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Morning Headlines 12/9/14

December 8, 2014 Headlines No Comments

The Federal Strategy For Collecting, Sharing, And Using Electronic Health Information

ONC has updated its Federal Health IT Strategic Plan: 2015-2020, establishing a set of goals that focuses on advancing interoperability, improving care delivery, engaging patients through digital health tools, and supporting medical research efforts through data mining and retrospective studies.

Why So Many New Tech Companies Are Getting into Health Care

Bob Kocher, MD, a former healthcare economics advisor to the Obama administration, publishes a piece in the Harvard Business Review analyzing the digital health innovation boom in the US, and the cost-saving opportunities that the new startups should be targeting.

Walgreens app makes virtual doctor visits a reality

Walgreens partners with telehealth vendor MDLive to provide virtual visits through its mobile app. The new service now available for residents of California and Michigan, with additional states coming online in 2015.

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December 8, 2014 Headlines No Comments

Monday Morning Update 12/8/14

December 6, 2014 News 5 Comments

Top News

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Alberta, Canada begins its search for a new clinical information system after a auditor’s report found that the $260 million it spent on EHRs resulted in systems that don’t talk to each other, requiring the continued use of faxing to exchange information. Progressive Conservative Member of the Legislative Assembly says, “Do we realize we need to have data exchange standards before we start adding systems? We need systems to talk. It blows my mind.”


Reader Comments

From Not My First Rodeo: “Cottage Health System in Santa Barbara, CA. Going Epic. Recently hired a project director and is moving quickly to hire FTEs from other regional Epic customers.” Somewhat old news, I think, given that Cottage’s bond rating agency mentioned the planned Epic expense in its July ratings report.

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From The PACS Designer: “Re: Chartcube. It will enhance your presentations of spreadsheets. Collaborate with colleagues using your iPad to focus on the really important elements of your spreadsheets.”


HIStalk Announcements and Requests

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I hereby acknowledge the will of the people in proclaiming Atlanta as the official “Healthcare IT Capital of the US.” Atlanta’s health IT network and civic pride turned out the vote with 45 percent of the 1,600 votes cast (including mine). Congratulations to the “Home of Peach Trees and HIT” (the only peach trees I know there are the 100 or so streets named that, but surely they must grow somewhere among all the concentric asphalt rings). New poll to your right or here: do you look forward to going to work Monday mornings? Vote and then click “Comments” to explain.

It’s a very slow news season and that situation will likely continue over the next few weeks. I could do as the industry rags do and simply pad out this post with endless paragraphs covering non-newsworthy topics, crank out poorly thought out editorials that say nothing new, or pretend that pointless announcements deserve extensive coverage and an easily churned out backstory containing mostly unrelated historical facts. However, I’ve decided (as I always do) that instead I’m going to avoid wasting your time and mine and give you a few minutes (and me a few hours) of your life back. I promise I haven’t omitted anything important and I will continue to be verbose when events warrants. Meanwhile, I’m going to take the rare opportunity to get off the computer and hopefully do something fun.


Last Week’s Most Interesting News

  • A new JASON report prepared for the federal government says the health IT systems market is moving in the right direction with regard to interoperability, but that initiatives are not complete because systems sometimes only export entire documents, omit patient information, or provide APIs whose use is contractually limited to customers rather than entrepreneurs.
  • HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources).
  • ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.
  • Madison’s alternative weekly newspaper says that Epic has backed down from its plan to extend its non-compete term from one year to two for employees who quit to join consulting firm Vonlay after its acquisition by Huron Consulting Group.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers, executives, and clinicians, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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The Cleveland paper profiles CoverMyMeds, whose CFO predicts it will become a billion-dollar company. The company, with annual revenue of $50 million and growing, doubled its headcount this year to 140 and expects to double it again in 2015 after an undisclosed investment by Francisco Partners. I interviewed co-founder Matt Scantland a couple of months ago.


Sales

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Everyday Health chooses Validic to integrate consumer data into its digital health and wellness platform. Validic announces several more new customers, including WebMD and UPMC, that increase its client population from 80 million to 100 million. The company is presenting and exhibiting at the mHealth Summit this week.


Other

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A brilliant example of for-profit, non-peer reviewed “journals” that publish articles for a fee: two “predatory” scientific journals accept for publication an article containing indecipherable, randomly generated text as submitted by three authors, all of them characters from “The Simpsons.”

The Coalition for ICD-10 responds to the ICD-10-sarcastic comments of a generally IT-whiny AMA President Robert Wah, MD (who has an informatics background and served as deputy national coordinator of ONC, yet somehow now hates everything about healthcare IT) in saying that seemingly wacky ICD-10 codes have good reasons for their use. Example: “Sucked into a jet engine” might seem eye-rollingly hilarious unless you spend 18-hour days on a Navy ship flight deck trying to avoid doing just that. I have to say that I’ve been hoping someone would give Wah (and the AMA) a good spanking for his ridiculous, self-serving rhetoric  and the group did exactly that:

Dr. Wah complains about the number of codes and the detail in ICD-10 but fails to mention that much of the additional specificity in ICD-10 was at the request of medical specialty societies. Nor does he mention that there are no ICD-9 codes for many critical healthcare issues. There is no code to report and track Ebola. There are inadequate codes for tracking service-related health problems for our veterans. There are no codes to help us research sports-related concussions among young athletes. It’s hard to understand why the AMA is not demanding that this kind of information be available in our national data.


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.

 

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December 6, 2014 News 5 Comments

Morning Headlines 12/5/14

December 4, 2014 Headlines 1 Comment

HL7 Launches Joint Argonaut Project to Advance FHIR

HL7 will work with a large consortium of vendors and health systems to develop a standardized data sharing API and a set of common vocabularies that all EHR vendors could adopt to exchange discrete data and improve interoperability.

Computer-Generated Vs. Physician-Documented History of Present Illness (HPI): Results of a Blinded Comparison

Researchers created a computerized questionnaire that collects clinical data from both patients and providers and then produces a narrative history of present illness. A panel of 48 physicians then blindly evaluated them against physician-documented HPIs, concluding that the computer-generated HPIs were more complete, more useful, more succinct, and better organized.

State says it has repaid $1.3M in overpayments

Massachusetts pays back $1.3 million in Meaningful Use incentive payments after a federal audit found that local hospitals received $2.1 million in overpayments. Representatives from the state Medicaid agency report that the remaining balance will be subtracted from future payments to the overpaid hospitals.

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December 4, 2014 Headlines 1 Comment

News 12/5/14

December 4, 2014 News 10 Comments

Top News

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HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources). Working with HL7 will be athenahealth, Beth Israel Deaconess Medical Center, Cerner, Epic, Intermountain, Mayo, Meditech, McKesson, Partners HealthCare, SMART from Boston Children’s, and The Advisory Board Company. HL7 says the group will create FHIR-based EHR data sharing API specification by the spring of 2015. The big news here: (a) the second JASON report called for a big vendor to propose an open API standard instead of waiting around for the government to do it; (b) FHIR and APIs are a heck of a lot better than today’s document-based interoperability standards and probably better than the customized jungle that the HL7 standard has become; and (c) getting Epic, Cerner, Meditech, and McKesson together at the same table covers nearly all of the hospital EHR market and Epic, particularly, is a key member given its non-participation in CommonWell (and Epic and Cerner already have customers using APIs).

I asked an expert who shall remain unnamed to summarize Project Argonaut:

Project Argonaut is beginning the hard work of not only formalizing the API calling sequence (the easy part and something most vendors already do), but to formalize a set of vocabulary objects – Problems, Allergies, Notes, etc. with controlled vocabularies and predictability. To make FHIR really work, both must be done well. If FHIR succeeds, it will allow third parties to create an “app” and be able to run it in any FHIR-compatible system without the meet and map exercise with each implementation. What we’ll need to do with FHIR is to ensure people don’t get ahead of themselves and customize the “resources,” otherwise we’ll be back in the same boat as HL7 v2. FHIR is at the peak of inflated expectations. It will be great as a minor plug-in where there’s a UI or visualization, but not so great for machine-to-machine communication where one of the endpoints might not always be reliable for high-volume transfers at scale – some of the simpler web service configurations can be horribly inefficient, like making separate grocery store trips for each item on your list. There may be audit and security issues as well.

I asked another expert how the Argonaut Project might relate to CommonWell:

There is no immediate connection, but over time, CommonWell could add services that are based on the FHIR standard that the Argonauts are trying to speed up. For example, CommonWell today uses XCA to move CDA documents around, but that can be cumbersome if all the doctor wants is to get a list of known allergies from some other site. FHIR makes the later query much easier than using XCA to move a "fake" document that contains only allergies. So, CommonWell will benefit from the success of the Argonaut work (assuming it’s successful!) But otherwise, there is no direct connection, though some of the same people are involved with both.


Reader Comments

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From Ken L. Ration: “Re: HIMSS. Our designer got a good laugh from this HIMSS15 promotional graphic. One thought it was an attempt to be edgy, but the general consensus is that it’s a marketing fail.” I think it’s an insightful graphic: those benzene ring-shaped items are probably snowflakes burying HIMSS attendees who would much rather be almost anywhere else — Chicago came in seventh of 11 desired HIMSS cities last time I surveyed, with the clear winners being San Diego, Las Vegas, and Orlando.

From Roy G. Biv: “Re: physician billing services. Do health systems keep using them after implementing Epic? Could you ask your readers if, for instance, the keep using athenahealth’s PM and billing service post-Epic?” Readers have been duly notified – responses are welcome.

From HIT5982: “Re: Medhost. Let 71 people go Wednesday all at once. HR cleaned out their desks while they were being told. I was one of them – I worked in the department division (EDIS, Patient Flow, perioperative) and was told the emphasis will shift to Enterprise (clinicals, financials, patient access, revenue cycle). Departmental sales were down this year.” Reported by two readers. I reached out to the company for a response but didn’t receive one. Nothing says Christmas like being laid off.

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I shall digress and pontificate on the topic of layoffs. I’ve seen both sides over the years: (a) I was literally on my way out the door before getting a last-minute reprieve in my one and only vendor job many years ago, where layoffs every quarter were a given as executive bonuses became threatened by poor financial numbers mostly due to their own poor decisions; and (b) I have personally marched at least 20 people out of the hospital IT department through a gauntlet of their peers as I served as judge, jury, and executioner for high-level decisions that I neither made nor agreed with. Both situations were largely created by clueless, spreadsheet-circulating executives who were shockingly indifferent to the havoc they were wreaking on the lives of people and their families. While some of the folks who get axed deserved it and should have been canned a lot sooner, many of them had been given perfectly fine performance evaluations but were singled out for factors beyond their control: changing organizational strategy, their own demographics, higher salaries that they had been voluntarily offered to them, and doing their jobs every day instead of kissing executive butt and backstabbing their co-workers. Readers regularly send me personal stories about being cut loose and I always provide the same response: you’ll be better off in the long term because who wants to work for a company that lays people off? To people all over the industry who have to face the holidays (and their families) with uncertainty, fear, and feelings of personal inadequacy for whatever reason, I am truly sorry. It will get better.

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From Pierre Dukane: “Re: slimy companies. This site [URL omitted] charges consultants $300 per quarter to be on the ‘elite’ list for go-live job notifications, using information it gathers from other members and online job postings (duh). The ‘About’ page doesn’t say who runs it and the domain registration information is blocked. I can’t believe people pay for this garbage. Also, an HIT consulting firm’s recruiter is sending emails offering entry into a gift certification drawing if they ‘forward any email you receive from another recruiter or company regarding current opportunities or referral incentives.’ What happened to working the old-fashioned, honest way? No wonder clients and consultants feel so negatively about consulting firms.” It wasn’t hard for me to track down the operator of site you mentioned, which doesn’t seem to be offering much for $1,200 per year. But hey, it’s a free country, and he’ll either get business or he won’t depending on the value he provides. I’ve had both good and bad experiences with recruiters that I’ve either hired or been placed by, but I agree that quite a few questionably motivated people see it as nothing more than making easy money by matching Resume A to Job Posting B. Nearly everything in life can be explained by supply vs. demand.

From Elsa: “Re: BJC’s core clinicals replacement. Vendors were to have been notified Friday. I was shocked that it wasn’t Cerner – my source says it’s Epic. Not sure how they’ll justify the cost when they laid off staff, cut charity care, and froze raises.” Unverified.

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From Not Quite: “Re: JASON report. ONC is putting a lot of stock in it, but it’s a fake that is partially plagiarized from Wikipedia. The report lists many references, but fails to list Wikipedia, from which many things were copied. ONC should ask for our money back!” No report should ever reference Wikipedia since it’s not a vetted reference, but hopefully the JASON folks cited their primary references properly, at least where a source contained something that isn’t common knowledge.


HIStalk Announcements and Requests

Voting for the US capital of healthcare IT has been heavy, with Madison leading the pack and Nashville and Boston pulling up as a distant second and third. Voting ends this weekend – my poll is here.

This week on HIStalk Connect: Data scientists with athenahealth are monitoring the onset of the 2014-2015 flu season and note an early uptick in flu-related visits. Google is said to be revamping the internal components of Google Glass in an effort to boost battery life. Personal genome testing startup 23andMe will begin selling genetic tests in Canada and the UK after a year of trying and failing to secure FDA approval for US sales. 

