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EHR Design Talk with Dr. Rick 11/25/15

November 25, 2015 Rick Weinhaus 4 Comments

Designing a New EHR User Interface: The Paper Chart is the Wrong Metaphor

“New technology demands new representations.” Alan Cooper, Robert Reimann, and David Cronin, About Face 3.

When we are presented with a radically new technology, at first we can’t take advantage of its potential.

Instead, we apply old ways of thinking – old metaphors – to the new technology. Most of the time, the old metaphors don’t work.

In the early days of the automobile, many flawed designs resulted from the fact that at first people could only conceive of the auto as a “horseless carriage.” As a result, many early autos looked and rode a lot like their horse-drawn precursors.

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It took a long time for people to stop using the metaphor of horse and carriage when thinking about the automobile. Designers and drivers had to realize that the auto was fundamentally different from its horse-powered predecessor, with its own set of strengths, which eventually included speed, comfort, and reliability. It was only then (and only after we made the commitment to develop an infrastructure of better roads and highways) that innovative auto technology could fully blossom.

Similarly, before the era of EHRs, the paper chart was the predominant tool for organizing and making sense of a patient’s medical record. The paper chart is a powerful cognitive tool, but its strengths are very different from those of the electronic health record. Just as the metaphor of the horseless carriage constrained auto design, the metaphor of the paper chart constrained EHR design, limiting its potential.

The paper chart came in two basic types.

One type of chart, often used in doctor’s offices and other ambulatory settings, was a manila binder where documents of whatever category (notes, labs, orders, imaging studies, reports, procedures, and so forth) were simply added in chronological order to the documents already in the chart.

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The other type of paper chart, used in some ambulatory settings and for almost all inpatient care, was a ring binder, with multiple divider tabs which organized documents by category.

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New documents were added to the chart first by tab – that is, by category – and then by date.

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Both these filing strategies were different solutions to an inherent limitation of the paper chart – a piece of paper can physically only be in one place at a time. Although this physical constraint limited how data in the paper chart could be organized and reviewed, the tangible, physical aspects of the paper chart partly compensated for this filing limitation. For instance:

  • Different paper colors and textures were often used to designate different kinds of documents.
  • You could easily flip back and forth between two or more parts of the chart without getting lost.
  • When reviewing the chart, the documents were right there. You didn’t have to first click on a tab, select a document from a list, and then open it.
  • You could flag important documents for future reference by using sticky notes or paper clips.

Unfortunately, when EHRs were first being designed, instead of taking advantage of the potential strengths of digital technology, it was natural to adopt the metaphor of the paper chart. Many of the major EHR vendors adopted one or the other of the filing strategies described above, usually some variant of the latter, tab-based system, where documents are organized by category, and only then by date.

Surprising as it sounds, what this means is that if you are using Epic or Cerner or many other EHRs (at least the way they are usually configured), you can’t do something as simple as get a single date-sorted list of all clinically relevant documents.

In the era of paper charts, if you were using the tab-based system, this was just a fact of life. A physical document could only be filed first by category or first by date.

There is no such limitation, however, with digital documents. From the user’s point of view, a digital document can, in fact, be filed in two places at the same time. To retain the old paper chart metaphor when designing the EHR user interface makes absolutely no sense. The antiquated metaphor constrains and limits the design.

Now you may figure that this is not really a major issue – that it shouldn’t make that much difference whether an EHR organizes a patient’s documents first by date or first by category. But remember that if you are a doctor, nurse, or other care team member, as part of each visit, you are going to need to review the patient’s history, especially the interval history – what occurred since the last visit.

Consider the workflow below, recommended in a training video for a major ambulatory EHR which, like Epic and Cerner, uses a tab-based design to organize the patient’s documents by category.

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Much has been written about the time involved and the number of clicks required by most EHRs to accomplish this kind of task. I believe, however, that an even bigger problem is the cognitive burden a tab-based design imposes.

First of all, most tab-based EHR user interfaces violate a basic principle of interaction design – that of visibility. Specifically, until you click on a tab, you can’t see which documents are present or even if any exist.

Second, working with lists of dates in numeric format is cognitively challenging.

Third, when switching back and forth between documents stored in multiple tabs, you expend working memory keeping track both of the chronological order of the documents you’ve reviewed as well as their subject matter. There’s not much left for interpretation.

Unless you have experienced first-hand what it is like to review chart after chart, day after day in this manner, it’s hard to fathom how this kind of needless cognitive effort interferes with patient care.

The point is that EHR user interfaces do not need to be constrained by the old paper chart metaphor. The digital nature of EHR technology allows us to design better, albeit different user interfaces.

For instance, in addition to simply being able to switch back and forth at will between displaying documents by date or by category, digital technology can support:

  • Graphically displaying both the chronological order and the subject matter of documents by using an interactive timeline.
  • Using color, shape, size, and location to encode information visually, allowing us to use our high-bandwidth visual processing system to perceive much of the data.
  • Acquiring detail with a simple mouse hover or comparable touchscreen gesture.
  • Animating navigation to help the user stay oriented in information space.
  • Displaying detail plus context on the same screen.

I have long proposed that most doctors use a chronological mental model in thinking about the patient – the patient’s history should unfold like a compelling story. Furthermore, displaying information graphically shifts the balance of mental effort from cognition to perception, sparing cognitive resources for patient care issues.

If this is the case, compared to using current tab-based designs, a timeline-based, graphical user interface for the EHR should make it easier for doctors and nurses to review, explore, navigate, and select EHR documents.

In my previous post, I proposed an EHR user interface design of this nature, The EHR TimeBar. For those readers who have not yet seen the design or who would like to review it in connection with today’s post, it is described in the document below. Although the TimeBar design displays documents in chronological order, it also supports both searching and filtering by category (see pages 19-22).

The document above describes the EHR TimeBar. Click the two-headed arrow bar icon to display it full screen since it will be hard to see otherwise. It can also be downloaded as a PDF file here.

Next Post: Telling a Story on a Timeline

Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

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November 25, 2015 Rick Weinhaus 4 Comments

HIStalk Interviews John Halamka, MD, CIO, BIDMC

November 23, 2015 Interviews 8 Comments

John D. Halamka, MD, MS, is chief information officer of Beth Israel Deaconess Medical Center and chief information officer and dean of technology at Harvard Medical School.

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What responses are you getting from your suggestion that Meaningful Use be dissolved and rolled into other CMS programs?

I would say 95 percent of the responses that I’m getting are very favorable. They say that the last five years has been like running a marathon every day. There’s a point at which you’re tired. You have to step back and say, "We’ve run a long distance." Now, how do we take that next step?

People of course say there’s some subtlety to moving forward, such as the Medicaid program was really about taking those without resources and funding them, as opposed to the Medicare program, which was initial funding followed by penalty. So when you say, “eliminate the program,” do you really mean no longer pay Medicaid providers to finish their implementations? 

That’s not at all what I meant. Which is to say, let’s get away from the idea of penalties on the Medicare side. Keep our Medicaid program still going, because if you’ve not finished your implementation, we’ve got to get that done. Instead of being highly prescriptive about the Medicare must-dos and the penalties resulting if you don’t, let’s offer some outcomes and let’s offer some variability. People have made that subtle comment.

One of the things they’ve also made a comment about is that I have recommended this FHIR standard. It’s something that is seemingly forward-looking. It’s the sort of thing Google and Amazon and Facebook would do. Some in the industry have said, yes, but there are some existent standards that are widely deployed. So maybe instead of just saying it must be FHIR and only FHIR, can you tolerate a transition period where some of the incumbent standards are used where they’re appropriate?

Of course. Being a reasonable person, I recognize change doesn’t happen overnight. You can’t go from a skateboard to a flying car. You might have some intermediate states. That’s recognized.

People have also commented, "Did you really mean to be negative about ONC?" What I tried to say … you write a lot, so you know it’s hard … I absolutely am not critical of any person. All I’m asking is, is the set of ideas, of getting very prescriptive and elaborative about the certification process, really a good idea? I think the answer with the certification rule is, it’s just too expansive in scope. It’s just  going to be too hard for stakeholders and especially developers to hit all the details that are in that rule.

The problem is that every time you give a developer an “or,” it means “and.” They’re going to say, "You could do it this way, or you could do it this way, or you could do it this way." There are customers who are going to ask for each of the variations. Really what it does is it takes our healthcare IT developers out of commission for a couple of years.

That’s really what I was getting at. People at ONC are very hard working and very well meaning, just probably as you pointed out early in the conversation have been so heads down in the details that they didn’t really look at the forest — they were looking at the bark. So, let’s step back.

Another thing that people have said is, "Did you really mean to eliminate all kinds of certification?" What I was getting at by saying let’s focus — if there were just three goals, maybe the right answer there is there’s still some kind of certification process, but it really is very narrow.

An example I can give you is if you went out to Best Buy today and you bought a DVD player, it will have a little Blu-ray symbol on it. You can expect that when you get it home and you plug in a Blu-ray disc, it will play. What I was saying is that we should focus on three things, such as can you use FHIR to do a push of data or a pull of data or get a patient to pull their data? You could imagine — of course I’m making this up as we go — that there are three little labels that you could be putting on the EHR package analogous to the Blu-ray label, so that you know when you got the package home, I will be able to push a payload to a trading partner or pull data from a foreign EHR.

Certification today is a multi-man year exercise where you are asked to enter a ZIP code and come back the next day and prove the ZIP code is still there. It’s just onerous, as opposed to a very narrowed set of, “When you take this home, it will do this.” Two or three things, not a thousand.

That’s the feedback. That’s the summary of what I’ve heard back.

You seem to be frustrated lately that the government is more involved in everything: HITECH, HIPAA, and  ICD-10, all enforced through Medicare. Do you think CMS has too much influence on what happens in the exam room between a provider and a patient?

I do. I’m not partisan in any way. It’s not that I have a Republican agenda or a Democratic agenda. I just try to have a multi-stakeholder agenda.

Here is an example. If Meaningful Use said, "We’re going to count the number of transactions you did,” but yet those transactions which I counted were actually not helpful to coordinate patient care or respectful of the patient’s wishes, was it really meaningful to count transactions? Here’s an example. You must, for a transition of care summary 5 percent of the time, ensure that from Provider A to Provider B, a package of stuff is sent. It turns out that package of stuff may be a bag of smelly garbage. That is, it’s 1,094 pages of completely unhelpful information, but I can count it in my numerator.

Wouldn’t a better measure be as a doctor, nurse, social worker, or physical therapist were you actually able to coordinate the care of this patient because you received the information that you thought was helpful to do so, somehow? As you know, I don’t have stock in any company. I don’t endorse any organization, so this is an exemplar. KLAS gathered together Cerner, Epic, eCW. Meditech, Athena, Surescripts, and others. If we want to look at the experience of data sharing rather than transaction counting, what questions would you ask?

Here’s a perfect example where the private sector said, we are very willing, in a Consumer Reports-like fashion, to have an independent entity call up 100 of our customers and ask them all these experiential questions which then will reflect — almost like a Yelp review — on the experience of interoperability with our product. That to me is a far better approach than CMS counting the number of bags of garbage that you sent.

What KLAS is proposing presumes that providers really want to share data with their competitors, at least on some occasions. Do you think customers are really demanding interoperability?

The United States has global capitated risk, bundled payments, and valued-based purchasing that’s been going on for five years in Massachusetts. Yet you go to the Midwest and there’s still fee-for-service.

Let me reflect on New England. We today at Beth Israel Deaconess have 1 billion dollars per year of bundled payment, risk-based contracts. We have told every doctor in our community it is not possible to manage risk unless we have, at every transition of care, about 150 data elements to understand what care was delivered. What’s the care plan? Who’s the care team? What’s the next bit of care the patient needs? What are the diseases we’re monitoring?

What you find, at least in our area, it isn’t even a question of siloed data, information blocking, or competitive whatever. It is an existential question. If you do not share data, you can’t survive, because we are paid for wellness, not sickness. I think a much more potent motivator than Meaningful Use or stimulus or compliance or penalty is this idea of, I will pay you when the patient is healthy or give you a fixed amount to keep them healthy. That eliminates these competitive kinds of barriers in information exchange.

Health systems haven’t done a good job at managing wellness or overall health outside of their own facilities. Are they capable of making the change from episode-driven care to population health management?

I just looked at our Pioneer ACO experience. I recognize that the Pioneer ACO program has very mixed outcomes. But at least at Beth Israel Deaconess, where we have 450 locations of care, we have gone beyond what we would call the EHR and now focus on the care management medical record. 

At our ACO, we have a single, normalized database that receives all the Meaningful Use transactions from every one of our clinicians and hospitals and urgent cares and SNFs and all the rest. Then the care managers are looking for variation. They’re looking for gaps in care. They’re looking for opportunities. They’re looking at risk and these sorts of things. 

I’m told we’re the #3 ACO in the country and the #1 in New England because of our capacity to reduce cost and improve quality with this care management medical record approach. You’re correct that the off-the-shelf products that exist today don’t do that very well, but it is certainly possible to use technology to accomplish the goals of, as MACRA will suggest, value-based purchasing.

The mainstream press and politicians seem to be paying attention the reactive phrases “gag clauses” and “information blocking.” Are big health systems using their EHRs to reinforce their market power?

When I say I’ve never seen information blocking — this is like the Loch Ness Monster, often talked about, but never seen — people do comment that information blocking can take many forms. Like a hospital that is technically not capable of sending information or a hospital that is 200 miles away from a referring physician and hasn’t quite got to the data transmission to those in the periphery. Again, speaking from Massachusetts, I have not seen hospitals and doctors use information blocking as a competitive weapon, thinking that if it’s my data, I will retain the patient and I will make more money.

In fact, I’ve quite seen the opposite. That is, there is this sense that if I need data for managing care and you need data for managing care, we had better bilaterally exchange data because it is no longer a competitive advantage to maintain a data silo.

The only time I’ve seen sluggishness in the transmission of data are for the reasons that I mentioned. That is, technically maybe a vendor or an IT department isn’t quite familiar with the technology. Or that there’s a Pareto diagram of all the clinicians we interact with and we’re going to start with the ones that are close, while the ones that are 200 miles away, we’ll get to. It’s not volitional. It’s just a function of resource.

What do you think of ONC’s proposed health IT safety center?

I have to read more about that. As I’ve read the various presentations about it, the concern that we have is that as we introduce new processes and technology, sometimes we create new errors and that we don’t really discuss those new errors in an open way. In New England, we have a patient safety organization which comes together to openly discuss these in a what I call a blame-free environment. I think that’s the notion of what ONC is trying to do at a national level.

I’ll give you a silly example. It’s not true, but it would illustrate the problem. If you came to me with high blood pressure and I wrote you for atenolol, which begins with A-T, I would never on a piece of paper write anything other than atenolol. Of course you couldn’t read it, but it would say atenolol. Whereas if I had an EHR that had a Google-like look-ahead feature and I started typing A-T and the first thing that came up was Ativan and I clicked on it and I was giving you Ativan, I’m giving you now something that’s an antianxiety drug instead of an antihypertensive.

That is a an error of commission. That is an error of technology that would have never happened in a manual process. I think those are the sorts of things that we identify locally in Harvard that ONC wants to see at a national level and Congress wants to see at a national level, enumerated and fixed.

Are EHRs poorly designed or are doctors just unhappy with the information insurance companies and the government require before writing them a check?

Probably there are a couple of answers to that. This usability question … I’m sure you’ve heard many, many people quote Justice Potter: "I have no idea what usability is, but I know it when I see it." Having an objective metric of usability … NIST is trying, but it’s hard.

Why are there usability challenges? I could argue Meaningful Use itself creates usability challenges. If, for example, there is a quality measure that says I must, in my denominator, only include people that have had strokes less than two hours ago. "Mrs. Smith, did your husband start talking funny one hour and 59 minutes about or two hours and one minute ago?" I now need to literally build a pop-up in the middle of my EHR workflow with a question about the timing of the stroke. It would never be part of my normal clinical data workflow.

As we do all these quality measures, as we do more and more structured data capture, what you find is that these vendors are having to add on all of these fields outside of workflow. That creates enormous usability problems.

One of the members of the Standards Committee said that they had actually done a usability analysis of how many clicks a nurse must use to admit a new patient and to document that new patient admission. The answer was 523. That was really just a function of all the regulatory mandates that require all the structured data capture.

I think we would all agree that each of the federal mandates on its own is a noble thing. All of us think domestic violence should be identified and treated, but that is just one of 100 structured things you ask on admission, "Do you feel safe at home?" That just creates real usability burden. Of course, one asks, are there other ways one can do this, such as a natural language processing or ways in which a free text entry is parsed by a computer and the clicks are reduced?

One of the things that I have suggested to Karen DeSalvo — and I think she recognizes it as a good idea —is maybe a certification criterion for the future is, “Did you eliminate the number of clicks by 50 percent?” Part of that has to be that the regulations were simplified so that we could.

I always assume that if one EHR requires 523 clicks, others might be 518 or 591. It’s not as though one vendor approaches things so differently that only they have problem with the number of clicks.

I would agree with you. Although, I live in a Web-mobile world. If you look at the user possibilities in a Web-based or mobile-friendly framework versus one that was more based on a client-server framework, I think you can probably achieve a better user experience on the Web than client-server. Many, many people debate that and I have no objective evidence to back it up, so it’s purely my bias. 

First, reduce regulation. Secondly, as we move to different kinds of technologies on the client side, probably the user experience will be enhanced.

Direct messaging never seemed to get the traction people expected, maybe because nobody ever took the responsibility to publish and manage a Direct address directory. Does Direct still have relevance in interoperability?

Here was the problem with Direct. As you say, whatever we chose — it could have been FTP, it could have been REST, it could have been SMTP — it depends on an ecosystem, not a standard. Dave McCallie, I think, wrote a guest post on my blog saying, “Standards are necessary, but insufficient.” So to say, “We will mandate Direct" was a lot like saying, "We will mandate you to drive a car, but we won’t have any highways.” How come you aren’t driving? Well, let’s see. We don’t have road signs and we don’t have maps. We don’t have any laws or governance. It’s pretty hard to drive. 

What should have happened with Direct is it should not have been mandated as fast as it was. It should have been encouraged and an ecosystem developed first. You’ve seen what I’ve written about things like a provider directory. It’s pretty hard to have successful Direct messaging in a community unless somebody has a directory of places to message to. DirectTrust, of course, is trying to work on the directory and certificate bundles and that sort of thing. When the Meaningful Use Stage 2 requirement was launched, DirectTrust didn’t have all that stuff built. Surescripts is trying to do the same thing.

You’re starting to see private industry building the missing enablers. As I wrote in the blog piece, some enablers may be government based. Some may be private industry based. Or you might have both. But it’s pretty hard to mandate the Direct protocol before the enablers exist.

Healthcare IT always gets stuck with some mandate that moves us sideways instead of forward. Are you concerned that we’ll chase data security with nothing really different than it was before?

You might guess that I spend a vast amount of my time on information and security. The challenge is, I mean, sure, go invest $5 million in technology. That won’t help you so much. You are going to be as vulnerable as your most gullible employee. What we’ve found is that you must invest, sure, in detection, prevention, and all the good things like firewalls, antivirus, and malware prevention, that sort of thing. But you also must educate every member of your workforce and you really have to reinforce that education.

For example, we have an internal, self-created phishing campaign that we use to test our employees’ knowledge of, “I just emailed you a password reset message with a URL in China. Did you click on it or not?” Of course, beyond that, you need very good policies, policies that people can actually comprehend. When I tell you, "You had better not show up at work with an unencrypted device," what does that mean? What kind of encryption? How do I do it? Be very specific. It’s hard to hold employees accountable for doing the right thing unless you show them how to do the right thing.

I tell people security is a process that will never be done. It isn’t a discrete project that you do once and forget. It’s technology. It’s education and policy. We can do it, as you say. It’s certainly an effort. It takes a lot of resource, but done right — and I think we can do it right — it’s an enabler.

Some of your CIO peers have told me they don’t stand a chance in trying to defend against a nationally sponsored, sophisticated cyberattack. Does government have a role or can something else be done to help individual health systems protect themselves?

There’s probably a couple of answers to that. Threat notification — that’s certainly important. That’s where, yes, the government has now crossed multiple industries, tried to create enabling legislation to share cybersecurity threats and vulnerabilities and do that in a way that can protect us all. So yes, we probably need to do that.

