMotion announces that 37 EHR vendors have used its Direct secure messaging service to achieve 2014 ONC-ACB certification.
  • PatientSafe delivers three areas of consideration for bringing contextual communication to clinicians in a follow-up blog regarding clinicians struggling to find the context.
  • PMD announces that its mobile patient status verification is accelerating hospital reimbursements.
  • GetWellNetwork’s O’Neil Center publishes an e-book entitled“Patient Engagement: Beyond the Buzz” including ten interview and articles with provider perspectives and insider insights.
  • HealthEdge partners with NTT DATA to offer a migration program from TriZetto Facets technology due to Cognizant’s acquisition of TriZetto.
  • Judy Starkey (Chamberlin Edmonds & Associates) joins Streamline Health’s board of directors.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 30, 2014 News 5 Comments

Monday Morning Update 9/29/14

September 27, 2014 News 3 Comments

Top News

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Apple’s HealthKit health data aggregation system and the apps that use it go live after being pulled previously from the initial iOS 8 rollout due to unspecified bugs. Some HealthKit-powered apps that are back in the App Store after the iOS 8.0.2 update are FitPort, MyFitnessPal, WebMD for iPhone, and Carrot Fit. HealthKit allows iPhone-collected fitness measures to be forwarded to other iPhone apps, brokering the exchange using the phone owner’s permissions of allowable data sources and destinations. That might be the most significant aspect of HealthKit – the consumer-patient is in charge of the collection and movement of information about them.


Reader Comments

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From Ben and Jerry: “Re: Chuck Podesta. Gone from Fletcher Allen, now CIO of UC Irvine Health.” Verified per his LinkedIn profile.

From WisconsinBeerGut: “Re: Epic to Cerner conversions. I’ve worked for Epic and consulting companies and I’m not aware of any clients that have replaced Epic. Some mergers to watch that involved Epic and non-Epic users are NorthShore-Advocate in Illinois and UAHN-Banner in Arizona.” Given Epic’s cost, you’d have to really hate it to contemplate spending money to replace it. That’s not the only reason that it keeps users, but it may be significant one.

From Ex-Epic: “Re: Cernover. Judy prides herself on the fact that Epic has never lost a customer to Cerner or any other vendor. There have been some small scale de-installs for various reasons unrelated to dissatisfaction with Epic and those of course get swept under the rug, but to my knowledge (and according to Judy) there has never been an Epic to Cerner move.”

From AtUGM: “Re: Epic’s app exchange announced at UGM. It envisions that hospitals will sell their self-developed apps. My organization has discussed this with Epic, but Epic hasn’t provided any way to do it other than as a spin-off, which we’re loath to do. Eclipsys had an app exchange and I don’t think it went anywhere. It would be great if you wrote a feature discussing these app development opportunities with the big companies and what it would take to actually be useful to those of us in the industry.” I assume that vendor-specific app stores work like Apple’s – the vendor skims 20-30 percent off the top and sells apps that meet their published requirements. I would be interest in hearing about anyone who’s actually bought an app from a healthcare IT vendor’s store. I would be worried about paying a lot for something that might be poorly supported or that won’t be enhanced regularly.


HIStalk Announcements and Requests

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Most poll respondents like the idea of a 90-day MU reporting period for 2015 instead of the 365-day version that is official for the moment. New poll to your right or here: is it OK for an EHR vendor to block system access to a late-paying practice or hospital? Leave a comment after voting with your thoughts.


Last Week’s Most Interesting News

  • Intermountain Healthcare joins the Cerner-Leidos-Accenture DoD EHR bidding consortium.
  • Hospital operator HCA announces its intent to acquire physician systems vendor PatientKeeper, signaling that it will remain a Meditech clinical system customer.
  • A government report exposes HHS-CMS infighting and incompetence as Healthcare.gov went down in flames at its launch last October.
  • ZirMed acquires predictive analytics vendor MethodCare.
  • ONC Chief Science Officer Doug Fridsma, MD, PhD resigns to become president and CEO of AMIA. 

Acquisitions, Funding, Business, and Stock

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Oncology data vendor COTA closes $3.7 million of a planned $7 million funding round. Most of the folks involved are from Hackensack University Medical Center’s cancer center.

Meditech finally issues its 2013 annual report that was due 11 months ago but was held up following revenue recognition changes. Revenue was down a bit from 2012 at $580 million, but net income rose to $133 million (that’s an enviable margin). Neil Pappalardo owns nearly 41 percent of the company, or about $680 million worth. The directors and officers of the company have been around forever, with the newest hires among their ranks having joined the company 24 years ago.


People

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FCC Director of Health Initiatives Matt Quinn leaves the agency for a job with Intel.


Announcements and Implementations

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CareSync announces version 2.5 of its personal medical records system, which adds the ability to collect and track information from 80 health and fitness apps such as Fitbit and Withings blood pressure cuffs.

CVS Health announces new MinuteClinic affiliations with University of Maryland Medical System, UTMB, and UAB.


Government and Politics

An investigation finds that HHS paid WebMD $14 million to promote the Affordable Care Act.


Other

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Glucose monitor manufacturers and the FDA express concern that the technologically sophisticated family members of diabetes patients are hacking the devices to make them more useful, partially because FDA takes forever to approve manufacturer-requested changes. A group of engineers, many of them parents of diabetic children, modified a glucose monitor to send readings to a website so that parents can monitor their children who are away on sleepovers.

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A Premier study of ACOs finds that while most are improving care using basic internal systems such as EHRs, patient registries, and data warehouses, they struggle with bringing in data from external sources and providing patient-facing technologies. The key obstacles are interoperability problems and cost.

Penn Medicine (PA) has developed 75 apps, including the MedView physician portal and new Connexus patient data display app.

Weird News Andy provides a non-weird item: US hospitals aren’t prepared to handle Ebola-related patient waste since no disposal packaging has been approved, causing waste management companies to refuse to accept it. Emory University Hospital finally convinced Stericycle to accept 40 bags of infectious waste by first autoclaving it, but only after CDC brokered a deal.

Death rates dropped at two English hospitals that moved from paper-based vital signs charting to using the VitalPAC electronic system that provides warnings when patients are deteriorating. The hospitals developed the “early warning score” software with a vendor.

Here’s the more traditionally odd Weird News Andy article, which he titles “Give It a Shot.” The state nurse’s union sues Brigham and Women’s Hospital for requiring employees to get a flu shot after voluntary efforts failed to move the needle (pun intended) above 77 percent participation vs. 90 percent success in peer hospitals. State law prohibits hospitals from requiring employees to get a flu shot even though several hospitals require it as a condition of employment.  


Healthcare Analytics Summit 14 Report 

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I attended Health Catalyst’s Healthcare Analytics Summit 14 last week, my first visit to Salt Lake City. Note: in the interests of disclosure, the company comped my registration fee although I paid my own expenses otherwise. I took the photo above from my room’s balcony, by the way – a very brief rain shower kicked up on a sunny afternoon and created a double rainbow over the City-County Building.

The Health Catalyst folks were hoping for around 100 attendees and ended up with 500. The event was held in a beautiful five-star hotel, the Grand America, which had surprisingly reasonable prices and outstanding service. Rooms, food, and meeting facilities were excellent.

Salt Lake City apparently is not quite as Mormon Church-driven as I naively expected since you can actually get ethnic food and alcoholic beverages, although some odd rules are in place (as explained to me, you can’t order drinks without buying food, so you pay $2 for a bowl of peanuts to allow you to order a beer). Good restaurants were an easy walk away, everything from tapas to tacos (my choices: Green Pig Tavern, Eva, Himalayan Kitchen, Caffe Molise, and Tin Angel Cafe). It’s a lot smaller city than I would have guessed – around 200,000 residents – and the mountains create an attractive backdrop. I checked out a rehearsal of the Mormon Tabernacle Choir that was inspiring. The weather was a lot hotter than I expected. My overall impression of the city was favorable, although since I don’t ski, I’m not sure I would have a non-business reason to return.

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The event logistics were unparalleled. Plenty of Health Catalyst folks were on hand to direct people, answer questions, and even run a Genius Bar-type setup to help attendees use the cool app developed for the conference, which allowed interactive voting, reacting to speakers, and connecting with fellow attendees. I happened to chat with the guy whose company developed the app while walking to a session and he said it was built specifically for this conference. If it can scale, it would be pretty cool for larger conferences as well.

Presenters included Glenn Steele, Jr. MD, PhD, president and CEO of Geisinger Health System; James Merlino, MD, chief experience officer, Cleveland Clinic; Mike Leavitt, former Utah governor and former HHS secretary; Ray Kurzweil, director of engineering, Google; Penny Ann Wheeler, MD, president and chief clinical officer, Allina Health; and Charles Macias, MD, MPH, chief clinical systems integration officer, Texas Children’s Hospital.

A bizarre press restriction prevents me from even mentioning the name of the keynote speaker, although you can see it here. That’s too bad because I would have gushed about how entertaining and surprisingly relevant he was, and my fellow attendees seemed to agree given their highest rating of his keynote from all of the first day’s sessions. It was a bold choice by Health Catalyst. I enjoyed his talk more than any keynote I’ve ever heard. He would make an outstanding HIMSS keynote presenter, much better than the drones they’ve propped up on stage lately.

My least-favorite speaker was Mike Leavitt, who always struck me as a lightweight political journeyman turned opportunistic lobbyist. He rambled and misspoke to the point that I was checking email for most of his presentation. Everybody else did a great job, although I might have dialed back the presence of Health Catalyst people on the podium a bit if the intention was to engage attendees who don’t necessarily have a Health Catalyst connection. It got a bit confusing since three of the folks involved are from the same family (Burton) and were introduced with both past and present titles as the company made changes over the years, so I couldn’t keep track of who’s who as they came and went from the podium over the two days. I didn’t get a whole lot from the three breakout sessions, so for me the value was in the keynotes.

Health Catalyst used information collected from the app to announce some interesting (and sometimes creepy) facts gleaned from audience responses, such as that Android users were most likely to blow off the breakout sessions after attending the keynotes. Every session included several instant poll audience questions and a team of analysts presented the results immediately as the presenter paused. That was pretty cool and a nice touch to connect presenters with the audience.

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I should also note that this was neither a user group meeting nor a selling opportunity. The presenters for the most part were vendor-neutral and talked about using data in general, not Health Catalyst’s products in particular. I also applaud the company for really thorough preparation right down to the minor points of quality of the handouts, stage setup, and food and break logistics. Also a high point was distribution of an internally written book that I’ll be reading cover to cover. They really have a lot of good information to share that transcends their products alone.

Some of the memorable points of the conference from my perspective:

  • It’s clear that the hasty move to electronic medical records and health apps is creating more data than anyone understands. We’re at the exploratory stage, trying to figure out which of thousands of data points are relevant in predicting outcomes or triggering interventions. This is exciting. We are surrounded by data that we don’t yet know what to do with, but the first glimmers of success are coming out.
  • A lot of people, including many of healthcare’s leaders, aren’t convinced that the industry should be data driven. Not only does the “medicine as an art vs. a science” argument arise, but leaders often have personality types that value bold decisions based on emotion, history, gut instinct, leading through relationships, and valuing consensus over facts. As was said several times in the conference, it takes courage to use data, especially when it tells us something we don’t want to hear or that requires unsavory actions.
  • Becoming a data-driven organization requires two attributes. The first is fairly simple from the non-IT point of view – collecting and analyzing the information. The second is having the organizational willpower to do something with it. Facts alone don’t change anything – leadership is required.
  • Better care costs less. Analysis nearly always shows that the highest-cost organizations deliver lower-quality care. The upside of this is that we can improve care and outcomes without spending a penny more than we already do as a society, provided we have the will to do it.
  • As the unnamed keynote speaker pointed out, people mimic those who are having success. The organizations improving care and reducing cost through the use of data will find their competitors raising the bar by doing the same. Nobody wants to be in the higher percentiles of cost or the lower percentiles of quality, so as competitors eye each other warily, it’s likely that they will raise the boats for everyone.
  • Everybody has a data warehouse. Most of them don’t provide useful information.
  • You can’t selectively intervene on individual patients by using claims data. By the time you take action, the high-cost patients have costs trending back down and you’ve missed the opportunity.
  • People seem to love QlikView as a data analysis and presentation tool. I noticed several presenters from provider organizations were using QlikView dashboards.
  • An interesting thought from one presenter: “We don’t take a quality assurance or compliance approach.” In other words, it’s not effective to chase the 2.5 percent of outlier providers. Instead, move the 80 percent even higher since improving the already-good majority has a much greater overall impact.
  • The maturity progressions looks like this: data reporting –> data analysis –> decision support –> predictive analytics.
  • “Predictive analytics without actions an interventions are useless.” You can predict things you don’t care about or are reluctant to act on.
  • The most relevant health factors involve socioeconomics. Healthcare delivery organizations can’t fix those.
  • The wisdom of crowds still has value even in an analytics-driven organization.

I give this conference a high grade. The logistics were superb, the size and scope was just right, the value was significant, and the speakers were well chosen and interesting.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
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September 27, 2014 News 3 Comments

Morning Headlines 9/26/14

September 26, 2014 Headlines No Comments

Intermountain Healthcare Partners with Cerner to Provide Clinical Governance for Leidos Partnership for Defense Health

Intermountain Healthcare joins Cerner, Accenture, and Leidos on their joint-bid to win the DoD EHR deal, making Cerner the only vendor with a prominent health system listed as a contributing member.

Premier, Inc., eHealth Initiative survey suggests many ACOs lack mobile applications and face high costs

A survey of 62 ACOs find that 95 percent are experiencing significant problems integrating data across disparate systems, and that 90 percent cite cost and ROI of health IT solutions as a barrier to adoption.

Workgroup for Electronic Data Interchange ICD-10 Survey Results

A survey of 514 providers, vendors, and payers finds that while some progress has been made in preparation for the ICD-10 transition, most organizations have slowed, or completely halted, preparation efforts.

MEDITECH: Form 10-K Annual Report

After an 11-month delay in financial reporting due to revenue recognition issues, MEDITECH files its 2013 year end results: revenue fell three percent to $579 million, while net income rose slightly to $133 million.

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September 26, 2014 Headlines No Comments

DoD EHR Update from Dim-Sum 9/26/14

September 25, 2014 News 2 Comments

 

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Between 2000 and 2003, Harvard Business School published a case study on Toyota industrial engineering processes in a hospital. Toyota collaborated with Beth Israel and LEAN Healthcare was born – now that was a great and interesting collaborative. Well defined and the results were quantifiable!

Collaboratives can add value; even ones that may not sound great at first could prove to define and refine standards, improve care, and actually enable better quality controls for care. If you like collaborative approaches, take a look at what has been done between Deloitte and Northern New England Accountable Care Collaborative (NNEACC). The solution is called Insight. After mentioning that new collaborative, I cannot help but remember a strange and poorly constructed one. How can anyone forget the ill-fated relationship between Philips and Epic that ended in 2006?

I can think of one specific collaborative that has promised the world and delivered almost nothing (see NwHIN). However, after a cursory read of the DHMSM Team Leidos article about a collaborative effort linking Cerner’s mega client Intermountain Health on governance structure, I began to think of what other collaboratives I would want to accentuate and/or at least commoditize so that I might differentiate my team to compete for the DHMSM opportunity. IBM will certainly throw in an Epic-esque client that has provided the groundwork for improvements across the Epic stable of solutions. I even think CSC and Allscripts might find their favorite client pet co-development.  I think I like Collaboratives.

