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Readers Write: Not Just Ransomware: Common EHR Threats You Need to Know

December 12, 2016 Readers Write No Comments

Not Just Ransomware: Common EHR Threats You Need to Know
By Robert Lord

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It is no secret that data breaches are becoming more common and increasingly more expensive. New threats to patients’ electronic health records (EHRs) are constantly emerging, forcing healthcare organizations to be on the lookout for potential dangers so they can eliminate threats quickly. It is important for organizations to understand the array of potential threats to the EHR, allowing them to make decisions on how to best protect this sensitive data.

After talking with healthcare stakeholders inside hospital systems, the federal government, etc., and distilling themes that continually come up, I thought it would be useful share what I’ve learned.

Think Twice Before Opening That Email — Phishing and Social Engineering

Phishing scams represent a very real danger to EHRs, but they are often overlooked by healthcare organizations because they assume such threats cannot break through their security. Phishing scams are email or social engineering attacks that try to appear legitimate in order to get healthcare employees to release patients’ sensitive medical information. Such attacks often use email or website scams to either target patients’ information directly or to obtain an employee’s username and password, thereby gaining access to that organization’s entire EHR.

Just recently, a phishing email disguised as official OCR Audit communication about Phase 2 Audits went out to healthcare organizations. Thankfully, it was only a misguided attempt at marketing for a cybersecurity firm, but it could have been much worse. In December 2014, an employee of Seton Healthcare Family opened a scam email. The resulting breach released the medical record numbers, Social Security numbers, insurance information, demographic information, and clinical data of 39,000 patients.

Nevertheless, even if phishing attacks are not the cause of a breach, they can still represent a threat. After the massive breach of Anthem Inc., for example, affected patients began receiving scam emails that promised them free credit monitoring, thus demonstrating that phishing attacks remain a threat even in the wake of a data breach.

Star-Studded HIPAA Violations Can Be Costly — VIP Patient Privacy

The temptation to peek at the medical record of a celebrity or public figure represents a real threat to patient privacy. VIP patients deserve the same right to privacy as the general public, and steps need to be put in place to guarantee that their sensitive information is kept safe and the treating medical facilities out of the headlines.

In 2011, UCLA Health System came to a settlement with the federal government, agreeing to pay $865,000 after two unnamed celebrities alleged that UCLA employees had viewed their medical records without authorization. Two years before that, in 2009, California health regulators fined Kaiser Permanente $250,000 after some of its employees looked at the medical record of Nadya Suleman, the famous mother of octuplets. Unfortunately, there are many other examples of employees being fired or healthcare organizations being fined because they did not protect the privacy of their VIP patients.

The Family Doesn’t Need to Know Everything — Snooping Threat

The desire for relatives, friends, or even co-workers to snoop into patients’ records often result in messy – and costly – data breaches. In 2013, a nurse accessed the records of her nephew’s partner without authorization and saw that her nephew’s partner had given birth to a baby and put the child up for adoption five years earlier. The nurse then announced the news at a family funeral. After the victim sent a complaint to the hospital, the nurse was terminated and gave up her Florida nursing license.

A similar lawsuit involving Aspen Valley Hospital District and a former employee is currently ongoing. A former employee of the hospital, who was also a patient there, alleged that several employees of the hospital violated his privacy when they disclosed that he had HIV “as a piece of conversational gossip over drinks.” The unnamed patient is currently seeking an apology, compensatory damages, punitive damages, and attorney fees from the hospital. These are but two examples of how devastating these seemingly small breaches can be to the affected patients.

The Biggest Threat to Patient Privacy is Hiding in Plain Sight — Insider Threat

Some of the most dangerous threats to EHRs are criminal insiders. In this type of attack, an employee of a healthcare organization steals patient information from the inside, using his or her access to do so. Earlier this year, Jackson Healthcare Systems found out how dangerous these threats can be the hard way. In February, the health system reported that one of their employees had gone “rogue” and stolen the information of 24,000 patients over the course of five years. The stolen information included names, birth dates, home addresses, and Social Security numbers. As the Jackson Healthcare Systems example demonstrates, these breaches are so dangerous because they are so difficult to detect. In this case, it took five years before the organization was able to identify and eliminate the insider threat.

Business Associates and Contractors

Business associates and contractors within healthcare organizations represent a growing vulnerability for the EHR, especially in recent years. The US Health and Human Services (HHS) established the Omnibus Rule in 2013, which required the business associates of healthcare organizations to adhere to the HIPAA Rules. Unfortunately, there is still much work to be done to address this vulnerability.

In July of this year, Catholic Health Care Services, a business associate for six skilled nursing facilities, agreed to pay $650,000 for HIPAA violations after a mobile device was stolen. The data breach affected 412 patients. Moreover, this is not an isolated incident; according to a report from Protenus and DataBreaches.net, 30 percent of all data breaches in the first eight months of this year involved a business associate of a healthcare organization. In other words, 4.5 million patients have been affected by data breaches of third parties thus far in 2016.

Lost and Stolen Devices

One final threat to EHR is lost and stolen devices, including laptops and mobile devices. If the information on the lost device is not encrypted or the encryption is not working, all someone has to do is open the device and look at the information for a breach to occur. And if the device was stolen, the criminals do not even have to decrypt the information for them to be able to use it.

One example from this year involves Seim Johnson, an accounting and consulting services company. In February 2016, Seim Johnson reported to HHS that a laptop had been stolen. The encryption on the laptop malfunctioned, exposing the private information of almost 31,000 patients. And these types of breaches are becoming increasingly frequent, with Verizon’s 2015 Data Breach Investigation Report stating that 45 percent of all healthcare data breaches are the result of stolen devices.

Knowledge is Power

As more and more healthcare organizations make the switch from paper to electronic health records, it will become increasingly important for organizations to be able to protect their patient records. Of course, this also means that threats to EHR will become more varied and more sophisticated. Healthcare organizations must be well informed about the different types of threats that exist so they can put security measures in place to effectively combat them, and ultimately protect the privacy of their patients.

Robert Lord is co-founder and CEO of Protenus of Baltimore, MD.

HIStalk Interviews Hemant Goel, President, Spok

December 12, 2016 Interviews No Comments

Hemant Goel, MBA is president of Spok.

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Tell me about yourself and the company.

I have been in healthcare IT for over 30 years. I’ve worked for some large organizations, EMR providers, and I’ve worked for imaging solution companies as well. I joined Spok two years ago.

I’m very well conversant with all of the IT challenges for CIOs and hospitals and how it helps them. How IT has helped in patient care from "To Err is Human" to where we are now with Meaningful Use and all the advancement that has taken place in contributions of healthcare IT and helping clinicians out.

Spok is a player in healthcare IT, where we provide critical communication. Things that EMRs or other systems don’t do. This is fast paced, where minutes count in getting hold of nurses, physicians, alerts, codes, and who’s on call. Our mission is to provide critical communications in a timely basis to the right people so they can react to the situation.

Biomedical devices have evolved into IT or informatics systems. Will messaging follow that same path?

Pagers are going through a transformation as the messaging industry itself changes. Encrypted pagers are out there, two-way pagers, alpha-numeric. There has been an evolution of pagers. They have their own network. They don’t rely on the cellular networks like Verizon, AT&T, and Sprint kind of networks. They are their network with broadband and low frequency, so they are more reliable.

The change is that smart phone and the smart messaging technology are taking over, but reliability is still an issue. Oftentimes you say, I sent you my message, did you get it? They say, I didn’t see anything and the phone has been sitting right here. Those are some of the things that have to get better. When reliability improves, smart phones and smart messaging apps are the future. But pagers have a place right now.

The second thing is that for some employees – like cleaning staff or food staff — hospitals cannot give them smart phones because they are too expensive. Pagers are very convenient and suffice for them. We’re finding that there is a shift in pagers to the organization employees that are more staff. Pagers can help, they’re secure, and they maintain privacy.

There are also physicians who are not willing to give up the pagers. Just like if you go back to the imaging and PACS days, it took a long time before radiologists gave up film even though PACS systems were ready. Eventually it happened. That’s exactly what’s going to happen with pagers. Eventually the technology and reliability in messaging using smart phones and cellular coverage and Wi-Fi is going to be so much better that pagers will disappear. But I think that we are at least eight to 10 years out.

What kind of documentation of messaging activity and proof of delivery do hospitals need?

It’s a combination of both hospital and vendor-provided technologies, including carriers. One of the things we find is that hospital Wi-Fi coverage and overlap coverage is very important. It has to be there and coverage well tested.

On the technology side, I’ll give you a simple example. When I fly out of Minneapolis, there’s airport Wi-Fi that my phone picks up because I do it every day. If I don’t accept the terms and conditions, it kind of gets stuck there. When I don’t get an email after a while, I realize I did not accept terms and conditions. My phone is stuck because it’s defaulting to Wi-Fi data pickup as opposed to my cellular data pickup.

We are working with the providers and technologies to say, is it possible that if I subscribe to it in a way that says if my Wi-Fi is there but I’m not receiving data, switch to cellular and inform me that messages aren’t coming through based on some of my activities that I would expect. It’s a combination of us as vendors, infrastructure providers like cellular companies and their coverage, and of course Wi-Fi coverage inside the hospital. All three of them are advancing and they’ll get better and that will make a big difference in the reliability.

I read that cell phones are used a lot more for text messaging than for making or receiving voice calls. Does that provide any lessons learned for your business?

Millennials rely mostly on messaging and very little on voice calls. I’ve got kids who are millennials and they have WhatsApp and Facebook Messenger. I can’t tell you when they decide to use what, but they use both of them. Being  curious in the IT world myself, I’m trying to figure out the pattern as to what prompts them to use which one and where.

