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Monday Morning Update 5/26/14

May 24, 2014 News 13 Comments

Top News

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Cerner CEO Neal Patterson tells shareholders that the company is transitioning from a healthcare IT company to a healthcare company, echoing sentiments expressed in the company’s most recent earnings call. Cerner executives say the company will dominate areas that include aggregating information across providers, reducing healthcare costs, improving outcomes, and providing consulting services related to population health management.


Reader Comments

From Katherine Kroessler, MD: “Re: EMRs and Meaningful Use. The burden is overwhelming for small practices. More physicians will become employees and use systems where someone else crunches the numbers. My small practice’s EMR is fine for MU, but it has increased our overhead and staffing and thus has decreased physician income. We have some electronic lab/DI data and others come on paper. Docs fax paper referrals and we fax back paper consults because our systems don’t talk to each other. Information gets put in folders to be scanned and has to be tracked down when the patient is in the room. However, if you are in a large contained system, all of that works seamlessly. The government should have created an incentive for IT vendors to use the same interface requirements so their systems could talk to each other. Doctors are being reduced to clerks and spend more of their valuable time clicking boxes and coding unless they are part of a large infrastructure that automates that for you. I just hope that new doctors will know how to think about patients and not just how to copy and paste notes. Listening to our patients is our most important skill because, at least in neurology, 90 percent of the time the diagnosis comes from the history. Doctors will become employees of large systems and their thought processes and workups will be governed by those systems. Let’s hope the systems get it right because the MDs phasing out of medicine will all be Medicare patients soon enough.”


HIStalk Announcements and Requests

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Eighty percent of respondents think ONC should certify EHRs only if they offer external program access (APIs) for interoperability. New poll to your right: is the Meaningful Use Stage 2 slowdown good or bad?


Announcements and Implementations

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KLAS announces that it is developing a myKLAS mobile app.

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Epic is named the #5 best company for employee pay and benefits in a Glassdoor review of employee surveys. It’s probably the one company on the list whose name the average American wouldn’t recognize.


Government and Politics

The White House says HHS has passed a cybersecurity assessment that was required by a presidential order, saying its voluntary efforts are sufficient to address cyber risk.

Oregon Governor John Kitzhaber said he fired the director of Oregon Health Authority in March effective immediately over the Cover Oregon health insurance exchange debacle that will end up costing nearly $300 million, but the local paper discovers that he’s still on full-time status and getting paid $14,425 per month, at least until July when his vacation pay runs out. Federal investigators issued several subpoenas last week to people at both the health authority and the insurance exchange, apparent interested in finding out whether state officials lied to CMS about the project’s status to get more federal money.  

CMS announces the second round winners of its Health Care Innovation Awards. Among them: $15.9 million to the American College of Cardiology Foundation for  the SMARTcare provider feedback and decision support tools for reduction of inappropriate procedures; $7 million to the Association of American Medical Colleges for an electronic consult and referral model in five academic medical centers; and $10 million to UCSF for a monitoring system for dementia patients.

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Sam Foote, MD, the retired Phoenix VA doctor who turned wait list whistleblower, says in a New York Times opinion piece that he doesn’t think the current VA investigation will be effective because it’s being performed by Veterans Integrated Service Network office workers who will just ask employees a few questions, while he would rather see an anonymous electronic provider survey. He also says the VA’s VistA system is excellent and second to none in transferring information from one VA facility to another. He concludes by saying that any negative findings will be pushed back because it’s an election year.


Innovation and Research

Researchers at Stanford University develop an externally rechargeable embedded implant it calls an “electroceutical” that may be able to cure specific medical conditions using radio energy.


Other

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The CEO of Athens Regional Health System (GA) resigns after problems with its Cerner implementation. A dozen doctors sent a letter to administration complaining about lost orders, medication errors, ED patients leaving AMA after long waits, and an inpatient who wasn’t seen for five days. They also complain that the implementation timeline is too aggressive and the users aren’t ready. The doctors claim that Cerner problems have caused several doctors to drop their hospital privileges and others to send patients to a competing hospital. The health systems foundation VP said in a letter to donors and volunteers, “The last three weeks have been very challenging for our physicians, nurses, and staff … parts of the system are working well while others are not.”

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HIMSS congratulates some new EMRAM Stage 6 organizations.

Medical educators say that doctors are losing the ability to diagnose based on a physical examination, instead relying on sophisticated tests. One says he has seen cases where “technology, unguided by bedside skills, took physicians down a path where tests begot tests and where, at the end, there was usually a surgeon and often a lawyer. Sometimes even an undertaker.” Medical schools are going back to basics, teaching students, for example, to use a stethoscope instead of an EKG. A former NEJM editor weighs in after his experience as a patient at Mass General: “Doctors now spend more time with their computers than at the bedside,” with electronic medical records containing only short descriptions of how he felt and looked, but with “copious reports of the data from tests and monitoring devices” that generated few documented conversations. A professor and doctor tells the story of a resident desperately clicking through a febrile patient’s EHR looking for a cause when a short walk to the patient’s room would have made it obvious that his IV site was inflamed. Another says foreign doctors are more competent clinically than their American counterparts because they are either trained to rely less on technology or don’t have much of it available.


Someone asked me the other day if Vanderbilt was still using WizOrder. I assume so, even though McKesson’s commercialized version of it under the Horizon nameplate is being put slowly out to pasture.  Apparently this physician informaticist was impressed.

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The Houma, LA paper profiles Objective Medical Systems, started by a group of cardiologists to create a specialty-specific EHR. It captures the output from medical devices, presents a combined view of test information, and can recommend research papers relevant to the patient’s condition.

Weird News Andy says we should fight illness with fist-bumps instead of handshakes according to a JAMA article that urges creating “handshake-free zones” to reduce the spread of pathogens. The article says shaking someone’s hand could eventually become as much of a social taboo as smoking.

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Photo: Pete Marovich/EPA

Monday is Memorial Day, set aside to honor the one million US Armed Forces members who died while serving. Thanks to them, you are free to decide that you won’t fly the flag, visit a military cemetery, or think about those who made the ultimate sacrifice on your behalf. That’s not to say it wouldn’t be nice for you to do those things voluntarily on Monday. 


Book Report
Where Does It Hurt?

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Where Does It Hurt? is an entertaining, punchy potpourri of ideas, just what you would expect from athenahealth’s Jonathan Bush and his professional co-author. The book is breezy and fun, with self-effacing humor and first-person stories about Bush’s experience with the healthcare system as a paramedic, a failed consultant, a failed birthing center operator, and now the successful co-founder of a pretty big back-office services and software provider.

Bush works his readers into righteous indignation by pointing out the fairly obvious things that are wrong with our broken and massively expensive healthcare system. Most of his anecdotal everyman ire is aimed at hospitals, which should be interesting since their fat and happy leadership (in his mind) are the prospects that will drive athenahealth’s planned growth into health systems. (He probably shouldn’t hand out copies of the book as part of the company’s pitch to hospital prospects.) 

Where Does It Hurt? delivers on its title, with nicely summarized and fun-to-read examples the maddeningly illogical healthcare system. Consumers rather than healthcare insiders are the target audience for the recitation of issues covered in far more specific and analytical detail elsewhere. As you would expect, Bush travels in circles different from the rest of us, so when he wants to learn something (and share it with readers), he has access to the CEOs and politicians who will tell him first hand.

Where it fails to deliver is on its subtitle: “An Entrepreneur’s Guide to Fixing Health Care.” The book is long on criticizing the system in its 241 pages, but short on offering new ideas about how fix it. He doesn’t fall short on “the vision thing,” but perhaps he could have been more prescriptive, especially given the barriers of government meddling, the political power of organizations profiting handsomely from the status quo, and the disconnect between those receiving services and those who pay for them, all of which have sucked the energy out of most of the good ideas that have floated around.

Early on, Bush declares that “healthcare is the new oil” in urging entrepreneurs to create profitable businesses that target monolithic, protective hospitals and the massive chunk of healthcare spending they consume. He provides fascinating examples such as Steward Health Care and Florida Woman Care, relayed mostly as conversations between himself and the CEO of those companies, and how they found easily picked low-hanging fruit in the inefficiency of their lumbering big-hospital competitors that weren’t adding much value in providing routine services.  He suggests that the idea of the Affordable Care Act had promise, but most of what it could have accomplished was neutered by special interest lobbyists into being little more than insurance for a lot more people instead of really reforming anything.

The “what should we do about it” message isn’t as clearly presented. After reading the book, I went back through it twice (it’s not all that big) to manually pick out what seem to be its main suggestions since it’s a bit all over the place.

  • The industry should train lower-level people to perform routine tasks, just like the military does in turning an 18-year-old with poor academic achievement into a weapons operator by breaking everything down into simple steps. He wondered in his New Orleans EMT days why there weren’t a swarm of $9 per hour EMTs like himself providing services in the community rather than just hauling patients with routine problems to the ED (in the cab-u-lance, as he refers to it.) He sees retail clinics as a model that works for up to 70 percent of the patients who would otherwise be sitting in the expensive ED’s waiting room.
  • Hospitals, especially academic medical centers, should transform into focused factories that offer fixed-priced services for specific, complex treatments in which they have developed notable expertise, leaving routine services to less-expensive providers. Hospitals fund their high-overhead operations by drastically marking up basic tests and procedures without adding any value and that money could be better spent elsewhere.
  • Big hospitals should overcome their geographic constraints by employing telemedicine and providing air transportation for patients who need their specific treatments.
  • Community hospitals shouldn’t get a free pass to make a lot of money just because they erect impressive buildings, staff EDs, hire a lot of people, and instill community pride. He says they should be reconfigured into providing emergency and high-acuity services and be paid accordingly since inpatient bed demand is already dropping significantly. He observes that hospitals are fighting to keep control of their fiefdoms, buying each other and medical practices to snuff out potential competitors that might undercut them in bidding for insurance company contracts.
  • State-specific limitations on provider licensing and insurance sales should be eliminated, as should artificial provider limits such as certificates of need.
  • Doctors should realize the power they have and band together rather than selling their practices to hospitals.
  • The government should loosen up anti-kickback laws so that providers can pay each other for information, such as contributing data. (Bush adds an interesting note that doctors selling their practices to hospitals is the ultimate kickback given the increase in business hospitals get from their referrals.)
  • The government should eliminate the requirement that only providers can run ACOs, opening up the market to entrepreneurs.
  • Insurance companies should offer tailored packages instead of the one-size-fits-all type. They should also offer barebones plans for those who don’t need extensive coverage.
  • The government should encourage new entrepreneurial insurance companies by backing their risk as it does mortgages through Fannie Mae.
  • Patients should be financially engaged in the healthcare decisions they make, should learn from each other, and should demand data.
  • Providers should manage populations and offer health management rather than just healthcare services, such as coaching, classes, and exercise.
  • Epic is part of the problem because it was designed to do what big academic medical centers want – protect their near-monopolies. Its high price ensures that most independent practices can’t afford it, giving Epic’s big customers the leverage to tell those practices to use their Epic system (at a discount) or risk being left out, giving those hospitals more control of the market and the data needed to protect it.
  • Entrepreneurs shouldn’t try to sell software to those big hospitals because the changes they will demand will reflect their inefficiency, turning the entrepreneur’s fresh approach into the same old systems everybody else is selling.
  • Data is the key to figuring out which treatments are effective.

I enjoyed the book and recommend it for those not expecting magic answers. It contains a lot more observations of problems than solutions, and healthcare insiders won’t learn very much from the admittedly interesting presentation of what’s wrong with healthcare. If I got my $11.99 worth (Kindle edition) it would probably be because it’s entertaining to hear Bush’s take on what those of us in healthcare see every day as being part of that expensive system that needs to be overhauled. You can hear a lot of Jonathan Bush’s ideas for free by watching business TV shows, so there’s no reason to sit impatiently waiting for the sequel.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

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May 24, 2014 News 13 Comments

News 5/23/14

May 22, 2014 News 3 Comments

Top News

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Nevada fires health insurance exchange contractor Xerox and announces plans to shut down its site, saying it will instead rely on Healthcare.gov for at least a year and then decide whether to spend many more millions to build a new exchange. The state has paid Xerox $12 million of the $72 million contract value and says the site’s many problems can’t be fixed by the next enrollment period that starts in November despite a personal promise from the CEO of Xerox. According to a board member, “We’ve seen so many broken promises from Xerox on how they’re going to fix it that at some point it just becomes not credible.”


Reader Comments

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From Skeptic: “Re: Patrick Dempsey investing in CrowdMed. He made a big splash in Seattle about a year ago, coming in to ‘save’ Tully’s, a local coffee company. After incredible news coverage, he pulled out as an investor.” Dempsey ended up suing his investment partner, claiming that the owner borrowed money against the coffee company’s assets at an exorbitant rate without telling him. I think I would be cautious about bringing in a celebrity investor with deep pockets and high visibility, but also an ego accustomed to constant care and feeding.

From Jackie: “Re: HIStalk emails. Just wanted to say I love the new format with a snapshot of the article and the time it will take to read it. Great idea!” Thanks. I’m not doing it for news posts since those are broken out by category and therefore reading time isn’t as relevant since not everybody reads them all.

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From MoreCowBells: “Re: new CMS rule. The press release includes the matrix you published, but not the asterisk and footnote. For Stage 2 sites, it makes a hug difference in what they will and won’t be able to do to attest.” Above is the footnoted version from the NPRM (highlighting mine), which seems to suggest that 2011 Edition CEHRT can be used in 2014 only if the provider’s EHR vendor hasn’t released a 2014 certified product. Lots of people are complaining about the proposed change for one reason or another, but the bottom line is that as long as providers plan to keep cashing HITECH checks, Uncle Sam gets to attach the strings. It also provides a lesson learned: if more than 20 percent of providers are moaning that they won’t be ready by a given federal deadline, don’t bother getting ready yourself because the date will be moved back.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Logicworks. The New York City-based company, founded in 1993, helps providers meet MU Stage 2 requirements to automate security risk analysis, address encryption and security of data at rest, and implement security updates. It offers an application-specific solution for NIST 800-certified cloud-based offsite disaster recovery for EHRs, with unplanned system failover with less than two hours of downtime. Its medical image archive and vendor-neutral archive for PACS breaks the never-ending cycle of adding storage capacity as imaging data grows. The company can help with application decommissioning as well, retaining legacy data in a cost-effective, HIPAA-compliant cloud. Logicworks also offers cloud solutions (public, private, and hybrid) and managed Amazon Web Services cloud hosting. As the company says, customers don’t come to it looking for a cloud, they’re looking for solutions for particular problems, and that’s what they offer. Thanks to Logicworks for supporting HIStalk.

I cruised YouTube to see what’s available for Logicworks and found this overview.

This week on HIStalk Practice: HHS representatives weigh the pros and cons of using Medicare data to alert public health officials to the potential needs of vulnerable patients during a disaster. Accountable Care Options and its physician network earn a $4.2 million bonus from CMS as part of its participation in the Medicare Shared Savings program. Oncologists list the pros and cons of moving from independent practice to hospital employment. A solo physician line items his reasons for closing up shop, citing meaningful use of an EHR as the final straw. Health systems and public health departments enter the new world of urgent care and retail clinics. The VA’s troubles show no signs of being swept under the rug. CMS and ONC publish a proposed rule that would slow down the MU program by extending Stage 2 through 2016. The government considers a national “biosurveillance” system that will give it near real-time access to the private medical information of citizens in the name of national security. Not all physicians stick their heads in the sand when it comes to online reviews. Thanks for reading.

This week on HIStalk Connect: As Apple’s WWDC nears, Dr. Travis speculates on how its anticipated new mHealth app Healthbook will work. Rock Health introduces its sixth class of startups that focus on ICU analytics tools, primary care telehealth, population health, and a private health insurance exchange. High school Junior Jack Andraka wins the Siemens We Can Change The World Challenge with a water purification text that is nearly 200,000 times cheaper than currently available tests, also having in 2012  won the Intel International Science and Engineering Fair with a new pancreas cancer screening test that is 168 times faster and 400 times more accurate than currently available tests. Mango Health raises a massive $5.25 million Series A round for its medication adherence app.


Acquisitions, Funding, Business, and Stock

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Healthcare consumer marketing vendor Clariture gets $1 million in seed funding from Nashville VC The Martin Companies.

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ZirMed acquires population health management platform vendor Intelligent Healthcare.


Sales

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Marshfield Clinic chooses Strata Decision Technology’s StrataJazz as its integrated financial platform.

Community Care of North Carolina will implement CitiusTech’s BI-Clinical platform.

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St. Joseph Health (CA) selects InterSystems HealthShare for its data sharing initiative.


People

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AMC Health names Walter D. Hosp (HMS Holdings) to the newly created position of CFO.

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Intelligent InSites names Shane Waslaski (Varistar) as president and CEO.

MEA|NEA appoints Mary Dooley (Xerox) as director of sales, partners, and channels.


Announcements and Implementations

Henry Schein Medical will offer athenahealth’s services to its customers as part of its ConnectHealth offering that includes Dell, Midmark, Siemens, and Welch Allyn.

Ping Identity announces Ping One, a mobile app for single sign-on for iPhone, iPad, and Android devices.


Government and Politics

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The Senate shelves the Innovation Act, a patent reform bill overwhelmingly approved by the House that would have made it harder for patent trolls to sue companies (most of them in the technology sector) using dubious patent claims. Senator Patrick Leahy (D-VT) removed the bill from the Senate Judiciary Committee, stating in his announcement that patent trolls are a real problem, but that the proposed bill would have imposed unintended consequences on legitimate patent holders.  


Innovation and Research

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A JAMA opinion article on big biomedical data says that deep EHR information can be connected to broad data sources such as claims data, social media, and credit card purchase history to create a big-picture view of individual patients and their health risks. The problems are lack of a national patient identifier and privacy and security concerns. The authors are Harvard docs Griffin Weber, MD, PhD; Kenneth Mandl, MD, MPH; and Isaac Kohane, MD, PhD. I would think that a patient survey would find considerable discomfort with this possibility.


Other

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The Houston paper profiles Memorial Hermann Hospital’s Virtual Care Check program, in which discharged patients at high risk for readmission receive home visits and are monitored remotely via a scale, blood pressure cuff, pulse oximeter, daily questionnaires, and a tablet running software from the hospital’s partner Vivify Health.  The hospital says the program’s patients are readmitted as low as 5 percent of the time vs. the national average of 12-15 percent. Memorial Hermann also announces the rollout of a free 24-hour RN-staffed Nurse Triage Call Center that anyone in greater Houston can call to ask questions or determine where to seek care, created after a study found that about half of Harris County ED patients could have been managed in a primary care setting.

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Valley View Medical Center (AZ) loses its external phone connectivity and computer network for 11 hours after a Frontier Communications outage caused by a damaged cable.

Surescripts says that more than half of all eligible prescriptions in 2013 were transmitted electronically, with nearly three-fourths of office-based physicians using e-prescribing.

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A law firm that had just won a $25 million verdict against a Korea-based medical imaging company withdraws from the case when its client, Texas-based cardiac MRI vendor LDBS, admits that a Cerner contract it introduced into evidence was falsified by using a fictitious email address. The CEO of LDBS had claimed he attended RSNA 2010 and saw the Korean company’s engineers demonstrating LDBS’s technology in a competitor’s booth.

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A Reuters investigative report says that a grand Black Sea estate allegedly built for Russian President Vladimir Putin was paid for by skimming money from $200 million in inflated medical equipment contracts. The report names two people it claims bought medical equipment from Siemens and then sold it at inflated prices to the Russian government as part of a $1 billion healthcare modernization project, with $56 million of the money finding its way to Swiss bank accounts and then to the builder of the estate.

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An AHRQ hospital survey on patient safety culture finds that while organizations are encouraging teamwork and organizational learning, more than half of respondents fear mistakes they make will be held against them, nearly half say patient care information isn’t communicated well when patients are transferred or during shift changes, and nearly half think employees are too overworked to provide the highest quality care.

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An PwC report says Hispanics will drive the US healthcare economy because: (a) more than 10 million of them will gain insurance through the Affordable Care Act; (b) they are cost-conscious; (c) they are heavy mobile users; (d) they don’t like sharing medical information; (e) less than half have a regular doctor and they don’t necessarily believe that the doctor knows best; (e) they will use retail clinics, community health clinics, and pharmacists to manage non-urgent problems; (f) they distrust the government and insurance companies and would rather see information in English since the translations are often poorly done.

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NPR profiles Qstream, a Harvard-created company that sends sequential emailed quiz questions to doctors and nurses to keep their education current. Eight Boston hospitals are testing a series of blood pressure questions that use bizarre stock photos and memorably silly cases to entertain and inform the recipients, who often compete against other using assumed names. Hospitals are posting leaderboards of the aliased participants, and as always happens with anonymized physician performance metrics, the always-competitive doctors have figured out who is who and where they stand among their peers. 


Sponsor Updates

  • HealthMEDX is rated as the #1 EMR vendor in the new KLAS report, “Long-Term Care 2014: Which Vendors Deliver on the Fundamentals?” with 100 percent of customers saying they would buy its product again.
  • Forward Health Group CEO Michael Barbouche will speak at Connecting Michigan for Health June 4-6  in Lansing. He presented last week at the CEhp’s Alliance Industry Summit in New Brunswick, NJ.
  • Nordic releases a case study on Baylor Scott & White’s use of its remote solutions offering for go-live support.
  • DataMotion discusses current and future email regulations.
  • Premier Inc’s safety expert Gina Pugliese joins The Physician-Patient Alliance for Health & Safety board of advisors.
  • Kareo is selected as a 2014 Red Herring Top 100 North American award winner.
  • GetWellNetwork clients experience a 76 percent improvement in pain well controlled as well as improvements in environment of care, medication teaching, heart failure readmissions, and falls.
  • MedAssets announces that its 2014 Technology and Innovation Expo, to be held October 28 in Dallas, TX, is accepting applications for exhibitors.
  • NTT Data commits  three years of support for the North Texas Food Bank’s Food 4 Kids – Plano Program.
  • OTTR Chronic Care Solutions will integrate XynManagement’s XynSiteTM suite of data analysis tool with its longitudinal patient tracking solutions and services.
  • Nuance will add voice capabilities to Oracle mobile apps.

