Home » Search Results for "search":

News 6/27/14

June 26, 2014 News 5 Comments

Top News

image

Philips will deploy clinical applications in a Salesforce.com-powered cloud environment that’s centered around patient relationship management. Two applications will be launched this summer, eCareCoordinator and eCareCompanion, which are collaboration platforms for monitoring chronic condition patients at home.  Philips says future offerings will incorporate information from EMRs, medical devices, home monitoring, and wearables. The platform will be open to developers to create add-on products.


Reader Comments

image

From Otto Complete: “Re: HTRAC East conference in Leesburg, VA. I attended this week and found it to be amazingly enlightening! Limited vendor involvement, zero exhibitors, and passion for IT improvement in our space, along with tremendous information sharing – these are just a few of the compliments I would give the conference. As you are a thought leader in our field, I wanted to be sure this group was on your radar.” I hadn’t heard of the group or conference, but they get points from me for being non-profit and for bundling meals (and an open bar) with the registration fee. The write-up says it’s invitation-only and limited to around 200 attendees, with minimal vendor participation and no exhibit hall.

SNAGHTML4f322d7

From Demon Deacon: “Re: Wake Forest Baptist IT department. The CMIO and VP of clinical applications positions were eliminated and will be replaced with a chief clinical information officer.” Unverified, although a search of Google’s cache turns up the now-removed job posting that I assume they filled. They’ve had a lot of IT turnover after their horrific Epic implementation.


HIStalk Announcements and Requests

This week on HIStalk Practice: Avecinia Wellness Center CEO Unaiza Hayat, MD shares the details of successfully attesting for S2MU and the role good physician leadership plays in any implementation. HIE merger creates largest in Michigan. Nashville physicians show no love for Epic. Verizon gets into the telemedicine game. Maine Primary Care Association goes live with new pop health technology. Thanks for reading.

This week on HIStalk Connect: researchers with Sandia National Laboratory make headway on their work developing non-invasive ways of monitoring electrolyte levels. Google unveils Google Fit, a digital health developers’ platform that promises the same basic functionality that Apples HealthKit offers. San Francisco-based startup Grand Rounds raises a $40 million Series B round to expand its growing network of physician thought leaders who offer remote second opinions on complex cases.

Listening: Chicago-based Eleventh Dream Day, probably the best and hardest-rocking Midwestern band that nobody’s heard of thanks to their record label’s incompetence. Also: Queens of the Stone Age.

My latest reading peeves: (a) cutesy reporters who start off a healthcare technology story with, “The (technology name here) will see you now.”; (b) using “there” as the subject of a sentence; (c) clickbait headlines, tweets, and lame slide shows that will do anything to get you to click even though you will regret it almost immediately; (d) referring to doctors as Dr. John Smith, which doesn’t tell us what kind of doctorate John earned; (e) surveys that try to hide low participation by giving results only as percentages; and (e) as I try to ignore the flood of World Cup chatter, people who confuse spectating with exercising in referring to someone else’s athletic team as “we.” I’ll keep the porn analogy that popped into my head to myself.


Webinars

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

We’ve decided to post the recorded videos of our HIStalk Webinars on YouTube to avoid the playback problems some viewers were having. The webinar, Cloud Is Not (Always) The Answer, ran live this past Wednesday. Not only did Logicworks do a great job in taking our suggestions and input from two CIOs into account to perfect their content and delivery, running the recorded version from YouTube is cleaner and faster, with no signup required to start watching.


Acquisitions, Funding, Business, and Stock

image

CareCloud borrows $25.5 million from a growth capital lender. I’m never cheered by a company taking on debt just like I wouldn’t be thrilled about a relative signing up for a home equity loan, but I guess it’s good news to be found credit-worthy and to have your plan for using the money vetted by someone whose objectivity is inarguable given their interest (no pun intended) in being repaid.

image

Physicians Interactive, which markets life sciences products to physicians, acquires consumer health information site WebHelp.

image

Imprivata’s raises $66 million in its Wednesday IPO.


Sales

Central Florida Health Alliance (FL) chooses MModal for transcription technology and document insight.

Sutter Health (CA) selects Orion Health to build and deploy its HIE.


People

image

Mark Caron (Capital BlueCross) is named CEO of population health and analytics systems vendor Geneia, which is owned by Capital BlueCross.

image

The Jersey Health Connect HIE names Judy Comitto, VP/CIO of Trinitas Regional Medical Center (NJ), as its board chair.  

Secure email vendor DataMotion appoints Kathleen Ridder Crampton (United HealthCare Group) to its board.


Announcements and Implementations

image

Ivenix announces that it is developing a new smart IV pump that will feature a smartphone-like user interface, enhanced IT capability that includes Web-based EHR integration and analytics, and new pump technology.

image

Telehealth solutions provider AMC Health says it has integrated its system with Epic.

Verizon announces Virtual Visits, a secure video technology platform that allows consumers to connect with doctors. The company hopes to license the technology to health plans (i.e. doctor not included.)

image

The non-profit CCHIT, which exited from what it said was the unprofitable EHR certification business in January 2014, announces its new mission of selling developers advice on how to get their EHRs certified.

image

Biometric Signature ID announces its handwriting-powered identity authentication system for Epic. It seems that handwriting would not be reliable given that users would be “writing” with their fingertip on a small screen while standing up in most cases, but maybe they’ve figured it out. You can try cracking a “Go Verify Yourself” signature-powered access page on their site.


Government and Politics

A Bloomberg editorial says that the Affordable Care Act is drawing a disproportionate number of people with chronic conditions to sign up for health insurance, which could possibly drive insurance companies out of the market or force the President to try to bail them out (with questionable legality) as he promised upfront to get them to participate.

CMS claims that its much-maligned Medicare fraudulent claims detection system prevented $210 million in payments in 2013, its second year of operation. That works out to something like 0.02 percent of total payments, a fraction of the government-estimated $50-60 billion that CMS improperly pays each year, and less than a monkey throwing darts could turn up before hitting the Beltway by noon on the Friday before Independence Day.


Other

A Wisconsin high school loses its track coach to Epic, where he will become a project manager. He says, “I’ll be working to implement software, and going out to hospitals and clinics, visiting with doctors and nurses, and discuss their ideas and concerns with the developers at Epic … I’m no computer whiz. They say they want people who are able to distinguish themselves through their careers, and they’ll teach the rest. There will be a lot of learning.”

image

An editorial in Applied Clinical Informatics says that specifying advance directives should be easy and the resulting preferences should be stored by HIEs and shared via interoperability. It proposes an input sheet that looks like a US tax form in making the analogy that advance directives should be as easy as electronic filing of taxes. Misusing the term as “advanced directives” drives me crazy (you make them in “advance,” not “advanced”) so it was disappointing that “advanced” made an unwelcome appearance three times in the mostly-correct article. Note the subtle humor in identifying the form as 419, the police code for a “dead body found.”

A small (120 responses) AMDIS-Gartner survey of CMIOs finds an average annual salary of $326,000 in a range of $206,000 to $550,000. Respondents reported slightly less job satisfaction than last year, higher CMIO turnover, and an overwhelming preference for reporting to the chief medical officer rather than the CIO.

image

In Canada, a $300 million privacy lawsuit is filed against Rouge Valley Health System that alleges two hospital employees sold the names of 8,300 mothers of newborns to an investment who cold-called them to sell education savings plans.

Google CEO Larry Page says yet again that 100,000 lives would be saved each year by more healthcare data mining. He’s made that claim (without backing it) several times.

A Bloomberg article says that hospitals are starting to use consumer information from big data sources to target their at-risk patients for interventions, such as finding out which asthma patients are buying cigarettes or whether heart patients are allowing their gym memberships to lapse. Patients say hospitals making cold calls about health habits is intrusive, but hospitals say they need to aggressively manage their patients under new payment models.

A new KLAS report reaches an obvious conclusion: only Epic, Cerner, and Meditech are expanding their hospital EMR client bases. Actually I was surprised that Meditech was included since my perception is that they are falling behind rather than gaining, but I assume KLAS has hard data suggesting otherwise.


Sponsor Updates

  • Validic will be featured by TEDMED 2014 as one of its chosen “transformative startups and the inspiring entrepreneurs that power them.”
  • Optimum Healthcare IT will be featured in a June 29 episode of “21st Century Television” on Bloomberg Worldwide.
  • Jeanette Ball, RN, PCMH CCE of CTG Health Solutions shares her experience working with western New York providers to create a PCMH framework in the Journal of Clinical Engineering.
  • CareTech Solutions launches its website built on CareWorks CMS v4.1.
  • ESD shares how to implement automated testing.
  • Navicure partners with Acculynk to launch a customized payment platform for providers.
  • Netsmart posts a white paper exploring the similarities and difference in PC and behavioral health.
  • Allscripts receives 23 commitments for expanded Allscripts Sunrise solutions such as Ambulatory Care, Emergency Care and Surgical Care.
  • Practice Fusion partners with Emdeon to offer automated health plan eligibility check in its EHR.
  • Juniper Networks announces the capabilities and enhancements of its Next-Generation Firewall and SRX Series Services Gateways.
  • The Advisory Board Company is profiled by a local news station for its community volunteer projects.
  • Extension Healthcare discusses how EHR alerts have contributed to alarm fatigue and offers a two-part white paper on managing alarms to improve patient safety.
  • Wellcentive client Children’s Health Alliance (OR) receives the Analytics All Stars Award for Population Health Project of the Year award.
  • Albany Area Primary Health Care (GA) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.
  • Divurgent offers a series of free conference calls on big data and analytics.

EPtalk by Dr. Jayne

It’s been a completely random week at work. Most of the practices we acquired earlier in the year have stabilized from a revenue cycle perspective, so it’s time to bring them up on EHR. Once the Independence Day holiday rolls by, it will be full steam ahead.

There have been a couple of last-minute glitches though, mostly involving providers behaving badly. There are always challenges when a practice has to change its culture, but I’ve not seen this many employed providers who don’t seem to remember that they’re employed.

Some of our operational leaders try to soften the blow by referring to them as “partners” or “associates,” but the bottom line is that they are employees. If we were partners, there would be shared decision-making and give and take. There would not be top-down leadership with requirements that must be adhered to. There would not be contractual obligations that require compliance with a host of regulatory items. There would not be penalties for failure to adhere to documented policies.

I’m fortunate to have an implementation team that’s well-seasoned and grateful for its manager and her solid leadership. Since the team has had a couple of months without active deployment cycles, we front-loaded the calendar with some of the most difficult providers. That way they can get them done while they’re still fresh. The majority of the team agreed they’d rather save the best providers for last rather than having to look forward to all the difficult ones at the end.

From Stay Glassy San Diego: “Re: Dr. Chrono’s Glass app. Did you see it? They’re referring to it as the first wearable health record.” I did see, it but I’m not sure it’s actually a wearable record as much as a different way to interface with the record. Physicians can store a video of an office visit in the EHR but it’s not clear how that translates to discrete data or the other hoop-jumping we need for payers and incentive programs. I did find it interesting that media reports cite 300 of the 60,000 drchrono clients as users of the Glass app. They may have downloaded it, but given psychosocial and privacy concerns around use of Glass, I’d be surprised if that many were actually using it. According to the company website, users can sign up to be beta testers, which doesn’t exactly sound like widespread adoption to me. If there are any readers who have actually used it, I’d be happy to share your stories.

clip_image001

From App-e-tite for Destruction: “Re: Open Payments, did you look at any of the other government apps that were available? Some are amusing.” I was on a pretty focused expedition the other day but did have some time tonight to check out the Mobile Apps Gallery at USA.gov.  In addition to Apple and Android, they still offer content for BlackBerry. There’s an app to help you through the National Gallery of Art as well as one to locate alternative fueling stations for electric, biodiesel, CNG, and other non-gasoline vehicles. I spent some time playing with the FDA Mobile app, which has medication recalls and safety alerts as well as consumer updates. There’s also a radiation emergency app, one that manipulates census data, a rail crossing locator, and a ladder safety app to boot.

What’s your favorite government app? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 26, 2014 News 5 Comments

Morning Headlines 6/26/14

June 25, 2014 Headlines No Comments

Four to six teams expected to bid on Defense health record effort

FCW predicts that a total of just four to six teams will compete for the upcoming DoD EHR contract, with three already being identified as: Epic/IBM, CSC/Allscripts/HP, and VA/Vista.

A medical first: Quadriplegic man controls arm using a chip implanted in his brain

A quadriplegic man has regained muscle control of his arm through the help of a computer chip implanted in his brain that captures and transmits commands to an electrode-packed sleeve worn around his arm. One researcher explains “It’s much like a heart bypass, but instead of bypassing blood, we’re actually bypassing electrical signals. We’re taking those signals from the brain, going around the injury, and actually going directly to the muscles."

Verizon Expands Access to Medical Care for Patients, With ‘Verizon Virtual Visits’

Verizon introduces a HIPAA-compliant telehealth platform that it will market to health systems, payers, and employers.

View/Print Text Only View/Print Text Only
June 25, 2014 Headlines No Comments

News 6/25/14

June 24, 2014 News 1 Comment

Top News

image

Emdeon will acquire Capario for $115 million in cash from its private equity owner Marlin Equity Partners, with Emdeon announcing plans to incorporate the CaparioOne revenue cycle management product into its Intelligent Health Network.


Upcoming Webinars

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Acquisitions, Funding, Business, and Stock

image

KPMG acquires Cincinnati-based Zanett Commercial Solutions, an Oracle partner and health IT consulting firm.

image

A new $152 million funding round for doctor-finding site ZocDoc values the company at $1.6 billion.

image

Second medical opinion site Grand Rounds raises $40 million in funding. The company charges $7,500 for an online review by a nationally recognized physician, while arranging an appointment with a specialist costs $200. The company says that its second opinion finds the original doctor wrong 60 percent of the time, giving employers more than a threefold benefit to their investment, which for companies of fewer than 1,000 employees is $10 each per month. The company also offers physician-to-physician consultation for hospitalized patients who demand a review by a recognized expert. It would be interesting to know how they choose the “top 3 percent of specialists in the nation.”   

image

IMS Health will acquire some product lines of Cegedim, which sell life sciences marketing solutions, for $520 million in cash. Cegedim’s Pulse Systems products for medical practices (PM/EHR, RCM, patient portal, patient kiosk) weren’t mentioned as being part of the deal.


Sales

image

St. Luke’s (MN) chooses Strata Decision’s StrataJazz for Decision Support.

Cerner signs a 10-year deal with existing customer Mission Health (NC) to work on unspecified innovation and population health projects.

image

University Health Shreveport (LA), UMass Memorial Medical Group (MA) and Baptist Memorial Health Care (TN) select Infor Healthcare financial solutions.

RegionalCare Hospital Partners (TN) will deploy Agilum Healthcare Intelligence’s BI solutions and services across its eight hospitals in seven states.

Verizon will provide AirWatch by VMware to its US enterprise clients.


People

image

M. Bridget Duffy, MD (Vocera) joins the board of scribe and EHR consulting vendor Essia Health, formerly known as Scribes STAT.

image

Athenahealth names Kristi Matus (Aetna) to the newly created role of EVP/chief financial and administrative officer.


Announcements and Implementations

Premier, Inc. launches PremierConnect Price Lookup, which will allow members and vendors look up pricing information for nearly 7 million contract items.

CSC will partner with Allscripts and HP in vying for the DoD’s $11 billion EHR replacement. CSC wastes no time in playing the card of Robert Wah, MD, its chief medical officer and newly installed AMA president.

The newly merged Great Lakes HIE and Michigan Health Connect choose Great Lakes Health Connect as their new name.


Government and Politics

image

Janet Woodcock, MD, director of FDA’s Center for Drug Evaluation and Research, says the agency’s Mini-Sentinel drug surveillance system that’s being piloted combines claims and EHR dispensing data from 18 large healthcare organizations in a common data model that its safety scientists can query with drug safety questions. It covers 153 million people, 4 billion drug dispensing episodes, and 4 billion patient encounters.

A South Dakota newspaper points out that small claims collection lawsuits for medical expenses often violate patient privacy since they list the services for which the patient owes the provider. One collections agency requests that each of its lawsuits be sealed to prevent casual electronic observers from prying into a given patient’s procedure codes.

Above is video from Tuesday’s 21st Century Cures digital health roundtable convened by the US House Energy & Commerce Committee. Among those speaking are Jonathan Bush (athenahealth), Jeff Shuren (FDA), Martin Harris (Cleveland Clinic), and Brian Druker (OHSU).


Other

Seven-bed Reagan Memorial Hospital (TX) says it was unable to pay its vendors after the only employee who knew how to issue checks from Meditech quit. They’re back on track after having Meditech train more people.

