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Morning Headlines 12/7/15

December 6, 2015 Headlines No Comments

Seattle-Based Group Health To Be Acquired By The Larger Kaiser Permanente

Kaiser Permanente will acquire Seattle-based insurer and provider Group Health Cooperative for $1.8 billion upfront, plus an additional $1 billion paid out over the next several years.

Fit as fiddles

The Economist reports on the US health insurance industry in the post-ACA marketplace, noting that all five major insurers have seen triple-digit stock price growth since the law was passed.

California Attorney General grants conditional approval for Daughters of Charity hospital deal

BlueMountain Capital Management, a New York City-based hedge fund, gets approval to invest in nonprofit Daughters of Charity Health System.

Indegene Further Strengthens Presence in U.S. Healthcare Analytics Market Acquiring SmartCare Population Health Analytics Platform

India-based Indegene Lifesystems acquires population health analytics platform SmartCare from Vantage Point. Financial terms of the deal were not disclosed.

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December 6, 2015 Headlines No Comments

Monday Morning Update 12/7/15

December 5, 2015 News 11 Comments

Top News

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Kaiser Permanente will acquire Group Health Cooperative, a Seattle-based provider and insurer with 600,000 members and annual revenues of $3.5 billion. Kaiser will pay $1.8 billion upfront and says it will spend another $1 billion over the next several years in creating its Washington Region. The 70-year-old Group Health offers innovative member technologies, but has struggled with budget cuts and layoffs for several years.


Reader Comments

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From Billy Gladstone: “Re: HIMSS. You pulled their self description from their latest press release. What happened to it being a “mission-driven not-for-profit?” This announcement contained more ambitious wording that aggressively pitches its data services. The latest Form 990 I could find for HIMSS was for FY2013, in which it reported a loss of $2.6 million on revenue of $82 million, of which $30 million came from the annual conference, $16 million from publishing and conferences, and $10 million from membership dues. It paid some big salaries for an organization of that size, many multiples of what a tiny hospital with $82 million in revenue would pay its executives.

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HIMSS paid consultant Jack Beaudoin, formerly of HIMSS Media: $567,000. It also paid $1.4 million to Armin Scheuer Consulting, which I assume is related to its 2011 acquisition of his former company, Berlin-based So2say Communications. It reported $250,000 in lobbying expenses. HIMSS finished its acquisition of MedTech Publishing in 2013 and made it a disregarded entity to protect its own tax-exempt status, with the renamed HIMSS Media bringing in $14.4 million.

From Not From Me: “Re: Charles Sorenson, CEO of Intermountain Healthcare. Will step down as CEO effective fall 2016.” Unverified.

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From RegularReader: “Re: Daughters of Charity in California. Gets AG approval to sell itself to a for-profit company.” A hedge fund will be allowed to invest in the struggling non-profit health system with the option to buy it outright after three years in the largest non-profit hospital transaction in California history. The hedge fund names its management company Integrity Healthcare without apparent intentional irony (although the “charity” part of the name would be equally ironic under its involvement). Looking on the bright side, yet another example of unapologetic, bare-knuckles profit-seeking on the backs of sick people just might — as in the case of Martin Shkreli’s Turing Pharmaceuticals — force the country to realize what a mess it made of its healthcare system starting in the mid-1960s and where that’s left us 50 years later.

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From Sunquester: “Re: new Sunquest offices. I’m really looking forward to the new office. During the dark days of being private equity owned, little was done for employees.” I agree – other than an extended commute for some employees, it’s nice to get a fresh workspace with a view. Google Earth shows the new building in the foothills of some 8,000-foot Tucson mountains near many plush resorts and restaurants, which should upgrade the lunch options quite a bit. I’ve inhabited everything from a windowless hospital basement to a private office with a beautiful lake view, and while you quickly lose awareness of your surroundings through familiarity, it does indeed give you a sense of your value to your employer and their priorities. My one non-hospital job was working for a vendor whose ever-deepening financial distress was caused by ever-deepening management incompetence. Maintenance to our beat-up old office building was always being deferred until future good times that never came. Our salvage yard-quality cubicles were constantly being reconfigured to support the latest executive emissions that dribbled down from their top-floor, mahogany-walled bunker. The director of my area decided that we would all become energized by staying after work on our own time (it was mandatory) to paint the interior walls of our floor, complete with the jaunty stripes that he envisioned as being reflective of our newfound swagger and inevitable success. The company provided the paint and a terrible fried chicken dinner that — not surprisingly given our executive track record of cluelessness and questionable allocation of resources — was ordered in insufficient quantity to feed the people who gave up hours of their free time to perform menial labor, suffer through faux camaraderie, and elbow each other aside in a vulture-like attempt to snag a chunk of poultry carcass before it ran out (which was probably an apt metaphor for what it was like working there – those in the back of the line who found the chicken bowls empty heatedly accused those who preceded them of taking extra pieces). One week later, the company conducted its next round of layoffs and reorganizations, leading one of the managers who was fired and forcibly marched out of the building to declare bitterly afterward, “The worst part is that I wish I hadn’t painted those damned walls.”


HIStalk Announcements and Requests

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Ninety percent of poll respondents will get their medical insurance through their job or via family coverage, with just five percent buying it directly from insurance companies or Healthcare.gov. Mak says he had to postpone retirement for a year because individual health insurance is now so expensive, adding, “Like all massive government programs, the cost is astronomical when compared to the number of individuals benefitting.” Lgro’s employer doesn’t offer a group plan, so he’s paying $14,000 for family insurance whose coverage doesn’t kick in until he has spent $8,000, doubling what he paid in his previous job that offered insurance. Jeff says Obamacare isn’t perfect but at least he can get family insurance from Healthcare.gov until a better option becomes available.

New poll to your right or here: what role does your job play in your existence? Vote and then click the poll’s Comments link to explain since I’m really interested in how people view their work as part of their overall lives.

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Speaking of work and life, a friend who has barely survived repeated, horrific bouts of cancer was telling me that she plans to keep working at her health IT vendor employer because she’s worried that the large company can’t replace her even though her remaining lifetime will probably be short. That’s the saddest thing I’ve heard lately — expressing unconditional employer devotion under the misguided belief that such fealty is mutual and not recognizing that “irreplaceable employee” is an oxymoron regardless of your org chart altitude. You might be surprised at how quickly you are forgotten and how little difference your absence makes if strategies change, money gets tight, or you run afoul of someone who outranks you. I’ve never mistaken a paid job for a loving, supportive relationship and I hope others don’t – life is too short to place your entire identity and sense of well-being in the hands of a company (for-profit or otherwise) that is by definition incapable of returning the favor. Tombstones don’t contain job titles and hearses don’t pull U-Hauls full of meaningless company awards and unspent retirement funds. I recall the answer Ivo Nelson gave me in a 2009 interview when I asked him why he was starting another company (Encore Health Resources) when he was already immeasurably wealthy from selling Healthlink to IBM:

This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy. You say, "What kind of legacy would I want to leave?" and it would be a legacy that’s more related to being a good father to my children and being a good husband to my wife. That kind of stuff. Not anything I do professionally.

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I’m thinking about hiring someone part time to critically review journal articles related to health IT. Ideally it would be an informatics grad student with a clinical background, access to an online medical library, and the ability to critique research methods and conclusions for a general audience. Email me.


HIStalkapalooza

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People are already emailing me about the February 29 event. Here’s what is happening.

  • “I want to come” signups will start very soon for HIStalk sponsors, then for everyone in early January.
  • We won’t be able to accept new event sponsors after next week because we need to move our focus to planning.
  • I am still looking for a single “rock star CEO” sponsor who wants a significant HIStalkapalooza presence and involvement with private space, bar, and food to entertain 100 people or so.

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Have you ever dreamed of playing your music on a big music hall stage in front of a bunch of cheering people screaming “Free Bird?” We’re exploring the idea of starting HIStalkapalooza early with music provided by volunteer health IT people who also have a significant musical history. Send Lorre a link to your video or audio and tell me what you would play on stage if chosen. You’ll have to bring any instruments you need unless we can work something out with HOB or the band. I remember years ago at HIMSS when the opening session started with a really good band that turned out to be Dave Garets, Jonathan Teich, and some other industry folks who had at one time paid the bills as musicians.

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One last item: HISsies nominations are open. Nominate your choices and I’ll put the most-nominated ones on the final ballot that will be emailed to HIStalk subscribers in a couple of weeks. It’s like the presidential primary: vote now or don’t complain about the choices made by more responsible voters. I’ve added a new item just for fun, “Industry figure you’d most like to see on stage at HIStalkapalooza,” figuring maybe I can get someone famous if they know readers want to see them there.


Last Week’s Most Interesting News

  • Welltok acquires Silverlink to expand its patient engagement capabilities.
  • Private equity investor and former Vitalize Consulting Solutions Chairman and CEO Bruce Cerullo joins Nordic Consulting as chairman and CEO.
  • MIT Hacking Medicine announces that it will publish reviews of digital health tools.
  • The Health IT Policy Committee’s API Security Task Force holds its first meeting.
  • NantHealth postpones its planned IPO because of unfavorable market conditions.

Webinars

December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.

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

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of innovation lab and VP of clinical development and informatics for clinical software solutions, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

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


Acquisitions, Funding, Business, and Stock

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India-based Indegene Lifesystems announces the acquisition that I mentioned was imminent last week, the SmartCare population health analytics platform from Vantage Point.

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The Economist observes that despite the competition that the Affordable Care Act was supposed to create, America’s five biggest health insurers have seen their share prices triple in the past five years and all are making huge profits that are still trending upward after ACA’s implementation. They’re being helped by the federal government, which is handing off Medicare and Medicaid healthcare to insurance companies. The article concludes, “The vast expense and unintelligible complexity of American healthcare may be a national disgrace, but they are a huge opportunity for firms that can navigate the system and minimize costs.” I graphed the five-year share performance of Cigna (blue, up 273 percent), Humana (red, up 202 percent), Aetna (teal, up 244 percent), Anthem (pink, up 130 percent), and UnitedHealth Group (purple, up 221 percent) vs. the S&P 500 (blue, up 68 percent). Don’t bet against statistical experts.

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Lee Equity Partners sells PDR Network to Genstar Capital. PDR Network was formed from Physician’s Desk Reference, Healthcare Notification Network, and LDM Group in moving the print-based publication to a digital business.


People

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Premier, Inc. names David Vorhoff (Deloitte Corporate Finance) as SVP of corporate development and strategy.

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Ingenious Med names David Lamm (United Allergy Services) as CFO.

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Southeastern Health (NC) names consultant Steve Milston as CIO.


Announcements and Implementations

The American College of Cardiology, Geisinger Health System, and xG Health Solutions will develop software based on ACC’s guidelines and Geisinger’s methodology.

Allscripts and TeleTracking will integrate their products and sell each other’s offerings.


Privacy and Security

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@CandidCIO found a fascinating security breach buried in the SEC filings of wireless networking vendor Ubiquiti Networks. The company discovered a phishing attack in June 2015 in which $47 million of its money had been transferred to the overseas accounts of scammers. Its ever-vigilant auditors concluded after the fact that, “the Company’s internal control over financial reporting is ineffective due to one or more material weaknesses.”

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University of Rochester Medical Center will pay $15,000 to settle HIPAA charges after it gave one of its nurse practitioners a worksheet containing the names, address, and diagnoses of the 3,400 patients she had treated there. She gave the worksheet to Greater Rochester Neurology, at which she had accepted a new job, who mailed the patients letters announcing that the NP was joining them. URMC received patient complaints about the letters and fired the nurse practitioner.


Technology

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I use Bitdefender and received an email pitching its Bitdefender Box, a router-attached, smartphone-controlled security appliance that protects every device that’s connected to a home network in what the company calls the “Security of Things.” It costs $199 upfront and then $99 per year for updates, which is a pretty good deal since it theoretically replaces a houseful of individual antivirus and firewall subscriptions. It works on Windows, Apple, and Android devices and also provides a personal VPN service to extend its security to wherever a mobile device is being used. I won’t buy it just yet until they get the bugs worked out, but I think this is the future of malware protection. It might be something hospitals make available to employees or doctors that work offsite or on personal mobile devices since they are often the network’s weak link. 


