Recent Articles:

HIStalk Interviews Travis Bond, CEO, CareSync

September 19, 2016 Interviews No Comments

Travis Bond is founder and CEO of CareSync of Tampa, FL.

image

Tell me about yourself and the company.

I’m the founder and CEO of CareSync, which is my ninth company. My last company was Bond Technologies, which created one of the very first browser-based EMRs in the world. We had the opportunity to exit to the Eclipsys Corporation back in 2008, I believe.

I put the band back together in 2011 to create CareSync, which is a patient-centered electronic medical record that has a service on the side that basically acts as a record aggregator service. Carbon-based interfaces go out and get records and put them in a usable format that can be later searched, shared, and collaborated on. That all gave way to a business opportunity that CMS created in 2015 for chronic care management. That’s where we are today as one of the industry’s largest providers of chronic care management services under the new code.

Which is the chicken and which is the egg in offering a product that both consumers and their providers use?

It was probably providential in some ways that we cut our teeth on a consumer product. We weren’t bound by Washington, DC regulatory requirements for a product roadmap. What’s really useful for people when they become a clinical patient is they need information and they need resources that help them to shorten the gap between what providers are saying and doing on their behalf and how they can then respond. That product, started in 2013 and known as CareSync Plus, had about a 3 percent conversion rate when we went out and advertised it to people.

It is the CMS product that now gives us the business-to-business product. We act as the vendor on behalf of the provider to offer essentially the same service. The difference — and why we still have a chicken and an egg — is that about 5,000 members a month come onto the CareSync platform as family members. Some of those family members want the same services that CCM provides under CMS for themselves. We really couldn’t sunset a legacy product when there were still people who wanted to be more of an active caregiver or wanted to be more engaged patient.

What is the scope of the CCM business?

CMS has released information only about twice on how many people and how many claims they’ve produced. At last count several months ago, about 300,000-plus have been enrolled in CCM programs since their inception in 2015. From our point of view,  the geography of that number of claims is all 50 states. We have users in 30 states alone. It’s not really because we had any grand master plan, it’s that there is an alignment with many practices that want to try to care for people where they live, work, and play, not just at points or nodes of care.

I think CMS was disappointed that it did not ramp up as quickly because CMS had identified that they were going to pay $10+ billion every year for this program. Theoretically, it created a much bigger total adjustable market per year, $16 billion in 2015 and 2016. That number actually increases to a possible addressable market to $20+ billion because now they’ve given three new codes out to incentivize the market. One is an enrollment code and the other two are to address complex chronic care.

It’s not going away. It was a slow-starting process, but it’s being addressed from many different areas. The inevitability of chronic care management programs throughout healthcare has pretty much been set in stone and will just continue to grow as other new things have been introduced in healthcare over the last several decades, like HMOs and PCMHs and others. This is just another one in the fold that will continue to mature.

If I’m a physician and I think you’re a candidate to participate in CCM, what is your obligation as a patient?

It’s really quite simple. There is the consent process, which CMS wanted to know that there was written confirmation that a patient was elected to participate in something that they were eligible for. In this case, two or more chronic conditions. The chronic conditions, though, were very liberally interpreted by CMS, meaning that they were not going to actually put edits on what a provider thought was a chronically ill condition for the patient. If you look at ICD-9 alone, there are over 4,500 conditions which are marked or flagged chronic in nature.

From a patient’s perspective, it really is how you design the program. Patients need to have access to information, electronically or written, and have access to those that can access that information and are clinically trained or licensed 24/7. It’s more of an access from the vendor or the provider’s perspective. The patient, outside of them consenting to the program, just needs to make themselves available. The program  is designed to give back more time and resources to where patients need it and that’s in the consumption of the treatment plans that various providers are administering to them, a reconciliation of that.

We’ve found that variability of patient engagement is as wide as any that you could imagine. Some just like to be called once a month and talked to. Others will have inbound calls and want to talk extensively about their progress. We have patients that will be a few minutes a month or it could literally be in the several hundred minutes per month. Patient requirements are still low, other than their co-insurance or co-pay responsibilities.

Otherwise, it’s intended to be a service that is aggregating information, creating a comprehensive care plan that the patient can then consume and can be collaborated and administered, and then lastly, creating a health summary that can be provided back to the patient or anyone who is seeing the patient. Overall, patient requirements are still low, but it’s incumbent on the provider to maximize the value to the patient of the program as prescribed under CMS.

How does Medicare verify or monitor that services were provided and not just billed?

In the CMS program, you bill Medicare and they pay based upon whatever edits they can run through a computer system. They don’t verify until they actually audit.

This code is really no different. They’ve said at least initially in the first couple of years that they weren’t going to put edits on their claims, meaning that they weren’t going to necessarily determine whether a chronic condition had met some criteria that Medicare would feel is not chronic enough or chronic in the right way. They’ve left that up to the physicians’ discretion.

What we’ve found is we have hundreds of chronic diseases that are on our lists for the patients who we serve. As you know, there are even several thousand rare diseases that meet the chronic definition. As it stands right now, we’ve not seen any claims denied as it relates to the diagnosis that has been tied to the CPT code 99490.

How did CareSync’s recent $20 million in new funding come about and how has it changed what you do?

We were very fortunate to have a lot of venture capitalists and strategics already having conversations with as it related back to our legacy product, CareSync Plus. Many people felt that there needed to be a connective tissue, if you will, for patients where they’re in the space that we call the dark space, which is where you are when you’re not at an appointment or a hospital setting. This dark space is like trying to navigate between airports without a radar system or air traffic control. The thesis was that surely some entity or some party would benefit if patients were better monitored and/or had the opportunities to help themselves adhere to what was prescribed.

When the code came out, it was the match that lit the fire. We were setting ourselves up with people who thought that there were problems in healthcare that could be solved with a combination of nurses and technology. Having those things in place when the code came about allowed us to execute on closing financing rounds from those players. They have since then recommitted to continuing to fund CaresSync.

We feel that the chronic care management market will continue to grow significantly, especially under the new codes in MACRA. We have 18 months of solid data that shows that providers are getting paid. We’re seeing real tangible benefits for clinical outcomes as well. Nine percent of our patients that come into the system have a severe drug-to-drug interaction that no one knew about. That’s nearly one in 10, which is pretty significant because it’s the severe drug-to-drug interactions that potentially are lethal. Sixty-four percent of our patients avoided a duplicate test because they had the results with them. A provider avoided re-prescribing another test because they felt that they had the results that they needed at the time of care.

There are many things that illustrate the advantages of the program. Those things obviously matriculate back to value when you look at an investment community. The key thing in pairing up investments from the investment community and being an entity in this space is the ability to execute at scale. We have found that it is much easier to have a chronic care management program at 30 nurses than it is 300. There are natural elements of growing and scaling that process and learning a lot of things along the way.

I think that what you’ll see overall in the market is that there will be a continued interest from the investment community in supporting this dark space and the vendors that emerge from this innovation opportunity.

Are you seeing any improvement in the ability and willingness of hospitals to provide patients with their electronic records in whatever form they request?

They’re getting a little bit better, but we’re getting a lot smarter. It’s the combination of the two that has created the net result that we are getting better, faster results from the data.

There has been an implementation of these HIT systems lag, in terms of those professionals who are running these systems even knowing that there are features to share the information. There’s still the HIPAA cloud of death and despair that hangs over all of these institutions. They feel that they need to protect this data, even from those who originated it, like the patient. That becomes primarily an education step. There’s still also a lot of medical-legal sensitivity. Why does a person want their data? Do they think we did something wrong?

That’s still a case-by-case process that we have to go through at CareSync. It’s still far easier for a provider to request information than it is a vendor. A vendor is always suspect. It is slowly changing. I wouldn’t say that we have a marked increase in the amount of freedom of information posture of these institutions that hold large amounts of it, but at least we’re seeing some incremental changes in a direction for the positive.

You were selling EHRs in the heady days. Are you glad you aren’t still in the EHR business?

Yes. [laughs] I am glad that I’m not there. In retrospect, the advent of EMRs bogged down the efficiency of a visit.

Having some medical training acted as the foundation for creating our EMR program and helped me. Technology took away from a lot of the observation skills. A  good portion of medical school training is spent in diagnostics and observations of patients. Those just can’t be done simultaneously while also working through documentation requirements.

Hopefully, programs like chronic care management and other things that try to reintroduce an experience that the patient feels comfortable in talking and sharing information and how that’s captured — I’m hoping that we can blunt some of the negative impacts that EMRs had. But I would say that if I ever had to be reincarnated, I would not go back into building any piece of software for ambulatory healthcare. That was a very painful pioneering pathway to walk.

Do EHR vendors get blamed for too many clicks and too much pointless information collection instead of those parties on the back end who require collecting that information before paying providers?

Yes. I would have to side with the EMR vendors on this one. It’s not their fault. It’s Washington, DC that creates the product road maps for vendors now. It’s not what users want.

Users want a certain amount of clicking so that they can document, recall, and have that information available for the next visit or for other providers. There’s real fundamental and foundational value to EMRs. But the direction they’ve taken in terms of usability, unfortunately, was hijacked by those that were writing the checks for them in the first place. Under ARRA,  the government was paying for them, but as a result of them paying for them, they were able to create what they were going to be under Meaningful Use.

There’s always a balance here. We are better off that we now have EMRs, undeniably. You’re in a far better place in being able to record this information a way that we can learn it more rapidly off the science of healthcare and treating those that have disease.

The disadvantage is that we’ve made the billing system on par with the IRS tax code. We’ve made it so complicated that it’s very difficult to do an effective visit with the necessary amount of documentation in a way that demonstrates what took place such that it could be reimbursed on par for what happened. I’m hoping that we’ll eventually get through this, but I’m worried about the overall physician dissatisfaction with their job as we go through this lonely period of transition.

Are consumers really gaining power, demanding their data, and becoming involved as participants in their own care or are we just wishfully thinking that was the case?

I think it’s slowly happening. The best chance that we have in terms of developing technologies for patients is that patients are becoming more consumer aware. That to me is probably the biggest weapon that we have. The patient is probably the greatest sleeping giant in all of healthcare. When you go through Uber or a good banking scenario or a good restaurant experience, you understand how brands compete for your business, your attention, and the right to serve you. They see that as a privilege. That’s how good businesses become great businesses.

Healthcare has had the patient lag, where they’ve been more passive and they’ve not really felt like they’re in an empowered position. I think a lot of things will start to accumulate to hit a tipping point where the patient will be more in a position of a consumer. When that light bulb goes off, the technology that they’re experiencing healthcare in needs to be more on par with other things that they experience in their lives.

The biggest advantage to the payer, the provider, and the patient is that when you look at where healthcare falls down, it doesn’t fall down in a science problem. It falls down in to an adherence and data-sharing problem. It’s not like we need better cures — we just really need to implement more effectively the ones we’ve already discovered.

Where do you see the company and the industry in the next 5-10 years?

We’ll be making more decisions in real time. Things like IBM Watson and other types of analytics that will be under the hood … we’ll  see like a TurboTax for health. These things have happened, so you need to do these things.

The problem with healthcare that we’re going to finally get our hands around over the next 10 years is, how do I go do those things? If somebody tells me to get an MRI, who’s going to do that for me? Innovation is going to start to fill in this last mile of putting the things that need to get done to actually getting done and being tracked. That will start to figure its way out over the next 10 years, principally because it’s being funded against something that is challenging our economy, where 86 percent of the dollars are being spent out there to manage chronic disease. If we don’t get our hands around it, we will end up breaking both the legs of the US economy.

What will change is that vendors, payers, and providers will figure out how to play nicely with the patient who ultimately is writing a big part of the check, whether in taxes or insurance premiums. They will start to find an experience to where they’re now more engaged. Not in vendor classic term of engaged, but making them a more efficient component of the healthcare equation.