Harvard was attacked by Anonymous in 2014 with a massive distributed denial of service attack. This was published in The Globe, so I’m not revealing anything that is a secret. Was Harvard ready for a massive denial of service attack by a hacktivist group? That wasn’t one of the threats that anyone had enumerated as likely. So sure, the government can help us with that. If there is a mechanism of using government to help with forensics when you’re getting these kinds of attacks that are virulent and new, probably the government has more resources than an individual hospital.

I suppose one thing I would say is enforcement by OCR and OIG and other folks has to be done with an eye to, what is the community standard? If I see you as a patient and I do everything per the community standard but you still die … I mean you could sue me, I suppose, but generally malpractice looks at, was the standard of care followed, regardless of outcome achieved? If I put in intrusion detection and prevention and malware this and that and mobile encryption but still a state-sponsored cyberterrorist penetrates me? Probably I did everything I should have and I couldn’t defend again this highly virulent attack. Not my fault. You sort of hope OIG and OCR and others recognize it’s a community standard question not a, “I avoided all breaches forever,” because we will never all avoid breaches.

Do HIPAA fines and regulatory action need to be changed in some way to be less punitive and more constructive?

I certainly think that government regulators have to enforce based on volitional, “I spilled data because I actually gave it to somebody that I shouldn’t have,” or what I’ll call egregious malpractice. "I bought a wireless access point at Best Buy and put it on my data center," as opposed to, “I’ve had two publicly reported breaches over the last two years, neither of which I could control.”

As an example, if a doctor goes out to the Apple store and buys a device and thinks that adding a password to the device is the same as encryption and then the device is stolen but it was a device I didn’t even know about. Of course today, I the CIO am accountable for this device purchased at the Apple store that wasn’t encrypted. Of course, we do everything we can to now educate and anything we buy we encrypt, and all the rest. We did our best.

So, guys, what should we do? Tackle every individual who enters our building carrying a non-encrypted technological device? It’s not technologically possible. Recognize that there are gradations of things we can do and can’t do. Hold us accountable for the things we can do and recognize that education is often the best we can do in many circumstances and decide that that’s OK.

You mentioned in your write-up about the Meaningful Use program that it may have stifled innovation. What kind of innovation do you think healthcare or healthcare IT needs and what’s the best way to achieve it?

I have 19 developers total at Beth Israel Deaconess. Remember, we still self-build our EHR. It isn’t that Epic and Cerner and Meditech and Athena and eClinicalWorks or whoever are doing a bad job. It’s just that the kind of things that our clinicians have demanded and the prices we can afford to pay mean that building still works for us.

Look at the Meaningful Use “Statement of Burden.” I’m sure you’ve read all those thousands of pages. You look at these burdens like, “It will only take you 30 man-years to certify your EHR.” You’re like, "I have 19 people, total." Instead of working on Apple Watch medication reconciliation for elders in their home, I am now doing certification scripts. That’s where it has truly paralyzed my development shop for the last three years.

The kinds of things that our patients are asking for are more mobile technologies, more patient and family engagement, more what I’ll call family decision support, better access to information. There’s all these things that you would think, “Oh, if we were a customer service-driven organization, we would naturally offer them.“ But we have a choice — customer demand or federal regulatory stimulus and penalty. For the moment, we’ve got to go with regulatory demands.

People will then criticize me and that’s OK, saying "See, you shouldn’t self-develop. You should just go buy Epic and Cerner or whatever.” That’s fine, but Beth Israel Deaconess for 30 years has had this idea that innovation happens in the trenches, and that probably it’s a good idea to have a doctor code and come up with something that is solving a problem they saw today rather than wait a few years for a vendor to include it as a feature. Wouldn’t you love to have doctors and pharmacists and nurses and social workers creating software that solves real-world problems? Isn’t that the kind of innovation that we want to support?

What patient-facing technologies are you using or considering?

Recently we launched a program in our ICUs called MyICU. You’re familiar with various patient portals and these sorts of things. If you’ve ever had a loved one in an ICU or been in an ICU yourself, you know there’s a dizzying amount of data, but not a whole lot of information and wisdom.

What we’ve done is create an iPad app that shows patients and families –we’ve just written a paper that you’ll see published in JAMIA shortly about how we decide, based on patient privacy preferences, to share information with what family members and how does that work if the patient is intubated debated and that sort of thing – but it’s essentially a real-time dashboard saying, here are the goals that you have for today in this hospitalization. Here are your preferences for care. Here’s how the patient is doing against those goals. Here are the events of today. You’ve built this closed-loop information system with messaging back and forth between care team and patient and real-time interpretation of data into wisdom. Suddenly patients and families are saying, wow, I’m really an equal partner in my care here.

My father died two years ago and was in an ICU. Of course they said, "You know, his ejection fraction is 20 percent and his O2 sat on a non-rebreather is 82 percent and his creatinine has gone from three to five." Of course my mother goes, "Uh, and?" This app wouldn’t show you that. It would say the goal was to get him off a ventilator and that’s now red, so things aren’t looking so great. Or, we want to make sure that his organs are doing well, but that’s red, so they’re not. The kind of thing we’re focused on is not just raw data, but wisdom.

Is it hard to reconcile the science of informatics that could be versus the reality of what has to be?

Doug Fridsma, who is now the CEO of AMIA, and I had this discussion during the conference. He said that AMIA is striving to pivot from being a research-oriented group — the sort of folks that are in a lab and they’re more or less trying to push the envelope of possible — to a gathering of applied informaticians who are asking, how do you take Epic and optimize the care plan? Or, how do you take Cerner and do population health?

It’s exactly the point you make, that it’s probably a great use of all the smart people in our country to optimize the things we are seeing in the trenches as opposed to just work in the laboratory. That’s really what they want to do.

Do you have any final thoughts?

You may glean from some of my writing that there’s a hint of pessimism. We have been overwhelmed with Meaningful Use, ICD-10, the HIPAA Omnibus rule, and the ACA. The government has co-opted our agenda. Many of those great people in government who we worked with early in the Obama administration when there was hope and change have left.

I want to make sure the readers know that I’m incredibly optimistic about the future. What I see is that we are going from an era where we’re following regulatory requirements to an era where we, in theory, will be incented to innovate based on new kinds of payment models. Therefore, we actually will see – not one top-down command and control, this is what you must do, enumerated list of prescriptive regulations – but if you want to give all the 80-year-olds Apple Watches and monitor their vital signs and have visiting nurses come to their homes and keep them out of the hospital, we’ll reward you for that. Oh, but you don’t like Apple Watch? That’s OK, you can do something else.

I really feel that we’re on this cusp of moving to a new kind of work where we’re going to run lots of pilots. We’re going to learn. That’s really, I think, what the Institute of Medicine ultimately wants us in the next 10 years to be, is this learning healthcare system that tried a lot of things. Many of them will fail, but when they succeed, we’ll share them broadly.

That’s why I maintain my optimism. That’s why I come to work every day. That’s why, after 20-some years, I’m still a CIO.

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November 23, 2015 Interviews 8 Comments

Morning Headlines 11/18/15

November 18, 2015 Headlines 1 Comment

Policy: Certified Technology Comparison Task Force

ONC holds its first Certified Technology Task Force meeting. The group will research and make recommendations on the development of an EHR comparison tool. It will present its findings on January 20.

Cerner raises concerns about Loftin’s new role

Cerner sends a letter to the University of Missouri expressing concerns over its transition plan for Chancellor R. Bowen Loftin in the wake of his announced resignation. Loftin was offered a position as the director of university research at the Tiger Institute for Health Innovation, an organization co-managed by Cerner and UofM.

Does Cambridge University Hospital’s Epic project indicate NHS lacks capacity?

In England, insiders working at Cambridge University Hospital describe the internal culture during an Epic implementation that ultimately led to the resignation of the Trust’s CEO and CFO, saying “There was a plan, there was a vision and it was going to happen. There was no sense or reason to the process, it was bloody-mindedness.”

App Orchard – Trademark Details

Epic secures a trademark for “app orchard,” the name it will use for its upcoming app store.

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November 18, 2015 Headlines 1 Comment

News 11/18/15

November 17, 2015 News 2 Comments

Top News

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The Certified Technology Comparison Task Force of ONC’s HITPC held its kickoff meeting Tuesday. The task force is charged with developing a Consumer Reports-type EHR comparison tool.


Reader Comments

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From IsIT True: “Re: Daniel Barchi, CIO of Yale New Haven Health System. He will succeed Aurelia Boyer, CIO at New York-Presbyterian, when she retires this year.” I asked Daniel, who verifies that he will be leaving YNHHS and the Yale School of Medicine at the end of this month, joining New York-Presbyterian as CIO in December.

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From Repurposed Turkey: “Re: Southern Illinois Healthcare. Has selected Epic to replace Meditech, NextGen, and McKesson Practice Partner. Epic jobs have been posted.”


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor National Decision Support Company, the exclusive distributor of ACR Select, the American College of Radiology’s Appropriateness Criteria (ACR AC) that supports value-based imaging. It offers integration-ready Web services  that allow healthcare organizations to present evidence-based ACR AC guidelines to ensure that the right patient gets the right scan for the right indication. Up to 10 percent of the rapidly growing number of diagnostic imaging orders are medically unjustified or duplicated, causing needless expense and excessive patient radiation exposure. National Decision Support Company provides physicians with guidance as they enter orders, presenting an appropriateness score for the selected modality and indications and prompts them to consult a radiologist when appropriate. The score can also be silently recorded to help health systems understand and manage quality improvement opportunities. Medicare will in 2017 require ordering physicians to prove that they have reviewed Appropriate Use Criteria when ordering MRI, CT, nuclear medicine, and PET. Thanks to National Decision Support Company for supporting HIStalk.

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Mrs. Buscho from Colorado sent photos of her English as a Second Language students using the tablet and keyboard we provided via DonorsChoose, saying they use it to look up photos and words to boost their vocabularies. Ms. Cassidy says her class of students with autism is using the set of 22 instructional CDs we bought for interactive circle time, with non-verbal students now able to point at the screen to answer questions and remain part of the group.

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I ran across 100Kin10, a New York non-profit whose goal is to train and place 100,000 new STEM teachers by 2021. It has 230 public and private partners and has placed 28,000 teachers so far since it was formed in 2011 in response to President Obama’s challenge. Teacher candidates from all walks of life complete a nine-month program.


Webinars

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

November 20 (Friday) 2:00 ET. “The Athenahealth Leadership Institute Presents: Dr. John Halamka Interviewed by Jonathan Bush.” Sponsored by Athenahealth. Presenters: John Halamka, MD, MS, CIO, Beth Israel Deaconess Medical Center; Jonathan Bush, CEO, Athenahealth. Providers are fed up with interface fees and the lengthy, fragmented narratives we’re exchanging today. But what is the right course of action to help deliver better care across the continuum? Bring your questions as we join Dr.Halamka and Jonathan Bush to discuss the current state of healthcare and how we can improve care coordination and interoperability.

December 2 (Wednesday) 1:00 ET. “The Patient is In, But the Doctor is Out: How Metro Health Enabled Informed Decision-Making with Remote Access to PHI.” Sponsored by Vmware. Presenters: Josh Wilda, VP of IT, Metro Health; James Millington, group product line manager, VMware. Most industries are ahead of healthcare in providing remote access to applications and information. Some health systems, however, have transformed how, when, and where their providers access patient information. Metro Health in Grand Rapids, MI offers doctors fast bedside access to information and lets them review patient information on any device (including their TVs during football weekends!) saving them 30 minutes per day and reducing costs by $2.75 million.

December 2 (Wednesday) 1:00 ET. “Tackling Data Governance: Doctors Hospital at Renaissance’s Strategy for Consistent Analysis.” Sponsored by Premier, Inc. Presenters: Kassie Wu, director of application services, Doctors Hospital at Renaissance; Alex Eastman, senior director of enterprise solutions, Premier, Inc. How many definitions of “complications” (or “cost” or “length of stay”…) do you have? Doctors Hospital at Renaissance understood that inconsistent use of data and definitions was creating inconsistent and untrusted analysis. Join us to hear about their journey towards analytics maturity, including a strategy to drive consistency in the way they use, calculate, and communicate insights across departments.

December 3 (Thursday) 2:00 ET. “501(r) Regulations – What You Need to Know for Success in 2016.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare Solutions. Complex IRS rules take effect on January 1 that will dictate how providers ensure access, provide charity assistance, and collect uncompensated care. This in-depth webinar will cover tools and workflows that can help smooth the transition, including where to focus compliance efforts in the revenue cycle and a review of the documentation elements required.

December 9 (Wednesday) 1:00 ET. “The Health Care Payment Evolution: Maximizing Value Through Technology.” Sponsored by Medicity. Presenter: Charles D. Kennedy, MD, chief population health officer, Healthagen. This presentation will provide a brief history of the ACO Pioneer and MSSP programs and will discuss current market trends and drivers and the federal government’s response to them. Learn what’s coming in the next generation of programs such as the Merit-Based Incentive Payment System (MIPS) and the role technology plays in driving the evolution of a new healthcare marketplace.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Real-time ADT notifications vendor PatientPing raises $9.6 million from investors that include Google Ventures. The Boston-based company was founded by David Berkowicz, MBChB (Massachusetts General Hospital), Jay Desai (Center for Medicare and Medicaid Innovation), and Lara Sinicropi-Yao (Kyruus). 

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Medical scribe provider ScribeAmerica acquires Essia Health, the third competitor the company has absorbed this year.


Sales

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Gifford Medical Center (VT) chooses Medhost’s EDIS.

An unnamed “large German government hospital” selects the Visage 7 Enterprise Imaging Platform.

An unnamed Texas ACO chooses ZeOmega’s Jiva population health management solution.

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Anne Arundel Medical Center (MD) selects receiving dock software from Jump Technologies. The company is fully confident that everyone who reads its press release already knows or doesn’t care that the hospital is in Annapolis, MD since it failed to mention that fact in its announcement.


People

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Shannon Epps joins Divurgent as VP of activation management.

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Fujifilm Medical Systems names Johann Fernando, PhD (Accuray) as COO and promotes Diku Mandavia, MD to chief medical officer.

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Paul Kleeberg, MD (Stratis Health) joins Aledade as medical director.


Announcements and Implementations

Spok chooses Guthrie Clinic (PA) as winner of its innovation award for having OR nurses text updates to patient families using the company’s Spok Mobile secure texting app.

Nuance announces PowerScribe 360 version 3.5, which includes multimedia reports with embedded PACS images, advanced lung cancer screening registry reporting, and enhanced quality guidance content for radiologists at the point of documentation. The company will demonstrate the product at RSNA.

HealthMyne integrates Epic EHR information into its quantitative imaging analytics platform.

Inspira Health Network (NJ) announces a 26 percent increase in HCAHPS scores for hospital quietness at one of its hospitals that deployed Practice Unite’s communications solution to reduce overhead pages at night.


Privacy and Security

Microsoft announces formation of a 24×7 Cyber Defense Operations Center to detect and respond to threats.

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A survey finds that most people don’t mind sharing their health information with their physician and their family, but the percentage expressing a willingness to share drops off considerably after those two. Patients don’t want the government seeing their information, perhaps unaware that CMS knows just about everything about those on Medicare unless they choose to pay cash instead.

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A federal judge dismisses an action brought against lab testing firm LabMD by the Federal Trade Commission, which claimed that consumers were injured in two old data security incidents. The first incident was reported by Tiversa, a security vendor who was trying to sell its services to LabMD. A former Tiversa sales manager said its warning to LabMD was “the usual sales pitch” and said no breach actually occurred. The second involved documents recovered in an identity theft investigation. The judge ruled that any consumer risk was theoretical and scolded the FTC for relying on Tiversa’s “unreliable” claims. It appears that Tiversa is still in business selling peer-to-peer cyberintelligence services, while LabMD shut down after being buried in court costs and customer defection due to the now-dismissed charges. LabMD was never charged with a HIPAA violation, only with deceptive trade practices, which seems to make little sense in this case (as the judge validated).


Innovation and Research

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Keith “Motorcycle Guy” Boone urges licensed providers to complete an HL7 survey that seeks to determine which data elements are needed to support continuity of care.


Technology

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India-based Practo will offer Uber integration with its doctor search app in India, Singapore, Philippines, and Indonesia. It will give users a “call Uber” button along with their appointment reminder so they can get a ride.


Other

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Cerner protests the terms under which University of Missouri Chancellor R. Bowen Loftin accepted a demotion following student protests that also triggered the resignation of the president of the entire university system. The separation agreement between Loftin and the university says he will take a leadership role with the Tiger Institute for Health Innovation, which is a partnership of the university and Cerner. Cerner wants references to Cerner and the Tiger institute removed from the agreement, saying that Cerner as a partner should have been consulted or notified in advance before Loftin was promised that role.

Epic trademarks App Orchard as the name of its upcoming app store.

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A Politico article recently claimed that Connecticut’s attorney general “has reportedly opened investigations into Epic Systems and hospital networks” for information blocking. I emailed the Connecticut AG and received the response above. That’s Strike 2 against Politico, which previously stirred up a lot of hot air about non-existent EHR gag clauses in a much-cited article that offered no proof whatsoever.

Michael Arambula, MD, PharmD, president of the Texas Medical Board, defends the board against the “continued widespread perception that Texas is behind the times and restricting access to healthcare when it comes to telemedicine.” He was responding to a previous editorial that criticized the board’s requirement that doctors conduct a face-to-face exam on a patient before treating them by video visit. Arambula says “there are very few telemedicine scenarios which are prohibited in Texas.”

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AMA President Steven Stack, MD says physicians can’t be blamed for IT failures. By that logic, all automobile accidents, including those caused by careless or unskilled drivers, are the fault of car manufacturers.

In England, insiders at Cambridge University Hospital NHS Foundation Trust blame its struggling Epic implementation on an unrealistic budget, an overly aggressive timeline, and inadequate user training.

A judge will hear the case of two IT professionals who were fired from their jobs at the decommissioned Hanford nuclear power plant in Washington after they complained that the company’s EHR was not tracking medical restrictions correctly. OSHA had previously ordered contractor Computer Sciences Corporation to pay the pair $186,000 in back wages.

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Weird News Andy notes that one of several failed insurance co-ops, New York’s Health Republic, may stick hospitals with the $160 million it owes them now that the state has shut it down. The failed insurance company owes physician practices “tens of millions of dollars” as well. The state has ordered the insurer to stop paying some claims even though providers are still contractually obligated to keep providing services to its policyholders. New York denied part of the insurer’s rate hike request earlier this year even though it knew it was failing financially.


Sponsor Updates

  • Medical staff scheduling system vendor Lightning Bolt Partners will integrate its product with Imprivata Cortext.
  • AdvancedMD reports a smooth ICD-10 transition for its independence practice customers and billing services partners, with 100 percent of them ready on October 1 and the first practice receiving ICD-10 payment seven days after.
  • Huntzinger Management Group is named as one of the consulting industry’s fastest-growing firms.
  • Premier posts a promotional video for PremierConnect Enterprise.
  • EClinicalWorks will exhibit at the New York Health Plan Association 2015 Annual Conference November 18-19 in Albany.
  • SyTrue’s natural language processing technology is featured in “Unlocking the Value in Unstructured Data.”
  • Healthcare Call Center Times features Healthfinch client Essentia Health’s efficiency gains.
  • Built in Colorado ranks Healthgrades ninth in its list of Top 100 Colorado Tech Companies.
  • Huntzinger Management Group ranks tenth in Consulting Magazine’s list of fastest growing firms.
  • Burwood Group is recognized as a Cisco TelePresence Video Master Authorized Technology Provider Partner.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 17, 2015 News 2 Comments

Morning Headlines 11/13/15

November 13, 2015 Headlines No Comments

It’s Way Too Easy to Hack the Hospital

Bloomberg Business profiles white hat hacker Billy Rios, the analyst whose work exposing cybersecurity vulnerabilities in medical devices led to the recent FDA safety warning on Hospira infusion pumps. He says, “hospitals seemed at least a decade behind the standard security curve.”

Epic Systems forum addresses hot topic in medical records: interoperability

Cerner and Epic square off on interoperability at a Madison, WI health IT conference, with Cerner once again inviting Epic to join CommonWell, and Epic declining, saying it should not have to buy into an exchange network that wouldn’t be good for its customers or patient care.

NHS children monitored using McLaren Formula One technology

In England, patients at the Birmingham Children’s Hospital are being monitored with technology designed for racecar drivers from the McLaren Formula One team. The system monitors heart rate, respiration rate, and oxygen levels in real time and alerts the care team if the patient’s condition deteriorates.