Other

Cerner and several Kansas City groups are sponsoring programming events for 400 female students this week, hoping to change their perceptions of technology careers. Two of the six locations are Cerner campuses. I hadn’t heard of the non-profit Hour of Code, but it’s pretty cool: anyone can organize an event and 150 million students worldwide have participated as the organization strives to improve diversity in computer science.

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A Wells Fargo Securities report titled “Does Epic Own the Future?” finds that while the average physician EHR user is 49 years old, Epic’s user base is a little bit younger (by a year or so) and Practice Fusion has the highest average age of 51.7. The report theorizes that recent graduates are increasingly going to work for big, Epic-using health systems, while Practice Fusion’s free EHR attracts older doctors who don’t want to spend money or effort on an EHR close to their retirement. I don’t disagree with the theories, but the age spread isn’t enough to get too excited about, I doubt it signals anything important, and it doesn’t distinguish between inpatient and ambulatory use or physicians who are forced to use multiple systems. Slightly interesting is the statement that Epic has more than a 25 percent market share among new graduates vs. all of its competitors that are bunched up at between two and 10 percent.

The EDs of Cleveland’s hospitals will phase out ambulance diversions, which should be interesting presuming they occasionally had valid reasons for not taking new ambulance patients in the first place.

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Flooding in the technology hub of Chennai, India causes its premiere, 1,000-bed hospital to lose power and life support systems, killing at least 18 inpatients in a Hurricane Katrina-type situation. Caregivers kept some patients alive by ambu bagging them for up to 48 hours. All communications were down and roads to the hospital were submerged under six feet of water.

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This is fun: world traveler and Dell CMO Nick van Terheyden, MD tweets from Dubai that the United Arab Emirates government has blocked Internet access to HIStalk.

A Harvard Business Review article by Frederick Cerise, MD, MPH, CEO of Parkland Health and Hospital Systems (TX) says large, publicly supported safety net health systems like Parkland have an advantage because they are driven by community needs and give clinicians a greater voice in decision-making. He says Parkland has been operating like an ACO since 1989, receives 36 percent of its budget as a county allocation rather than for billing more services, and can resist the financial temptation to offer high-paying but questionably beneficial services. He mentions that the hospital’s tele-dermatology service loses money since half of its patients are uninsured, but it still offers an efficient way to deliver services.


Sponsor Updates

  • HealthLoop publishes “5 Things You Need to Know About CMS’s First-Ever Mandatory Bundled Payment Program.”
  • TierPoint will host an open house December 10 in Marlborough, MA.
  • Visage Imaging debuts several products and enhancements at RSNA 2015.
  • VitalHealth Software and Zynx Health will exhibit at the IHI National Forum on Quality in Healthcare December 6-9 in Orlando.
  • Voalte releases a new case study, “How Avera McKennan Achieved Efficient Caregiver Communication with Voalte Platform.”

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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December 5, 2015 News 11 Comments

Morning Headlines 12/4/15

December 4, 2015 Headlines No Comments

Welltok Acquires Silverlink to Enable Multi-Channel, Targeted Engagement

Welltok raises a $45 million funding round and acquires Siverlink, a consumer engagement vendor.

UK Ministry of Defence selects CGI to provide integrated electronic health record information service

In England, the Ministry of Defence contracts with CGI to implement the EMIS EHR across its 400 medical facilities.

The Growing Gap in Electronic Medical Record Satisfaction Between Clinicians and Information Technology Professionals

The Journal of Bone & Joint Surgery presents survey data highlighting the gap in EHR satisfaction scores between clinicians and hospital IT professionals.

Community Health Systems and American Well Collaborate on Telemedicine Initiative

Community Health Systems contracts with American Well to begin offering telehealth visits to residents served by its 198-hospital, 29-state area of operations.

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December 4, 2015 Headlines No Comments

News 12/4/15

December 3, 2015 News 1 Comment

Top News

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Patient engagement technology vendor Welltok acquires consumer communications company Silverlink, also announcing $45 million in new funding to support a portion of the acquisition.


Reader Comments

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From Sport Pepper CMIO: “Re: EHRs. This is an interesting article which highlights what many of us know already.” The article in The Journal of Bone & Joint Survey looks at the post-implementation gap in EHR satisfaction, where IT people and administrators are happy but clinicians aren’t. That’s not too surprising since those non-clinicians have the most influence on which systems are chosen and how they are implemented. The article hints and what I’ve always claimed – it’s not so much that clinicians hate the concept of EHRs, they realize that both internal and external non-clinicians employ them as a blunt instrument (sometimes with the best of intentions, at least based on their own agendas) to create and enforce new rules that deliver minimal patient value. Few people enjoy using technologies intended to control their behavior – that would be like a prisoner loving their ankle monitor.

From Zealous Zygote: “Re: news. I always get what I need from your site. As an educator, I also note that it is presented so I remember it well.” That’s my goal. I use these methods to hopefully make myself and everybody who reads what I write a little bit smarter about healthcare IT:

  • I choose only newsworthy stories that provide reader value. Curation takes probably 80 percent of the time I spend on each post as I wade through the mountains of poorly communicated junk. Unlike other sites, I have no fixed space to fill and I’m not paid per word, so I have no incentive to pad out a one-sentence story into 12 paragraphs that waste reader time.
  • I summarize each item as succinctly as possible and make it as highly readable as I can.
  • I add context where it provides value, whether that be a back story or my own opinion.
  • I use illustrations when they make sense (no stock photos, in other words).
  • I provide a link to a source when possible for those who want to read more.
  • I provide a cynical, sometimes sarcastic point of view that doesn’t otherwise get much airplay in the fizzy, self-congratulatory world of health IT.

From Beeper King: “Re: smartphone app for secure communications. We tried one vendor’s solution. The big issue was that you couldn’t shut the thing up when you were with a patient by pushing a button in your pocket like you do with a beeper — you had to take out the phone, open the app, and engage with it. Then you lost the reminder for later. Also, there was no way to turn on or off your call status or transfer to another within the app itself. You had to call a paging company number, follow a phone tree of commands, and, if you were transferring call to someone else, to remember their damned number. The hospitalists rejected the thing out of hand.” It sounds as though it was designed by technologists rather than clinicians. 


HIStalk Announcements and Requests

I received generous donations for my DonorsChoose project from Carla, Mike, Chris, and an anonymous reader totaling $1,650, to which I applied matching funds from both my anonymous vendor executive as well as private foundations to fund this rather amazing list of teacher grant requests in their entirety:

  • Math manipulatives for Ms. Brown’s elementary school special education resource room in Harper Woods, MI
  • A Chromebook and accessories for math instruction for Mrs. Shaw’s fourth grade class in Philadelphia, PA
  • Two Amazon Fire tablets for math and science self-study for Ms. Lacey’s elementary school class in Houston, TX
  • Five tablets for Mrs. Chavis-Ramirez’s elementary school science class in Houston, TX
  • An iPad Mini and programmable robot to create a Kids Coding Club for Ms. Carbo’s first grade class in Atlanta, GA
  • A STEM early learning kit for Mrs. Almiron’s kindergarten class in Port St. Lucie, FL
  • Four tablets and cases for math and science learning centers for the special education class (Down syndrome, cerebral palsy, traumatic brain injury, etc.) of Ms. Munoz’s Grades 5-6 in Pasadena, TX
  • Five animation software and hardware kits to produce science movies in Ms. S’s elementary school class in Houston, TX
  • A 3D printer for the high school science class of Mr. Swedman in Keaau, HI
  • An anatomy model and learning kits for Ms. Wilson’s special needs class in Richmond, VA
  • Two Chromebooks for targeted math study in Mr. Colasacco’s sixth grade class in Brooklyn, NY
  • A programmable robot to create a makerspace in the school library and a learning club by Mr. Lincheck’s elementary school in Houston, TX
  • Two tablet keyboards for Mrs. C’s elementary school class in Houston, TX
  • Two Chromebooks for the high school physics class of Mr. Lewis in Houston, TX
  • 20 sets of headphones for the elementary school inclusion class of Mrs. Ortego in Lake Charles, LA
  • Seven sets of headphones and cables for computer learning in Mrs. Allen’s learning disabled class in Heath Springs, SC
  • Microbiology lab equipment for the four full (and waitlisted) classes of the first microbiology course ever offered by Ms. Westover’s high school in Norcross, GA
  • A science library for the elementary school class of Ms. B in San Bernardino, CA
  • 40 portfolio binders for the gifted class of Mrs. Perez in St. Petersburg, FL
  • A STEM bundle for the elementary school class of Mrs. Huynh in Houston, TX

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Mrs. Kay from Wisconsin (near Epic, in fact) says that she and her elementary schoolers “love our Samsung tablet” that we provided via DonorsChoose that allows them to check out public library books electronically, some of which include audio files so the students can follow along. She says they use the tablet every day in reading block, adding, “I have truly seen a deeper love of reading from many of these students who we might think of as reluctant readers.”

The best reason to buy travel insurance for non-domestic trips is medical evacuation coverage that will pay to fly you back to a US hospital if you experience a medical catastrophe in a location with limited medical resources. I was thinking that someone should offer a US-only plan that will evacuate people with narrow-network insurance from the 99 percent of the country their policies don’t cover back to their home location to avoid otherwise likely financial ruin. An analysis finds that many 2016 plans do not have a maximum cap for out-of-network expenses they don’t cover, meaning a heart attack in another state is the patient’s financial responsibility at full list price. Of this I have zero doubt: medical bankruptcies are going to balloon in 2016 and many of the folks involved will be middle-class people with insurance they purchased through Healthcare.gov thinking it would protect their family just like employer-provide plans. The uproar will commence just in time to be a hotly debated topic in the 2016 presidential election. The only hope — and it’s a slight one — is that next year’s ACA enrollment will grow to reflect a more typical customer pool, i.e. healthy people will sign up and help pay for the unhealthy ones who quickly jumped on board last year.

This week on HIStalk Practice: Arizona’s Practice Transformation Institute leverages HIE capabilities. A physician’s propensity for EHR eye lock boils down to gender. Dr. Gregg gives thanks for HIT. Blue Cross and Blue Shield of Alabama begins covering telemedicine visits. Family physicians have trouble seeing the ROI of value-based payments. Two Point expands data-conversion services to providers. Physician awareness of prescription drug monitoring programs is surprisingly low. CVS Health EVP Andrew Sussman, MD discusses the company’s partnership with Epic and Health is Primary, plus plans for telemedicine.

This week on HIStalk Connect: Welltok raises $45 million in new funding and announces the acquisition of patient engagement vendor Silverlink for an undisclosed sum. GOQii raises a $13 million Series A to ramp up its personal wellness coach and activity tracker platform. Propeller Health signs a new R&D agreement with GSK to develop medication utilization sensors for its Ellipta dry-powder inhaler. Scripps Translational Science Institute will recruit 6,100 volunteers to wear a heart rate monitor for four months as part of a study designed to improve atrial fibrillation diagnosis in high-risk populations.


Webinars

December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.

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

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenter: Stephen Claypool, MD, medical director of innovation lab and VP of clinical development and informatics for clinical software solutions, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

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

Here’s the recording of Wednesday’s VMware-sponsored webinar, “The Patient Is In, But the Doctor is Out: How Metro Health Enabled Information Decision-Making with Remote Access to PHI” by Josh Wilda, VP of IT at Metro Health (MI).


Acquisitions, Funding, Business, and Stock

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A Washington Post investigation finds that the Department of Defense questioned the lab technology of Theranos in 2012, passing on its fingerstick methods. CEO Elizabeth Holmes asked four-star Marine General James Mattis, who later joined the company’s board, to dispel the DoD’s “blatantly false information.” Mattis pushed hard to have Theranos tested in Afghanistan, drawing a Marine Corps caution that he needed to stop personally pitching the company.

