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Morning Headlines 5/20/16

May 19, 2016 Headlines No Comments

Theranos throws out all Edison blood test results from 2014 and 2015

Theranos issues tens of thousands of corrected lab test results from samples processed on its proprietary Edison analyzer between 2014 and 2015.

#FHIR and the Gartner Hype Cycle

Grahame Grieve, architect of HL7’s FHIR protocol, says that FHIR is being overhyped and denounces the idea that FHIR will solve interoperability.

ITelagen Acquires Planet Logic to Provide World-Class Cloud Hosting Solutions

ITelagen, an EHR hosting and support vendor, acquires competitor Planet Logic.

Sandwell & West Birmingham Hospitals NHS Trust appoint Cerner as preferred supplier for major Electronic Patient Record programme

In England, Sandwell and West Birmingham Hospitals NHS Trust chooses Cerner Millennium.

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May 19, 2016 Headlines No Comments

News 5/20/16

May 19, 2016 News 1 Comment

Top News

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Theranos cancels or corrects the results of tens of thousands of lab tests it ran in 2014-2015 on its proprietary Edison analyzer. Basically, the company says none of those results can be trusted even though the medical decisions made from them have long since happened.

One doctor who sent a patient to the ED in 2014 because of abnormal lab results recently received a revised report in which the corrected results were actually normal. In addition, an insider says Theranos regularly reported inaccurate coagulation results because it incorrectly programmed its Siemens analyzer.

This admission by Theranos is ample cause for the company’s doors to close even before CMS metes out its likely punishment. The privately held (and therefore minimally transparent) company hyped its technology without medical evidence; claimed as its niche a questionably advantageous (except in pretending to be a high-multiple technology company) finger-stick sampling method that turned out not to work; loaded its board and management team with people who know nothing about healthcare; expended extraordinary effort to avoid participating in the mainstream medical community; advocated that consumers order their own lab tests even though the clinical and financial impact of that practice has not been studied; and now admits to a remarkable level of incompetence in not even being able to correctly program another company’s analyzer. Selling cheaper lab tests isn’t much of a draw (no pun intended) if the results are untrustworthy. Theranos needs to give back the tiny bit of volume it took from Quest and LabCorp and find something less critical for its college dropout founder to pursue while waiting for the inevitable patient class action lawsuits to gather steam.


Reader Comments

From Damascus Sword: “Re: MD Anderson. Encore did the selection, Santa Rosa did the go-live, but whoever ran the implementation (Deloitte, I think) would have been paid fees far exceeding the other two.” Unverified.


HIStalk Announcements and Requests

I’ve figured out how to filter out the 99 percent of political “news” (especially of the emotional Facebook and Twitter variety) that is really just zealots spewing intolerant invective: skip anything that uses a carefully chosen unflattering photo of a political figure or that refers to that person by last name only. I apply similar criteria for scientific or technical articles in which the author pretends to be informative while actually editorializing – I move on immediately if I see the words “fortunately” or “unfortunately.”

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Mrs. Boyd says students in her North Carolina class have “taken ownership of their learning and celebrate each other’s success” by using the two Osmo gaming systems we provided in funding her DonorsChoose grant request. Most interesting to me is that she reports — as have other teachers for whom we have provided group learning technology – that it has brought some shy students out of their comfort zone as they participate more actively, which will probably benefit them long after they’ve forgotten the specific lessons.

This week on HIStalk Practice: Keizer Solutions acquires Colonial Valley Software. PatientPop raises a $20 million Series A. The Midwest Independent Physicians Practice Association gets into telemedicine. The Center for Rheumatology’s expansion strategy highlights the tough choices physicians must make to remain independent. Medical Association of Georgia plans to launch private HIE. Consortium of Independent Physician Associations opens for business in Ohio. CityMD CMO David Shih, MD shares the challenges urgent care facilities face when it comes to adopting healthcare IT.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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EHR hosting and support vendor ITelagen acquires competitor Planet Logic.

Onex Corp. again places medical imaging vendor Carestream Health on the market, considering separating its medical imaging and dental imaging business in raising up to $3 billion. The buyout firm acquired Eastman Kodak’s healthcare business for $2.35 billion in 2007 and failed to attract a buyer in 2013 at the $3.5 billion price it sought. The company made $360 million EBIDTA on revenue of $2.1 billion in 2015.

Quality Systems (NextGen) reports Q4 results: revenue flat, adjusted EPS $0.19 vs. $0.21, meeting revenue expectations and beating on earnings. 


Sales

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England’s Sandwell and West Birmingham Hospitals NHS Trust chooses Cerner pending financial approval.

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Lake Health (OH) chooses Cerner Millennium and HealthIntent, replacing Soarian.

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Houston Methodist (TX) selects Phynd to manage and share the data of its 21,000 providers.

Decatur Morgan Hospital (AL) chooses InfoPartners for its Meditech 6.0 to 6.1 upgrade.


People

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Stratus Video hires Brad Blakey (CareCloud) as VP of sales and marketing.


Announcements and Implementations

SAP announces its Connected Health ecosystem and its most recently announced partners CancerLinQ, Castlight Health, and Dharma Platform.

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Health IT startup Vericred announces availability of API-driven drug formulary datasets for health plans in all 50 states. The API returns information on drug formulary tiers, prior authorization, step therapies, and quantity limits.

InterSystems releases its TrakCare Enterprise laboratory business management system, with initial implementation in two NHS trusts.


Government and Politics

CHIME and the Association for Executives in Healthcare Information Security send comments to a Senate hearing on ransomware, suggesting that Congress remove the HHS restriction on pursuing a national patient identifier (which it says will make health records less attractive to hackers since they won’t have otherwise identifiable information such as SSN) and to “encourage investment through positive incentives for those who demonstrate a minimum level of cyberattack readiness and mature information risk management programs.” I can’t imagine any industry other than healthcare that could keep a straight face while asking Congress to pay its members for keeping their own business information secure.


Privacy and Security

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A hacker claiming to be part of the Anonymous group leaks a database from two hospitals in Turkey in retaliation for a previously rumored Turkish hacker’s attack on two US hospitals. Anonymous denies any involvement.

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The hackers behind the TeslaCrypt ransomware sunset their product and post the master decryption key on their support site.


Technology

UC Irvine’s medical school posts a video showing the use of smartphone-powered digital health technologies. 


Other

FHIR architect Grahame Grieve says FHIR is being hyped as the solution for interoperability, adding that groups like HL7 can’t impose prescriptive information models or force vendors and providers to standardize processes – it can only provide a common way for them to do it if they’re so inclined. He adds that conforming to FHIR doesn’t accomplish anything unless it’s supported by cultural changes. 

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A prenatal imaging clinic in Canada blames a computer virus after it gives a dozen parents-to-be identical ultrasound images that also match the sample image featured on the company’s website.

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Australian Computer Society profiles the year-old, non-profit CancerLinQ, an American Society of Clinical Oncology project that is analyzing the information of 1 million US cancer patients to identify treatment patterns and to allow doctors to search symptoms and treatments. Its CEO says that only three percent of cancer patients qualify for clinical trials, but the automated collection of EHR information for the other 97 percent creates a rapid learning system in which any doctor who contributes de-identified information can use the entire database.

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Weird News Andy sings happily along to his just-created TV jingle, “Cleaner, Fresher, Softer Arteries!” Scientists find that a sugar that’s the active ingredient in the Febreze air freshener can remove plaque from hardened arteries. WNA cynically notes that the article’s last line should really be its first – the sugar can’t be patented, so drug companies aren’t interested in sponsoring the clinical trials that would allow it to reach the human market.


Sponsor Updates

  • Valence Health opens registration for its Further 2016 value-based care conference September 14-16 in Chicago. 
  • HDS will exhibit at the Cerner Great Lakes RUG May 31 – June 2 in Chicago.
  • Influence Health will exhibit at the Healthcare Marketing & Physician Strategies Summit May 23-25 in Chicago.
  • InterSystems will exhibit at the Midas+/Xerox Annual Symposium May 23-25 in Tucson, AZ.
  • National Decision Support Company adds support for ACR’s Radiology-TEACHES and R-SCAN initiatives to its platform.
  • Frost & Sullivan recognizes Intelligent Medical Object’s medical terminology platform for enabling the clearest patient narrative.
  • LiveProcess will exhibit at the Mississippi Preparedness Summit May 24-26 in Biloxi, MS.
  • Obix Perinatal Data System will exhibit at the HIMSS Northern Ohio Trade Faire & Conference May 26 in Cleveland.

Blog posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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May 19, 2016 News 1 Comment

EPtalk by Dr. Jayne 5/19/16

May 19, 2016 Dr. Jayne 1 Comment

The week has been chock full of stories that unfortunately I can’t even remotely write about. Although some of my experiences are universal and could happen almost anywhere, sometimes I run into situations that I can’t imagine happen more than once. I’m pretty good about writing them down, though, in the hopes that I can change them up a little bit and use them in the future.

If nothing else, this week I have gotten a lot of practice in trying to maintain my composure when I literally wanted to laugh out loud. I’ve also made good use of my skills in talking executives off the proverbial ledge when they’re ready to jettison staffers, building hope that with hard work and thorough follow-up, we can turn things around and prevent further casualties.

One thing I can talk about is my work with customers who want to work on population health projects. The first thing I do is a run a working session called “What is Population Health” that forces the organization’s leaders to come to terms with the fact that it’s often ill-defined, and even more so given the fact that everyone around their table has a different idea of what they think they need.

Plenty of people still think they’re going to be able to buy a single technology solution that’s going to deploy itself with minimal input. These are the folks that also think that these are IT projects rather than clinical and operational ones, and who are generally surprised when I explain that it’s going to take a village to get them done and that no one is going to be allowed to abdicate their responsibilities.

My clients often complain about their software vendors, demanding more bells and whistles than what exists in current general release versions. In my experience, many customers are using only a fraction of the tools they’ve already got, and sometimes the continued banter about future content is just an excuse to avoid dealing with current-state problems.

One of my clients had been fighting with a vendor about their ability to create complex reports to identify certain sub-populations of patients. In reality, the client wasn’t ready to handle even the simplest of population health work flows and refused to admit it. They need to spend a lot more time looking at their staffing and deciding who they want to be as a practice before they start outreach and disease management programs. For starters, they have to deal with their six-month appointment backlog and their insane phone volumes. Until they address those issues, they can’t handle more patient visit volume or consider offering non-face-to-face visits.

I love a good challenge, and the groups I’m working with right now are unlikely to disappoint. Although they require the kind of long-term consulting that’s going to need not only my partner and me but some contractors to execute, some of the help they need is of a more routine nature. I’m never surprised by how many organizations lack the basics, such as communication plans, service level expectation agreements, and other types of policy and procedure documentation.

There are different ways to approach dysfunctional organizations. Sometimes it needs to be done from the top down, sometimes from the bottom up, and sometimes you just want to implode the whole thing and start from scratch. Figuring out the best way to approach it given an organization’s culture and leadership is sometimes more of an art than a science and sometimes it’s frankly voodoo.

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The week has also been full of non-work laughs, with the best occurring at my home airport, recently made infamous by a viral video about their TSA lines. Fortunately, I had TSA PreCheck, so I was in a shorter (yet still long) line when my companion and I observed a woman with a hula hoop trying to cut the line. She started all the way at the back of the regular line and just kept working her way past passengers until she got to the first airport employee who was sorting the PreCheck passengers from those with regular clearance. She was slurring her speech, explaining that she was going to miss her flight and that she needed to get to the front of the line with her friends. Although the agent stalled her for a bit, eventually she was let through.