What we have found is that for some reason, messaging applications are more utilized. Texting is more utilized. It catches attention to respond right away in the transactional moment better than if you were either to send an email or have a phone conversation. One of the reasons for the demand for messaging applications is people saying, if I have an email or task that’s important or urgent, can you also text me? They respond to that much better.

I guess there is a human factor or psychology involved, but that is indeed true. People respond to messaging and texting and they are using it more for quick, urgent transactions and not emails and phone conversations that much.

Isn’t that phenomenon a technical validation of the pager model that people dismissed as primitive? The messages are once again asynchronous and text-based, with the only real difference being that they’re now sent and received on phones instead of on two-way dedicated pagers.

Sure, but it’s the consolidation of devices that drove it. Pagers were only doing paging. You couldn’t make a phone call on them. You had to look at the pager then you had to pick up the phone. Now you can look at a pager, send a  text message, and make a call to you without having to switch my devices.

The whole world of healthcare IT is about efficiency, quick access, integration, interoperability, single devices, what everyone would want. We have also found that the saturation is more than 100 percent of devices because most people now are starting to have two smart phones, professional and personal.

But you are right that at the end of the day, it’s going back. But because you can do more with your phone and more with the app and while pagers were just doing paging, the shift is there. For physicians, nurses, and emergency responders, pager reliability is still a reason to pick it up.

Is secure healthcare message a commodity? What are the differentiators?

I’ll broaden this a little bit because a lot of CIOs and CMIOs in my network have that question, too. You get secure messaging from IMessage. WhatsApp recently put up secure messaging. There are consumer applications that do secure messaging, but they don’t do it in the context of healthcare.

Now there’s a healthcare cadre of application providers that provide secure messaging, Spok being on of them. How do you differentiate yourself? The way we are approaching messaging is that messaging is one aspect of critical communication. It’s not just for physicians and nurses. Critical alerts are another one of them. The care team coordination, to help a patient get better — that’s what everyone is driving towards.

We will all eventually arrive at the same place, just like the EMR companies did. Cerner, Epic, Meditech, Allscripts, and McKesson all had their departmental solutions and eventually became a unified electronic medical record that everyone is driving towards. You hardly find any standalone pharmacy systems now. It just won’t happen with the advent of patient safety and Meaningful Use.

There are messaging companies that do messaging for physicians or for nurses. But eventually a critical communication that encompasses all stakeholders and role-players — physicians, nurses, patients themselves, family engagement like Meaningful Use talked about, the Affordable Care Act, plus other staff engagement and clinical engagement — all that should happen in a single platform with directory accessibility to drive efficiencies and clinical outcomes.

That’s what we believe and that’s what our drive is. Not just messaging for one stakeholder, but critical communication across the entire spectrum for all role-players. I believe everyone will end up there. Then, who’s got a good mousetrap?

What is the hospital demand for EHRs and other transaction systems to drive and document communication directly instead of requiring users to send messages manually?

Interoperability is going to be huge. You mentioned earlier that texting is more common than phone calls or emails. Electronic medical records initiate some things and we should be prepared as a technology to take that initiation and convert that into transactional messages that are needed.

On the flip side, sometimes our transactional messages can drive some of the things happening in the EMR, which is a system of record. We are a transaction in time that occurs. It can be driven by an EMR or we can help drive the EMR based on certain events. When there’s an emergency and there’s an ambulance coming in to the ED, nobody has the time to sit around and take a look at the EMR. You’re stabilizing the patient, you’re calling folks out, you’re calling the doctors, and codes are being initiated.

That’s where companies like Spok come in. The code message has to go to the right nurse, right physicians, and everyone has to come there. You don’t have time to sit down or the luxury to go research or pull up all the things that are happening in the system of record. That’s a clear example of how a messaging or a paging of those kinds of transactional systems can drive the EMR. Then you can go back and do your documentation into those.

Then there are situations in a hospital where you’re in the ICU or in other areas where the EMR can drive a text message to say the patient needs to be taken to radiology. Or there’s an urgent situation and you send a code out and everyone has to show up there.

You can have both sides of the equation. Interoperability is key to make sure we provide an open enough systems that those workflows are well accounted for.

What kind of hospital communications issue negatively impact patient satisfaction?

The biggest one we hear is alarm fatigue. The alarm annoyances in the quiet hospital — which is a big hospital initiative – is one of the most important areas when you’re in the acute care setting.

The second one is waiting on staff. Lots of times you’re waiting on somebody to show up. The care teams are big and there are lots of people and you are not sure who is coming to see you when. Something as simple as you’re ready to be discharged and you know you’re going to be discharged, but it takes three hours while you are waiting on someone to come in and say, "Yep, you’re good to go." That’s a problem. Many other things, but noise and wait times are the two biggest areas that we believe need to be addressed.

A quick text message that says, "You have discharged the patient, everything looks good, here is the discharge order that we can text securely” is a great way to get the patients out and get them feeling better about going home. As alarms thresholds go off or they are about to go off, it can alert the nurse and they can come and take a look at it, that’s even better. That’s a couple examples of how patient engagement and patient satisfaction are going to be hit directly by these kind of technologies.

Do you have any final thoughts?

It’s a great time to be in healthcare. The country and our healthcare system is going through a massive change. It’s always pivoting and changing, and for the better. The infrastructure of healthcare IT is in place, EMRs are in place. Now we have to take it to the next level of wellness and outcomes that are preventive healthcare and make our experience even better and better as the population gets older. I am very delighted to be in this field, have been for 30 years. I have seen a tremendous amount of changes. I’m glad to be a part of contributing to the way we treat patients and how we make lives better. It’s a good place to be.

Morning Headlines 12/12/16

December 11, 2016 Headlines No Comments

Wireless-Life Sciences Alliance (WLSA) Combines Operations With The Personal Connected Health Alliance

HIMSS-owned Personal Connected Health Alliance merges with the Wireless-Life Sciences Alliance. Both organizations focus on promoting the use of technology in improving health and wellness.

21st Century Cures and the Road Ahead

John Halamka, MD presents his thoughts on the 21st Century Cures Act in a recent blogpost.

Partners posts $108m operating loss, its largest

Boston-based Partners Healthcare posts a $108 million operating loss, its largest in 22 years, despite a seven percent rise in revenue. Partners attributes its losses almost entirely to it low-income families and individuals on the state’s Medicaid program.

NIH competition seeks wearable device to detect alcohol levels in real-time

NIH launches a design competition with a $200,000 first place prize that challenges hardware developers to create a wearable that can actively monitor blood alcohol levels.

Monday Morning Update 12/12/16

December 11, 2016 News 2 Comments

Top News

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The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.

PCHA — formed in 2014 by Continua Health Alliance, mHealth Summit, and HIMSS – merged with the Partners Connected Health Symposium in October 2016. 

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PCHA’s Connected Health Conference, the former mHealth Summit, kicks off today (Monday), but its speaker star power seems to have dropped off considerably since I saw Bill Gates there in 2010. Here’s what I had to say about the mHealth Summit when I attended in 2013, which anyone attending this week’s show is welcome to compare and contrast:

I felt as though I had intruded on a geeky academic conference in 2010 … Presentations back then were often about public health projects in Africa, government informatics research, and government policy … I felt somewhere between virtuous and bored being there. HIMSS, as it usually does, put all of that unsexy and unprofitable subject matter almost out of sight. Now the conference is a freewheeling ode to capitalism showcasing companies willing and able to pay big bucks for space in the exhibit hall and in the endless number of HIMSS-owned publications. The exhibit hall is like a downsized version of that at the HIMSS conference and most of the educational sessions are either about companies or feature vendor people as presenters or moderators … HIMSS seems to be positioning the mHealth Summit as the minor league of its conference portfolio. Most of the small mHealth exhibitors will be toast in a couple of years, but those who survive will graduate to the big show, the HIMSS conference … The same issues dominated this year as in 2010. Nobody’s really sure what mHealth is, basically punting off by saying anything that runs on a smart phone must be, which means the subject matter is entirely unfocused and confusing. Startup companies keep trying to convince each other that they can hang on long enough to be bought out. Everybody fervently believes that mobile apps and brash startup spirit can transform the US healthcare system into one that’s cheaper, more health-focused, and more consumer driven. It’s always easy for me to be cynical and dismissive, but especially so at the mHealth Summit.


Reader Comments

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From FlyOnTheWall: “Re: SPH Analytics. President and CEO Al Vega is out and the VPs, SVPs, and enterprise teams are all gone.” Unverified, but Vega’s bio has been expunged from the executive page and four of the eight execs listed on the August 2016 cache of the page are equally invisible. Vega’s apparent replacement, J.T. Treadwell, is a money guy who sits on the board of half a dozen companies. I didn’t recall having heard of SPH Analytics, having mentioned them just twice in HIStalk, once for hiring someone and another for choosing an underlying technology.

From The PACS Designer: “Re: CDI with ICD-10. With the launch next month of ICD-10 Procedure Codes, the increased specificity of ICD-10-PCS Clinical Document Improvement will give procedures much improved descriptions of what treatments a patient has endured. For example, a patient having a two stent insertion procedure would have the following ICD-10 Procedure Coded recorded: 02710D6 Dilation of Coronary Artery, Two Arteries, Bifurcation, with Intraluminal Device, Open Approach. This more specific ICD-10 code replaces 5 ICD-9-CM codes which are 36.03,00.41,00.44,00.46, and 36.06. As one can see, ICD-10 is a big improvement over ICD-9.”

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From Smelly James: “Re: IBM. Putting itself at the feet of Donald Trump with several healthcare mentions. It wasn’t shy about suggesting future business interest with the VA. This letter will fit well in future RFP protests.” IBM CEO Ginni Rometty apparently congratulated Trump right after the election, suggesting six areas in which IBM could support his political agenda, including a cognitive computing system for the VA. She also dropped not-so-subtle hints that IBM would appreciate his proposed changes to a “punitive” tax system in which IBM’s $68 billion offshore cash stash would be taxed at a Trump-proposed 10 percent vs. the current rate of 35 percent in bringing it into the US, saving the company (and costing taxpayers) $13.6 billion.