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November 13, 2015 Headlines No Comments

News 11/13/15

November 12, 2015 News No Comments

Top News

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Bloomberg Businessweek puts medical device hacking on its cover, profiling a security expert who was criticized for announcing that he had found that medical devices are full of security holes. “All their devices are getting compromised. All their systems are getting compromised. All their clinical applications are getting compromised and no one cares. It’s just ridiculous, right?” The security expert was hospitalized himself and played around with an automated dispensing machine for medications just outside his room, which he easily penetrated using a known, hard-coded password that let him open any drug drawer he wanted. He’s buying his own medical devices to prove how vulnerable they are.

Experts say hospitals rely on device manufacturers to implement security, but they remain a weak link in exposing a hospital’s entire network. A security firm describes what it learned by creating a “honeypot” fake medical device to see who tried to penetrate it:

The decoy devices that TrapX analysts set up in hospitals allowed them to observe hackers attempting to take medical records out of the hospitals through the infected devices. The trail, Wright says, led them to a server in Eastern Europe believed to be controlled by a known Russian criminal syndicate. Basically, they would log on from their control server in Eastern Europe to a blood gas analyzer; they’d then go from the BGA to a data source, pull the records back to the BGA, and then out … In addition to the command-and-control malware that allowed the records to be swiped, TrapX also found a bug called Citadel, ransomware that’s designed to restrict a user’s access to his or her own files, which allows hackers to demand payment to restore that access.


Reader Comments

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From Occasional Angel: “Re: Theranos. I thought you’d get a laugh out of the company’s job posting for a communications director, which includes the requirement for an ‘agile thinker ability to respond quickly in shifting situations.’” Theranos certainly continues to experience shifting situations, nearly all of them causing further damage to the company. The latest headline is that grocery store chain Safeway is trying to wangle its way out of a previously unannounced Theranos partnership going back several years to put draw stations in 800 of its stores. The chain’s executives noticed that Theranos results sometimes differed wildly from the same test run by other commercial labs. Safeway also questioned why Theranos often drew samples from both a finger stick and by vein, with one of its executives astutely questioning “If the technology is fully developed, why would you need to do a venipuncture?” Safeway spent $350 million on the in-store clinic areas that featured granite countertops and video monitors, but is now using those areas only to administer vaccines.

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My most positive impression of Theranos is that they were able to get the funding to invest in what must have been an ultra-expensive array of automated lab testing equipment (Nanotainer-powered or otherwise) that allowed it to undercut the price of huge-scale competitors. Lab testing is a lot more like a factory than a Silicon Valley startup and it requires brick-and-mortar drawing stations that send samples off to centralized labs, which as why I assume Theranos tries to convince everyone it’s the next Apple instead of an ambitious drop-off dry cleaner. It’s hardly a national diagnostic powerhouse given that its only locations are in California, Arizona, and Pennsylvania. In addition, most of those locations are in the drugstores of  Walgreens, which seems to be distancing itself from Theranos pending review of its test process.

From Marketeer of the Beast: “Re: your rebranding of a health system to the made-up name Blovaria. Here’s how I would explain it. ‘Blovaria is a unique way to recognize our evolution in the marketplace. Our new name is the ideal platform to help us deliver market-leading bloviation with extreme variation in patient outcomes’… and on and on.” I like marketing folks that see the humor in what they do. I disdain marketing-speak and committee-driven company depersonalization into a “brand” that often tries to rewrite history and overpromises future company performance, but I believe strongly in much of what makes up marketing. Honest marketing tries to effectively convey a company’s values and vision in a noisy market, which is problematic when the paying customer wants marketing to cover up their incompetence or misplaced mission of simply pocketing cash by any means possible. Marketing people usually write well and are entertaining, so I’d be interested in running a guest article (anonymously, if that helps) from someone willing to explain the goods and bads of what they are asked to do.


HIStalk Announcements and Requests

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Mrs. Read from Florida sent photos of her students using the STEM exploration tools we provided via her DonorsChoose grant request. She says they’re working on a project where they’ve programmed the Sphero app-enabled robotic ball to detect underwater forces, adding that some of the students have been motivated to join the school robotics team as a result. Ms. Santoro from Connecticut sent photos of her first graders working with the tablets we provided, saying some of them don’t have access to technology at home and are asking to use them even when their assigned work is finished.

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I got a kick out of this tweet from Nick Kennedy, who apparently enjoyed my mhealth Summit rant. He has history in healthcare IT, but is now the founder and CEO of a private flight-sharing company. It’s fun knowing that someone reads HIStalk just because it entertains them.

This week on HIStalk Connect: Walgreens expands its telehealth offering to 25 states and updates its wellness app to capture glucose and blood pressure readings from its line of wireless medical devices. Researchers from Cedars Sinai Medical Center and UCLA find no improvement to 30-day readmission rates or six-month mortality rates when enrolled in a remote patient monitoring program. The American Association for Cancer Research has launched a data-sharing campaign that will create a central repository for researchers to store and analyze tumor gene mutation data. TigerText raises a $50 million Series C investment to help it expand its healthcare-focused communications platform.

This week on HIStalk Practice: The Wright Center receives the 2015 HIMSS Ambulatory Davies Award. Rep. Tom Price introduces the Meaningful Use Hardship Relief Act. The Patriot Promise Foundation launches to help connect veterans with better, technology-enabled care. PracticeMax acquires Medical Management Corp. of America. Greenway Health’s Rob Newman dishes on the KLAS Keystone Summit. The Retina Group of Washington selects a new EHR from Modernizing Medicine. New DreamLab app crunches cancer research data while you sleep. Ask the Doctor acquires Patients Connected.


Webinars

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

November 20 (Friday) 2:00 ET. “The Athenahealth Leadership Institute Presents: Dr. John Halamka Interviewed by Jonathan Bush.” Sponsored by Athenahealth. Presenters: John Halamka, MD, MS, CIO, Beth Israel Deaconess Medical Center; Jonathan Bush, CEO, Athenahealth. Providers are fed up with interface fees and the lengthy, fragmented narratives we’re exchanging today. But what is the right course of action to help deliver better care across the continuum? Bring your questions as we join Dr.Halamka and Jonathan Bush to discuss the current state of healthcare and how we can improve care coordination and interoperability.

December 2 (Wednesday) 1:00 ET. “The Patient is In, But the Doctor is Out: How Metro Health Enabled Informed Decision-Making with Remote Access to PHI.” Sponsored by Vmware. Presenters: Josh Wilda, VP of IT, Metro Health; James Millington, group product line manager, VMware. Most industries are ahead of healthcare in providing remote access to applications and information. Some health systems, however, have transformed how, when, and where their providers access patient information. Metro Health in Grand Rapids, MI offers doctors fast bedside access to information and lets them review patient information on any device (including their TVs during football weekends!) saving them 30 minutes per day and reducing costs by $2.75 million.

December 3 (Thursday) 2:00 ET. “501(r) Regulations – What You Need to Know for Success in 2016.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare Solutions. Complex IRS rules take effect on January 1 that will dictate how providers ensure access, provide charity assistance, and collect uncompensated care. This in-depth webinar will cover tools and workflows that can help smooth the transition, including where to focus compliance efforts in the revenue cycle and a review of the documentation elements required.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Here’s the recording of Thursday’s webinar titled “Top Predictions for Population Health Management in 2016 and Beyond,” sponsored by Medecision.


Acquisitions, Funding, Business, and Stock

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TigerText raises $50 million in Series C funding to expand the rollout of its secure messaging app.

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The HCI Group acquires UK-based High Resolution Consulting and Resourcing. HCI CEO Ricky Caplin says the company is in “major expansion mode” and will likely announce additional acquisitions shortly.

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Arizona-based HealthiestYou gets a $30 million investment from Frontier Capital. The company offers video visits, insurance connectivity, a provider director, and drug pricing lookup.

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Turing Pharmaceuticals, the most-hated company in America after pharma-brat founder and former hedge fund manager Martin Shkreli jacked up prices on ancient but vital drug Daraprim, records a $15 million loss on revenue of $5.6 million for Q3. The privately held company will soon start clinical trials for drugs for treating epileptic encephalopathies and PTSD, introducing both hope and despair among those patients who might benefit from the drug but know how hard Turing will put the financial screws to them or their insurance company to obtain it. The first drug earned the FDA’s fast track designation, which makes it surprising that Shkreli didn’t just sell that certificate on the open market since they’ve gone for as much as $350 million. Shkreli is also looking for producers for his upcoming (c)rap album. Those with artistic aspirations but minimal talent always seem to settle for being posers in recording rap, writing children’s books, or appearing on reality TV shows.


People

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Galen Healthcare Solutions hires Steve Brewer (Origin Healthcare Solutions) as CEO. Former CEO Jason Carmichael will remain on the board.

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Former IDX CFO Jack Kane joins the board of Health Catalyst. He also serves on the boards of Aesynt (which was just sold for $275 million), T-System, and Athenahealth. He’s also involved with several other former IDXers (including former CEO Jim Crook) in OpenTempo, which offers staff scheduling and workforce management solutions for large medical practices.

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Practice Fusion names interim CEO Tom Langan to the permanent role.

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Jeff Surges (Healthgrades) will join health plan enrollment technology vendor Connecture as CEO.

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Gene Amdahl, who went from being educated in a one-room South Dakota school without electricity to leading the development of the IBM’s System/360 mainframe and later the formation of compatible mainframe competitor Amdahl Computing, died Tuesday at 92.


Announcements and Implementations

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Caradigm adds electronic prescribing of controlled substances (EPCS) to its Identity and Access Management solutions (single sign-on, context management, and identity management).


Privacy and Security

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A proof-of-concept medical records project wins the Blockchain Hackathon in Ireland. It uses the blockchain to anonymize a patient’s electronic records and make them viewable to doctors or others to whom the patient gives their public identifier, retrieving the information via BitTorrent. A blockchain database securely stores a public ledger of transactions, in essence an ever-growing, append-only transaction log that does not require the participation of any third party to change hands. If you’re excited about the potential healthcare use of blockchain, consider writing an HIStalk guest article so educate the rest of us who have heard the word but don’t know much about it.


Technology

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The Philadelphia-based Health Care Innovation Collaborative issues a call for chronic disease health project ideas, from which it will choose winners who will work with one or more of its partners that includes CHOP, Drexel University, Independence Blue Cross, Jefferson Health, and University of Pennsylvania Health System. The group was formed by the Greater Philadelphia Chamber of Commerce to increase Philadelphia’s health IT activity. 

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In England, hospitalized children are being monitored by early warning software originally developed for Formula One race drivers. The pilot project involves wireless vital signs sensors attached to the chest and ankle that send data for real-time analysis and alerts. 


Other

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BIDMC CIO John Halamka, MD expands on his observations and recommendations for the Meaningful Use program, which he says served its purpose but should be dismantled as it tries to do too much and interferes with patient care. Some of his observations:

  • EHR certification threatens usability, interoperability, and EHR quality while also diverting resources away from more important work.
  • Nobody is intentionally blocking information exchange – it’s really “incompetence that feels like blocking.”
  • Government regulation isn’t the answer to solving societal problems and each new requirement adds a layer of clueless auditors.
  • Prescriptive regulation, additional structured data elements, and new quality measures don’t help create disruptive innovation. A business imperative is required.
  • The MU program should be rolled into other CMS incentive programs such as Alternative Payment Models and MIPS.
  • ONC has become distracted by political agendas, excessive focus on certification, and issuing grants, where it would provide better results as a policy shop that addresses specific problems such as safety and error reduction.
  • Stop blaming health IT vendors and providers as the enemy.
  • Focus on the few things that really matter, not the 117 goals in the Federal Interoperability Roadmap.

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A Health Affairs article says the Meaningful Use program increased hospital EHR adoption, but the effect of penalties as opposed to rewards is uncertain and small and rural hospitals continue to lag. Hospitals cited their challenges as cost, lack of physician cooperation, and the complexity of the MU program.

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The San Diego paper profiles startup Doctible, which has created a network of local providers who offer discounted cash prices and online booking for people with high-deductible medical insurance. It bugs me that, like most other sites that list physicians, it puts “Dr.” in front of their name and “MD” after, which is incorrect.

Epic and Cerner face off on interoperability at the Disruptive Healthcare Conference at UW-Madison. A Cerner VP again calls for Epic to join CommonWell, while Epic’s VP says the company already helps its customers connect to CommonWell and shouldn’t have to “buy in” to CommonWell just to keep doing that, explaining, “There is not a magic future down the road in which there is one health information exchange network called CommonWell.” Both VPs agree that hospitals and practices need more incentives to share information.


Sponsor Updates

  • AdvancedMD offers a $10 Amazon gift card to anyone who requests their information kit.
  • PDR will exhibit at the McKesson Chain & Health System Pharmacy User Conference November 17-18 in Pittsburgh.
  • Stella Technology is sponsoring and attending the NYeC Gala Awards to promote health IT in New York City November 18.
  • Liaison Healthcare will exhibit at the PointClickCare Summit November 16-19 in Palm Desert, CA.
  • LiveProcess will exhibit at the first annual Association of Healthcare Emergency Preparedness Professionals Conference November 17-18 in Omaha, NE.
  • MedData will exhibit at the HFMA Region 9 Conference November 15-17 in New Orleans.
  • Recondo Technology, the SSI Group, and Streamline Health will exhibit at the HFMA Region 9 Conference November 15 in New Orleans.
  • PatientPay sponsors the iPatientCare National User Conference.
  • PerfectServe will exhibit at the American Association for Physician Leadership Fall Institute November 13-17 in Scottsdale, AZ.
  • Lexmark will exhibit at RSNA15 to benefit Camp Invention’s STEM programs for children across the US.
  • ZirMed is sponsoring and will present at “Data-Driven Revenue Cycle” November 18 in Atlanta.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 12, 2015 News No Comments

HIStalk Interviews Joshua Mandel, MD, Harvard Medical School

November 11, 2015 Interviews 2 Comments

Joshua Mandel, MD is on the research faculty at Harvard Medical School and is the lead architect for the SMART project collaboration between HMS and ONC.

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Tell me about yourself and your job.

I am on the research faculty at Harvard Medical School. I’m in the department of biomedical informatics there. I work on making it easier for patients, clinicians, and researchers to work with electronic health data. I got there via medical school, where as a medical student I realized there was a lot more that computers could be doing for us than they were doing.

Describe the SMART project and how it relates to FHIR.

SMART Health IT, which is an acronym for Substitutable Medical Applications and Reusable Technologies, is a project that was originally sponsored by the federal government, by the Office of the National Coordinator for Health Information Technology, with a goal of building an app platform that allows third-party apps to plug into various kinds of health information systems. We specifically focus on apps that plug into electronic health records, which might be apps that clinicians use, apps that plug into patient portals, personally-controlled health records the patient would use, or apps that plug into data warehouses that researchers might use.

The goal is to provide apps with everything they need to be able to present a consistent user experience. The apps shouldn’t have to know about all the internal details of each different health IT system. The goal is to abstract the apps from those details. That’s the high-level goal of SMART.

We use a number of technologies under the hood to make that work. We use a set of open technologies everywhere we can. We use an emerging specification from HL7 called Fast Healthcare Interoperability Resources, or FHIR, to provide the data layer of access. FHIR gives us a set of data models and it gives us a Web-oriented REST API that application developers can use to query an electronic health records system for data.

Then on top of that, we layer a security model using OAuth 2 and OpenID Connect so that users can sign into apps using their existing accounts so they don’t have to create a new account for every app they want to use. That includes a permissions model, so you can give apps access just to the data that they need and you don’t have to give apps access to everything in your system.

We wrap all that together with a little bit of glue so that we can actually plug these apps into, for example, an electronic health records system. You might be a clinician working with an EHR system from Cerner, Epic, or any number of vendors beginning to implement these specifications. When you’ve got a patient record open inside one of these systems, you can launch an app and it knows about the context of what you were doing inside of the EHR, so that app can launch directly on the patient that you already have open and help you get some new jobs done that the original EHR didn’t have any functionality for.

How will that be positioned against vendors who have declared themselves to be open and created their own equivalent of an app store or an ecosystem with partners that they’ve approved?

We’re seeing interesting trends from the electronic health record vendors towards allowing certain kinds of third-party tools to integrate with these EHR systems. There’s still some big, open questions about the extent to which we’ll see standards as the basis for that integration versus vendor-specific data access.

We can actually separate out two questions. One question is, what are the technical mechanisms by which the access works? Are we using standards like FHIR? Are we using vendor-specific APIs? That’s the technical piece of it.

Then there’s a policy piece. Regardless of whether you use standards or whether you use vendor-specific APIs, there’s a policy piece about which apps are going to be allowed to talk to a given system and how are vendors and healthcare provider organizations together going to control that access.

What levels of capability or interest in SMART are you seeing from the three significant inpatient EHR vendors?

Overall, the goal of SMART is to provide an interface where apps can plug into outpatient systems, inpatient systems, and various other kinds of health information systems, including health information exchanges and researcher-facing systems. We don’t have an exclusive focus on the inpatient world, but of course it is an important area.

We’ve been very encouraged over the last few months by the participation of a number of the big EHR vendors in a project called Argonaut. Argonaut is running an open implementation program, where anybody who’s building an app or an EHR can join for free and go through a series of development steps with us, where they can build out support for SMART on FHIR one step at a time. We’re running this open implementation program and we’ve had a couple of dozen organizations actively participating. That includes many of the big-name electronic health record vendors.

EHR vendors and even providers themselves don’t have much incentive to let patients choose and use whatever apps they want that tie into their legacy systems. How hard will it be to gain traction when the patient is the only obvious advocate?

There’s a lot of moving parts to an ecosystem like that. I talked a little bit about what’s the technology to make the platform work. I talked a little bit about what’s the access control policy. The other big question is, who’s the audience? Who’s using these apps?

We see a very clear motivation on the side of provider organizations to be able to rapidly adopt, and even to build, new applications that serve direct business interests or direct clinical interests. We see a strong internal motivation from healthcare organizations to be able to launch new apps.

For example, we have an app that we deployed at Boston Children’s Hospital that helps take better care of children with high blood pressure. It takes data from the EHR and uses them to compute blood pressure percentiles, which are normalized by a child’s age, height, and gender. That’s how you’re supposed to make a diagnosis of high blood pressure in children, by calculating those percentiles.

The EHR has all the data, but it doesn’t do the calculation, so we built an app to do the calculation. There’s a very clear motivation on the part of the clinical organization to be able to deploy an app like that –it runs inside the hospital, runs on top of hospital data, helps take better care of patients. We can think about other kinds of apps, which might be patient-facing applications, where a patient says, "I want to use this new health management tool I found." That represents a paradigm shift for provider organizations.

It’s still an open question how internally motivated these organizations will be to let patients bring these apps to the table, but I’m very encouraged by the recent Meaningful Use Stage 3 final rule, which came out and said that patients should have the right to access their own health data using whichever apps they want.

It’s been said that people didn’t know they needed an iPhone until it came out. What would be the equivalent that would tell patients that they need interoperable health apps?

I don’t think we’ve seen our first killer app, so to speak, in this space yet, but we certainly see a strong interest along the lines of patients who are managing chronic diseases, where they have to see a number of healthcare providers and the system is not tight knit enough today that the healthcare providers from these different organizations really communicate very well. A patient is very motivated to improve that communication, so apps and tools that help them do that are a powerful selling point.

Another area which we’re only just beginning to explore is apps that help you shop around for the right healthcare services, whether it’s deciding on the healthcare insurance that’s the best fit for you given your actual usage patterns or shopping around for a procedure or drug given the insurance that you have. The more data that apps can access, both about you individually and about other patients in the ecosystem who might be like you, the better you’ll be able to make decisions that work for you.

What data sources would you need to provide an estimation of utilization? Would it be claims data plus EHR data?

I think looking at a combination of electronic health record data plus insurance claims is a very good place to start. There are some open kinds of claims data at the population level the government makes available that you can use for a very rough cut, but I think we’ll also see more partnerships being formed with aggregated data being shared that can help compute better decisions.

Geisinger formed XG Health to commercialize their apps that tie into Epic. Is that an early example of the kind of ecosystem that could be created around legacy EHRs that aren’t necessarily done through vendor-specific proprietary technology?

We’re seeing a trend in several places and Geisinger is a great early example of an institutional drive to innovate and to find a broader market based on these innovations. If you invest a lot of institutional time and money building a tool that works inside your own organization, that’s great — you can reap the benefits internally.