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Seamless Medical Systems, which offers a mobile device check-in app for medical practices, closes a $2.5 million investment.


Sales

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Baystate Health (MA) chooses Imprivata Cortext for secure communications.

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Community Health Systems will offer $39 virtual doctor visits to patients in the communities where its 198 hospitals are located. It will use American Well’s telehealth platform.

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Broward Health (FL) chooses Cerner HealtheIntent for population health management.

The UK Defence Medical Services chooses CGI to provide an integrated EHR for its 400 sites, which will be based on the PCS system from EMIS Health. CGI will host the system and manage its help desk.

For-profit Manipal Hospitals (India) chooses IBM’s Watson for Oncology for its 15 hospitals.


People

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MedSys Group names P.J. deRijke (Warbird Consulting Partners) as VP of client relations.

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Fairfield Medical Center (OH) names Alan Greenslade (Greenslade Consulting) as CIO.

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Hal Wolf (McKinsey & Company) joins The Chartis Group as director.

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Private equity investor Bruce Cerullo, formerly chairman and CEO of Vitalize Consulting Solutions that was sold to SAIC/Leidos in 2011, joins Nordic Consulting as chairman and CEO. He replaces Mark Bakken, who left the company in March 2014 to start an early stage venture capital fund.


Announcements and Implementations

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Catalyze announces Redpoint, a set of EHR integration tools for digital health vendors that includes pre-configured scripts, EHR connectivity tools, and workflow components.

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Health station vendor Higi will use Validic’s digital health platform to capture real-time consumer biometric information as part of its patient monitoring and wellness programs. Chicago-based Higi was founded by Chicago Sun-Times Founder Michael Ferro of Merrick Ventures,former chairman of Merge Healthcare. He’s credited with saving Merge in 2008, with the company’s $1 billion acquisition by IBM putting around $200 million in his pocket in return for his $15 million investment. 

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Quality improvement, cost containment, and clinical content technology vendor LogicStream Health graduates from the accelerator program of TreeHouse Health, the first of its portfolio companies to achieve all transition milestones. The Minneapolis-based company was co-founded by a pharmacist and a physician and counts Texas Health Resources among its customers. 

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HIMSS announces its Value Score measure of the value of healthcare IT, which I assume it will sell since the announcement didn’t indicate otherwise and its self description seems ambitious (although one might quibble at the inconsistent use of the essential Oxford comma in the announcement’s first sentence and spelling KPIs as KPI’s in the accompanying graphic):

HIMSS is a global voice, advisor and thought leader of health transformation through health IT with a unique breadth and depth of expertise and capabilities to improve the quality, safety, and efficiency of health, healthcare and care outcomes. HIMSS designs and leverages key data assets, predictive models and tools to advise global leaders, stakeholders and influencers of best practices in health IT, so they have the right information at the point of decision.

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Zynx Health announces integration between its ZynxOrder evidence-based order set development system and Epic inpatient.


Government and Politics

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CMS analysis finds that US healthcare spending jumped 5.3 percent in 2014 after years of low growth, which it says is primarily due to expanded coverage under the Affordable Care Act and increased drug spending. The $3 trillion in annual expense represents 17.5 percent of GDP and $9,523 per person. The increased rate of growth is still less than before the Affordable Care Act, which the White House touts as evidence that ACA is insuring more Americans without large cost growth increases. Critics point out that the modest spending increase may be masked by insured Americans who are being forced to pay ever-higher deductibles or who avoid seeking care they can’t afford even with insurance. Somehow hospitals evaded being named as being significantly responsible for higher healthcare costs. I maintain that if you want to see who is most responsible for high US healthcare costs, follow the money and check the 1040 tax forms of the individuals involved – you’ll see a lot of drug company executives, hospital administrators, high-powered surgeons, insurance company suits, and healthcare vendor executives who became millionaires (even in working for a supposedly non-profit organization) from the mess that is our healthcare system.


Privacy and Security

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Centegra Health System (IL) exposes the information of 3,000 patients when the mailing equipment of contractor MedAssets was misconfigured to send two statements per envelope instead of one, with each patient receiving their own statement plus one from another patient.

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Cottage Health System (CA) notifies 11,000 patients that an incorrectly configured server exposed their records to Google searches at the end of October. The problem was discovered by a cybersecurity firm hired to perform a security audit, which I suppose means the engagement’s ROI was substantial. Or maybe not – the cost of the breach response and any resulting fines or lawsuit awards might be the same regardless of who found the problem or whether it actually exposed any information.


Technology

MIT non-profit spinoff institute MIT Hacking Medicine will publish in the next few weeks a “best apps” list and consumer reviews of digital health tools. It says expert reviews are important because most apps have few downloads and reviews and don’t use good design practices. The institute’s co-directors are students: Tatyana Gubin is studying mechanical engineering at MIT with a focus on medical devices, while Christopher Lee is a Harvard-MIT PhD student and co-founder of a company that developed a disposable drug reconstitution system.


Other

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Several patient advocacy groups launch Partners for Better Care, which seeks manageable out-of-pocket costs, cost transparency, adequate provider networks, reasonable healthcare costs, and equitable access to drug therapies. That last item justifiably raises a red flag given that the group’s initial funding came from drug maker Novo Nordisk, which took heat for jacking up the price of its Levemir insulin almost exactly in tandem with that of competitor Lantus to over $300 per vial, leading to questions about whether the brand name drug marketplace is really competitive. Shareholders of  Denmark-based Novo Nordisk probably like Levemir’s pricing a lot more than the patients who use  it – the company’s stock is up 22 percent in the past year and 161 percent in the last five, giving the company a market value of $145 billion. I couldn’t find a listing of the officers or board members for Partners for Better Care except that the announcement referenced without detail its executive director, Mary Richards, who I assume isn’t the WJM Minneapolis beret-tossing one.

Turing Pharmacecuticals CEO Martin Shkreli says he was wrong to increase the price of old but critical drug Daraprim by 5,000 percent – he wishes he had increased the price even more. He says, “Our shareholders expect us to make as much money as possible … the idea that pharmaceuticals are exempt from capitalism is insane.” As I’ve said, Shkreli is a saint in finally showing the true colors of drug companies as cartoonishly evil villains rather than the dulcet-toned suits who pretend to exude concern for patients rather than profits. Their indefensible prices, especially here in the US, speak for themselves.

BIDMC CIO John Halamka, MD concludes in his year-end review that “ICD-10 benefited no one” and expresses his hope that the industry moves to bundled payments so that ICD won’t be needed for billing, replaced for analytics purposes by natural language processing translation of unstructured text into SNOMED-CT codes. He’s optimistic about 2016, as he indicated in my interview with him a couple of weeks ago, now that the “weights around our ankles (ICD-10, MU) are finally coming off.”

Weird News Andy would have headlined this story as, “I bet you’re stupid.” A man in China desperate to raise rent money takes a $1,200 bet that he wouldn’t swallow a five-inch saw blade and a five-inch nail. The good news is that he won the bet, but the bad news is that the evacuation of the hardware occurred surgically rather than naturally, with the medical costs exceeding his winnings.


Sponsor Updates

  • Sixteen Influence Health clients receive eHealth Leadership Awards.
  • Valence Health publishes “Helping Solve the US Healthcare Crisis: The Provider’s Guide to Building a Successful Plan.” The 292-page electronic book is available on their site or on Amazon.
  • An InterSystems survey of lab professionals in Australia finds that laboratory information systems aren’t equipped to deliver the desired cost savings and efficiencies.
  • LiveProcess exhibits at the National Healthcare Coalition Preparedness Conference through December 4 in San Diego.
  • Oneview Healthcare launches an internship competition. 
  • LogicStream Health is exhibiting at the IHI National Forum in Orlando, FL next week.
  • Pediatric Associates of Dallas reduces billing costs after implementing the PatientPay paperless payment solution.
  • Former L&D nurse and clinical analyst Darcy Dinneny discusses her experience with PeriGen’s PeriCalm solution.
  • Qpid Health will exhibit at the IHI National Forum on Quality Improvement in Health Care December 6-9 in Orlando.
  • Streamline Health will exhibit at the HIMSS Revenue Cycle Solutions Summit December 7-8 in Atlanta.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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December 3, 2015 News 1 Comment

EPtalk by Dr. Jayne 12/3/15

December 3, 2015 Dr. Jayne 1 Comment

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I engaged this week in what might become my favorite annual holiday event – crashing the medical staff Christmas party at a hospital where I’m not on staff. My good friend Anjali called, again asking me to be her rent-a-date. Last year her husband had to travel, but this year he’s apparently studying for final exams for his master’s program. I think it sounded like a convenient excuse to avoid being around doctors talking shop, but was happy to go with her again even though last year’s party had more EHR discussions than social time. Now that I’m freelance, it doesn’t hurt to network when I can.

Last year there were some, shall we say, “senior” physicians wearing some rather loud plaid jackets. I almost died laughing when I saw that some of the more junior physicians had taken the trend to an ironic new level, sporting so-called “Ugly Christmas Sweater” suits. The first gentleman was wearing the blue and red number above with a pair of white patent leather shoes. I tried to get a photo, but with the dim lighting, it was impossible and I didn’t want to be too conspicuous with my flash. Several of his companions had similarly awful ties and cummerbunds and I can’t help but think that this is going to be a new trend and I’d better secure my invite for next year’s party early.

I ran into a couple of old friends who recently moved from my previous employer to this hospital’s medical group. It was somewhat gratifying to hear that they found the grass wasn’t really any greener in their new positions and that they find their new EHR just as awful as the one I used to be responsible for. Given some of the major shifts going on with value-based care and new reimbursement models, it will be interesting to see if physicians begin shifting alliances or if we start to see even more consolidation among the employed physician ranks.

My other excitement this week was the quarterly provider meeting at my practice. Because of travel conflicts, it’s the first one I’ve attended. Given some of the news that was announced, I was glad to be there in person so I could see my colleagues’ faces. Effective immediately, we are opting out of the Meaningful Use incentive program. There was actually applause and a couple of high-fives. This weekend the EHR will be modified to disable all the extra screens that were added so we could check all the boxes that ended up not being all that relevant to our model of care. The providers were ecstatic to say the least.

The practice owners are extremely process-oriented and determined that the changes to the system will remove literally hundreds of thousands of clicks for users over the next year. I admire their dedication to detail and their gutsiness in deciding to just say no. Our patient volumes have grown dramatically since I started working with this group and it’s fair to say that the revenue from additional patients we’ll be able to accommodate if we can work more efficiently will more than cover any penalties. Having been in the EHR driver’s seat for so many years, it’s been very interesting to work with them as an end-user.

They asked me to stay after for a few minutes. I’m the most part-time of all the physicians and work the fewest hours each month, but had previously volunteered to work some of the less-desirable shifts to allow the full-time staff to have more time with their families. I suspected that they were going to ask me to pick up a couple of extra shifts over the holidays since I had mentioned to the COO that I’m not traveling this month. What I did not suspect, however, was that they would offer me a leadership position in the organization.

I would be going back to formal CMIO duties with a bit more operational authority than I’ve had in the past. I’d also be spending dedicated clinical time at one of our expansion locations, which the organization plans to use as a pilot site for new initiatives and for vetting workflow changes. Our workflow is already pretty serious as far as quality, efficiency, and patient satisfaction are concerned so I’m very flattered by their belief that I could help take it to the next level. I have to say that the idea of being able to return to a CMIO position without dealing with Meaningful Use or hospital politics is seriously tempting.

Although I’ve enjoyed doing more consulting this year and have learned a tremendous amount, the travel quickly becomes less than fun. Based on what I’m being offered, they’ve done an outstanding job of figuring out what makes me tick and what I might find compelling enough to give up my frequent flyer status. They know me well enough to not expect a quick decision on such a weighty matter and I’m sure we’ll have additional discussions over the next few weeks. A wise man once told me that you should spend 10 percent of your time looking for your next gig. Sometimes I guess your next gig might just fall in your lap, though.

What’s your dream job? Email me.

Email Dr. Jayne.

