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News 1/10/14

January 9, 2014 News 3 Comments

Top News

1-9-2014 10-34-30 PM

inga thumb Merge Healthcare discovers in an internal review that a former sales employee falsified the existence or amount of certain customer contracts. Merge had not invoiced any of the customers or recognized revenues, meaning previously reported results are not affected. However, the company reduced its non-GAAP subscription backlog totals over 25 percent from prior statements. The sales rep, who had been paid about $250,000 in commissions on the invalid contracts, has admitted to falsifying the orders and has offered to pay restitution. Merge has referred the matter to the US Attorney’s Office. While the rep’s actions are reprehensible, I am sure that plenty of sales veterans (me included) in HIT and other industries are aware of other instances of  “creative accounting” in order to hit quotas.


Reader Comments

1-9-2014 10-35-38 PM

From Politico: “Re: Greenway. Major layoffs this week.” Unverified, but reported by several readers, one of whom gave a number of 80 affected employees.

From Nasty Parts: “Re: Carrollton is cratered. Rumor is 150 people downsized at Greenway’s former HQ, including the VP of HR. This comes on top of an exodus of sales executives, including two VP. Approximately 10 of the top reps have left, many because they did not want to sign the feared Vista non-compete. Also, word is that the HQ of SuccessEHS, another Vista acquisition, was also cleaned out today.” Unverified, but Nasty Parts has been right several times in the past. We didn’t receive a response to our inquiry.

From Xflo-Bee: “Re: Cerner. I’m hearing a lot of buzz on the wire about Cerner being the focus of a big lawsuit over a state reporting SNAFU. Can anyone verify?”

From Bob A. Booey: “Re: MU attestation. We’re having an awful time trying to attest for 2013 MU on the CMS website. Here is the response from CMS. ‘We have been notified that the Registration and Attestation Application is experiencing technical difficulties. This is currently being investigated. At this time, we do not have an estimated time for resolution. Please try again later. We apologize for any inconvenience this may cause.’”

1-9-2014 10-15-33 PM

From MT Hammer: “Emdat. A new banner on Emdat’s website points to another Nuance acquisition.”


HIStalk Announcements and Requests

inga thumb Here’s some HIStalk Practice highlights from the first week of 2014: doctors who Google patients. CMS wants to ban abusive prescribers from government programs. Free app Figure1 allows physicians to share de-identified photos of medical conditions. Patients from practices affiliated with University Hospital (GA) embrace the health system’s Epic portal. Montana requires insurers to reimburse telehealth visits at the same rate as in-person visits. Brightree and athenahealth will share patient referral data. Dr. Gregg provides insight on why some physicians choose to remain independent. While you are stopping by, sign up for the email updates so you don’t miss a post. Thanks for reading.

inga thumb We sent our sponsors an email earlier this week about our activities at the HIMSS conference, so if you should have seen this and didn’t, email me

1-9-2014 12-56-29 PM

inga thumb Speaking of HIMSS, I ran across this infographic depicting the importance of social media during HIMSS14. Mr. H, Dr. Jayne, and I will be providing occasional updates on Twitter, but you’ll also want to make sure you are following Lorre (@Lorre_HIStalk). She’ll be manning our HIStalk booth (#1995) and passing along our impressions of the exhibit hall’s best and worst booths, as well as tips for finding the coolest swag, free cocktails, and good coffee.

Last chance: HISsies nominations will close shortly, so nominate your choice for Best Vendor, Best CIO, etc. ASAP.

HIStalkapalooza details and registration will be available next Wednesday, January 15. We’re getting a bunch of emails every day asking about it, so please save us some time by hanging in there until next week. Our primary sponsor still has spots for two more co-sponsors who will be recognized in a variety of ways, so email me if your company is interested.

1-9-2014 9-34-01 PM

Welcome to new HIStalk Gold Sponsor Wide River Consulting. The Lincoln, NE-based company offers healthcare IT consulting services with an emphasis on serving hospitals in rural and underserved communities. Wide River has helped 50 Critical Access and Rural Hospitals that were struggling to keep up under the weight of ICD-10, MU, EHR upgrades, and PQRS reporting, often with vendors that find it challenging to send people to their locations. The company offers a wide range of technical and engineering services through a partnership with Sterling. Executive Director Todd Searls tells me that with the REC grants ending, PPCPs and CAHs need a low-cost way to keep forging ahead with Meaningful Use and Wide River can help. The company’s ICD-10 services are a big hit as well. CAHs can get a one-year subscription to Wide River’s Meaningful Use Help Desk for $175 per month and providers can sign up for $60 per month, gaining access to experts who can help with MU-related questions ranging from patient portals to exclusions. The company’s goal is to help teach small and rural hospitals to succeed with the resources they have, even helping them form mini-HIT co-ops. Thanks to Wide River Consulting for supporting HIStalk.


Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.


Acquisitions, Funding, Business, and Stock

Shareholders of Health Management Associates approve the previously announced $3.9 billion sale of the hospital chain to Community Health Associates.

Endo Health Solutions will sell its HealthTronics business to Altaris Capital Partners for total consideration of up to $130 million, including $85 million in cash upfront. HealthTronics is a provider of urological products and services, including the UroChart EHR and meridianEMR systems.

1-9-2014 10-42-01 PM

Lumiata, formerly known as MEDgle and the developer of a predictive analytics platform for healthcare, closes a $4 million Series A round led by Khosla Ventures.


Sales

1-9-2014 10-47-00 AM

Dameron Hospital Association (CA) selects Allscripts Sunrise clinical products suite.

1-9-2014 12-22-08 PM

Presbyterian Senior Living (PA) will implement AOD Software’s long-term care EHR across its 23 locations.



People

1-9-2014 11-23-59 AM

VMware promotes Ben Fathi from SVP to CTO.

1-9-2014 11-23-15 AM

Telehealth solution provider AMC Health names John Larus (Clinipace) SVP of solutions development for the clinical trials division.

1-9-2014 11-21-57 AM

RCM provider Encoda names Michael Kallish (RemitDATA) CEO, replacing co-founder William Cox, who will assume the role of president and CTO.

1-9-2014 11-53-23 AM

Impact Advisors appoints Steven Schlossberg, MD (Yale School of Medicine) VP/CMO.

1-9-2014 12-15-42 PM

Surescripts announces that CEO Harry Totonis will step down effective March 2014 and that it has hired an executive search firm to find his successor.

AHIMA members elect Angela Kennedy (Louisiana Tech University) as president/chair of the board of directors, a role she has held since June following the death of Kathleen A. Frawley. Members also elected Cassi Birnbaum (Peak Health Solutions) president/chair elect; Jennifer McManis (Crowley Fleck Attorneys) speaker of the house; and Zenethia Clemmons (HHS OCR), Virginia Evans (Emory Healthcare), and Colleen Goethals (Midwest Medical Records Association) directors.

Southcoast Health System (MA) hires Greg Robinson (AltaMed Health Services) as executive director of enterprise informatics.



Announcements and Implementations

ICUcare and IEEE will collaborate to develop a universal industry standard/specification and a free web-based middleware API to help healthcare providers map data from medical devices to EHRs and other health information systems.

1-9-2014 12-04-06 PM

Advocate Eureka Hospital (IL) implements electronic patient and e-forms technology from Access.


Other

1-9-2014 11-05-23 AM

The Institute of Medicine proposes a standard framework to help providers identify and quantify the costs and benefits of EHR implementations.

Non-profit hospitals paid their CEOs a mean compensation of $594,781 in 2009, according to a JAMA Internal Medicine-published report. Hospitals with high levels of advanced technologic capabilities compensated their CEOs $135,862 more than hospitals with low levels of technology.

A Reuters article says that drug companies, with newly limited access to doctors per PPACA requirements, are moving their sales efforts to EHRs. It mentions Practice Fusion, which sells EHR pop-up ads, and EHRs that email refill and vaccine reminders that don’t clearly state if the message is sponsored by a drug company.

Weird News Andy says the appropriate ICD-10 code is “X59.9 or X12 or combination thereof.” At least 50 people are scalded from emulating TV weather people who tossed boiling water into cold Midwestern air to watch it freeze.


Sponsor Updates

  • AirWatch wins three 2014 Compass Intelligence Awards in the enterprise mobility category, while AT&T was named the best service provider in the health and wellness category, as well as a winner in multiple non-healthcare related categories.
  • Lexmark’s Perceptive Software launches Perceptive Media Connector, which enables the cloud-based capture, management, and access of video content with the Perceptive Content client interface.
  • Ping Identity opens registration for Cloud Identity Summit 2014, scheduled for July 19-22 in Monterey, CA.
  • KLAS extends a high early-performance score to Health Catalyst for its healthcare-specific analytics platform.
  • ChartWise Medical Systems and TrustHCS partner to offer ChartWise’s CDI software with TrustHCS’s coding services and ICD-10 education.
  • Ellis Medicine (NY) cut overtime costs by $721,000 during the first six months after deploying API Healthcare’s workforce management technology.

EPtalk by Dr. Jayne

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After several extremely slow news weeks, I’m glad to see things are starting to heat up. I’ve heard a lot of buzz about the Consumer Electronics Show, which is taking place this week in Las Vegas. Several readers have sent me blurbs about wearable tech. I’m not nearly as much of a fashionista as Inga, but I do like to keep an eye on the trends, especially when they’re related to health IT.

The first product I looked at was the wearable ambulatory blood pressure monitor from iHealth. It’s both USB- and Bluetooth-enabled and allows for blood pressure readings at intervals of 15-120 minutes. Most home blood pressure monitoring units are bulky and patients are not as compliant as they might be. It is compatible with both iOS and Android and can store up to 200 measurements. It reminds me a bit of a futuristic version of the shoulder holsters worn by 1980s television cops, but with a touch of neoprene.

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The company also has a wireless ambulatory ECG device that looks pretty cool. Instead of having multiple sticky leads attached to the patient, it has a single unit that is worn under clothing. In keeping with the throwback 80s vibe, it reminds me of the handset of a vintage rotary phone, although it doesn’t appear to come in avocado green or harvest gold. Bluetooth connectivity to iOS allows for real-time transmission of readings. Both it and the blood pressure monitor are still awaiting FDA clearance and pricing isn’t yet available, so put your credit cards away.

Another reader sent me an article about the need to design tech wearables for women. I was excited to read about Ringly, which is creating jewelry and accessories that receive notifications from the wearer’s mobile phone. Being alerted by jewelry would be much nicer than the incessant phone checking I see. After recently working in an office where the front desk staff notified the back office of patient readiness using an extremely loud intercom (“patient for Dr. Jayne!”) I wonder if we could tie it to the EHR patient tracker. Ringly’s goal is to create jewelry that looks like jewelry rather than gadgets and also to allow users to leverage its app to prioritize the alerts they receive.

Don’t get me wrong, gadgets can be cool. I wear a Garmin when I run that screams, “Hey, I’m a GPS! No way you’re mistaking me for a watch!” I’m not crazy about how it looks, but its function makes it tolerable. On the flip side, there’s Everpurse, which can charge a cell phone on the go and looks nice as well. Although they’re sold out of virtually everything except the persimmon leather clutch, I might have to keep an eye on the site for new offerings.

Looking back at some of the promotions from the Consumer Electronics Show, Intel has launched its Make it Wearable contest to help identify the next generation of accessories. Maybe someone will develop a white lab coat with a sensor to track the level of dirt on the cuffs or the time since it was last laundered. I can think of a couple of physicians who would benefit from that functionality.

How about a patient hospital gown that alerts you when your backside is flapping in the breeze or one that self-adjusts to prevent unintended exposure? The video clip on the Intel website showed a dress that appeared to be zipping itself, so it might just be in the realm of possibility. Maybe next year Inga and I should include the Consumer Electronics Show in our meeting and convention plans. Have a connection that can help us register? Email me.



Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 9, 2014 News 3 Comments

Morning Headlines 1/9/14

January 8, 2014 Headlines 1 Comment

The HIMSS Health IT Value Suite

HIMSS launches a platform designed to help hospitals substantiate the value of healthcare IT investments by collecting hundreds of case studies that demonstrate EHR related safety, quality, or financial improvement, and then creating a nice data visualization that lets you explore the information.

A Standard Model For Evaluating Return On Investment From Electronic Health Record Implementation

Citing a wealth of conflicting studies that base their findings on non-standardized research methodologies, the Institute of Medicine proposes a standard framework to help providers identify and quantify both the costs and benefits of EHR implementation.

FDA Wants to Leverage Electronic Medical Records to Probe for Adverse Events

The FDA is looking for contractors to help it begin mining EHR data for signs that a post-market drug may be causing unknown adverse events.

Cincinnati Children’s Hospital Reaches Stage 7

Cincinnati Children’s Hospital, an Epic hospital, earns HIMSS Stage 7 designation for both its hospital and 14 of its associated ambulatory offices. 2.2 percent of US hospitals and 1.2 percent of ambulatory practices have now achieved Stage 7 designation.

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January 8, 2014 Headlines 1 Comment

News 1/8/14

January 7, 2014 News 1 Comment

Top News

1-8-2014 6-34-26 AM

Two healthcare-focused private equity firms will invest $77.5 million to take minority positions in MedHOK, which offers care, quality, and compliance software.


HIStalk Announcements and Requests

1-8-2014 5-29-05 AM

Welcome to new HIStalk Gold Sponsor Coastal Healthcare Consulting. The Mountlake Terrace, WA-based company has completed 850 engagements and won numerous KLAS clinical implementation awards since its founding in 1995. Most of its consultants have been with the company for at least 10 years. Offerings include Catalyst (SWAT team project crisis response), Convergence (reducing denied claims), Fusion (linking technology to clinical processes), and Wave (application support, workflow analysis, system build, and activation). Product expertise includes Allscripts, Cerner, Epic, GE Healthcare, and Meditech. Industry long-timer Amy Noel, RN is CEO of the company. Thanks to Coastal Healthcare Consulting for supporting HIStalk.


Upcoming Webinars

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years.

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.



Acquisitions, Funding, Business, and Stock

1-7-2014 11-51-07 AM

Press Ganey acquires On The Spot Systems, developer of a real-time data capture system for patient feedback, and launches Point of Care, a solution that allows providers to capture patient feedback via tablets and mobile devices.


Sales

Mount Sinai Health System (NY) selects MU Assistant from SA Ignite to automate its MU attestation process.

The Guam Regional Medical City hospital will deploy Allscripts Sunrise EHR and Financial Manager platforms when it opens in late 2014.

The Department of Defense awards Carestream Health a  one-year, $70.2 million contract for medical imaging technology.


People

1-7-2014 7-32-21 PM

McKesson Specialty Health and the US Oncology Network appoint Jeffrey Kao (Coventry Health Care) CIO/SVP of information and technology services.

1-7-2014 7-33-36 PM 1-7-2014 7-34-26 PM

T-System promotes Mark Horner from VP of client services to SVP/GM of RevCycle+ and  expands CFO Steve Armond’s duties to include leading the company’s documentation solutions.

1-7-2014 8-07-10 AM

Jacob Nguyen (Craneware) joins VitalWare as EVP of business development and operations.

1-7-2014 7-35-30 PM 1-7-2014 7-36-55 PM

Vocera names Rhonda Collins (Fresenius Kabi, USA) chief nursing officer and promotes Steve Jackson from COO of its ExperiaHealth division to chief strategy officer.

1-8-2014 7-34-58 AM

David Cerino (Zynx Health) is named CEO of WiserCare.


Announcements and Implementations

1-8-2014 7-02-06 AM

Fairfield Medical Center (OH) goes live this month with a fingerprint ID system from CrossChx.