One has to wonder, what was the primary edict for the collaborative, and what measurable outcomes have been reported – indicating value? To what extent have the monies invested into the collaborative been shown to improve profitability or improve PQRS results? I am not against collaboratives so much as I have a real desire to understand how some of them were stood up and made financially viable, why some dissolved, and most evolved with grand entrances into the market only to die a death of irrelevance. I think I like Collaboratives.

I for one like the New York eHealth Collaborative and the Massachusetts eHealth Collaborative, and not just because they have the word collaborative in their name. I think they are practical entities that leveraged historical regional extension centers, where money was initially provided by public funds and, through attrition and maturation of models and adoption challenges, the collaboration actually had to collaborate. They had to collaborate to survive. These collaboratives had to figure out smart ways to make their collaborative viable. Their challenge, unlike Intermountain Health (for Cerner) or Kaiser (for Epic), is that they had to work with disparate and competing entities, clinicians that were not incented by what their crosstown rivals did. The collaborative’s cross regions that did not in and of themselves support huge populations, and yet they wanted to know how their colleagues worked in other parts of the state, in rural, suburban, and urban environments.

Sounds remotely like the military HIT that we have grown to appreciate and fear. I like those collaboratives because they have to work together even though they are in a “coopetition” mode. (They were built to compete, to differentiate their medical specialty, and yet they know that cooperation has to occur for a peaceful co-existence and patient-first mentality. Thus the term “coopetition.”)

Honestly, I wish Team Leidos, Accenture, and Cerner would chat up their HealtheIntent population health tool, and what can be done to improve care coordination, quantify targeted chronic-disease management, improve appropriate care measurements, lower readmissions, and provide dynamic quality measures that actually act as a catalyst for patient engagement. Maybe Team Leidos could express its thoughts on how to turn prescriptive, descriptive, and predictive analytics into actionable analytics – impacting care and quality of life? Why not share its philosophical thoughts on data liquidity and how that could be the conduit for improved EHR and research data mining? Take the time to share their approach to research – we know IBM will reference Judith’s Cogito – so compete.

Maybe I am being harsh. I guess I am all too aware of how collaboration in the federal government has not always worked out very well. The best example of a collaboration was between the VA and DoD to share – or rather to transition – the EHR for a service member en route between active duty into veteran’s care. The best analogy: “Imagine spending the day as a cub scout during a camp out, eating gummy bears, enjoying hot dogs roasted over an open flame and masticating pounds of beef jerky on the three-hour canoe trip!” That was the planning for the debacle between DoD health and VA health – now imagine being stuck in the tent all night with those boys – that is pretty much the result of DoD/VA EHR interoperability – a smelly tent!  Not sure if there is a lesson in that story, but after reading it aloud, I smiled.

The good news is that at least DHMSM competing teams are looking to grab practical experience and applying it to the DoD HIT environment. Any collaboration with organizations that embrace HIT standards is a great thing. Any collaboration that shows that the HIT development vendor actually possesses a veracious understanding of governance structure – bully for them. Any collaboration that can accentuate the divine path to full-on proactive adoption, well then … that is Heaven. I like the move, and expect to see a lot more collaborating.

Inasmuch as I like the collaboration with Intermountain Health, I really would like to hear more about lessons learned from Accenture’s effort in Singapore. Cerner should express lessons learned from its NHS efforts. After all, Cerner had to work with Fujitsu (sort of the equivalent of our service integrators in and about the Beltway). Fujitsu is a less-than-stellar example of HIT consulting talent that was appointed by the NHS to implement, integrate, and manage the regional program. Maybe a white paper on nexus process and data touch points that could improve continuity of care with an eye on improving outcomes and lowering readmissions would be helpful and germane.

DHMSM is about transition and data liquidity. The DoD will not get excited with the commercial version of efforts to move from fee-for-service to value-based care. However, the DoD will perk up and pay attention to care coordination – so focus on the client and similar client experience and their deficits, lessons learned, and what new approaches improved adoption and workflow. One should remember that the DoD has stated on several occasions – mostly during Hill meetings – that the DoD does want to be more innovative like Kaiser (code for Epic). Cerner probably sees Intermountain Health as its Kaiser, so why not leverage that as a collaborative? I just hope Cerner can provide the depth of white papers and analysis of pre- versus post-Cerner in Utah and a lesser extent Idaho. That would be good news for the DoD.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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September 25, 2014 News 2 Comments

News 9/26/14

September 25, 2014 News 1 Comment

Top News

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Intermountain Healthcare (UT) joins Cerner and Leidos in their bid for the DoD’s new EHR system. Intermountain will provide clinical governance of solutions and workflow to be proposed for the $11 billion Defense Healthcare Management Modernization Initiative (DHMSM). Intermountain is in the process of implementing Cerner’s EHR and revenue cycle solutions across its 22 hospitals and 185 clinics. The move is no doubt yet another feather in the cap of Cerner President Zane Burke, interviewed this week in the local paper: “It’s a really interesting time. We have a lot of work left in front of us, but I love the position we’re in and the clients that we have on the journey with us. It’ll be a lot of fun.”

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Dim-Sum, HIStalk’s intrepid DHMSM insider, shares always entertaining and thought-provoking insight into the Intermountain “collaborative.” A snippet:

“After a cursory read of the DHMSM Team Leidos article about a collaborative effort linking Cerner’s mega client Intermountain Health on governance structure, I thought of what other collaboratives I would want to accentuate and/or at least commoditize so that I might differentiate my team to compete for the DHMSM opportunity. IBM will certainly throw in an Epic-esque client that has provided the groundwork for improvements across the Epic stable of solutions. I even think CSC and Allscripts might find their favorite client pet co-development. I think I like collaboratives.”


Reader Comments

From Chris Jaeger, MD: “Re: Sutter Health’s HIE discussions with Orion Health. As Sutter Health’s CMIO and executive sponsor of its HIE efforts, I can state without a doubt that the following post is false:
From Deal Breaker: “Re: Sutter Health. Stops discussion with Orion Health after its HIE project goes on for nine months. …”
Our collaborative relationship with Orion and related HIE efforts have never stopped – to the contrary, we continue to make great progress while also actively planning the next phases of establishing robust data exchange with those that share in the care of our patients.”


HIStalk Announcements and Requests

This week on HIStalk Practice: Athenahealth looks for the next great startup. TekLinks partners with Greenway. Doximity goes live in Utah. Physician practices in Texas take home quality improvement award for use of HIT. Physicians feel slighted by CMS thanks to attestation "glitch." Healthcare.gov costs more than originally thought. Physician executives have options when it comes to standing desks. Thanks for reading.

This week on HIStalk Connect: Dr. Travis analyzes the non-traditional roles that cloud-based computing has found in healthcare thus far, and speculates on its future. Researchers in Paris are working with 3-D video cameras to create virtual reality-based surgical training aids. Virtual visit provider Teladoc raises a $50 million Series C.


Acquisitions, Funding, Business, and Stock

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Allscripts and Citra Health Solutions (formerly Orange/MZI) announce a partnership to make their services available to each other’s customers. Citra, which provides consulting services and technologies for providers and payers, unveiled its new name and branding at the Allscripts user group meeting last month.

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ZirMed acquires predictive analytics vendor MethodCare and announces plans for a Chicago-based Healthcare Analytics Center of Excellence led by MethodCare staff. Moving forward, MethodCare will operate under the ZirMed name.

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Conifer Health Solutions agrees to acquire physician practice business solutions vendor SPi Healthcare for $235 million. SPi CEO John O’Donnell will join Conifer’s senior management team, reporting to President and CEO Stephen Mooney. The transaction is expected to close in Q4 2014.


Sales

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North Philadelphia Health System (PA) selects Medhost’s inpatient EHR for implementation at St. Joseph’s Hospital and Girard Medical Center.

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Beaufort Memorial Hospital (SC) selects the Access Passport online forms solution to take its paper-based accounts payable, human resources, and administrative documentation processes digital.


Announcements and Implementations

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Community Hospital (NE) goes live on a patient portal from Relay Health.

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Children’s Healthcare of Atlanta joins the Georgia Health Information Network. CHOA has integrated GaHIN’s Georgia ConnectedCare product into its Care Everywhere HIE application, which it launched earlier this year to facilitate data sharing with other providers using Epic.

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Kennedy Health System (NJ) adopts the MedAptus Professional Charge Capture Solution for hospitalists at its three acute-care facilities.

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Sightseeing.com announces the availability of the MyMedicalRecords PHR to its customers. The PHR will offer travelers access to their medical records and such documents as passports, birth certificates, immunization records, and insurance policies.

Practice Fusion announces that its customers will soon be able to order, manage, and receive lab test results within its EHR through Quest Diagnostics. Physicians will also have the option to share test results with patients through the Patient Fusion portal.


Research and Innovation

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A survey of 62 ACOs reveals that poor interoperability between organizations remains a big barrier to improving clinical quality. Additional findings include:

  • 100 percent of respondents find access to data from external organizations challenging.
  • 95 percent find interoperability of disparate systems to be a significant challenge.
  • 90 percent feel the cost and ROI of HIT has become a key barrier to further HIT implementation.
  • 88 percent face significant obstacles in integrating data from disparate sources.
  • 83 percent report challenges integrating technology analytics into workflow.

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WEDI releases the results of its ICD-10 Industry Readiness Survey, which finds that vendors, payers, and providers have made some progress in preparing for the October 1, 2015, transition, but not nearly as much as likely needed for a glitch-free switch.


People

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Jim Dowling (QuadraMed) joins Qpid Health as vice president of sales.

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Michael McDermott, MD (Radiologic Associates of Fredericksburg) takes on the role of CEO at Mary Washington Healthcare (VA) beginning January 1, 2015.

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Bob Taylor, DO (Greenway) joins Clinical Architecture as CMIO.

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Ryan Witt (Juniper Networks) joins ClearDATA Networks as vice president of growth and innovation.

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Steven Steinhubl, MD (Scripps Translational Science Institute) joins Vantage Health as chairman of the board.


Technology

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This article covers the debut of Spruce, an app that lets users privately share photos and medical information with dermatologists, and then receive in-app treatment. Baseline, Cowboy Ventures, and Kleiner Perkins Caufield & Byers contributed $2 million to the launch in initial seed round financing.


Other

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Samsung, the Children’s Fund, and Columbia University announce at the 2014 Clinton Global Initiative Annual Meeting a two-year partnership to develop the Samsung Innovation Center at the Children’s Health Fund. The center will focus on advancing access to and quality of healthcare for medically underserved children through telehealth and other strategies.


Sponsor Updates

  • Intellect Resources describes Ochsner Health System’s (LA) challenges and results of its Epic implementation.
  • Connance will share how the University of Rochester Medical Center increased its charity care dollars while reducing bad debt during the HFMA Region 2 Fall Annual Institute October 22-24 in New York.
  • ReadyDock discusses the vulnerability of mobile devices to virtual and pathogenic attacks in a recent blog post.
  • Aprima and First Databank offer electronic prior authorization through Surescripts connection.
  • Etransmedia shares how a pediatric cardiology practice was able to reallocate resources after working with Etransmedia’s RCM team to automate its front office.
  • Billian’s HealthDATA shares 10 recent healthcare CIO placements.
  • CareSync rolls out V2.5, which combines wearables data with medical records using integrations through Validic partnership.
  • Craneware will host its first Revenue Integrity Summit October 14-16 in Las Vegas.
  • Greenway becomes the first ambulatory information provider to have a solution recognized as a Validated System by Healtheway’s eHealth Exchange Product Testing Program.

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EPtalk by Dr. Jayne

Our hospital recently hosted a healthcare career day for middle school students. We’re in an economically depressed part of town with some serious socioeconomic issues, yet fully realize we’re going to need dedicated and well-educated healthcare workers to deal with the challenges we’ll continue to face. The goal of the day was to expose them to various opportunities either directly in or supporting healthcare. They were able to visit various areas of the hospital, including sterile processing, the laundry, patient care floors, engineering, and an operating room.

Some students were grossed-out by the idea of direct patient care, but were interested in engineering or IT, which is a good thing. It takes an army of people to keep an institution of our size going and often those jobs are independent of patient census or case mix, which is a good thing for job security. The highlight of the day for many was being able to see one of the air ambulances land and speak with the flight crew.

As a member of hospital administration, my role was to shepherd a group of students through various stations set up throughout the hospital, where they could talk directly to staff and learn about their jobs and how they contribute to the healthcare team. As is predictable with students in that age group, frequent questions included: “What’s the grossest thing you’ve ever seen? What’s the worst injury you’ve ever seen?” My favorite question was, “Is the stuff that happens on Grey’s Anatomy really true?” which made me wonder why a parent was letting a 10-year-old watch a show about sex-crazed doctors.

At one point, the air ambulance pilot received a question about emergency situations. He told the student his question was in the top 10 list of things he didn’t want to experience, to which the student responded “What’s number one?” I had to give him full credit for that one. I kind of tuned out after that because I was thinking about what I’d put on my own top 10 list of things of things I never want to happen.

I’ve experienced some things in my IT and practice careers that would definitely make that list:

  • Someone accidentally activated the fire suppression system at our corporate data center. Because we were using Halon, the building had to be vented by the local fire department with their positive-pressure ventilation equipment. This took about eight hours for a building the size of our data center. Unfortunately, our “hot backup” failed due to a defective network switch, requiring all practices to go to paper.
  • A local road crew cut the T1 line to my office. Luckily, we equipped key staff with wireless cards and network hot spots, so it wasn’t that big of a deal.
  • With my first EHR, the clinical documentation workflow went through a “locking” process as the provider finalized the note. This was after the provider reviewed the documentation on screen. Unfortunately, during the locking process some kind of character limit went into effect, causing the documents to truncate. When patients returned for their follow-up visits, their plans (at the bottom of the documents) were missing critical elements. Nothing makes your blood run cold like reading “Counseled patient on…” and having that be all that remains of your highly detailed patient plan.
  • Vendor sunsets a product that actually supports your workflow and that your staff likes, transitioning you to a product that is not yet ready for prime time. This has now happened to me twice.

None of these are quite as scary as having rotor failure on your helicopter or having the landing pad collapse underneath you, but in our world they’re pretty unnerving. What’s on your top 10 list of things you never want to happen? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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September 25, 2014 News 1 Comment

News 9/24/14

September 23, 2014 News 1 Comment

Top News

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Hospital operator HCA announces that it will acquire privately held physician systems vendor PatientKeeper. Terms were not disclosed. I spoke to PatientKeeper President and CEO Paul Brient ahead of the announcement. “HCA is a longstanding customer of our view-only portal, our clinical review tool,” he said. “Now HCA will deploy all of our software – CPOE, clinical documentation, and medication reconciliation – over top of their Meditech systems. They will invest to make it even more useful to their doctors.” Brient will serve as CEO of PatientKeeper, which will be operated as a wholly-owned subsidiary of HCA. Its 160 employees will continue to work from company headquarters in Waltham, MA, supporting the company’s 58,000 physician users. The acquisition is expected to close by the end of the year.


Reader Comments

From Garbanzo Being: “Re: HCA. Will remain on Meditech and not transitioning to Epic or Cerner as has been rumored. PatientKeeper helps extend the life of Meditech for HCA.” HCA didn’t say that specifically, but PatientKeeper President and CEO Paul Brient hinted to me that HCA likes PatientKeeper over Meditech better than Epic, suggesting that its Epic experiments have concluded and the go-forward platform will be Meditech. He didn’t mention whether HCA will do a Meditech 6.0 upgrade, the challenge of which sent them sniffing around Epic in the first place.