Above is Deborah Peel, MD of Patient Privacy Rights at TEDxTraverseCity on “Designing Technology to Restore Privacy” from a few weeks ago. She’s also starting a campaign, #MyHealthDataIsMine.

image

Fitch Ratings holds the rating on bonds of Beebe Healthcare (DE) at BBB-, one step above junk status, with EHR implementation contributing to its losses.

image

The State of Montana starts notifying 1.3 million people — more than the entire population of the state — that hackers got into a state health department server containing their medical information. A surprising amount of medical information was stored on the server, including “health assessments, diagnoses, treatment, prescriptions, and insurance.” Also on the same server: the bank account information of 3,100 department employees and contractors and 50 years’ of birth and death certificate information.

image

Parkview Health (IN) pays $800,000 to settle an OCR HIPAA investigation in which a retiring independent doctor who was transferring her patients to new practices found 71 boxes of medical records dumped in her driveway when she got home. The hospital says it has since replaced its insecure paper records with an EHR.

On Computerworld’s “100 Best Places to Work in IT 2014” in the “Large Organizations” category are Sharp HealthCare (#7), Texas Health Resources (#8), OhioHealth (#10), Carolinas HealthCare System (#20), Cedars-Sinai Health System (#21), Cancer Treatment Centers of America (#27), Children’s Hospital of Philadelphia (#33), Cerner (#37), Ascension Health (#39), HCA (#42), Kaiser Permanente (#45), and McKesson (#50). On the “Midsize Organizations” list are Miami Children’s Hospital (#8) and Genesis HealthCare System (#12). UHC takes the #2 spot in the “Small Organizations” category.  

image

A small (111 hospitals) AHA-sponsored survey finds that a third of the responding organizations don’t feel they have the right executive team in place to execute their strategy, with their biggest talent shortfall being in creating non-traditional partnerships, managing community and population health, and managing change. Just half have a CIO/CTO on the executive team, and only 20 percent say the CIO is always involved in making decisions. The report predicts the emergence of new executive titles that include chief population health manager, VP of cost containment, chief patient engagement officer, and VP of clinical informatics.

“No Matter Where,” a movie about HIEs in Tennessee, has a limited premiere in Nashville. The executive producer is Kevin Johnson, MD, professor of pediatrics and biomedical informatics at Vanderbilt University School of Medicine.


Sponsor Updates

  • Black Book Rankings names Streamline Health’s Looking Glass ECM system as #1 in the “Document Improvement” category of “Financial Products and Services.” Also #1 in its category is PatientKeeper in the “Charge Master” and “Charge Capture” categories.
  • Netsmart is providing CareManager to the Early Connections Network in Tennessee.
  • Levi Ray & Shoup announces its MFPsecure pull printing software that enables secure delivery for Ricoh devices.
  • Craneware earns HFMA Peer Review Designation for five products for the tenth consecutive year.
  • Agilum Healthcare Intelligence introduces its new website and BI solutions.
  • Health Catalyst posts a video demonstration of its new Financial Management Explorer.
  • MedAssets introduces the first module of it revenue cycle analytics suite Contract Analytics during the 2014 HFMA National Institute in Las Vegas.
  • Vital Images releases VitreaExtend advanced visualization solution that supports up to three simultaneous users.
  • Navicure launches BillingBetter.com to connect medical billing companies and practices and provide education resources on billing.
  • MedAssets unveils the next generation of Decision Support Costing and Contracting this week at the 2014 HFMA National Institute in Las Vegas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 24, 2014 News 1 Comment

Morning Headlines 6/23/14

June 22, 2014 Headlines No Comments

Secretary Burwell announces steps to bolster management and accountability ahead of the 2015 open enrollment period

Incoming HHS Secretary Sylvia Burwell reorganizes the Healthcare.gov management team in preparation for the 2014 open enrollment period, beginning in October.

Evidence based medicine: a movement in crisis?

BMJ publishes an article calling out evidence-based medicine practices as being laden with unintended, negative consequences. The article cites an overabundance of evidence, particularly evidence that does not result in meaningful quality gains, as well as the pharmaceutical industries heavy handed influence on research, and evidence-based medicine’s inability to cope with patients with comorbidities.

Medical Device Data Systems, Medical Image Storage Devices, and Medical Image Communications Devices – Draft Guidance for Industry and Food and Drug Administration Staff

The FDA publishes draft guidance confirming that it will not enforce regulations on Medical Device Data Systems, which are define as hardware or software products that transfer, store, convert, or display medical device data.

New Technology Helps Vets Navigate the Medical Quagmire

The Huffington Post profiles BlueButton, calling it a means for veterans to download all of their VA and DoD medical records so that they can skip the unacceptable waiting lines at the VA and seek care elsewhere.

View/Print Text Only View/Print Text Only
June 22, 2014 Headlines No Comments

Monday Morning Update 6/23/14

June 22, 2014 News 2 Comments

Top News

image

HHS Secretary Sylvia Burwell reorganizes the staff of Healthcare.gov in preparation for the next open enrollment period that starts in November, hiring Andy Slavitt of Optum (above) as CMS principal deputy administrator. Optum helped fix Healthcare.gov after its disastrous rollout. Slavitt fills the vacant position that places him as second in command to CMS Administrator Marilyn Tavenner, replacing Jonathan Blum, who left the agency in April. Burwell also announced plans to hire a Healthcare.gov CEO and CTO.


Reader Comments

From Dingo Boot: “Re: HIStalk Practice. I took a break from reading but I’m back. A double dose of industry news there and on HIStalk gives me an edge, I think.” Thanks. Jenn is doing an amazing job on HIStalk Practice. She is contributing in other less-obvious ways and will most likely become more visible on HIStalk.

image

From The PACS Designer: “Re: the bionic pancreas. A new concept to help with Type 1 diabetes has been announced by Boston University. The bionic pancreas device uses uses a smart phone, glucose monitor, and insulin pump to automatically control blood sugar levels.” Quite a few groups were working on the concept, including University of Virginia, but what’s different about this device is that it can manage both high and low blood glucose because it is loaded with both insulin and glucagon. This one’s getting coverage because it was mentioned in a NEJM article describing results from a tiny study of 52 patients over five days. It avoids finger sticks by using a continuous glucose monitor and lets the patient describe what they just ate, such as a “typical breakfast” or “small bite.” Most interesting is that the system doesn’t know or care what type and dose of insulin the patient has been administering since it’s measuring blood glucose continuously – all it needs is the patient’s weight and their descriptions of meal size.  


HIStalk Announcements and Requests

image

Epic supports interoperability as well or better than its competitors, according to 75 percent of a large number of poll respondents (630). Quite a few thoughtful and informed comments were left on the poll, many of them non-anonymously. I’ll excerpt a few that are from real-life experience rather than the more common sideline Epic bashing or cheerleading:

I’ve worked with several vendors over the years and plenty of HIEs. At the end of the day, Epic connects to other Epic facilities or to non-Epic just fine. Epic to Epic is priceless and effortless. More than 50 percent of the patients in the US today are or will be using Epic when the current Epic pipeline is implemented. For organizations that are not Epic, we expect them to connect to a commercially available HIE or to the federal level HIE (eHealth Exchanged managed by Healtheway). We have no plans to connect our Epic system to other EHRs directly, not when the states and fed are encouraging and incenting us to connect to HIEs.

Epic has already built and tested connections to a wide variety of other vendors, so that implementation is rather easy. Epic notifies us when a new vendor connection is available and we are eager to proceed based on prior success. When configuration changes are found, Epic promptly addresses and tests changes, so there is no finger pointing or project delays. Epic is dedicated to interoperability in a way that I don’t see from a variety of other EHRs. Interoperability projects with Epic will be delivered in a fraction of the time and at a fraction of the expense of many other vendors

My experience with Epic and Direct messaging to date is less robust than some other vendors. At this point in time, Epic can only send and receive CCDA documents — other enclosures like notes, radiology reports, discharge summaries, .wav files — are unable to be sent from Epic to other EMRs. I have seen other EMRs be able to send us different types of information, including free text notes (like an email) and we cannot process them. So in this regard, Epic has lower performance than other vendors.

Our hospital connects with other Epic facilities, local, state and national government organizations and we are currently working on connecting with non-Epic entities. Whether we connect via Query/Retrieve or interfacing, Epic has always been extremely knowledgeable and helpful in assisting us to link to Epic or non-Epic entities.

Very impressed with Epic interoperability. They do it the best of any vendors we’ve had to work with. If we are frustrated its the lack of real standards across the industry. Id like to see true semantic interoperability.

Epic has the ability, but not the will to interface with other vendors. As one of those vendors, our customers are not getting what they need to support their workflows in specialty areas when Epic declines to provide interfaces to vendors supporting specialty areas.

New poll to your right (or here): have you as a patient had a video-based “visit” in the past year? Vote and then click the “Comments” link to describe.

Listening: new from Mali Music, also known as 26-year-old Kortney Jamaal Pollard from Savannah, GA. His heartfelt lyrics are always uplifting and often religious, while musically it’s mostly neo-soul with some light rap thrown in. It’s likely to polarize people who react strongly to some aspect of his work, which I did: I loved it. Coincidentally sticking with the Georgia theme, I’m also listening to the defunct, Athens-based Magnapop.

firsthistalk

Saturday was the summer solstice, which means it had more hours of daylight than any day of the year. It also reminded me that Friday marked 11 years since I wrote the first HIStalk post. Several of the folks who have recently recommended me on LinkedIn have been readers since the beginning, or at least nearly so, with quite a few going back to 2005 or 2006. Thanks for reading regardless of how long you’ve been doing so. I’m lucky to be doing something that gets me so excited every single day that I can’t wait to get started.


Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Sales

image

Centegra Health & Wellness Network chooses Valence Health to provide infrastructure and support for its clinically integrated network.


Government and Politics

image

FDA publishes draft guidance stating that won’t enforce regulatory controls on Medical Device Data Systems (MDDS) because they pose low risk to the public and are important for advancing digital health. MDDS are medical devices that transfer data electronically (such as from a ventilator to an EHR), store and retrieve data (blood pressure readings), convert data using preset specifications (pulse oximeter data to printed form), display data (displaying a patient’s EKG), or store or communicate medical images. Only apps that control other medical devices would continue to be regulated. The 60-day comment period is open.

image

ONC will present a webinar on Thursday, June 27 at 1:00 ET on how to implement digital privacy notices on websites. PatientPrivilege won ONC’s contest to create compelling, easy to implement online NPPs – its example shows how one might look.

A Huffington Post article talks up Blue Button (and Humetrix’s iBlueButton) as a way for veterans to work around the never-ending DoD-VA EHR fighting, saying it’s easier for veterans to just download their own information and take it to whoever they’re seeing, including private practice doctors.


Other

image

Niko Skievaski, the guy behind “Struck by Orca: ICD-10 Illustrated” (you have more time to buy it now that ICD-10 is delayed) has made the Breadcrumbs knowledge management software available for free. Users can ask questions and receive answers from the health IT community, members of which earn reputation points from the moderators.

A BMJ essay says evidence-based medicine is having a crisis, postulating that its promise isn’t being met because: (a) drug and device vendors have hijacked the process by manipulating clinical trials and publishing only favorable research to create “evidence”; (b) the amount of available evidence is unmanageable for practicing physicians, even with technology help; (c) the low-hanging fruit of managing established diseases has already been picked and the emphasis has moved to industrial-scale screening that may involve unexpected opportunity costs or unintended consequences; (d) less-skilled or lazy doctors may treat by template rather than by using experience and judgment; (e) EBM gives bureaucrats a way to impose rules that marginalize the physician’s skill and eliminate the opportunity for the patient to be involved in the decisions made about them; and (f) EBM works best for a single condition, which isn’t usually the case. The authors plea for a return to “real” EBM that uses the physician’s judgment, involves the patient, resists the use of “evidence” created by special interests, and places ethical care as its highest priority.

I’m fascinated that Google just bought home security and camera vendor Dropcam for $555 million in cash. The Wi-Fi video service offers live streaming, two-way talk, alerts, and night vision. Naturally I was thinking about healthcare uses, such as monitoring processes (like in the OR, pharmacy, etc.) or as a patient advocate wisely unwilling to leave a loved one lying in a hospital bed surrounded by potential misadventure. The company has lots of competitors, but their product looks simple to set up and my interest was more in the concept rather than the specific product. On the Big Brother side of the argument, I can just see a clueless, overly controlling Dilbertesque IT director demanding that work-from-home employees have the camera trained on their chairs at all times.

A video from Missouri Economic Development highlights Cerner’s program to hire military veterans.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 22, 2014 News 2 Comments

HIStalk Interviews Farzad Mostashari, CEO, Aledade

June 20, 2014 Interviews 9 Comments

Farzad Mostashari, MD, MSc is CEO of Aledade of Bethesda, MD.

image

How do you pronounce the company’s name? Is it Allay-DODD?

Allay-DADE.

Explain the company’s business model and what Venrock’s interest is in backing it with a significant investment.

The business model is pretty simple, actually. We’re going to give physicians – independent primary care practices – pretty much everything they need in order to form and join an ACO. The key business model for an ACO in this case is that the main revenue source for us comes if and when we generate total healthcare spending reduction and improvement in total healthcare quality and coordination.

This is all predicated on our belief that with the right tools, with the right technology, with the right boots on the ground, with the right team, with the right primary care providers, we can go right at the heart of what’s ailing healthcare today and get to better care, better health, and lower cost. If we can do that, the company prospers and the primary care docs prosper.

 

Who actually writes you checks and how do you calculate that savings that I assume you’re getting a percentage of?

There is an organization, an accountable care organization, which we will stand up. That entity then enters into contracts with health plans. The contracts with the health plans basically say, “You have a projected total cost for this panel of 5,000 or 10,000 patients. If we come in below that benchmark, the health plan gets half and the ACO gets half.” The largest plan in the world, Medicare, now has this available for primary care providers throughout the country. Many other health plans are following suit.

 

If I’m a physician and I decide I want to get in on this ACO thing, who are my fellow members or should I even know or care?

Healthcare is very local. We believe that you need boots on the ground, like the Regional Extension Centers in a way, harking back to that. Or even before that, to my experience with Mat Kendall, my co-founder, when we were in New York City. We went to 233 independent practices and we enrolled them in the Primary Care Information Project. This is similar, where in a given geography, we get a field team out, we find the right practices, and we bring them together, oftentimes with practices in a group they haven’t worked with before.

But really the work is done one-on-one with the practice. There’s a common set of tools — referral management tools, patient management tools, and risk management tools — but the real work happens in an individual, given practice, with the team going into the field.

What we’re looking for isn’t really networks of docs that have already come together. We’re looking for the independent, individual practices who might have thought, gee, I really want to get into this, but I’m just one practice — I only have a few hundred patients. They can’t by themselves enter into these risk arrangements. They need to be part of a bigger group. We’d be aggregating them with other docs who could form the core of this new high-value network.

That’s part of the value proposition we offer. It’s not that we’ll sell to anyone or work with anyone. A big part of this is the filtering out to make sure the people — the people you’re in the boat with — are really the people you want to be in the boat with.

 

What’s the risk to the practice?

Risk is something we have to manage. One risk is that it turns out there’s someone in the boat who’s not pulling their weight. Part of what we have and part of what Medicare requires is some incentives within the ACO that say, “We’re not just going to divide up the shared savings totally equally.” How much your participate in the ACO makes a difference in how much of a share you get. How do you on the key performance indicators determines how much of a share you get. In extreme cases, if someone’s really not doing anything, you can be expelled from the ACO. You can be voted off the island. That’s one risk.

I spent nine months at Brookings becoming a little bit of a student of ACOs that have succeeded and those that haven’t. One of the risks is if you don’t understand the regulations and their implications. This is one where being someone who’s been a regulator before and who understands how the regulators think is pretty helpful — to be able to reduce that risk for them. To say that I understand and our team has an in-depth understanding of what the regulations say and also what the implications of them are so you avoid some of the gotchas that have gotten people before.

 

I assume the doctor’s entire panel doesn’t just go ACO — there’s some blend of insurance patients and then adding new patients and converting some patients.

Exactly. This is perfect because it helps you transition.

It’s really hard to be going from one day doing fee-for-service regular practice and the other day to be taking full cap risk as part of Medicare Advantage. That’s not really feasible. There’s no health plan in the world that’s going to just turn over full risk contracts to you if you haven’t had the experience with this.

This is an ideal transition path for practices who know that’s the direction they’re in, that the future is value-based purchasing and being able to take accountability for total risk. This is training wheels, one-sided risk from CMS for three years. I’d love to go to a casino that gives me one-sided risk. [laughs].

In this model, if you get savings over the threshold, you share it with CMS. If costs go up, you don’t have to pay CMS the difference. It’s a really perfect opportunity for them to begin to gain the skills, gain the competencies, gain the tools, and then ramp up the risk. Ramp up with the number of different health plans that are participating. Expand to other commercial plans — as I said, more and more are going to be willing to give you these sorts of deals if you’ve proven your ability to manage risk. Then ramp up in terms of the kinds of risk you accept.

Initially, maybe you start off with one-sided risk. Then in three years, if you’ve done a good job with that, then you can feel more confident to move to two-sided risk or even delegated capitation agreements, where you get paid upfront for managing the total cost.

