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HIStalk Interviews Tim Burdick, MD, CMIO, OCHIN

October 13, 2014 Interviews 7 Comments

Tim Burdick, MD, MS is CMIO of OCHIN of Portland, OR.

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Tell me about yourself and OCHIN.

I’m a family physician, increasing the amount of my time over the past eight years in healthcare informatics. Currently I’m one day a week in clinic at a rural health clinic as a family physician and four days a week as chief medical informatics officer at OCHIN. OCHIN runs a hosted Epic EHR for 350 clinics. Eighty-four healthcare organizations contract to use our EHR.

 

Epic gets criticism that its product is a walled garden and it’s not interoperable. What’s your opinion?

I think the interoperability frustrations cross all EHR vendors at this time. I don’t see that Epic is any better or any worse than others.

We’ve had good luck building interfaces and interoperability with other systems, with regional HIEs in and out. We have projects going with the VA, with Social Security Administration, and several HIEs. We do a million CCDA transactions with other Epic shops around the country.

Epic’s increasingly been good about opening their APIs. I’m not sure it’s fair to single out Epic. Certainly with the lack of any kind of national standard on interoperability, there hasn’t been a big push to make it happen.

 

Will the government every lay down a standard that everybody has to follow?

I think it is changing. Clearly Karen DeSalvo has over and over again said that she’s going to push the interoperability issue, so I see that coming. I think there have been other pressing issues for the HIT community that we needed to address before we could tackle interoperability.

The time has come for us to do it. It just hasn’t happened yet because we just weren’t there yet.

 

You’ve mentioned the challenge of state-specific interoperability requirements, such as California’s mental health reporting and its requirement that providers review lab results before putting them on the patient portal. Will the states standardize?

I’m not sure I see the states working together to do that. What’s happening, for example, in the case of the California legislation preventing organizations from releasing lab results to patients, as of October 1, federal law allows the laboratory companies to release results directly to patients. As a result of the federal law, state laws like the one in California are now superseded, so that’s no longer an issue for us in California.

It’s going to have to be strong federal lead on this that pulls the states into a common compliance rather than states coming together on things.

 

Do you have a solution to address the difficulty of connecting to state registries such as those for immunizations?

Again, it’s going to come down to standards. If we have a standard that says, these are the core data elements for an immunization registry. These are the requirements that you need to be able to do to pass that information from the EHR to the registry, from the registry back into an EHR, or from the registry to a patient portal. That will bring everybody along so that we’re not having to individually create 22 different interfaces and standards.

 

You operate in 22 states, but it could be a 50-state problem.

We could potentially have that problem. OCHIN is expanding. Certainly there are plenty of other large healthcare organizations that are in multiple states and having to deal with this issue as well.

If you look at Meaningful Use requirements around interoperability, if for Meaningful Use Stage 2 and Stage 3, we have to have every single eligible provider using some sort of registry list, immunization registry, or special disease registry, and we have to do one-offs in every single state, that’s not scalable, as I said in the testimony.

If we can build one interface, either to a federal registry or at least build it at the state level or the regional level or the county level, but know that those interfaces are all going to look the same and have a same standard set of data elements and same transactional messaging processes, then we can scale it up as a healthcare system.

 

You’ve said that some of those registries are run by drug or medical equipment vendors and charge fees as a for-profit company would. Can you tell me more about what you’ve seen?

ONC keeps a list of all the different registries — who runs the registry, what the quality registry is, whether it’s a diabetes registry or heart failure registry, and the costs associated with sending the data to those registries.

There is not good transparency around how the data are going to be used. If you’re sharing the data with that registry, can the owners of that registry then use that information? Some of it Is PHI. Can they use it for their own research purposes, their own marketing purposes, are they associated with a pharmaceutical or device company?

Some of those are fairly expensive. If you’re a larger organization, it’s going to cost you a huge amount of money to connect to one of those registries, and yet at the same time, there’s a federal mandate that we do connect to registries like those. Though we get some money back in Meaningful Use dollars, the cost of connecting to those registries on a monthly subscription basis is enormous, and frankly prohibitive.

The third piece is that healthcare organizations are hooking up to those registries and sending data just as a check box so that organizations can say, we’re sending data to a registry so we can collect our MU dollars. But the value that those registries provide back to the eligible providers is questionable.

As with most of the Meaningful Use stuff, I believe firmly that the intentions for Meaningful Use are good and that it’s pushed the healthcare industry along in the right direction, but we need to get away from doing it for check boxes to doing it to drive clinical improvement.

That means that we need to value back from those registries to the providers. It needs to be integrated back into the EHR rather than just saying here’s a website where you can go log on to a third-party app where there’s registry data about your patient population that are no way tied back to clinical care in a clinical operations.

 

I got two types of reader comments when I mentioned that some of the public HIEs are charging full participation prices to providers who just need to submit to public health registries. Some said they need a viable business model and a provider is either in all the way or out, while others said public health requirements shouldn’t force an organization to join as a full participant for that reason alone. What do you think?

I see both sides of that. Clearly if you’re a business and you’re going to stand up some sort of data warehouse and provide some quality metric reporting around that, that’s a difficult technology. OCHIN’s been working on it for several years. It comes at a very real cost to employ the developers and to do that work. I’m fine with organizations charging for that.

The difficulty comes when there’s a federal mandate to do this. As I said earlier, the financial incentives to do it don’t cover the cost of subscribing for these services. The transparency is that if I’m going to be paying hundreds of thousands of dollars to hook my Eligible Providers up to some registry, I need to know very, very clearly who’s collecting that money, what the money’s going to, and what kind of data use is going to happen with that information. I don’t think we have that level of transparency.

I’m not opposed to organizations collecting fees to cover their costs and even making a profit off of that. But we need to know who they are, what they’re doing with the data, and what their intentions are.

In addition, I think it would be great if the CDC, NIH, Institutes of Medicine, some of the other federal organizations could host some federal registries rather than doing it at the state level. Again, coming back to this idea of Eligible Providers in 22-plus states for OCHIN, if I can’t find a federal registry, then I’ve got to start reaching out to state registries.

The other example here would communicable disease surveillance, infectious disease surveillance registries. Those are largely at the state level. It’s just not practical for me to reach out with interfaces to 22 states. But if I can submit diabetes information, heart failure data, infectious disease surveillance data to a federal agency on a federal program at a cost that is subsidized by the federal organizations – ONC, CDC, etc. – then I can scale it up and there is less of an issue of questions about potential profiteering and lack of transparency.

It’s in the interest of organizations like CDC to start developing those federal registries and being able to collect the data and use those for national healthcare initiatives. I see it as a win-win.

 

Is Meaningful Use Stage 2 causing other unintended consequences that aren’t in a patient’s best interest?

That’s difficult. Yes, there are definitely unintended consequences and negative impacts. I’m firmly committed to the long-term benefits of Meaningful Use. With the significant earthquake changes that things like Meaningful Use bring along, there’s going to be the unintended consequences that we need to work through. But I don’t think that in any way negates the vision of Meaningful Use and HIT improvement processes.

 

Is it a short-term problem that patients are confused by having to log in to several patient portals, one for each provider, to look at their own data?

I think it’s a medium-term issue. There is a growing market for vendor-agnostic PHRs. HealthVault, Apple getting back into it, Google getting back into it. There are other third-party companies getting into this. Some of those were represented at the ONC patient engagement meetings a couple weeks ago.

I think there’s going to be a competitive market for that type of work. That’s going to drive it pretty quickly. Karen DeSalvo has mentioned at several meetings that I’ve attended that ONC is interested in supporting that process in some fashion or another. I see this issue being a two- to four-year growing pain problem that will have some solutions in the foreseeable future.

 

What do you think the business model or overall goal should be for public HIEs, or what we would have called a RHIOs in the old days, beyond just letting providers look at information on the screen?

The idea of having either a pass-through model or a data repository where the data are going to be held for a period of time while keeping the data in some sort of separate system … I think that model has not proven value and doesn’t have any long-term financial viability to it, as witnessed by innumerable failures of RHIOs in the past.

From a Triple Aim perspective, what we really need is for the data about a patient to get pushed through to a provider at the point of care within their EHR — whether it’s in an office visit or a care coordinator working on patient population issues — so that if that patient has had a hemoglobin A1C done by an endocrinologist a week ago at a different healthcare facility, the data are actionable in real time within the EHR.
The patient’s data need to move seamlessly across platforms. Care Everywhere works well and there are other things like that, but it still requires me to go out and look for that information and it still doesn’t move easily back and forth, even between EHR systems that are using the same vendor.

We need to get away from that model that a patient’s data exists in different instances separately and move to a place where the patient’s data coexists simultaneously and in real time in any instance of their care. That’s going to allow us to make it actionable to drive clinical decision support, panel management, and population health. That’s going to get us to Triple Aim.

The other thing it allows is on the patient-facing side of things for the patient to be able to see their information in a collated fashion and not in a siloed fashion so that they understand their healthcare picture not from the perspective of, “This is my cardiologist’s view of me. This is my pulmonologist’s view of me. This is my PCP’s view of me,” but, “This is the healthcare system’s view of me as an individual patient.”

 

Will the CommonWell initiative will make an appreciable difference in interoperability?

I think that’s to be determined.

 

Do you think Direct messaging will have a significant role or has it missed its opportunity?