This week on HIStalk Practice: Payers in Colorado build online claims data-sharing tool for physicians. HIPAA compliance at physician practices is found to be woefully lacking. Gila River Health Care goes with NextGen, while Advocate Community Partners selects eClinicalWorks. Practice Fusion VP argues for net neutrality, while Amazon takes advantage of lightning-fast consumer Internet connections. AMA winner Nancy Adams asks, “Interoperability? How about achieving operability first?” Thanks for reading.


Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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Integrated payments network vendor InstaMed raises $17 million in a private placement, $2 million more than it was seeking.


Sales

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Rio Grande Valley Health Alliance (TX) and Lakewood Health System (MN) choose Lightbeam Health Solutions for population health management. I interviewed CEO Pat Cline a few months ago. 

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Western New York’s HEALTHeLINK HIE chooses Stella Technology’s clinical data access technology for analytics and reporting.

Children’s Hospitals and Clinics of Minnesota chooses Strata Decision’s StrataJazz for decision support and cost accounting.

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Granite Health Network (NH) selects athenahealth’s athenaCoordinator Enterprise Population Manager.

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The Medical Center at Bowling Green (KY) chooses ProVation Medical for its cardiac cath lab.


People

CompuGroup Medical US promotes Navid Asgari to VP of service and support for its ambulatory information services division.


Announcements and Implementations

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Lehigh Valley Health Network (PA) announces that its physician group will move to Epic.

Levi, Ray & Shoup announces release of a new user interface for Epic users of its VPSX output management solution.

Imprivata announces OneSign 5.0, a new version of its authentication and access management product.

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Children’s National Health System (DC) opens an Innovation and Learning Center to house Bear Institute, its partnership with Cerner. The announcement is confusing, but I think it’s just a new physical space to house the existing project, which was announced just over a year ago.

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CareSync launches its Chronic Care Management service that allows providers to earn Medicare’s monthly CCM payments.

Perceptive Software launches Perceptive Interact for Google Apps, which allows users to integrate Gmail content into Perceptive Content for review, routing, and collaboration.


Government and Politics

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ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.

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Someone tweeted out this fascinating article from March called “Sinkhole of Bureacuracy,” which describes the 600 federal government employees who push paper in the abandoned limestone mine run by Iron Mountain in the middle of nowhere in Pennsylvania at a cost of $56 million per year. Previous federal government automation efforts of the government’s retirement program failed despite spending well over $100 million. A former employee described the manual process as, “I used to chase people for months — literally — for one signature on one piece of paper. You want to talk about an egregious waste of taxpayer money? … On a daily basis, we would get from five to 50 e-mails, asking everybody to take time out of their day to search their desks for case files.” The article says the old mine is legend in the federal government, quoting former CTO Aneesh Chopra as calling it “that crazy cave.”

Massachusetts says it has repaid most of the $2.1 million in Medicaid EHR incentives that were incorrectly given to 19 hospitals that were identified by the HHS OIG. The state blamed requirements that are hard to understand and hospitals that reported incorrect data to the federal government.


Innovation and Research

A small study finds that a computerized symptom questionnaire that was turned into a History of Present Illness narrative using computer algorithms created a better HPI than physicians doing it themselves.


Other

Hospitalists at two Oregon hospitals form a union, hoping to remain as hospital employees rather than being outsourced to a national firm.

A review of a tiny sample of the 100TB (!!) of data hackers took from Sony finds medical information, in the form of doctor letters for medical leaves of absence. The responsible hacker group, possibly from North Korea, has posted some of the information publicly, including salaries, scripts, and video files of unreleased Sony movies. The hackers also released a Word document titled “Passwords” that some idiot Sony executive had used to store all of his computer passwords and credit card information. Sony was burned by hackers in 2011 who stole credit card numbers and took down its PlayStation network for weeks. 

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New York police arrest radiologist James Kessler, MD, MPH for copying the information of 97,000 patients of his former employer onto a portable hard drive with intention of starting a competing business.

Singer and cancer survivor Melissa Etheridge, just announced as a keynote speaker for GE Healthcare’s Centricity Live user conference, creates a line of prescription-only “cannabis-infused fine wines” that provide “a delicious full body buzz.”


Sponsor Updates


  • An Imprivata video provides an overview of electronic prescribing of controlled substances.
  • HCS provided 50 tickets to the Los Angeles screening of the overwhelmingly positively reviewed Glen Campbell documentary “I’ll Be Me” in support of Alzheimer’s awareness. The company will be contributing to the Salvation Army through the holidays on behalf of its clients.
  • DataMotion earns accreditation as a Certification Authority and Registration Authority from DirectTrust.org and EHNAC, allowing it to issue and manage digital certificates in addition to its role as an accredited Health Information Service Provider.

EPtalk by Dr. Jayne

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ONC will hold its annual meeting February 2-3, 2015. The email announcement caught my eye in mentioning that “the two-day meeting will gather over 1,200 health IT fans,” but on the registration website, it had been toned down to “health IT partners.” The event includes “an exciting panel of ONC’s former National Coordinators,” according to the email. I’m not sure if that’s enough of a draw to convince me to head to Washington in February. If you’re planning to attend, keep us in mind for rumors and newsy tidbits.

GE Healthcare announces its Centricity Live 2015 meeting April 29-May 2, 2015 at the Walt Disney World Dolphin Resort. Keynote speakers include Atul Gawande, Melissa Etheridge, and LeVar Burton. That lineup looks pretty good compared to some I’ve seen. I stayed at the Dolphin a couple of nights before HIMSS and it’s in a minimally mousey part of the Disney compound. Given the recent weather in my neck of the woods, I’m sure by April I’ll have a complete deficiency of Vitamin D, so if anyone wants a sassy traveling companion, let me know.

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My good friend Anjali called last week asking for a favor. The annual Christmas Party at her hospital (it’s a faith-based institution, hence the name) was looming. Her husband had to travel and she didn’t want to go alone. She’s run three half marathons with me and has had my back in countless clinical situations, so how could I say no? She works at a hospital across town where I only know a handful of medical staff members, so I was looking forward to a holiday party where I could have a couple of glasses of wine without being interrogated about our EHR.

We were a little late heading out. She had picked up a dose of flu vaccine from the local retail pharmacy and was planning to vaccinate her daughter. The pediatrician’s office was already out of vaccine and the pharmacy won’t vaccinate children under 8 even with a physician’s order, so she decided to get creative. Unfortunately, she’s a surgeon with few pediatric vaccine skills, so I was persuaded to step in.

It’s a sad commentary when you have to work the system to vaccinate your child. Most parents don’t have that option, but I was happy to help. Needless to say, that vaccine won’t be making it into the state immunization registry, but I did email her the Vaccine Information Statement so I don’t run afoul of the feds.

The tables were packed when we arrived. We grabbed the first open space we found. We were next to a husband/wife physician couple – she’s a radiologist on staff and he’s an internal medicine physician elsewhere in town. The odds of a physician conversation (regardless of setting) eventually turning to EHRs and healthcare IT is nearly 100 percent if you talk long enough, and tonight didn’t disappoint.

The radiologist is pretty happy with the hospital’s system. She appreciates being able to view the entire patient chart when there are questions about what an ordering provider hopes to achieve with a diagnostic test. She also enjoys not having to help the radiology staff decipher cryptic physician handwriting.

Anjali told them she preferred handling patient messages from home after her daughter goes to bed rather than having to stay in the office. A couple of other people chimed in and I thought for a brief moment that the EHR love fest might continue in the spirit of holiday togetherness.

The bubble was burst when the internal medicine physician started complaining about his EHR. He complained of the burden of data entry with little return. He said he didn’t understand why there wasn’t any data exchange with other practices or hospitals or why he doesn’t have access to reports on his patients’ health status.

I asked a couple of questions about his practice and his system and was able to deduce that he is actually on my hospital’s platform, through our affiliate subsidy program. Anj picked up on this as well and gave me a little eyebrow raise. She knows I led deployment of our private HIE more than six years ago and that our users regularly exchange data between owned and affiliate practices as well as our multiple hospitals.

She’s also on the same ambulatory EHR although on a different platform, so was able to provide some positive counterpoints to keep him from going too far. I didn’t want to reveal myself as the owner of the platform due to the potential for turning a holiday gathering into a debate, so I excused myself for another glass of wine.

Most of our providers are satisfied with our system and are seeing the benefits of our patient registries, actionable reports, and interoperability. I’m going to need to get to the bottom of why his practice isn’t having a good experience and figure out what we need to do to get them to the same level satisfaction. I’ve reached out to our affiliate program manager so that I can review his implementation documentation and support tickets to try to identify what might have gone awry. I just wish I had heard about it through or formal processes rather than as an aside at a party.

Anj has never seen me in full Administralian mode and told me she was impressed at how I kept my cool while the physician was ripping apart the system I’ve spent the better part of a decade implementing, optimizing, and personally ensuring that practices receive value for their efforts. I must say I haven’t always been unflappable in these situations, but they have become easier over time. I’ve learned to pick my battles and not let situations get out of control.

We did enjoy some seafood and a nice string quartet, as well as good conversation with other physicians.

Have any strategies for enjoying the company holiday party? 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.

 

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December 4, 2014 News 10 Comments

Readers Write: 10 Talent Trends to Watch in 2015

December 3, 2014 Readers Write 1 Comment

10 Talent Trends to Watch in 2015
By Anthony Caponi

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The entirety of my career has been spent in the healthcare staffing industry. Consequently, I have been at both ends of the spectrum. There were tough times in 2008 and 2009 as the nation’s economic recession spilled into healthcare hiring. Then, as part of the American Recovery and Reinvestment Act of 2009, numerous jobs were created with the promotion of EHR adoption.

The healthcare IT industry is absolutely on the rise. However, we will also see some obstacles, including a talent and skills gap. Below is a list of 10 increasing trends for 2015.

Increasing Mergers and Acquisitions

Healthcare reform is becoming a powerful catalyst for the consolidation and integration trend in the hospital industry. A study conducted by Kaufman Hall found that hospital mergers and acquisitions increased 10 percent in the first quarter of 2014 compared with the same time frame the previous year. Overall, studies indicate a continuation of several trends, including increasing numbers of acquisitions. These mergers and acquisitions that are taking place are resulting in a number of highly qualified CIOs in the job market.

Big Data Employment Boom

The data economy needs dedicated people — 4.4 million of them by 2015 in the IT field alone, according to a Gartner Research analysis. In the U.S., a McKinsey & Company report projects a shortfall of between 140,000 and 190,000 big data professionals with deep analytical skills by 2018. Additionally, the impact of big data on employment goes far deeper than the deep analytics and IT fields. Companies need professionals at all levels that are not necessarily educated in deep analytics but are nevertheless big data-savvy.

New C-Level Positions

The chief data officer (CDO) is a new position coming into play in the healthcare IT industry. Hospitals are using the role to try to "leverage data as a strategic institutional asset … It’s about how to transform data into information, how to transform information into better-informed decisions," according to Seattle Children’s Hospital CDO Eugene Kolker.

Another position that is becoming more popular in the healthcare IT space is the chief nursing information officer (CNIO). According to a Modern Healthcare report, about 30 percent of hospitals and health systems now have a CNIO and that number is expected to grow. CNIOs are helping hospitals implement their EHRs and other healthcare IT projects because of their expertise in how nurses use patient data.

Growing Job Market

The healthcare sector is poised to add 5 million jobs by 2020, according to a report by AMN Healthcare. The increased use of technology for healthcare applications is the primary factor for the growing job market. Healthcare job growth averaged 26,000 positions per month between March and September of this year, jumping significantly in the second quarter and continuing into the third quarter, according to the Altarum Institute’s Center for Sustainable Health Spending.

More Interim Executives

The number of interim executives is growing and the demand for interim talent has become apparent. This trend will become a growing part of the employment movement, especially in healthcare IT-related roles like CIOs and CMIOs. With the expected sizable number of baby boomers retiring, combined with the number of independent delivery networks and hospitals in the U.S., it’s easy to see that the demand will grow. This means that there will likely be a shortage of experienced healthcare executives in 2015, which means demand for interim healthcare executives will only grow over time.

Talent Shortage

As baby boomers retire in record numbers, the healthcare IT industry is feeling the pain of a talent shortage. In an article in InformationWeek.com, Asal Naraghi, director of talent acquisition for healthcare services company Best Doctors, says she “absolutely” sees an IT talent shortage. Tracy Cashman, senior VP and partner in the IT search practice of WinterWyman, also says she sees a genuine talent shortage. "There are more jobs than people who are skilled," she says. While she’s starting to see an uptick in engineering graduates, "we’ve been feeling this since the [dot-com] bubble burst," Cashman says, when college students were worried that all IT jobs would move to India. "And we’re still fighting that," she says.

Universities Offering Healthcare IT Degrees

Cloud computing, big data, mobile technology — three of the biggest trends in IT are changing the way the healthcare industry deals with information and creating a big need for trained healthcare IT professionals. Thus, colleges and universities have started offering healthcare IT as a major, where students learn what it takes to function as a fully capable software developer in any professional environment, but specifically tailor their skills to the rapidly expanding healthcare IT field.

Specialists in Demand

Today’s IT shops don’t just want experience, they want deep experience. “IT organizations are under intense pressure to deliver projects faster than before — and that need for speed necessarily influences IT hiring. The IT generalists, and even some topic generalists, such as infrastructure managers, have found their roles left by the side of the road, as project leaders hire for deep experience in specific niches, such as cloud security, DevOps, and data analysis and architecture.”