 

You mentioned the boots on the ground approach. Is this tied in any way to the Regional Extension Centers?

Well, you know, I have been a huge fan of the work of the Extension Centers. I’ve been saying for some time that the future for those Extension Centers is going to be in providing not health IT help, but actually getting into practice transformation. There’s not the funding available from the federal government for them to expand in a major way and to have a sustainability for those Extension Centers.

But you know, this could be a set of services that they could contract with us or anyone else to provide. This could be part of the sustainability model for Extension Centers moving forward if those Extension Centers have demonstrated their value to the providers and have the ability to move beyond just health IT to true practice transformation.

 

Assuming you work with the RECs in some capacity, who do you employ within the company?

There’s a set of central resources that you need that you don’t want to duplicate for every ACO — for every ACO to have their own legal team and have their own regulatory review and have their own IT team. 

One of the things I’ve realized is once you are doing this ACO work, I can’t tell you the number of IT companies who assure me that they have the solution for me. [laughs] I’m the former National Coordinator for Health IT. I’ve seen a few products in my day. I have a sense and my chief technology officer Edwin Miller has been involved with some 30 different products. We have the ability to weed through and find out what makes sense to buy, what makes sense to build, and how do you assemble this all into one integrated technology platform. For a small ACO to do that, that’s just prohibitive.

I’ve talked to many ACOs  who a year into it say, “We haven’t done anything because we’d have to start all over with our IT vendor.” That’s part of the central support that they get — the integrated technology platform, the data, the analytics, the regulatory, the legal, protocols, all that stuff. Then that’s partnered with the boots on the ground, which are local to them. A medical director who’s dedicated to them. A nurse coordinator. The project managers and transformation staff who go into the practice. The best of both worlds.

 

You mentioned EHR optimization and the integrated data and technology platform. Do you anticipate working with the EHRs each practice runs or will you have a relationship with vendors that will become the standard for the ACO?

Step one is I’m going to pre-select the practices based on their ability to demonstrate Meaningful Use. For me, Meaningful Use is, “You’ve got to be this tall to ride.” Because without that, you don’t have the data to be able to make all this work.

Two, you and I know well that the EHR systems are not optimized, particularly for population health. We’re not going to rip and replace people’s EHRs, but we’re going to optimize the hell out of them. Make sure that the efficiency is there, that the workflows make sense, that the work of documentation doesn’t all fall on the poor doc. That you actually make use of the data you’re collecting. That their decision supports are meaningful and tied to the quality measures they’re trying to accomplish. That the registry functions actually work as intended.

Our team will have something of an advantage having not just implemented the certification and Meaningful Use qualities, but having actually built, with Edwin, three cloud-based EHRs that met the Meaningful Use requirements. So step one, make sure that they have the basic foundation.

Step two, optimize the heck out of them. Step three, bring to bear the tools that EHRs aren’t really built for. I wrote about this after HIMSS last year. There are too many people selling shrink-wrapped population health — reporting, really, not management — tools that are trying to automate stuff when we’re in the discovery stage. I think the first infrastructure we really need is a discovery set of tools, where you have a very flexible data architecture underneath with some very flexible data analytics tools on top. Then you figure out what it is after you do discovery. Then you create protocols. Then you move to automation.

We’ll look at what’s available right now in terms of both the fundamental underlying data architecture, the middleware tools that are needed, the analytic tools that ride on top, and then some frameworks for being able to create custom visualization into that framework. As I’m describing it, I’m sure you are seeing the flavor of what we’re building is not monolithic software platforms or enterprise pieces of software. It’s really more of a platform that becomes a chassis with separation between the logical layers.

 

There are a lot of certified products, so in a given group of practitioners that might want to be part of an ACO, you might have 10 or 15 EHR systems. How can you optimize those systems not knowing them first-hand like the users of those systems do?

I think we’re going to need to probably develop and hire and add to the team people who are experienced and experts in each of probably the top half a dozen, maybe eight EHRs, that will probably account for the bulk of our practices we want to work with. That’s one. 

Two is to work with the vendors. This is one of the advantages that I’ll have. I’ll continue to take a vendor-neutral approach on the EHR side, which is more comfortable to me, and I’m sure there will be some that see the opportunity to work with us and will be able to learn from us even as we are working with them to optimize their solutions for the practices.

The EHR vendors need to learn how to optimize their own systems for population health management. There will be no one better to work with than us in terms of figuring out what that means.

 

You’ll be supporting some number of the more popular EHRs and then building the data layer that’s aggregated across all members of the ACO and you’ll provide analytics and population health management tools to sit on top of that?

Correct.

 

From the physician’s standpoint, you’re handling the administrative overhead. They’re just using the EHR they’ve always used and it’s somewhat invisible to them other than optimization changes or changes to meet quality standards. You’ll report back to them from the centralized version of their data collected with everyone else’s.

That’s right. Same EHR, just better. [laughs]

 

Hospitals and even practices are hearing “ACO” and are writing checks having no idea what they need or want. Will people get burned trying to jump too early on what they think the future will be?

I think this is a key risk for for ACOs — jumping on with the wrong technology and the wrong technology platform. Assuming that there’s going to be some magical ACO technology that’s going to solve your problem. This is still very much about discovery before we get to automation.

 

What have we learned about ACOs since the arguably mixed success of the Pioneer group? Can ACOs work everywhere and not just in areas where Medicare is paying too much?

Great question. I think my team at Brookings was the first to actually identify the individual 29 who had gotten shared savings and then start to look at the predictors and correlates of that.

What we found was that, one, it had been assumed that the Pioneer-type ACOs, the big integrated delivery networks, were going to blow the small physician-led ACOs out of the water. That was not true. Thirty percent of the physician-led ACOs demonstrated savings in Year One versus 20 percent of the hospital-sponsored ones. That’s a really interesting observation.

The second observation that I’ve had in a more qualitative than quantitative way has been that among a lot of ACOs that didn’t succeed, there were three factors and one underlying issue. The one factor was that they didn’t understand the regulations. The second factor was that they didn’t use data. They didn’t use data, they sat on the data, this treasure in the form of the claims data of every client paid by CMS, they just sat on it. They didn’t do enough with it. The third thing was that they didn’t change practice enough. They had monthly meetings and that was kind of it. If you do that, it’s too hard. You’re not going to generate savings.

I think those three factors are going to be more important than where you are. It’s can you use data? Have you invested enough, both in terms of your time and in money, in changing what you do? Third, do you understand the regulations? That’s what I’m bringing to the practices.

What you still need — and no one can hand it to you — is will. The will to change. That’s what we have to select for.

 

Hospitals I’ve worked in were swimming in data but didn’t act on it because there wasn’t enough imperative. Do we have enough data to move to a value-based payment model? Do you think the economic pressure will be enough to get people to pay attention?

I do. I do. Particularly for the smaller primary care practices.

With the hospitals, it’s more complicated. A, they have tons of competing demands. Forget about academic medical centers who have the teaching mission and the research mission and all of that mixed in. Even in just the tertiary care setting you have all these entrenched structures that reflect the fee-for-service optimization world.

For the hospital, life begins with the emergency room admission. Now you’re asking them to think about how to prevent an admission. That is totally foreign to a hospital and totally schizophrenic in terms of their revenue, where on the one hand they’re trying to reduce admissions, but on the other hand that’s their revenue and their bread and butter — heads in beds.

With a physician — and particularly a primary care-led ACO — it’s much easier. One, you don’t have tons of committees [laughs] to navigate through. It’s a small practice. The doc gets together with the office manager and their nurse and they say we’ll do this, and they do it, and it happens. I’ve seen time and time again in trying to make changes that it’s easier in the smaller practices than in the larger institutions.

Two, the incentives are much more meaningful to the primary care doc who is making $150,000 a year. That’s their take-home pay — $150,000 a year on average. For them, saying you could make an extra $50,000 or $100,000 – that’s really meaningful. That’s game-changing for them, whereas for a hospital to get back half of the revenue that they lost, that’s not really a game-changer.

 

How do you see small practices being configured differently with primary care docs getting squeezed by mid-levels and then operating under an ACO model?

We’re not going to try to totally upend the practice. We’re going to start with pretty simple stuff. Is there going to be someone to answer the phone at 9:00 at night when the patient calls or is there an answering service that says to go to the emergency room? That’s not totally upending the practice structure, exactly.

I think in the ultimate manifestation of really optimizing for value, what I suspect we’re going to see is primary care providers using referrals as consults. Neil Calman at the ACO Summit talked about how when as a group of family medicine docs they took over a practice that had tons of specialists in it – 10 orthopods and a hematologist or whatever – and they looked at what the patients were coming in for, they realized this is family medicine stuff. They were managing people with stable anemias. They were managing people with stable seizure disorders.

Use specialists as consultants, not to manage patients with stable conditions. That’s an example of disruption, where the primary car doc starts to do more of the work and not just refer patients reflexively to this specialist for this and that specialist for that and a third specialist for that and a fourth specialist for that. 

Their job, frankly, is going to become a lot more interesting. That lets them shed some of the boring stuff that pays the bills today – the strep throat, the poison ivy. Let the mid-levels do that. Heck, let the urgent care center do that. Let CVS do that. Focus on what the highest value work is that each part of the healthcare system can provide.

 

Where do you hope the company is in two or three years?

For me, I want to have the most successful ACO in the country. [laughs] That to me is success, where we’re the best. We’re the best. We figure out how to use data and technology to bring the focus on the outcomes.

Gosh, I just can’t wait to tear into the meat of what we’ve needed to do, which is about the outcomes. It’s about being able to focus on how do we get measurably better health, measurably better patient experience, and lower cost. And use data and technology in really fundamental ways to accomplish that, but to have our eyes on the prize instead of structures and processes and so forth.

 

Do you have any final thoughts?

It’s an exciting time. This is in some ways a strange turn for me to do a startup and join the ranks on the private sector side. But in other ways, it just feels incredibly familiar to me. [laughs]

Let’s start with a blank piece of paper. Let’s think about what the world needs and build a team, build an awesome team, that can use data to improve population health. In a way, I feel like I’ve been in training for this all my life.

View/Print Text Only View/Print Text Only
June 20, 2014 Interviews 9 Comments

News 6/20/14

June 19, 2014 News No Comments

Top News

image

The American Hospital Association urges CMS and ONC to quickly adopt plans that were identified in its Notice of Proposed Rulemaking that would give hospitals flexibility in the combinations of EHR certification and Meaningful Use stages that are permitted for 2014. AHA observes that the proposals are last minute given that the last FY2014 reporting period is July through September 2014 and the NPRM’s comment period won’t be finished until that reporting period is underway, meaning that “hospitals are essentially being asked to act on faith that the agencies will finalize these proposals as written while risking that they may not.” AHA also wants the 2015 reporting period shortened to 90 days and to avoid setting a firm October 2016 start date for MU Stage 3 given that “fewer than 10 hospitals and 50 EPs had attested to Stage 2” as of mid-May.


Reader Comments

From Clueless About HIT: “Re: magazine’s Top 100 ‘HIT’ vendors. Many represented their revenue from payers, life sciences, and government health as ‘HIT.’ This includes Cognizant, Optum, Infosys, TriZetto, Syntel, and Edifecs. Either these vendors are clueless about what ‘HIT’ means or they are deliberately misreporting. It also speaks volumes about publications that come up with these lists.” I never even look at those lists, to be honest. They’re great for the magazines who make them up to sell ads, but even if the numbers are accurate (and that’s obviously dependent on interpretation), who cares? Bigger vendors aren’t necessarily better vendors, and anyone who would make a buying decision based on a company’s annual revenue is likely to be disappointed. I think I’ll sell spots on a “Coolest Vendor” list and donate the proceeds to charity – at least some good would come from it.


HIStalk Announcements and Requests

This week on HIStalk Practice: ARcare CIO Greg Wolverton talks agility and mandatory EHR training. Virginia’s "people problem" gets in the way of HIE. Mobile access to EHRs takes a back seat to workflow. Physicians may be the biggest barrier to HealthKit’s success. Dr. Gregg pontificates on the inevitability of change. The Brookings Institution highlights the top challenges of Medicare ACOs. ONC leadership changes have some questioning the longevity of the Meaningful Use program. Thanks for reading.

This week on HIStalk Connect: Former National Coordinator Farzad Mostashari, MD, launches a startup that will focus on optimizing EHRs for primary care practices interested in joining an ACO. Dr. Travis discusses the promising but very new telecharting market. In an effort to keep up with Apple and Samsung, Google will unveil its new health data platform at next week’s Google I/O developers conference. Mr. HIStalk interviews Colin Konschak, CEO of Divurgent.

Listening: Birdy, the 18-year-old singer-songwriter from England who has recorded several international hits and contributed a track to “The Hunger Games.”


Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Acquisitions, Funding, Business, and Stock

image

BlackBerry reports a surprise quarterly profit and announces the Passport, which CEO John Chen says is either the world’s smallest “phablet” or its largest phone. It features a hardware keyboard at a 4.5-inch square display. The device will be marketed to healthcare users, which is a key target of the struggling BlackBerry.

Vocera opens an office in Dubai, UAE.


People

image

Fraser Bullock (Sorenson Capital) is elected chairman of the board of Health Catalyst, replacing David A. Burton, MD.  

image image

Valence Health names Tony Gutierrez (Missouri Care) as VP of operations of its health plan division and Jack Risenhoover (Napier Healthcare) as VP of business development.

image

Kryptiq hires Jacquelyn Hunt, PharmD, MS (Bellin Health System) as chief population health officer.

image

AirStrip appoints Orlando Portale (Palomar Health) as chair of its newly created Innovation Advisory Board.


Announcements and Implementations

image

Aprima will offer dashboardMD’s performance management and BI reporting tools.

image

Kareo offers medical practices a guide for registering for the VA’s “Accelerating Access to Care Initiative,” which allows them to serve VA patients who can’t get appointments for primary or specialty care.

In England, Cerner launches a SaaS version of Millennium for smaller NHS trusts (under 500 beds) that can’t afford its system otherwise. The company says it’s similar to a US version used by 70 hospitals.

Athenahealth announces that its users account for 59 percent of the 485 providers who have attested for Meaningful Use Stage 2 even though its market share is les than 3 percent.

Hartford HealthCare’s Integrated Care Partners goes live with High Line Health’s Visual Analytics Platform for population health management and value-based care.

image

California Telehealth Network chooses HealthFusion’s MediTouch as its first EHR partner.


Government and Politics

Governors of several New England states say they will explore sharing prescription data to thwart doctor-shopping drug seekers who cross state lines. 

ONC will present a webinar on the FDASIA draft report on Friday, June 20 at 3:00 p.m. Eastern.

The US House Energy & Commerce Committee’s 21st Century Cures seeks guidance on how the vision of a digital health ecosystem (mobile apps, EHRs, cloud, and big data) can be realized to create new treatments and cures. Public input is solicited to cures@mail.house.gov. The group will convene a roundtable in Washington, DC on Tuesday that includes Jeffrey Shuren, MD, JD (director, FDA’s Center for Devices and Radiological Health), Martin Harris, MD (CIO, Cleveland Clinic), Jonathan Bush (president and CEO,athenahealth), and Joseph M. Smith, MD, PhD (chief medical and science officer, West Health.)


Innovation and Research

SNAGHTML7fc2ce3

Apple files patent applications that include an iPhone receiving sensor data — including from at least one that’s worn and not part of the iPhone — and calculating a “personal scorecard” and triggering alarms.


Other

image

image

The Wall Street Journal profiles Flatiron Health, which gathers de-identified treatment and outcome data from cancer centers to give doctors visibility into how treatments are working for the 96 percent of patients with cancer who aren’t enrolled in a clinical trial. The 28-year-old co-founder, who with his Flatiron Health co-founder sold their advertising technology company to Google in 2010 for $81 million, says it was hard to get the cancer center CIOs and doctors to contribute information they considered proprietary. The company has 105 employees, has 200 cancer centers on board, and received a $130 million investment from Google in May 2014, using some of the money to acquire oncology EHR vendor Altos Solutions.

A survey by FICO (the former Fair Isaac) finds that 80 percent of people want to communicate with their providers via smartphone, while 76 percent would like medical appointment reminders and 69 percent say they want appointment scheduling and medication reminders.

image

Rady Children’s Hospital (CA) exposes the information of 14,000 patients when employee accidentally attaches a worksheet to emails sent to six job applicants.

A Huffington Post report calls out for-profit hospices that make up nearly 60 percent of the total, including 6,100-employee Vitas, which was bought out for $406 million in 2004 by the parent company of Roto-Rooter. Companies are accused of upcoding, sending marketers to find dying hospital inpatients to sign up quickly, enrolling patients at Medicare’s expense who were healthy enough to play golf, treating patients against their will, and having a high rate of safety and patient care violations. Experts say the problem is that Medicare pays set day rate, encouraging hospitals to enroll patients who don’t require their services and provide higher levels of services than the patient needs. Medicare’s data shows that non-profit hospice had an average length of stay of 69 days vs. 105 days for for-profits.

image

Fletcher Allen Health Care (VT) will change its name this fall to The University of Vermont Medical Center.