EPtalk by Dr. Jayne

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As you would expect, the hot news in the administrative halls of our medical group this week was the play by CMS to again change the game for Meaningful Use. On the first pass, it looks like a benefit for providers, but I’m always skeptical until I look at the complexity of the details. Honestly, I tried to read the entire document (which at only 28 pages is nothing compared to the other Proposed Rules that emanate from CMS) but just couldn’t make it through.

I’m a TV junkie, so I was reminded of an episode of “Grey’s Anatomy.” One of the characters has a photographic memory. Some of the senior residents need information from paper charts to prep for their oral board exams, but they can’t take the charts to study them. They convince Lexie to try to memorize the charts and she starts, but partway through, she just snaps and her brain quits working. Another character makes a comment along the lines of, “You broke her.”

After today, I know how that feels. My boss expects me to be an expert on everything CMS within moments of its release. There is just no way to do so. CMS often conflicts itself (look at the FAQ evolution if you think I’m kidding) and delegates authority to a maze of regional contractors who each make their own de facto rules.

As a provider, I’ve had it up to here with CMS and Congress meddling in health care. If I was an independent physician, this would be the final straw that would convince me to opt out of Medicare and take my chances.

I’m a good reader, logical thinker, and smart enough to make it through medical school, yet I cannot begin to understand all of the regulations, especially when they start conflicting with each other. Our health system now employs a team of people to try to keep up with them and we can barely keep our heads above water. By extension, I can see no way (other than paying a fleet of consultants or going crazy) an independent provider can hope to play the game.

And that’s what it is — a game. Meaningful Use is just another fiery hoop for everyone to jump through. Since it’s all or none, you can work yourself to the bone, have everything right, but be thwarted by arcane rounding rules (don’t get me started) that will defeat you in the end. You can be defeated by patients who refuse to comply with your advice and have no interest in accessing their records. (I was visiting a practice today where nearly 80 percent of the patients refused their clinical summary documents or left them in the exam room.)

You can be defeated by the inability to get all the reports to run at the end of your attestation quarter if you’re trying to hit July / August / September. There’s no grace period – attestation has to be done by October 1 – so prepare for an all-nighter. If you have a power outage, you’re doomed. Hope there aren’t any hurricanes that weekend for our east coast readers trying to squeeze it in.

Anyway, we’ve all been through the angst of this for months and months, and now they’re going to probably change the dates again. We don’t know whether we can trust CMS. We don’t know how hard to work in the mean time – there is a 60-day window for commentary on the rule and no guarantees that it will be put into place unchanged – so essentially many of us are still on the hamster wheel whether we want to be or not. It’s discouraging, disheartening, and disrespectful to the many people who have worked so hard over the last year, only to have the end game change again.

I understand how we came to be here. I understand population health and the need to have big data. I understand the need to see vast numbers of patients to make sure everyone is served. I understand the need to coordinate care. But on the other hand, I understand the need to be able to spend my time just being a doctor – listening to patients, understanding their needs, and helping them get better. It seems that has been completely lost in all the noise and churn of regulations, guidelines, and rulemaking.

I’m not old enough to have practiced in the “olden days” of medicine when you could get away with writing a note that said “Sick – Penicillin” and charge $5 and be done with it. I certainly see the appeal however. I wonder if I could deliver primary care much cheaper if I went to the old-school approach? Without insurance or all the referral-chasing, I could probably slash my overhead by 80 percent. Without all the overhead, I could lower my prices. With lower prices and fewer distractions, I could help more patients. This is the heart of the direct primary care model, which is gaining traction in many communities. It’s an appealing proposition for more and more physicians.

A lot of providers who are learning to use electronic health records complain of being turned into data entry clerks or having to take on the duties that used to belong to the unit secretary. I initially went into IT and administration to help patients (and my peers) at a higher level. Unfortunately, I’m spending more time chasing federal rules, reading legislation, and trying to understand arcane documents than I ever thought possible.

Maybe I should have gone to law school after all. Maybe it’s just CMIO burnout. Maybe my brain is broken. Maybe I just need to get over it.  But on the other hand, maybe we just need all these other entities to get out of our patient -physician relationships.

What do you think about the proposed changes to MU? Email me.


 Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.
Contact us online.

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May 22, 2014 News 3 Comments

HIStalk Interviews John Gobron, CEO, Aventura

May 19, 2014 Interviews No Comments

John Gobron is president and CEO of Aventura of Denver, CO.

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Tell me about yourself and the company.

We were founded at Denver Health. We were built to fix and improve a problem called clinical work flow. In the Denver Health case, especially with respect to roaming desktops. In the process, we came up with some pretty neat ways to solve security problems and came up with some mobile innovations as well.

I’ve been in healthcare IT for 20 years. I helped build a company called Sentillion. I spent time with Microsoft’s Health Solutions Group in the UK and ran the healthcare vertical for Symantec.

 

What are the big issues in trying to balance clinician convenience, access to systems, IT security, and device standardization and setup?

The big challenges often come down to workflow. Ultimately, we’re trying to facilitate a system that improves patient care and does it largely in a digitized way.

If you go back 20 or more years, everything was paper. The physician-patient relationship was based on intimate eye-to-eye contact. The doctor wrote stuff down and still maintained eye contact, but that wasn’t perfect. 

We’ve tried to introduce computers, with a lot of success in some areas and less so in others. Innovations like CPOE tried to help with the mistakes that were being made largely through human error, like handwriting and things like that. But the problem is that computers tend to interrupt workflow, especially when it comes to a physician or a nurse treating a patient. 

We get in the middle and make the interactions faster and more intuitive. For all the great work computers do, they are fundamentally dumb instruments. They don’t know what to do until you tell them what to do. We provide what we call awareness to the computing experience. We try to know what the user wants to do and tell the computer that before the user actually interacts with the computer itself.

 

Who are your competitors?

We’re doing new stuff. We don’t have any directly line-of-sight competitors, but we have a lot of what I will call peripheral competitors.

The most notable is probably Imprivata on the single sign-on front. We’re often compared to the traditional space of access and identity management and you have Caradigm in there and Imprivata as well. Two big ones. On the virtualization side, we’re largely complementary to our partners like Citrix and VMware.

In the sense of awareness, we really don’t have anyone. We can provide user awareness and that’s largely thought of as a single sign-on. but we’re also providing location awareness, device awareness, patient awareness and a combination of those. There’s really not anyone in our direct line of sight.

 

What can you do with that information?

We create effectively an immediate and customized user experience for the doctor and nurse. Capture their badge or otherwise identify themselves to a machine. Because of who they are, where they are, and what they want to do, we custom-mold that desktop to say, the user might need this set of applications. They might need to be in this area of this application. We deliver it in generally four to six seconds.

 

You can do this with any major system, such as Epic, Cerner, and Meditech?

Yes. We’re 100 percent application agnostic. We’re really managing the desktop itself and then the applications on the desktop. We haven’t had an application we couldn’t interface with or a workflow we couldn’t solve. We’re pretty agnostic when it comes to what applications a doctor and a nurse might be using.

 

The earlier challenge was to get clinicians to use systems since that use was not mandatory. Now it’s mandatory in most cases, so instead they complain about the overhead required. Is that better or worse for the company?

That’s a very interesting way of saying it. It’s very accurate. In my life with Sentillion, we were largely dealing with a voluntary user population. The nurses today and yesterday were largely employed by the hospital and had to do what the hospital told them to do. Doctors weren’t employed.

Today, there’s still a mismatch and there’s acquisitions going on. But from a hospital perspective and even an outpatient perspective, they’re needing to use the EHR or risk not getting money or getting fined. It doesn’t fundamentally change the need to make it better because it’s not optimal.

But the way we go about it is different in that the days of, “We can save you some time, that’s great, let’s buy this system” are mostly in the past. The world in front of us, the world we live in now, is “show me the hard ROI.” If I’m going to buy something like your solution or anything like it, show me how you reduce my actual spending or increase my actual revenue into the hospital.

 

It must be tough with EMR optimization and mandatory regulatory work to convince people to look at your system in addition to everything else.

It is. Probably every vendor reading HIStalk probably has a similar perspective on this. We look at what’s important to the hospital we’re talking to, overlaid with whatever will bring the most amount of value. Then we have a good match, and if we don’t, we come back and talk to them at a later date.

 

Hospitals are interested in anything that can help them with Meaningful Use, integration acquisitions, or connecting with physician practices. Does Aventura’s product look more attractive with those issues?

Absolutely. That’s where we stand out. 

I mentioned awareness. A lot of the core measures go way beyond just getting into the application. That’s good, but that’s commoditized technology. The next generation is not just getting me to an app, but getting in the right place of that app, eliminating a lot of the clicks and menu choices and navigation that get me where I need to be in order to hit my Meaningful Use number, in order to hit my 60 percent CPOE or my core measures or things like that.

That’s where we’re looking to innovate and have been innovating, with respect to putting information up. We can help navigate to a patient record. We can put some information there that may assist with helping the hospital achieve their Meaningful Use numbers in particular.

When you think about acquisitions, you largely think about the drive in healthcare across America right now to move care outside of the four walls of the traditional hospital and out to an outpatient setting, or even ideally out to the home. That’s the ultimate mobility. Historically we saw mobility as a doctor and nurse going from room to room to room rounding or providing care or surgery. That happens in the inpatient workflow. But the outpatient workflow is where we as a health system or as an ecosystem are going to see some of the bigger financial savings and impact and obviously outcomes as well. People heal better faster and less expensively in their homes, in places of greater comfort. 

As healthcare looks to do that, people will still need to use the computer systems. They’re just going to be more mobile. That’s a really good place for us to innovate with the ability to go back and forth between desktops and mobile devices, whatever they may be. Still bringing access to the information, but doing it anywhere they want to be.

 

You’ve worked outside of the US and for big companies outside of healthcare. What is the most striking thing about healthcare right now?

I had a wonderful experience in the UK. I had moved there in 2008 to lead Sentillion’s European expansion. It was a privilege to learn about how healthcare is delivered in different parts of the world.

The striking similarity is that workflow, is workflow, is workflow no matter where you are. Clinicians in Birmingham, England see patients and use computers largely the same way as doctors and nurses in Birmingham, Alabama do. In socialized medicine countries, these systems are obviously less concerned with transactional billing, but the core focus of improving patient care is still the same, as are the core struggles of improving this workflow

 

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

The excitement that I have, and that is shared by Aventura and our customers, is that we’re really onto something with respect to a platform called awareness. We can be aware of a user, their location, their device, and the patient they’re in front of.

But my favorite question when I wrap up meetings is, what else should we be aware of? What else could we be aware of to help you? Those discussions are fun to have and they help drive our innovation in the company.

At a high level, where we will be going is an expansion of our awareness platform, to be able to do more things to drive efficiency, security, all those good benefits into the clinical workflow.

 

Do you have any final thoughts?

I just wanted to say thanks for HIStalk. I’m a huge fan and I really appreciate the work that you do. It’s not only informative for people like myself, it’s fun to read. I helps foster a nice sense of  camaraderie in our industry and I’d just like to say thanks for that.

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May 19, 2014 Interviews No Comments

News 5/16/14

May 15, 2014 News 2 Comments

Top News

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Medfusion files suit against Allscripts, claiming the company didn’t live up to its agreement to resell Medfusion’s patient portal to EHR customers of Allscripts. Medfusion says Allscripts owes it $5 million, with damages potentially tripling the lawsuit’s value. The lawsuit claims:

  • The companies signed a five-year agreement valid through July 17, 2014.
  • Allscripts delayed implementation and billing of the Medfusion portal for more than a year for some customers, creating an unpaid backlog for Medfusion and causing the companies to amend the agreement to require Allscripts to start billing new customers within 30 days. Medfusion says that backlog cost it more than $10 million.
  • Because Meaningful Use requirements were expected to boost demand for patient portals, Allscripts agreed to include the Medfusion portal in every new Enterprise and Pro deal it signed and market the product as its only portal solution.
  • Allscripts refused to integrate Medfusion’s online forms capability.
  • The companies amended their agreement to give Allscripts 55 percent of net revenue and recurring charges while Medfusion would get 45 percent.
  • Allscripts acquired Jardogs early in 2013 and announced it without warning at HIMSS13, where Medfusion was co-marketing its portal with Allscripts.
  • Allscripts started marketing the Jardogs product as its preferred solution (FollowMyHealth) before its contract with Medfusion ran out and also started converting customers waiting to have Medfusion’s portal implemented to the FollowMyHealth product.
  • Allscripts created marketing material that compared the FollowMyHealth product to Medfusion’s with the conclusion that its own product was better.
  • Allscripts stopped developing its end of any portal enhancements and blamed Medfusion when clients reported issues.
  • Medfusion accused Allscripts of breach on April 14, 2014, saying it had not paid $5.5 million worth of outstanding invoices. Allscripts, it says, sent payment of just under $1 million in response and disputed the remainder.
  • Medfusion says customers told it that Allscripts made misleading statements in trying to get them to sign three-year contracts with Allscripts, including that: (a) Allscripts had terminated the agreement due to Medfusion problems; (b) Medfusion was going out of business; (c) Medfusion wasn’t providing portal updates and the customer would have to implement the Allscripts product to qualify for Meaningful Use; and (g) customers would be invoiced for May even though Medfusion wasn’t invoicing Allscripts that month because of their dispute.

Reader Comments

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From Hobie Cat: “Re: Google Glass. Being handed out to all medical students at UC Irvine. The link made the rounds this morning with the subject, ‘Does this have HIPAA violation written all over it?’ Perhaps someone from UC Irvine can chime in with thoughts on how they’re approaching HIPAA. I’ll also be curious about how patients respond to this technology during rounds and the perception of a student talking to themselves and head nodding toward the ceiling to wake up Glass while in the room with the patient… ‘Just turning on the Glass, yo!’” The medical school says students in their first two years will use Glass during anatomy and clinical skills courses, while those in their third and fourth years will wear it during their hospital rotations, especially in the ED and OR. Google stores the information saved by off-the-shelf Glass, so in the absence of a business associate agreement with Google (which they probably won’t sign since it’s a consumer device) and because Glass doesn’t encrypt, I would say its use in patient care settings is a HIPAA problem. However, the UCI announcement says they are using proprietary software that is HIPAA compliant, probably the Pristine system they were piloting earlier this year, so they are trusting their vendor.

From TooMuchCoffee: “Re: UK’s Royal Devon. Going to Epic, although ‘affordability is a huge issue.’ At least they’ll get something that works – NHS spent billions on a failed decade-long project involving GE Healthcare and other vendors that produced nothing.” Royal Devon and Exeter NHS Trust chooses Epic as vendor of choice. It will now undertake a 12-week study to see if it can afford it.

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From Fighting Accountants: “Re: Northwestern telestroke team. Congratulations for winning the Innovation Award at their annual nursing fair. They save lives and improve outcomes where it wouldn’t otherwise be possible. Not all health IT is as painful as an EMR.”

From Joey Junior: “Re: Mayo. Heard any rumors about the Cerner-Epic faceoff?” I haven’t. I will defer to readers.

From Concerned: “Re: voice mail messages. I need HIStalk reader insight. A large academic hospital organization would like to store their voice mail messages on Exchange Server. I don’t feel that this is ideal, but does it actually violate HIPAA?” I’m sure an expert will weigh in, but my interpretation is that voice mails left by patients (which I assume is the content you are referring to) are not covered by HIPAA since they didn’t start out in electronic form, the provider didn’t listen to them initially, and nobody suggested the patient leave PHI-containing voice mails. Providers leaving messages for each other might be problematic, though, but the server is still inside the firewall and the messages can’t be forwarded outside or accessed without security credentials. I haven’t convinced myself, so let’s hear some other viewpoints.


HIStalk Announcements and Requests

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Several of the reader-submitted items you see here came from the all-purpose contact form, which accepts comments and attachments and whisks them straight to my inbox, where they may age gracefully until I get to them.

Highlights from HIStalk Practice this week include: Xerox fares poorly when it comes to state Medicaid management systems. GA-HITREC’s Dominic Mack, MD weighs in on the HIMSS 2014 Regional Extension Survey results. Physicians have differing opinions about the business model of CrowdMed, which is looking to turn a profit via crowdsourced medical advice. ONC approves ANSI for a second term as an approved creditor for its HIT certification program. Athenahealth finds itself in the same quagmire as Facebook and Tesla. "Anonymous" sends letters to 30 patients alerting them to the ease of stealing their medical information. A solo-practice physician becomes the first in New Jersey to attest for MU Stage 2, thanks to help from NJ-HITEC. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the state of patient engagement and questions whether the Patient Engagement Framework, developed by the National eHealth Collaborative and HIMSS, is an ideal tool for benchmarking progress. Researchers at Johns Hopkins develop a smartphone-based carbon monoxide breathalyzer that they hope will provide smoking cessation programs the tools to objectively measure smoking abstinence more easily. Cedars-Sinai Health System announces that it has formed a partnership with MemorialCare Health System to create a shared health technology VC fund called Summation Health Ventures

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Ms. Barnes sent this photo from her Mississippi kindergarten classroom, for which we as HIStalk readers provided write-and-wipe boards and markers (you can see them in front of the students) in response to her DonorsChoose grant request. She reports that the class is using them for practicing their writing and they wouldn’t have them otherwise because of district budget cuts.


Acquisitions, Funding, Business, and Stock 

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Oscar, a technology-powered startup that sells medical insurance only to New York residents so far, raises another $80 million in funding, bringing its valuation to nearly $1 billion.


Sales

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The VA chooses Agilex and Calgary Scientific for enterprise viewing of radiology images on a variety of devices.


People

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Applied Health Analytics hires Craig Smith (The Advisory Board Company) as president of its Coalesce consulting division.

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Lee Fowinkle (McKesson) joins InformedDNA as CTO.


Announcements and Implementations

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Mercy Hospital (MO) breaks ground on its four-story, 120,000 square foot, $50 million virtual care center that will house its 300 telemedicine program employees for remote management of ICU, stroke, cardiology, sepsis, radiology, pathology, nurse on call, and home monitoring.

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Health Care Cost Institute, a non-profit funded by UnitedHealth Group, will in Q1 2015 make available to the public medical claims data from private insurers, the first non-government healthcare pricing data to be released. Aetna, Humana, and Kaiser Permanente have signed on.


Government and Politics

HHS’s Medicare Fraud Strike Force charges 90 people, including 27 clinicians, for fraudulently billing Medicare for $260 million. The defendants were charged with a variety of activities that include paying pharmacy kickbacks, billing for undelivered products and services, charging the government for 1,000 unneeded power wheelchairs, and laundering money using Medicare beneficiary information. HHS also announced that it has indicted the Brooklyn surgeon who billed Medicare for $85 million worth of surgeries that he didn’t actually perform.

ONC chooses ANSI for a second three-year term as the accreditor of its certification bodies.


Innovation and Research

A study of primarily Iowa VA hospital ICUs finds that telemedicine didn’t reduce 30-day mortality rates or length of stay.


Other

A free, eight-week online course, “Exploration of SNOMED CT Basics,” runs through June 13 if you have time to double up on the video lectures to finish in time.

The Chicago-area nurses union National Nurses United launches a heavy-handed campaign against “experimental, unproven medical technology” (specifically, EHRs.) Much of it rings true, unfortunately, even the dot matrix printer.

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Roshni Nadar Malhotra, the only child of a technology billionaire from India, will spend $168 million to build a network of Johns Hopkins-affiliated health clinics starting in New Delhi. She says IT will be a key component.

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The Pittsburgh business paper reviews the federal tax forms of West Penn Allegheny Health System, noting that Allscripts was its second-highest paid contractor at $7.3 million.

Employees of a company that won a $1.2 billion HHS contract to process paper insurance applications from health insurance exchanges are staring at computer screens with nothing to do, a whistleblower claims. The whistleblower says the employees have been told to refresh their screens every 10 minutes to give the appearance that they are accomplishing something. Serco, the British contractor that won the big contract, is under investigation in England for overbilling the government. I wrote about the company in October 2013, including the patient harm it caused when it took over the largest pathology labs in England’s NHS in 2009.

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An editorial by Newt Gingrich on the VA’s problems says the VA and DoD need to integrate their IT systems (which is much more of a DoD problem than a VA problem):

Every effort to integrate Department of Defense and VA medical record systems has failed. The result has been an absurd process of transitioning from active duty health services to VA health services. At a time when you can instantly make airline and hotel reservations or get money from an ATM worldwide in seconds, it takes 175 days to transition a veteran’s care from the Defense Department to the Department of Veterans Affairs. The DoD and VA spent $1.3 billion to build a joint electronic medical record system for their health care services before the two secretaries announced in February that they were abandoning the effort. This is on top of the over $2 billion the Defense Department has spent on a failed upgrade to its own electronic medical system.

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The mHealth Summit opens its call for presentations for the 2014 meeting, due June 27. The meeting will be December 7-11 in National Harbor, MD.

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Interesting: a suspicious fire in the medical records department of a psychiatric hospital in Trinidad and Tobago erupts one month after the health authority requested copies of the hospital’s medical equipment purchasing records. The hospital, which is looking at EHRs, says it will have to create records by asking patients about their history. It hopes to make a second set of paper records for patients to take home.

Weird News Andy says when it comes to cancer vs. measles, it’s no contest for this patient. Mayo Clinic doctors try a desperate cancer treatment in injecting enough genetically modified measles virus into a female patient to inoculate 10 million people. The doctors say the use of viruses to fight cancer, known as oncolytic virotherapy, has been tried since the 1950s and in this patient’s case, seems to have worked.