View/Print Text Only View/Print Text Only
September 19, 2016 Interviews No Comments

Morning Headlines 9/19/16

September 18, 2016 Headlines No Comments

Operations Returning to Normal at ARH Facilities as Computer Systems Go Back Online

Appalachian Regional Healthcare (KY and WV) reports that its networks are back up after a cyberattack left the health system running on downtime procedures for the last three weeks.

Community Health Said to Explore Options Including Sale

Community Health System’s shares climbed 16 percent on rumors that the 158-hospital health system is looking for a buyer.

Cambridge trust sets outsourced commodity IT services market-test

In England, Cambridge University Hospital NHS Foundation Trust looks to outsource its IT infrastructure, service desk, and security services in a seven-year, $182 million request for proposal.

HHS takes steps to provide more information about clinical trials to the public

Drug and medical device companies will be required to publish all NIH-funded clinical trial results to ClinicalTrials.gov beginning in January 2017.

View/Print Text Only View/Print Text Only
September 18, 2016 Headlines No Comments

Monday Morning Update 9/19/16

September 18, 2016 News 1 Comment

Top News

image

Appalachian Regional Healthcare brings the computer systems of its Kentucky and West Virginia hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by an attack of unspecified malware. At least one hospital source says the attack involved ransomware, but the hospital declined to confirm citing an ongoing federal investigation.

image

ARH says its IT department took its systems and network down to stop the spread of the virus, causing downtime it described as causing “some inconvenience for a few weeks.”


Reader Comments

image

From Follow the Money: “Re: Mayers Memorial Hospital District (CA). Their EHR was down for two weeks at a cost of $100,000.” The forwarded board of directors meeting agenda did not indicate the source of the downtime, but says half of the $100,000 was spent on “equipment to mitigate future issues.” I don’t know which system was down, but an earlier board meeting agenda mentions Paragon. It’s fun to read a small hospital’s simply written meeting information, which includes such interesting thoughts as an upcoming chocolate festival fundraiser, the poor attitudes of the ED doctors, a sticky ED door that unintentionally left the department open to the public, and the development of an IT disaster backup solution that might need to be revisited.

From HTCGLOBAL: “Re: CareTech Solutions. Jim Giordano is no longer president and CEO as of this past Friday. Seven top executives have resigned in the past six months. HTC Global continues to offshore work.” Unverified, but the company’s executive page and Giordano’s LinkedIn profile are unchanged. HTC Global Services, which offers IT and BPO services, bought the company in December 2014.

From Ex-PwC Consultant: “Re: PricewaterhouseCoopers Advisory Services. Has been quietly laying off workers all summer, with rumors of 20-25 percent let go.” Unverified.


HIStalk Announcements and Requests

image

Nearly half of poll respondents think the most important healthcare issue in the presidential election is healthcare costs. New poll to your right or here: who would you vote for if the presidential election were held today?

I’m excited to offer (below) the first of an ongoing series I’m calling Decisions. I’ve been talking with the folks at Definitive Healthcare about getting fresh updates about hospital software decisions and the company graciously offered to share what they learn with HIStalk readers. They didn’t even ask for anything in return, not even a plug, but it’s only fair to credit them as the source.


Last Week’s Most Interesting News

  • HHS awards $87 million in EHR improvement grants to 1,310 safety net health centers.
  • Altos announces that it will acquire Anthelio Healthcare Solutions for $275 million.
  • McKesson withdraws its participation in the independent InSight user group conference after Meditech and Cerner are invited to present alternatives to McKesson Paragon.
  • Russian backers breach the World Anti-Doping Agency’s systems and publish the medical records of Olympic athletes.
  • Apple releases iOS 10, which includes C-CDA support via HealthKit.
  • In England, NHS awards $13 million each to 12 health IT global exemplars to establish best practices.
  • Dartmouth-Hitchcock Medical Center (NH) will lay off 460 employees, blaming its financial losses on billing-related expenses and implementing of new IT systems.

Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

image

Money-losing, for-profit hospital operator Community Health Systems is rumored to be exploring the sale of its business, although the company’s massive debt may limit interest. Shares are down 76 percent since June 2015 even after a 16 percent jump Friday when word of the possible sale leaked out. The company operates 158 hospitals.


Sales

image

The Healthix HIE (NY) chooses Verato’s identity management technology, which claims to deliver up to 98 percent matching accuracy by comparing known information to that contained in commercially available databases. The VA is another customer. Verato raised $12.5 million in a single funding round in January 2015 under its original name Araxid.


Decisions

  • Blue Mountain Hospital District (OR) will change time and attendance software from Healthland to ADP on October 1, 2016.
  • Valley Hospital (WA) will switch from Meditech to Cerner in 2017.
  • Lakes Regional General Hospital (NH) will move from NextGen to Cerner in December 2016.
  • Saint Clare’s Hospital – Denville (NJ) will replace Cerner with Epic in early 2018.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


Announcements and Implementations

image

In England, Cambridge University Hospital NHS Foundation Trust will outsource its IT infrastructure services for an estimated $182 million over seven years. HPE provides those services now via a 10-year agreement signed when the trust chose Epic in 2012. The trust’s growing financial deficit and significant quality problems triggered the resignation of its CEO and finance director in September 2015.


Government and Politics

image

The National Institutes of Health will require drug and medical device companies to post the results of all NIH-funded clinical studies – not just the favorable ones – to ClinicalTrials.gov starting January 18, 2017.

image

Oracle will pay $25 million in cash and provide products worth another $75 million to settle lawsuits over its performance in the failed Cover Oregon insurance exchange, for which Oracle was originally paid $240 million. The state had sought $6 billion in damages, but wasn’t willing to take the case to trial since legal fees alone would have run $1.5 million per month and it had already paid lawyers $20 million in the several lawsuits each party filed against the other.


Privacy and Security

image

Forward Health Group’s security expert Ed Skaife is named Up and Comer Runner-Up in an international security leadership award competition.


Other

image

The three big drug companies that manufacture insulin have increased average prices more than tenfold in the past 20 years in lockstep, with all three companies expressing indignation that anyone would look at list prices since insures get big discounts. The chart above shows the price of Humalog and Novolog, but you would notice that only with sharp eyesight since the prices remained identical while rapidly increasing over 20 years.

Vince and Elise offer Part 7 of their “Rating the Ratings” series, this time looking at physician practice EHRs.


Sponsor Updates

  • Experian Health will exhibit at the RBMA Fall Educational Conference September 25-27 in New Orleans.
  • PatientMatters will exhibit at the Minnesota Hospital Association Annual Meeting September 21-23 in Brainerd.
  • Qpid Health, Sagacious Consultants, Versus Technology, and Zynx Health will exhibit at Epic’s UGM September 21-23 in Verona, WI.
  • Red Hat announces plans for new facility in Boston.
  • The SSI Group will exhibit at the AMSURG Connections Café September 28 in Lake Buena Vista, FL.
  • Sunquest Information Systems will exhibit at CAP’16 – The Pathologists Meeting September 25-28 in Las Vegas.
  • Surescripts will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
  • Audacious Inquiry is sponsoring the SHIEC Annual Conference in Scottsdale, AZ this week.
  • Meditech will attend the 2016 InSight Annual Conference September 27-30 in San Antonio, TX.
  • TeleTracking sponsors The DAISY Award for Extraordinary Nurses.
  • Tierpoint will host Techpalooza September 22 at its facility in Durham, NC.
  • Valence Health will exhibit at the ASHHRA annual conference September 24-27 in Grapevine, TX.
  • Verscend will host its annual conference September 27-30 in Palm Desert, CA.
  • Consulting Magazine includes Huron on its list of 2016 Best Firms to Work For.
  • Healthwise is included in Fortune’s “100 Best Workplaces for Women.”
  • ZeOmega launches the ZeExchange e-newsletter.
  • ZirMed will exhibit at HBMA The Healthcare Revenue Cycle Conference September 21-23 in Atlanta.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 18, 2016 News 1 Comment

Morning Headlines 9/16/16

September 15, 2016 Headlines No Comments

HHS awards over $87 million for health centers’ IT enhancements

HHS announces $87 million authorized within ACA to help  health centers in the US implement EHRs and transition to value-based reimbursement programs.

Library of Evidence to Aid Radiology Imaging Decisions, Curb Wasteful Tests

Harvard Medical School launches a free clinical decision support system designed to help doctors chose appropriate imaging tests for each patient. The system will integrate with EHR systems so that the evidence is presented to clinicians within existing workflows.

Eight Senators Introduce Emergency, One-Year Legislation Allowing States to Offer Americans More Health Insurance Options Next Year

HELP Committee Senators, including HELP chairman Lamar Alexander (R-TN) introduce a one-year emergency bill that would expand purchasing options for consumers that rely on public insurance exchanges for health insurance and waive the mandate penalty for those that did not buy insurance.

25 CIO pay packages revealed

NetworkWorld profiles the 25 highest paid CIOs, with Walgreens CIO Tim Theriault topping the list at $13.6 million and former Kaiser Permanente CIO Philip Fasano listed third in his new role at AIG, where he earns $8.4 million.

View/Print Text Only View/Print Text Only
September 15, 2016 Headlines No Comments

News 9/16/16

September 15, 2016 News 12 Comments

Top News

image

HHS will provide $87 million to 1,310 safety net health centers for purchasing or upgrading EHRs, supported by the ACA’s Community Health Center Fund that was extended under MACRA.

image

HHS reports that 98 percent of health centers use EHRs. Nearly three-fourths of the patients they serve are insured.


Reader Comments

image

From Lana Retentive: “Re: Charleston Area Medical Center (WV). Goes live this week in the first prominent Soarian to Millennium conversion that was supposed to have been completed in June. The go-live vendor has been asked to bring in SMEs in charging and patient accounting, but no word on whether they’re using a charge validation vendor.” Unverified.

image

From Xander Steel: “Re: startups. You told the would-be CEO that HIStalk readers won’t be interested in companies until they reach either $1 million in funding or $5 million in revenue. I’m not really interested in stories about capital raised when there’s no existing demand. Any chance when you disclose investment funding that you can also mention whether the company has actual revenue? I know it’s easier said than done since the companies aren’t publicly traded.” I don’t know how to get revenue information since those small companies rarely want to disclose it (which tells you that it’s likely minimal) and their numbers would be self-reported and unaudited anyway. My newsworthiness threshold of $1 million in funding is low enough that many companies can raise that much without having any paying customers, which doesn’t necessarily mean you would be wise to become one. Significant funding suggests that investors with access to inside information bought in for good reason, but that might be based on future opportunity rather than present revenue (much less profit).

image

From Doughboy: “Re: Epic. Can you believe that a publication ‘reported’ that the company’s R&D spending exceeds Silicon Valley companies without doing any type of verification?” I believe it. The obviously star-struck publication ran Judy Faulkner’s claim that Epic spends 50 percent of operating expenses on R&D without validating that number, then compared it to the SEC-filed data of Epic’s publicly traded competitors in trying and failing to make a point without letting those companies respond. The goal was obviously to earn clicks, not to provide useful information.


HIStalk Announcements and Requests

image

Welcome to new HIStalk Platinum Sponsor InMediata. The Charlotte, NC-based company‘s InBanking payment reconciliation solution eliminates manual ERA payment and patient payment reconciliation to bank deposits; automates complex billing scenarios by splitting ANSI 835 files into separate billing systems; and converts paper payments to electronic files for posting and reconciliation. CEO and industry long-timer John Marron explained the “banking as the last mile” problem well when I interviewed him a few months ago, pointing out that while front-end RCM functions are mostly automated and clearinghouses have become commoditized, the back-end work (payments, reconciliation, and payment analytics) is mostly inefficiently manual. Thanks to InMediata for supporting HIStalk.

This week on HIStalk Practice: Medical associations weigh in on new MACRA options. The Maine Medical Association endorses DrFirst eRx solutions. AMD Global Telemedicine expands Massachusetts headquarters. Mediware adds PQRS reporting capabilities to its rehab EHR. Lynchburg, VA-area practices join Privia Medical Group. CompuLink gets into telemedicine.

