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HIStalk Interviews Jay Katzen, President, Elsevier Clinical Solutions

March 31, 2015 Interviews No Comments

Jay Katzen is president of Elsevier Clinical Solutions.

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Tell me about yourself and the company.

I’ve been at Elsevier for just about eight years now. Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals. The goal is to empower them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries.

From a clinical solutions perspective, our goal is to deliver solutions to improve health across the care continuum, which goes to students, clinicians, and the extended care team as well as patients.

 

Elsevier’s offerings cover a lot of depth and breadth, ranging from research journals to point-of-care content. How does that help reduce the gap between knowledge discovery and actually putting information into practice?

One of the key things about Elsevier is that we cover research through action. It covers the educational side as well. Our #1 goal is to provide the right information to medical students and nursing students to help them be the best practitioners. We deliver our solutions to primarily the provider setting, although we also go into the commercial setting, which is retail pharmacies and things like that.

Generally, we provide our information to the enterprise for use by clinicians and the staff at any point of need. There are referential solutions to look up information about what’s the diagnosis, what’s the best treatment, what is the evidence supporting the information. Delivering information to be deeply embedded into their CPOE system or electronic medical record with a goal of providing the information at the point of need to make a better decision.

Part of the way we are closing the gap is that we cover across the spectrum. We also ensure that we localize it or customize it to the individual hospital’s practices.

 

Do you ever review what information people are looking up to detect trends, such as how Google Flu Trends works?

We do. I would say it’s in the early stages of some of that. We’re looking at some new products that help us analyze that more.

There’s obviously a lot of work going around big data and analytics, but we continually review a couple of things. Number one is what people search on in general. We look at click-through patterns and things like that to try to figure out if there are ways we can optimize the system to help individuals get to the answer faster. It’s also to understand whether there are gaps in what we’re providing because people may not be finding what they need. That’s on the clinical practice side.

On the research side, we look at this to see if there are areas where they want to perform new research or areas where we need to invest from a general standpoint.

 

Are users looking beyond just finding information to instead have it made actionable by presenting it automatically at the point where they might need it?

The industry is going much more towards point-of-need information. That’s not just for clinicians — that’s for patients as well.

As our customers evolve, they’ve made significant tens of millions or hundreds of millions of dollars of investment in their infrastructure, such as CPOE systems. The reality is that investing in systems alone is not improving quality across the care continuum. It’s not standardizing care. They need content to be embedded into their systems to drive improvement in care and to improve quality.

At least from what we’ve seen and in working with our customers, number one, they want the information more actionable. They want it embedded into the systems and tied to patient context. But they also want to make sure that it’s meaningful and that it can be impactful. Lots of research around alert fatigue. Our goal is not to alert the physician, pharmacist, or nurse on every potential thing out there — it’s to ensure that we deliver the information and that it’s going to be meaningful to them to make a better decision.

The same thing applies and is applying more to patients. We have a segment focused on patient engagement. If you look at Meaningful Use Stages 1, 2, and 3, more and more information has to be delivered to the patient with the goal of empowering the patient to take control of their care. The way to do this is not just to send general information about diabetes or Crohn’s or hip replacements — it is around customizing it to the individual needs as well as their specific instances.

The actionable information applies not only to clinicians, but applies to patients, but it also has to be delivered in the workflow, whatever the workflow might be, so it’s valuable to them versus having them be proactive and go search it. It has to be pushed down to the individual.

 

How do your products support care teams, including those that are virtual?

This is one of the benefits and differentiators we have as an organization. Our products are designed around interdisciplinary care teams, especially our care planning products, our order set products. We’ve put a lot of focus on how teams are working now and how they’re going to work in the future.

From a collaboration standpoint, some of the things we’re testing now are around patient engagement. Not just delivering information to an individual patient, but it’s also creating a seamless connection for the patients back to their clinicians. We’re looking at testing some products with some heart failure patients where they can flag things on their mobile device. That sends an alert back to their primary care physician, who can make a call and connect with the patient. There’s collaboration on the care team, but also an increased need for collaboration between the patient and the provider.