Certainly some folks would say that it missed its opportunity, that the concept is so fundamentally flawed that it can never be executed on a large scale.

I don’t think anybody has shown that Direct is not viable, but I don’t think anybody has shown that Direct will work at a large scale, either. The issue of sharing directories and trust bundles across organizations that don’t have close working relationships with each other is unproven at this point.

At OCHIN, we are building out our Direct address directories. We are starting to share those with outside organizations. The uptake is slow on it. Just the mechanics of how to move the data back and forth, integrating that into clinic workflows on the clinic side, as well as how to set up those address within the EHR.

It’s still an early process technically. We’re facing things like that some organizations that we work with want every provider to have their own Direct address. If they set it up that way, then does an inbound message come through directly to that provider’s in-basket? If so, does the provider know what to do with that information and does that information get processed the right way in clinic?

Some organizations want to take the approach where the organization’s going to get a Direct address and the individual providers won’t. Then it will come in and some staff person will process those messages and move them around.

Even just simple questions like which process are we going to through with that organization address or an individual Eligible Provider address. We don’t even know how we’re going to handle that. Until we try those different things for a month or a year, I don’t think we’re going to know for sure what’s going to work in clinics.

 

If you were king of interoperability for a day, what would you do?

What I would really like to see right away is for the healthcare industry — healthcare providers, payers, federal government — get together a summit of thought leaders and define 30 clinical data elements that are needed to improve Triple Aim, things like hemoglobin A1C levels and left ventricular ejection fraction. Agree that these are just the basic elements that we need to start with in order to improve our Triple Aim outcomes.

Define those at a national level and figure out for those finite number of elements, how is every single EHR vendor going to really easily make that data flow out? How are we going to really easily make that data move in? What role does the federal government have in helping consolidate a national pass-through model that will at least make those common data elements available seamlessly across organizations.

 

Do you have any final thoughts?

The big issue here is patient matching. It really is going to come down to our ability to match our patients. Until we tackle a patient matching issue, we can come up with standards all day, but if the patient match rate is 20, 30, 40 percent, then we’re not going to get there.

I doubt there’s a political willpower to bring back to the table a conversation about a national healthcare ID. If we’re not going to do that at a federal level, then healthcare organizations and patient advocacy groups need to tackle this issue on a non-legislated fashion.

One of the things that I mentioned in my testimony would be developing a grassroots organization that allows patients to have an interoperability member card. It’s going to have on there the patient’s name the way they want it spelled consistently, down to capitalization and hyphenation. It’s going to have a date of birth, and in the case of patients who were born outside of the United States, we can’t continue to just randomly assign January 1 to tens of thousands of patients whose birthday isn’t documented.

If we use a phone number for patient matching, even if the patient’s no longer using that phone number for communicating with the clinic, we can at least continue to have them use that same phone number for patient matching.

It becomes a proxy for a standard ID, but that patient’s going to carry that card with them year after year. Those elements aren’t going to change. They can voluntarily take that card to registration at a hospital, lab, radiology facility, outpatient clinic, or the ER. The data for that patient are going to get populated in registry systems at every healthcare organization that that patient touches. That’s going to allow us to do patient matching at a much, much higher percentage.

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October 13, 2014 Interviews 7 Comments

Morning Headlines 10/13/14

October 12, 2014 Headlines No Comments

No On Proposition 46

A coalition made up mostly of California medical associations launches a website arguing against proposition 46, which would increase maximum malpractice awards, subject clinicians to random drug testing, and mandate that prescribers check the states drug abuser database before writing narcotics prescriptions.

$77 million investment in new health records technology has Alameda Health System struggling to pay its bills

Alameda Health System announces that it has nearly run out of cash, attributing its problems in large part to a failed $77 million Siemens Sorian roll out. The health system’s CFO David Cox says, “the system makes it difficult to collect the right information that you need to bill a claim and makes it hard to identify what kinds of errors are occurring. …. It’s very disjointed right now. A lot of mistakes are being made."

Second Ebola case confirmed. Texas health worker wore ‘full’ protective gear

A nurse caring for the Ebola patient that was being treated at the Texas Health Presbyterian Hospital in Dallas has tested positive for Ebola. Meanwhile, in Liberia, public health workers report that the epidemic has shown small but measurable signs of slowing.

Kaiser Permanente and their Journey to Transform their Supply Chain

Kaiser will redesign its supply chain management processes to increase the effectiveness of its unit-level inventory processes, and to streamline procedure setup by digitalizing surgeon preference cards.

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October 12, 2014 Headlines No Comments

Monday Morning Update 10/13/14

October 11, 2014 News 3 Comments

Top News 

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Opponents of California’s Proposition 46 – which would quadruple the maximum allowed pain and suffering medical practice award, mandate drug and alcohol testing of physicians, and require that physicians and pharmacists look up controlled substance prescription patients in the little-used CURES drug abuser database – launch a voter campaign suggesting that the CURES database would be vulnerable to hacking. Many of the coalition’s members are healthcare providers and member organizations.


Reader Comments

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From Bob Loblaw: “Re: Stanley Healthcare. The complete incongruity of this reputable firm flirting in the healthcare arena was probably the need for one or more of its executives to have something to say at the cocktail circuit. None of the senior managers has healthcare experience and many of the clinical experts were jettisoned in the inevitable rightsizing. Their attempt to force the amalgamation of security organizations, furniture companies, a cart company, and a grossly overpromised acquisition of an Israeli company have resulted in a monster of Frankenstein proportions. RIFs have begun and Stanley Healthcare will be absorbed into Stanley Security.” Unverified.


HIStalk Announcements and Requests

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It’s a 53-47 “no” vote on President George W. Bush as HIMSS15 keynote speaker. New poll to your right or here: should ONC create and run a national health IT safety center? The Comments link on the poll allows you to expound further.


Last Week’s Most Interesting News

  • NantHealth raises another $250 million in funding from the government of Kuwait and rounds out its executive team with several new hires.
  • GE Healthcare CEO John Dineen resigns, replaced by John Flannery, whose extensive GE experience includes none related to healthcare.
  • Ochsner Health System (LA) says it is the first of Apple’s beta sites to go live with HealthKit-Epic integration.
  • CMS reopens the EHR hardship exception period through November 30, 2014.
  • Walmart announces plans to sell health insurance in its stores and its ambition to become “the number one healthcare provider in the industry.”
  • Facebook may create online health support groups and supporting health-related apps.
  • Texas Health Resources reverses its statement that its Epic setup allowed Thomas Duncan to be discharged from its hospital without being recognized as a potential Ebola patient despite his statement that he had just arrived in the US from Liberia.

Webinars

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


Acquisitions, Funding, Business, and Stock

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Shares of Streamline Health hit a 52-week low as the company’s market capitalization drops to under $70 million. Above is the one-year performance of STRM shares (blue) vs. the Nasdaq (green).


Government and Politics 

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Internal documents suggest the overall cost of the Massachusetts health insurance exchange is much higher than the figure provided last week by Governor Dev Patrick. Temporary Medicaid plans for citizens who were unable to use the failed website will cost state and federal taxpayers $700 million, raising the exchange’s total cost to nearly $1 billion. 


Innovation and Research

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California HealthCare Foundation creates a downloadable healthcare accelerator database, saying that demand for accelerators is increasing even though evidence is skimpy that their members will be successful or that the accelerators add value. An expert says the accelerator success rate is about one out of every 7-10 companies. The report adds that while entrepreneurs like joining one or more accelerators,  the need to join a second highlights the failure of the first, and that anyone with “ loft-like space, an unlimited electrical supply, some former entrepreneurs, and a good network of local supporters” can start their own accelerator. It concludes that the recent rash of newly announced accelerators may end up doing more harm than good this early in the hype cycle and many of them will not survive. The report lists six accelerator models:

  1. Independent companies, profit or non-profit, that take equity from participants (Rock Health, Healthbox).
  2. Enterprise-based, where companies provide help only to startups building a product that they themselves might want to use (Microsoft, Boston Children’s Hospital, Optum).
  3. Product-specific to expand use of a particular platform (athenahealth’s More Disruption Please).
  4. Economic development funded by governments or organizations to promote local job growth (100health, DreamIt Health, New York Digital Health Accelerator).
  5. University-affiliated programs that may primarily involve technology transfer (UCSF’s Catalyst, Boston’ Center for Integration of Medicine and Innovative Technology).
  6. Collaboration programs that connect large corporate partner sponsors to startups (Health XL, Avia).

Other

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Daughters of Charity announces that it will sell all six of its California hospitals to for-profit Prime Healthcare.

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An infectious disease physician who with a colleague treated the third Ebola-infected patient in the US says that only one of the doctors entered the patient’s room to minimize contact, while the other observed via two-way video and documented in the EHR. She adds, “We joked about who had the easier job, since writing notes and orders in an electronic medical record can be a formidable task.”

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Alameda Health System (CA) says it has run out of cash and used up all of its credit trying to recover from a $77 million Siemens Soarian and NextGen implementation that “did not go as well as planned.” The system’s new CFO says, “The system makes it difficult to collect the right information that you need to bill a claim and makes it hard to identify what kinds of errors are occurring. …. It’s very disjointed right now. A lot of mistakes are being made.” A physician adds, “There’s not a single part of the hospital — inpatient, outpatient, ER — that has fully functional (electronic health records).”