This week on HIStalk Connect: Sanofi and Verily Life Sciences launch diabetes management company. Chrono Therapeutics raises a $47.6 million Series B. Frost & Sullivan recognizes Validic with an innovation leadership award. Samsung-backed smart belt startup raises more than double its Kickstarter goal.

image

I’m beginning to think that a significant percentage of health IT executives sport disfiguring facial injuries or were raised in Amish families considering that their graven image is nowhere to be found on the Internet, including on their LinkedIn profiles. I frankly distrust people whose photos aren’t available online. It’s only slightly better when someone shrinks their LinkedIn photo in failing to understand that the right process is to use a full-sized image and let LinkedIn thumbnail it automatically, which doesn’t seem too far beyond the understanding of technology executives.


Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

image

Huron Consulting Group renames itself to Huron.

Team messaging vendor Klara, which describes itself as “a professional WhatsApp for medicine,” raises $3 million, increasing its total to $5.5 million. The company pivoted from teledermatology software to messaging just a few weeks back. It did not inspire my confidence that the company’s website was down all day Thursday as I tried to learn more.

In Germany, officials reportedly raid the offices of eight drug wholesalers, including McKesson, to determine if they illegally conspired to avoid stealing each other’s customers.

image

A federal judge allows Cave Consulting Group’s antitrust lawsuit against OptumInsight to continue. CCG says OptumInsight, owned by UnitedHealth Group, controls 90 percent of the claims grouper software market only because the company it acquired in 2003, Symmetry Health Data Systems, lied on its patent application. UHG agreed in April 2015 to pay CCG $12 million for infringing on its patents.

image

A Network World review of the 500 largest publicly traded companies finds that 25 of them disclose CIO pay. On their list is former Kaiser Permanente CIO Phil Fasano, who joined insurer AIG in the newly created position of EVP/CIO in late 2014 and was paid $8.4 million in 2015 as the #3 top earner. Walgreens Boots Alliance CIO Tim Theriault took the #1 spot with $13.6 million.


Sales

image

Vigilance Health (CA) chooses population health management technology from EQHealth Solutions for chronic care management and care coordination programs in 51 California counties.

Nebraska Medicine chooses and implements Nuance Dragon Medical One for clinical documentation in Epic, with 94 percent of its surveyed doctors saying it helps them practice better medicine, 71 percent reporting that their documentation has improved, and 50 percent saying Nuance saved them at least 30 minutes per day.


People

image

Julie Boughn (Cognasante) joins Audacious Inquiry as senior director.

image image

CTG promotes Angela Rivera and Robert Barras to vice president.


Announcements and Implementations

image

The Department of Defense approves the participation of Fort Drum Medical Department Activity (NY) with the HIE of HealtheConnections, which will combine the military’s medical records of soldiers and families with those contributed by 300 connected civilian facilities to create a single overall view.

image

Harvard Medical School launches Library of Evidence, which offers free, evidence-based imaging clinical decision support that can be embedded in EHRs to help clinicians choose the most appropriate imaging tests.

image

Lenovo Health and LifeMed ID partner to offer an identity management solution that includes a trusted patient ID token that links to medical records. According to Lenovo Health’s website, providers can “achieve 100% accurate.”

image

National Decision Support Company will offer cardiac imaging appropriate use criteria from the American College of Cardiology.


Government and Politics

Eight Republican senators that include HELP committee chair Lamar Alexander (R-TN) introduce emergency, one-year legislation that would eliminate ACA-mandated penalties for those who don’t buy health insurance and would allow consumers who are covered by exchange-issued plans to use their federal government premium subsidies to buy plans elsewhere.


Privacy and Security

From DataBreaches.net:

  • A dental practice whose patient information was exposed to the Internet explains the odd situation: (a) the practice gave live patient data to a vendor whose system it was considering; (b) the practice decided that same year not to buy that system; (c) the vendor took the server offline in 2004; and (d) somehow the server (now unsecured) was brought back online 10 years later for a two-week period in 2014 during which the practice’s patient information was exposed.
  • The Dark Overlord (or other hacker claiming to be him) threatens to publish patient information from St. Francis Health System (OK) unless it pays $15,000 by Sunday.
  • A single ransomware author claims to have made $94 million in profit during the first half of 2016.

SNAGHTML2992e41

A legal preview of patient and provider class action lawsuits brought against Banner Health (AZ) following a breach of its food service point-of-sale systems that exposed the information of 3.7 million people raises these issues:

  • The plaintiffs don’t know whether hackers actually accessed or used the information, only that they might at some point.
  • The suit does not claim breach of contract, which doesn’t always work in breach lawsuits, and instead argues that Banner made an enforceable promise without consideration (promissory estoppel).
  • The plaintiffs argue that Banner didn’t notify them promptly.
  • The case uses recent FTC enforcement actions to claim that Banner violated the FTC act that says lax cybersecurity constitutes “unfair or deceptive acts.”

Technology

image

Accenture announces a health IT innovation challenge tied to its venture fund.

BSX Athletics launches a Kickstarter campaign to fund its LVL wearable hydration monitor. It has raised $200,000 vs. a goal of $50,000 and is a smart idea that apparently actually works, although Kickstarter projects are notorious for failing and not everybody wants to wear a one-trick wristband 24/7 .


Other

An HHS OIG report finds that for-profit hospices are aggressively recruiting patients who aren’t terminally ill and who may not know that choosing palliative care means they won’t receive other treatment. Medicare paid $15 billion for hospice care in 2013 and is trying to recover $1 billion from for-profit hospices in which one in three patients leave the service without dying, double the rate of non-profit hospices. In Mississippi, 41 percent of hospice patients were discharged alive. 

image

Former New York City Mayor Michael Bloomberg donates another $300 million to the Johns Hopkins Bloomberg School of Public Health, saying the US should lead the world in life expectancy instead of placing 31st. Bloomberg has donated $1.5 billion to Hopkins, of which the School of Public health received $684 million, explaining, “It’s a lot cheaper to prevent than to cure, and it’s certainly a lot more humane.”

A man who had been hospitalized for 22 years with spinal muscular atrophy dies at 54, to the consternation of employees who had grown attached to him. It would be interesting to see the final bill and to know who’s paying it.


Sponsor Updates

  • Impact Advisors and NTT Data make Consulting Magazine’s list of “Best Small Firms to Work For.”
  • InterSystems and Intelligent Medical Objects will exhibit at the Epic UGM September 21-23 in Verona, WI.
  • PDR Network CMO Sal Volpe, MD receives the 2016 Patient-Centered Medical Home Practice Award.
  • Live Process will exhibit at California Hospital Association Disaster Planning 2016 September 19-21 in Sacramento.
  • Nordic is named one of Madison Magazine’s best places to work.
  • Vyne President and CEO Lindy Benton presents at the HERe Conference in Nashville.
  • AlleyWatch spotlights MedCPU in its coverage of New York City startups that have raised the most amount of money.
  • Meditech and Nvoq will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
  • Navicure will exhibit at Kansas MGMA September 21-23 in Overland Park.
  • Netsmart will exhibit at the Kansas Public Health Association conference September 20 in Wichita.
  • Nordic will host an open house September 19 in Madison, WI.
  • Obix Perinatal Data System will exhibit at the Georgia Perinatal Conference September 21-23 on St. Simon’s Island.
  • Infor Healthcare will exhibit at ASHHRA 2016 September 25 in Grapevine, TX.
  • Clockwise.MD will exhibit at the UCAOA Fall conference in Nashville September 29 – October 1.
  • Christy Kaplan and Susan Tolan of The Chartis Group presented “Transforming Care Coordination: Keys to Operationalizing Your Pop Health Strategy” at the HIMSS Population Health Forum this week.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 15, 2016 News 12 Comments

EPtalk by Dr. Jayne 9/15/16

September 15, 2016 Dr. Jayne No Comments

I was reminded today that this year marks the 20th anniversary of the Health Insurance Portability and Accountability Act of 1996, affectionately known as HIPAA (or HIPPA, as the case often is). As much as we lamented its beginning, most of us had no idea how much more regulation we would see in the healthcare space during the subsequent decades. Physicians and other healthcare providers are now more regulated than they have ever been, which has contributed significantly to physician burnout and early retirement in many communities.

Regulations are often nested within other policy and regulatory documents. A recent example of this is a requirement in the proposed 2017 Medicare fee schedule that would require surgeons and other procedural physicians to report a series of G codes during the postoperative period. The codes vary based on place of service, patient complexity, and time. They don’t match cleanly with existing bundled services. The fee schedule also proposes changes to the quality measures used for Accountable Care Organizations, which also met with resistance.

Sometimes CMS announces plans which benefit physicians, which feels like a rarity. The recent announcement of a “pick your pace” approach to MACRA implementation was welcomed due to the apparent flexibility of the approach. There are a few options for MIPS reporting in 2017:

  • Providers can simply test their ability to report data, doing so at least once at some point during the year. Completion of testing allows providers to avoid penalties and ensures that systems are functioning prior to greater participation in subsequent years.
  • Providers can also consider reporting for part of the calendar year. However, they must report performance in all three Composite Performance Score (CPS) categories. This approach could result in a small bonus in 2019.
  • Providers can report the full calendar year (again in all three categories) to achieve what CMS describes as a “modest” bonus in 2019.
  • Providers participating in certain Advanced Alternative Payment Models can qualify for a five percent bonus.

Selecting the third option will depend on the ability of vendors to quickly become compliant with the requirements of the final rule, which is expected to be released by early November. This means that they have very little time to achieve software readiness and upgrade thousands of providers. Depending on vendor resources and how much prep work has been done in anticipation of the release of the final rule, full-year reporting may be little more than a pipe dream.

For those of us who live and breathe this on a daily basis, having some flexibility in reporting seems refreshing. But for the large numbers of physicians and practices who have no idea what MACRA even is, let alone that these regulations are coming, the flexibility won’t be very comforting.

I recently received a blast letter from the Drug Enforcement Administration letting me know I would have to upgrade my browser in order to access DEA resources and renew my registration. That’s insignificant to many physicians, yet the DEA felt it was important enough to mail paper correspondence to every registered physician across the country. MACRA and the associated penalties and incentives are a big deal. Where is the letter to all Medicare providers? CMS is expecting physicians to follow blogs and tweets and webcasts that many physicians don’t even know exist.

I’m not absolving physicians from being responsible for what is going on in the world around them, but merely commenting on the reality of many physicians out there, which has also been reflected in various surveys and articles. Ultimately if a physician is going to contract with a payer, he or she is responsible for knowing the rules, but it certainly could be easier.

What’s also not easy is figuring out how to actually achieve savings under Alternative Payment Models. Recently CMS released performance data for 2015. The numbers show that of 404 Medicare ACOs, only 125 of them qualified for shared savings. Of the 392 Shared Savings Program ACOs, only 119 qualified for shared savings. Participation in Pioneer ACOs continues to shrink, with only 12 remaining.

I don’t think those statistics make Alternative Payment Models look appealing to the average physician. Of course the “appeal” is different for providers employed by hospitals and large health systems who are simply forced to participate. Those that weren’t successful based on the metrics are still doing the extra work required of ACO members but just not getting the shared savings payments at the end.

I do feel that CMS is listening and trying to respond. Recently they changed the rules for the Medicare Chronic Care Management services code to remove a requirement that providers have 24/7 access to patient records. The code allows providers to bill for coordination of care for patients who have chronic conditions. However, I’m not sure what kind of burden the 24/7 rule really was.

The bigger barrier in my experience is the fact that patients have to pay a portion of the charge, and many don’t see the benefit because the services performed on their behalf are often done behind the scenes – phone calls to consultants, review of personal health log data, etc. There’s also a process required to obtain patient consent for participation which adds to challenges in adopting the service. I find it funny that people who will pay for a maintenance/protection program for their phone will balk at paying for something similar to help safeguard their health.