McGraw-Hill Education CIO David Wright says, "More and more, the hands-on coders, we’re looking for people who are just really deep in whatever discipline we’re trying to hire." And he isn’t the only one advocating for specialization; Asal Naraghi, Director of Talent Acquisition for healthcare services company Best Doctors, also says, “The trend has gone into more specialized skill sets."

Video Interviewing and Skype More Popular

The use of remote yet face-to-face interactions such as video interviewing and Skype is on the rise. Advanced technology is giving people a way to present themselves with depth and personality to hiring managers and recruiters. In addition, new hires meet the team before they even step in the office.

Interview Process Becoming Lengthier

The interview and hiring process have become more elongated in recent years, a trend that we can expect to see more of in 2015. According to Anne Kreamer, a journalist who specializes in business and work/life balance, “Data compiled for the New York Times by Glassdoor found that an average interview process in 2013 lasted 23 days versus an average of 12 days in 2009. And time-consuming assignments and auditions for candidates … are the new normal.”

Anthony Caponi is vice president of healthcare IT of Direct Consulting Associates of Solon, OH.

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December 3, 2014 Readers Write 1 Comment

Curbside Consult with Dr. Jayne 12/1/14

December 1, 2014 Dr. Jayne 1 Comment

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As much as some of us complain about our jobs or life in the healthcare IT trenches, most of us have a lot to be thankful for. I experienced that first hand this week with an emergency department shift that was unlike any I’ve ever worked.

I was called to work at the last minute. That should have made me suspicious, but it was a post-holiday shift so I figured it was just poor planning on someone’s part.

To start things off, the entire hospital was on lock-down due to protests across the country and a specific threat of protests near our facility. Unfortunately, there wasn’t any mechanism to communicate that to staff members in advance.

The only entry is through the main lobby. Nurses, patient care techs, and physicians were wandering around the building swiping our badges since we didn’t know what was going on. Once people got to the other side of the building and made their way in, they were late for their shift, which is never a good way to start.

Instead of having clear communication from hospital leadership (not like we all have email addresses or anything), we had to rely on what people had heard through the rumor mill. About 30 minutes into the shift, we finally got a straight story from the charge nurse. It didn’t make any difference to the way we were caring for patients, but it allowed us to mentally prepare for what might be coming our way should we have an actual protest at the hospital or receive casualties from nearby incidents.

Mentally preparing was all we could do since there apparently isn’t a policy and procedure for how to handle civil unrest. The other doctor on shift with me joked that we were ready to handle Ebola, yet had no plan for something that was actually likely to happen given recent events.

I fired up Twitter on my phone and immediately subscribed to the local media, figuring that would be a decent way to keep tabs on the situation. All of the local TV stations had been blocked by IT, but one of the EMS guys pulled up Broadcastify at the nursing station, which let us hear police scanner traffic. Patients were another good source of information since the threat of a protest certainly didn’t keep anyone from coming in.

As a safety-net facility, the staff is used to working under stressful conditions. Most took it in stride. I work at this hospital only a handful of times each year and it always impresses me how well it holds together even though there may be a substantial amount of duct tape and some baling wire involved.

I was running the fast track side of the ED, so I didn’t expect to see any major trauma if things got rough, especially since the hospital lowered their trauma center level a couple of years ago. In the morning, most of my cases were truly primary care – people who had run out of their medications due to the clinics being closed and not having refills, sinus infections, colds and flu, and so on.

I was grateful for the defaults in my EHR that let me document the visits quickly since our volume was picking up. Towards the lunch hour, there was an announcement that protesters were at an intersection about a quarter of a mile from the hospital. We expected things to slow, but they didn’t.

I saw a couple of Thanksgiving-induced casualties (pro tip: if you cut yourself while cooking, you need to have it stitched up within 12 hours or there’s not much we can do) including a woman who had her hand smashed in a shopping center door during the Black Friday madness. What really made me think of Thanksgiving, though, was realizing just how many times I had searched for non-English versions of patient education handouts during the shift. As much as we sometimes complain about EHRs, this time ours performed like a champ.

I looked through my “complete chart” board and realized I had seen patients from Somalia, Ethiopia, Bosnia, Iraq, Guatemala, Mexico, and China. It’s powerful to know that despite its flaws, we live in a country where people are willing to leave their homes and families for a chance at something better.

Ultimately, the protesters never approached the hospital. Other than being one of the busiest shifts I’ve ever worked, it was pretty unremarkable. I feel privileged to be able to care for such a diverse population and am definitely glad the EHR was up to the test.

Have a story about the EHR actually making life easier? Email me.

Email Dr. Jayne.

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December 1, 2014 Dr. Jayne 1 Comment

Monday Morning Update 12/1/14

November 30, 2014 News 3 Comments

Top News

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Cloud solutions provider 8K Miles Software Services acquires 30-employee Epic consulting firm SERJ Solutions. 8K Miles says it will use the newly acquired expertise to create cloud-based healthcare solutions. I was curious about SERJ’s self-proclaimed marketplace difference, which it describes as follows: “Through our unique and multi-faceted approach, SERJ is able to ensure your EHR implementation is successful by providing strategic and subject matter expertise, software tools to increase productivity and provide an immediate return on your investment, and a proven post-implementation support model.  We are committed to our clients, every step of the way.” Here’s a challenge: name one consulting firm’s “why we’re different” statement that suggests that they really are different in specific ways. I’m not saying there aren’t any, just that they are rare. 8K Miles is headquartered in San Ramon, CA and has an office in Chennai, India, which might explain why all seven members of its leadership team have Indian names. Meanwhile, even though 8K Miles declined to announced what it paid for SERJ, its CEO tells a financial site in India that it paid what I think is $2.5 million cash (if I did the conversion from Rupees Crore correctly) plus a potential earnout, with SERJ taking in annual revenue of $6.4 million.


HIStalk Announcements and Requests

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Half of the respondents to my poll say they’ll use less IT-related consulting in 2015 as they did in 2014, with 14 percent predicting they’ll use more. New poll to your right or here, in a repeat of my 2011 poll that named a clear and possibly surprising winner: which city has the strongest claim to call itself the US capital of healthcare IT? Perhaps the winning metropolis will arrange an official and expense-paid visit for the award-bearing HIStalk delegation.

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Some folks involved with CommonWell Health Alliance have offered to answer questions from HIStalk readers after seeing several comments here. Send me anything you’d like to know about its technology, plans, business model, or anything else and I’ll get their response.

This week on HIStalk Practice: MediGain acquires Millennium Practice Management Associates. HIE-sponsored patient portals face an uphill adoption battle, while Epic’s portal wins rave reviews. Notes from the Health IT Leadership Summit. Dr. Gregg offers “It Do and It Don’t” observations on the impact of MU. Drchrono integrates biometric authentication into its EHR. James Stevermer, MD answers five questions. PracticeFusion docs see almost zero patient demand for wearable data integration. MD Mama puts being thankful in perspective.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

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Listening: new from Brooklyn-based power pop band Nude Beach, which sounds like Tom Petty singing lead for The Replacements. I’m also revisiting concert video from the best live band in the world: Sweden’s The Hives, featuring the singer Mick Jagger wishes he could be, Howlin’ Pelle Almqvist.


Last Week’s Most Interesting News

  • ECRI Institutes includes missing or incomplete EHR information in its “Top 10 Health Technology Hazards for 2015”
  • CMS extends the 2014 Meaningful Use attestation deadline from November 30 to December 31 because its attestation software wasn’t ready in time.
  • Beth Israel Deaconess Medical Center (MAI) pays $100,000 to settle a state complaint involving an unencrypted stolen laptop.
  • In Canada, a Montreal newspaper agrees with the health minister that the province’s $500 million EHR project is “an abysmal failure.”
  • Emdeon announces that it will acquire Change Healthcare for $135 million. Change Healthcare markets a benefits management system focused on helping employees make the most of their health benefits,

Acquisitions, Funding, Business, and Stock

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Vivify Health receives a reported $15 million in Series B funding. The Plano, TX-based company offers remote patient monitoring and care coordination tools.

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Vista Equity Partners will buy British software vendor Advanced Computer Software Group for $1.14 billion. The company’s healthcare-related offerings include a community-based EHR and software for home care, ED, and long-term care.


People

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James Parks, former CIO of Box Butte County General Hospital (NE), is sentenced to three years in prison for storing child pornography on his hospital PC, discovered by his own IT staff who were investigating a hospital-spread virus that originated on his device.


Announcements and Implementations

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Johns Hopkins Nursing magazine covers the September switch of Johns Hopkins Bayview Medical Center from skilled nursing facility to specialty hospital, which including moving it from paper to Meditech.

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GE Healthcare announces keynotes for its Centricity LIVE 2015 user conference, April 29-May 2, 2015 in Orlando: Atul Gawande, MD, MPH (surgeon and author), Melissa Etheridge (singer-songwriter), and LeVar Burton (actor, director, and the guy who wore what looked like a car air filter over his eyes in “Star Trek: The Next Generation”).


Innovation and Research

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VGo telepresence robots, tablet devices, network equipment, and software from Vecna Cares are sent to Ebola treatment units in Liberia, moving paper-based recordkeeping to electronic. Robotics researchers hope the telepresence robots can serve as interpreters, deliver supplies, decontaminate equipment, and bury deceased Ebola patients.


Technology

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An MIT Technology Review article titled “Google Glass is Dead; Long Live Smart Glasses” says interest in Glass has rapidly evaporated as Google has lost key personnel and failed to advance the product from geek beta experiment to consumer mainstream. The article says Glass’s biggest problem is the way “Glassholes” look wearing the device and concerns by those nearby that they are being unknowingly recorded. The article says the technology is fine, but the form factor needs to evolve so that the technology is hidden within the glasses instead of being perched like a prism on top of them, perhaps even being incorporated into a contact lens. It’s a tough break to have developed an entire business around an orphan product that may never make it out of beta. Meanwhile, disillusioned Glass Explorers are trying to unload their devices on eBay for less than the $1,500 they ponied up to get preview versions.


Other

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Gilbert Lederman, the former director of radiation oncology of Staten Island University Hospital (NY) will pay $2.35 million to settle Medicare fraud claims. He is best known for (a) his hospital commercials that ran on New York radio; (b) pestering a dying George Harrison to sign his son’s electric guitar; and (c) turning his office walls into a self-promotional billboard, as described by New York magazine as, “the kind of celebrity shrine you see in Italian red-sauce joints.”

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An internal email provided by a reader contains more details on the Epic outage following its October 26 go-live at England’s Cambridge University Hospitals Foundation Trust.

University Hospitals (OH) fires an employee for inappropriately accessing the electronic medical records of 692 patients.

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At least 5,000 Russians, many of them doctors, march through Moscow to protest a healthcare reform plan driven by sagging oil prices and Western sanctions that would eliminate up to 10,000 physician jobs and close 28 hospitals and clinics in the next few weeks. Proponents say the actions are necessary to enact President Vladimir Putin’s pledge to increase physician salaries to twice that of the average employee by 2018.

An Annals of Family Medicine editorial written by ADFM’s Education Transformation Committee says medical school graduates require EHR competence that can be gained only by first-hand experience, recommending that supervised, patient-centered EHR use be added as an Entrustable Professional Activity even though some medical schools bar such access since students aren’t allowed to bill for their services.

The always-entertaining folks at pMD post Thanksgiving-related ICD-10 codes on their blog:

  • W61.42XD – Struck by turkey, subsequent encounter (drily noting, “If you find yourself confronted with a live turkey, you may want to rethink your Thanksgiving strategy”).
  • W29.0 – Contact with powered kitchen appliance, subsequent encounter.
  • K21.9 – Gastro-esophageal reflux disease without esophagitis (aka “heartburn and indigestion).
  • W52.XXXA – Crushed, pushed or stepped on by crowd or human stampede, initial encounter (a Black Friday special).
  • W22.02XA – Walked into lamppost, initial encounter (alcohol-fueled parade mishaps).

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The career development team at Besler Consulting ran a Thanksgiving food drive for the South Brunswick, NJ food pantry.

Also running a holiday food drive, this time a virtual version: Aprima employees are collecting money for the fifth year for Metrocrest Social Services, which serves communities near the company’s offices in Carrollton, TX. They like the “virtual food drive” idea because the organization pays less than retail and can provide fresh foods instead of just canned goods. Last year Aprima’s employees provided more than six tons of food, double that of the previous year. 

 

Vince Ciotti’s inaugural CLAS Report names Epic #2 in a very important category, with the billionaire-led company losing to a thousandaire who packs a size advantage.


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.

 

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November 30, 2014 News 3 Comments

News 11/26/14

November 25, 2014 News 2 Comments

Top News

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ECRI Institute announces its “Top 10 Health Technology Hazards for 2015”:

  • Setting medical alarms incorrectly.
  • Incorrect or missing information in EHR and other IT systems.
  • IV line mix-up.
  • Inadequate sterilization of surgical instruments.
  • Ventilator alarms incorrectly set to warn of disconnection.
  • Improper use and failures of patient-handling equipment such as lifts.
  • Inadequate training on robotic surgery systems.
  • Inadequate cybersecurity for medical devices and systems.
  • Lack of hospital resources to manage medical device recalls and software updates.