But more and more, there’s a desire to be able to share these tools, or sell these tools, outside of an organization. Anything you can do to build apps in a vendor-agnostic way, to build them in a standards-compliant, openly integrated fashion, lowers the cost of integrating this app with more systems downstream, makes it easier to export innovations beyond your own organization.

Vendor of mobile apps haven’t usually done the research to prove that the product improves cost or outcomes. They also often seem to target users who are already health focused. Will app developers need prove the value of what they’ve created?

I think there’s a few ways to measure the value of an application. One is to figure out how people like it and how they perceive that value. Two is to try to measure objectively how the app performs on some metrics that you define.

One of the really exciting things about this health app ecosystem is you can start to use apps as the instruments of research. We see examples of this happening along traditional institutional lines. For example, Duke Medicine has built an app that they’re using as part of a research project to evaluate how well patients know their medication regimen — how well they know which medications they’re supposed to take at which time of day. They’ve built a tool as a SMART on FHIR app that provides a patient with an interface for saying, "Here’s what I take in the morning, at noon, and at night." They’re able to drag and drop pictures of pills from a virtual pill box into these various categories. Then researchers can correlate how well patients perform at this task with other measures of medication adherence and start to figure out whether tweaking the parameters of this task can lead to improved adherence.

Whether you think that’s a great idea or not, the fact is we can use an app to do a measurement and to produce a traditional clinical research result, which you would never be able to do if you had to start from scratch and integrate this thing into the EHR just to fetch the med list. The fact that you can get the med list from the EHR and get all the patient demographics from the EHR out of the box with standards is what makes that kind of research possible.

Then we also see research happening in other new and exciting ways, for example, with mobile applications that collect data explicitly through surveys and implicitly through sensors. There’s a lot of good work happening, for example, on the iOS platform with ResearchKit in that direction today.

Are patients involved enough in the design of what they want, need, and will use instead of letting health systems manage app design?

I think the healthcare industry always struggles to figure out where and how to involve patients. Frankly, there’s a lot of bottom-up work that’s happening today in the patient application space, where companies are starting to build consumer-facing tools that don’t always make sense to the traditional healthcare ecosystem. But as consumers adopt them, we have a better and better idea of what’s really interesting and useful from the patient perspective.

I think it’s very hard for institutions, in a lot of cases, to do the right thing by involving patients. But we’re seeing very good bottom-up innovation that happens from outside of the institutions, and that might be the best indication we have of what really matters.

What do you expect to hope and see in the next five to 10 years in terms of how systems are opened up or interconnected?

Looking out to the longer term, my main hope is to see connectivity become more and more invisible, to have established pipelines where data arrive where they need to, and are available at the point of care, and are available at home without our having to take many explicit steps to make it happen.

What I’d like to see are clinical systems that understand the job that a user’s trying to do. Understand what it means to make a diagnosis or choose a correct treatment, taking into account clinical practice guidelines, the particular clinical situation at hand, taking into account patient preferences, and making it much easier to understand the risks and benefits across the board.

We need readily accessible data, both from the individual patient level and from the clinical knowledge domain. We need all those kinds of data available at the point of decision-making. My hope is that, by standardizing the core of these data access protocols, we can get there in the next five to 10 years.

Do you have any final thoughts?

From the perspective of the SMART Health IT project, we’ve seen an incredible amount of interest and enthusiasm around these APIs that, when we started building them in 2010-2011, the feedback we often got was that it felt like a science fair project and it wasn’t ready for the real world. The interesting thing is that not that much about the technology has changed, but given the overall landscape of EHR adoption and an increasing level of demand from end users for tools that fit their needs better, suddenly this technology has become incredibly mainstream in really short order. It’s been really humbling to be part of that experience.

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November 11, 2015 Interviews 2 Comments

News 11/11/15

November 10, 2015 News 3 Comments

Top News

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Walgreens expands its $49 MDLive-powered telemedicine services to 25 states, integrating it into the Walgreens mobile app rather than requiring users to install and run MDLive’s own app. The company also launches the ability for Walgreens Balance Reward members to connect to Walgreens-brand glucometers and blood pressure machines and will pay members for recording their measurements regularly. The company says 500,000 active devices are already connected. It’s amazing what can be accomplished with healthcare technology when incentives are aligned.

I have zero doubt: Walgreens is the most technologically advanced and most consumer empowering company in healthcare. They’ve driven more innovation into the health experience than anyone.


Reader Comments

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From Solid-State Component: “Re: mHealth Summit. Is it just me or is the conference the same recycled buzz year after year? Everybody is always talking about what they’re going to do or how wonderful mHealth and wearables will eventually be, but I don’t see a lot of real-life action or results.” The conference’s premise has moved from shaky to absurd as the expiration date has been reached on the idea that mobile health is an edgy concept that stands separate from any other kind of health or healthcare. Everything is mobile by definition – when did you last hear the phrase “mobile banking” or “mobile music?” Wearables have run their course (no pun intended) without accomplishing anything other than to allow healthy people to stroke their egos. I’ve heard of nearly none of the companies or presenters at this week’s conference, which seems unchanged from the two I’ve attended previously that were painfully unfocused and uninformative, a weird conglomeration of mobile messaging projects in Africa, mostly bored venture capitalists, pedantic academics, and clearly doomed startups with laughably minimal healthcare experience. It has become the industry’s Single A farm team, where most of the players will deservedly never see an inning in The Show but keep plugging away hoping to attract a paying customer or paying acquirer, huddling together for validation in National Harbor, MD and pretending they wouldn’t really rather be at the HIMSS conference with the big boys. I ran across a few interesting people and companies when I attended previously, but mostly I was kind of embarrassed to be part of it, rather like the one and only time I attended the TEPR conference as it was wheezing its last breaths.

From Nom de Nonsense: “Re: pointless company rebranding and strange names. I thought you would enjoy this Economist editorial.” I did indeed, as the author calls out the “ever-sillier ways” in which companies are identifying themselves. Examples: AbInBev/SABMiller (the multi-merged global beer conglomerate) and Diageo (another alcoholic beverage conglomerate that hides cool names like Guinness under its bland skirt). It calls Yahoo “tediously wacky,” dislikes made-up conjoined names (PingStamp), and loathes misspellings (Kabbage). It calls out PricewaterhouseCoopers (one of those infuriating “we can’t decide which name is most important after we’ve merged” company names, later rebranded to PwC) for being convinced by a branding agency to call its spinoff consulting business Monday, although it sold the business to IBM before the change. The article concludes that plenty of good names remain (Alphabet was good enough for Google) to obviate the need for “Scrabble spillage,” assuring that great companies will do just fine with boring names but clever names won’t save struggling ones. The article’s only omission is not mentioning companies that pointlessly capitalize their entire name, the marketing equivalent of shrieking and stomping childishly to be heard over the competitive din. Here’s my challenge to you: what are the most-contrived, least-informative, or most-annoying company names in healthcare IT? Let me know and I’ll run a list of what I’m sent.

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From What’s the Vector Victor: “Re: SNOMED. Has terms for the number of prior abortions. Our vendor, Practice Fusion, displays quantities of 1, 6, and 8 under the search. Does this happen in other SNOMED crosswalks?”

From Truven Watcher: “Re: Truven Health. Continued dismal operational performance.” The latest 10-Q shows that the company lost $15 million in the quarter and $66 million in the first nine months of the fiscal year. It contains a lot more financial detail than my attention span can manage. 


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor TierPoint. The St. Louis-based IT and data center services provider offers flexible, scalable, and secure solutions: production and disaster recovery clouds, co-location, and managed services (managed backup and business continuity, managed security, managed networks, DDoS protection, and enterprise hosting). A case study from services provider Clario Medical describes its migration from TierPoint-hosted servers to a private cloud infrastructure (load-balanced servers and SSD drives running VMware’s VSAN) with managed security services and HIPAA compliance. Some of the company’s 3,000 customers include Kootenai Health, WellDoc, and the Bill & Melinda Gates Foundation. Thanks to TierPoint for supporting HIStalk.

I found a TierPoint video titled “Tips for a Successful Cloud Migration.”

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My inexpensive but capable Asus tablet developed a charging problem after a couple of years of reliable use, which gave me the excuse I needed to skip a repair and instead get something zippier and slicker (although it turned out to have been a curling iron-scorched power cord that I’ve replaced and it’s working fine again). A bit of research turned up my deal: Walmart has the iPad Mini 2 16GB for $199 with free shipping or in-store pickup. I had it running almost instantly after I picked it up yesterday at the store — it automatically brought over most information from my iPhone, even (shockingly) my recent browser searches and auto-completes. Screen resolution on the Retina display, Netflix streaming, and speed are great and the battery life seems excellent. I had considered a direct-from-China off-brand that has good reviews for $60, but I think it’s probably worth the difference to get Apple, plus the eight-inch screen is much better for reading or streaming than the seven-inch standard while not being as bulky as the 10-inch iPad. It would make a great Christmas gift for almost anyone since it’s really easy to set up and use. I’m far from being an Apple fanboy, but this is a great deal, especially since Apple sells the same model for $269.

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Ms. W sent photos of her Washington fourth graders using the headphones and flash drives we provided via DonorsChoose. She says struggling readers are getting more engaged by using the audio versions of some textbooks and are using the flash drives to take their writing assignments home or to the public library.

I’m annoyed at banks and other companies whose recorded greeting asks me to say or enter my account number, reads it back painfully slowly from the computer for my confirmation, but when I finally get a human on the phone, they have no idea who I am or why I’m calling.

I’m also annoyed at doctors and others who smugly observe (with no originality whatsoever) that EHRs were designed “just for billing,” as though they wouldn’t stoop so low as to use computers to get paid. I suspect they aren’t seeing patients pro bono or as a hobby.

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Unrelated, but for fellow geeks: Joel Hodgson launches a $2 million Kickstarter campaign to bring back the original Mystery Science Theater 3000 with 12 new episodes. We’ve got movie sign!


Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

November 20 (Friday) 2:00 ET. “The Athenahealth Leadership Institute Presents: Dr. John Halamka Interviewed by Jonathan Bush.” Sponsored by Athenahealth. Presenters: John Halamka, MD, MS, CIO, Beth Israel Deaconess Medical Center; Jonathan Bush, CEO, Athenahealth. Providers are fed up with interface fees and the lengthy, fragmented narratives we’re exchanging today. But what is the right course of action to help deliver better care across the continuum? Bring your questions as we join Dr.Halamka and Jonathan Bush to discuss the current state of healthcare and how we can improve care coordination and interoperability.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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GE Healthcare acquires consulting firm The Camden Group.


Sales

Great Plains Health Alliance chooses Cerner Millennium for its 25 affiliated critical access hospitals in Nebraska and Kansas.

Heart of the Rockies Regional Medical center (CO) chooses Aprima for its ambulatory clinics.


People

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DeLicia Maynard (Christus Health) joins Besler Consulting as VP of solution strategy.

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Orion Health hires Susan Anderson (Alberta Health) as managing director of its operations in Canada.

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OhioHealth Marion General Hospital promotes interim Regional VP of Medical Affairs Mrunal Shah, MD to the permanent role. He was previously SVP of healthcare informatics at OhioHealth.

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University of Vermont Medical Center promotes Doug Gentile, MD to CMIO.


Announcements and Implementations

Validic and Quintiles will work together to develop digital health technologies to recruit drug study participants via disease-specific patient communities, capture the remote activity biometric information of drug study participants, and monitor the long-term drug efficacy of drugs after their FDA approval.

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Flatiron Health enhances its OncologyCloud to link to EHR and practice management systems to find missed or incorrect drug charges.

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University of Mississippi Medical Center will provide telehealth monitoring services to 1,000 new patient enrollees each month by the end of 2016 using technology from Intel-GE Care Innovations.

Boston Children’s Hospital will use IBM’s Watson in a project that will match genetic mutations to kidney disease to identify treatment options.

Nuance announces that its cloud-based Dragon Medical voice recognition is capturing 100 million “patient stories” each year as sales have increase 30 percent month over month since the beginning of the year.

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Bottomline Technologies announces that its Investigation Center, which it describes as a surveillance camera for monitoring user and network activity for privacy and security problems, has earned Meaningful Use Modular Certification.

XG Health Solutions launches XGLearn, an educational platform for population health management that uses approaches developed by Geisinger Health System.


Government and Politics

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The Department of Defense awards CACI a three-year, $77 million contract to develop clinical analytics tools. CACI created its healthcare business by acquiring analytics vendor IDL Solutions in January 2013. CACI announced just five days ago that it had been awarded a three-year, $39 million contract to continue support of the DoD’s Theater Medical Information Program. Shares of the publicly traded CACI value the company at $2.5 billion.

A Minneapolis TV station finds that local VA hospitals are listing phony board certifications for some of their doctors. An ED doc whose profile says he is licensed in Michigan and Wisconsin was actually turned down for Wisconsin licensure because he owed $69,000 in back taxes. 

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The Senate’s HELP Committee asks HHS to explain what it’s doing to prevent medical identity theft. The first four of its 12 questions are above.


Privacy and Security

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Hackers develop encryption ransomware for Linux servers, requiring website administrators to pay a Bitcoin ransom of several hundred dollars to regain access to their files.

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A judge rules that University of Cincinnati Medical Center isn’t liable for the Facebook posting of a patient’s medical records by an employee. The patient was the new girlfriend of the employee’s former boyfriend. The photo of the medical records, which contained a diagnosis of maternal syphilis, was accompanied by the employee’s comments that the patient was a “hoe” and a “slut.”


Technology

Apple CEO Tim Cook says that while he doesn’t want to put the company’s Watch through FDA’s approval process as a medical device, he “wouldn’t mind putting something adjacent … maybe an app, maybe something else.”

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The Sequoia Project (the former Healtheway) and Care Connectivity Consortium propose a framework and maturity model for a national patient matching. They’re seeking feedback.


Other

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ECRI Institute lists its top 2016 technology hazards. Most interesting to me was #10, where people plug a random gadget into the USB port of a medical device that causes it to malfunction.

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Another New York hospital system rebrands itself, with the New York City Health and Hospitals Corp. asking everybody to call it NYC Health + Hospitals. The president of the system, which wants people to stop calling it HHC, vomits up the marketing blather he was obviously force fed in explaining, “Our new brand graphics symbolize a true evolution as we transition from a hospital-centric corporation to a healthcare delivery system focused on providing an exceptional patient experience and building healthy communities.” The package includes a new tagline, “Live Your Healthiest Life.” The organization formerly known as HHC declined to say how much the name change will cost. My view of how encounter-driven hospitals have renamed themselves over the years without really changing anything goes like this:

  • Smithtown Hospital
  • Smithtown Medical Center
  • Smithtown Regional Medical Center
  • Smithtown Health – Regional Medical Center
  • Blovaria (my idea for a made-up descriptive name, although I need a marketing person to come up with an overwrought and thoroughly unconvincing explanation of what it means and why a new name was necessary)

Publicly traded genomic test kit vendor Foundation Medicine, alarmed by reduced test ordering volume, says it will “educate” oncologists on ordering more tests, market itself harder, and push for higher reimbursement from Medicare.

A woman sues a gym after she falls asleep in its sauna for two hours and the resulting burns require amputating all of her toes. She says the gym “should at least watch out for your safety and well-being,” adding a backup argument that the sauna was improperly installed. As is always the case, the woman says it’s not about the money, but her heartfelt desire to prevent it from happening to others.

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Sponsor Updates

  • USA Today features AirStrip President Matt Patterson, MD and innovation partner IBM.
  • Anthelio Healthcare Solutions will exhibit at HFMA Region 9 November 15-17 in New Orleans.
  • AHA Solutions endorses the YourCareUniverse consumer engagement platform.
  • Aventura explains how its Roaming Aware Desktop works in a new video.
  • Bernoulli CEO Janet Dillone is featured in OR Today.
  • Xconomy profiles Qualcomm Life’s acquisition of CapsuleTech.
  • CoverMyMeds will exhibit at the Medicaid Health Plans of America 2015 Conference November 11-13 in Washington, DC.
  • Experian Health will host its annual Financial Performance Summit for clients in San Antonio November 16-18.
  • Divurgent receives the Inside Business Roaring 20s Award, ranking as one of the area’s top 20 fastest-growing companies.
  • EClinicalWorks will exhibit at the 2015 Western States Health-e Connection Summit & Trade Shows November 17 in Scottsdale, AZ.
  • Extension Healthcare will exhibit at the National Veterans Small Business Engagement November 17-19 in Pittsburgh.
  • Medecision is recognized by Black Book Market Research as a top financial solution for value-based healthcare.
  • Healthcare Growth Partners advises iVantage Health Analytics on its sale to The Chartis Group.
  • Healthgrades Chief Marketing Officer Emeritus Judy Blackwell receives the John A. Eudes Vision and Excellence Award.
  • Healthwise will exhibit at the ACO Congress November 16-18 in Los Angeles.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 10, 2015 News 3 Comments

Monday Morning Update 11/9/15

November 7, 2015 News 9 Comments

Top News

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Sheldon Razin, who founded Quality Systems, Inc. (NextGen) and has served as the company’s board chair for 41 years, retires. He will be replaced by board member Jeffrey Margolis, who is also chairman and CEO of Welltok and the founder of TriZetto.

Razin’s first QSI retirement came in 2000, when he resigned his president and CEO roles as a result of longstanding power struggle with activist shareholder Ahmed Hussein. Hussein resigned his own board position in 2013 with a parting shot in publicly announcing that Razin’s board involvement was damaging the company. QSII shares are trading at less than half their 2010 price and about the same as their value in mid-2005. Razin holds shares worth $150 million.


Reader Comments

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From PM_From_Haities: “Re: Allscripts’ quarterly results. Don’t fall for anything less than standard accounting, which shows the company lost money in Q3. See here – no one ever adjusts EPS down.” I’ve always been torn by whether to report GAAP or adjusted earnings, but leaned toward the latter only because the big investment firms seem to favor excluding supposed one-time events that are under the company’s control such as stock compensation and restructuring costs. Allscripts turned its most recent quarter’s $5 million GAAP loss into a $25 million non-GAAP gain; the company hasn’t reported a GAAP profit since September 2012. The article eloquently describes why CEOs love less-stringent accounting measures that are similar to the “our patients are sicker” excuses that hospitals embrace in explaining objectively measured but unimpressive outcomes:

Insofar as CEOs and CFOs understand their job to be upholding the fragile psychological state of their shareholders by managing earnings in an emotionally supportive way, GAAP makes their jobs harder by sometimes requiring firms to issue financial statements that are not uplifting. But companies have a response. Because GAAP rules must cover a broad variety of circumstances, firms can usually make the argument that GAAP fails to comprehend relevant complexities. Everyone is special, especially when they miss earnings estimates.

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From Lawn Dart Trauma: “Re: Main Line Health. Word is they’ve chosen Epic. They’ve always been Siemens – I’m surprised Cerner wasn’t able to keep them in the fold.” Unverified.

From I’ll Show You Mine If You Show Me Yours: “Re: Epic. I’m a director at a customer hospital. Our analysts are getting calls from Epic’s support representatives asking for our hospital’s operating margin. A friend of mine at Epic told me that Judy asked employees to get this information for all Epic customers. I suspect they’re trying to assess if there’s financial trouble at other Epic sites in the way of some recent news reports. It’s frustrating since the general sense I get from colleagues is that development and service of Epic’s billing applications have atrophied greatly with the outsized focus they’ve had on clinical applications and when Epic is opaque about how it spends our money. The slow reaction times in the past few years is galling when I go to UGM and see where most of the money has been spent. I enjoy the show one day a year in Deep Space, but the quality of the other 364 days is suffering.” Unverified.


HIStalk Announcements and Requests

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It was a 60-40 split on whether customers or patients would be impressed with the respondent’s employer if they had inside information. New poll to your right or here: is the impact of private equity and venture capital firms on the health IT industry positive or negative?

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Ms. W. from Texas was so excited to hear that reader donations had funded her DonorsChoose grant request for electronic quiz tools and math activity stations that she immediately emailed, “I cannot express the excitement and happiness that has consumed me. When I saw the email that said ‘funded,’ my eyes began to water. As a classroom teacher, I saw the struggles and have come out of pocket for so many other projects. It hurt that this was something I couldn’t provide them with. Then we were blessed by you. Your generosity will help so many students better grasp the concept of math.” Meanwhile, Mrs. S in Colorado says her fifth graders vie for the chance to use the math games and materials we provided, sending the photo above.