Kaiser Permanente is working on supply chain redesign, hoping to reduce duplicate inventory, increase patient care time of nurses, and manage expired and recalled items. They are also scanning product ID barcodes into the EHR so that product effectiveness can be reviewed electronically afterward.

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Physician and professor Abraham Vergese says in an interview with Eric Topol, MD that technology is infringing on the patient-physician relationship:

It is taking us away, and society will judge us poorly about 20 years from now. They’ll look back and say, "You were complicit. Why did you let Epic and all these electronic medical records rule your life? You actually signed up to learn the new ICD codes and plug them in. Exactly what did this do for patient care?" And the answer is that it did nothing for patient care. It did everything for billing. I feel like the lone piper saying this, but it is clear that we are all feeling the frustration of being forced to do things that have nothing to do with patient care. They are all about billing.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 11, 2014 News 3 Comments

Morning Headlines 10/10/14

October 9, 2014 Headlines No Comments

RTI International to develop road map for health IT safety center

ONC contracts research firm RTI international to “create a roadmap for the development of a national health IT safety center.”

HIMSS and AVIA Launch HX360 to Improve Health Care Delivery through Emerging Technologies

HIMSS and digital health accelerator AVIA launch a new collaborative service designed to help hospitals adopt next-generation (non-EHR) technologies.

2014 Results from Survey on Health Data Exchange

An eHealth Initiative survey of 125 HIEs finds that achieving financial sustainability and overcoming difficulties interfacing with a multitude of EHRs are the key barriers preventing broader interoperability.

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October 9, 2014 Headlines No Comments

News 10/10/14

October 9, 2014 News 1 Comment

Top News

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


HIStalk Announcements and Requests

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

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

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


Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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


Sales

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

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

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


People

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

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

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


Announcements and Implementations

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

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


Government and Politics

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


Technology

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

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

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

Other

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

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


Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

Got photos? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 9, 2014 News 1 Comment

Morning Headlines 10/9/14

October 8, 2014 Headlines No Comments

Concerned Groups to Congress: Act Now on FDASIA

58 organizations, including McKesson Corp., athenaHealth, and the US Chamber of Commerce, send a letter to Congress urging them to pass legislation to enact the health IT oversight framework that was proposed by FDASIA in April.

HealthCare.gov Testing to Be Confidential

Healthcare.gov will open for insurer testing this week, but insurers are being told by CMS that the process is confidential and that testing results may not be disclosed.

Robotic Surgery Brings Higher Costs, More Complications, Study Shows

Researchers from Columbia University publish a study exploring the use of robotic surgeries for ovary and ovarian cyst removal, concluding that robotic surgeries are more expensive and lead to more complications than regular minimally invasive surgery.

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Readers Write: I-STOP May Be the Biggest Health IT Game-Changer of All

October 8, 2014 Readers Write No Comments

I-STOP May Be the Biggest Health IT Game-Changer of All
By Tony Schueth

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Over the years, e-prescribing has needed and seen its share of enabling game-changers as it competes against the sub-minute it takes to write a paper prescription. But none may be bigger than the New York state law, I-STOP, that requires all prescriptions to be transmitted electronically by March 27, 2015.

More impactful than Meaningful Use, the Medicare Prescription, Drug Improvement and Modernization Act (MMA), or the Medicare Improvements for Patients and Providers Act (MIPPA)? Potentially yes, but not necessarily in a positive way or limited to e-prescribing

In August 2012, the governor of New York signed the Senate Bill 7637/Assembly Bill 10623: Internet System for Tracking Over-Prescribing (I-STOP) Act into law. At the time, New York’s Attorney General Eric Schneiderman said, “I-STOP will be a national model for smart, coordinated communication between healthcare providers and law enforcement to better serve patients, stop prescription drug trafficking, and provide treatment to those who need help.”

Unlike other states where it is optional, New York prescribers are required to check the New York State prescription drug monitoring program registry database before writing a prescription for any controlled substance. I-STOP has other provisions, as well, such as improving safeguards for distribution of prescription drugs prone to abuse; medical education courses, public awareness efforts; and establishment of an unused medication disposal program.

The State of New York obviously sees e-prescribing as part of a bolder effort to curb prescription drug abuse. Kudos to the state legislators for getting that. Electronic prescriptions flow through a secure, closed channel from prescriber to pharmacy. Each step of the process is electronically logged. It is unquestionably a vast improvement over paper in reducing fraud and impeding diversion.

A law of this magnitude from a bellwether state is impactful in many ways. Other states are surely watching and, should it be successful, will likely follow. But if it’s not successful, there will be implications, too.

The impact begins with pushing along the nascent effort of e-prescribing of controlled substances (EPCS). Although the DEA passed an interim final rule in 2010 permitting such an effort, its uptake has been slow. According to Surescripts, as of July 31, 570,000 EPCS prescriptions were transmitted via their network year to date. That puts EPCS adoption at far less than one percent since about 500 million of our 3.85 billion retail prescriptions are for controlled substances.

As a recent case study supports, the biggest challenge for EPCS is that physicians still don’t know that they can prescribe controlled substances electronically and pharmacists aren’t aware they can accept them in that manner. This lack of awareness keeps physicians and pharmacists – especially independents – from requesting such functionality from their vendors. As a result, too many EHR, e-prescribing, and pharmacy vendors assign a lower priority to EPCS with what little bandwidth they have outside of Meaningful Use, ICD-10, and NCPDP SCRIPT 10.6.

According to Surescripts, only 14 prescriber vendors are certified for EPCS. While those include three of the top five EHRs and the “ePrescribing inside” markets share leaders DrFirst and NewCrop, version issues, client factors, up-sell challenges, and other considerations mean that only a  small number of EHRs are EPCS-enabled.

Nationwide, the pharmacy side is not there yet, either. While the two largest chains are able to receive and process controlled prescriptions electronically, many of the smaller chains and independents are not. According to Surescripts, 31,000 of 67,000 pharmacy locations are enabled for EPCS.

After enhancing their products to meet the New York guidelines, however, both EHRs and pharmacy software vendors should find taking their EPCS solutions elsewhere to be less of a challenge.

All that said, nationwide, it will continue to be the classic, “Which comes first, the chicken or the egg?” situation. To get past that, it takes education and coordination, which are elements of I-STOP.

For the education component, I-STOP charged a workgroup of stakeholders and the Department of Health with responsibility to guide public awareness measures. Our EHR clients tell us they aren’t hearing from their New York customers, so are physicians in New York unaware of I-STOP? A simple Google search on I-STOP yields a few articles, most from when it launched. Hopefully, a huge campaign is planned.

The prescriber consequences are significant, especially for physicians. According to the New York Bureau of Narcotic Enforcement (BNE), non-compliance is punishable by a $2,000 fine, imprisonment not exceeding one year, or both. Furthermore, it is considered to be professional misconduct by the applicable professional boards, which could lead to suspension or revocation of professional licenses.

With government mandates, enforcement is always a question. People who know the BNE and New York’s Attorney General Office say they wouldn’t hesitate to enforce this, especially given the larger objective of curbing fraud and abuse. To be sure, I wouldn’t want to be the vendor that caused the $2,000 fine or any of the more serious consequences.

From a coordination perspective, there’s nothing like a mandate and deadline to get everyone on the same page. But the consequences are to the prescriber, not the pharmacy, and the EHR vendors just have to deal with upset clients.

So, how is it going? We don’t have the most up-to-date data about New York specifically. As of December 31, 2013, 62 percent of physicians in New York were routing prescriptions, according to Surescripts. While a lot can change in a year, 38 percent of physicians are not prescribing electronically, and as noted earlier, fewer than one percent are e-prescribing controlled substances nationally. Only one of the top two EHRs in New York is EPCS-certified through Surescripts, so the others have a lot of ground to cover by March 27, 2015.

What if large numbers miss the deadline? Issuing fines to that many prescribers will be a logistical — not to mention political — challenge. They could issue an ICD-10 or MU Stage 2-like extension or waivers. However, there’s a lot of frustration out there about those delays. New York issuing such outs or just not enforcing the law could further lessen the impact of all mandates, arguably making I-STOP the biggest game-changer ever, and not just for e-prescribing.

Tony Schueth is CEO of Point-of-Care Partners of Coral Springs, FL.

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Readers Write: A CIO’s Perspective on the Options for Health System Analytics

October 8, 2014 Readers Write 2 Comments

A CIO’s Perspective on the Options for Health System Analytics
By Gene Thomas

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Buying an EMR is an important decision, but choosing an analytics solution is far more important. In today’s healthcare marketplace, installing an EMR is table stakes. Granted, it’s necessary and expensive table stakes, but it’s still just the starting point.

The real key to transforming healthcare performance lies in analytics and the humans that use and make data-driven decisions. An EMR captures the data. Analytics uses that data to deliver the insight needed to improve the quality and cost of care.

Improving quality and cost is on everyone’s mind. At the organization where I serve as CIO, Memorial Hospital at Gulfport in Mississippi, it is a critical priority. The majority of our volume comes from Medicare and Medicaid beneficiaries and the uninsured. We are a not-for-profit, single-hospital system. We have to focus on costs and quality in order to continue to serve our community.

Fortunately, we’re advancing steadily along the path of putting infrastructure in place to drive the necessary improvement. We rolled out our integrated EMR this spring and we are now implementing our analytics solution.