Harrison Medical Center (WA), which affiliated with Franciscan Health System last year, will switch to Epic this summer.

Riverside Medical Center (IL) implements the DebMed electronic hand hygiene compliance monitoring system.

Wesley Medical Center (KS), Cypress Surgery Center (KS), and Surgery Center of Kansas go live on Anesthesia Touch from Plexus Information Systems.

inga thumb McKesson announces the general availability of its Paragon Ambulatory Care Practice Management solution, which is an extension of its single database HIS for inpatient facilities and designed for hospital-owned practices. I understand the PM module was developed internally, as opposed to a bolt-on of one of McKesson’s acquired products, and that an EHR module is also in the works. Sounds like McKesson is positioning itself to compete with Epic and Cerner in the IDN market.


Government and Politics

The Office for Civil Rights proposes an amendment to the HIPAA privacy rule to allow certain entities to disclose the identities of individuals with mental health “prohibitor” status to the gun background check system. The change would apply to individuals who have been involuntarily committed to a mental institution; found incompetent to stand trial or not guilty by reason of insanity; or otherwise deemed by a lawful authority to be in danger of themselves.

CMS reports that more than 30,000 hospitals, physicians, and medical equipment providers are using its online esMD documentation system instead of mail or faxes for auditor medical record requests and prior authorizations requests for power mobility devices.

1-8-2014 6-01-46 AM

A new OIG report says CMS and its contractors haven’t done enough to address Medicare fraud related to EHRs. It recommends that CMS provide guidance to its contractors on detecting fraud and suggests they review provider EHR audit logs. The report identifies inappropriate EHR copy-pasting and creating of false documentation to support higher charges as key fraud issues. CMS responded by saying it will develop copy-paste guidance and identify best practices for its contractors to detect fraud associated with EHRs.


Innovation and Research

South Dakota philanthropist T. Denny Sanford donates $125 million to Sanford Health (SD) to support the incorporation of genomics into the health system’s primary care programs, including added genetic testing information to the EHR to allow clinicians to personalize drug therapies. Sanford has donated $1 billion to the health system that bears his name.


Other

1-7-2014 9-42-35 AM

QlikTech’s QlikView earns the top spot among business intelligence products in a KLAS report on the healthcare analytics market.

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inga thumb According to a JAMA-published study, not too many physicians are joining Mr. H’s smoking doc for smoke breaks. Only about two percent of physicians admit to smoking, compared to 16 percent of the general population and 25 percent of licensed practical nurses.

1-7-2014 8-31-06 PM

A local paper profiles Whidbey General Hospital (WA), which experienced critical cash flow issues during its transition to Meditech. The hospital claims its billing process was abnormally slow after the system went live in May and caused A/R levels to climb and cash on hand to decline. The hospital, which expects to spend $7.5 million on its Meditech installation, is recovering. The paper incorrectly blames the ACA rather than than HITECH for requiring the use of EMR to avoid financial penalties.

A federal judge dismisses a patient’s lawsuit that charged a healthcare provider violated HIPAA laws when an employee’s laptop was stolen. The judge ruled that only HHS can enforce HIPAA and individuals do not have the right to bring lawsuits for its enforcement.

1-7-2014 8-50-30 PM

The Pittsburgh paper profiles hospital pharmacy automation vendor Aesynt, the former McKesson Automation / Automated Healthcare that was sold to Francisco Partners in November. It says the company has developed new hospital drug management software being tested by UPMC and Intermountain. President and CEO Kraig McEwen says the company has introduced more products in the past 12 months than in the past five years. He also says the company is looking for acquisitions  that will help it expand its offerings for reducing hospital drug costs.  

IBM’s “Jeopardy”-winning Watson computer is falling far short on the company’s revenue targets. Healthcare is its most promising market, but a $15 million M.D Anderson cancer genomics project is “in a ditch” according to the IBM executive in charge. A Watson oncology regimen project at Memorial-Sloan Kettering could go live later this year. IBM’s business plan calls for Watson to contribute $1 billion in annual revenue by 2018, but it has only generated $100 million in its three-year existence. The main problem is the effort required for engineers to program Watson for each business case so that it can learn from available information.

1-8-2014 6-53-33 AM

Massachusetts will launch the second phase of the Mass HIway HIE Wednesday at Beth Israel Deaconess Medical Center. The HIE  has received $55 million in federal funding.

E-Health Ontario, the provincial agency tasked with creating EHRs for all Ontarians, will share $2.3 million in performance bonuses across its 704 staff members. The payout follows a court settlement that restored payouts that were cancelled in 2011 as part of a controversial wage freeze.

John Lynn of EMR and HIPAA is producing an April 7-8 Las Vegas conference covering healthcare IT marketing and PR.

James Parks, former COO/CIO of Box Butte General Hospital (NE), is indicted on seven counts of child pornography after the hospital reports finding explicit content on his computer.

The governor of Minnesota blames IBM for problems with its state-run health insurance exchange that launched October 1. Minnesota Governor Mark Dayton sent a highly critical letter to CEO Ginny Rometty last month that blamed the company for a laundry list of items:

Your product has not delivered promised functionality and has seriously hindered Minnesotans’ abilities to purchase health insurance or apply for public health care programs through MNsure…. your product has significant defects, which have seriously harmed Minnesota consumers.


Sponsor Updates

  • CCHIT certifies that the Arcadia Analytics Meaningful Use Calculation Engine v1.0 is compliant with the ONC 2014 Edition criteria as an EHR module.
  • PeriGen recognizes Barbara LaBranche, senior director of clinical informatics design and usability, for being named an EHR Game Changer.
  • Muhammad Chebli, interoperability product manager for NextGen Healthcare, discusses the importance of interoperability in achieving MU2 objectives, particularly summary of care.
  • Liaison Technologies reveals its top predictions for 2014, including the dramatic growth of data integration complexity and the normalization of mass customization.
  • Nuance Communications demonstrates wearable devices with Dragon Mobile Assistant and Swype keyboard for smartwatches at this week’s CES 2014 in Las Vegas.
  • Prominence Advisors is named one of the 50 top Chicago employers of Generation Y employees (those aged under 33).
  • Visage Imaging releases a demo video shot at RSNA of its Visage 7 Enterprise Imaging Platform.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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January 7, 2014 News 1 Comment

HIStalk Interviews Joseph Mayer, MD, CEO, Cureatr

January 6, 2014 Interviews 2 Comments

Joseph Mayer, MD is founder and CEO of Cureatr.

1-4-2014 6-41-02 PM

Tell me about yourself and the company.

I started Cureatr when I was a resident at Mount Sinai here in New York City. Prior to that and during my residency, I’ve always been a clinical research guy. I did med school at Columbia and focused on clinical operational workflow research. How you optimize consults, communication between the floors and pharmacy, and even looked at inter-organizational workflows like PCP into the hospital, etc. This is an area I’ve been passionate about since I started my training. 

I started Cureatr with a guy that I had gone Stanford undergrad with, Alex Khomenko, about two weeks before I started my residency. I had formed this idea during the last couple of years of medical school and worked closely with Bob Sideli at Columbia. I got together with Alex who, at that time was director of engineering at 23andMe on the West Coast, flew out and met with him, and said, “I’ve got this idea. I’m starting my residency in a couple of weeks, but let’s work on this together. I’ll be in a great environment to get feedback to understand what our users need, also what the administrators need.”

One thing led to another. We built out Cureatr  during the first year of my clinical training. Our first real launch was in the medicine department at Mount Sinai in January 2012. 

It’s been really a whirlwind since then. We were part of this New York Digital Health Accelerator program, with 20 leading payor-provider orgs in the state which works closely with companies like ours to make sure there’s a product fit for what their needs are. We just closed our Series A financing with Cardinal Partners and Milestone Venture Partners. It was a $5.7 million around in October of this year.

 

Many companies are suddenly offering secure messaging for clinicians. Who are your biggest competitors and how is your product different?

We’re running into the guys you would expect, the TigerTexts of the world on the lightweight messaging side of things and on the nurse-first device side of things, Voalte and the legacy guys like Vocera and Avaya.

When I started Cureatr, I was interested in messaging as a part of some of these workflow problems. If you look at what a workflow consists of, you’ve got the communication piece. That’s a huge part of it, probably about a third of your time. You’ve got the documentation piece and CPOE documentation — that’s probably another third of your time.The last third is management, getting access to actual data. Obviously, unfortunately, you probably spend less time on implementation than you do in a lot of other areas of the care process. When I started Cureatr, I was interested in how do we build a tool for the whole part of this. 

Let’s start with messaging. There probably are a lot of messaging companies, but the penetration of these types of modern communication and workflow tools is incredibly low in this market. There’s no clear leader. It’s still a very green market.

We’re trying to differentiate ourselves by coming at this from the angle of, let’s find a couple of specific use cases or workflows that are highly repeated in your organization or for your patient population. Let’s deploy this combination of communication plus some task management plus some basic integration with other systems. Routing and care team mapping is a big part of that. That’s our differentiator. That’s the way we’re looking at helping our customers. 

The other big thing is more and more of our customers are interested in inter-organizational use cases. They need to think about what goes on beyond the four walls of the hospital, because from their perspective, the care episode no longer ends with discharge. We’ve gotten some early customers, like the DaVitas of the world, who are thinking a little bit ahead of the curve on cross-continuum care management and want to apply our tools to those areas. We are focusing on customers who are interested in that today because we think that’s going to be a growing need in the future where we can build some expertise.

 

Is the model that an enterprise would pay for the system, but there’s an individual app that people can download for free?

We are very hands on around implementation, very hands on around working closely with the enterprise and finding these specific use cases. But we get contacted all the time by folks like my father, a small private practice who want to use it. We obviously see value in letting them, but above value to them, the value to the bigger hospital customers we work with making the onboarding experience for the smaller organizations very easy, very lightweight. But our customers are mostly large enterprise guys like Sinai.

 

It’s same product that could be downloaded for free, just with more enterprise-type services bundled?

It’s modular. We have our core messaging piece. Then we have something we call structured messaging, which is a feature that the enterprise needs to create a step-by-step workflow for a specific use case. There’s a core, very lightweight messaging piece that’s very easy to download and get up and running within a couple of seconds, but if you want to get those other modules, if you want to get single sign-on, if you want to get documentation or tie in to your ADT or EMR or lab system, that’s what our enterprise customers will get.

 

What kind of numbers do you have using just the standalone free version versus those that are using it via enterprise?

It’s almost all enterprise customers. We wanted to get the product right. We wanted to build the infrastructure of a company before we started doing a lot of marketing. We haven’t done a lot of this “are your docs texting?” replacement-type marketing. We’ve mostly focused on talking to thought leaders and rolling it out to larger enterprises. I would say 90 percent of our customers are through an enterprise customer, any organization that’s purchased 500-plus licenses.

 

How many organizations do you have as customers?

We have about 10 large enterprise customers and then some large primary care groups, some larger multi-site practice groups. But in terms of large paying enterprise customers, we have about 10.

 

You offer read receipts and the ability to attached a photo securely. Is that unusual?

That stuff’s great and useful, but it’s what our customers expect. I would think anybody who is a serious company in the states does have that type of functionality.

The things that are really different between us and the product are, first of all, we built this from the ground up in a hospital and a health system. Our products have been optimized for clinical users. We have status and presence, which is a big thing in a clinical space.

The way I look at the world, and I think the way most providers do, is that there are only probably four or five pieces of information at any given time that are actionable and valuable to the care team. We are trying to create a shared view of the patient around this in real time as much as possible for the care team. It’s tying into those other systems and understanding how to smartly separate the signal from the noise around very actionable information is what we’re trying to optimize the product. But also maintaining a very good, solid, secure messaging user experience. 

That’s why things like read receipts, directory integration, scheduling integration, photo sharing, document sharing …  we have the wound care company that’s piloting our product, and it’s revolutionary for them because all of a sudden they can, instead of having to fax the face sheet from the patient when they’re discharged where they’re going to follow up with wound care or with vascular, they can send the PDF or even send a photo of the face sheet and have a very real-time, two-way back and forth to make sure that that patient is getting the right follow-up care. We’re starting from almost ground zero in healthcare, so things like that can have a very large, positive impact on workflow, on efficiency, on provider and patient experience, and satisfaction and experience.

 

You have data from Mount Sinai that was self-reported from a survey. Do you have any more specific analyses of either outcomes or anything more than just what the users report?

We’ve got a study that just came out that I can share with anybody who’s interested in following up privately, but we don’t have permission yet from this large academic health center to share that data because it’s literally fresh off their presenting at a conference. But we have some very exciting data around time saved, efficiency linked to earlier time of discharge, i.e. length of stay reduction and HCAP impact. We do not have randomized, evidence-based clinical trial data at this point. Very few companies in healthcare IT do.

We have two customers we’re partnering with to run some 12-month longitudinal studies looking at outcomes on specific clinical hospital performance metrics, both on the inpatient and outpatient side.

 

How did working with an accelerator help the company?

I am very grateful to the NYeC because we got unique exposure to the best hospitals in New York. Even more than that, everybody who was doing this program was very invested in trying to create a new ecosystem around where … Hospitals are just not used to working with startups. As a startup, time is your most valuable resource. Hospitals don’t move quickly. The thing that we got from the accelerator — more than the money and more than the PR — was literally a very accelerated access and  feedback to the C-suite and users.

The big challenge for anybody in healthcare IT today is, how do you think through the ROI story and how to measure the ROI for your product? There are a lot of companies right now in this healthcare IT space sprouting up. The death of many them will be not thinking about that piece, not having access to the right folks in the big health systems and the healthcare world in general to think through that piece.

That’s what we got out of this accelerator much more quickly than we would have from one customer or from going and talking to your friend’s dad who’s some executive at a hospital. We had invested folks giving us that kind of feedback through this program. I would recommend that program for anybody and I would do it again.

 

Where do you see the company going in the next few years?

There’s real value in secure texting or replacement pager stuff, but we’ve come up with what I think is the most effective, repeatable process for deploying secure messaging leveraging mining of the data for optimizing secure messaging in these larger enterprise customers. The next 12 months is really about what’s coming after messaging. Optimizing the care team mapping side of things, i.e. routing of messages to the right person at the right time, or routing information at the right time beyond messaging, task management.

These are the workflow tools. That’s what customers are telling us that they want. When you look at the most successful implementations of technology in healthcare IT and most successful companies, they’re very much focused on a couple of specific use cases or clinical use cases or workflows where they’re doing that better than anybody else. Our goal is, let’s find those use cases, let’s deploy messaging and these other tools around it, then let’s actually measure an ROI and let’s actually make it very clear for our customers how to achieve that ROI in future implementations. 

Building the product and the implementation and services side of the business to support that is the most critical thing right now, because from a sales side, there’s great demand for this right now. It’s almost a function of keeping up with that demand and making sure that our product is truly adding value to our customers.

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January 6, 2014 Interviews 2 Comments

Monday Morning Update 1/6/14

January 4, 2014 News No Comments

From The PACS Designer: “Re: Google Apps starter. With the continued growth of mobile devices, Google has exploited this trend with a mobile app landing platform for the iPad, iPhone, Android Tablet, and Android Phone. Now and in the future it will be easier to get apps to play on no matter which mobile device you may have in your possession as Google expands this landing platform with even more mobile solutions.” Google is everywhere these days, but I’m finding their apps less capable and more annoying. They tie everything into your Gmail account even when you don’t want them to, and the initially intriguing minimalist design of all Gmail-related apps is now just as annoying and clunky as a 1980s Invision screen (example: Gmail doesn’t support using the Delete key to delete an email, instead going the proprietary/obscure route by using the E key instead.)