I’m mentoring some medical students and several are out on ambulatory clinical clerkships, working with practicing community physicians. They always have questions about how regulations are going to impact them in practice. Sometimes I have answers and sometimes there are no good answers. What they see, however, is definitely driving them away from primary care, where it seems that providers feel a greater burden. We’re getting thousands of new Medicare beneficiaries each day, so the need for processes and policies is real in order to successfully manage the demands. I think many of us wish that there was just a better way.

What are you doing to celebrate the 20th anniversary of HIPAA? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
September 15, 2016 Dr. Jayne No Comments

Morning Headlines 9/15/16

September 14, 2016 Headlines No Comments

Risa Lavizzo-Mourey Stepping Down as President and CEO of Robert Wood Johnson Foundation

Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey announces that after 14 years running the $10 billion private research foundation, she will retire.

US healthcare chain unveils UK plan for private hospital overlooking Buckingham Palace

Cleveland Clinic files plans to build a 205-bed private hospital in London’s upscale West End.

49 states plus DC reduce avoidable hospital readmissions

CMS releases new data on the Hospital Readmissions Reduction Program showing that readmission rates fell by eight percent nationally. Other than Vermont, all states and Washington DC reported readmission decreases.

Slavitt says high premium increases are result of one-time effects

Acting CMS Administrator Andy Slavitt defends the increased premiums on ACA insurance exchanges by saying they are likely a one-time adjustment resulting from the end of risk adjustment payments.

View/Print Text Only View/Print Text Only
September 14, 2016 Headlines No Comments

Readers Write: The Surgeon General’s Rallying Cry Against the Opioid Epidemic Must Also Be a Call to Arms for Healthcare IT

September 14, 2016 Readers Write 2 Comments

The Surgeon General’s Rallying Cry Against the Opioid Epidemic Must Also Be a Call to Arms for Healthcare IT
By Thomas Sullivan, MD

image

In a rare open letter to the nation’s doctors, US Surgeon General Vivek Murthy, MD, MBA sounded a rallying cry to engage their greater participation in the opioid-abuse crisis afflicting our country. Missing from the USSG’s commendable call to arms, though, was mention of the role technology plays in reducing drug diversion and doctor shopping and providing ready access to services to support patients.

Those of us in healthcare IT know that we are critical to this cause. The USSG is talking to our customers, and we know our customers aren’t adopting as quickly as they could the substance abuse-fighting technologies that are widely available to them. This includes a variety of technology solutions such as:

  • E-prescribing technology, particularly EPCS to support the electronic prescribing of controlled substances, which is key to helping providers more efficiently deploy and monitor prescription medicines being prescribed or over-prescribed across a practice.
  • Medication adherence monitoring technology that lets providers gauge in real time, at the point of encounter, a patient’s level of compliance with drug therapy and provide patients with evidence-based support and services for self-management.
  • Clinical decision support that helps doctors avoid adverse drug events and medication errors.
  • State-run prescription drug monitoring programs (PDMPs) designed to help law enforcement track the use of controlled substances and help prescribers identify doctor shoppers and others seeking illicit access to controlled substances.

Specific to the opioid abuse epidemic, the most important next step is for physicians to be able to check PDMPs within their normal workflow. Simply said, the integration and availability of PDMP data within e-medication management solutions — e-prescribing, medication history services, medication adherence tools and the like — will result in the greatest use of PDMP data and the best one-two tech-assisted punch we have in the opioid battle.

Over the past two years, policymakers have begun to take action in using EPCS to address this crisis. This past March, New York State took a major step toward this goal when it began requiring e-prescriptions for all controlled substances as well as all non-controlled substances, frequently referred to as “legend drugs.” Known as I-STOP, the Internet System for Tracking Over-Prescribing act, originally passed in 2012, New York’s experience now serves as a case study for other states that wish to modernize their prescribing infrastructure and address opioid abuse.

Maine as well now will require opioid medications to be prescribed electronically via Drug Enforcement Agency-certified EPCS solutions beginning in July 2017. Several other states including Massachusetts, Missouri and Maryland are also considering or working to pass mandatory EPCS requirements for prescribers.

Unfortunately, neither New York nor Maine PDMP data is currently accessible to health IT vendors for integration into the prescribing workflow of providers.

E-prescribing – the direct digital transfer of patient prescriptions from provider to pharmacy – is broadly recognized as an important tool in helping promote patient safety, convenience, and overall efficiency for all stakeholders in the prescription process. E-prescribing is well understood to assist prescribers by allowing patients and doctors to better guard against medication errors, such as drug-to-drug interactions, reduce common errors inherent in paper-based prescribing — including illegible handwriting, misinterpreted abbreviations, and unclear dosages, — and provide critical decision support tools.

Despite the fact that, nationwide, more than 70 percent of doctors transmit most prescriptions electronically, the vast majority of these prescriptions are only for legend drugs. In comparison, less than 10 percent are using EPCS solutions to e-prescribe controlled substances. However, in New York, the I-STOP legislation has driven adoption of EPCS to over an estimated 70 percent. As such, all indications are that the laws passed in New York and Maine mandating use of EPCS and PDMPs will almost certainly prove helpful in curbing opioid abuse, fraud, and diversion and help prevent possible addiction down the line.

However, full adoption of PDMPs will likely never be achieved until the PDMP information is accessible in the doctor’s technology workflow. Ultimately, the opioid-abuse battle needs to be fought through states enabling their respective PDMP data to flow through doctors’ own workflows, as opposed to requiring that physicians and clinicians go outside their familiar software tool and interact with a separate portal in order to access their respective state PDMP databases.

In the case of New York State, the Medical Society of the State of New York conducted a survey that found a large percentage of prescribers believed that forcing mandatory compliance was placing an undue burden on their practices. No doubt, physicians feel overburdened with IT mandates. Improving integration between PDMPs and electronic health records will alleviate some of these burdens and allow for better compliance.

States must work more closely with the healthcare community to remove obstacles that will allow as close to 100 percent compliance as possible. Every state has the opportunity to learn from New York to smooth implementation and drive adoption to make a meaningful impact on the growing opioid abuse epidemic. Leadership in healthcare IT companies must be more vocal about our role and responsibilities in enabling doctors on the ground.

With the US Surgeon General weighing in, those of us in the healthcare IT community must rise up to make our voices heard. The importance of integrating e-medication management tools and EPCS solutions with PDMP data cannot be overestimated. It is the best path toward helping our customers — the doctors — make the right decision, at the right time, with the right data, on the right platforms.

Thomas Sullivan, MD is chief strategy and privacy officer of DrFirst of Rockville, MD.

View/Print Text Only View/Print Text Only
September 14, 2016 Readers Write 2 Comments

Readers Write: The Electronic Health Record and The Golden Spike

September 14, 2016 Readers Write 1 Comment

The Electronic Health Record and The Golden Spike
By Frank D. Byrne, MD

image

On May 10, 1869, at a ceremony in Utah, Leland Stanford drove the final spike to join the first transcontinental railroad across the US. Considered one of the great technological feats of the 19th century, the railroad would become a revolutionary transportation network that changed the young country.

clip_image002

For the past few years, the healthcare industry and the patients in its care have experienced a similar “Golden Spike Era” through the deployment of the electronic health record (EHR). Others have used this analogy, including author Robert Wachter, MD at a recent excellent presentation at the American College of Healthcare Executives 2016 Congress on Healthcare Leadership.

Why is this comparison relevant? While the Utah ceremony marked the completion of a transcontinental railroad, it did not actually mark the completion of a seamless coast-to-coast rail network. Key gaps remained and a true coast-to-coast rail link was not achieved until more than a year later and required ongoing further improvements.

Similarly, while a recent study indicated that 96 percent of hospitals possessed a certified EHR technology and 84 percent had adopted at least a basic EHR system in 2015, there is still much more needed to achieve optimized deployment of the EHR to make healthcare better, safer, more efficient, and to improve the health of our communities.

Nonetheless, the EHR is one of the major advances in healthcare in my professional lifetime. It is an essential tool in progress toward the Institute for Healthcare Improvement’s “Triple Aim for Healthcare”– better patient experience, lower per-capita cost, and improved population health. We cannot achieve those laudable goals without mining and analyzing the data imbedded in the EHR to generate useful information to guide our actions. Advances in data science are enabling the development of meaningful predictive analytics, clinical decision support, and other tools that will advance quality, safety, and efficiency.

But there is much work to do. Christine Sinsky, MD, vice president of professional satisfaction for the American Medical Association, and others have written with concern about dissatisfied physicians, nurses, and other clinicians who feel the EHR is distracting them from patients care and meaningful interactions with their patients.

“Contemporary medical records are used for purposes that extend beyond supporting patient and caregiver … the primary purpose, i.e. the support of cognition and thoughtful, concise communication, has been crowded out,” Sinsky and co-author Stephen Martin, MD note in a recent article.

Perhaps you’ve also seen the sobering drawing by a seven-year-old girl depicting a doctor focused on the computer screen with his back to her, his patient.

clip_image004

Some of the EHR’s shortcomings may be the result of lack of end user input prior to implementation, possibly due to the implementing organization not incorporating the extensive research gathered by the EHR providers. Further, even if one gets end-user input prior to implementation, there’s always challenges prior to go-live, and it seems to me that optimization after implementation has been under-resourced. And let’s not look at temporary ”fixes” as the best and final answer. I was dismayed recently to see “hiring medical scribes” listed as one of the top 10 best practices in a recent Modern Healthcare poll.

Don’t get me wrong, to have a long game, you must have a successful plan to get through today, and if hiring scribes can mitigate physician dissatisfaction until the systems are improved, so be it. But scribes are a temporary work-around, not a system solution.

As an advisor to an early-stage venture capital fund, I’ve enjoyed listening to many interesting and inspiring pitches for new technology solutions. Initially, my algorithm used to rate these ideas was:

  • Is it a novel idea?
  • Will enough people or organizations pay for it?
  • Do they have the right customer?
  • Do they have the right revenue model?

Thanks to the input of physicians, nurses, therapists, and other clinicians, and the work of Dr. Sinsky and others, I quickly added a fifth, very important vital sign: Will it make the lives of those providing care better? Similarly, author, speaker and investor Dave Chase added a fourth element to the Triple Aim, caregiver experience, making it the Quadruple Aim.

When I was in training, we carried the “Washington Manual” and “Sanford’s Antimicrobial Guide” in the pockets of our white coats as references and thought we had most of the resources we needed to provide exceptional care. Now, caregivers suffer from information overload of both clinical data and academic knowledge. Some query Google right in front of their patients to find answers.

In healthcare today, we work within a community of diverse skills and backgrounds, including clinicians, non-clinicians, computer scientists, EHR providers, administrators, and others. To achieve our goal of improving health and healthcare for individuals and communities, we must work together to organize, structure, mine, and present the massive amounts of data accumulated in the EHR. To me, the concept of population health is meaningless unless you are improving health and outcomes for my family, my friends and me. Just as the placement of “The Golden Spike” was only the beginning of railroad transportation becoming a transformational force in American life, the fact that 96 percent of U.S. hospitals possess a certified EHR is just the beginning.

I have been accused of being a relentless optimist, but I firmly believe we can use the EHR to improve the caregiver and patient experience (I believe patients will and should have access to their entire medical record, for example), and fulfill the other necessary functions that Sinsky and Martin describe as distractions from the medical records’ primary purpose: “quality evaluations, practitioner monitoring, billing justification, audit defense, disability determinations, health insurance risk assessments, legal actions, and research.”

Lastly, there is one more similarity to “The Golden Spike.” In 1904 a new railroad route was built bypassing the Utah track segment that included that historic spot. It shortened the distance traveled by 43 miles and avoided curves and grades, rendering the segment obsolete. Already, many EHR tools, applications and companies have come and gone. Many of the tools we use now remain rudimentary compared with what we really need. We must use what we have to learn and continuously improve, and frankly, we need to pick up the pace. The patients, families and communities depending on us deserve no less.