 

That sounds like your Tonic platform, where consumers can enter information on a mobile device. What kind of information can they enter and how does that flow through to the provider?

It’s a couple of things. One is the Tonic platform and one is a pilot we have which is called Digital Dialogues, which we’re doing with IMS.

Digital Dialogues is around congestive heart failure. The patient can capture information that is then sent back to the physician to create that connected network. 

Tonic is a tremendous platform that has a lot of potential to expand what we can deliver and when we can deliver it. Initially, patients go into a hospital and it’s around capturing information about that patient. The unique thing about the Tonic platform it’s a gaming-type system where it makes it fun for the patient to answer questions. Based on the questions, we can then deliver information that is more specific to them. If they have Crohn’s and we have information videos or other information on Crohn’s, we can direct it to them right at that point of need or action.

The platform allows us a lot of flexibility as far as when the patient or consumer is interacting with the platform and what we can deliver to them based on what their specific requests are, right at the point of need.

 

Is it a change in the company’s direction to go beyond supplying reference material for providers to supporting consumers who are seeking their own information, perhaps as an alternative to Web searches?

Absolutely. First of all, our primary market is to the institution for use by clinicians. But the reality is that in today’s healthcare market, the patient or consumer has to play a significant role in their care. We’re working with hospitals to implement the Tonic platform, which includes our content and information solutions. It’s the trusted provider — patients going into the hospital will get the same information that the hospital is using internally as well as when patients go home.

We cover the information needs across the spectrum, whether it’s a physician or pharmacist looking up information about a disease, what’s the best treatment, what’s the best plan of care, are there interactions, and things like that. We deliver all that from a clinical perspective, but just as importantly, we need to deliver similar type of information geared toward the patient so they can understand it and they’re empowered from a care standpoint.

If you look at the statistics today, there’s almost a trillion dollars of waste in healthcare. Big chunks of that are because patients don’t understand their care, they’re readmitted, they don’t follow the regimen that’s provided to them. It’s pretty critical that patients or consumers understand what their needs are, how to improve their care, and why it’s important to follow it, as well as what the implications are if they don’t, so that we can reduce the overall waste in the healthcare system.

 

Do you see any possibility of a single shared care plan where all of a patient’s providers and the patient themselves can contribute to it, perhaps wrapped around standard evidence-based content and some sort of workflow capability?

We’ve looked at that in the past, whether it was for care plans, order sets, or other type of content — a collaborative content creation or updating mechanism. What we’ve found is that while things are standardized across the US healthcare system or other systems, the reality is each healthcare system wants to put their own stamp on it or have their own tweaks, whether it’s care plans or order sets.

We provide mechanisms inside of an institution to collaborate across different kind of committees, whether it’s on care plans or order sets. We’ve talked to people outside to see if they want to do it in a more community-based environment, but so far, that hasn’t gotten a lot of traction.

I think it comes down to the fact that there are a lot of complexities around that, from a standpoint of keeping them current, ensuring that if evidence changes or a drug is removed, that’s propagated throughout everything. How do we reduce liability but ensure that people have access to the best information they can? Those are some of the challenges to the community-based infrastructure.

 

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

My goal and the vision of the company is to lead the way in science, technology, and health. Healthcare is still in a state of disarray. Based on the stats from a study that came out, a thousand people die every day in the US from preventable medical errors. It’s just not acceptable. It’s our responsibility as a company to deliver our solutions to students and professionals to improve the quality of care.

If I look out at the next three to five years, it’s just continuing in the current strategy. We can significantly improve healthcare and reduce errors by ensuring that our care planning products and our order set products are implemented in these systems, utilized, and that the right training is delivered to the institution to ensure standardization of care. We’ll be delivering more and more of our information deeply embedded into our health HIT partners.

Another big component for us is around patient engagement. We talked about that already and how the patient is playing a much larger role in their care. That’s a focus for us. I see that continuing and evolving and increasing over the next three to five years.

We’re a global company. From a clinical solutions business standpoint, a significant part of our revenues comes from outside the US. We continue to invest in many countries outside the US. As the evolution of the infrastructure increases in the UK, Germany, Spain, China, Japan, etc. we continue deliver the same types of solutions and the same type of impact outside the US as well.