1-4-2014 8-19-56 AM

Poll respondents find Medicare’s fraud-sniffing efforts to be unimpressive. New poll to your right: what will be the biggest challenge for hospital CIOs in 2014? The length of the list suggests the challenges inherent in that job.


Upcoming Webinars (Times are Eastern) 

1-4-2014 2-32-14 PM
January 7 (Tuesday), 1:00 p.m. Clinical Analytics for Population Health Management. Sponsored by HIStalk. Presenter: Cora Sharma, principal analyst, Chilmark Research. As providers move from fee-for-service to value-based payment models, they must not only comply with ever-proliferating quality metrics, but also transition from a cost-plus business model to one of cost containment. 

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years. 

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

HIStalk-sponsored webinars are non-commercial presentations of broad interest. I appreciate our pro bono presenters, who get a sizeable audience and recognition without the frustrations involved with presenting at a conference. Contact me if you’d like to present.


1-4-2014 9-21-20 AM 1-4-2014 2-33-19 PM

Welcome to new HIStalk Gold Sponsor The Loop Company. The Williston-VT-based research advisory firm helps companies launch new offerings, enter new markets, win more business, and create customer loyalty. They design programs to help companies understand how the market perceives them and can help improve sales, marketing, product development, and operations. It’s a new venture from old HIStalk friend and industry long-timer Gino Johnson, who created the excellent CapSite healthcare IT research and advisory firm that HIMSS acquired and rolled into HIMSS Analytics in October 2012. Thanks to The Loop Company for supporting HIStalk.

HISsies nominations continue, so please submit yours now. It will only take a couple of minutes and you can skip categories you aren’t interested in.  I’m enjoying reading the early nominations for worst vendor, Lifetime Achievement Award, and the always-popular “industry figure with whom you’d most like to have a few beers.” Long-time readers may remember years ago when Jonathan Bush won that category (as he often does) and agreed to let me auction off an evening with him as a charity fundraiser.

Listening: Blue Coupe, made up of hard-rocking 1970s legends Dennis Dunaway (the shamefully underappreciated bass player and principle songwriter for Alice Cooper when it was a real band) and the Bouchard brothers Joe and Albert (key members of Blue Oyster Cult), thus the band’s name as a nod to the respective histories of its members. The band started out playing Alice Cooper covers, but earned Grammy attention for new material in 2011/2012.


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

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In Australia, the ambulance service of New South Wales requires a government bailout after its aborted EMR and billing system project left it with $7.5 million in invoices it couldn’t send out.

North Carolina, which just passed a law requiring hospitals treating Medicaid patients to participate in the state HIE, sends out nearly 50,000 new Medicaid cards to the wrong people.

1-4-2014 10-57-35 AM

Intelligent InSites names investor and executive board chair Doug Burgum as interim president and CEO, replacing Margaret Laub, who has left the company. Burgum founded accounting software vendor Great Plains and sold to Microsoft in 2000 for $1.1 billion.


Weird News Andy likes the story that he titles “Print a Liver – 2014,” to which he adds a “Silence of the Lambs” pop reference in wondering if they can also print a nice Chianti (although I seem to remember that the book instead said “big Amarone” before Hollywood dumbed down it down for less oenophilic  moviegoers.) A California biotech firm says it will successfully use 3D printing to create a human liver (or more precisely, a working model of a human liver suitable for drug company research) by the end of this year.

“Taking from Peter to Pay Paul” is WNA’s assessment of a survey of doctors in England, in which a third of them want to charge each ED patient $16 to to discourage usage for minor complaints. The patient counterpoint would be that appointments are hard to get and practices are closed nights and weekends. We have similar challenges here, obviously: the ED is always open and free if you can’t or won’t pay, while urgent care isn’t always open and they expect money upfront.

1-4-2014 1-17-29 PM

Strange: a medical student examining a standardized patient (an actor playing the role of a patient) pretending to have an abdominal aortic aneurysm detects the actual condition, alerting the instructing physician to urge the man to see a cardiologist. He does and is found to require stent replacement surgery. According to the patient’s wife, “Jim’s life was saved by a UVA medical student, no doubt about it.”

Vince covers the $14.5 billion acquisition of HBOC by McKesson in this week’s HIS-tory. I think he’s planning to wrap up his HIS-tory series after the next couple of installments. I will miss them since I have enjoyed every one.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 4, 2014 News No Comments

News 1/3/14

January 2, 2014 News 3 Comments

Top News

1-2-2014 7-58-42 PM

President Obama announces that he will nominate Leon Rodriguez, director of the Office for Civil Rights of HHS that enforces HIPAA, for Director of Citizenship and Immigration Services in the Department of Homeland Security.


Reader Comments

1-2-2014 7-45-24 PM
Photo: Brian Snyder/Reuters

From DZA MD: “Re: Baystate Medical Center. Cerner PowerChart crippled with record inpatient census and Nor’easter in full effect. Unable to process timely discharges before brunt of storm arrives.” Unverified. As I write this Thursday evening, Massachusetts is about to get nailed by a winter storm that will bring up to 30 inches of snow in places with wind chill as low as 20 degrees below zero and even colder Friday night.

From Dirk Benedict: “Re NextGen lawsuit. Mountainview Medical Center in Montana sues NextGen, saying it didn’t install its $441,000 EHR system as promised.” The six-bed hospital contends that NextGen was to install a system “which would permit MVMC to demonstrate ‘meaningful use’ of such electronic health records through all stages of applicable federal regulations” and was to complete implementation by October 1, 2013. According to NextGen’s website, NextGen Inpatient Clinicals EHR 2.6 is 2014 Edition certified as a modular EHR, so it’s difficult to determine what the exact issue(s) might be. NextGen provided us with this statement:

We cannot comment on the pending litigation, other than to say that we firmly believe the allegations made by Mountainview Medical Center are without merit and we will defend against them vigorously. We confidently stand behind the quality and performance of our products and offerings.

1-2-2014 6-06-14 PM

From Intractable Vermonting: “Re: Vermont health insurance exchange. The cost overruns have been tremendous and the politicians responsible pass it off as ‘changing project scope costs money.’ 99 percent of all IT leaders in the US would be fired if they managed a project in this fashion. Also, security is the last thing that is built into the technology before it goes live and I am sure there were shortcuts taken with all these exchanges. The hackers know that most sites require Social Security number to register.” The Vermont Health Connect insurance exchange website is the most expensive IT project ever undertaken in the state, running up a tab of $172 million, of which the federal government contributed $48.7 million. One big contractor was the ever-present CGI, which managed to turn its $42 million contract into $84 million worth of billables while missing key deadlines that kept the site from being ready on October 1. CGI was smart: the state says the delays cost $26 million, but CGI’s contract says it can be penalized a maximum of $5 million.


HIStalk Announcements and Requests

1-2-2014 5-48-35 PM

It’s time for the HISsies nominations. What’s your choice for “Stupidest Vendor Action Taken,” “Most Overused Buzzword,” “Industry Figure With Whom You’d Most Like to Have a Few Beers,” and “HIStalk Healthcare IT Industry Figure of the Year?” Enter your nominations, from which the most-nominated choices will go on the final ballot in a week or so. That means no complaining if your choice isn’t on the ballot and you didn’t nominate them.

1-2-2014 6-15-48 PM

HIStalkapalooza registration will open up the week of January 13. Read HIStalk religiously for the link to the signup notice in the next couple of weeks. We fill up really fast every year. Above is a photographic hint of the venue for those wondering. The primary sponsor has a couple of co-sponsors whose support will allow the event to be even bigger and better. If your company is interested in getting exposure as a HIStalkapalooza co-sponsor, let me know and I’ll connect you since they are willing to take on two more.

1-2-2014 6-39-01 PM 1-2-2014 6-48-11 PM

Welcome to new HIStalk Platinum Sponsor healthfinch (they tell me it’s supposed to be all lower case). The company offers RefillWizard, which improves doctor efficiency as a “Team-Based Decision Support System” that improves patient safety while reducing refill turnaround time by up to 95 percent. They begin by preparing a customized savings document like the one above and making recommendations to optimize the refill process. They have found that 62 percent of refills can be selectively and safely delegated to clinical staff, reducing the staff time to 34 seconds (some PCPs spend 1-2 hours per day just managing refills.) RefillWizard, which just won the Allscripts Open App Challenge, works either with paper protocols or integrated with the EMR. HIStalk readers probably know DrLyle (Lyle Berkowitz, MD), the company’s chairman and chief medical officer. Thanks to healthfinch for supporting HIStalk.

I found this healthfinch RefillWizard overview on Vimeo.


Upcoming Webinars (Times are Eastern) 

January 7 (Tuesday), 1:00 p.m. Clinical Analytics for Population Health Management. Sponsored by HIStalk. Presenter: Core Sharma, principal analyst, Chilmark Research. As providers move from fee-for-service to value-based payment models, they must not only comply with ever-proliferating quality metrics, but also transition from a cost-plus business model to one of cost containment. 

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years. 

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify and extract waste from their systems


Acquisitions, Funding, Business, and Stock

Healthcare Data Solutions acquires StratCenter, a provider of healthcare provider data.

1-2-2014 9-09-48 PM

Stryker Corporation will acquire surgical sponge counting technology vendor Patient Safety Technologies, Inc. for $2.20 per share. The company’s market cap is $85 million.


Sales

1-2-2014 11-52-35 AM

In the UK, King’s Mill Hospital signs a five-year, $5.9 million EHR contract with Specialist Computer Centres and McKesson.

Medical billing company Medorizon Partners selects InstaMed’s patient payment plan technology.

The Defense Logistics Agency awards TeraRecon a maximum $30 million fixed-price contract for the procurement of radiology systems and services.

Central Georgia Health System will implement Infor’s healthcare business automation applications.


People

1-2-2014 11-54-08 AM

CareTech Solutions hires Daniel Lincoln (Palace Sports & Entertainment) as corporate controller.

1-2-2014 11-55-09 AM

CMS announces the retirement of COO Michelle Snyder, who supervised development of HealthCare.gov. The agency says Snyder had originally planned to retire in 2012 but stayed on at the request of CMS chief Marilyn Tavenner.

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CareView Communications, which offers patient flow and safety solutions, promotes Steven G. Johnson from president to CEO, taking over for Samuel A. Greco, who is retiring for health reasons. Careview also names Sandra K. McRee (McRree Consulting) COO and appoints Jason T. Thompson to the board, replacing his father, Tommy G. Thompson.    

1-2-2014 7-26-42 PM

Direct Consulting Associates promotes Frank Myeroff to president.


Announcements and Implementations

Baptist Memorial Health Care (TN) goes live on Epic this week at four minor medical centers and at its Baptist Medical Group clinics. Four Memphis-area hospitals are scheduled for a March 11 go-live.


Government and Politics

1-2-2014 8-13-46 PM

A new North Carolina law requires hospitals with EHRs to connect to the state’s HIE and submit data on services paid for with Medicaid funds.

The Department of Defense issues an RFP to keep AHLTA and CHCS running through the end of 2018 after plans for a joint DoD-VA EMR were scrapped last year when costs were estimated at $28 billion. The value of the new contract is estimated at $250 million to $1 billion. DoD is looking at a commercial replacement for contractor-developed AHLTA, whose estimated cost to taxpayers was up to $5 billion.


Innovation and Research

1-2-2014 8-06-17 PM

A study of 295 smartphone apps that claim to prevent, detect, or manage cancer finds no published studies that prove their usefulness, effectiveness, or safety.


Technology

The FDA extends the Kinsa Smart Thermometer the first-ever 510(k) clearance for a smartphone-connected thermometer.

The US Patent and Trademark Office issues CommVault Systems a patent for efficient data management improvements, such as docking limited-feature data management modules to a full-featured data management system.


Other

Riverside Health System (VA) announces that a now-terminated LPN inappropriately accessed the records of 919 patients over a four-year period.

Cerner completes the purchase of the 237-acre tract for its planned $4.3 billion office development in south Kansas City.

1-2-2014 12-09-10 PM

Ward County (TX) officials will give Ward Memorial Hospital an additional $200,000 to cover a budget shortfall that is partially blamed on their recent EHR implementation (Healthland Centriq, I believe.) 

A new study contradicts the Affordable Care Act assumption that putting uninsured Americans on Medicaid will reduce ED visits, instead finding that ED visits in Oregon increased by 40 percent as the newly insured sought ED for issues that could have been handled in physician offices. The primary author, an MIT economist, concludes that, “As I tell my economics students, when something is free, people use more of it.”

The Department of Justice joins the whistleblower lawsuit of two Charlotte, NC contract ED physicians who claim for-profit hospital chain Health Management Associates offered them kickbacks to order unnecessary tests and increase admissions. The doctors say HMA’s Pro-Med software was programmed to automatically order batteries of tests on ED patients based on their complaints before they were seen by a physician. They say HMA required EDs to admit 50 percent of Medicare patients whether they needed it or not, quoting a 2009 email from an HMA executive to ED managers that said, “Big declines in over 65 admissions – you know what to do!”

A Huffington Post reprinted piece by writer and medical resident Brian Secemsky, MD doesn’t have much good to say about the EMR used by the underserved clinic where he works:

After several months of receiving emails full of buzzwords such as improved care coordination and effective closed-loop med administration from the powers that be, I couldn’t help but drink the Kool-Aid and join the anticipated excitement of integrating an innovative source of technology into an over-booked and often overwhelming practice. Where my mind was brimming with images of easy-to-use tabs, high-yield keywords and a system where clinic documentation could effectively reflect patient encounters using minimal time and effort, I was instead bombarded with yet another early ’90s-style template full of odd-sized buttons and novel concepts that were the far from intuitive. The spiked punch quickly wore off the minute I first fumbled through this bulky piece of technology, and I was back to spending hours each night typing away, well after seeing the last of my patients.

1-2-2014 6-34-23 PM

Weird News Andy likes this unlikely innovation and even suggests the above graphic for advertising. A car mechanic in Argentina falls asleep after watching a YouTube video about a machine that extracts corks from wine bottles, then wakes up inspired to invent a device that uses an inflated plastic bag rather than forceps to extract babies stuck in the birth canal. Against all odds, WHO has endorsed his invention and a US device maker has licensed it.

1-2-2014 8-51-31 PM

A bizarre article concludes that the government is planning to execute US citizens. It concludes that ICD-9 code E978 (legal execution) is part of a secret plan to create an “International One World Government,” claiming that, “Even more disturbing, is finding out American citizens have been subject to the ICP Medial code for many years. Thus, giving the United Nations our private information through coding.” The article proposes a solution even more dramatic than ICD-10 foot-dragging: the US should pull out of the United Nations.


Sponsor Updates

  • Sunquest releases new versions of Sunquest Laboratory and Sunquest Molecular.
  • The Boston Globe profiles Sumit Nagpa, CEO of Alere Accountable Care Solutions.
  • Jason Fortin, senior advisor for Impact Advisors, discusses the impact of Meaningful Use in 2013.
  • EDCO Health Information Solutions posts a Point of Care Scanning Process video.

EPtalk by Dr. Jayne

I received a lot of feedback about this week’s Curbside Consult. I’ll be posting more responses to the original reader email in the next Curbside Consult, but wanted to share some quick responses in the interim.

One reader asked for more detail about how we’ve tied the physician bonuses to EHR use. I can’t claim credit for the approach since we copied it from another organization, but it has worked well. It only applies to employed physicians using the group’s EHR platform. We have a couple of practices that we have acquired that are on other systems and are not yet converted, so they are exempt for now.

Physician bonus amounts are determined by three factors: patient satisfaction, clinical quality scorecard results, and productivity. A sliding scale is used for each element. For example you might receive 100 percent of your patient satisfaction and productivity bonuses but only 80 percent of your quality bonus.