A reader who wishes to remain anonymous donated $500 to my DonorsChoose project, asking that I fund elementary/pre-school science and math classes. I applied various sources of matching money, including from my anonymous vendor executive, to fully fund these grant requests:

  • Two Amazon Fire HD Kids Edition tablets for Ms. Torres’ pre-K class in Dallas, TX.
  • Five physics STEM kits for Ms. Owens’ elementary school class in Indianapolis, IN.
  • Math manipulatives for Mrs. Johnson’s elementary school class in Tulsa, OK.
  • Four Chromebooks for Mr. Wild’s high school math classes in Kealakekua, HI (I deviated a bit from the donor’s wishes in choosing a high school project because available matching money made the cost nearly nothing).
  • Two refurbished iPad Minis for Ms. Desai’s elementary school class in Alvin, TX.
  • Hands-on STEM learning tools for Ms. Lam’s first grade class in San Francisco, CA.

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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Last Week’s Most Interesting News

  • MedAssets will be acquired for $2.7 billion by Pamplona Capital Management, which will divest the company’s group purchasing and consulting business and combine the revenue cycle segment with Precyse, another of its holdings.
  • Cerner’s quarterly report meets earnings expectations but falls short on revenue.
  • Meditech’s quarterly report shows the continuation of an ongoing slide in revenue and profit, with services rather than product sales making up an ever-greater percentage of total revenue.
  • Francisco Partners sells it Aesynt pharmacy robotics business to Omnicell for $275 million just two years after acquiring it from McKesson.
  • Quality Systems announces that it will acquire cloud EHR vendor HealthFusion for up to $190 million.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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From the Allscripts earnings call:

  • Recurring revenue made up 75 percent of the company’s total revenue.
  • Non-GAAP earnings removed $9.9 million in expenses for severance, work on the company’s unsuccessful DoD bid, and settlement of outstanding litigation.
  • GAAP earnings were reduced by $1.4 million to account for the company’s equity investment in NantHealth.
  • The company says that inpatient EHR competitors who are leaving the market (presumably McKesson and the former Siemens) give Allscripts more opportunities.
  • President and CEO Paul Black says TouchWorks and Sunrise will begin integration with NantHealth’s protocol and algorithm work within six months.
  • The company says it has under-penetrated its client base in services sales compared to “one of our large competitors” (presumably Cerner) and hopes to improve that.

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Evolent Health announces Q3 results: adjusted revenue up 45 percent, adjusted EPS –$0.16 vs. –$0.31. Shares rose 13 percent on Friday, but are still down 20 percent from their first day of trading in June.


People

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As a reader previously reported, Graham King, former president of Shared Medical Systems and McKessonHBOC, died last week at 75.


Privacy and Security

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Hartford Hospital (CT) and EMC will pay a $90,000 settlement to the state for allowing an unencrypted laptop to be stolen in June 2012 from the home of the hospital’s contractor, EMC. Both organizations agreed to encrypt patient data and provide privacy and security training to employees.

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Police officers who wear body cameras have to remember to turn them off when entering a hospital to avoid violating patient privacy, according to the Kinston, NC police department. The department says officers will otherwise be violating HIPAA, which isn’t true because police departments aren’t covered entities and therefore have no obligation to follow HIPAA requirements.


Other

A Texas man pleads guilty to wire fraud for conspiring with others to pose as Cerner employees in order to sell hospital equipment and to defraud investors. The group registered a Cerner LLC corporate name, opened a bank account under that name, and registered Web domain CernerInc.com in selling a $1 million MRI machine to a Texas hospital, which the hospital reported to authorities when the real Cerner declined to help them install it.

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CMS reinstates Faxton St. Luke’s Healthcare (NY) after it says it fixed ED problems that allowed a violent psychiatric patient to be  released without evaluation. He killed three family members hours later. The hospital changed its order entry system to make it easier to order mental health assessments, added a hard stop so that triage nurses can’t skip documenting suicide risk assessment, and ordered physicians with illegible handwriting to use dictation software.

A judge orders Geisinger Health System to provide salaries of its executives and doctors to the family of one of its medical residents who died of a brain hemorrhage while admitted to one of its hospitals. The family is suing Geisinger and wants the salary information to determine the value of the resident’s lost life. The health system has fought the disclosure of executive salaries, arguing that the information is proprietary and strategic.

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A Bellevue, WA orthopedic surgeon sues a patient who posted an unflattering Yelp review of his work, saying she damaged his business and personal reputation. The patient’s also filed a complaint with the state medical board, but they dismissed it as lacking evidence of a violation.

The New York Times profiles a Nepal-based ophthalmologist nicknamed the “God of Sight” who developed a five-minute, $25 cataract removal procedure that he has used to restore the vision of 120,000 people. The doctor manufactures his own $3 replacement intraocular lenses to avoid the $200 cost of commercially produced ones. His success rate is the same as that of US doctors who use $1 million machines.

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The Pensacola, FL paper profiles local businessman and philanthropist Quint Studer, who worked his way up through hospital administration to become CEO of Baptist Health Care (FL), a job he left to start consulting firm Studer Healthcare Group in 1998. He sold 70 percent the company for $217 million in 2011, after which it was sold to Huron Consulting Group for $325 million in January 2015.

Johns Hopkins BSN student Stephanie Olmanni, whose background includes education and experience in music and film scoring, creates a nice parody of Adele’s “Hello” that describes her frustration trying to wade through the bureaucracy of obtaining a California RN license. 


Sponsor Updates

  • TransUnion President and CEO Jim Peck is featured on the cover of The CIO Review.
  • Valence Health and Aldera share insights on risk-based healthcare landscape.
  • Health Catalyst ranks first among healthcare technology companies on the list of Utah’s 100 Fastest Growing Companies of 2015.
  • Winthrop Resources SVP Brad Swenson will present at the Virginia Hospital and Healthcare Association Annual Meeting November 11-13.
  • Xerox Healthcare wins the Best New Venture Award as part of Market Gravity’s 2015 Corporate Entrepreneur Awards.
  • ZeOmega places twelfth on the Metroplex Technology Business Council’s 2015 Fast Tech Awards List. The company also received MTBC’s Momentum Award for placing on the list five years in a row.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 7, 2015 News 9 Comments

News 11/6/15

November 5, 2015 News 1 Comment

Top News

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Allscripts announces Q3 results: revenue up 3 percent, adjusted EPS $0.13 vs. –$0.06, meeting revenue expectations and beating on earnings.


Reader Comments

From Worried: “Re: HHS and Department of Justice. Investigating [vendor name omitted] for fraud in EHR certification and safety issues.” Unverified, so I’ve left out the company’s name. Let me know if you have specific information.

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From All Hat No Cattle: “Re: KLAS’s proposed interoperability measures. These are good and will really help highlight the issues, especially those that allow users to call out issues from within their own provider organizations. Issues like opt-in/opt-out are huge. I think it will also highlight the incredible job that Epic has done in allowing its clients to share information, which is becoming the gold standard.” The draft KLAS questionnaire for providers to assess their interoperability capability and use is indeed pretty good, targeting high-value connections rather than giving credit for connections that patients and clinicians don’t really care about. My only tiny quibble is that the document defines interoperability as “the ability” to exchange and use information, while the survey far more importantly assesses whether providers are actually doing it. The downside of the provider survey approach is that those who are unwilling to share information will point fingers at everyone else, skewing the results since it’s easier to blame generic “technical barriers” than to admit that you don’t want to provide information to your competitor and vice-versa. I guarantee that if health systems and doctors were paid a per-record fee for sharing their information, they would quickly overcome every alleged barrier and would pressure their technology vendors to figure it out (see: Meaningful Use bribes). The business case for helping patients being seen elsewhere is shaky.

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From Poor Quality: “Re: University of Mississippi Medical Center. Gets an F in quality from Leapfrog, making it the worst in the state.” The hospital responds with the standard “our patients are sicker” excuse, saying other hospitals dump their problem patients on UMMC and that patients should not avoid the hospital just because it earned a failing grade. Sicker patients or not, UMMC scored horribly in all six surgical safety categories, such as leaving objects in the bodies of surgery patients. The chief medical officer says it’s not about whether the hospital earns an F or an A, it’s about improving outcomes for patients as a group, although not leaving sponges in patients might be a good start toward accomplishing both.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor LogicStream Health. The Minneapolis-based company, co-founded by a pharmacist and a physician, applies algorithms to hospital or clinic EHR data to develop clinically appropriate protocols, with one client reducing its post-surgical venous thromboembolism by 80 percent in improving outcomes and saving $1.1 million by applying individual risk assessments. The company’s platform quickly identifies clinical process problems to support data-driven adjustments that improve quality and provider satisfaction. It offers specific quality improvement modules for VTEs, catheter-associated UTIs, and central line-associated blood stream infections; cost containment solutions for high-cost labs and drugs; and the ability to measure the impact of order sets and nursing flowsheets. Co-founder Daniel Rubin, MD, MHI presented a webinar on reducing care variation that provides background. Thanks to LogicStream Health for supporting HIStalk.

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Reader donations of $150, to which I applied available matching funds via DonorsChoose, provided math activity stations and wireless quiz technology for the fourth grade class of Ms. Williams in Lancaster, TX;  a CD player, lapboards, and clipboards for small-group math instruction for the class of Ms. Penagos in Carrollton,TX; and math supplies and games for Mrs. Johnson’s kindergarten class in Silvis, IL. Meanwhile, Mr. Moore sent an update from Minnesota with the photo above of his students using the STEM materials we provided.

A brilliant Twitter enhancement request comes from @Farzad_MD as he’s getting bombarded by conference attendees (some of them reporters paid by their conference presenter employer) live-tweeting banal observations and quotes that are useless out of context (and often within context). His idea: allow Twitter muting by hashtag. That would work great for squelching dull tweetchats as well, or to allow users to create Twitter “folders” that you could follow separately to bypass their sports cheerleading and instead focus only on their work-related tweets. I might add a second variant: allow muting a Twitter account for a user-defined time out, like shushing them until the conference they’re yapping about is over. The few people I follow on Twitter are mostly insightful 95 percent of the time but some of them are insufferable when they get unduly aroused by some meeting, sporting event, or personal accomplishment.

I still haven’t heard a word from anyone who has actually seen an EHR gag clause, so I’m calling BS on the reporter who stirred up that whole issue in the first place (along with the mindless parrots who squawked about that article despite its lack of evidence and obvious confusion as to what a “gag clause” even is). My assertion is unchanged: the pressure you feel to avoid speaking up about patient-endangering software problems is far more likely to come from the executive suite of your health system, not that of your software vendor.

This week on HIStalk Practice: Healthcare.gov opens with no signs of IT trouble … yet. EClinicalWorks breaks into the UK market via a new partnership. The NC Medical Society Foundation works with Chess to transition rural practices to ACOs. Sanctus Healthcare implements CCM services from McKesson BPS. Wellero President Hanny Freiwat offers physicians advice on increasing patient payments before the end of the year. SHIN-NY targets physician practices after reaching RHIO milestone. The Toledo Clinic joins the Ohio Independent Collaborative. Culbert Healthcare Solutions Director Jaffer Traish offers best practices for streamlining the efforts of IT and operations.

This week on HIStalk Connect: Teladoc’s stock price falls 10 percent after reporting its Q3 results, which showed signs of impressive organic growth but still shows the company operating in the red after 13 years in business. Fitbit reports its Q3 results, posting better than expected earnings. The company was also named in a countersuit from rival Jawbone alleging that it has established a monopoly in the fitness tracker market. Monclarity raises $5 million to launch a "brain games" cognitive training app, despite widespread skepticism from neuroscientists over the effectiveness of such apps. Lumo raises $10 million to launch a B2B wearables platform that sets a company up with sensors, software, and an API to launch their own fitness tracking wearables powered with Lumo’s technology.


Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Consulting firm The Chartis Group acquires iVantage Health Analytics.

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From the Cerner earnings call:

  • EVP/CFO Marc Naughton said the company is disappointed about missing revenue expectations by $20 million, but delivered record bookings and has a strong pipeline that includes a $13.9 billion revenue backlog. The drive is that clients are tying payments to milestones and even to specific health system performance targets.
  • The former Siemens Health Services brought in $250 million in revenue, 22 percent of Cerner’s total revenue, but was responsible for half of its $20 million revenue miss as some former Siemens clients dropped their maintenance agreements. Cerner says sales of the former Siemens products are “minimal … Siemens is negligibly impacting us” and that was the plan all along.
  • President Zane Burke says the company differentiates itself from Epic by “the ability to deliver value along with predictable costs and timelines” as opposed to “their list of clients, where the significant costs of deploying and maintaining their systems have been cited as a key reason for financial challenges is starting to impact them in the marketplace.”
  • The company says Epic-using Geisinger chose Cerner for population health management because “our capabilities could not be equaled by a competitor.”
  • The company had two displacements of an unnamed ambulatory cloud competitor (presumably Athenahealth) due to “their lack of execution, failure to meet established objectives, rising costs after teaser rates, and a realization by the client that they ended up needing similar or more staff even though they thought they had outsourced the function to our competitor because they left much of the harder work and complex work to the client.”
  • The company warns that revenue from its Department of Defense subcontracting will be slow, with the first Leidos task order representing less than 1 percent of Cerner’s quarterly bookings. That task order was valued at $98 million and 1 percent of Cerner’s quarterly bookings is $16 million, so at least for the quarter, Cerner’s cut of the DoD contract is less than 16 percent.

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Cognizant reports Q3 results: revenue up 24 percent, adjusted EPS $0.76 vs. $0.66, beating revenue expectations but falling short on earnings. The company’s healthcare segment, which includes its $2.7 billion acquisition of TriZetto last year, contributed 30 percent of Cognizant’s revenue ($939 million) in a 43 percent jump.

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Dell is rumored to be planning the sale of $10 billion worth of its non-core divisions to ease the $50 billion in debt it will take on to acquire EMC, with the former Perot Systems being one of the assets that could be placed on the block. Dell bought Perot for $3.9 billion in 2009.


Sales

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For-profit, 16-hospital Iasis Healthcare (TN) chooses Cerner for EHR and revenue cycle systems.

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San Joaquin General Hospital (CA) will implement Cerner.

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Walgreens will implement Epic’s EpicCare in its 400 retail clinics beginning early next year, replacing its proprietary EHR. I think the drug chain’s 8,200 pharmacies use Greenway’s EHR, which I would expect to be at significant risk of eventual displacement since they obviously looked elsewhere for the clinics and they are bragging on the interoperability opportunities Epic will provide. Some of the sites and fast-on-the-draw tweeters missed the fact that this announcement pertains only to the in-store clinics, not all of Walgreens (yet).

ZappRX chooses the e-prescribing state law review data set and services from Point-of-Care Partners.


People

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Rush Health (IL) hires Julie Bonello (Access Community Health Network) as CIO. I’m fascinated by her LinkedIn profile that shows she earned a BSN and then an MS in computer science, dropped out of the CIO role for several years to run the family’s chain of noodle shops as she cared for her aging parents, then jumped right back in as CIO of Cook County Health and Hospitals.

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J. P. Fingado (Francisco Partners) joins healthcare talent manager software vendor HealthcareSource as president and CEO. Francisco Partners acquired the company in May.

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Community Health Systems announces that SVP/CIO Gary Seay will retire at the end of the year.

Orion Health hires Robert Pepper (NeuroTrax) as VP of marketing for North America.


Announcements and Implementations

Influence Health announces a new version of its Connect clinical portal, which alerts physicians of frequent visitors who may be at risk for readmission and integration of DynaMed’s clinical information.

Medecision and Forward Health Group partner to provide population health management solutions to New York DSRIP participants.

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Quest Diagnostics will sell de-identified patient lab results through analytics vendor Medivo to drug companies, which will then use the information to target their marketing to individual physicians. Medivo calls their business “delivering the promise of precision medicine by providing decision support on the use of targeted therapeutics,” which is probably not what pie-in-the-sky “precision medicine” dreamers have in mind when they picture using data to treat patients rather than to sell more drugs.

Healthgrades will expand its online appointment scheduling capabilities in partnership with MyHealthDirect.

Lincoln Surgical Hospital (NE) uses Summit Scripting Toolkit to import scanned documents from clinical modalities into Meditech, requiring just eight hours of analyst time to create and test the script and move it to production.

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Durham, NC-based Touchcare, which offers a $99 per provider per month telemedicine app, adds a web-based provider dashboard and integrated billing capability.


Government and Politics

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John Halamka, MD, recapping the November HIT Standards Committee meeting, repeats his call to dissolve the Meaningful Use program and move Stage 3 requirements into CMS’s upcoming Merit-Based Incentive Programs (MIPS).


Privacy and Security

An ED study finds that 71 percent of patients who use Facebook or Twitter don’t mind doctors looking at their accounts, although I can’t imagine any ED doctor who would find that any more useful that the uneventful stream of wearables data they rightfully ignore. Maybe that would be more useful for PCPs who could possibly wade through all the inevitable junk to piece together some sort of social history that the patient could have just told them directly. Or, perhaps there’s your startup idea: a private, Facebook-like app just for the intuitive entry of health status information that you share with whomever you want (doctor, family member, etc.) Maybe you post your weight or sleep schedule and your doctor gives it a “like” or adds a slightly scolding comment.


Technology

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Amazon Web Services could bring in $16 billion in annual revenue by the end of 2017, making it the company’s most valuable business at up to $160 billion.

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Researchers from Vanderbilt University School of Engineering make the hardware and software of their swallowable medical robots available via open source. The devices, also known as wireless capsule endoscopes, can be guided rather than just carried along by intestinal activity as are PillCams.

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Precision medicine is here after all: CDX develops a chemical sensor that also uses big data and machine learning to analyze a sample of marijuana and apply the experience of that strain’s users to determine whether it will deliver the desired outcome (medical or otherwise) to the app user. The company will earn revenue from displaying paid advertising of dispensaries. The company plans to expend its “electronic nose technology” into other areas, such as air and water quality. This is a brilliant business model all around.


Other

In Pakistan, Hayatabad Medical Complex, alarmed by employees and physicians moonlighting in nearby medical facilities on company time, requires them to clock in using biometric ID. Board members also mandated that all procurement be moved online.

I’m amused that the AMA’s Thursday tweetchat on digital medicine innovation was led by its CMIO – who doesn’t even have a Twitter account.

I don’t understand this at all. A DC business paper profiles ListenPort, which it contrasts to Yelp and Twitter in providing a private place to complain directly to management. I thought we had that already in products called “email” and “texting.” They offer a free basic account, so maybe I’ll try it out.

A former purchasing assistant with England-based health IT firm Ascribe is sentenced to four and a half years in prison for stealing $900,000 from the company over five years. She used the money, obtained by paying phony invoices to herself, for vacations, cars, a house, and to pay off her son’s drug debts. Ascribe hired her even though she had previously been convicted for stealing from a previous employer. Ascribe sold itself to EMIS Group in 2013 for $88 million but says it could have gotten $5 million more had the theft not reduced its profitability.

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AMIA will induct 13 new Fellows in the American College of Medical Informatics on November 15.

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An Atlantic article says programmers should stop calling themselves “engineers” since they aren’t regulated, certified, or required to take continuing education. It says the tech industry has cheapened the term “engineer” by applying it to everybody who isn’t in sales, marketing, or design.

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I haven’t watched TV for years, but this week’s episode of “CSI: Cyber” titled “Hack E.R.” (although “Hack E.D.” would have been better) apparently spins a tale of a hospital whose network was penetrated by ransom-seeking hackers through a smart TV (what the heck hospital has those?), causing the death of a patient when they disable her heart monitor. The hospital couldn’t take the network down because it would disable all their ventilators (huh?) Then a patient died when the malware-affected EHR didn’t give his doctor an allergy warning as he entered an order. The entire episode, which seems absurdly hammy and unrealistic (being TV, after all), streams here with a ton of commercials and gratuitous on-screen graphics as annoying as those “pop up” shows from years ago. I couldn’t hack (no pun intended) more than a few seconds’ worth, but I notice the series stars Ted Danson (who looks like Sam Malone’s grandfather even with his wig on) and the episode was directed by Eriq La Salle, who played Dr. Peter Benton on “ER.”