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From Rural HIT: “Re: Smith County Memorial Hospital and Family Practice. Went live on Cerner, the first of 25 critical access hospitals in the Great Plains Health Alliance switching to Cerner CommunityWorks.” The internal announcement suggests that the hospital was using Siemens Soarian and was steered to Millennium by its new owner Cerner.


HIStalk Announcements and Requests

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Most poll respondents are interested in the most significant international health IT news stories. Mobile Man says it’s hard to make comparisons since other countries have different payment models, while Susan is interested because we in the US think we have the best healthcare in the world but really we excel only in spending the most. HIT Geek summarizes, “Innovation has no nationality.” New poll to your right or here: how do you expect your healthcare spending (including insurance premiums) to change in 2017 vs. 2016?

Thanks to Jenn for covering my little pre-Christmas break last week. I waded deep into some HIStalk website technology catch-up when I returned, with some tricky upgrades to newer versions of PHP and other stuff that will hopefully make the site more stable and secure.

I was chatting with someone about terrible singers who still have managed to create hugely successful singing careers – the names that came up included Neil Young, Bob Dylan, Willie Nelson, and Rod Stewart. That doesn’t even count those warblers who sound passably good only through audio techno-trickery. One who could carry a tune, though, was Emerson, Lake, and Palmer’s Greg Lake (also of King Crimson), who died last week at 69. We lost two-thirds of ELP in 2016 with the suicide of Keith Emerson, leaving just P and ensuring that their collective demise will be alphabetical.

Listening: a new cover of the telethon chestnut “You’ll Never Walk Alone” from Massachusetts celt-rockers the Dropkick Murphys.

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We provided 21 sets of headphones for Ms. S’s elementary school class in Tennessee in funding her DonorsChoose grant request. She teaches math and science to two classes totaling 44 students and says the classroom sounded like an arcade as students used the Chromebooks for assigned exercises, but now it’s quiet and they can concentrate.

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Donations from reader Laura and Direct Consulting Associates, plus matching money, fully funded these DonorsChoose teacher grant requests:

  • An amplifier and microphone for Ms. L’s high school class in Center Line, MI
  • Two Chromebooks for the seventh grade math class of Ms. F in Phoenix, AZ
  • Two tablets and headphones for the kindergarten class of Ms. W in Los Angeles, CA
  • A library of 26 science books for Mrs. G’s first grade class in Saint Paul, MN
  • A greenhouse set for Mrs. M’s high school class of severely mentally and physically handicapped students in Elyria, OH
  • Eight tablets for reading and math listening libraries for Ms. B’s kindergarten class in Kansas City, MO
  • A 9×12 reading circle carpet for Mrs. V’s first grade class in Seagoville, TX
  • A document camera for Ms. B’s second grade math class in Phoenix, AZ
  • 15 sets of headphones for Mr. S’s second grade class in Yonkers, NY

Ms. W sent a note saying, “Your kindness and generosity bring tears to my eyes! I love telling my students how amazing and kind people all over the world donated and funded our projects so we can have fun learning and be successful in the future. Then, I remind them when they have accomplished that to remember to pay it forward. For now they will learn how they can help protect our environment with the tablets!”


Last Week’s Most Interesting News

  • The Senate passes the 21st Century Cures act, which includes healthcare IT provisions related to interoperability, privacy, and security.
  • Entrepreneur Sreedhar Potarazu, MD, founder, chairman, and CEO of the now-defunct business intelligence vendor VitalSpring Technologies, pleads guilty to defrauding shareholders of the company by hiding its tax liabilities, overstating its financial condition to the tune of $30 million, and falsely telling investors that the company was on the threshold of being sold for a profit.
  • CompuGroup Medical ends discussions about a possible takeover of Agfa.
  • Epic’s quality assurance employees again sue the company claiming they were misclassified in being ineligible for overtime pay.
  • China-based Apex Technology completes its acquisition of Lexmark, renaming its enterprise software group (which includes the former Perceptive Software) as Kofax and announcing plans to sell it.

Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.

Here’s the recording of last week’s webinar titled “Get Ready for Blockchain’s Disruption.”


Acquisitions, Funding, Business, and Stock

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Asset monitoring vendor Emanate Wireless raises $1.5 million in angel funding.

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Health coaching app vendor Vida Health raises $18 million in a Series B funding round, increasing its total to $24 million.


Sales

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Rusk County Memorial Hospital (WI) chooses Harris Healthcare Affinity ERP.

Los Angeles County Department of Health (CA) selects Allscripts EZCap for benefit management.


Decisions

  • Cogdell Memorial Hospital (TX) will go live on Cerner in 2017.

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


People

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Ed Park will join Athenahealth’s board following his previously announced resignation as EVP/COO that takes effect December 31.

Steve Holmquist, industry long-timer and SVP of new client development at Allscripts, died on November 29, 2016 in Phoenix, AZ. He was 55.


Announcements and Implementations

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New Zealand primary care provider Pegasus Health chooses Canada-based Intrahealth as its patient management system vendor of choice, ruling out Epic due to its cost.


Government and Politics

John Halamka summarizes the health IT impact of the 21st Century Cures act. He seems mostly positive, but is concerned about the effort required of EHR developers. His highlights:

  • ONC’s HIT Policy Committee and HIT Standards Committee will be merged into a single HIT Advisory Committee.
  • HHS is charged with developing voluntary certification of health IT for medical specialties and sites where the technology isn’t available or is not mature.
  • Vendors are prohibited from information blocking, are required to publish APIs, and must provide HHS with performance documentation. HHS is empowered to reward or punish performance as appropriate.
  • New interoperability, security, and certification testing criteria will be developed and ONC will get $15 million to support them.
  • HHS will develop or support a trusted exchange framework and ONC will publish an annual list of health information networks that are capable of using it.
  • Vendors must be able to exchange data with registries and will be treated as patient safety organizations for reporting and conducting care improvement activities.
  • The GAO will review ONC’s work on patient matching.
  • The GAO will conduct a study of the ability of patients to review their own PHI.

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NIH issues a challenge to develop a wearable sensor that can measure blood alcohol levels in real time, offering $200,000 for the first-place prototype and $100,000 for second place. The sensor would help researchers study alcohol use disorder and related conditions without relying on questionably reliable self-reported drinking data.


Privacy and Security

Fortified Health Security releases a review of 2016’s significant cybersecurity issues and its outlook for 2017.


Other

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EClinicalWorks issues a curious patient safety announcement about its EHR as part of its “ongoing effort to respond to and minimize such risks,” suggesting that users:

  • Pay attention to the company’s patient safety notices and apply available patches and upgrades
  • Update their Multum or Medispan drug databases
  • Designate a patient safety officer as ECW’s patient safety liaison
  • Confirm that orders are accurate and encourage patients and their families to do the same
  • DC and re-enter changed medication orders rather than modifying the existing order.
  • Limit the use of custom medications
  • Report any patient safety concerns or unexpected software behavior to ECW or by filing an ONC complaint.

ONC cited ECW’s announcement as the key item in its email newsletter, echoing the company’s recommendation to iECW’s customers that they apply available upgrades and report problems to the company and via ONC’s complaints website. I asked ONC If the announcement was triggered by a settlement with ECW over some unspecified issue and they said no, but the announcement suggests some kind of problem that raised ONC’s interest.

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Partners HealthCare posts its largest operating loss ever at $108 million, most of that coming from its Medicaid insurance division. Partners says it isn’t being paid enough by commercial insurers and government programs to cover its labor and drug costs. Including investment performance that must have been awful, Partners lost $249 million in 2016.

India-based media claim that 280 people have died of grief and shock following the December 5 death of Tamil Nadu Chief Minister Jayalalithaa Jayaram, raising the question (at least for me) of how their cause of death was determined. The political party in power says it will compensate their families and will also pay $750 to a party official who set himself on fire and another who cut his finger off in mourning.  


Sponsor Updates

  • Spok publishes a case study of the implementation of its Care Connect Suite at St. Dominic – Jackson Memorial Hospital (MS).
  • TelmedIQ earns a 91.4 score in KLAS’s review of secure communications.
  • Dimensional Insight earns top scores in 14 KPI categories in BARC’s “The BI Survey 16.”
  • The Chartis Group publishes “Election 2016: Implications for Providers.”
  • PeriGen’s PeriCalm Checklist is nominated for an Edison Award.
  • TeleTracking releases a new podcast, “The Essentials: 2017 Regulatory and Compliance Requirements for Patient Flow.”
  • CIOReview names Validic a Most Promising Healthcare Solution Provider of 2016.
  • Glassdoor ranks CoverMyMeds and Health Catalyst in the top 50 places to work nationally.
  • Verscend Technologies celebrates the 20th anniversary of its DxCG risk adjustment and predictive modeling solution that serves as the foundation of CMS’s hierarchical condition categories.

Blog Posts


Contacts

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

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Morning Headlines 12/9/16

December 8, 2016 Headlines 4 Comments

Expanding Capacity for Health Outcomes (ECHO) Act Requires Exploration of Digital Health Opportunities

The House of Representatives passes the ECHO Act, a bill that will expand telehealth services to remote and underserved communities. The bill will now make its way to the President’s desk for signature.

Former Google Ventures CEO Bill Maris is raising a new $230 million fund to focus on health care

Google Ventures founder Bill Maris announces that he is raising a $230 million investment fund that will focus on health care investments.

Physician Productivity Startup Augmedix Secures $23 Million to Continue the Nationwide Expansion of its Smartglass-based Remote Scribe Services

Google Glass startup Augmedix, which offers remote scribe services to help doctors navigate EHRs and document encounter notes while in the exam room, raises a $23 million investment round.

