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Morning Headlines 3/31/16

March 30, 2016 Headlines No Comments

MedStar Health Update Regarding Computer Downtime

MedStar restores access to its major clinical systems 48 hours after a malware attack crippled the systems network.

It’s game over for the robot intended to replace anesthesiologists

Johnson & Johnson announces that it is pulling the plug on its anesthesiology robot Sedasys because of poor sales.

Analysis of clinical decision support system malfunctions: a case series and survey

A study published in JAMIA analyzing clinical decision support malfunctions at Brigham and Women’s Hospital concludes that malfunctions occur frequently and often go undetected. 93 percent of surveyed CMIO’s reported having experienced a CDS malfunction.

Details of Anthem’s massive cyberattack remain in the dark a year later

A year after a cyberattack that left the medical information of 78 million people exposed, the FBI is still investigating the attack and little new information has come to the surface.

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March 30, 2016 Headlines No Comments

CIO Unplugged 3/30/16

March 30, 2016 Ed Marx 8 Comments

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

The Invisible People

All of us have a handful of individuals that did something truly spectacular for us. A mentor who provided invaluable guidance in your career. An Aunt who sent you cash at the precise moment you found yourself short. A coach who helped you find your pace. Parents who sacrificed their education so they could fund yours. A music teacher who helped you find your groove.

I suspect most of us recognized their generosity of time and resources and acknowledged their contributions and then moved on.

But what about the others who unknowingly enabled your success? The others whose names you don’t even know. The others whose faces you would never recognize. The others whom, as a collective, did more than any single contributor you do know. The others who are actually responsible for your success today!

Have you seen them? The individuals who silently served you. Those who invested in you without thought of payback? I didn’t. Until today.

I was showing my kids a video of a recent talk where I was giving thanks to a handful of individuals who sowed into my life where today I reap the benefits. It hit me that in addition to these key people there have been hundreds, perhaps thousands of others who collectively made me who I am. I never acknowledged them. I never said thanks. I forgot them. I was blind.

Today, that changes. What about you?

The praying ladies. As college freshman, a handful of us musicians decided to visit nursing homes to play songs. These beautifully gray ladies shared with us that they had been praying for us. Yes, for 20+ years they prayed for hours daily for the students at our university. It was in college when my spiritual eyes awakened and I believe they had something to do with it.

The den moms. I was active in Cub Scouts and I know there were mothers who tolerated us hyperactive youngsters and helped us find our way. I don’t remember any names or faces, but they loved us to maturity as we learned how to build fires and tie knots. This experience paved my way to become an army engineer officer.

The coaches. I played youth soccer for many years and can only recall one coach. But I know each one of them helped develop me into a pretty decent striker over the years. Soccer became important to me as I entered high school, where I needed all the sport-induced self-esteem I could get. Success on the pitch was the foundation for my vision and participation on TeamUSA.

The sidelines. I have run hundreds of races and have never failed to finish. There were times when I was ready to shred my racing bib, but there were always those darned people on the sidelines exhorting me to finish. Be it a downtown 5K run, cycling up the Swiss Alps, or an Ironman, I owe my finishes to those cheering me on who did not even know my name.

The cleaners. I have occupied many offices throughout my career and have spent early mornings and late nights in them. I spoke with many of the people who cleaned those offices, and with others, I just exchanged pleasantries. In each case, they were part of the team that helped our organizations achieve success. Their kind words and cleaning skills helped me keep my office uncluttered so I had the right environment for success. All those awards they dusted hanging on the walls belong to them as much as to my visible team.

The administrative assistants. Of course I loved all assistants I engaged with regularly, but what about all the others in the background? These are the people that make organizations and people hum, the glue that keeps momentum flowing and collaboration happening. I know my success is enabled by all of them.

The swimmer. I have always struggled with efficient swimming. I was doing requisite laps at a hotel pool one day when the person next lane over spoke to me as we were taking a break between sets. He gave me a tip on my breathing technique that helped improve my stroke and I became faster. While I remain slow, I am no longer last out of the water.

The counselor. In sixth grade, I went to this week long “High Trails” camp in the Colorado Mountains. I don’t recall this particular counselor’s name or face, only that I did have a crush on her. I was experimenting with poetry and she encouraged me to keep writing and to share my heart. This blog and my books are a result of her words.

Teams. I always try to remember everyone’s name, but as my teams grew to 100 and then 1,000, I was no longer able to recognize everyone. But I know—oh, but I know — that all of our achievements were not because of me or even my direct reports. It was all about the team, especially those who toiled behind the scenes and made things happen. Achievements where we have leveraged technology to enable superior business and clinical outcomes are because of them.

It is the invisible that make you visible.

Who are the invisible people in your life?

I bet there are thousands. Find some and give them thanks. Practice the kind of humility that acknowledges your success has never been about you, but is the result of the invisibles whom enabled you to be who you are and rise to your level of training, stewardship, and vision.

Do you want to multiply your significance, your impact to the world? Do you want your life to matter? Be invisible to someone.

Genuine satisfaction comes from serving those who will never know you helped them, nor have the ability to give back. The invisibles.

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

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March 30, 2016 Ed Marx 8 Comments

HIStalk Interviews Rick Adam, President, Stanson Health

March 30, 2016 Interviews 1 Comment

Rick Adam is president and COO of Stanson Health of Los Angeles, CA.


Tell me about yourself and the company.

I’m a serial entrepreneur and have done several different startups in healthcare IT. I’ve been with Stanson about 15 months.

The company was founded by Dr. Scott Weingarten, who was the founder of Zynx. Scott wanted to do something new and different. He wanted to put clinical advice in front of physicians who are ordering. Scott got the company started and then I was hired to help Scott scale it up.

What’s the connection between the company and Cedars-Sinai?

Scott was at Cedars 20 years ago when he came up with the idea for order sets. Cedars funded what became Zynx. Then Scott left and was CEO for Zynx for 16 years. It ultimately ended up as part of Hearst Publishing.

About four years ago, Scott wanted to do real-time CDS as docs order. Hearst didn’t want to do it, so Scott went back to Cedars with two hats on. He’s SVP for clinical transformation at Cedars-Sinai. They also wanted him to go ahead and start this new company to launch point-of-care CDS. Scott is founder and chairman of our board. Our primary funding source so far has been Cedars-Sinai.

How do you tie your product into EHRs?

It’s a little different from vendor to vendor. We’re operational in Epic. We’re developing a system in Cerner. We’re working with Athenahealth and Meditech on integration.

Epic has a Best Practice Alert rules engine. We write Epic rules that our customers then load into their Epic BPA engine. When an order meets the criteria to fire the alert, we trigger the alert and it shows up inside the physician’s order entry screen. Then they either accept it or reject it and can cancel the order right inside their natural workflow. We’re operating in 80 hospitals and 25,000 docs that use Epic.

External to Epic is our analytics facility. We outload the log every night and then wrap it back around analytics so the medical management of health system can see how their clinicians are reacting when they see alerts. The analytics system is in the cloud, but the actual interaction with the clinicians is native inside Epic.

Someone told me that at least two vendors asked to license your analytics and dashboard to improve what happens after their own alerts have fired and been acted on.

The popularity of our analytics has been a little bit of a surprise to us. We understood that it was valuable so we could see the efficiency and effectiveness of our own clinical recommendations. We outload everything in the log.

What surprised us was the customers were interested in seeing what other alerts were happening and behaving. For example, their drug-drug, drug-allergy alerts which typically have very low followed rates, they could see that. Most large Epic clients have written some best practice BPA alerts on their own. There’s no real tool to see how they’re performing. For example, Henry Ford likes our content, but I’d say they probably like our analytics better.

Are hospitals following up on alerts that are constantly overridden even though they are clinically appropriate given evidence-based guidelines?

For the alerts we’ve written, we continuously refine them and make then more pertinent and more likely to be on target.

We had a client-written alert that fired 2,500 times and was followed once. Once they saw that, they just turned it off. The issue of alert fatigue is really serious. All of us need to be much more careful what we put in front of a clinician in order to improve efficiency and safety.

With our tool, you’re going to see a lot of curation of what alerts are out there — emphasize the ones that are helpful and start shutting down the ones that don’t do any good. They just clutter up the doctor’s workflow.

In the medical management process in these health systems and in the government system, it’s common to take our reports and go to a clinician. In the old days, you would go to a clinician and say, “You use too many CTs.” They would say, “My patients are different.”

Now we say, “There’s a recommendation from Choosing Wisely and the American College of Radiology that says don’t CT headache first-time presentation. You overrode that 50 times. Why are you doing that?” That’s the dialogue between clinical leadership and the physicians. It’s patient-specific and  order-specific. It only fired if the patient met the criteria. It’s a much more targeted conversation with clinicians now.

In many cases the clinicians like the feedback. They’ll say things like, “I want to do the right thing. Help me figure out what the right thing is.” When you wrap back around, you say, “You’re a really good follower of clinical advice.” That’s one thing. You have another guy and you say, “You’re on the low end of followed rights. Why is that?” It’s a more targeted, more clinically oriented discussion.

What outcomes are properly presented Choosing Wisely recommendations having on clinical practice?

We have inpatient ones and outpatient ones. It varies pretty widely over the recommendation. I’d say on the low end, we get followed rates of, let’s say, 15 percent. On the high end, we get followed rates as high as 60 percent. This compares to other CDS, where a one or two percent followed rate is considered adequate.