I started this article by stating how important analytics is. Choosing what type of analytics solution to implement was not a decision we took lightly. I want to outline here the factors we considered as we made that choice.

I wouldn’t say that selecting our EMR solution was easy, but the fact that there were only a handful of viable options certainly simplified the process. Choosing an analytics solution was a different story. A wide variety of analytics solutions are available and they all claim to drive quality and cost improvement. We looked at BI tools. We researched multiple vendors with point solutions that address areas like capitated payments, fee-for-quality, and ACOs.

Ultimately, we decided that the right solution for our enterprise-wide analytics strategy would be an enterprise data warehouse (EDW). But even then there were several possible paths to take. We could build our own EDW, we could adopt our EMR vendor’s emerging EDW solution, or we could implement an EDW solution from a third-party analytics specialist vendor.

We quickly dismissed the option of building it ourselves. We simply didn’t have the time or resources for a trial-and-error, homegrown approach. That left us to decide between our EMR vendor’s EDW and a specialist’s solution. We went with the specialist’s solution.

Our EMR vendor’s EDW was relatively inexpensive and there was something attractive about the convenience of having one less vendor to manage. Still, I approached their EDW offering with some skepticism. I trusted their ability to handle all of the transactional functionality that is an EMR vendor’s core competency, but analytics is not part of that core competency.

Ultimately, we set three criteria as essential in an vendor. Any analytics vendor we selected would have to demonstrate the following.

A significant track record with analytics

EMR vendors really don’t have an analytics track record. Their analytics experience lies mainly in tactical operational reporting. They can easily tell me how many of my patients are on a certain medication, but my improvement initiatives will require much greater sophistication.

Specialist vendors, on the other hand, have been living and breathing nothing but analytics for years (and sometimes even decades). The best ones can share concrete examples of how their solutions have driven measurable quality and cost improvement.

The agile data architecture required to handle big data

Our EMR vendor is obviously an expert on transactional systems architecture, but that doesn’t translate to expertise in architecting a powerful analytics solution that runs on a completely different type of database. With so much volatility in healthcare today, I wanted to be sure I had a flexible architecture for analytics that could expertly adapt to new rules, standards, vocabularies, and use cases.

The ability to integrate data from multiple systems, including competitors

This was a huge consideration for us. EMR vendors are generally unwilling or unable to pull data from external sources, particularly competitive systems. We needed a solution that was source-system neutral and only the third-party analytics specialists could deliver that. Integrating data from just about any system you can imagine is their core competency. My understanding is that some EMR vendors have recognized the need to allow integration of data from beyond the EMR, but they are years behind the specialists in terms of doing this well.

I recently came across a 2013 survey by CHIME that found that 80 percent of CIOs believe analytics is an important strategic goal, but that only 45 percent feel they have a handle on it. I don’t claim to be an expert on analytics, but I hope that this brief account of my experience so far will be helpful to some.

My biggest piece of advice to any colleague that has yet to tackle analytics is to get started as soon as possible. I believe that CIOs need to change. Our focus can’t be just on the bits, bytes, databases, and servers. All of that is still an important element of what we do, and I have a staff that takes care of those details, but my focus as CIO is to provide data and information to all stakeholders—our executives, our clinicians, our patients, and more—to help drive better outcomes. That means a top area of focus for me is on analytics.

Gene Thomas is chief information officer of Memorial Hospital in Gulfport, MS.

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October 8, 2014 Readers Write 2 Comments

Readers Write: Communicating Across the Continuum

October 8, 2014 Readers Write No Comments

Communicating Across the Continuum
By Steve Whitehurst

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As consumerism continues to permeate the healthcare industry, hospitals must place more emphasis on how they treat their patients across the entire care continuum, inside and outside the four walls of their facility. To do this, patients must be addressed at every touch point in order to fully meet their needs and sustain their satisfaction.

Though increasingly important, many hospitals struggle with supporting patients’ 24/7 communication needs due to limited staff, reduced budgets, and unclear communication expectations. Yet without a communication plan in place, interacting with and keeping patients engaged and satisfied can be very difficult, thereby limiting a hospital’s ability to sustain an enhanced patient experience, increase patient satisfaction, keep patients compliant with their care plans, and build brand loyalty—not to mention it can potentially increasing the risk for readmission.

By creating a comprehensive communication strategy leveraging a mixture of communication services leveraging live operators and clinicians as well as automated technology platforms across the continuum, hospitals can effectively manage their interactions with patients inside and outside the facility’s walls to increase both care quality and patient experience.

With Meaningful Use incentives and other regulations driving the implementation of patient portals, many healthcare organizations are pouring resources into electronic communication platforms that use email or direct messaging to communicate with patients. Although these methods certainly improve engagement, they are not always effective at reaching all patients or providing personalized attention.

For instance, most patient portals are capable of delivering educational material to patients. However, there’s no way of knowing whether the patient actually reads and understands the information unless someone directly asks and engages the patient in conversation. Whether face-to-face or over the phone, once personal interactions are lost, the organization loses its ability to make sure patients are adhering to their medications and complying with their care plans.

Conversely, hospitals that employ high-touch communication strategies, such as the following, can engage patients across the continuum to promote more favorable outcomes, in addition to realizing measurable improvements in patient satisfaction and HCAHPS scores.

  • Live voice follow-up after discharge. One of the most effective methods for reaching patients, this communication tactic enables organizations to know when they’ve reached patients and provide personalized communication to their patients by asking and answering questions, ensuring patients are adhering to their medication and care plans, and providing additional education. Statistics show that patient satisfaction improves when communication services like live voice are leveraged at specific touch points in a patient’s care continuum.
  • Communication to support care coordination. For patients with complex conditions, multiple comorbidities, or who are high-risk for readmission, communication services can improve care coordination by going beyond discharge follow-up to help patients navigate their care plans. These services, for instance, can help patients with medication management (including medication reconciliation and adherence), disease management, and health coaching. As an example, when patients are prescribed new medications or receive changes to previous prescriptions, it can be difficult to figure out which medications should be taken, when they should be taken, and specific side effects to look for. Care coordination follow-up support can help patients navigate these questions, ensuring they take medications in the most appropriate way. Likewise, these services can also identify barriers patients may have in obtaining or taking their medications and offer solutions to help with adherence.
  • Answering services. Inbound services that receive calls from patients provide opportunities for healthcare organizations to address questions or concerns immediately rather than waiting for providers to return phone calls. When these services are managed by highly trained teams qualified to listen to and answer patient concerns, it allows organizations to meet patients’ needs more efficiently in a timely manner, thus increasing patient satisfaction levels.
  • Automated services. Although live voice interactions are most effective for facilitating conversations between patients and providers, automated services can be useful for routine patient outreach, such as reminding patients to schedule and attend upcoming appointments or refill prescriptions. By leveraging automated services in appropriate situations, organizations can concentrate their human resources on more meaningful interactions with patients.

Whether managed in-house or outsourced, a comprehensive communications plan will enable hospitals to continue the patient-provider conversation long after patients leave the facility, enhancing their experience throughout the entire care continuum.

Steve Whitehurst is the vice president and general manager of Stericycle Communication Solutions.

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October 8, 2014 Readers Write No Comments

Morning Headlines 10/8/14

October 7, 2014 Headlines 1 Comment

Payment Adjustments & Hardship Exceptions

CMS announces that it will reopen the submission period for hardship exception applications for both eligible professionals and eligible hospitals, with a new application deadline set for November 30.

John Flannery to Lead GE Healthcare

GE Healthcare CEO John Dineen  announces his resignation, effective immediately.  He is reportedly leaving the company to pursue leadership opportunities outside GE. Dineen will re replaced by John Flannery, GE’s current head of business development.

Ochsner Health System First Epic Client to Fully Integrate with Apple HealthKit

Ochsner Health System (LA) announces that it has connected its Epic EHR with Apple’s HealthKit to capture daily weight readings from wireless scales that are issued to heart failure patients enrolled in the health system’s remote patient monitoring program.

Health Care Website Fix Cost Mass. Additional $26M, Patrick Says

Massachusetts Governor Deval Patrick announces that the state’s health insurance exchange is fixed, costing $26 million to repair and bringing the total cost of the exchange to $254 million.

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October 7, 2014 Headlines 1 Comment

News 10/8/14

October 7, 2014 News 14 Comments

Top News

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CMS will reopen the submission period for EHR hardship exceptions through November 30, 2014. Valid circumstances are vendor delays in providing 2014 Edition CEHRT and the inability to attest via the 2014 CEHRT Flexibility Rule. They didn’t give a reason, but it’s probably because their attestation system wasn’t working and providers were going to be penalized for another CMS technology screw-up.


Reader Comments

From Zephyr: “Re: Ebola. Epic is hosting a conference call Wednesday to allow users to share strategies for screening, notification, and management of communicable diseases.” Unverified, but I think all ED system vendors should consider doing this. Epic has a vested interest since it was called out (correctly or not, depending on which hospital press release you believe) by Texas Health Resources, which owns the hospital that discharged an Ebola patient from its ED due to poor communication of his stated recent visit to Liberia.