A North Carolina business paper mentions the status of EHR deployment in the state. Wilmington Health is about to go live with NextGen, New Hanover Regional Medical Center is expanding Epic to give inpatients access to MyChart, and Novant is expanding Epic use throughout its facilities. Tad Dunn, CIO of New Hanover, says 70 percent of the citizens of North Carolina now have a chart in Epic.


Sponsor Updates

  • Connance announces the Analytically Optimized Revenue Cycle, predictive analytic and workflow strategies to increase cash 10-30 percent and reduce cost up to 25 percent.
  • Elmhurst Clinic (IL) shares how its use of healthfinch RefillWizard has led to happier doctors.
  • Nuance announces that Valley Medical Center (WA) gained $2.2 million in revenue by using its Clintegrity 360 clinical documentation improvement program.
  • Fujifilm Medical Systems USA will demonstrate the latest version of its Synapse Cardiovascular and it Synapse Mobility mobile ap, which will allow viewing of non-DICOM information from its vendor-neutral archive in EHRs such as Epic, at the American Society of Echocardiography meeting in Portland, OR starting this weekend.
  • Sagacious Consultants will participate in the HFMA ANI 2014 in Las Vegas June 22-24.
  • Predixion is recognized as a Challenger in the Advanced Analytics Market by Hurwitz & Associates.
  • Texas Pulmonary & Critical Care Consultants is experiencing increased doctor collaboration since going live on pMD Messaging.
  • Texas Children’s Hospital shares how it improved appendectomy outcomes using Health Catalyst’s analytics solutions.
  • InterSystems expands its New York City office.
  • Aspen Advisors celebrates its eighth anniversary, adding 10 clients this year.
  • Divurgent announces the addition of Cost to Collect service to its Revenue Cycle Management Practice solution.

EPtalk by Dr. Jayne

clip_image002

Quite a few readers responded to my recent Curbside Consult regarding a telemedicine solution a potential part of an employee benefits package. One made a very good point:

I read your recent op piece on the new “benefit” your HR department is trying to roll out to employees. I wondered what issue they were trying to solve, other than be on the “bleeding” edge of offering this service? If the employees have an access issue, seems like the first step would have been to meet with medical staff leadership and brainstorm alternatives. I’m just a CIO with no clinical background so I can’t bring a clinical perspective to the discussion, but the one that I always tell my colleagues I do have is that of a patient and how our decisions are viewed through those “lenses.” In this case, I wonder how someone I don’t know and have never met will understand me within the full context of my medical history and current environment and can deliver better quality and outcomes than someone who does.

That’s a very good point and one that was brought up to some degree in our committee’s discussion. It also makes a good point about IT solutions. In general, it’s good practice to understand the business problem you’re trying to solve prior to looking at vendors. In our case, the business problem is that we’re notoriously cheap. Our employees haven’t had raises in years (blamed on MU-induced belt tightening). Many of us suspect they’re trying to use this as a way to make up for what we’re lacking in salary or other retention perks. Another reader wrote:

As a long-time practice administrator in hospital systems, I totally agree with your reaction. The med exec committees will have a heyday and make life miserable for the hospital administrators. Aren’t we all trying to keep care within our own “families?”

Another physician reader referred to the story as, “Almost Dilbert material, except there are too many layers of absurdity.” I almost spit coffee on my keyboard as I read that because I had to withstand the pointy-haired boss in a previous life. The need for patient privacy was also a recurring theme:

At our facility, we have an aggressive strategy to significantly incent our employees to receive care within our network. The loudest noise we hear on this topic is what you alluded to – patient confidentiality. It is cited as the #1 barrier to our employees seeking care with us.

Readers also sent plenty of tips about nice seaside locations where I could consider practicing. It’s looking awfully tempting. Another travel-savvy reader sent me this article about the urgent care clinic that recently opened. Since the airport already has a liquor store in the baggage claim area, it was only a matter of time. They do offer hangover remedies including intravenous fluids, vitamin B12, and oxygen. I wonder if Chicago O’Hare will offer the same options for HIMSS15 travelers? Not likely.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 19, 2014 News No Comments

Health IT from the CIO’s Chair 6/18/14

June 18, 2014 Darren Dworkin 2 Comments

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers. Objects in the mirror may be closer than they appear. MSRP excludes tax. Starting at price refers to the base model; a more expensive model may be shown.

Mary Meeker’s 2014 Internet Trends

clip_image002

Each year Mary Meeker publishes a report describing Internet trends. I’m not sure I know the full history of the report, but she traditionally presents it in the spring at the AllThingsD conference (formerly run by WSJ) and now at the new version of the conference called <re/code>.

It is hard to imagine how much research and data must be collected to produce such a data-rich report. I have never seen her present it live, but I’m told she shares the whole thing in an action-packed 15-minute presentation.

The full report is available here. It is truly amazing and is one of my favorite things to read of its kind.

Since my world is healthcare IT, here are a few of my own opinions of how the larger trends described will have an impact.

Trend #1

clip_image004

Tablets are growing at a faster rate than PCs and laptops ever did, with a growth rate of 52 percent. With only a 6 percent population penetration or 439 million global units, we will likely soon see tablets pass both desktops and laptops. I think this will translate to at least three things in the healthcare setting: (a) the mobile shift has another big wave coming; (b) like smartphones before tablets, the unit growth will be propelled by BYOD; and (c) users will expect to use multiple devices in one setting and be able to easily navigate between them.

Trend #2

clip_image006

Cyber threats are intensifying along all dimensions. They occur more frequently, happen faster, and result in more serious implications. An exposed machine is likely to be compromised in 15 minutes or less. While healthcare has struggled to not lose information and has achieved a mostly failing grade, we are in for a major shock wave as new entrants begin to seek the data we have.

Trend #3

clip_image008

I hope healthcare is really at the inflection point predicted. The backdrop plays out as follows:

  • Providers have underutilized technology historically.
  • HITECH Act brought billions in spend.
  • 52 percent of consumers want access to tools to manage their care and data on quality, satisfaction, and reviews of doctors and hospitals.
  • 84 percent of hospitals have EMRs.
  • 51 percent of doctor’s offices (and rising) have EMRs.
  • 62 percent of consumers/patients want to communicate via email.
  • Venture fund investing in health IT is up 39 percent to $1.9B.

Some of the hottest spaces will be employer engagement, telemedicine, adherence tools, and chronic disease management platforms.

Trend #4

clip_image010

While our existing client-server and even our cloud-based healthcare applications will continue to struggle with interoperability (of workflow, not so much around data), everyone will get a new chance at building it right. The mobile platform will create an environment to have single purpose, best-of-breed apps working in a unified way in a dynamic user-initiated platform.

Trend #5

clip_image012

The term “big data” is overused, misused, and probably overhyped. But that is probably because it is still early and it is hard to get actionable results today. From a trend perspective, it could be the most exciting thing to watch in healthcare in the years ahead. It will pose complex challenges around transparency and privacy, but we should imagine a healthcare world that is filled with sensors producing troves of data that we can analyze and problem solve in real time.

Trend #6

clip_image014

Privacy will drive new approaches to have data that is uploadable and shareable without being findable. This trend will probably help us get around complex privacy concerns in the short term by making the data single use.

Trend #7

clip_image016

It won’t be just about what wellness or health sensors we have on our bodies or even in our bodies. Our smartphones will sense things for us. We might not need a fitness band if our phones can tell us the same thing. Samsung’s new device has 10 sensors. Apple’s new iPhone will likely match or surpass that.

Trend #8

clip_image018

Bigger, cheaper, and faster. Compute measured by $ per 1mm transistors from $527 in the 90s to $0.05 now. Storage measured by $ per Gigabits from $569 in the 90s to $0.02 now. Bandwidth measured by $ per 1,000 Mpbs from $1,245 in 1999 to $16 now. All the while, use of the cloud is rising. It is getting hard to imagine why any healthcare organization would be thinking to build a new massive data center of the past.

Trend #9

clip_image020

Beautiful new interfaces aided by data-generating consumers will not just be the new standard, but the only standard. As consumers and employees continue to use a host of well-designed apps in their daily lives, tolerance for poorly designed UI will plummet. As consumers continue to engage in managing their health information through provider-based portals, the EMR titans will either rapidly evolve their UI or be disrupted by those who can.

Trend #10

clip_image022

Precision medicine is on the way (period).

Mary Meeker’s whole report is 144 pages (with an additional 20 pages in the appendix – referenced as the slides she ran out of time to talk about). I recommend you give it a read.

Let’s not just find a better mousetrap. Let’s disrupt the whole idea. Mary’s report should challenge us all to re-imagine!

1-29-2014 12-54-46 PM

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

View/Print Text Only View/Print Text Only
June 18, 2014 Darren Dworkin 2 Comments

News 6/18/14

June 17, 2014 News 16 Comments

Top News

image

Nuance is reported to be discussing a sale of the company to Samsung, with shares rising nearly 10 percent Monday and a bit more on Tuesday on the rumor. One might speculate that the recent addition of two of Carl Icahn’s people on Nuance’s board may have heightened the money-losing company’s interest in finding a buyer. Samsung already uses Nuance’s voice technology in its devices (as does its arch nemesis Apple, for which Nuance provides Siri), but would probably have little interest in Nuance’s considerable healthcare businesses that includes Dragon speech recognition, transcription, clinical documentation and coding, and image sharing. Highly paid Nuance CEO Paul Ricci ($78 million compensation in three years and shares worth $60 million) swelled Nuance with a bunch of acquisitions in two main sectors (healthcare and mobile) and has declined to focus its corporate strategy despite lackluster results, while Icahn likes selling off individual parts to create shareholder value. It will be interesting to see whether cash-rich Apple will be threatened enough by the rumored Samsung interest to make overtures of its own for the $6 billion market cap Nuance or perhaps part of it if Nuance is willing to break it up.


Reader Comments

image

From Joe: “Re: rumored Nuance acquisition talks. Ironically Domino’s announced its Nuance-powered ‘order your pizza by voice’ app today. There’s probably a ‘Pete’s a delivery boy’ misrecognition joke in there somewhere.” Domino’s, which like Walgreens and other retailers is making technology an integral part of its product, says that typing characters is becoming obsolete and its app (which features order-taker “Dom”) will differentiate it from competitors. It’s refreshing to see how non-healthcare companies use technology to improve their business and customer experience given obvious, non-government mandated incentives (i.e., profit) to do so.

image

From KayCee: “Re: Epic. I asked Epic about whether their name should be capitalized.” KayCee inquired of Epic, “Only Mr. HIStalk seems to be defending the position that an all-caps reference reflects ignorance” and asked the company’s position. Epic’s response from spokesperson Shawn, who said the email was forwarded to him because, “We don’t have a marketing department,” states “EPIC” was used in an old version of the logo, but that was changed in the late 1990s and “Epic” is correct. I enjoyed Shawn’s erudite conclusion, which is more tolerant than mine: “Without judging whether it represents ignorance or an historical homage to our early years, we’re pretty forgiving and accepting of the misuse.” I will stubbornly point out that Shawn said that writing EPIC constitutes “misuse.”

image

From Art Vandelay: “Re: Walmart opening clinics. The mind begins to work when combining this with information from Castlight Health: there is no state exchange or ‘caid expansion, Austin, TX has very expensive office visits but isn’t representative of the state, Walmart enters with a low-cost alternative. Most large health systems aren’t worried about retailers like Walmart, CVS, and Walgreens entering the market. It is less about primary care and more about interrupting their ecosystems for chronic care management – how will the data come back, will they use similar protocols, will patient education materials and the plan of care align.” Walmart will open its second and third company-owned clinics in Texas, expecting to expand that to a dozen this year in a pilot project. They will offer primary care services for $40 and will treat insured Walmart employees for just $4, but they won’t take private insurance, only Medicare and Medicaid down the road. The clinics will be staffed by nurse practitioners and managed by workplace clinical operator QuadMed.


HIStalk Announcements and Requests 

Lorre has a lot of webinars going on and could use more CIO-type reviewers to fill out a quick evaluation form after watching a recording of the rehearsal that lasts about 30 minutes. I will send a $50 Amazon gift certificate as my thanks (or just my thanks to the folks who can’t accept them because of employer policy). Let me know if you can help out every now and then. I provide each Webinar presenter with three reviews of their practice session — two from CIOs and one from me – to make their live day webinar the best it can be in terms of educational value and in keeping my short attention span engaged. If you’d like to present a webinar, I’m all ears for that, too – I’m up for anything that is educational and interesting to readers.


Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Speaking of webinars, Steve Blumenthal’s abstract for his EHR contracts one was witty, so we suggested he do a video introduction. I can’t help but snicker every time I play it, especially when I see his fake smarmy, “Oh, I just noticed the camera was running five feet from my face” introduction. He’s a good actor and funny (even by non-lawyer standards), so it should be a good webinar.


Acquisitions, Funding, Business, and Stock

image

Cost management systems vendor Equian, which changed its name from Health Systems International a few weeks ago, completes its acquisition of AfterMath Claim Science, which offers data mining cost analysis solutions to payors. 

image

Consulting firm VeritechIT acquires Health Technology Solutions, a one-employee consulting firm run by Terry Grogan, acting CTO for Temple University Hospital (PA). It appears from VeritechIT’s bio page that Michael Feld — listed as founder, president, and CEO – is also acting CTO of Lancaster General Health System (PA).

image

Medical device maker Medtronic acquires competitor Covidien for $42.9 billion in cash and stock, giving Medtronic a convenient excuse to move its headquarters out of US tax jurisdiction to Ireland even though the company’s name will continue as Medtronic and its “operational headquarters” will remain in Minneapolis. Several companies have taken the acquisition route to evade the 35 percent US corporate tax rate that’s one of the highest in the world, the only method remaining to accomplish that since US laws now prohibit a company from simply moving its headquarters offshore to pay a lower tax rate (12.5 percent in Ireland). The deal also gives Medtronic a place to spend the $14 billion of foreign profits it has parked offshore to avoid paying US taxes.

image

From the Streamline Health Solutions earnings call:

  • President and CEO Bob Watson apologized for the late financial report, caused by a change in CFOs, a change in audit firms, and completion of an internal controls audit required by the company’s market capitalization.
  • The company is offering the commercialized version of analytics software it acquired last year from Montefiore Medical Center.
  • In a refreshingly honest announcement, Watson said the company erred in taking on work to help its clients go live faster in hopes of being able to recognize more revenue from the backlog, which Watson said didn’t really help and cost the company twice as much as expected. He concluded, “An outside consultant stepping into XYZ health system doesn’t have the innate natural knowledge of how that health system’s IT infrastructure is organized and therefore cannot be that helpful. So that was our plan that didn’t work.”
  • Sales of computer-assisted coding solutions were delayed after the “disastrous” results experienced by early adopters of “some of our well-known competitors.”
  • The acquisition of Unibased Systems Architecture resulted in one new Q1 sale and renewals worth a total of $10 million.
  • The company’s products have been renamed within the Looking Glass family nameplate and underlying analytics platform.

image

Healthcare benefits electronic payment systems vendor Evolution1 will be acquired by corporate payment solutions vendor WEX for $532.5 million in cash. The Fargo, ND-based Evolution1 has 300 employees.


Sales

image

Children’s Hospital Los Angeles (CA) and Wisconsin Statewide Health Information Network (WI) choose Orion Health’s Rhapsody Integration Engine.

The FHP Health Center (Guam) selects eClinicalWorks.

image

Thibodaux Regional Medical Center (LA) will implement Health Catalyst’s Late Binding Data Warehouse and Analytics platform.


People

image

Practice Fusion names Robert Park (Chegg) as CFO.

image

Dan Baker (NextGen) joins Remedy Informatics as SVP of sales.

image image

HealthStream hires Tom Schultz (Infor) as SVP of sales and promotes Michael Sousa to SVP of business development.

Payment financing company CarePayment names Craig Hodges (Emdeon) as CEO. Outgoing CEO Craig Foude will stay on as board chair and managing partner for Aequitas Capital, founder and owner of the company.


Announcements and Implementations

image

Aesynt, the former Pittsburgh-based McKesson Automation plus its acquired Health Robotics, says it signed 18 IV automation contracts in Q4. Those are for the former Health Robotics i.v.STATION hospital IV room products.

The Central Texas division of Baylor Scott & White Health goes live on API Healthcare’s ShiftSelect.

Memorial Hermann (TX) launches Wolters Kluwer UpToDate Anywhere for its 12 hospitals and 5,000 affiliated physicians.