The EHR plays into that in two ways. Since we’ve been fully adopted on EHR for many years, all of our quality reporting is now derived from EHR data (no more manual chart reviews). If providers are not documenting in the EHR, their scores will be low. We initially did a hybrid approach with both manual chart review and EHR reporting while physicians were adopting, but that has been phased out. Our staffing for compliance reviews has dropped significantly. They used to take three full work days per physician and now they take two to three hours per physician.

The major way that EHR applies to the bonus, however, is simple. All visits must be documented in the EHR and must meet our minimum data standards. These aren’t a lot different than the paper chart. The visit has to be complete within 24 hours of the patient visit and has to include certain critical data elements that essentially align with CMS coding requirements. For example, documentation has to have a chief complaint, history of present illness, review of systems, review of pertinent patient history, physical exam, and an assessment and plan.

We expected this to be present in the paper world and now it’s actually easier since the data is shared across the multispecialty group rather than living in separate paper charts by location. Providers can review histories with one click rather than having to dig for histories that may have been mentioned in various progress notes. Our physicians were not particularly good at keeping the paper problem list and past / family / social history face sheets up to date on paper.

For some practices that were challenging implementations, we actually had to physically visit the practice and make sure they didn’t have shadow charts. One site didn’t have charts, but had “jackets” for each patient. We didn’t just fail them outright but gave them three months to remediate, then audited them again. Over the last few years that the EHR requirements have been attached to the bonus structure, we’ve been fair about doing pre-audits so people know where they stand, then allowing enough time for them to remediate before their final audit.

The reader also asked about the “standards” that I mentioned our physicians have to meet to stay employed. Some are pretty simple – no OSHA or CLIA violations, favorable scores on coding and compliance audits, and getting along with their partners and staff. Some are more rigorous. We have high standards for clinical quality, and physicians are graded on blood pressure control, appropriate use of drugs for coronary artery disease, cholesterol control, influenza vaccination, cancer screening (colorectal, breast, prostate), diabetes management, and a couple of others. Physicians who can’t keep their scores in the desired range are remediated (as are their office staff – many of the metrics can be improved by leveraging staff and using standing orders including vaccination and screenings).

Finally, physicians are expected to be productive – specifically, to be above the 75th percentile based on MGMA data. That’s a lot to ask, but the group makes it clear when physicians join and it’s actually spelled out in the contract. Our compensation parallels this – our physicians consistently earn salaries in the top 20 percent based on MGMA data. If they choose to work less than full time, the productivity expectations are scaled accordingly. Our retention rate has been very good. Most of the providers who leave within five years of joining have a family reason. For example, they may only work with us for a year or two while they wait for their spouse to receive a residency or fellowship appointment that requires relocation.

In addition to their bonuses, our providers also received a hefty chunk of their Meaningful Use payments as a cash bonus. This differs from most organizations I’ve talked to that tend to keep the MU payments at the corporate level. I think the way we shared them is especially surprising given the fact that our providers don’t pay anything for EHR software, training, or maintenance. The only EHR-related charge that the practices incur is for hardware, which averages $8,000 – $10,000 per provider every three to four years.

Another reader asked how we handle the EHR records with a physician who chooses to leave the organization (or is let go) yet wants to keep his or her patients and office location. It’s actually pretty easy. We have a subsidized EHR offering (under the Stark exception) so we already have local private physicians on our EHR database with independent practice data. We simply copy the charts of active patients (those seen by the provider within the last three years) into a new practice in the EHR. Only clinical data is copied, no financial data and no accounts receivable.

If the provider is on staff at one of our hospitals, he or she may be eligible for a subsidy. Otherwise they pay fair market rate and we host it similar to a SaaS model offering. Although the providers can still share data with the employed practice, they have to do it through our private HIE rather than sharing a direct chart within the multispecialty practice. Providers are charged $0.50 per chart for the copy. That’s a holdover from our old contract when we had paper charts and they paid that much for the paper charts. I have no idea where that number came from — it’s been in place for at least 15 years.

If they choose not to stay on our platform, we have a third-party consultant perform an extract based on the new vendor’s specifications. It’s the same very skilled consultant we use when we acquire practices and bring the data into our system. Once the drive goes into the Pelican case and enters the physical transport protocol, though, it’s out of our hands.

I’ve seen two physicians treated poorly by their new vendors. One took several months to move the extracted data onto the new EHR. Another simply turned the data into PDFs and parked it in the new EHR’s scanning system, which is pretty sad considering the level of discrete data we can provide. Providers can also buy a system directly from our vendor and we’ll do the extract in that situation as well.

I’ve shared a lot of fairly specific information this week, so I hope it doesn’t come back at me. Stay tuned for the next Curbside Consult. I’ll be sharing my thoughts on infrastructure and interoperability as well as what happens when you try to drive a Ferrari in a corn field.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 2, 2014 News 3 Comments

Advisory Panel: Telehealth Projects

December 30, 2013 Advisory Panel No Comments

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 question this time: Is your organization running or planning telehealth projects?


Assuming the term telehealth includes scope of technologies included in the HRSA definition, we run remote ICU monitoring across our WAN. In addition, we continue to expand the use of mobile clinics that roam around our geography. These clinics include videoconferencing between clinic providers, patients, and remote specialists. We are planning additional work with a national telehealth provider.


No, my organization is still struggling to implement CPOE, keep the beds full, reduce readmissions, etc., etc., and we have not got that far yet.


This shows up in our annual strategic plan every year and it’s there this year too. But I haven’t been able to generate much interest among my medical staff, even the members who travel hundreds of miles for outreach clinics. We run a telemedicine epilepsy clinic and we have the usual teleconferences, but that’s about it. So I’ve retained some consultants to explore options like e-visits, home monitoring, and video visits using webcams with the med staff.


We have a few telehealth services we consume for a couple of specialties. For example, we have a small pediatric hospital and will perform remote echoes with specialists at a leading children’s facility for special patient cases. We do not have any plans to provide any additional telehealth services within our organization or service areas at this time.  


Multiple coordinated efforts related to telehealth as we are approaching from a number of perspectives. More traditional eICU, using remote monitoring of multiple ICUs from a centralized location where critical care physicians and other clinicians are monitoring beds across multiple hospitals. Tele-psych consults in our emergency departments. Developing newer capabilities for virtual ambulatory visits, more acute or urgent care conditions where audio/video is effective in connecting a patient and a provider. Our EMR is really helping with efficiency in this service area and also with tele-psych and ICU areas. The key being that tele-X software, hardware can help best facilitate the patient encounter but it’s important to realize our EMR is needed for order entry, documentation, communication with the local hospital pharmacy, etc.


We currently have a monitoring station set up in our ICU for pediatrics so that our patients can be “seen” by a specialist at a large teaching hospital in the state.  We are currently proposing to provide healthcare services to our local detention centers. If accepted, we’ll go the telehealth route.


ANGELS – Antenatal & Neonatal Guidelines, Education, and Learning System – consists of 23 hospitals and clinics who receive clinical services from us, as well as 18 hospitals who participate in a tele-nursery with us as the hub. Neonatal mortality rates for Medicaid declined from 4.5 per thousand to 3.3 per thousand. ANGEL EYE – one-way video from NICU to authorized family members. AR SAVES – Stroke Assistance Through Virtual Emergency Support – consists of emergency support for 42 hospitals across the state. Increase delivery of TPA from <1 percent to 29 percent in participating hospitals. Other telemedicine services – psychiatry, pediatrics, geriatrics, rehab medicine, cardiology, internal medicine, burn, trauma, genetic counseling.


We’re doing projects with telehealth, telepsych, home health monitoring, remote hospitalist consulting, and have others we’re thinking about. While telemedicine has been around for decades now, it seems to be really heating up lately.


[from a vendor member] We are working with several organizations who are planning telehealth projects. However, it is like NLP at this point – all talk, no action.


We are on the receiving end in that we use a telehealth service (neurology consults) in our ED. It works well, although the service and support has proved problematic. The cart contains all the video components, but when there was a problem, they had no local service techs. This left it to our staff to troubleshoot – if we were a smaller very rural hospital we may not have had the expertise to troubleshoot their equipment on our end. Overall the service has been a benefit to the hospital in that we have a shortage of these specialists to take call.


We actually do a lot of telemedicine, both inside our health system and with external partners and that program is continually expanding. Our main service lines at this point are Neuro, Pediatrics, and Psychiatry. The primary locations served tend to be emergency departments in order to deliver otherwise unavailable specialty care to patients.


Yes, for various disease states and ethnically diverse populations.


A year and a half ago, we agreed to work with a vendor on a case study to determine if telehealth would positively impact outcomes. Telehealth was new to them and they struggled to develop a website for data collection and patient interaction. For the research study we needed IRB approval and a contract with us. Once the attorneys got involved, everything came to screeching halt. A year later, we have a contract and pending IRB approval. Perhaps in the near future we can begin the study with our diabetes and CHF patients.


We have long offered telehealth via phone and web visits for mild, acute problems (e.g. URI, UTI), and we charge a separate fee for those. We are also now looking at using telehealth technology to do remote care at corporate clients.


Vague talk only about telepsychiatry to local ERs and jails.


Telehealth in use for burn, stroke, and psych consults. All working very well with different technology solutions including iPad and a mobile robot looking device.


To meet requirements for Level 1 nursery, we have neonatology sub-specialists on tap, credentialed and available. This is a great solution to consultations that would otherwise require transfers. It is another question entirely whether early transfers are in the baby’s best interest; it may be that telehealth consultations get an actual consultation in the odd hours, where if the baby were in the actual institution providing the consultants, there would be more of the "I’ll see them in the morning" mentality. Of course, in that setting, the consultant is probably more comfortable with the nursing and ancillary staff, so it may be about the same outcome. Still, it feels good to have an actual clinician to clinician discussion about a specific case.


We’re doing a lot of tele-stroke work. A real smart stroke neurologist with an interest in the technology. He’s serving other organizations and when not on site, he starts care using his tablet and the stroke robot in the ED supported by a stroke nurse-practitioner or neurosurgery PA.


Virtual visits are part of our future plans, none running yet.


We are rolling out telemedicine to support our network of six rural health clinics. This will be essentially to push the access to our specialists. Rollout is over next three months.


Radiology uses NightHawk services from the other side of the globe for night preliminary reads, but that’s it.


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December 30, 2013 Advisory Panel No Comments

Morning Headlines 12/30/13

December 30, 2013 Headlines No Comments

PCORI Awards $93.5 Million to Develop National Network to Support More Efficient Patient-Centered Research

The Patient-Centered Outcomes Research Institute will invest $93 million in a new project aimed at developing a collaborative network of health systems, payers, and patient groups working together to conduct more efficient health research.

Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part I): Assessment of Participant Reach and Adoption

A study published in the Journal of Medical Internet Research designed to measure the participation and adoption rates of a text-based type 2 diabetes program finds that only 39 percent of enrolled participants completed the 14 week program, leading researchers to conclude that text-based programs may not be appropriate for everyone.

HIMSS Career Services to Focus on Veterans

HIMSS will launch a program aimed at introducing military veterans to " future careers in the health IT industry." The program, which was government funded, will be located on the exhibit floor at HIMSS14. Any military veterans that might be interested in the health IT industry need only get themselves down to the HIMSS conference, pay $575 for a single day conference pass, and then proceed to the “A Hero’s Welcome to Health IT” booth. Once there, they’ll meet other veterans that are working in health IT that will be able to answer questions for them, and they’ll learn about HIMSS entry-level certification exams.  

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December 30, 2013 Headlines No Comments

Monday Morning Update 12/30/13

December 29, 2013 News 6 Comments

12-29-2013 9-01-12 AM

From Informatics Doc: “Re: PCORI. Announces who they will fund to build clinical data research networks and patient-powered research networks, which has a fairly ambitious national goal. MU-compliant EHRs will be a key component to several networks.” The Patient-Centered Outcomes Research Institute, a non-profit created as part of PPACA/Obamacare,  approves $93.5 million to fund 29 clinical research data networks that will form PCORnet, a national network that will study clinical outcomes. Of the 29 participating organizations, 11 are hospitals, plans, and health networks that will provide real-time patient encounter information, while the other 18 are patient-operated, condition-focused groups. Quite a bit of technology is involved, including interoperability and data collection from EHRs such as Cerner and Epic, data standardization, patient-facing applications, and population health management tools. Harvard Pilgrim Health Care Institute won a $9 million contract in September to run the program, naming as directors Richard Platt, MD, MS from Harvard Medical School along with Robert Califf, MD from Duke University Medical Center. I think it’s a great idea, although the politics and special interests involved in translational research make it hard to predict whether it will be successful in turning new medical data into health-improving and cost-saving principles. 

12-29-2013 2-11-27 PM

From The PACS Designer: “Re: iPhone 5S. With the gifting completed for the holiday, TPD thought it would be useful to post instructions for the HIStalkers who may have received the iPhone 5S. Since it can be daunting getting started with the 5S,  providing detailed instructions will get you going sooner.”
12-29-2013 7-20-01 AM

Barely more than half of poll respondents think Karen DeSalvo was a good choice to be Farzad’s replacement as National Coordinator, although none of those who voted added a comment to explain their position. The suck-up organizations (which is pretty much all of them) can’t say enough good things about her even though most of their flattery is either superficial or irrelevant, so to you naysayers, what don’t you like about her? Leave a comment on this post if you like. New poll to your right: how would you grade Medicare’s fraud prevention efforts?

12-29-2013 8-16-29 AM

The Associated Press Oregon names Cover Oregon’s botched insurance exchange website as the state’s top news story for 2013, summarizing:

Once considered a national health care leader, Oregon produced the worst rollout in the nation of the new national health insurance program. While the crippled federal website eventually got up and walked, Oregon’s remained comatose, unable to enroll a single person online. The state had to resort to hiring 400 people to process paper applications. Officials lay much of the blame on the primary information technology contractor, Oracle Corp., and withheld some $20 million in payments. But state officials’ own actions played a role, too. In the face of disaster, they insisted on doing things The Oregon Way, clinging to a grandiose vision of creating a grand health IT system that would not only enroll new people in the national health insurance program, but also provide other vital services. In the midst of the finger-pointing, executive director Rocky King went on indefinite medical leave, and chief information officer Carolyn Lawson resigned.

12-29-2013 10-31-27 AM 

Massachusetts, whose healthcare programs inspired Obamacare, has paid $11 million of a $69 million contract for creating its health insurance exchange website, which has enrolled only 2,800 people due to technical problems. The state says the system, built by Healthcare.gov lead contractor CGI, is slow, displays random error messages, and times out. It requires applicants to submit their information online, then wait for a mailed letter before signing up for insurance. Both Massachusetts and Vermont have halted payments to CGI for their insurance exchange sites, saying the company isn’t meeting its obligations.

12-29-2013 9-30-52 AM

Canada-based CGI, whose Healthcare.gov contract is worth around $300 million of that site’s $700 million cost so far, has a market cap of $10.6 billion. It’s one-year share price chart is above, with GIB in blue and the Dow in red. Vanity Fair’s profile of CGI is unflattering, citing previous unhappy customers and creative acquisition-related accounting practices (the company is made up of 70 acquired entities.) Industry long-timers will remember its 2004 acquisition of American Management Systems (AMS), from which quite a few hospitals bought medical records scanning and workflow applications. Including my hospital at the time, which earned AMS/CGI strong consideration for my “worst vendor” list. The article summarizes:

The story of how the Obama administration and the Centers for Medicare and Medicaid Services (CMS), the agencies tasked with implementing the Affordable Care Act got it so wrong is still unfolding. Much of the blame has to fall on an insular White House that didn’t want to hear about problems, and another chunk has to land on CMS, which instead of hiring a systems integrator, whose job it would have been to ensure that all the processes feeding into healthcare.gov worked together, kept that role for itself. As anyone who has worked with the federal government on such projects knows, it is utterly inept when it comes to technology.