From Doppelganger: “Re: MU. We are an EH trying to attest since July for Stage 1 Year 2 for the period April-June 2014. We first attested under Medicaid for 2012, then Medicaid and Medicare in 2013. There’s a bug in the CMS website – they think we’re in our third year of attestation, so we must be on Stage 2. I’ve heard this is happening to everyone who attested under Medicaid for 2012 only. CMS said the bug would be fixed on October 1. It still isn’t and my CFO wants his ‘free’ money!” CMS seems to be struggling with its websites these days, so I’m sure others are having the same problem.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Cognizant, which bought TriZetto two weeks ago for $2.7 billion, acquires healthcare digital marketing company Cadient Group.  

Rock Health runs an interesting interview with a Goldman Sachs healthcare IT guy on doing IPOs. A good quote: “Being public—not just going public—can put you in a very powerful position as you continue to build your toolset and maximize its importance in the world. But the process is time intensive and distracting, so always be objective and sober about it. Maintain control and don’t let the euphoria and momentum of the IPO process carry you away such that you later wish you had spent time continuing to innovate and build the business rather than focusing on the IPO.”

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Hewlett-Packard will split into separate companies, one (Hewlett-Packard Enterprise) focusing on enterprise hardware and services and the other (HP) on PCs and printers. 

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Medical supply manufacturer Becton Dickinson will acquire CareFusion for $12 billion in cash and stock. CareFusion’s health IT-related product lines include Alaris (smart IV pumps), MedMined (infection surveillance), and Pyxis (medication and supply dispensing). The company was a 2009 Cardinal Health spinoff. The Department of Justice fined CareFusion $40 million earlier this year for paying high-profile patient safety advocate Charles Denham, MD nearly $12 million to recommend the company’s skin prep cleanser via the National Quality Forum.

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Alteryx, which offers software that allows minimally technical users to create workflow-driven applications from data sources, raises $60 million in a Series B round. The company, which partners with Tableau and QlikView, offers a 14-day free trial download.


Sales

United Physicians (MI) will roll out Wellcentive’s population health and risk management solutions to cover all its patients.

Community Health Centers of Arkansas will implement eClinicalWorks Care Coordination Medical Records across 10 practices and 58 locations.


People

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GE Healthcare President and CEO John Dineen resigns effective immediately to “look at new leadership opportunities outside GE.” He will be replaced by SVP of business development John Flannery.

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Sheryl Bushman, MD (NYU Langone Medical Center) joins Optimum Healthcare IT as CMIO.

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Sean McDonald, who founded the Pittsburgh-based hospital pharmacy robotics vendor Automated Healthcare and sold it to McKesson in 1996, leaves his CEO job at Precision Therapeutics.

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Jim Cato, EdD, RN, MSN, CRNA (Christus Spohn Health System) joins GetWellNetwork as SVP of clinical integration and operations.


Announcements and Implementations

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XIFIN will use SyTrue’s terminology as a service to improve pathology services billing and to ease the conversion to ICD-10.

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A local newspaper article by Lee Memorial Health System (FL) CIO Mike Smith describes its go-live with Epic MyChart.

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Caradigm releases a population health applications bundle that includes its Intelligence Platform plus modules for patient knowledge aggregation, risk management, quality improvement, and care management. 

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Surescripts integrates its CompleteEPA medication prior authorization system with Epic.

T-System releases system-agnostic Ebola patient screening tools that are free to all providers.

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Premier adds real-time predictive analytics from Predixion Software to its PremierConnect data management and decision-making platform.

Merge Healthcare adds electronic referral and order management to its iConnect image sharing network.


Government and Politics

Medicare will change its five-star rating system for nursing homes after news organizations questioned the validity of self-reported data. Among the changes will be mandatory quarterly electronic submission of payroll data to verify staffing levels and an auditing program to validate quality measures ratings.

The VA, following up on its investigation of long wait times, fires three health system directors and its chief procurement officer. One of the fired directors announced his retirement four days before his termination was made public, which the chairman of the House Veterans’ Affairs Committee called, “semantic sleights of hand.” The procurement officer was fired for inappropriately influencing a contract award and then trying to block the resulting investigation.

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Massachusetts Governor Deval Patrick says the state’s health insurance exchange has been fixed for $26 million and a total cost of $254 million, far les than the $600 million total that a think tank had estimated last month.  

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A Texas Senate committee is holding hearings into how Ebola patient Thomas Duncan ended up at Texas Health Presbyterian Hospital and why the hospital’s ED discharged him even though he was feverish and told the nurse just came back from liberia.  


Innovation and Research

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Orlando Portale, president of Health Innovation Partners, mocks up an Ebola early warning app for hospital EDs that would connect to the system in which the US Department of Customs & Border Protection records the itineraries of travelers entering the US. if the government authorized access its system, doctors could review the patient’s travel history by entering the patient’s last name, gender, and date of birth. Sounds like a great idea other than the inevitable privacy objections that would arise from having the visit plans of foreign travelers available outside of the government.

A Brigham and Women’s Hospital EHR review finds that doctors experience “experience fatigue” later in the day and are 25 percent more likely to inappropriately prescribe antibiotics late in their shifts. As if that’s not bad enough, the study found that doctors often ordered antibiotics questionably even when they weren’t tired, about 30 percent of the time.


Technology

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Ochsner Health System (LA) announces that it is the first site to integrate Apple HealthKit with Epic, bringing in weight from wireless scales to monitor home patients for congestive heart failure. I cringed when I typed “weight” since I recall my physics professor adamantly declaring that the correct term is “mass.”

An Exconomy review says there’s not much evidence proving that digital health improves outcomes, but it’s not reasonable to withhold clearly beneficial technologies while waiting for the perfect study to be performed. The best quote is from Joe Kvedar, MD of Partners Healthcare’s Center for Connected Health, who says its tough to get insurance companies to pay for apps for conditions such as smoking cessation where the medical cost benefit won’t be realized for years, possibly after the patient has moved on to another insurer. “That’s why so many companies say they’d rather make a cute thing to put on your wrist, make some money, sell it, and move on to the next thing.”


Other

University of Michigan gets a $1.6 million AHRQ grant to study how clinicians use EHRs, email, and pagers and how those systems can be set up to reduce communications failures.

Several high-end restaurants in Los Angeles are tacking on a 3 percent dinner tab surcharge line item to cover the cost of providing health insurance to their employees. Some patrons are complaining that, like other costs of running a business, the extra fee should be built into menu prices, but the restaurants argue that their leases and insurance are priced based on gross revenue and 3 percent wouldn’t cover it by that method. Some of the restaurants agree that it doesn’t make sense to pay servers nearly nothing and force them to live on tips, so they’re considering adding an all-inclusive service fee. 

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Masimo Corporation, which flashily launched a patient safety foundation last year with an on-stage appearance by President Bill Clinton, is found in a ProPublica investigative report to have been reprimanded by the FDA for failing to respond adequately about complaints about the safety of its own medical devices. An expert who reviewed the agency’s findings found it troublesome that the company challenged a complaint about a device’s alarm system involving a patient death, adding, “When a company refuses to respond in any way to the FDA other than to say that the FDA is wrong on every issue, that’s not very credible.”  

Health Catalyst puts out a good video called, “If Restaurants Were Run Like Hospitals.”

Researchers looking at Beth Israel Deaconess Medical Center’s patient portal usage through 2010 found that patients sent an average of about one email every other month per patient, with about a fourth of all patients signing up for the portal and a third of those (8 percent of all patients overall) sending at least one message to their doctor. Physicians received about one email per day. The authors conclude that physicians should be required by their job descriptions to respond to patient emails. That’s interesting, but the information is awfully old and the conclusions are questionable as a result.

Walmart will allow in-store shoppers to compare and select health insurance plans, adding that the company’s goal is “to be the number one healthcare provider in the industry” and that the foot traffic will allow it to sell customers prescriptions, non-prescription medications, optical services, and retail clinic services. The company also announces that it will stop offering health insurance to the 30,000 of its employees who work fewer than 30 hours per week, meaning those employees will lose their 75 percent Walmart premium subsidy.

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Weird News Andy is amused by PitPat, a Bluetooth-enabled exercise tracker for dogs. WNA adds that the cat version would be locked on 99 percent sleep.


Sponsor Updates

  • Sanford Health (ND) VP of clinical operations Jeff Hoss describes the use of an RTLS from Intelligent InSites and Sonitor to improve ambulatory patient processes in a video presentation.
  • Medicity earns HISP certification from DirectTrust and EHNAC.
  • Streamline Health will begin work on a $7.5 million, five-year deal for its abstracting solution with a new channel partner.
  • Georgia West Imaging and Outpatient Imaging (GA/AL) select McKesson Business Performance Services for its RCM.
  • Netsmart announces that over 1,000 attendees are participating in its CONNECTIONS2014 client conference through October 9.
  • GetWellNetwork CEO Michael O’Neil, Jr. is speaking at the US News Hospital of Tomorrow summit October 6-8 in Washington, DC.
  • CTG Health Solutions’ Joseph Eberle will share his experience identifying improvement opportunities for chronic kidney disease patients at the National Association of Health Data Organizations Annual Conference October 8.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 7, 2014 News 14 Comments

HIStalk Interviews Paul Roscoe, CEO, VisionWare

October 6, 2014 Interviews 1 Comment

Paul Roscoe is CEO of VisionWare of Newton, MA.

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Tell me about yourself and the company.