If these things are coded properly and presented properly, the Choosing Wisely recommendations get a lot of uptake. They came from the American Board of Internal Medicine and their 70 sub-societies, like cardiology and radiology. It’s not the government telling you what to do or the payer telling you what to do — it’s advice from your colleagues and your sub-society. It’s a lot easier for the docs to look at that and conclude that it’s good advice.

How do see the role of societies in creating guidelines like these going forward?

I think there will be more. However, I would say that, in terms of influence, we’re getting lots and lots of recommendations from CMS and Medicare now. For example, the PQRS series. Choosing Wisely mostly doesn’t do recommendations. PQRS, Physician Quality Reporting System — which is going to morph into MACRA – is “do,” “do in addition,” or “do instead.”

For example, you’ve got a heart failure patient — I’d like you to prescribe a beta blocker and ACE inhibitor. If we look in the medical record and we see it’s not there, we can alert the doctor that it’s missing. That ties to physician reimbursement, both bonuses on the upside and penalties on the downside. Then there’s a huge push for bundled payment starting this year with hips and knees. Most of the clinical advice that’s going to come out in the next year will be driven by CMS.

What are the most important lessons that you’ve learned in your career?

Most of my experience is on the provider side. The people who run health systems are dedicated, smart, hard-working, credentialed people. But they have a lot going on and there’s a lot of distraction going on. A lot of noise in the system.

The hardest thing to get IT projects moving is that you have to come up with a good enough explanation and a good enough value proposition for what you’re proposing. You have to come up out of the noise and get the leadership’s attention and give them a really good ROI — both financially and quality-wise — on why they should consider doing your project.

The technology is plenty hard enough, but getting onto the health system’s priority list is even harder. The hardest thing is to come up with a great communication program where the decision-makers and health systems understand your offering as one they should take a hard look at.

What are the most important factors that impact whether a startup will succeed or fail?

Assuming they’re trying to get customers out of the provider set, they’ve got to understand what the provider’s strategy is and how their tool, their offering, or system, or whatever helps the health system meet its strategy.

From our point of view specifically, as we move into payment reform and fee-for-value instead of fee-for-volume, it’s critical that you get the clinicians to shift their clinical practice. Eighty percent of the cost in healthcare is the result of a physician making a decision. You’ve got to get into that decision-making and get them to make a better decision or the right decision given where the health system is trying to go.

For anybody trying to bring health IT into the marketplace, you’ve got to match what you’re reasonably capable of doing as a vendor and what’s on the A-list for the decision-makers in the health system. That’s the trick.

Where do you see the company in five years?

We’re early in this market of putting information in front of physicians and having it change their mind. It’s going to be a valuable line of work for us and other people. It has a chance to be a big business and to make a meaningful difference in the way healthcare gets practiced.

I saw an interview with Paul Ryan. They were talking about how hard it is to attack entitlement. They said, do you think you could do Medicare reform? Ryan said Medicare is going to go bankrupt, which is in nobody’s interest. We’ve got to do something different in Medicare to preserve the system.

In some small way, Stanson helps clinicians get a higher quality clinical outcomes for less resource. The driving force behind that is Medicare driving the fee-for-value. In our own small way, we’re going to help preserve Medicare and everybody is going to be better off. I think we’ve got a chance to be a really big company because we add a lot of value.

Do you have any concluding thoughts?

We’re in a really great time. The country has paid the bill for putting in all these electronic health records. The government subsidized $31 billion and health systems have paid way more than that to get these things up and running. Essentially, the railroad tracks are down.

On average, we look at 30 elements in the medical record before we give the physician advice. We look at their medications, we look at their lab results, we look at their age, their presenting symptoms. Ten years ago, you couldn’t do that, because the stuff wasn’t digitized.

To get the Meaningful Use money, you have to get clinicians entering their own orders. We now have the point of attack where the clinician is ordering something. We have a rich amount of digitized medical records. We finally have the infrastructure to start giving people intelligent clinical advice.

The technology is there. The payment reform is the driver for change. There’s never been a better time to be in healthcare technology. We’re going to see huge advances in the next five years. It’s an exciting time to be in the business.

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March 30, 2016 Interviews 1 Comment

Morning Headlines 3/30/16

March 29, 2016 News No Comments

Statement from MedStar Health Regarding Computer Downtime

10-hospital system MedStar Health is hit with a computer virus that has restricted access to its network and EHR system, forcing users back to paper documentation. Officials from the hospital have not confirmed whether a ransom has been demanded.

Banner to invest $1 billion for facilities in Tucson, Phoenix

Banner Health will implement Cerner at the recently acquired University of Arizona Health Network by 2017, replacing Epic.

Contracts: Defense Logistics Agency

DoD signs a one-year, $77 million extension with Philips Medical Systems to continue using its “patient monitoring systems, subsystems, accessories, consumables, spare/repair parts, and training.”

Security alert! New ransomware found inside Microsoft Word

A new healthcare-focused ransomware package is being passed around within Microsoft Word macros that uses Microsoft’s PowerShell framework to download malicious code and initiate the ransomware attack.

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March 29, 2016 News No Comments

News 3/30/16

March 29, 2016 News 15 Comments

Top News


Ten-hospital MedStar Health, the largest health system in the Baltimore-Washington corridor, shuts down its electronic systems and turns away elective patients and after what appears to be a ransomware attack that began Monday morning. The systems remain down. The FBI is investigating.


Despite MedStar’s assertion that it is unaware of any demands for ransom, some of its employees reported seeing a pop-up window demanding payment in bitcoin.


Senate HELP Committee Chair Lamar Alexander (R-TN) says the MedStar attack proves that HHS should quickly implement requirements from the Cybersecurity Information Sharing Act of 2015, which calls for HHS to:

  • Appoint a cybersecurity leader.
  • Create a healthcare cyberthreat report.
  • Create a task for to submit recommendations and to disseminate federal cyberintelligence threat information.
  • Publish voluntary best practices.

Reader Comments

From MD Prof: “Re: NY e-prescribing. You mentioned an exemption for patient-requested paper prescriptions. Can you provide a link to the regs?” I had run across a source that said patients can request paper prescriptions, but upon reviewing the regulations and the stated exceptions, I don’t see such language, so I don’t believe patients have that option after all. Patients and prescribers could see some problems:

  • Patients may want to price-shop multiple pharmacies and can’t without having a paper prescription.
  • They might not have a particular pharmacy in mind at that moment.
  • They may want to send some prescriptions to one pharmacy and others to a different one to save money and new electronic prescribers may struggle with how to do that.
  • If the requested pharmacy doesn’t have the medication in stock, the prescriber will have to issue a new electronic prescription to a different pharmacy.
  • Patients might choose a pharmacy that is closed for a holiday or for normal hours of operation.

All of these are especially problematic for ED physician prescribers, who would be hard to reach if prescription changes are needed. I’m also not clear of pharmacies can still transfer prescriptions among themselves, which I assume they can once it has been created electronically. MD Prof also notes that it’s a pain for doctors to perform the required manual patient lookup on the I-Stop website to identify possible doctor shoppers and suggests further integration of that database with prescribing systems.

From Circular Logic: “Re: site. I wasn’t able to get on for part of Monday.” Me neither, at least for a few minutes mid-morning. It was really busy yesterday for some reason, with more daily page views than even during the HIMSS conference. In fact, it was the busiest day since July 30, 2015 when the DoD contract winner was announced and when I decided I needed to upgrade to a bigger dedicated server. Maybe it’s time again.


From C. Cortez: “Re: rumors. I hope you don’t listen to the comments of people complaining about running industry rumors. Those rumors are usually correct.” My survey shows that only 1.3 percent of readers don’t enjoy reading rumors on HIStalk, which is not really surprising given that I’ve been running them since 2003 and therefore the audience is somewhat self-selecting. What I’ve learned in that 13 years is that nearly everybody loves reading well-placed “rumors” until they hit too close to home, at which time the indignant commenter suddenly proclaims them to be “gossip.” Many big stories have been broken here from reader rumors, while the rest are still entertaining.

From Sue Veed: “Re: interoperability. Judy Faulkner is still describing technical problems and calls for national standards. The problem is now 40 years old with no resolution in sight. The banking industry adopted MICR check standards in no time and healthcare is still dithering. Why?” I heard a keynote years ago by Dee Hock, a local banker who almost single-handedly created what was then BankAmericard (now the Visa credit card system after which competitors are modeled). He explained that it was tough to convince banks (which were local and regional rather than national back then) that it was in their best interest to work together in a decentralized way to create a nationally available electronic credit card network for their shared customers, which he later described as the prototype for “chaordic” organizations that “blend competition and cooperation to address critical societal issues.” Healthcare IT is stuck in the mid-1960s with no heir apparent to Dee Hock available to convince providers and IT vendors that everybody wins (especially the customer) if they share information.

HIStalk Announcements and Requests

image image

We provided Mrs. Openlander from Missouri with several sets of math and reading flash cards for her K-5 school in funding her DonorsChoose grant request. The cards are placed in high-traffic areas so that hallway waiting downtime can be used for extra instruction.

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Also checking in is Ms. Wilson from Virginia, who passes along to HIStalk readers that the five human anatomy models we provided are being used for class demonstrations and “center time,” where the teachers have created add-on learning exercises such as an interactive anatomy whiteboard game. She concludes, “Our students have grown so much in the short time we have had the new materials. I cannot tell you how good it makes us feel to watch them interacting and striving to learn in ways that before you gift we never thought possible … your gift has changed the lives of our students and us forever.”

A quote I can’t get out of my head: “There’s no such thing as a cloud. It’s just someone else’s server.”