By now plenty of people were watching the spectacle from all four or five lines that were snaking their way towards the actual TSA agents. She was just shoving past people by this point, with no one stopping her. Whether they were worried about getting into a confrontation with someone who was possibly impaired or disturbed or something else, most of them stepped aside as she pushed past, thumping passenger after passenger with her hula hoop slung over her shoulder. Most of us in the PreCheck line were waiting for TSA to send her packing, but were surprised that they let her through.

This circus was a stark contrast to my experience at another airport recently, where my friend was forced to check her bag because it was slightly non-rectangular, having been crushed on an earlier flight to the point where it exceeded the bag-sizer’s dimensions by half an inch due to its skewed shape. At that airport, they were examining bags before people were allowed in the security line, vs. my recent experience where the hula hoop was allowed through. I’m pretty sure a hula hoop fits neither in the overhead compartment nor under the seat in front of you, so I wonder what they did with it on the flight.

Regardless, it was good to have some diversion before I boarded a flight where I knew I’d be immersed in the exciting world of QRUR reports, which require a 20-page document to explain their contents. I envy the travelers that board with a stack of magazines or their headphones and eye mask. Those magical minutes during takeoff, taxi, and landing before I can fire up my laptop and get to work are always good times to reflect on the week ahead or behind, depending on which way I’m heading.

I chuckled to myself as I thought of one client leader who still can’t figure out how to pronounce my name despite multiple onsite visits. One of his colleagues told me they play a behind-the-scenes game to see how he’ll mangle it next. Someday I’m going to write a book, and it’s going to center around the fact that you can’t make this stuff up.

What are the craziest things you encounter during your work day? Email me.

Email Dr. Jayne.

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May 19, 2016 Dr. Jayne 1 Comment

Morning Headlines 5/19/16

May 18, 2016 Headlines 2 Comments

Statement from the College of Healthcare Information Management Executives and the Association for Executives in Healthcare Information Security

In a letter to the Senate Subcommittee on Crime and Terrorism, CHIME addresses the threat cyberattacks pose to healthcare organizations, saying “. Even the largest healthcare delivery organizations, with the greatest investment in security programs, may still fall victim to bad actors as we have seen with some of the largest retail organizations, financial institutions and even the federal government suffering large-scale breaches.”

Rating hospitals by the stars: The feds’ latest plan to measure quality is the most controversial

The Washington Post outlines the industry concerns that led to CMS delaying the implementation of its new star rating system for hospitals.

Obamacare Rates Rise in New York, and So Does Political Risk

Insurers in New York are requesting premium increases averaging 17 percent in New York. Alan Murray, CEO of New York insurer CareConnect, says, “If these requests aren’t approved, you are going to see more carriers leaving the market.”

ER docs sue HHS over out-of-network payments

The American College of Emergency Physicians is suing HHS over a provision of ACA that allows insurers to underpay for out-of-network emergency medical services.

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May 18, 2016 Headlines 2 Comments

GE Healthcare Announces Project Northstar

May 18, 2016 Interviews 9 Comments

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GE Healthcare announced this morning at its Centricity Live 2016 user conference in Phoenix, AZ its next-generation IT solution for ambulatory care delivery. I spoke with GE Healthcare IT VP/GM Jon Zimmerman of the company’s value-based care solutions team ahead of the announcement.

Describe Project Northstar that is being announced.

Project Northstar is GE Healthcare’s next-generation IT solution for ambulatory care delivery to fundamentally help practices thrive in the world of value-based care. We strongly believe that the move to value-based care is on. It’s not going to be a light switch. It will be a transition over time.

We also see that the tools and services that have been built around population health have not been integrated with care delivery from a community perspective. It’s certainly not completely integrated with revenue cycle management with both value and volume in mind. Payers are changing, too, so there’s new payer connectivity required.

We’re taking a point of view from a physician’s workflow and driving population health integrated with care delivery, integrated with revenue-cycle management both value and volume, with new forms of payer connectivity to take waste out of the system. Our drive is to increase quality, efficiency, and financial performance for customers.

Is this a standalone product or is it just for Centricity users? Who is the target customer?

The audience starts with GE Centricity Practice Solutions / GE Centricity EMR first, but we built it with open principles. We believe that some of the advanced ACOs may want to take some of the capabilities that we’re offering and also make them useful and integrated on top of other EMRs.

Is it an upgrade or a separate product that Centricity customers will buy?

Look at it as an extension from what people have today with a migration path to roll it over Centricity over the next few years. We believe that a big-bang replacement would be a very bad and disruptive idea. Many of our customers have given us great clues on how to do a safe, smart migration transition. It’s not a big bang, turn that off, turn that on.

What providers and partners did you work with?

We worked with Westmed Practice Partners in Westchester, NY starting almost two years ago. One of the things that was highly attractive about working with Westmed is that they were scoring very high in their quality measures. Their efficiency measures and their ability to collect revenue from their fee- and value-based contracts were also very good. Their leadership knew what they were doing. They knew how they did it.

They were pushing our products up to and beyond their capabilities in order to make that happen. When I thought about how we were going to get to that next generation and who we could work with, I thought it would be good to start with somebody who was so very skilled and who knew us so well. That was Westmed Practice Partners, specifically Dr. Simeon Schwartz, the chairman and CEO.

Was the product built from scratch?

It is not being built from scratch, nor is it being acquired. This was a big discussion that Simeon and I had in the beginning. We are building certain components. We’re also assembling capabilities from different technology providers across the industry.

I don’t think anybody is going to be able to have the time to just go build from scratch, but taking a modern, 21st-century approach is going to be key. We have the luxury of leveraging is a lot of the investments that GE is making with Health Cloud, so this is an extension of what GE is doing as well.

It seems that you’re picturing an ecosystem with components provided by partners. How will that look?

First and foremost, we took a tabula rasa approach, meaning a blank slate. Once we got comfortable with one another in Westmed – and other practices have also helped us design this — one of the keys was, how do you guys work? What do you do all day? We went even to the depths of, with appropriate permissions,observing their delivery of care.

We broke it down with a number of usability experts. GE Corporate, GE Digital has been investing in usability expertise and usability engineers. We leveraged those to break down the work processes of a pretty complex multi-specialty practice. We also focused strongly on, as you would imagine, that primary care is the quarterback, and that user experience is a big deal.

On the business side, we said, how does that work? How can we make a system provide more value for the providers? We broke the providers’ work into basically four areas.

Number one is that I need to understand. When I’m going to see a patient, I need to know a lot about them. How should a system gather that information for me?

Once it gathers that information, I need to know what I’m supposed to do. I need to know how to work. Underneath that is a rules engine that we’ve selected. The rules will be based on what the clinicians want to do. We’ll get rules from specialty societies or individual practices and combinations thereof. They will create a rules-driven system that’s based on a modern user experience with workflow guidance to then get the providers to do what the providers know that they need to do. Our approach here will remove clicks, but also provide consistency through the guidance of the decision-makers for that practice.

The next piece of work is that I need to review and sign. Rules comes in and say, did I do all the things that I’m supposed to do that will be impactful for my volume-driven revenue cycle? Did I document what’s required for my quality reporting?

Last but certainly not least, there’s follow-up care coordination and care management that creates a continuous loop in the system versus a set of independent acts.

For the user experience, we’re using the same technology that Google uses. That’s called AngularJS. For the rules engine, we’ve purchased a commercial rules engine and we’ve put that into our stack. To fill the rules engine, we’re working with a number of practices, with Dr. Schwartz being the first. We have another one signed up specifically for cardiology. We have a workflow engine. Our cloud provider is technologies from GE Health Cloud and supplemented by some things we’ve been doing with Microsoft and Azure over the last few years.

You mentioned reduced clicks and the user experience. You’re not replacing the UI of Centricity, correct?

We had a lot of robust dialogue with our customers on this. The first and greatest impact that we can have is the process of creating intelligent orders — orders that take the context of the patient, the context of the payer, and the context of evidence-based practice and build them into one.

In our initial implementation, users will be in Centricity up to the point where it’s time to create an order. Then the new system takes over seamlessly. It pulls all the information that customers are used to in Centricity. Now you’re into the cloud experience, the next-generation system. Once you complete that set of tasks, we bring you back into the world that you live in.

Physicians spend an awful lot of their time, as they should, in workflows for ordering and diagnosing. That’s why we did that. The more that we talk with customers, they said, "You made absolutely the right choice."

How are you using payer information?

I was one of the lucky people who got to work as a pioneer to invent what we know today as the EDI systems of the US for healthcare starting back in the late 1980s. I have a long-term relationship with working between payers and providers. Just before I came to GE, I was lucky enough to work with a great company called Availity, a provider / payer network owned by 21 Blue Crosses and Humana. I got the opportunity to  understand a lot of the payer processes and what’s missing in the bridge between payers and providers that creates an awful lot of wasted work.

GE was an inaugural investor in the AHIP Innovation Laboratory. AHIP, the payers’ professional association, knew that they had to create more innovation because of the trends that we see. We are inaugural investors.

We are reverse engineering the exchanges of information between payers and providers that goes through phone calls, faxes, physical mail, and portals and embedding that into our current and next-generation systems. A very important point: this is not going to have to wait for a next generation. We’re doing that now.

Let me give you a couple of examples. In Medicare Advantage, being able to prove as a payer that you are closing gaps in care and that patients are getting  good care requires that if the payers see that things are not happening at differential analysis, then we can take a gap in care directly from a payers’ system. Some are pushing them out through sidecars and eligibility transactions. We put that information into the providers’ workflow so the know what’s necessary to be done. Then the providers can use their normal processes to get the work done and deliver the care.

Then payers are going to want it reported back. They’ll  take it through a claim, or some are asking for CCDAs to be sent to them. We also are building the capabilities to deliver the clinical care documents, then the summaries with details, back to the payers so they can ingest them into their various systems, not their claim systems.

Another example is the need for hierarchical condition categories for risk adjustment. We can construct the appropriate data sets that payers are constantly calling the providers for and we can deliver it to them electronically. We know this because we work directly with payers and providers in their distinct workflows to be able to build these new bridges, to do it as electronically as possible within the workflows to reduce burden, reduce waste, and deliver on the Triple Aim.

What’s the timeline for delivering the product?

The first wave is going to come out in Q1 ’17. We’re working with our user groups and providers directly. There’s that preparatory. Then the orders module will come out first, followed by more enhancements that we’re going to be delivering in the RCM, followed by more and more clinical documentation and a collaboration. We’re also simultaneously building a lot more interoperability for collaboration among providers.

Everything that we’re doing from a workflow and technology perspective is being supported by a cloud-based interoperability collaboration hub and supported by analytics that are integrated as well, because there’s going to be a lot of adjustments over time.

We see this complete picture rolling out over the next three years. Based on demand and based on the number of ecosystem partners that we see, we hope to be able to accelerate that, but we want to first and foremost do no harm and create a lot of value as people have to change their business models during this very dynamic time, like none other that we’ve seen before in this industry.

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May 18, 2016 Interviews 9 Comments

Paging Dr. Facebook

May 18, 2016 News No Comments

HIStalk looks at how healthcare use of social networks is changing in light of consumer expectations and provider comfort levels.
By
@JennHIStalk

The rise of social media usage in healthcare settings has increased over the last several years as the entire industry has moved to a more digital-centric way of doing business. Whether it’s patient portals, online bill pay, way-finding apps, or online appoint check-in, patients — and providers, to some degree — have become used to conducting the business of healthcare via convenient, easily accessible, Web-based tools.

While patients in the US may never log in to patient portals with Facebook credentials, their providers are inching their way ever closer to incorporating social networking tools into relationship-building aspects of care.