I’m the CEO of VisionWare. Before VisionWare, I was the CEO of Crimson. I’ve been involved in healthcare technology for the past 25 years in both Europe and the US.

VisionWare was a company I’d known for many, many years, founded by Gordon Cooper, a friend of mine. While I was tracking the company, I also got a chance to see VisionWare from a customer’s perspective because while I was at Crimson, the technology team decided to deploy VisionWare’s master data management solutions to help the Crimson platform.

 

What’s the definition of master data management?

Master data management is a well-understood genre of technology tracked on a horizontal basis. Gartner has a magic quadrant for master data management, for example. From a healthcare perspective, people may have looked to master data management in terms of technology like EMPIs, or enterprise master data indexes.

Master data management as we define it is the ability for VisionWare particularly to provide an effective and a single perspective on integrating the various different disparate data sets that exist from a healthcare organization — matching, verifying, governing, visualizing that data across these different data silos to provide a 360-degree view of the healthcare data.

The most obvious one of that is patient data, but it could be a 360-degree view of a provider, a facility, or an entity of any description. Patient is the most obvious one.

 

If you look at the competitive landscape of analytics, where would you position VisionWare?

VisionWare’s technology enables a lot of the analytics solutions that are out there in the healthcare domain at the moment. I know that coming from Crimson that one of the challenges for a lot of the analytics, population health, and care management solutions that are out there is accurately identifying the patient and accurately identifying that patient across the various different care venues in which those types of solutions are being deployed. They are very sophisticated. They have great insight. But only as far as the lowest common denominator, which is accurate patient information or accurate physician information.

We don’t see ourselves as competitors to analytic solutions per se. We have a lot of those analytics and population health vendors that approached VisonWare recently and are looking to integrate our master data management technology to enable a more effective view of the patient information within their solutions.

The obvious example is to look at situations where there are multiple systems. If you look into any health system — never mind an accountable care organization — you will find lots of disparate clinical and financial systems. Organizations are increasingly looking to link those two domains together, so the recipe for mismatched or inaccurate patient data is there.

Now you expand that as you look at the complexity of a health system, not just an inpatient setting, but also inpatient ambulatory. Then you expand that even further to affiliates, employed practices, long-term care, and skilled nursing facilities. You’ve got a very complex picture where the patient’s information is being held. At every one of those venues, there’s opportunity for that patient information to be inaccurate. When I want to lift up and look holistically and longitudinally at that patient, it’s very difficult unless I’ve got accurate patient information.

Clearly disparate systems and the disparate nature of healthcare delivery is promoting this challenge. But even in situations where you’ve got a single EMR system … there was some research done not that long ago relative to the Epic deployment at Kaiser, where it talked about a single deployment of an EMR, but different instances of Epic across different regions. It reported that just within the Epic domain that the rate of patient identity matching fell to somewhere around 50 or 60 percent when they were sharing information across different regions, even within the Epic world. Clearly a single system doesn’t always mean that you’ve also got a handle on effective patient matching.

 

What’s the cause of mismatched patients within a single system?

You’ve got a number of challenges. The data that’s being collected at these various different registration points is not necessarily conforming to a standard of data governance. How information is collected at Point A on a patient may be very different than the way it’s collected at Point B. How we might use a simple thing as a surname field may be very different from system to system.

There’s really for many of our clients not a lot of data governance standards in place. That’s promoting the challenges of dirty data coming in. You can have the most sophisticated matching algorithms, but if you haven’t sourced the issue at the point at which the data’s being entered, then you’ll always have challenges.

We believe that master data management can be solved to a degree with technology, but it should be part of an overall information governance strategy that health systems are starting to embrace. We are realizing that in this post-EMR era, they’ve got amazing digital assets, amazing data that is locked up in these systems. But without being able to accurately identify that data and to be able to normalize and harmonize it, it starts to lose its value.

When people think about interoperability being the Holy Grail, sharing an IHE profile, HL7 document, or CCDA in itself will not solve this problem because there are still challenges where technology can help probabilistically and deterministically matching these patients together. That’s what we do at VisionWare.

 

What customer base do you have or seek?

The company was based historically out of the UK. Over the last couple years from the UK, we have been focused on selling to two primary constituents, the HIE landscape and also with technology companies who are looking to provide a master data solution within their own product portfolios. We’ve been successful in both of those areas. We have a large number of HIEs and a number of different technology companies.

Increasingly over the last year since I joined, we’ve now started to focus our efforts on the provider marketplace, ACO marketplace, and the payers. What we’re finding is that a lot of those organizations have the first-generation EMPI technologies. They’re finding that those are somewhat monolithic. They were developed in an era where you only needed to look at inpatient data. That was the key driver.

In today’s world of healthcare and care coordination across this continuum, those first-generation technologies aren’t really fit for purpose. That’s why we started to see quite a lot of traction in the last six to nine months with a solution that was more designed to operate in this more collaborative environment.

Not to keep going on about this, but one of the things that’s quite unique about VisionWare and was appealing to me when I looked at the company is this notion of what we call a collaborative data model. The ability for us to not say, “This is the definition of a patient or a provider, take it or leave it” as some companies in this space do. It’s more, “You give us the data as you see fit and it’s our responsibility to make sure that we can take that data in whatever format, match it, merge it, and send it back to you in the format that you want.” It’s much more collaborative as opposed to predefined.

 

Analytics companies that are new to healthcare might have missed the concept of patients coming from different venues and different systems without a single identifier. Do you think they are just starting to see the nightmare of what seems simple in identifying a patient?

I think there’s definitely some aha moments for a lot of those vendors, where they realize that they’re taking the data in from those various customers and that they’re responsible for making sure that they can create meaningful value from it. One of those challenges is being able to accurately identify that patient. Yes, we’ve seen quite a lot of traction there.

What we’ve also seen is organizations that have gone through acquisitions. One of our clients is a very large electronic medical record vendor who went through an acquisition of another vendor in their space and wanted to provide a way of quickly having a single view of the patient across these two assets now instead of a single asset. We see that in a hospital setting, as organizations are increasingly looking to either employ practices or merge with other hospitals. That in itself presents large challenges in being able to identify accurate patient data or provide the data across those various assets. So M&A activities tend to be a big driver for us as well.

 

People may also miss the need for a master provider index and what that means in terms of credentialing or doing any kind of quality work. Is that something that’s also not very state of the art from other vendors?

The first stage of the work that we did with our friends at Crimson was around providing a single provider registry. For any level of quality reporting or performance analytics on a physician, you need to make sure that you’ve got an accurate representation of all of your physician’s activity. Without having a provider directory, that’s challenging. That’s a big area.

 

What’s the interest in your geospatial capabilities and how that might be used in a public health context?

When you think about data on a patient, we understand data that’s been captured in a hospital or an ambulatory setting. Particularly around patient engagement, there’s a lot of information that is presenting itself on patients – and it will continue to get larger and larger — that might be interesting for a care manager.

The problem you’ve got is that data may be patient supplied or it might be sourced from non-hospital-based systems. Therein lies the challenge. How do you take some of the information from these other areas that a patient’s interacting with that historically hospitals don’t really care too much about? But now as we’re trying to engage the patient or trying to understand how the patient is managing their healthcare, we may take more notice of. There is a challenge there of how you link that information that’s being provided to the hospital information systems.

We have a solution specifically aimed at allowing us to enrich hospital data with third-party data that we’re obtaining or is being obtained by the health system from a variety of different sources. A simple example would be how do you look at an increasing number of self-pay patients? The ability to do effective credit scoring might be important for our health system. How do you link that patient with data that might be in Experian or other credit-scoring system? That’s a challenge. It might seem very simple, but it’s actually quite a big challenge for a lot of healthcare organizations to match that Paul Roscoe with that Paul Roscoe in the credit scoring system without a solution that allows that to happen.

 

Hospitals have to become more interested in what happens to patients who aren’t having an encounter using more of a CRM-type system instead of just waiting for them to show up. Are organizations interested in using your tools to do outreach for at least targeted groups of patients?

Yes. Not only those cases we talked about, but we’ve also created within the VisionWare portfolio a visualization layer that allows us to visually represent a patient in ways that might be interesting to look at, but you couldn’t get from a flat analytics view that you might get through the dashboard, etc.

If you think about it, we’ve mastered all of the data that’s flowed through the health system. We know the patient. We know the relationship with that potential patient’s family. We know the relationship with the physician. We’re in a great position to be able to then provide a visualization layer that allows you to explore the data in meaningful ways.

You might put this in the hands of a care manager who’s looking at a particular small panel of patients and wants to understand as much as they can about their interactions with the health system regardless of where they are. That’s particularly relevant in an HIE way. You might have access to data now across this broader network. This visualization layer allows you to visually explore the data, potentially on a patient-by-patient basis, and see correlations and data that might not have been obvious to you before.

 

With ACOs or acquisitions, hospitals are suddenly getting access to data from other systems. Do they have to figure out how a given patient fits into the new grand scheme?

Absolutely. You’ve got situations where you might have a small fragment of the patient record, but the patient is being seen in another facility. Without knowing the connection between that sliver of Paul Roscoe and the broader Paul Roscoe that might be in a medical record that’s being held somewhere else, you may be missing an opportunity from an engagement perspective.

It may be more fundamental than that, maybe patient safety issues. I’m treating this Paul and I don’t really have the longitudinal view of Paul because I don’t have that complete medical record because it’s been duplicated or mismatched. There’s significant impacts to that.