Listening: Built to Spill, Boise-based indie rockers who start a small-hall tour in late May as they approach 25 years of bandom. Also, new Italy-based symphonic metal from Rhapsody of Fire.


March 30 (Wednesday) 1:00 ET. “Coastal Connect Health Information Exchange: Igniting the Power of Events-based Notifications Webinar.” Sponsored by Medicity. Presenters: Cory Bovair, application specialist. CCHIE; Andy Biviano, director of product management, Medicity. Wilmington, NC-based CCHIE, which covers 800 physicians and 1.4 million patients, implemented Medicity Notify for real-time clinical event notifications to help reduce ED utilization, improve care quality, and enhance patient satisfaction. In the first 30 days, physicians and care managers received more than 3,000 admission and discharge notifications.

April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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

Acquisitions, Funding, Business, and Stock


Dell will sell its IT services business, the former Perot Systems, for $3.05 billion to Japan’s NTT Data to help pay for Dell’s planned $60 billion takeover of data storage vendor EMC. Dell bought Perot Systems for $3.9 billion in 2009. NTT Data, a subsidiary of Japan’s national telephone company, acquired IT systems and services vendor Keane for $1.2 billion in 2010, giving it the Optimum hospital product suite.


Alphabet’s (Google) Verily Life Sciences is losing top executives and its governmental connections with FDA and HHS due to the abrasive management style of CEO Andrew Conrad, STAT reports. The company has apparently abandoned its project for connecting medical devices to the cloud, with all of its team members departing the organization. Also gone is the co-founder of the project to develop a glucose-monitoring contact lens. A biotech consultant who previously worked for a research institute Conrad founded describes him as, “We used to joke and call him the seagull of science. He used to fly in, squawk, crap over everything, and fly away. You couldn’t engage him for more than 10 minutes. It was sort of the overpromise, under-deliver.”


The Department of Defense issues a $77 million, one-year contract extension to Philips for “patient monitoring systems, subsystems, accessories, consumables, spare/repair parts, and training.”

Announcements and Implementations


Boston Children’s Hospital (MA) launches Feverprints, an iPhone app powered by Apple ResearchKit that will use crowdsourcing to explore normal temperature variation and evaluate the effectiveness of fever medications.


Carolinas HealthCare (NC) will implement Epic at Southeastern Health (NC) via a shared services agreement. I believe Southeastern runs McKesson Horizon for inpatient and eClinicalWorks for ambulatory.

AARP Health Innovation@50 announces the ten finalists for its April 27 pitch event:

  1. Cake (end of life planning)
  2. Medvizor (patient instructions)
  3. Penrose Senior Care Auditors (senior check-up app)
  4. PicnicHealth (personal health record)
  5. Savor Health (nutrition)
  6. SeniorHabitat (senior care facility selection)
  7. SensaRx (wandering sensor)
  8. SingFit (music as medicine – video above)
  9. UnaliWear (fall detection and medication reminder watch)
  10. Well Beyond Care (non-medical assistant finder)

Privacy and Security

A new ransomware variant called PowerWare is discovered to be targeting healthcare specifically in spreading itself via macros embedded in Microsoft Word documents posing as email-attached invoices. It’s smarter than similar types of ransomware, invoking the “fileless” native automation tool Windows PowerShell to download a script and then encrypt the PC’s files. This would be another great reason to demote users who have Administrator privileges or who can run programs with elevated permissions.



Peer60 releases “Trends in Revenue Cycle Management.” Some of its findings: (a) cost is the top criterion for selecting a RCM vendor; (b) collections is the most-outsourced provider service; and (c) the most-unmet RCM needs are denials management, contract management, and value-based reimbursement.


A 60-patient study finds that the fingerstick blood tests previously offered directly to Arizona consumers by Theranos give results that vary significantly from results obtained from venipuncture samples that were sent to Quest and LabQuest.


Banner Health (AZ) will complete by fall of 2017 the replacement of Epic by Cerner at the two Tucson hospitals formerly owned by University of Arizona Health Network, which it acquired in 2015. Banner says the switch will provide “significant savings” to the hospitals, which spent an unbudgeted $32 million and a total of $115 million on their 2013 Epic project, causing a $29 million fiscal year loss that was followed by the sale of UAHN to Banner.  

Sponsor Updates

  • Aprima will exhibit at the Texas MGMA Annual Meeting March 30-April 1 in Dallas.
  • The Baltimore Business Journal lists Audacious Inquiry as one of the five largest software developers in the Baltimore area.
  • Catalyze publishes a new e-book, “Innovation Doesn’t Follow Rules.”
  • Besler Consulting will exhibit at the HFMA Hudson Valley Annual Institute 2016 April 7 in Tarrytown, NY.
  • Burwood Group Justin Flynn will present at the Palo Alto Networks Ignite 2016 Conference April 4 in Las Vegas.
  • Carevive Systems shares its latest presentation, Survivorship Care and Care Plans: Transforming Challenges into Opportunities.
  • Direct Consulting Associates sponsors the HonorHealth Charity Golf Classic in support of the HonorHealth Military Partnership.
  • Divurgent will exhibit at the AEHIS/CHIME Cyber Security Lead Forum April 4 in San Francisco.
  • EClinicalWorks will exhibit at the 2016 Health Care Symposium April 1 in Costa Mesa, CA.
  • Healthwise will present at the Society of Behavioral Medicine meeting March 30-April 2 in Washington, DC.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.


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March 29, 2016 News 15 Comments

Morning Headlines 3/29/16

March 28, 2016 Headlines No Comments

Dell will unload IT services unit to Japan’s NTT Data

Dell will sell its IT services unit to NTT Data for $3.05 billion, money it will use to finance its $67 billion acquisition of EMC.

Google’s bold bid to transform medicine hits turbulence under a divisive CEO

Verily, Google’s life science business, has lost a dozen senior members of its team in the last year.  Former employees say that CEO Andrew Conrad is divisive and impulsive and has created a challenging work environment for staff.

Theranos Results Could Throw Off Medical Decisions, Study Finds

A study by researchers at the Icahn School of Medicine at Mount Sinai finds that Theranos cholesterol results were lower than Quest and LabCorp results by an average of 9.3 percent, enough to influence medical decisions.

House tentatively OK mandatory prescription drug monitoring

In Arizona, legislators are working on a bill that will establish a prescription monitoring program within the state’s HIE.

Protecting Employees’ Health Data

The New York Times calls for limits on employer access to employee health information, citing concerns that it could make workers vulnerable to discrimination.

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March 28, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 3/28/16

March 28, 2016 Dr. Jayne 4 Comments

I spent several days this week performing an assessment of a client’s EHR support team. The IT director had been pressing leadership for more employees. The CIO, however, suspected that perhaps there were other issues on the team keeping people from being maximally productive. I had been tasked to determine not only whether there are process issues, but whether the team has the right skill sets to be effective.

You may be asking why a physician or CMIO is doing this kind of work. Even though this type of work can be done by non-physician consultants, many of the organizations I work with have found that the recommendations carry more weight when they come from a clinical informaticist.

Just observing in the office, I found the usual distractions and interruptions – instant messenger, email notifiers, and text messages which kept people from focusing on their work. Additionally, the support staff wasn’t particularly differentiated as far as which types of issues they handled. Working with somewhat of a call center mentality, staffers were expected to handle every call that came through in a round-robin fashion, regardless of the nature of the issue. Staffers were positioned to handle whatever was on the other end of the phone, even though the callers might have neurosurgical problems and the person answering the phone might be a rheumatologist.

The support team had varying levels of experience – some were clinical, some were technical, and some actually had zero healthcare IT experience and minimal training yet were expected to handle calls successfully. Part of my assessment includes individual staff interviews, during which I determined that one staffer in question had never even been to formal training on the application he was expected to support. Worse, he wasn’t a new employee, but had been there for nearly six months, and his manager had continually promised she would get him scheduled for training but never delivered.

That in itself was a red flag. It’s hard to on-board employees when you don’t have a formal training program. The best organizations I have worked with expect new hires to complete specified training and demonstrate proficiency within the first 90 days. At some, this may also include achieving certification from the vendors of the applications they are supporting, if they are not already certified. Usually those requirements are baked-in as conditions of employment, making it easier to break with someone who can’t meet expectations.

The individual interviews also uncovered that some team members had particular expertise that was going to waste considering how they were being utilized. One was a lab expert, another was a nurse, and yet another had extensive process improvement training from a previous position. Given their round-robin deployment on support tickets, their skills were going unused. Several of their responses indicated boredom and frustration.

My interview of the manager was particularly enlightening. She stopped the interview multiple times to deal with text messages, phone calls, and even people walking by the office. Observing her outside the interview, I can only describe her work habits as firefighting. Everything was a crisis requiring immediate attack.

I also interviewed a director and a vice president, neither of whom seemed particularly knowledgeable about the work going on below them. They seemed fairly content to manage from above without accountability for their teams’ performance. One flatly stated that, “Getting results is why I have managers. That’s their job, not mine” even though he acknowledged that his managers weren’t terribly effective in actually achieving the desired goals. The VP admitted he had no experience with clinical systems or working with physician groups and that he had just been given this department when the last VP left.

It was clear that culture issues were at play as well as general inefficiencies, and I included a discussion of that problem in my formal report. I was looking for additional documentation about workplace distractions and came across several recent pieces about email as one of the roots of all evil.