Twitter Consults Take Off

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Will social networks ever be used as bona fide care tools? With HIPAA’s tight hold on patient data and the love/hate relationship consumers have with privacy, the role of said networks as diagnostic tools remains a pipe dream at best. Not so in India, however, where Practo has added Twitter-based healthcare consults to its ecosystem of digital tools for providers and patients.

The startup, which claims to be Asia’s number one physician search engine, launched the @AskPracto Twitter account in early April, giving users in India, the Philippines, and Singapore the ability to tweet their health questions to the handle and receive responses back from Practo-affiliated physicians in near real time.

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“We are excited about our partnership with Practo, as this addresses a fundamental need for users and opens up the benefit of real-time healthcare information access to millions of users,” said Ravi Bhaskaran, Twitter’s head of business development for India and South Asia, leading up to the launch.

Bhaskaran’s comment highlights the need for Web-based tools that make it easier for people to access care. With a population of over 1.25 billion, India has more Internet users than the US has people. Healthcare access, especially in rural areas, is — at the risk of understating a nationwide problem — a challenge for those looking to connect with physicians at brick-and-mortar facilities. Thus, mobile, Web-based communication tools seem like the go-to answer for issues of access and provider availability.

“We believe that healthcare issues can be addressed and awareness can be raised by social networks like Twitter,” says Practo Assistant Vice President of Marketing Varun Dubey. “With this partnership, we are making it super easy for people to get access to healthcare information right from Twitter. This collaboration will enable millions of consumers to get quick access to relevant healthcare information and make better, more informed decisions about their health.”

Response to the collaboration has been overwhelmingly positive. “We saw impressive traction on the first day of the campaign,” says Dubey, “with over 5,000 questions being tweeted by consumers with answers sent from @AskPracto. More than 8 million people have participated so far on the social media platform, and this number is growing every day. We’ve actually received questions from many more countries including the US, Australia, and even parts of Africa and Latin America.”

Such collaborations may offer citizens in less developed countries an easy, albeit extremely high-level, answer to issues of access. Their ability to succeed in the US remains doubtful, especially when it comes to the inevitable questions of privacy and physician reimbursement. Dubey is quick to note that Practo takes patient privacy “extremely seriously. Consumers can always come straight to Practo Consult and ask their questions anonymously.”

He is slightly more evasive when it comes to how Practo physicians are reimbursed for their time on Twitter, moving the conversation back to the company’s proprietary physician-patient consulting platform. “All healthcare specialists on the Practo Consult platform respond to questions in order to generate more awareness and enable consumers to make more informed decisions about their health,” he explains. “This in turn helps them build their value as a qualified, experienced, and trusted doctor. If you think about it, a patient who gets the right answer on Practo Consult from a verified doctor will trust that doctor and is likely to visit him or her in the future for any healthcare problem that needs to be assessed in person.”

While the @AskPracto handle is likely part of a larger marketing push to drive users to the company’s private consulting platform, it can’t be denied that opening up healthcare expertise by way of social media will likely offer underserved patients an easy, affordable way to have their high-level healthcare questions answered.

Messaging Apps Make Provider Wish Lists

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The concept of healthcare diagnoses via social media seems to be taking a different turn here in the US, with secure messaging apps piquing the most provider interest and vendors responding accordingly. Remote consulting startup HealthTap launched its service via Facebook’s Messenger app last month, offering users the ability to submit questions and receive answers from the company’s physicians covering 141 specialties.

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“HealthTap is a really cool platform,” says Piedmont Healthcare (GA) Chief Consumer Officer Matt Gove, “and them getting into Messenger makes all the sense in the world. But when you’re a healthcare provider, you have a different cost structure. We have a different way of interacting with people. We have a different goal in terms of increasing the health of our communities and building long-term relationships with individuals. It’s a bit different than the app that allows you to quickly ask a question and keep moving.”

“We’re certainly interested in how to use digital technology to provide alternative models of care,” he adds, “but I haven’t seen the use of social networks to diagnose people. Where I am most excited is not doing it inside social networks, but doing it inside messaging apps. That’s what has the most potential – inside Facebook Messenger where you can have a secure conversation with people about their medical issues.”

“We occasionally use messenger apps to engage with folks about their specific experience with us,” Gove continues. “It’s not as much about the clinical side as it is about the experience side. To be fair, in many ways, I think the customer’s perception of quality is really about the experience they have with us. The average person doesn’t understand clinical quality, but they do understand if you smile and say hello and ask them if they need something. Did you provide them with an easy to understand bill? That’s where the experience breaks down for most people. It’s not in the direct interaction with the caregiver. That’s where we’ve been focusing on — how to better use secure messaging apps to have conversations with people.”

Gove adds that a HealthTap-type messenger app would be nice to have, but it’s not likely to happen until the service is seen as more than a novelty, a sentiment based on Piedmont’s rollout of virtual visits. “We’re getting extraordinarily good reception for it,” he explains. “There’s a hurdle to get people over the novelty piece and see this as just as good as what they’re used to. I would put HealthTap getting into Messenger into that same category. I think messenger apps are an important part of the future. We are not there yet, and if Piedmont isn’t there yet, there won’t be many systems that are.”

The Future Role of Social

Gove, who has gained a well-earned reputation for pushing the boundaries of social media marketing within healthcare organizations like Piedmont and Grady Health System (GA), continues to look for innovative ways to use social media within the healthcare setting. Looking ahead, he hopes to get a better handle on using the social networks that have the most user traction and growth.

“I’ve yet to meet a health system that does Snapchat very well,” he says. “Most of my colleagues describe it as a cesspool. That may or may not be correct. It certainly made me laugh when they said it. It reinforces the fact that Facebook will always be a very powerful place for us to be. Twitter isn’t there and isn’t going to get there. Instagram is okay, but I don’t see it evolving to something that becomes a great tool for engagement. I think you’ve got to look at where people are aggregating and excited and engaged right now and figure out how to best leverage that.”

For now and the foreseeable future, provider use of social media seems to be about building relationships with patients and prospective customers. Gove believes that health systems are just getting to the point where they can use social media in an effective way to have conversations and build those relationships. Making the leap to using Twitter as a clinical tool is not in their near futures.

“I think most providers are looking at social as a way to maintain relationships, which again gets into the messenger space,” he says. “Facebook is their mobile strategy. There’s no denying that as everybody continues to get on Facebook, and as the average age of the Facebook user trends older, that something else takes its place on the young end. Don’t forget that so many of the patients that we need to maintain relationships with everyday are older. Them getting on Facebook is a wonderful thing.”

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May 18, 2016 News No Comments

HIStalk Interviews Don Rule, Founder, Translational Software

May 18, 2016 Interviews No Comments

Don Rule is founder of Translational Software of Bellevue, WA.

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Tell me about yourself and the company.

My background is in software, first at Dun & Bradstreet and then Microsoft. It occurred to me while I was at Microsoft that the ability to digitize biology through sequencing is something that’s going to be very important to healthcare. I spent a lot of time thinking about it there. When I left Microsoft in 2008, I spent a year in a genetic testing lab and realized that just about every lab is going to be interested in genetic testing, but the ability to understand the implications of those tests is not readily apparent.

You’ve heard of the $1,000 genome and the $100,000 interpretation. Getting the cost of that interpretation down is critically important. That’s what we’re focused on. Having looked at all the different shiny objects we could follow, we focused very much on pharmacogenetics because we feel pretty strongly that that’s going to be the first and most pervasive use of precision medicine.

How often do genetic test results change a physician’s mind about prescribing a given drug?

Something came out from Mayo Clinic recently that said if you look over all the potential mutations that there are, the vast majority of people have some mutation that will be actionable at some point in their life. In terms of a specific individual, it’s a little bit skewed because often they don’t get tested unless there’s a suspicion of a problem, so we know we have a sampling error here. But I would say at least 60 percent of the time there’s something that’s actionable.

That patient’s genetic predisposition could mean that a given drug might be entirely inappropriate, or it could be that the dose that would otherwise be chosen might be too high or too low, correct?

That’s correct. For example, 20 percent of the population doesn’t metabolize Plavix well. But if you put together a collection of drugs — and it’s not uncommon that people are taking anywhere from five to 15 drugs — across that collection, it’s pretty common that there is something that you would either adjust the dose or you might look for an alternative on the basis of the person’s metabolism and other factors.

Can you correlate a patient’s new genetic testing results against their old medical history to learn something new, like why treatments have failed or that doses were inappropriate?

Forensically, looking at somebody’s metabolism is not uncommon in trying to understand the cause of adverse drug effects. The most famous case was in Toronto. A woman who had just delivered was given codeine for pain. Four days later, her baby died. It turns out she had multiple copies of the gene that metabolizes codeine into its active form, which is morphine. She instantly processed that codeine into morphine, it was expressed in her breast milk and the baby died. It was only through that sort of forensic analysis that they understood what was going on there.

Are drug companies going back to look for genetic reasons their products may not always work well?

Absolutely. In fact, even some of the development pathways they’ve taken have mitigated away from the cytochromes that they know are variable in different people, or at least mitigated toward different cytochromes. From the CYP2D6 or CYP2C19 that they know are altered in many people in the population, they’ve moved to drugs that are CYP3A4 and CYP3A5 and potentially killed some drugs that would be very beneficial if you could understand who in the population would benefit from them.

Can they determine that genetic influence in the lab while developing the drug or do they have to wait until the drug is rolled out to a broad population to see what happens?

That’s one of the reasons we think pharmacogenetics is going to be so compelling. There is a lot of good data about how drugs that have been approved are metabolized. The FDA, for a very long time, has required studies that show exactly what genes are in effect at the time it’s metabolized to get an idea of what pathways clear it and, to a lesser extent, what pathways are affected by the drug.

As a company, will you stick to pharmacogenetics or expand into other areas of personalized medicine?

There certainly will be others. We look at ourselves as more a platform for genetic analysis. Pharmacogenetics, again, we think there are hundreds of millions of people that could benefit from it and the data is well understood because of the FDA and other studies. But we have begun to broaden. We have a cystic fibrosis panel that’s coming out. We have some other infectious disease that we’re looking at for later in this year, as well as some licensing around functional medicine. There are lots of areas that it’s applicable to. But again, we see pharmacogenetics as well proven, very important to the clinical process, and readily available.

Does the decreasing cost of genetic testing justify having it done just to guide drug therapy decisions?

One of the transitions that the industry will go through in the next couple of years is from reactive to proactive. Right now, it’s common to get a genetic test when you think you’re going to be prescribing Plavix. You’ll see what happens, what is the viability of Plavix, because there are other alternatives, but they’re much more expensive.

What we see happening over time is beginning at hospitals like Inova, where they get the test early in life and keep it in the medical record. From that point on, for the rest of your life, anything you get prescribed, you can at least check it to see if there are genetic determinants of the efficacy or toxicity of the drug. You can make decisions on that basis. The real key there is building that into your clinical decision support in such a way that the physician can make use of that test throughout the future.

Is only one lifetime test required for a given patient to determine not just the pharmacogenetic influences that have already been documented by research, but also those that might be discovered in the future?

There is one broadly relevant test that would be relevant to, say, 180 drugs. There are a few a little more specific. For example, specific drugs for HIV,  there might be a gene that’s fairly difficult to test that would be relevant to that, so you might do a reflex test if you’re considering Abacavir for a particular patient. Certainly there are panels now that cover the vast majority of the drugs that are known to have important genetic effects.

Other than the patient, the beneficiary would seem to be insurance companies that can avoid the cost of ineffective therapy or the treatment of genetically driven therapy complications. Are they willing to pay for the testing?