Palomar Health’s Glassomics incubator for Google Glass releases a demo video of potential medical applications, including real-time integration with patient monitors and the EHR.

12-29-2013 2-13-01 PM

Hawaii Governor Neil Abercrombie releases $21.7 million in state capital funds for healthcare projects, of which Hawaii Health will receive $14.3 million for EHR-related projects.

Venture Beat predicts the hot tech buzzwords for 2014: “growth hacker” (data-driven marketing people); “nth screen” (sharing across devices); “design thinking” (human-focused innovation); “ephemeral sharing” (Snapchat-like shared data that disappears); and “hyperdata” (cooler than the now-unhip term “big data,” but meaning about the same thing).

In England, NHS and Department of Health create The Walk, an exercise app that combines a pedometer with a mystery story that unfolds as more steps are accumulated toward 500 miles of walking. It was developed by the creators of Zombies, Run!, which similarly combines a mystery story with running.

Hope Phones collects unwanted cell phones, allowing individuals and companies to outfit global health workers with the erased and furbished devices. Donation couldn’t be simpler: just print a postage-paid label from their site and put your phone in the mail. It’s part of Medic Mobile, a San Franciso-based public charity that uses mobile technology to improve health.

A Hero’s Welcome to Health IT, a government-funded program, will introduce military veterans to careers in health IT at the HIMSS conference. It offers mentoring and entry-level certification.

12-29-2013 2-46-21 PM

ONC’s annual meeting will be held January 23-24 at the Washington Hilton in DC, with 1,200 attendees expected.  It will probably be the first public appearance of new National Coordinator Karen DeSalvo, MD, who will start at ONC on January 13. 

The txt4health mobile personalized messaging program for diabetes management launched by three ONC-designated Beacon Communities reached a good many participants in Michigan, Ohio, and Louisiana, but more than half of them dropped out of the 14-week program, many of them apparently just ignored the messages, and only 3 percent of active participants tracked their weight. The article generously concludes that “this type of approach may not be appropriate for all.”

12-29-2013 1-55-14 PM

The board chair of a children’s hospital in Greece is arrested for demanding a $34,000 bribe from an advertising company that had been awarded a $262,000 contract to develop an anti-obesity campaign for children. He was also fired from his full-time position with the National Bank of Greece. The bribe was paid by an informant wearing a wire, which recorded the man’s stated rationale: “What kind of an idiot would I be to have made a 190,000-euro deal and not kept a cent for myself?”

12-29-2013 2-02-55 PM

Strange: parents of a newborn sue a Pittsburgh rabbi, claiming he severed their son’s penis while circumsizing him. Surgeons reattached it during an eight-hour microsurgery that involved six blood transfusions, two months in the hospital, and leech therapy. According to the rabbi’s website, “A doctor’s medical circumcision, usually performed in the hospital on the second or third day after birth, does not fulfill the requirements of a Bris Milah and is not considered valid according to Jewish law.”


Sponsor Updates

12-29-2013 9-09-57 AM

The annual holiday fundraiser held by Surgical Information Systems raised $15,000 from employees to support Cookies for Kids Cancer, Donor’s Choose, Toys for Tots, USO Wishbook, and The Weekes House.

12-29-2013 9-13-09 AM

Employees of ESD donated toys for Lucas County Family Services, which supports abused and neglected children.

The Lab Executive War College and CHUG (Centricity Healthcare User Group) donate hundreds of extra conference backpacks annually to Coffee Creek Backpacks project, run by Frog Pond Church in Wilsonville OR, which provides women newly released from the local correctional institute with essentials to help them return to society.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

125x125_2nd_Circle

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December 29, 2013 News 6 Comments

News 12/27/13

December 26, 2013 News 11 Comments

Top News

12-26-2013 7-01-06 AM

CMS adopts final rules that extend the Stark exception sunset date from December 31, 2013 to December 31, 2021. The amendment allows healthcare entities to continue subsidizing physician purchases of EHRs and includes additional rule modifications, including:

  • The exclusion of lab companies from donating EHR items and services
  • The elimination of the e-prescribing capability requirement
  • Updates to the interoperable provision
  • Clarification of the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services.

HIStalk Announcements and Requests

inga thumb   Mr. H whisked away Mrs. H for a little holiday this week, but he should be back this weekend. We’re about to be in the midst of the pre-HIMSS fury so I am glad he took time for R&R with Mrs. H before the craziness begins.

inga thumb  News was slow on HIStalk Practice this week but you’ll want to check out the letter Dr. Gregg sent to Digital Santa before St. Nick jumped on his sled.  Thanks for reading.


Acquisitions, Funding, Business, and Stock

The HIMSS Foundation and the National eHealth Collaborative merge their organizations and announce plans to create the HIMSS Center for Patient- and Family-Centered Care and to integrate NeHC’s educational and HIE programs with existing HIMSS resources.

PM and RCM service provider Medical Transcription Billing files a registration statement for a proposed IPO.

12-26-2013 12-51-39 PM

The Singapore government invests $500,000 in Ring.MD, a telehealth startup focused on improving access to high-quality physicians in Asia. The company was founded by Justin Fulcher, a 21-year-old entrepreneur who has been coding since he was seven and started his first business as a preteen.


Sales

12-26-2013 2-40-26 PM

Big Bend Hospice (FL) selects Allscripts Homecare software.

12-26-2013 2-42-49 PM

CareTech Solutions will provide consulting services to Medicine Bow Technologies (WY), which is developing a disaster recovery plan for services impacting Invinson for Memorial Hospital.

 


People

12-26-2013 2-46-03 PM

Cerner names former Indiana governor/current Purdue University president Mitch Daniels to its board of directors.

12-26-2013 12-42-09 PM

Family Health West (CO) hires Pam Foyster (Quality Health Network) as clinical informatics director.

 

 


Announcements and Implementations

Jamaica’s minister of health says his country will being implementation of an $50 million EMR system for hospitals and primary care clinics during the first quarter of 2014.

12-26-2013 2-47-16 PM

Maine Medical Center will increase its Epic EMR investment from $145 million to $200 million and dedicate about two-thirds of the funds for additional employee training. Health system officials admit they originally underestimated the resources required for training and may have made a mistake by starting the implementation at its 6,000-employee Maine Medical Center, rather than a smaller pilot facility. Earlier this year the hospital’s CEO said the Epic rollout and incorrect billing issues contributed to a $13.4 million loss in the first half of its 2013 fiscal year.

12-26-2013 2-48-59 PM

Weems Memorial Hospital (FL) goes live on its $450,000 EMR from CSS.

Sagacious Consultants launches Sagacious Analytics to help hospitals improve reporting and make better use of EMR data for performance measurement.

Vermont Information Technology Leaders makes radiology and transcribed reports from Fletcher Allen Health Care available to providers via the state’s Medicity-powered HIE.

 


Government and Politics

CMS announces the formation of 123 new accountable care organizations, bringing the total number of established ACOs to more than 360.

 


Innovation and Research

A new influenza forecasting method developed by Columbia University’s Mailman School of Public Health is proving almost twice as reliable as traditional approaches that rely on historical data. The system combines real-time estimates from Google Flu trends and CDC surveillance programs.

 

 


Technology

12-26-2013 2-55-33 PM

Apple secures a patent for an embedded heart rate monitor for smartphones.

 


Other

A USA Today article looks at how the adoption of HIT and preventative care are improving healthcare and lowering costs. David Blumenthal, MD highlights areas requiring more work, including moving from fee-for-service payment models to risk-sharing or team-pay systems; improving care coordination through the use of IT; educating consumers on how to choose better care based on quality and lower costs; and, increasing the use of standards to lower administrative costs.

Mount Sinai Hospital (NY) reports a 40 percent decline in its sepsis mortality rate since implementing an early warning system within its EMR. The system triggers an alert whenever staff enter vital signs that match the criteria for early sepsis.

12-26-2013 10-25-15 AM

Over two-thirds of HIT professionals participating in a HIMSS compensation survey report receiving a salary increase in 2013; the average reported salary was $110,269.  Almost half of the 1,126 survey participants also received bonuses with the median bonus equal to three to four percent of annual salaries.

 


Sponsor Updates

  • NextGen posts its January webinar schedule.
  • Optum opens an on-demand health and wellness clinic in  Overland Park, KS.
  • Imprivata hosts its second user conference HealthCon 2014 May 4-6 in Boston.
  • Forbes profiles Ping Identity founder and CEO Andre Durand.
  • As the industry shifts to P4P and ACOs, API Healthcare VP of nursing Karlene Kerfoot predicts a shift in healthcare jobs from hospitals to home care agencies, outpatient surgery centers, and urgent care clinics.
  • Info-Tech Research Group names Informatica a Champion in its Data Integration Tools Vendor Landscape.
  • EDCO posts a video highlighting its point of care scanning process for clinical staff.

EP by Dr. Jayne

It’s a very slow week here since a good portion of our department took vacation days around the Christmas holiday. I’ve enjoyed the relative quiet and am glad to see that people are staying off of email. CMS shared some holiday cheer by emailing providers to remind them that if they didn’t e-prescribe in 2012 or 2013 they will receive their penalty in 2014. I don’t know why they insist on calling it a “payment adjustment” rather than a penalty. Penalties related to Meaningful Use will begin on January 1, 2015 so if you’re going to avoid them you need a solid strategy now.

I’m keeping my eye out for exciting opportunities in the New Year and was interested to see a couple of CMIO postings pop up at organizations that haven’t had a CMIO previously. Although it may be exciting to be the first CMIO and to be able to define the role, I don’t envy anyone taking a job at an organization that is just now figuring out they need one. A couple of the job descriptions were nebulous to the point where I’m wondering if the hospital even understands what they are looking for.

Medical Economics recently did a piece on the survival of the doctor-patient relationship. Physicians cite administrative burdens as the highest threat (41.9 percent) followed by EHR at 25.8 percent. I’m glad the article makes the point that some of the tasks could be assigned to other office staff members. I still struggle with physicians who insist on doing work that could be done by support staff including printing lab requisitions, tracking down test results, processing refill requests, and dealing with insurance paperwork.

The article addresses the EHR challenge more specifically – citing anecdotal stories of physicians who spend 10 minutes of a 15 minute appointment typing. I’m continually surprised by the number of my peers who refuse to learn to type. If you’re going to use free-text rather than structured documentation, typing skills are essential. I remind our physicians that if they mastered biochemistry and tying surgical knots they can learn to touch type but they still resist. I’ve even tried a games-based approach to try to harness their competitive natures, but haven’t had a lot of success.

Another physician states he spends “eight to 10 minutes per chart entering information not directly related to patient care, mainly tied to quality metrics.” Based on conversations with some of our providers I’d have to challenge that statement. We have a large employed provider base and it’s always a shock when someone thinks that a particular clinical quality element is “not my problem” especially in the ACO environment. We’re fortunate to have an EHR where the quality metrics are baked into the documentation – there’s not a lot of extra work to do. I know many sites don’t have this advantage but for us there’s no excuse.

I recently went a couple of rounds with a surgeon who said the patient’s morbid obesity was “not my problem.” I countered that if he plans to do any procedures on her, it certainly is his problem because of the risk of complications directly related to the obesity, not to mention the need to find out if there is diabetes related to the obesity because that alone can complicate wound healing. The same thing applies to our orthopedic surgeons who don’t want to check blood pressures. Fortunately our organization has made measurement of vital signs part of the required elements for physicians to receive bonus payments, so it makes it easier for me to push back at them.

I know there are a lot of EHRs out there where the documentation isn’t so simple and having used a couple of them I’d encourage physicians to look for alternate strategies to make it easier. I did a stint as a locum tenens where the physicians dictate using voice recognition and then staff post-loads the discrete data elements that the system doesn’t recognize. It worked well and the physicians had a high level of satisfaction. Essentially the extra two patients a day they could see by using voice recognition allowed them to pay for the extra staff needed to load the data. It was revenue neutral but the physicians felt better not clicking as much as they used to.

I think the key to managing quality indicators is having a plan on when they are going to be addressed. I see a lot of physicians struggling to try to address every indicator at every visit and it’s just not necessary. My EHR allows me to filter and only see those items that are due in the next three months, six months, etc. so that helps somewhat. Our group also has policies about when the indicators are to be addressed. For example, patients in for an annual preventive visit should have all preventive services due during the next 18 months addressed. This covers them for the next year and a little bit extra should their return appointment be delayed.

The article also cites the amount of time needed to have a conversation with the patient about screening services as a barrier. We provide extensive training to our medical assistants (no nurses in our world) on how to address preventive services with patients during the intake and rooming process so that the patient knows it will be a topic of discussion. The staff can provide educational materials for the patient to read before the physician enters the room, which can make some of those conversations easier and faster. Additionally, providers are not expected to address all preventive services on acute visits. We rely on our automated outreach mechanisms to catch those patients who don’t come in for preventive visits or who have lapses in care. This has been a major physician satisfier because the acute visits remain fairly quick and they don’t have to spend time worrying about patients falling through the cracks.

Having policies on when to address what kinds of services doesn’t have anything to do with the EHR – we actually had these policies in place in the paper world – but they’ve made a great deal of difference. We also provide training for support staff on completing pre-authorizations and pre-certifications so that work can be handed off even in a small office that doesn’t have dedicated referral staff. Looking at the operational workflow and staff training has helped physician satisfaction and hopefully will be one of the things bolstering the patient-physician relationship in our organization. Does your organization have any secret recipes for success? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

smoking doc

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December 26, 2013 News 11 Comments

Morning Headlines 12/24/13

December 23, 2013 Headlines No Comments

HIMSS Foundation and National eHealth Collaborative Merge

The board of directors from both the HIMSS Foundation and the National eHealth Collaborative have approved a merger of the two organizations, effective December 23. NeHC was created five years ago by HHS as an independent, non-profit organization that worked closely with the ONC to encourage effective use of health IT. The original five-year funding agreement from ONC ended in 2013.

Taking the EHR penalty: More doc offices may opt out

The financial incentive to continue along with Meaningful Use may not be strong enough to persuade eligible providers to adopt Stage 2 and 3 functionality, according to the American Academy of Family Physicians, whose Center for HIT director Dr. Jason Mitchel commented, “We saw a 17% drop off of meaningful users that engaged in 2011 but didn’t in 2012. I think it’s going to be more for 2013.”

Editor’s letter: 10 years and 6 czars into HIT, where are we now?

Diana Manos reviews the 10 year history of the ONC, which, if you include the newly named Karen DeSalvo, MD, has been led by six national coordinators.

Top Scientific Discoveries of 2013

Healthcare dominates Wired’s list of Top Scientific Discoveries of 2013, which included: Genome editing, imaging advancements that allow researchers to render the brain transparent, building functioning organs from stem cells, and a variety of implantable electronics designed to improve health.

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December 23, 2013 Headlines No Comments

Curbside Consult with Dr. Jayne 12/24/13

December 23, 2013 Dr. Jayne 1 Comment

12-23-2013 8-53-02 AM

I’ve seen this graphic about the interpretation of scientific jargon multiple times. It seems to turn up on Facebook or in an email every now and then. I read a fair amount of scientific literature and thinking of the alternate meanings always makes me smile. You could use it to play a kind of Mad Libs substitution game to liven up whatever article you’re reading.