Despite their best intentions, people struggle with email management. This is particularly acute in organizations like my client’s, who don’t have clear policies about email use. When I’m engaged to provide guidance, I always recommend policies which include expectations for response (if you need a response in less than three business days, you need to use phone or in-person communication) as well as a specification on which types of issues belong in email and which don’t.

Interesting in some of the studies was the fact that employees using email were less likely to achieve deep work states. Over the last year, I’ve started seeing more organizations where employees never achieve deep work states. Sometimes they’re constantly dealing with customer “fires,” but more often, I’m seeing employees who are put in that position by a lack of leadership and strategic planning. In workplaces with these cultures, I often see evidence of people working from home or from their phones. When asked about these behaviors, workers often cite “the need to keep up” or the fact that they can’t get anything done at work. Both of these are just symptoms of a larger problem.

In other situations, workers may not understand how the tasks they are performing fit into larger initiatives, which can create frustration. One client I worked with in the fall was running parallel initiatives out of two teams without any coordination of efforts. Leadership didn’t account for the fact that employees have friendships across teams, and when they learned of the parallel efforts, their perception was that their projects were competing rather than complementary. This lead to a spiral of frustration as workers were suspicious that they were being set against each other or that a “losing” team might end up being downsized.

In one organization I recently visited, people were constantly told about the organization’s key objectives and vision, but there has been little to no communication about how they’re actually going to go about achieving those objectives. That type of work environment quickly leads to frustration and then to apathy. I also had concerns about workplace violence, as the marketing department had the corporate focus words imprinted on stones for employees to have as focal points on their desks. I’m betting more than a few of them get thrown from time to time.

These higher-level dysfunctional behaviors were present at my client, in addition to the micro-level dysfunction that I identified looking at their individual work habits. What the client felt was going to be a straightforward analysis of their EHR support team revealed not only a poor staffing plan and misuse of some fairly expensive human capital, but also a lack of strategic planning. There were also some other red flags in dealing with this client. I knew that my findings weren’t going to go over well because they didn’t fully support management’s original theory that the team was overwhelmed or just wasn’t working hard enough.

Fortunately, I had scheduled an onsite presentation of my findings so that we could discuss them rather than just sending them a report after the fact and having a call to review. Although some members of the leadership team seemed genuinely shocked (or at least were very good at making it look that way) the majority of them didn’t seem terribly surprised. Several of them (including the director and the VP) were skeptical of the findings and my recommendations, and based on their responses, I don’t think they’re at a point where they’re ready to make changes.

One of them actually accused me of “muck-raking,” which is a term I haven’t heard since the last time I took an American History class. Another (who apparently missed the memo on why I was there in the first place) said I was just “coming up with make-work tasks to justify my existence.” Those are pretty powerful words to say to someone who was specifically hired to complete a well-defined project, not to mention to someone who was specifically hired by your boss to figure out why your department is a disaster.

I didn’t find their responses surprising at all since they were obviously trying to defend their turf and protect their own necks. We’ll have to see what the CIO decides to do with the findings. Based on the personalities involved and their obvious resistance to change, I’m not too thrilled about the possibility of a follow-up engagement should they request one.

Regardless of where they decide to go from here, I left them with quite a few concrete recommendations for the team in question as well as for their leadership team. It’s sad to say, but clients like this are becoming the norm for me. I’m eager to do work for an organization that has leadership, vision, and focus but just needs a kick in the pants to get it done rather than one that seems oddly happy in their dysfunction.

Have any client prospects? Email me.

Email Dr. Jayne.

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March 28, 2016 Dr. Jayne 4 Comments

OpenNotes: From Grassroots Effort to Nationwide Movement

March 28, 2016 News No Comments

We look at the evolution and future of OpenNotes — from the impact it has had on patient engagement, medication adherence, and physician workflows to the technological challenges of implementing a truly vendor-agnostic tool.
By @JennHIStalk


Six years ago, the notion that patients could have electronic access to their doctor’s notes was almost unheard of. The note was a safe, private place where providers could document a clinical encounter without worrying about a patient’s reaction to their accompanying commentary. The note was for internal use only, which no doubt gave providers a certain poetic license to describe patient ailments and mindsets in the bluntest of terms. Enter OpenNotes, now a national movement that encourages providers to adopt open access to clinician notes as a standard practice of care.

A Grassroots Beginning

The movement began in 2010 as a year-long study funded by the Robert Wood Johnson Foundation that tested the OpenNotes concept with 105 PCPs and over 13,000 patients at Beth Israel Deaconess Medical Center (MA), Geisinger Health System (PA), and Harborview Medical Center (WA). The trial was considered a success, with patients reporting that access to physician notes helped them feel more educated about and in control of their care. They were also more apt to take their medications, share their notes with other caregivers, and communicate and collaborate more with their physicians.

Participating physicians experienced similar positive results, with just a handful reporting longer visits and taking extra time to address patient questions outside of regular visits. While a larger percentage reported taking more time to write notes and change documentation content, none of them stopped providing access once the trial ended.

As RWJF President and CEO Risa Lavizzo-Mourey, MD said at the trial’s conclusion, “The evidence is in. Patients support, use, and benefit from open medical notes. These results are exciting and hold tremendous promise for transforming patient care.”

Growth Gets Underway

Since results from the initial OpenNotes trial were published in 2012, the movement has expanded almost exponentially across the country. Twenty-six healthcare organizations — including the VA and most recently Duke Health (NC) — are now providing open-note access to over 6 million patients.

The movement shows no signs of slowing down thanks to an additional $10 million in funding from RWJF, Cambia Health Foundation, Gordon and Betty Moore Foundation, and Peterson Center on Healthcare that will be used to roll out OpenNotes access to 50 million patients across the country.

The investment doesn’t stop there. We Can Do Better, a nonprofit OpenNotes advocacy group that works alongside the NorthWest OpenNotes Consortium, received a grant earlier this year from the Oregon Health Authority Office of Health IT to help spread OpenNotes to small to medium-sized physician practices in Oregon, and to work with healthcare IT vendors on making OpenNotes easy to access via their EHRs and patient portals.

CHIME has also thrown its support behind the initiative, announcing last month its intent to collaborate with the OpenNotes movement on accelerating health data sharing as part of its participation in the Precision Medicine Initiative.

Change Management Trumps Technical Necessity


“There is very little funding needed for OpenNotes rollouts,” says Amy Fellows, MPH, executive director at We Can Do Better and an OpenNotes team member. “The main effort is around change management – convincing providers that this is going to be a good thing and something that won’t add to their workload. We hear that OpenNotes is a much easier and smoother rollout process than many previous facility implementations. It really is all about the upfront change management, then ripping the Band-Aid off and getting it turned on. In some cases, a small number of skeptics can delay or moderate an implementation. The issues are cultural, not technical.”

Technical requirements do, of course, need to be taken into consideration. According to Fellows, facilities using Epic and Cerner should be able to easily configure their systems to support OpenNotes. “We attended HIMSS16,” she adds, “and spoke to many other vendors about their capability to offer OpenNotes, including EClinicalWorks, Allscripts, and NextGen.”

Fellows adds that OpenNotes is working to develop a best-practices sheet with recommendations for vendors on how to configure OpenNotes so that it is patient and physician friendly.

Digging Into Provider Best Practices

Fellows and her OpenNotes colleagues in the Northwest have had ample opportunity to discuss provider best practices at Northwest Open Notes Consortium quarterly meetings. “OpenNotes seems to be an evolutionary process, so even those that have done it come to learn about national efforts bringing it to mental health, inpatient, and other specialties,” she explains. “We know about 1 million patients [in the Northwest] have the ability to access their notes, but it is dependent on each organization’s strategy in promoting their patient portal, and how easy they make it to access the note, i.e. do they send an email tickler inviting patients to access their notes with a link taking them directly to that part of the patient portal after log in?”

“We believe best practice includes internal and external promotions, reminders, and easily accessible notes,” Fellows adds. “Initial implementation should include some time spent with clinicians on avoiding documentation practices that can confuse patients – acronyms, cut-and-paste approaches, confusing medication lists or problem lists. Avoiding jargon can also be helpful, i.e. ‘patient denies,’ or ‘patient complains.’ Sensitizing clinicians to terms that activate patients, like ‘obese’ or ‘addicted,’ is worthwhile, too.”

Geisinger Sets the Bar


Geisinger, an original OpenNotes trial participant, has expanded its involvement with the program by rolling it out to new physicians as part of best practices. “Right now, we’re looking at 1,700 providers including advanced practitioners and case managers across the system who access OpenNotes as part of their care,” says Rebecca Stametz, senior director of clinical innovation at Geisinger. “Looking at it from mobile utilization, we have gone from 2,005 unique users to about 150,000 with about 550,000 unique hits off of our portal.”

“Since the trial, we’ve rolled it out as a best practice across care settings, with the exception of pockets across our system like psychiatry, maternal-fetal medicine, and EENT,” Stametz says. “We’ve decided to pause on areas where we were unsure of any implications and where we felt we needed to take a deeper look. That being said, new physicians that get on-boarded, especially those in ambulatory, have access to OpenNotes. It’s now part of our care process.”

Serving up OpenNotes to patients is as easy as a visit to Geisinger’s patient portal. “It’s really one of the benefits that [they] have when enrolling with MyGeisinger or our patient portal, both Epic,” she explains. “It’s really about word of mouth – marketing it as a best practice and utilizing it via internal systems. There really isn’t anything to purchase outside of the EHR and maybe a patient portal, which most of the systems who are implementing OpenNotes already utilize.”