Fitbit buys smartwatch maker Pebble’s software assets

Fitbit acquires smartwatch maker Pebble’s software and intellectual property. Financial terms were not disclosed, but analysts value Pebble at $40 million.

News 12/9/16

December 8, 2016 News No Comments

Top News

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The Senate passes the 21st Century Cures Act in a 94 to 5 vote, sending it to the President’s desk for signature. The President praised the $6.3 billion legislation Wednesday and confirmed that he would sign it. Sen. Lamar Alexander (R-TN), chairman of the Senate health committee and one of the most ardent proponents of the bill, was understandably excited given that it has been circulating for two years and is considered to be one of most heavily lobbied pieces of legislation in recent memory. It provides money for cancer research; funds mental health treatment and resources to combat the opioid abuse epidemic; helps the FDA speed up drug approvals; and bolsters healthcare technology goals related to interoperability, privacy, and security.


HIStalk Announcements and Requests

This week on HIStalk Practice: Arianna Huffington includes Doctor on Demand in new wellness venture. Banner Urgent Care goes with RCM services from Zotec Partners. Health apps found sorely lacking in privacy precautions and safety standards. Marathon Health upgrades its EHR for workplace health centers. Montana preps for statewide HIE. PPJ Healthcare Enterprises raises $5 million.


Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.


Acquisitions, Funding, Business, and Stock

Google Ventures founder Bill Maris raises a $230 million venture fund dubbed Section 32 (a likely homage to Star Trek’s Section 31 security operation) that will focus on healthcare investments. Maris, who left Google earlier this year, plans to run the fund solo from San Diego rather than Silicon Valley.

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Augmedix closes a $23 million round of funding led by new investors McKesson Ventures and OrbiMed. It has raised over $60 million since launching its Google Glass-powered remote scribing service in 2012. Jenn talked with CEO and co-founder Ian Shakil about the company’s plans to move beyond its core services in “Value-based Care Prompts Glass to Grow Up.”

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Brentwood, TN-based consulting and staffing firm Vaco merges the newly acquired Pivot Point Consulting and Greythorn – both based in Washington – to form Pivot Point Consulting, a Vaco company. The new subsidiary brings together 50 employees and combines Pivot Point’s EHR implementation and advisory services with Greythorn’s recruitment expertise.

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The patent case over CRISPR-cas9 technology, likely the most valuable patent in biotechnology, begins as the University of California argues to have MIT and Harvard’s patent invalidated and transferred to UC. The patent office awarded The Broad Institute of MIT and Harvard its first CRISPR patient in April 2014, during which time it was reviewing UC’s patient, filed in May 2012.

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After much speculation, Fitbit buys Pebble’s software assets for an undisclosed sum, though Bloomberg has valued the transaction at less than $40 million. Pebble, which launched via a crowdfunding campaign in 2012, will no longer produce or sell its smartwatches.

Looking to further bolster its diminishing wearables market share, Fitbit also will work with Medtronic to add glucose monitoring to its fitness trackers. Type 2 diabetes patients will be able to combine their Fitbit-generated data with Medtronic’s IPro2 Continuous Glucose Monitoring system, which can send pertinent data to a patient’s provider.


People

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Juliana Hart (Verscend Technologies) joins MedCPU as vice president of market development.

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Brooke Patterson (FEI Systems) joins health IT and management consulting firm ARDX as SVP of government services.

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Cricket Health appoints University of California-San Francisco nephrologists Carmen Peralta, MD chair of its medical advisory board, and Anna Malkina, MD medical director.


Announcements and Implementations

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Chicago-based Union Health Service implements RadNet’s RIS, speech recognition, and mammography tracking.

Nemours Children’s Hospital, Seven Rivers Regional Medical Center, and Westchester General Hospital sign up for the Florida HIE’s event notification service, which patient hospital encounter notifications to participating ACOs, physicians, and payers.


Technology

SecureDx.net develops Secure Data Exchange messaging technology featuring two-factor authentication.


Sales

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Looking to set up a private HIE, Chicago-based Rush Health chooses HealthShare interoperability technology from InterSystems.

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Schleicher County Medical Center and Nursing Home (TX) taps CPSI subsidiary American HealthTech to help it implement technology upgrades to its clinical and business management operations. The company will also provide Medicaid AR management services.

TaraVista Behavioral Health Center (MA) signs on for MedSphere’s OpenVista EHR. The inpatient facility will also utilize the company’s Phoenix Health Systems division for IT support.


Government and Politics

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The FBI indicts 21 employees from Forest Park Medical Center (TX), claiming that they paid $40 million in bribes and kickbacks in exchange for referrals to its purely out-of-network health system. Those indicted include owners Alan Beauchamp, Richard Toussaint Jr., Wade Barker, and Wilton Burt; and Jackson Jacob and Andrea Smith, both of whom set up separate shell companies to funnel bribe and kickback payments to surgeons in exchange for the referrals.

The DoD taps Medical Information Network – North Sound to develop and maintain an HIE-like portal that will be accessible in any clinic or hospital within the DoD system. Integration with the department’s new Cerner-built EHR, currently in pilot phase at several bases in Washington, is expected.

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The House passes the telemedicine-friendly Expanding Capacity for Health Outcomes (ECHO) Act, which now heads to the president’s desk after receiving unanimous Senate approval last week. Once signed into law, the act will set in motion an HHS study on the feasibility of training providers to expand technology-enabled healthcare delivery in underserved areas.


Research and Innovation

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NantHealth makes its Quantum Immuno-oncology Lifelong Trial (QUILT) Programs available via ClinicalTrials.gov. CEO Patrick Soon-Shiong, MD believes making the QUILT trials available through the NIH registry will improve patient access to active and future immunotherapy-based trials for a variety of cancers.


Other

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Quite a space oddity: David Bowie treats former astronaut Buzz Aldrin in a New Zealand hospital after Aldrin was rescued from the South Pole after falling ill. The 86 year-old was part of a tourist group that was visiting the Amundsen-Scott South Pole Station through December 12.


Sponsor Updates

  • Imprivata will exhibit at the CIO Forum December 8 in Yorba Linda, CA.
  • Ingenious Med receives the Emerging Company of the Year Phoenix Award from the Metro Atlanta Chamber.
  • Database Trends and Applications Magazine names InterSystems Cache a trend-setting product in data and information management for 2017.
  • Kyruus will present at the Carolina Healthcare Public Relations & Marketing Society meeting December 9 in Charleston, SC.
  • Liaison Healthcare expands its relationship with London-based reseller partner AK Loman.
  • LifeImage releases video insights from RSNA 2016.
  • Gartner includes LiveProcess as a representative vendor in its 2016 market guide for clinical communication and collaboration.
  • Meditech shares a brief case study featuring Anderson Regional Medical Center (MS).
  • Netsmart will exhibit at the Community Behavioral Healthcare Association of Illinois Conference December 12 in Schaumburg.
  • Computerworld names NTT Data VP of Digital Experience Lisa Woodley a 2017 Premier 100 Technology Leader.
  • Black Book ranks Nuance first in CDI for the third consecutive year, and first for end-to-end coding, CDO, transcription, and speech-recognition technology.
  • Health Catalyst receives the 2017 Glassdoor Employee Choice Award.
  • Rock Health names Health Catalyst CEO Dan Burton the winner of its annual Most Beloved CEO award for 2017.
  • Verscend Technologies publishes a new white paper, “The Evolution of DxCG, the Gold Standard in Risk Adjustment and Predictive Modeling.”

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 12/8/16

December 8, 2016 News No Comments

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The FDA is making available its data on adverse events stemming from foods, dietary supplements, and cosmetics. I found it interesting that the coded symptom data contains numerous British English spellings: hospitalisation; dyspnea; diarrhea; and pale faeces to name a few. Pretty unusual for a United States governmental agency. Repeat offenders included the full range of “5-Hour Energy” products; B-complex vitamins; cabbage; and a number of products with the name “cleanse” in their names, which is not surprising to this physician.

I attended a continuing education session this week. Although I learned a lot, it was the first time that I heard so many gambling metaphors in one place. I’m used to hearing sports phrases, but the gambling references were new to many of the attendees. I had the privilege of explaining what “table stakes” were to a newly-minted pediatrician, as well as the meaning of “double down.” I’m grateful to my former partner who once invited me to be part of a ladies’ poker night, which ended up being less about poker and more about wine and catching up. It’s always a good reminder for presenters to consider their audience before including figures of speech. There were also some Yiddish references and some regional slang, which, although entertaining, might have been confusing to some.

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The reader mailbag brought quite a bit of correspondence this week. I always enjoy hearing from readers, even if it’s just a “thanks for writing” type comment. Being anonymous and doing most of my work solo while watching “Call the Midwife” can feel pretty lonely, so thanks for the feedback.

From Texas Tornado: “I enjoyed your recent mention on MU reporting. Would text analytics be helpful in this MU attestation scenario? I understand the push to do more discrete documentation, but what if you could report on structured and unstructured data combined? Does it really matter if the data is discrete or not as long as you can report on it?” That type of approach would certainly be appreciated by many clinicians who have been clicking their little hearts out over the last half decade. With most of the EHR-based quality reporting platforms I’ve seen, however, most documentation has to be discrete and in a fairly narrow workflow to “count” for quality measures. Ultimately, as natural language processing evolves, I think we will see more information being transformed to discrete data points; but I’d love to see some other approaches.