Reader Comments

From Tank Girl: “Re: consulting downturn. Implementation staff augmentation business is tough and rates are down. Strategic IT consulting is good if not on an upswing.” A couple of readers made similar observations – the hardest-hit companies are those that were just reselling go-live bodies without adding much value otherwise.

From Smitten: “Re: Karen DeSalvo’s closing address at AMIA. A remarkable performance. She walked up to the podium in front of several hundred, spotlight in her face, a stapled speech or whatever it was in hand, but no matter. Without glancing at it once, she spoke close to 30 minutes straight, without hesitation or stumbling, and lost neither the story nor the passion. She lacked neither humor or emotion. National Coordinator is nice, but if this woman does not become Surgeon General, then we’re missing a gift-wrapped package on our doorstep. Count this as a wager.” I didn’t see video from her AMIA talk, but here’s her TedXNOLA presentation from 2010.


HIStalk Announcements and Requests

It appears that a spammer is spoofing the email address Imprivata used early this year for HIStalkapalooza announcements. I’ve been getting a ton of junk mail from histalkapalooza2014@imprivata.com with a purported fax link that’s actually a malware page. Obviously you don’t want to click the link even though the return address belongs to a company offering secure communications technology.

Holidays are good times to recognize the contributions of employees, so consider my “Beacon of Selfless Service” award. Managers, peers, and customers can nominate a non-management employee (vendor or provider) who went above and beyond. I’ll also be running recaps of holiday-related company good deeds or celebrations over the next few weeks, so feel free to send those along, preferably with a photo or two.

Apple’s iOS offers a nice option to disable auto-play videos when visiting a site over a cell connection. Every browser should have the option to suppress auto-play videos (including not just Flash-based video, but HTLM5 too). I haven’t found anything that works reliably yet, so I’m still jumping a foot in the air when I click a story on a new or sports site and the video I didn’t want to see starts playing automatically and loudly. I really dislike auto-play video.


Acquisitions, Funding, Business, and Stock

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CareTech Solutions provided a statement following my Monday report that the FTC granted its approval for an acquisition by IT/BPO outsourcer HTC Global Services: “CareTech Solutions has made an ‘Intent to Sell Filing’ with HTC Global Services, a Troy, Michigan based global provider of IT solutions and business processing outsourcing. We are now undergoing the necessary administrative process that goes along with this filing. At this time, there is currently no agreement.”

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HIMSS acquires the Online Journal of Nursing Informatics, a free, quarterly, online-only journal produced by team of volunteers.

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Streamline Health Solutions gets a $10 million credit facility.

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Nuance reports Q4 results: revenue up 6.4 percent, adjusted EPS $0.33 vs. $0.30. Healthcare sales rose 7 percent to make up 47 percent of Q4 revenue. Chairman and CEO Paul Ricci said in the earnings call that revenue is growing and operating margins are stabilizing after two years’ of decline.

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Covisint will depart the Detroit building of its former parent Compuware, moving its headquarters and 250 employees to Southfield, MI after choosing Michigan’s incentive package over offers from Austin, TX and Raleigh, NC.


Sales

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Robert Wood Johnson University Hospital extends its Allscripts Sunrise contract through 2020 and will use TouchWorks as the EHR for its network.

Memorial Healthcare (MI) will replace pagers with Imprivata Cortext.

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Kennedy Health System (NJ) chooses eClinicalWorks Care Coordination Medical Record and Electronic Health Exchange.


Announcements and Implementations

Scottsdale Institute releases an IT strategy report from a CIO roundtable at its September summit, sponsored by Impact Advisors.  I didn’t see anything surprising or particularly insightful in its recommendations from eight big-system CIOs to support hospital consumerism:

  • Focus on the patient and family experience
  • Maximize use of patient portals
  • Implement e-visits and telemedicine
  • Improve use of mobile technology
  • Develop a retail strategy
  • Improve IT security via standards and user training
  • Implement analytics carefully
  • Reduce variability
  • Develop software in-house as needed to fill gaps

Lakewood Health System (MN) will participate in the Medicare Shared Savings ACO of Essentia Health (MN) and will use its Epic EHR under Epic’s Community Connect program. Lakewood went live on McKesson Paragon in 2012.

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TransUnion Healthcare announces that the KLAS’s new patient access report rates the company as the highest-performing vendor for its patient pay estimation and propensity to pay solutions.

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University of Iowa Hospital and Clinics wins the enterprise Davies award. They’re on Epic.


Government and Politics

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CMS extends 2014 Meaningful Use attestation deadlines for hospitals from November 30 to December 31, primarily because CMS didn’t get its own software ready in time to meet the original date.

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The CEO of 49-bed Magnolia Regional Medical Center (AR) tells its board that the hospital had to return $287,000 in HITECH money after undergoing a Meaningful Use audit.

A draft bill created by Senators Orrin Hatch (R-UT) and Michael Bennet (D-CO) would limit FDA’s jurisdiction over EHR and other medical technology that its authors label as having low risk to patient safety.


Innovation and Research

A literature review concludes that corporate wellness programs increase employer healthcare costs while providing no net health benefit.


Technology

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Proof that Twitter’s user interface is somewhere between baffling and maddening: Twitter’s CFO accidentally tweets out to the whole world (instead of his intended individual recipient) an acquisition-related message.


Other

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In England, a county review of the $300 million Epic implementation of Cambridge-affiliated Addenbrooke’s Hospital finds that ED performance dropped 20 percent after go-live and the ED had to go on diversion after the system went down on November 1. Hospital executives have been denying significant problems, admitting only minor problems with a blood transfusion analyzer interface. Chief Clinical Officer Afzal Chaudhry, MBBS,PhD (above) says the implementation is going well given its large scope.

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Eight hospitals and several practices went back to paper for several hours Monday when a data center power surge took down the IT systems of Eastern Maine Healthcare Systems (ME), which had eliminated 40 IT positions a few weeks ago to reduce annual expenses.

The Cincinnati business paper covers University of Cincinnati Medical Center’s eight-patient clinical trial in which tablet-powered systems from Intel-GE Care Innovations are being used to monitor discharged liver transplant patients.

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An article written by a former advertising executive and Presidential speechwriter five days before he died of prostate cancer on October 31 describes the fighting between his oncologist and insurer over his treatment. He said he and his doctors followed every rule of Health Republic / MagnaCare, but the insurance company refused to pay after waiting five months to claim his doctors were out of network, ignored his calls, blamed him using for incorrect physician codes, and said his doctors were lying to him about being in network.

For I know now how this company really feels about their customers. It was perfectly expressed in the letter I received last week when they tried to explain why they were turning down my oncologist’s request for that critical cancer test. It was, of course, a form letter. Very legal. “The request for outpatient medical services has been reviewed and has not been certified.” But they gave themselves away with a very strange sentence—their only effort to acknowledge me as a human being. It read: “Member is over 85 year old and continues to smoke.” So, that’s it. According to my insurers, I have already lived too long. And because, until recently, I enjoyed my two or three cigarettes a day, I am a bad boy who is not worth the cost of keeping alive. No wonder they won’t pay.

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The medical license of a New Mexico OB/GYN who is also the incoming president of the state medical society is suspended after charges that he had sex with patients and his employees, was inebriated while seeing patients, left a woman in labor so he could have sex with another patient, and wrote “inappropriate notations of a personal nature into certain patient medical charts.”

Weird News Andy says “8 Million a Second” isn’t Judy Faulkner’s salary, but rather the number of bacteria that are transferred during an intimate kiss, with the result that romantic partners share the same “microbiota” on their tongues for at least hours after kissing and and sometimes permanently. WNA also cites another study in which kissing was found to chemically reduce stress and increase bonding, also observing found that men prefer “sloppy” kisses as a prelude to amorous activity because those kisses transfer testosterone.


Sponsor Updates

  • Salar’s clinical documentation and billing solution, TeamNotes, earns Meaningful Use 2 certification.
  • Fujifilm announces that it has installed 4,000 Synapse PACS, making it the most widely used medical informatics vendor.

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.

 

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November 25, 2014 News 2 Comments

Morning Headlines 11/25/14

November 25, 2014 Headlines 1 Comment

EHR Program Announcement

CMS extends the Meaningful Use attestation deadline from November 30 to December 31.

Congress ponders health IT regs and the FDA, again

Senators Orrin Hatch (R-Utah) and Michael Bennet (D-Colo) are collaborating on a new health IT regulatory bill that would eliminate FDA oversight and remove medical device tax requirements for most EHR and clinical decision support systems.

Validating drug repurposing signals using electronic health records: a case study of metformin associated with reduced cancer mortality

Researchers are turning to EHR data analysis to help them discover potential new uses for existing prescription drugs. Vanderbilt University and Mayo Clinic demonstrated the effectiveness of the approach after correlating metformin, a type-2 diabetes medication, with improved cancer outcomes.

AHA president and CEO to retire at the end of 2015

American Hospital Association president and CEO Rich Umbdenstock announces that he will retire at the end of 2015. AHA has engaged Korn Ferry, a national executive search firm, to find a replacement.

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November 25, 2014 Headlines 1 Comment

HIStalk Interviews Siva Subramanian, SVP Mobile Products, Zynx Health

November 24, 2014 Interviews No Comments

Siva Subramanian is SVP of mobile products for Zynx Health of Los Angeles, CA.

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Tell me about yourself and the company.

My background is in communications technology. I worked as head of product management for Nortel and Avaya, doing their healthcare vertical products, providing communications solutions to hospitals. That’s how I came across the challenges that hospitals faced in coordinating care. Communications was a big piece of this. They needed something more than just phones.

My wife, also the co-founder at CareInSync, was the head of quality improvement and also a hospitalist by training from UCSF and currently at the VA. Her area of research is care transition. That created a perfect storm for me to understand the challenges, understand the customer needs, as well as what the ideal solution could be like, which led to the founding of CareInSync.

 

Several companies are popping up to offer secure messaging and care coordination, sometimes both. How would you define the broad categories and positioning of competitors with ZynxCarebook?

If you can visualize, I draw a layered diagram. At the very bottom layer are basic communications. Whether they are phone or text messaging, whether it’s a secure text or not secure text, doesn’t matter. That’s basic communications that can connect one to many or one to one, most often one to one.

Above that, the next layer is the patient-centered team communications, which involves not just a formation of the team which is around each patient, but tracking of the work flows associated with each of those team members to keep the team structure integrity as the patient moves from one setting to another. That’s care team messaging and work flow that comes about.

Then on top of that, once we have a team that’s delivering care for a patient continuously connected to a solution such as ours, we can now direct evidence-based interventions based on where the patient is, where they’re going, what the roles of the people in the care team are, based on a set of content that’s been proven out, and work flows that have been proven to be efficient and effective. 

We need to have all three layers to deliver outcomes and improvement through healthcare organizations. If you’re doing just the bottom layer, which is what a majority of the basic secure messaging solutions do, then what you’re doing is trading off a phone for a text-based modality. That is an improvement, but it’s marginal at best.

 

When you talked about the interventions that are based on content and work flow, tell me what that means and how the acquisition by Hearst brings that together with the other elements that Hearst offers.

In my previous company, Nortel-Avaya, as a communications company, you could only do so much. You could replace modalities or perhaps make a more efficient connection. But that’s where you stopped.

To  go to the next level, you needed healthcare domain experience to understand the work flow of the 15-20 different disciplines of care team members that connect around a patient, depending whether they are in an acute setting, post-acute setting, or even at home. That required us to work through and work with healthcare organizations to understand that. Of course my wife was a key player in all this.

Then we leveraged a lot of existing interventions that have been proven to improve care transitions, like Project Boost and Project Red. We realized that if we were to grow beyond CareInSync, we needed a more sound footing and a credible footing in the clinical domain, which is to be able to leverage a much bigger bank or library of clinical interventions. That way we can direct all this information to the right people who are now captured by our solution.

That’s why the marriage with Hearst/Zynx became very timely for our group and an appropriate fit. It helped us differentiate from the lower-layer players.

 

What are examples of improving clinical outcomes from tying together communications, content. and work flow?

A very good example that ties all of these three layers together is a patient who is showing up at the emergency department. The patient’s being tracked by a care manager as part of an accountable care organization. The care manager has no idea that this patient has shown up at the ED.

Our solution can automatically alert when a patient tagged as high risk arrives in the ED. The care manager is automatically notified and brought into the team. They can now input into our mobile solutions key risk factors that they are aware of, which are very important for that ED doctor, who is only going to spend probably two or three hours with that patient and then they will either admit them or discharge them from the ED. That information and communication with someone who knows that patient well needs to happen in a matter of seconds, before the ED physician or nurse has taken some action on that particular patient.

Some of our existing customers have made a footprint in navigating the patient away from a high-cost approach to doing what that patient did not ask for versus what is a better approach for the patient preferred based on their choices of being DNR and things like that. They have had very real examples of cost savings as well as improved outcomes for the patient, not to mention better dignity of care for that particular patient.

 

A study just came out showing what most of us in healthcare already knew, that handoffs and changes in care settings are a big problem. Can technology and content be used to improve the handoff process?

That’s pretty much what we do. When we connect the things together, we provide a very concise set of assessment forms that gauge the barriers that this patient is going to have as a transition. For instance, from an acute setting to home. Those barriers then are married, if you will, to interventions that mitigate those particular barriers.

A good example is, if the patient has no transportation and lack of social support, meaning they live alone, then we automatically trigger a notification and invite a social worker into that patient’s team. This patient requires transportation to pick up medication, transportation to their primary care office. That connection is made in real time.