Sponsor Updates

  • Extension Healthcare sponsors the National Coalition for Alarm Management Safety.
  • Capario shares five facts about eligibility verification.
  • Capsule’s Halley Cooksey relates the NFL draft to selecting a committee to evaluate technology.
  • PatientKeeper posts its summer conference event schedule.
  • Orchestrate Healthcare posts an article called “What is Healthcare IT Integration?”
  • HDS will attend MUSE on May 27-30 in Dallas.
  • Park Place International offers seven tips for project managers to get and stay organized.
  • Jennifer Crowley from MedAptus discusses the importance of time in the daily life of a provider.
  • The Outsourcing Center names Springhill Medical Center (AL) and Allscripts winners of its 2014 Outsourcing Excellence Award in the Best Healthcare category.
  • TriZetto will offer  grouping, edit, compliance and pay-for-outcomes logic from 3M in its NetworX Pricer and NetworX Modeler solutions.
  • Iatric Systems launches Business Associate Manager as a tool for compliance with the HIPAA Omnibus Final Rule.
  • Sentry Data Systems completes a Service Organization Control 3 examination.
  • Summit Healthcare joins the federal initiative for standards-based healthcare communication DirectTrust.
  • Black Book names ADP AdvancedMD, Allscripts, Aprima, Care360 Quest, eClinicalWorks, eMDs, Greenway, Kareo, McKesson, and Optum to its list of top EHR, PM, and billing vendors.

EPtalk by Dr. Jayne

I was excited to hear about HR 4077 , which would exempt physicians and other healthcare professionals from antitrust laws when they take part in contract negotiations with health plans. Although it doesn’t apply to Medicare, Medicaid, or other governmental payers, it seems like it could help independent physicians as they fight the big payers. Having been part of such a physician network in the past (although it was determined that we violated antitrust laws and our contracts were voided) it could be a help for many providers.

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My informaticist friend @techydoc tweeted a link to this healthcare data map last week. It’s amazing all the places our data goes, sometimes whether we want it to or not. Apparently one place data doesn’t go, however, is to my mom’s doctor appointment. Her physician recently moved from one practice location to another within the same physician group. Despite the fact that they’re on a common EHR platform and also have an HIE in place, she was told they had to key in all her information again. It’s a shame they didn’t catch her last name and give a better answer, because I implemented the EHR and HIE in question. Sounds like someone needs an in-service.

HIStalk Practice picked this up first, but I wanted to throw in my two cents on this study that concluded that costs rise when hospitals own physician practices. The data used for the analysis was for the period 2001-2007. It doesn’t take into account the shared savings plans that have come into play during the last six or seven years. There are also just too many confounding factors present. To get an accurate analysis, I think you’d have to have to control many more of the variables. Maybe in a couple of years we can get some robust data from Accountable Care Organizations that have both employed and independent provider participants.

From The Major: “Re: site visits. As usual, thanks for sharing. I have been through a site visit (as a consultant, and my client was the jerk) like that. We had an hour ride back from the site to his hospital, where I naively told him he wouldn’t learn anything if he didn’t listen and ask good questions.” Several readers wrote to commiserate about my recent site visit experience. I’m happy to report that I received a note of apology and a cookie basket for my staff. Either the CMIO understands his behavior wasn’t appreciated or one of his accompanying colleagues is trying to smooth things over for him.

From Oceans Eleven: “Re: site visits. A long time ago we were an early adopter of a particular vendor. Based on our success, we eventually did about 100 site visits over the first few years. What became apparent after the first few minutes with a couple of them was that they had no intention of signing with any vendor. Much to the chagrin of the sales guys, we immediately scaled back our planned agenda and sent them on their way to the beach, which was probably the covert reason for the visit.” I’ve looked at dozens of products over the years and that approach hadn’t occurred to me. I’m thinking the next site visit we do might have to consider geography as well as how similar the facility is to ours. Besides, it’s been a long winter and I’m feeling a little pale. I’m sure an increase in my Vitamin D would be beneficial.

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Anyone who has ever engaged in a friendly game of Office Bingo should appreciate this card, courtesy of a reader at Authentic Medicine. I used it during a recent pep talk from our chief medical officer. She was trying to explain why it was a good idea that all the experienced emergency physicians are being let go so we can replace them with cheaper independent contractors who don’t know our hospital or our patient population. Did I mention the emergency department is barely a third of the way through with a massive construction project that has required everyone involved to bend over backwards to preserve quality patient care? The hospital is transitioning in a little over a month – it will be interesting if nothing else since we’ll have new residents and new attending at the same time. I reached BINGO after barely a handful of sentences.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.

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May 15, 2014 News 2 Comments

News 5/14/14

May 13, 2014 News 7 Comments

Top News

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The Phoenix VA hospital that is charged with creating a secret waitlist to hid months-long treatment delays waited until the last minute to implement the electronic waitlist system whose VA rollout started in 2001. According to a former VA official, “Phoenix was one of the very last to deploy. Transition from a paper-based system to the electronic one was not handled well. From what I hear, there was a great deal of resistance from staff as well.” The electronic system was introduced to increase transparency and reduce paper-based mistakes.


Reader Comments

From KD: “Re: Epic. I heard a rumor they will buying InterSystems. Any chance you can get the lowdown?” I haven’t heard anything and my one possible source hasn’t responded. I’m highly skeptical. Arguments for: Epic customers pay a lot for InterSystems Cache’ licenses and Epic and its customers are heavily dependent on that company as a result. Arguments against: almost everything else. The companies have been working collaboratively together for decades, their founders are billionaires and don’t need the money, Epic has never done an acquisition and that would be a huge one, and both companies generally stick to their knitting (the exception being a couple of InterSystems application acquisitions years ago.) I can’t imagine this is true.

From Lee Brother: “Re: MU Stage 2. At a conference, John Halamka says most hospitals will either apply for an exemption or quit the program completely.” That’s likely given that only four hospitals have attested so far. Running your business is more important than running after government money that comes with strings attached.


Acquisitions, Funding, Business, and Stock

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Pharma commercialization services vendor Quintiles will acquire consulting firm Encore Health Resources, hoping to use real-time EHR information to give drug companies outcomes data. Houston-based Encore has 250 consultants.

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McKesson announces Q4 results: revenue up 25 percent, adjusted EPS $2.55 vs. $1.48, beating consensus estimates of both. From the conference call:

  • Technology Solutions revenue was down 1 percent on the quarter, up 5 percent on the year.
  • The company expects Technology Solutions revenue to “decrease modestly” in FY2015 because of declining Horizon business and “the impact of eliminating a low-margin product line.”

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The Advisory Board Company says in its earnings call that it paid $25 million to acquire HealthPost, a physician finder and appointment scheduling site that will be rolled into the company’s Crimson analytics offerings that are used by 1,400 hospitals. HealthPost has seven employees, seven customers, $1 million in annual revenue, and is break-even on the P&L side. According to Advisory Board Chairman and CEO Robert Musslewhite,

“HealthPost is a cloud-based ambulatory scheduling solution that enables health systems to reduce referral leakage and track new patients by using it. It does it with what we felt like was a market leading SaaS technology that enables physicians and consumers to identify the right provider of care, based on certain criteria, especially in terms of geography and it makes it a very easy one-click appointment booking experience for either the provider or the patient. So we’re excited about it. In terms of how we’re going to roll it out, it’s still TBD. I imagine we will have a program launch coming from it, then more news on that down the line. But your question — as your question indicate, its certainly very complimentary to a lot of the works that we do in Crimson Market Advantage and with our MRS acquisition from last summer.”

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WestView Capital Partners makes a minority growth investment in Meditech technology solutions provider Park Place International.

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Three Lawson Software founders will pay $5.8 million to settle insider trading charges related to the company’s 2011 acquisition by Infor.


Sales

Partners HealthCare (MA) will consolidate several laboratory, pathology, and blood banking systems in moving to systems from Sunquest.

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Saint Francis Health System (OK) will deploy Perceptive Acuo VNA. 

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University of Louisville Physicians (KY) selects Shareable Ink’s Anesthesia Cloud and ShareMU for 45 of its providers across 20 operating rooms.

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Vanderbilt University Medical Center (TN) chooses CitiusTech’s BI-Clinical health content and analytics.

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UW Medicine (WA) hires Versio (formerly known as ScribeRight Transcription Agency) to bring legacy ambulatory data into its new Epic system.


People

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Medfusion names Michael Raymer (MModal) as VP of solutions management.

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Predixion Software names Costa Harbilas (HP Software) as SVP of global sales and Terri Avnaim (Quest Software) as VP of marketing.

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Abington Health (PA) hires Jonathan Sternlieb, MD (Holy Redeemer Health System) as CMIO.

Greg Shorten (Allscripts) joins Shareable Ink as chief growth officer.


Announcements and Implementations

Nominations are open through Thursday for Mosby’s Superheroes of Nursing contest.

EClinicalWorks says that more than half (580 of 1,147) of Federally Qualified Health Centers use its products, four of them being Davies winners.

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Cerner’s community health work in Nevada, MO is profiled in the Kansas City paper, which points out that the healthcare IT market is maturing and the project can help generate consulting revenue for Cerner and enhancement of its Healthe Intent population health management software. According to Cerner’s population health VP, “It’s in the DNA of our company to have the vision and passion to fix what’s broken in health care. We’ve solved the data problem. Now, it’s not about what the doctor does. It’s about what the individual does.” According to an analyst of the all-important stock market, “Other than goodwill with the client, I’m not sure how they get paid for thinking about real-world population management.” The Healthe Intent system is running at two hospitals, one in Chicago and another in Vancouver, with a third to be announced.


Government and Politics

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The Massachusetts Health Connector health insurance exchange failed because the three state agencies involved didn’t communicate with each other, according to a board member of the $57 million site, which the state will be replacing. "There wasn’t a single point of management. It was poorly set up and it was this horrible combination where the contractor [CGI] would get different orders and would do none of them."

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North Carolina’s HHS signs a data use agreement with the NCHIE as part of a House bill that requires hospitals to submit the demographic and clinical data of Medicaid patients to the HIE, allowing DHHS to monitor services and patient safety.


Innovation and Research

Researchers develop a smartphone app that analyzes the voice tone of callers with bipolar disorder to provide an early warning of mood changes.

The SVP/MD of medicine and technology of medical device maker Medtronic says the company’s biggest competitor won’t be current players, but rather “will be Google. I am certain of it.” He cites Google’s $8 billion annual R&D budget and its recent work on a smart contact lens that can measure glucose levels. He adds about healthcare, "It’s where the money is. We’re spending 18 percent of the GDP on healthcare. Why wouldn’t they think that’s where they want to be? We spend more on healthcare than we do on manufacturing in the US, so everybody thinks it’s their destiny.”

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Venture capitalist Beth Seidenberg, MD of Kleiner Perkins Caufield & Byers offers advice for entrepreneurs trying to get a foothold in the tricky world of digital health:

  • Build interfaces to open up intentionally built data silos
  • Help customers make their own decisions.
  • Figure out a revenue model upfront.
  • Make healthcare apps social so users don’t get bored.
  • Include healthcare experts on the management team.

Other

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Confused about “correlation” vs. “causation” when a shoddily created study claims that Event A must have caused Event B because they happened together? See the chart above from a website devoted to ridiculous examples of “Spurious Correlations.”

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It seems there’s a national healthcare IT conference every week, and despite claims that everybody in healthcare is struggling financially, somehow those conference rooms (and $300 hotel rooms) keep filling up with attendees. I suspect many of those attendees just keep popping up at one conference or another since I don’t know many working people who have the travel budget and time off to support endless conference attendance. One conference I hadn’t heard of is running now: the National Healthcare Innovation Summit in Boston. It’s put together by HIMSS, apparently, since membership gets you a $700 discount on the $1,095 registration fee and the browser’s tab title is “HIMSS Innovation Summit.”


Above is a tweet from Microsoft HealthVault GM Sean Nolan, who says Meaningful Use complainers are “whiny.”

Financially struggling Cochise Regional Hospital (AZ) is fined for violating its license by not providing surgical services for two years, last cleaning its operating rooms in July 2012. The 25-bed hospital says part of its correction plan is to spend $2 million on an EHR. Its website touts its advanced technology from Empower Systems, which I’ve only mentioned once in HIStalk, in 2011 when the company’s CEO quit.

A report finds that at least 15 hospital executives in Connecticut were paid more than $1 million last year, including six from Yale New Haven Hospital alone. The VP of psychiatry at Hartford Hospital made $3.24 million.

The UPMC employee who sued her employer for a data breach drops payroll processor Ultimate Software Group from her suit, saying she was mistaken in thinking that UPMC used its services.

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University of Mississippi Medical Center CIO David Chou lists 10 technologies that are revolutionizing health IT:

  1. Smartphones
  2. WiFi
  3. BYOD
  4. Government mandates
  5. VoIP
  6. Social media
  7. Virtualization
  8. IP-based medical devices
  9. Mobile health
  10. Big data

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Johns Hopkins School of Nursing offers a free, five-week course (known as a MOOC, or massive, online course) on “The Science of Safety in Healthcare” starting June 2. Pay $39 and you get a certificate; add another $60 for CNE hours. Peter Pronovost is one of the instructors.

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Two tear-down analyses of Google Glass find that the $1,500 gadget contains either $80 or $152 worth of parts.

Weird News Andy questions, “Dim bulbs or bright lights?” Two British doctors refuse to use energy-saving light bulbs in their homes and instead stocked up on the obsolete incandescent types. One claims the bulbs cause sunburn-type damage over time, while the other worries about the possibility of cataracts and macular degeneration.


Sponsor Updates

  • Portland (OR) IPA certifies a pilot group of clinics for NCQA’s Patient-Centered Specialty Practice Recognition using the IRIS referral management system of Proximare Health.
  • Allscripts announces GA of Sunrise Surgical Care 14.2.
  • GetWellNetwork CIO David Muntz will deliver the keynote address at the DoD/VA Healthcare Summit in San Antonio, TX next week.
  • TriZetto will offer Enkata’s claims processing system to its consulting clients.
  • EDCO Health Information Solutions publishes a blog post, “True or False: Decentralized Records Scanning Reduces Chart Quality.”
  • A Beacon Partners blog post urges providers to use the ICD-10 delay to gain a competitive advantage.
  • Visage Imaging will demonstrate its enterprising imaging platform at the SIIM annual meeting in Long Beach, CA this week.
  • Holon discusses the use of HIE for for identifying and reducing ED frequent fliers in a recent blog posting.
  • Wolters Kluwer will sell POC clinical decision support solutions to nursing schools for use in their curriculum.
  • CliniComp will participate in the Association of Women’s Health, Obstetric and Neonatal Nurses 2014 Convention June 14-18 in Orlando.
  • Health Catalyst shares its history, goals, and direction.
  • AirWatch expresses its intention to continue working with BlackBerry.
  • Shareable Ink announces the members for its newly-formed Anesthesia Leadership Board.
  • ADP AdvancedMD offers a guide on how financial reporting is changing the way private practices operate.
  • Terry Edwards, CEO of PerfectServe, will speak at the WLSA Convergence Summit in San Diego May 14.
  • Arcadia Healthcare Solutions, Certify Data Systems, and CTG Health Solutions executives weigh in on the challenges of forming and operating an ACO.
  • Truven Health Analytics will provide technical support for CMS during the Testing Experience and Functional Tools demonstrations in Community-Based Long Term Services and Supports program.
  • CommVault extends its relationship with Microsoft to provide data management and protection.
  • Navicure achieves faster product development times by using of VMware vCloud Suite for provisional testing and development environments.
  • MModal opens a healthcare technology center in Bangalore, India.
  • Lexmark’s Perceptive Software passes all integration tests at the 2014 IHE North American and European Connectathons.
  • NextGen Healthcare earns its third Surescripts White Coat of Quality award.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.

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May 13, 2014 News 7 Comments

News 5/9/14

May 8, 2014 News 5 Comments

Top News

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Google Ventures invests $130 million in oncology data platform vendor Flatiron Health, which will use some of the money to acquire oncology EMR vendor Altos Solutions. The two 20-somethings who founded Flatiron Health sold Google their online advertising platform for $81 million in 2010. They knew nothing about advertising or healthcare before starting their companies. Their first Flatiron oncology rollout was in 2013. It’s a lot of money, so let’s hope Google’s investment outcomes exceed their healthcare ones.


Reader Comments

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From Dave Miller: “Re: UAMS. We are now live fully everywhere on Epic. It has gone really well, with just a few of the usual minor bumps (printing, security, scanning, etc.). I think this has been the best of my three Epic go-lives (University of Chicago, Carle Foundation Hospital, now UAMS). I guess you can teach an old dog new tricks. We also did enterprise speech recognition, device integration, and barcoding among other things. We went from a HIMSS Stage 4 to a Stage 7 (application in process). My lab team made me an honorary member of the Beaker team with the shirt above, maybe because I am a former med tech.” Dave is vice chancellor and CIO of University of Arkansas for Medical Sciences in Little Rock. Congratulations to the team. I told Dave he has more Epic experience than some of the consultants out there.

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From Joe: “Re: IBM’s Watson. I followed your link from HIStalk and got a Chat Now window on IBM’s page. I’m curious about Watson in healthcare, so I accepted. See the transcript – I decided to open with a (perhaps obtuse) nod to Alan Turing, which I figured any good IBMer should appreciate. Touchy, touchy! Or maybe they have an algorithm that indicates anyone skirting around Turing Test references is clearly a cycle-wasting tire kicker.” I replied to Joe, “Maybe the IBM rep was indeed a Turing fan and decided to prove in the most definitive way possible that he’s not a computer!” Joe says he’ll try again, asking, “Did you kill our previous session because you ARE a computer, or you are a human trying to PROVE that you’re not a computer?”

From Trey Hermanos: “Re: athenahealth. Can somebody tell me how many providers athenahealth has on their network? An article says 37,000, but Jonathan Bush said 52,000 at a recent conference. Their implementation is a breeze compared to others, but in their quest for growth and relevance, they risk losing the 1-10 doc practices that made them what they are today, the practices that aren’t getting decent service and call-backs from their account managers. They gave their award for improved patient experience to Target’s clinics, the same corporation that compromised the identities of millions. The company doesn’t think you need to see a doctor for ‘small things,’ a view held by many despite the fact that the knowing when something is simple or not requires skill and sophisticated knowledge. A recent article called ‘Nurses are not Doctors’ said you have to know a lot to do primary care – the Target and Walgreens clinics are there to sell what’s on their shelves. There is no respect for knowledge and we spoil our patients the way we spoiled our kids to the point they have no coping skills and grow up entitled. Athenahealth must feel undervalued and not appreciated enough, sort of like primary care.”

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From HIT ESQ: “Re: patent troll. A company called Presqriber is filing a massive number of patent infringement cases against EHR vendors. It has no Google hits except these cases. Its patient is for an ‘Interactive Medication Ordering System.’ They appear to be the first major patent troll in a few years.” The patent is from 1998, so I bet someone bought it from a defunct vendor (“Poetry” is referenced as the system name, which had some California pharmacists and urgent care people involved and is presumably long gone) and hopes to milk vendors for go-away money. They hit all the majors in their list of 20 except one – Epic, who has a history of launching a full-scale legal counteroffensive on patent trolls. HIT ESQ also called attention to two class action lawsuits brought against Cerner for claimed labor standards violations, which although I can’t pull up the documents since I don’t have access to the PACER system, usually means a salaried employee claims they should have been paid for overtime because they were misclassified and should have been hourly. 


HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: A report finds that higher payer doesn’t necessarily equal higher job satisfaction. Another says the physician industry generates $26 billion in sales revenue and supports $15 billion in wages and benefits. Northwestern Memorial Physicians Group and Northwestern Medical Group merge to form the second-largest physician group in Chicago. A trio of ophthalmologists turns to crowdsourcing to fund their digital physician on-call answering system. A study uncovers the fact that hospital prices and privately insured patient spending increase when hospitals acquire physician practices. A physician pleads with Forbes editors to get RAC bounty hunters off his back. Arizona Care Network and Northeast Medical Group launch separate ACO initiatives with payers. Don’t write athenahealth’s eulogy just yet –several company partners make product announcements. 

This week on HIStalk Connect: Google continues its move into healthcare, as it grows its team of A-list genetic scientists working on its Calico moonshot project. Google also led the massive $130 million Series B funding round of oncology data analytics startup Flatiron Health. In other non-Google related news, PatientsLikeMe CEO Jamie Heywood discusses the details of its recent Genetech deal. 

Listening: new from Brody Dalle, the former (female) lead singer of The Distillers.

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Want to get in touch? I created a new contact form that covers everything I could think of. Submissions go straight to my inbox (which is usually overloaded, so keep expectations modest.)  There’s a link at the top of this page, too.


Acquisitions, Funding, Business, and Stock

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Castlight Health reports Q1 results in its first report as a publicly traded company: revenue up 339 percent, adjusted EPS -$0.72 vs. –$1.19, beating on revenue but missing earnings estimates by a mile. The company, whose market capitalization is around $900 million, had revenue of $8.4 million and lost $24 million in the quarter. Shares have dropped nearly 75 percent since CSLT’s March IPO, which some analysts called at that time “the most overpriced IPO of the century.” Castlight Health was founded in 2008 by Todd Park (White House CTO and athenahealth co-founder), Bryan Roberts (Venrock), and Giovanni Colella, MD (RelayHealth). Shares that rocketed to $40 on IPO day are now worth around $10 less than two months later.

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Allscripts reports Q1 results: revenue down slightly, adjusted EPS $0.07 vs. $0.09, missing expectations on revenue.  