As a medical informaticist (Now improved! With Board Certification!) I read the literature with a pretty critical eye. That probably goes back to my medical school training when I learned the importance of understanding whether the patient population in a clinical study was similar to the patient in front of me before deciding whether to use its data to alter my treatment plan. I’ve also read far too many studies that lack statistical validity or pursue therapies that although clearly proven are just irrelevant in real-world medicine. I’ve spent most of my medical career in the community rather than in the academic space and know that they can be vastly different environments.

As part of my preparation for taking the American Board of Preventive Medicine Clinical Informatics certification exam, I attended the AMIA Clinical Informatics Board Review Course. Although it was great to actually sit down and discuss informatics with others in the field, it was a little surreal at times. I’m used to working in a bit of a vacuum – most of the time I’m the only clinical informatics professional in any given meeting – so being surrounded by scores of my peers was a bit overwhelming. The fact that several people in the room were the authors of the texts I had been reading to prepare added to the intellectual climate.

By listening to some of the questions asked during the class, one could tell that some of the attendees were significantly more academic than others. I ended up spending most of the breaks off to the side with several attendees who were more community/clinical-based like I am. After the course, AMIA launched a listserv for attendees and being a silent participant has been entertaining. Watching highly-intelligent physicians interact over minute details of one thing or another can either be educational or mind-numbing depending on the topic and the people involved. Since we’re in a fairly new field, the group is very good about bouncing ideas off one another and one recent series of posts revolved around the idea of the environmental scan.

In a nutshell, an environmental scan is a review of the political, environmental, social/cultural, and technical factors around a business, industry, or market. Organizations benefit from doing an environmental scan periodically to understand the factors influencing their business and the challenges they may face now and in the future. One member was looking for evidence demonstrating a clear return on the efforts of doing such a systematic review. Her employer wanted it proven before they agreed to conduct one. Respondents quickly piped up with examples of business practices that may not be evidence-based but are good ideas, such as paying bills on time (which is pretty funny in and of itself) but one response had me laughing so hard I had to physically get up and walk around after reading it.

This particular scholarly work was published in the British Medical Journal and is titled “Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials.” Although it’s subscription-only, the abstract is available. The authors set out on a systematic review of randomized controlled trials “to determine whether parachutes are effective in preventing major trauma related to gravitational challenge.” Essentially they did searches of Medline, Embase, the Cochrane Library, and other sources to try to find literature proving parachute use is a good idea. Not surprisingly, they could not find any randomized controlled trials of “parachute intervention.” The conclusions are what pushed me over the edge (somehow the more formal-appearing British spellings make it even more humorous):

As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

It just goes to show that even those among us who are most academic can still have a sense of humor. It also reminds me (along with the original “show me the money” question about the environmental scan) that there are a lot of administrators and other people out there who still don’t understand what we do or what we can bring to the table as part of this new discipline. I’ve got a couple of people in mind that I’d like to enroll for that parachute trial. Perhaps you know a few candidates?  Email me.

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December 23, 2013 Dr. Jayne 1 Comment

News 12/20/13

December 19, 2013 News 7 Comments

Top News

HHS names Karen DeSalvo, MD, MPH, MsC National Coordinator for Health Information Technology. DeSalvo, health commissioner for the City of New Orleans, will start on January 13, succeeding Farzad Mostashari, MD, MsC. According to an internal email from HHS Secretary Kathleen Sebelius, “Throughout her career, Dr. DeSalvo has advocated increasing the use of health information technology (HIT) to improve access to care, the quality of care, and overall population health outcomes –including efforts post-Katrina to redesign of the health system with HIT as a foundational element.”


Reader Comments

12-19-2013 5-44-16 PM

From MC Scanner: “Re: Apple commercial. The video for ‘Misunderstood’ that will air on TV next week brought tears to my eyes. It’s amazingly powerful – even better than their ‘1984’ ad.” Maybe I’m just being a Scrooge, but it seemed to me like a lame, Microsoft-style attempt to make people believe that their lives are incomplete unless they experience it using consumer technology. This commercial features a kid who chooses not to participate in family holiday activities with everybody else, instead messing around with his phone and recording everything for the big reveal when he shows the edited video to the family on the big screen TV. The message appears apt for the self-obsessed Facebookers of the world who can’t turn their smartphones off long enough to participate in the world instead of documenting it in Kodak moments for public display. I was creeped out when the family stopped doing everything warm and loving about the holidays and instead stared at themselves on TV, suddenly overcome with affection for the kid who couldn’t relate to them otherwise (probably because he never stops staring into his phone). Here’s my alternative, non-Apple approved holiday message: put down your electronic pacifiers, spend time with people you love, forget the always-beckoning fantasy world of your phone for just one day, and live like a human instead of an online avatar.

From Unnamed: “Re: [company name removed]. Laying off US employees right before Christmas, moving jobs to India, cutting budgets by 25 percent, and disregarding outstanding financial commitments. Sounds like a HISsies ‘Stupidest Vendor Move’ category.” We had some financial problems with that company, too.

From Jack: “Re: Orion Health’s list of best healthcare reporters and blogs. I saw this and figured either your actual name was on here (gasp) or whomever wrote this doesn’t actually read HIStalk. But how in the world do you get left out of that list?” HIStalk gets left off quite a few of the “best HIT sites” lists for several reasons: (a) it competes with the interests of whoever created the list; (b) it’s based on an Internet metric like Alexa or Klout scores; (c) they can’t figure out whether to consider HIStalk a blog or something else; or (d) they think other sites are better, which is perfectly fine and maybe they’re right. I never look at those lists and I often haven’t heard of the sites they proclaim as the busiest or best, but all I know is that Orion Health sponsors HIStalk, which seems to indicate they think it’s OK even though it’s not on their “Five Healthcare IT Reporters You Need to Follow” or “Health IT Thought Leaders” list.


HIStalk Announcements and Requests

inga_small From HIStalk Practice in the last week: a few moonlighting suggestions for physicians. CMS offers informal reviews for EPs and group practices who will be subject to the 2014 eRx payment adjustment. CMS confirms that providers who assign their reimbursement and billing to a CAH under Method II are now eligible to participate in the MU program as EPs. A solo physician does a commendable job addressing a data breach. Salaried GPs in the UK face declines in compensation. My favorite gift, regardless of the holiday, is having new readers, so please take a moment and stop by. Thanks for reading.

Listening: The Honorary Title, a Brooklyn-based indie rock band that flamed out in 2009 without a lot of success. I’ve been obsessed with Nada Surf lately and they sound a good bit like them.

12-19-2013 6-15-33 PM 12-19-2013 6-21-15 PM

Welcome to new HIStalk Gold Sponsor (and HIStalk Connect Platinum Sponsor) CareSync. The Florida-based company offers a family health record and the mobile-based Visit Manager that provides access to a family’s medical records, organizes questions for providers, and stores to-do lists and notes, all to get family members organized before, during, and after their medical appointments. Information can be selectively shared with providers and family and friends who are helping with health needs. It allows tracking of health goals, prescriptions, emergency contacts, and providers. The company’s team of medical records specialists will even help assemble and organize the health information. It is reasonably priced and could make a nice Christmas gift for a family member. You probably know some of the industry long-timers who are involved – Travis Bond (Bond Technologies) and Amy Gleason, RN (Allscripts), to name two. Thanks to CareSync for supporting HIStalk.

I found this CareSync video on YouTube that explains it much better than I just did.


Sales

Mercy Health Physicians (OH) will implement PatientPoint’s patient engagement solutions.

Queen Elizabeth Hospital King’s Lynn (UK) selects iMDsoft’s MetaVision for its ICU.

Children’s Medical Center (TX) engages PCCI to build predictive analytical models to identify children at-risk for asthma crises and to develop an information exchange between pediatric and social services providers.


People

12-19-2013 12-42-34 PM

ClearDATA names Scott Whyte (Dignity Health) SVP for growth and innovation.

12-19-2013 8-39-01 AM

Ryan Donovan (Visa) joins Practice Fusion as VP of corporate communications.

12-19-2013 8-45-05 AM

CareInSync hires Cheryl Cruver (The Advisory Board Company) as SVP of provider solutions.

12-19-2013 9-13-32 PM

Rainu Kaushal, MD, who holds a number of roles including informatics at Weill Cornell Medical College and New York-Presbyterian Hospital, is named chair of the college’s Department of Healthcare Policy and Research.



Announcements and Implementations

Arch Health Partners, a medical foundation affiliated with Palomar Health (CA), deploys Phytel’s population health management platform.

Kansas HIE and the Lewis and Clark Information Exchange connect their networks.

University of Colorado Health migrates 17,000 mailboxes from three disparate healthcare organizations on multiple legacy email platforms into one single consolidated Microsoft Office 365 environment. The consolidation is expected to save the organization $13.9 million over 11 years.

Landesklinikum Amstetten (Austria), AZ Sint Lucas (Belgium), Hospital La Pitie-Salpetriere and Centre Hospitalier Regional De Metz-Thionville (France), and Medway Maritime Hospital (UK) go live with the iMDsoft MetaVision platform.

Wesley Medical Center, Cypress Surgery Center, and Surgery Center of Kansas go live on Anesthesia Touch from Plexus Information Systems.

Lehigh Valley Health Network (PA) implements Salar’s TeamNotes, which sits on top of GE Centricity EMR to facilitate ICD-10 compliant documentation.


Government and Politics

A report by the Senate Commerce Committee highlights minimally regulated data brokers that buy and sell patient data, including disease-specific patient lists and in one case, lists of rape and domestic violence victims.

The VA’s ongoing cybersecurity problems are the subject of a Federal News Radio series, which points out the material weaknesses listed in its financial statements. Among them: failing to revoke network access of terminated employees, failing to keep unauthorized software off the network, and improperly securing Web-based applications. An unnamed government official says the VA CIO’s office has developed a siege mentality against Congressional inquiries, concluding,

“I find it disingenuous in how they are responding to this and the degree of contempt they have in how they are approaching this. They feel it’s a witch hunt. There is a marked lack of respect for the committee by the IT leadership. How they are managing the process is indicative of the lack of respect for Congress and particularly the Veterans Affairs Committee. They think it’s a game so they will evade, obfuscate and they will basically come back with just the bare minimum so as not to be out of compliance.”

12-19-2013 10-20-31 PM

The Oregon government official in charge of the state’s trouble-prone health insurance exchange website resigns. The state had bragged that its marketplace would be one of the most advanced when it opened October 1, but it still can’t handle electronic applications and required hiring 400 workers to process paper forms. Carolyn Lawson, CIO of the Oregon Health Authority and Department of Human Services, stepped down Thursday for “personal reasons.”

12-19-2013 9-29-02 PM 12-19-2013 9-30-58 PM

Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH) introduce the Telehealth Modernization Act of 2013, which would create a federal definition of telehealth based on an earlier California definition with the hopes of standardizing inconsistent state-level policies. It addresses patient-provider relationships, informed care,  provider documentation, sending documentation to other providers, and prescribing requirements.


Technology

Scripps Health launches a pilot of the Sotera Wireless ViSi Mobile vital signs wrist monitor, which measures ECG, heart rate, pulse,  oxygenation, and temperature.

MMRGlobal is awarded another patent, this time for just about everything a person can do to access health information on a mobile device.


Other

The healthcare industry is making slow progress on preparing for ICD-10, according to a WEDI readiness survey. About 20 percent of vendors claim they are halfway or less complete with product development, while about half of providers have yet not completed an impact assessment. Meanwhile, about one-third of health plans have not initiated internal testing; two-thirds have not started external testing.

12-19-2013 5-12-32 PM

The Orlando newspaper profiles Automated Clinical Guidelines, which offers some kind of clinical pathway guidance product whose company-provided description is obfuscated by a writhing nest of unintelligible HIT-related cliches that marketing people dream about when you naively ask what a particular product does and 20 minutes you still have no idea:

ACG has developed an innovative healthcare ecosystem that is patient-centered, operates in real-time, is language-independent, and serves up evidence-based medicine for application on a worldwide basis. The ACG expert system represents a breakthrough in processing structured clinical information utilizing automated clinical guidelines. ACG software is a patented, smart, internet-based, and platform independent solution to the medical crisis in a demographically aging world faced with a severe shortage of physicians. ACG is NOT an EMR or an EHR product and in fact operates in a product space that is totally EMR/EHR independent. ACG revenue streams come from annual renewable institutional contracts, physician patient visits on a per click basis, and by medical products advertising. The ACG ecosystem is an elegant design that requires little or no training and guides the user by use of Symbolic and Boolean logic clinically correlated algorithms, as opposed to current attempts to use database centered templates and report writers.

12-19-2013 5-36-03 PM

The Houston newspaper writes up Decisio, which formats information from patient monitors into an electronic triage system. Says CEO Bryan Haardt, who was COO of Prognosis Health Information Systems until June 2013, “Today’s thermostats have more intelligence than most medical monitors.”

12-19-2013 7-36-34 PM

Cottage Health System (CA) discloses that the information of 32,500 patients was exposed when a vendor inadvertently opened up one of its servers to the Internet. As is nearly always the case, the problem was discovered by someone who found the information while Googling names. Surely there must be a monitoring service that can ping a supposedly secure server from outside the firewall and raise an alert if it gets in.

AMIA runs a list of its members who passed the first clinical informatics subspecialist exam in October.

12-19-2013 10-38-05 AM

inga_small A 66-year-old man files a lawsuit against Advocate Condell Medical Center (IL), claiming that hospital security guards threatened him, beat him, and bit him as he attempted to discharge himself from the ER. The main waited six hours for treatment of his TIA before trying to depart for another hospital, at which time he says seven security guards verbally and physically attacked him. Following the altercation, he claims he was injected with narcotics, strapped to a gurney, and kept in the hospital for six days.

12-19-2013 6-08-37 PM

Weird News Andy offers a list of items “for all the HIStalk techies in your life” from this article, cynically saying of an anesthesiologist robot, “What could go wrong?”

WNA will be sorry he didn’t see this first. A Chicago ED doc says he deals with sex-related accidents twice per week, enough to make him the star of a stupid new reality show (was that redundant?) called “Sex Sent Me to the ER.” Some of the cases he’ll cover involve people who fell on penetrating foreign objects (right), broken penises, and a 440-pound male virgin so focused on his first sexual experience that he pushed his girlfriend’s head through a wall. It looks stupid, sensationalistic, and poorly made, which of course means it will be an instant hit.


Sponsor Updates

12-19-2013 5-18-19 PM

  • Visage Imaging lists the top five trends it observed about enterprise imaging at RSNA 2013.
  • QPID releases some funny, holiday-themed training videos for its customers (1, 2, 3).
  • The MarketsandMarkets research firm ranks Perceptive Software’s Acuo VNA platform the world market share leader among all independent and PACS-affiliated VNA solution providers.
  • ICSA Labs awards CliniComp’s Essentris v213.01 software 2014 Edition Inpatient Modular EHR ONC Health IT Certification.
  • Deloitte includes Kareo on its Technology Fast 500 list of fastest growing technology, media, telecommunications, life sciences, and clean technology companies in North America based on its 797 percent growth over the last five years.
  • Gartner positions Informatica as a leader in its 2013 Magic Quadrant for Data Masking Technology report.
  • University College London (UCL) and Elsevier will establish the UCL Big Data Institute to explore innovative ways to serve the needs of researchers by providing analytical data for scientific content.
  • The Drummond Group certifies Alere Analytics Clinical Quality Measures Services version 2.1 and Public Health Electronic Laboratory Reporting and Communication Portal version 3.2 for ONC-ACB MU as Modular Inpatient and Modular Ambulatory solutions respectively.
  • T-System offers free T-Sheets flu documentation templates to hospitals and healthcare providers.
  • Greenway Medical Technologies wins the 2013 Intel Innovation Award for its PrimeMOBILE app for Windows 8.
  • Besler Consulting releases a review of the Hospital Outpatient Prospective Payment System 2014 final rule.
  • Experian integrates its identity proofing and risk-based authentication platform Precise ID for health care portals with Epic’s MyChart patient portal.
  • Impact Advisors principal Laura Kreofsky discusses HIT in 2014.
  • E-MDs Cloud Solutions v. Cirrus achieves ONC-ACB certification for MU Stage 1 and 2 and is compliant as a Complete EHR 2014.
  • Huntzinger Staffing Solutions expands its offerings to include Cerner staffing and sourcing services.
  • Carolyn Brzezicki, senior clinical specialist for Healthwise, challenges readers to behave as if they have Type 2 diabetes for one day.
  • Billian’s HealthDATA hosts a January 16 #HITchicks Tweet Chat.
  • HIStalk sponsors winning Fierce Innovation Awards include Health Catalyst for Best Problem Solver and Data Analytics; Patientco for RCM; QPID for Best Cost-Saver and Clinical Information Management; and CoverMyMeds in the HIE category and an overall award in Best in Show: Best New Product/Service.
  • Australia’s Adelaide Research and Innovation names Wolters Kluwer Health an Innovation Champion based on its ongoing partnership with Joanna Briggs Institute to bring evidence-based practice resources to healthcare institutions globally.