I believe it was the CHIME survey not that long ago in which a fifth of respondents said that there were adverse events happening from mismatched patient information. This is fundamental, not nice to have. There are patient safety concerns that can be addressed by having a more effective handle on your patient and integrity of your patient data.

 

Where do you think the company’s future lies?

What we are focused on at the moment is building out a larger install base in the US. We think there is a lot of difference between what we do and what the incumbent vendors are doing.

Our job at the moment is to get our name out there. Doing the work that we’re doing with your organization helps. And help health systems understand how our approach is different than the incumbents that are in the marketplace — speed to deploy, the price point that we can offer to our customers in the US, and also just the sophistication of the solution.

Our goal at the moment is to build a strong base in the US. We have a strong UK organization already behind us. That platform allows us to build out our US organization and continue to deliver value for our US healthcare customers.

One of the other areas that we can do is innovate. You’ll see us shortly coming out with a solution which allows us to look at, for example, biometric data on a patient and link back to a patient’s identity. This is a potential Holy Grail of patient identity, which is the linkage of a patient’s biometric signature with the information that’s being stored in the health system. We think we’ve got a really effective way of doing that.

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October 6, 2014 Interviews 1 Comment

Health IT from the CIO’s Chair 10/6/14

October 6, 2014 Darren Dworkin 8 Comments
Fine print: The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

Hospital technology is not having a good week. First an EMR flaw was identified in the handling of an Ebola patient, and now this.

Hospital says spreadsheet flaw led to overspending
Administrators did not see the analyst’s note in the spreadsheet, officials say

10:00AM – October 5, 2014

Officials at UASP Hospital (Unique and Sick Patients Hospital) allege that a flaw in the hospital’s spreadsheet application prevented administrators from seeing negative budget variances, leading the hospital to spend too much money.

Background on the case

On Sunday evening, officials confirmed the case of overspending after an analyst submitted an invoice for payment in a cost center already over budget, setting in motion actions that would have UASP hospital over spend.

The trouble with spreadsheets

According to the hospital, the administrator who approved spending the money followed hospital protocol. Although the analyst had included the information about the negative budget variance in the correct cost spreadsheet tab, the administrator never saw the notation.

"Protocols were followed by both the analyst and administrator. However, we have identified a flaw in the way the administrator and analyst portions of our spreadsheet software interact in this specific case. In our spreadsheets, there are separate administrator and analyst workbook tabs," according to a hospital statement.

"The documentation of spending variances was located in the analyst workflow portion of the spreadsheet, and was designed to provide high reliability analyst process to allow for the spending and approval under administrative pre-approval limits," the statement explains. As a result, "the documentation of spending variances would not automatically appear in the administrator’s standard workflow."

Could your hospital handle financial variances?

The hospital says it has since moved the budget variance into the workflow for both administrators and analysts. It has also modified the spreadsheet to highlight any large expenses when a cost center is close to its budget.

According to the hospital, "We have made this change to increase the visibility and documentation of budget variances in order to alert everyone… We feel this change will improve the early identification of variances in the budget, and bring to our attention any over spending"

While not named, it is well known that Microsoft is a leading vendor in the spreadsheet space and the current vendor of UASP Hospital. Reached for comment, Satya Nadella, CEO of Microsoft. added, "Even more important, we must have courage in the face of opportunity."

Marc Benioff, CEO of Salesforce.com noted on CNBC, "The era of the traditional software ‘load, update and upgrade’ business and technology model is over … It is time for The Business Web"

Note: while I am poking fun at how we can blame technology, the severity of the Ebola disease is no laughing matter. My thought and prayers are with all Ebola patients around the world as well as the courageous caregivers putting their lives at risk every day. There are many ways to help. I have chosen to donate to the Red Cross.

1-29-2014 12-54-46 PM

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

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October 6, 2014 Darren Dworkin 8 Comments

Curbside Consult with Dr. Jayne 10/6/14

October 6, 2014 Dr. Jayne No Comments

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Given the recent events at Texas Health Presbyterian Hospital Dallas, the Ebola virus is all our hospital can talk about. We’ve been combing through our infectious disease protocols and scheduling education sessions to ensure people have access to all the resources available.

It’s daunting to think of what might happen should the disease get a toehold in the US. Many of our hospitals are already taxed with the usual communicable diseases. During flu season last year, one of the local pediatric hospitals had to put a M*A*S*H style tent in the parking lot to handle all the cases coming in.

Although Ebola is statistically less infectious than other diseases (including HIV, SARS, mumps, and measles), the lack of available treatments and high mortality rate frighten the average person. NPR had a great graphic that we’re using to help educate staff and patients about the need to ensure we have appropriate precautions in place to treat all communicable diseases, not just the most worrisome ones.

We have measles outbreaks in our community every couple of years due to some concentrated populations who do not vaccinate. Measles has a fatality rate of around 25 percent in underdeveloped nations, compared with an average fatality rate of 50 percent with Ebola (although specific outbreaks have ranged from 25 percent to 90 percent). For readers who don’t have a clinical background, the World Health Organization fact sheet provides good information about what your clinical co-workers are contemplating.

According to WHO, single travelers have spread the disease to countries including Nigeria and Senegal, which adds to the worry around a traveler bringing it to the US. Unfortunately, the early phases look a lot like other viral illnesses – fever, fatigue, muscle aches, and headache.

I probably saw 10 patients with those symptoms in the emergency department during my last shift. If we had treated each one like a potential carrier, it would have brought our patient flow to a screeching halt. From an epidemiology standpoint, IT resources are going to be critical for surveillance and identification of potential cases in the US.

I’m glad Texas Health Resources released a clarification on their earlier statement that cited a “flaw” in the EHR as contributing to the release of the patient at his initial presentation. Ultimately, it’s up to the physician to take a detailed history and physical. We all know that even with the best nursing protocols, patients will occasionally add details when a second (or third) interviewer talks with them.

It used to drive me crazy as a student when a patient would tell the resident (or worse, the attending) a detail that they had omitted even when I asked specifically about it. It may be the time between evaluations that makes the patient think about other details, or maybe one feels more empowered and able to formulate thoughts after telling the story previously.

My initial response to their statement about a flawed EHR was to take offense on behalf of their physicians. It was almost like saying their physicians aren’t responsible for thinking about elements not prompted by the EHR, or that they’ve totally given themselves over to cookbook medicine. I reached out to a friend on staff there who shared my opinion. Whether there was pressure from Epic to update the press release or whether it was from the medical staff, it was the right thing to do.

Now I’d like to see their root cause analysis on why the history was not taken fully into account and whether the presence of scribes was contributory. I’d also like to know what kind of providers saw the patient and whether there were other circumstances at play, such as shift change, a full patient board, staff who called out sick, etc. Those factors have led to mistakes at my institution and they’re much harder to place solutions around than making sure the EHR fires alerts and that personal protective equipment and isolation rooms are readily available.

I’m curious as to what other institutions are doing to prepare themselves for a potential outbreak. Are you modifying your EHR workflows? Email me.

Email Dr. Jayne.

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October 6, 2014 Dr. Jayne No Comments

Morning Headlines 10/7/14

October 6, 2014 Headlines 1 Comment

BD to Acquire CareFusion for $12.2 Billion

Becton Dickinson will acquire smartpump manufacturer CareFusion for $12.2 billion in cash and stock. The deal comes out to $58 per share, a 28 percent premium on Friday’s closing price.

NantHealth Completes $320M Series B Equity Investment and Expands Leadership Team with Healthcare Industry Veterans

NantHealth, the health IT startup of healthcare billionaire Patrick Soon-Shiong, raises a $320 million Series B round to accelerate development of its EHR, which it claims will deliver “integrated, evidence-based, genomically-informed, personalized care.”

Can Telemonitoring Reduce Hospitalization and Cost of Care? A Health Plan’s Experience in Managing Patients with Heart Failure

A Geisinger report set to be published in the December issue of Population Health Magazine finds that telemonitoring programs targeting heart failure patients reduced overall hospitalization rates and led to a savings of $3.30 for each dollar spent.

Progress report: Open Test Method Development Pilot Program

The ONC publishes an update on its Open Test Method Development program, in which EHR certification testing standards for ePrescribing and clinical decision support features are being created through a community-led development process.

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October 6, 2014 Headlines 1 Comment

Morning Headlines 10/6/14

October 5, 2014 Headlines 3 Comments

Facebook plots first steps into healthcare

Reuters reports that Facebook is exploring health care solutions, including disease-specific online support groups, and Facebook connected digital health apps.

Hewlett-Packard Plans to Break in Two

The Wall Street Journal reports that HP will split into two separate companies, with an announcement expected Monday. The company will split its personal-computer and printer business away as one entity, and establish the other with its corporate hardware and services operations. 

Clarification from Texas Health Resources

Texas Health Resources retracts an earlier statement it made blaming its EHR (Epic) for allowing an Ebola patient to be discharged after an ED physician failed to notice that nurses had documented recent West African travel in the system.

Ebola dropped-ball diagnosis linked to hospitals’ IT culture

Athenahealth CEO Jonathan Bush jumps at the opportunity to mention that if the country ran its health IT platform on the cloud then time sensitive alerts, like warning of recent West African travel in patients with flu-like symptoms, could be built into physician workflows at a national level very quickly, rather than at each individual hospital. He says, “I hope soon that nobody will be on enterprise software and these things will be managed by people across thousands of hospitals."