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Nuance reports Q2 results: revenue up 5.5 percent, adjusted EPS $0.28 vs. $0.34, beating expectations on both.  

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The Advisory Board Company reports Q4 results: revenue up 15 percent, adjusted EPS $0.34 vs. $0.34, beating expectations on both.

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Hedge fund manager David Einhorn sent athenahealth’s stock price reeling this week when he said his firm has shorted the company’s shares because athenahealth is a faux cloud vendor whose real business is unsexy business process outsourcing that doesn’t deserve high share valuation. He didn’t just blurt it out – his slides from the investor conference presentation summarize his analysis:

  • The company has failed to meet its 30 percent organic growth target for 2013, analysts have cut revenue expectations for the next two years, and earnings estimates keep going down.
  • He says ATHN and some of the friendly analysts who cover it use a lot of buzzwords in describing what the company does, hoping to make it sound cooler and deserving of high share price, instead of what it is – an efficient business process outsourcer similar to lower-margin companies like MedAssets and Accretive Health.
  • The valuation numbers of Morgan Stanley, which also happens to be ATHN’s largest shareholder, are shaky (although that company might also question Einhorn’s negative analysis since he, too, is providing supposedly unbiased information that could move ATHN share price in a personally beneficial direction.)
  • Einhorn questions Morgan Stanley’s assumption that athenahealth’s inpatient business will jump from 0 to 40 percent of its revenues and that it will launch an inpatient revenue management service that will bring in $2.5 billion a year.
  • The report says Epic is unbeatable in hospitals and will expand into other markets, including gaining ground with hospital-acquired small practices that might otherwise be athenahealth prospects.
  • He says that HITECH is winding down and practices that wanted EHRs have already bought them, with Kareo, eClinicalWorks, and CareCloud offering lower-priced RCM and EHR products as athenahealth competition.
  • Capitation would hurt athenahealth, he says, because providers would be paid upfront and wouldn’t need its help.
  • He predicts a worst-case share price of $14 vs. then-current $127 (now $107), saying ATHN is like the 2004-era WebMD.

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Meanwhile, Jonathan Bush said Thursday that Einhorn doesn’t understand the company, which he then compared to Uber, Airbnb, and Amazon. He added, “The right price of athena is … completely out of my pay grade,” but told also CNBC that he’s sure ATHN is a $1,000 stock and then said, “Who cares about net income?”

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Streamline Health will acquire the assets of cost and spend management solutions vendor CentraMed.

Cedars-Sinai Health System (CA) and MemorialCare Health System (CA) form Summation Health Ventures, a healthcare IT development fund that will seek startups not only for potential return, but their capability to create technology that the hospitals can use.


Sales

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Lake Taylor Transitional Care Hospital (VA) will implement HCS Interactant for its LTACH and SNF service lines.


Announcements and Implementations

An engineer who helped develop ride service Uber launches Pager, which allows Manhattan residents to request an off-hours telephone consultation or house call from participating doctors. Telephone calls cost $50 (of which Pager skims $10), while house calls run $300 and the company keeps $50. Like Uber, Pager is thinking about surge pricing, raising charges when demand is high. It has only 20 doctors participating during its launch testing period. He should have chosen a less-generic name: Uber was always easy to find, but I couldn’t locate anything on Pager despite extensive Googling.

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Policy documentation software vendor PolicyMedical will integrate with the Access electronic forms system.

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Hybrent announces a medical supply ordering application for clinical staff.

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Mandi Bishop, Nick Kypreos, and Lauren Still put together Team FloriDUH to create open source data visualization tools. They’ve been invited to compete at Health Datapalooza in Washington, DC June 1-3 and have formed a non-profit foundation to distribute tools they build. They are hoping to raise $10,000 in a Medstartr project that starts Friday, May 9 to cover travel costs and extend their product offerings.


Government and Politics

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HHS Secretary Kathleen Sebelius, who I assumed was long gone but apparently isn’t, leads a thinly veiled cheer for the Affordable Care Act in touting its supposed benefits as analyzed from HHS’s databases: a tiny reduction in readmissions and a nine percent drop in hospital-acquired conditions in 2011-2012 and a claimed 15,000 lives and $4 billion in healthcare spending saved. President Obama’s nominee to replace Sebelius, Sylvia Burwell (above), faced her first Senate confirmation hearing Thursday and received near-universal compliments, even from Republicans.

New York-Presbyterian Hospital and Columbia University will pay $4.8 million to settle charges related a 2010 privacy breach in which the medical information of 6,800 patients was exposed when a CU physician-programmer tried to deactivate a personally owned server he had connected to NYP’s network, opening up the patient information it contained to the Internet. The error was discovered, as it always is, by someone Googling individuals and turning up inpatient clinical information. Neither organization had checked the server’s security, conducted a risk analysis of all systems, or developed policies and procedures for database access. It’s the largest HIPAA fine ever.

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Health Information Technology Exchange of Connecticut will be shut down since the HIE has spent its federal grants without accomplishing a whole lot.


Other

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A former Epic intern and employee who worked directly for Judy Faulkner for a time writes about his experience in a Madison online publication. He says Judy isn’t reclusive, just more interested in tending to her company and its customers than gabbing with reporters. He anguishes over whether the company spends too much on fancy buildings. He says Epic is good place to work because it quickly jettisons underperforming employees, but wonders if it shouldn’t hire more experienced people even if Judy’s long-held belief is that she can turn a new college grad into an “Epic person” in three years while experienced hires would take twice as long.

Weird News Andy reacts to this story by saying, “Mmmmm, bacon.” Scientists question the 1950s study that claimed saturated fats cause heart disease, saying the researcher chose specific countries that would prove his point, used small sample sizes, and studied one country during Lent when nobody was eating meat or cheese. The Wall Street Journal essay by the author of a pro-saturated fats book says that funding by Crisco’s manufacturer, Procter & Gamble, made the American Heart Association a national force and the group later spearheaded a move to vegetable oil for a “healthy heart” even though proof was lacking.


Sponsor Updates

  • Alan Worsham (Sutter Health) and Joe Schmidt (Emory University School of Medicine) join Culbert Healthcare Solutions as practice directors.
  • InterSystems TrakCare gains the largest share of non-US hospitals and is named a clear leader by KLAS.
  • Perceptive Software’s Larry Sitka will speak on breast tomosynthesis and John Hamdor will present on image-enabled EMR management at the SIIM14 conference.
  • Tampa General Hospital (FL) is live on Wolters Kluwer UpToDate Anywhere integrated into Epic.
  • Extension Healthcare releases a two-part white paper to aid hospitals with compliance with clinical alarm safety.
  • Capsule Tech celebrates National Nurses Week by posting celebrations and nurse-focused activities on the company’s blog.
  • Merge’s Mark Bronkalla explains the service model of PACS shifting to enterprise IT in a recent blog posting.
  • Gwinnett Medical Center and Connance will co-present at the Healthcare Business Insights’ Spring Member Retreat on “How Revenue Cycle Can Change Patient Loyalty.”
  • ICSA Labs certifies 29 vendors in April, including HIStalk sponsors Iatric Systems, Quest Diagnostics, and Orion Health.
  • Netsmart advocates for behavioral health providers on Capitol Hill.
  • Visage Imaging offers a NVIDIA case study in connection with a video detailing the architecture of the Visage 7 Enterprise Imaging Platform.
  • Aspen Advisors Founder and Managing Principal Dan Herman and principal Jody Cervank discuss IT’s impact on operations, clinicians, cost and productivity at a regional VHA COO/CFO Joint Affinity Group.
  • Ashish Shah and Brian Ahier of Medicity discuss the landscape and future direction of data exchange networks in a recent article.
  • Carolinas HealthCare System shares how Medicity was instrumental in its HIE CareConnect success.

EPtalk by Dr. Jayne

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We hosted a site visit at the office yesterday. It’s been a long time since we’ve done one and I had somewhat forgotten what an adventure they can be. We’ve been a reference site for our ambulatory vendor for years, but because of everything going on with upgrades, Meaningful Use, and ICD-10 preparation, we had taken a break.

We’re old pros at site visits since we were early adopters of EHR and had put our ambulatory physician practices through an accelerated implementation that was not only rapid, but successful. We had only been live for a few months before the vendor started asking us to host site visits. Initially I was naïve enough to think it was simply because we had done a great job. Only later (after I swiped our vendor contract from an unattended filing cabinet) did I learn that our CFO had leveraged potential site visits against discounts on our initial software purchase. I’m glad he was confident in our potential abilities!

Our formula for site visits is pretty standard. Our local vendor exec and the prospect’s vendor exec bring the entourage to our corporate headquarters. We start with a presentation on the history of the physician group and our ambulatory project. We share some fairly detailed information about our methodology, decision making, and implementation processes and then talk about results we’ve achieved over the years.

Although most of the groups that visit us ask to go to the practices and shadow physicians, we have a strict policy of not allowing it. We make that clear when the site visit is scheduled. The disruption to patient care is aggravating to our physicians, and if I was a patient, I wouldn’t want a bunch of visitors looking over my doctor’s shoulder and asking questions about the software.

Instead, we invite some members of our clinical advisory board to join the group for lunch. Most of them will have their laptops or tablets with them, which allows for hands-on discussion of workflow or how they handle challenges. Not all of them are serious fans of EHR, but they usually provide a balanced perspective.

Although members of the vendor sales team are usually present, they’ve learned to just sit back and let it unfold. There have been a couple of account reps that tried to jump in and camouflage deficiencies in the product, but being on the receiving end of our evil eye usually shuts them up. We’re completely open about what the clinical and billing systems will (and won’t) do. Most of the reps have learned that prospects appreciate that level of candor.

We’ve had some visitors that were squeamish about having the vendor in attendance. When that’s the case, we’re happy to kick the vendor people across the street for coffee. Other visitors have tried to beat up on the vendor with them in the room in the hopes of increasing their negotiating power by making the product seem deficient.

My favorite site visit was a couple of years ago. The revenue cycle director and I are good friends and have done so many talks together that we decided to mix it up and do each other’s parts in the presentation. I’m not sure the prospect fully understood the humor of what was going on, but the sales execs could barely keep straight faces as I chatted about denial management and my billing colleague started talking about clinical quality.

Even though we’re somewhat contractually obligated to host site visits, our vendor has never asked us to hide anything or to portray anything other than our real experience. They’ve been respectful when we simply have too much on our plate and understanding when we refuse to do them because we’re waiting for delivery of code that’s been delayed and we want to make a point. We actually have fun doing them since we get to tell our story and we’re proud of what we’ve accomplished in an industry that’s still in its relative infancy.

You never know how visitors are going to behave in a site visit until they start talking. This one was one of those doozies.

It was a bit of an unusual visit to start with. The visitors were already live on our vendor’s platform, but had “paused” their implementation. They were coming to us to see an example of a success story and to hopefully learn ways to improve when they restarted their project. They are a high-value client, so a vendor VP and some other execs came along for the ride. Although they had provided us the back story beforehand, it was interesting to watch the visiting CMIO explain that his initiative was essentially a failure / money pit without actually admitting as much.

We set the stage with our group’s profile, which was similar to theirs when we started our project. We went through our financials, success metrics, clinical quality indicators, and then jumped into the discussion of our implementation methodology and physician adoption strategy. No matter what platform you’re on, the latter two are critical in my book. Implement faster than your organization can handle or slower than it needs and you have a mess. Fail to think about physician adoption and you have the same mess, but exponentially larger and more painful.

Barely two slides into our EHR implementation presentation, the visiting CMIO started interrupting. Every time I would talk about how we did something, he would jump in with a counterargument about why that wasn’t a good idea. I would talk about how we implemented our pilot practices in phases and he would explain that in his master’s coursework, they had discussed that phased implementations are a mistake. I’d talk about how we brought laboratory and document interfaces live with the billing system (months before EHR) to pre-populate charts and he’d argue with me about medico-legal risk. I would say the sky was blue and he would try to tell me it was brown.

I thought I was holding it together pretty well in the face of his bad attitude, but I had to work to not laugh at my co-workers, who kept darting their eyes around to see how people were reacting to his bluster. I spotted a sidebar conversation that I knew was probably an attempt to guess how long I was going to let him continue his boorish behavior. The sales execs were increasingly agitated and tried to redirect him without being adversarial, but no one from his hospital tried to intervene.

Finally, I reached my breaking point. You can make fun of some of our user engagement strategies. You can think we’re goofy at times with how we do team building and change management. But don’t diminish the product of thousands of hours of hard work by our staff and end users, especially when you’ve got your own project on hold and your vendor is flying you around the country trying to help salvage your implementation. And definitely don’t try to tell us our strategy “can’t possibly be effective” when we have brought hundreds of physicians live successfully with no real revenue impact to them.

I gave him my best “steely-eyed missile man” look – the same one I give medical students when they appear particularly unprepared and which has been honed by years of craziness in the ER. I simply said I guessed we didn’t have anything to really teach them and handed the presentation controller to my revenue cycle colleague.

She’s usually the master of the poker face, but this time her expression said it all. I thought I heard a couple of people suck in their breath, but they were drowned out by the sound of the vendor VP choking on his breath mint.

To her credit, my colleague rapidly advanced through the rest of my slides and dove right into the wonders of the central business office without missing a beat. I caught a couple of smirks among our site visit guests, so I’m encouraged that there is hope for them even though their boss is clearly a jerk. The CMIO seemed to be trying to figure out what had just happened and started sputtering and trying to backtrack, but my colleague pressed ahead. I’m betting our vendor won’t be inviting him to any other client sites any time soon. I’m hoping our next guests leave their confrontational physicians at home.

Are you a reference site? Have any good stories? How do you deal with adversarial visitors? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 8, 2014 News 5 Comments

News 5/7/14

May 6, 2014 News 12 Comments

Top News

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Comments from hedge fund manager David Einhorn send shares of athenahealth down nearly 14 percent Tuesday after he tells investment conference attendees that ATHN is one of a few “bubble stocks” trading at high valuations for no good reason. He added that athenahealth really isn’t a cloud vendor deserving of high share price multiples since its main role is as a business process outsourcer of mundane back-office physician practice tasks. He also said that athenahealth’s promotional videos are full of buzz words and that “Epic’s dominance will only grow” as “the undisputed winner from the fragmented IT market.” He predicted the company’s shares will drop 80 percent. Above is the one-year chart of ATHN (blue) vs. the Nasdaq (red), with shares closing Tuesday as Nasdaq’s fifth-largest percentage decliner.


Reader Comments

From Bratman: “Re: Vonlay acquisition by Huron Consulting. The acquisition price was $35 million, all cash, and was a 1.2 times multiplier on revenue. There were several interested acquirers. The price may have ended up lower since Epic forced the Vonlay owners to modify the terms of the Vonlay-Epic agreement to extend the non-compete for former Epic employees from one year to two years. Epic required this change before it would agree to transfer the Vonlay agreement to Huron. The legality of forcing Epic employees into non-compete agreements they never knew about or agreed to is definitely up for debate and the length of the new non-competes likely makes them unenforceable. Epic seems to be using its power to try to minimize employee attrition and limit the supply of certified third-party consultants.” Unverified.

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

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QPID Health raises $12.3 million in a Series B funding round and adds a board member from New Leaf Venture Partners.

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Radiology outsourcer Alliance HealthCare Services acquires the assets of OnPoint Medical Diagnostics, which offers a cloud-based scanner quality control system used by 81 hospitals, for $1 million in cash and two years’ of royalties.

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Huron Consulting Group closes its acquisition of Epic consulting firm Vonlay of Madison, WI.

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Pittsburgh-based teledermatology technology vendor Iagnosis raises $2.8 million from angel investors.

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Xerox will acquire ISG Holdings, which offers workers’ compensation software systems under the StrataCare and Bunch CareSolutions brands, for $225 million.


Sales

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Valley General Hospital (WA) chooses Medsphere’s OpenVista EHR for its 68 beds.

Alere Accountable Care Solutions will build a community-wide HIE for Whittier Independent Practice Association (MA).

Emerald Physicians ACO (MA) selects the eClinicalWorks Care Coordination Medical Record.


People

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Oneview Healthcare names Jeff Fallon (Fallon Strategy) as president, North America.

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ESD hires Cinthia Tenorio, LPN (Lake Health System) as CDI practice director and John Ortego (CTG) as Meditech practice director.

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Tracy Gregory (Linguamatics) joins SyTrue as chief scientist.

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Patrick Clark (Vonage Business Solutions) joins Wellcentive as CFO.

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Accenture CEO Jorge Benitez will retire from the company at the end of August.


Announcements and Implementations

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MModal announces enhancements to its Fluency Flex mobile dictation application for iOS devices.

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In Australia, Sydney Children’s Hospital Network announces plans to use commodity software for its telemedicine program, including Lync videoconferencing and Skype video calling, both from Microsoft.

RadNet goes live on Nuance PowerScribe 360 at the first of its 250 imaging centers and 27 practices.

Advocate Medical Group of Chicago (IL) implements Forward Health Group’s PopulationManager and The Guideline Advantage.

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Propeller Health earns FDA approval for the new generation of its inhaler-measuring asthma monitoring system.

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St. Joseph’s Hospital Health Center (NY) goes live with Epic.

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Zoeticx makes available an API that it says will allow developers access to “any EMR system.”


Government and Politics

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Massachusetts announces that it will abandon its $57 million CGI-built health insurance exchange website and hire hCentive, which developed three other state marketplaces, to build a new one. The state also says that just in case that doesn’t work, it will just join the federal exchange in November. Massachusetts isn’t sure if it will need to ask the federal government for more money than the $174 million it already received since it is disputing its CGI contract, but the “dual track” option it chose (the sequel to its disaster movie) will cost another $100 million.

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CMS reports that only 50 doctors and four hospitals have successfully attested for Meaningful Use Stage 2 through (or “thru,” as the slide says) May 1. CMS also reports that it has approved 66 of 72 applications for hardship exceptions.

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Michelle Consolazio of HHS tweeted this photo of the HIT Policy Committee thanking outgoing member and Epic CEO Judy Faulkner, who has been replaced as its vendor representative after four years by Cerner CEO Neal Patterson.

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The talking heads in this hysterically partisan and sensationalist Fox News program seem exceptionally clueless yet smugly superior about nearly everything, but Jesse Watters (I don’t watch TV, so I don’t know who he is) outdoes himself at the 12:40 mark when talking about the VA wait list controversy by declaring, “They’re still using paper records at the VA. They’re not even computerized yet.” That’s embarrassing no matter what your political persuasion, but of course he only plays a journalist on TV and can’t be expected to differentiate between disability claims forms and medical records.

National Coordinator Karen DeSalvo, MD says her husband, also a doctor, uses a “clunky” EHR. A bit of Googling suggests that her husband is (or at least was) an ED doc at Lakeview Regional Medical Center in Covington, LA, so perhaps his clunky EHR could be identified. I assume it’s Meditech since it’s an HCA hospital.


Innovation and Research

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MedStar Health (DC) will co-locate some of its employees in the offices of DC-based incubator 1776, connecting the health system with technology startups to arrange pilot projects. MedStar will also provide education for the 20 percent of 1776’s companies that deal with healthcare.

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IBM names 25 finalists in its Watson Mobile Developer Challenge. Those that are healthcare-related include GoGoHealth (telemedicine), Ultramatics (personalized health answers), Ringful Health (patient-physician communication), GenieMD (health management), Biovideo (information for expectant mothers), and Sense.ly/MyIdealDoctor (medical information).


Other

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Community Hospital (IN), which is treating the first US patient to be infected with Middle East Respiratory Syndrome (MERS), used its Versus RTLS system (along with video surveillance recordings) to identify employees that had come in contact with the patient, earning a mention on the local TV news report. Hospital CMIO Alan Kumar, MD says, “We can tell down to the second how long they were in contact with the patient, and how long they were in the room, and provide data to CDC.” According to the state’s health commissioner, “MERS picked the wrong hospital, the wrong state, and the wrong country to try to get a foothold.”

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Durham County, NC commissioners vote to give Lincoln Community Health Center $500,000 to install Epic, half the amount it requested. The $2 million implementation would allow the clinic to connect with Duke University Health System’s Epic system. Commissioners suggested hitting up Duke for more than the $1 million it offered toward the cost, with one saying, “In the big scheme of what’s been invested at Duke, between $500 million and $700 million, this additional half a million, I would hope they would be able to absorb that and do what needs to be done.”

Investor Lisa Suennen (“Venture Valkyrie”) writes a blog post about the recent Health Evolution Partners Annual Summit that is brilliant in both insight and wit.

And this group of people, who know everything there is to know about how we got into such a healthcare system mess (because they helped create it) and what has got to be tackled to fix it (even if not how to do that exactly) is dealing with quite a conundrum. They are caught in a vortex where they have to straddle the old world and new world—the land where healthcare decisions are mostly still driven by volume and not quite ready to chuck it all for a world based on “value.” … it is impossible to train the entire hospital to act in two completely different ways based on the patient who shows up. You simply can’t run two different workflows and two different case management programs and two different follow-up programs efficiently. Most of the time the actual caregivers in a hospital—physicians, nurses, etc.—don’t even have a clue in what insurance program or risk-pool the patient is enrolled; certainly no one is yet handing out bar-coded wrist bands that tell the caregiver whether to minimize or maximize services, based on the financial motivation (I hope).

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Points from the 2014 HIMSS Regional Extension Center Survey, with 37 of 60+ RECs (which have received $677 million in taxpayer support) responding:

  • Nine out of 10 say their #1 business issue is staying alive, with several respondents saying financial sustainability isn’t possible or isn’t something they’ve planned adequately.
  • One-fourth of the RECS say they won’t be viable by the end of the year, and half of those that say they’ll survive expect state grants to keep them solvent.
  • Three-fourths of them want more ONC grants to keep afloat.
  • One-fourth of the respondents say they will partner with other RECs to ensure their viability.
  • Staffing ranged from two to 80, with an average of 23 FTEs.
  • The #1 services priority is providing information services related to business intelligence and data warehouses, while optimizing EHRs and providing Meaningful Use services came in right behind.