They are willing. There’s a big challenge right now, though, in reimbursement. If you’re a pharmaceutical company going in to get a new drug approved, you can afford to spend for a gold standard clinical trial for it. In the world of a diagnostic, where the drug may be off patent for 20 years, diagnostic companies don’t have the same returns as drug companies. Even once they’ve produced the evidence, they can’t necessarily patent that evidence, so it might be available to all their competitors. The evidence creation has lagged behind.

In fact, there’s a really challenging dichotomy now between NIH and FDA. They are pushing forward in precision medicine and CMS is pushing back. That’s a difficult place where the industry is in right now. We really haven’t figured out how to get beyond that.

What is especially interesting about that, though, is that we’re beginning to see some forward-thinking payers who are willing to run tests themselves, who are willing to run trials themselves, to see what they could potentially save by putting pharmacogenetics in place. They look at it as a competitive advantage to lower their costs relative to their competitors.

What information from your system do Inova’s clinicians see in Epic?

At this moment in time, what they see is a static report. The evolution that we see in the future is that we can provide, in that static report, the information that’s relevant to the physician at the time they’re ordering the test, but then make the rest of the data available in the EMR as clinical decision support for other decisions in the future. That is certainly a vision that we all share. We’re early on in the implementation of that.

First Databank is distributing your knowledge in their reference content that drives order guidance and alerts from vendor clinical systems. Will that make your information more easily used and widely available?

That’s exactly the approach we’re taking. We’re working on providing what we have, making it available available through a standards-based API so that anyone — whether it’s a pharmacy system, an EMR, an application in an EMR, First Databank, or someone who works with the payers — can plug into our system and say, "Should this person be tested on the basis of the drugs that they have? Where should I order the test from? Once I have the results of that, can I go back and re-query it on the basis of some new set of drugs or some prescription change that I’m doing in the future?"

Where do you precision medicine going in the next five years?

There are a couple fields to look at. Cancer is pretty well along now. There’s a lot of work going on and that will be pervasive in the next five years.

It  takes more parties to put pharmacogenetics into place, so I think in the next five years, we will see the majority of forward-thinking organizations incorporating pharmacogenetics into the prescribing decision factor.

For things like heritable disease, the interpretation and the understanding will be so readily available that for many of the things that are diagnostic odysseys now and many of the things that are rare diseases that are heritable, those will be much, much easier to find in the future, much easier to understand.

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May 18, 2016 Interviews No Comments

Morning Headlines 5/18/16

May 17, 2016 Headlines No Comments

VA edges closer to rollout of new health record platform

The VA reports that the Enterprise Health Management Platform, its Vista web overlay, will be up and running by the end of the summer.

New $1.2b Partners computer system brings prescription for frustration

The Boston Globe highlights employee frustrations with Partners Healthcare’s newly implemented $1.2 billion Epic system.

This health-care trend could make your hospital stay $2,000 more expensive

Edith Ramirez, chair of the FTC, argues that consolidation in the healthcare industry is eliminating needed competition and driving up the cost of care.

Hackers hold DeKalb Health computer systems hostage

A ransom ware attack at DeKalb Health (IN) has forced the hospital to implement downtime operating procedures and divert EMS to other facilities.

Cerner Faces Another Lawsuit Over Its Overtime Policy

Help desk workers at Cerner have filed a class action lawsuit against the company, alleging that they are required to work 48 hours a week but are not paid overtime.

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May 17, 2016 Headlines No Comments

News 5/18/16

May 17, 2016 News 5 Comments

Top News

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The VA says it will have its Enterprise Health Management Platform (EHMP) running by the end of summer. It’s a graphical front end for VistA that I’m guessing is the Facebook- and Google-like “prototype” that was mentioned a couple of months ago.

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VA Chief Information Strategy Officer David Waltman said during a demonstration that, “The interoperability between the VA and the [DOD] record system exceeds any electronic health record systems that are anywhere in the non-government environment.” EHMP builds on previous development work for the VA-DoD Joint Legacy Viewer and will replace CPRS as part of the VistA Evolution program.

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The VA has released a software development kit for the open source EHMP, hoping that companies will extend or commercialize it.


Reader Comments

From Dutch Loaf: “Re: ransomware webinar. That had to be the best-attended of those you have had and it was very useful.” John Gomez’s ransomware webinar was indeed excellent, and while it did very well with 115 live attendees and 700 YouTube views afterward so far, the leader is still Vince and Frank’s November 2014 “Cerner Takeover of Siemens, Are You Ready?,” the YouTube recording of which has been viewed an astounding 7,750 times.

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From Boots on the Ground: “Re: MD Anderson’s Epic project. The reader comment referring to Encore Health Resources should have noted that Santa Rosa Consulting ran the successful  go-live, providing 1,100 associates in the largest, single-sourced go-live.” Verified. Encore got a $50 million contract for selection and other services, as the reader pointed out, but Santa Rosa ran the go-live.


HIStalk Announcements and Requests

I was interviewing Hayes Management Consulting President and CEO Pete Butler the other day when he mentioned how long he has been reading HIStalk, going back to his days as the company’s western region director when he recommend to founder Paul Hayes that they sponsor. I checked my old emails and can thank Hayes Management Consulting for supporting my work for 10 years – they signed up in July 2006. Which also reminds me that HIStalk itself turns 13 years old on June 3, entering that awkward, insufferable teenager phase.

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Ms. Stuckeman from Texas reports that her after-school science and math club “embarked on a journey of exploration and invention” when they received the machine-building kits we provided in funding her DonorsChoose grant request. She adds, “They were so excited to have these shiny new building materials. Students came across problems and had to solve them. This made them stronger as it challenged them to think critically through trial and error. Team members rejoiced with confidence as they were proud of what they had accomplished.”

Listening: hard horror punk rock from Wednesday 13, which sounds like Alice Cooper mixed with Iron Maiden and Dixie Dead. The band is really just Joseph Poole from North Carolina’s barbeque capital of Lexington along with some backing musicians in tribute to 1980s horror films.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Financial Times has fun with the rock concert / party rally launch of the Siemens Healthineers name, calling it “a writhing, Spandex-clad horror” and noting that at the end, “A few arms were raised bearing phones to capture what was possibly the most embarrassing corporate rebranding event ever.” The article notes that the launch violated three rules:

  • Don’t try to put your corporate values to music since that always creates mass humiliation.
  • Don’t create eye-rolling names by cutting and pasting parts of other words.
  • Claiming to be one team with one dream doesn’t make it so. It just makes you look stupid.

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Healthcare-only technology and consulting firm CitiusTech will hire up to 1,200 new employees this fiscal year, increasing its headcount by nearly 50 percent. CEO Rizwan Koita says the company is hunting for acquisitions.

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Decisio Health launches its FDA-cleared Decisio Clinical Intelligence Platform, which formats patient monitor information into an electronic triage system, and closes a $4.5 million second round of funding.

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Pharmacy software vendor Rx30 acquires competitor Lagniappe Pharmacy Services.

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Experian Health signs 276 new deals and 479 existing client contracts in Q4.


People

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The Indiana HIE hires Valita Fredland, JD (Indiana University Health) as VP, general counsel, and privacy officer.

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Jason Griffin (Encore, A Quintiles Company) joins Orchestrate Healthcare as AVP South.

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Parallon Technology Solutions names Charles Bell, DO, RPh (HCA) as chief medical officer.

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Mercy Health (OH) hires Jeff Carr (Cintrifuse) as its first chief innovation officer.


Announcements and Implementations

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PokitDok releases its Pharmacy Benefits Solution, a set of three APIs (pharmacy plan, pharmacy formulary, and in-net work pharmacy) that allow EHR users to check a member’s prescription insurance and send prescriptions to in-network pharmacies.

American Well creates an online marketplace that will allow its customers to exchange services, such as providers who can create and market condition-specific telehealth programs to insurance companies and employers. Consumers seeking telehealth services can choose doctors from provider organizations that market their services.

DSS will incorporate First Databank’s medication reconciliation and e-prescribing solutions in its open source EHR.


Government and Politics

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The Missouri Health Connection HIE supports the governor’s veto of funding that would have helped the state’s Department of Social Services connect to it. MHC says unnamed special interests (Cerner?) “are working to hinder and fragment the adoption of HIE in Missouri.” MHC claims the proposed budget would have prevented hospitals from freely choosing an HIE and would have forced MHC to share patient information with competitors without having privacy and cost structures in place. The counterpoint might be that federally funded MHC wanted to connect with DSS and then charge competing HIEs for connecting to it. The governor said he vetoed the line item funding because it would have allowed some providers to participate without paying. Missouri HIEs have been fighting for control for years. Perhaps ONC should launch its data blocking investigations in Missouri, starting with organizations that have received HHS/CMS/ONC grant funding specifically to facilitate data exchange.

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FTC Chair Edith Ramirez says she’s worried about hospital mergers that are creating expensive health system monopolies, adding that competition is also vital for maintaining hospital quality. The president of the American Hospital Association disagrees, saying the creation of a modern healthcare system requires such mergers.

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The state of Arizona spent millions (it isn’t sure exactly how many) to develop a tissue and organ specimen database that has been abandoned. The system was used by only three hospitals and did not have a sustainable business model, leading to its shutdown in September 2014. Hospitals are trying to resurrect the system, hoping to rebuild it using a different contractor since the original one has since left the state. That company’s founder says the real challenge is that hospitals don’t necessarily want to share their research information in a competitive environment. It’s a lot like hospitals not willing to financially support HIEs or share their information on them.

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The National Cancer Institute solicits research ideas for the National Cancer Moonshot Initiative, with already-submitted ideas being publicly visible on the site. 


Privacy and Security

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Dekalb Health (IN) says a ransomware attack last week forced it to take its systems down, transfer patients out, and initiate ambulance diversion. The health system did not say in the announcement whether it paid the ransom demanded.

The government of Kuwait will require all citizens and visitors to undergo DNA testing to create a national database for use in criminal cases and paternity claims. Visitor samples will be taken upon arrival at Kuwait International Airport.


Technology

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A Florida business paper profiles Medical Tracking Solutions, which offers medical device companies a supply chain system for tracking the devices they stock on consignment in hospitals. The COO says the system replaces “really old school” hospital methods that involve forms that are hand-filled and faxed.


Other

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Cerner help desk employees file a class action lawsuit against the company, claiming they were expected to work at least 48 hours per week without being paid overtime because their positions were misclassified as exempt. Four other overtime lawsuits are pending against Cerner.

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A Navicure survey of 300 provider executives finds that the most significant patient payment challenges are patients who can’t pay, the need to educate patients about their financial responsibility, and patients who don’t pay on time. Patient payments make up a significant portion of revenue for most organizations, with one-fourth of respondents saying it’s 31 percent or greater. The majority of respondents acknowledge that they don’t store patient credit card information, send electronic statements, or offer automated payment plans.

Patients of a Virginia lab company that was acquired by a competitor following its bankruptcy filing to settle kickback charges are being sent bills for tests done as far back as 2009. Bankruptcy lawyers for former high-flyer Health Diagnostic Laboratory, which had $375 million in revenue in 2013, were ordered by the court to try to collect its $50 million in unpaid bills to pay off its remaining debt. The competitor who bought the company is receiving complaints and threats about the collection practices even though it didn’t buy the overdue accounts along with the business and thus isn’t involved with the collection efforts. 