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From King Biscuit: “Re: Office Practicum. Announced to clients that they acquired EHR/PM vendor Workflow.com. Odd since OP is a small company and it’s a competing product. The email suggests a move away from a pediatrics-specialty product and possibly a wholesale platform change.” I don’t know anything about Workflow.com except that it founded by Packy Hyland, who also founded Hyland Software (now Onbase by Hyland).

From Shannon: “Re: 3M’s CAC 360 Encompass R2 (Release2). Has numerous major problems. Coders not happy using it. 3M is currently merging their 2 NLP platforms — will this be too late for ICD-10 implementation date? Will the other CAC vendors be able to capitalize on this weakness?” Unverified.

From Deal Breaker: “Re: Sutter Health. Stops discussion with Orion Health after it HIE project goes on for nine months. Is this the reason there are not any US reference sites for Orion all accounts travel to Canada and New Zealand?” Unverified. I think a site visit to New Zealand would be pretty great since I’ve heard it’s spectacular there and they (unlike much of the world) love Americans.

From All Hat No Cattle: “Re: Cernover. Don’t forget that Integris in Oklahoma (12 hospitals) is moving to Epic, too. Care New England in RI now Epic outpatient. How long until CHI moves across to Epic for their remaining sites on Cerner like KentuckyOne?” I tried to muster an argument that at least some sites have moved from Epic to Cerner, but I was just speculating since I couldn’t name any. The Cernover list is a bit one sided, so chime in if you know if an Epic-to-Cerner move that wasn’t triggered by a health system acquisition and standardization.

From Bob White: “Health 2.0. Lots of innovative companies there, although they all start to sound alike after a while.” The conference gets lots of people excited even though 95 percent of the startups there will sink without a trace because they aren’t that sharp, are underfunded, are poorly managed, or let their technology arrogance override their healthcare ignorance. I wish them all well, but I don’t have the patience to watch Darwinism in action as they desperately try to find pilot sites, customers, or acquirers before they run out of runway. My interest picks up once they hit $5 million in annual revenue because once they get that big they probably won’t disappear entirely.


HIStalk Announcements and Requests 

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Welcome to new HIStalk Platinum Sponsor ZeOmega. The Plano, TX-based company, founded in 2001, offers the Jiva population health management platform to payers, providers, and value-based care organizations. A recent client success is Indiana health plan MDwise, which reduced readmissions by 66 percent and length-of-stay by 65 percent, saving $6.5 million per year with Jiva. Jiva is scalable and stable with redundancy and recovery built in and the new release adds more capabilities to support accountable care and value-based health delivery models in integrating workflow, analytics, content, and communication capabilities. The folks there would be happy to do a demo for you. Thanks to ZeOmega for supporting HIStalk.


Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

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Royal Philips NV announces plans to split into two companies – one devoted to lighting, the other to healthcare and consumer goods that will operate under the HealthTech name. The announcement follows in the footsteps of similar moves made by rival Siemens last year.


Sales

Community Health Center of Southeast Kansas and Health Partnership Clinic (KS) select eClinicalWorks EHR and RCM for their 12 combined clinics.

Catholic Health Services of Long Island (NY) chooses Connance predictive analytics and vendor management technology.

Sheltering Arms Rehabilitation Center (VA) deploys Strata Decision’s StrataJazz as its financial platform.


Announcements and Implementations

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North Country Hospital becomes the first in Vermont to go live on the state HIE. Larger hospitals like Fletcher Allen Health Care will be online by the end of the year.

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Waterbury Hospital (CT) integrates TigerText secure messaging into its Cerner EHR. The hospital has also been in the news due to rumors of a possible takeover by Tenet Healthcare Corp.

Surescripts announces the addition of four pharmacies and three EHR vendors to its Immunization Registry Reporting service.

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The Bronx RHIO selects Direct secure messaging services from DataMotion for its affiliated healthcare organizations. The Visiting Nurse Service of New York and SBH Health System (NY) are among the first to use the service.

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Zynx Health launches the ZynxCarebook mobile platform to help streamline coordinated care efforts between inpatient and after-care providers.


Government and Politics

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White hat hackers from the HHS inspector general’s office report that their attempts to break into Healthcare.gov earlier this year alerted them to a “critical vulnerability.” Their attempts to exploit it were thwarted due to defenses already in place.

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Representatives Diane Black (R-TN) and Peter Welch (D-VT) introduce the ACO Improvement Act. If passed, the act would permit ACOs to use remote-patient monitoring and store-and-forward technologies for delivery of images to providers far away.

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Alaska’s Department of Health and Social Services files a lawsuit against Xerox for "failing to timely and adequately implement the [Medicaid payments] system and failing to timely and accurately pay Alaska providers." The state is seeking $46.7 million in damages, and has already shelled out $154 million in advance payments to providers to help see them through the Xerox delay.


Research and Innovation

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Ali Parsa, MD creator of the UK-based Babylon subscription health service, announces that he is prepared to take the Babylon app to the Middle East and Africa to reach populations with little reliable access to healthcare, but high adoption of smartphones. "We are now looking at parties who have a large customer base, such as supermarkets, big public institutions, mobile phone companies, and newspapers,” he says. "If people can go into Tesco and by an iTunes card, why can’t they buy a Babylon access card?"


People

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Mark Hyman, MD (The UltraWellness Center) joins the Cleveland Clinic as director of its new Center for Functional Medicine. Patrick Hanaway, MD (Institute for Functional Medicine) will serve as the center’s medical director.

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Jeff Pate (W Squared) joins Aegis Health Group as executive vice president of business development.

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White House CIO Steve VanRoekel resigns to join the USAID, where he will work as a senior adviser in the fight to halt the Ebola outbreak.

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Doximity hires Emily Peters (Uncommon Bold) as VP of marketing communications and Peter Alperin, MD (Kelvin) as VP/GM of connectivity solutions.  

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Bruce Brandes (Valence Health) is named managing director of Martin Ventures. 

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ONC Chief Science Officer Doug Fridsma, MD, PhD resigns to become president and CEO of AMIA.


Announcements and Implementations

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Billings Clinic (MT) is implementing just-released Caradigm Quality Improvement to identify gaps in care and make improvements in clinical workflow at point of care.


Other

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Construction company DIRTT makes news for using open-source software from the classic video game Doom to design hospital wings and office spaces. CEO Scott Jenkins says the system will help hospitals that want to reconfigure a room’s wall panel quickly for patients with different needs, or to accommodate new technology.

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Apple CEO Tim Cook announces that the company’s new “spaceship” headquarters in Cupertino, CA, will be the “greenest building on the planet.” Scheduled to open by the end of 2016, the new HQ will be powered exclusively by wind and solar energy.

CompuGroup Medical locks Full Circle Health Care (ME) out of its EHR system in a billing dispute. The financially struggling practice admits that it stopped paying its maintenance fees 10 months ago after CompuGroup bought its original vendor HealthPort and increased monthly fees from $300 to $2,000. The practice has moved to a new EHR and wants access to its old system for 48 hours to copy patient records that will otherwise be unavailable, putting patients in danger, but says CompuGroup installed a “phone home” kill switch without its knowledge that won’t let the practice log on even in read-only mode. CompuGroup makes the analogy that people who don’t pay their electric bill have their power shut off eventually. Meanwhile, the patients get to enjoy being used as human shields as the vendor and customer bicker. Someone should have read their contract more closely before signing it, I suspect.

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Weird News Andy summarizes this story as “Three’s a Crowd.” A Florida woman pays $20,000 to have a third breast added, saying she wants to make herself unattractive to men so she wouldn’t have to date any more (as WNA says, hasn’t she heard of just turning men down?) The real reason is likely her stated dream of starring in an MTV reality show, with possible titles being rich in punning opportunities. WNA notes that the story has been declared a hoax (not surprising given the obviously ‘shopped picture), but that shouldn’t stand in the way of its entertainment value.


Sponsor Updates

  • Arcadia Healthcare Solutions will demonstrate a new version of its Arcadia Analytics solution at Health 2.0 this week. It uses Informatica technology to integrate information from 20 EHR and claims systems to report on reporting for performance management, cost and utilization analysis, and patient outreach and care planning.
  • Amerinet signs a new agreement to offer VitalWare revenue cycle technology to its members at negotiated pricing.
  • Alan Rosenstein, MD, an expert in disruptive physician behavior, posts a PerfectServe article titled “Emotional Intelligence – Understanding Patient, Staff, and Physician Needs.”
  • DocuSign publishes a blog post titled “BAAs and Beyond: Meeting the September 22 HIPAA Deadline.
  • Shareable Ink will work with students from Bentley University on user interface design.
  • Park Place International achieves SSAE 16 Type II standards compliance for OpSus Cloud Services.
  • EClinicalWorks CEO Girish Navani joins a panel discussion at Health 2.0’s annual conference to discuss how technology is improving the patient experience.
  • US News and World Report indicates that 96 percent of Honor Roll hospitals in its “Best Hospitals and Best Children’s Hospital’s 2014-2015” use Wolters Kluwer Clinical Drug Information.
  • Gritman Medical Center (ID) is live on AtHoc’s emergency communication solution.
  • Validic announces a 20 percent increase in its digital health ecosystem with new integrations including hospitals, health systems, payers, pharma, and wellness companies.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 23, 2014 News 1 Comment

Monday Morning Update 9/22/14

September 20, 2014 News 4 Comments

Top News

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”Behind the Curtain of the Healthcare.gov Rollout,” a report from the US House Committee on Oversight and Government Reform (the committee is wildly anti-Democrat, but still interesting) contains fascinating details of the internal panic once CMS realized they were in way over their heads right after Healthcare.gov went live and failed. It concludes that infighting between CMS and HHS forced the development team to work through US CTO Todd Park, with CMS attempting to hide security exposure, keep HHS in the dark, and insist on a full site launch instead of a phased approach. Some fun snips from internal emails the committee dug up as HHS and CMS people duked it out electronically, sometimes using their private rather than government-issued email accounts:

  • [Unidentified HHS employee]” “Your leadership only wanted to hear beautiful music … clearly these people are not smart enough to pull it off … you could definitely see the CYA moves coming a mile away.”
  • [Unidentified HHS executive, referring to CMS Deputy Director of IT Henry Chao]: “I grow wear of the bull#### passive/aggressiveness of Henry … the other way to do this is through a complete covert ops mission to unseat the CMS FFE rules engine.”
  • [HHS CTO Bryan Sivak, pictured above]: “It’s all negative. I’m going to embark on a campaign to declare victory without fully launching.”
  • [HHS CTO Bryan Sivak, responding to an email in which CMS admitted that the site could not handle more than 500 concurrent users]: “Anyone who has any software experience at all would read that and immediately ask what the f## you were thinking by launching.”
  • [HHS CTO Bryan Sivak, responding to US CTO Todd Park’s claim that the site’s problems were all related to user volume even though officials knew that wasn’t the case]: “This is a f###ing disaster. It’s 1am and they don’t even know what the problem is, for sure. Basic testing should have been done hours ago that hasn’t been done.”
  • [HHS CTO Bryan Sivak]: “1. Bad architecture. 2. Not enough testing. Pretty simply really.”
  • [HHS CTO Bryan Sivak, replying to the former HHS employee who transferred to CMS and suggested she might not be much help]: “If you don’t get access, I’m probably going to start being a little bit of a d###, which will give you ample opportunity to badmouth me and gain the trust of people at CMS.”
  • [CMS employee, in urging that Healthcare.gov code be removed from open source repositories]: “This Github project has turned into a place for programmers to bash our system, submit service requests (!), and now people have started copying Marketplace source code that they can see and making edits to that.”

Reader Comments

From LL Fauntleroy: “Re: Cerner shops. The number of major ones that have pulled the plug to go with Epic (the industry term is ‘Cernover’) is the best-kept secret in health IT since neither the company nor clients announce it. Some I know from the last couple of years. Loma Linda, Dallas Children’s, Stanford Children’s, University of Utah, John Muir Health System, Connecticut, etc. There are also hospitals pulling the Cerner plug in Australia (Royal Children’s) and elsewhere around the world. There are also a number of shops that run Cerner inpatient but Epic outpatient, or Epic rev cycle, and are rumored to be considering switching, such as Northwestern. Why doesn’t HIStalk write about this?” I’ve written about those of which I’m aware, which is most of these, but I have to depend on readers to tip me off since I’m not omniscient. HIMSS Analytics could verify this trend (if it is one) or identify other Cernovers (or “Epicstinguishes” since surely a few health systems went the other direction), but they aren’t about to tell me for free.

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From SoCalSurfLegend: “Re: Prime Healthcare. Three of their southern California hospitals are implementing Epic. Prime is adamant that they will not use consultants. How long before they realize it can’t be done? I’ll set the over/under at three months considering that Prime’s ownership group is the cheapest bunch around.” Unverified. Prime Healthcare’s majority owner is Prem Reddy, MD, an India-born cardiologist who has made a fortune buying and operating financially aggressive hospitals and is known as a generous philanthropist. His wife, daughter, and son-in-law are doctors.

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From BJ Hunnicutt: “Re: BJC. My sources say Cerner won the demo round. Allscripts lacked functionality and the reps interrupted their own demo team to inject irrelevant information, while Epic seemed stale and self-important. BJC uses Allscripts inpatient at two academic campuses, Allscripts ambulatory for the medical school faculty clinics, the FollowMyHealth portal, NextGen for employed physicians, McKesson Horizon at the community hospitals, both Cerner and Horizon lab, and Soarian financials. They also have a homegrown clinical data repository and a massive interface support staff to keep it running. The McKesson Horizon situation is probably a key driver. I make Cerner the favorite because of their strong demo and existing relatively new Soarian backbone, plus the two other major health systems in town (SSM and Mercy) have Epic and BJC won’t want to look like they’re jumping on the bandwagon late.” Unverified. BJC’s site says the IT department has a $200 million annual combined budget and 800 employees who specialize in “clinical-based software solutions, integration of disparate systems, and expert systems intended to support caregivers in clinical practice.” Headcount assigned to that middle one seems entirely justified given the apparently lack of appetite for standardizing systems.

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From The PACS Designer: “Re: Windows 9. Microsoft announces September 30 as Win 9 day, with a new Start menu, a virtual desktop feature, and a notification center.” Better get out early to camp out a spot in line. Oh, wait, that’s Apple. It’s pretty bad when the most exciting new feature of a highly touted new release is to restore functionality idiotically removed in the previous one.


HIStalk Announcements and Requests

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It’s a 55-45 respondent split on whether Apple will have any influence on health and healthcare. Steven Davidson, MD added this comment to his vote: “Apple is the baby boomer tool of choice. Consumers, aka activated, engaged patients are growing in number and power and will adopt tools that enable/enhance their power. Apple wants to be that tool vendor and is the first major (well maybe Nike, but they’re giving up) consumer brand to offer a mostly complete as it is tool set. I think their presence is important and I think the hospitals still don’t get it–with a small number of notable exceptions.” New poll to your right or here: should the MU 2015 reporting period be reduced to 90 days?

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Welcome to new HIStalk Gold Sponsor Phynd. The Kearney, NE-based company offers a cloud-based platform that synchronizes provider data from all of a hospital’s IT systems into a single profile, allowing hospitals to accurately answer the question, “Who are your doctors?” that includes billing address, communications preferences, licensing, internal system IDs, exclusionary lists, and contracting. It uses a patent-pending Universal Provider Profile (UPP) for all 3 million US providers, making it easy for frontline users to add a new provider on the fly, also supporting custom fields and taxonomies on any topic and from any IT system. Data quality can be easily determined by each provider’s UPP Score. Folks at Yale-New Haven Health recently did a presentation on how Phynd solved their problems involving 7,000 Epic users and 40,000 referring physicians: outdated credentialing information, endless calls to get updates, manual lookups, and lack of auditability of updates. Thanks to Phynd for supporting HIStalk.