Measuring Success Now and Later


Given Geisinger’s track record with OpenNotes, Stametz is well poised to offer what success with OpenNotes means to the organization. “Success means that patients feel more connected to their care,” she explains. “They want OpenNotes. They feel like there’s open communication and they have confidence in their ability to manage their own care. Studying the long-term implications of end users is something that we’re going to begin to tackle now with our national partners.”

Stametz adds that little to no impact on physician workflow is also a part of Geisinger’s definition of success. “We were wondering about disruption to workflow and whether or not people actually utilize those notes if they became open,” she says. “We know that 99 percent of those patients wanted the practice to continue, so there were benefits we didn’t anticipate. We observed that some patients began to gravitate towards physicians that offered note access. I think one of the big things from a Geisinger perspective is that there was little concern or complaints from providers or patients.”

OpenNotes is just beginning to reach a maturity level that will enable researchers to determine its effect on outcomes. Thus far, the only hard data available is a paper published last fall in the Journal of Medical Internet Research that shows patients with open-note access have better blood-pressure control than those who don’t.

Fellows adds that several implementers have evaluated their efforts with surveys similar to the original OpenNotes research surveys. “Patient-reported outcomes have been very similar in each one,” she explains. “All of the implementations we are aware of have gone well with no physician workflow disruptions. Email traffic has been flat, and when made available, portal traffic has increased.”

“The most revealing metric,” Fellows adds, “has been the rate of patients opening notes and the rate of physicians hiding notes. Patients viewing notes are highly dependent on patient reminders and internal/external promotion. Hiding notes is unusual and mostly done by a small number of physicians. The incidence of hiding notes decreases with time.”

Moving Beyond Primary Care


Many OpenNotes participants are venturing into new territory. Several organizations, including BIDMC, have launched mental health pilots to gain a better understanding of how increased transparency could potentially benefit psychiatric care. Vancouver Clinic is exploring the value in allowing adolescents to view their notes with or without parental proxy access. Fellows also foresees eventually rolling out OpenNotes to more vulnerable patient populations, such as non-English speakers, those with health literacy issues, and underserved and safety net populations.

For Geisinger, the next phase of OpenNotes is about expansion and better understanding what patients want to get from its access. “What are the long-term implications for end users who have been using OpenNotes for the past five or six years?” Stametz asks. “We don’t know those answers, but we’re beginning to work with national partners like BIDMC to find out. For example, if patients and family caregivers were able to write their own narrative within the note, what would that do for goal setting, treatment planning, communication, encounter time, etc.? We’re at the tip of the iceberg with the ways we could leverage the impact OpenNotes has had and its potential in other areas.”

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March 28, 2016 News No Comments

HIStalk Interviews Matt Patterson, MD, President, AirStrip

March 28, 2016 Interviews 2 Comments

Matt Patterson, MD is president of AirStrip of San Antonio, TX.


Tell me about yourself and the company.

I’m a physician by training, with a background in head and neck surgery and as a Navy physician. I spent some time with McKinsey before joining AirStrip.

I’ve been here for four years. I was with the company during the transition from making the first FDA-cleared mobile applications for waveform-based data into a full platform called AirStrip One, which can accommodate essentially any clinical data source in a single workflow to enable a variety of care collaboration and innovation workflows.

Mobile health was a specialty niche when AirStrip was started, but now it’s a given that any software has to work well for mobile users. How is the industry is doing in that regard?

What we’ve seen is the continuation of a pattern that was around when we first started. There certainly is a push to provide a mobile extension of health IT stacks. What we are ahead on still to this day is the ability to aggregate across multiple, disparate sources of data and to stream that data to analytics, third-party, and decision support platforms, in addition to providing just the essential elements that are important for decision-making in a clinical workflow. I think that is quite distinct. We’re ahead on that, but in general, most people recognize that having a mobile extension of the software stack is a valuable addition to healthcare.

Is the Apple-like ecosystem of third-party healthcare apps real or is it just wishful thinking?

It’s more the latter. As a physician myself, I’m always skeptical about having to have too many applications to go to. It’s akin to having too many pagers on my belt walking around the hospital. Most clinicians are not necessarily looking to segment their workflow experience if they can avoid it.

That said, no single vendor is going to be able to accomplish all the things that any one clinician needs to do at any given point. You’re always going to have a number of different applications out there that are each trying to satisfy certain elements of the clinical workflow. But the concept of having a clearinghouse or a hosted environment that somehow corrals all these beasts is missing the one key point, which is, how do all of these things work together? It’s the interoperability piece that the industry is way behind on. 

We have dedicated our entire mission and product evolution around solving for the interoperability. I’m OK with whatever it takes to address the clinical workflow. Different vendors and different applications can lift different parts, but it needs to feel like a singular, unified, coherent, and elegant workflow for the clinician. Otherwise, you’ll never get adoption.

What steps are needed to open up EHRs to those third-party applications?

The most powerful lever in my mind is to make the ask with a powerful health system client at your side. What’s become very, very clear is that, despite the numerous promises of these large EMR vendors that either they can do what the health system wants them to do or that another smaller innovative company is already doing today, most health systems are waking up and realizing, "You’ve been telling me this answer for 10 years and you still haven’t delivered on the things that are already out there in the marketplace that more nimble companies are accommodating.” 

The time is now to open up complete, bi-directional APIs to allow these innovative firms to plug and play nicely with the EMR environment. That’s the most important thing. The reason I focus on that is that the typical answer that you’ll hear stems around technology standards, policy, government, and all that type of stuff. I can tell you right now the tools exist today to do complete, effective, bi-directional, Web-based APIs to all the major EMR vendors in the market.

I applaud things like FHIR and other standards. They’re a step in the right direction, but they are years and years away. The tools already exist. It’s simply the blocking that is getting in the way. The data blocking can manifest in not only technical ways. It can manifest in political ways, and it can manifest in financial ways. We’ve experienced all three.

How do you approach that issue? Are you all set in dealing with Cerner and Epic, or is it a battle every time you need to connect a new client?

It gets easier and easier. The work that we’re doing today, I never would have even imagined possible three years ago. It is absolutely moving in the right direction, albeit it much more slowly than we would like to see. 

What we have done is always use our clients as the voice, because it is the client’s voice. It’s not just AirStrip that’s out there asking for this and looking to monetize it. This is really about our clients coming to us trying to solve the problems that they have and AirStrip having a willingness to innovate through providing interoperability and workflow solutions.

We have developed very, very important strategic relationships with large IDNs across the spectrum of large healthcare IT vendors. Not just EMRs, but also on the monitoring side. We absolutely are side by side with our clients in the requests that we make, which are quite reasonable and are based on sound clinical and business cases for workflows that are in demand in the marketplace.

Are people distinguishing between interoperability as in sharing patient data among sites vs. snapping applications together within the same health system?

I don’t really see much of a distinction. Increasingly where I’ve seen the conversation turn is a patient-centered approach to interoperability. The answer is all of the above. The more that we take a more consumer and individual orientation towards data ownership and stewardship, that should be the North Star. All things should bow to that.

All efforts to monetize simple movement of data from Point A to Point B should be eliminated. The only thing that deserves monetization these days is adding value, creating workflows, and doing things with the data that are meaningful for patients.

If you take a patient- or consumer-centric view of the world, you recognize that there are challenges not only in connecting all the existing stacks within a particular health system together and making them work seamlessly, but it also includes situations like you describe where you have different facilities on different platforms and those need to communicate effectively as well.

What is the right level of FDA oversight for IT systems that have a biomedical component?

The FDA aligns themselves in the spirit of patient safety. That is appropriate, and that should be their mission and guiding force. It’s interesting when you get into things like what happened recently with the non-binding guidelines around interoperability, that the focus was on devices and how they communicate with the outside world. Interoperability was the focus. Somehow, that came under the realm of patient safety. I have a lot of things that I could go into on that topic, but I’ll pause there and not do that now.

Sticking with the question, there just needs to be a certain degree of risk that you cross, regardless of what you do from an application standpoint or device standpoint, where the FDA should regulate and should provide guidelines in the interest of public safety. I think that that’s appropriate. Most importantly is just to be very clear about what those situations are and then to make it as efficient as possible for innovative companies to submit their applications when appropriate and get approval.

Do you think the government climate supports innovation in healthcare IT?

I have been incredibly encouraged by what I’ve seen come out of the Capitol recently. In particular, I’ve been very encouraged with the work being done by Senator Alexander and the HELP Committee. We were referenced in a recent letter to Secretary Burwell by several members of the House of Representatives in an urgent plea to address interoperability and data blocking. There’s a lot of very, very positive momentum towards opening things up and allowing innovation to take place.

That’s another reason why just the timing of the release of the FDA’s non-binding guidelines recently on interoperability is very, very interesting to me. In some ways, I see it as a potential foil on the good conversations that have been taking place. I certainly don’t fault the FDA for wanting to address patient safety. I think that’s what they should do. But the timing is interesting. Similar to the way that HIPAA and Stark have been misused and misunderstood and that has stifled innovation, I could see almost safety blocking – that’s the only way I can put it — stifling innovation. “In the name of safety” type of thing, that the recent guidelines might have an unintended effect.

How has your experience as a Navy surgeon shaped your career?

Gosh, it did in so many different ways. I was fortunate enough to be an undersea medical officer while I was in the Navy. That allowed me to work with the fast-attack submarine group. It also allowed me to work with the Special Forces. I was the medical director at the Naval Special Warfare Center, which is the first training area for the Navy SEALs.