The Boston Globe reports EHR employee complaints at Partners Healthcare (MA), whose $1.2 billion Epic project is the largest ever undertaken by Partners. A maternity nurse says she speaks for others like her in complaining that the system has come between her and her patients, calling it “tedious, labor intensive, and you feel like you can’t do what you want to do.” One doctor, annoyed at having to work at a wall-attached monitor with her back to her patients, retired early. On the other hand, the article is hardly a shining example of thorough investigative reporting, with the newspaper chatting with just 24 of 68,000 Partners employees. One might also note that the “you can’t do what you want to do” comment is exactly why hospitals implement EHRs.

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Weird News Andy says a man was “saved by the pizza.” Employees of a Domino’s Pizza in Oregon become concerned when a customer who has ordered delivery almost every day for seven years fails to place an order for 11 days. They sent a delivery driver to check on him, but the man didn’t answer the door or answer his phone. The driver called 911 and deputies found him on the floor suffering from an apparent stroke. He’s in stable condition.


Sponsor Updates

  • Impact Advisors posts a white paper, “The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways.”
  • LogicStream posts a recording of its webinar, “Reduce CAUTI Through Clinical Process Measurement.”
  • AirStrip CEO Alan Portela will speak at the Medical World Americas conference May 19 in Houston.
  • Nordic kicks off its Community Giveback Week.
  • CultofMac.com highlights AirWatch BYOD technology.
  • NCQA awards Aprima with PCMH Pre-Validation status.
  • Clockwise.MD will exhibit at the Pediatric Urgent Care Conference June 1-3 in New York City.
  • RN FM Radio will feature Bernoulli CNO Jeanne Venella, RN May 18 at 3pm ET.
  • The Boston Globe features BIDMC’s use of Clockwise.MD’s online appointment reservation service. 
  • Divurgent donates $5,000 to Dell Children’s Medical Center of Central Texas during its annual retreat.
  • Bloomberg profiles GE Healthcare CEO John Flannery.
  • ClinicalWorks will exhibit at the 2016 annual meeting of the California Orthopedic Association May 19-21 in Dana Point, CA.
  • Extension Healthcare will exhibit at the AAMI Conference & Expo June 3-6 in Tampa, FL.
  • Healthwise will exhibit at the Cognizant / Trizetto User Group Meeting May 22-25 in Palm Desert, CA.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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May 17, 2016 News 5 Comments

Morning Headlines 5/17/16

May 16, 2016 Headlines 2 Comments

Pfizer to Buy Anacor for $4.5 Billion

Pfizer announces that it will buy Anacor Pharmaceuticals for $4.5 billion, a 55 percent premium on Friday’s closing share price.

Giving New Doctors the Tools They Need

In a New York Times op-ed, a Harvard Medical School resident describes medical education as predicated on memorization and insufficient and outdated. He argues, “In an era of big data, Google and iPhones, doctors don’t so much need to know as they need to access, synthesize, and apply.“

Federal survey finds ‘troubling’ online behavior that could impact medical record sharing

A Census Bureau survey of 41,000 households finds that the recent uptick in data breaches across industries has made consumers shy away from online services over privacy concerns.

Exploring Concordance of Patient-Reported Information on PatientsLikeMe and Medical Claims Data at the Patient Level

A study evaluating the accuracy of self-reported medical data shared on PatientsLikeMe compared self-reported multiple sclerosis diagnosis with claims data and finds that the information collected on the site was largely accurate.

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May 16, 2016 Headlines 2 Comments

Curbside Consult with Dr. Jayne 5/16/16

May 16, 2016 Dr. Jayne 4 Comments

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I’ve been doing a fair amount of travel lately, which usually ends up in administrative tasks being pushed to the side. Although I try to handle things real-time on the road, there are always things that accumulate at home.

I spent most of the weekend playing clean-up, doing such exciting things as organizing documentation for my accountant and making appointments for automotive maintenance and piano tuning. Being in a world where everyone wants to do everything online, I dread having to do business with people or organizations that insist on doing business by phone, yet have limited working hours. I also spent several hours getting information together for a financial planning session, but putting the documentation together just made me wonder if I’m ever going to be able to retire.

With all the turmoil of MACRA, MIPS, and the never-ending parade of acronyms that I’m sure will continue, I don’t have to worry about having enough business as a consultant. I probably work a little more than I want to, partly because I’m still playing catch-up with retirement planning, owing to the decade that I spent with student loan payments that prevented more than minimum savings.

I do some career counseling for pre-med students and always make sure to bring up the debt aspect for those considering careers in medicine. I’m hopeful for the future when I meet with young, idealistic go-getters who are ready to save the world. However, I find that most of them haven’t thought about all the ramifications of becoming a physician.

It’s graduation time, and thousands of recent grads are going to be packing up and heading off to medical school. Although there are more so-called “non-traditional” students in the ranks, the majority of medical school students come straight out of college. Once school starts, they’re immersed in a world that demands all their time and can wreak havoc on families, relationships, and personal well-being. Although there are safeguards now with regards to work hours and student and trainee supervision, it’s still a very difficult path for anyone to choose.

A non-medical friend came across this piece on bullying in the operating room and asked whether I had ever experienced that kind of treatment. Although it was never directed at me, I definitely witnessed it, especially in high-stakes specialties such as surgery and critical care. I did personally experience bullying that was less dramatic but no less distressing. Although those kinds of behaviors are less tolerated now than they were when I was in training, they haven’t gone away.

Organizations spend a great deal of time and money working on cultural problems. For people to do their best, they need to feel like they are part of the team and that their participation matters. They need to feel like their work is meaningful and that the people around them value and appreciate their efforts. Sometimes changing culture isn’t enough. In the case of bullying, there need to be clear policies and procedures around what is and is not acceptable behavior in the workplace. Those who break the rules need to be subject to corrective action that is applied evenly regardless of job title or political status.

When an organization aims to change its culture, it needs to do more than just pay lip service to the idea. I see a lot of groups just going through the motions, saying the right words while they take the wrong actions.

One hospital I worked with hired a vendor to deploy an electronic employee engagement platform while completely missing the point about what their employees wanted and needed to feel valued. They didn’t want to receive boilerplate e-cards – what they really wanted was meaningful feedback from their supervisors during the course of their day-to-day work. They didn’t want to hear about their “total rewards” when the organization eliminated personal days and the ability to roll over sick days from year to year. They wanted to believe that the leadership understood them and their needs.

I worry that the increasing stresses to the healthcare system will further strain employee morale as organizations are going to be asked to deliver more with resources that are already strained. For those of us straddling the tech and healthcare worlds, it’s increasingly difficult to watch tech vendors offer their employees perks such as unlimited vacation and gourmet employee catering when hospitals are cutting benefits and front-line clinical staff barely get lunch breaks. I think some of these vendors have forgotten where the money comes from – ultimately it’s all funded by you and me, whether we’re funding it as patients, payers of insurance premiums, or as taxpayers.

It’s not just IT vendors that are guilty – plenty of organizations are feeding at the healthcare trough. Even though we hear about the most egregious examples of drug markups and Medicare fraud, there are countless examples of profiteering. I recently overheard a conversation in a hospital cafeteria where a medical device sales rep was talking about his new Porsche. Although I believe everyone should have a chance to be successful and should enjoy the benefits of their hard work, bragging about it at a table within earshot of patients who might be choosing between paying for medicine and purchasing groceries is just tacky.

This is the environment that our idealistic future physicians will be faced with as they start their training. I can’t even fathom what healthcare will look like in four years when they complete medical school, let alone in seven to 10 years when they finish residencies and fellowships. Will we see mass exodus of seasoned physicians? Will we see mid-level providers and ancillary professionals delivering an increasing percentage of care? Or will physicians opt out of the new world order and go back to delivering care the old fashioned way, with direct payments from their patients?

What does your crystal ball show for the future of healthcare? Email me.

Email Dr. Jayne.

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May 16, 2016 Dr. Jayne 4 Comments

HIStalk interviews Bill Van Wyck, President, Zillion

May 16, 2016 Interviews No Comments

Bill Van Wyck is president and chief innovation officer of Zillion of Norwalk, CT.

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Tell me about yourself and the company.

I’m the president and chief innovation officer of Zillion. We are a technology platform that powers digital healthcare products that are redefining engagement with consumers. It’s allowing healthcare providers to standardize and deliver better care to consumers outside a facility.

What can customers do with your product?

Companies all across various types of healthcare stakeholders are using Zillion’s technology to deliver three main areas of care in the form of digital programs. Preventive care, like medically necessary weight loss to pre-diabetes type programs. Care management and disease management for more chronic conditions including diabetes, smoking cessation, and depression. The third category is procedural care – bariatric programs, including pre-conditioning and post-conditioning, post-surgery, prenatal programs, and even in orthopedics for knee replacements and shoulder replacements.

Many software companies want to be involved with patient engagement. Where does Zillion fit in?

Zillion has approached the healthcare vertical from a technology perspective. We look at the combination of services and look at the industry jargon around point solutions such as telemedicine, telehealth, population health, and so on. We look at that more from a configuration standpoint and a software technology standpoint.

The differences in the market exist where healthcare has been trying to build vertical silo products to address specific conditions. The reality is that patients don’t typically have just one condition. They are overweight and may have depression, or they may be diabetic and need other types of procedures and support. There are co-morbidities and multiple chronic conditions that exist in the real world.

Having a common backbone platform like Zillion where you can design, create, and deploy programs to patient populations and then refine and refine and modify those programs at scale is a differentiator for healthcare stakeholders. When you look at what they’ve been building, typically none of them interact with existing systems. They’re not interoperable. They don’t always reach patients on the devices and the technology that they use day to day.

Can patients customize the view they’re given? If I have both COPD and a heart condition, is the presentation seamless?

To play that back, the patients don’t configure the content or the availability of services on the platform. The clinician, caregiver, provider, or the payer are configuring and designing best-in-class programs based on evidence-based care plans. It’s keeping the doctor in the process. 

That’s where Zillion is highly differentiated. The industry has focused a long time on these member portals and wellness portals, configurable portals which are largely self-serve. In the real world, if you’re going to drive outcomes, standardize plans, and offer compelling services that impact behavior, you need to keep he caregiver in the process. You need to keep best-in-class content programs delivered and designed by professionals.

We look at it as an iceberg. The tip of the iceberg is the member portal. Everything below the water includes coaching portals, program administration portals, practice-based on-boarding portals, as well as administration portals that allow the population of caregivers to work together to serve and benefit the patient. It is served up to the patient in a whole new way.

My question really was that if I’m a physician and I’ve ordered weight loss content for you and then you have a heart attack, can I just turn the heart attack content on and you start seeing it within your existing presentation?

That’s exactly correct. You can add content, augment content, and even assign and augment services in the form of types of caregivers and credentialed clinician and make those available to patients depending on their needs.

Who is your typical user user? What parts of your platform can be used out of the box without creating original content?

In terms of who is using this as a patient or a member, typically the payers are targeting self-funded employers, typically populations that have in excess of 200-300 users. They are offering products to stem the tide of chronic illness or disease within an organization.

When you look at more procedural care, you move into a different demographic. With orthopedics, you may be moving into a 60- to 75-year-old bracket, which is not in the self-funded world, but they are individuals who are being offered programs as part of a procedural care program. There it’s a different population and demographic of users.

Clients of Zillion span everything from payers to providers to specialized care practices to even device manufacturers. Depending on those types of clients, they have different levels of availability of content and plans. You look at what’s been delivered by a facility in terms of programs. You may go in for a procedural care plan for a bariatric center or comprehensive weight loss center and everything has been delivered in person with paper, quizzes, and scripts and in the form of documentation and different types of caregivers there. Zillion is going to them and taking a combination of people, content, and program cadence and bringing those together on the platform to deliver that to patients.