Government and Politics

The VA will issue an RFP next week for a commercial patient scheduling system to work within VistA, with its CIO saying that while VistA’s clinical system is “one of the best out there,” its non-clinical modules haven’t kept up. He also says that current events make it obvious that the new system will include extensive auditing features to review changed appointments. The VA gave up on a previous attempt to build its own scheduling system a few years ago and nothing seemed to happen with the open source Health eTime app that won the VA’s scheduling system competition last fall.

image

Health IT Now says HITECH has paid $24 billion to subsidize information-hogging EHRs and wants HHS to make data sharing (at no extra customer cost) a certification criterion. Health IT Now is a coalition of patient groups, providers, employers, and payers – it claims that Aetna, American Cancer Society, AHIMA, IBM, Intel, Oracle, the US Chamber of Commerce, and a few health systems are members – whose agenda involves promotion of interoperability standards, Meaningful Use changes to emphasize lower cost and improved outcomes, innovation and increased use of telemedicine, and medical licensing that spans state boundaries. I first reported on the group in mid-2007, saying, “The founding members include a couple of former Congressmen ([Nancy Johnson and John Breaux] and a cross section of influential medical, professional, and other organizations. I don’t think I’ve heard anything from them since (their “About” page claims “we will continue a formidable education agenda in 2012”), so while I agree with their platform, I don’t think it’s having much of an impact inside the Beltway. The only named employee is Executive Director Joel White, a former Congressional staffer who omits the group from his LinkedIn profile and instead list himself as President and CEO of Horizon Government Affairs, which sells political services and operates four other non-profit coalitions: Council for Affordable Health Coverage, Rare Disease Legislative Advocates, Prescriptions for a Health America, and Newborn Coalition.

DoD releases the third and near-final draft of its $11 billion DHMSM EHR solicitation, removing the veterinary medicine requirement, eliminating required use of any particular development methodology, and making the contract performance-based. Vendors will have a chance to ask questions on Industry Day next Tuesday, June 24, which would be fun to write up if you’re going.


Innovation and Research

Microsoft announces Azure Machine Learning, available in July, that will allow users who store data in its Azure cloud to use drag-and-drop predictive analytics. Potential healthcare uses include scheduling, reducing readmissions, and anticipating disease outbreaks.


Other

image

Research by The Commonwealth Fund finds that the US health system is not only the most expensive among 11 developed nations, it is also the worst, coming in dead last in access, efficiency, equity, and healthy lives, primarily due to the lack of universal healthcare coverage and support for the patient-physician relationship. The report also calls out the stubborn resistance to using healthcare IT. The bright spot, the report says, is that the Affordable Care Act is improving access and the system is moving toward more value-based payments. Methodology footnote: the study was done by surveying around 3,000 US residents with a self-rated health status of below average and recently treatment for a serious problem that involved at least one hospitalization, so the sample size wasn’t very large and the results reflected patient perception more than hard measures. The president of The Commonwealth Fund is former National Coordinator David Blumenthal, MD, so naturally the report pays disproportional attention to EMRs. Still, nothing in the results is all that surprising since it measures overall health of a cross-section of citizens, not just the specific healthcare outcomes of the more privileged among us.

The Wall Street Journal profiles Dignity Health’s use of Google Glass for clinical documentation, which it claims allows physicians to double the amount of time they can spend with patients. Dignity is using software from startup Augmedix to send Glass-collected information and commands to the EMR. It’s a small pilot started in January 2014 – the CMIO and two other docs – but they say manual EMR entry was reduced from 33 percent of their total time to 9 percent.

An apparent tornado damaged several homes and an elementary school within a mile of Epic’s Verona, WI campus Tuesday morning, but nobody was hurt.

image

Overlake Hospital Medical Center (WA) gets a S&P bond ratings upgrade to A, primarily due to completion of its Epic implementation.

image

In China, Internet giant Alibaba, which has more sales than eBay and Amazon combined and is planning a US IPO, unveils a 10-year plan to disrupt China’s notoriously backward hospital system with online payments, patient scheduling, e-prescribing, hospital transfer, insurance claims management, and eventually wearables and other prevention technologies. The company had released a patient self-scheduling application for 600 hospitals last year to fix the eight-hour process of getting an appointment, but the government shut it down over privacy concerns (not mentioning that the site competed with the government’s own online service). The announcement of Future Project is here, although you should probably be able to read Chinese since Google translates it as, “Today, Alipay announced a program called ‘future hospital.’ Payment was originally conducted in hospitals, registered, classified ad will be transferred to PayPal platform. The implementation of this plan is completely far away from us, section house, ‘said the doctor chase behind the ass, give praise it pro’ story can become true?” And in other breaking news, all your base are belong to us

image

Alexian Brothers Health System (IL) cancels plans to form an accountable care entity to manage Medicaid patients, saying it’s too hard to connect the 10 EHRs used by 80 percent of the doctors, not even counting those that might have been added to the network later. The ACE would have been required to connect 60 percent of its network to the Illinois HIE within 15 months, include 100 percent within 30 months, and file electronic summaries of care for 70 percent of the network within 15 months.

image

CHIME’s Keith Fraidenburg tweeted out this photo of Tim Stettheimer presenting at the CHIME/AMDIS CMIO Boot Camp at Ojai, CA this week. Attendees are welcome to send me a write-up about the experience.

Pittsburgh insurer Highmark stops paying higher physician chemotherapy fees devised by hospitals buying oncology practices and then billing out drugs at the much higher hospital outpatient rate. Other insurers are trying to hold down oncology costs by paying oncologists a stipend to use less-expensive (and less-profitable) chemo regimens or bundling all treatment costs into a flat payment. Brand name chemo drugs cost an average of $10,000 per month, giving physicians a financial incentive to use more expensive ones as insurance companies haven’t protested for fear of losing oncologists in their network.

image

Mary Milroy, MD, the new president of the South Dakota State Medical Association says EHRs add an hour of busy work to a doctor’s day, adding that, “The systems we use are cumbersome, designed by IT people and not medical people. The huge problem is they don’t communicate.” Her clinic uses NextGen, another practice she covers uses Epic, and the local hospitals use Epic and Meditech. She says none of them talk to each other.

HIMSS Analytics has issued a new report about cloud computing, but with that ever-blurring line between whether HIMSS is a member organization or a vendor, you can’t download it without providing your email address, telephone number, job title, and other contact information for the inevitable sales cold call. I’m still not clear on how HIMSS managed to change HIMSS Analytics from a for-profit subsidiary to part of the non-profit HIMSS.

Non-profit patient advocate group Stupid Cancer launches an Indiegogo campaign to raise $40,000 to develop its free Instapeer app, which will connect young cancer patients to other patients, survivors, and caregivers.

image

In England, Health Secretary Jeremy Hunt says new guidelines calling for hospitals to list the name of each patient’s doctor over their bed is a “huge step forward for patient safety” since it’s not always clear where the medical buck stops. A spokesperson for a patient group said writing names on a board is fine, but that won’t accomplish much if the doctor doesn’t stay in touch with the patient.


Sponsor Updates

  • Regenstrief Institute joins ConvergeHEALTH by Deloitte, a real-world evidence and analytics consortium.
  • SD Times names InterSystems and its Cache’ system as one of the software industry’s top 100 innovators in the Database and Database Management category..
  • RelayHealth announces that RelayHealth Financial has bolstered RelayAssurance Plus 5.0, providing transparency into your claims lifecycle.
  • AirWatch by VMware opens registration and lineup of analyst speakers for the AirWatch Connect Global Tour 2014 in Atlanta, London, and Sydney.
  • McKesson launches Benchmark Analytics service to provide custom reports and consultation to optimize performance.
  • GetWellNetwork CEO Michael O’Neil discusses the CDC Morbidity and Mortality report on the cost of cancer survivorship with a local journal.
  • Kareo and Falcon EHR partner to provide cloud solutions to nephrology practices.
  • Gartner names Informatica as a Leader in the 2014 Magic Quadrant for Structured Data Archiving and Application Retirement.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 17, 2014 News 16 Comments

Morning Headlines 6/17/14

June 16, 2014 Headlines No Comments

VA Seeks Proposals for New Scheduling Technology

The VA will issue an RFP for commercial scheduling software to replace its existing VistA scheduling system which, in the fallout of the VA waitlist scandal, has been heavily criticized as being outdated and unfit for use.

Major medical records breaches pass 1,000 milestone as enforcement ramps up

The HHS “Wall of Shame”, which lists all organizations that have had major data breaches, passes the 1,000 breach mark this month. One in 10 US residents is estimated to have had their health data compromised as a result of major data breaches.

Google Wants To Collect Your Health Data With ‘Google Fit’

Google will return to the consumer health space with a new Android-based platform called Google Fit. Google Fit captures health data from activity trackers and medical devices and consolidates it into a centralized platform. The move comes despite Google’s past failures in the consumer health space. Google launched Google Health in 2008, a service with a remarkably similar business model, only to shutter it in 2011 due to an overwhelming lack of consumer interest. The unveil pf Google Fit will take place during next week’s Google I/O developer conference.

ACA triggers big drop in Minnesota’s uninsured rate

The uninsured rate has dropped 41 percent in Minnesota, to below five percent, since September’s ACA enrollment period began. Research lead Julie Sonier said, “We have never seen anything like the change that we have seen between last fall and May 1st of this year.”

View/Print Text Only View/Print Text Only
June 16, 2014 Headlines No Comments

HIStalk Interviews Aaron Sorensen, Director of Informatics, Temple University School of Medicine

June 16, 2014 Interviews No Comments

Aaron Sorensen is director of informatics at Temple University School of Medicine of Philadelphia, PA.

image

Tell me about your job.

I’m at Temple University at the School of Medicine with an affiliated health system. Our new leadership is keen on creating a robust infrastructure to support clinical research. I’m heading up the informatics aspects of that.

 

What is the informatics influence in the School of Medicine?

Within the health system, you have the IT shop that runs a myriad of clinical systems. There’s a feeling from the researchers that all this data exists, but it’s hard to get at. What do you do with it once you have it? What are the appropriate safeguards regarding compliance and privacy? 

The School of Medicine is trying to make it so that every time a clinical researcher wants to ask a question of the clinical data, it doesn’t become a maze that you get lost in, with different people are telling you different things. There’s this straightforward way to do it and you can go to a central team of people that will guide you through the path and help you along your way.

 

Describe how PCORnet came about and what it does.

My understanding is that over 10 years ago, when the NIH was originally thinking about redoing the way they fund clinical research extramurally at academic medical centers, the PCORnet idea was floated. The feeling was that it would be costly and it would be hard to achieve. They had other priorities, so instead of doing that, they funded the CTSA awards.

PCORI, the Patient-Centered Outcomes Research Institute, is not a federal organization, but it’s funded through the Affordable Care Act. It’s federal dollars, but it itself is a independent non-profit. The feeling was that it was worth pursuing the idea of creating a network of hospitals that have the ability to share de-identified patient data for the purposes of clinical research. 

Although they have grants that fund all different kind of things, just like the NIH does, I believe the crown jewel within the PCORI portfolio is PCORnet. It has 29 funded groups, some of which focus more on general health system patient populations, whereas others are more focused on particular patient groups with specific diseases.

 

What Temple systems are contributing data to PCORnet?

In terms of our electronic medical record, we’ve been on Epic outpatient for about three years. We’re just now kicking off the project to go with Epic inpatient. Epic, as most EMRs, receives a number of feeds from different systems. When you get to the back-end Epic reporting database, you not only have the data that originated in Epic, but from a number of different systems.

For our contribution to PCORnet, we are only using our Epic back-end database that gets feeds from cardiology systems, pulmonary medicine systems, and billing type of data. It’s a wide range of things. For the purposes of this project, we are only using what comes into our central EMR.

 

Can researchers query data from any or all of those 29 contributing organizations?

Yes and no. The 29 break out into two groups.

The patient-focused ones that are disease specific are called PPRNs, the Patient-Powered Research Networks. The health system ones, of which Temple plays a role, are called CDRNs, or Clinical Data Research Networks. 

I don’t know 100 percent what the PPRN plan is. I think it’s slightly less ambitious than the CDRN plan of which I’m a part. I can speak to the 11 funded groups that are part of the CDRN and that cross the country. 

There are two aspects to the PCORI contract. Our network is the University of Pittsburgh, Johns Hopkins University, Temple, and Penn State Hersey. Within our network, we have been funded to create the ability to share data for two different diseases. One is rare disease – idiopathic pulmonary fibrosis. Then a more common disease, for which we chose atrial fibrillation.

At the CDRN level, at the national PCORnet level, we have to support two cohorts. One is what they originally called an obesity cohort, but then they decided they wanted to expand beyond people who are already obese to include people who are at risk of becoming obese. They’re now calling it the weight cohort. We’re going to support a weight cohort. 

Then we have to have a randomly chosen one million plus patient pool from which PCORnet can do centralized queries. Each of the 11 groups has to make available at least one million randomly selected patients, or else their whole patient population, for these centralized queries. As well as a subset of that which will be used specifically for to measure issues around obesity. For that group, you have to have collected good data on weight, height, calculating BMIs, and things around diabetes, coronary artery disease, and certain co-morbidities associated with obesity.

 

Do researchers have to file paperwork for what they’re looking for? Can you tell how they are using the system?

Yes. Within our network, we have IRB protocols that have been set up to allow for the researchers to ask certain questions. That’s specified ahead of time and is pretty locked down.

For PCORnet, they have the ability to ask anything. The data is always de-identified. You’re not typically ever sharing patient-level information. You’re aggregating it so that they can get an understanding within a given population how it breaks out — what the demographics are, what the prevalence or incidence of a given disease is, etc. 

For those questions, they are not pre-established. It’s not like at the beginning of the project that we know, “We will ask these 100 questions over the next year and a half.” Each funded site will have the ability to not respond to a given query, assuming that they have good justification not to do so.

 

The advantage to the researcher is that they might need to reach outside of Temple to identify a patient cohort large enough for their project, right?

Exactly. For our rare disease, idiopathic pulmonary fibrosis, at the time we submitted the grant, we estimated that we only had about 70 living patients with that disease. If you went to Pitt, which was the highest, they maybe had about 350 or so. 

With only 70 patients, maybe you don’t even have the number to show any statistical significance in certain differences between drugs or other interventions you’re trying to assess. Whereas if you were to combine all the centers together and you get above 500 patients, then all of a sudden potentially you have the ability to make a finding that will stick with the general population.

 

Is there a plan to add organizations or conditions or to use the data more widely?

Yes. We were initially funded for 18 months. That 18 months is supposed to be used largely to build an infrastructure to support future research. There will be some research done during the 18 months, but the idea is to make sure you can set up this robust network for the future. 

PCORI has said that they will be having a Phase 2 in which no longer will they be paying to help you set up this infrastructure, but instead they will want specific questions answered. You have the ability to then apply for Round 2 funding, in which you will potentially participate in clinical trials where, using the network, you identify certain patient profiles and you go out and enroll them in certain studies, or for large-scale retrospective studies, where you harness the power of the longitudinal data you have for your one million plus cohort of randomly selected patients times 11.

So at least 11 million patients that you can then query to say, over the last 10 years, patients with this profile who were given this type of therapy, how did they fare over the last 10 years compared to this other therapy? There will be a Phase 2 where we can extend the funding to actually try to answer certain questions.

In terms of being awarded the contract, everyone was being asked, to what level is your institutional leadership committing to making this sustainable over the long run? Should the money dry up tomorrow, do you have strategies and do you have commitments from your top leaders to make sure that this stays in place and that you extend it to anyone outside of the network so that any non-funded investigators have the ability to ask any center and consortium … my consortium is called PATH , the initials of all the participating institutes. Geographically, we’re the mid-Atlantic CDRN. So anyone in our geographic area who is not at a funded institution has the ability to request access to our data and to collaborate with any of our investigators on any particular study.

 

Is there anything else you’d like to talk about?

The one really neat thing that’s come out of this that’s linked to PCORnet is the use of i2b2. It stands for Informatics for Integrating Biology in the Bedside. It’s an open source software package created at Boston Children’s. It is used extensively throughout the Harvard-Partners HealthCare network. It allows you in an open, non-proprietary way to take data out of any clinical system, merge it with other data you might have – such as genetic data from other systems — and to make it queryable, both at your institution or potentially teaming up with other institutions. The adoption rate has been growing by leaps and bounds.

Temple was not an i2b2 user before this initiative. While we are implementing it for the purposes of PCORnet, as are many of the other CDRNs, we also are using it as a springboard to create an internal tool that our investigators can use for any patients of any disease asking potentially any questions using the EMR data. 

A lot of times when an institution implements a new clinical data warehouse, they take their time and go step by step. It evolves over a period of years, potentially. Whereas because of this PCORI initiative, we had to go from zero to 60 quickly. Phase 1 lasts 18 months, and at the end of 18 months, you have to show that you’ve successfully created this infrastructure which can be used for robust clinical research. 

The i2b2 prevalence within academic medical centers over the US has been growing. As I dug into it, I realized that people use it in different ways. If you are trying to share data with another institution via i2b2, one approach is to try to convert all your data to the same standard. If you have internal lab codes and the other institution has their own internal lab codes, you could try to convert all your codes to a standard like LOINC. Or, you could allow them to stay as they are and then you have some lookup table that converts on the fly from your local ones to a standard.