Normally this would require someone to make several pages and phone calls that may or may not complete and then the receiving person has to dig into the patient’s records to find all this information. We eliminate all that to make these interventions timely and for the right patient at the right time.

 

You saw the potential impact of mobile technology vs. desktop devices early on. What capabilities do you see in the future for using mobile in a clinical setting?

The two examples I described would be either sub-optimal or at worst not even be possible for a web-based solution, because as you know, they all require someone to be sitting in front of the computer looking at the information. The one thing that care providers lack into this environment — maybe two things, because technology is one — but the other thing is time, because they’re taking care of 20 different patients or more simultaneously. To change context in your mind around who needs what, you need a tool that can dynamically present to you which patient needs what in real time.

That push-based technology is going to become more and more prevalent. This is why physicians, if you’ve seen the stats, are moving to smartphones by the droves. They’re leveraging not just solutions, real-time solutions, but also just any type of content. It needs to be at the point of care, and most of the healthcare providers are rarely sitting down in a conference room discussing with other people.

 

A lot of the cost and the inefficiency of healthcare is trying to orchestrate the resources to be in the same place at the same time. Surgery is always a good example, where you’re trying to bring together a team, equipment, supplies, and the patient. Mobile brings people together. Are customers seeing job satisfaction improvement because people know where they’re supposed to be and when?

There are two types of scenarios. One is where there’s no other alternative, that the people have to be in the same place at the same time, as you described. Surgery is one.

Another example is where they wish they could be at the same place, same time, but they just cannot, like when you’re rounding on a patient. It’s very important for everybody to write their inputs, get the assessment that is interdisciplinary in nature, and then go back and take care of the patient based on their discipline. That’s very challenging in an acute care environment.

What we enable is a virtual huddle. Essentially, meaning they’re all connected around the patient. Assessments are kind of like a a very simple Google Doc for a patient. They’re real time, shared, simultaneously updated, and interventions are driven automatically. We help, with the mobile devices, alleviate that need for certain types of needing to be together and we make that virtual.

For others, a good example is a physician is talking to a patient. The patient may as a result of the conversation need to talk to some other discipline. With a real-time tool, you can pop open the patient’s page, see who the other provider is. Regardless of what shift or when the time of day is, you can instantly contact that person, and if need be, have them come to the room when the patient needs that.

Just-in-time care is going to become more prevalent. Care is going to become more efficient. Part of the reason is there’s no choice. Hospitals, if they don’t become more efficient, are going to be out of business.

 

I saw the product offers checklists. What are people doing with those?

Two things. When Gawande published “The Checklist Manifesto,” it made absolutely a very big splash. But if you read this book, he says two things — checklists and collaboration. Unfortunately, collaboration didn’t make the buzz when he published that book.

That’s what we bring together. We bring together a dynamic checklist that is driven based on the patient’s specific needs. We bring that collaboration, because the checklist filled by one person alone in the care team is not of any value if the other people have not read it and used it to influence their care.

By taking what would be otherwise a clickable form in an EMR or a paper form and making it a shared item that multiple people can simultaneously update and then it dynamically changes based on these rules and interventions that I alluded to earlier around that care team — that’s what really brings and makes an effective checklist.

 

What level of integration do you need to have to get other information sources such as the electronic health record?

At minimum, our product only requires a registration feed, an ADT feed. We require demographics information to identify the patient and to track as they move from different settings in the acute care environment or when they go into the post-acute environment. Beyond that, any other information that our tool uses is all entered into our tool because it’s primarily a very concise and very specific tool aimed at transitions, handoffs, and transfers.

You don’t need the mountain of information that’s in the EMR to make this process effective and efficient. There are specific touch points such as a discharge summary or an intake risk assessment. Certain customers have asked for that to be brought in, which we do on a custom basis. But the majority of our deployments are based on purely just ADT input. It’s a very lightweight input into our system.

 

Developers who are new to healthcare usually create an easy standalone application that doesn’t touch HIPAA and doesn’t  integrate with anything. What are the challenges when you’re trying to develop and support something that’s enterprise-grade for a healthcare setting and fully connected versus those simple standalone apps that work in their own world?

We went through this dilemma early on. Unfortunately, even the investment world has been caught in that bubble trying to invest in very simple applications, because they feel that that is something that can be understood easily and can grow.

Unfortunately, there’s not a whole lot of those type of applications that can deliver strong value and outcomes to a healthcare organization or even to a patient. That’s just the nature of the healthcare beast. If you’re selling to a hospital, you need a solution that is part of the work flow, even if it’s just a single discipline.

Like for instance, nurse. It’s very hard to do one slice of one small piece of a nurse’s work flow and survive as a company or as a solution. You may get few adoptions. No clinician wants to go to one place for certain things, then go to another place for certain other things.

Where some of this is being made easier or the barriers are being lowered is with mobile phones and tablets. Because of the push technology, the user doesn’t have to make a conscious decision to switch applications. The push can automatically present the information that they need to know at a given time. That’s alleviating some of this, but for a large portion of it, the applications need to be quite sophisticated and enterprise-grade with HIPAA compliance and other characteristics which makes it difficult for a start-up to scale without a significant amount of investment or being acquired. We chose a partner that can take us there. Zynx Health is ideal.

 

It’s difficult for companies to get a foothold. It’s tough to get a pilot. They have to compete for attention on the mobile device. They have to do some sort of outcome study or return on investment. Do you think it’s inevitable that most start-ups will fail and that those do succeed will have to be acquired to get critical mass?

I believe so. There will be many that are not able to even find that initial customer to fully deploy. Those that find it often flounder in the first four or five customers.

Once you’re over 10-plus, then you start getting that mass of implementation experience and references. But getting to 10 customers requires a significant level of runway because sales cycles in this world are … six months is a very good cycle, I would say. You have to have longevity or very significant amount of cash behind you from major investors.

Some start-ups have made it to that point — AirStrip is a good example –  but they’re going to be very few and far. A few of those will be acquired and then there will be many, many of those that just don’t make it.

 

What do you see for the future?

The direction we started out in fortunately didn’t require too many pivots to arrive where we are. Again, we’re extremely fortunate to find a partner like Zynx Health within the Hearst Health network that’s laterally aligned at the Zynx Health level, because care transitions and care continuum as well as just enabling team-based care for patients is a significant part of the Zynx Health vision as well, guided by evidence which they have gathered and are the market leaders. We are very happy to be part of that.

If you look at the Hearst Health Vision, this now takes us into the home environment, there’s the payer environment … Hearst has made investments into all of these areas. Under Hearst Health, now we’re able to share information across these portfolio companies to become bigger than the sum of the parts.

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November 24, 2014 Interviews No Comments

Advisory Panel: Favorite Vendor

November 24, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: Who is your favorite healthcare IT-specific vendor (product or services) right now and why?


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IMO, Intelligent Medical Objects. They have a team that we’ve seen be proactive in finding ways to help ease our physicians’ jobs. Their products are cost effective, especially when we point to amount of provider happiness they return. We’ve partnered with them for at least one beta partnership and are currently considering another, in part because of how easy they are to work with.


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I’m pretty happy with Allscripts right now. It’s a completely different company under Paul Black vs. Glen Tullman. Now that I’ve said that out loud, I’ve probably jinxed the relationship. 


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Epic delivers an adequate documentation system that automates workflow, can be integrated with other clinical and administrative systems, and scales to our very large care delivery system.

Epic. Sorry, that might not be the politically popular answer. But they are continuously focused on making their products better and making their customers successful. And the idea that they are trying to block interoperability in some way is frankly nuts. The recent back-and-forth in the press on interoperability and who is the best or the most committed is mostly posturing in advance of the impending DoD contract. Could Epic do better in this area? Absolutely. Could Cerner and the rest of “CommonWell?” Absolutely. We need a common standard.

Epic. They are the most focused on healthcare reform and the most ready to adopt and support the changes.


I don’t have a favorite company right now as I am dealing with too many that I would like to get rid of.


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Favorite is Wairever. They offer Plexina, which is a content management tool that we use for developing and managing order sets. The tools they provide are fantastic and their responsiveness has been great.


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Fortified Health Solutions. They partner (and I do mean partner) with us to provide security monitoring and consulting. We’re much safer than we were a year ago because of their recommendations and guidance.


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My favorite vendors lately are Vocera and small nurse call vendor called Critical Alert Systems. They have been extremely engaging and get it – they both have engaged individually and collaboratively to figure out how we achieve our desired result. They have been candid, direct, and honest. I wish larger vendors would get off their high horse and act like they did when they were half their size. Every CEO should ask themselves: how did we act when we had half the customers and market share? My favorite services company lately is Beacon Partners. Ralph is easy to do business with, easy to interact, with and hasn’t let me down yet!


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Cerner is my favorite vendor as they are rescuing Siemens from the mud.  (I am a Siemens customer.)


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EClinicalWorks. They have many shortcomings, but are delivering a usable ambulatory EMR at a decent ROI. Their support folks respond and often can help solve problems.


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I am absolutely overwhelmingly impressed with Salesforce.com. They are not an HIT vendor, but they have shown me an ability to provide a malleable platform along with a team of leaders who really get it.


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Meditech. Provides the best level of support, especially with their task management system. Meditech has also become more proactive and letting clients know about software issues and severity of the issues. The stability of the system is still topnotch, with no unplanned downtime in our environment in over two years. Meditech also has a lower maintenance cost then many of our other vendors. Not that you asked, but the vendor that we struggle with the most is eClinicalWorks. Communication with eCW is very, very difficult and they don’t use their task management system very well.


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Microsoft Azure and Office 365. Removes a heavy load of keeping the lights on. CommVault — best solution to backup to Azure and have the ability to preform legal/investigative searches.


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There are two I would highlight. The first is the best staffing firm in the world, iMethods Inc out of Jacksonville, FL. They are the only firm I have worked with that realize that is a person with a resume versus a resume that happens to come with a person. The other company is dbMotion. We are working on a project with them right now where we will connect all of our community data and make it actionable at the point of care, where it is needed most. Great stuff there that will put our community in a great position for the future.


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November 24, 2014 Advisory Panel 1 Comment

Morning Headlines 11/24/14

November 23, 2014 Headlines No Comments

Beth Israel fined $100,000 for patient data breach

Beth Israel Deaconess Medical Center will pay a $100,000 fine after an unencrypted laptop containing personal information of 4,000 patients and employees is stolen. The Massachusetts attorney general’s office says that lax data security practices were to blame for the data being compromised.

Traditional primary care, meet next year’s model

The Advisory Board Company publishes a consumer survey focused on the growing retail clinic (Walgreens, CVS) model of delivering primary care, and what it means for traditional family practice offices.

Electronic health records project has been a failure

In Quebec, a local paper scrutinizes a $563 million government funded project that was scheduled to bring EHRs to all primary and secondary care providers in the province by 2010. The project is now four years behind schedule and looking at revised cost of $1.6 billion.

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November 23, 2014 Headlines No Comments

Monday Morning Update 11/24/14

November 23, 2014 News 9 Comments

Top News

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Beth Israel Deaconess Medical Center (MA) will pay $100,000 to settle a state complaint over the 2012 theft of a laptop that contained the health information of 4,000 employees and patients. The attorney general said the hospital broke the law in failing to encrypt the device. CIO John Halamka says the hospital has since started encrypting all devices and requires employees to verify annually that their personal devices are encrypted.


Reader Comments

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From Sam Lawrence: “Re: CommonWell. I read through their website to understand what exactly they offer and was unsuccessful. Tons of reference to ‘services’ and appears to be written entirely in vague marketing-speak. What can the two endpoints exchange? CCDAs? Discrete data? If so, what data? Can it be viewed and pulled directly into the EHR at either end? Do users have to query for data or is it passively making connections behind the scenes? Maybe this is coming, but instead of some fluff quotes, I’d like to understand what the provider actually gets and how it’s helpful.” Their website has specific use cases and refers to documents that members receive, so I assume it’s really just non-members who are still in the dark. CommonWell gets a pass for their hastily prepared HIMSS13 publicity rush, but for a group that talks a lot about transparency and openness, they aren’t very good at either when it comes to explaining their business model, technology, and the status of their offering to the industry as a whole (they’re kind of like Epic in that regard, in fact). The latest announcement looked like a committee-edited PR fluff piece. I suppose that’s inevitable when you ask several EHR vendors to collectively agree on anything. Loftily stated benefit to mankind notwithstanding, I fully expect that McKesson and Cerner expect to make money or gain competitive advantage from their participation, so I would just like them to say so.

From Donald: “Re: health IT consulting. We’re seeing a huge downturn. Rates are down a bit and opportunities are way down. Every consultant and recruiter I’ve talked to says the same thing.”

From Mr. Ron Anejo: “Re: health IT consulting. The market is dead. Very few large implementations remain, providers aren’t chasing MU $, and uncertainty surrounding possible repeal of the ACA has Medicare heavy hospitals and health systems freezing spending. In speaking with many consultants, they’re terrified because recruiters are no longer calling them 10 times a day with offers and aren’t sure how long they will be without work. Supply (consultants) definitely outweighs demand for services right now — consulting firms should be able to drive down pay rates and hospitals should push for lower rates.”