Frank D. Byrne, MD is the former president of St. Mary’s Hospital and Parkview Hospital and a senior executive advisor to HealthX Ventures.

View/Print Text Only View/Print Text Only
September 14, 2016 Readers Write 1 Comment

Morning Headlines 9/14/16

September 13, 2016 Headlines No Comments

Atos to acquire Anthelio Healthcare Solutions

French consulting firm Atos acquires Anthelio Healthcare Solutions for $275 million.

HIMSS launches international buddy programme to support NHS Digital Exemplars

HIMSS offers to match the 12 NHS hospitals recently selected to establish themselves as digital health “exemplar” with US hospitals capable of offering guidance and relevant expertise.

Electronic Capabilities for Patient Engagement among U.S. Non-Federal Acute Care Hospitals: 2012-2015

ONC reports that 95 percent of US hospitals allow patients to electronically view their health information, while only 69 percent offer patients the ability to electronically view, download, or transmit their health information.

The Mobile Doc

Apple releases iOS 10, which includes HealthKit support for C-CDA, which will let patients download their medical records into HealthKit and share parts of that information with other apps. Duke Health (NC) reports that it has already updated its patient portal to support the new functionality.

View/Print Text Only View/Print Text Only
September 13, 2016 Headlines No Comments

News 9/14/16

September 13, 2016 News 1 Comment

Top News

image

France-based consulting firm Atos will acquire Anthelio Health Solutions for $275 million. The announcement states that Dallas-based Anthelio’s annual revenue is $200 million and that its owners are a London investment firm as well as McLaren Health Care Corporation (MI), Anthelio’s largest customer.

Anthelio CEO Asif Ahmad will stay on to lead the new company’s US healthcare practice. The former PHNS changed its name to Anthelio in early 2011.

The acquisition was accurately reported here on August 12 via a rumor report from HIT Enthusiast that Anthelio did not acknowledge when I inquired.


Reader Comments

image

From Tired CIO: “Re: InSight conference. The independent McKesson user group has invited Meditech and Cerner to attend its annual meeting in case someone wants to talk to them about replacing Paragon.” A forwarded email from McKesson says InSight’s board didn’t let the company know until September 7 that it was bringing in Cerner and Meditech as co-sponsors of the user group meeting. The McKesson email adds that having competitors in attendance makes it impossible to share the company’s proprietary information with the group, so it is pulling out of the conference. McKesson adds that it is considering extending its own user forums that run concurrently in San Antonio to include everything it had planned for InSight. It’s also creating its own user group.

image

From Mimsey: “Re: InSight conference. McKesson is expected to make an announcement Wednesday about the disposition of its Enterprise Information Solutions, which includes Paragon. Meanwhile, people aren’t happy that the company won’t be presenting at InSight.” At least one attendee says they may just cancel their non-refundable travel since they spend 90 percent of their InSight time attending McKesson-led sessions and workshops and it’s not worth it since McKesson isn’t coming. That person questions why Cerner and Meditech needed to be invited to the conference since they would happily travel to any prospect’s site to do demos without having to meet them at InSight. I have to agree with that attendee – even though McKesson has burned a lot of healthcare IT bridges and is about to leave its customers in a lurch of unknown dimensions, it’s unreasonable to expect McKesson to attend the meeting with its competitors who were invited specifically to pitch to its customers. Attendees got shafted once by McKesson and now by their user group. The InSight board should admit that it made a bad decision and un-invite Cerner and Meditech in trying to make up with McKesson one last time to salvage their conference. I doubt McKesson is really going to create its own UGM since it will be dumping all of the products into the new company formed with Change Healthcare anyway, so nobody will care about McKesson a year from now. Meanwhile, we’ll see what happens the morning of September 28 at the InSight session titled “EIS Roadmap.”

From Startup CEO: “Re: my startup. I would love to get a mention on HIStalk.” OK, here’s your mention, in the form of a list: (a) a one-person consulting company isn’t a startup since ‘startup’ implies impressive investment, momentum, and a team with ambitious goals; (b) you aren’t a real CEO if you’re the only employee; and (c) HIStalk readers won’t care about your company until it hits either $1 million in funding or $5 million in revenue (and maybe not even then).


HIStalk Announcements and Requests

image

I was surprised to receive an oddly worded bulk email from Black Book that included screen shots from the “Rating the Ratings” series Vince and Elise did. While I’m happy to be called “the industry’s objective health information systems resource,” let the record show that I wasn’t asked for permission, I didn’t actually rate anyone (Vince and Elise did that), and while I’ve run surveys in the past whose methodology and response rate I was proud of, this one wasn’t one of those – it was informal, not validated, and self-selected.

image

Medicity was the first HIStalk sponsor going back to 2004, so when they asked if I would be willing to return the favor and sponsor their Client Summit being held this week by providing pens and pads, I said sure (I just now realize  the irony of giving digital health attendees old-fashioned pens and paper). I’m always scrounging at the HIMSS conference exhibit hall to get a (rare) notepad to go with the (ubiquitous) pens, so hopefully someone found the matching set useful.

image

Welcome to new HIStalk Platinum Sponsor Infor. The New York City-based company delivers industry-leading, healthcare-specific solutions used by 5,000 organizations in 30 countries (including 72 percent of US hospitals larger than 150 beds) to integrate, plan, track, and manage vital assets such as people, supplies, clinical data, relationships, and financial resources. On-premise or cloud-based solutions support human capital management, financial management, patient-centered supply chain management, enterprise performance, relationship management, business intelligence and analytics, and clinical interoperability. Thanks to Infor for supporting HIStalk.

I found this overview of Infor CloudSuite Healthcare on YouTube.

Listening: the impressively remastered  (for the second time) the Beatles “Live at the Hollywood Bowl,” a fascinating audio memento of the band’s 1964 and 1965 concerts there. I’m sure today’s listener can hear the music better than the four lads back then given the insane fan screaming that overcame their primitive audio equipment but is nicely dialed back here. They sound surprisingly talented, warm, and tired but enthusiastic, just the way they should be remembered 50 years after their final August 1966 live performance in San Francisco after conquering the world by their early 20s. Also: new from Madison, WI-based Garbage, whose heavy-with-hooks sound is hard to categorize and equally hard to listen to without desk-drumming.


Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

image

Bedside patient engagement technology vendor Lincor Solutions will merge with its Australia-based distributor to form Lincor Limited, which will be listed on the Australian Securities Exchange. Lincor CEO Chris Cashwell will be CEO of the new company.The Hills Health Solutions business generated $23 million for publicly traded parent company Hills Ltd. in the most recent financial year.

image

Surgery workflow management technology vendor ExplORer Surgical raises $1 million in a seed funding round. The company’s “surgical playbook” system was developed by University of Chicago, which is among its investors.

image

Diabetes management app vendors Glooko and Diasend merge.


Sales

image

Wise Health System (TX) chooses Allscripts Sunrise and CareInMotion.

Medical Center Hospital (TX) will expand its rollout of Spok Care Connect.

image

Graham Health System (IL) chooses electronic patient signature and e-forms from Access.

Nebraska Medicine chooses Epic’s Healthy Planet population health management system.

image

Palmetto Health (SC) will use Glytec’s eGlycemic Management System for the 40 percent of their hospitalized patients who require insulin. The system, which will integrate with Cerner, includes the Glucommander insulin dosing medical device, GlucoSurveillance to flag candidates for insulin therapy, and GlucoMetrics for monitoring key performance indicators.

image

Carilion Clinic (VA) selects PeraHealth’s clinical surveillance solutions.


People

image

Kit Check hires Gary Voydanoff (NextGen) as chief commercial officer.

image image

Oneview Healthcare names Seth Bokser, MD (UCSF) as chief medical officer and Lyle Berkowitz (Northwestern Medicine, Healthfinch) as special advisor on innovation.

image

Imaging decision support vendor HealthMyne names Arvind Subramanian (Wolters Kluwer Health Clinical Solutions) as CEO and board member. He replaces Praveen Sinha, who remains on the board.

image

Ingenious Med hires Joe Marabito (IkaSystems) as CEO. He replaces the retiring S. Hart Williford, who will remain board chair.


Announcements and Implementations

HIMSS offers to match the 12 just-named NHS digital health Global Exemplars with an international provider partner, which is a condition of the $13 million in funding. The announcement suggests that HIMSS wants to sell its EMRAM and CCMM benchmarking services to the newly funded trusts, which have committed to partner with organizations such as Cleveland Clinic and Mayo Clinic to  take advantage of their expertise.

image

Pallav Sharda, MBBS, MMI, MBA publishes “Before Disrupting Healthcare: What Innovators Need to Know.”

Vital Images adds support for Nuance PowerScribe 360 and PenRad PenLung to its lung screening application.


Government and Politics

image

ONC says 95 percent of US hospitals allow patients to view their information electronically, 87 percent allow them to download it, and 69 percent give patients the ability to view, download, and transmit the information. The information is self-reported by hospitals and therefore suspect based on the understanding of whoever filled out the AHA survey. I doubt that two-thirds of hospitals allow patients to transmit data via the Direct protocol or otherwise and I’m confident that very few patients have done so regardless. I say from experience that hospitals hold tightly onto the information they think is theirs, not the patient’s, and the HIM department or release-of-information vendors that are stuck in the 1960s guard those gates enthusiastically knowing that HHS OCR’s enforcement is indifferent.

SNAGHTMLb050c83c

A group of Republican congressional committee chairmen questions CMS’s “pay and chase” practices, asking Acting Administrator Andy Slavitt to provide more information about how CMS’s Fraud Prevention System is being used.


Privacy and Security

From DataBreaches.net:

SNAGHTMLb11e442d

  • Russia-based hackers breach the World Anti-Doping Agency and  publish the prescription information of US Olympic athletes. A group called Fancy Bears says it was shocked by “how Olympic medals are won” and will “start with the US team, which has disgraced its name by tainted victories.” I blurred the drug names on the file of tennis player Serena Williams above, but the hackers didn’t (the drugs were not performance-enhancing or even all that interesting, but I wouldn’t expect a hacker to know that).
  • Yuba-Sutter Medical Clinic (CA) notifies patients that it was hit by a ransomware attack on August 3. They say they regained access to their systems “relatively quickly,” but didn’t specify whether that was from restoring backups or paying off the hacker.
  • California-based occupational health provider US HealthWorks announces that a stolen laptop containing emails with patient information was encrypted, but apparently the employee had attached the password to the device.

Technology

HL7 chooses Bryn Lewis, PhD as the winner of its C-CDA viewer challenge.

image

Apple released iOS 10 — which includes C-CDA support via HealthKit — on Tuesday and Duke Health (NC) announces that it will allow patients to download their MyChart portal data into Apple Health, where it can be shared with other apps.


Other

image

Drug company Mylan, which enraged consumers with its never-ending EpiPen price increases, paid its five top executives $300 million over the past five years, more than competitors several times its size. The company, whose market cap is $22 billion, came in #2 behind Regeneron, which paid its top five executives more than $500 million.

A Health Affairs blog post co-authored by singer Barbra Streisand calls for researchers to include a representative number of women in their studies and to examine their data to see if findings have a gender-specific component. She says as an example that women’s heart disease is different from that of men, yet has not been as well studied or as consistently diagnosed.

BCS, The Chartered Institute for IT interviews Robert Wachter, MD about health IT, particularly that in England.

A reporter for the Tucson newspaper describes his first-hand experience watching Theranos CEO Elizabeth Holmes and the company’s lobbyists schmoozing state officials in convincing them to pass a law that allows consumers to order their own lab tests in Arizona and to allow Theranos to open wellness centers in Phoenix-area Walgreens stores. He summarizes:

This is where Arizona’s leadership fell down on the job: It failed to protect Arizona customers from a company that found the state an easy target in its zeal for deregulation. This wasn’t a company that was seeking tax breaks and incentives, which perhaps made their proposal an easier sale. What they needed was a law that gave them access to Arizona’s people.