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Fitch downgrades the bonds of Centegra Health System (IL), blaming its acquisition of physician practices and its EHR rollout (McKesson Paragon, I believe) for “light operating profitability.”

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Blue Cross Blue Shield of North Dakota fires its CEO right after the company reports an $80 million loss largely due to problems in its Noridian Healthcare Solutions subsidiary, which developed Maryland’s failed health insurance exchange website. Paul von Ebers had vowed Thursday to improve the organization’s financial position by reducing administrative overhead, which its board took to heart in unanimously voting Monday to fire him effective immediately.

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Guess which vendor is looking for a marketing director? Wrong … it’s HIMSS, trying to find someone to help push its many publications.

@deansittig tweeted out a link to an Epic promo-type video by Lucile Packard Children’s Hospital Stanford (CA) that is well done, but I liked the one above better.  

Some hospitalists at the annual conference of the Society of Hospital Medicine focus on IT issues, urging their peers to “establish ourselves for the informatics role we have taken” by earning informatics subspecialty board certification.

Weird News Andy intones that “exercise can kill you.” In Portland, OR, a naked man doing pushups in the middle of the street at 4 a.m. is run over and killed by a car, with predictable toxicology results pending. WNA can’t keep his hands off his Oregon as he files another story that he calls, “is there a governor in the house?” as ED doc and Oregon Governor John Kitzhaber jumps out of his limo to perform CPR on a collapsed woman (WNA wonders he couldn’t spare some compressions for Cover Oregon.)

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The family of a Miami doctor sues the driver of the Lamborghini in which he died when it crashed into a car stopped at a light at over 100 miles per hour two weeks ago. The driver, the founder of a vodka company, was drunk when he and the doctor left the Versace Mansion after discussing investments. The non-practicing doctor had a vodka company, too, going by the nickname Dr. Vodka.


Sponsor Updates

  • Deloitee’s Harry Greenspun, MD is interviewed about mobile health devices on Federal News Radio.
  • Strata Decision Technology, MedAssets, and Prominence Advisors are named to Becker’s “150 Great Places to Work in Healthcare.”
  • Helen Figge with Alere Accountable Care Solutions discusses how to still meet requirements for MU Stage 2.
  • Capsule’s Michelle Grate explores healthcare as a complex adaptive system and explains why it matters.
  • Beacon Partners recommends five steps for developing a CDI program as part of preparation for ICD-10.
  • Voalte releases a white paper offering three key elements to secure physician texting.
  • Advanced Data Systems will integrate Merge Healthcare’s iConnect Network with its MedicsRIS.
  • Truven Health reports that premature or low-birth weight infants funded by Medicaid cost nine times more than uncomplicated newborns.
  • T-System’s Elizabeth Morgenroth offers three reasons to start documenting for ICD-10.
  • Aventura CEO John Gobron discusses awareness computing bringing intelligence to the clinician workflow at the Healthcare IT Institute in Sarasota, FL.
  • Cottage Hospital (NH) reports that it has saved over $100,000 in interface fees since going live on Summit Healthcare’s interface engine.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 6, 2014 News 12 Comments

Morning Headlines 5/6/14

May 5, 2014 Headlines No Comments

Epic, Cerner are top EHRs for docs meeting meaningful-use requirement

Epic remains the top vendor for Meaningful Use attestations by eligible providers with a complete EHR, while Cerner is the top vendor for EPs attesting with a modular EHR.

Health Information Exchange among U.S. Hospitals Continues to Grow, but Significant Work Remains

ONC says in a recent report that 93 percent of US hospitals now possess a certified EHR. In a separate report, it says that 62 percent of the same hospitals are using HIEs to exchange laboratory results, radiology reports, clinical care summaries, or medication lists with outside providers.

Fitch Rates Centegra Health System & Affiliates, IL Ser 2014A Revs ‘BBB'; Downgrades Rev Bonds

Fitch Ratings has lowered its outlook for Centegra Health System (IL) from stable to negative, and issues a rating of BBB on its revenue bonds. Fitch expected improved performance in 2013, but one-time EHR implementation costs, combined with an increase in practice acquisitions, dampened financial results. Centegra then added $200 million in debt to pay for construction of a 128-bed hospital.

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Monday Morning Update 5/5/14

May 4, 2014 News No Comments

Top News

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Blue Cross Blue Shield of North Dakota partially blames its poor 2013 performance on newly implemented EHRs of providers that delayed their insurance claims submissions, which it says caused it to underestimate the value of those claims. I didn’t realize until reading the CEO’s discussion that Noridian Healthcare Solutions is a subsidiary of BCBS of North Dakota. Noridian built the failed Maryland health insurance exchange and was fired from its $193 million contract in February. Maryland has hinted that it may sue Noridian in hopes of getting back some of the $55 million it has already paid toward Noridian’s five-year contract. North Dakota’s insurance commissioner says the agency is watching BCBSND to make sure it doesn’t try to increase insurance premiums in the state to cover Noridian’s projected $17.8 million loss. Every time I hear that name I think of Veridan Dynamics from “Better Off Ted.”


Reader Comments

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From Guillermo del Grande: “Re: CIOs. Here’s a list of “A Few Things CIOs Should Know (Or Think About).”

  • If you want the FDA to regulate EMRs but have a service level agreement of two days for major fixes, you may want to learn about software development models. If you have to ask what a software development model is, how did you get to be a CIO?
  • FDA requires waterfall development. This is not Niagara Falls.
  • How many of the good EMRs use waterfall any more? Here’s a hint: not many. Most are agile. EMRs are more complicated than a medical device. How many different medical devices connect to your EMR? Do you even know? Do you feel like testing every scenario per medical device that connects to your EMR? Do you think your vendor does that?
  • Are you afraid to let developers and your IT people watch healthcare and the software in action? You’re not agile. You’re going over the waterfall in a barrel.
  • If your SLA is two days, but you require a change control meeting that only happens every two days, and then a software testing process that takes two days, and then another change control meeting, and then only migrate changes once a week, you may have a problem.
  • How long does it take your vendor to fix a minor issue? You should be asking this question before you buy.
  • What makes you think your IT staff can fix a problem in a SLA period when you don’t know if it’s something your IT folks can do or it’s something the vendor has to do?
  • Do not try to manipulate an IT staff or a vendor into repairing your highest priority by only reporting that item. IT staff have lots of end users. Vendors have lots of customers and sometimes will fix issues only if lots of different customers are seeing them.
  • If you think a problem made it to the field because the software testers at the vendor didn’t find the issue, you don’t know much about how software companies. Remember that story about the guy who had his heart burned out of his chest a few years ago because of a bug? If not, look it up on HIStalk — it was a known issue for 10 years. Ask your vendor how many known issues they have in their tracking system. Hint: they’re not all reportables.
  • The Supreme Court is reluctant to take new cases and software developers are reluctant to fix bugs for many of the same reasons and use some of the same processes.
  • “Not a customer workflow” is heard at many a vendor to defend not fixing a bug, often before there are any customers.

Thoughts on FSMB’s “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine”

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The Federation of State Medical Boards is a Euless, TX-based non-profit trade association that represents all US medical boards that license physicians. It does not make regulations directly, but state boards usually adopt its recommendations.

Key points from its report include:

  • Telemedicine is defined as requiring videoconferencing. Encounters conducted via telephone or email are not telemedicine.
  • Physicians must be licensed in the state “where the patient is located” because physicians are licensed by individual states.
  • A physician-patient relationship must exist, but it can be established using telemedicine technologies.
  • The physician must document the patient’s history. Having the patient complete an online questionnaire doesn’t count.
  • The physician should obtain the patient’s informed consent, including a description of the security features of the telemedicine technologies being used.
  • The physician must make themselves available following the encounter.
  • The physician may not promote services for which they are receiving payment or benefits.

The intention of the group is clear. It wanted to prevent providers from selling prescriptions online. Nearly all of the wording restates requirements that are already in effect for traditional physician-patient encounters, clarifying that those requirements hold true for telemedicine-based encounters. The policy attempts to prevent online-only practices by prohibiting misleading websites, undisclosed financial relationships, and running an online consultation service simply to sell drugs online.

The only significant (but unsurprising) recommendation is that physicians must hold a license in the state where the patient is physically located during the encounter. That also is no different for traditional medical practice – an ED doctor in Florida can see vacationing patients from anywhere in the world from a Florida-based hospital, but he or she can’t travel to those other states to treat the same patients at their homes unless licensed there.

The most positive development for telemedicine supporters is that the model policy allows patients to be managed entirely by telemedicine without an in-person component.

The negative aspects of the model policy are:

  • FSMB isn’t a particularly transparent organization and didn’t disclose the members of the work group or who it consulted to develop its proposed policies. It also did not provide a way to incorporate industry or patient feedback.
  • Doctors already diagnose and treat patients by telephone and email, but those options are not considered telemedicine in the model policy, although it doesn’t limit or prohibit them. That would suggest that nothing changes for those visits, although future questions may come up involving payment for services.
  • Doctors must be licensed in the state where their patients are located, which isn’t even accurate in some cases (military physicians.)
  • It doesn’t address the desirability (nor should it have, most likely) of national rather than state-by-state licensure of physicians or an expanded reciprocity program that would make it easier to practice across state lines. That’s the biggest clash between telemedicine proponents and state regulatory boards, whose revenue and power come from overseeing in-state professionals and (arguably) protecting them from competition.
  • It calls for requirements that exceed those of non-telemedicine encounters, such as prohibiting randomly assigning patients to physicians (which EDs, walk-in clinics, and other services do routinely) and requiring that the medical records of patients be reviewed before treating them (which urgent care providers can’t do by definition.)

The conclusion is that telemedicine proponents wanted a policy that opened up state borders and encouraged innovative care, while FSMB’s goal was to prevent unethical doctors from running pill mills and online medical scams.


HIStalk Announcements and Requests

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A commendable 37 percent of poll respondents use an activity tracker at least five days per week. New poll to your right: should doctors be licensed nationally instead of state by state? It’s an important question if you think telemedicine can improve the efficiency and geographic reach of physicians.

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

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Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

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Vocera announces Q1 results: revenue up 10 percent, adjusted EPS –$0.14 vs. –$0.07, beating expectations for both. VCRA shares were the second-largest NYSE percentage losers on the news, shedding 14.7 percent. From the conference call:

  • The company released the Vocera Collaboration Suite and an expanded Vocera Care Experience in the quarter.
  • It opened a development shop in India.
  • President and CEO Brent Lang called hospital spending “challenging” as hospitals wait to see where changes in patient population and healthcare reform go.
  • He quoted a report that says 97 percent of hospitals don’t believe their nurses have the right tools to determine the availability of caregivers and that consumer-grade smartphones aren’t working well for hospitals.
  • Lang mentioned a tentative US Army study in which use of Vocera’s system provided a 12-month payback.
  • The alarm management system it gained with its mVisum acquisition in January 2014 will be launched this summer.
  • Lang said the company will pursue more acquisitions.

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Evariant, which offers a patient marketing platform, raises $18.3 million in a Series B funding round.

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Hc1.com says it will create 175 jobs in central Indiana over the next five years, having just received $3 million in state tax credits. I can’t really tell what the company is selling since the site is a mess of buzzwords and vaguely feel-good statements behind one of the worst company names I can imagine (shades of 1999), but it seems to be a customer relationship management system for outreach labs and radiology practices.

General Dynamics will lay off at least 645 Utah-based call center employees it had hired under a CMS contract to take Healthcare.gov related inquiries about insurance.

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CPSI announces Q1 results: revenue up 5 percent, EPS $0.69 vs. $0.63. From the conference call:

  • The company installed financial systems in nine hospitals and clinical systems in 12.
  • Add-on sales made up 26 percent of total revenue
  • The company expects to gain ground with MU Stage 2 as “a number of our competitors continue to struggle with obtaining certification for their software, as well as struggling with the installation and usability of their software in the small hospital market.”
  • Its new ED module will GA in Q3.
  • CEO Boyd Douglas says that while Epic and Cerner talk about moving into smaller hospitals, CPSI isn’t seeing much of that, mostly just their usual small-hospital system competitors (Meditech, McKesson Paragon, and Medhost, I assume.)
  • The Leerink Swann analyst managed to say “sort of” four times in one question, also using that annoying verbal crutch twice in a follow-up question.

Sales

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The Defense Health Agency awards Leidos a $70.7 million, sole-source contract to support its EHR systems for the next 11 months.

Nashville-based MindCare Solutions signs the first customer for its tele-behavioral platform and provider network, Genesis HealthCare, which will offer remote psychiatric services to its 400 skilled nursing facilities.


Announcements and Implementations

New York State Immunization Information System will use Blue Button to make records available to the parents of patients.

AMIA calls for nominations for its 2014 awards for informatics leadership, nursing informatics, informatics health policy contributions, and informatics innovation. Winners won’t necessarily be the best, just the best who pay AMIA dues: a key selection attribute is “demonstrated commitment to AMIA through membership.”

The Boston Business Journal profiles Alere Accountable Care Solutions, mentioning that it will offer its care management, connectivity, and analytics systems in Europe. I interviewed CEO Sumit Nagpal in October 2013.


Government and Politics

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President Obama makes fun of Healthcare.gov at the White House Correspondents Dinner on Saturday, saying that he has replaced his campaign slogan “Yes We Can” with “Control-Alt-Delete.” Near the end of his presentation, he pretended to have problems with a video and former HHS Secretary Kathleen Sebelius got a cameo as she rushed to the podium to fix it. The President’s last words of the evening, after thanking the press and uttering the obligatory “God Bless America,” were “Thank you, Kathleen Sebelius.” Other than following the party line, I question whether the fired Sebelius did anything worthy of that level of adulation.


Other

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A Minneapolis cardiologist, intrigued by the use of scribes in the ED, tries them in his cardiology clinic. The four doctors he studied were spending all but two minutes of their average 13-minute patient visit working on the computer. Turning that work over to scribes shortened the visits to nine minutes, but beyond that efficiency gain, patients got seven minutes of that as face-to-face time, nearly four times as much compared to non-scribe visits. The doctors saw 60 percent more patients using scribes, boosting revenue by $206,000 in 65 clinic hours. Patient satisfaction was unchanged, which is nice for making a case for scribes but not so nice for the doctors — all that extra face time apparently didn’t impress patients.

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Dr. Andy’s HIStalk Practice rant on the problem list is drawing interesting comments from his physician peers. Example: why can’t the problem list attribute cause and effect, or allow attaching meds to specific problems (or more than one problem?)

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The dean of the new Dell Medical School at the University of Texas (I wonder who paid for that?) says that while Austin is behind in a competitive biotech industry market, “Areas like digital health and informatics, no one owns that right now. That is an area that’s rapidly growing and ultimately it will win and be a huge area … Companies who handle personal data see that health is a huge frontier and represents a huge economic engine, but no one has been able to innovate the platform that scales to a huge field … There are companies waiting to do that, but no one is inviting them in. We can do that.”

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Mineral Community Hospital (MT) reports to its board that its NextGen implementation resulted in unplanned upgrade-related downtime and a 45-day delay in sending bills out for the 25-bed hospital.

A man Googling for CPAP machines for his sleep apnea notices that unrelated Google searches start displaying ads for those devices, leading him to complain to the Office of the Privacy Commission of Canada that targeting ads based on a health-related search constitutes a privacy violation. The office agrees after an investigation, determining that the practice not only violated its advertising guidelines, it also violated Google’s own policies that state the company won’t use health-related browser cookies to target ads. Google blames some of its advertisers and says it will improve its training and monitoring programs.

New York State Insurance Fund blames a software upgrade after the medical records of 20 worker’s compensation patients are to the wrong attorneys.

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Bizarre: a mother is awakened by the sound of a man’s voice in her sleeping 10-month-old daughter’s room screaming, “Wake up, baby.” She runs into the room and sees the camera of the video baby monitor turn toward her as the hacker who is controlling the camera starts screaming obscenities at her. The woman’s Foscam IP camera had been updated to fix a security flaw, but she didn’t know about it. The conclusion is that the Internet of Things will give hackers a lot of household (and hopefully not hospital) gadgets to play around with.


Sponsor Updates

  • The Health IT Quality Solutions Program of Quest Diagnostics certifies iPatientCare’s EHR as a Silver Quality Solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 4, 2014 News No Comments

News 5/2/14

May 1, 2014 News 4 Comments

Top News

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Defense contractor ManTech International will acquire 7Delta, which provides healthcare IT contracting to the VA, DoD, and HHS. ManTech wants a piece of the VA’s Transformation Twenty-One Total Technology program, for which 7Delta has won more task orders than any other vendor.


Reader Comments

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From Matthew Holt: “Re: HIMSS Analytics interview. Can the HIMSS PR people just stop with the BS? How many times do they have to say that they are a ‘cause-based, mission-based organization?’ This guy is selling market research to IT vendors and HIMSS non-vendor ‘members’ are all providers feeding at the federal teat. None of them are helping the starving in Africa. HIMSS has been on an acquisition tear in the conference and media business, including doing some extremely uncharitable activities towards its competitors there (not to mention the way they treat their vendor clients.) And Steve Lieber got paid $900K in 2011 and presumably over $1m by now. I’m a capitalist, I have no problem with anyone making money in healthcare while trying to change the world for the better, and I support the idea of more IT being a good thing. But seriously, who are they trying to fool with this rhetoric?” I seem to remember that HIMSS Analytics was originally set up as a for-profit subsidiary of HIMSS when it was first acquired many years, but something (presumably the IRS) forced a change. HIMSS is like hospitals: somehow it keeps minting more and more money and using it to buy for-profit companies (conference organizers and publishers, mostly) and then suddenly declaring them to be non-profit. The annual conference generates a ton of cash that can only go so many places: big salaries (check) and acquisitions (check). Or the less-obvious choice: HIMSS could scale its income to its expenses rather than vice-versa.

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From Boy Wonder: “Re: Allscripts. The company sent an email to its portal users saying Medfusion caught the the company off guard with its announcement.” Medfusion announced this week that an unspecified payment dispute will force it to shut down access to its portal by Allscripts customers as of May 31, 2014 unless they sign a new contract directly with Medfusion. The Allscripts email reassures those users that they can be live on the Allscripts FollowMyHealth portal (the former Jardogs product it acquired in March 2013) by October 1 if they commit by May 31. The bottom line is that those 30,000 users have to make a commitment to one of the companies within four weeks, and if they choose Allscripts, they’ll have to try to strike their own deal with Medfusion to keep their portal running until they can make the switch. The Tullman-era Allscripts made a colossally bad decision to redistribute Medfusion’s portal instead of developing or acquiring its own, making both the company and its customers vulnerable to the actions of an external vendor. Allscripts predecessor Misys made a similarly bad decision in licensing a customer version of iMedica (now Aprima) that Allscripts resold as MyWay before retiring it and leaving those users in an equally unpalatable position through no fault of their own. In both cases, Allscripts gets a black eye for putting its customers in a jam and then trying to migrate them to another Allscripts product to fix it.


Dim-Sum provides the usual cryptic and amusing update of the Department of Defense’s commercial EHR system selection process, or as he or she describes, “Status and latest rumors in the halls of bedlam, located right K Street.” This is a huge many-billion dollar deal and the only insider reports I’ve seen are coming right here from Dim-Sum, so thanks for the update.

May 2014

  1. DHMSM competitive teams are almost in place.
  2. Themes are being discussed, ideas are being circulated and people are starting to wonder, “Why did I pick this team?”
  3. CACI, where are you, and has anyone seen where Harris, SRA, and yes even CGI went?
  4. HP is getting press and nobody knows why. I bet you wish you thought of the Newseum “experience” (outstanding job by IBM/Epic, or should it be Epic/IBM?)
  5. Whatever you do, IBM, do not mix Epi-BM for your team moniker. That is a bad connotation in healthcare.
  6. GDIT is sitting on the sideline with Northrop Grumman watching in awe as their fellow poobah Lockheed has found functional and willing partners in Siemens and Athena. Good luck, best of breeders! Lockheed please note: Boston is an academic mecca, you will be comfortable there. Now the firm in the Philly suburb, whatever you do, do not wear a Redskins tee shirt — Eagles fans will hurt you.
  7. CSC is trying to figure out how they can make a cloud in the shape of an EHR – fun!
  8. Accenture is still confident, proof positive that their strategy was focused on any large EHR vendor in the Central time zone. Personally, I like the combination – well done, Jim and Ken – airline tickets are cheaper to Kansas City anyway. Kansas City, sadly, is located 70 miles south of the airport.
  9. Teams are congealing. However, smalls are scrambling and the ones invited to the table are excited. They tend to pontificate upon their vast knowledge of the current environment and then wonder if that is something to brag about.
  10. IBM, can you please bring back the Blue Man Group for an epic focused percussion’ fest? That would be very cool, and yes, the pun was intentional.
  11. There will be an online course for all participating COTS vendors explaining  cutting edge Kyrgyzstan interoperability standards like FTP, as well as expressing how each and every hospital across the Military Health System has one single positive attribute — they serve heroes. Outside of that, the technology is fair to awful.
  12. Had some initial thoughts about themes for each team:

    IBM / EPIC: “Judy and Watson, sitting in a tree, K-I-S-S-I-N-G!”
    Lockheed / Athena, Siemens: “We build planes, ships, and missiles. How tough a nut can healthcare be?”
    Accenture / Cerner: “DHMSM is like an onion — lots of layers and lots of tears.” Sorry, Accenture, my kids are watching Shrek.

More in June…


HIStalk Announcements and Requests

I hear through murky sources that a huge acquisition will be announced Friday morning (by “huge” I mean “you won’t believe it.”) I’m skeptical, but also receptive to being tipped off early if you are knowledgeable of the supposed deal. The fact that I’ve heard it only once suggests that my caution is well placed.