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From Deborah Kohn: “Re: ICD-10 phase-in. I contacted Sue Bowman, AHIMA’s Senior Director, Coding Policy and Compliance (Public Policy & Governmental Relations), who confirmed and articulated what I suspected. Per Sue: It’s not just a matter of accepting both code sets – someone has to process the codes, be able to analyze and compare data, etc. With different providers on different code sets, it would be a nightmare. And there is also the matter of coordination of benefits. Our healthcare delivery and reimbursement systems are too inter-connected to allow different entities to use different code sets for the same date of service.” CMS is abound with botched, expensive IT projects (Healthcare.gov being just the most visible one), so I wouldn’t be optimistic that the checks will keep flowing without interruption. Here’s a free tip for mainstream reporters looking for a big story: start sleuthing around in the spring to see how confident CMS’s contractors and project people are about their ICD-10 readiness and how thoroughly they’ve tested. I bet they, like providers, just moved on to something else while waiting out the year-long delay.

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From Jello Biafra: “Re: CareTech Solutions. Has it been sold to Mr. Madhava Reddy?” Weekend confirmation is hard to get, so I’ll stick with facts: (a) the Federal Trade Commission approved on November 20 the acquisition of CareTech Solutions, Inc. by Madhava Reddy; (b) Madhava Reddy is president and CEO of IT/BPO outsourcer HTC Global Services; and (c) both companies are located in Troy, MI.

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From Dan: “Re: Dr. Oz. Invites fans to send him questions via Twitter, getting gems such as ‘I just got my flu shot — when can I expect to develop autism?’" America’s favorite daytime TV huckster doctor should have known better to take to the Twitterverse given the flack he takes for touting bizarre miracle drugs and refusing to have his children vaccinated. My favorite questions asked of him: (a) “What has been your most profitable lie for money so far?”; (b) “Is snake oil gluten free?”; and (c) “Why have you not been censured or fired from Columbia Surgery for conduct unbecoming a physician, scientist, and gentleman?”

From The PACS Designer: “Re: Office 365 sharing. The Garage Series for Office 365 ProPlus highlights a nice upgrade called shared computer activation, which can enhance productivity for multiple users of any computer.” It uses Remote Desktop Services to allow multiple users to connect to the same remote computer simultaneously to run Office 365 ProPlus programs like Word or Excel. It was announced using hospital nurses as an example.


HIStalk Announcements and Requests

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Most poll respondents left their most recent jobs because of problems management could have resolved, with 50 percent saying they didn’t like management, were overworked, or lacked opportunity. A surprising 9 percent said they were fired from their last position. New poll to your right or here for hospital or practice people: how much IT consulting will you use in 2015 vs. 2014? Vote and then click Comments to explain – I’m curious about what seems to be a consulting downturn and I’d like to learn more.

Some interesting comments from last week’s poll:

  • Laid off. Other hand-picked layoffs included people who had worn out their welcome at the company after on-the-job injury, bereavement, and of course, cancer.
  • Competition was eating our lunch nationally, and their response was to constantly cut staff and raise prices; classic short-term thinking.
  • The software company where I worked for many, many years sent me to India to train developers. After I returned, the company decided they didn’t need the experienced local staff and our jobs were outsourced to India.
  • I left, not because I was unhappy or underpaid at my last job, but because I saw an large challenge in my new job… this new job came a’-calling and the offer was intriguing. Essentially the same money, but in a warmer climate. The job though was to start a program from scratch, accelerate it as quickly as possible. I wanted to see if I could do it.
  • When I turned in my notice, management went after me. They contacted Epic to look into if I might be trying to go into consulting. Epic found I was. My management told them to blackball me in an attempt to get me to stay. The job which I was to start in a few weeks disappeared. The site and recruiter were told by Epic that they could not do business with me since I was leaving an active installation, which was untrue.
  • Individuals in management roles tended to be those who stuck with the company the longest, rather than individuals who were talented or forward-thinking. There was no official training that management received, as far as we knew, so most managers didn’t know how to grow their team members or keep them at the company (most managers had no idea how to handle HR issues either, like what to do when an employee told them they wanted to quit).

I was frustrated at not being able to see a journal article because it’s behind the paywall of a for-profit journal publisher. My conclusion: journals should continue providing a service in vetting and editing submitted research articles, but perhaps the authors should pay a submission fee and let everybody read the resulting article for free. That would serve several purposes: (a) it would reduce the number of crap articles that are accepted only because the journal is desperate for content; (b) journals could stop accepting ads if they haven’t already, or they could all start running ads as long as the editorial process is separate; and (c) human knowledge would be diffused to everyone, not just high-paying subscribers. That’s especially true of articles written from government-sponsored research or by government employees: why should I as a taxpayer have to pay to see them? It’s the author that gets bragging rights and personal benefit, so let them pay. I’d also like to see an impartial panel of experts grade the methodology, originality, and applicability of each article, which might shame sloppy authors or journals into not wasting reader time.

Listening: new from Gerard Way, the former singer of My Chemical Romance. Not bad, although MCR was a lot better.


Last Week’s Most Interesting News

  • CVS Health announces plans to open a 100-employee technology development center in Boston that will create consumer-engaging technologies and work with health-related startups.
  • EHealth Initiative’s “2020 Roadmap” calls for the federal government to refocus Meaningful Use on interoperability, get EHR vendors to offer API access to their systems, and align federal agency interoperability efforts.
  • Cleveland Clinic creates Adeo, a for-profit company and website that will sell software developed by it and academic medical centers in the Healthcare Innovation Alliance.
  • Emdeon announces that it will acquire consumer engagement tools vendor Change Healthcare for $135 million.
  • A Salesforce blog post describes how Johns Hopkins Healthcare is using its platform to manage high-risk patients, seemingly confirming a big healthcare push by the company.
  • UPMC takes a $9 million gain by selling a procurement systems software company it created to a private equity firm.

Webinars

Webinar recordings recently added to YouTube:

Improving Trial Accrual by Engaging the Digital Healthcare Consumer

Cerner Takeover of Siemens, Are You Ready? Vince and Frank have hit over 1,000 YouTube views in four days, giving them a good shot at surpassing Dim-Sum’s all-time record.


Government and Politics

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Karen DeSalvo tweeted out this farewell photo with Jacob Reider in a nice gesture. They have something in common: both are doctors who used to work full time for ONC.


Technology

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US News profiles Health Heritage, developed by NorthShore University HealthSystem (boy, do I hate that multiply conjoined words name created by marketers run amok – why create a dumb name that 99.9 percent of your customers couldn’t spell in a bar bet?). It’s a genomic decision support system that combines family history to information from Epic, developed by the founder of Apache Medical Systems. Of 3,000 people who signed up and downloaded their NorthShore information, 13 percent were flagged as being high risk for cancer.


Other

An Advisory Board survey lists the reasons doctors are worried about retail clinics:

  • They will siphon off the profitable and more easily managed simple cases.
  • Patients don’t understand the value of provider continuity and will seek convenient access instead.
  • Retail clinics will move up the food chain in offering ever-expanding services that threaten the medical group model.

My reaction as a patient:

  • If a practice can’t survive without cranking through expensive but mindless sore throat and fever encounters that trigger an automatic (and often clinically inappropriate) antibiotic prescription, then we have too many practices.
  • Providers haven’t in most cases demonstrated the value of continuity to their patients, treating each encounter like an impromptu hooker visit where the patient describes what they have and what they want in 10 furtive minutes of bartering and eventual consummation of a clumsy balance of compassionate care and bare-knuckle capitalism.
  • If retail clinics can threaten the overpriced, underperforming, and often patient-indifferent healthcare system and that system refuses to change, then I’ll happily go to Walgreens or CVS where I get treated like paying customer and can park for free close to the door. I feel perfectly safe as long as the provider (whether it’s a PA, NP, or telemedicine doc) knows when to turf me off to experts when they’re in over their head.

It’s really odd to me that retail clinics made a big splash, were seemingly on the verge of extinction, and now are seen as a big threat to entrenched providers (the “odd” part being why it took so long).

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Florida’s Blue Cross Blue Shield company installs a HealthSpot telehealth kiosk in its Miami center to allow members to access doctors from Miami Children’s Hospital. HealthSpot even did a nice job Photoshopping MCH’s logos onto stock photos of its device.

In Canada, a Montreal newspaper’s editorial says Quebec’s EHR project is “an abysmal failure,” adding that its health minister agreed in an interview. The project was supposed to cost $500 million US and be finished by 2010, but is now targeting a $1.4 billion cost and 2016 completion date. The editorial blames the variety of EHRs that were approved (nine for practices, four for hospitals) that can’t exchange information.

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Weird News Andy says this article on the privacy-invading possibilities of 90-minute DNA criminal profiling creates should also have addressed potential medical uses, such as finding genetic disorders that mimic MS or identifying people with genetic sensitivity to warfarin or chloroquine.


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.

 

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November 23, 2014 News 9 Comments

Morning Headlines 11/21/14

November 21, 2014 Headlines No Comments

Emdeon to Acquire Change Healthcare

Emdeon announces that it will acquire Change Healthcare for $135 million. Change Healthcare markets a benefits management system focused on helping employees make the most of their health benefits,

Fiscal Year 2014 Top Management and Performance Challenges Identified By the Office Of Inspector General

The Inspector General of HHS publishes a list of the top 10 challenges it is facing. The list touches on a number of health IT initiatives, including: validating spending for federal and state health insurance exchange markets, and monitoring the EHR Incentive Program for fraud.

Can we predict the unpredictable?

Researchers at the University of Windsor unveil a forecasting algorithm that can monitor EEG waveforms and predict oncoming seizures in epileptic patients 17 minutes ahead of time.

Merge Healthcare to Introduce Merge One for Ambulatory Radiology at RSNA 2014

Merge unveils a new solution, called Merge One, which is designed to support ambulatory imaging centers. Its provides a RIS, PACS, financial system, universal viewer, cloud archive, document management, and business analytics.

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November 21, 2014 Headlines No Comments

News 11/21/14

November 20, 2014 News 3 Comments

Top News

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Emdeon will acquire Change Healthcare for $135 million. The company offers consumer messaging, lookup, and education tools to improve engagement.


Reader Comments

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From Former McKesson: “Re: McKesson reorg. McKesson Technology Solutions has another big reorg, the third in three years, this time in the MCCA business unit. MTS has lots three good GMs in the past 12 months and middle managers are fleeing.” Unverified. An attached internal email from Jeff Felton, president of McKesson Connected Care and Analytics, says that several RelayHealth business lines have been combined into McKesson Connectivity & Analytics under Ken Tarkoff and that several reporting changes have been made.

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From Judge Smails: “Re: country club brawl, with a healthcare IT twist.” Police responding to a 911 call break up a fistfight at the tony Boston-area Weston Golf Club, started when the club’s president ordered jeans-wearing guests to leave the premises because of their dress code violations. The club president who apologized and then resigned was Tom Ferry, president and CEO of hospital software vendor Curaspan. I interviewed him a couple of years ago. I’m siding with him: people everywhere (restaurants, cruises, meetings, etc.) are offended at the idea that clearly stated dress-related rules might inconveniently apply to them and being loudly obnoxious usually gets them a quiet exemption.

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From Mike Kovner: “Re: Medicare ACO Shared Savings Program results. CMS has posted the Performance Year 1 final financial reconciliation and quality performance results for all MSSP ACOs with 2012 and 2013 agreement start dates. Kudos to the 52 ACOs that produced real savings and met the threshold for clinical quality measures. Memorial Herman ACO was the big winner with a $28M earned Shared Savings payment, followed by Palm Beach ACO with $19M. Tough break for the six ACOs that produced savings but did not meet the quality threshold, leaving real money on the table.” Mike sent over a detailed worksheet that I’m sure he would be willing to share.

From Ohio MD: “Re: ICD-10. We’re a busy orthopaedic EP. Both 5010 claims and HCFA 1500 can handle both code sets, so why not allow a phase-in over several years? There’s no way to do end-to-end testing since you can send a claim to CMS, but you don’t get payment, and no other payers allow testing as far as I know. Plus getting signed up for CMS testing is an absolute nightmare, especially for small providers.” Readers are welcome to weigh in: is a hard compliance date for ICD-10 necessary? CMS has had plenty of time to prepare with the one-year delay, so why can’t it start accepting either version now?

From Sinking Ship: “Re: [consulting firm name omitted]. Earlier this week rumors were spreading that the company has over 50 percent of its consulting staff on the bench due to poor performance by the sales teams.” Unverified and likely not possible to verify, so I left the large company’s name out. Maybe the sales team is underperforming, but I believe we may be seeing a downturn in the healthcare IT consulting business in general due to fewer go-lives and government meddling with ICD-10 dates and Meaningful Use tweaks. That could be my own incorrect perception from talking to a couple of folks. If you’re on the front lines, tell me what you think.


HIStalk Announcements and Requests

This week on HIStalk Practice: Greenway, CVS, and Quirk open new facilities. CMS Compare websites come under GAO’s fire. Pediatrician Sapna Mukherjee, MD discusses her use of HIT at her concierge practice. Healthcare.gov sees fewer glitches than several state-run exchanges. Seacoast Orthopedics & Sports Medicine physicians achieve MUS2. ONC welcomes several new staff members. Thanks for reading.

This week on HIStalk Connect: Harvard public health researchers launch a heart health calculator that evaluates lifestyle choices rather than blood pressure and cholesterol levels.  Walgreens rolls out on demand lab tests across its 8,200 facilities. Cue, a digital health startup making smartphone-based lab analyzers, raises a $7.5 million Series A.