Sponsor Updates

  • ComputerWorld profiles GE Healthcare’s move to a new transaction processing engine, and awards the company its Data+ Editors’ Choice Award.
  • HfS Research names Xerox a top business services provider in population health and care management as-a-service.
  • Aprima and Healthfinch will exhibit at AAFP’s Family Medicine Experience September 21-23 in Orlando.
  • Tech Week profiles Madison, WI-based Catalyze as part of its City Snapshot series.
  • LogicStream Health will host a wine tasting with appetizers for Epic UGM attendees on Wednesday, September 21 lakeside at Monona Terrace in Madison.
  • Besler Consulting produces a new podcast, “What to look for in the next generation of hospital finance professionals.”
  • The Tampa Bay Technology Forum includes CareSync in its list of finalists for its Technology Company of the Year Award.
  • CTG, Divurgent, and Healthwise will exhibit at the Epic UGM September 19-21 in Verona, WI.
  • Stella Technology will sponsor the SHIEC Annual Conference in Scottsdale, AZ September 18-21.
  • Healthcare Growth Partners advises Essette on its sale to HMS.
  • Cumberland Consulting Group becomes a sponsor partner of the HealthCare Executive Group and its annual forum being held this week in New York.
  • Healthgrades will present a session on launching startups internally during Denver Startup Week September 19.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 13, 2016 News 1 Comment

Morning Headlines 9/13/16

September 12, 2016 Headlines 1 Comment

Feds support Teladoc challenge to Texas telemedicine rules

The DoJ and FTC are backing Teladoc in the telehealth vendor’s legal battles with the Texas Medical Board, saying that the board’s restrictive telemedicine rules are anticompetitive and were not appropriately reviewed.

Patient Engagement Survey: Far to Go to Meaningful Participation

Survey responses from the NEJM Catalyst Insights Council Survey on the Patient Engagement finds that 70 percent of health systems are making some effort to improve patient engagement, with most reporting that patient portals are the most effective tool at their disposal.

CMS just announced new flexibility for providers under MACRA. Here’s how to think about it.

The Advisory Board’s Eric Cragun, Senior Director of Health Policy shares his thoughts on the recently announced multi-track timeline options that will be available under MACRA.

Digital Health Startup EverlyWell Announces Public Launch at TechCrunch Disrupt Battlefield, World’s Premier Startup Launch Competition

As Theranos falls from grace, TechCrunch profiles EverlyWell, another consumer-foucsed startup intent on disrupting the lab testing business.

View/Print Text Only View/Print Text Only
September 12, 2016 Headlines 1 Comment

MACRA’s Marketing Problem

September 12, 2016 News No Comments

HIStalk digs into why provider awareness of MACRA is lacking and the likely impact it will have on their ability to stay in business.
By
@JennHIStalk

image

The Medicare Access & CHIP Reauthorization Act has seen its fair share of headlines since it was introduced just before HIMSS15. MACRA’s implications for patients and providers contributed to a lot of the show-floor buzz in Chicago that year, while conversations around its potential for payment reform heated up even more in Las Vegas at HIMSS16. The release of a 962-page proposed MACRA rule in April provided fodder for industry media outlets, and last week’s release of four “pick your pace” options ahead of a final rule have no doubt eased the anxiety of many physicians fretting over the January 1, 2017 start date.

In short, it seems that MACRA has spent more than its fair share of time in the spotlight, leading many in the industry to assume that providers have been keeping up with its developments.

image

The results of a Deloitte survey of physicians on MACRA awareness and preparedness (conducted before the proposed rule was released) tell a very different story. Of the 600 primary care and specialty physicians surveyed, 50 percent admitted to having never heard of the legislation, while 32 percent knew it only by name. Independent physicians were more aware of it than employed MDs, though not by terribly much at 21 versus 9 percent.

Where does this unawareness stem from? Have providers become so accustomed to regulatory delays that they no longer pay attention until implementation is just weeks away? Has CMS, for lack of a better phrase, shot itself in the foot when it comes to introducing legislation that providers automatically assume is too cumbersome to digest and apt to be postponed numerous times?

Providers who have attempted to keep the lights on through Meaningful Use, ICD-10, and now MACRA surely can’t be blamed for not keeping up with the latest reforms issued from on high. Or can they?

Too Busy to Take Notice

image

“It’s not only physicians who have a lack of awareness,” explains Mitch Morris, MD, vice chair and a US global sector leader at Deloitte. “It really snuck up on the industry in general. Even now when we go in and do a briefing in the executive offices of a health system or payer, they say, ‘Wow, I didn’t realize all of that was in MACRA.’ It’s not very well understood. Unlike in the ACA, which had lots of publicity and everyone was dissecting it from Day 1, MACRA was thoroughly bipartisan and didn’t get a lot of [mainstream] publicity. The medical trade associations, the usual source of news for providers, just haven’t really been pushing this. On the surface, it sounds like a boring topic, but as you peel away the layers, you realize it’s going to be very impactful.”

image

AMA Immediate Past President and emergency department medical director Steven Stack, MD says Deloitte’s findings line up with the association’s own from its physician focus groups. “I think the upcoming changes are difficult for many to absorb while they are fully engaged in the day-to-day work of their practices,” he says. “And, keep in mind that when the legislation was enacted in April 2015, physicians were told the new system would not be implemented until 2019. They had good reason to believe there was no hurry for them to get up to speed.”

“Finally, it is simply not possible for the AMA or anyone else to begin broadly disseminating detailed educational material until the final regulation is issued,” Stack says. “We have been developing resources intended to help physicians get ready, but really all they want to know is what the rules are. We just don’t have all the information yet.”

image

Physicians working in the trenches of day-to-day care echo Stack’s observations. “I think most physicians would agree that the best use of their time and skill would be to simply treat patients and stop worrying about the endless administrative tasks of medical practice,” says Scott Mayer, MD, director of quality control at Today Clinic (OK). “Time to practice the art of medicine sounds so nice, but the reality is that being a physician these days requires so much time be spent outside of patient care that it has become increasingly difficult to keep up with so many changes in healthcare.”

“Patients need treatment now,” he emphasizes, “so unless a policy takes effect immediately, a lot of physicians don’t want to deal with it until it is absolutely necessary. I also suspect that many these days here the word ‘change’ and snort in disdain at the thought of something else that will further complicate their ability to practice medicine.”

University Physicians Group (NY) Medical Director and Aprima Chief Medical Officer Jeffrey Hyman, MD adds that lack of MACRA awareness on the part of employed physicians may stem more from the fact that once a physician is employed, the ‘business’ of running a practice becomes akin to background noise, outranked by patient care. “As an independent,” he adds, “you still have to worry about every issue of the practice of medicine to be successful and so attention is paid to every last detail.”

Today’s Diversions Trump Tomorrow’s Regulations

image

The details diverting the attention of physicians away from MACRA preparation are numerous and probably well known to HIStalk readers. “For physicians in private practice,” says Mayer, “a considerable amount of attention, resources, and stress are focused on just getting paid for the services they provide. Decreasing reimbursement rates, more regulations, more paperwork, and the increasing costs of maintaining a profitable medical practice are sure to distract a lot of us. We are wondering what the future of medicine looks like while doing our best to provide quality care now, find joy in our work, and avoid burnout.”

Hyman puts burnout at the top of his diversion list, too. “It’s a big deal these days,” he emphasizes, “and non-physicians have difficulty with this concept. Treating patients takes a great deal of concentration on details of their histories and physical findings, ordering lab and radiology tests, and then putting all these facts together and coming up with a successful treatment plan. Also, the need to think about formularies, getting pre-authorizations, and dealing with call-backs, admissions, and labs coming in … and don’t forget the EHR and all of its messages coming in at a furious pace. It takes a great deal of attention and MACRA, when read, sounds like a future issue. It just seems distant.”

Hyman’s observations on EHR-related physician burnout, while nothing new, seem to continually be backed up by studies large and small. A prime example is an AMA-sponsored time and motion study released last week that found ambulatory practice physicians spend almost twice as much time working on the EHR or performing other desk tasks as seeing patients. Observed MDs spent only 27 percent of their available time in face-to-face interactions with patients.

The results aren’t surprising to Morris, who notes that for the third year in a row of Deloitte’s research, three out of four physicians will answer that EHRs take too much of their time and cost too much money. “As an industry, we still have a long way to go so that they feel they add value. We’re not where we should be with the vision of EHRs.”

Morris is quick to add that no matter their employed or independent status, the time and attention of physicians are increasingly spent dealing with tremendous reimbursement pressures. “There’s a lot of pressure to move from volume to value-based payment systems,” he explains, “where part of their income is placed at risk. That pressure has many physicians very, very anxious and, to some degree, angry. They’re not always sure who to be angry with, but they’re not happy about the situation that they’re in. Even though the economy has recovered and there’s more discretionary spending, there’s still a lot of screws being turned down on physician incomes.”

Passing the Buck

Morris brings up a good point with regard to the slow boil of physician’s anger at being put in a position that leaves them little time with patients and even less to deal with impending regulations like MACRA. It could be argued that numerous entities should be on the receiving end of that emotion – CMS, payers, trade groups, and vendors – even patients and physicians. Fingers will likely start pointing to these same groups once MACRA hits, no matter the chosen start date, and physicians realize they’re out of time and unprepared.

image

“The industry has the obligation to educate and provide reasonable technology, tools, processes, and training to physicians to assist in the change management of MACRA,” says Kareo CMIO Tom Giannulli, MD, MS. “Those entities that contract with physicians should be very clear as to how their contracts will change. This includes CMS, which unfortunately does not communicate as well with physicians as they could, and based on their historical record, their deadlines are generally not respected. I would like to see them set up a website and online education program that requires each MACRA-participating physician to sign in and complete a half-day course on tech, tools, process, and regulation in order to continue their Medicare billing at full rate. There are a lot of other groups that have and can share a viewpoint, but those they contract with are the right source of information.”

Stack also feels that, while everyone has a role to play, CMS needs to reach out to provide simple tools and procedures to help physicians succeed. “They must strengthen their help lines and educate their staff so they can provide accurate information,” he adds. “CMS should also conduct train-the-trainer sessions and provide much more support to specialty societies to help them answer questions of particular interest to their members. Organizations like the AMA, state medical societies, and national physician groups can be very helpful by tailoring complex material more to the needs of their own members. Specialties, for example, can highlight quality reporting and CPIA activities that are most relevant to their audience, and so greatly simplify the learning process.”

“Employed physicians will likely be spared some of the specific tasks,” he adds, “and the need to be mindful of all the reporting deadlines, but there’s no doubt they will still encounter workflow and documentation issues.”

Hyman looks for MACRA guidance from Northwell’s dedicated group of staff already dealing with these issues and, as one would expect, UPG’s EHR vendor. “Aprima is also coding a great deal of information into their program to assist their doctors in getting this done successfully,” he adds.

Getting Started (but Preparing for Delay)

Hyman and his colleagues have been preparing for MACRA since it was first announced in 2015. “Our group of analysts, the Incentive Team , has begun the teaching process,” he says, “and we will interface between our physicians and the rules so it gets done in the most efficient way for our doctors. We will be ready with our team approach and help from our vendor, but understand that there most likely will be a delay as there was with ICD-10, Meaningful Use, and PQRS.”

Today Clinic staff, on the other hand, are just beginning their MACRA prep. “Our plan is to continue with our quarterly provider and staff meetings where we focus on things like MACRA,” Mayer explains, adding that he too wouldn’t be surprised if the start date was pushed back.

“Honestly, I don’t know how any practice can be prepared by January 1,” Stack says. “That is why the AMA and many others are recommending that the first reporting begin no earlier than July 1. Even compiling truly useful and accurate educational material by January is a heavy lift since we don’t expect to see a final rule until sometime in October and perhaps even as late as November 1. There is nothing in the MACRA statute that sets the start date for reporting, nor is there anything in the statute mandating that the reporting period be set at a full year, so CMS should have flexibility to begin at a later date.”