As I was experiencing this and going through the baptism by fire of getting our institution using i2b2, not only for PCORI but for ourselves, it became clear that there should be a boot camp that helps you think about all these things. It needs to give you what I call the mental scaffolding, so that from the beginning of a project, you can consider all of the types of decisions you’ll have to make and the potential downstream ripple effects.

I contacted Harvard, the folks that created i2b2 and the accompanying SHRINE software that allows you to connect other institutions. I gave them some ideas about how it would have been great if I had been able to take this intensive boot camp before our project started. We went back and forth and we’re going to offer a pilot i2b2-SHRINE boot camp at Harvard in early 2015. 

Harvard is trying to assess what type of a demand would there be for such a boot camp after the pilot. We’ll try to fill maybe 25 spots with the pilot, but then whether there is enough hunger and demand to offer it regularly. If any of your readers have any thoughts about that, I’d love feedback in order to gauge whether it’s a minor niche thing or if it has wide applicability.

View/Print Text Only View/Print Text Only
June 16, 2014 Interviews No Comments

Monday Morning Update 6/16/14

June 14, 2014 News 3 Comments

Top News

image

Cumberland Consulting Group will announce Monday that it has acquired Cipe Consulting Group, a 50-consultant, Seattle-based EHR and RCM consulting company. Franklin, TN-based Cumberland has 230 consultants.


HIStalk Announcements and Requests

image 

Responses to my poll about meeting attendance in the next year indicate that it’s the HIMSS conference (33 percent) and vendor user groups (26 percent) well out front, followed by CHIME (9 percent) and then a scattershot of other meetings with low percentage numbers. New poll to your right: how well does Epic support interoperability compared to other EHR vendors? After you vote, click the “Comments” link at the bottom of the poll to explain why you think so.

Things you can do to help me with HIStalk: (a) read HIStalk Practice and HIStalk Connect; (b) support my sponsors by checking out their ads, reviewing the listings in the Resource Center, and using the RFI Blaster for any consulting needs; (c) review the archived educational material on HIStalkU; (d) send me anything readers would find useful – people I should interview, conferences I should attend, and of course news, rumors, and fun stuff; and (e) tell people you know about HIStalk since I don’t advertise and nobody will hear about it otherwise. Thanks for reading HIStalk even though I started writing it in 2003 just for myself and it was mostly that way for years.


Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Acquisitions, Funding, Business, and Stock

image

Streamline Health Solutions reports Q4 results after a delay involving an auditor change and an internal controls audit: revenue down 3 percent, EPS –$0.14 vs. –$0.63.


Announcements and Implementations

image

IT gets the blame (at least from non-IT people looking for a scapegoat) for the failed $31 million Cerner implementation at Athens Regional Health System (GA). The hospital’s chief medical officer says users weren’t well trained and the CIO was holding back information, while Cerner claims IT was running the project without getting users involved. The CEO and CIO were forced out after physicians protested.  My suspicion is that the medical staff docs were already mad at administration over something unrelated, refused to participate, then capitalized on go-live challenges to get the CEO fired. The CIO was probably collateral damage since an IT system was the claimed problem.


Government and Politics

image

Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA) ask unnamed stakeholders for ideas on how the use of government healthcare databases can be expanded. Chuck asks a lot of questions and writes a lot of letters, but that’s usually the last you hear about it.

image

Vanderbilt University Medical Center’s Eric Boehme, associate director of informatics, worries that the already-complicated Meaningful Use timetable could take an unexpected turn between the recent Notice of Proposed Rule Making and the actual rule, as in what happened with ICD-10. He also takes an interesting long view: “This is all too late and too little. MU is in trouble. Two powerful committees in Congress asked for a pause for MU to evaluate the success of the program and to emphasize the lack of true interoperability. ONC has lost a significant portion of its funding as the stimulus money dries up. Recently, some members of Congress questioned how much ONC should regulate HIT. ONC National Coordinator, Farzad Mostashari, CMS Administrator, Marilyn Tavenner, and the HSS Secretary, Kathleen Sebelius have all resigned.”


Other

image

A Wall Street Journal editorial by patient safety expert Peter Pronovost, MD, PhD of Johns Hopkins Medicine urges consumers to “Beware Bad Data About Hospitals” in the current “Wild West” environment in which “there are greater protections about what claims we can make about toothpaste than a hospital or measurement organization can make about quality of care.” He recommends creating the equivalent of a Securities and Exchange Commission to oversee development and use of quality indicators. Until then, he suggests that consumers use only composite scores such as those from The Leapfrog Group and Consumer Reports. He concludes with a simple plea: “There really is very little useful information on pricing. There should be.”

image

An unnamed IT system goes down at Fletcher Allen Health Care (VT) Friday morning, forcing the hospital to go to paper.

image

The Detroit newspaper profiles Sorie Kanue, a former Michigan State football standout and team captain (playing safety) who worked in IT after college and then went to nursing school. He has been named nurse of the year twice at Detroit Medical Center’s Heart Hospital and is working on his MSN.

image

image

Fortune profiles Elizabeth Holmes, who as a Stanford sophomore in 2003 founded blood diagnostics company Theranos, which now has 500 employees and a valuation of $9 billion. When questioned by her professor about why she wanted to start a company, she answered, “Because systems like this could completely revolutionize how effective healthcare is delivered and this is what I want to do. I don’t want to make an incremental change in some technology in my life. I want to create a whole new technology, and one that is aimed at helping humanity at all levels regardless of geography or ethnicity or age or gender.” The company’s product can run dozens of tests from a single, tiny sample of blood drawn via pain-free finger stick, and the company’s app supports its pledge that “we believe you have the right to your own health information” and “answers at the speed of digital.” Test cost is as little as a tenth of what hospitals charge. Walgreens will put the company’s labs in many of its drugstores, but Theranos is also working with UCSF, Dignity Health, and Intermountain. Holmes says patients don’t have 40-60 percent of lab test orders drawn because of the pain or inconvenience involved.

image

”The Daily Show” invites a group of Google Glass fans to defend their worship of the technology, include one woman who claims that she was a victim of a hate crime because she wore Glass into a bar and filmed fellow patrons without their permission, eliciting their angry taunts as she cursed at them and announced while recording, “I want to get this white trash on tape for as long as I can.” The same woman’s neighbors had previously filed a restraining order against her for recording their private conversations. She and her fellow Glassholes probably should have stayed home: after hearing that Glass early adopters are called Explorers, the host responds, “Magellan was an explorer. Chuck Yeager was an explorer. You guys have a %&@! camera on your face.”


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 14, 2014 News 3 Comments

News 6/13/14

June 12, 2014 News 13 Comments

Top News

image

ONC announces that Chief Privacy Officer Joy Pritts, JD has resigned after four years on the job.


Reader Comments

From Anonymous Tipster: “Re: Wayne Tracy on VistA. I agree it would be a tragic shame to see VistA replaced. Unless Epic were to make some dramatic changes in its approach to interoperability, this could be a disaster for the VA. Anyone who has ever suffered through a migration to Epic could tell you how difficult this can be from a workflow perspective (not to mention cost overruns). You think there’s backlog now? Remember the iEHR project that died? It’s an election year and the money is rolling in big time from lobbyists  — maybe Epic will even begin to divert some of its campaign dollars to Republicans).” The DoD’s IT efforts have been financial disasters, with AHTLA and its predecessors rumored to have cost $10 billion. The VA has done very well with VistA, but its more recent efforts involving government contractors (BearingPoint’s CoreFLS at Bay Pines) were spectacular failures, so there’s no guarantee that VistA wasn’t a one-trick pony. It’s also true that DoD and VA don’t agree on anything despite their common responsibility in caring for active service members who eventually (hopefully) become veterans. Kaiser had to pull the plug on its IBM-developed system that cost hundreds of millions of dollars and replace it with $4 billion or so worth of Epic, so that’s an interesting IBM-Epic partnership (I can’t imagine Epic letting IBM tell its 25-year-olds how to implement.) Add replacing VistA to DoD’s $11 billion project and you’re probably talking about $30 billion worth of overruns, delays, and potential patient harm as the VA and DoD are forced to smoke their first-ever HIT peace pipe – that number has substance since the DoD walked away from iEHR because it was going to cost $28 billion and nothing involving the federal government ever comes in on budget, especially if the military is involved. Britain’s failed NPfIT has been called one of the most expensive government IT projects in history at around $17 billion, so we’ll beat that for sure. One final thought: Epic’s Judy Faulkner and InterSystems’ Terry Ragon are already healthcare billionaires as sole owners of their hugely successful private companies — an IBM-Epic DoD deal would certainly raise the numeric placeholder in front of their billions.

image

From Expandable Beltway: “Re: DoD bid. Cerner is teamed up with Accenture.” Unverified. I am getting anxious to hear what Dim-Sum has to say. Lorre would love to get him or her to present a webinar on the DHMSM topic, for which I would even arrange one of those voice-changing gadgets.

image

From Cool Runnings: “Re: Benefis EHR RFI. They use Meditech inpatient and replaced LSS with NextGen a few years ago. NextGen is taking a hit in Montana – a small hospital sued them, Bozeman Deaconess is rumored to be switching from Meditech/NextGen to Epic, and Community Medical Center in Missoula is merging with Billings Clinic, which very likely means a move from NextGen to Cerner Ambulatory.  I’ve heard that Benefis is talking to athena, but may be leaning toward looking for an integrated solution instead of just an ambulatory switch.” Unverified, but I should have checked Meditech’s online customer list, which would have told me that Benefis runs its soon-to-be-gone systems.  


HIStalk Announcements and Requests

It’s time to say goodbye to Inga, who has moved on to greener pastures after seven years of contributing to HIStalk and HIStalk Practice. She finished working on the sites in April and has finally tied up her last loose ends. Rumors that she is launching a healthcare shoe division of Christian Louboutin may or may not be unfounded, but we will wish her well in any case. Jennifer Dennard took over writing HIStalk Practice several weeks ago, while Lorre is happily handling the non-writing HIStalk chores.

This week on HIStalk Practice: ONC’s 10-year vision statement on interoperability prompts CommonWell to up its game. Several trade associations line up with telemedicine-related requests for new HHS head Sylvia Burwell. ARcare receives the HIMSS Analytics Stage 7 Ambulatory Award. Epocrates ranks number one again. HIT Policy Committee meeting numbers show $24 billion in MU incentive payments so far. Jim Morrow, MD gives healthcare IT its due as an independent physician. Wesley Medical Center docs face employment ultimatums. Northern Virginia launches the HeaLiXVA HIE. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the concept of patient ownership of health data, its benefit to public health in general, and the role that Apple and Samsung will play in advancing the concept. ZocDoc expands its business model to include corporate wellness services. Autism Speaks signs a deal with Google to create a database that will store 10,000 fully sequenced genomes in the cloud, where researchers across the globe can access the data.


Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.


Acquisitions, Funding, Business, and Stock

image

Imprivata sets terms for its $75 million IPO that values the access management company at around $400 million.

image

KeyBanc downgrades shares of CPSI, saying that Healthland is strong in the small-hospital market and that Epic’s Community Connect program is making it a competitor there as well.

image

Elsevier acquires Amirsys, which offers clinical decision support and learning tools for radiology, pathology, and anatomy that will be integrated with the Elsevier Clinical Solutions suite.

image

Mediware acquires Harmony Information Systems, whose systems help state and local agencies track long-term care policies.


Sales

image

The State of Vermont signs a six-month $5.69 million contract with OptumInsight for evaluation, remediation, and operations support for its health insurance exchange.

image

In England, Oxford Health NHS Foundation Trust awards a five-year, multi-million pound contract to Advanced Health & Care to develop an EHR that up to 3,500 clinicians will use on iPads. Oxford Health provides services for mental health, home care, children and family, and substance abuse.

image

Irving, TX-based USMD chooses the population health management platform of Lightbeam Health Solutions for its ACO and other risk-based programs. I interviewed Lightbeam CEO Pat Cline three weeks ago.


People

image

IMDsoft names Lars-Oluf G. Nielsen (Epic) CEO.


Announcements and Implementations

image

Estes Park Medical Center (CO) goes live on Medhost EDIS.

UPMC (PA) will deploy 2,000 Microsoft Surface Pro 3 devices to deploy its Convergence app, which UPMC says it first tried to roll out on the iPad without success. Convergence, developed by UPMC and Caradigm, gives clinicians a single view of UPMC’s Cerner and homegrown applications and suggests and monitors compliance with clinical pathways.

image

Nevada, MO, Cerner’s testbed for healthy communities, gets a new playground courtesy of the company and the Nevada Parks and Recreation Department.


Government and Politics

CMS reassures taxpayers that the workers who were sleeping on the job at the call center of Serco (which has a $1.25 billion Healthcare.gov contract) are busier now that the site is actually working.

Jon Stewart makes fun of the June 9 testimony of Assistant Deputy VA Under Secretary Philip Matkovsky, in which Matkovsky says in in the deadest of deadpans, “Our scheduling system scheduled its first appointment in April of 1985. It has not changed in any appreciable manner since that date.”

It isn’t just the VA that has an appointment problems. England’s NHS backlog hits three million patients who are waiting for appointments, not even counting six trusts that couldn’t report data because of computer problems. Still, NHS squeaked by in meeting the requirement that it treat 90 percent of patients within 18 weeks. As with the VA, increasing demand could cause NHS to start missing its goals routinely.

OpenFDA was possible only because the agency used a startup’s technology to turn its document backlog into discrete data. Captricity uses a combination of optical character recognition and crowdsourcing the unreadable parts by giving human reviewers “shredded” sections so they don’t see entire Social Security numbers or full names, preserving confidentiality. Pricing runs around 15 cents per page.


Innovation and Research 

image

Device maker Medtronic says every person will eventually want sensors implanted in their bodies that will generate data for self assessment, remote monitoring, and disease management. The company is testing a pill-sized cardiac pacemaker and has already released the Linq insertable cardiac monitor that’s the size of a AAA battery and uses cell technology for remote cardiac monitoring.


Other

image

Via Christi (KS) asks for patience as it tries to recover from slowdowns caused by its Cerner Millennium go-live, with one patient reporting a 12.5-hour wait to get from the ED to a bed.

A McKesson-sponsored report predicts that value-based payments will double within five years, to two-thirds of the total.

image

AMA approves guidelines recommending that limitations on physician payments for providing telemedicine services be removed as long as a valid patient-physician relationship has been previously established, the physician is licensed in the patient’s state and follows that state’s laws, and standards are followed the same as for in-person encounters.

CHIME and AMDIS announce an alliance in which CHIME will provide health IT support to AMDIS and AMDIS will provide physician informatics advice to CHIME. The organizations recently jointly offered the CHIME/AMDIS CMIO Boot Camp, modeled after CHIME’s longstanding CIO Boot Camp.

image

Georgia Regents University will host the week-long NLM Georgia Biomedical Informatics Course September 14-20 at the Brasstown Valley resort in Young Harris, GA. Applications are due July 7. The nationally known faculty will teach change agents (biomedical educators, medical administrators, faculty, and others who don’t have knowledge of the field but who can spread the word) how to apply informatics solutions such as clinical informatics, big data, and telemedicine to their delivery, research, and education challenges. Enrollment is limited and competitive since the National Library of Medicine will pay for the registration, travel, housing, and meals of those accepted.

image

For $2,500, you can buy a report containing a SWAG at the size of the EHR market over the next four years in which the authors clearly don’t have a clue about data precision and presentation. Either that or they are very good at estimating the market to within 0.004 percent. I don’t see them trumpeting proof of previous accuracy.

A hospital in France blames a drug delivery robot’s computer bug for sending $15 million worth of drugs to the incinerator in the past five years.

An English hospital apologizes for the death of an 11-month-old baby whose acute appendicitis was not diagnosed because the samples for ordered tests were not delivered to the lab. A Trust spokesperson said that the pathology computer system has been upgraded to flag specimens ordered but not received.

image

Castlight Health co-founder Giovanni Colella, MD (formerly of RelayHealth), says big data rather than government intervention is needed to fix healthcare. He recommends: (a) companies should analyze the claims data from their health plan to see what they’re paying for; (b) gag clauses prohibiting the release of price contracts between insurance companies and providers should be abolished; (c) the government should allow the private sector to use Medicare claims data and physician quality data; and (d) price, utilization, and quality data should be made publicly available in the absence of a compelling reason not to.

image

More from Castlight Health: the company releases interactive maps showing national in-network pricing for lipid panel, PCP visit, head CT, lower back MRI (above, which ranged from $676 in Fresno, CA to $2,635 in Sacramento, CA, just 171 miles away by car.)