Acquisitions, Funding, Business, and Stock

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Valence Health receives a $15 million growth equity investment, raising its total to $45 million.

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A questionable Fortune article called “Digital healthcare investments soaring again. Here’s why.” spends most of its pointless meandering talking up Castlight Health, which is hardly the poster child for why digital investments should be soaring. All of those sharp investors who jumped all over Castlight right after “the most overpriced IPO of the century” have seen their investments shed 72 percent of their value in just seven months (blue) vs. the Nasdaq’s gain of nearly 11 percent (red) over the same period as the company continues to lose big money. Castlight is still mysteriously worth $1 billion, or 28 times annual sales.


Sales

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Providence Health & Services chooses NantHealth’s Clinical Operating System and eviti|Advisor for genomic analysis and evidence-based cancer treatments.

Providence Anesthesiology Associates (NC) chooses TigerText secure messaging.

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WellSpan Health (PA) selects the Visage 7 Enterprise Imaging Platform.


People

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EHR scribe provider Essia Health names Anita Pramoda (TangramCare) to its board and William Moore (4medica) as CFO.

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Dave Morgan (Vista Consulting Group) joins Greenway Health as CFO. He apparently replaces Laurens Albada, but I’m not quite sure since the company’s leadership page lists Morgan but Albada still has a leadership profile that lists him as CFO. I haven’t seen any announcements either way, so I’m going with Dave.


Announcements and Implementations

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CommonWell Health Alliance announces (in a poorly written press release that makes it impossible to figure out what they’re actually announcing) that is offering its services to a broader market, that RelayHealth is its technology provider, and that Aprima and CareCloud have signed up as members.

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Greenway Health will open a technology development center in Cobb County, GA in early 2015 that will create 150 jobs.

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Revenue cycle and coding products vendor VitalWare launches VitalABN, a medical necessity validation tool that automates the Advance Beneficiary Notice of Noncoverage process.

MModal announces that its Fluency for Image Reporting can notify radiologists of documentation deficiencies in real time.

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Johns Hopkins Medicine and Premier will collaborate on educational, clinical, and analytics projects.

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A Salesforce blog post suggests that its rumored healthcare push is underway as it describes how Johns Hopkins Healthcare is using the company’s platform in an engagement program to keep high-risk patients out of the ED and to coordinate the schedules of home care workers.

GE Healthcare, a 50-50 joint venture partner in Caradigm along with Microsoft, will resell Caradigm’s single sign-on and context management solutions to integrate anatomic pathology information systems.

Merge Healthcare launches Merge One,  a cloud-based, transaction-priced solution for ambulatory radiology sites that includes PACS, RIS, financials, universal viewer, cloud archive, document management, and analytics.


Government and Politics

Newly discovered emails from former CMS COO Michelle Snyder say her boss, CMS Administrator Marilyn Tavenner, used threats and tantrums to insist that Healthcare.gov be launched on time no matter what. Snyder retired weeks after the failed launch. Meanwhile, the House Committee on Science, Space, and Technology gets its subpoena-powered audience with former US CTO Todd Park on Healthcare.gov. Republican members hammered away, while the ranking Democrat member apologized to Park for making him a  target for Affordable Care Act venting and said it will make it harder for Park to carry out his current job of recruiting wealthy technical entrepreneurs to federal government work once they see how he was treated.

The GAO says the consumer transparency tools created by CMS aren’t user friendly and fall short on cost and quality information. HHS agrees.

Another GAO report finds that the VA violates its own policy in failing to push out critical OS patches to desktops and laptops within 30 days.

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CMS forms the Office of Enterprise Data and Analytics and names Niall Brennan as its chief data officer.

HHS’s OIG lists the agency’s top challenges for FY 2014, one of which calls for HHS to make sure that Meaningful Use policies align with its goals and reflect “the changing health IT landscape,” adding that HHS should provide guidance on adoption, Meaningful Use, and interoperability and that HHS, CMS, and ONC stay focused on privacy, security, and fraud prevention.

Vermont cuts ties with economist Jonathan Gruber over his unflattering comments about lack of transparency in passing the Affordable Care Act. The state is ending Gruber’s economic modeling contract in which he bills his time at $500 per hour and that of programmers at $100 per hour. He and his associates collected more than $6 million in federal and state grants and contracts and he’s still working on an NIH project that will pay him $2 million.


Innovation and Research

Two University of Windsor researchers say their newly patented predictive software can monitor EEG waveforms and give someone with epilepsy a 17-minute advance warning that they’re about to have a seizure, although they studied only 21 patients. They also recognize that while it would be nice to let an epileptic know they need to pull their car over or surf one last wave before hitting the beach, it won’t do much good unless someone develops a portable, continuous EEG monitor (waterproof, in my second example).

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Finalists in Harvard’s Health Acceleration Challenge are Twine Health (personalized treatment plans),  Boston Children’s Hospital’s I-PASS (care team communication), Bloodbuy (a Priceline-like bidding system for hospitals to buy blood products), and Medalogix (predictive identification of patients as candidates for palliative care).


Technology

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The city of Cleveland will reportedly announce Friday that the Euclid Avenue area, home to several health-related organizations and vendors and locally branded the “Health-Tech Corridor,” will get 100-gigabit fiber optic broadband connectivity courtesy of a federal grant that will pay for it.

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Apple publishes WatchKit tools and guidelines to help developers move their iPhone apps to Apple Watch.

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A Santa Barbara, CA group that treats homeless people from temporary clinics it sets up in public parks uses a self-developed mobile EMR running Microsoft Access on $200 Chromebooks and a Wi-Fi hotspot. Its author says, “I do not have nearly as many coding options to control both the styling and the function as I would if I had coded the platform from scratch. What we gained was security, instant accessibility of all past charts for a patient, legibility, more detailed records, more accurate reporting, and much more.”


Other

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Botsford Hospital (MI), which recently merged with Beaumont Health System and Oakwood Healthcare to create  $3.8 billion system, will replace McKesson Paragon with Epic, which is used by the other members of the new system.

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Colorado RHIO announces that its Regional Extension Center will no longer offer free services now that its ONC grant has run out. The REC will be replaced with a fee-based services division. I would opine that dwindling Meaningful Use activity makes it even more unlikely (if that’s possible) that providers will spend their own money on its services.

A Truven Health Analytics-NPR poll finds that 75 percent of Americans see an EHR-using doctor, 68 percent are OK with having their de-identified health information shared with researchers, but only 22 percent would let their doctor or insurance company review their credit card transactions or social media information even if it might improve their health. More than half the respondents claim they have reviewed their information as kept by their provider.

EClinicalWorks CEO Girish Navani writes an Entrepreneur article called “The Case for Never Selling Your Company,” saying that eCW “is, and always will be, a privately-held company. I have no interest in selling it, regardless of any offer I may get. In addition, we don’t use investor cash or spend money we don’t have.” He says selling a company often changes its founding principles, threatens its longevity, and takes away the independence of its leaders.


Sponsor Updates

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  • Wellcentive SVP Mason Beard and CTO Kirk Elder accepted a finalist plaque for the Intel Innovation Award at the 2014 Health IT Leadership Summit in Atlanta on Thursday.
  • T-System is providing free flu T Sheets that include the latest CDC guidelines to all providers
  • NextGen Healthcare earns top ranking among healthcare IT vendors providing outsourced billing / RCM.

EPtalk by Dr. Jayne

I received a fair amount of reader feedback about this week’s Curbside Consult on proposed measures for Meaningful Use Stage 3.

From Ski Dude: “I enjoyed your article on MU Stage 3. Ever so true, as an IT consultant and patient I find the overly inquisitive requirements to be a burden. I have a customer, a primary care physician group with approximately 120 providers, that has a spread sheet for all the metrics they need to capture and for whom they have to report them. It is a 17 x 160 cell grid. I’m sure it’s costing these providers way more than they’ll gain in incentives or lose in reimbursements just trying to collect all the data and deliver it to the 17 data consumers.” I’m right there with you on that. Back before MU, we had approximately 20 metrics that we were tracking for providers as part of our internal Clinical Score Card. Every one of them was evidence-based and had a direct impact on patients: influenza vaccination, colorectal cancer screening, diabetes screening / glucose control / foot exams, etc. that had a real return on investment, either financial or in reduced patient morbidity and mortality.

Now we’re tracking hundreds of measures, some of which have not been directly proven to benefit patients. I wonder what our Institutional Review Board would think about the fact that our entire patient population (not to mention all of our staff) is part of an unapproved research project involving human subjects?

I’ve been asked to judge a local science fair this year. Looking at the packet of rules and regulations, what MU is doing to the healthcare community wouldn’t even pass muster for the seventh grade.

I received a couple of replies that surprised me, generally stating that the proposed measures didn’t go far enough to allow providers to make significant advances in MU3. Various suggestions included: tying the payments to actual data scores (not merely reporting the data); requiring HIE exchange on each and every patient visit; and requiring interfaces with data reported by patient mobile devices and apps.

If MU wasn’t already on its deathbed, I’m sure including those factors will push it into full arrest. It’s not that many of us disagree with these ideas, but including them in MU3 without significant financial support and adequate time to plan, code, test, and implement the features just makes them untenable. Not to mention that there is little evidence that wholesale implementation of these features (especially if it’s at the expense of tried and true population health work) may not have significant demonstrable benefit.

I also received one comment that made me smile.

From Thoughtful, Albeit Weird: “Great Column on MU3. It made me think of this: When you brought your car in for repairs, you would have to provide information to the counter person on how you had driven your car and when. What about the other cars in the house? Did you have an accident in the past couple of years? Parking or speeding tickets? What kind of gas do you use? When your mechanic is working on your car, would they have to check the brake, power steering, coolant, and other fluids and document the findings? Tire pressure? Document the state of the belts and hoses? What was the brand of brake shoes they installed? Why did they use that brand and not a different one? When they replaced the brake fluid, did they document that the old fluid was properly drained and that no water was in the line? Did they scan the brake fluid they installed? Did the software automatically check it was of the approved type for the car? If they did have to document these things the cost of every visit would have to go up because of the time involved in documenting these items (not to mention the purchase of the system they use to do the documentation) which leads to fewer customers seen per day. Instead, they use a sheet of paper with checkboxes that they give you (probably so they don’t get sued if something happens to your car). The government is setting the map for the marketplace instead of letting the market do it. I do not favor that approach.”

There are so many comparisons you can make here. At the hair salon, did my stylist counsel me on the risks and benefits of adding highlights and lowlights to my hair? Did he warn me that my elderly grandmother would think reddish lowlights to be tacky? Did he suspect that my wanting to change my color was a potential sign of emotional distress? Did he arrange follow up evaluation on exactly WHY I wanted a different color? Did he caution me that being a blonde might not actually mean that I would have more fun? Did he scan the bar code, document the lot number, and record other information about the chemicals in case there is a recall? Did he conduct a time-out prior to actually applying the color to make sure he had mixed the right combination and to ensure I was fully aware of what I was getting myself into?

Of course I’m just being sassy, but if you look at most industries that we depend on or use regularly, if they were being run like healthcare IT (not to mention healthcare in general) it would be like living in a dystopian sci-fi movie.

How do we stop the madness? Or should I change fields and start designing that hair stylist tracking software? 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.

 

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November 20, 2014 News 3 Comments

News 11/19/14

November 18, 2014 News 4 Comments

Top News

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HIMSS, IHE, and the EHR/HIE Interoperability Workgroup (created and led by the New York eHealth Collaborative) announce their combined efforts to streamline connectivity between EHRs and HIEs. IWG, formed in 2011 to improve that connectivity, will use ICSA Labs to test and certify products beginning in early 2015. It will continue its focus on standards and certification of query-based exchange and the use of Direct. The organization includes several HIEs and a large number of EHR vendors, including Cerner, Epic, and McKesson. 


Webinars

November 19 (Wednesday) 1:00 ET. Improving Trial Accrual by Engaging the Digital Healthcare Consumer. Sponsored by DocuSign. Presenters: B. J. Rimel, MD, gynecologic oncologist, Cedars-Sinai Medial Center; Jennifer Royer, product marketing, DocuSign. The Women’s Cancer Program increased trial accrual five-fold by implementing an online registry that links participants to research studies, digitizing and simplifying a cumbersome, paper-based process. This webinar will describe the use of e-consents and social marketing to engage a broader population and advance research while saving time and reducing costs.

Vince Ciotti and Frank Poggio delivered an HIStalk webinar Tuesday that held my rapt attention all the way through: “Cerner Takeover of Siemens, Are You Ready?” These guys have 90 years of healthcare IT expertise between them, including living through more than a dozen acquisitions as insiders, and both of them are cynical, snarky, and highly knowledgeable. Both also contribute regularly to HIStalk. Thanks to them for doing a great job. We had something like 280 attendees online and I’m sure the YouTube video recording will get a bunch of views — the record is held by Dim-Sum’s DHMSM 101 DoD one, which has been viewed 1,300 times in addition to the views it got directly from HIStalk and during the live session.


Acquisitions, Funding, Business, and Stock

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Analytics technology vendor MedeAnalytics acquires OnFocus Healthcare, which sells performance management systems.  