Navy medicine shaped my career in a few important ways. One, the concept of a flat team structure is prominent, particularly in the Special Forces community. I know that may come as a surprise when thinking of the Navy as a hierarchical place, but it’s surprisingly flat when it needs to be. There’s just an incredible esprit de corps and sense of teamwork that can happen in crisis. That gave me quite a bit of perspective on what’s important and what’s an emergency. You learn relative degrees of emergency very, very quickly in Navy medicine.

A second big thing is that it was my first introduction to telemedicine. It’s uncanny that I find myself in the situation I’m in right now, because AirStrip is obviously used a lot in various telehealth scenarios. My very first experience with telehealth was working up patients preoperatively remotely, even using scopes and some pretty advanced technologies, and never laying hands on the patient. The very next time seeing that patient was when they showed up to get an operation. Being that confident in my pre-surgical exam remotely had a profound effect on what I envisioned could be possible with application technology in healthcare. Both of those things I carry with me to this day.

Do you have any final thoughts?

We are at an important turning point when it comes to interoperability and innovation in healthcare. It’s going to take more than government regulations in order for us to get to where we need to be in the marketplace. I’m very, very encouraged that interoperability is a prominent part of the conversation coming out of HHS and coming out of the Senate and the House of Representatives. I’m very encouraged by work being done by interested parties like the Center for Medical Interoperability, because I think that what you’re seeing now is a much more patient-centered approach to the problem. When we focus on the patient, when we focus on the individual consumer, we cannot be wrong.

I envision a world very soon where consumers will essentially be allowed to hit the virtual “record” button on their medical data any time that they want to. Then have the ability on the fly, using plain English opt-in and opt-out types of scenarios and technology, to subscribe their data to anyone they want — vendor, health system, payer, provider, innovative company, you name it. Not only for their own benefit, but for the benefit of society at large. The only way we get to that place is by allowing wide-open interoperability among all of the technology players out there. We’re privileged to be a part of that ecosystem.

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March 28, 2016 Interviews 2 Comments

Dell Sells Its IT Services Business

March 28, 2016 News No Comments


Japan’s NTT Data will buy Dell’s IT services business, the former Perot Systems, for $3.05 billion. Dell is selling the business, which it acquired for $3.9 billion in 2009, to raise money to finance its $60 billion acquisition of storage vendor EMC.

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March 28, 2016 News No Comments

Morning Headlines 3/28/16

March 28, 2016 Headlines No Comments

Statement from Joseph Maldonado, MD, President, Medical Society of the State of New York

The president of the Medical Society of the State of New York asks for two exceptions to the new requirement that all prescriptions be written electronically. The first would exempt providers that write less than 25 prescriptions per year, and the second would reduce documentation requirements when technical problems temporarily force providers back to paper.

Dell Services Builds Momentum with Multiple $100M+ Deals

Dell Services signs $100 million deals with Dubai Health Authority and BCBS of Rhode Island.

Hackers Steal Data On 1.5 Million Verizon Enterprise Customers

Verizon loses 1.5 million customer records to hackers who are attempting to sell the information online for $100,000.

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March 28, 2016 Headlines No Comments

Monday Morning Update 3/28/16

March 27, 2016 News 7 Comments

Top News


New York’s mandatory e-prescribing mandate took effect Sunday despite a questionable level of prescriber readiness even after the one-year postponement a year ago. Allowed exceptions are drug items that require pharmacy compounding, parenteral drugs, items requiring lengthy patient instructions, or non-patient specific prescriptions. Paper or call-in prescriptions can be issued upon patient request or given technology failure, which then requires the prescriber to report the prescription to the state’s Department of Health, but the department has not implemented such reporting technology and suggests that prescribers just note it in the EHR instead.

Reader Comments


From No Flipping: “Re: ransomware. I searched HIStalk and there was an example from 2012, so it’s not a new problem.” I wrote about a clinic in Australia whose files were encrypted by ransomware in December 2012. I don’t recall hearing if the clinic paid the demanded $4,000 ransom, but I expect it did. Meanwhile, a ridiculously useless Wall Street Journal article manages to ask the wrong questions (or perhaps fails to understand the answers) of those it interviewed in claiming to share healthcare security best practices to prevent ransomware. The pearls of wisdom provided are: (a) assume malware will get through; (b) perform backups; (c) apply patches; and (d) educate employees. CIOs who learn anything from this breezy waste of time should probably just go ahead and quit or at least attend our webinar described below.  

From The_Epic_Guy: “Re: Epic. The company is having their implementation consultants put their Starbucks coffee into non-labeled containers to avoid reminding customers that its inexperienced people are costing a small fortune.” Unverified. I would have expected contracts to specify a per diem rate rather than individual charges so that Starbucks vs. McDonald’s coffee wouldn’t matter, but maybe that’s not the case.


From MCK Auto Pilot: “Re: McKesson. This site has interesting layoff rumors. All are unsubstantiated from employees who have been laid off, but in every exaggeration there is a kernel of truth.” Comments from claimed current or former McKesson employees complain about clueless upper management, the failed Better Health 2020 initiative, the cold manner in which employees were informed that their services would no longer be required, offshoring to India, and the likelihood that MCK will sell off what’s left of its IT business and whether anyone would want to buy it.

From Nasty Parts: “Re: Greenway layoffs. Four sales VPS have been downsized. Looks like the company is moving into a ‘protect the install base’ mode of operation.” Unverified. The four named VPs still list Greenway as their employer on LinkedIn, but most people don’t rush there first after they’ve been forcibly re-workforced.

HIStalk Announcements and Requests


Half of poll respondents work for a company that has laid people off in the past 12 months. New poll to your right or here: do you personally admire and respect the highest-ranking executive of your employer? I’ve divided the answers out into not-for-profit and for-profit choices to see if that makes a difference (which I should have done on the previous poll, too). Click the Comments link on the poll after voting to explain.


FHIR Family donated $500 to my DonorsChoose project, explaining, “HL7 has a big deadline on Monday, March 28 and I am in awe of all the work Grahame Grieve does in the background. This donation is in his name.” Through the magic of matching funds, the donation fully satisfied these teacher grant requests:

  • An iPad and case for Ms. Markussen’s first grade class in Dallas, TX
  • A laptop and document camera for Mrs. Lark’s middle school class in Brooklyn, NY
  • Math games for Ms. Burkett’s elementary school class in Independence, MO

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Mrs. Hale from Indiana says her third graders were so excited about the kid-friendly biographies we provided in funding her DonorsChoose grant request that they finish their other work early so they can work on biography projects.

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Also checking in is Mrs. Ortego, who says the headphones we provided for her Louisiana special needs elementary school class not only allow students to work without distraction, but also, “One of my greatest joys is that I have a hearing impaired student and he is able to put the headphones over his ears with no feedback from his hearing aids. This is the most amazing thing to experience. There is no frustration for this student.”

Last Week’s Most Interesting News

  • Allscripts and a private equity firm form a joint venture to acquire post-acute care EHR vendor Netsmart for $950 million.
  • The CEO of NYC Health + Hospitals denies rumors that he will be fired if the organization doesn’t go live on Epic on April 1 and dismisses reports by the former CMIO of one of its hospitals that a lack of readiness will endanger patients.
  • Three more hospitals report ransomware attacks.
  • AHIMA petitions the White House to allow HHS to work on a national patient identifier.
  • Apple announces CareKit, which will allow developers to create person health apps for the iPhone.


April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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

Here’s the recording of last week’s webinar, “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.”


Dell Services announces recent big contracts that Dubai Health Authority and BCBS of Rhode Island.

Government and Politics

The president of the New York State Medical Society politely asks for two changes to the just-implemented requirement that all state prescriptions be issued electronically rather than on paper or by telephone. He would like to see an exemption for those doctors who write fewer than 25 prescriptions per year and a reduction in documentation requirements when technical issues require issuing a paper prescription. Both seem reasonable to me.

Privacy and Security


Hackers steal and offer for sale the information of 1.5 million customers of Verizon Enterprise Solutions, whose services (including an extensive set of security offerings) are used by 99 percent of Fortune 500 companies.


Epic removes regular and diet soda from its vending machines and cafeterias to promote health, so bring your own supply from a local convenience store if you’re a Diet Coke fan taking classes in Verona.

Another medical transport helicopter goes down, killing all four occupants (including the patient) in Alabama. The for-profit company’s site boasts that it has a “proven clinical tract record.”


An interesting article describes the online problems experienced by people with unusual names: those who go by a single name, those with very long or short names that don’t pass field edits, and most interesting to programmers, people whose last name is Null. These folks often have to resort to telephone calls or snail mail to do tasks everybody else can accomplish online.

Sponsor Updates

  • Forward Health Group shares the wall-sized, hand-drawn graphics created in its UnBooth at the HIMSS conference, including population health management questions posed by visitors. 
  • EClinicalWorks releases a podcast recapping EClinicalWorks Day.
  • Extension Healthcare and FormFast will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
  • The Upstate Business Journal recognizes Glytec as an Upstate biotech player.
  • The Boston Globe features Healthwise CMO Adam Husney, MD in an article on how perks from pharmaceutical companies influence prescribing medicine.
  • Cumberland Consulting Group expands its business processing outsourcing services to pharma in a partnership with revenue acceleration software vendor Revitas.
  • Recondo Technology will exhibit at the HFMA Texas State Conference on March 29 in Dallas.
  • Experian Health will exhibit at NAACOs March 28-30 in Baltimore.
  • PatientSafe Solutions and PerfectServe will exhibit at the AONE Annual Meeting March 30-April 2 in Fort Worth, TX.
  • The Doctor Freedom Podcast features PatientPay founder and CEO Tom Furr.
  • Point-of-Care Partners ECare Management Practice Lead Michael Solomon discusses optimizing EHRs.
  • Streamline Health will exhibit at the 2016 WV HIMA Annual Convention March 30-April 1 in White Sulphur Springs, WV.
  • T-System awards its Client Excellence Award to Dosher Memorial Hospital (NC) for excellence in sustainable outcomes.
  • TeleTracking, Versus Technology, and Zynx Health will exhibit at the AONE 2016 annual conference March 30-April 2 in Fort Worth, TX.
  • TeraMedica will host a healthcare IT symposium April 7 in San Francisco.
  • Huron Consulting Group releases 2016 Healthcare CEO Forum report.