Sponsor Updates

  • A hospital group in Indonesia reports success in deploying InterSystems TrakCare.
  • A Rand Corporation study finds that Health First (FL) improved patient throughput significantly using systems from study sponsor TeleTracking Technologies to identify bottlenecks and improve processes.
  • InterSystems publishes a new white paper, “Creating Sustainable 21st Century Health Systems: EHealth and Health Information Technology.”
  • Navicure will exhibit at MGMA Mississippi November 6 in Pearl.
  • Strata Decision Technology announces highlights from its Decision Summit.
  • PeriGen will demonstrate its new PeriCALM CheckList at the Synova Associates Perinatal Leadership Forum November 11-14 in Dallas.
  • Obix will exhibit at 2015 Perinatal Leadership Forum November 11-14 in Dallas.
  • Medecision and its customer Baystate Health will present a session on population health management at the HIMSS 2015 Big Data & Healthcare Analytics Forum this week.
  • Experian Health will exhibit at the HMA CFO Forum November 11-14 in Utah.
  • Jefferson College of Public Health recognizes PatientSafe Solutions VP of PatientTouch Coordinated Care Amber Thompson as a 2015 Health Education Hero.
  • PDS CEO Asif Naseem is profiled in the local paper.
  • Validic announces client growth and enhancements that allow mobile app developers to connect to clinical devices and to Apple Health.
  • PerfectServe will exhibit at the American Association for Physician Leadership Fall Institute November 13-17 in Scottsdale, AZ.
  • Sandlot Solutions will exhibit at the HIMSS Connected Health Conference November 8-11 in National Harbor, MD.
  • The SSI Group will host a user group meeting in Nashville on November 10.
  • Streamline Health will exhibit at the HFMA Big Data Analytics Conference November 10-12 in Denver.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 5, 2015 News 1 Comment

Morning Headlines 11/5/15

November 5, 2015 Headlines 1 Comment

Cerner Reports Third Quarter 2015 Results

Cerner stock closed down 6.75 percent today after missing revenue expectations in its Q3 financial results and projecting lower Q4 earnings than analysts had forecasted. Quarterly revenue rose 34 percent to $1.1 billion, adjusted EPS $0.54 vs. $0.42.

Prestigious medical journals rejected stunning study on deaths among middle-aged whites

Two Princeton economists, one a recent Nobel Laureate, have discovered that mortality rates for whites in the US between the ages of 45 and 54 rose dramatically from 1999 to 2013. The findings, which are unseen elsewhere in the developed world, were rejected for publication by both JAMA and NEJM, before being accepted by the Proceedings of the National Academy of Sciences.

Better Together: High Tech and High Touch

A new study conducted by Nielsen Strategic Health Perspectives surveyed 5,000 patients and 630 providers on consumer attitudes toward a wide variety of technologies used in healthcare, including EHRs in the exam room, telehealth services, and text-based appointment reminders.

Many patients ok linking social media to medical records

In a study published in BMJ Quality and Safety, researchers ask adult ED patients if they would be willing to link their social media accounts to their EHR for medical research purposes, to which 71 percent of the patients agreed.

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November 5, 2015 Headlines 1 Comment

News 11/4/15

November 3, 2015 News 2 Comments

Top News

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Pamplona Capital Management will acquire MedAssets for $2.7 billion, announcing plans to divest the company’s group purchasing and performance improvement segments to VHA-UHC and merge its revenue cycle business with another of Pamplona’s recent acquisitions, Precyse. Pamplona says the new, privately company will be a national leader in outsourced revenue cycle, technology, and education, explaining:

Existing and prospective customers of the new, realigned company should expect a business that is dedicated to investing in integrating our technology both internally and with EMR software providers; improving the visualization and utility of our data; scaling our front, middle, and back-end services businesses; and, developing offerings in patient payments and value-based reimbursement. MedAssets and Precyse employees will be part of a growing, focused business that prioritizes long-term value creation

Pamplona will pay a 30 percent premium for shares of MedAssets. MedAssets said this summer that it was exploring strategic alternatives even as an activist investor called for it to replace some of its board members due to questionable acquisitions and undervalued shares. It also lost a key customer and and announced plans to lay off 5 percent of its workforce just a few weeks ago.

Pamplona acquired Precyse in July 2015 for an undisclosed price from Altaris Capital Partners and NewSpring Capital.


HIStalk Announcements and Requests

Want to connect with me on LinkedIn? I’m here, as is Dann’s 3,649-member HIStalk Fan Club

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Mr. Graham in Illinois sent photos of his students using the STEM materials we provided, saying, “The students have shown a great interest in science. They enjoy working with these activities and do the research that goes along with them. They have learned more from these kits than I would have ever been able to teach them using our science textbooks. It is very rewarding for me to see how much they enjoy science now and how engaged they are with these activities. We would like to thank you for supporting our grant and putting these awesome materials into our classroom.”

HIT Geek donated $100 for my DonorsChoose project, which with double matching funded $400 worth of classroom projects:

  • Eight scientific calculators for Ms. Tyler’s Algebra 2 class in La Mesa, CA.
  • Green screen broadcasting equipment for Mr. Ventura’s classes in Omaha, NE to allow students to produce morning news broadcasts and video projects.
  • A field trip to the Wildlife Science center for Ms. B’s Grade 6-8 class of emotionally disabled students in Brooklyn Park, MN.

HIT Geek likes reading about my funding choices. For others who would like to donate, here’s how to do it:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
  3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
  4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: revenue up 34 percent, adjusted EPS $0.54 vs. $0.42, meeting earnings estimates but falling short on revenue expectations. The company projects Q4 revenue and earnings lower than consensus, sending shares down 9 percent in after-hours trading following the announcement.

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EClinicalWorks announces the opening of a London office and the signing of its first UK customer, the 1,700-store Specsavers optical chain. ECW says it booked $100 million in international business in the past year.

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Teladoc reports Q3 results: revenue up 83 percent, EPS –$0.37 vs. –$2.68, with its loss meeting expectations and its $20 million in revenue beating slightly. From the earnings call:

  • The company touted future potential given its 60 percent telehealth market share in a market that’s only 1 percent penetrated.
  • Subscription fees made up 85 percent of the quarter’s revenue, with the remaining $3 million coming from telehealth visits.
  • The company will raise its visit fee from $40 to $45 on January 1.
  • Teladoc spent $1.6 million in the quarter on its legal fight with the Texas Medical Board and expects to spend up to $750K more in Q4.
  • The company emphasizes that customers get what they pay for, with some lower-priced offerings failing to deliver value.
  • The company says health systems are using its product to acquire patients, while health plans are using it for population health and care management.
  • Teladoc believes CMS will allow fee-for-service telehealth payments via Medicare and Medicaid.
  • The company is working with health systems to design a post-discharge program.

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Two co-founders and a former executive of travel and expense management system vendor Concur (sold to AP last year for $8.3 billion) join Accolade. The Plymouth Meeting, PA company offer Health Assistants who work with technology and analytics to  engage with consumers to reduce utilization and costs. The company claims a 98 percent user satisfaction rate, contacting healthy members an average of five times annually and reaching out to the least-healthy ones 24 times per year.

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Referral and access management technology vendor SCI Solutions acquires Clarity Health, which offers authorization and referral management services.

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Meditech announces Q3 results: revenue down 3.5 percent, EPS $0.37 vs. $0.50 as product revenue dropped 16 percent year over year due to lower sales. Nine-month net income slid to $51 million vs. $104 million in 2014. Here’s the five-year change:

Product revenue: $60,102,900 (2010) vs. $37,004,099 (2015) – down 38 percent
Service revenue: $58,368,348 (2010) vs.$82,102,999 (2015) – up 41 percent
Total revenue: $118,471,248 (2010) vs. $119,107,098 (2015) – flat
Net income: $31,957,358 (2010) vs. $13,591,077 (2015) – down 57 percent
Earnings per share: $0.89 (2010) vs. $0.37 (2015) – down 58 percent
Shareholder equity: $408,525,252 (2010) vs. $529,738,300 (up 30 percent)


People

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Best Doctors names Peter McClennen (Allscripts) as CEO.

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HealthMedx founder Charlie Daniels (CS Funding) will return to the company as COO.

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Sam Miller, former CIO at Massachusetts General Hospital and University Medical Center (AZ), died last month in Canada. He was 77.

A reader reports that Graham King, former president of Shared Medical Systems and McKessonHBOC’s IT business, passed away this week.


Announcements and Implementations

A two-year Geisinger study finds that patients given online access to their clinical documentation via OpenNotes have a slightly higher rate of adhering to their medication regimens. It’s an unimpressive finding, but perhaps asked the wrong question in the first place since the two observations don’t seem to have much intuitive correlation. 

Wheaton Franciscan Healthcare’s southeastern Wisconsin operations will join Ascension Health, which already had 150,000 employees and 131 hospitals. Ascension pays big salaries: the CEO made $8.5 million, the CFO $4 million, the chief medical officer $2.7 million, and quite a few executives at $1.5 million and up.

In England, Addenbrooke’s Hospital is testing an online tool that allows prostate cancer patients to set PSA testing reminders and to track their own PSA levels.

A small study of outpatient diabetic patients finds that use of Glytec’s Glucommander insulin management software reduced the average A1C level from 10.4 percent to 7.4 percent within 30 days.

Middle Park Medical Center (CO) will implement Epic via Centura Health, replacing Healthland.


Government and Politics

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The just-announced 2016 work plan for HHS’s Office of the Inspector General includes examining the effectiveness of the FDA’s oversight of medical device security to determine if it adequately protects patients.

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The FDA seeks input on how technologies such as apps, telemedicine, and biomedical sensors might be used in performing clinical trials for drugs. FDA wants to know what technologies are being used, how FDA can encourage their use, and what challenges need to be overcome, especially regarding the use of patient-owned devices.

I’m bored with taxpayer trough-lappers biting the hand that feeds them, including the AMA, which announces that the Meaningful Use program is “doomed” unless Congress lowers the bar. It says the market needs new EHRs to support the way doctors practice, not mentioning how many of its members bought whatever a salesperson stuck in front of them in their zeal to pocket a seemingly easy $44,000 taxpayer bribe. AMA blames Meaningful Use for physician data entry time, the requirement to collect pointless information, and for creating interoperability barriers. AMA concludes that physicians embrace new technology, but are stymied by bureaucracy. I hope they are right, actually – it would be just fine with me if Meaningful Use went away.

Medicare will eliminate higher payments for medical practices acquired by hospitals starting in 2017, lowering their payments to be the same as for non-hospital owned practices and saving $9 billion per year. However, the change isn’t retroactive, so it effects only newly acquired practices, meaning hospitals may buy practices even more aggressively to lock in their high Medicare rates. The AHA is predictably lobbying against the change, saying it will reduce access to care. The change may have limited impact anyway depending on how far value-based care has progressed by the time the change kicks in.

Two senators are investigating why 12 of 23 non-profit state co-op insurers funded by $2.3 billion in ACA loans have failed. The senators also express concerns that the surviving co-ops may be using “creative accounting” that may lead to even more failures. A report from a few weeks ago found that all but one co-op is struggling financially, with some of their leaders blaming Republican-led funding cuts. Observers say the co-ops set their premiums too low and had to use their federal loans to pay medical claims.

A national human resources team sent by the VA’s national headquarters to help fix widespread problems (including extended wait times) and massive employee shortages at the Phoenix VA hospital was sent home by the hospital’s acting director, who told them that he “calls the shots.” The team says hospital management was “obstructionist” and “clearly lacked integrity.” The Phoenix VA’s HR department uses paper-based systems with no tracking capability, hampering its hiring efforts. The team observed chronic abseentism that left clueless people in charge and noted that several HR employees refused to learn new IT systems because they would then be held accountable for completing tasks.


Privacy and Security

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An unnamed hacker earns a $1 million prize for creating a Web-based exploit for iOS 9, which is mostly interesting because company that sponsored the challenge sells hacks non-exclusively to the highest-bidding world governments and to the NSA. An ACLU technologist referred the earlier company as a “merchant of death” that sold “the bullets for cyberwar.” The new company, Zerodium, will undoubtedly sell the hack many times for far more than $1 million to governments interested in performing electronic surveillance.


Innovation and Research

The Birmingham business paper covers Alabama Eye Bank’s self-development of a FileMaker iPad app for collecting information from cornea donors. The CIO likes that developers only need to learn one tool to deploy to both mobile and to the Web.


Technology

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The Glow fertility app comes under scrutiny after the company presents data that claims women who use it to track their fertility cycles are 40 percent more likely to conceive. Researchers immediately pounced on that assertion since the analysis proved correlation but not causation. The study also didn’t control for important variables such as prior fertility treatments. An expert says the results most likely reflect selection bias rather than an app-inspired change in behavior.


Other

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The Boise newspaper digs up old news from 2012 saying that the implementation of Epic at St. Luke’s caused provider productivity problems. It appears that the reporter was just playing in some legal databases and decided to throw some factoids together to create a non-story.

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Here’s an infuriatingly stupid and insulting comment from an oncology site that also declared the ICD-10 switch to be “much ado about almost nothing.” I suppose the next time an oncology intervention saves someone from dying of cancer we should just say the tumor “blew over” instead of thanking the oncology team for saving them.

A small survey finds that people prefer receiving their lab results via a patient portal rather than by email, traditional mail, or voice mail.

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In England, NHS launches its digital maturity self-assessment that trusts are required to complete. NHS England created its own assessment in which trusts will rate themselves on how well they use their systems. NHS declined to use the HIMSS EMR Adoption Model, saying it measures use only within a given organization and NHS wants to focus on interoperability.

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A New York business paper delves into the expensive and not universally loved “rebranding” of North-Shore LIJ Health System to Northwell Health, chosen because it’s a neutral name that won’t limit the system as it expands. The system rejected similarly dull, feel-good names such as Laudica Health, Dedication Health, and Northstar. It will spend $20 million to roll out the new name.

Experts debate whether surgeries should be recorded on video as a “surgical black box” that could be used for learning or to defend malpractice lawsuits. Naysayers don’t like the possibility that recordings could be used to prove malpractice, would increase costs, and would expose the sometimes secretive goings-on of a typical OR.

Weirton Medical Center (WV) protests the $1.5 million an arbitrator awarded to a management company the hospital hired to turn its finances around, saying the company miscalculated payment rates and failed to prepare it to earn $1.8 million in Meaningful Use money.

Weird News Andy leans on the bar and starts his story with, “A deer walks into an ER …” An injured deer walks through the automatic doors of Strong Memorial Hospital’s ED and wanders down the corridor. Unlike other ED patients, the deer was taken out to the parking lot, where animal control officers killed it. 


Sponsor Updates

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  • Medicity celebrated Halloween with an ICD-10 graveyard titled “You Don’t Want to Die on This Hill.”
  • Fox Business profiles AirStrip’s integration with Apple Watch and its use at Montefiore Medical Center.
  • Wellcentive wins the “Emerging Company of the Year” award presented by the Metro Atlanta Chamber of Commerce.
  • Aprima will exhibit at the American College of Rheumatology Annual Meeting November 8-10 in San Francisco.
  • Awarepoint will exhibit at the iHT2 Health IT Summit November 3-4 in Beverly Hills, CA.
  • Bernoulli will exhibit at the American Association for Respiratory Care Congress November 7-9 in Tampa, FL.
  • Besler Consulting wins a 2015 Bright Bulb B2B Marketing Award for best small team in-house campaign.
  • CenterX will exhibit at the NCPDP Workgroup Meeting November 4-6 in St. Louis.
  • Sunquest will exhibit with GeneInsight at AMP 2015 November 5-7 in Austin, TX.
  • Nordic releases a video titled “After ICD-10: Minimizing pain, increasing gain.”
  • Direct Consulting Associates sponsors the HIMSS North Ohio Chapter Conference November 5 in Akron.
  • Connected for Care introduces its telemedicine solution and integrate it with HealthMedx’s LTPAC EHR.
  • Divurgent will exhibit at the Virginia HIMSS Fall Conference November 5-6 in Williamsburg.
  • EClinicalWorks and Healthwise will exhibit at the mHealth Summit November 5-6 in National Harbor, MD.
  • FormFast helps hospitals move away from paper documentation.
  • The Colorado Technology Association nominates Healthgrades EVP/CIO Douglas Walton for Apex CIO of the Year.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 3, 2015 News 2 Comments

Morning Headlines 11/2/15

November 1, 2015 Headlines No Comments

Francisco Partners to Sell Medication Management Company Aesynt to Omnicell

Omnicell acquires Aesynt, a company making medication robots and pharmacy automation systems, for $275 million.

CPSI Announces Third Quarter 2015 Results

CPS reports Q3 results: revenue is down 16 percent at $44.6 million, EPS $0.31 vs. $0.83. Stock prices fell 15 percent after the results were published.

Quality Systems, Inc. Announces Agreement to Acquire HealthFusion Holdings, Inc.

Quality Systems, which sold off its NextGen hospital EHR business last week, will acquire the cloud-based HealthFusion EHR for up to $190 million.

Healthcare IT Trends in England | 2015

Peer60 publishes a report on the UK EHR market, finding that Epic, Cerner, and Allscripts have replacement vendor mindshare among hospital executives, with Epic leading among the three. Epic’s only live customer in the UK is Cambridge University Hospital, where its $300 million implementation resulted in the resignation of the hospital’s CEO and CFO, and an investigation from the NHS Monitor.

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November 1, 2015 Headlines No Comments

Monday Morning Update 11/2/15

November 1, 2015 News 8 Comments

Top News

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Medication management technology vendor Omnicell will acquire Aesynt, which offers pharmacy robotics, for $275 million. As reader WhoKnows points out, McKesson bought the former Automated Healthcare in 1996 for $65 million and then sold it in late 2013 to Francisco Partners for a rumored $52 million. That’s either horrible McKesson mismanagement or a truly spectacular performance by Francisco Partners, which gets a five-bagger in just two years. The only acquisition I recall Aesynt having made was Italy-based Health Robotics, which was having limited success with its IV room robotics technology. FP didn’t even change the CEO when it bought the company – Kraig McEwen came on board in November 2011 and remains to this day.


Reader Comments

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From All Hat No Cattle: “Re: John Glaser. I noticed his CV lists his HIStalk Lifetime Achievement Award from 2011. I wonder if any of the other HIStalk award winners list theirs?” Probably not, but someone new will have that chance in around four months when we do it again. 

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From Over Easy: “Re: Hoag Hospital in Orange County. Rumor is another senior IT leader was released or resigned, which makes the third in the last four months. The hospital has implemented drastic budget cuts in IT and overall in the past two years.” Unverified. I don’t think I know anyone there.

From Wayne Tracy: “Re: VA-DoD interoperability. As a retired Naval Officer having commanded a field hospital (Fleet Hospital 13B) I have come to the conclusion that until Congress holds the Surgeon Generals of the Army, Air Force, and Navy as well as the head of the VA personally responsible, nothing is going to change. Give them a two-year deadline and withhold all medical computer budget funds until they are fully interoperable in real time (say, using HL7’s FHIR) or the budget goes away. It seemed to work when the railway system was not going to meat the end-of-year (2015) deadline — the New York to Washington line miraculously got done in two weeks. Somebody with big brass ones needs to be put in charge. Congressional oversight hasn’t worked to date,  just more deadline extensions. Congress, grow some!”

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From Wealthy and Wise “Re: Highmark. As patients grovel for care and medications, these guys are raking it in. No wonder they are struggling financially and cutting care and services. Shameful and despicable.” It’s big money in Pittsburgh healthcare, where Highmark Health’s former CEO earned $10 million in 2014 having worked there less than two years before he was paid to go away. Highmark paid its human resources chief $2.7 million and its treasurer $3.3 million. The CEO of arch-rival UPMC made $6.4 million.

From Purple Hay: “Re: UnityPoint Health System, Iowa. VP/CIO Joy Grosser is gone.” Unverified. Her LinkedIn profile is unchanged, but her patch of real estate on the health system’s executive page is now vacant. I searched their site for information and found only that she was paid $591K last year, with other fun information from their Form 990 being that their largest-expense contractors were all IT related: Epic ($7.8 million), McKesson ($4.7 million), and IBM ($4.5 million). Fifth-highest was a “branding agency” that earned $4 million for doing whatever vital, patient care-focused work that branding agencies are known for doing.

From Maven PR: “Re: headlines. You need sexier ones to bring more attention to what you write. I can help you.” I won’t stoop to the level that many or most sites do in shamelessly fooling readers into clicking over to crap stories by using CNN-type click-bait headlines, mind-numbing slide shows, pointless stock photos, and “listicle” articles that start with a number (in the form of “6 Tricks You Won’t Believe that Lame HIT Sites Use to Suck In Readers.”) I would hope that health IT people and advertisers are smart enough to realize that the steak they hear sizzling is usually just cotton candy, but regardless, I would rather have 100 smart, influential, engaged readers than 1,000 who mindlessly click on whatever shiny object is thrust in their face without recognizing that they’ve been had.