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The latest “CMIO Rant” from Andy Spooner, MD is on HIStalk Practice where he addresses “The Problem List: Foe or Enemy?” complete with screen mockups. His first rant was “The Great Prescription Pad Race.”

Highlights from HIStalk Practice this week include: Medfusion parts ways with Allscripts over payment disputes. The EHRA opposes ONC’s proposed 2015 voluntary EHR certification criteria. A National Quality Forum panel finds pay-for-performance programs unintentionally worsen disparities between rich and poor. Forty percent of physician practices are looking to replace their EHRs, while those struggling to improve collections are taking on more aggressive billing strategies. Researchers find that almost one-third of patients fail to fill first-time prescriptions. 2014 MU incentive payments indicate a potential slow-down in EP participation. Thanks for reading. This week on HIStalk Connect: NIH announces a series of grants aimed at spurring mHealth research focused on chronic disease management, remote patient monitoring, and telemedicine. Doximity, often described as LinkedIn for doctors, announces a $54 million Series C round. Israeli startup Consumer Physics launches a Kickstarter campaign to fund a handheld digital spectrometer that it claims can scan food and calculate calorie and nutritional content. Dr. Travis discusses the 10-year horizon of connected health devices and the implications that they could one day have on healthcare overall.


Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

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The Kuwait Investment Authority takes a $100 million position in Patrick Soon-Shiong’s NantHealth. I wasn’t paying attention to the company’s logo placement on the page above and thought that the female on the left was sporting a Hiawatha-like Native American headdress.

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Merge Healthcare reports Q1 results: revenue down 20 percent, adjusted EPS $0.04 vs. –$0.01. From the earnings call:

  • The ICD-10 delay moves up window during which hospitals may consider upgrading their imaging systems.
  • The company’s MU2 certifications give it opportunities with ambulatory radiology and orthopedic customers.
  • Merge improved its Epic integration and avoided an issue involving provisional patents.
  • Merge’s eClinical OS clinical trials system has 18,000 users.
  • The company will introduce a retinal screening product for diabetes and glaucoma patients, with the target customer being hospitals that are bearing risk.

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Streamline Health announces that its Q4 and FY2013 results will be delayed until the end of May as the company’s new auditors review its internal controls. The company says three unnamed go-lives will contribute recurring revenue beginning in Q2 and it booked a new sale for one of the products it obtained in its $6.5 million acquisition of Unibased Systems Architecture in February 2014.

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Etransmedia Technology acquires Medical Billing Solutions, expanding its geographic presence placing it in the top 10 large scale RCM services business.

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Athenahealth announces that CFO Tim Adams will leave the company to take the same role with electronic commerce vendor Demandware, naming VP/Controller Karl Stubelis as acting CFO.


Sales

New York City Health & Hospitals chooses UpToDate from Wolters Kluwer Health for mobile clinical decision support.

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Citizens Medical Center (TX) chooses electronics forms management from Access.


People

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IBM names Keith Salzman, MD (CACI International) as CMIO for IBM Federal, which hopes to sell Watson and other technologies to the federal government for healthcare use.

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Health Data Specialists promotes Bill Chandler to national accounts manager.

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TriZetto announces John McAuley (PatientPoint) as president of its provider solutions business.

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John Thornbury, a highly awarded hospital IT leader in England, died on April 28.


Announcements and Implementations


St. Vincent’s Medical Center (CT) goes live with Cerner, according to a tweet from the hospital’s CEO.


Government and Politics

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CMS proposes increasing Medicare payments by 1.3 percent overall for FY2015 for the 3,400 acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program and that have met Meaningful Use EHR requirements. Hospitals that haven’t met Meaningful Use would lose 0.675 percent of the proposed increase.  

ONC releases a 30-second promotional video about Blue Button.

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The VA says it will develop the next generation of its VistA EHR with the help of contests and challenges. Former VA guru Tom Munnecke is unimpressed: “It is not clear how the government owning all submissions in a contest will attract the best in the field. It is unlikely that many people would be interested in spending time and money to enter a contest where they give away their intellectual property.”

The Health IT Policy Committee will hold a May 7 public hearing in Washington, DC to review ONC’s certification process. It seeks input on allowing anyone to submit test cases so that certification measures real-world scenarios.

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HHS didn’t want the Congress-mandated ICD-10 delay in the first place so it’s hardly shocking, but a proposed 1,700-page rule changing Medicare payments seems to confirm that ICD-10 will be implemented at the earliest date allowed by law – October 1, 2015. It could be that someone just updated the pre-delay document and forgot that Congress mandated only the earliest date, not the actual date – it’s only a proposed rule. The same document also spells “HIPAA” as “HIPPA,” so even the federal government gets confused.


Other

Most physicians order unnecessary tests and procedures if their patients insist, but they also agree that ordering such tests and procedures is a big problem. They think doctors are better equipped to solve the problem (58 percent) than the government (15 percent), according to the telephone survey funded by the Robert Wood Johnson Foundation.

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Athenahealth VP Kyle Armbrester explains the company’s More Disruption Please program:

Our unique spin is that, because we take a percentage of net collection, we don’t actually partner with technology companies. We partner with outcomes companies like ourselves. So to be a part of the More Disruption Please program, we give our partner the scorecard, and that scorecard shows how they’re either driving more revenue to the doctors for doing the right things, or decreasing operational inefficiencies inside the providers’ workflow, or helping to improve patient and provider outcomes.

I’m always fascinated when family members riot and destroy hospital infrastructure after an unfortunate patient outcome (which doesn’t usually happen in the US, thankfully.) In Pakistan, a mob riots at a hospital, trashes the place, vandalizes cars in the parking lot, and beats up doctors and other employees after an appendectomy goes wrong and the patient ends up on a ventilator. Five days later, doctors haven’t declared the patient dead, and I wouldn’t either given the situation.

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Microsoft gives in on its “no more updates for Windows XP” policy after the Department Homeland Security warns people to stop using Internet Explorer until the company fixes a security hole present in versions 6 through 11 that “could lead to complete compromise of the affected system.” The company says it will issue a one-time-only Windows XP auto-update to fix the vulnerability.

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CHIME tweet out this photo of its 1994 Board of Trustees. Who can name them all?

Weird News Andy calls this story “Well Shut My Mouth.” Pediatrics nurses in a Saudi Arabian hospital are caught taping the mouths of babies shut to stop them from crying.


Sponsor Updates

  • First Databank will present new safety guidelines for pediatric dosing at the 2014 Pediatric Pharmacy Conference April 30-May 4 in Nashville, TN.
  • NC HIE upgrades its Orion Health Direct Secure Messaging.
  • Ingenious Med will integrate Entrada’s dictation and content fulfillment technology into its charge capture platform.
  • A report names Allscripts, Health Catalyst, McKesson and Verisk as key players in the population health management market.
  • HCS will lead a discussion on LTCH CARE data set changes at the NALTH meeting in Washington, DC this week.
  • Gartner names Validic in its 2014 Cool Vendors for Healthcare Payers report.
  • Health Catalyst announces speakers and topics for the Healthcare Analytics Summit 2014, to be held September 24-25 in Salt Lake City, UT.
  • DrFirst expands its Rcopia e-prescribing with electronic prior authorization functionality from CoverMyMeds.

EPtalk by Dr. Jayne

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Mr. H already scooped me on this one, but the Federation of State Medical Boards (FSMB) recently adopted “Policy Guidelines for Safe Practice of Telemedicine.” My gut reaction is that this is just another way for licensing boards to extract more money from physicians by requiring additional licensure. My second response in actually reading the document (numbered line by line such that it reminded me of a deposition) is that there seems to be a whole lot of self-importance going on here. The seven-and-a-half page document has a Preamble, for goodness sake.

Physicians have been practicing by telephone and using secure messages for years, but apparently now we need to codify new standards just because there is technology involved. News flash: all the old standards (HIPAA, standard of care, ethics, etc.) already apply.

Some of the policy’s contents are very much common sense:

  • The need for a “credible physician-patient relationship.” I suppose they’re trying to prevent physicians from turning into so-called pill mills, but then again they haven’t done a great job of preventing those in traditional face-to-face medicine. A quick look at the number of dishonest physicians selling work excuses and gratuitous prescriptions for controlled substances proves that.
  • Adherence to privacy, security, consent, and safety principles. Again, already in force simply because we’re physicians.
  • Proper supervision of non-physician clinicians.

On a subsequent read, however, several other provisions caught my eye.

  • “Where appropriate, a patient must be able to select an identified physician for telemedicine services and not be assigned to a physician at random.” Isn’t this exactly what happens when a patient presents to the emergency department, an urgent care, or many public health clinics? They are seen by the next available physician. They don’t get to pick and choose. Same thing with the assignment of patients to managed Medicaid panels, at least in my state. Again, not a lot of choice there and often a random assignment. Why should telemedicine be treated any differently?
  • “A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located.” Again, this feels like a money-grab. I practice in a border town. The idea that I should have to get a different state license to practice telemedicine on a patient when I can see them in person with the license I already have if they’re willing to hop in the car, bus, or train is preposterous. What is magical about telemedicine that I should have to prove my competence to another state board?
  • “The practice of medicine occurs where the patient is located.” I tend to think the practice of medicine occurs where my brain and ears are located – where I can hear, understand, and process the patient’s story. In medical school, we learned that 80 percent of the diagnosis comes from the history. The exam just confirms it and provides additional information when it is unclear. I guess the FSMB is now going to turn that old adage on its head. What if my patient sends me a camera phone picture of her rash (via a secure patient portal message using Certified EHR Technology) while on her beach vacation? Do I need a Florida license now because that’s where the patient is? The policy seems to say so, per Page 4, Lines 3-5 and 13-14. Maybe those line numbers were handy after all.
  • “The maintenance of preferred relationships with any pharmacy is prohibited.” Excuse me? I have had preferred pharmacies my entire career. I prefer Mom and Pop shops rather than chains, especially when they know their stuff and don’t try to sell my patients aisles of junk food, questionable candy, and outdated cosmetics. I really prefer a pharmacy that doesn’t tell the patient, “The physician never sent your script” when they’re too busy to check the secondary screen on their prescribing software. I agree with the follow-up sentence that physicians shouldn’t send scripts to a specific pharmacy in exchange for benefits if we’re talking about SIGNIFICANT benefits (oh yeah, there’s a typo on Page 7, Line 23) but really, no preferred pharmacy? Does the fact that the Mom and Pop down the street brings a physician homemade cookies during the holidays make her unduly coerced? After all, that’s a benefit. What if the physician also takes them cookies because she’s grateful they are so meticulous with her patients’ scripts? Does that negate the benefit?

In this day and age with the mobility of our society, mobility of physicians, and the technology at hand, it seems more and more preposterous that individual states should continue to license physicians individually and/or without a greater degree of reciprocity. There are all kinds of problems with physicians being disciplined in one state and just going for a license in another state. Why not have a national licensure process? I suppose a counter argument would be that Medicare has a single provider identifier but still can’t correctly identify fraud, but that’s another story.

I really like their closing paragraph. Here’s a winner: “…physician remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral)…” Why should this be unique to telemedicine? Isn’t this something we grapple with on a daily basis, patients who come in wanting a script or referral they don’t need? What about those that want a test “because Medicare pays for it” whether they need it or not? Often our remuneration is ultimately based on whether we comply, either through patient satisfaction scores or the simple fact that they will vote with their feet. On the flip side, what about aesthetic medical services? Aren’t those ultimately driven by patient-desired outcomes? Especially ones like this recent find for aesthetic foot surgery.

On its face, this policy regulates us too much in regards to telemedicine, but perhaps I’ll go a little Jonathan Swift and suggest that maybe we’re not regulated enough in regards to everything else. It’s like saying we’re going to regulate wine in a box but not in a bottle. At this point, the policy is “advisory” so states can take it, leave it, or modify it.

What do you think about the FSMB’s plans for telemedicine and telemedicine technologies? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 1, 2014 News 4 Comments

News 4/30/14

April 29, 2014 News 6 Comments

Top News

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MModal files its plan to exit Chapter 11 bankruptcy by August 15. The company provided a statement: “MModal is pleased to have reached this important milestone in our financial restructuring process. The proposed Plan of Reorganization reflects the previously announced agreement the company reached with the controlling majority of its lenders and bondholders that will dramatically reduce the company’s debt, strengthen its balance sheet, and provide it with significant financial flexibility.”


HIStalk Announcements and Requests

ICD

Bonny from Aventura provides an Charles Schulz-powered illustration of the ICD-10 situation that will resonate with many people.

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I noticed these signs in a doctor’s office today. It seems that all forms of customer-insulting emphasis are represented: capitalization, bolding, underlining, and massive deployment of exclamation points (always five except for the laptop message, which ends with an unprecedented six exclamation points for those undeterred by inferior numbers.)


Upcoming Webinars

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

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

4-29-2014 7-29-41 AM

Physician networking site Doximity closes a $54 million Series C fundraising round, planning to expand into Canada and to add other healthcare professionals, such as nurses.

4-29-2014 1-47-30 PM 

Truven Health Analytics acquires Fortel Analytics’ predictive healthcare fraud technology, which will be integrated into Truven’s payment integrity solutions.

4-29-2014 11-29-53 AM

General Atlantic commits $125 million to Alignment Healthcare, which offers a care coordination solution.

4-29-2014 1-49-40 PM

Alere reports Q1 results: revenue down three percent, adjusted EPS $0.55 vs. $0.53, missing revenue expectations. The company also reported that its Health Information Solutions segment experienced a decline in net product and services revenue from $134.2 million a year ago to $123.7 million.

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Press Ganey acquires Dynamic Clinical Systems, a patient-reported outcomes services and solutions provider.

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Infor completes its acquisition of substantially all the assets of GRASP Systems International, a provider of automated patient acuity, workload management, patient assignment, and consulting services.

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Consumer engagement provider Accolade acquires konciergeMD, which offers a platform for care plan adherence.

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For-profit hospital operator HCA discloses in its earnings call that it took in $30 million in EHR incentive money in Q1 vs. $39 million in 2013, incurring EHR-related expenses of $43 million and $26 million, respectively, meaning it spent exactly the same as it made in the two years. Seems like quite a coincidence.

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Roper Industries says in its earnings call that its Sunquest operation experienced “double-digit revenue growth” due to improvements in its implementation process and expects to have a “quite an exceptional year in 2014.”

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A German business magazine predicts that Siemens will announce on May 7  the elimination of 5,000 to 10,000 jobs and the merging of its four main divisions (industry, energy, healthcare, and infrastructure/cities) to create a flatter hierarchy.


Sales

Craneware wins a seven-year, $3.8 million contract with an unnamed US hospital group for its Chargemaster Corporate Toolkit.

Southern Illinois Healthcare, MBB Radiology (FL), Radiology Imaging Associates (CO), Southwest Diagnostic Imaging Center (TX), St. Paul Radiology (MN), and Washington Radiology Associates (VA) and 13 other organizations select Merge Healthcare’s iConnect Network interoperability platform for clinical data exchange.

CHE Trinity Health will implement Verisk Health’s Provider Intelligence solution and DxCG platform to manage its national population health management initiatives.

4-29-2014 9-48-17 AM

The board of trustees of Cumberland River Hospital (TN) approves $156,644 in upgrade costs to allow the hospital to update its CPSI software to meet Stage 2 MU requirements.

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The University of Arizona Medical Center will use services from Besler Consulting to identify Medicare Transfer DRG underpayments.

Kettering Health Network (OH) selects Wolters Kluwer Health’s ProVation Order Sets.

University of New Mexico Medical Group chooses StrataJazz from Strata Decision Technology for budgeting and planning.


People

4-29-2014 1-53-45 PM

Castlight Health appoints Ed Park (athenahealth), brother of co-founder and US CTO Todd Park, to its board.

4-29-2014 1-55-41 PM

Symphony Technology Group promotes Al Vega to president/CEO of Symphony Performance Health.

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Jonathan Perlin, MD, CMO will step down as chair of ONC’s HIT Standards Committee. He will be replaced by Jacob Reider, MD of ONC.

MEA|NEA appoints Scott Hefner (Jopari Solutions) VP of sales.


Announcements and Implementations

4-28-2014 3-24-39 PM

Practice Fusion launches a population health management offering in collaboration with drug manufacturer Merck, giving practices a real-time dashboard that compares a provider’s patient vaccination rate with the rates of other Practice Fusion providers.

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Regional Medical Center Orangeburg (SC) goes live on Cerner’s patient portal.

Central Illinois Health Information Exchange, Lincoln Land Health Information Exchange, Illinois Health Exchange Partners, and MetroChicago Health Information Exchange connect their health information exchanges, which collectively serve 63 hospitals.


Government and Politics

4-29-2014 1-17-28 PM

CMS releases an interactive search tool to streamline access to Medicare provider payment data.

The GAO appoints three members to the Health Information Technology Policy Committee: Christop U. Lehmann, MD, American Academy of Pediatrics (representing vulnerable populations); Neal Patterson, Cerner (representing vendors); and Kim Schofield, Lupus Foundation of America’s Georgia chapter (representing consumers and patients.) Paul Tang, MD of Palo Alto Medical Foundation was reappointed as physician representative.


Innovation and Research

Physicians reviewing EHRs carefully read the impression and plan section, but only quickly scan details on medications, vitals, and lab results, according to a study published in Applied Clinical Informatics. Researchers recommend optimizing the design of electronic notes to include “rethinking the amount and format of imported patient data as this data appears to largely be ignored.”

Brigham and Women’s Hospital chooses four companies in its “shark tank” competition for pilot projects: Twine Health (collaborative chronic disease management), MySafeCare (patient and family reporting of safety concerns), Healo (remote monitoring of wound healing), and Tenacity Health (peer health coaching.) 


Other

The Federation of State Medical Boards approves telemedicine guidelines that include a policy to apply the same standards of care for remote medical encounters as for in-person encounters. The guidelines also call for physicians to care for only those patients located in their licensure coverage areas, establish a credible patient-physician relationship; and adhere to safety and privacy principles.

A Boston Globe columnist names Nuance Communications CEO Paul Ricci as the most overpaid executive in Massachusetts based on his compensation of $87 million over the past three years, during which time the company’s share price dropped 16 percent.

4-28-2014 9-44-15 AM

Medfusion ends its relationship with Allscripts “due to unresolved payment disputes” and gives the 30,000 Allscripts users of its patient portal until May 31, 2014 to sign a contract directly with Medfusion. The termination is hardly a surprise given Allscripts acquisition of the competing Jardogs product last year.

Boston Medical Center (MA) terminates its transcription contract with MDF Transcription Services after discovering that the records of 15,000 of its patients are visible on the company’s Internet server.

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St. Joseph’s Hospital Health Center (NY) discloses in a prospectus offering to sell $68 million worth of junk-quality bonds to pay for a new power plant and EHR system that it will probably be sued over claims that a disruptive surgeon slapped and verbally abused anesthetized patients going back to early 2012.

Rural hospitals are considering EHR implementation assistance as one reason to affiliate with a larger organization, hoping to earn financial incentives or avoid penalties.

University of Mississippi Medical Center (MS) CIO David Chou recounts what it’s like when a hospital loses Internet connectivity and access to cloud-based applications. The article mentions that low adoption rates prevented using Twitter and Facebook for communication during the outage, which I assume means by smartphone cellular since nobody could get to those sites otherwise (although they could use self-hosted Yammer instead if Microsoft still offers that.)

A San Francisco Examiner opinion piece by an orthopedic surgeon complains about his hospital’s use of the “all-pervasive Epic” system, which he says has caused doctors to focus on the computer instead of the patient and has sterilized the medical record to the point of uselessness. He seems to blame the system for the behavior of its users, saying it only improves care “from the point of view who want to watch data from across the room” while he prefers to “talk to the patient” and be a “hands-on doctor,” neither of which as far as I know is prohibited among Epic users.

UPMC (PA) will partner with one of three unnamed companies to sell analytics software it developed to benchmark costs per individual physician. UPMC says it spent $5-12 million to develop the system, which it claims has reduced its readmissions by 37 percent.

4-29-2014 1-06-39 PM

A state audit reveals that a former IT consultant with the University of Iowa Hospitals and Clinics illegally sold $57,000 worth of hospital computers to staffers and friends between 2005 and 2013. A woman tipped off the IT department after trying to get technical support from Dell for a laptop the consultant gave her, only to be told that it was registered to the hospital.

Weird News Andy (“Weird News You Can Use”) finds this ironic: hundreds of attendees of the national Food Safety Summit in Baltimore get food poisoning. WNA is also transported by this story, in which doctors trigger vivid memories of a patient’s childhood as they stimulate areas of his brain with electrodes in trying to determine the cause of his epilepsy.


Sponsor Updates

  • McKesson launches Managed Mobile Services to simplify mobile device management.
  • iHS2 releases a research report entitled “Healthcare Security: 10 Steps to Maintaining Data Privacy in a Changing Mobile World.”
  • Craneware and its customer Southeastern Ohio Regional Medical Center will discuss the future of patient access at the National Association of Healthcare Access Management 40th Annual Education Conference May 16 in Hollywood, FL.
  • Independent auditor LBMC confirms that PerfectServe has achieved Service Organization Controls (SOC) 2 Type II of its security and privacy controls.
  • Allscripts recognizes its customer Carson Tahoe Health (NV) for attesting for MU Stage 2 using Allscripts Sunrise.
  • Medhost adds high-availability disaster recovery and remote monitoring and management to its managed IT service offerings.
  • Shake IT Baby is the theme for Impact Advisors’ annual Impact Palooza April 30-May 2 in Scottsdale, AZ.
  • William J. Leander, SVP for Santa Rosa Consulting, will discuss value-based healthcare at next month’s MUSE 2014 International Conference in Dallas.
  • Allscripts profiles Unity Health System (NY) in a blog post and discusses how dbMotion’s HIE technology helped Unity achieve better outcomes.
  • Liaison Healthcare partners with AOD Software to connect its long-term provider customers with lab and imaging vendors on the Liaison EMR-Link hub.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 29, 2014 News 6 Comments

HIStalk Interviews Cynthia Petrone-Hudock, Chief Strategy Officer, The HCI Group

April 28, 2014 Interviews 1 Comment

Cynthia Petrone-Hudock is chief strategy officer of The HCI Group of Jacksonville, FL.