 

Do you have any final thoughts?

Whether it’s Elsevier or any company out there, it’s our responsibility to partner with our hospital customers, physician offices, and clinicians better to look at co-development and other ways to deliver our information. It’s our responsibility from an Elsevier perspective, and from the industry’s perspective, to solve this problem.

We’re not there. We haven’t done it yet. If you look at the stats, if anything, they’re going the wrong way. We need to be more successful in ensuring that our information and the evidence is delivered at the right point of time to improve care. It’s something that has to happen in this marketplace. It’s not sustainable and we shouldn’t accept it.

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March 31, 2015 Interviews No Comments

Readers Write: A Prescription for Getting Face Time with Doctors at HIMSS

March 30, 2015 Readers Write 1 Comment

A Prescription for Getting Face Time with Doctors at HIMSS
By Chris Lundgren

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It’s no secret that it’s getting harder and harder to get face time with doctors. But I’m a sales guy, so I always see a silver lining in everything.

In this scenario, the silver lining is that doctors are just like you and me. They can’t live without their gadgets. Recent studies have shown that 75 percent of doctors own a smartphone and 55 percent use both a tablet and smartphone in their daily work. So while you may have a more difficult time connecting in person with doctors, you can still be very much connected.

The key to engaging doctors today is to use technology when the time is ripe. The upcoming HIMSS conference is the perfect example. It has a huge audience and nearly 60 percent of the attendees are healthcare providers. Let me repeat: thousands and thousands of doctors gathered in one space to live and breathe technology for five days. If that isn’t a jackpot waiting to happen, I don’t know what is.

Problem is, doctors are going to be running from one panel to another at HIMSS, so you can’t expect to get face time with them if you haven’t engaged them prior to the conference. And the way to do that is – you guessed it – through their gadgets. Here’s what I recommend:

  1. Ask them how they’re doing. Doctors are always asking others how they’re doing. Now that the pressure is on doctors to improve patient outcomes and reduce healthcare costs in measurable ways, it’s time to ask doctors how they’re doing and what’s on their minds. A quick and easy way to do that is a survey that asks 1-3 questions such as, “What topic(s) are you most interested in at HIMSS?”, “What do you hope to gain from learning about that topic?”, and “What other concerns are on your mind?”
  2. Make them a HIMSS-only offer. Limited time offers work time and time again because they create a sense of urgency. If you want to ensure that you get some face time at HIMSS, make sure you’re prepared to make offers that will only be available at the conference. Use the results of the survey to develop the offer or gather qualitative insights from your sales reps – what have their conversations revealed about doctors’ needs right now? Take advantage of email marketing for its quick response, analytics, and segmentation capabilities.
  3. Impress them with knowledge. A recent study showed that doctors are always hungry for new research, case studies, and other clinical knowledge that can help them in their work. But here’s the catch (and also the opportunity): they’re often too busy to look for it on their own. Do the work for them by delivering valuable content. Remember, they’re busy, so don’t deluge them with a library of links. Try a short list of statistics or a link to an article to get the conversation started. Tip: Information related to patients is hot right now and there’s a treasure trove of relevant content with a quick search.

Digital engagement is an essential component to any physician communication strategy. However, to maximize the results of such a strategy, the focus should be on quality rather than quantity. In addition, integrating a quality digital campaign with the right mix of print, mail, and telemarketing can optimize any effort. Be sure to get your reps to follow up with doctors on the phone or via email after a campaign goes out. Using this multi-channel approach can boost revenue by more than 10 percent. Good luck at the conference.

Chris Lundgren is VP of strategic sales for Healthcare Data Solutions of Lincoln, NE.

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March 30, 2015 Readers Write 1 Comment

Monday Morning Update 3/30/15

March 28, 2015 News 5 Comments

Top News

The Senate won’t review or approve the House-passed doc fix bill until after its two-week recess ends on April 13. You may recall that 2014’s one-year ICD-10 delay was inserted when the Senate, working hours before the previous SGR patch was set to expire, couldn’t muster enough votes to pass its own version of SGR bill that didn’t include the delay.