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Mr. Fraustro, the California teacher whose classroom got a 3-D printer courtesy of HIStalk readers, provided some photos of it in use. He says the students were excited when they fired it up for the first time and saw the flashing lights, heard the sounds, and smelled the printing filament and realized it exists beyond YouTube videos.

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Andy Spooner, MD of Cincinnati Children’s Medical Center wrote another great “CMIO Rant” posts on HIStalk Practice, this one rebutting the AMA’s list of EHR problems with things they could be doing instead of complaining about technology.

Listening: new from Train, complete with their trademark clever lyrics despite a dangerous turn into “background music for work” territory. Extra points for the jangly “I’m Drinkin’ Tonight.” Decent for a band that’s been plugging away for 20 years and is down to just two original members.


Last Week’s Most Interesting News

  • Congresswoman Renee Elmers (R-NC) introduces a bill that would allow providers to choose any three-month reporting period in 2014 for Meaningful Use reporting instead of the full-year mandate otherwise scheduled to begin October 1.
  • Apple pulls HealthKit-dependent apps from the App Store after finding unannounced bugs in HealthKit that will take at least two weeks to fix.
  • The American Medical Association and then its president take shots at poor EHR design and usability.
  • Former Kaiser Permanente CIO Phil Fasano joins insurance company AIG in the newly created position of EVP/CIO, with KP VP named as interim CIO as the national search for Fasano’s replacement begins.
  • Outsourcer Cognizant announces plans to acquire TriZetto for $2.7 billion.
  • An app developer trade group asks HHS via Congressman Tom Marino (R-PA) to make it easier for them to understand and comply with HIPAA requirements, some of which predate the iPhone.
  • Epic holds its UGM with over 18,000 attendees on hand in Verona, WI.
  • Illinois-based systems Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system, with a stated expected benefit being the sharing of electronic medical records between their respective Cerner and Epic systems.

Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

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Providence Health & Services launches Providence Ventures, a $150 million venture capital fund that will invest in companies focusing on online primary care access, care coordination and patient engagement, chronic disease management, clinician experience, analytics, and consumer health. It will be led by a former Amazon publishing executive. Providence will also create an internal innovation group to help it collaborate with early-stage companies, run by newly hired VP Mark Long (above), who was formerly CTO of Zynx Health.

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Identity and access management technology vendor Ping Identity receives $35 million in venture funding, bringing its total to $110 million.  


Announcements and Implementations

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The Tel Aviv, Israel-based McKesson Cardiology development group earns CMMI Maturity Level 5, the only FDA-regulated medical device software organization to achieve the highest software process improvement rating. I assume that’s the former Medcon that McKesson acquired for $105 million in 2005.


Other

Cerner and athenahealth say they, like Epic, are working on integrating their systems with Apple’s HealthKit. People seem excited about that for some reason.

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A New York Times article calls out “drive-by doctoring,” where surgical patients receive bills from clinicians called in without the patient’s approval, often billing them at out-of-network rates. A disk repair patient was billed $117,000 by an out-of-network “assistant” neurosurgeon he had never met. Another patient complained that plastic surgeons billed him $250,000 to close an incision and a “parade of doctors” dropped by regularly post-op without mentioning that they were billing him every time they said hello. The article points out that the US has more neurosurgeons per capita than other countries and Medicare is paying them less, so they attend seminars on “innovative” coding and convince other surgeons to fraudulently declare emergencies that require their services. This is bizarre to me: the hospital sent a surgical patient’s blood tests and ECG to an out-of-network lab.

New York Times reporter Elisabeth Rosenthal, who is a Harvard-educated physician (and who also wrote the article above about drive-by doctoring), rightly calls out the silliness (and profit-seeking motivation) of entrepreneur Vivek Wadhwa proclaiming that, “I would trust an A.I. [artificial intelligence]” over a doctor any day” since AI provides “perfect knowledge.” Leave it to technologists to utter some of the stupidest imaginable statements about healthcare, exhibiting their lack of knowledge about medicine and putting unwarranted faith in the inaccurate perception that given endless amounts of unaudited data and enough computer horsepower to churn through it, better outcomes will automatically be obtained (let’s match Watson against a skilled physician instead of a “Jeopardy” contestant in treating an elderly patient with multiple chronic conditions and see who wins). Rosenthal makes great points: (a) slick technologies, including fitness trackers, haven’t affected outcomes or costs; (b) “health” can’t be easily defined with the knowledge we have today; (c) it’s easier to collect data than to know what it means, such as whether low testosterone levels in men are relevant; (d) people die even when their data points are perfect; and (e) it’s easy to find measurable abnormalities in patients who are fine, leaving the choice of treating the measurement or the patient. She concludes that some but certainly not all medical outcomes can be affected by collecting more information:

One central rule of doctoring is that you only gather data that will affect your treatment. There are now devices that track the activity of your sympathetic nervous system as a measure of stress. But what do you do with that information? Other devices continuously monitor breathing for wheezing that isn’t noticed or audible. Does that matter? Some studies have shown that continuous monitoring isn’t useful for children hospitalized with bronchial infections.

If you were dieting, would stepping on the scale 1,000 times a day help you lose weight? Or consider the treatment of an abnormal heart rhythm. It’s true that constant monitoring for a few days can be highly useful to identify the pattern and what provokes the attacks. After that, though, for many patients a wearable cardiac tracker might simply record normal beats that normal people experience all the time, increasing anxiety for many patients.

The Minneapolis paper profiles Peter Kane, founder of two failed healthcare IT businesses (ProcessEHR and Phase-1Check), who since started  a co-working space.

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Weird News Andy has thoughts about this story, in which a since-fired 33-year-old female nurse is accused in a lawsuit of initiating “unsolicited sexual relations” with a 60-year-old male ICU patient waiting for a heart transplant, which the man claimed had happened with other patients. WNA’s analysis: “Was she so inept that his heart rate didn’t go up, or did alarm fatigue prevent someone from investigating?”


Sponsor Updates

  • Validic will announce new clients, integration partners, and connectable fitness devices at the Health 2.0 Fall Conference this week. The company will sponsor a Codeathon and participate in panel discussions.
  • Wellcentive will demo its population health management solution at the Health 2.0 Fall Conference.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 20, 2014 News 4 Comments

News 9/19/14

September 18, 2014 News 14 Comments

Top News

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Apple removes HealthKit-powered apps from the App Store on iOS 8’s launch day Wednesday, stating that an unspecified HealthKit bug will keep those apps offline for at least two weeks. Some app developers are reportedly scrambling to remove HealthKit dependencies from their products to avoid loss of momentum.

I upgraded my iPhone 5 to iOS 8 Thursday hoping to fix an ongoing “no SIM installed” error. While the Health app is present, it only supports basic data entry (body measurements, sleep, vital signs) until connected to source apps, so nobody’s going to get excited about that. It does offer a new Medical ID option so that users can enter emergency information (allergies, meds, contacts) that can be displayed on the iPhone’s emergency dialer screen when needed. Reader Is-It-The-Future-Yet says that feature could have “more impact than anything HealthKit or the silly watch is going to do to actually impact care,” although my observation is that you would still need a medical alert bracelet since first responders aren’t going to check your phone on the off chance you’ve entered something important there.


Reader Comments

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From St. Louis Cardinal: “Re: BJC. Looks like they’ve gone out to the market for EMR replacement. Order of demonstrations: Allscripts, Cerner, Epic.” Demos were completed four weeks ago. I don’t remember what they’re using, although I know they chose several Siemens Soarian apps a few years back and I think they have some Allscripts products as well.

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From MD Backle: “Re: Amazing Charts. Thought you might enjoy this email ad, in which they misspell EHR three times (twice as ERH, once as HER) plus misspell ‘it’s’ as ‘its.’ They need some proofreading!” Hopefully their programmers are better keyboarders than their salespeople.

From A Reader: “Re: KLAS report on Epic consulting, released as hordes of consultants are at Epic UGM. It would be great to hear your input on the report.” I don’t have access to KLAS reports, so I generally don’t bother mentioning them since there’s not much I can say having read only the teaser press release that intentionally discloses little of the expensive report’s contents.


HIStalk Announcements and Requests

We’re already planning for HIStalkapalooza at HIMSS15 in Chicago. We’ve booked an amazing (huge) venue, hired a band, and started planning the details that will ensure that this will be the best and biggest HIStalkapalooza ever. Contact Lorre if your company wants to participate as one of five sponsors who will get great benefits like event recognition, a private hosting area, a welcome/display space on the main floor, and a bunch of invitations to share with prospects, customers, or employees. We needed to exert more control and decided to forego the “single sponsor” approach, although we might still consider it if a company agrees to our terms in making it a great experience for attendees. I like this approach (which companies have suggested for years) because the event’s sponsors can make a big impression in front of a huge audience without having to bear the full effort and expense.

This week on HIStalk Practice: One family physician sticks up for EHRs. Dr. Gregg provides perspective on Meaningful Use. Alisha Smith shares last minute prep tips for the HIPAA Omnibus deadline. Research shows Apple won’t reach critical mass for world healthcare domination any time soon. Elation EMR CEO Kyna Fong discusses the importance of physician shadowing. New Jersey Physicians ACO goes with eClinicalWorks. Brad Boyd offers strategies for onboarding financial systems. Thanks for reading.

This week on HIStalk Connect: Keas raises a $7.4 million Series C to help expand its employee wellness platform. 6Sensor Labs announces a $4 million seed round for a portable food analyzer that can detect gluten and potentially other allergens. Researchers at the European Respiratory Society’s International Congress present study findings suggesting that lung cancer patients have measurably warmer breath, a characteristic that may lead to innovative new screening tools. 


Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Our secretive government health IT expert Dim-Sum delivered an amazing webinar Thursday on the Department of Defense’s $11 billion EHR project. We had large attendance and lots of questions in covering the EHR vendors and prime contractors that are bidding, the military health system’s structure, the opportunities for companies to do business as subcontractors, and the strengths and weaknesses of the competing teams (CSC-HP-Allscripts, IBM-CACI-Epic, Leidos-Accenture-Cerner, and PWC-GDIT-DSS.) It’s more like a conversation since we didn’t use slides, but it held my attention throughout and I highly recommend it to anyone with even a casual interest in how several billion of our taxpayer dollars will be spent or how our military members will be cared for. Thanks to the brilliant Dim-Sum for delivering a frank, funny, and highly useful presentation. 


Acquisitions, Funding, Business, and Stock

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Medseek changes its name to Influence Health to reflect its mission to influence consumer choice, brand loyalty, and health behaviors before, during, and after healthcare encounters.

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Larry Ellison will step down as CEO of Oracle. The 70-year-old company founder will be replaced by co-CEOs promoted from within, Mark Hurd and Safra Catz.

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China-based Internet and e-commerce vendor Alibaba conducts the highest-yielding IPO in the history of American stock exchanges, raising $22 billion and valuing the company at $168 billion. The company made tentative moves into healthcare IT in the past few months with an investment into a Hong Kong-based pharma software vendor.

Perceptive Software, fresh off a move to a new headquarters building, announces layoffs and the closing of  its offices in Beverly, MA and San Francisco.

Cerner gets Federal Trade Commission approval to acquire Siemens Health Services with early termination of the waiting period, keeping the acquisition on track for Q1 2015.


Sales

Central Clinical Labs selects Liaison EMR-Link to integrate lab results into the PointClickCare long-term care EHR.

People

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Kaiser Permanente names SVP of Enterprise Shared Services Dick Daniels as interim CIO, replacing Phil Fasano.

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Baptist Health System (AL) promotes CMIO Chris Davis, MD to CIO/CMIO. He has served as interim CIO since June.


Announcements and Implementations

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Sunquest and Partners HealthCare establish a strategic alliance to develop a next-generation genomic information system. Sunquest will make an investment in GeneInsight, a Partners-owned company that offers software for genetic testing reporting, results delivery, and collaboration.

The Denver Office of Economic Development names Aventura as a Denver Gazelle high-growth company.

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Holyoke Medical Center (MA) goes live on T-System’s EV physicians documentation system.

Dallam-Hartley Counties Hospital District (TX) implements Holon’s CollaborNet HIE.

Identity and access management solutions vendor Tools4ever will use technology from Boston Software Systems to automate its solutions.

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High Point Regional Health (NC) begins its implementation of Epic, which will replace Allscripts outpatient and McKesson inpatient now that the health system has merged into UNC Health Care. According to High Point’s COO, “This is one of the main reasons we sought out and merged with UNC, that is, to be able to take advantage of centralized resources, and high on that list was Epic. For us, it’s a great opportunity because it is becoming the default, go-to system in the state.”


Government and Politics

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Congresswoman Renee Ellmers (R-NC) introduces the Flex-IT Act that would allow providers to choose any three-month quarter for 2015 Meaningful Use reporting, explaining,

Healthcare providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.

The Meaningful Use Program has many important provisions that seek to usher our health care providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.

The Flex-IT Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.

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Mikey Dickerson, the former Google engineer brought on as administrator of the White House’s US Digital Service, says Healthcare.gov was a mess when he was called in to fix it as part of the “tech surge.” There was no system status dashboard, so “there was no place to find out whether the site was up or down except for watching CNN,” none of the project’s 55 contractors were tasked with maintaining uptime, and nobody seemed surprised or anxious that the site was down since government projects fail regularly. He explains his job change: “We have thousands of engineers working on picture-sharing apps when we already have dozens of picture-sharing apps. These are all big problems that need the attention of people like you. These problems are important, and fixable, but you have to choose to take them on. This is real life. This is your country.” I noticed that his LinkedIn profile lists his previous government-related service as “No Fancy Title, Thanks.”


Technology

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The Portland, OR business paper profiles startup ReelIDX, which offers platform for creating, managing, and sharing medical video content. It emphasizes recording the patient encounter for patient education and clinician review.


Other

Three North Carolina health systems – WakeMed, Wake Forest Baptist Medical Center, and Vidant Health – create a shared services company to reduce costs, with WakeMed’s CEO saying the systems hope to reduce their individual Epic operating costs and training efforts.

The Helsinki, Finland newspaper writes up “Apotti – a patient data system that costs more than a children’s hospital.” The government chose CGI and Epic as vendor finalists to develop the new system and expects to name the winner in early 2015. Total costs are estimated at $555 million.


This tweet from Epic’s UGM seemed to polarize the Twitterverse – do the disproportionate Epic-to-Epic numbers support or dispute Epic’s interoperability claims?

AMIA joins the Commission on Accreditation for Health Informatics and Information Management Education to develop accredit master’s programs in health informatics.

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Faculty of the School of Biomedical Informatics at Texas Medical Center don hats to celebrate National Health IT Week.