No matter the start date, Stack believes that, to get off on the right MACRA foot, physicians should first assess how they are performing under current programs since the new MIPS program will be based on those. “They also should begin exploring what qualified clinical data registries are available to them,” he adds, “since this is a new reporting vehicle that could simplify processes for them as well as yield more clinically useful feedback data.”

Morris has similar suggestions, but admits that, “You’d be hard-pressed to get everything in place by January 1 unless your organization already had a lot of this stuff in place and was just tweaking around the edges. I think the analytics capabilities and understanding your costs are difficult things. Even large health systems, which spend a lot of money on those things, struggle. Measuring my quality, having the data necessary to do that, and having the information necessary to understand my costs … I would include all of those as the biggest challenges to getting started with MACRA.”

Gauging the Likelihood of MACRA Success

MACRA’s marketing problem will eventually be a thing of the past. Delayed by choice or not, the program will be here sooner rather than later and physicians will have to make up their minds as to whether participation will be done with enthusiasm, trepidation, or opted out of altogether. MACRA will soon make clear just how painful a process it is for healthcare to move from fee-for-service programs to value-based payment systems.

“Money always talks,” says Mayer, “but to be honest, I am disappointed when the focus of policy changes or the support of policy changes is dependent on the money that will be generated, saved, or lost as a result. While it is very important to consider these things carefully, I worry that we don’t consider as thoroughly the impact such changes have on patients. Despite the intention of programs like MACRA to improve the quality of patient care, it may be hard to convince physicians to participate more for that reason than to avoid fines, decreased reimbursements, or for a promised bonus. Education, support, and follow-ups will be vital, which I think CMS is good at. What I hope to avoid is the need for more support staff to understand, implement, and maintain MACRA.”

Morris puts the move to value, which one could argue started long before MACRA was introduced, in perspective: “These are baby steps. The ACA was a step. Some of the initiatives after were steps. MACRA is another step. In many ways, this is the biggest step we’ve taken so far. I think the devil will be in the details of how well it’s executed. It’s one of those things that looks good on paper. Let’s see how it really works out.”


More on MACRA: Apples, Oranges, and Start-Date Changes

Most industry insiders familiar with MACRA seemed confident that the program’s start date will be delayed. Even CMS Acting Administrator Andy Slavitt hinted at that likelihood, and has since taken steps to ease the pain of participation with start-date options. The industry’s confidence in a delay is easy to understand, given that federal regulatory delays seem to have become the norm rather than the exception. Who can forget the beleaguered roll out of ICD-10? The anticipation of a MACRA delay lends itself to a comparative look at ICD-10.

“They’re definitely in the fruit category together,” says Mitch Morris, when asked if comparing the two is akin to looking at apples or oranges. “ICD-10 was a big change that was, for the most part, not welcome and being driven by the government. That’s definitely something they have in common. As you know, ICD-10 got delayed a couple of times before it was finally implemented, but it did really require some significant changes in office practice. If done well, it shouldn’t have had a negative impact on practice income.”

Morris adds, “With MACRA, also pushed by the government, there’s no formal sign of a delay, but as we learned from ICD-10, that can change with pressure applied to the appropriate places. MACRA has the potential to really change a physician’s income up or down, particularly those in independent practice, and particularly those who have a lot of Medicare patients. It will certainly change the dynamic, especially given the requirements and infrastructure necessary to participate.”

However, Steven Stack sees no similarities whatsoever. “I think this is entirely different,” he says. “ICD-10 in many ways was a simpler issue. It was a replacement for the already existing ICD-9 mandate. The ICD-10 issue focused on the need to be more detailed in documentation providers were already doing, in training their staff, and in lack of confidence that claims would be processed in a timely manner. Physicians were being told to keep enough money in reserves to cover their payroll and office expenses for six months due to anticipated claims payment delays. Physician practices don’t normally have that kind of cash on hand, and it was very alarming.”

“MACRA is largely about modifying an already complicated Medicare physician payment system, and then adding on new requirements for those who participate in advanced payment models,” Stack says. “There are a lot of changes happening at once all across the payment system. Quality reporting and meaningful use of EHR requirements are changing. A whole new method of measuring and comparing resource use has been proposed, new clinical practice improvement activities need to be identified and documented, and so forth. This transition will be far broader and much more complicated than the move to ICD-10.”

View/Print Text Only View/Print Text Only
September 12, 2016 News No Comments

Curbside Consult with Dr. Jayne 9/12/16

September 12, 2016 Dr. Jayne 2 Comments

clip_image002 

I wade through scores of emails each day, looking for items of interest for my columns. One recent email mentioned a new piece in the Journal of the American Medical Association titled, “The Ethics of Behavioral Health Information Technology: Frequent Flyer Icons and Implicit Bias.”

It caught my eye in particular because I’ve seen some pretty wacky icons in the dozen or so EHRs I’ve used during my career. One system’s demographic screen identified smokers with a little pack of cigarettes by their name, but this went away with the advent of Meaningful Use when smoking had to be further quantified based on the volume of cigarettes smoked and the number of days per week on which smoking occurred. It also had an American flag icon for veterans, which although I’m sure seemed like a good idea to some requirements writer or developer at the time, was problematic because the US isn’t the only country with a military, nor are American citizens the only individuals who serve in ours.

An EHR system I dearly loved (but which was unfortunately tied to a dysfunctional vendor, leading to de-installation) had an iconized chest x-ray that appeared when radiology results were available, and a smiling germ icon when a patient required isolation or contact precautions. There were many other icons that were not only intuitive, but served as shortcuts for the clinician, but I remember those two the best.

One icon that generated a lot of buzz at my health system when a new EHR was being installed was the one associated with expired patients. When that indicator was check-marked, a stylized angel icon complete with wings and halo appeared on the patient’s chart. Again, I’m sure someone thought it was a cute idea, but it was likely offensive to people from a variety of religious and spiritual traditions.

The JAMA article specifically addresses an EHR with an airplane icon that is used to identify “frequent flyer” patients. Unlike an airline frequent flyer whose high utilization is respected and encouraged, in healthcare jargon it tends to represent someone who seeks care frequently, and often for inappropriate reasons given the setting. Sometimes the term is associated with patients who are non-compliant, drug-seeking, or otherwise require additional clinician thought and creativity during the treatment process.

Although the article mentions that some emergency departments use lists or other methods to identify these patients, they take particular issue with the airplane icon, since “administrators may elect to configure so that clinicians can identify a patient as a high utilizer.” It goes on to explain that the plane may actually be color coded to identify the level of utilization.

Although I agree with the assertion that the icon “reinforces and encourages the use of disrespectful and stigmatizing terminology,” I have mixed feelings about their other reason for asserting that identifying high utilizers is “ethically and clinically inappropriate.” They claim that the icon “may frame the initial clinical interaction in a way that inhibits good diagnostic judgment” and may lead to poor patient outcomes. One of the key forces driving change in healthcare today is the idea that we need to identify and stratify patients who are the highest utilizers of health care and who are responsible for the largest portions of healthcare expenditures. We need to find those people who need extra resources to and supports to help keep them out of expensive care venues, such as the emergency department and the hospital.

Although the article specifically addresses psychiatric patients, physicians in all disciplines are being asked to identify these patients and care for them differently than everyone else. Health systems are investing large amounts of money in systems designed to do just this. Although the airplane icon is tacky, its function is no different than the red/yellow/green scoring that one of my current EHRs does when looking at patient risk for high utilization of services.

I do agree that flagging patients in this fashion creates potential risk for patients to be treated negatively. Although we’d all like to think that clinicians are going to be altruistic and make sure that they pull in a multidisciplinary team of social workers, therapists, behavioral health specialists, transportation services, etc. to handle these patients, the reality is that this population can be extremely difficult to treat and the supports needed are often scarce to non-existent. Especially in a risk-based reimbursement system, it’s often tempting for physicians to avoid these patients, leading to cherry-picking of the most healthy and compliant patients. The fact that they’re marked by an airplane rather than some other kind of icon doesn’t change the fact that these patients often receive different treatment than low utilizers. Sometimes the care may be negative, but identifying those at most risk can be beneficial for population management strategies.

The authors go on to mention the phenomenon of “diagnostic overshadowing,” where patients with mental health issues may be undertreated for medical conditions such as heart disease, diabetes, etc. There is more focus on the psychiatric illness, which may lead to overall poor outcomes and low quality care. This is a real phenomenon, often made worse by lack of resources. I worked at one emergency department where psychiatric patients in crisis were held over in the ED because the local psychiatric facility didn’t have physicians working on weekends so patients couldn’t be admitted. This creates an emotional (and sometimes physical) toll for those caring for these patients, which in itself leads to negative feelings about caring for similar patients in the future.

The authors make a brief foray into discussing social media platforms and patient engagement tools, calling out the need to include thoughtful development strategies that minimize problems like the airplane icon. They go on to state that, “Electronic medical record systems and behavioral health care applications should be built and tested in collaboration with patients, consumers, clinicians, social scientists, and ethicists who are sensitive to the broader ramifications of iconography and language.”

I’d like to point out that their continued use of the term “electronic medical record” throughout the piece may represent bias. It’s been a long time since we started calling them “health records” with a nod to the greater focus on health, wellness, and prevention and not just treating medical illnesses.

Regardless, I am skeptical that any of the current major vendors have social scientists and ethicists on staff, let alone iconographers. If they do leverage these folks, I’d be highly interested to hear about their work.

How does your system identify high utilizers of healthcare? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
September 12, 2016 Dr. Jayne 2 Comments

Morning Headlines 9/12/16

September 11, 2016 News No Comments

New plans to expand the use of digital technology across the NHS

The NHS names 12 health IT “global exemplars” that will receive $13 million in health IT funding to establish best practices and a new digital health academy.

ARH continues to dodge questions on computer breach

Appalachian Regional Healthcare (WV) responds to a local paper covering its ransomware-related computer outage by sending a legal notice explaining that if the paper continued to “deliberately publish statements which defame ARH, or cast it in a false light, we will have no other recourse but to consult with our attorneys in WV, to determine appropriate legal action."

The Ethics of Behavioral Health Information Technology

A JAMA article argues that flagging emergency department frequent fliers with special icons in EHR software is unethical and clinically inappropriate because it could influence the initial interaction in a way that might lead to biased diagnostic judgment.

View/Print Text Only View/Print Text Only
September 11, 2016 News No Comments

Monday Morning Update 9/12/16

September 10, 2016 News 12 Comments

Top News

image

In England, 12 NHS trusts will receive up to $13 million each from the government as “global exemplars” that will lead the way for innovation, while another 20 will be given $6.6 million each as “national exemplars” to improve their own digital technologies. The announcements follow publication of an NHS digitization recommendations report created by an advisory board led by UCSF professor Robert Wachter, MD.

Health Secretary Jeremy Hunt also announces an expansion of NHS’s 111 non-emergency line to include triage service, publication of an NHS guide of approved health apps, re-launching the NHS Choices patient services website as NHS.UK with a new capability for patients to download their own records in a Blue Button-like fashion, and publishing trust performance data for specific health services.


Reader Comments

From Recent Epic: “Re: Epic’s succession plan. It’s for the best that Carl has taken over, although whether he has any desire to stay remains to be seen. Judy’s leadership is becoming increasingly erratic as she advocates finding ways to charge for APIs and web services, has wild swings of opinion on hosting services, makes rash decisions in trying to make international deals, pushes salespeople to start cutting deals on previously principled pricing and contract provisions, and most disturbing for the direction of the company, spends an increasing amount of time on buildings and events.” Unverified.