From Atom Heart CIO: “Re: DonorsChoose. I think your legacy will be more about the charitable work you have done than with HIStalk, which is amazing given how successful HIStalk has become.” I don’t seek or expect a legacy either way, but it’s exciting thinking about how the donations readers make to DonorsChoose might, through some unlikely chain of events, help some kid become a legacy themselves. One of these days I’ll either decide to quit writing HIStalk or just die in the saddle, in which case I’ll fade away with my planned or unplanned final post being the only artifact of my anonymous existence (and leaving Weird News Andy homeless).

From The PACS Designer: “Re: ICD. With our first month under ICD-10-CM with no major issues, it’s time to focus on the next aspect, ICD-10-PCS (Procedure Codes). Since it will be done first here in the US, it gives us the opportunity to choose where we do it initially. TPD proposes that we do it with the VA and DoD so that a breakdown occurs to the barriers each of them currently have against each other working together to improve healthcare for our military and veterans.”


HIStalk Announcements and Requests

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Poll respondents were evenly split on whether they’d want Theranos running their lab tests. I agree with Don, who said that using the company’s services has nothing to do with a pinprick blood sample and everything to do with convenience and pricing. I enjoy visiting LabCorp and Quest about as much dealing with the people at the driver’s license office. New poll to your right or here: if your customers (or patients) knew what you know about your employer, would they be more impressed or less impressed?

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Mrs. G sent photos of the printer supplies, reading games, and early literacy books we provided to her Los Angeles pre-kindergarten class via her DonorsChoose grant request, adding, “There are no words to describe the impact this has had on my life. My students and I feel so blessed for your kind donations.”  Ms. G from Oklahoma sent photos of her students using the earbuds we provided to her elementary school class for online math intervention work.

I thought sure Facebook would collapse this weekend under the weight of every single parent in America posting pictures of their costumed children. Speaking of which, I was also thinking that people seem to like spending Halloween prowling around old buildings where people have died, making any former hospital an ideal choice since the number of deaths inside any of them must be huge.


Last Week’s Most Interesting News

  • A diverse group of lawmakers slams the VA and Department of Defense for their expensive and stubborn failure to integrate their electronic medical records systems.
  • Theranos restructures its board and takes another hit when the FDA labels its proprietary Nanotainer blood draw system as an uncleared medical device.
  • CMS reports a quiet, non-eventful October following the ICD-10 switchover.
  • The AMA and MedStar Health rank EHRs on user-centered design without actually doing any research or measuring usability.
  • Xerox and Lexmark announce poor quarterly results and announce plans to review and possibly restructure their operations.
  • Athenahealth shares jump sharply after beating quarterly expectations, while those of Huron Consulting tank on lowered guidance due to delays in two academic medical center projects.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Quality Systems Inc. will acquire cloud EHR vendor HealthFusion for up to $190 million. QSI announced just over a week ago that it sold its NextGen hospital business to QuadraMed.

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CPSI announces Q3 results: revenue down 16 percent, EPS $0.31 vs. $0.83. Shares took a 15 percent dive Friday on the news. The company seems to be struggling now that HITECH-fueled hospital EHR sales are drying up, leaving it to hope that a replacement market emerges. Above is the one-year share price chart of CPSI (blue, down 39 percent) vs. the Nasdaq (up 9 percent).


People

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Sarika Aggarwal, MD, MHCM (Fallon Health) joins XG Health Solutions as SVP of population health and chief medical officer.

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LifeImage names Matthew Michela (Healthways) as president and CEO. He replaces co-founder Hamid Tabatabaie, who will move to EVP and remain on the board.

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Former Siemens Healthcare North America President and CEO Gregory Sorenson, MD takes a minority interest in Deerfield Imaging, which offers image guiding technology, and will become its executive chairman.

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Jim Macaleer, co-founder, chairman, and CEO of Shared Medical Systems until he sold the company to Siemens in 2000, died last Thursday.


Announcements and Implementations

Fitch Ratings holds its rating of MetroHealth’s bonds as stable, concluding that the Ohio health system “has demonstrated the ability to be profitable with its challenging payor mix due to its longstanding electronic medical record (Epic), closed medical staff, and care management processes.”


Other

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Peer60 publishes “Healthcare IT Trends in England.” NHS hospital executives say their top challenges are physician and nurse shortages, care coordination, and managing and analyzing data. Allscripts, Cerner, and Epic hold high mind share in both EPR (above) and PAS, suggesting they are well positioned to gain business in both clinical and administrative areas.

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Greencastle Associates Consulting is named as one of three finalists for the US Chamber of Commerce Foundation’s “Hiring Our Heroes” award for hiring veterans and military spouses. Malvern, PA-based Greencastle was founded by Army Rangers and its three primary executives are all veterans.

Struggling Kinston Hospital (NC) ends its shared services agreement with Novant Health — which included IT improvements — after less than a year,

In Northern Island, Belfast NHS Trust underpays 1,500 employees due to a software error. The union declares the situation to be “totally unacceptable,” apparently finding it even worse than just “unacceptable.”

A healthcare IT entrepreneur says entrenched software vendors are stifling innovation by refusing to open up their systems to startups, causing new companies to burn through their seed rounds without sales to sustain them. He concludes that patients are harmed because “interoperability into the legacy systems of their customers still remains a primary roadblock.” To which I would offer a counterpoint: rightly or wrongly, we’ve defined healthcare (and therefore healthcare IT) as a business. As with any business, it’s irrational to expect competitors to behave in any way that isn’t self-serving, as much as we like to pretend that everybody’s primary motivation is altruistic patient care. Provider or vendor, you are naive and likely to be insolvent if your business plan assumes that your computers will voluntarily lower your barrier to entry.

I asked Vince Ciotti if he would write something about Jim Macaleer in way of tribute for the folks who knew him and who may not have heard that he passed away.


Sponsor Updates

  • DataMotion publishes an infographic titled “A Brief History of Data Breaches and Security Regulations in Healthcare.”
  • Ear, Nose and Throat Associates of Texas describes its easy implementation of Talksoft’s RemindMe application.
  • Vital Images will exhibit at HIMSS Latin America November 4-5 in São Paolo, Brazil.
  • VitalWare SVP of Operations Doug Picatti is featured in a CNBC report on key issues in the presidential debate.
  • Huron Consulting Group releases the latest edition of its clinical research management briefing.
  • ZeOmega will exhibit at the TAHP Managed Care Conference & Trade Show November 2-3 in San Antonio, TX.
  • Zynx Health will exhibit at the Meditech Physician and CIO Forum November 5-6 in Foxborough, MA.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 1, 2015 News 8 Comments

News 10/30/15

October 29, 2015 News 7 Comments

Top News

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Rep. Tammy Duckworth (D-IL), a former Army helicopter pilot who lost her legs when her Black Hawk took rocket-propelled grenade fire in Iraq, joins several other members of Congress who are fed up that the VA and Department of Defense still haven’t integrated their systems. Lawmakers are reviewing VA-DoD progress in a joint hearing of two House committees this week. Duckworth says that as a former VA employee, she regularly saw the DoD stonewall the VA’s projects in defending its turf. She’s also still mad about her first VA visit where she was asked to take her clothes off to prove that she was still an amputee since the VA wasn’t allowed to accept her DoD medical records, to which she replied to the physician assistant, “I’m not a gecko. They don’t grow back.” Chris Miller, who runs the DoD’s DHMSM project, testified that connecting the VA with DoD is harder than it seems, while the GAO’s IT director observed that her watchdog agency still doesn’t understand why the DoD and VA decided not to build a single system together in the first place. The GAO still wants that answer, but says that neither the VA nor DoD are responding to its inquiries. The GAO suspects that the VA and DoD have spent more than billion dollars in trying and failing to share information, which doesn’t even include the countless mega-billions of taxpayer money that was spent building and supporting their systems.

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Speaking of the VA-DoD imbroglio, some members of Congress are convinced that the only way to get the VA and DoD play nicely together is to have the President personally make them. Rep. Dan Benishek (R-MI) says of his peers, “We can’t stand the fact that we’re spending a billion dollars on integrating healthcare and you tell us it can’t be done. We get sick of this.” DHMSM’s Chris Miller says the organizations weren’t ready in 2011 because while the IT part is easy, nobody wanted to address the people and process issues. He opined that interoperability is worse in civilian healthcare, raising the ire of Rep. Gerry Connolly (D-VA), who scolded him by saying that both agencies deal with a specific population but “can’t get their acts together on behalf of the men and women we’re serving.”


Reader Comments

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From Don’t Mess with Texas: “Re: vendors pressuring clients. I heard that the day Texas Health Resources issued its press release blaming Epic for its improper treatment of its Ebola patient, Judy and Carl flew to THR that night to pressure the CEO into putting out a retraction, which they did. Epic plays hardball – they’ve done it at our site, too. I don’t blame Epic for being unhappy with the press release, and while veteran CIOs like me knew to take the release with skepticism, flying down in person to get a retraction is pretty heavy handed. I’m sure Epic’s spin is that they care so much for their clients that they wanted to show up in person and offer their help.” That entire process was bungled, although nothing in the THR recap describes a visit by anyone from Epic. THR leadership appears to have thrown Epic under the bus as a knee-jerk reaction without even talking to their own IT folks, who would have been involved with the configuration of the system that was blamed incorrectly (given their quick retraction) for missing their patient’s travel history. Any EHR vendor would have protested and asked for proof of their customer’s claim, although I agree that Epic is among the most vigorous enforcers of its own interests and I’m sure calls were made. THR wasn’t great at managing the Ebola virus, but it was much more aggressive in trying to manage the viral spread of unfavorable publicity.

From Uneasy Detente: “Re: vendor gag clauses. I’ve never seen them pre-loaded into one of my contracts, but I’ve signed a few with a major health IT software vendor as condition of contract settlement, where software doesn’t work and we refuse to go live, for example. The vendor may offer concessions or a refund conditional on signing a number of terms, which generally includes not going out and talking about the problem we’ve discovered. Here’s an example for your eyes only.” I can see why both parties would approve that condition given that they are reaching agreement on either a parting of ways or deciding not to implement a specific application. I’m on the fence about whether that’s a gag clause, but leaning toward no since the customer never actually went live. You would think that customers who did actually implement the application would see and report the same issue, but that’s wishful thinking. That leads us back to the same challenges we have with interoperability – as much as we as patients would like providers to publish and share information that might benefit us, there’s no incentive for those providers to do so and therefore they don’t bother. In fact, going public with software problems introduces the near-certain risk of creating an adversarial relationship with the vendor to which they’ve expensively hitched their wagon. I don’t know of any solution except maybe FDA-type oversight that requires companies to report the patient-endangering defects they discover. Just about any solution that requires providers – competing or otherwise – to voluntarily share information is not likely to succeed. Replace “providers” with “attorneys” or “car dealers” in the previous sentence to put it into a less emotional perspective.

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From QM Employee: “Re: NextGen Hospital Solutions. Can anyone explain why QuadraMed acquired it? QuadraMed has not sold their current solution for three years and their product has so many holes (surgery, emergency, scheduling, etc.). There are constant layoffs and some really great employees have left. NextGen customers are in the under-100-bed hospital range and their product is unstable.” The Canada-based parent of QuadraMed (Constellation Software) seems to have broken its own acquisition rules in buying both QuadraMed and NextGen Hospital Solutions since it claims to be interested only in companies that are #1 or #2 in their market, have at least “hundreds” of customers, and face “unimposing” competitors. I can see why QSI wanted rid of its failed hospital business, but agree that it’s puzzling why someone else would want it, although that brings up the strong possibility that it was basically given away just to eliminate distraction and appease torch-wielding QSI shareholders.

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From Erstwhile ICD-9er: “Re: Georgia Medicaid’s stance on ICD-10 coding specificity. The CMS leniency was limited to Medicare. Medicaid was given the authority to make the decision for themselves. Georgia is the first to come out with aggressive messaging around their acceptance of ICD-10 specificity. An important distinction is that they related all of their ICD-10 edits for UB claims, but are holding firm on CMS 1500 claims. They have posted notice of this to providers along with a list of codes that will likely be denied. They are accepting feedback from providers about which codes should be accepted.” Thanks for that clarification.

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From Kilt Lifter: “Re: ICD-10. Select Health Medicaid in SC refused to do any user testing prior to implementation. They are now telling practices they will not pay any claims until the end of November at the earliest.” The company’s ICD-10 FAQ page brags confidently about their testing, remediation efforts, and overall readiness for October 1.

From Public Health Helpful: “Re: public health. I’m a long-time HIStalk fanboy, but you hit it out of the park with your comment that we ‘irrationally celebrate advancements that are very narrow in scope.’ We should be doing what will benefit the most people in the most significant way – immunizations, blood pressure control, weight loss, cancer screening, following preventive guidelines, and using proven treatments.” The only way to fix “healthcare” is to embrace public health as other countries have done rather than tinkering with how we deliver reactive health-related interventions. We don’t like thinking about that because it requires uncomfortable discussions about social services and the role of government that quickly degrade into political divisiveness. It’s easier and much more profitable to focus on expensive interventions that benefit a small percentage of the population while the far larger population suffers (and drags down economic growth) with chronic conditions whose management standards are well known, just not well practiced by either providers or the patients themselves. We have all the knowledge we need to make the country healthier and therefore more economically competitive, just not the will to use it.


HIStalk Announcements and Requests

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I put the $750 raised by Dana Moore’s Epic vs. Centura basketball game to immediate use, applying matching money from my anonymous vendor executive as well as from other charitable organizations to fund these DonorsChoose projects:

  • A document camera for Mrs. Marler’s third-grade class in Phenix City, AL.
  • A video camera and accessories for recording advanced placement calculus and physics lessons so that absent students can review them later for Mr. Blachly’s high school class in Indianapolis, IN.
  • A STEM bundle for Ms. W’s elementary school class in Englewood, NJ.
  • An iPad Mini to support STEM studies in Mrs. K’s middle school class in Brooklyn, NY.
  • Four science activity tubs for Mrs. N’s elementary school class in Dothan, AL.
  • Two tablets for Ms. S’s first grade class in East Haven, CT.
  • A laptop and accessories for Ms. M’s class of eight emotionally disturbed first grade boys in South Bronx, NY.
  • Hands-on materials for Ms. M’s advanced placement statistics seniors in Denver, CO.

This week on HIStalk Practice: The wave of physician "Just Say No to Meaningful Use" movements rolls on. American Well digs further into the employer market. AdvantageCare Physicians achieves Stage 6 EHR adoption. ZocDoc and Kareo top the list of US-based deals with Q3 VC funding. A GAO "sting" results in further Healthcare.gov scrutiny. The Interstate Medical Licensure Compact Commission meets for the first time. Maine ups its healthcare price transparency efforts.

This week on HIStalk Connect: the FDA releases its inspection findings from an unannounced visit to Theranos, concluding that their nanotainer technology is an uncleared medical device. IBM Watson will debut on the Apple Watch in 2016 within a patient engagement app being developed by Welltok. Carnegie Mellon University researchers create an app that uses iBeacon technology to provide navigational support for blind users. The team behind the app hopes to add facial recognition features in the coming years. HealthTap launches a suite of new patient engagement apps in a bid to move into the enterprise healthcare space.


Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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McKesson announces Q2 earnings: revenue up 10 percent, adjusted EPS $3.31 vs. $2.79, beating Wall Street expectations for both. The company raised guidance and announced an additional $2 billion in share repurchases. Technology Solutions revenue dropped 6 percent, much of that due to “our decision to exit the Horizon hospital software business,” with good performance from payer solutions and RelayHealth.

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Theranos continues its fascinating, overly defensive implosion by eliminating seven of its 12 board member positions – including those held by Henry Kissinger and George Shultz – but creating a new board of counselors (which includes all of the old board members) and a medical advisory board. CEO Elizabeth Holmes claims the changes were made in July, although as in the case of the company’s proprietary lab methods, she provides no data to back up that assertion. The company’s new board includes Holmes, her COO, a billionaire who inherited his grandfather’s construction business, a retired general, and a wealthy lawyer who sues big companies. Some speculate that the departed board members wanted to distance themselves from the company and any potential litigation that may result. Meanwhile, Theranos, which has already raised $752 million, authorizes new shares that will value the company at over $10 billion, although that happened right before the critical Wall Street Journal came out.

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Leidos reports Q3 results: revenue up 2 percent, adjusted EPS $0.71 vs. $0.65, beating expectations for both.


Sales

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Carilion Clinic (VA) chooses Sagacious Consultants, now owned by Accenture, for revenue cycle improvement.


People

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Timothy Johnson, DO, MMM (Children’s Mercy Integrated Care Solutions) joins Valence Health as SVP of pediatrics.

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Ingenious Med names Scott McClintock (Have Marketing, Will Travel) as chief marketing officer.

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Corepoint Health names Dan Simenc (3M HIS) as sales VP.


Announcements and Implementations

Analysis by The Advisory Board Company finds that hospitals are increasingly implementing CDC-recommended antibiotic stewardship programs to reduce inappropriate use, but many of them are too short on staffing and data to be effective. Most organizations have pharmacists rather than the prescriber review orders, most don’t record monitoring overall antibiotic use by prescriber, and few have adequate data to determine whether their programs are improving patient outcomes.

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UV Angel announces an ultraviolet-powered patient room IT device disinfection system that automatically runs a cleaning cycle up to 40 times per day when it detects that a targeted device has been used.

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Atlantic Medical Imaging (NJ) goes live on patient self-scheduling from OpenDr.

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Hackensack University Medical Center (NJ), which self-styles itself with the annoying one-word nonsense of “HackensackUMC,” will integrate Gauss Surgical’s iPad-powered Triton blood loss estimation system with Epic.


Government and Politics

A study finds that the FDA is approving cancer drugs based on short-term patient response rather than their effect on overall survival, with the agency often neglecting to require manufacturers to perform the post-marketing studies that FDA required as a condition of approval. That means many of the most expensive and most important drugs on the market haven’t proven that they actually work, which has been a problem with oncology drugs for decades – drug companies, oncologists, and hospitals make tons of money pumping them into patients with soothing optimism but no guarantee that the patient will live longer or better.

While deaths from overdoses of heroin and prescription narcotics are skyrocketing – the former because addicts are switching from expensive and heavily marketed prescription drugs to cheaper heroin –  80 percent of addicts couldn’t get treatment even if they wanted it because capacity is lacking. I was talking to a first responder the other day who said exactly the same thing – in his tiny, rural town, heroin deaths are common since addicts can buy it on the street for a few dollars per dose vs. the high cost (no pun intended) of oxycodone and other prescription narcotics. The so-called war on drugs has been lost as prisons and morgues fill up and suppliers get even richer as reduced availability drives up prices (a lesson possibly learned from their legal but equally morally challenged pharma counterparts). As usual, these studies are coming from public health experts (Johns Hopkins Bloomberg School of Public Health in this case) since it’s not considered a healthcare or medical issue that provides a business opportunity.

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The Department of Justice arrests the former president of drug maker Warner Chilcott, owned by Allergan, for conspiring to pay kickbacks to doctors who prescribed its drugs. The company will also pay $125 million in fines and plead guilty to criminal charges. Meanwhile, Ireland-based Allergan and competitor Pfizer begin merger talks in what would create the world’s biggest drug company with a combined market value of $340 billion, making that $125 million fine look like a valet tip. It would also provide a way for US-based Pfizer to dodge US taxes in declaring the headquarters of the newly created company to be Ireland.

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CMS announces that it’s been a quiet October for ICD-10, with the number of claims submitted due to incomplete or invalid information remaining unchanged at 2 percent. The denial rate and percentage of claims rejected due to invalid ICD codes also hasn’t changed much. It a bit early to declare ICD-10 victory, but CMS seems to have defied the naysayers who didn’t believe its optimistic testing status reports.


Other

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The AMA and MedStar Health publish their review of EHRs for user-centered design, which instead of looking at actual user usability or testing anything against standards, simply reviewed ONC’s certification test results for use of best practices. The top-scoring products were Allscripts Enterprise, Allscripts Sunrise, McKesson Paragon, McKesson IKnowMed, and Athena Clinicals. Bottom-scoring products are EClinicalWorks Version 1.0, Dr Systems, Greenway PrimeSuite, Epic EpicCare Ambulatory, and NextGen Ambulatory. The analysis used factors such as the vendor’s self-reported UCD process, the involvement of clinicians in testing, and the design of rigorous use cases for testing. It’s a puzzling list when the ancient Meditech Magic finishes one spot behind Cerner in the top 10. I also wonder how meaningful it is to critique user-centered design process by repurposing certification submissions for individual products – you would think a given vendor would use the same design and testing methods for all of their products. The end result will be what it always is in healthcare IT: the top-ranked vendors will brag loudly about the results while glossing over the methodology and applicability, while the low-ranked ones will criticize the methodology and applicability while glossing over the results.