Blog Posts


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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March 27, 2016 News 7 Comments

Morning Headlines 3/25/16

March 24, 2016 Headlines No Comments

Raju to explain financial plan to Council, defend records system

NYC Health + Hospitals President and CEO Ram Raju claims the April 1 Epic go-live was a self-imposed deadline that he would be comfortable moving if needed, clarifying that he would not be fired for making that decision.

The Evolving EPCS Landscape 2016: A Prescription for Stopping Opioid Abuse

DrFirst publishes a paper on e-prescribing of controlled substances in the US, noting that while 82 percent of retail pharmacies are EPCS enabled, only 5.8 percent of providers are setup for EPCS.

Providers must release all of patient data to patients, families

The Ohio Supreme Court rules that any patient data kept by a health care provider must be released to patients and family members on request. Officials at Aultman Hospital argued that only patient data held within the medical records department was required to be turned over.

Thomas Health System Selects Parallon as its Meditech 6.1 Partner

Thomas Health System (WV) selects Meditech 6.1, upgrading its legacy Meditech Magic system and replacing its Cerner/Siemens Soarian system.

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March 24, 2016 Headlines No Comments

News 3/25/16

March 24, 2016 News 1 Comment

Top News


Allscripts and private equity firm GI Partners form a joint venture to acquire human services and post-acute care EHR vendor Netsmart, which will be combined with the homecare software business of Allscripts. Allscripts also contributed $70 million to the joint venture, which will pay $950 million for Netsmart. The company’s name and management team will remain in place. Allscripts says the JV will have an annualized revenue of $250 million and operating income of $60 million.

Netsmart has gone through several name changes, ownership changes, and acquisitions in its 20-year direct history and earlier connections going back to 1968. It went public in 1996, sold itself to private equity buyers for $115 million in 2006, and then was then sold for an unspecified price in 2010 to another private equity firm, Genstar Capital, which is rumored to be making 4.4 times its investment in the newly announced sale.

Reader Comments


From PM_From_Haities: “Re: Allscripts paying $70 million for a joint venture. It’s hard to imagine Allscripts giving up assets with out corresponding liabilities (debt). I’m looking forward to their audited financial results since they might require certain items to be disclosed, such as whether one customer represents more than 10 percent of revenue. The other item of interest with audited results is mark-to-market accounting of the Allscripts investment in NantHealth, which delayed its IPO due to unfavorable market conditions. Allscripts’ debt covenants contain asset-to-liability requirements and an unanticipated decline in asset value could seriously impact their delicate financial picture. The bright side of this JV is that Allscripts may be allowing a product that would languish with its other zombie EHRs to blossom into something good for home health.” Unverified. MDRX shares didn’t react much following the announcement, meandering down a bit Wednesday and then down a bit more Thursday.


From Green about the Gills: “Re: Greenway. Starting a layoff cycle this week. Right-sizing post the Vitera purchase and the EHR land grab of the MU era.” Unverified. However, I do see the company has “rebranded” itself.

From The PACS Designer: “The ICD-10-CM Clinical Modifications has a code J62 for silica related disease, and under this classification falls the longest word in the English dictionary. Silicosis is a form of occupational lung disease and within this category is the 45 letter word ‘Pneumonoultramicroscopicsilicovolcanoconiosis.’”

HIStalk Announcements and Requests


Mrs. Pryor from Oklahoma says her kindergartners love the programmable robots we provided in funding her DonorsChoose grant request, adding that they are a “huge motivator” that she has integrated into her reading and math curriculum.


Also checking in is Mr. Jewell of Arkansas, who says his sixth graders have gotten a lot more excited about engineering after working with the Lego Mindstorm kits we provided. He has conducted two enrichment classes that involved building and programming the robots and now there’s a waitlist for the next class.

This week on HIStalk Practice: Signallamp Health adds CCM jobs in Scranton. Mend wins big at SXSW. PCAST advocates for the advancement of telemedicine. Wearables earn dubious accolades for their inconsistencies. Telerehabilitation startup RespondWell celebrates a $2 million funding round. Night Nurse COO Stuart Pologe offers tips on balancing HIPAA compliance with efficiency across EHRs and paper records. GAO brings cyberattacks to light on the ACA’s sixth anniversary. OneCare Vermont selects care management software from Care Navigator. The US Oncology Network’s David Fryefield, MD lays out the strategy behind empowering value-based technologies.


April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

Contact Lorre for webinar services or for one final chance at her post-HIMSS discounts. Past webinars are on our HIStalk webinars YouTube channel.


Statewide ACO OneCare Vermont chooses Care Navigator’s care management software.

Thomas Health System (WV) will implement Meditech 6.1, replacing Cerner/Siemens Soarian and Meditech Magic.


Palomar Health (CA) chooses Ascend Software for accounts payable electronic imaging automation.



Lane Regional Medical Center (LA) hires Paul Murphy (Geocent) as CIO.

Announcements and Implementations

DrFirst publishes “The Evolving EPCS Landscape 2016: A Prescription for Stopping Opioid Abuse,” which finds that most pharmacies can accept electronic prescriptions for controlled substances while only 5.8 percent of prescribers are similarly EPCS-capable.


Boehringer Ingelheim Pharmaceuticals will offer users of its asthma inhalers the chance to sign up for health system studies to determine the effectiveness of Propeller’s usage tracking inhaler sensors.

Privacy and Security

Rep. Ted Lieu (D-CA) may propose a modification to the HITECH act that would require healthcare organizations to notify patients if they’re hit by ransomware.


The New York Times, explaining how it “decoded the NFL database” to debunk the National Football League’s concussion studies, admits that it was able to re-identify many of the 887 players that were listed only by an NFL-assigned code by reviewing the concussion date, whether the game was home or away, and whether it was being played on natural or artificial grass. The paper seems pretty pleased with itself for working around the method used to protect the privacy of the players.

Walmart confirms that a programming error caused the prescription records of 5,000 of its online pharmacy customers to be displayed to the wrong user.


Do this now to help prevent having your PC infected with the Locky ransomware: allow only digitally signed macros to run. Instructions are here.

The Ohio Supreme Court rules that patients are entitled to receive all information stored about them by providers, not just those data elements the provider intentionally filed in the medical record. A hospital that was involved in a wrongful death lawsuit unsuccessfully argued that it was not required to release the deceased patient’s EKG strips because they had been stored by its risk management department.



Google registers two healthcare-related images that may or may not have something to do with new medical apps.



NYC Health + Hospitals President and CEO Ram Raju, MD says the organization’s April 1 Epic go-live date is flexible and he won’t be fired for missing the date if the system isn’t ready. He says former Elmhurst CMIO Charles Perry, MD, MBA, who resigned in comparing the upcoming go-live with the Challenger disaster, took a parting shot as a “disgruntled” employee. Raju says previous CIO Bert Robles left shortly after the Epic project started because, “I didn’t want someone learning on the job,” leading him hire Ed Marx, who was recommended by Epic CEO Judy Faulkner. NY Health + Hospitals, which is projecting a $2 billion deficit, is rumored to be spending $1.4 billion on the Epic project.


Lancaster General Health (PA) investigates a 12-hour EHR outage of unspecified origin.

Sponsor Updates

  • Medicity CEO Nancy Ham writes for the HFMA blog on “Determining the ROI of Clinical Care Technology.”
  • A record number of providers, payers, and partners gathered at the InstaMed 2016 User Conference.
  • Live Process will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
  • Navicure will exhibit at the Office Practicum User Conference March 31-April 2 in Atlantic City, NJ.
  • Obix Perinatal Data System will exhibit at the Sanford Health Perinatal, Neonatal, and Women’s Health Conference March 31 in Sioux Falls, SD.
  • The Irish Times profiles Oneview Healthcare founder Mark McCloskey.

Blog Posts


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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March 24, 2016 News 1 Comment

EPtalk by Dr. Jayne 3/24/16

March 24, 2016 Dr. Jayne 4 Comments

Several readers responded to my recent request for information on EHR vital signs data entry alerts. Epic has not only color changes that indicate an out-of-range value, but the possibility of a hard alert that forces the user to address the value. I got a chuckle out of the warning for our erroneous pulse of “13270,” which read as follows:


I’m fairly certain that a pulse of 500 is incompatible with life, which makes me wonder if this is a vendor value or something the customer configured.


This week has been a veritable news roundup of interesting articles and newsy tidbits. Popular Science featured a wearable patch that can not only monitor blood glucose, but also deliver medication. Using the pH of sweat along with temperature changes that align with a high blood glucose level, when certain conditions are reached, a micro heater in the patch dissolves a layer of coating, releasing the drug metformin via microneedles. Commentary on the recent publication notes that it’s not clear whether the device can last a full 24 hours and whether it will withstand exercise and increased sweat. Its ability to deliver human-scaled drug doses is also an issue. From the physician standpoint, I’m not sure about metformin as the choice of drug due to its mechanism of action, but it’s certainly an interesting technology to think about.