From Datapref: “Re: HIMSS Analytics. MU attestation made it easy to find out who has installed which products, with higher quality. Their ‘Logic’ rebrand intentionally makes it hard to export mass data and the UI is a mess. They have a long lag time (3-4 months) getting financial data updated after it’s been published by CMS, while Definitive, Billian’s and even AHA are less than one month.” Unverified. HIMSS Analytics still has the massive competitive advantage of being owned by HIMSS and thus being able to dole out to its paying customers HIMSS points that earn better exhibit hall booth locations. Personally, I’m not in favor of well-funded, theoretically non-profit member organizations recruiting corporate members while also selling them services and in some cases competing with them. I would be interested in seeing the latest 990 tax forms from HIMSS to see how much HIMSS Analytics brings in, but I haven’t found its latest filing so far.

image

From Pippi Longstocking: “Re: Bob Wachter’s UK digitization report. His only informatics credential is having written an awful and extraordinarily slanted book, cherry picking information to fill in a predefined narrative. The UK report seems to be mostly written by consulting firms. I find it odd that Ross Koppel speaks to informatics, Christine Sinksy to burnout, Deborah Peel to privacy, Julie Adler-Milstein to safety, and now Bob Wachter to success.” It’s interesting to me that in the “Look Inside” preview of his book on Amazon (since I haven’t bought or read the book), Wachter says that David Brailer, MD, PhD, the first National Coordinator who was appointed in early 2004, hinted that President George W. Bush’s push for EHRs came about only because he was jealous of the billions England’s Tony Blair was spending on the ultimately failed NPfIT program. Wachter also says Brailer wasn’t in favor of creating the very ONC he was later tapped to lead, worried that the federal government’s smothering bureaucracy would stifle innovation. I don’t know about Wachter’s informatics expertise, but he’s a good writer.

image image

From Bunchy Donovan: “Re: iPhone announcements. Removing the headphone jack has healthcare consequences since that’s how some device-attached apps use it as a connector.” The change may well put some minimally successful app vendors out of business, which might be a good thing in a herd-thinning sort of way. Meanwhile, Apple will offer an alternative to those $4 non-Apple earbuds I use at the gym — the wireless and surely easily lost AirPods, which will cost $159 and will make the wearer look as douchebaggy as those people whose Bluetooth headsets are permanently implanted in their ears. I assume the AirPods came from the Beats by Dr. Dre line that Apple (over)paid $3 billion to acquire in mid-2014. Apple has transformed itself from solving problems I didn’t know I had to solving problems that  I actually don’t have at all. Your life is pretty darned good if you can allocate $159 (plus the cost of a new and barely improved iPhone) to solve the crisis of tangled earbud wires.

From Silver Spoon: “Re: hospital administrative residencies. Would you recommend them?” They’re great if you can get chosen for them. The faith-based national system I worked for placed only well-connected graduates of their low-ranked religiously affiliated schools in those jobs even though 99 percent of our patients did not practice that religion and in most cases weren’t even aware of the connection. Not surprisingly, the chosen ones were usually fast-tracked in the “people like us” leadership model. I passed up an early-career option of working a stint in the Middle East after hearing a friend’s report of being culturally insulted and professionally disrespected as though he were a mercenary shoeshine boy there, a situation my hospital system colleagues and I found ourselves in without the long flight.


HIStalk Announcements and Requests

image

Insurance companies offered the poorest customer service experience to respondents to last week’s poll, while lab companies and dentists caused the fewest problems. Hospitals ended up mid-pack, but Beebob shared recent ED visit experience that included lack of wristband checking, nearly being administered morphine despite his or her clearly recorded allergy, employees never washing their hands, and doctors and nurses leaving their EHR sessions active when leaving the room so that anyone could have clicked through patient lists and charts, all of which were reported by letter to their CEO and safety VP with no response.

New poll to your right or here: what should be the key healthcare issue in the presidential election? “Key” means you have to choose the single most important issue instead of yearning for a lazy “all of the above” option that would relieve you of your responsibility make a decision.

I’ve received several emails weekly from investment companies (both in the US and elsewhere) wanting to talk to me about publicly traded health IT companies. I get those all the time, but the volume has picked up, which isn’t a problem for me since I just delete them without responding. They must have a good business model in getting free advice and reselling it as their own insight. Just about everything I know is right here on the HIStalk page for anyone to read anyway. 


Last Week’s Most Interesting News

  • CMS offers providers four “pick your pace” options for 2017 MACRA/Quality Payment program participation in 2017.
  • Device maker St. Jude Medical sues a security firm and an investment research company for manipulating its share price and profiting from short sales via the issuance of questionably accurate security vulnerability reports.
  • In England, a health IT committee issues its digitization recommendation report.
  • Epic asks the US Supreme Court to review a lower court’s ruling that the company can’t force employees into arbitration to block class action lawsuits over employment disputes.
  • UCSF will lay off 17 percent of its IT staff and offshore their jobs to India after its IT expenses doubled from 3 percent of its operating expense total to 6 percent in the past five years.
  • A tiny, AMA-sponsored observational study finds that ambulatory practice doctors spend twice as much time working on the computer and doing desk work than seeing patients.
  • Apple toughens up App Store standards for health-related apps to increase review of those that provide inaccurate data and to limit drug dose calculation apps to approved healthcare entities.

Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

View previous webinars on our HIStalk webinars YouTube channel.


People

image

Stephen Ondra, MD (Health Care Service Corporation) joins open source data management vendor Amida Technology Solutions as chief strategy officer.


Announcements and Implementations

SNAGHTMLa068ec4c

USC’s family support center and gerontology school provide family caregivers with support resources (care planning, reminders, task management, and self-care content) via an app developed by Los Angeles-based Care3. The three founders have experience that includes working in Aetna’s Healthagen technology businesses.

image

A new Peer60 report compares Epic and ChipSoft in the Dutch EPR market. Interesting factoids: (a) no ChipSoft hospital reported an improvement in financial outlook, while a fair number of Epic respondents did; (b) Epic scored considerably higher in enhancing patient engagement; (c) Epic scored much better in improving user workflow; (d) Epic’s “would recommend” scores are hugely higher; and (e) nearly half of the users of both systems say their projects ran over budget. The report contains a lot more interesting detail. All I know about Amsterdam-based ChipSoft is that they used to give out cool clogs from their booth at the HIMSS conference, but I stopped asking about them years ago because their booth people (who you might expect to be rosy-cheeked and happy if your only cultural reference is a Dutch Boy paint can) were always eye-rollingly surly in insisting that you put them on right there instead of packing them away for later.


Privacy and Security

2016-09-09_14-41-25

This promotional email from Healthcare Informatics seems to miss the obvious fact that if you’re pitching an advertiser’s ransomware material, you should probably not use a gibberish link that the recipient won’t click on if they are even vaguely aware of phishing practices. 

From DataBreaches.net:

image

  • The political team of a British member of Parliament tweets out a photo of the candidate cold-calling supporters that also included in the background a whiteboard containing the telemarketing system’s clearly visible (but since changed) log-in credentials.
  • Appalachian Regional Hospitals, whose systems are apparently still down following a ransomware attack several weeks ago, threatens to sue the local newspaper for asking questions about the situation and for publishing “statements that defame ARH or cast it in a false light.” It’s an interesting by-product of gaining public exposure for cybersecurity weaknesses or breaches that the affected organization often lashes out legally at the messenger (since the perpetrator isn’t handily available) in trying to protect their public image. 
  • The FBI charges two young men with using social engineering to hack the Internet accounts of several senior government officials that include the CIA director and Director of National Intelligence, using the information to harass them and to download sensitive information that they posted on the Internet. They gained access to the master federal law enforcement computer system, listened to the voicemails of senior officials, took control of their TVs, harassed them and their spouses by phone and email, distributed their contact lists, and fooled their spouses into providing their log-in credentials by claiming that their passwords needed to be reset.
  • Researchers warn that it would be easier for hackers to disable the country’s 911 emergency call systems by overloading their limited incoming lines with automated spurious calls from malware-infected mobile phones, estimating that 6,000 infected phones could disable an entire state’s 911 system and 200,000 could take down the entire national system.

Other

Three academic psychiatry authors write in their JAMA editorial that it’s not ethical for EHRs to flag frequent ED flyer with an airplane icon, saying it’s disrespectful and that such labeling may impede good diagnostic decision-making.

image

Dartmouth-Hitchcock Medical Center (NH) will lay off up to 460 employees in the next few months following a $12 million loss in the fiscal year ending June 30. The hospital’s billing-related expenses increased by $115 million as it changed billing and revenue management systems — which caused a $40 million revenue overestimate – and outsourced its RCM activities to Conifer Health Solutions. According to the CEO, “Other great organizations are experiencing similar downturns with the implementation of new systems and rising expenses.” DHMC implemented Epic at a cost of $80 million in 2011, after which its bond ratings agency attributed its weak operating performance to reduced state funding and its Epic costs.

image

Examples abound around the world where a single, dramatic photo engaged a previously indifferent public and turned a magnifying glass onto the society we’ve created. This Ohio police stop photo of two West Virginia adults zonked out in a heroin-induced stupor as the woman’s four-year-old grandson looks on just might do it in forcing us to examine our drugged-out society and the impact of only-in-America drug marketing and pricing decisions (over-marketed and thus overprescribed OxyContin whose high prices moved addicts to cheap but notoriously impure heroin freely entering the country after a failed war on drugs, with overdose victims sometimes revived as they were in this case with overpriced and thus less-available naloxone). Both adults have prior records for DUI, drug possession, resisting arrest, and other offenses. You are wrong if you think the epidemic can’t affect you or your family beyond being robbed by drug-seekers – this guy was driving on public streets seconds before this photo was taken, having just missed rear-ending a stopped school bus as he tried to take the woman to the hospital before being stopped by an off-duty officer from the East Liverpool Police Department.

Vince and Elise review the comments received about Black Book and KLAS from my reader survey in Part 6 of their “Rating the Ratings” series.

Here’s one of the most brilliant and hilarious TV ads you’ll ever see, a new Cigna public service message from the “TV Doctors of America” advocating annual physicals that many of their real-life counterparts don’t feel are medically indicated.


Sponsor Updates

  • T-System will exhibit at ENA Emergency Nursing 2016 September 14-17 in Los Angeles.
  • Crain’s features TeleTracking Technologies in its coverage of New-York Presbyterian’s new mission control center.
  • Valence Health will exhibit at Further 2016 September 14-16 in Chicago.
  • Frost & Sullivan recognizes Validic for the 2015 North America Frost & Sullivan Award for Visionary Innovation Leadership.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 10, 2016 News 12 Comments

Morning Headlines 9/9/16

September 8, 2016 Headlines No Comments

Plans for the Quality Payment Program in 2017: Pick Your Pace

CMS announces four different timeline options for participating in the MACRA Quality Payment Program, each of which will allow providers to avoid penalties, and many of which would include positive payment adjustments.

Making IT work: harnessing the power of health information technology to improve care in England

In England, Bob Watcher, MD co-authors a Department of Health report on moving the NHS forward with health IT adoption.

DeepMind’s first NHS health app faces more regulatory bumps

Google’s AI company DeepMind will suspend the use of an acute kidney injury detection app that it co-developed with the NHS until the software is approved by the UK’s medical device oversight regulatory agencies.

Arizona’s Pinal County Gains Health-Law Exchange Insurer

Blue Cross Blue Shield of Arizona has agreed to offer public exchange plans in Pinal County, which will prevent the county from being the first with no ACA plans available to its residents.

View/Print Text Only View/Print Text Only
September 8, 2016 Headlines No Comments

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reader Comments

  • Jacob Brink: RE: Coast Guard and Epic --- What will come of the coast guard issue? Is it deeper? Why is it that every Epic install en...
  • Similarly: http://medcitynews.com/2016/12/cerner-delay-military-ehr/?rf=1 “There are other pieces of business in the DoD,” ...
  • Re: Coast Guard: Where are you seeing this? The newest result for "politico coast guard" in Google is the article you linked, which is fr...
  • Jordan: ICYMI: More bad news on the Coast Guard/Epic stuff. Epic is under investigation for what seems to be another under bid...
  • Desperado: Meltoots -- No fear! New HHS leader Price is heavily supported ($$$) by physician led associations. He's well aware of t...

Sponsor Quick Links