Some organizations have the wherewithal to create some of this type of content. By example, larger payers will sit down and build a business around a pre-diabetes program. They construct this content at a very, very high grade. Whereas if you go to an orthopedic group or a specialized group, they can use more rudimentary content. They can use more mechanical content. Move your knee this way, move your shoulder that way, do this, don’t do that. It’s less entertaining and much more practical in its delivery.

Zillion allows our clients to lay that out longitudinally, almost like an education curriculum over time. You can set up what happens chronologically across that program. What services do they have access to when? What content gets served during what week? What questionnaires and what data do we need to intake at various points along that program?

Using the combination of video conferences, content serving, IoT device integration, and so on, we can get patients to engage at very, very high rates for very long periods of time. At the end, you have better data to make better decisions in terms of modifying that program to achieve goals.

What’s the secret to not just offering a program but actually moving the needle on the health of the people who need it most, not necessarily just those who are attracted to a health tool?

There’s a shift from wellness programs to not-so-wellness programs. Wellness programs, which were typically paid for by large employers out of their benefits budget, were availability of services to help typically the 30- to 40 somethings who participate in those types of programs. The value proposition of those was largely based on absenteeism and a lot of squishy metrics that really didn’t resonate from an ROI perspective.

These organizations are now focusing on real programs that are evidence-based that include and require often real caregivers in the process. Those caregivers are in different roles these days, everything from coaches to therapists to RNs to RDs to actual doctors. Using different combinations of those and doing it in a scaled way drives better behavioral change than you could ever do with self-service apps.

Zillion is powering those next-generation digital products by combining those video communications apps with digital workforce scheduling with content management and servicing and data analytics. Bringing those four together to build compelling programs across those various areas I went through earlier.

Where do you see the company moving in the next few years?

We’re going to continue to build out the Zillion platform as a service. It is the underlying backbone for all the programs that run on Zillion. Zillion will look to add multiple programs and platform-level services and integration that make the product more and more valuable and relevant to broad-scale healthcare products. We look to build out as many programs as we can for our clients on our platform.

We are a software technology company, so we focus on driving utilization of our platform. A clarifying point is that we do not brand any product Zillion. We build products quickly for our costumers and configure them quickly for our customers which are branded under their names, using their content and their care practices.

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May 16, 2016 Interviews No Comments

Morning Headlines 5/16/16

May 15, 2016 Headlines No Comments

Rethinking MACRA, a follow up

BIDMC CIO John Halamka revisits his earlier analysis of MACRA.

Google’s NHS deal does not have regulatory approval

The partnership between Google’s artificial intelligence unit, DeepMind, and the Royal Free London NHS Foundation Trust does not have ethical or regulatory approval from the NHS, according to an investigative report from New Scientist.

Tor Founder: Your Medical Records Are The Next Big Target For Hackers

Speaking at a conference on cybercrime, Paul Syverson, co-creator of the anonymous web browser Tor, predicts that “Medical identity theft is poised to take over as the primary form of identity theft.”

Study assesses performance of direct-to-consumer teledermatology services

A study evaluating the clinical quality of teledermatology services finds significant issues, including incorrect diagnoses, treatment recommendations that contradict guidelines, and prescriptions that were issued without a discussion about possible side effects.

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May 15, 2016 Headlines No Comments

Monday Morning Update 5/16/16

May 15, 2016 News 3 Comments

Top News

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John Halamka revisits his criticism of the proposed MACRA requirements, specifically suggesting that HHS focus on rewarding three specialty-specific outcomes at a time, allowing each specialty to choose those three outcomes and giving doctors free rein to use whatever technology they need to achieve them.

Halamka also suggests limiting EHR certification to basic care coordination interoperability functions:

  • Sending a summary of care to a recipient listed in a national provider directory.
  • Querying a record locator service and retrieving a common data set.
  • Sending a care summary to a patient-provided address.
  • Populating a relevant registry.
  • Interacting with a prescription drug monitoring program.

Reader Comments

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From Mister F: “Re: MD Anderson / Encore’s $50 million contract. Trace the relationships of current MDACC leadership > Encore leadership > Healthlink. It’s fraternity-based procurement behavior. If someone had the time to create the map of Healthlink alums in provider leadership roles, those in services (vendor) roles, and the subsequent contract awards, it would look pretty interesting.”

From Mark: “Re: Qardio’s real-time blood pressure and scale monitor that was just launched. Do MDs really want this ‘continuous’ information? Is this a billable service? How will MDs replace lost income with fewer patient visits?” Technology companies anxious to get a foothold in the lucrative healthcare market often confuse their limited sensor and analytics capabilities with what will work in real life to improve oucomes. Doctors don’t have the time or interest to monitor a patient’s self-measured vital signs, which have minimal diagnostic or therapeutic value (ask any nurse how often they ignore inpatient vital signs monitors without clinical consequence). It’s a situation similar to companies convinced that the biggest problem in medicine is lack of accurate diagnosis and offer technology to assist where assistance usually isn’t needed, not to mention that diagnosing from data alone ignores that art of medicine. It’s rarely healthcare professionals that come up with these ideas, and when it is, they’re usually ignoring the practical practice of medicine hoping nobody will notice and buy their product anyway.


HIStalk Announcements and Requests

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Poll respondents say it’s the federal government and doctors themselves who are most responsible for physician dissatisfaction. Some respondent thoughts:

  • Ann Farrell says MACRA is crazily complex, but adds that doctors have been self-centered for decades in denying their quality statistics and failing to lead the charge on patient safety. She welcomes income-focused doctors to the world in which RNs and other employed professionals live — KPI games, stagnant wages, job loss, unrealistic productivity goals, and dwindling respect.
  • Frank Poggio says doctors have been their own worse enemy since the start of Medicare, first fighting the concept but then jumping on the bandwagon when Part B was introduced, making many specialty doctors millionaires but not helping PCP who found that, “When you go to the bed with the devil, you wake up in hell.” He adds that doctors have an image problem both with patients and with payers because of the way they practice.
  • Meltoots (who is a doctor) says the profession may be seen as whiny, but physicians are being beaten senseless with constantly changing regulations, fighting with insurance companies, patients who can’t pay their large deductibles, board certification headaches, and RAC audits. He says everybody should be paying attention if it’s so bad that John Halamka is on the ropes. He or she adds, “It takes 14 years of training just to make a fresh new me and another 17 of practice experience that is truly invaluable to my abilities as a surgeon. With my low costs and my quality numbers, CMS and ONC should be begging me to stay on board and not be penalizing me 2 percent because I cannot do MU. And with MACRA, it looks like they want to ratchet me down 9 percent. Look at my costs per patient, co-morbidities, and readmit rate and tell me I’m a bad deal for CMS. No chance.”

New poll to your right or here: would you recommend the hospital or medical practice where you had your most recent medical experience as a patient? Overachievers are welcome to click the Comments link on the poll after voting to explain.

I’m annoyed that Yelp, Tripadvisor, and LinkedIn are forcing website readers on mobile devices to open their proprietary app to continue reading. Not only do I resent being forced into their walled gardens, they often launch the App Store instead of handing off smoothly to their app that I’ve already installed.

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Ms. Hardy and her Pennsylvania class of 18 elementary school students are “incredibly grateful” for the document camera, dry erase lapboards, and computer speakers we provided in funding her DonorsChoose grant request. She has students show their math answers on the whiteboard so she can easily see which ones need extra help. She reports that the document camera makes the students more eager to share their work  and allows the visual learners to see lessons and materials modeled for them in their preferred learning style.


Last Week’s Most Interesting News

  • Theranos shuffles its board and its president steps down.
  • MD Anderson attributes its $160 million year-over-year drop in net income to its Epic implementation.
  • NantHealth files for an initial public offering.
  • McKesson loses a Horizon hospital to Cerner and a 14-hospital Star and Horizon group to Epic.
  • HHS Secretary Burwell acknowledges to the ACP that Meaningful Use has been “burdensome” and “inflexible” for doctors and reinforces HHS’s interoperability agenda.
  • ProPublic’s online narcotics prescribing database that was intended to call out questionable prescribers has the unintended consequence of being used to identify those prescribers by drug-seekers.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Sales

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Doctors Community Hospital (MD) chooses the Summit Express Connect interface engine to manage all EHR connections.

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Lincoln Surgical Hospital (NE) selects Access Passport for Web-based electronic forms integrated with Meditech.


Announcements and Implementations

ZeOmega releases Clinical Assessment Protocols for its Jiva population health management platform.

Penn State Health (PA) signs up for virtual ICU monitoring from Mercy Virtual.


Privacy and Security

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The creator of the Tor anonymous Web browser (which powers the “dark Web” hacker haven) warns that medical identity theft is fast becoming the primary form of identity theft. He mentions that an unnamed healthcare organization is developing anonymous online drug tests, health services, health chat, and research questionnaires. He defends anonymous browsing as being similar to encryption in initially being used by people trying to hide something, but eventually becoming mandatory for secure, Web-powered commerce.

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Children’s National Health System (DC) warns that its outsourced transcription provider, Ascend Healthcare Systems, misconfigured a server and thus allowed access by FTP to the information of 4,000 patients over a one-week period in February 2016. The health system stopped doing business with Ascend in mid-2014 and notes that Ascend failed to meet its contractual obligation to delete its data.

New Scientist magazine, which exposed England’s NHS data sharing agreement with Google two weeks ago, finds that neither Google nor the Royal Free London NHS Foundation Trust have requested ethical approval. It also notes that Google’s recently acquired DeepMind app has not been registered as a medical device. Royal Free defends sending Google the fully identifiable information of 1.6 million patients each year, saying that patients give their implied consent when their information is used by IT companies related to direct patient care.


Technology

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Entrepreneur profiles India-based ICliniq, which offers an online doctor consultation app that uses a bot running on the WhatsApp-like messaging program Telegram. The company also offers a standard Android version.

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A LinkedIn article by Cyrus Maaghul describes out-of-hospital use cases for blockchain technology that include tracking drug development, clinical credentialing, population heath data analysis, insurance risk pooling, telemedicine, and remote device monitoring. He’s head of product and technology for Phoenix-based PointNurse, which offers virtual visits with nurses for patient navigation, referral, consultations, disease management, and remote monitoring.

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A Memphis man’s LifeVest wearable heart monitor and defibrillator saves his life when his heart stops beating in his sleep. The device has a 98 percent first-shock success rate for patients at risk for sudden cardiac arrest. The device first earned FDA approval in 2001, although I don’t recall hearing about it until now.


Other

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Scripps Health’s Q2 financial report shows that its Epic project will cost $309 million in capital and $361 million in 10-year operating cost, although it expects to save $211 million of that by retiring applications that Epic will replace.

The New York Times notes that people who buy medical insurance via Healthcare.gov or state exchanges are often treated as second-class citizens even though their policies are issued by the same big insurers as employer-provided plans. Many providers don’t accept exchange-issued policies, provider networks are narrower and geographically limited, and some policies offer no out-of-network coverage at any price. The article notes that exchange-issued policies often omit high-priced providers that have local clout to set high prices, such as Memorial Sloan Kettering being left out of every exchange-sold plan even though New York employers would not find that acceptable for their employees. The article also observes that many of the doctors listed in insurance company directories aren’t accepting new patients even though federal law requires insurance companies to keep their provider directories current.

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Direct-to-consumer teledermatology websites made a lot of mistakes when diagnosing and treating fake patients. In 62 encounters with 16 websites:

  • None of the doctors asked for the patient’s ID.
  • Two-thirds of the sites assigned a doctor without giving the patient a choice, mostly without disclosing the doctor’s licensure status. Some of them used offshore doctors who aren’t licensed in California where the study was performed.
  • Only one-fourth of the doctors asked who the patient’s PCP was, and only 10 percent offered to send them records.
  • Patients were rarely offered warnings about the risks of the drugs prescribed during the encounter.
  • Clinicians diagnosed correctly most of the time when shown a photo in which the condition was obvious, but failed to ask good questions otherwise.
  • The doctors missed significant diagnoses such as secondary syphilis and gram-negative folliculitis.
  • The treatments ordered didn’t always follow guidelines.