A clickbait Venture Beat article titled “EHR giant Epic explains how it will bring Apple HealthKit data to doctors” takes 16 paragraphs to state the obvious: user information from iOS’s HealthKit can be grabbed by Epic’s MyChart (with the patient’s permission) and then populate Epic. It misses the real challenge as to what happens on the Epic side, not only in the form of alerts or actions, but what clinicians are supposed to do as a result. The challenges aren’t technical:

  • The data that an iPhone can collect is basic and not all that useful diagnostically except perhaps trended over time (such as a gradually increasing weight).
  • Most app developers won’t get FDA approval to add logic that would find the one piece of potentially useful information out of thousands of data points, so that means tons of useless and unreviewed junk will get dumped into Epic.
  • Providers aren’t paid to watch consumer-captured information. Even now patients could email their doctor with logs of weights, blood pressure, and blood glucose, but doctors aren’t paid to read them. It’s also not clear who should be watching the information – PCP, specialist, nurse, or someone else?
  • Healthcare is designed around encounters, not monitoring. App developers don’t understand that medicine isn’t as digitally right or wrong as their world – most of us as patients want to be treated as individuals, not worksheets of measures limited by the convenient availability of sensors.
  • Hospitals and practices may decline to allow patients to send them information since that accepts responsibility for doing something with it. Nobody wants to get sued for malpractice for missing one abnormal measure.

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Steven Stack, MD, president-elect of the AMA, says EHRs are immature, expensive, and poorly designed. He adds that poor EHR usability is a significant driver of physician dissatisfaction. He doesn’t explain why AMA’s members greedily and voluntarily bought those systems despite their faults hoping to pocket a few dozen thousand dollars in free MU money. The market is where it should be, at the intersection of supply and demand, and perhaps the AMA should be convincing its members who are providing the demand as customers instead of scolding the companies that meet it. It’s like complaining that you hate Taco Bell while waiting in line to get your daily bean burrito. Stack has done committee work for ONC, was involved with the PCAST Report (that mostly touted Microsoft as the answer to all healthcare IT problems), and is on the board of eHealth Initiative (which includes quite a few vendor members). He’s always been a usability critic.

At least 15 children die in Syria after receiving UN-provided measles vaccine, with a preliminary WHO report speculating that medics accidentally gave the muscle relaxant atracurium instead of the vaccine since the drugs are packaged in similar vials and were stored in the same refrigerator.

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A security publication finds medical records on sale in bulk on a black market Internet site, apparently stolen from a Texas life insurance company’s applicant database. The writer bought records and verified their accuracy, with prices as low as $6 for each “fullz,” slang for a complete set of records that the buyer can use to open fraudulent credit card accounts, access bank accounts, or take over someone’s identity.

UCSF surgeon Wen T. Shen says he’s embarrassed for patients to see his lack of typing skills, but doesn’t like the alternatives:

Wait until after the patient leaves to start charting (impractical given our clinic workflow); hire a medical scribe to do my documentation for me, as detailed in a recent New York Times article (not happening with recent budget cuts); use the nifty speech-to-text dictation device provided to all clinicians (feels extremely weird and off-putting to do this in front of patients); actually learn to type (old dog/new tricks, dwindling brain plasticity).

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Weird News Andy says, “I <3 this password,” although he adds that it might be tough to get into your phone to dial 911 during a heart attack. Researchers develop an authentication method that uses wristband-detected ECG patterns as “the perfect password,” although people with fibrillation might not be ideal users.


Sponsor Updates
  • Nordic announces that it has earned the top ranking among Epic implementation support and staffing consulting firms in a new KLAS report. Also named in the report is Orchestrate Healthcare, the highest ranked vendor-agnostic consulting firm in the implementation support and staffing category.
  • ADP AdvancedMD’s EHR earns ONC-ACB certification as a Complete EHR.
  • Huntzinger Management Group recognizes its clients and IT professionals for National Health IT Week.
  • Access provides Normal Regional Hospital (OK) with giveaways to help celebrate National Health IT Week.
  • EClinicalWorks names several ACO clients that are generating savings after deploying its CCMR.
  • ESD’s Phil Sierra discusses the value of healthcare IT in a recent blog.
  • Etransmedia shares a video about its success and growth.
  • SRSsoft is participating in the American Society for Surgery of the Hand conference in Boston this weekend.
  • Truven Health Analytics and National Business Group on Health partner to facilitate an improved Employer Measures of Productivity, Absence and Quality program.
  • AirWatch by VMware offers instant support for devices running on iOS 8.
  • An Imprivata survey finds that 65 percent of hospitals will use Virtual Desktop Infrastructure within two years and 84 percent of those will add single sign-on.

EPtalk by Dr. Jayne

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The physician lounge was buzzing this morning with the news of HR-5481, the “Flexibility in Health IT Reporting Act.” If passed and signed into law, it would allow providers to report 90 days rather than a full year in 2015.

I have to say my pulse quickened when I saw it. Congress set precedent with their ICD-10 push. This one might have less of a chance, however, since it’s not being tacked onto another high-profile bill. Maybe we can hook it to a bill everyone can get behind, such as the “We Love Mom, Apple Pie, and America Act.” If this passes, it just might defibrillate Meaningful Use, moving it from “mostly dead” to “slightly alive.”

In other bandwagon-jumping news, the American Medical Association releases a paper on setting “Priorities to Improve Electronic Health Record Usability.” I’m not a big fan of the “blame the EHR” game since there are so many more factors that influence usability, user behaviors, and generally how the health system runs. Rather than putting all of our eggs in the proverbial basket and assuming that if we just “fix” the EHR everything will be awesome, let’s look at the other issues that cause slowness and waste in health care.

My laundry list includes E&M Coding, obnoxious precertification requirements placed on physicians without good reason, The Joint Commission requirements, RAC audits, payer audits, Meaningful Use, other certification body requirements, and numerous non-value-added steps throughout the day. I could go on, but it would be aggravating. Although some of these have been shown to improve outcomes, many are just nuisances. Let’s take a multi-pronged approach and stamp out ALL poor usability, not just that of the software variety.

Back to the AMA, they again sent Medicare reimbursement codes for end-of-life care discussions to CMS for consideration. I’m in favor of efforts that would actually help physicians be paid for non-procedural work. We don’t die well in the United States. TV and media paint a picture of heroic lifesaving measures where everyone recovers fully, but don’t ever show patients with poor outcomes. The last time this came up, the scare tactics around “death panels” crushed any hope of approval.

As a primary care physician, one of the best things I can do as part of our partnership is talk to you about end-of-life care, getting your wishes out in the open and ensuring you have a support system that can carry them out when the time comes. Unfortunately, this isn’t for just Medicare patients. We need a national dialogue (heck, our EHRs all have prompts for it anyway) for patients of all ages. Young women die in childbirth, people are in horrific accidents, and overall stuff just happens.

I had some nurses make fun of me when I rolled into an outpatient surgical procedure with my healthcare power of attorney and living will at the tender age of 31. As a physician, I don’t want “everything” done and am firmly convinced there are things worse than passing on. Unfortunately, there’s no way commercial payers will cover this service until Medicare takes the lead or until patients pay out of pocket.

Until then it’s just one more thing we have to do without compensation, like keeping your diagnosis list maintained in both SNOMED and ICD-9 and explaining ethnicity to elderly people who have no idea why we would need to gather that type of information. I’m expected to share all data, but patients can pick and choose what I see, potentially placing them at risk. Proponents of MU argue that the potential of up to $44K worth of incentive payments effectively compensates us for all the extra work, but it doesn’t even scratch the surface.

I’m interested to hear what else we should ask Congress to fix for us while they’re at it. Got an idea? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 18, 2014 News 14 Comments

Health IT from the Investor’s Chair 9/17/14

September 17, 2014 Investor's Chair No Comments

Some Musings from the Chair

With summer winding down and Labor Day in the rear view mirror, it felt like a good time to write a quick Investor’s Chair post and share one or two of the more interesting things I’ve noted in the market of late.

The biggest news of the summer was clearly Cerner’s announced acquisition of Siemens’ healthcare information technology unit (or, as we old timers would say, Shared Medical Systems.) When I got a call from a reporter related to the transaction, my first reaction was a sense (as perhaps the Siemens folks would say) of schadenfreude, as this is yet another example of yet another European technology company foundering on the shores of the US healthcare IT market (think Misys).

Recall that Siemens bought SMS 15 years ago for $2.1 billion, only to sell it now for $1.3 billion. Why the decrease in value? Perhaps because in the greatest boom times our sector has ever seen (thanks in no small part to ARRA), revenues over these 15 years were astoundingly FLAT!

With this purchase, Cerner is now the clear sector leader and will enjoy mammoth cross-selling opportunities given the product fit. Cerner is a clinical leader, where Siemens (née SMS) always lagged there and was more focused on financial systems. (In fact, I recall the former CEO of SMS explaining to me that Cerner’s clinical focus was off base!)

From an investor perspective, this was a good use of both the cash hoard Cerner had built up on its balance sheet and its high-multiple stock, allowing the deal to be almost instantly accretive – especially with the $175 million in pre-tax synergies the company guided to in its press release. While the stock traded fairly flat around the release (likely because rumors had circulated for several weeks prior to the deal, causing the deal to already be priced into the stock), Cerner’s shares are up almost 10 percent as I’m writing this post, more than twice the S&P — Ms. Market seems to be more excited.

The vast majority of analyst commentary has been positive and we here at the Chair are fans of the purchase as well. The only thing that gives me pause as a long time Cerner watcher (and fan) is that the company has zero history of large-scale M&A and the sector has not been kind to such large-scale bets in the past.  What’s especially noteworthy here though is that the cultures of the two companies are literally more than an ocean apart, and in the words of famed management guru, Peter Drucker, “Culture eats strategy over breakfast”.

That said, the price Cerner paid clearly de-risks the acquisition, and Cerner is known for its strong culture (and full parking lots).

Another aspect of autumn I’m eagerly anticipating is attending the Health 2.0 Fall Conference in a few weeks. My impressions of the 2010 event can be found here. I missed it last year, so I’m really looking forward to the opportunity to see some of the new thinking and more cutting edge tech that this event usually attracts. With “digital health” so beloved of the venture world these days, I’m expecting both a fair number of cheap but cheerful innovators with apps and dreams, but also know there will be more than a few companies straight out of HBO’s show “Silicon Valley” strutting their stuff and spending their VCs’ money on booths and travel like there’s no tomorrow (and if they’re not careful, there won’t be).

Part of what I like most about this event is the great dichotomy in participants, sponsors, and attendees. I’m also particularly excited to be mentoring the HealthTraction component, Health 2.0’s Startup Championship – CEO mentoring for companies of all sizes is one of my favorite aspects of ST Advisors’ work.

As for the actual sessions, in the past they’ve varied from truly fascinating to really annoying, but that’s the beauty of industry conferences. My big complaint is that the conference moved from San Francisco to “the Valley,” but I’m keeping an open mind and will be writing a debrief post afterwards. Drop me a note if you’d like to drink some sponsor’s wine or coffee during the event.

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Ben Rooks spent a decade as an equity analyst and six years as an investment banker. Five years ago he formed ST Advisors to work with companies on issues of strategy, growth, and exit planning (among other fun topics). He lives in San Francisco with his wife and the cutest dog ever!

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September 17, 2014 Investor's Chair No Comments

HIStalk Interviews Marc Grossman, Principal, WeiserMazars

September 15, 2014 Interviews 1 Comment

Marc Grossman is principal with WeiserMazars of New York, NY.

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Tell me about yourself and the company.

I’ve been in the healthcare IT industry for 30 years. I’ve worked on the provider side as a hospital administrator and have been doing healthcare IT consulting for about 25 years.

I work for WeiserMazars. It’s an international consulting and accounting firm. I head up the healthcare national practice within the United States. Our clients are all provider-side clients in healthcare IT.

 

How are hospitals selecting and implementing systems differently now than they were five or 10 years ago?

There’s really not been that much change in how they’re selecting core systems. Hospitals typically keep systems for 10 to 20 years, which is a lot longer than most people would expect. I think it’s due to financial reasons.

We’ve gone through a lot of clinical selections recently. Our emphasis was on clinical systems due to Meaningful Use. There’s a cycle that I see the industry going through in the type of system, whether it’s financial, patient accounting, clinical lab, radiology, and so forth. But the process is basically still the same. That hasn’t changed.

 

The pendulum always swings back. People are paying more attention to revenue cycle and even talking about customer relationship management systems. What systems do you think are poised to make a comeback?

Patient accounting is going to see a big shift. That also has a lot to do with the fact that Siemens is being purchased by Cerner. Lab systems are starting to go through a cycle again.

People have in the past three or four years started looking at systems that haven’t taken off significantly yet. Systems related to population health management, data analytics, data warehousing, business intelligence. Those types of systems will cause a shift in purchases.

 

What are you seeing with lab systems? 

We’re seeing a push for an integrated approach, getting away from best of breed. You see it with Epic. You see it with Cerner. Those are probably the two biggest right now that I see people moving to. If they already have Epic, they’re moving to Epic’s lab. If they have Cerner, they’re moving to Cerner’s lab. 

We have seen that in lab systems, there seems to be a cycle about every seven years. I’d say about half of organizations are replacing. They keep it for about 14 years, typically, and about every seven years, we seem to be doing a lot more lab system selections than we have in the past. I’m talking about replacement of whatever they have — best of breed or some kind of niche vendor system.

 

How do you see Cerner’s acquisition of Siemens unfolding?

A lot of it’s going to depend on where the Siemens client is. Are they live on Soarian or in the process of implementing Soarian? Cerner has been much more successful with their patient accounting system recently. They’ve changed the name because it had such a bad reputation – they no longer call it ProFit. 

I believe Cerner is buying Siemens for intellectual property. On the patient accounting side, I think they’re also looking at the RCO base that Siemens has, which is a great revenue stream for them. 

Given Cerner’s history and the industry’s history over the last 20-30 years, Siemens Soarian and Invision product support is going to go downhill. I think they probably won’t sunset it officially for at least 10 years, just because I know Siemens does have numerous contracts which are going out 10 years. I also hear Siemens’ sales guys are really pushing to provide great deals right now, to get people to sign up or extend their contracts for 10 years. 

Like we’ve seen with many other vendors that purchased other systems, Cerner is clearly not going to put R&D money into two patient accounting systems and two clinical systems if they have an integrated system now. I just don’t see any indication that Cerner is going to continue the development of any of the Soarian or Invision products.

 

What are you seeing with population health management and analytics?

We’re seeing a lot of disappointment because the systems are so early in their life cycles. People are hearing a lot of promises from various vendors, both the major players like Cerner, Epic, and Allscripts and down the line. They have products in their infancy.

Then you have the niche players, which definitely have more mature systems, but there’s still a lot of disappointment even with those. Difficulty with interfacing issues and difficulty with the depth and breadth part of the applications.

 

Is there a mature enough process in place in hospitals that even if the systems could give them what they want, that they could follow through on the promise of either population health management or analytics?

I’ll say eventually we’ll get there. I don’t think we’re there yet.

Some of the larger academic medical centers that have large IT shops, are more sophisticated, and have a lot more money to spend have gotten their feet wet, some of them 10 years ago. But a lesson we have to learn is that vendors and consultants set false expectations. It’s a multifaceted challenge that we’re dealing with in our industry.

The biggest problem we have is that our industry is the only industry that I know of where the revenue side of the financial equation is heavily regulated, but the cost side is totally unregulated. We have a ton of regulations, a ton of incentive programs, but the money isn’t there to pay for all the wants and the needs.

We also as an industry need to accept responsibility for the fact in that we don’t have real standards when it comes to interoperability. Each hospital thinks that it’s unique. I’m not suggesting that they’re not different in some ways and some have certain specialties that others don’t. But the reality is that they’re in competition with each other, so they’re not willing to share things where they should be sharing.