From Roaring Waters: “Thanks for your discussion of the need for clinical participation in IT projects. As a vendor selling to the acute care environment, I am always shocked at how often patient care workflow solutions are handed to an IT or non-clinical person to evaluate and determine how it will impact clinical workflow. I know people have been talking about end-users making user workflow decisions for decades, but for some reason these basics of project management are lost. Providers themselves are just as guilty, as I see them constantly passing these decisions off to a non-doc or non-clinical user to make decisions about their workflow and ultimately the patient care they deliver. It’s mind-boggling!” The providers that pass the buck for decision-making are often the first to complain when workflows or solutions don’t meet their needs. Another variation on this that I’ve seen lately is to pass the decision to a clinical representative who doesn’t actually practice or who doesn’t have any real buy-in to the clinical situation at the institution. I’ve been working with a group for nearly a year that has a CMO who constantly criticizes the EHR and demands a move to Epic, yet hasn’t shown up at a single executive briefing or strategy session where the EHR has been discussed. His comments are strictly hit and run via email and one-off conversations with the Board of Directors, which hasn’t learned to say no to his shenanigans. His peers are working hard for solutions and all he does is tear down their work, which is unfortunate.

From Science Guy: “Thank you for your comments about clinical staff having to take ownership of the quality reporting. Having worked in healthcare in both the payer and clinical side … there is a paradigm shift taking place that many clinicians have not come to grips with. That is that the payers are driving more and more of the clinical decisions based on outcome data and not clinical judgment. It is becoming increasingly difficult to practice medicine in a vacuum without using clinical information to justify decision making. Having worked at a University Medical Center, I saw this very plainly as the more experienced physicians struggled with this very topic and resented the IT staff for ‘creating additional hoops for them to jump through.’ I heard the statement more than once that ‘my time is too valuable for this … and my time is better spent healing patients than working on the computer.’ On the other side of the coin, there is a whole new generation of physicians coming out of school that are much more computer literate. They embrace using information from the health record to support their decision making. They realize this information could assist them with their clinical decisions, and all of this data was really just another clinical diagnostic tool to improve care. I guess my point is that like any other change, this current shift will cause a lot of frustration for a lot of staff, but it is certainly not going away. Hopefully many of the more experienced staff will be motivated to change as they see their younger peers embracing this technology and ultimately the patients will benefit from these changes. But hopefully, in the meantime, your information will help with the whole ‘shooting the messenger (the IT staff) mentality.’”

As a young physician working in clinical informatics for the first time, it took me longer than it should have to learn to stop shooting the messenger. Looking back, I realize I was working with a very inexperienced IT staff that had no idea how to work with physicians and didn’t understand how much havoc a poorly-run EHR project could have on a practice. I assumed that since the hospital had contractually agreed to provide me a paperless practice with a functional HER, that they would also provide staff that had the skills to deliver it. Some of the individuals involved in that debacle are now some of my information technology BFFs and we continue to learn a great deal from each other. Whether it was encountering chicken wire in the wall that was interfering with wireless connectivity or having providers install their own black-ops routers under their desks, it was kind of fun working in the early days (read “Wild Wild West”) of health IT.

Have you ever used poultry netting as a drywall patch? Email me.

Email Dr. Jayne.

Morning Headlines 12/8/16

December 7, 2016 Headlines 2 Comments

Congress passes 21st Century Cures Act, boosting research and easing drug approvals

The Senate passes the 21st Century Cures Act in a 94 to 5 vote, sending it to the President’s desk for signature. The President praised the bill Wednesday and confirmed that he would sign it.

Twenty-One Indicted in the Forest Park Medical Center Health Care Fraud

The FBI has indicted 21 employees from Forest Park Medical Center (TX), claiming that they paid $40 million in bribes and kickbacks in exchange for referrals to its purely out-of-network health system.

CRISPR court hearing puts University of California on the defensive

The patent case over CRISPR-cas9 technology, likely the most valuable patent in biotechnology, begins as the University of California argues to have MIT and Harvard’s patent invalidated and transferred to UC.

Slavitt: ‘There should be no pride of authorship’ with healthcare reform

During an interview at Modern Healthcare’s 2016 Leadership Symposium, Acting CMS Administrator Andy Slavitt called on lawmakers to focus ACA reform discussions on parts of the law that are not working, saying “If we can improve upon the things that were started in the ACA, we should do it. It doesn’t matter if that comes from a Democrat. It doesn’t matter if it comes from a Republican.”

Morning Headlines 12/7/16

December 6, 2016 Headlines No Comments

Meet Emily, Ireland’s first ‘digital baby’

In Ireland, Cork University Maternity Hospital goes live with Cerner as the first hospital in a plan to deliver a single, shared maternity EHR across the nation.

Political donor pleads guilty to investment fraud scheme

Sreedhar Potarazu, an ophthalmogist and political commentator on cable news outlets, pleads guilty to criminal investment fraud charges after lying to investors about his health technology startup’s finances to secure $30 million in investments.

IBM’s Watson Now Fights Cybercrime in the Real World

IBM’s Watson business unit has launched a pilot program aimed at developing cybersecurity monitoring tools for healthcare and several other industries.

Security Experts Warn Congress That the Internet of Things Could Kill People

Harvard University professor and cybersecurity scholar Bruce Schneier discusses the recent IoT-based denial-of-service attack on Dyn servers and the risk that such attacks pose to hospitals and public safety.

News 12/7/16

December 6, 2016 News 3 Comments

Top News

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Ireland goes live on a nationwide maternal and newborn clinical management system at Cork University Maternity Hospital, making newborns like Emily, above (dubbed the country’s “first digital baby”), initial recipients of a digital patient chart. The Cerner-developed MN-CMS will roll out across the country’s 19 maternity units over the next three years, with near-term go lives planned for University Hospital Kerry, Rotunda Hospital, and National Maternity Hospital in Dublin. The new technology is the first of its kind in the world, and marks the Irish healthcare system’s first interoperable EHR.


Webinars

December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.


Acquisitions, Funding, Business, and Stock

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Potomac, MD-based ophthalmologist Sreedhar Potarazu pleads guilty to charges related to a $30 million investment fraud scheme tied to VitalSpring Technologies, his now-defunct healthcare business intelligence company. Potarazu admitted to defrauding over 150 shareholders by lying about the company’s finances, failing to pay payroll taxes, hiding tax liabilities, and even going so far as to concoct a charade around a fake prospective buyer. He faces 15 years in jail.

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Theranos will dissolve its Board of Counselors, including two former secretaries of state, the former director of the CDC, and a former secretary of defense. James Mattis, a retired Marine general who has gained notoriety as President-elect Donald Trump’s pick for secretary of defense, will remain on the company’s Board of Directors.

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Grail, a spinoff of DNA-sequencing company Illumina, looks to raise $1.7 billion to fund large-scale clinical trials in the UK to test early-stage cancer detection tools. The company was initially funded early this year via a $100 million Series A round led by Illumina.

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Boston-based PatientPing raises $31.6 million in a Series B financing round led by Leerink Transformation Partners and Andreessen Horowitz. The company plans to double its workforce and expand beyond the six states it currently serves. Vermont announced statewide adoption of the care alert technology in April. The company raised $9.6 million in venture funding last year.

Germany-based CompuGroup Medical walks away from Agfa acquisition talks for undisclosed reasons. It began discussions with the Belgian company in late October.


People

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Shafiq Rab (Hackensack University Health Network) will join Rush University Medical Center as CIO and SVP effective January 9.

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Joe Driscoll (PC Connection) joins Verscend as CFO.

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The American Society of Clinical Oncology hires George Komatsoulis (NIH) as its first chief of bio-informatics.


Announcements and Implementations

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ColumbiaDoctors (NY) will roll out mobile patient engagement technology from HealthGrid across its 95 locations.

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Dayton Children’s Hospital (OH) begins a two-phase implementation of GetWellNetwork’s bedside Interactive Patient Care software. Phase two will take place next Summer with the opening of a new hospital tower.

Athenahealth adds ADP’s workforce payroll and time and attendance software to its AthenaOne offering for hospitals and health systems.

Rochester RHIO adopts the Connect Image Exchange Transfer-to-PACS workflow from EHealth Technologies.


Sales

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Lurie Children’s Hospital of Chicago chooses MerlinOne’s digital asset management system.

The Oklahoma Dept. of Human Services opts for case management technology from Mediware to help it better care for aging and/or disabled residents.

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Rusk County Memorial Healthcare (WI) selects Harris Healthcare’s Affinity ERP solution for automation and integration of accounting and financial tasks.

Pharmacy procurement and utilization management company Sentry Data Systems signs on with NTT Data Services for data security and hosting.


Technology

Baxter launches the Sigma Spectrum Safety Management system, including infusion data analysis and reporting and technical support.

Premier develops performance benchmarking technology that sheds light on potential reimbursements and prioritizes areas of improvement.

Meditech releases a fall risk-management tool kit.


Government and Politics

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HHS releases the latest round of healthcare spending figures, which show a 5.8-percent growth in 2015 – the fastest rate since 2008. That puts the average annual healthcare spend for one person at close to $10,000. The increase coincided with 9.7 million people gaining insurance coverage under the ACA, and 10.3 million more enrolling in Medicaid.


Research and Innovation

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Tenable publishes a cross-industry analysis of cybersecurity preparedness, noting that readiness scores dropped an average of six percent from last year. It gave the healthcare industry a “D” in overall preparedness, a grade lower than its score of the previous year.


Sponsor Updates

  • Agfa Healthcare will present several sessions at the European Summit on Digital Innovation for Active & Healthy Ageing this week in Brussels.
  • Audacious Inquiry wins The Baltimore Sun’s 2016 Top Workplaces Award.
  • Arcadia Healthcare Solutions will exhibit at the CCO Oregon Cost of Care Conference December 13 in Salem.
  • Besler Consulting releases a new podcast, “Key takeaways from the 2017 OPPS Final Rule.”
  • B2B Marketing features Bottomline Technologies CMO Christine Nurnberger.
  • E-MDs offers early bird pricing for its user conference and symposium June 18-20 in Grapevine, TX.
  • EClinicalWorks will exhibit at the 2016 Connected Health Continuum December 11-14 in National Harbor, MD.
  • HCI Group releases a new podcast, “EHR Training: Developing Your Curriculum, Using Your LMS, and Organizing Your CTs ft. Stephen Tokarz.”
  • An Aprima survey of 312 physicians and practice staff finds that 52 percent believe a Trump presidency will improve healthcare, while 48 percent seem confident in a positive financial impact.
  • Meditech customer Farrer Park Hospital (Singapore) receives numerous health IT accolades.
  • PokitDok publishes, “5 Healthcare IT Trends to Watch in 2017.”
  • EClinicalWorks issues reminders about patient safety and the use of its EHR software.