The study’s authors note, however, that those same doctors might have performed equally poorly during in-person sessions, so maybe it’s not teledermatology itself that’s the problem. They suggest that while direct-to-consumer medicine can be be effective, the clinicians should be part of the practice or health system the patient already uses rather than randomly selected contractors of third-party sites.

UPMC reports that it paid six of its executives at least $2 million in its most recent fiscal year, including $6.43 million to President and CEO Jeffrey Romoff. CIO Dan Drawbaugh made $1.57 million.

TV consumer reporter John Stossel complained about poor customer service while he was hospitalized for lung cancer, but now he offers his solution: high-deductible insurance that forces consumers to shop carefully. Maybe he missed the recent research that found that what actually happens is that people just skip getting care rather than shopping more carefully for it. He also takes a logical leap in assuming that people paying more out of their own pockets will create an environment he describes as: “When patients shop, doctors strive to please patients rather than distant bureaucrats. More doctors give out their email addresses and cellphone numbers, and shorten waiting times. Their bills are easier to read because the providers want customers to pay them!” A lot of Americans now have high-deductible plans, so he as an investigative reporter should be able to fund examples where his idea has actually worked.

Sixteen VPs/SVPs of Wheaton Franciscan Healthcare will lose their jobs in its merger with Ascension Health, among them SVP/CIO Greg Smith.

The family of comedian Joan Rivers settles the medical malpractice lawsuit they brought against the New York city clinic where she died during a routine endoscopy. The suit claimed that the gastroenterologist performed a laryngoscopy despite the concerns of the anesthesiologist, while a CMS investigation found that the clinic failed to keep proper medication records, didn’t record the patient’s weight, failed to obtain informed consent, and allowed staff to take selfies with Rivers before she died.

Vince and Susan move along with their 2016 vendor review, covering small vendors in Part 4.

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Weird News Andy says this man’s heart’s in the right place, even if it’s the wrong place. A patient’s complaint of right-side chest pain radiating to his right shoulder is found to have situs inversus, a rare condition in which all of the major visceral organs are on the opposite side of normal.


Sponsor Updates

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  • Huron Consulting Group employees lead nearly 100 events during its annual day of service.
  • ESD offers a discount on automated testing solutions to CHIME members.
  • T-System will exhibit at the MIHIMA 2016 Annual Meeting May 18-20 Bay City, MI.
  • Talksoft is chosen as Greenway’s Intergy Partner of the Month.
  • Visage Imaging will exhibit at ACR 2016 May 16-17 in Washington, DC.
  • Zynx Health announces the winners of its 2016 Clinical Improvement Through Evidence Award.
  • Experian Health and PatientMatters will exhibit at the HFMA Florida Spring Conference May 15-18 in St. Petersburg, FL.
  • Red Hat announces the agenda and keynote speakers for Red Hat Summit 2016, June 27-30 in San Francisco.
  • The SSI Group will exhibit at the Rural Hospital Alliance of Mississippi meeting May 18-20 in Orange Beach, AL.
  • Streamline Health will exhibit at the 2016 Michigan HIMA Annual Meeting May 18-20 in Bay City, MI.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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May 15, 2016 News 3 Comments

Morning Headlines 5/13/16

May 12, 2016 Headlines 4 Comments

GPs told to review patients at risk as IT error miscalculates CV score in thousands

Doctors in England are being asked to reconsider statin prescriptions for thousands of patients after experts discover that the widely-used SystemOne EHR had been miscalculating cardiovascular risk for the last seven years.

An Unintended Side Effect of Transparency

ProPublica notices that drug seekers have been using its Prescriber Checkup tool, a national database containing the prescribing habits of doctors, to find providers most likely to prescribe narcotics.

Fitch Rates Memorial Hospital at Gulfport’s (MS) 2016 Revs ‘BBB’; Downgrs Outstanding

Bond ratings of the city of Gulfport, MS issued on behalf of Memorial Hospital at Gulfport has been downgraded due to a sharp decline in liquidity and an EHR implementation (Cerner) that lead to “an unfavorable increase to accounts receivable.”

Zocdoc Announces New EHR Integration to Improve Access and Interoperability for Health Systems and Patients

Zocdoc announces that it will integrate its patient self-scheduling software with Epic via an API.

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May 12, 2016 Headlines 4 Comments

News 5/13/16

May 12, 2016 News 1 Comment

Top News

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Theranos President and COO Sunny Balwani will retire, which Theranos says is part of a broader reorganization that involves creating three new positions – chief medical officer, head of research, and COO. The company has also added three board members, two of whom were already on the board until Theranos replaced them in a hasty October 2015 reaction to media coverage questioning its technology claims and a CMS investigation of its clinical practices.

Balwani was a technology executive with no medical or science experience when he was put in charge of the company’s California lab in 2009, which CMS later cited as posing “immediate jeopardy” to patients.


Reader Comments

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From Frank Poggio: “Re: HHS challenge to design a simpler patient bill. This is the height of hypocrisy. Does CMS think providers on their own created the insane billing requirements and processes? It started with Medicare Part A, then B, then D. Co-payments, deductibles, out of network, referral approvals, contractual allowances, UC charges, and on and on. Next, billing systems will have to deal with VBP, P4P, bundled payments, MACRs, and more. Providers never asked or suggested any of these — they just have to figure out how to carve up charges /costs and services and put it all on a one-page bill. A 1995 analysis found that the Federal Register contains 11,000 pages dealing with an IRS 1040 submission, but hospital billing required 55,000 pages to describe. If CMS really wants to simplify the patient bill, they need to go to a single-payer system. Until they do that (not likely), the patient bill will continue to be the mess it has been for the last 50 years. Who do I call to collect my $5k?” I had the same reaction. Not only is billing too complicated for even providers and payers (much less patients) to understand, the bill is constantly amended over months as the parties involved negotiate who will pay what. It’s absurd to think that patients will assume financial responsibility when nobody can tell them what they owe at the time they owe it, not even accounting for the fact that bills are full of errors and questionable practices that patients aren’t equipped to analyze and report no matter how well presented the information might be. In comparison, IRS forms and tax policies are a consumer-friendly delight.

From Wonky Warrior: “Re: George Washington Medical. Appears to be switching back to Allscripts from Epic at six of their sites.” Unverified, although a recruiter’s email sent my way says that six recently acquired sites (four urgent care centers and two OB/GYN practices) were on different EHRs, they moved to Epic, and now they’re going back to Allscripts EMR, which is what the medical faculty plan uses. 

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From Jenson: “Re: MD Anderson. Encore did indeed run the selection process. It’s a great business model – Encore runs the procurement, chooses the vendor that requires the most third-party integration support (Epic), and then gets nearly $50 million to support the Epic project. I would pick Epic every time.” The internal document is here. The same regent’s meeting agenda from late 2013 also included a nearly $5 million contract with Cognizant for ICD-10 implementation services.

From Pithy Patti: “Re: MACRA. HHS is out of touch if it expects providers to understand 962 pages of legislation.” Here’s an important point that a lot of self-proclaimed experts are missing: nobody expects providers to individually read and understand those 962 pages. We all follow a lot of laws and rules that are mired in endless pages of legalese somewhere in the government, but that doesn’t mean we’re expected to read and interpret those documents on our own. The government’s job is to pass laws that pass legal muster and convey legislative intent, not to create breezy, easily digested summaries of what they mean so that laypeople can use the Congressional Record as their personal policy manual. That’s a job for non-government experts (consultants and associations, for example) who turn those dense documents into rules their constituencies can follow, just like they do for payment rules that providers follow. The Affordable Care Act had a couple of thousand pages that nobody read (including the politicians who voted for or against it), but it has spawned dozens of thousands of pages of regulations that spell out the specifics.

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From Kellan Ashby: “Re: Siemens Healthineers video on YouTube. It’s been pulled. Siemens Embarrassedineers?” Fear not – someone reposted a copy of the corporate atrocity-filled video. Sing and air-guitar with me, “Oho, oho …” Just in case it accidentally gets removed from YouTube again, I’ve downloaded a copy.


HIStalk Announcements and Requests

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Ms. Mills from Texas says the electric circuit kits we provided in funding her DonorsChoose grant request have had a great impact on her fifth graders, who have gained confidence in progressing from the easy projects to those that required all the kit’s parts.

I had an appointment with a new doctor this week, having taken the first available slot (mid-May) when I made the appointment (early January). I was encouraged when the practice sent me a link to its Practice Fusion portal to provide basic information. I arrived 30 minutes early to complete the inevitable pile of paperwork, which was just as I expected (entering my name and date of birth maybe a dozen times on a clipboard full of forms for medical history, insurance, notice of privacy practices, release of information, and so on). I returned the forms and waited for 15 minutes before I was called to the desk, only to be told that the doctor was out sick for the day (which they didn’t mention when I checked in) and that I should have received a call the previous to reschedule (they had transposed the digits of my phone number). The next available appointment was three more weeks out. I’m not sure which worries me more, the inefficiency of the staff or the fact that they use a free EHR and lots of paper to run the practice. We’ll see how it turns out.

This Week on HIStalk Practice: St. Thomas East End Medical Center goes live on Greenway. ReGroup Therapy raises $1.8 million for virtual mental health consults. Pediatric Medical Associates makes the leap to electronic records. British researchers take the first steps in developing a diagnostic video game. Retailers rate their top challenges when it comes to jumping into healthcare. Healthix President and CEO Tom Check offers insight into the challenges of bringing physician practices into the HIE fold.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Teladoc reports Q1 results: revenue up 63 percent, EPS –$0.40 vs. –$5.87, meeting revenue expectations but falling short on earnings. The company reported big increases in telemedicine visits and membership and touted high satisfaction rates, with President and CEO Jason Gorevic saying in the earnings call that telehealth has a higher barrier to entry than many people believe and that its competitors are stumbling in trying to achieve scale. The company spent an unbudgeted $1 million in legal expenses, including $700,000 in its fight with the Texas Medical Board, and will spend another $4 million in legal fees in the remainder of 2016. Teladoc expects to lose around $42 million in the fiscal year. TDOC shares are down 40 percent since their June 2015 IPO, valuing the company at $440 million.

The 14-year-old CEO of a company that sells first-aid vending machines claims he turned down a $30 million acquisition offer from an unnamed healthcare company. He started the company last year after winning a business plan contest in his high school’s entrepreneurship class. The Six Flags theme park has ordered 100 of the machines, which dispense kits of Band-Aids and other supplies for up to $20. One of the four revenue sources he offers is “selling opt-out data.” The machine also requires the purchaser to acknowledge a form that releases the organization that installs it from liability. I’m not sure I’m really buying the success story since the alleged acquisition offer and product sales are hearsay and since then he has raised his unsubstantiated asking price to $50 million, but I’ll try to suppress my cynicism that the world doesn’t really need a Redbox stuffed with overpriced Band-Aids.


Sales

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Freeman Health System (MO) chooses the Empower patient portal from Influence Health.

British Columbia’s Interior Health Authority chooses FormFast for enterprise forms standardization and automation in its 22 facilities, integrating with Meditech.

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Hospital for Special Surgery (NY) chooses Strata Decision’s StrataJazz for cost accounting and continuous improvement.