The other issue is that each individual hospital’s incentives are not in sync with the government’s incentives and drive. The government can save money by having hospitals operate in a certain way. Each hospital doesn’t necessarily benefit from it. The desire of where we’re going to put our money at each hospital is not consistent.

 

Is the era of hospitals running applications from their own data centers fading as they move to the cloud?

We’re at least five to 10 years away from that. I’m hearing from a lot of our clients – they want to get out of the data center business. I don’t know if it’s going to necessarily be the cloud. There’s definitely a push to move more to RCO-RHO kind of approach like Siemens and Cerner have been doing for many years.

 

When hospitals negotiate agreements with companies to host their applications in whatever form, what’s important for them to look at contractually to protect their interest?

Service levels, to make sure that response time and downtime is going to be sufficient. Address areas related to growth and the impact on fees. Also, the whole issue of who really owns the data and how do you access that data if and when the arrangement ends. It sounds like a simple thing, but the reality is that it’s often very difficult for hospitals when they’re trying to pull out of an RCO arrangement to easily get their data.

Those are probably the biggest issues in my mind — cost, access, and availability.

 

What are the top issues that are challenging health system IT departments?

What I’m hearing from most of our clients are four or five big issues. CIOs expressing concern that they have too much on their plates, not just individually, but as an organization. They have too many high priorities and don’t have the necessary resources in most instances. ICD-10, Meaningful Use, the related offshoots from all of that, population health, changes in reimbursement, growth in terms of hospitals buying up physician practices or buying other hospitals or merging.

A second category is lack of strong IT governance. A lot of what relates to that unfortunately at many hospitals, especially at smaller hospitals, CIOs still do not have a full seat at the table. They’re often viewed as not being strategic. A lot of the hospital executives still view IT as a necessary evil rather than a strategic enabler. It becomes an uphill battle for CIOs.

There’s a lot of frustration and lack of trust among a lot of the executive leadership at many healthcare providers due to the history of false promises and expectations that were not met in the industry over the many years. Look at how many failures we’ve had with just EMRs alone and how organizations have had to replace systems.

Even in this day and age, I find a lot of executives don’t understand what systems are going to really give them and that systems are not going to solve all their problems. It’s just an enabler as opposed to the solution itself.

 

Do you have any concluding thoughts?

We’ve actually grown a lot as an industry. I think we still have a lot of growing to do.

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September 15, 2014 Interviews 1 Comment

Monday Morning Update 9/15/14

September 13, 2014 News 6 Comments

Top News

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Illinois-based Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system with 16 hospitals, 45,000 employees, and $6.5 billion in annual revenue. The CEOs of both systems say more mergers or acquisitions are likely as hospital consolidation continues. They also touted the benefit of shared electronic medical records and future plans to roll out more patient-facing technologies. I would bet that NorthShore’s Epic will eventually become the new standard, replacing Advocate’s Cerner system.


Reader Comments

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From Core Consumer: “Re: Apple and Epic. Apple used Epic screen shots in their HealthKit presentation. There’s no doubt that the companies signed a partnership agreement. Just because details weren’t announced doesn’t mean it didn’t happen.”

From The PACS Designer: “Re: Office 365 Garage Series. With the focus these days on security, Microsoft in their Garage Series wants everyone to know where the Office 365 improvements will be to enhance user performance, collaboration, and connectivity.” I’m surprised Microsoft hasn’t crowed more loudly about Apple’s iCloud breach.

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From Smooth Operator: “Re: Kaiser CIO Phil Fasano. Kaiser confirms that Phil has resigned. There’s all sorts of internal discussion on who will be named interim CIO.”


HIStalk Announcements and Requests

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HIMSS and CHIME are the organizations most often joined by poll respondents. New poll to your right or here: what influence will Apple have on health and healthcare? Vote and then click the Comments link on the poll to elaborate further.


Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

We ran a couple of great, well-attended webinars in the last few days. Here’s “Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success.”

This is last week’s “Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success.”


Sales

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The Amerigroup Texas Medicaid health plan will use analytics from Treo Solutions, which was recently acquired by 3M Health Information Systems.


Announcements and Implementations

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Australia’s leading interactive patient care vendor, Hills Health Solutions, will distribute patient engagement technology from Lincor Solutions. The agreement was signed during a trade mission visit to Australia by officials from Ireland, where Lincor is based. The company’s touch-screen offerings for both wall-mounted and mobile devices include clinician EMR access, audio and video patient calling, entertainment, patient education, surveys, and meal ordering.

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Visage Imaging is sponsoring the full-day New York Medical Imaging Informatics Symposium this Thursday, September 18 at New York City’s Marriott Marquis. The $70 registration fee includes a sushi lunch and up to 6 AMA PRA Category 1 credits.

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National Decision Support Company releases an Epic version of its ACR Select evidence-based imaging appropriateness module that includes not only the decision support rules, but also recording utilization data that can be reported from Clarity and Reporting Workbench.


Government and Politics

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Nevada votes to shut down its Nevada Health Link health insurance exchange and move to Healthcare.gov after a problematic rollout and the firing of contractor Xerox, who had a $75 million contract to build the site. The state announced plans in May to use Healthcare.gov for at least a year, but decided last week to make the switch permanent.


Other

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The weather this week in Verona, WI for Epic UGM attendees: highs in the mid-60s, lows in the low 40s, sunny all week other than a chance of rain Monday morning.  The local paper and TV stations are warning commuters of significant traffic delays through Thursday. The folks at Madison-based Nordic wrote up “10 ways to make the most of your 2014 Epic UGM experience.”

The Yakima, WA paper covers EMR use by doctors who aren’t thrilled by it. One is the chief medical officer of Community Health of Central Washington, who says doctors are using up to half of the already-brief patient encounter to work on the computer and complains that EHRs weren’t designed by doctors. Another doctor says EHRs can improve care and patient relationships if doctors stop their foot-dragging and give patients the benefit of real-time lab results and e-prescribing. 

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Bonds of SoutheastHEALTH (MO) are downgraded with a negative outlook after the hospital loses $39 million in 2013 because of revenue cycle problems caused by its Siemens Soarian implementation.

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”The Onion” covers telehealth.

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The Permanente Medical Group CEO Robert Pearl, MD lists five reasons healthcare IT isn’t widely embraced:

  1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
  2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
  3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
  4. EHRs provide clinical value, but slow physicians down.
  5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

My list might instead be:

  1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
  2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
  3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
  4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
  5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.

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California HealthCare Foundation covers the Cerner implementation of Los Angeles County’s Department of Health Services, which will replace several siloed systems that require photocopying paper charts to transfer a patient from one of the county’s hospitals to another. Harbor-UCLA Medical Center goes live first on November 1.

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Tampa General Hospital (FL) fires an employee who it identified from audit logs as having printed the facesheets of several hundred surgery patients without authorization.

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An oral surgeon in Pennsylvania creates a public outcry when he lays off an employee of 12 years because he says her cancer (ovaries, liver, and pancreas) will leave her unable “to function in my office at the level required while battling for your life.” The doctor claims his intentions were noble: he laid her off so she could collect unemployment during treatment, he says, after which time she’s welcome to come back to work.

A hospital in England bans use of the term “computer on wheels” or “CoW,” fearing that patients might be insulted in hearing a nurse ask a colleague to “bring that CoW over here.” They like “workstation on wheels” better. A cynical employee said patients weren’t the problem, but rather hospital executives tired of hearing employees complain that the computer system is a “right cow” to use.

Here’s another example, along with bathroom scales in the homes of obese people, that having health data is not the same as using it: McDonald’s admirably posts calorie counts for every menu item and offers low-calorie choices like salads, apple slices, yogurt parfaits, and bottled water, but nobody buys the healthy items – they’re lining up for 600-calorie milkshakes masquerading as coffee and the 1,200-calorie feed trough known as the Big Breakfast. It would be interesting to calculate the annual death toll from both kinds of malnutrition – over and under.

Weird News Andy declares this story to be “efficient drug operation.” Federal agents arrest two employees of the Bronx VA hospital for using its mailroom to receive packages of cocaine mailed from Puerto Rico.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 13, 2014 News 6 Comments

News 9/12/14

September 11, 2014 News 2 Comments

Top News

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Former Allscripts CEO Glen Tullman launches Livongo Health, which will offer diabetes monitoring that includes an FDA-approved interactive glucometer and analytics. The company received a $10 million investment from General Catalyst. Its leadership team is sprinkled with former Allscripts people.


Reader Comments

From Vendor_Neutral: “Re: Apple. After months of being annoyed by misleading blog posts about Apple and Epic’s alleged partnership, I went back and watched that portion of WWDC this morning. Here is the direct quote: ‘We’re also working with leaders in health care applications like Epic Systems, now they provide the tech that enables hospitals serving over 100 million Americans, and so now with their integration with HealthKit, patients at these leading institutions will be able to get closer in sharing their information with their doctors.’ That’s all they said! NOTHING about a ‘partnership.’ They merely got early access to HealthKit. Let it be known that that is it.”

From Kaiser Roll: “Re: Phil Fasano. Resigned as CIO of Kaiser Permanente as announced in an email from CEO Bernard Tyson.” Unverified.


HIStalk Announcements and Requests

This week on HIStalk Practice: ABQ Healthcare Partners goes live on Allscripts. American College of Physicians outlines why MDs hate EHRs. Amazing Charts, athenaClinicals, and Meditouch vie for best EHR title. Research shows that primary care practices that create their own patient portal adoption strategy earn strong participation. The American Telemedicine Association grades states on telemedicine reimbursement and physician practice standards. Thanks for reading.

This week on HIStalk Connect: Apple unveils its long-awaited smartwatch, which will track activity and heart rate, but still falls short of what many were expecting for health features. The Mayo Clinic announces that it will work with IBM on a project that will use the Watson supercomputer to help analyze patient charts and match them with relevant clinical trails. Wellframe, a Boston-based startup, raises an $8.5 million Series A for its smartphone-based patient education and reminder tools.


Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

Google acquires Lift Labs, which makes a sensor-powered stabilizing spoon that helps people with tremors eat normally.

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Streamline Health Solutions announces Q2 results: revenue down 17 percent, EPS –$0.14 vs. -$0.07. Above is the one-year share price chart of STRM (blue) vs. the Nasdaq (red).

Privacy monitoring vendor FairWarning announces first-half results that include 104 percent growth in existing-customer revenue, 6,500 healthcare facilities as clients, and 64 hospitals running its SaaS-based product.


Sales

Capella Healthcare (TN) chooses Medhost’s YourCareLink to submit information to state public health reporting agencies.

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Phoebe Putney Health System (GA) selects Harris Corporation’s FusionFX Provider Portal.

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Evans Army Community Hospital (CO) will deploy AtHoc’s emergency communication solution.

Community Health Network (IN) will link its community Epic, Cerner, and Meditech EHRs through Health Catalyst’s Late-Binding Data Warehouse and Analytics Platform.


People

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Jack Janoso is named CEO of Fairfield Medical Center (OH). He was promoted from VP/CIO to CEO at Sharon Regional Health System (PA) before taking the new job.

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Beaumont Health (MI) — formed via the merger of Beaumont Health System, Botsford Health Care, and Oakwood Healthcare – names Subra Sripada as chief transformation officer of the 10-member executive team. He was previously chief administrative and information officer at Beaumont Health System.

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David Sides (iMDsoft) joins Streamline Health Solutions as EVP/COO.

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Boston Software Systems promotes Matthew Hawkins to EVP of healthcare strategy and sales.

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Jay Anders, MD (McKesson) is named chief medical officer of Medicomp Systems.


Announcements and Implementations

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Gillette Children’s Specialty Healthcare (MN) goes live on the Versus Advantages Clinic patient flow system.

AirWatch introduces AirWatch AppShield to provide security and management capabilities.

MModal launches an outpatient medical coding service.

Elsevier chooses Clinical Architecture’s Symedical terminology management system for its InOrder order set tool.

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MetroChicago HIE goes live with 31 hospitals using technology from Sandlot Solutions.

A Health Catalyst-sponsored survey of CHIME members (70 respondents) finds that analytics is the highest-priority IT investment, followed by population health and ICD-10.


Government and Politics

ONC announces that it will make minor tweaks to its 2014 certification criteria instead of rolling out voluntary 2015 criteria as previously planned. It will also name certification criteria by their year of approval going forward and will discontinue the “Complete EHR” certification.


Technology

Samsung pokes fun at this week’s somewhat anemic (and health-free) announcements from Apple, which seems to be morphing into Microsoft as it (a) pre-announces a product that won’t be available for a long time; (b) enters an existing market (smart watches) instead of creating a new one; and (c) fails to meet expectations in not talking about its rumored Health offering, possibly because of (a) limited stage time given the urgency of discussing fashionable watches and enlarged iPhone screens; (b) the moving target nature of whatever it’s going to eventually do, or (c) poor timing given that iCloud was just hacked.

Researchers from MIT and Georgia Tech find that Google Glass can measure pulse and respiration using its built-in gyroscope, accelerometer, and camera. You could say it’s for people who wouldn’t be caught dead wearing Glass.


Other

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The American Telemedicine Association reviews the telemedicine-related physician practice and licensure standards of all 50 states. The components included physician-patient encounter (are in-person initial visits required are are more restrictive standards in place); telepresenter (does the law require someone to be physically present with the patient during the session); informed consent (is the patient required to sign off differently than for in-person visits); and licensure (does the state offer out-of-state licensure reciprocity, exemptions for physician-to-physician consultations, and conditional licensure). Twenty-three states and DC earned an A grade, 27 got a B, and one (Alabama) had the lowest composite score and a C grade.

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Billionaire doctor Patrick Soon-Shiong makes the cover of the September 29 issue of Forbes, whose reporter seems as confused as the rest of us over whether he’s a genius, a blowhard huckster, or both. It points out that despite his spending $1.3 billion of his own money to acquire a bunch of unrelated technology companies (most notable in healthcare IT: iSirona), his grand ideas for “solving” healthcare are vaporware so far even as a rollout to Providence Health & Services is planned. The article mentioned Soon-Shiong’s tendency toward wild hype and his historic, greedy shafting of business partners, investors, and family members (“more of a wheeler-dealer than a scientist.”) Forbes concludes that his Nant-related holdings (including NantHealth) are worth $7.7 billion and he will start running IPOs next year, with NantHealth being the first.

Several publications are running breathy news items that Epic has hired a lobbying firm, none of them crediting HIStalk as their source since I reported it here on August 14 as tipped of by a reader who follows federal lobbying registrations.

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Epic’s user group meeting starts Monday, with 10,000 attendees riding buses from hotels as far away as Wisconsin Dells to get to Verona. Meanwhile, the company is again named the largest employer in Dane County, WI with 7,400 FTEs.

In the UK, breast cancer screening vans are upgraded with satellite links to allow employees to enter and access patient information and to send images directly to hospitals.

The family of Joan Rivers will reportedly file a $100 million lawsuit against the for-profit endoscopy clinic where she died during a throat operation, claiming the clinic allowed one of the doctors to perform an unplanned biopsy that should have been done in a hospital instead.

Weird News Andy titles this story “Moob.” In England, a man complains of gender discrimination when NHS turns down his request for cosmetic breast surgery to correct a lopsided condition caused by gynecomastia. “Women get boob jobs on the NHS but I can’t get help,” he says, while NHS maintains that they don’t pay for surgery that has no demonstrable health benefit.