EPtalk by Dr. Jayne

I keep my eye on Twitter for interesting health IT items. A mention of “24 Outstanding Statistics on How Social Media has Impacted Health Care” caught my eye, mostly because of the use of the number 24. Usually articles will feature a top 10, top 20, maybe a top 25 but I thought going with 24 was an interesting choice. The statistics are drawn from some interesting sources from advertising and media firms to Mashable.

The first two numbers weren’t surprising: 40 percent of consumers say social media impacts how they deal with their health, 18-24 year olds are more likely than 45-54 year olds to use social media, and so on. The third did surprise me: 90 percent of those 18-24 said they’d trust medical information shared by others on their social media networks. This little tidbit doesn’t give me a lot of hope for humanity since my “official” practice persona is Facebook friends with a number of our patients in that age bracket. Let’s just say that most of the posts from that demographic are not exactly systematic literature reviews.

I wonder if they also buy into links for “one simple way to lose belly fat” or “avoid this one food to lose weight?” Behind the closed door of the exam room, I’ve heard a lot of things that 18-24 year olds say about health issues and can confidently attest that most of them have been bogus. Typically those conversations have been in the realm of reproductive health, which probably adds to the mystery of some of their statements, but I’m not sure I’d trust most of the advice these teens have been given by their peers.

Back when the Internet was all we had, I used to counsel patients that the Internet is like the world’s largest bathroom wall. There are a lot of things written on it and some of them are certainly true, but it’s hard to figure out which. The number and volume of sites, apps, and sources available now makes keeping track of the truth even more challenging.

Only 31 percent of healthcare organizations have written guidelines for social media, which I think is low, especially if the respondents were organizations of any size. A good friend of mine is a plaintiff’s attorney and regularly licks his chops at the prospect of litigating cases where medical advice was inappropriately given via social media or where patient-specific information was inadvertently released. Another statistic later in the piece states that 26 percent of hospitals participate in social media, so perhaps the relatively low rate of those online makes the guidelines percentage look a little better.

I liked the statistic that 54 percent of patients are “very comfortable” with their providers using online communities to aid in treatment. It’s validating for me personally since I was once yelled at by a hospital VP after being quoted in a newspaper interview about using the Internet to search for information while seeing patients. He told me it was “unseemly” to admit that you didn’t know everything the patient needed you to know and would undermine confidence. I’ve always found patients appreciated the fact that I admit I don’t know everything and am willing to make sure I have the correct approach before I apply it to their situation.

Although 41 percent of people claim social media would impact their choice of a physician or hospital, I’d like to see the numbers if we asked which was more influential: social media or insurance coverage. I’m pretty sure reimbursement trumps reputation and quality much more often than most of us would like. Among resources used to health information, Wikipedia was at 31 percent. Since I personally use Wikipedia to validate information fairly often, that felt low to me.

I was heartened to learn that 60 percent of people trust physicians’ social media posts over any other group. In real-life clinical practice, it felt like I was often competing against Aunt Betsy or the neighbor up the street, so six out of 10 isn’t bad. Given this number in light of the statistic about the 18-24 year olds being so trusting of items seen on social media, I should probably start posting “safe sex” advice on my professional Facebook page. I’m sure my grandmother would be scandalized, but I can say I’m doing it in the name of science.

The final statistic mentioned is that Facebook is the most popular for hospitals that have an online presence. I must admit, my professional self no longer follows my hospital’s Facebook presence because I simply couldn’t take it any more. Rather than being a good source of health information and patient advocacy, it had become little more than a marketing vehicle. If I read one more congratulatory back-pat for earning some bogus “Top Whatever Hospital Center of Excellence Patient Choice Satisfaction” award, I was going to need anti-nausea medication.

What would Mark Twain think of the information age and its lies, damned lies, and statistics? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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December 19, 2013 News 7 Comments

Advisory Panel: HIMSS Booth Reps

December 18, 2013 Advisory Panel 6 Comments

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 question this time: When you are approached by a rep at a vendor’s booth at the HIMSS conference, what factors (their mannerisms, appearance, actions, handouts, etc.) make you most likely to pay attention?


He or she needs to be very outgoing and engage me. I’m generally exhausted and numb from all the activity on that floor. I have trouble sorting the wheat from the chaff.


It’s important that the booth signage and setup communicate something about the products or services the company offers. Weird, techy names and generic descriptions like, "Biodynametric. We enhance interoperability and efficiency across the continuum," and I pass on by. Second, the guy who lunges at me from the booth is another non-starter. Professional dress and demeanor combined with a pleasant introductory line usually works. "Are you having a good show?" Or, "Good afternoon. Are you interested in learning about our new line mobile device integration software?" Something like that.


A drug rep once told me, when I asked her to not waste my time and to tell me something that I did not know already, that in sales training they are told that it takes a doctor eight times to hear a message before they start registering and remembering to write their drug. Needless to say she never set foot in my office again, but later I learned  that Big Pharma  calls this "the rule of seven touches.” It is indeed believed that it takes that long to build a relationship based on trust. Having said that, I like to see a vendor who does not ask for my email after we just got introduced, only to bombard me with their white papers. Who does not act as if they would rather be somewhere else, but who also makes me want to see or speak to again. Who understands that I will not sign a contract at their booth and that I will not be impressed by the size of their booth or the amount of useless goodies but by their humility and knowledge. Also, since the number of doctors walking the hallways at HIMSS is dwindling and the decision and buying power is being stripped away from them, if the vendor sees an MD who is still practicing and  took the time to be there, maybe he or she should listen to him before throwing a sales pitch as it may teach a thing or two about how doctors think and operate. It is ultimately the doctor who is the end user of IT and unless we talk about patients treating themselves( there seems to be no shortage of solutions for "do it yourself" under the disguise of "patient engagement") we cannot take our eyes off that ball or soon the HIT vendors will sell to …each other. And in my exam room it is getting pretty crowded.


A non-salesy and personally engaging approach works well for me, particularly ones that don’t make me feel like I’m trying to be picked up in a bar. Don’t glance at my badge before you look me in the eyes. And I particularly dislike the sales pickup lines like, “Do you have any concerns or issues about or around [fill in your self-serving topic]…” They are quite the turn-off and I will say no even if I do. Engage me and let the conversation go where it may. If there is an opportunity for a fit, things will take care of themselves.


To be honest, I generally avoid the stalkers. I put on my “don’t talk to me” face and it’s been pretty successful to date. Also, I don’t generally use HIMSS to research new products. I use it as an opportunity for face time with my current vendors.


If it actually starts with a conversation rather than a sales pitch. (How are you enjoying the show? What have you found interesting so far?)


Personally, I rarely react well to being approached by a vendor rep. My preference is to walk through their booth to get a feel for what I’m seeing on their screens or promotional details, and if I find something I find interesting, I’ll ask a rep to explain it to me then. And when they do, my preference is that they skip all the BS and just hit me with the major points, key facts, concepts etc. of their solutions. I don’t need to spend time hearing how we all understand XYZ (e.g, reimbursement, big data, ACOs, HIEs, whatever). I don’t want to spend any time chatting or building a relationship with them. Suggestion to vendor reps:  think "speed dating," but focusing on your solution, not each other. You don’t really need to know what issues and challenges we’re facing — we’re all facing the same ones. I have 1,000 vendors to see today — make your few minutes count and maybe I’ll come back for more.


I know it sounds superficial, but the first impression is very important. If the person looks dirty or sloppy, I will not take time to talk to them. I feel that if they cannot put their best foot forward when representing the company, then they will not put their best foot forward with me as a customer. I also want someone who is friendly and makes eye contact. My biggest complaint at HIMSS or any show is that a lot of booth reps act like they don’t want to be there or want to be bothered talking to anyone. Friendly, energetic, and knowledgeable wins every time in my book.


Unfortunately, appearance matters. The best sales pitch is lost if  you don’t look like you represent a vendor with its stuff together. I seldom visit booths at which I have not made an appointment, but taking that walk around and getting inundated with pitch after pitch can be fun sometimes. When I do,  I first look to someone who appears like a professional (neat in whatever booth attire they have chosen – but I prefer business attire to the casual polo shirt.) Second, they have to be able to give me the “what we sell” pitch in two minutes or less. If they can accomplish this, the chance of me stepping into the booth to look at the product is greatly increased.


I tend to be uninterested in or entirely put off by being approached at all. The most annoying vendor hall experience I had was a vendor rep that caught sight of my badge and followed me for a while and then approached me by name as if he were another attendee. Very off-putting. I go to the vendors that I want to talk to on my own — don’t approach me. I do my homework ahead of time to determine who will have something I want to learn more about or a possible solution to a problem we have, but I will also skip them and mark them off the list of potential partners if I cannot quickly get a friendly and informed representative to pay attention.


I avoid anyone in stilettos or sexy outfits. I’m not there for sex – I’m there to learn. Someone who looks genuine and actually has a pedigree is someone I walk towards. Sex does not sell in HIT, only when trying to sell Viagra or something. Get rid of the sexy pots at HIMSS booths.


If I don’t know anything about the vendor, I need to hear a compelling elevator speech about what they do. During that speech, if they are articulate and passionate, I may stay longer. If I do, then appearance and mannerisms help keep my attention. If all they know is the elevator speech, I move on. A stunning blonde with nice legs overrides all these professional considerations. If I do know something about the vendor, I would probably just move on.


This falls into two categories. (1) I already know I want to see the vendor, in which case I will look for someone who is experience and can give me the real details. Or said another way, I avoid the young kids who look like it’s their first conference as well as the high-level VPs who can only give me high-level answers. (2) An unexpected surprise… maybe it’s a vendor I had heard about somewhere, or maybe they have a slogan that is intriguing or better some stats that stand out (e.g. "We save our practice 10 percent of costs a year!") Usually these are the smaller booths and there are only 2-3 people there, and they are always very helpful and grateful and give a good talk.  


I’ve never been to HIMSS but I’ve been to plenty of other professional conferences where pharmaceutical reps were trying to lure me into their booths and I’ve been to the user conference of my hospital’s EHR software vendor which has their own reps and those for affiliated products lying in wait. Thus, I’m fairly confident that HIMSS would be similar. In general, I walk up the middle of the aisle slowly, feigning disinterest to get a sense of whether I have any interest at all in the products being offered. Part of my reconnaissance involves watching the interactions of the booth reps with unsuspecting passersby. Then I go back up the aisle and stop at key booths of interest. If the reps do not look professional or are cloying or annoyingly pushy, their product is crossed off my list of stops unless it’s REALLY amazing. When I stop at a booth of interest, I’ll glance at their materials if they’re with someone else (and sometimes move on if it’s not of interest). If they’re available, I’ll ask them to tell me a bit about their product. If they are straightforward, answer questions reasonably, and let their product sell itself, that’s a big plus. If they come on too strong with buzzwords and marketing hype or start asking too many "friendly" personal details (e.g., "Oh, I see from your badge you’re from Badger Falls — my Aunt Bessie’s ex-husband grew up there") I’ll say that I just wanted to get their materials and that I’m not in the market right now. Then I hightail it off to the next booth. This dramatically improves my efficiency and lets me spend quality time at the booths that are of greatest help. Even if I’m really interested in a product, it’s not efficient to deal with a rep who’s not knowledgeable or just trying to sell me a bill of goods (sometimes I’ll go back to such a booth later when a different rep is there.) When I do get a handout, if it’s pure marketing pablum, it goes straight to the circular file. I want to see details that will help me make a decision. With software-related products, a key to try to product for 10 days or a sample CD to get an actual feel for the program gives multiple bonus points in my eyes. Again, the booth is confident enough in its product that it knows it can sell itself.


I try to ignore all sales people as much as possible while waking the halls.


I am rarely approached by vendors, and when I am, I feel I am being treated like the the last girl in the bar at closing time. When I seek out a vendor (I do my homework) or I am attracted by a display, I want the elevator pitch, some literature, and contact information. I pick the person that seems most likely to give me what I am looking for without being clingy. Mannerisms? Professional. OMG, no flirting. Appearance? Sorry, but the middle-aged white guys or the person that the other boothies defer to  is the person with the most efficient pitch. If it helps, it is harder to pick out who is in charge than it used to be.


When I’m asked a question. “Are you interested in learning more about _____ ?” Not a brand name, but rather a function or feature –I can see the brand name since I’m right at the booth. Pitch your product with a question, and I don’t mean of the form, “What are you currently using for _____?” In short, don’t sell—teach.


Mannerisms, appearance, first sentence.


I have found that the art of navigating the HIMSS hall is to have a plan. Know what you are looking for, perhaps even the vendors you are interested in, and so forth. I have found the hall to be more beneficial if you add intentionality to your visits. I do not like gimmicks, but a free beer, water, snack, or other food item helps. I also like vendors that provide trash bags (oh, I mean, brochure bags,)  I do not like vendors that “attack” a passerby.


If I’m in their booth because I haven’t heard of their product or don’t know much about it, then I’m focused on how quickly and clearly they can explain their product’s practical application and how it can provide value to my organization. If I’m there because I have decent knowledge of their product, then my goal is most likely to get specific questions about how their product works answered. In this case, the last thing I want to hear is them talk about the practical application and value proposition of their product. I’m focused on the knowledge of the person I’m speaking to. If they quickly say that they cannot answer my question, kudos. I’ll give you a second chance. If they blow smoke, then I may blackball them when I get home. In either case, if the sales person talks about a partnership or attempts to get to know my personal interests, then they immediately lose points in my book. Their job is to take as much of my health system’s money as they can while ensuring that they provide good enough service for us to perpetually pay upgrade and maintenance fees, not buy me tickets to the World Cup (which would be the right way to bribe me). My advice to the sales folks — open our conversation by asking me why I’m there, what I know about their product, and if I have any specific questions for them. As I answer those questions, ask clarifying questions about my business situation (facility size, location, etc.), and then tackle the problem at hand. It will work way better than the gibberish your marketing person wrote.


A mild manner is preferable (Jimmy Stewart over John Wayne). A working demo of their product and the knowledge to use it – amazing how often this is not available (Alfred Turing over Don Knotts). I am a fan of understanding the challenges of a community hospital and not quoting how they solved a problem at Johns Hopkins or UCLA (i.e. Fred MacMurray over Roseanne Barr).


Appearance and mannerisms. Down to earth “real” people versus salesy used car salesman type folks make me want to stop and talk. The booth babe costumes really turn me off. Because there are so many booths at HIMSS, the signage is also one of the things that gets me to stop for a look.