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October 5, 2014 Headlines 3 Comments

Monday Morning Update 10/6/14

October 3, 2014 News 42 Comments

Top News

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A Reuters report says Facebook is working on healthcare tools that include chronic disease support communities and health apps. It adds that the company has been meeting with healthcare experts and entrepreneurs and is setting up a health app R&D unit. Mark Zuckerberg’s wife is a doctor, so maybe it will do more than just the usual privacy invading and ad serving. Meanwhile, the company apologizes that it performed mood manipulation experiments on unwitting users by tweaking their news feeds to show extra-cheery or extra-depressing items to see how they reacted.


Reader Comments

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From David: “Re: CMS Open Payments. ProPublica has downloaded the database and made it searchable as Dollars for Docs. They’ve also done a great job with Treatment Tracker, which breaks out Medicare payments to doctors.” It’s pretty funny (or sad if you’re a taxpayer) that the non-profit newsroom quickly whipped up a perfectly fine consumer-friendly version of the mess that CMS and its army of highly paid contractors created.

From WhoopsInVA: “Re: Anthem BCBS in Virginia. Forgot that ICD-10 wasn’t actually going live this month and are rejecting all incoming claims because of diagnosis. Our athena rep just emailed us about this.”

From The PACS Designer: “Re: new iPad Air and Mini. Apple will be holding its next event on October 16 for the new versions of its iPad Air and Mini devices. It will interesting to see the changes they are making with the its iOS 8 system installed.” Maybe it’s just me, but I’m losing interest in Apple’s overly dramatic announcements of incremental product tweaks. The fanboys still achieve mandatory technical arousal and obediently line up outside the Apple Store as they’ve always done (ironically resembling the Big Brother-obeying monochromatic drones from Apple’s famous “1984” commercial), but Apple is a lot less interesting without Steve Jobs. I’m pretty sure I’ll do the same in eventually replacing my phone as I did with my iPad: buy a more innovative product for a less money even though it won’t come with the self-congratulatory hipster delusions in hanging around the Apple store pretending to be artsy and cool.  


HIStalk Announcements and Requests

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Most readers say it’s not OK for an EHR vendor to deny a hospital or practice access to its patient information in a billing dispute. New poll to your right or here: What’s your reaction to HIMSS announcing President George W. Bush as a keynote speaker for HIMSS15?

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Here’s my opinion on Bush as a HIMSS keynote: he wasn’t interesting as President, so I don’t really care what he has to say now that he’s cashing in on his pitiful legacy (unless he’s announcing that he finally turned up those pesky WMDs.) The HIMSS strategery is probably to scratch his back in return for his industry-enriching 2004 declaration that every US citizen would have an electronic medical record by 2014, so perhaps he will strut out in a flight suit and yet again prematurely declare “Mission Accomplished.”

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We’re putting together our MGMA guide featuring sponsors of HIStalk, HIStalk Practice, and HIStalk Connect that will he exhibiting or will be available to meet with interested attendees. Contact Jenn by Monday evening if your company sponsors and hasn’t already provided information.  

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

  • The CMS Open Payments database goes live with inaccurate physician payments information and usability criticism.
  • CMS announces that it will miss its date to move Healthcare.gov’s hosting to HP, with its only option to leave it running on the previously problematic Verizon infrastructure through the open enrollment period.
  • UnitedHealth Group’s Optum division acquires MedSynergies, which offers physician practice billing and quality services.
  • Informatics pioneer Morris Collen, MD of Kaiser Permanente dies at 100 years old.
  • Experts warn health systems to test for the newly discovered Shellshock Unix vulnerability.
  • Epic CEO Judy Faulkner says in a rare interview that the company developed its own interoperability tools only when it became clear that the federal government wasn’t going to set clear standards.
  • Apple restores its HealthKit health data aggregation system and third-party apps that use it in an iOS 8 update.

People

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Spok names Hemant Goel (Siemens Health Services) as COO.

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Jim Dwyer (Santa Rosa Consulting) joins RCG Global Services as SVP and healthcare practice leader.


Government and Politics

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ONC loses another of its leadership team as Chief Nursing Officer Judy Murphy will resign to take the same position with IBM Healthcare Global Business Services. To quantify the turnover, I looked back at the ONC leaders who presented at HIMSS13: Farzad Mostashari (gone), Judy Murphy (gone), Doug Fridsma (gone), David Muntz (gone), Jacob Reider (still there), Jodi Daniel (still there), Lygeia Ricciardi (gone), Mat Kendall (gone), Joy Pritts (gone), and Kelly Cronin (still there).


Technology

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The FCC fines Marriott for blocking personal hot spots in its conference center to force attendees to buy its overpriced Wi-Fi services. Marriott issued a lame statement of protest, claiming that its actions were intended to protect guests from “rogue wireless hot spots” (at a larcenous price, of course) and blaming the FCC for “ongoing confusion.” The FCC took action after a Gaylord Opryland attendee claimed the hotel was “jamming mobile hot spots so that you can’t use them in the convention space.” Let’s see how this plays out at the HIMSS conference. Since my ATT wireless plan includes free tethering and 10GB of data transfer, I don’t even bother with airport Wi-Fi any more and I will quickly switch to my hotspot in a hotel if their Internet service is poor or expensive (or, as is often the case, both). Rumors abound that convention centers play games with cellular and Wi-Fi coverage in the exhibit hall to force exhibitors to buy their expensive network access.


Other

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This is bizarre. Texas Health Presbyterian Hospital (part of Texas Health Resources) initially said it discharged Ebola patient Thomas Duncan from its ED because of an EHR setup problem, explaining in considerable detail that the patient’s travel history was located only in the nursing workflow part of Epic where the physician didn’t see it. News media were all over that statement, leading THR to issue a a hurried retraction at 9 p.m. local time Friday evening saying it was correcting the previous day’s release and the EHR was fine after all. My speculation is that Epic complained vigorously about being thrown under the bus (but not by name) and threatened legal action, forcing THR to claim that its detailed, carefully explained statement was incorrect. My biggest concern – could the doctor have been so robotized by the EHR that he or she slipped on critical thinking? EHR or not, the patient sitting right there in front of you is telling you a story that you’d better listen to. What about the nurse, who had just been told by a patient with fever that he’d just come from Liberia? That information would seem to suggest a higher level of response than just dutifully entering the information in Epic and moving on. Computers sometimes fail, but not nearly as often as people. At least THR’s problem raised an industry red flag that had clinicians and programmers all over the country working this weekend to evaluate their processes and systems to make sure it doesn’t happen to them.

Update: a reader’s comment about the use of scribes sent me Googling and it turns out that Texas Health Presbyterian Hospital Dallas uses scribes in its ED. It would be interesting to know whether scribes were involved in this instance.

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Meanwhile, a poorly and smugly written piece in The Atlantic declares that, “The Ebola Patient Was Sent Home Because of Bad Software.” The author collected all of her inexpert healthcare IT opinions into one unfocused article, proclaiming the “atrociousness” of many EHRs and their “gaping loopholes,” complaining that the hospital was blaming “the robots,” opining that “a flawed EHR might have lead to the spread of an incurable virus,” and then veering off into a rant about interoperability, which has zero to do with anything. Author credentials are fair game if you’re going to editorialize, so let’s check hers: an intern until 2010, moved down from global editor to staff writer after 10 months in the higher position, wrote about home design and architecture, and listed her most recent accomplishment on LinkedIn as, “Talk about beards on the radio.” Nothing makes me angrier than people who’ve never spent a day working in either IT or healthcare blasting out their entirely unqualified opinions in passing themselves off as authoritative. The Atlantic should be ashamed for letting this dreck hit the airwaves just to get something reactionary up quickly. HIStalk Reader Tom called her piece “more than ridiculous,” observing that “highly configurable EMR software was used to ensure a medical mistake in clinician workflow never happens again.”

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Athenahealth’s Jonathan Bush, using his limelight-seeking power to ride the Ebola story in touting his company at Epic’s expense (while claiming he’s not) from his second home on the set of CNBC, trots out his stump speech to easily charmed reporters about “pre-Internet software” with no “network effect,” wrapping up with his company commercial in saying, “I hope soon that nobody will be on enterprise software and these things will be managed by people across thousands of hospitals.” He omitted the obvious rest of the sentence, “ … and instead will be running the sort-of cloud system and offshore-powered mailroom I sell that allows ATHN shares to trade at 1,220 times earnings.”

The government of India announces plans to make e-prescribing mandatory for all doctors to reduce corruption and inefficiency.

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Attorneys consider a plea deal for a third-year medical student who is accused of stealing a breast cancer patient’s iPad during a Code Blue in which the patient died at UCLA Medical Center. The patient’s family is most upset by the fact that the student allegedly wiped off the patient’s information before re-registering it to herself, depriving them of the chance to see the thoughts the patient had left for them.

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A 38-year-old Russian billionaire bank founder releases plans for “the world’s most pleasant hospital” that he will erect in the Dubai-inspired, purpose-built Tunisian Economic City. The hospital will sit on a man-made lake, look like a cruise ship, and require employees to dress (but not swear) like sailors.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 3, 2014 News 42 Comments

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