Sponsor Updates

  • MedAssets issues a call for speakers for the 2015 Healthcare Business Summit April 7-9, 2015 in Las Vegas.
  • Connance presents a video case study of the challenges and successes of Carolinas HealthCare System (NC) after implementing its revenue cycle solution.
  • Billian’s HealthDATA offers its Vitals hospital news and RFP feed free to the public.
  • Aventura will participate in the SE conference of the HIMSS Summit in Nashville September 16-17.
  • The CDC and Premier release research indicating that unnecessary hospital antibiotic use costs $163 million.
  • Chilmark Research names Wellcentive a “Standout” Vendor in Product and Market ratings in Population Health Management Analysis.
  • Health Catalyst shares the results of its recent survey of CHIME members which indicates analytics is their top priority.
  • Aspen Advisors highlights its framework and recent engagements with organizations that are realizing the full value of their EHR.
  • Frost & Sullivan recognizes GE Healthcare IT with an innovation award for Centricity Financial Risk Manager.

EPtalk by Dr. Jayne

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It’s amazing how varied my work as a CMIO can be at times. Hot on the heels of some ridiculous implementation escapades, I’ve had a week of actually enjoyable work. I started the week attending a web-based focus group for one of our vendors. They did a great job putting it on and I give them an A-plus for facilitation skills.

The task at hand was to review some mock-ups for updated Patient-Centered Medical Home workflows. Instead of just throwing us into the content, they took the time to talk with the group about our existing workflows, including the good aspects as well as the challenges. The moderator made sure everyone was participating with a good mix of calling on people and letting them volunteer.

Web meetings are always hard, especially with a group of attendees that don’t really know one another. Someone is always trying to talk over the group or failing to mute themselves while they’re banging around their office, but we didn’t have any of that.

Only after they heard our needs did we see the mock-ups. It was an effective strategy because you didn’t have people throwing out all kinds of additional needs because they hadn’t thought it through. We were validating our needs against their ideas rather than being reactive.

Additionally, their mock-ups were well done with real-world scenarios. I’ve seen samples from other vendors where it looks like they just chose random drugs from a reference book, but these were spot on. I appreciated the fact that they prepared for us rather than asking us to imagine how it would be for the scenarios we see every day.

Usually after a four-hour web meeting I’m ready to bang my head against the wall (assuming no martinis are available), but I was actually a bit sad to see this one end. We’re regrouping in a few weeks, however, so that gives me something to look forward to.

Following the focus group, I was able to use the fact that my boss is out of town and our standing one-on-one is cancelled to do some belated spring cleaning in my office. It’s amazing how much junk accumulates. I’m ashamed to say I found a bunch of marketing collateral from HIMSS that I shoved in a drawer six months ago and promptly forgot. Sorry, marketing folks, I won’t be following up. But the cool Mylar folding wine bottle drip-proofer attached to one packet was a nice find.

Today I was able to spend some time mentoring a relatively new physician champion at one of our hospitals across town. Although he has a great deal of knowledge on the inpatient side, he’s just starting to get involved in ambulatory projects. He’s also studying for the clinical informatics board exam next month, so we talked about tips and tricks.

His facility is relatively new and has always been paperless, so it will be interesting to see how he does working with physicians who are transitioning from paper to EHR at the same time they’re transitioning to being employed. I’ve shared some of my horror stories, but from the expression on his face, I’m pretty sure he thought I was making them up. I can’t wait until he has a war story of his own.

The most fun thing about working with him is showing him some of the cooler features of our EHR. I spend so much time listening to physician complaints about how bad it is and how computers are ruining the practice of medicine that it was good to get an outsider view of its capabilities. He’s had formal training from the vendor, but taking that knowledge and applying it to a real-world practice workflow when you’re being interrupted by phone calls, nurses popping their heads through the doorway, and the mounds of paper that inhabit our “paperless” offices is another thing.

The best part of the meeting was when he asked what websites I would recommend to help him learn more about the IT landscape. I get an “F” on my mentor report card because I unfortunately couldn’t tell him about HIStalk. Hopefully he’ll stumble upon it or maybe one of the other informatics staff will recommend it, but it’s always a surreal experience when my worlds almost collide.

Got an alter ego? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 11, 2014 News 2 Comments

Health IT from the CIO’s Chair 9/10/14

September 10, 2014 Darren Dworkin 6 Comments

Fine print: the views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

EMRs – Application or Platform?

It is hard to go very far these days with out someone looking to dismiss EMRs as “just the transactional system.” It seems every new IT innovation or idea is the next big thing that will do us the favor of connecting with our installed systems, but do so much more. Population health, analytics, mobility, and patient engagement are all the new platforms to focus on.

Wait. EMRs are depended on every minute of every day to enable care delivery through zillions of transactions and are the result of years of hard work and untold dollars. They aren’t a platform? Really?

I want to believe that our enterprise EMRs are really agile platforms on which care delivery can be transformed. They are just works in progress. Oracle, SAP, Facebook, and Salesforce.com all started as applications and grew into platforms. Some better than others, but it was a journey.

In my mind, our industry’s EMRs are on this same path. I think that the EMRs brought to us by Epic, Cerner, and Meditech (which I will refer to as the Gang of Three) all have a shot to truly be called a platform.

If the Gang of Three want to be seen as a platform and not just an application, they will need to evolve as did their big brothers in the ERP world.

Demonstrate market share dominance through rapid growth, consolidation, and the other vendors pivoting their business models in other directions as not to compete head to head. A goal here is to establish enough customer mass that effective and brilliant “group think” could take place. The market moves buyers to want enterprise all-in-one solutions instead of best-of-breed department ones.

I’m going to give the Gang of Three a grade of A on this one.

Demonstrate innovation of function, design, and features. Basically, they should be darned good — maybe even outright awesome — at transactions. Expect to see massive investments in R&D and lots of co-innovation with customers.

I’m going to give the Gang of Three” an A on this one, too.

Be regarded as having deep industry capabilities, clear and comprehensive road maps, and embedded best practices. Other software vendors from other industries would view the vertical as too complex to enter based on the learning curve.

The Gang of Three earns a split grade on this one. Deep healthcare knowledge, A. Comprehensive roadmaps, B. Embedded best practices, C.

Provide analytics. This would be translated as performance suites with end user-centric dashboards, complex and robust data integration suites, comprehensive data quality tools, and the real belief that they are enabling massive amounts of information to be transformed to competitive knowledge.

The Gang of Three gets a B+ for focus and initial efforts, but a C for execution.

Support mobility. This would be demonstrated by enabling wireless workflows across the organization. Optimized work can be done from anywhere, at any time, and on any device. Costs and tools matter in this space, so device management and security are key parts of all offered solutions.

The Gang of Three earns a C. Good progress on vision and good early applications, but with lots of work ahead.

Demonstrate reliability, flawless uptime and performance, and sub-second response times. Terabytes of data managed and delivered at the speed of thought. The paradigm of all information available in real time would be realized and would drive the enablement of new workflows never imaged before the system was installed. With the reliable availability of information, new business models to share and move data around the ecosystem would emerge.

I’m going to give the Gang of Three a B+.

Platforms are not just about function, but equally about cost. They would need to enable the shift within the IT organization of today that typically has 80 percent of costs on tactical IT delivery and 20 percent on strategic initiatives to at least a 50/50 split. IT operational costs consuming the majority of resources are lowered through hosting, cloud, and other leveraged services to allow for greater spending on innovation. Support costs are predictable and fall over time. Costs act as a consolidation driver as much or more than workflow.

This earns a B for the Gang of Three.

The toughest and probably the most important area for our gang to distinguish themselves as a platform is to create choice by building a leveraged open ecosystem. Choice would be fully realized by creating open APIs to access data models and workflows. Customers and third-party vendors would look to solve problems by building solutions within the system and innovation would be an open challenge to solve for everyone.

The Gang of Three gets a D-. This alone isn’t the definition of a platform, but it is crucial to the mix. This is the biggest area in which our gang needs to improve.

So, Gang of Three, it is time to get everyone involved to help us solve problems. Talk to your customers and third-party developers, court them, and encourage them to build their applications in such a way that they have a technology dependency on you. Risk some value you may create on your own, but balance it by figuring out how to extract value from your new workforce – your third-party developers.

It is time to enable choice!

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Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

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September 10, 2014 Darren Dworkin 6 Comments

HIStalk Interviews Charlie Enicks, VP/CIO, Georgia Regents University and Health System

September 1, 2014 Interviews 1 Comment

Charlie Enicks is VP/CIO of George Regents University and Health System of Augusta, GA.

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Can you describe the contract you just signed with Cerner?

Cerner has similar arrangements in a couple of places. At University of Missouri, they call it the Tiger Institute. They just recently did something at Children’s National in Washington called the Bear Institute.

They agreed to a long-term agreement that sets out a way of operating and allows us to, from a strategic standpoint, innovate with Cerner and with Cerner and Philips. We’ll have an innovation committee that has a membership from our research and clinical group, from Cerner, and from Philips to talk about what could be either three-way or two-way innovation. We’re very excited about that part. 

What it allows us to do from a strategy is accelerate the pace of implementations that we can get done here. With our current financial situation, we can’t really get capital at a fast enough pace to get done what we want to get done. This contract smooths the cost out over 14 years. The Year 1 rate is lower and in the out years, the operating side is about equal to what we’d expect and the capital side is lower because of the investment Cerner is willing to make.

That includes moving the Cerner software and data to Kansas City to their data center. It includes moving the service desk to Kansas City, where it will be open 24 hours day, seven days a week, whereas we’re operating 14 hours, five days a week, which is problematic in a clinical environment. Ten senior associates will relocate to Augusta and work here. Five of those employees will be focused on innovation and process improvement projects that we plan to undertake.

It improves our disaster recovery and security profile. We have started putting together plans to operate a warm site. We’re looking at an investment of five to 10 million dollars to do that, so we avoid that step.

 

Which employees will not move to Cerner?

I’m responsible for the university as well. The university applications, our audio-visual effects, our client services on the university side will stay with the university. I’ll have CMIO, a chief information security officer, my university operation, and the administrative. We’ll still be doing all the contracting for non-Cerner applications and hardware.

 

Are they taking over the entire operation?

They’re taking over the operation of it and they’ll make recommendations about different things, but we do the procurement. It could possibly pass through Cerner if Cerner can get a better deal for us, but it’s not a requirement.

 

Fourteen years is a pretty long contract to lock in. What led you to have the confidence in Cerner to be willing to do that?

We’ve worked with them for 12 years. The 14 years was picked because of our Philips arrangement — it started last year and was a 15-year deal. We wanted those to be concurrent. There are typical ways to get out of the contract should either party decide at earlier than 14 years that it really doesn’t make sense.

My personal experience with Cerner went back to Emory back in the early 1990s during the genesis of the Millennium software. But I had not worked with them for almost 20 years. In the last two and a half years, I’ve been very impressed with where they’re going with their company, the services that they’re offering, and the direction of software.

Our access to capital is limited. Our growth strategy as an academic medical institution is creating enough clinical work for our students and residents. We’ve got relationships all over the state.

For us, this represents a way to get done what we need to do. We don’t have the capital to switch to some other vendor. We’ve decided to become a strong partner with Cerner. We think that will get us where we need to go.

 

Do you think it will become common that hospitals will be looking for someone to do their hosting or move to a cloud-type environment?

I would absolutely agree this is a trend. You’ve got companies like Novant in North Carolina — they’re starting to do this in the Epic space — and other companies. You’re going to see more and more of it.

Cerner recognized that. I guess they started the remote hosting a little over 10 years ago. But their ITWorks component of this, and their new software like the population health management, which is a cloud-based solution — that’s really where they’re moving as well.

I agree, I think this is going to be more and more the case as this stuff gets very complex and expensive to manage. Even though Augusta is an attractive place to some people. It’s very hard to recruit senior-level Cerner folks to Augusta.

 

What other things are you struggling with?

Like everybody else, we’re struggling with getting Stage 2 Meaningful Use tested. We’re very close — we still have some transition of care. We need to get those numbers up a little bit. But we’ll get that done.

Our issue predominantly in the clinical space is that we’ve had the product for a long time. We need to optimize what we’ve got, but we also need to get in the oncology module, the anesthesia module, and the maternity module. That’s really what’s keeping me up. Before this opportunity, I really didn’t see a way out of being able to get all that done in a timeline that the clinicians needed to do their work.

For the other projects that I’m worried about it in the health system, Cerner will be responsible for managing those. We’re doing a total voice over IP replacement for the university and the health system. Cerner will be managing it. We’re doing a consolidation of our Active Directory. We will still be buying the software, hardware, or services. Cerner will be responsible for executing.

 

Do they have those resources or will they staff up to meet your needs?

They do have a fairly extensive number of resources. They’re not sitting on the bench somewhere not doing anything, but we would be the 17th or 18th client that utilizes their ITWorks service. They’ve got a pretty extensive group out of Kansas City doing this now.

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September 1, 2014 Interviews 1 Comment

News 8/29/14

August 28, 2014 News 1 Comment

Top News

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Apple updates its privacy policy to prohibit companies whose apps connect to its HealthKit platform from selling user data to marketing firms. The change comes just ahead of the expected announcement of new health-related iOS 8 capabilities, including Apple’s Health app. Deborah Peel, MD of Patient Privacy Rights reacted to the announcement by saying, “If Apple is really doing this, if they’re really saying to developers that you can only use the data for the specific purpose that app provides the user and that they can not share the data with anyone else without informed consent, that is the victory of victories. That’s what we’re seeking from all of the 100,000 of the companies that are now selling health data.”


Reader Comments

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From Aruba Layoffs: “Re: Aruba Networks. Many talented people let go as healthcare technology spending is way down.” Wireless networking vendor Aruba isn’t healthcare specific. Both its revenue and earnings announced this week beat expectations, revenue is growing at 30 percent annually, and share price matches the Nasdaq at 25 percent growth in the past year. The company is, however, laying off 65 employees and moving 75 jobs to Oregon, India, and Ireland, but it sounds like that’s related to shifting resources to less-expensive locations rather than because of financial problems.

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From Stephanie Reel: “Re: Star-Spangled Spectacular. I wonder if your readers would be interested in something that has everything to do with our nation, but nothing to do with our industry?” Baltimore celebrates the 200th anniversary of the National Anthem — written as Francis Scott Key observed the British bombardment of Baltimore’s Fort McHenry — with a week-long celebration September 10-16. It features visiting ships, a Blue Angels air show, a concert (Kristin Chenoweth, Melissa Etheridge, Denyce Graves-Montgomery, Kenny Rogers, Train, and the Baltimore Symphony Orchestra), festival villages, and of course fireworks. Stephanie is CIO for Johns Hopkins University and Hopkins Medicine – both campuses are worth a tour if you visit Baltimore for the celebration. You can bring the kids and take short side trips from the Inner Harbor to DC and Lancaster, PA along with seeing the Orioles play the Yankees that week.

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From Jimmy John: “Re: HIPPA. I thought you would enjoy this magazine’s misspelling.” At least they were inconsistent from one line to the next amidst the click-baiting headlines – 50 percent right is better than none. They’re owned by HIMSS (or is that HIMMS?), as is the publication devoting 12 lazy paragraphs to a wandering, not-too-interesting story with the breathy “Generalissimo Francisco Franco is still dead tonight” style headline: “New HIPAA breach details remain vague.” The “new” breach occurred in June and details are “vague” because the reporter just cobbled together the story and quotes from wire reports.