People

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The NIH names Patti Brennan, RN, PhD (University of Wisconsin – Madison) as director of the National Library of Medicine.

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Lee Horner (CareCloud) is named president of telemedicine at remote interpretation services vendor Stratus Video.


Announcements and Implementations

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Health Catalyst eliminates its non-compete agreements, no longer restricting for whom employees can work after leaving the company.

ZocDoc will integrate its appointment-finding and patient self-scheduling marketplace with Epic using APIs.

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Sunquest announces GA of Laboratory v8.0.


Government and Politics

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CMS, responding to small medical practice concerns about MACRA, publishes a fact sheet and reminds that it will accept comments about the proposed legislation through June 27. I’m not sure that “flexibilities” is an actual word (sort of like “implementations”), but it does seem that CMS is listening and they (along with ONC) have been pretty good about soliciting and using stakeholder feedback.

A federal judge rules that the US government can’t subsidize the cost of health insurance for lower-income Americans by reimbursing insurance companies for income-based premium reduction, saying that the administration overstepped its bounds since Congress did not approve that expense. Insurers were reimbursed for more than half of the exchange-issued policies, and if appeals fail and the payments are stopped, insurance companies will be stuck with paying several billion dollars per year themselves, giving them strong incentive to stop selling policies on the exchanges. It’s a complex issue that is beyond my understanding, but Tim Jost at Health Affairs provides expert opinion.


Privacy and Security

Allen Hospital (IA) notifies 1,600 patients that their information was accessed by a former employee whose EHR login credentials had not been deactivated despite having apparently left the organization seven years ago.

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Ponemon Institutes’s annual healthcare privacy and security study, sponsored by ID Experts, finds that 90 percent of the 91 covered entities have had a breach in the past two years, although most involved fewer than 500 records. It calculates the cost of a provider breach as $2.2 million. Half of the reported breaches involved criminal activity, with an additional 13 percent caused by a malicious insider. Providers continue to worry most about careless employees, but a significant number also worry about cyberattacks and the use of unsecured mobile devices. One-third of providers say they’ve bought cybersecurity insurance.


Technology

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@drnic1 tweeted about Luxe, an Uber-like service that will meet you wherever you are, park your car securely, and return it to wherever you want for $5 per hour or a flat rate of around $15 per day (the price varies by city, but that includes both the parking car and the service). They’ll even wash your car or fill it up with gas for a bit extra. It’s available now in San Francisco, LA, Chicago, Seattle, Austin, and New York. That would be cool when you’re driving into the city for meeting, heading off to the airport, or attending an event that might charge $20 or more to park in an uncovered and unsecured lot. I would enjoy not only the cost savings, but the lack of stress and time required to find a spot and then hunt down the car afterward.


Other

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Doctors in England are told to review patients for whom they had prescribed statins after experts find a seven-year-old error in the QRISK calculator provided in the SystmOne EHR sold by UK-based TPP. QRISK is a short questionnaire that determines the disk of cardiovascular disease.

ProPublica notices from Web traffic to its 2013 Prescriber Checkup — a database that shows heavy opioid prescribers based on Medicare Part D data – that drug seekers are apparently using it to find doctors who are most likely to write them narcotics prescriptions.

Minnesota’s health department cites a nursing home operator for two deaths involving mistakes in transcribing medication orders, one involving a blood thinner transcribed to the wrong resident’s chart and the second due to a 10-fold morphine dose transcription error.

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US Army Sgt. Elizabeth Marks, the combat medic who won four swimming events this week at the Invictus Games — for injured military personnel and veterans — and received her medals from the competition’s organizer Prince Harry asks him to instead take her medal to the medical team at England’s Papworth Hospital that saved her life from respiratory distress in 2014. The 25-year-old Arizona swimmer joined the Army at 17 and suffered a serious hip injury while deployed to Iraq in 2010 that left her with no sensation in her left leg.

The ratings agency of Gulfport, MS downgrades the city’s bonds issued on behalf of Memorial Hospital at Gulfport, noting a sharp decline in liquidity that the agency partially attributes to an increase in AR days following the hospital’s Cerner implementation.

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This is a great graphic making the social media rounds, although like most graphics, it’s nearly impossible to determine the source.

A Washington Post reporter touring a hospital in North Korea with government handlers is ushered out for asking too many questions in the staged situations that tried to put the country in a positive light. She apparently insulted her hosts in noting ancient diagnostic equipment, staff who aren’t allowed to access the Internet, supposedly frequently used PCs for which nobody knew the password, and a photo op with a perfectly made up patient who strangely had no personal effects or chart in her room. I assume “The Interview” wasn’t available on the patient entertainment system.

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Weird News Andy has Hollywood gold in mind with his script for “Snakes in the Ceiling,” inspired by the story of a live python falling from the ceiling at Tacoma General Hospital (WA). WNA wonders if the reptile subsisted on hospital food during its stay. A visitor brought the snake into the hospital a month ago in a cat carrier filled with stuffed animals (any one of those elements might suggest a need for mandatory psychiatric observation), then called the hospital to report that he had lost his slithery friend. The hospital, to its credit, called him back so he could take his wayward pet back home to do whatever it is that people do with pet reptiles in the privacy of their homes. I’ll stand by my long-held assertion that hospitals are the one place where you see a random and often disturbing cross-section of the citizenry that you would ordinarily avoid.


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  • Medicity CEO Nancy Ham is named one of the most powerful women in healthcare IT. Also named is Vyne President and CEO Lindy Benton.
  • Bernoulli will present a poster on alarm reduction during the 18th Annual NPSF Patient Safety Congress, May 23-26 in Scottsdale, AZ.
  • ID Experts sponsors the Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data.
  • Influence Health announces the 2016 eHealth Excellence Award Winners.
  • Orion Health announces that its software manages 102 million patient health records globally.
  • AdvancedMD launches patient-centric solutions for independent OB/GYN practices with a limited-time promotion at the ACOG conference.
  • GetWellNetwork will host its user conference May 23-25 in Philadelphia.
  • InterSystems will exhibit at VA Healthcare 2016 May 16-18 in Arlington, VA.
  • Early bird registration for Health Catalyst’s September 6-8 HAS16 ends May 27. 
  • Nordic releases a white paper titled “Value-based care: How’d we get here and how do we go forward?”
  • LifeImage and National Decision Support Co. will exhibit at ACR 2016 May 16-17 in Washington, DC.
  • LiveProcess will exhibit at the 2016 Virginia Public Health & Healthcare Preparedness Academy May 17-18 in Portsmouth, VA.
  • Bernoulli will exhibit at the at the Association for the Advancement of Medical Instrumentation (AAMI) 2016 Conference & Expo, June 3-6 in Tampa, FL.
  • MedData will exhibit at the ASCA Annual Meeting May 19-21 in Grapevine, TX.
  • Obix Perinatal Data System will exhibit at the CSO HIMSS Spring Conference May 20 in Dublin, OH.
  • Direct Consulting Associates will exhibit at the Central & Southern Ohio Spring HIMSS Conference May 20 in Dublin.
  • Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
  • ECG Management Consultants will co-host the first annual Behavioral Health Business Summit May 12-13 in Chicago.
  • EClinicalWorks will exhibit at the American Telemedicine Annual Meeting and Trade Show May 14-17 in Minneapolis.
  • Hayes Management Consulting will exhibit at CHUG and GE Centricity Live 2016 May 17-20 in Phoenix.
  • HCS will exhibit at the HealthTech Conference 2016 May 19 in Newark, NJ.

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May 12, 2016 News 1 Comment

EPtalk by Dr. Jayne 5/12/16

May 12, 2016 Dr. Jayne, News 1 Comment

I spend a lot of time hearing physician complaints about EHR usability. It’s certainly sensitized me to the issue of usability in general.

Let’s face it – there is some pretty poor software out there, in all spaces. There are some websites I visit that just want to make me scream, especially ones that use technology reminiscent of Geocities circa 1990-something. No matter what industry one works in, if you have to use something day-in and day-out that makes your life harder, you’re not going to be happy.

I was grateful today that I only have to renew my state controlled substance number once every couple of years. It’s bad enough that I have to register with both the federal Drug Enforcement Agency and also with my state, but their website put me over the edge.

I knew it was going to be a pain when the login screen told you to make sure you had enough time to finish the renewal because the system might time out on you. Then, it told me to turn off my pop-up blocker, but not until I had been through multiple screens that had to be resubmitted when I arrived at the pop-up step. They also introduced new fields that had to be completed for each practice location — fields detailing the number of hours per week spent in various activities such as patient care, ambulatory administration, inpatient administration, research, etc. Since I work a varied schedule at more than a dozen sites, this meant pulling numbers out of the air to populate more than 72 fields.

Additionally, when you save each location, it fires a popup that tells you that you need to complete the fax number for the location if it has one, despite it not being a required field. That was another 12 clicks and 12 screen refreshes that I didn’t need to do.

The final usability flaw was when I arrived at the credit card payment screen. Although it leaves the card number and CVV fields blank, it pre-populates the expiration date. If you’re like me and either multitasking or simply get distracted, you look back and the expiration field has numbers in it, so you move on. Unfortunately it then pops up that your card is expired, and sends you back three screens for you to re-key the information.

It felt like an exercise in futility, but what’s a girl to do? Complaining to the board that regulates your ability to prescribe certain drugs feels like you’re just asking for an audit. There’s no competition and no choice, so you just have to pay your fee (which feels like a cash grab, since we’re already regulated by the DEA) and be happy about it. Or if not happy, at least resigned.

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On the opposite side of the usability chasm, there are plenty of vendors who are actually getting it done. One of the things I enjoy most about HIMSS is checking out emerging solutions and looking at vendors that are trying to break into the market with something novel. It doesn’t always have to be a “gee whiz” product. but it might be just someone who is doing things better or slightly different than the people who are already in the market.

I recently had a chance to look at iScribeHealth and learn about their journey to market. Their mobile app solution is an adjunct for EHR documentation. It allows providers to enter key data elements such as medications, problem list updates, histories, and more without using the EHR. It also supports dictation and charge entry.

They recently took their first batch of clients live. It’s quite different moving from the development phase to the real world and I’ll be interested to see how things go over the coming months. They’ve got some good hooks in their marketing material – encouraging users to “free yourself from late nights spent updating patient charts and wishing you had chosen a different career path.”

They’re also pushing the patient engagement aspect, allowing physicians to focus on the patient at the point of care and not on the technology. They also have automated reminders and surveys to connect with patients outside of the visit. Personally, they had me with their martini glass icon. Who doesn’t like a cosmopolitan in their daily workflow?

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Just when you thought you had recovered from HIMSS16, it’s time to start planning your submissions for HIMSS17. The call for proposals opened last week and runs through June 13. They’re also looking for reviewers to take a look at all the content submissions during the summer months. I’ll let you do the math on how many months it is from the time the submissions are due until the actual presentation and determine for yourself whether it’s easy to keep things fresh with that kind of lead time.

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I’ve previously been somewhat down on the American Academy of Family Physicians and other organizations for enabling some of the negative forces impacting physicians today. They have posted some introductory modules covering MACRA and the shift to value-based care. I appreciate their taking it down to the basic level that many physicians need to try to understand what’s about to happen to them.

In people news, today the National Institutes of Health announced the appointment of Patricia Flatley Brennan, RN, PhD as the new director of the National Library of Medicine. She has a long history in the informatics community. I find it most interesting that her doctorate is in industrial engineering and she has worked to leverage that knowledge in health care. The best implementation director I ever worked with was a ceramics engineer by training, so I appreciate what that background and mindset can bring to the table.

Email Dr. Jayne.

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May 12, 2016 Dr. Jayne, News 1 Comment

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