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December 3, 2015 Dr. Jayne 1 Comment

Morning Headlines 12/3/15

December 3, 2015 Headlines No Comments

National Health Spending Growth Accelerates In 2014

The CMS Office of the Actuary publishes new data showing that healthcare expenditures rose 5.3 percent in 2014, after five consecutive years of historically low growth. Health spending now accounts for 17.5 percent of national GDP.

UnitedHealth Says It Should Have Avoided Obamacare Longer

UnitedHealth CEO Stephen Hemsley says the company will lose about $500 million on public insurance exchanges between 2015 and 2016. He explains, “It was for us a bad decision. I take accountability for sitting out the exchange market in year one so we could in theory observe, learn and see how the market experience would develop. This was a prudent going-in position. In retrospect, we should have stayed out longer.”

Health Care Providers Need a Value Management Office

Harvard Business Review analyzes the role a “value management office” would play in health systems migrating to new value-based reimbursement models, citing MD Anderson Cancer Center (TX) and Hospital for Special Surgery (NY) as examples of organizations where such offices are working well.

E-mails reveal concerns about Theranos’s FDA compliance date back years

Internal emails from Theranos reveal that the DoD reported the company to the FDA in 2012 after evaluating the technology for use in theater. CEO Elizabeth Holmes called on Theranos board member and four-star Marine Corps General (ret.) James Mattis to intervene on the company’s behalf.

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December 3, 2015 Headlines No Comments

Readers Write: 501(r) — Are You Ready for This?

December 2, 2015 Readers Write 1 Comment

501(r) — Are You Ready for This?
By Jonathan Wiik

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Last time I checked, hospitals have a lot on their plates. Remember October? ICD-10 ring any bells?

In case you haven’t heard, another new set of regulations — under section 501(r) of the Affordable Care Act — is set to take effect in 2016 for all 501(c)(3) non-profit hospitals. The implications: comply or lose your tax-exempt status.

It’s a hard truth, but the healthcare industry is facing more regulations than nuclear power—look it up. These new regulations are far from straightforward. Compliance with 501(r) can be incredibly complex. The entire process can take anywhere from several months to a year, depending on how smart your people are.

Not to mention expensive. Staff, signage, documentation, training, etc. are all crucial elements of effective 501(r) compliance. What’s more, you may need to hire a new employee or two just to manage the task.

In a nutshell, 501(r) requires that you satisfy new regulations around CHNA, FAP, ECTP, AGB, and EAC. (Go ahead and look up those up after you read up on nuclear power—or just read on.)

Here’s what you need to know about 501(r):

  • Congress passed the Patient Protection and Affordable Care Act (PPACA) in 2010.
  • Prior to this, some non-profit hospitals had been engaging in aggressive billing and collections efforts that brought their “charitable” status into question.
  • This led to the enactment of section 501(r), which requires non-profit hospitals to demonstrate the benefits they provide to their patients and community from a financial standpoint.

As part of 501(r), non-profit hospitals must now meet four specific requirements in order to maintain their tax-exempt status:

  1. Conduct a periodic community health needs assessment (CHNA).
  2. Provide written financial assistance and emergency care policies (FAP, ECTP).
  3. Establish limitations on charges for emergency or medically necessary care (amounts generally billed or AGB).
  4. Set policies and procedures related to billing and collection activities (extra ordinary collection or EAC).

There are three basic approaches you can take when it comes to compliance:

  • Ignore it, do nothing, and assume that you’ll handle it when something happens.
  • Check with the experts in your organization to see where you stand.
  • Take a proactive approach, put a team together, perform an assessment, and establish an action plan. (Hint: choose option 3 if you want to bolster your charity status, prevent poor patient experiences, ensure your tax-exempt status, and maybe even reduce future expenditure.)

Here’s how to get 501(r) right:

  • Measure the pros and cons, risks and rewards of tax-exempt status against the costs of 501(r) compliance. I the juice worth the squeeze? Personally, I think it is for a variety of reasons, but it’s still helpful to understand what you’re in for.
  • Document, document, document. Proper documentation is a crucial requirement of 501(r), but it can also be used to show that you’re making a good-faith effort to comply with the rest of the requirements.
  • CHNA. This may actually help support your strategic plan. Are the programs offered by your hospital meeting most of the needs of your community? Are all your resources in sync with the community? Have community wellness and health in general become better, worse, or stayed the same?
  • Reputation insulation. Compliance can actually help you avoid negative patient experiences and minimize bad press. Along with the “worth” of your non-profit status in the community, in hard and soft costs, the fines can pile up quickly.
  • Use third-party data to presumptively determine eligibility for FAP. 501(r) clearly permits the use of presumptive eligibility, which enables you to assess a patient’s financial health early in the revenue cycle. By streamlining this process with third-party data, you can realize increased or accelerated cash flow as well as save time and money by converting manual workflows into automated processes.
  • Documented standard work. The use of third-party data can help facilitate a consistent (unbiased) and efficient method for identifying which patients are eligible for financial assistance, effectively taking the guesswork out of the equation. Additionally, 501(r) requires that you thoroughly screen patients for eligibility before sending them to collections or initiating extraordinary collections actions. Again, by using third-party data, you can identify which self-pay accounts can be pursued for collections and which accounts can be presumptively qualified for charity care. This allows for an accelerated segmentation of aged self-pay accounts into payment, charity, and bad debt buckets.

At the end of the day, it’s important to evaluate your patient mix and adjust policies to fit any changes, as well as track and measure your results. Be sure to establish measureable goals to ensure that your FAP-reporting processes are meeting 501(r) standards as well as your patient population mix. Setting a specific number of goals will help keep the focus on the high-priority tasks, ensuring that your processes can be measured more effectively. Are you ready for this?

Jonathan Wiik is principal, revenue cycle management, with TransUnion of Chicago, IL.

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December 2, 2015 Readers Write 1 Comment

Readers Write: Clinical Decision Support: Are We Ready to Invest?

December 2, 2015 Readers Write 1 Comment

Clinical Decision Support: Are We Ready to Invest?
By Jaffer Traish

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Sometimes great ideas are just ahead of their time. Microsoft launched a smart watch in 2004. Digital currency received 100M in venture funding, but collapsed in the dotcom era. Google Glass has come and gone – or has it?

Evidence-based medicine and the marriage with technology is another open playground. Opportunities abound to create interactive, engaging clinician workflows to support real-time decision-making and enhance not just clinical outcomes, but the patient experience and revenue integrity.

The Hearst Corporation’s portfolio includes efforts to improve real-time medication decision support, maintain the currency of order sets and care plans, as well as drive care team and care transition communication. Wolters Kluwer is similarly working on the above, as is Elsevier in their respective product portfolios. The CMS value-based purchasing and other HITECH act incentives provide some soft carrots to push forward.

EHR vendors also provide significant clinical content (sometimes including specialties as well) that provide a very practical head start, though with no assessment of evidentiary integrity. Some startups like Stanson Health are also tackling niche areas of decision support.

The meta-analysis, categorization, and dissemination of evidentiary information is not a hard science. Teams of clinicians and coders together can review hundreds of articles and publish findings relatively quickly. Most healthcare systems have enterprise subscriptions to evidentiary libraries to consume these findings. Even as there is disagreement among communities over studies and trials, that very disagreement is the impetus for further study.

Some EHR vendors support communities of clinicians coming together to bridge the gaps in knowledge and best practice findings, especially in pediatric care.

Healthcare systems aren’t software development shops. Most don’t develop teams to tackle this opportunity. Instead, they hire analysts to manually manage the change (painful and expensive). The evidence subscription vendors have been trying, though they aren’t the EHR experts – the integration approach has been flawed. Groups like OpenCDS are refreshing and bring attention to standards development and process, though still ahead of its time. Last but not least, implementation, rollouts, ICD-10, and other priorities have taken the spotlight.

Clinicians are adjusting to their systems. Are they be ready to do focused collaboration on their (ex.) 200 order sets with evidence depth?

EHRs are maturing their decision support tools. Are they ready to participate more fully in sharing public specifications for standard decision support ingestion?

Evidence vendors have grown revenue streams on non-integrated IT tools. Are they willing to wipe the slate and start fresh with new API models?

Revenue cycle teams have been focused on SBO models, centralization, and patient satisfaction, but there is a strong link to revenue integrity with the reduction of unnecessary tests and improved standards of care. Is the CFO ready to demand this value?

In talking with many CXOs, some truly want to insource this activity while others would prefer to pay –  to have content and evidence managed externally and reap the lessons and value from others. Both models could prove effective. Today, the costs are high dollar subscriptions. Perhaps these costs need to be part of a risk strategy and not paid without successful implementation.

Today, if an African American would have better outcomes with a different antibiotic, the clinician should have this information at his/her fingertips in the workflow.

Today, if a drug is removed from the market, it should be removed from the clinician’s selection in swift manner without much manual intervention.

Today, if the several major children’s hospitals wanted to jump online and compare their pediatric specialty order sets, they should be able to do so with ease and share the best.

Today, if there are 500 opportunities to improve clinical content with evidence supported changes within an organization, the CFO should know what the patient outcomes and related costs/savings may be.

The list goes on, and we can do all of this today – manually.

The challenge is not dissimilar from the interoperability debate. Just as we need a national patient identifier, adopted patient security measures, and implementation cost-sharing that includes practices, hospitals, patients and providers, the same theme can be found here. We need public specifications through collaboration, a change in the way evidentiary information is so proprietary today and closer partnerships with innovation teams.

Organizations each pay $50k-1.2M for decision support systems today in existing budgets. Various market analysis projects decision support to be a market of $550M by 2018, and upwards of $2B in the future. Let us demand more for our healthcare dollars.

 Jaffer Traish is VP of the Epic practice at Culbert Healthcare Solutions of Woburn, MA.

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December 2, 2015 Readers Write 1 Comment

CIO Unplugged 12/2/15

December 2, 2015 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

DNF

In many sports, DNF is a commonly used acronym. It means, “Did Not Finish.” It means you crossed the start line, but not the finish line.

There are many reasons for a DNF, often out of one’s control, like a crash or an unanticipated physical issue. A dog once ran through the spokes of my coach’s bike during a triathlon. At 25 miles per hour., neither she nor the dog had a chance. DNF.

Many stop short because they realize they may not podium or they lose the fire. Let me speak plain here – some are just quitters. They realize the course ahead is harder than they thought so they stop. I don’t respect that. In the sporting rink or at work, this latter kind of DNF is nothing to be proud of.

Listen, I get the desire to quit. Lots. When I shared last month on my race in Zofigen, I did not tell you all of the story. The accident I had prior to the World Championships wreaked havoc on my core muscles. When I completed the bike portion (150K) of the race, I could barely dismount. I almost toppled over as I raised my leg over the frame. As I left transition to finish the second run (30K), I was hobbling and had to walk.

I was in so much pain and so embarrassed. I was representing our country and all I could do was walk. I never walk! Humbled, I continued to hobble, all the while wanting to quit. In my mind, I was justifying clever excuses and preparing the elevator pitch, my tweets to followers and posts to Facebook as to why I quit. Vanity.

But something in me would not allow me to do that.

I eventually began to run, especially when I was within sight of a competitor. It was painful and humiliating to run so slow, but I did. My body adjusted and I gained speed and eventually finished. The most exhilarating finish of my career. While I knew I did not retain my title of top 100 duathlete in the world, I had so much satisfaction. I dug deep. I refused the DNF label. I crossed the finish line. Success!

I can tell you that on more than one occasion, I called a former boss to see if I could just quit my new job and go back to my old one where things were more familiar and comfortable. I tried to DNF. Thankfully, my former bosses talked me out of quitting so early. I persevered. The rest is history.

Training is a given. The foundation to success is to be well trained. So why do the well trained DNF? It comes down to attitude and it is predictable. There are two key indicators: predisposition and motivation. Check yourself here. I have to check myself as I prepare for each race and new job. It is not automatic.

Predisposition. First, if you do not have a predisposition to quit, let that be your motivator to persevere. I think about that when I want to stop. I know if I stop this race, it will make it easier to stop in another race. Break the pattern before it can even take hold.