Blog Posts


Contacts

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

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Morning Headlines 12/6/16

December 6, 2016 News No Comments

US Health Spending in 2015 Averaged Nearly $10,000 Per Person

Healthcare spending climbed 5.8 percent in 2015, the fastest rate since 2008, according to a recently published HHS report.

Theranos Dissolves High-Profile Board of Counselors

Theranos announces that its Board of Counselors, including two former secretaries of state, the former director of the CDC, and a former secretary of defense, will retire in 2017.

Global Cybersecurity Assurance Report Card

Tenable publishes a cross-industry analysis of cybersecurity preparedness, noting that readiness scores dropped an average of six percent from last year, and giving the healthcare industry a “D” in overall preparedness.

Illumina spinout Grail is seeking to raise $1.7 billion for large-scale clinical trial: sources

Grail, a spinoff of DNA-sequencing company Illumina, is in the process of raising $1.7 billion to fund large-scale clinical trials in the UK to test early-stage cancer detection tools.

Curbside Consult with Dr. Jayne 12/5/16

December 5, 2016 News 2 Comments

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Many organizations are starting to get ready for their Meaningful Use attestations early next year. Those that prepared well in advance and monitored their performance as the year rolled along are simply dotting the proverbial “i” and crossing the “t” before the year closes out. Others are in panic mode, realizing that they waited too long to get serious about it, or failed to follow up. I was contacted recently by a couple of clients that fell into the latter category, and was sorry to have to tell them that there isn’t a lot that I can do to help them.

One group started the year strong, using their EHR’s quality measures dashboard to make sure providers were posting solid metrics for their identified measures. They provided retraining for the end users as needed, making sure documentation was done using as much discrete data as possible. They were headed strong into May, and then had some changes in their office dynamics that resulted in the loss of some key staffers. The new office manager was tasked with picking up the Meaningful Use readiness work, and there is some debate about whether she simply didn’t do it or whether she told one of the partners that she was too overwhelmed to take it on.

Practice leadership realized about a month ago that they hadn’t been seeing any reports, and hired a new resource to start managing things. It took her several weeks to get up to speed, and even then it seems that it was too little, too late. Many of the providers have slipped back into documenting their visits using free text and dictation, and based on how the system reports, they aren’t getting credit for their documentation. The managing partner reached out to me asking for my firm to completely take things over for the rest of the year. I was willing to give it a go, until he demanded that I assure him that his providers would meet certain numbers on the metrics. Without a magic wand or a time machine, it would be pretty impossible to correct that much missed documentation, so I elected to take a pass.

Another client had a supposedly savvy IT person who was modifying patient visit data on the backside of the system. He would take the providers’ visits, and if there was free text documentation that kept the visit from qualifying for certain metrics, he would perform database inserts to trigger the discrete data points. That might be a valid approach as long as there is solid documentation on what is being done and clear boundaries around it, but they failed to document the plan or the authorization. Now the physicians are in a battle about having people modify their charge without approval of the individual visits, and it’s probably going to tear the practice apart. They wanted me to come in and audit the database and see how widespread the modifications are, but given the state of the practice, there isn’t enough money on the table for me to get into the middle of something like that.

These examples illustrate, in part, a major issue that we’re still seeing in healthcare IT. Far too many providers and organizations still think that these types of projects are technology projects. I hear a lot of nebulous references to “the IT department” owning such initiatives when really they are clinical/operational initiatives with IT support. There’s also a lot of blame on the EHR vendors. Although I’ve definitely seen my share of flawed workflows, strange workarounds, and oddly calculating measures, clients have to realize that unless they’re willing to switch systems, they have to work with what they have in front of them. Of course, they should also open tickets or support cases or use whatever complaint mechanism their vendor provides, but at some level the customer is responsible for selecting or staying with a particular vendor.

When physicians push back against my assertion that they need to own these projects along with their practice operational leaders, I ask them if they would assume that the company that manufactured the fax machine or the person who dialed it is responsible for the information written in the letter they’re sending to their consulting or referring physician. (Don’t get me started on the fax machine analogy. It’s sad that I have to use it, but so many offices are still faxing letters back and forth that it’s an effective way to make the point.)

It’s now December, and there are somewhere around 17 or 20 work days left in the year for most practices, depending on how you handle your holidays. If you’ve been asleep at the quality measures wheel for most of the year, there is virtually no way to make it up before the attestation window closes, unless you’re willing to engage in database shenanigans or know someone who will on your behalf. You’re not going to be able to retrain providers to fix their workflows for this year, but you can start educating them on what they need to do differently for 2017. And hopefully those organizations who are in a bind at the moment have realized what they too need to do differently for next year, if they want to be successful.

Whether you look at it as succeeding in a world of changing payment structures or avoiding penalties or complying with the requirements of your employer, staying ahead of quality reporting requires a lot of work. Providers have to be constantly monitored for compliance with recommended workflows. End users have to be educated on ways to support the providers so they don’t become data entry clerks. Practice managers and administrators need to be running reports regularly and taking action to mitigate issues as soon as they identify them.

Leadership should be careful on how often they run reports though and what results they expect – I had one client who was running them twice a week, and complaining that they weren’t improving. We had to have a lengthy conversation about interventions and how long they take to bear fruit, since it’s nearly impossible to change provider or end user behavior overnight. That’s also assuming that you actually reached the providers with the intervention, and that half of them weren’t in the operating room or missing it because they were rounding or not reading their email. Even with significant incentives or penalties, it’s still going to take several weeks (if not months) for new workflows to become part of daily routines.

Managing quality metrics is definitely more of a marathon than a sprint. How is your group doing with MU attestation preparation? Email me.

Email Dr. Jayne.

Morning Headlines 12/5/16

December 4, 2016 Headlines No Comments

Allscripts to extend EMR offerings in Australia

Allscripts acquires Australian EHR vendor Core Medical Solutions. adding both localized software and employees with deep knowledge of Australian healthcare workflows to Allscripts.

Harris Computer Corporation Acquires IMDSoft

Harris acquires iMDSoft, expanding its footprint in healthcare. The company will be run as an independent business within Harris and will be run by iMDSoft EVP Shahar Sery. Financial terms were not disclosed.

Epic Systems sued again for overtime wage issues

Epic quality assurance employees file a class-action lawsuit against the company arguing that they were misclassified by Epic as exempt from overtime rules.

Legal battle delays fourth Vancouvercenter building

Cerner sues iCapital founder Ahmed Saeed Mahmoud Al Badi after his company subcontracted Cerner to help develop a national EHR for the United Arab Emirates but stopped paying once work was complete. Cerner has filed complaints in Washington and Oregon, where it is seeking $60 million in real estate assets owned by Mahmoud Al Badi.

Monday Morning Update 12/5/16

December 4, 2016 News No Comments

Top News

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Allscripts acquires Australia-based Core Medical Solutions for an undisclosed sum. The company’s BOSSnet clinical information system seems to be its best known product, with numerous implementations across the Western part of the country. CMS will operate as an Allscripts subsidiary out of its South Australian headquarters in Adelaide. Allscripts has had a strong foothold in South Australia since 2010, when the government enlisted the company to develop and roll out an Enterprise Patient Administration System across its 80 hospitals to the initial tune of $225 million – a figure that has since escalated to $317 million over 10 years.


Last Week’s Most Interesting News

  • The House passes the 21st Century Cures act in a rare, bipartisan 392-26 vote and sends it off for the Senate to review.
  • A CDC report finds that the number of people struggling to pay their medical bills has fallen sharply in the last five years. Researchers cite reduced unemployment and the implementation of ACA as the primary reasons.
  • The Senate unanimously passes a bill requiring HHS and GAO to analyze the University of New Mexico’s Project ECHO pilot program and report on opportunities to expand the program nationally.
  • President-elect Donald Trump selects Rep. Tom Price, MD to replace Sylvia Burwell as the next HHS secretary, and health policy consulting firm CEO Seema Verma to succeed Andy Slavitt as the next CMS administrator.
  • Rupert Murdoch will likely lose $200 million in Theranos investments after his own newspaper, the Wall Street Journal, exposed the company for misleading investors.

Webinars

December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.

December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.


Acquisitions, Funding, Business, and Stock

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Apex Technology and related investors wrap up their acquisition of Lexmark, originally announced in April. Lexmark’s Enterprise Software Group will separate from the investor-led company and rebrand to Kofax. Former Vice President and CFO David Reeder will take over as president and CEO, and appears intent on selling off the software business as quickly as possible to focus on its imaging assets. The sale includes the assets of Perceptive Software, which Lexmark acquired in 2010.

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Dallas-based civil and criminal justice technology company Securus Technologies acquires Quebec-based PHD Medical’s telemedicine assets. Securus has been intent on broadening its healthcare offerings for correctional facilities, having acquired EHR vendor Cara Clinicals last year, and healthcare management systems business Archonix in 2013.

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Cerner finds itself in the real estate market thanks to legal battles with Ahmed Saeed Mahmoud Al Badia, a property developer with ties to the United Arab Emirates Ministry of Health, which hired Cerner in 2008 via a subcontractor agreement with Al Badia’s company, ICapital, to develop a national EHR system. Cerner contends it hasn’t been paid the full amount due, despite finishing the project. It is suing Al Badia and trying to seize a $30 million mixed-use development and other assets to recoup $63 million it claims to have lost on the project.