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Tell me about yourself and the company.

I have a background in financial institutions, about 17 years. I’ve spent about the last eight years in healthcare.

As our mission states at The HCI Group, I focus on collaborating somewhat from a management consultant perspective. I work with clients to identify what their needs are and then develop creative solutions that reduce the cost of healthcare and at the same time improve their ability to increase the quality of healthcare.

We were established to meet the system implementation needs of healthcare organizations, but we promote cost-effective solutions. In the electronic health record arena, that seems to be very important these days.

 

People always compare healthcare to the early days of banking before ATMs and online services. How do you compare the two?

It’s quite fascinating because I do see a lot of analogies. We are at the stage now in healthcare where we’re selecting systems and implementing them, but then truly sustaining them in a cost-effective way and getting to interoperability.

You think about interoperability in the banking world. They’ve mastered it. I think we’ll push a little further in healthcare when it comes to data analytics and making sure that we’re using the data that we capture in a proactive and focused way. We saw some of that in banking, too, but I think it will mean more in the protocols of care in the healthcare arena.

 

Treating patients as a customers means hospital systems should include some aspects of a customer relationship management system. Is there a demand for those capabilities?

Yes. A lot of our focus is on business intelligence. We launched a sustaining support service line at HCI. Our goal is to support users of the electronic health record, but when you really think about it, it’s business intelligence of how they’re using that system to meet the needs of their clinicians who are taking care of their patients is what it’s all about. 

Maybe the future, when we’re talking about patient engagement, it’s really the analytics around that and the touch points of how the patients are interacting with the healthcare system which will be key. Forward thinking, where are we three to five years from now? It’s full-service care and you can interoperate on the health record. You’re certainly putting that full-service care capability in the hands of a clinician.

 

Back to the bank analogy, hospitals are putting in systems that run what happens inside the bank or at the ATM, but not how banks market to customers and prospective customers in between and keep them engaged. Could the same transition happen in healthcare?

Yes.  I think healthcare is starting to realize that they can get their arms around that capability. We’re seeing it now. We’re seeing it with marketing departments and healthcare systems who are now focused on engaging the consumer. Even with the new consumer technology, whether it’s handing out free Fitbits and having folks proactively start to monitor their health and having reasons for them to be reaching out to the doctor in a proactive way.

It’s exciting. I think we will see that. It gets back to the ability for the patient to be in control of their care. I’m hoping that’s what the enabling technology brings to bear.

 

For large hospitals, the market has pretty much boiled down to Epic versus Cerner. From the selections you’ve been involved with, why do hospitals choose one versus the other?

They start with their thoughts around the business case and their total cost of ownership, including their incumbent situation. But they do focus on functionality and where they want to get down the road. 

Quite often the cultural difference between the two organizations plays in some of the demonstrations and the ability to understand how their patient will be engaging with their organization going forward and whether that’s an integrated touch point or not. Most of my background is in Epic, but The HCI Group is vendor neutral.

 

How do you characterize the cultural factor differences between the vendors and which one prospects respond to?

I haven’t been around the block enough to weigh in on that from a client’s perspective. I’m guessing different clients would tell you they have different reasons why they are more comfortable in one camp versus the other.

Both systems, of course, are very exciting for us to be working with, and just knowing that we have organizations worldwide that are getting on EHRs for the first time, which is also exciting. We do a lot of work in that space, so I get to see organizations who are literally on paper, and just knowing that they’re going to get on electronic medical records is changing the protocols of care at the moment they go live. 

It’s more a fit and feel between the two organizations and whether that organization feels confident that they’ll have interoperability opportunities down the road. I think even the paper-oriented firms abroad are very focused on someday it should all interoperate.

 

Have hospitals done a good job in understanding and budgeting the post-live requirements for personnel and maintenance costs? 

I think there’s a lot of realization going on after they get past the capital period and they’re in their expense mode. They’re realizing that they need to focus on the lowest common denominator. 

For instance, our sustaining support line is a good example where when we go into an organization, we help look at the total process of supporting that application. At every point along the cycle, if there’s a way to do that service at a higher quality and a lower cost, of course we assist in improving the process. It’s the ability of having capacity that can ebb and flow, whether you’re looking at an upgrade or you’re looking at bringing in the new module that you didn’t go live with out of the gate. 

I do believe the CIOs are finding themselves in the situation where they’re explaining to the CFO why their piece of the total cost of ownership pie has gotten bigger. In some cases, it’s going to stay that way because you can no longer give care without the enabling technology. This is where The HCI Group is going to be able to go in and collaborate. Every organization’s slightly different. Some will say, I need a little support with the Epic application, for instance. Others will say, it’s the whole support model — I just can’t keep the staff on board at the right caliber to be servicing my clinicians. The unique approach by organizations in terms of what is best for their future is where we focus. A lot are going down the path of shared services, which I’m sure you’ve heard about.

 

Do you think hospitals looked at the cost of these systems as requiring a return on investment or did they just assume they are a cost of doing business?

If you had asked me eight years ago, I would have said they’re a cost of doing business. Now I believe organizations are more focused, even on the international front, with making sure they at least can realize the benefits that go along with spending the money. The return quite often is focused on the quality of care, which is nice to hear.

But there’s a new eye on this total cost of ownership that I didn’t see when I entered eight years ago. It’s exciting for me because some of our international clients are public healthcare systems, and whether you’re spending the public’s money or you’re spending an individual’s or a payer’s money, you still want to be doing it an efficient, effective way. I’m happy to see that.

 

How are the needs of those international customers different from domestic ones?

We are focused on being recognized as a global leader in delivering innovative IT solutions. What we’re finding is there’s a lot of opportunity on the global front to learn lessons that we’ve experienced here in the States.

I think you do have to take into consideration where they are in the journey. Some are where you may think healthcare in the US would have been 20 years ago. It looks to someone from the States like a pretty simple, low-hanging fruit opportunity, but what it brings is a tremendous transition. I think it’s greater change management for them than we have experienced here as we’ve come along. 

In most cases, whether we’re in the UK, the Middle East, or Australia, when I turn the system on, we’ll be changing protocols of care in our country, which is very exciting, to making sure that we’re being fiscally responsible. It’s been wonderful to work in that international marketplace and bring to them lessons learned so they don’t have to maybe climb over the same hurdles that we have done here in the States.

 

Have you worked on projects where hospitals wanted to involve patients more in their care?

A few organizations, we’ve worked with around patient engagement. The ones that are most exciting, they’re not being really led by the IT department — they’re being led by the business development arm of the organizations. 

Of course, in the Epic world, there’s Connect, but then there’s also these opportunities to engage the community in care, some of the new devices that are out for the consumers. What’s exciting about is it there’s a focus to think through new strategies to engage patients. It’s more than just the patient portal. It’s the medical devices that you may be able to use in your home and bringing more home health, which as the baby boomers age, we definitely need to be focused on as an industry. It’s been exciting to be working with the business development arms of the healthcare systems.

 

Give me some unusual, bold predictions for the next 3-5 years.

It’s really analytics and how we’re going to end up using all of this massive data. I think there will be a blip in inefficiencies since we have the challenge of big data, how we govern, what’s being asked of the IT department to pull out information around that data and use it in a positive way to change care, evidence-based care and research. That’s the exciting part.

We’re all  heads down pushing through the new technology today, but the exciting part will be five years from now. There are organizations, of course, that are ahead of the curve and doing it already. But to bring the rest of the country and the world to where we have as close to real-time information to be making great decisions.

 

Any final thoughts?

In terms of looking at where The HCI Group operates, we’ve just recently brought in a new CMIO, Dr. Bria. He has a fabulous background as one of the founders of the concept of the CMIO. He’s going to be working on some clinical service lines for us which start to leverage the ability of what the electronic health record has brought to the industry. So I guess in closing, wait and see what we’re able to do with it. We’re all excited at The HCI Group to have him on board and to refocus ourselves on the CMIO’s needs and not just the CIOs that we support so well today.

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April 28, 2014 Interviews 1 Comment

Monday Morning Update 4/28/14

April 26, 2014 News 9 Comments

Top News

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Cover Oregon waves the white flag and shuts down its $248 million health insurance exchange website without having enrolled a single citizen. The state will convert the site for Medicaid enrollment for an additional $35 million (federal taxpayers will pay 90 percent of that) and everything else will be turfed off to Healthcare.gov. The only winner is Oracle, which was paid $134 million even though the state says the company failed to deliver what it promised. The folks who run Cover Oregon, who seem to think their credibility emerged unscathed, say it would have cost $78 million to fix the disaster it oversaw but only $5 million to piggyback onto Healthcare.gov, which it could have done on Day 1. The money Cover Oregon wasted, like that of other states that decided they could build their own sites slightly less incompetently than the federal government, is pretty much gone since the site was to have paid for itself via a tax on insurance company sales.


Reader Comments

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From The PACS Designer: “Re: Google Ara. Google’s approach to the next smartphone will be a modular one called Ara from Google’s ATAP (advances technology and projects) group. By allowing the Android phone to be constructed to a controlled style, it will let developers limit what a user can do with the smartphone. This should be of interest to those who want to reduce BYOD usages in institutional settings.” It’s an interesting approach, like taking tablets back to the IBM-compatible PC days when you could buy components from anybody and just plug them in. I suppose the upside is that your phone will have a long life cycle since it’s really just a core board that accepts components. On the downside, Google excels at building ugly, frustratingly non-standard products (Gmail) and Apple and Samsung phones are selling just fine even if they are rendered obsolete after only two or three years. Not to mention that Google has no retail stores from which to sell and support consumer hardware. I’m no expert, but this project has “bust” written all over it, which seems to be a regular occurrence among the Googlers these days.

From Ex-Epic: “Re: Epic. Has been sending a team of people to Denmark (Copenhagen) for a few months now on regular sales/early stage implementation meetings. Haven’t seen it mentioned here with the other international sales mentioned lately.” I mentioned in November 2013 that Epic would be providing systems for all of eastern Denmark.


HIStalk Announcements and Requests

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Most poll respondents don’t think any differently about HHS after it released Medicare physician payment information. New poll to your right: do you use an activity tracker such as FuelBand or Fitbit at least five days per week? My sense is that the wearables fad is over – the devices don’t measure a whole lot given their cost and walking still isn’t fun or practical for many people – they don’t need discouraging electronic reminders that they failed to meet their goal.

Listening: new from Stream of Passion, because I can go only so long without needing some Dutch progressive-opera metal (fronted by a female singer from Mexico for some reason.)

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I support DonorsChoose projects that help classrooms in need, and in return, I get nice thank-you emails and photos from the teachers who appreciate the support. I realize I haven’t mentioned the most satisfying part – receiving letters from the students themselves. This particular project was for remanufactured toner cartridges and file drawers for a total cost of $187 as donated by HIStalk on behalf of readers. One of the students said, “I’m grateful that you donated to us because some teachers don’t have any printing supplies and my teacher was one of those people, but now he’s not, so I’m thanking you.” This is from a highest-poverty school in Mississippi, where the teacher (Mr. Delperdang, a Teach for America teacher )was spending his own money printing classroom materials from home.  


Upcoming Webinars

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


Acquisitions, Funding, Business, and Stock

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From the Cerner earnings call:

  • The company’s backlog increased to $9.24 billion. For non-investment types, “backlog” refers to products or services that have been sold, but whose revenue hasn’t been recognized due to accounting principles. In non-manufacturing businesses like healthcare IT, backlog is a good thing because it represents sales that haven’t shown up as income yet but will down the road. Backlog isn’t positive for manufacturers because it means your factory isn’t cranking out widgets fast enough, meaning you’ll need to make big capital investments to increase capacity or else your customers will find another vendor.
  • Sales revenue increased 4 percent, but the big jump was in services at 25 percent. Cerner is very good at generating that kind of recurring revenue without having to go through the grueling process of finding new customers, especially ones who are also considering Epic.
  • The company sold zero new ITWorks or RevWorks deals, and in fact “have not added a full RevWorks client in recent quarters.” Cerner just can’t seem to get anything right when it comes to financial software and services.
  • 25 percent of the quarter’s bookings were to non-Millennium customers. That’s a big deal – obviously the company is taking business away from someone else’s customers.
  • The company says the ICD-10 delay will give a slight boost to its revenue cycle business because some prospects were on a software hold while focusing on ICD-10. They didn’t mention that if that’s true, business will take the same slight downturn next year when ICD-10 looms again.
  • Revenue from sales outside the US dropped 16 percent, mostly because of reduced low-margin hardware numbers.
  • Cerner’s highly publicized deal with Intermountain Healthcare was summarized as pushing trigger events in front of clinicians, with the challenge being to turn the processes Intermountain has developed into “self-contained diagnostic, treatment, outcome, and reimbursement containers” that “replaces the claim in the fee-for-service world” and that can be used in non-Cerner systems. Sounds great if it works, which has never been the case in any example I can recall where a big-name hospital’s rules were benevolently sprinkled down like holy water on bowing masses of less-blessed hospitals.
  • The company mentioned HIMSS exhibits that showed “elegant graphs that purport to provide great insight into the data,” but that unless you can put that information in front of the physician in real time, “you’re just reporting the news vs. making the news.” That sounds inherently true, but the reality isn’t quite that dramatic – a hospital could use an analytics system to find potential areas of improvement (right down to the individual physician) and then use its order entry/clinical decision support system to build in guidance make it easier for physicians to do the right thing. Hospitals have plenty of capability built into the systems they already own without chasing yet another Intermountain project that seems to work for nobody except Intermountain. Every hospital I’ve worked in had plenty of information that could have improved outcomes and cost – what they lacked wasn’t technology, but rather the willpower to make the significant percentage of cowboy doctors follow the agreed-on rules. They needed competence and leadership, not more information to ignore.
  • Concluding the Intermountain hype was a statement saying that the most exciting part of the partnership is to sell Cerner consulting services.
  • The company still claims it can steal some Epic clients who have reached EMRAM Level 7 “because they don’t feel like the solution they have will suit their future needs.” I would think the best chance of that happening would be to undercut Epic’s maintenance costs, but Cerner didn’t mention that.
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Tee Green, CEO of Greenway Health, provided HIStalk with this statement regarding the departure of President Matt Hawkins (above),who came over from his previous role as CEO of Vitera when Vista Equity Partners bought Greenway and combined the two companies in November 2013:

Matt Hawkins was instrumental in driving the growth and operational efficiencies at Vitera Healthcare, helping position that organization to combine with Greenway Medical Technologies and SuccessEHS to form the company Greenway Health is today. As Matt prepares to assume a new leadership role outside of Greenway, we’re very excited for him and wish Matt and his family nothing but the best. As Greenway moves forward, our priorities remain the same: to continue supporting and enhancing our solutions and to help our customers remain efficient and financially strong as they deliver care that improves the health of their patients and whole patient populations.


Sales

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Texas Health Resources will deploy the AirStrip One clinical mobility solution throughout its system.


People

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Joshua Seidman, PhD (Evolent, ONC) joins Avalere Health as VP of the newly created Center for Payment and Delivery Innovation (according to the press release) or Center for Delivery System System and Payment Innovation (according to his LinkedIn profile.)

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KentuckyOne Health (KY) names Doug Jones (Providence Health & Services) as regional CIO.


Government and Politics

The AMDIS listserv brings up an interesting CMS attestation calculation quirk: any measure that requires “more than” a specific percentage actually requires the next-higher whole number percentage. You fail if you hit 50.4 percent on a measure that requires “more than 50 percent” since CMS rounds down to 50 percent and you didn’t exceed that. It’s bizarre that they round numbers at all.

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The HIMSS EHR Association offers its comments to ONC’s proposed 2015 EHR certification criteria:

  • Early notice of proposed changes helps vendors prepare, but doesn’t address the real problem — certification rules are changed too often.
  • Vendors would have less than a year to build 2015 requirements into their products, so they want the edition labeled as 2016 rather than 2015.
  • Vendors can’t spend all of their time chasing certification requirements – they also have to consider customer requests and other government-mandated changes.
  • ONC underestimates the cost for vendors to keep up with its requirements – EHR says the real cost numbers are 10 times those ONC puts out and the 2015 criteria will be more than 15 times more expensive than ONC claims.
  • EHRA doesn’t think certification should be required for anything other than providers collecting HITECH money – certification should not be broadly expanded.
  • EHRA says it’s not reasonable to put the electronic clinical quality measures in 2017 edition certified software – there’s not enough time left.   

Innovation and Research

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Brigham & Women’s Hospital (MA) will hold Pilot Shark Tank on Monday, where entrepreneurs are invited to pitch their ideas to hospital doctors and nurses who can approve a pilot project. Finalists are CareMon (3D optical patient monitoring), Constant Therapy (iPad-based stroke rehab therapy), Healo (remote monitoring of wound healing), Home Team Therapy (PT programs for home), MySafeCare (patient and family reporting of safety concerns), Revvo (bio-adaptive exercise bike), Tenacity Health (peer health coaching), Twine Health (collaborative chronic disease management), VerbalCare (patient-caregiver communication), and Vital Score (Apgar-like scoring of unhealthy behaviors that contribute to chronic illness).


Technology

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In the least-surprising news of the week, Google+ goes comatose as its leader quits, its teams are reassigned, and the groups working on its Hangouts and photo features are moved under the Android operating system. Only Google could have designed product even clunkier and more confusing than Facebook except without the first-mover advantage and network effect that keep Facebook popular (at least for now.) Nobody wanted to use it as a Facebook alternative, so maybe at least some of its expensively developed parts can be salvaged for something useful. People wants EHRs to be as simple to use as Facebook, so maybe Google could drag up the moldy source code for Google Health and kludge something together that would turn two flops into one success.

Most electronic hospital  equipment can be taken over by hackers,according to a study by healthcare provider Essentia Health: IV pumps can be changed over the network, Bluetooth-powered defibrillators can be triggered at will, and unsecured medical images can be viewed by anyone, for example. The Essentia team also found that they could reboot some devices to force them back to factory defaults and that many pieces of equipment are connected directly to the Internet instead of being inside the firewall, allowing any hacker to simply plug into an available hospital jack and start finding devices to hack. A key finding is that EHRs accept data from unauthenticated devices, so bogus information could cascade into more harmful treatment decisions.

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More speculation on why Nike stopped manufacturing its FuelBand activity tracking hardware: the software portion (NikeFuel) may end up on Apple’s iWatch or other wearable platforms.


Other

Security experts say the hacker network that calls itself Anonymous may be responsible for a series of cyberattacks launched against the website of Boston Children’s Hospital (MA), which left patients and clinicians unable to use the hospital’s portal (the site is down as I write this Saturday afternoon). The group had demanded that the hospital fire the head of its child abuse prevention unit after a high-profile custody battle in which the hospital filed medical abuse charges against the parents of a 15-year-old female patient who was later placed in the state’s custody. Anonymous found itself embarrassed two weeks ago when it launched attacks against Israel-based sites, but Israeli hackers launched a counterattack by tracking the IP addresses of the Anonymous members and hacked their computers, including hijacking their webcams to snap and publish photos of the not so Anonymous members.

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Athenahealth announced last week that it was dropping its membership in the HIMSS EHR Association, which it says “ostensibly” represents EHR vendors in federal policy debates. The company says it “never really belonged there in the first place” because EHRA is dominated by non-cloud EHR vendors and athenahealth isn’t really an EHR vendor but rather a services company (a debatable point.) Athenahealth (a) doesn’t like that EHRA pushes for more vendor-friendly federal policies (longer timelines, lower bars) and (b) wants CMS to name vendors whose customers seek hardship exemptions while EHRA “presses just as hard to protect its members from the consequences of their failures by opposing any such disclosure.” EHRA decided not to wage press release warfare with athenahealth, but says its membership diversity creates value and credibility and while it’s sorry to see athenahealth leave, some of the company’s statements are incorrect (specifically the one claiming that EHRA opposes hardship exemption transparency, about which I could indeed find no stated EHRA position.) Athenahealth also says it takes too much time to explain to people why it regularly disagrees with its own trade association. My opinion: athenahealth voluntarily joined EHRA hoping to gain something from it (DC influence, publicity) and is quitting for the same reason (publicity and hoping to differentiate itself competitively from its former fellow members, especially after ATHN announced unimpressive quarterly result last week). Customers don’t care one way or another, and with the company’s size, it can do its own Washington glad-handing. Every member of CommonWell Health Alliance (except Sunquest) is also a member of EHRA, so maybe athena should storm off from that group as well.  At some point, a large, publicly traded company crosses the line from “disruptor” to “disruptee” and athenahealth may be getting close.

ECRI Institute’s listing of healthcare IT data integrity as the #1 problem facing healthcare organizations includes specific examples: data entry errors, missing or delayed delivery, accepting incorrect default values, copying and pasting, using both paper and electronic systems, and incorrectly attributing device data to the wrong patient. It recommends assessing clinician use, improving testing, offering better training, and giving users an easy way to report system problems they see.

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Athenahealth’s Jonathan Bush and business writer Stephen Baker team up to write Where Does It Hurt?: An Entrepreneur’s Guide to Fixing Health Care, available May 15. Sounds interesting except that JB’s incessant verbosity makes it tough to convince free milk drinkers to plunk down cash to buy the cow.