Sponsor Updates

  • Healthland will offer its hospital customers Meaningful Use Manager of Iatric Systems to help with their Meaningful Use attestation.
  • Grinnel Regional Medical Center (IA) reports a seven percent increase in cash collections, 79 percent of payments made via self-service, and 124 saved hours per month in a two-year review after its go-live with Patientco’s payment automation solution.
  • Impact Advisors and the Scottsdale Institute publish a report from the CIO Summit on IT Cost Management and Value Realization.
  • Sixteen medical innovations were showcased at Premier, Inc.’s Innovation Celebration in San Antonio, TX this week.
  • Quest Diagnostics certifies MedicsDocAssistant EHR v. 7.0 from Advanced Data Systems as a Silver Quality Solution under its Health IT Quality Solutions Program.
  • Janssen Diagnostics collaborates with Halfpenny Technologies to provide specialized reporting for HIV/AIDS healthcare.
  • GetWellNetwork recognizes several providers for using its solutions to improve care at GetConnected 2014 in Chicago, IL.
  • Hills Health Solutions signs a distribution agreement to make Lincor’s interactive patient engagement technology available in Australia and New Zealand.
  • Craneware and Centura Health (CO/KS) will co-present best practices of charge capture during HFMA ANI 2014 in Las Vegas June 24.
  • InstaMed shares how its Premium Payments solution has changed the consumer payment process.
  • Medfusion publishes a white paper on creating patient value through portals.
  • Gartner names Covisint a Leader in Identity and Access Management as a Service.
  • PeriGen CNO Rebecca Cypher will discuss fetal heart rate interpretation at AWHONN 2014 in Orlando June 14.

EPtalk by Dr. Jayne

clip_image002

This has been a rough week in the healthcare IT trenches. Our medical group has been in acquisition mode again, resulting in the addition of several new specialties. Unfortunately, this time around our EHR vendor doesn’t have content for any of them.

Luckily we’ve been through this enough to have a process in place. Our implementation team sends out a staffer or two to observe the practice’s current state workflow and documentation style. This is essentially a reconnaissance mission. We try to blend in and to avoid having the practice ask us a lot of questions while we gather data.

The team then comes back and makes a presentation to the implementation manager, the application team manager, and me to talk about what their current process looks like and how much we’ll be able to handle with the EHR as-is, without any additional development. Depending on the specialty, it’s hit and miss.

For example, when we added vascular surgery, we were able to handle 95 percent of their needs because we have both general surgery and cardiovascular content. On the other hand, when we’ve added certain pediatric subspecialties, we’ve had to get creative with what we choose to offer them. Vendors haven’t quite figured out that children are not just little adults and it’s not as easy as just having them use adult content with the same specialty name.

For example, pediatric cardiology deals with care for children who have had a variety of surgical procedures that are largely unspoken of in the adult cardiology world. On the flip side, there isn’t very much coronary artery disease or many triple vessel bypass surgeries among the pre-adolescent set.

Often we’re working with physicians who are used to dictating their notes and having them transcribed. We’ve had good success at putting them in our EHR “core” templates for documenting histories, assessments, and plans, but we augment the “story” part of the visit with voice recognition. It’s a hybrid approach, but it prevents us from doing costly development that will only be used by a handful of physicians. It also provides for physician satisfaction in that they’re used to being able to include a detailed narrative in their visit documentation.

We encountered a rare bird this week, however: a subspecialist who seriously believes she’s going to be happy with point-and-click documentation. She wants us to build a whole herd of custom screens for her. She dictates on the hospital system at present and has no previous experience with discrete data.

In our experience with other physicians of the same subspecialty, it’s generally not worth building custom screens. They tend to change their minds before the content is even built. If they don’t change their minds, once they see it, they decide it’s too “clicky,” and 90 percent of the time they end up dictating anyway.

We had our follow-up meeting with her today. We ran through the options and asked her to try some typical click-by-click workflows in the general medicine templates just to get a feel for what it would be like. She wasn’t terribly proficient, so we had her try voice recognition within the system. She did fairly well with that. It was clear to the team that she’ll likely do better with that kind of hybrid approach. The subspecialist was unconvinced, however.

We moved to our next tactic,  which is to ask the physician to use our recommended workflow for a couple of months and then decide if we still need custom content. It was obvious that she was not buying what we were selling. She told us we were just being difficult and didn’t want to do what she asked. She then accused us of trying to skimp on her content for budgetary reasons.

We explained the history with other physicians in her specialty, even trying to show her the content we had previously built that her peers had abandoned. She didn’t want to see that either, but made it completely clear that she expected us to build custom content for her alone. I knew we weren’t going to win this discussion, so we agreed to go back to the office, brainstorm other solutions, then meet up in a few weeks.

In debriefing with the team in the car, we’re not sure what to do for her. We have more than a decade of experience doing this. We know what works and what doesn’t work. However, we have a physician with no EHR experience (and no track record as an end user – she won’t even use the hospital system) who is demanding a certain course of action. My team asked what we should do.

My thoughts went into doctor mode. It feels like the scenario where a patient is demanding an antibiotic where none is indicated, or insisting on a procedure that could potentially be more risky than it is worth. The patient in this case is arguing with the IT-equivalent of our professional medical opinion as to the course of care. In the medical world, we wouldn’t be bullied into doing something that is not of benefit. Not to mention that building clicky screens for a provider who has never been exposed to that documentation style is a recipe for unhappiness.

Our plan is to bring some of her soon-to-be colleagues in the same subspecialty with us to our next meeting and hope that their shared experiences will steer her in the right direction. We’d like her to make the choice herself without us having to flat out reject her request, but I’m not sure how we’ll handle it if she doesn’t start to get on board with our advice. Being new to the group, we know her level of trust of our team is low and her experience with EHR is minimal, so that seems like a logical approach.

I never like disappointing people. It’s always difficult to have those conversations with patients when you deny their requests. It’s doubly challenging when you’re dealing with a peer who might be more senior than yourself, and particularly difficult when they’re in a seemingly more prestigious subspecialty than your own.

In other parts of the physician universe, we’re also dealing with some significant Meaningful Use issues where physicians are requiring retraining and a lot of hand-holding. This was just one more thing to add to the mounting heap of stress.

I polled a couple of my CMIO peers on how they handle these situations. They didn’t have too many better answers. For all our readers on the implementation and content side, what’s your take? Is there a silver bullet solution? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 12, 2014 News 13 Comments

CIO Unplugged 6/11/14

June 11, 2014 Ed Marx 3 Comments

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

Data-Driven Performance

I have a confession to make. While I am an uber advocate of data-driven performance in healthcare and IT operations, I seldom apply these tools to my personal life. Sure, I look at data when I consider investments and major purchases, but, put it this way, you’ll never see me with a Fitbit!

I am witness to the power of data to shape clinical transformation. Are you kidding me? Serving in organizations with mature electronic health records and advanced business intelligence tools, I see the evidence in our quality reports all the time. Bam! Data-driven outcomes for sure. Evidence-based medicine—check. Ditto on the business side. In fact, my organization is among the first in the country to post our data-driven metrics online. Transparency is a great motivator.

For all my talk on leadership, innovation, connected health, and business intelligence, you might expect me to be a walking wearable. Nope. I’m wired as a visionary. Details are not my forte. I might have a grand idea for a party, but I leave the planning and execution to the detailed-minded organizers.

When it comes to athletic endeavors, I’m about getting to the finish line fast. Forget style and quality form; just get out of my path.

Over the years, the downside of this method caught up with me. Time was no longer my friend. Another confession: my performance had stayed flat for a few years. I wanted to see improvements, so I needed to change.

My friend Ben Levine is a perennial “top doc.” He runs the Institute for Exercise and Environmental Medicine and is one of the world-renowned types who’s been kind enough over the years to help train my mountain climbing teams.

image

Ben took me through the paces of his research lab. Part of our deal meant I had to be in a study and sport a wearable for a while.

After analyzing all the tests, he told me my body was capable of greater performance. My lifelong conditioning gave me a good base, including a resting heart rate of 40 (occasionally six BPM when asleep). But I had not reached my physiological potential.

image

I researched and found a triathlon coach to help me get to the next level of performance. Of course, it turned out that Amari of Dallas-based Playtri is a total data hog. She stretches me (no pun intended) beyond my comfort zone with all these wearables and resulting analytics.

In the past, I would cycle in a race and hope for the best by just doing whatever felt good. Now she had me monitoring a combo of heart rate, cadence, and wattage. Speed is secondary. If I focus on the analytics, the outcome (speed) will take care of itself. If I only look at speed, as I did in the past, I might dismount my bike only to find I have no legs left for the run —bonk!

I posted last fall about qualifying for regionals and then for the national Duathlon (run/bike/run) championships. Through grit, I lucked out and secured the last spot (age group) on Team USA. It was not pretty, but I made the team.

With the World Championship on the horizon as well as other important races, the time for data-driven performance arrived. A real life experiment—with me as the subject. Time to walk the talk.

Albeit imperfect in my utilization, Amari’s training formula is completely driven by near real-time data feeds. She makes adjustments based on daily training and race results. I dutifully wear the gear and upload. She parses the data, does meta- and microanalysis, and off we go.

What were the 120-day results?

image

I am writing this post on the plane home from the World Championships in Pontevedra, Spain. I followed Amari’s race plan, which was all data points: 150-165 BPM heart rate on the first 10K, 270 watts on the bike, never going lower than 165. It was not “outrun the person in front of me,” but to be patient and focus on my data. If I did that, the results would be my friend.

I finished in the top 25. I was the #4 American (an upgrade from #18 last fall) to cross the finish. Data-driven performance! I’m a believer. I can’t wait until I perfect the technology and discipline myself further under Amari’s coaching to see even stronger outcomes.

Personal life imitates professional. We must all push our organizations and ourselves to become data driven.

While being data driven leads to improved outcomes, no data tool could ever create the following. Intrinsic motivation does have a purpose.

image

The home stretch with .5K to go. I saw the Team USA Manager exhorting us to finish strong. Tim handed me Old Glory as I ran by and said, “Catch two more racers!” I caught my two as I turned into the stadium sprinting to the finish. Waving my country’s flag. Hearing chants of “USA USA USA.” Tears of joy.

Go Team USA!

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

View/Print Text Only View/Print Text Only
June 11, 2014 Ed Marx 3 Comments

Morning Headlines 6/11/14

June 10, 2014 Headlines No Comments

IBM Joins Forces with Epic to Bid for Department of Defense Healthcare Management Systems Modernization Contract

IBM announces that it will partner with Epic in the pending DoD EHR vendor search, naming IBM CMIO Keith Salzman, MD, MPH and 22-year Army doc, as project lead.

Intermedix Corporation Acquires T-System’s Physician Billing Division

T-System sells its ED billing solution to Intermedix, stating in a press release that it would focus its efforts on ED clinical and coding workflow.

Taxpayers Face Big Medicare Tab for Unusual Doctor Billings

The Wall Street Journal analyzes CMS payment data and finds that 2,300 physician practices earned $500,000 or more by repeatedly billing for a single procedure. One doctor in California billed Medicare $2.3 million for a non-invasive cardiac procedure that he describes as “exercise while lying on your back.” Though he is not a cardiologist, his practice performed the procedure more times than all of the cardiologists at the Cleveland Clinic combined.

Alliance for Connected Care

The Alliance for Connected Care writes a letter to incoming HHS Secretary Sylvia Burwell asking that she use her authority to relax telehealth reimbursement regulations.

View/Print Text Only View/Print Text Only
June 10, 2014 Headlines No Comments

News 6/11/14

June 10, 2014 News 12 Comments

Top News

image image

Our intrepid beltway reporter Dim-Sum has been telling us for months that IBM and Epic are pitching for the DoD’s $11 billion EMR contract, which IBM now confirms in announcing its intentions. Heading the project will be IBM CMIO Keith Salzman, MD, MPH, who was an Army doc for 22 years. Dim-Sum’s reports have been minor masterpieces of puns, semi-obscure references, and teasing hints, but I just realized that even his or her phony name is yet another one: the bid falls under DHMSM (DoD Healthcare Management Systems Modernization). I suspect we will get a June report shortly, but in the meantime, you might want to refer to his or her updates from March 5, March 28, April 9, and May 2 now that their accuracy has been confirmed (he or she reported here that it would be IBM-Epic two months ago.)  


Reader Comments

image

From Big Sky: “Re: Benefis Health System in Montana. Has an RFI out for EMR replacement.” Unverified. I don’t know what they’re running for inpatient, but they finished a huge NextGen ambulatory rollout a couple of years ago.

From Speechless: “Re: HIMSS chapter speakers. We are putting together a panel discussion for the fall on healthcare IT innovation. If you could choose one or two East Coast speakers, who would they be? We’re thinking of a progressive hospital CIO, someone interesting from one of the incubators, and a provider-side innovation leader.” Let’s crowdsource it with HIStalk readers – leave a comment with your suggestion or if you’d like to volunteer to present (or you can email me.) I’ve been a HIMSS chapter program chair and it’s hard to get good non-vendor speakers.

image

From Demon Deacon: “Re: Wake Forest Baptist Medical Center. Successfully launched Epic Inpatient for the Lexington Medical Center, which was the last Wake Forest hospital to go live.” Congratulations to WFBMC for getting the job done despite some disastrous (and preventable) early missteps that cost the health system a lot of money and credibility. My fellow barbeque fans might consider a site visit given that Lexington, NC has the highest ratio of pits-to-people in the country and one joint (Lexington Barbeque, aka “Honey Monk’s”) fed world heads of state at a 1980s summit at the request of President Reagan.

image

From Power Seeker: “Re: power strips. Joint Commission says that CMS ‘is no longer allowing relocatable power taps, referred to as RPTs or power strips, to be used with medical equipment in patient care areas, including operating rooms, patient rooms and areas for recovery, exams, and diagnostic procedures. The restriction does not apply to non-patient care equipment such as computers and printers or to areas such as nurse stations, offices, and waiting rooms.’ If this is true, time to invest in companies that sell UPS solutions.” It’s true. Patient care rooms are going to need a lot of red wall jacks to plug in medical devices individually. Hospitals will also need to check their liability insurance since power cords will be running all over the place and tripping people. I see the point – even UL-approved power strips aren’t intended for critical medical devices where failure could be disastrous (if there’s no battery backup, anyway) — but alleviating that risk will be ugly in already-crowded patient rooms.

From Wayne Tracy: “Re: Monday’s post. I’m very cynical about the VA’s problems and agree that because of commercial vested interests, VistA is quite likely to become a fall guy. VistA in my opinion is the most comprehensive user-developed healthcare clinical application. My fear is that the lack of advocacy is because: 1) Sonny Montgomery is no longer in Congress, 2) No vender will make money on it, 3) No consulting company can charge an arm and a leg to implement it. The proposals to do away will the VA healthcare system are at best naive. Last time I looked at our mental health system, I’m compelled to assert that it is woefully inadequate. What system can deal the population of amputees and brain trauma cases plaguing some two million recent vets? Some have suggested that some 50 percent are or will experience PTSD and related psychological problems. What civilian healthcare organization is prepared to deal with that large a patient population, or more importantly, has the proven expertise? If you think the backlog is bad now, just wait. This administration and Congress has good intentions that will potentially result in a diminished quality of care at greater expense.” Wayne is an industry long-timer and a retired Navy officer. I agree with all of his points. VistA will take a fall because the VA’s volume and people problems are drawing beltway buzzards and arrogant DoD’ers who can’t wait to see VistA replaced with something way more expensive even though it has been a poster child for doing IT the right way for patients (although the VA has struggled with automating patient scheduling). Nobody wants to talk about his second conclusion – we civilians weren’t really paying attention to what was happening in Iraq and Afghanistan because the death toll didn’t seem all that high. Our military participants were coming home alive but physically and mentally mangled and now we have to figure out how to pay for their care whether it’s delivered by the VA or otherwise. I’ve argued in the past that the VA should be dissolved and care provided by the existing healthcare system, but I’m not confident that system can handle the volume any better or that we can manufacture enough additional red ink to cover the cost.


HIStalk Announcements and Requests

Listening: Circa Survive, thoughtful indie rockers from Doylestown, PA. I’ve been listening to them nonstop once I got over my disappointment that the singer isn’t a sensitive female but instead is a high-voiced guy. Those of us with a clinical persuasion will appreciate this song title: “The Difference Between Medicine and Poison is in the Dose.” They’re touring now with Ume, who I also like a lot. Also, new albums from First Aid Kit and Passenger.  

image

I was reviewing Steve Blumenthal’s slides from the June 24 webinar below – he’s going to be fun, I suspect, especially for a lawyer. I also sat in on the rehearsal for the radiology workflow one and it was interesting to hear about teleradiologist workflow with the high volumes of images they deal with – no wonder they sit in a quiet, dark room and look at on-screen pictures while talking into a microphone all day. Like programmers, I’m guessing they rarely see daylight.


Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  A Health Catalyst Overview: An Introduction to Healthcare Datawarehousing and Analytics. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This short, non-salesy Health Catalyst overview is for people who want to know more about the company and what we do, with plenty of time for questions afterward. Eric and Mike will provide an easy-to-understand discussion regarding the key analytic principles of adaptive data architecture. They will explain the importance of creating a data-driven culture with the right key performance indicators and organizing permanent cross-functional teams who can measure, make and sustain long-term improvements.

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.