Epic faces another class-action lawsuit pertaining to its overtime pay policies. This particular suit contends that quality assurance workers were illegally denied overtime pay despite the fact that they mainly tested Epic’s software products by simulating user experiences and documenting problems – work that required little training or education in computer programming or engineering. (Higher-level employees like analysts, programmers, and software engineers are typically exempt from overtime pay rules.) The company faces two other overtime-related lawsuits filed early last year on behalf of technical writers who believe Epic illegally classified them as exempt from overtime wages and then paid them a fixed salary irrespective of the number of hours worked.


People

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James Aita (Idea Couture) joins Medicomp Systems as director of strategy and business development, North America.


Decisions

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  • Sleepy Eye Municipal Hospital (MN) will switch clinical and physician documentation software from Healthland to Meditech on December 1.
  • UConn John Dempsey Hospital (CT) will go live on Epic in June 2018.

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


Announcements and Implementations

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The New Hampshire Health Information Organization can now share data with NH providers who care for veterans inside and outside of the VA.

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Gillette Children’s Specialty Healthcare expands its telemedicine program to facilities in Central Minnesota. The state passed legislation last year requiring payers to cover virtual consults to the same degree they would in-person appointments.


Privacy and Security

From DataBreaches.net:

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  • Tampa General Hospital (FL) settles a class-action lawsuit related to a non-hospital employee’s unauthorized access of patient information and the hospital’s failure to adequately protect that information. The hospital maintains it is not responsible for the misdeeds of former employees related to the access.
  • Glendale Adventist Medical Center (CA) fires a nurse after the employee accessed the records of 528 patients without permission.

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NIST’s National Cybersecurity Center of Excellence seeks help with designing simple and secure mobile login methods for first responders. Organizations interested in supporting the single sign-on effort can submit a letter of interest to NIST, which hopes to begin developing use cases in January.

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University of Iowa Hospitals and Clinics recovers from a six-hour Epic downtime caused by an electrical problem in one of its main server rooms. The health system shifted to standard downtime procedures and transferred critical services from its data center to a redundant data center off site.


Innovation and Research

A HealthLoop health literacy study of 2,226 diagnostic imaging patients finds that those offered educational materials via digital means were more likely to correctly identify what ionizing radiation was than those that received paper materials. The digital engagement group was also “significantly” more at ease with undergoing examinations using such radiation compared to their paper-based counterparts.


Sponsor Updates

  • Experian Health will present at the VA AAHAM meeting December 9 in Williamsburg, VA.
  • PokitDok will present at Health 2.0 Asia-Japan December 6-7 in Tokyo.
  • Surescripts and ZeOmega will exhibit at the AHIP Consumer Experience & Digital Health Forum December 6-9 in Chicago.
  • TierPoint will host the Nebraska Security Summit December 8 in Omaha.
  • Zynx Health will exhibit at the National Forum on Quality Improvement in Healthcare December 4-7 in Orlando.
  • Sutherland Healthcare Solutions publishes “Meaningful Use Stage 3 and its Impact on the Healthcare Industry.”

Blog Posts


Contacts

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

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Morning Headlines 12/2/16

December 1, 2016 Headlines No Comments

Millions Of People Are Having An Easier Time Paying Medical Bills

A CDC report finds that the number of people struggling to pay their medical bills has fallen sharply in the last five years. Researchers cite reduced unemployment and the implementation of ACA as the primary reasons.

California Tests Electronic Database For End-Of-Life Wishes

California will create an electronic registry to store end of life orders of residents which will be accessible by local emergency and social service providers.

Omnicell to Acquire Leading Pharmacy Provider Ateb, Inc.

Omnicell will acquire Raleigh, NC-based Ateb, Inc. for $41 million in cash. Ateb develops pharmacy-based medication adherence and chronic disease management solutions and has a customer base of 15,000 pharmacies across the US and Canada.

News 12/2/16

December 1, 2016 News 3 Comments

Top News

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The House passes the 21st Century Cures act in a rare, bipartisan 392-26 vote and sends it off for the Senate to review next week.

Provisions include a less-thorough FDA drug approval process, $5 billion in NIH research funding, $1 billion to address the opioid epidemic, and mandatory EHR interoperability requirements that prohibit information blocking with potential fines of $1 million. The bill would also combine ONC’s HIT Policy and HIT Standards committees

A controversial measure that would have reduced requirements for drug companies to continue publicly reporting their payments to providers was removed.

The bill would be funded by taking money away from preventive health projects.


Reader Comments

From Luna Immortal: “Re: [vendor 1 name omitted]. I’m hearing that they have an upcoming merger and wonder if it might be [vendor 2 name omitted] since there’s a lot of people who worked at both companies and Vendor 2’s home health software vendor stake would help Vendor 1, whose product isn’t robust.” Unverified. Sorry about all the Vendor 1/Vendor 2 stuff, but I don’t usually list the names of publicly traded companies when I run rumors even when it’s not hard to figure out who’s who.

From Byte Bard: “Re: upcoming webinar. Your speaker’s bio says his prior company went public. That’s not accurate – it was an SEC Regulation D investment.” I see a good bit of accomplishment inflation in this industry, like the executive’s LinkedIn profile I was reviewing this morning that, in the absence of actual graduate education, listed one of those super high-priced, days-long visit to the campus of a big-name school that offers programs for those who are flush with cash but who don’t find it convenient to earn an actual graduate degree like many of their underlings managed to do. I’ll trust your resume forensics in this case. I recall that I got all kinds of nasty and threatening emails years ago when I wrote about unaccredited schools and linked to the bios of healthcare people who were throwing around their fake MBAs and PhDs. If the credential can’t withstand any sort of inspection, then it has no place on a resume or LinkedIn.


DonorsChoose Updates

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Donations from (a) the anonymous vendor executive who asked me to do a reader cybersecurity survey; (b) long-time reader Marty; and (c) our own @JennHIStalk funded these DonorsChoose classroom projects:

  • A library of books and a storage cart for Mrs. L’s first grade class in Cedar Hill, TX.
  • 30 calculators for Mrs. S’s sixth grade math class in Union, SC.
  • Math games for Mrs. S’s first grade class in Independence, MO.
  • Learning center headphones for Ms. M’s elementary school class in Chicago, IL.
  • Programmable robots for the library’s makerspace of Mrs. E’s elementary school in Greenwood, SC.
  • Science teaching items for the sixth grade class of Mrs. S in Union, SC.
  • Hands-on learning stations for the learning disabled students of Mrs. P’s kindergarten class in Oklahoma City, OK

Mrs. S from SC, who says she was “thrown in” to teaching science after school had already started and therefore had no materials to work with, checked in:

You do not know how much this means to me and to my students. This has been a difficult year trying to teach my students with limited supplies. I can’t wait to tell my students tomorrow morning. I’m sure they will be just as excited as I am. Thank you for your generosity.

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Industry long-timer Tom sent a very generous personal donation with a note saying that it’s sad that charity has to provide classrooms with essential learning tools, but he’s still happy to donate for “our future adult citizens.” The matching money really added up in funding these teacher grant requests with Tom’s donation:

  • A listening center for Mrs. H’s first grade class in Battle Creek, MI.
  • Additional books for the library of Mrs. L’s first grade class (the first donation to her class was above).
  • A mobile organizer and spelling games for Mrs. S’s elementary school class in Gaffney, SC.
  • Three sets of building blocks for Mrs. K’s elementary school class in Rome, NY.
  • An iPad Mini for read-along lessons for Ms. N’s elementary school class in Brooklyn, NY.
  • A social emotional library of 33 books for the International Baccalaureate class of Mrs. M in Nashville, TN.
  • Non-fiction books and subscriptions for Ms. S’s elementary school class in Chula Vista, CA.
  • Robotics and engineering kits for Mrs. G’s elementary school class in Springfield, NY.
  • STEM learning project kits for Ms. L’s elementary school class in Independence, MO.
  • Music and band supplies for Mrs. R’s elementary school class in Wasco, CA.


HIStalk Announcements and Requests

My fatigue is growing with lazy health IT reporters who craft “news” stories consisting mostly of loosely woven together tweets or quotes extracted from them. They should be practicing journalism that they promote via Twitter, not using Twitter as a news source. Every time I think that journalists (if you care to call them that) can’t possibly get lazier or less informed, they prove me wrong. The “eyeballs at any cost” movement among sites that don’t charge a subscription fee (and thus trade in titillation rather than education) has made us collectively dumber than we already were and that’s saying a lot. 

I’m also tired of people repeating the well-intentioned but dead wrong trite assertion that “Your ZIP code determines your health more than anything.” If that were true, people would be miraculously cured just by moving. Health status is certainly related to socioeconomic factors that are prevalent in a given ZIP code, but you and I won’t fall apart medically just because we move to East St. Louis. It’s a cute phrase that ironically confuses cause with effect and applies broad group characteristics to every individual in the group. Healthcare people should know better.

This week on HIStalk Practice: AbleTo adds care coordination capabilities to behavioral telehealth service. PCPs found extremely lacking in willingness to fess up to medical errors. Topline MD practices roll out telemedicine capabilities. Orb Health raises $3.2M for CCM-focused care coordination tech. Culbert Healthcare Solutions CMO Nancy Gagliano, MD shares four reasons why telemedicine hasn’t taken off more quickly. Excellus BCBS preps for MDLive roll out. CompuGroup Medical adds rehabilitation module. WebPT CEO Nancy Ham shares her thoughts on the importance of workplace culture in attracting top talent.