Predictors to a DNF character:

  • History—are you a quitter?
  • Do you jump jobs when things get sketchy?
  • Do you quit early on friends who disappoint you?
  • Do you often take shortcuts or blow off responsibilities?

Motivations of a DNF character:

  • Do you have a defined purpose for the job/race?
  • Is the event part of a larger goal?
  • Do you have a story for why you are in the job/race?

Since we can identify DNF predictors and motivations, we can take action to reverse the pattern if that is our character. It is pretty simple, really.

  • Stop quitting.
  • Vow to not quit when the going gets tough by setting goals. I had a goal that I would stick with any new job a minimum of two years.
  • Take on smaller races and tasks and build positive history which will lead to increased confidence and ultimately motivation.
  • Do routine introspection and let motivation develop and drive you. Figure out why you want to do that race or why you want to take that job. Let that sustain you through troubled times.
  • Think about the long-term and overall vision and let a story develop. Think what the final chapter would read like. Let this story unfold before you.
  • Surround yourselves with others that will hold you accountable.

Why is this so critical to think about? From a career point of view, it is easy for hiring managers to spot DNF character. Most will toss your resume in an instant if you show that pattern. You are easy to spot and will never make it past the first screening.

Moreover, from a personal perspective, it is hard for friends and family to count on a DNF personality, which then creates significant barriers that lead to mistrust and unfulfilled relationships.

Before your next race or your next job, think about these things. No matter where we fall in the DNF definition, we can all learn and embrace these concepts to ensure the probability that we will finish whatever race is set before us — at play, at work, or in life.

Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.

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December 2, 2015 Ed Marx No Comments

Morning Headlines 12/2/15

December 2, 2015 Headlines No Comments

Joint: API Task Force

The Health IT Policy Committee’s API Security Task Force, organized to work through security issues associated with an open API infrastructure, held its first meeting this week.

Allscripts Announces Share Repurchase Program

Allscripts announces that it will repurchase up to $150 million of its common stock, representing 5.2 percent of the company’s outstanding shares.

Why the US Pays More Than Other Countries for Drugs

The Wall Street Journal analyzes the many forces contributing to exorbitant drug prices in the US, compared to other developed nations.

UNC, Duke hospitals post record 2015 revenue as WakeMed reports loss

WakeMed (NC) posts a $50 million operating loss for its 2015 fiscal year, blaming the loss on a number of one-time expenses including its Epic implementation, construction of a new 61-bed hospital, and operating a chronic disease management program.

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December 2, 2015 Headlines No Comments

News 12/2/15

December 1, 2015 News 5 Comments

Top News

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The Health IT Policy Committee’s API Security Task Force held its first meeting Monday, co-chaired by Josh Mandel (Harvard Medical School) and Meg Marshall (Cerner). The group is charged with identifying privacy and security issues with open APIs. Its next meeting is this week.


Reader Comments

From Frying Burrito Brother: “Re: DonorsChoose. Our company would like to donate and I don’t see instructions.” I have matching money left, which I will apply to your donation made as follows:

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

From Equine Hindquarters: “Re: EHR databases. You wrote a long time ago that they should all use the same basic schema and compete on additional tables as well as their UI.” I’ll update my suggestion as follows. Each EHR should contain a basic set of tables with a universal format so that any authorized party can retrieve patient demographics, visits, medication lists, etc. That eliminates the need to convert proprietary tables or run the query through an HIE that may or may not be translating correctly. That also places onus for the data accuracy and completeness on the EHR vendor, who is best equipped to manage that task. Those interoperability tables would be separate from the existing EHR tables to avoid exposing proprietary information or methods. It’s like exporting a CCDA or other document except that it resides permanently in the vendor’s database with real-time updates and could be accessed via standard APIs with minimal effort or system knowledge. The vendors know their own systems, so let them populate these standard tables instead of forcing everybody who needs access to their patient information to figure it out for themselves.

From Pippi Longstocking: “Re: Microsoft Lync. Does anyone know of an acute care facility that has fully converted to it? If so, how was HL7 addressed and is backup and stability similar to a traditional communication platform?”


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Spok (pronounced “spoke”). The Springfield, VA-based company is a market leader in critical communications solutions – clinical alerting and notification, secure hospital communications, physician and nurse scheduling, paging, and contact center technologies. The company chose its new name in 2014 following the 2011 acquisition of Amcom Software by USA Mobility. The Spok Mobile secure texting app allows users to send images and video along with text, with full logging and HIPAA compliance. Spok Critical Test Results Management helps meet National Patient Safety Goal #2 in quickly sending radiology and lab results to the right clinicians on their mobile devices, accelerating the treatment plan and discharge process as appropriate and protecting against malpractice lawsuits. The FDA-approved Spok Messenger sends mobile alerts from nurse call systems while routing non-clinical requests to the appropriate team member. Paging remains relevant as an essential part of critical healthcare communications due to its high reliability and low cost and Spok offers both wide-area and onsite versions of it. Thanks to Spok for supporting HIStalk.

Here’s a YouTube video case study that describes Banner Health’s use of Spok solutions to create patient-centric communications.

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I’m among the one-third minority who pronounce the name of this site “H-I-S-talk” rather than the “Hizz-talk” preferred by two-thirds of 335 poll respondents. Dean says he doesn’t like turning acronyms into words and was baffled when people at his previous employer pronounced “URL” as “earl,” which reminds me of my annoyance at people pronouncing Joint Commission back in its JCAHO days as “jayco,” which makes no sense at all but is at least less annoying than lowbrow humorists who gleefully turn FHIR into tediously non-clever “fire” puns. Two respondents offered a variation I hadn’t though of in “hisstalk.” At least nobody said they incorrectly assume that: (a) the “his” is the opposite of “hers,” or (b) the name has a religious connotation.

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Mrs. Jarrell from Louisiana reports that her seventh graders are learning about integers as they use the math manipulatives and electronic quiz tools we provided via DonorsChoose.

I get a bit queasy when I see how HIMSS advises its vendor members on how to sell their products to its provider members, as evidenced by the pitch for its recent webinar that gets me going in several ways:

  • It uses “social” as a synonym for “social media,” which it is not (although I’m at least happy it’s not the retch-inducing “sosh”). It also bleats out “leverage” and “utilize” instead of the less-pompous and perfectly serviceable “use.”
  • It pitches the use of social media to “generate excitement about your brand before and during HIMSS16 utilizing its expert team,” with the expert team to be “utilized” being that of HIMSS Media, which seems to have happily eliminated the firewall between alleged news reporting and for-hire pitching. I’ve yet to experience tweet-induced excitement about a company, especially when the tweets in question emanated from those folks.
  • It claims that screwing around with Twitter and Facebook will result in “transforming yourself from a vendor into a trusted advisor.” That’s asking a lot from simply assigning some 20-something kid to post unoriginal, corporate-approved thoughts that decision-makers will never read because they have far better things to do than monitoring Twitter. It’s usually a really bad idea to make a vendor your “trusted advisor” unless the advice you seek is that you should buy whatever they’re selling.
  • It reminds me that HIMSS makes millions from pimping low-paying provider members to high-paying vendor members while also selling itself. I like some of what HIMSS does, but the emphasis on its own bottom line keeps increasing. They’re almost as bad as AAA, which bombards me trying to sell insurance, car repair, vacations, sponsor-supported products, credit cards, and even used cars when all I want is roadside assistance and maybe an occasional hotel discount.

Webinars

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

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

December 2 (Wednesday) 2:00 ET. “Creating HIPAA-Compliant Applications Without JCAPS/JavaMQ Architecture.” Sponsored by Red Hat. Presenters: Ashwin Karpe, lead of enterprise integration practice, Red Hat Consulting; Christian Posta, principle middleware architect, Red Hat. Oracle JCAPS is reaching its end of life and customers will need a migration solution for creating HIPAA-compliant applications, one that optimizes data flow internally and externally on premise, on mobile devices, and in the cloud. Explore replacing legacy healthcare applications with modern Red Hat JBoss Fuse architectures that are cloud-aware, location-transparent, and highly scalable and are hosted in a container-agnostic manner.

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

December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.

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

December 9 (Wednesday) 1:00 ET. “Looking ‘Back to the Future’ on Clinical Decision Support and Data Warehousing.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Dale will use a 2006-era slide deck (complete with old-school graphics) on using an enterprise data warehouse in clinical decision support, as it was originally presented to several masters-level informatics classes nearly 10 years ago. Some of the information in the “time capsule” will be laughably wrong, while some will still be relevant. Either way, reviewing the past will help inform the future. A highly interactive Q&A will follow.

December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenter: Stephen Claypool, MD, medical director of innovation lab and VP of clinical development and informatics for clinical software solutions, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

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


Acquisitions, Funding, Business, and Stock

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Allscripts announces a share buy-back of up to $150 million.

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Sunquest Information Systems will move its Tucson, AZ headquarters to an office building on the north side. Google Maps indicates that it’s a 26-minute drive between the offices, just in case you’re an employee trying to assess your quality of life impact. I’ve had my hospital commute involuntarily changed a few times by an office move, where the folks in charge seemed surprised that most employees weren’t thrilled about wasting more hours driving every week just to stare at the same cubicle walls moved to a further-flung part of town. My limited analysis was that somehow the new building was always closer to the wealthier neighborhoods where hospital executives lived and featured an even nicer version of Mahogany Row on whose plush carpet the peons rarely trod except as guests at their own termination.

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Blue Cross Blue Shield of Michigan acquires insurance company software vendor IkaSystems, which has some executive team members who have worked for various health IT vendors.


Sales

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University of Chicago Medicine (IL) chooses Valence Health to support its clinically integrated network, the 30th such organization to implement the company’s unified clinical information solution.

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Skagit Regional Health (WA) chooses Epic at an estimated cost of $72 million over five years. ECG Management Consultants, which managed the selection, says Skagit will displace Meditech in the hospital and NextGen in its clinics.


People

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Online second opinion provider 2md.MD hires Kirk Rosin (Aetna) as chief strategy officer and Kristin Herrera (UnitedHealthcare Global) as chief growth officer.

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Florent Saint-Clair (DR Systems) joins Dicom Systems as EVP.

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CTG promotes Amanda LeBlanc to VP/chief marketing officer.

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Kate Crouse (Smart Exec Tech LLC) is named network CIO at Kings County Hospital – Central Brooklyn (NY).

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Vital Images names Paul Markham, DBA (Origenetics) as VP of marketing.

Rob Senska, Esq., MBA (Somerset Medical Center) joins Besler Consulting as director of compliance services and associate general counsel.


Announcements and Implementations

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Yale-New Haven Hospital (CT) implements Mobile Heartbeat’s MH-Cure clinical smartphone app, with three-fourths of its physician users saying it has improved patient workflow and safety.

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Naunce and the National Decision Support Company announce their collaboration to support ACR’s Imaging 3.0 by offering NDSC’s ACR Select appropriate use criteria along with Nuance PowerScribe 360 and PowerShare Network.

National Decision Support Company also announces that it has signed an exclusive agreement with Cerner to make its ACR Select imaging appropriate use criteria available to Millennium users.

Craneware will demonstrate a new version of its Pharmacy ChargeLink solution at the ASHP Midyear Clinical meeting, which includes predefined formulary mapping to Epic Willow and Cerner PharmNet.


Privacy and Security

In Canada, a former administrative assistant of Alberta Children’s Hospital is charged with 26 counts of inappropriately accessing patient records. She had already been fired for snooping.


Technology

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Microsoft announces PowerApps, which it says will allow non-technical employees to create apps that work on any device by using Office-like templates, a drag and drop workflow designer, and connections to cloud and on-premises services such as Salesforce, Dropbox, and databases. That would be pretty cool if it works as described since subject matter experts typically struggle when trying to move handy, Office-powered workgroup apps to web or mobile environments without technical help.