Engadget reviewed a business card with built-in electrocardiograph capability from MobilECG. The card is open source and schematics are posted online, so I’m thinking perhaps my nephews would like to try their hand at building one.

Content vendor Wolters Kluwer has made its Zika Virus order sets available for download. The World Health Organization has declared it a global threat and there have already been nearly 200 cases reported in the United States. The order sets include one for infants to assess for congenital infection, as well as those for emergency department and outpatient settings. Other freely available order sets include Ebola evaluation, ischemic stroke, low back pain, myocardial infarction, pneumonia, and more.

Even though I’m behind the scenes at HIStalk, I still rely on it for healthcare IT news. I was glad to see mention of the AHIMA petition in support of a voluntary unique patient safety identifier program. Being in the healthcare trenches, I’m more worried about incorrect data matching than I am about people misusing my data, so it’s a risk I’m willing to take. It’s not the complete answer, but I can’t help but think that it would be better than what we have.


I also appreciated Mr. H’s mention of the retirement of Groupwise at BJC. I remember using Groupwise fondly – my favorite feature for scheduling recurring appointments, when you could just pick dates off the calendar rather than having to follow a straight formula. It was an absolute necessity when I had to schedule physician advisory board meetings – we alternated Tuesdays and Thursdays so that conflicts would be shared throughout the group. Also great for meetings that occurred the first and third Wednesday, etc. Much easier than sending multiple appointment series. Users can’t convince Microsoft to get rid of the unholy “Clutter” folder in Outlook, so it’s doubtful Microsoft would ever consider this type of enhancement.

HIStalk is also a place where readers can ask for feedback and advice. One emailed me asking if I knew of any companies that might have a “lab” of EHR vendors to connect to. He’s trying to test some integrations but frustrated dealing with individual vendors. If anyone knows of that kind of arrangement, leave a comment to pass along the information.

I mentioned in this week’s Curbside Consult that our practice is seeing an increase in volume that we’re at least partially attributing to the shift towards high-deductible health coverage. Price transparency is one of our talking points. Reader Intrigued asks, “For those of us who missed it or are search challenged, where did you discuss this before? Definitely interested in learning more about your experience.”

I’ve mentioned it a couple of times in passing over the last few months. As for data, we have referral tracking and patient satisfaction survey data which shows the trend. We can capture who has a high-deductible plan from our practice management system and can see who chose us for "cost" in post-visit surveys. We also can see trends on the number of patients who visit us because they can’t access their PCP or don’t have a PCP. There are definitely multiple drivers fueling our growth, but I continue to be impressed by the number of patients who are paying attention to cost.

A reader asked about my recent mention that Institute for Health Improvement courses have been approved for ABPM LLSA credit. I clarified with my source that the approved courses include: Quality Improvement Curriculum, Graduate Medical Education, and the Patient Safety Curriculum. Too bad I already took my mandatory Patient Safety course through the National Patient Safety Foundation, because it sure would have been nice to also get the LLSA credit.


I enjoy reading scholarly articles, although some are best left for bedtime. “Do You Smile with Your Nose? Stylistic Variation in Twitter Emoticons” was perfect for a mid-day break, however. Analyzing the 28 most used emoticons in American English tweets, it demonstrates “that the variants correspond to different types of users, tweeting with different vocabularies.” I shared it with a friend who edits journals for a living and she responded back with this gem, “20 PhD Students Dumb Down Their Thesis.” I’m fairly certain that #5 might have been submitted by one of my medical school classmates.


Chocolate cake as the new breakfast of champions? Thanks to Dr. Lyle Berkowitz for sharing this article summarizing research on the benefits of chocolate. Morning chocolate consumption has been found to have positive influences on weight loss and improved performance on cognitive function. I think I’m going to make chocolate part of my complete EHR implementation plan from here on out.

What’s your favorite vehicle for chocolate consumption? Email me.

Email Dr. Jayne.

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March 24, 2016 Dr. Jayne 4 Comments

Morning Headlines 3/24/16

March 23, 2016 Headlines No Comments

Allscripts is buying stake in Netsmart Technologies

Allscripts and private-equity firm GI Partners will pay a combined $950 million to acquire behavioral health software vendor Netsmart Technologies as part of a new joint venture. Allscripts will pay $70 million in cash and merge its home health software business into the new venture, resulting in a company with an annual revenue of $250 million.

Opportunities and Challenges in Advancing Health Information Technology

During testimony before the House Committee on Oversight and Government Reform, National Coordinator Karen DeSalvo, MD discussed ONC’s interoperability roadmap and the agency’s efforts to help expand the use of alternative payment models.

New HIPAA audits will target healthcare industry’s business partners

The HHS Office for Civil Rights announces that the next round of privacy and security audits will target business associates and insurers.

In Its First Year, Has Apple’s ResearchKit Revolutionized Medical Research?

Fast Company recaps ResearchKit’s first year in operation, highlighting some of the successes and barriers to growth researchers are seeing with the framework.

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March 23, 2016 Headlines No Comments

Readers Write: Time for Providers to Lead the Price Transparency Revolution

March 23, 2016 Readers Write 5 Comments

Time for Providers to Lead the Price Transparency Revolution
By Jay Deady


With ICD-10 in the rear-view mirror, providers now face a new challenge – answering the public and media call for consumer price transparency. High-deductible plans now cover nearly a quarter of those Americans with commercial insurance, raising the ante on patient financial responsibility. Yet large numbers of patients remain confused about how much they will owe for hospital services—a full 36 percent, according to one survey.

This problem, unheard of in other consumer industries, not only endangers patient satisfaction scores, but threatens to increase the bad debt load of organizations already struggling with severely low margins.

While insurance companies and employers have deployed some pricing tools, they have done a poor job of accurately representing multiple providers’ fees within a geographic area. New technologies are available from a handful of companies that let providers take the price transparency bull by the horns and lead themselves.

These technologies transcend the usual approach of mere compliance with a state’s price transparency laws. Posting a list of charges on a provider’s website may satisfy the letter of the law, but it fails to give consumers an accurate picture of what they will owe for services. Knowing this, providers have struggled to come up with an alternative that does not reveal proprietary information to their competitors. Most have concluded there is no way for them to easily accomplish this and they refer questions to patients’ insurance companies.

But it turns out the path to truly efficient, accurate, and accessible price transparency is one that healthcare consumers can take themselves—directly from the provider’s website.

Healthcare consumers want – and deserve – an accurate understanding of what they will owe for services before they are rendered. The operative word here is “accurate”—as in an estimate based on the consumer’s current levels of insurance coverage. Or, in the case of a self-pay patient, an estimate based on the provider’s discounted fees for consumers that pay fully out of pocket.

Either way, with self-service pricing, healthcare consumers generate the estimates themselves, typically from an online calculator on the provider’s website. The process is quick and hassle-free. A consumer simply inputs their name, insurance plan number, and perhaps two or three more data elements. Within 10 to 45 seconds, a complete and accurate estimate appears, giving consumers immediate, line-item insight into what they will owe.

The process is powered by rules-based engines that automatically query, retrieve, and combine data from payer portals with the hospital’s charge master data and payer contracts. Analytics plays a critical role in assuring the estimate is accurate, including analysis of previously adjudicated claims to identify variances.

Such a tool neatly solves one of the most persistent challenges with implementing price transparency: the pitfalls of making proprietary financial information public. As a provider-facing solution, and because patient-unique information needs to be entered to generate an estimate, not just anyone can use the calculators. This is vastly preferable to putting a list of total charges or paid amounts out there for all competitors to see, which neither reflects negotiated rates with payers or the patient’s accurate out-of-pocket costs.

At the same time, self-service price calculators appeal to today’s information-driven patients and nicely align with how they already seek pricing on other purchases, from airfare to mortgages.

One of the most promising advantages of a self-service price calculator is its potential to engage consumers in multiple ways. After generating a price estimate, for example, the calculator could prompt high-deductible and self-pay consumers to view payment plan options. It could even engage those patients with concerns about their ability to pay and schedule time with a financial counselor. Realistically, we can only expect such concerns to grow along with the increasing number of high-deductible health plans. Since these plans were introduced in 2006, they have increased from 4 percent to a whopping 24 percent.

A deductible payment and co-insurance spread out over a year, or whatever the time span the provider and patient agree on, is clearly more manageable than a lump sum payment. Armed with clear, accurate information about how much they will pay—and how—healthcare consumers can better plan for paying their medical bills. This in turn will help reduce a hospital’s bad debt or charity write-offs.

Most important, patients who clearly understand their financial responsibility are more likely to schedule rather than delay urgently needed care. This reason, above all others, is why providers would be wise to take control of the price transparency issue now.

Jay Deady is CEO of Recondo of Greenwood Village, CO.

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March 23, 2016 Readers Write 5 Comments

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Reader Comments

  • Anonymous Ex-Epic: Epic wasn't doing anything that many other companies weren't also doing. They are also a perfect target for cases that c...
  • TPD!: The debate about "vendor-agnostic"or "vendor-neutral can go one for ever with no one winning the debate. TPD prefers th...
  • Keith McItkin, PhD.: @andy_slavitt With all due respect, interoperability is a goal, but the safety, usability, and efficacy of these devi...
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  • English Speaker: Linguistic prescriptivism: the longest losing battle in written history....

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