Listening: new from Seattle-based lo-fi rockers Dude York, which to my untrained ear can sound like the Pixies one minute and the Thermals the next. Their drummer nails it. I’m also kind of enjoying their former neighbors from their Walla Walla days, the riot grrrlish Chastity Belt, who bristle at being called a “girl band” in saying that all the members “just happen to be female” and that nobody would call Led Zeppelin a “boy band.” We get great recorded performances of both courtesy of the U-Dub affiliated KEXP in Seattle, which offers live streaming of its radio programming (I’m listening to it now). 


Webinars

December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.

December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.


Acquisitions, Funding, Business, and Stock

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Document Storage Systems will acquire Streamline Health’s patient engagement suite that includes patient scheduling and surgery management. Those are the former systems developed by Unibased Systems Architecture, which Streamline acquired in 2014 and then renamed from ForSite2020 to Looking Glass Patient Engagement. I ran a reader rumor from Twice Bitten on October 5, 2016 saying that Streamline had laid off half of the team involved. DSS offers products and services to government and commercial clients based on the VA’s VistA, so I’m not sure what they’re planning to do with the former USA products.

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Omnicell will acquire Raleigh, NC-based Ateb, which offers pharmacy-enabled care and population health management solutions, for $41 million in cash. CEO Frank Sheppard left his IBM developer job in 1992 to form the company.

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Lifestyle telehealth software vendor Fruit Street raises $3 million from physician investors in a Series A funding round.

I messed up my New Zealand dollars currency conversion conversion in summarizing Orion Health’s just-announced results. Here’s the corrected version:

Orion Health announces first-half 2017 interim results: revenue up 9 percent, operating loss $12 million vs. $19 million in the first half of 2016. Shares dropped 18 percent to a record low on the news and are down 64 percent since the company’s 2014 IPO. While revenue is up, losses are down, and the company projects profitability in 2018, Orion’s cash position has dropped to $17 million after a net cash outflow of $23 million in the first six months of the fiscal year. The company has also expressed some concern that its predominantly US customer base might defer decisions following the presidential election, but it believes healthcare IT initiatives have bipartisan support.


Sales

Allied Physicians Group (NY) chooses Dimensional Insight’s Diver Platform for analytics.


People

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Greg White (Allscripts) joins PerfectServe as COO.


Announcements and Implementations

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Spok announces the T52 two-way pager that allows encrypting messages.

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Health Catalyst launches Healthcare.ai, an online repository of open source machine learning algorithms.

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National Decision Support Company expands its CareSelect clinical guidelines to include the Choosing Wisely campaign,medications, labs, and blood management.

NTT Data Services (the former Dell Services) announces analytics partnerships with Imbio (lung analytics) and AnatomyWorks (brain mapping analytics).

DrFirst will integrate pharmacogenetics-based point-of-care electronic prescribing from Translational Software into its Rcopia medication management system.

Northwell Health and Siemens Healthineers form research partnership to address imaging effectiveness and outcomes.


Government and Politics

A CDC study finds that the number of people whose families are struggling to pay their medical bills has dropped 22 percent in the past five years due to an improving economy and the large number of people who gained insurance through the Affordable Care Act.


Privacy and Security

From DataBreaches.net:

  • In Australia, SA Health fires two more employees for inappropriately accessing medical records, raising its total to seven after a February crackdown.
  • A research team hacks 10 types of implantable medical devices, claiming that a hacker could kill pacemaker and defibrillator patients within 15 feet.
  • In Canada, Carleton University temporarily bans Windows-using students from its network after ransomware takes down its internal systems.

Innovation and Research

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A group of cadets in an Israel Defense Force officer training course creates a digital bracelet and associated sensors that can be attached to wounded soldiers to record information about their treatment. The bracelet is powered by near-field communication technology that connects to the smartphones of medics. Medical teams are testing it for potential general army rollout.


Other

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California is testing an electronic registry for POLST (Physician Orders for Life-Sustaining Treatment) forms that would allow first responders and clinicians to look up their wishes for emergency treatments. POLST forms, intended for use by people near the end of their lives, contain actual provider orders and thus are more stringent than advance directives. Advocates fear that the barrier to widespread electronic registry use will be that hospitals won’t share their data. 

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This is sobering: gunshot detection system vendor Shooter Detection Systems gets its first (unnamed) health system customer.


Sponsor Updates

  • Agfa Healthcare, GE Healthcare, and Lexmark Healthcare complete the RSNA Image Share Validation program.
  • Xerox develops a printer for ambulatory providers capable of sharing patient information via the cloud.
  • EClinicalWorks will exhibit at the Orthopaedic Summit December 7-10 in Las Vegas.
  • Deloitte includes Evariant in its list of fastest growing technology companies in North America.
  • Iatric Systems will exhibit at the Privacy & Security Forum 2016 December 5-7 in Boston.
  • Imprivata will exhibit at IHI’s National Forum on Quality Improvement in Healthcare December 4-7 in Orlando.
  • Deloitte includes Ingenious Med on its list of fastest growing technology companies.
  • InterSystems will exhibit at the NYeC Digital Health Conference December 6-7 in New York City.
  • CompuGroup Medical adds a rehab module to its WebEHR.
  • EHR integrations drive nationwide adoption of CareSelect Imaging.
  • Navicure will exhibit at the HIMSS Revenue Cycle Solutions Summit December 6-7 in Boston.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 12/1/16

December 1, 2016 Dr. Jayne No Comments

Breaking Up is Hard to Do, or Caveat Emptor

I’ve been doing change management work for longer than I care to admit, so I’ve seen firsthand that change is never easy. It’s human nature to be risk-averse to some degree, and many people have deep-seated feelings that change is risky. I’ve enjoyed my work helping physicians and their staff members through the challenges of implementing EHRs and expanding their use of technology, moving them from the “no way” group to the “I can’t manage without it.”

I’ve watched some physician friends move through that transition and it’s been gratifying even though I haven’t been involved in their projects. As an EHR proponent, I’ve been on the receiving end of a lot of complaints about technology, and seeing people reach the point where it enables their work instead of causing heartburn keeps me going. Relying on EHRs has its own challenges, though, particularly when a practice breaks up.

One of my closest friends has spent the better part of the last three years going through such a breakup. Her group of three surgical subspecialists had been stable and productive for years when one of the partners became disabled and could no longer perform surgeries. They held it together while they recruited a replacement physician, taking on extra work to cover the portion of the overhead no longer funded by the departing partner. Unfortunately, the new physician didn’t work out and debts mounted. The remaining partner simply decided to stop working, forcing my friend to terminate the partnership rather than take on debt trying to keep the doors open.

The stress has been significant, but she was starting to see light at the end of the tunnel as she agreed to join another group in town. Since they were on the same EHR vendor, her hosting team promised her an easy conversion. She ran the pricing past me and I thought it looked low. Digging into the agreement, I noticed that it was only a demographic conversion and no clinical data was to be converted. Instead, the clinical data was going to be converted to PDF and added to the imaging portion of her new practice’s EHR. We talked through the ramifications of that, and whether she would rather have the data converted or abstracted. Due to the episodic nature of most of her patient relationships, she was willing to risk it.

I expected her to call after a week or two in the new practice, asking for an abstraction vendor. It wasn’t two hours into her new practice before she was inundating me with text messages and emails. The conversion wasn’t the problem – the EHR was the problem, along with the practice staff.

In a small practice, there may be only one or two super users. In this case, both of them had quit since the last time a new physician joined the practice. No one in the office knew how to add her to the provider master file, so they simply added her as a user since that’s all they knew how to do. As a physician, she didn’t know that was an issue until she started trying to issue prescriptions and apply her electronic signature to office notes. No one in the office knew how to contact the help desk, so she called me, knowing that I’ve worked with her vendor before.

I gave her the help desk number and some pointers on what to ask for and hoped for the best. I felt so bad for her. The average physician looking for a new practice situation is more focused on questions about the call schedule and how expenses are shared than he or she might be on asking about the number and availability of super users or system admins. Especially if we’ve come from a highly functional EHR support framework, it might never cross our minds. We take it for granted that things just work, not remembering all the hard work and setup that it took to get the system to the place where we could see patients.

We may also take it for granted that every installation of a given vendor’s system is the same. Although there may be core modules that are the same, practices and hospitals often customize and configure many portions of their system, unknown to the average end user. Additionally, not every installation is on the same version of a given piece of software. In my friend’s situation, her new practice was on an older version of the system. The visit documentation templates were nearly unrecognizable to her, as they pre-dated her previous system by several major releases. I’m sure asking for their release version and the number of their most recent content patch wasn’t part of her interview questions, either.

Fortunately, I was able to call in a couple of favors and get her some immediate help, although we haven’t been able to get her set up with electronic prescribing or updated letterhead for her patient plan documents. She’s not yet present in the patient portal and can’t order labs, but at least she can print prescriptions, document her visits, and bill out her charges.

Although the old adage about “buyer beware” certainly applies, these are uncharted waters for most physicians. Most physicians that are making moves are consolidating into larger groups or are being acquired by hospitals and health systems. It’s not as common for them to move from one small practice to another, but even in that situation, groups may be on a hospital’s community EHR offering or on a fully hosted solution. It’s rare to see a small practice trying to maintain their own client-server system and I think many physicians would fail to deduce that arrangement if they were in her shoes.

Back in the day when EHRs were just coming on the scene, I started my “on the side” consulting business by helping small practices with system selection and implementation. I’m thinking I may need to consider a new business line helping physicians on the move who need help teasing out potential EHR pitfalls during the practice selection process. It would definitely be a niche offering given the number of new grads joining hospital-owned practices, but for those physicians faced with a situation like hers, it would be worth it. Once the match was made, it would lend itself nicely to conversion and/or abstraction services.

My friend has given me permission to use her experiences to create checklists and questionnaires to help prevent other physicians from going through similar circumstances. I’m sorry she had to go through it, but I’m going to be ready for the next physician who needs help evaluating a practice opportunity.

How do you onboard new physicians? Email me.

Email Dr. Jayne.

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