Other

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The US Supreme Court declines to hear the case of a retired Texas veterinarian whose license was suspended for offering online pet advice in yet another clash between Texas professional boards and telemedicine providers. The vet says the state’s requirement that he physically examine an animal before offering telephone advice violates his free speech rights. He was offering only advice, not the writing of prescriptions.

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WakeMed (NC) blames its $50 million FY2015 loss on major expenses that include its Epic implementation, construction of a new 61-bed hospital in Raleigh, and running a care management program, but says the numbers are deceiving because the investments will pay off later. Meanwhile, neighboring Duke University Health System, which reported $355 million in profit on $3 billion in revenue, says its Epic-related financial hit from last year is history and Epic is now delivering the expected results. UNC Health Care System made $119 million on $3.2 billion in revenue.

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Coca-Cola’s chief science and health officer retires following a New York Times report that described how the company secretly funded a non-profit that urged Americans to exercise more instead of drinking less soda as advocated by what Coke called “public health extremists.” The CEO of the non-profit, which has since shut down, accepted honoraria and travel expenses from Coca-Cola before he formed the group. He’s a professor at the University of Colorado School of Medicine, which returned Coke’s $1 million donation following the article’s publication. Coke also paid $500,000 to University of South Carolina, which says it’s not giving the money back.

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A Wall Street Journal investigative report finds that Americans provide most of the global drug industry’s profits because of pharma’s political clout, an unwillingness by Americans to limit use of expensive drugs regardless of proven therapeutic benefit, laws that prohibit Medicare from negotiating drug prices, the fragmented US healthcare system in which lack of a single government buyer allows drug companies price their products however they like, and demand-generating direct-to-consumer advertising that most countries don’t allow.

In the Cayman Islands, the former board chair of the health services authority is on trial for defrauding the public after the HSA awarded a patient swipe card contract to a firm in which he held partial ownership. Witnesses testified that the technical committee’s choice of Cerner angered him to the point he a sent a copy of Cerner’s proposal to the owner of eventual winner AIS Jamaica, with whom he planned to open a pharmacy business.

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Facebook CEO Mark Zuckerberg announces in a letter written to his newborn daughter Max that he and his wife Priscilla Chan, MD will give away 99 percent of their Facebook shares – worth $45 billion today – via a foundation that will focus on personalized learning, curing disease, connecting people, and building strong communities.

A KPMG survey finds that 80 percent of organizations report their ICD-10 transition as smooth, although its methodology of surveying 300 attendees of an ICD-10 webinar is lazy.

A tiny observational study finds that doctors who enter information into the EHR during patient visits not only communicate less as you might expect, but also argue more with their patients and earn lower satisfaction scores. That may mean that those doctors don’t communicate well, but it could also indicate that the observations made involved patients who were sicker or newer, thus requiring more data entry and less catering to the patients’ every whim. The most telling aspect would be how the computer and monitor were positioned in the exam room, which heavily drives patient perception as being either exclusionary or participatory.

Websites that offer estimated medical procedure costs, including those run by insurance companies, often give consumers incorrect cost information that leaves them paying higher-than-expected expenses out of their own pockets, according to an NPR review. Reasons include health systems that quietly buy other providers and increase their prices, use of historic or aggregated prices, and not knowing exactly what procedures a doctor might perform during a visit or how the doctor will code and bill it. Price transparency is also nearly non-existent as prices are hidden inside non-public contracts between payers and providers.

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Weird News Andy enjoyed the programmer jokes I ran recently and offers “Mr. Boole Comes to Tea” in a belated celebration of George Boole’s 200th birthday.


Sponsor Updates

  • Anthelio Healthcare Solutions will exhibit at the HIMSS Gulf Coast Chapters event December 4-5 in Birmingham, AL.
  • Capsule will exhibit at the IHI National Forum on Quality Improvement in Health Care December 6-9 in Orlando.
  • Divurgent ranks amongst CIOReview’s 50 most promising healthcare solution providers.
  • Fujifilm debuts an updated version of Synapse RIS at RSNA.
  • Visage Imaging is demonstrating Visage Ease mobile imaging results enhancements at RSNA.
  • Healthfinch will exhibit at The Institute for Healthcare Improvement Annual Conference December 6-9 in Orlando.
  • Huntzinger Management Group interviews client ProMedica CIO Rose Ann Laureto about the organization’s Epic go live.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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December 1, 2015 News 5 Comments

Morning Headlines 12/1/15

November 30, 2015 Headlines No Comments

UnitedHealth Sees 2016 Revenue Slightly Below Estimates

Ahead of its Tuesday investor day, UnitedHealth projects 2016 revenue of $180 billion to $181 billion, short of analyst expectations. The insurance giant noted earlier this month that its public exchange business as underperforming and would cut into profits.

Highmark Medicare Advantage members to retain in-network access to UPMC

The Pennsylvania Supreme Court issues a ruling preserving in-network access to UPMC doctors and facilities for Highmark Medicare Advantage health insurance customers.

Glens Falls Hospital picks single electronic health record, data provider to streamline systems

Glens Falls Hospital (NY) will expand its current inpatient Cerner install to replace Epic in its ambulatory space and GE Healthcare in patient registration and billing.

Lahey Clinic computer theft leads to $850,000 HIPAA settlement

Lahey Clinic (MA) will pay an $850,000 fine and enter into a corrective action plan to settle privacy and security violations filed by the OCR after a 2011 unencrypted laptop theft exposed the records of 599 patients.

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November 30, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 11/30/15

November 30, 2015 Dr. Jayne 2 Comments

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I wrote last week about open enrollment for health insurance and other benefits. A reader sent me this screenshot of his company’s enrollment management system, giving it an “F” for usability. Although the rolling hills are probably supposed to calm employees before they see what their premiums will be this year, the fact that they obscure half of the labels is likely to increase anxiety. Not to mention, can you trust a company that doesn’t care if you can read the password requirements or not?

Another reader wrote about the expanding list of employee-paid options his company offers. In addition to medical, dental, and vision insurance and flexible spending accounts, employees also had the option of choosing pet insurance and a legal services PPO.

I admit that I don’t know anything about contract legal services, but found it kind of funny that lawyers would start down the slippery slope that got physicians to where we are today. We’ve seen what having third-party payers has done to the healthcare system and are still trying to cope with payments that are spiraling down while insurance company profits continue to climb. If anyone has inside knowledge on this trend, I’d be happy to run comments.

Nearly everyone I’ve talked to about open enrollment and health care coverage has mentioned that they get either a premium discount or a penalty (whichever way you look at it) depending on the presence or absence of certain health-related behaviors. Anecdotally, the most common are discounts for being a non-smoker or participating in a smoking cessation program.

Close behind are discounts for having certain lab screenings done, although the results aren’t taken into account. My former employer required lab screening for all employees to get the lowest rate, regardless of whether the labs were evidence-based or indicated. Although I’m sure they got a volume discount for having the lab work done, the concept of coercing people into having screening tests isn’t exactly driving down the cost of healthcare.

Looking at my former team (which was fairly young), only 20 percent of them were in an age bracket where the blood work was actually indicated. I’ve had plenty of conversations with Medicare patients who want a specific test regardless of whether it’s indicated simply because “Medicare covers it and I’ve earned it,” which is no way to practice medicine. Seeing this type of behavior reinforced by private payers is disappointing.

The other troubling thing about the whole business is the aspect of coercion. Those of us who believe in evidence-based medical care have spent our careers trying to order the right tests for the right patients at the right time, not just doing things because they’ve always been one way or another. Even simple laboratory tests are not without risk. There is a chance that they will uncover an “abnormal” but irrelevant value that will lead to patient distress or to further unnecessary testing. There is also the loss of the patient’s time in going to have the test and jumping through related biometric screening hoops.

Additionally, I’m not aware of a significant amount of high-quality research that shows that these programs actually work as far as driving healthy behavior or reducing overall healthcare expenditures. There are a handful of papers but the design and execution are somewhat variable. I’m not sure how I feel about employees being part of an experiment – when I was in academics, I would have to get approval from the Institutional Review Board to do something like that with my staff. Employers, however, have carte blanche to do whatever they want.

Everyone is awfully keen on these “wellness” programs, but they’re of varying quality. I saw a patient at the office last week who just needed documentation that he had a “physical” so he can get a discount on his insurance. There was no description of what exactly was to be included in the physical. The general “physical” has not been shown to reduce morbidity or mortality. Age-appropriate preventive and wellness visits can have an impact, but they’re best performed by a primary care physician who knows the patient and his or her history.

Unfortunately he showed up at our urgent care, where in the absence of specific criteria (such as pre-participation sports physical or a pre-employment physical), the content can be somewhat variable. Half our physicians are Emergency Medicine certified and they’re not that into continuity of care. He also presented to the office the day after Thanksgiving, which is historically one of the top three busiest days of the year at our practice and probably not the best choice for a preventive medicine visit unless you want to catch influenza or an upper respiratory infection in the waiting room.

I picked him up rather than one of the ED docs, so he did receive a full age-appropriate preventive medicine visit with preventive health counseling and notes on what screenings he should start having and when. I’m not sure how much he actually absorbed, though, and since we’re a walk-in urgent care, there’s not likely to be much continuity.

Another spin on this is the employer-owned health practice, where employees actually see on-site physicians for wellness visits, chronic disease management, and associated services. A friend of mine started working in one of these practices last year and found it to be much harder than she anticipated. She finds a tremendous conflict of interest with patients tending to want to conceal certain information that they wouldn’t want their employers to know. Although there are supposed to be safeguards in place, patients don’t always trust them.

Another negative aspect of open enrollment is the annual churn of patients having to change physicians when their coverage changes. Often this means starting over in the middle of treatment or having delays in care due to the need to obtain new referrals and authorizations. When I was in a traditional primary care practice, January always brought a flood of requests to transfer medical records, often with notes from the patient apologizing for leaving and asking us to let them know if we ever decide to start taking XYZ insurance plan.

For someone who became a family physician because I hoped to care for people longer than a year or two at a time, it was just sad. I’m personally averaging five primary care physicians in the last 15 years, which isn’t ideal as a patient.

I’m not sure what the answer is, but I hope it involves the ability of patients to choose physicians based on quality and cost and without network restrictions or burdensome processes. Somehow I think that’s just too much to ask, though.

What do you think the answer might be? Email me.

Email Dr. Jayne.

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November 30, 2015 Dr. Jayne 2 Comments

HIStalk Interviews Clay Johnston, MD, PhD, Dean, Dell Medical School

November 30, 2015 Interviews 1 Comment

S. Claiborne “Clay” Johnston, MD, PhD is dean of Dell Medical School at the University of Texas at Austin. Campus construction will be completed in May 2016 and the first medical school class will begin studies in June 2016.

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How have medical schools have changed over the last 20 years and how will the Dell Medical School will be even more different?

Medical schools are changing, and I think a little more rapidly now. They certainly haven’t changed as much as they should have.

The one realization is that lectures don’t work so well. There’s a lot more emphasis on flipped classroom type approaches to teaching, small group learning, that kind of thing.

More recently, too, there’s a greater appreciation of the fact that –  the way I learned was memorization focused, just cram all this knowledge. The reality is that information is cheap today. The resources available to physicians are much more accessible and are generally more accurate than memory for things that aren’t used frequently. Therefore, the need to memorize so much stuff is really not there.

There’s been some de-emphasis of that memorization task and more about how we find the data that we need, how we integrate that data, and how we use it solve problems. Those are some of the broader trends that are going on.

Obviously we want to take advantage of those, but also we’re coming without an existing curriculum. We have a lot more freedom than existing schools, where you always have people who defend the status quo and created that beautiful lecture set on the Krebs cycle and they’re just not going to let it go. We don’t have that, so that gives us a different perspective. 

For us, it’s more about, what is it that we want from health and from healthcare as a society? Then, what is the appropriate role of the physician in that ideal vision of what the health system should look like?  Then, how do we provide the best training to meet those needs, particularly given the problems in the health system? That completely opens your eyes in terms of thinking about, what is the skill set?