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December 18, 2013 Advisory Panel 6 Comments

Morning Headlines 12/18/13

December 17, 2013 Headlines No Comments

Former Microsoft Executive Kurt DelBene To Replace Jeff Zients

CMS taps recently retired Microsoft VP Kurt DelBene to take over Healthcare.gov. DelBene was formerly in charge of the Microsoft Office division. He will take over for Jeff Zients, who stepped in to oversee the immediate fixes needed just after the October 1 launch.

HealthTech Unifies Brands as MEDHOST, Names Herrod as President

HealthTech, the parent company of MEDHOST, HMS, and Patient Logic, consolidates all of its businesses under the MEDHOST brand name and names Craig Herrod president of the new organization. Herrod was formerly the president and CEO of MEDHOST.

Paulsen Introduces Legislation to Streamline and Enhance U.S. Healthcare Delivery

Congressman Erik Paulsen introduces a bill that would require the use of clinical decision support tools by physicians when ordering imaging studies on Medicare patients.

New Approaches for Delivering Primary Care Could Reduce Predicted Physician Shortage

A RAND study looks at alternative models for delivering primary care services that would help alleviate the growing physician shortage. Researchers focused on the patient-centered medical home (PCMH) and the nurse-managed health center (NMHC) models and found that projected PCP shortages could be substantially reduced by increasing the use of these models.

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December 17, 2013 Headlines No Comments

News 12/18/13

December 17, 2013 News 6 Comments

Top News

The 2014 defense authorization bill, which has been endorsed by both the House and Senate, requires the DoD and VA to develop by the end of January “a detailed plan for the oversight and execution of the interoperable electronic health records with an integrated display of data, or a single electronic health record.” If the agencies miss the deadline they risk losing their ability to spend more than 25 percent of the estimated $344 million in funding needed for the project and will be required to notify military and veterans committees before dispensing any project funds in excess of $5 million. The system deployment deadline is end of 2016.


Reader Comments

12-17-2013 1-11-40 PM

inga From Lion: “Re: LinkedIn. OK, I’m curious. What is the deal with your profile picture?” There’s no faster way to peg yourself as a HIStalk Newbie than by asking Mr. H why a healthcare-related website features a smoking doctor or why I have hot shoes on my LinkedIn profile. I shared with Lion that I used to have the Inga avatar on my profile, but the LinkedIn police took it down, saying only photos were acceptable. I feel like such a renegade every time I see the sexy shoe photo on LinkedIn, though I’m now thinking it’s time to feature a new pair. Stay tuned.  

12-17-2013 6-32-42 PM

From Leaving T-System: “Re: big changes at T-System last Friday. Sunny Sanyal will leave the company in January, now looking for new CEO. Mikael Ohman, COO will be working on special projects only. Jim Mullen, SVP Sales is leaving to join Allscripts. Mark Horner is now SVP & GM over RevCycle+, already updated his LinkedIn page.” Varian Medical Systems has already announced that Sunny Sanyal will be taking over as SVP and president of its Imaging Components businesses as of February 7, 2014.  We appreciate T-System’s response to our inquiries:

It is with mixed emotions that we can confirm those changes are accurate. Sunny made the decision based on a personal need to work closer to his family and spend more time with his wife and three children. Sunny was very well-liked and respected at T-System and we will truly miss him. Sunny will remain as the CEO of T-System until the end of January. On a positive note, we have some additional, exciting changes that we would like to share with HIStalk readers. John Trzeciak, a long-standing board member and principal at Francisco Partners, will help with the transition and step in as the interim CEO of T-System while we search for a replacement. John has an extensive background in leading healthcare organizations and helping companies manage leadership transitions, and is already engaged in the T-System business through his role on the board. We are excited to announce that Tom Dunn has been named as Executive VP of sales and marketing. Tom had tremendous success as the sales and marketing VP at QuadraMed, helping the company achieve double-digit growth. We anticipate that he will drive further alignment of our new revenue cycle and documentation solutions. Jim is leaving to pursue new opportunities and we’re grateful for his contributions. Additionally, Mark Horner was promoted to senior VP and GM of our revenue cycle solutions while Steve Armond, T-System CFO, was promoted with additional responsibilities that include operations for client services and performance solutions.

12-17-2013 9-41-01 PM

From Dr. L: “Re: technology tip. I appreciated your review of the Asus MeMo Pad and the tip to find it on sale at Office Depot! I checked immediately and snagged the last one at my local store. I’m in a similar situation with an aging device, and it’s helpful to follow someone you trust to wade through the plentiful options. I was considering one of the new iPad Minis, but I agree the Asus delivers a lot of value and doesn’t feel like I’m skimping. You’d have a lot of grateful followers if you included a regular Personal Technology section on your blog. I recall a comment several years ago about your strategy to use your iPod Touch on WiFi instead of an iPhone, and I adopted that idea, too. Many thanks to you and your team for all you do each week. You’re the highlight of my day!” I appreciate those nice words and I’m still loving the Asus, especially for $120 (try playing this movie on it to appreciate the HD display.) I don’t buy a whole lot of technology, but I usually get excited about it when I do, because I’m a nerd, obviously, and a bargain hunter besides. It would be fun to have readers weigh in on their latest purchases and the deals they’ve found.


HIStalk Announcements and Requests

12-17-2013 6-48-04 PM

Welcome to new HIStalk Platinum Sponsor Lincor. The 10-year-old Nashville-based company’s patient engagement technology portfolio includes PatientLINC (touch-screen, in-room access to clinical information for caregivers and  patient tools, communication services, and entertainment such as on-demand video and games); ClinicalLINC (secure bedside EMR access via wall-mounted terminals);  MediaLINC (in-room patient access to educational materials and entertainment); and MobileLINC (patient access to medical information, educational materials, and entertainment on their mobile devices). All of these increase patient satisfaction and improve outcomes, helping hospitals meet Medicare-funded requirements for patient satisfaction, readmissions, and Meaningful Use. The company’s systems are used by 120 hospitals and 25,000 beds all over the world, and the world headquarters have been moved from Cork, Ireland to Nashville. Just this week the company announced another funding round, this time of $3 million, to expand in the US and EMEA. Thanks to Lincor for supporting HIStalk.

My YouTube cruise turned up this new and well-done video overview of Lincor’s LINC technology.


Acquisitions, Funding, Business, and Stock

12-17-2013 6-33-29 AM

HealthTech Holdings, which includes the HMS, Patient Logic, and Medhost brands, changes its name to Medhost and names Craig Herrod president. He previously served as president and CEO of the Medhost division.

Juniper Networks will acquire WANDL, a provider of software solutions for multi-layer networks, for $60 million. 


Sales

At Home Healthcare (TX) selects Procura Homecare software as its home and community care platform.

The Louisiana Senior Care Coalition chooses eClinicalWorks Care Coordination Medical Record as its population health management solution for advancing ACO objectives.

12-17-2013 6-22-19 PM

The VA St. Louis Health Care System will implement LiveData PeriOp Manager and integrate it with its existing VistA EHR.

Hospital Sisters Health System (IL) chooses Passport to provide RCM solutions and services to its 14 hospitals and network of affiliated facilities.

Intermountain Healthcare (UT) selects Elsevier ClinicalKey to provide electronic medical reference and knowledge-based information to its clinicians and medical libraries.


People

12-17-2013 10-48-26 AM

Medfusion names Vern Davenport (MModal) president and an equity partner.

12-17-2013 9-28-06 AM

Jack Redding (Mount Sinai Medical Center) joins Halfpenny Technologies as SVP of sales and marketing.

Oncologist Susan Desmond-Hellman, MD, MPH (UCSF) is named CEO of the Bill & Melinda Gates Foundation. One of her key policy recommendations to the National Academy of Sciences was creation of a knowledge network that would allow sharing patient data across research and clinical practice to tailor treatments to individual patients.

T-System appoints Tom Dunn (QuadraMed) EVP of sales and marketing.

12-17-2013 5-50-58 PM

inga Kathleen Sebelius announces the appointment of former Microsoft executive Kurt DelBene as senior advisor to lead and manage the Healthcare.gov project. DelBene was president of the Microsoft Office division, leading me to wonder if he’ll be typing many of his own memos in Word and if the memos will ever include the term “EHR.” Wouldn’t it be great if he were able to lobby his former employer to fix that annoying EHR/HER auto-correct issue?


Announcements and Implementations

HIMSS and HHS are recruiting for an “Innovator in Residence” to serve a two-year term to develop and implement a nationwide patient data matching strategy.

12-17-2013 6-18-02 PM

Susquehanna Health (PA) implements Summit Provider Exchange technology to provide bidirectional integration between its hospitals and physician practices running NextGen EMR.

Bay Area Medical Center (WI), which recently signed a letter of intent to partner with Aurora Health Care (WI), begins implementation of Epic, the platform already in place at Aurora.

The Illinois HIE and Missouri Health Connection will share clinical patient data.

12-17-2013 12-10-00 PM

Essentia Health-Virginia (MN) goes live on Epic.

Polk County Human Services (WI) adopts Forward Health Group’s PopulationManager to track and analyze the progress of patients with substance abuse disorders.

Palomar Health (CA) goes live with AirStrip ONE for remote EKG access, co-developed by the organizations based on Palomar’s MIAA (Medical Information Anytime Anywhere) platform that AirStrip acquired in mid-2012.

12-17-2013 7-50-09 PM

Oncology EMR vendor Altos Solutions and outcomes and analytics vendor COTA announce a partnership to sell value-based cancer care systems in the US.

In the UK, the Department of Health opens bidding to choose a new outsourcing provider for its Oracle HR management system, planning to replace McKesson after 13 years. The contract is valued at up to $730 million over six years.

12-17-2013 8-21-36 PM

UPMC’s Children’s Hospital (PA) will make its physicians available for second opinions to members of MDLIVE, which offers secure online access to physicians.

In England, NHS’s clinical research group uses QlikView to review clinical data quality and find unusual patterns.


Government and Politics

12-17-2013 6-19-56 PM

Medicare publishes a list of the 97 best and 85 worst hospitals for hip and knee replacements based on post-surgery complications and readmissions.

inga Congressmen Erik Paulsen (R-MN) and Jim Matheson (D-UT) propose legislation that would mandate the use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement when they order diagnostic imaging tests. The goal is to provide doctors with immediate feedback and recommendations for the appropriate tests to order. Sounds like a great idea that would likely create a few administrative nightmares.

Big pharma wants an independent investigation of the FDA’s computer security after a database containing clinical trial results and drug marketing plans submitted by drug companies was hacked last month. The drug companies are afraid their confidential information could end up in the hands of a competitor. FDA says the attacked system didn’t contain such information.


Other

12-17-2013 9-05-13 PM

ReferralMD Founder and CEO Jonathan Govette, like others, says that EMRs will become unbundled the same way that a myriad of Craigslist features turned into much better individual platforms started by others. Above is how he sees that happening (click the image to enlarge). Tip from @ForwardHealthGP.

HIMSS will hold an mHealth Summit Middle East in Abu Dhabi in May 2014.

12-17-2013 9-54-13 PM

StartUp Health and AARP release a report on digital health in consumers over 50. Like much of what’s packaged as mHealth, it’s mostly aimed at investors rather than consumers.

Saint Francis Hospital (NY) says its Meditech implementation forced it into bankruptcy with $50 million in debt, but adds that it was the hospital’s own poor financial implementation and not Meditech that cost it “tens of millions of dollars” of uncollectible revenue. The hospital will sell itself once it exits bankruptcy.

A group of New York City parents files suit against the city and the Department of Education, claiming that disruptive 6- and 7-year-olds are being sent by ambulance to area EDs in violation of the Americans with Disabilities Act solely because the schools can’t handle them. According to one mom, “It has caused a financial and emotional strain for me and my entire family. I feel that they sent my son to the emergency room as an excuse to not do their job. If my child acts up at home I cannot send my son to the hospital emergency room.”

12-17-2013 10-39-45 PM

A California newspaper profiles 20-employee, Sebastopol-based E-Health Records, which develops EHRs primarily for use in developing nations. It runs on Android-powered tablets over Amazon cloud services.  

inga A former HHS investigator shares tips for preparing and responding to a fraud and breach investigation. The investigator says one of the biggest mistakes an organization can make during an on-site visit is to make the investigator wait. I’m guessing he’s never had to be on hold forever while trying to follow up on a Medicare claim. Now that’s waiting.

12-17-2013 7-46-39 PM

Weird News Andy summarizes this story as, “Makes it easy to put on socks.” Doctors in China reattach a man’s severed hand to his ankle for a month while he regains strength for hand surgery. I’m not entirely buying it – the story sounds suspicious and the picture looks a bit Photoshoppy.

WNA also notes this non-weird story, which describes November’s US hospital admissions as the lowest in a decade, with the survey sample of 98 hospitals reporting that admissions were down more than four percent.


Sponsor Updates

  • LRS releases the Mobile Connector for VPSX software, which allows users to print documents from any mobile device to any VPSX-defined output destination.
  • Athenahealth will integrate Merge Healthcare’s iConnect Network into its athenaClinicals EHR to allow users to receive and view exam results and diagnostic-quality images.
  • Wolters Kluwer Heath integrates its Health Language Provider Friendly Terminology with Epic EHR for mid-size to large practices and for hospitals.
  • Greenway Medical adds Digital Assent, a provider of patient satisfaction survey solutions, to its online Marketplace of value-added partners.
  • McKesson Episode Management releases 22 new episodes based on the PROMETHEUS Payment Evidence Informed Case Rate definitions, making it the first automated bundled payment solution to support the latest PROMETHEUS model.
  • InstaMed has grown to 1,000 providers and has processed over $30 billion in healthcare payments in 2013.
  • Razornsights employees celebrate the company’s Founder’s Day by building shoebox gifts in support of Operation Christmas Child.
  • Minnesota’s Office of the Commission of Health certifies Sandlot Solutions a health data intermediary, authorizing the company to provide HIE services in the state.
  • Maryland hires Optum/QSSI to provide project management and operational support for the Maryland Health Connection website.
  • A Nashville paper spotlights Lincor Solutions and the launch of its patient engagement technology for hospitals and health systems.
  • Health Catalyst board member and former Intermountain CIO Larry Grandia wins the 2013 Utah Governor’s Medal in Science and Technology.
  • Fujifilm demonstrated its Synapse products and the showed the MU Stage 2 capabilities of its Synapse RIS at RSNA
  • T-System authors a case study featuring its facility coding customer Memorial University Medical Center (GA), which boosted its ED revenues 20 percent through its coding initiative. 

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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December 17, 2013 News 6 Comments

Morning Headlines 12/17/13

December 16, 2013 Headlines No Comments

athenahealth, Merge Healthcare Partner for Data Exchange

athenahealth and Merge Healthcare announce a strategic partnership that will connect Merge’s iConnect Network with athenahealth’s ambulatory EHR. The partnership will enable athena customers to view high-resolution images and exam results coming from Merge within their EHR.

Congress demands no more iEHR delays

Next year’s National Defense Authorization Act has language in it that requires the DoD and VA to develop an acceptable iEHR plan by the end of January 2014. The bill further stipulates that “Not later than October 1, 2014, all health care information contained in the Department of Defense AHLTA and the Department of Veterans Affairs VistA systems shall be available and actionable in real-time to health care providers in each Department through shared technology.”

HHS seeks an innovator to attack patient matching

HHS CTO Bryan Sivak says that the departments next innovator-in-residence will lead the search for better patient matching technologies to help HIEs return the correct patient chart in the absence of a national patient ID system.

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December 16, 2013 Headlines No Comments

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