Strange: a New York doctor is sued for stiffing the Scores strip club for $135,000 worth of lap dances in four visits over 10 days. He claims he was drugged by club employees and disputes that he was even present despite security camera video suggesting otherwise. A Scores spokesperson said of the cardiologist, “If I had five dancers dancing for me, I’d be in the ICU. He’s a heart doctor – I guess he’s got a good heart.”


Sponsor Updates

  • Liaison Healthcare enhances its EMR-Link EHR interoperability solution with Meaningful Use Stage 2 capability.

Switching from a Cloud-Based EHR Vendor

I mentioned a while back about hearing from a physician practice that was finding it next to impossible to extract EHR information from their cloud-based EHR to move to a different system. I offered to write about the experience from the points of view of both the vendor and the practice. Here is a summary of the communication, which should provide lessons learned for both customers and vendors.

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From Matthew “Toby” Cox, MD, MPH, Families First Pediatrics, South Jordan, UT

  • We started with ADP AdvancedMD in April 2011, but found it didn’t meet our needs and we are switching to the peds-specific PCC EHR.
  • ADP Advanced MD claimed on their website that they won’t hold data hostage – they will provide an encrypted hard drive with all data plus mapping and documentation within one week for $1,250.
  • We paid $1,250 on January 30, 2014 and received a thumb drive several weeks later. The new vendor, PCC, says the new information is a comma-separated value file that makes no sense.
  • After several weeks of getting no response, ADP AdvancedMD (whose national headquarters is less than a mile from our practice) sent a technician, who said the file the practice was given was incomplete. Another file was supposed to be sent, but wasn’t.
  • Three months later, we still have no usable data and the ADP AdvancedMD representative suggested pulling up every patient chart and printing a PDF.

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Response from Jim Elliott, VP of marketing, ADP AdvancedMD

  • The delay was due to a process issue that has been resolved.
  • The ADP AdvancedMD rep hand-delivered the 4.5GB data file that can’t be split into smaller files readable by Access or Excel because records are sorted by date of service and that would break up a patient’s chart.
  • The practice had set up templates and each field they used can only be defined by the practice since the system doesn’t “know” how they are being used.
  • The new vendor, PCC, understood the layout and required no further changes.

From Dr. Cox

  • Nobody from ADP AdvancedMD told us in training that when we added items to templates that we were adding “codes” that would complicate the data extraction process.
  • Our last EHR conversion from another vendor at least gave us individual patient PDFs that could be accessed by a menu button – not ideal, but usable.
  • The practice management data extract from ADP AdvancedMD was perfect. Only the EHR information is a problem.
  • I asked ADP AdvancedMD during their sales pitch about our access to our data if we decided to leave since it seemed unusual that they were offering a month-to-month contract. Their salespeople said we would have access to the data and be provided a hard copy of it. I was not savvy enough at that time to probe deeper into this as I took their word for it (dammit Jim, I’m a doctor, not a computer data specialist!)

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From a programmer at Physician’s Computer Company (PCC)

  • We never indicated to ADP AdvancedMD that we found their extract usable. The limited guidance we received was weeks later and only after repeated requests.
  • We do vendor conversions every week and have done every major vendor. This is the only one that we have not been able to convert.
  • Anyone on ADP AdvancedMD who thinks they can switch vendors is deluded.
  • Here is a consecutive snippet … it’s the same date of service for the same patient, but it’s a random mix of stuff.

From Dr. Cox to ADP AdvancedMD

  • If you were handed that data file, how would you import the information into Advanced MD step by step?
  • Has anyone every successfully imported that information into another system?
  • Is a bulk export to an industry-standard layout (CCD/CCR/CCDA) possible?
  • Can a mass export to PDF be done as a last-ditch effort to get patient information into their new system?

From Jim Elliott to Dr. Cox

  • There were communications gaps between the two vendors. ADP AdvancedMD spoke to PCC’s technicians and understood that the new vendor had everything needed to convert.
  • ADP AdvancedMD is still a few months away from delivering the capability to bulk export to CCD or CCR, but it can be retrieved from individual patient records.

The practice’s information is still not available in their new system three months after their initial request and payment and Dr. Cox is worried about the clinical impact to patients of missing three years’ of their data.

My suggestion: regardless of whether your EHR vendor is a traditional or cloud-based one, ask them now (not later) for the names of former customers who successfully migrated off their platform with all data intact (which will prove that it’s at least possible). Or, far less desirably, ask for a sample extract with documentation.

I’ll also ask the technical folks who work for EHR vendors to weigh in on the data snippet above. Would your company be able to migrate intact, complete patient records using a file with that layout? It looks to me as though the individual items are identified using free text and non-standard codes that would be meaningless outside the source system.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 26, 2014 News 9 Comments

Morning Headlines 4/25/14

April 24, 2014 Headlines No Comments

Cerner Reports First Quarter 2014 Results

Cerner reports Q1 results: Revenue is up 15 percent, to $784 million, driven by all-time high bookings of $910 million. Adjusted EPS $0.37 vs. $0.33, meeting analyst’s forecasts.

A fatal wait: Veterans languish and die on a VA hospital’s secret list

The Phoenix Veterans Affairs Health Care system, unable to keep up with the VA’s mandated 15 to 30 day appointment turn-around time, starts maintaining a secret "off the books" wait list where some veterans end up waiting for more than a year. As a result, an estimated 40 veterans died while waiting for care they otherwise would have received. The House Veterans Affairs Committee has ordered all records from Phoenix to be preserved while an investigation is launched.

Congress unhappy with DoD, VA health records progress

House lawmakers will withhold 75 percent of the VA/DoD’s 2015 budget request for their joint EHR project until they demonstrate that progress is being made.

Medical Records and Health Information Technicians

The Bureau of Labor Statistics is predicting a 22 percent increase in jobs for medical records and health IT workers over the next 10 years.

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April 24, 2014 Headlines No Comments

News 4/25/14

April 24, 2014 News 4 Comments

Top News

4-24-2014 3-29-28 PM

Cerner delivers strong Q1 numbers: revenues up 15 percent, adjusted EPS of $0.37 versus $0.33 a year ago, both in line with analyst estimates. The company also reported its $910.2 million in bookings was an all-time number for a first quarter.


Reader Comments

4-23-2014 11-18-55 AM

From Haberdash: "Re: Matt Hawkins. Greenway sent an email to customers saying that President Matt Hawkins is on the way out.” The note, which was sent Tuesday, indicates that Hawkins is leaving the company to pursue “an exciting new leadership position outside of the company.” The departure of Hawkins, who was CEO of Vitera Healthcare prior to the Greenway/Vitera merger, could be unsettling for any Intergy customers already concerned about Greenway’s long term product strategy. I emailed the company Wednesday for a comment but have not yet received a reply.


HIStalk Announcements and Requests

4-24-2014 2-25-32 PM

inga Mr. H is out and about today so I am flying solo. I am not sure what he’s up to but since I’d like to be sitting on a beach with an umbrella drink, I’m just going to pretend he’s doing something fun like that.

Some highlights from HIStalk Practice this week include: EHR vendors could learn from Surescripts’ “alliance of foes” model. The AMA reminds providers to order their ICD-9 codebooks for 2015 now that ICD-10 has been temporarily shelved. CVS MInuteClinic surpasses 20 million patient visits since opening its first in-pharmacy site in 2010. Rushed physicians create frustration and tension for both patients and providers. Orthopedists were the most highly compensated physicians last year. Wikipedia trumps Google Flu Trends and the CDC in tracking flu outbreaks. Dr. Gregg promotes “multiview” as a necessary EMR feature. Thanks for reading.

This week on HIStalk Connect: Nike shuts down its Fuelband activity tracker line, cancels plans to introduce a new tracker this fall, and eliminates 55 of the 70 staff members in the activity tracker business unit. Twitter announces the winners of its #BigData grant program, half of which were healthcare-focused research projects. In an otherwise neglected market, eCaring raises a $3.5 million Series A for a simplified health journal designed to help seniors age in place by trending for changes in physical or behavioral health and alerting appropriate caregivers.

 

 


Upcoming Webinars

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

 


Acquisitions, Funding, Business, and Stock

4-24-2014 5-59-20 PM

VMware reports Q1 results: revenues up 14.2 percent and adjusted EPS of $0.80 vs. $0.74, beating estimates.

4-24-2014 6-00-20 PM

Kaufman Hall, a provider of financial consulting services and software for healthcare, acquires Axiom EPM, a provider of financial performance management software for healthcare and other industries.

4-24-2014 6-01-16 PM

Huron Consulting Group enters into an agreement to acquire the assets of Vonlay.

4-24-2014 6-03-27 PM

Quest Diagnostics posts Q1 numbers: revenues down 2.3 percent and adjusted EPS of $0.84 vs. $0.89 a year ago, missing estimates. Quest blames an unusually harsh winter that deterred people from going to its centers for tests.

4-24-2014 6-04-08 PM

NexJ Systems acquires Liberate Ideas, developer of a point-of-care patient education solution.

4-24-2014 12-56-39 PM

Owlet, developers of a smart baby bootie monitor that measures a child’s heart rate, raises $1.85 million from multiple firms, including ff Venture Capital and Eniac Ventures.

Heart Corporation expands its Hearst Health group and Zynx Health division with the acquisition of CareInSync, the developer of a mobile platform for provider-patient communications.

4-24-2014 4-07-22 PM

CTG attributes its 22 percent drop in Q1 profits on lower revenue from its healthcare technology services business. CEO James R. Boldt says the lower revenues are the result of hospitals delaying EMR and other IT implementation projects as they manage Medicare cuts from a year ago.

HealthStream reports Q1 results: revenues up 29 percent and flat earnings of $0.07 per share, beating revenue estimates but missing on earnings.

 


Sales

4-24-2014 2-56-27 PM

Crozer-Keystone Health System (PA), Tahoe Forest Health System (CA), Capital Health (NJ) and Hocking Valley Community Hospital (OH) will implement the InteHealth Patient Portal.

Michigan Health & Hospital Association Keystone Center will use RegistryMetrix from ArborMetrix at 60 hospitals to capture OB data and measure clinical performance.

4-24-2014 2-59-17 PM

Johns Hopkins Health System selects Carestream Health’s Vue PACS system.

Southern Illinois University HealthCare selects Allscripts TouchWorks EHR for its physician clinics.

4-24-2014 3-46-20 PM

SCL Health System will implement Stanson Health’s clinical decision support system.

 


People

4-24-2014 5-20-42 PM

Population health management and patient engagement provider Rise Health names Connie Moser (McKesson) president and COO. Moser replaces Mark Crockett, MD, who will remain as CEO, and Fred Croft, who will shift to CFO.

QPID Health forms an advisory that includes David W. Bates, MD (Brigham and Women’s Hospital); John D. Halamka, MD (Harvard Medical School); Julia Adler-Milstein (University of Michigan); and Robert M. Wachter, MD (University of California, San Francisco).

4-24-2014 6-46-47 AM

Extension Healthcare hires Jill Vavala (CareFusion) as CNO.

4-24-2014 6-57-58 AM

Covisint names Michael Keddington (McDermott & Bull Executive Search) SVP of worldwide sales.

4-24-2014 5-22-01 PM

The NCQA appoints Michael S. Barr, MD (American College of Physicians) EVP in charge of leading the organization’s research, performance measurement, and analytics efforts.

4-24-2014 1-51-06 PM

David J. Bensema, MD moves from CMIO to CIO for Baptist Health (KY).

4-24-2014 2-31-56 PM

Essia Health names Rachel Leiber (Providence Health & Services)  to lead the company’s EMR implementation services division.

4-24-2014 2-50-55 PM

Accretive Health CEO Stephen Schuckenbrock will step down from the troubled company when his contract expires October 2.  Last month the company was delisted from the NYSE after failing to file restated financial reports from 2012.

 


Announcements and Implementations

4-24-2014 10-03-27 AM

The Greater Houston Healthconnect network and the Austin-area Integrated Care Collaboration establish health information sharing through the Texas Health Services Authority’s HIETexas.

4-23-2014 2-53-30 PM

American Health Network implements eClinicalWorks Care Coordination Medical Record for population health management to manage its three ACOs in Ohio and Indiana.

Via Christi Health (KS), which is owned by Ascension Health, will go live on its $85 million Cerner system June 1 across all of its Wichita hospitals and clinics.

Behavioral Health Information Network of Arizona leverages NextGen’s Mirth Connect platform to become the first statewide behavioral health information exchange in the country.

4-24-2014 5-24-10 PM

Lady of the Sea General Hospital (LA) goes live with T-System’s EDIS EV.

4-24-2014 3-50-31 PM

The W. W. Caruth Jr. Foundation awards Parkland Center for Clinical Innovation (TX) a $12 million grant to establish the Dallas Information Exchange Portal to connect Parkland Memorial Hospital with local social service agencies.

 

 


Government and Politics

HHS says two entities have collectively paid almost $2 million to resolve potential HIPAA violations following the theft of unencrypted laptop computers.

The House Appropriations Committee approves a 2015 budget plan to that would hold back 75 percent of the VA’s requested funds to upgrade its EHR until Congress is convinced the DoD and VA are making progress in their efforts to share EMRs.

4-24-2014 2-42-29 PM

CNN reports on the Phoenix VA Health Care System and how delays in scheduling appointments has led to 40 deaths. The report also reveals details of a scheme by VA managers to hide the scheduling delays in order to improve official scheduling metrics. A retired VA doctor claims that the health system maintained a “sham” waiting list that was shared with Washington officials that showed timely appointments, as well as a real but hidden list with wait times of more than a year. To create the secret list, staff entered appointment details into the computer, printed the screen, but did not save what was entered. Patients remained on the secret list until the scheduled appointment was within 14 days, then details were transferred  to the sham list and the hard copy was shredded. The US House Veterans Affairs Committee is now investigating.

4-24-2014 2-39-30 PM

The FBI warns that healthcare systems and medical devices face an increased risk of cyberattacks because private health data has a higher financial payout on the black market than credit card numbers.

 


Other

4-24-2014 6-16-30 PM

The chairman of the board of supervisors for Riverside County Regional Medical Center (CA) takes Huron Consulting to task and questions its lack of progress fixing the hospital’s financial woes. Huron, which is six months into a $26 million dollar engagement, was hired to implement cost-saving initiatives to address the hospital’s $83.2 million cash shortfall, but so far the deficit has only been cut $1.2 million. The hospital’s CFO defended Huron’s work, noting that the company’s efforts have already contributed to $9 million in savings, but declining patient traffic during the same period has resulted in a $12 million decline in revenue.

4-24-2014 1-56-25 PM

The Department of Labor predicts a 22 percent increase in the number of jobs for medical records and health information technicians between 2012 and 2022.

Health IT, care coordination, and drug shortages lead an ECRI-complied list of top 10 patient safety concerns for healthcare organizations.

4-24-2014 4-12-58 PM

Forty percent of physician practices are looking to replace their existing EHR, according to a Software Advice report. Among buyers replacing their EHR product, the most common replacement reasons: the current solution is too cumbersome and/or integration is needed between applications.

A Rhode Island court issues a consent decree saying that the state’s EHR database CurentCare must be more transparent and offer patients more privacy protection. The ruling stems from a 2010 lawsuit filed by the ACLU that charged the state’s department of health didn’t spell out clearly or publicly enough how patients could remove or change their own records from the database.

A quaky lawsuit out of Oregon: a woman sues her mother’s neighbor after the neighbor’s pet duck attacked her. The duck ambushed the woman without provocation, causing her to fall, break her wrist, and sprain an elbow and shoulder. The victim, a retired nurse, is seeking $275,000 for pain, suffering, and other damages.

 


Sponsor Updates

  • Elsevier will market Stanson Health’s CDS alerts and analytics solutions.
  • IDC Health Insights names Wellcentive a leader in its MarketScape report on US population health management vendors.
  • Merge Healthcare releases iConnect Retinal Screening for identifying and diagnosing patients with diabetic retinal disease.
  • Quest Diagnostics recognizes Liaison Healthcare’s EMR-Link solution with its Quality Solutions Certification for meeting or exceeding HIT quality standards for secure clinical lab ordering and results reporting.
  • BESLER Consulting will market the MedAptus charge capture management suite to its clients and MedAptus will promote BESLER’s revenue recovery and compliance services.
  • McKesson Business Performance Services adds outpatient and inpatient facility coding services to its coding and compliance portfolio of services.
  • CommVault enhances its PartnerAdvantage program for channel partners to accelerate revenue growth and simplify collaboration.
  • Quest Diagnostics acquires the remainder of Steward Health Care System’s (MA) outreach laboratory services operations and will provide testing services to providers previously serviced by Steward.
  • iHT2 posts highlights from its Atlanta Health IT Summit.
  • Imprivata hosts its HealthCon 2014 conference May 4-6 in Boston.
  • Aspen Advisors shares a white paper on building a technology roadmap to support an organization’s value-based model.
  • Orion Health and two of its customers will discuss how state public health agencies can expand the use of integration engines to prepare for quality reporting during the Public Health Informatics Conference April 29-30 in Atlanta.
  • Health Catalyst opens registration for the 2014 Healthcare Analytics Summit September 24-25 in Salt Lake City.
  • Aspen Advisor principal Jim B-Reay offers tips for keeping the mind fresh in  CHIME’s CIO Connection.

EPtalk – by Dr. Jayne

I caught up with one of my medical school buddies this week as she was passing through town on the way to the class reunion that I’m skipping. She’s a primary care doc turned informaticist as well, so the opportunity to talk shop with someone who has walked a mile in the same virtual shoes as me was exciting. We got to chatting about the Flip the Clinic initiative which aims to “re-imagine the medical encounter between patients and care providers.”

The website has a variety of information on “flips” in categories like communication, design, education, empowerment, etc. The idea is that by making the clinical interaction better, patients will be healthier and providers happier. Although I like the idea it’s a little hard to get on board without some objective evidence that these interventions will make a difference. Some of them are straightforward: reducing noise in the healthcare environment, or removing physical barriers between patients and the office staff. Others are more abstract such as reforming the broken payment system. I think it’s great to have a discussion but I’m not seeing how some of these concepts will translate into practice, especially for those of us who are in employed models.

My former classmate and I have both struggled with being employed physicians and our inability to get buy-in from administrators when we want to try innovative maneuvers. Administrators frequently want proof that we’ll have positive return on investment but fail to realize not all returns are monetary. It’s difficult to try to find energy to fight the status quo when all the forces surrounding us (MU, CMS, HIPAA, and the rest of the alphabet soup) seem designed to stifle any attempt to think outside the box.

It’s going to take more than concerned individuals to truly Flip the Clinic. Organizations will need to address culture issues and there will need to be institutional buy-in before change can begin. The commitment needed to actually have that level of change take place, let alone “stick” and become hard-wired is something that very few of us can muster right now.

From Demo Dave: “Re: replacement systems. I sold EHR systems to physician groups for 15 years, all before MU started to skew the market. At least 30-35 percent of the systems I sold were to practices looking for additional functionality that was already in their existing system. These practices simply never learned to utilize the capabilities of their existing systems. When an administrator told me their existing EHR was lacking functionality or reporting, I simply smiled and confirmed what they wanted in a new system. I then focused demonstrations and implementations to meet their needs.” Many EHRs have gotten to the point where they have more features than users can understand let alone incorporate on a daily basis. Anyone who thinks they can learn a system with a few days of training and never think about it again is woefully shortsighted. Having workflow validation and optimization visits at 30, 60, and 90 days post go-live can help – any bad habits can be corrected and new features can be regularly introduced to those users who are ready for them. Customers should also consider actually reading the user manual and other documentation before they throw the proverbial baby out with the bath water.

Most of our readers know I enjoy a good cocktail and also love to travel, so I was intrigued by a story on NPR that talked about powdered liquor. I should have read it right away rather than bookmarking it for later – when I returned it had been updated stating it’s not actually legal in the US. Apparently I’ll have to go to Japan, Germany, or the Netherlands to check out the options.

Speaking of the need for a stiff drink, there’s still a fair amount of chatter about the release of the Medicare payment data. The newest Coda-a-Palooza challenge  calls for developers to leverage that data to “help consumers improve their health care decision-making.” I’m a professional, I understand what the Medicare data does and does not reflect, yet I still struggle to think of ways that the data can be useful in consumer decision-making. The site says the data “shed significant light on how physicians actually work.” Excuse me? How does data on Medicare payments explain how I care for patients? Maybe I’ll understand better in June when the winners are announced. In the mean time, any explanations that you can send my feeble post-call brain?

Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 24, 2014 News 4 Comments

News 4/23/14

April 22, 2014 News No Comments

Top News

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


Reader Comments

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


Upcoming Webinars

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



Acquisitions, Funding, Business, and Stock

4-22-2014 11-36-25 AM 

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

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Informedika changes its name to Health Gorilla.

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


Sales

4-22-2014 11-44-46 AM

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

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Griffin Hospital (PA) will implement athenaCoordinator Enterprise.

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

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

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Missouri Baptist Medical Center will deploy the Vocera Communication System.



People

4-22-2014 11-21-15 AM

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

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

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

4-22-2014 12-20-58 PM

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

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

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


Announcements and Implementations

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

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

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

4-22-2014 12-34-36 PM

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


Government and Politics

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


Other

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

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

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


Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 22, 2014 News No Comments

HIStalk Interviews Jim Prekop, CEO, TeraMedica

April 16, 2014 Interviews No Comments

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

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Tell me about yourself and the company.

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

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

 

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

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

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

 

What about universal viewers?

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

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

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

 

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

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

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

 

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

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

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

 

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

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

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

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

 

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

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

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

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

 

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

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

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

 

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

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

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

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

 

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

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

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

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

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April 16, 2014 Interviews No Comments

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Reader Comments

  • JR Bak: Re: retail clinics There is so much packed into this situation and your comments, which is neither good/ bad or right...
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