From our perspective, physician leadership is a big problem. Being able to look at system-level problems, work in teams, and use technologies and other new approaches to solving these system problems creatively. Those are some of the key things that physicians ought to be involved in. Not just to not resist them, which is a common problem now, but to actually help to lead them.

That’s what we’re doing. We’ve got a curriculum that’s very much designed around training these physician leaders of the future.

A significant percentage of medical school graduates either don’t follow with a residency or they take a non-patient care role after using up a class spot and the educational subsidy. How do you set reasonable expectations, especially as prospective students hear about burnout among practicing physicians?

We need to focus on why those physicians are burned out and look at the systems that have been put in place that have led to that burnout. One of the dysfunctions of the fee-for-service system is that it does not compensate people well for things like office visits or the cognitive aspects of medicine. It  does compensate well for procedures. Over time, the cognitive aspect reimbursements have been ratcheted down for physicians, so they’ve had to see more and more patients.

Then electronic health records were introduced. Their primary function today is billing. They have eroded even further the meaningful time that doctors spend with their patients. 

Those are just a couple of examples, but important ones for how we’ve made jobs like primary care really unpleasant. There’s very short visits — the average office is now 12 minutes. Up to half of that could be spent just documenting the visit in a very dysfunctional electronic health record.

The reasons that docs go into medicine have been lost. Having those meaningful, important discussions and time with patients is much more difficult today. 

How, then, do we change the system so that docs can spend more time with patients and maybe work with patients in whole new ways, you know, like email? It’s used in every industry. Why not allow patients to email their docs and make that part of the job of a physician to manage patients by whatever technologies make the most sense?

What do we tell our students? Well we tell our students, it’s your job to keep people healthy and to get them healthy again when they’re not. In the traditional approach, that was to be done in clinic visits and in ORs and emergency rooms. Now, open your eyes up and think about how you could do that best. If I gave you a panel of 3,000 patients to take care of, what would you put in place to make sure that they’re as absolutely healthy as they could possibly be and that you have meaningful discussions with them? 

You probably build a team around yourself. You would use technologies. OK, show me what that looks like. Tell me how we can build that and that there are ways to get paid for it. 

Medicine needs to evolve that way. Then the physician burnout also can go away because that perspective is just as important to fixing the health system.

Texas makes a lot of headlines related to telemedicine. Will telemedicine and other non-face-to-face technologies be part of your curriculum?

Yes. They need to be. To say that those technologies shouldn’t be important in the delivery of healthcare is just so short-sighted.

So many of the things that are currently addressed in office visits could be addressed much more readily by email. That opens up the possibility of more frequent interactions that can help patients who wonder, for example, whether a side effect they’re having is related to a new medicine they started. If we do that, then the office visits can be much more meaningful because you don’t need as many. 

There are definitely ways to easily imagine to push things forward, including telemedicine. Yes, we need to then engage our students in that.

Do you think the low-pay, high-workload model of medical residency that’s funded by federal taxpayers still makes sense?

It’s a strange model, but the reality is that the residents have two functions. They provide real work and help, which is why we feel like they deserve some salary, but they are primarily learners. They’re there to finish up their training. That’s in the best interest of society, to have that. 

Who should pay and how? It ends up the federal government actually pays for the minority of residents. Most are paid for through the hospital system. So it’s really, truly a strange, hybrid system. Could there be a better system? Probably. We do need to pay them something, but they don’t justify getting paid at the same level as physicians who have finished their residency.

Where in a physician’s career are the majority of concepts and treatment methods developed? How can a physician who has been out of school for 20 years remain as current as one who graduated five years ago?

I think that’s a learned behavior, not a deterministic one. I don’t think there is a point at which physicians are more difficult to teach. 

Physicians in general love their independence and love to be the final say in whatever it is that they work in. Traditionally, they’ve not been so comfortable changing over time. But honestly, if you look at systems, there have been some systems that have changed dramatically and pushed more to evidence-based medicine quite comfortably, where the physicians — a whole variety of different types within that system — move forward in lock step with the evidence. A good example is Kaiser Permanente.

I think there are processes and ways of working together and teaching each other and continuing to focus on education that can encourage those behaviors.

How much of medical practice is based on evidence and whose job is it to incorporate it ongoing?

Most of what we do in medicine, there’s not solid, high-quality evidence to support. It’s done because it seems reasonable, or it’s done because it’s always been done, that way or it’s done because the science underneath it seems to probably make sense, or it’s done because another patient was treated that way and did fine so it’s probably fine to continue. High-quality evidence — where you’ve got, for example, randomized trial data — that’s a minority of the decisions and weighty decisions that physicians make.

Currently it isn’t clear whose responsibility that is. I would say that physicians ultimately have the responsibility to practice based on the evidence, to stay current and to stay true to the evidence. But it is extremely difficult to do that in standard independent practice because things move so quickly and because it requires more adjudication than just reading papers. You have to really look at the papers in light of other evidence. You have to read the papers deeply. You have to think of the alternatives. 

That works better when groups of physicians and others come together to decide what standards they will practice under. Then the system really does have some responsibility for making sure that this can happen better.

In our case, we do feel like this is a responsibility that we have back to this community — to work with the excellent physicians here, but help them to stay excellent forever. How will we do that? We’re looking at ways. They need incentives to stay current. How do we work in creating those and then create those educational opportunities and also those arenas in which they can review and judge and decide on evidence that they should all follow.

How will you teach students to respect both traditional, large-scale, well-developed studies –which are often published only if the for-profit company sponsoring them likes the results — versus self-interpreted smaller data sets that will be available almost everywhere?

Obviously you have to teach them a lot more about how you look at data and what the issues are with it. The spectrum that you just described — be suspicious about Phase 2 clinical trials. Phase 3 clinical trials, those are so expensive that you have to publish it results from a Phase 3 clinical trial. That’s less likely, but the early-phase clinical trials — that is an important source of bias, as you say.

The individualization of care is the thing that was implied by your second question, you know, "These 10 people who look like you did well" — you don’t get that information necessarily from a clinical trial. You get it from a broader spectrum of folks who are eligible. They might do some sub-group analysis, but they’re never powered to adequately show a difference by sub-group.

Then obviously the problem with that evidence is that it’s weak. Maybe it’s luck that they all did well. Maybe doing well is an expected outcome, so it would be rare to actually have something bad happen. Maybe they were selected in a certain way that made them all do well. You can’t know.

How do you teach that? Data is going to be all around us and that’s a wonderful thing, because it gives us all kinds of additional information that if we’re careful, can be extremely useful in improving care, improving outcomes for our patients, keeping people healthier. 

We have to expose our students to that throughout the curriculum and get them involved in projects in which they’re using data to solve critical health problems. That’s what we do. We take them out of their rotations and they work for nine months in innovation and leadership blocks. They solve real health problems.

If the goal is to make our overall population healthier, what’s the right blend of what you  teach doctors to do as physicians in practicing medicine versus the public health approach that might include areas such as housing, education, income, or personal behavior?

It’s important for physicians to understand the full spectrum. Healthcare only accounts for 20 percent of the potential to improve health. Eighty percent of it comes from all that other stuff that you mentioned. If the goal of the physician is to keep people healthy, they need to be aware of that 80 percent and also understand how to integrate that into their practice or into their broader, system-level solutions to health problems.

The question is, where you draw the line? Are physicians going to be proponents of income equality because income differences lead to health issues? No, probably not. It’s not about getting to the political and the governmental aspects of the predictors. 

What if it is about diet and exercise? Those behaviors, or taking your meds — those are important things in which physician interventions or system-level interventions that could include a physician on the team are important things for the health system to focus on. It makes sense for physicians to have roles in those areas.

That stuff becomes critical to our curriculum. It is far more effective and can be cost saving to keep people healthier than it is to treat them once they are sick. The highest paid health professionals are physicians. Why shouldn’t they be engaged in that? Why shouldn’t they be helping to guide it rather than just been focused on the patch-up work?

Being in Austin and being associated with Dell suggests a focus on drug and technology research, but the product of such research is usually commercialized expensively without necessarily improving overall outcomes. How do you balance the human need for research with the desire of medical companies to make big profits and raise healthcare costs even more?

That’s one of the key reasons I’m here. I was the associate vice-chancellor of research and responsible for the Clinical and Translational Science Institute at UCSF. Our job was to accelerate discoveries from the laboratory out into health improvement. 

The reality was just as you said. We could keep doing that, but they’re going to be always maximally priced. They never lower cost, but they always elevate cost of care. That’s true — they have control of the pricing, so they price it to the point that it’s somewhere between $50,000 and $200,000 per quality-adjusted life year. That makes sense from their perspective to do that, but it just contributes to the problem where you’ve got so much cost that you can’t really afford innovation any more. 

That to me suggested, gosh, we’ve got to find a new way. What we’re trying to do is set up the health system to embrace and look for solutions that drive down cost. I think that we’ve left a lot of fruit low hanging on the trees because we haven’t had that perspective.

One example is antipsychotics. We know, as we’re looking at expensive health problems in Austin, the homeless — some of whom are schizophrenic — are a huge burden. Their outcomes are just terrible. It’s hard to get them to take their meds. It’s part of their disease. But if we had long-acting drugs, that could dramatically reduce the cost compared to what we pay today, with drugs that have to be given daily and are probably taken weekly if you’re lucky. That is an example of how taking a different perspective opens up new approaches, also for research.

Our hope is to integrate those perspectives throughout the research channels that we’re developing . We know we’ll have discoveries that come out and cost $200,000 per quality-adjusted life year, but our focus is to really concentrate on those that actually can reduce cost and improve outcomes.

It’s easy in the medical trenches to become disillusioned with what physicians are being asked to do, what issues they face that are beyond their control, and how the US healthcare system compares to countries that structure things differently. What will you tell students they need to do to improve it?

This is the absolute best time to go into medicine. We’ve gotten a point where we’re at the precipice — where physicians are unhappy, patients are unhappy, and we’re still costing the country a huge amount, 40 percent  more than Switzerland and that’s the next closest country. We’re at this crisis point. That means this is the time at which we can really push forward the creative solutions to healthcare. 

What are those solutions? Some are  easy to imagine, and as soon as we change the payment schemes, they become obvious and we’ll catch on. The payment schemes are changing. Some are not so obvious. It’s early days in what will be a really exciting point in medicine. I don’t think practicing medicine will look like it does today even 10 years from now.  I think it will be much more technology enabled, much more data enabled. The physician will be a true partner in improving health. That transition will be wonderful for those in practice and for the population.

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November 30, 2015 Interviews 1 Comment

Morning Headlines 11/30/15

November 29, 2015 Headlines 2 Comments

Dr. Patrick Soon-Shiong is postponing IPO of healthcare data company NantHealth

Healthcare billionaire Patrick Soon-Shiong, MD, will delay the IPO of his digital health startup NantHealth until market conditions improve. Soon-Shiong explains, “We’re basically ready. The problem is, we don’t want to go out in the current market. There is no reason for us to go out there in a bear market.”

Partners enters a genetics market

The Boston Globe covers Partners Healthcare’s sale of GeneInsight, its home-grown gene analysis software, to Sunquest Information Systems.

Medical Company LabMD Sues FTC Lawyers Over Data-Privacy Case

LabMD sues three FTC lawyers after being driven out of business over the agency’s poorly-investigated data privacy accusations. The case against LabMD was eventually thrown out by a DC judge and the now-defunct business is suing the FTC’s lawyers for “bringing a case based on fictional evidence.”

Samaritan plans for huge bump in IT spending

47-bed Samaritan Healthcare (WA) will implement Epic at a cost of $12 million. CFO Paul Ishizuka notes that the total cost is “magnitudes higher” than the hospital had spent on previous systems, but explains that interoperability across inpatient, ambulatory, and other health systems was the ultimate objective.

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November 29, 2015 Headlines 2 Comments

Monday Morning Update 11/30/15

November 29, 2015 News 7 Comments

Top News

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Billionaire Patrick Soon-Shiong, burned by poor IPO and biotech markets that evaporated $1 billion of the value of his NantKwest following its July IPO, postpones his planned IPO of NantHealth. “There is no reason to go out in a bear market,” he says.