Acquisitions, Funding, Business, and Stock

image

T-System sells its ED billing business to Intermedix, saying it will focus on its clinical and coding initiatives that will continue to be offered under the RevCycle+ brand.

image

Indianapolis-based startup Indigo Biosystems raises $8.5 million in venture capital and replaces its CEO with the company’s founder. Its clinical laboratory software interprets visual results from instruments such as mass spectrometers, flagging outlier data for human review.

image

Oncology drug maker Celgene invests $25 million in NantHealth to develop personalized medicine for cancer. There’s a connection: NantHealth founder Patrick Soon-Shiong sold his own chemo drug company, Abraxis BioScience, to Celgene for $3 billion in 2010.


Sales

image

The federal government awards ScImage a two-year, $45 million contract for its Picom365 Enterprise system, including PACS, diagnostic viewers, VNA, and workflow tools.

image

United Arab Emirates-based physician helpline vendor Mobile Doctors will implement mobility solutions from Cerner.

image

Freestanding Cypress Creek ER (TX) chooses Wellsoft’s EDIS.

image

Mission Health (NC) will advance its population health management with Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

Children’s Health Alliance (OR) chooses Wellcentive’s population health management solutions.

Catholic Health (NY) selects Perceptive Software’s enterprise content management system to integrate with its Infor financial and HR systems.


People

image

Sunquest officially announces that Matthew Hawkins (Greenway Health) has joined the company as president.

image

Capsule Tech promotes Kevin Phillips to VP of marketing and product management.

image

Former athenahealth CFO Carl Byers (Fidelity Biosciences) joins the board of Netsmart Technologies.


Announcements and Implementations

ZeOmega announces the 5.6 release of its Jiva population health management system.

image

Healthcare Engagement Solutions signs an agreement with Cleveland Clinic Innovations to further develop its Uniphy mobile technology platform.

image

Rockcastle Regional Hospital (KY) goes live on Medhost, sending data to the Kentucky HIE through YourCareLink.

IntraCare North Hospital (TX) goes live on Medsphere’s OpenVista.

Belmont University and the Tennessee chapter of HIMSS launch a healthcare IT certification program for individuals.

The mHealth Summit announces that it will host the Global mHealth Forum for low- and middle-income countries, to be co-located at its December 7-11 conference in National Harbor, MD.

image

Castlight Health announces GA of Castlight Enterprise Healthcare Cloud, which provides four solutions for self-insured employers: cost-optimization analytics, benefits design, a catalog of available third-party services, and a mobile benefits app for employees. Shares were up 3 percent Tuesday, but still down 58 percent from the closing price on IPO day less than three months ago. The company’s valuation is $1.5 billion on $20 million in annual revenue and $75 million in annualized losses.


Government and Politics

A  VA self-audit of 731 facilities finds that 13 percent of schedulers were told to enter desired appointment dates different from what the patient requested, eight percent of facilities kept external scheduling lists invisible to the VA’s EWL/VistA systems, and unrealistic targets encouraged facilities to game the system. New patients waited up to three months to see a doctor. The VA announced immediate changes: eliminating the 14-day appointment target as unreasonable, implementing real-time patient surveys, conducting an external audit, freezing new hires and eliminating bonuses at VA headquarters and regional offices, and creating an HR team to get clinicians hired faster.

image

CMS may be congratulating itself publicly for releasing Medicare payment data (which it did only after losing a lawsuit in trying to prevent it), but the more the statistical jockeys play around with the databases, the more obvious it becomes that CMS is asleep at the taxpayer wheel. A Wall Street Journal analysis finds that 2,300 providers were paid $500,000 or more from performing single procedures or services, some of them operating well outside their area of expertise. A non-cardiologist was paid nearly all of the $2.3 million he billed Medicare for in 2012 for performing a rare and questionable cardiac procedure (“exercise while lying on your back,” advertised on his site above) on all of his Medicare patients, with his entire training in the procedure consisting of “reading lots of articles, studies, and clinical trials.”An orthopedic surgeon billed Medicare for $3.7 million in one year even though he didn’t perform a single surgery – he charged for 108,000 massages and manual manipulations. It was billed by his former employer, Abyssinia Love Knot Physical Therapy, a PT chain run by self-proclaimed “Pastor Shirley.”

image

HHS tweeted this picture, which it captioned, “Welcome Secretary Sylvia Mathews Burwell!” I haven’t seen anything official that she has been sworn in.  

The Indian Health Service contributes its VistA-based RPMS scheduling system to the OSEHRA open source community.

image

The Alliance for Connected Care writes to Sylvia Burwell even before she takes office as HHS secretary, urging her to use her authority to open up telemedicine reimbursement for all ACO providers, not just those located in specific rural areas as is the case today. The trade association, run by former government officials Tom Daschle, Trent Lott, and John Breaux, actually sent two letters, one signed by its business members (Walgreens, WellPoint, and Teladoc, for example) and the other signed by a couple of dozen big health systems. The American Telemedicine Association sent Burwell a letter of its own listing sweeping improvements that would be enabled by paying everybody for delivering telehealth services, with that letter signed by mostly by big vendors (and HIMSS.) One might infer that while patient care could improve under such an arrangement, vendor and provider revenue would most certainly do so. Sylvia hasn’t even found the restroom yet and already the special interests are pawing at her.

image

Statistics presented at Tuesday’s HIT Policy Committee meeting indicate that of EPs who first attested for Meaningful Use in 2011, 84 percent attested in 2012 and 75 percent in all three years of 2011, 2012, and 2013. Nearly half of those who attested the first year and then skipped 2012 returned in 2013. EHR incentive payments totaled $24 billion through the end of May.

image

AHRQ, presenting at the HIT Policy Committee meeting Tuesday, says that lack of EHR interoperability is a big problem, recommending that ONC define an “overarching software architecture” within 12 months and require EHR vendors to develop and publish APIs to support it. I’m pretty sure that’s not going to happen.


Other

St. Francis Hospital (GA) admits that one of its employees sent a mass email to 1,175 patients using CC: instead of BCC:, exposing the email addresses to all recipients. Apparently even that triggers the breach notification rule, at least according to the hospital’s interpretation.

BetaBoston profiles Seratis, a secure messaging app for care teams. The company is offering free personal use and hopes to get a Boston pilot. Their site is light on details, so it’s hard to determine whether its product is differentiated from similar apps from bigger players.

image

Victor Dzau, MD, stepping down as CEO of Duke University Health System (NC) on June 30 to become president of the Institute of Medicine, looks back on his tenure with comments about Duke’s $700 million Epic system:

I think we all recognize that to provide the best care for patients, you need an integrated information technology system … you can capture all the information of the patient made available to the providers and the patient, and make it available throughout the entire system … Through Epic, we are able to connect with other systems that have Epic, such as Novant and many others; now UNC just implemented it … It really is an entire information system that allows you to look at charge capture, laboratory testing, finances, work flow, decision-making … it’s a phenomenal system that can help us really improve patient care … about a year ago, I launched an institute called Health Innovation to try to make the whole place think about better ways to think about patients to try to bring together this whole large amount information that we have now through electronic health records and the use the analytic capabilities to look at data, big data, to determine how we can be a learning health care system, and try to use the new technology of digital technology sensors and others to manage patients better in the community in their homes and so they don’t have to use our facilities as much … we have Durham Health Innovation which is an initiative that we will work with the Department of Health and others bringing in geographic information systems, mapping the patient, the community, where do they live, what are the economic factors, what’s the closest clinic where’s the closest grocery store, the closest barber shop to work together to improve their health.

image

This seems like the worst app idea ever. A Singapore company creates Hospital PIX, the usual lame hospital finder app that also allows users to “post reviews about OBAMACARE.” That’s not even the “worst” part: it also encourages doctors, nurses, and patients to post their hospital photos (we have this thing called HIPAA over here). The fake photos from “Benson Hospital” feature an entirely Asian medical staff and the hospital distances shown are all from Indonesia, so perhaps the app’s localization isn’t quite complete.

In Alberta, Canada, the government-backed Telus Wolf system goes down on Monday, leaving practices without access to lab results, medical histories, and medications. According to one doctor, “There is no longer any government support. We pay $2,000 a month for this. Who is going to hold Telus accountable now? The government has abandoned us. Cost and issues switching patient data when systems are not compatible prevents us from going somewhere else.” Telus acquired Wolf Medical Systems in February 2012.

The Apple Toolbox site files a Freedom of Information Act request to find out what was discussed in several meetings between Apple and the FDA last year. The highlights:

  • Apple thinks the FDA’s guidance on mobile medical apps is appropriate.
  • The company believes it has a “moral obligation” to do more given the increasing number of available mobile sensors.
  • FDA will regulate apps based on their intended use, not necessarily because they use a particular sensor. For example, FDA wouldn’t regulate an consumer-oriented information nutrition app that uses a glucometer, but would consider the same app a medical device if it is targeted to diabetics.
  • Apple and FDA will work more closely together to ensure that Apple’s plans don’t run afoul of FDA’s requirements (it’s good to be Apple).

Weird News Andy questions whether this was really the “responsible” anesthesiologist. Washington’s health department suspends the license of a Seattle anesthesiologist for sexting during surgeries, accessing patient images for sexual gratification, and having sex at the hospital. Investigators found 250 sexually related messages he had sent while in surgery, including pictures he sent to patients of his exposed genitalia, one of which he captioned, “My partner walked in as I was pulling up my scrubs. I’m pretty sure he caught me.” 


Sponsor Updates

  • Greenway customer ARcare (AR) earns recognition as Stage 7 of the HIMSS Ambulatory EMR Adoption Model.
  • Impact Advisors is named to Crain’s Chicago “Fast 50 List” of high-growth companies.
  • A pMD blog post addresses “Medical scribes: the solution to EHR inefficiencies, or just a temporary bandage?”
  • First Coast Cardiovascular Institute (FL) reduces charge lag after going live on MedAptus charge capture.
  • Kareo and ChartLogic partner to deliver cloud solutions for surgical, orthopedic, and otolaryngology specialties.
  • Gartner names AirWatch as a Leader in the 2014 Magic Quadrant for Enterprise Mobility Management.
  • Verisk Health SVP Matt Siegel will moderate a panel discussion on value-based healthcare at AHIP Institute June 12 in Seattle, WA.
  • Truven Health Analytics launches its cost-sharing reduction analysis and reconciliation solution for health insurance exchanges.
  • Merge Healthcare is hosting a Coding Contest for Computer Science students June 11 at the University of Waterloo in Canada.
  • ADP AdvancedMD supports the Greater Springfield Habitat for Humanity during a corporate team-building day.
  • NaviNet collaborates with Informatica to deliver a “smart” network.
  • E-MDs will offer Lightbeam’s population health management solution to its clients.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
June 10, 2014 News 12 Comments

Curbside Consult with Dr. Jayne 6/9/14

June 9, 2014 Dr. Jayne 5 Comments

I mentioned that I was planning to start working in an urgent care that documents patient visits on paper. I fell into an opportunity with an independent facility and worked my first shifts this week. A reader asked if I had mentioned during the job interview that I would be blogging about my work and whether I’ve been able to remain anonymous in my various work roles.

The answer to the blogging question is “no.” I enjoy my day jobs and wouldn’t want to jeopardize them. Although I share many stories about my work, there are a great many stories that don’t get told because they might result in specific people or organizations being identified. Some of the best tales will go with me to the grave.

A reader once said that as a CMIO, I’m still a doctor, but my patients are sick hospitals and physician offices. That’s true to a degree and I guard their information as I do with patient information. Often my material reflects events that are so common they could apply to many organizations across the country, so camouflaging the events and players isn’t necessary.

As far as my clinical duties, I do think I’ve been able to remain anonymous. Frankly most clinicians in the trenches are too busy keeping their heads above water to even know that there’s an entire health care IT community out there. They may not know who their own CMIO is or what he or she does, let alone that there are scores of us who know and talk to each other. The idea that there would be blogs talking about EHRs and the people who use them to torment physicians isn’t even remotely something that would cross their minds.

If I use photos from work, it’s often months after they were originally taken or in a slightly different context than where I obtained them. I have a veritable treasure trove of photos I’ll never be able to use because they would be easily identifiable or involve people that I know read HIStalk. I also use photos that have been sent to me by readers when they can help embellish something I’m writing about. Hopefully if anyone recognizes those, the story is different enough from their reality that they don’t make the connection.

Back to the world of paper records. I arrived at the office ready to go. It’s a little different vibe from working the ER. The lack of a metal detector and security guard was refreshing, although I admit after my first procedure, I missed wearing scrubs.

The physician I worked with was quick to show me the processes and systems. Staff does the intake interview, gathers the history, and performs any needed pre-testing based on a written standing order. The clipboard goes in the door with a magnet to indicate which patient should be seen next. Simple and elegant, although low tech.

The physician sees the patient, documents on a paper template (they have a dozen or so templates for their top conditions plus some more generic versions), then comes out and order whatever additional tests are indicated. If there aren’t any, we prepare the discharge instructions and prescriptions, which are done via computer. The prescription ordering system isn’t sophisticated, but it does have hard-coded selections for the most common drugs, sortable by body system and diagnosis. If you can’t find them, there’s a search dialog, and if you get in a real bind, there’s a paper script pad in the drawer.

I have to reiterate that this is obviously not a practice that is trying to achieve Meaningful Use. As an opt-out site, we’re not asking super-detailed questions about smoking history or the types of tobacco used. We’re not asking race and ethnicity. We’re not codifying problems in SNOMED. Since we’re not part of a hospital system or accredited by The Joint Commission, we’re also not spending time assessing suicide risk, nutritional status, or any number of possibly irrelevant scenarios on all our patients. This leaves us time to actually see our patients at a reasonable pace.

Even though the first part of the shift was fairly busy (5-6 patients per physician per hour), the pace didn’t seem extreme. I think mostly it felt like I was able to focus on the patient’s current needs and not feel expected to address unrelated issues just because someone made a regulation that said I needed to.

Once the provider is finished, the nursing staff then takes the discharge instructions and scripts, goes back in the exam room, counsels the patient, and addresses follow-up needs. Then the patient gets to go home. Their plan may not have all their medications printed on it nor their list of historical diagnoses, recent vitals, or a host of other things, but it does have the information they need to care for today’s problem and to follow up with their primary care physician.

Up to this point, I’ve focused on the things that made today easy. Let’s talk about what made it difficult.

The first thing that jumped out at me was the fact that there is no drug or allergy checking when we write prescriptions. Although physicians have used paper scripts for years and there are plenty of people who argue that we were better on paper, I can’t help but think that I’m going to harm someone because I don’t have technology backing me up.

I calculated most of my weight-based pediatric prescriptions two or three times because I didn’t trust myself. I had one pharmacy call-back for prescribing a drug that might have had a mild to moderate interaction with a patient’s current medication. I know it would have flagged in an electronic prescribing system, but I’m wondering if there is a chicken vs. egg phenomenon going on. Did I miss the interaction because my vigilance was weakened by my reliance on technology? Or would I have missed it anyway?

I ended up customizing 80 percent of the patient education materials to include additional precautions or information that I like to provide for my patients. Most EHR systems would allow some level of saved customization. but our discharge system doesn’t. I’ll likely create a text document of common phrases that I can use to populate them in the future and just keep it open on my desktop.

Unlike some chain or pharmacy-related urgent cares, we don’t have an easy way to send information back to the primary care physician. It’s something that definitely merits discussion with my new employer.

Looking at the workflow with a critical eye, there were other inefficiencies. Staff had to transcribe lab data to the chart that might have been interfaced with an EHR. Patient education topics had to be searched manually rather than linked from diagnoses. These inefficiencies were virtually unnoticed, though.

Having done more than one stint as a science fair judge, I can’t say this was a valid experiment of any kind. Comparing this practice (regardless of whether it uses paper or EHR) to any other place I’ve practiced in the last several years would be like comparing apples to unicorns.

One major difference is the ability to focus on the patient’s presenting problem rather than extraneous but required information. Another is the encouragement to rely on support staff for tasks like order entry and diagnosis code lookup. It’s been so long since I was just able to articulate a diagnosis without codifying it that I didn’t know what to do with myself.

Whether it was due to the workflow process, the patient acuity mix, or other factors, I noticed one thing. Even after 12 hours of non-stop work, I felt like I had spent more of my day being an actual physician than in doing other tasks. We’ll have to see if I still feel this way in six months, but right now I’m cautiously optimistic. I’m still going to lobby for e-prescribing, though.

Have a story about going back to the basics? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
June 9, 2014 Dr. Jayne 5 Comments

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

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

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Follow

Reader Comments

  • Brian Too: Re: Hiring a P-T analyst for the cost of a F-T analyst These situations are caused by a policy or process that is on...
  • #superbowlbowels: I had similar thoughts about the OIC commercial, which was followed later by a pink intestinal mascot "gut guy" running...
  • George W: Quick correction: Skagit Valley is in Washington, not Alaska...
  • Kermit: Re: Senate health committee. Noticed "Directs the GAO to conduct a patient matching study within one year." It's an on-g...
  • One more comment....: Re: your comment "when I heard an ad pitching a prescription drug for treating opioid-induced constipation. We must have...

Sponsor Quick Links