HIStalk Announcements and Requests

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School has started, so I sponsored some new DonorsChoose projects involving Teach for America teachers, doubling the impact of HIStalk readers since the Bill & Melinda Gates Foundation matched our contributions to fully fund them all. Teachers of DonorsChoose projects provide photos and updates, so I’ll have more later. What we as readers did:

  • Purchased headphones and whiteboards for Grades 3-5 of a highest-poverty school whose teacher is urging her students to take ownership of their education, accept leadership roles, and share knowledge in groups that include peer tutoring.
  • Bought 50 library books for a high-minority, high-poverty North Carolina charter school that has 100 percent college acceptance of its seniors.
  • Provided a listening center for a highest-poverty school in southern Kentucky, whose energetic English teacher is struggling with ninth graders who haven’t read a book in years, some of whom have learning limitations.
  • Bought six bilingual picture dictionaries for a middle school class of a highest-poverty school in New Orleans, whose large population of new students from Central America are working hard to learn English.

Meanwhile, I heard today from the teacher of a high school engineering class for which we bought a 3-D printer. He says he has had to redesign his lesson plans and projects for the better, the number of students in his classes has doubled, and he makes them think about, “How would you model that in the Replicator? What medium should we use?” He taught students the importance of scale and precision by having them create an iPhone case. He says, “I am overwhelmed with requests from the students about what is in the printing queue.”

This week on HIStalk Practice: Dr. Gregg shares a humorous take on voice recognition and “otto collect.” McGree Medical goes live on Epic’s Community Care EHR. HealthSpot prepares to install 100 telemedicine kiosks. Walgreens implements Greenway’s EHR in over 8,200 pharmacies. South Florida Medicine Director of PM Alyson Tiedeman shares her thoughts on managing IT across a large medical group. CarePoint Health System goes with eClinicalWorks for its medical practices. Results are in from the annual HIStalk Practice Reader’s Survey. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses health IT IPOs and speculates who the next batch of likely contenders might be. Peer60 analyzes the patient portal market and the varying levels of success health systems are having with each vendor’s offering. Skullcandy partners with USC to host a digital health innovation contest focused on encouraging development efforts at the cross section of health IT and music.


Webinars

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.

September 11 (Thursday) 1:00 p.m.ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.

Encore did a great webinar Wednesday on “Enterprise Data – Tapping Your Most Critical Asset for Survival” that some registrants couldn’t view because of a GoToWebinar problem in its latest code update. You can watch it above or on YouTube. Jonathan Velez, MD (CMIO – Hartford HealthCare) and Randy Thomas (Encore) did a nice job and filled the 40 minutes with solid information.

Meanwhile, here’s a case study on how to be a crappy software vendor like GoToWebinar, owned by Citrix:

  • Don’t QA your new releases. Instead, outsource QA to your customers and then just roll them back to pre-broken versions when they call in problems.
  • Don’t notify customers of known problems, especially those that affect critical processes like viewing and recording webinars. Admitting failure will shake their confidence.
  • Instruct your support reps to quickly tell callers that their problem is a known issue. Everybody loves to hear it’s not just them.
  • Keep support callers on hold when they call the high-priority service number and play annoying messages throughout telling them how great support will be once they get through. This heightens their anticipation.
  • Propose illogical solutions, such as restarting a webinar already underway even though that would prevent anyone from seeing it. The support engineer will seem more skilled since no non-engineer would propose a similarly out-of-touch solution.
  • Ask customers to trust you in rolling back to old code versions, even when they have no way to verify that the change works (unless they have 100 friends willing to hop on an impromptu webinar to see if they can get in). You trust them to pay their bills, so the should trust you to release pretty good code.
  • Just give up, as did the person from Citrix who told me apologetically, “Maybe it’s time for you to find a new webinar provider.” This reverse psychology will make them want you even more.

I apologize if GTW’s bug locked you out of Wednesday’s webinar. The video above is perfect and worth watching.


Acquisitions, Funding, Business, and Stock

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Craneware acquires Scottish patient access mobile systems vendor Kestros Limited, which has been selling primarily to NHS Trusts.

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September 10 is a critical day for Castlight Health and its tanking share price: the lockup period ends and the pre-IPO shareholders will be able to sell up to 76 million shares, which closed at around $40 on IPO day in March but are now trading at less than $12. That’s a 70 percent haircut, but the company still has a $1 billion market cap on less than $30 million in annual revenue and huge losses. Maybe co-founder Todd Park can swing by on his new West Coast White House gig and apply Healthcare.gov-like CPR.


Sales

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Robert Wood Johnson Health System (NJ) expands its relationship with NTT Data in selecting its Optimum RCM suite.

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Kaweah Delta Health Care District chooses Access for electronic forms and patient signatures.

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Marshfield Clinic (WI) standardizes on Client Outlook’s eUnity university image viewer and collaboration tool for its homegrown CattailsMD EHR.

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Georgia Regents Health System (Augusta, GA-based GRHealth) signs a $400 million agreement to turn over its IT operation to Cerner, which it says will save it 15 percent of its operating costs annually and make its annual expense predictable. GRHealth operates Georgia Regents Medical Center and Children’s Hospital of Georgia. The system says all 132 employees will receive offer letters from Cerner. Cerner became interested in the arrangement last year when the system signed a $300 million clinical technology partnership agreement with Philips, indicating along with the Siemens acquisition that Cerner sees a future in merging IT systems with clinical monitoring.

Sunquest will expand its relationship with private pathology lab CellNetix to work on anatomic pathology workflow solutions.


People

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Boston Software Systems promotes Steve Cohen to COO.

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David Watson (Oracle) will be named CEO of the new California Integrated Data Exchange (Cal INDEX).


Announcements and Implementations

Walgreens completes the rollout of its Greenway Health EHR to all of its 8,200 locations, allowing its pharmacists to counsel patients and provide immunization and testing recommendations.

Aspirus Wausau Hospital (WI) announces an OR digital integration project that will feature a centralized OR hub equipped with touch-screen monitors that can display images from all devices and modalities. It will use Brainlab’s Buzz digital OR.

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Sentry Data Systems announces its 340B Technology Backbone to help pharmacies manage their 340B drug purchasing programs.


Government and Politics

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Bloomberg reports that Google executive Megan Smith is the top candidate to replace Todd Park as US CTO. Smith’s background is the Google X skunkworks lab, so unlike her predecessors Aneesh Chopra and Park, she has no healthcare experience. She is married to re/code technical reporter Kara Swisher, although they are separated.

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Meanwhile, the White House confirms that CTO Todd Park will continue working for the White House after returning home to California, recruiting technical talent for government work in a new role of technical advisor.  President Obama said in a statement, “From launching the Presidential Innovation Fellows program, to opening up troves of government data to the public, to helping spearhead the successful turnaround of HealthCare.gov, Todd has been, and will continue to be, a key member of my Administration. I thank Todd for his service as my Chief Technology Officer, and look forward to his continuing to help us deploy the best people and ideas from the tech community in service of the American people.”


Innovation and Research

XPRIZE names the 10 finalists competing for its $10 million Qualcomm Tricorder XPRIZE: Aezon (US), CloudDX (Canada), Danvantri (India), DMI (US), Dynamic Biomarkers Group (China), Final Frontier Medical Devices (US), MESI Simplifying diagnostics (Slovenia), Scanadu (US), ScaNurse (England), and zensor (Ireland.)

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President Obama will champion ElectRx, a $79 million, five-year DARPA-run project to implant computer chips in troops and veterans to promote faster healing. The program’s manager describes it as “a closed-loop system that would work in concept like a tiny, intelligent pacemaker” to assess conditions and send electrical stimulation to induce healing. A related effort will detect mood changes associated with PTSD. I don’t know how they’ll deal with FDA approval.

Speaking at the American Legion National Convention in Charlotte, NC, President Obama said,

So we’re going to keep at this until we end this backlog once and for all. And as we do, we’re going to keep working to liberate you from those mountains of paper. We’ve got to move towards a paperless system — electronic health records that our troops and veterans can keep for life, and that could cut down on some of the bureaucratic red tape so that you’re getting the benefits that you’ve earned a little bit faster. 


Technology

Korea-based medical wearables startup Ybrain raises $3.5 million in a Series A round. Its product isn’t the usual fitness tracker: the US-educated team has developed an electrical stimulation device that it says can combat the effects of Alzheimer’s when used at home for 30 minutes per day, five days per week. The company hopes to launch its service in early 2015.

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Apple co-founder Steve Wozniak says he expects the company to create a market for wearables starting with upcoming announcements on September 9 that will likely include the iWatch. He says he expects fitness monitors to be involved and maybe an EKG display at some point, but in the mean time, he’s not a fan of the category:

I feel that wearables are a hard sell. They are go-betweens for your smartphone but are an extra piece and need special advantages that the smartphone doesn’t have, in my opinion. If they are just a Bluetooth go-between then it could wind up in the category of Bluetooth headsets: Fun to wear and show off for a day.

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Discover magazine highlights three projects that owners of 3-D printers can perform to help people in need. Among them: use downloadable designs to print and assemble a prosthetic hand for someone who needs one, requiring around $50 in parts and 8-14 hours of printer time. The first e-NABLE conference will be held at The Johns Hopkins Hospital (MD) on September 28.

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More on 3-D printing: in the UK, 12 NHS trusts are using 3-D printers to test implants before surgery to reduce cost and OR time, including bones for facial reconstruction surgery, hip replacements, and forearms. In China, surgeons implant a 3-D-printed vertebra in the spine of a 12-year-old cancer patient.


Other

Sharp HealthCare (CA) becomes the tenth of the 32 Pioneer ACOs to drop out of the program, saying that local wages rose 8.2 percent in San Diego but the Pioneer model doesn’t adjust payments accordingly.

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Drug maker Bayer starts a healthcare accelerator for Europe-based companies, offering a 3.5-month program of mentoring, free office space in Berlin, and around $65,000 financial support, taking as much of 10 percent equity in return. The five startups chosen from 70 applicants are Cortrium (a device that measures temperature, activity, respiration rate, and EKG); PharmaAssistant (medication reminders via smartphone); Parica (vital signs analysis); FabUlyzer (measuring fat burned after exercise); and Cardimoni (checks heart rate and rhythm).

AMIA’s annual meeting will be held November 15-19 in Washington, DC. The early bird member registration fee of $795 ended Thursday, August 28, but it’s still discounted to $895 through October 23 (then $995). Keynotes will be Amy Abernethy, MD, PhD of Flatiron Health (I interviewed her last month) and National Coordinator Karen DeSalvo, MD, MPH, MSc. Ross Martin, MD will head up the talent show, which will provide a musically equipped stage and a house band for participants, who need only bring “additional instruments, props, and groupies.”

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Cisco CEO John Chambers says the US and other developed countries will go bankrupt if they don’t fix their healthcare systems, adding that technology has a key role (although he seems to pay little attention to the caregivers on the other end of it):

The first thing that will happen is all devices on our bodies, in hospitals and in our homes will be connected. The second technological advance is video, which is the way people will prefer to communicate in the future. Video can connect any health care professional to any patient and to any specialist, all at tremendous speeds. You’ll be able to receive medical expertise 24/7. Health care applications will combine the technologies of cloud and big data, whether in the hospital or in your home. Video allows a different level of collaboration, and it offers security and privacy from your home. This is the Internet of Everything … in a typical hospital, there are nine to 15 different applications that were never designed to share information with each other. And without a common medical record that has the appropriate security and privacy built into it, moving data from one application to another is difficult …  The end game should be connecting any patient to the best healthcare professionals in the world at any time, using video-driven, low-cost technology.

Greenway Health CEO Tee Green accepts his Ice Bucket Challenge, offering to make a donation to ALS Association for every employee who sends him a video of themselves doing the same.

Weird News Andy asks if Oompa Loompas were vegetarians because he never found them attractive: a study (of questionable scientific validity) finds that the healthy skin glow of people who eat high-carotenoid vegetables is more attractive than a suntan.


Sponsor Updates

  • Kyle Silvestro of SyTrue will participate in a panel discussion titled “How Cloud Based Solutions Allow for Improved Coordination of Care and Patient Satisfaction While Reducing Overall Costs of Billing”at the Radiology Business Management’s fall conference October 19-21 in Seattle.
  • GetWellNetwork CEO Michael O’Neil will facilitate a breakout session, “Interactive Patient Engagement and Activation Workshop: What’s in a Number?” and will present “ePatient Entrepreneur Story” at the Stanford Medicine X conference on September 4.
  • Craneware announces the appointment of Russ Rudish (Deloitte Touche Tohmatsu) to its board as non-executive director.
  • Emdeon launches its co-pay assistance program for retail pharmacies, Emdeon Easy Save.
  • AirWatch renovates and expands its former headquarters.
  • TeleTracking Technologies will launch multiple solutions at its client conference October 26-29 in Florida.
  • Sentry Data Systems shares how a Rand report clarifies the 340B program impact and provides steps to ensure its longevity.
  • NextGen announces that its ambulatory EHR V 5.8.1 has earned 2014 ONC HIT Cancer Registry Certification.

EPtalk by Dr. Jayne

Recent research at the University of Michigan finds that patients with low literacy and low comprehension of numerical concepts are less able to understand online lab results. The Internet survey of 1,800 adult patients looked at simulated diabetes results and whether patients understood if labs were within or outside of reference ranges. Less literate patients were also less able to determine when they should call their doctor, based on the data.

Researcher Brian Zikmund-Fisher is quoted as saying, “We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them.” At the other end of the spectrum, over three-quarters of patients with higher literacy skills could identify levels outside the reference range. He goes on to state the need for more research on the best ways to display lab data.

When we first started releasing lab results directly to patients, our physicians voiced concerns. Physicians wanted to hold the results until they could put a comment with them, as they had done in the paper world. Many of our physicians would mail the patient a copy of the test results with a handwritten “OK” or “great” or “double your Lipitor and see me for fasting labs in six weeks.” Our administration overruled the physicians.

Initially we received more phone calls about labs. Most physicians changed their behavior to start counseling patients about potential lab results at the time they were ordered or drawn to reduce the potential for calls.

That approach is fine when you’re counseling a patient on an existing diagnosis or if the labs in question are “maintenance” labs, although it adds a new dynamic to the visit that we don’t always have time for. Looking at other scenarios, I don’t think it’s the best approach when you’re dealing with a new diagnosis, particularly if it’s an emotionally charged one such as cancer or other potentially fatal conditions. I’d like to at least get to those patients on the phone first before they see the results on the patient portal.

Our results release in real time, so it puts the physicians in the position of “stalking” lab results in the evening and over the weekend, then frantically trying to get in touch with patients before they log on. An uncertain diagnosis is certainly stressful for the patient, but it also weighs heavily on the physician. Adding time pressure isn’t optimal for anyone, especially if the physician needs to consult with other members of the care team prior to talking with the patient.

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National Health IT Week is almost upon us again, with the goal of raising “awareness of Health Information Technology’s power to improve the health and health care of patients across the nation.” When IT solutions are used to transform care and improve quality it can be a powerful thing, but when tools are employed without goals, accountability, or governance, it doesn’t make the world a better place. There are key themes for each day of the week:

  • Patient Engagement
  • Advancing Interoperability Through Meaningful Use
  • Advancing Interoperability Across the Care Continuum – Beyond
  • Advancing Interoperability Through Standards
  • Clinical Quality & Safety

I couldn’t help but notice that quality and safety are last on the list. I’m going to give ONC the benefit of the doubt and assume that they are building the week towards the most important aspect, but if that’s true, then it puts patient engagement towards the bottom.

Why do we seem to revere the means more than the ends? Email me.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
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August 28, 2014 News 1 Comment

Morning Headlines 8/26/14

August 25, 2014 Headlines No Comments

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August 25, 2014 Headlines No Comments

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