Reader Comments

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From Turkey Trotter: “Re: poll idea. How do readers pronounce HIStalk?” You can vote here. It’s always been H-I-S-talk for me, but I don’t know which is more common know since I rarely hear it spoken by anyone else as I write it in solitude. The name’s back story is that when I first started putting random thoughts online back in 2003, the old blogging tool I was using (Blog City) required entering a site name. The term for hospital IT back then was “hospital information systems,” and from that, I quickly (and not very creatively) came up with “HIStalk.” Not that it really mattered since literally nobody was reading other than me.

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From Publius: “Re: New York-Presbyterian. I predict they will go Epic in the next 1-2 years. They are the only major NYC healthcare organization not on Epic, new CIO Daniel Barchi was CIO at two Epic organizations, and a plethora of experienced Epic consultants will be available from NYC Health + Hospitals, NYU, HSS, Montefiore, etc.” I had the same thought as soon as I heard Daniel was going there, plus the Weill Cornell physician group is already on Epic while the rest of the organization is on Allscripts. A NYP contact tells me they aren’t planning to look elsewhere, but I would be surprise if they don’t at least consider it.

From Steeple People: “Re: clearinghouses. How many EMR/PM vendors own their own? And if they don’t, which one do they use?” Vendor folks are welcome to provide their answer by leaving a comment.

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From Vince Ciotti: “Re: CPSI acquiring Healthland. CPSI’s revenue had flattened out in the last couple of years. Healthland’s customer base is very small facilities such as Critical Access Hospitals that have little funding as the company struggles to convert its Classic users to Centriq. CPSI has a strong sales and marketing team and must be aiming to sell Healthland customers its Thrive system – like Cerner acquiring Siemens, each replacement of the Classic system that will be sunsetted in two years will mean several million in booked revenue, quite a windfall for CPSI if they can make the sales. Healthland has made few new sales in the past few years and the privately held company has revenue of only around $80 million with 500 employees. It was acquired by Francisco Partners in 2007.” Vince has offered to do a webinar on the acquisition, which I think might be fun. 

From Kaiser Cutter: “Re: programmer joke. A programmer’s wife asks him, ‘Can you pick up a loaf of bread, and if they have eggs, get a dozen?’ He returns home with 13 loaves of bread. She asks, ‘What happened?’ He said, ‘They had eggs.” I returned the favor with this one. Why do programmers always mix up Halloween and Christmas? Because Oct 31= Dec 25.


HIStalk Announcements and Requests

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Sixty percent of poll respondents think everybody — not just covered entities — should be regulated by federal patient privacy laws. Mak doesn’t want taxpayers footing the bill for the inevitable bureaucracy, but HIT Geek says we need a common, simple nationwide privacy standard that can be easily enforced by built-in mobile device security controls. New poll to your right or here: where will you get your 2016 medical insurance? Click the Comments link on the poll after voting and let me know whether you’re happy with your coverage and its cost.

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Our DonorsChoose project provided an iPad for the Nevada first grade class of Mrs. Sensibaugh, who says the students are using it daily to study math and language concepts. She adds, “My students have been motivated and truly excited to use this wonderful technology. They can’t believe that someone actually cares so much about their education that they would donate such a wonderful, thoughtful gift.” Mrs. Owen from Indiana says that only two students per class have their own calculators and rulers, with our donation of 25 of each allowing students to perform dimensional analysis, mole conversion, and density graphing. I like how she attached them to clipboards and labeled them.

One of my recurring off-topic rants is the ridiculous price of razor blades, whose non-interoperable cartridges are so expensive that many stores bizarrely lock them away with the electronics. I found a solution: a safety razor like my grandfather used and high-quality blades that cost $9 per hundred (all blades fit all razors). The blades are not only good for several shaves, but are also double-sided, so I figure the $9 worth will last me for at least 2-3 years. Now I just need to convince people of the absurdity of high-technology cars riding on expensive and dangerous rubber balloons.


Last Week’s Most Interesting News

  • CPSI announces that it will acquire small-hospital systems competitor Healthland for $250 million, also giving the company a presence in 3,300 skilled nursing facilities.
  • AcademyHealth takes over the Health Datapalooza conference.
  • A research firm predicts that ransomware will infect medical devices for the first time in 2016.
  • The DoD announces that its Joint Legacy Viewer, which allows users to view combined data from the VA’s systems and its own, meets the federal requirement that the two organizations deploy interoperable systems.
  • A court rules that Tata Consultancy employees who downloaded proprietary Epic material while posing as client consultants constitutes “inside hacking.”

Webinars

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

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

December 2 (Wednesday) 2:00 ET. “Creating HIPAA-Compliant Applications Without JCAPS/JavaMQ Architecture.” Sponsored by Red Hat. Presenters: Ashwin Karpe, lead of enterprise integration practice, Red Hat Consulting; Christian Posta, principle middleware architect, Red Hat. Oracle JCAPS is reaching its end of life and customers will need a migration solution for creating HIPAA-compliant applications, one that optimizes data flow internally and externally on premise, on mobile devices, and in the cloud. Explore replacing legacy healthcare applications with modern Red Hat JBoss Fuse architectures that are cloud-aware, location-transparent, and highly scalable and are hosted in a container-agnostic manner.

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

December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.

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

December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenter: Stephen Claypool, MD, medical director of innovation lab and VP of clinical development and informatics for clinical software solutions, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

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


Acquisitions, Funding, Business, and Stock

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The Boston newspaper covers the previously announced sale of Partners HealthCare’s GeneInsight genetic testing  software to Sunquest, which will pay Partners sales royalties. The article mentions similar software deals between Partners and Health Catalyst and Beth Israel Deaconess Medical Center and Athenahealth.

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India-based healthcare software vendor Indegene Lifesystems expects to hit $250 million in annual revenue by 2020 and plans to go public within 2-4 years. The company says it will announce an acquisition in the next few days and is also in acquisition talks with an unnamed population health management analytics company.

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Georgia-based Brightee, which offers durable medical equipment and hospice software,  will expand R&D headcount at its Scotland offices to 150-200 employees. President and CEO Dave Cormack, who is from Scotland and was a director of Aberdeen Football Club, hopes to double annual sales to $240 million within 3-4 years.


People

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Culbert Healthcare Solutions promotes Jaffer Traish to VP of its Epic practice.


Announcements and Implementations

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Peer60 releases Trends in Medical Imaging Technology just in time for RSNA. It finds that radiology providers are most excited about breast tomosynthesis and cloud-based imagine sharing. VNA vendor preference is fragmented but Merge holds the lead, ACR Select enjoys a 60 percent mindshare in clinical decision support, and Nuance leads the “favorite imaging IT leaders overall” category. 

GE announces the GE Health Cloud for its imaging devices. The company also announces Centricity radiology apps: Cloud Advanced Visualization, Multi-Disciplinary Team Virtual Meeting, Case Exchange, and Image Access Portal.


Government and Politics

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Medical testing firm LabMD, which says it was driven out of business after seven years of fighting Federal Trade Commission charges of lax data security, fires back by suing three of the FTC’s lawyers for illegal and unethical prosecution. The FTC’s case, which was dismissed last week by a federal judge who found that no consumer harm occurred, was based on information from security vendor Tiversa. LabMD claims that Tiversa illegally hacked its systems and then threatened to expose the breach unless LabMD signed up as a Tiversa customer. LabMD CEO Michael Daugherty says the FTC should focus on real data breaches instead of potential ones and should be more transparent in conveying its expectations to companies, especially healthcare ones. He adds that FTC is made up of enforcement lawyers rather than technology experts and spent millions of taxpayer dollars pursuing his case, observing that HHS is a lot more willing to work with providers in trying to improve data security.


Other

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In Western Australia, a government committee finds that 783-bed Fiona Stanley Hospital is still riddled with IT problems a year after an opening that was marked by delays and cost overruns. Employees report that  a patient admission requires 15 minutes, the incompatible ICU system requires staff to print and scan a transferred patient’s record, and a poorly designed Wi-Fi system with limited coverage forces nurses to communicate via walkie-talkie. The report adds, “No hospital in the North Metropolitan Health Service is able to electronically access a medical record created at FSH,” although it concedes that given limited IT budget and skills, limited interoperability is reasonable and the new system is still better than paper records. The committee expressed concerns that no system in Australia can issue a delivery receipt for discharge summaries, leaving the sender unaware of whether it was received and acted upon appropriately.

In Australia, a cancer patient is given an incorrect chemotherapy dose due do a typo on a printed protocol form. Royal Adelaide Hospital’s hematology service noticed its error after six months and sent a group email with the subject line, “Updated AML … protocol uploaded.” Flinders Medical Center didn’t update its forms and gave the man half the desired dose. He’s one of 10 leukemia patients who were underdosed, of which two have relapsed and died. An independent review questions why Royal Adelaide sent a bland email that didn’t highlight the urgency of the required change and to alert clinicians that they likely underdosed their patients if they didn’t double-check the form’s incorrect dose calculations.

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Samaritan Healthcare (WA) will spend $12 million to implement Epic, increasing its annual system maintenance cost from $500,000 to $2 million. According to the CFO, “It is a much, much more expensive system than we are using right now, so our whole trick is, how do we maximize the investment in the system? Because it will give us so much more and better information. Can we extract the information to reduce cost and improve care? That’s really what our task is as management.”

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PatientKeeper offers a Thanksgiving-specific ICD-10 infographic.

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Hospitals in England urge consumers to avoid their EDs on Tuesday as 40,000 junior doctors and their British Medical Association labor union plan a 24-hour strike on Tuesday during which they will treat only emergency patients. The doctors will strike again on December 8 and 16, but on those days they won’t treat any patients at all, even those with urgent conditions. BMA expects the government to send Army medical staff to cover the EDs. The residents are protesting a change proposed by Secretary of State for Health Jeremy Hunt that would expand hospital services to seven days per week following reports that patients are 15 percent more likely to die if admitted on Sunday instead of Wednesday. Junior doctors already work weekends and nights, but worry the proposed changes will cut their overall pay.

The Columbus, OH newspaper finds that Ohio’s medical records copying costs are among the highest in the country, as providers can charge $3.07 per page for the first 10, $0.64 for pages 11-50, and $0.26 for additional pages. Neighboring Kentucky, in contrast, mandates that providers give patients the first copy of their records at no charge. Actual charges for a 10-page record range from $3.60 at OhioHealth to $30.70 at Mount Carmel and Ohio State.

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The New York Post reports that North Shore-LIJ Health System paid its president and CEO $10 million last year, much of it as a retirement payout even though he’s not retiring. New York-Presbyterian paid its CEO $4.6 million and gave several of its “honchos” housing allowances and chauffeurs, while Montefiore Medical Center paid its head $4.8 million. The state hospital association gave the standard checklist of excuses: it’s a tough job and the market is so competitive that hospitals would lose their executives if they didn’t pay them millions.

Vince Ciotti provides a tongue-in-cheek overview of system longevity.

Weird News Andy titles this story “To Womb It May Concern.” in which a not very convincing article (“it blew our minds,” reports the gushy writer) predicts that surgeons will within 5-10 years successfully transplant a uterus into a former male (transgender woman). WNA quotes Homer Simpson addressing Marge in bed: “But it’s uterus, not uter-you.”


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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November 29, 2015 News 7 Comments

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

November 25, 2015 Rick Weinhaus 4 Comments

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

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

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

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

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

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

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

The paper chart came in two basic types.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Next Post: Telling a Story on a Timeline

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

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November 25, 2015 Rick Weinhaus 4 Comments

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Reader Comments

  • Concerned: It's so sad that you would attack Rob and Peggy like this. They are loved by the organization and have gone above and be...
  • reading: Bravo to Mrs. Sutton from Illinois....She’s now having the students teach fraction concepts to second graders to “en...
  • It's Over 9000: ZDogg just made my Friday....
  • correction Mr. H: It's not homey, it's homie, homie :)...
  • ZdoggMD: is pretty wack yo--brother is played out. Thirsty....

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