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Online wellness coaching vendor Fruit Street Health offers free shares in the company to those who lost their investment in CEO Laurence Girard’s previous failed venture. I wouldn’t bet my money on those shares either since it charges $300 per month for four weekly video calls with a fitness coach and dietitian, at least not before reviewing this site whose entire mission is “to protect investors from Laurence Girard” that claims he has said repeatedly that Prevently was a Ponzi scheme and that he’s not disclosing several other failed ventures.

CVS Health will open a 100-employee technology development center in Boston for “building customer-centric experiences in healthcare” and to connect with health-related startups. The company — which operates drugstores, pharmacy benefits management, specialty pharmacies, and MinuteClinic retail clinics — will also open three drugstores that will be used for live testing of new digital technologies. Its Digital Health group is headquartered in Woonsocket, RI, where it recently opened a Digital Experience Center.

Kaiser Permanente will open retail clinics inside four California Target stores. Insurance competitor Blue Shield of Competitor says it will contract to have its members covered in the KP locations, which will also accept Medicare and Medi-Cal in offering services for minor illness, checkups, and chronic disease monitoring.  

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UPMC sells its 51 percent interest in the procurement systems vendor it created — Prodigo Solutions — to a private equity firm, realizing a $9 million gain.

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Zipnosis, which offers consumers a $25 televisit using an automated interview and clinician review, receives an undisclosed seed round investment.

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North Bridge Growth Equity secures a majority stake in Atlanta-based Ingenious Med.


Sales

Chicago-area FQHC Mile Square Health Center chooses Forward Health Group’s PopulationManager and The Guideline Advantage.

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Memorial Healthcare (MI) and King’s Daughters Medical Centers (MS) engage Iatric Systems to perform EHR-neutral integration with Apple Health.

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Orlando Health (FL) chooses Ingenious Med’s charge capture system.

Ob Hospitalist Group (SC) chooses PatientKeeper Charge Capture for its physicians that provide services to 75 hospitals.

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Arnot Health (NY) selects eClinicalWorks for EHR and health exchange for its 160 providers.

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Virtual Radiologic chooses SyTrue’s natural language processing systems to extract information from its radiology reports, with plans to use the company’s Semantic Search to present teleradiologists with exams similar to the one being reviewed to drive clinical performance and efficiency.

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St. Elizabeth Healthcare (KY) selects Strata Decision’s StrataJazz for cost accounting, budgeting, capital planning, and financial planning.

Rio Grande Valley HIE and University of Texas Health Science Center choose Wellcentive’s population health management solutions to help manage the care of people with diabetes.


People

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CTG promotes Ted Reynolds to SVP with responsibility over CTG Health Solutions.

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George Evans (Singing River Health System) joins Sagacious Consultants as principal consultant.

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The HCI Group names John McDaniel (NetApp) as VP of innovation and technology solutions.

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AMC Health hires Bruce Matter (GE Healthcare) as SVP of sales and client development.

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Afik Gal, MD, MBA (PwC Consulting) joins QPID Health as VP of product innovation.

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Siemens Health Services CEO John Glaser will join Cerner after its acquisition of SHS is complete. He says, “I’ll join as a senior vice president, focused on driving technology and product strategies, interoperability, and government policy development.” Leaders of acquired companies don’t usually last long, so we’ll see. As Vince and Frank said in Tuesday’s webinar, Siemens customers should get any promises in writing from Cerner, not from Siemens.

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Cal INDEX HIE hires Greg LeClaire (Aetna) as CFO; John Lee (Oracle) as CTO;  and Doug Hart (ConvergeHealth) as VP of marketing and corporate communications. Also hired but with no photo available anywhere I could find on the web: Andrea Leeb, RN, Esq. (LA Care Health Plan) as chief privacy officer. I’m amazed at technology people who don’t keep their LinkedIn profile current or who don’t include a photo of reasonable quality. Mistake #1 (second only to not including a photo at all): shrinking down the head shot to horrible quality, missing the point that LinkedIn thumbnails it automatically while still displaying the full-sized original when clicked. Mistake #2: using an informal snapshot that adds distracting features such as the shoulders of other people from the cropped group photo or a Hawaiian lei. Of course this advice comes from someone whose own profile doesn’t have a photo, but I have an excuse: LinkedIn shut mine down until I removed the “Caddyshack” image of Carl Spackler.


Announcements and Implementations

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Faith Community Hospital (TX) successfully attests for Meaningful Use Stage 2 shortly after choosing and implementing the RazorInsights EHR and using its Meaningful Use Dashboard.

Memorial Healthcare System (FL) is sending referral information from its ED to Henderson Behavioral Health (FL) to integrate medical and behavioral services. The health system sends HL7 C-CDAs from Epic to Henderson’s Netsmart CareRecord EHR that include completed labs, demographics, medical summary, meds list, and vital signs.

The Greenville, SC paper profiles ChartSpan Medical Technologies, which has developed a new PHR app for iOS.


Government and Politics

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A Federal Trade Commission investigation into website privacy certification company TRUSTe results in a $200,000 settlement. TRUSTe didn’t perform some of the the annual website privacy audits it promised. It also failed to require certified sites to display an updated seal indicating TRUSTe’s conversion to a for-profit company in 2008. 

Michigan’s top-earning doctors in CMS’s Open Payments database of drug and device company payments explain their income as follow, a good example of just how complicated the issues are around medical payments:

  • A diagnostic radiologist who was paid $688,000 by a medical device manufacturer says he doesn’t use the needle biopsy and software he developed because he no longer does biopsies. He says he supports Open Payments to expose doctors who are paid to use products on their patients.
  • A GP who was listed as earning $571,000 from a drug company is actually the medical director of a clinic that was paid for conducting three studies. The doctor does research work only and is paid a salary by the clinic, while the drug company payments were made to the clinic itself and he received nothing.
  • A plastic surgeon who earned $341,000 in drug company money for training doctors to use an Allergan breast implant says he doesn’t promote the product and loses money when consulting for up to $5,000 per day since that’s a tenth of what he would make otherwise.
  • A University of Michigan Medical School orthopedic surgeon who was paid $201,000 in royalties for a knee replacement device says he follows his employer’s conflict of interest guidelines and doesn’t receive royalties when the device is used by anyone within UM.
  • An orthopedic surgeon who made $196,000 from device companies says he holds 55 patents and he tells patients if he’ll get paid for using a particular one.

Innovation and Research

A study finds that use of EMR-triggered, telephone-based prescription refill reminders for heart-related drugs was associated with very slightly improved medication compliance and outcomes.

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A small, short-term study finds that smartphone-based weight loss apps (specifically MyFitnessPal) don’t really help users lose weight.

A Penn Medicine study finds that ambulatory clinic doctors prescribed generic drugs as a higher percentage when the EHR was modified to require an extra click to show the brand name item.

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The Washington Post profiles the Swasthya Slate, an inexpensive device that connects to Android-powered phones and tablets to perform 33 diagnostic tests. The device has been tested in India, where it excelled at detecting preeclampsia, increasing the rate of needed testing, and reducing administrative time for healthcare workers from 54 percent of their day to 8 percent. They expect the cost of the device to be around $150 at full production and see potential for its use with telemedicine.  

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Walgreens will offer inexpensive, minimally painful blood tests from startup Theranos, with the service already launched in the Phoenix area.


Technology

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Statistical software vendor SAS co-founder and CEO Jim Goodnight, PhD, a North Carolina programmer turned multi-billionaire,  tells a banking technology magazine that the data warehouse is not obsolete:

Fraud, customer intelligence, compliance — if you have the right set of data all together, you can use that set of data, you don’t have to keep go looking for data every time you need something. That’s one thing Hadoop provides. It’s a great place to store data. Also, you’re buying these 1.2 terabyte disks at about $300 apiece, you can hang 20 of these on a server and it’s local, so you can read the data straight on the machine … We’re seeing a shift away from that kind of hardware [IBM mainframes] to commodity. People are dropping AIX boxes and going to Linux x86 boxes and Intel chips. The chipsets are incredible. Dell has a machine we really like, it’s called an R920 and it has four slots, you could put four chips each with 16 cores, you end up with a server with 64 processors, you can put three terabytes of memory in that machine, and it’s about $100,000.



Other

Brigham and Women’s Hospital (MA) announces that the information of 1,000 patients was exposed in September when a robber held up a doctor at gunpoint, tied him to a tree, and forced him to give up his cell phone and laptop passwords. 

The bonds of Duke University Health System (NC) remain at an ‘AA’ rating despite a $65 million reserve adjustment due to a collections slowdown caused by its Epic implementation and problems with new IT systems at both North Carolina Medicaid and Blue Cross Blue Shield of North Carolina.

In Ireland, the health service is reviewing why a five-hospital group invited only one vendor to respond to a clinical information system RFP. Auditors also want to know whether the former CEO of the hospital group disclosed that he previously worked as a consultant for the company, Northgate Public Services.

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The provider folks behind “Just Epic Salary” make their survey results available for free Excel download. Some of the highest average salaries were for permanent hire physicians ($348,000), permanent hire management ($243,000), and contracted application management ($187,000), although even with 753 responses some of the categories had a small sample size.


Sponsor Updates

  • CIO Review names secure communications vendor PerfectServe as one of the “20 Most Promising Healthcare Tech Solutions Providers in 2014.”
  • Versus Technology announces that Amerinet members will receive discounts on its RTLS products.

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.

 

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November 18, 2014 News 4 Comments

Curbside Consult with Dr. Jayne 11/17/14

November 17, 2014 Dr. Jayne 3 Comments

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Color me less than thrilled that the Institute of Medicine is now asking for EHRs to capture additional social and behavioral data as part of Meaningful Use Stage 3. That’s assuming that Meaningful Use is still viable now that the money is nearly gone and more than half of ONC’s senior leadership has left in recent months. Practice administrators have been dazed and confused trying to figure out if they are better off trying to apply for hardship exceptions, take advantage of the flexibility rule, or throw in the towel altogether.

I recently met a practice administrator who swore up and down her providers were attesting for Stage 2, even though they hadn’t yet installed a patient portal and didn’t have a Direct interface. Then again, she also thought that Patient-Centered Medical Home was some kind of design/construction initiative rather than a practice transformation activity, so I shouldn’t have been surprised.

I understand that the Institute of Medicine sees EHRs as a great place to mine data for research, but patients are already weary of having their privacy invaded. Anyone remember the Florida legislation to control whether providers could ask about firearms in the home? My vendor actually had to code in a setting where a practice could hide the firearms questions to avoid running afoul of the law.

Although we’re pushing patients to be more engaged and it’s nice to work with them when they are, at least in my world the majority of patients don’t care about engagement. They just want to be treated and get back to work, their kids, or whatever else was going on in their lives before they got sick. They’re not interested in proactively managing their health when they’re living paycheck to paycheck and think that even questions about alcohol and tobacco use (which are clearly linked to major health outcomes with most people understanding their significance) are over the line.

When we had to start asking about race and ethnicity, we spent on average two to three minutes per patient explaining why we needed that information and helping patients figure out how to answer the question. Many patients thought they were interchangeable, so we were at the front desk educating them on the vagaries of demographic data rather than collecting their co-pay and speeding them back to see the doctor. At least those particular pieces of demographic information don’t change over the life of the patient, so you only have to ask them once.

Now the academic crowd is going to push us to ask about factors that could change at every visit, including depression, education, intimate partner violence, financial resource strain, physical activity, social connections/isolation, and stress. I can tell you without gathering data or an exhaustive chart review that most of my patients would require discussion of the last four.

As a good primary care physician, I should be asking about these things anyway, but I want to ask about them at an appropriate time during an appropriate visit, after I have built a relationship with the patient. I don’t want them turned into screeners that my staff has to administer to every single patient so we can avoid being penalized.

Will providers be judged on the percentage of patients who follow advice to manage these issues, like we’re currently judged on the number of patients we can convince to go for colonoscopies or mammograms? That’s not what I signed up for as a physician. I should do my best to encourage my patients, but didn’t I spend a lot of time in medical ethics learning about patient autonomy and how the paternalistic model of healthcare delivery has to go? We’re just asking for more cherry-picking by providers as they dismiss non-compliant patients from their panels to improve their numbers.

Most patients don’t understand that their data is already being used for research by health plans and other payers without their specific understanding or consent. Sure, it’s probably in the fine print somewhere and it’s either aggregated or de-identified, but if you asked them whether they understand where their data goes or what it’s used for, they would say no. When people think their information might be used in a way they don’t want it to be used (or to be out of their control), they’re going to lie.

Mr. H’s recent poll showed that nearly half of HIStalk readers have withheld medical information from a provider due to privacy concerns. I’m one of them, I admit. Parents are lying on the California home language survey  because they don’t want their children labeled as “English learners” for fear they will miss out on other educational opportunities. The old medical school adage of “take the amount of alcohol the patient says he uses and double it” reminds us this is not a new phenomenon.

How about let’s actually get people to use the EHRs they already have and use them well rather than pushing more minutiae on overburdened end users? A friend of mine has an EHR with a great onboard reporting tool, yet hasn’t leveraged it at all for actual clinical care. They’re so busy trying to get their patient portal enrollment numbers up and micromanaging the rest of their “all or none” Meaningful Use metrics that they’ve lost their ability to do cancer prevention outreach, immunization campaigns, or other interventions that have been actually proven to save money as well as improve people’s lives. And that, dear readers, is a shame.

What do you think should be in Meaningful Use Stage 3? Email me.

Email Dr. Jayne.

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November 17, 2014 Dr. Jayne 3 Comments

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