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Santosh Mohan, a management fellow at Stanford Health Care and long-time HIStalk reader, sent over this photo if the IT department’s Halloween celebration, in which the three folks above are dressed up as the (a) electronic (b) medical (c) record. I like subtle humor like this because once you get it, you can feel superior in imagining folks who didn’t get the joke.

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Meanwhile, PatientSafe Solutions tweeted out this photo of its team. It brings back not-so-fond memories of my hospital’s IT department Halloween celebration, which despite featuring nothing more interesting than pumpkin bowling and orange-iced cupcakes, had to be renamed to the politically correct “fall festival” when a couple of employees complained that it celebrated devil worship.

Weird News Andy cries, “Bring out your dead” as he reads how New York’s health insurance exchange enrolled 354 dead people for health insurance, paying out $325,000 in claims to 230 of them. Design flaws, including people having multiple identification numbers, caused another $3.4 million in overpayments in the program’s first year.


Sponsor Updates

  • Healthcare Data Solutions publishes a white paper titled “Understanding the Opportunities & Challenges of Telehealth 2015.”
  • Impact Advisors sponsors an article titled “A Unique Approach to Business Analytics: The Scottsdale Institute Health IT Benchmarking Program.”
  • Stella Technology and DataMotion will participate in the interoperability showcase at the New Jersey and Delaware Valley HIMSS chapters conference in Atlantic City October 29-30.
  • InterSystems CEO Terry Ragon is featured in MIT’s Spectrum Magazine.
  • PDR and Leidos Health will exhibit at the NextGen User Conference November 1-4 in Las Vegas.
  • LiveProcess will exhibit at the New England Rural Health Round Table November 5-6 in South Bridge, MA.
  • Wellcentive CEO Tom Zajac will present at the inaugural meeting of The Leader’s Board for Population Health Management November 5 in Dallas.
  • MedCPU is recognized as one of Entrepreneur’s “Best Entrepreneurial Companies in America.”
  • Navicure will exhibit at Michigan MGMA October 30 in Mount Pleasant.
  • Recondo Technology and Sutherland Healthcare Solutions will sell each other’s solutions.
  • Over 1,000 health and human services leaders attended Netsmart’s Connections 2015 client conference, which featured mental health advocate and former Congressman Patrick J. Kennedy.
  • NTT Data will exhibit at the 2015 LeadingAge Annual Meeting and Exposition November 1-4 in Boston.
  • Obix will exhibit at the 14th annual Perinatal Conference November 5 in Dublin, OH.
  • Epworth Eastern Hospital (Australia) realizes improved outcomes with Oneview interactive patient care technology solutions.
  • PerfectServe will exhibit at ASN Kidney Week November 3-8 in San Diego.
  • The SSI Group will exhibit at the Georgia HFMA Fall Institute November 4-6 in Savannah.
  • Streamline Health will exhibit at the Health IT Leadership Summit November 3 in Atlanta.
  • Surgical Information Systems will exhibit at HealthAchieve 2015 November 2 in Toronto.
  • Surescripts will exhibit at the NextGen 2015 user group meeting November 1-4 in Las Vegas.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
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October 29, 2015 News 7 Comments

Morning Headlines 10/29/15

October 29, 2015 Headlines 1 Comment

Senate passes cybersecurity information sharing bill despite privacy fears

The Senate passes the Cybersecurity Information Sharing Act, a bill designed to curb cyberattacks by providing US companies legal immunity for sharing protected information with the federal government. CHIME published a statement of support just after the bill cleared the Senate.

EHR User-Centered Design Evaluation Framework

AMA publishes findings from its EHR user-centered design study, with McKesson and Allscripts finishing at the top with perfect scores, and Epic falling behind both Cerner and Meditech’s legacy system. AMA evaluated 20 EHRs in the study, choosing a mix of inpatient, ambulatory, current, and legacy systems.

HealthTap wants to provide hospitals with their own ‘operating system’

HealthTap launches an all-in-one patient engagement platform designed to help health systems roll out telehealth, secure messaging, online appointment booking, appointment reminders, and a population health analytics system.

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October 29, 2015 Headlines 1 Comment

News 10/28/15

October 27, 2015 News 10 Comments

Top News

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FDA declares the proprietary nanotainer blood draw containers used by Theranos to be an “uncleared medical device” following a Wall Street Journal report that the company had voluntarily already stopped using the finger-stick containers for all but one test. A September FDA inspection of the company’s Alameda, CA facility noted a number of deficiencies, including shipping its nanotainer collection tubes across state lines without having them approved by the FDA; not performing quality audits; and documenting required software validation on a shared Excel worksheet. Meanwhile, Theranos says it will now publish data proving the effectiveness and accuracy of its methods.


Reader Comments

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From Prostetnic Vogon Jeltz: “Re: ICD-10. Georgia Medicaid is denying claims that use unspecified ICD-10 codes even though CMS said that wouldn’t happen. When I first see a patient with atrial fibrillation, I might not know whether it is paroxysmal, persistent, or chronic – that’s what the unspecified codes are for. I think this is important for HIStalk readers to know about.” The agency didn’t say it wouldn’t be ready for ICD-10, so it appears to have simply made the decision that it will not conform to CMS’s policies.

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From Unbridled: “Re: PatientSafe Solutions. They have parted ways with CEO Joe Condurso.” Joe is still listed as president and CEO on the company’s web page, but an internal email sent my way says he resigned last Friday in a mutual decision and that Chief of Staff Si Luo will take over as president. The company announced last Wednesday that it has acquired readmission technology vendor Vree Health.

From Publius: “Re: VA. I predict the VA will go full Epic, forcing Epic and Cerner to get serious about developing interoperability with each other since DoD will be on Cerner. This will benefit all customers. A Cerner-Epic ROI exchange will be as seamless as Care Everywhere (Epic to Epic ROI module).” Politicians seem to be fretting that since VistA uses old technology (just like Epic), it therefore should be replaced with a commercial product despite the VA’s decades-long satisfaction with its internally developed system. The VA and DoD always seem to find reasons to not work together, so perhaps choosing Epic would prolong the hostilities.

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From All-Around Good Guy: “Re: Lee Marley, SVP/CIO, Presbyterian Healthcare Services in Albuquerque. She has left and will be missed. The data center was built and Epic was installed during her tenure.” Unverified.


HIStalk Announcements and Requests

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A reader who wishes to remain anonymous donated $250 to my DonorsChoose project, to which I applied double matching (from my anonymous vendor executive and from charitable foundations) to purchase materials for Mrs. Sandler’s elementary school class in Aurora, CO (math games), Mrs. Jones’s K-2 class of intellectually and emotionally disabled students in Galivants Fry, SC (math manipulatives), Ms. Sobczak’s Grade 1-3 class of students with communication disorders in South Holland, IL (math games), and the elementary school class of Mrs. Bowers of Oklahoma City, OK (headphones for online math intervention programs).

I’m regularly puzzled when people email me story links that I covered days before, apparently thinking that because other sites ran the news days later that I missed it. I don’t think I’ve ever missed a significant story, so I can only implore you to read all of HIStalk each time I post news on Tuesday and Thursday nights and over the weekend. Reason: other sites keep repeating the same news over and over trying to get more clicks, while I assume readers are smart enough to only need to see it once and therefore I don’t run repeats. Obviously my logic is incorrect if folks are either skimming or skipping certain posts. My other suggestion is to avoid assuming that just because I can summarize a big story in a few sentences doesn’t mean it’s not important – I don’t pad out the content with a lot of filler.

Who should I interview? Tell me someone who: (a) doesn’t work for a for-profit organization; (b) is smarter than most people; (c) is interesting and opinionated; and (d) I haven’t already interviewed recently. I like to expose fresh viewpoints, but those who possess them don’t always volunteer to be interviewed.

I was thinking that what we need to learn in this country that advancing health for a tiny percentage of the population (via precision medicine, expensive celebrity surgeons and surgical gadgets, and dramatic and expensive interventions) is the wrong goal. Our overall health (and health expense) isn’t driven by new developments for the wealthiest and best informed, but rather how well we can move the public health needle for the most people who are involved alongside the medical experts. Research and new medical technology aren’t needed when we can’t even broadly roll out basic services such as prenatal care, end-of-life counseling, mental health treatment, and addressing the social determinants of health. I worry that we irrationally celebrate advancements that are very narrow in scope and outcomes.


Gag Clauses: I Find No Evidence They Exist

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Some of the worst and most sensationalistic healthcare IT reporting I’ve seen (and I’ve seen a ton) involves so-called gag clauses, where IT vendors supposedly insert standard contractual terms that prohibit users from openly discussing patient-endangering software errors. That inflammatory topic, like the Loch Ness monster, has generated a lot of rhetoric (some of it political) despite the lack of proof that gag clauses actually exist.

Take the above hype-filled story, in which the reporter not only provides no examples of the gag clauses he claims to have seen, he completely confuses standard intellectual property (IP) terms — like not being allowed to post source code or product documentation on the Internet — with prohibiting EHR-using providers from speaking publicly about product problems via a non-disparagement clause.

The folks at HIMSS Analytics gave me access to its CapSite Database, which contains actual vendor contracts they obtained using Freedom of Information Act requests. I reviewed dozens of contracts from Epic, Cerner, Meditech, Allscripts, EClinicalWorks, Athenahealth, and several other vendors.

I didn’t see a single clause that prohibits customers from speaking out about software problems. I had previously challenged readers to give me a real-life example of a gag clause and I didn’t receive any there, either.

My experience working for providers is that any pressure to keep quiet about software problems is self-imposed. Health system executives don’t want to jeopardize an expensive implementation or annoy their vendor “partner,” so internal policies require that employees obtain approval before making any public comments or publishing articles. The CIO of one of the health systems I’ve worked for said outright that nobody in the IT department (including clinicians) was allowed to publicly comment on anything without his explicit review and approval (“I’ve been burned by that before”) or they would be subject to termination, which may give you insight as to why I remain anonymous.

Epic has raised the most ire by enforcing the intellectual property provision to include screen shots. Customers can’t publish or share Epic screen images – even those involving customizations of Epic they perform themselves – without approval from Epic. The company’s rationale is that screen design exposes IP, where just seeing what fields are captured provides a lot of insight as to what’s happening under the covers such that a competitor could steal the logic. They give permission to publish the screenshots when that isn’t the case.

That doesn’t prevent users from talking about or describing Epic software problems. It just means they can’t publish screen shots, documentation excerpts, or source code (yes, Epic customers receive source code) to make their point without the company’s permission. I saw nothing to prohibit or even discourage that kind of discussion in any of the contracts I reviewed. Perhaps it is included elsewhere, such as in the particulars of Epic’s support fee rebate program where customers get money back for voluntarily following Epic’s suggestions, but I haven’t seen it or heard of a real-life example. I’ve also not heard of a vendor taking formal action against a provider for making unflattering software comments.

I’ll throw out one more challenge and them I’m calling gag clauses a Snopes-like false rumor spread by misinformed people. If you’ve seen an example of a vendor software contract that includes anything resembling a gag clause that prohibits customers and their users from talking about product or company problems, send it my way anonymously and confidentially. I would also like to hear of examples where a provider has spoken unfavorably about a company or product and was pressured to stop, either from the vendor or from their employer, since I suspect that information pressure is far more common.


Webinars

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Sunquest owner Roper Technologies acquires CliniSys Group and Atlas Medical, which offer laboratory information systems to 2,000 labs in Europe and lab-customer connectivity in the US, respectively.

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Walgreens is rumored to be preparing for a Wednesday announcement that it will buy competitor drugstore chain Rite Aid for up to $10 billion and will take on its $7.4 billion debt load. The deal would give Walgreens 17,800 stores worldwide vs. the 7,800 owned by CVS. Walgreens would also gain Rite Aid’s walk-in clinics, wellness stores, and EnvisionRX pharmacy benefits business. Italian-born businessman Stefano Pessina became the CEO and majority shareholder of Walgreens when it acquired his British pharmacy chain Alliance boots Group in 2012, giving the 74-year-old net worth of $14 billion.

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Xerox reports Q3 results: revenue down 10 percent, EPS –$0.04 vs. $0.22 following a $385 million write-down after pulling out of two state Medicaid system contracts. The company says it won’t sell itself, but “a comprehensive review of structural options for the company’s portfolio is the right decision at this time.” Above is the one-year share price chart of XRX (blue, down 28 percent) vs. the Dow (red, up 4 percent). Shares dropped 8.3 percent Tuesday to a 52-week low on 13 times average volume.

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Lexmark announces Q3 results: revenue down 7 percent, adjusted EPS $0.57 vs. $0.96. The company’s board has authorized “the exploration of strategic alternatives to enhance shareholder value and unlock the intrinsic value created by the company.” Shares dropped 13 percent following Tuesday’s announcement before the market’s open. Above is the one-year share price chart of LXK (blue, down 25 percent) vs. the Dow (red, up 4 percent).

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San Francisco-based, 15-employee medical image analysis vendor Enlitic raises $10 million from an Australian diagnostic imaging company.

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HCA announces Q3 results: revenue up 6.9 percent, adjusted EPS $1.17  vs. $1.18. The company blames lower profit on patients who were previously insured but stopped paying their Affordable Care Act premiums. The board authorized the repurchase of up to $3 billion of the company’s shares.


Sales

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Emerson Hospital (MA) chooses MedAptus charge capture.

Dialysis Clinic (TN) chooses the EClinicalWorks EHR.

UNC Health Care (NC) and UF Health Shands Hospital (FL) choose Lexmark’s vendor-neutral archive.

Catholic Health Initiatives will expand its agreement with Allscripts to include managed services and its FollowMyHealth patient engagement platform. Mineopie reported as a rumor on October 21 that CHI had signed managed service agreements with both Allscripts (outpatient) and Cerner (inpatient). CHI signed a  three-year, $200 million infrastructure outsourcing deal with India-based Wipro in March 2013 with little fanfare since except for IT employees complaining on Glassdoor that outsourcing, layoffs, and marginal management has put IT in shambles. The CEO said in 2010 that the organization would spend $1.5 billion on EHRs and other IT systems.


People

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Jyotishman Pathak, PhD (Mayo Clinic) is named chief of health informatics at Weill Cornell Medicine.


Announcements and Implementations

IBM releases Datacap Insight Edition, which can classify and route scanned documents using advanced imaging, natural language processing, and machine learning. It provides an unconvincing healthcare example: “Where doctors and hospitals are transferring hand written notes and images into electronic health records for analysis or filing.”

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Truman Medical Centers (MO) and Cerner will work together in piloting healthcare IT and giving Cerner employees on-site experience.

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Peer60 publishes “Into the Minds of the C-Suite 2015.”

The American Dental Association’s ADA 2015 conference chooses DataMotion to provide Direct Secure Message and secure e-mail solutions as the technology backbone for secure digital exchange demonstrations.


Privacy and Security

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In a remarkable statement, an FBI cyberattack expert says the agency often advises people to just pay cybercriminals the demanded money when a PC is infected with ransomware, which locks their computer information until payment is made to release it. He suggests that the malware is so sophisticated that payment is the best option, with the others being to revert to a backup or pay a security expert to try to remove the malware. Knowing that most people never make backups means they’ll pay either way. It’s a bit surprising that people still store their one single copy of valuable data on their local hard drive, which is a problem we’ve always had in hospitals where employees ignore strong suggestions (or policies) to store everything on the shared drive only. You can easily determine those who didn’t by the volume of their whining when they report a problem that requires immediately replacing or re-imaging their laptop or desktop.

Investigators conclude that China-based hackers breached insurer Anthem because the Chinese government is desperate for ideas on how to care for its aging population. Chinese citizens were promised universal access to healthcare by 2020, but they are not satisfied with the cost, quality, and gaps between the rich and the poor. Somehow the hackers missed the fact that the US has failed equally spectacularly on those same issues despite spending many times more than China and everybody else, so perhaps our cyber-retaliation involves hoping they follow our pitiful example.

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Celebrity gossip site TMZ says several employees of Sunrise Hospital (NV) have been fired for trying to take photos and look up the medical records of former NBA star and comatose brothel patron Lamar Odom.


Other

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A observational study by Massachusetts General Hospital finds that medication errors were made in half of its surgeries, a third of which caused patient harm. The most common errors involved mislabeled drugs, incorrect doses, failing to treat situations indicated by vital signs, and documentation mistakes.

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In Australia, the Queensland government will provide an extra $4.2 million to support the Cerner rollout at the newly opened Lady Cilento Children’s Hospital, which has had many planning-related problems since its opening including an IT budget estimated at $29 million now standing at $67 million.

A state audit finds that South Australia’s Cerner Millennium pathology information system implementation skipped project steps and will fall short of money to complete the project, as additional costs for an unplanned disaster recovery center, legacy system decommissioning, and absence of an electronic ordering module are expected to exceed originally estimated costs of $22 million by several million dollars.

UMass Memorial Health Care (MA) will staff its $700 million Epic implementation by moving its 500-employee IT team to downtown Worcester to create room to house the 250 new hires needed. That’s what the local business paper says, although I would bet a lot of those new IT people are assigned there temporarily for the Epic implementation only. A common Epic implementation model is to choose existing IT team members for the Epic project via interviews and scores on Epic-mandated personality tests, hire new people as needed using the same interviews and tests, bring on temporary resources from clinical and administrative departments to provide subject matter expertise, and move everybody to a sequestered location where they won’t be bothered by unrelated IT work. A lot of those folks are borrowed until after go-live, when they return to their home departments. Hospitals usually hire experienced consultants as well to get them through implementation, after which they go away.

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I mentioned previously that I had run into problems using Stride Health to look up available health insurance in various parts of the country to see how many plans involve high deductibles (answer: just about all of them). The company quickly responded with a request for details, then let me know that they had fixed the problems, one of which they hadn’t heard of until my report. It’s working great now.

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In bizarre irony, the SXSW festival cancels two panel discussions covering the bullying of females in the online gaming industry after it receives threats of on-site violence. Members of Gamergate, whose members claim a lack of game journalism transparency, have threatened gaming industry women, vowing to publish their personal information or to rape or kill them.

Weird News Andy calls this story “You Don’t Know Squat.” A hospitalized woman in labor passes on the nurse’s recommendation that she perform squats to hasten her delivery, instead choosing to dance down the hall to a rap tune.


Sponsor Updates

  • Medecision will sponsor the HIMSS Summit of the Southeast 2015 October 29-30 in Nashville and HIMSS Big Data and Analytics Forum November 5-6 in Boston.
  • AirStrip will exhibit at The Health Management Academy’s CMO and CMIO Forums October 28-30 in Deer Valley, Utah.
  • Bernoulli becomes a sponsoring partner of the AAMI Foundation’s Coalition for Alarm Management Safety and Coalition to Promote Continuous Monitoring for Patients on Opioids.
  • Bottomline Technologies sponsors the nonprofit Leadership Seacoast for the fourth consecutive year. 
  • Divurgent wins Business of the Year and Executive of the Year awards from the Business Intelligence Group.
  • EClinicalWorks will exhibit at the 2015 NJPCA Annual Conference October 28-29 in Las Vegas.
  • Extension Healthcare receives a 2015 Innovation Award in the Technology category from the Greater Fort Wayne Business Weekly.
  • FormFast will host a virtual user group meeting November 3 and 4.
  • HCS will exhibit at the LeadingAge 2015 Annual Meeting November 1-4 in Boston.
  • HDS will exhibit at Summit of the Southeast 2015 October 28 in Nashville.
  • Healthcare Growth Partners advises Lavender & Wyatt Systems on its sale to Netsmart.
  • Zynx Healthcare SVP of Mobile Strategy Siva Subramanian, PhD will participate as a panelist at Partners HealthCare’s Connected Health Symposium October 29-30 in Boston.
  • Burwood Group becomes one of the first Citrix Solution Advisors to complete three Citrix specializations in virtualization, networking, and mobility.
  • CitiusTech will exhibit at the NAHC Annual Meeting 2015 October 28-30 in Nashville.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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