Reader Comments

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From Raygun: “Re: Epic. They’ve never posted in social media, but I got this in my LinkedIn stream.”

From Hanoi Hotel: “Re: [vendor name omitted.] Supposedly laying off 300 people. Trying to get better intel.” I’ve omitted the name of the publicly traded company. Update: a second reader confirmed the first reader’s statement that the company is Allscripts.


HIStalk Announcements and Requests

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The least-trusted interoperability organization is CommonWell, according to 50 percent of readers. If you add the totals of its members that are listed in the poll, the distrust number increases to 78 percent vs. Epic’s 22 percent. Respondent James explained his thought: “McKesson’s CEO has said in quarterly calls that he expects CommonWell to gush licensing money any day. Cerner’s documentation is near impossible to find. Epic’s HL7 documentation is there for all to see but that doesn’t do much in the expense department. Athena’s API is non-healthcare-industry-standard, which is a good thing, but it can’t move the market.” A third of the votes came from the Madison area, although Epic was hosting a bunch of customers there and there’s no way to separate their votes from those of Epic employees. New poll to your right or here: what’s the #1 reasons you would decline to do business with a startup?

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A year ago I donated most of the proceeds from the Top Spot banner ad at the top of every HIStalk page (it mostly ran during the HIMSS conference) to classroom projects via DonorsChoose.org. Teach for America teacher Ms. Moore sent photos this week of her students enjoying the 50 library books we as HIStalk readers donated to her school (with matching funds from the Bill & Melinda Gates Foundation). Her school, in which 65 percent of students get free or reduced price lunches, is the sixth-highest performing school in North Carolina, with 97 percent of students performing at or above grade level and 100 percent of seniors accepted to college (85 percent of those are the first in their families to attend college). The Top Spot banners are still available if your company wants HIMSS exposure and to help me fund more classrooms in need.

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Our networking event for HIStalk sponsors will be held Sunday evening (April 12). I’m offering great food and a premium open bar at a nice venue not far from the river and Miracle Mile. I had this last-minute thought: if you’re the CEO of a non-sponsor startup and want to network with some great folks, tell me why you’d like to come and I’ll choose up to five to join us at my expense.


Last Week’s Most Interesting News

  • The House passes an SGR doc fix bill that is free of ICD-10 delay language.
  • HHS publishes drafts of Meaningful Use Stage 3 and 2015 certification requirements.
  • Industry leaders John Halamka and Micky Tripathi question the direction and value of ONC’s Meaningful User and EHR certification programs.
  • Vermont’s governor threatens to shut down the state’s floundering health insurance exchange and move to Healthcare.gov.
  • The head of the Department of Defense’s EHR project suggests that it will choose the bid group that offers the best services, not necessarily the best EHR.

HIStalkpalooza Sponsor Profiles

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Do you need a little Tonic to help face those Healthcare Challenges? Visit Elsevier booth #2207 to witness how our innovative solutions and services empower patients and providers and improve clinical outcomes embedding trusted medical content at every stage in the patient journey. Participate in our exciting Healthcare Challenge and win special event giveaways. Are you curious to learn about extreme patient engagement? If that doesn’t convince you, than how about cocktails and mocktails served with a flair? Please join us for our daily in-booth happy hours. We look forward to seeing you there.

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Mark your calendars… HIStalkapalooza gold sponsor Divurgent will be bringing back their ever-popular Children’s Hospital Charity Drive to the HIMSS exhibit floor to raise monies for Ann & Robert H. Lurie Children’s Hospital of Chicago. Divurgent’s booth #1891 will feature a fast-paced, interactive Trivia Charity Drive, inspired by the explosively popular mobile app game, Trivia Crack. It will be hard to miss the vibrantly-colored Trivia Charity Wheel as HIMSS attendees spin to see what trivia category they will land on, along with what donation value Divurgent will contribute on the attendee’s behalf. Make sure to visit booth #1891 to help Divurgent meet their goal of raising $5,000 for Lurie Children’s.To view all of Divurgent’s exciting events and happenings during HIMSS, click here.


Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.


Acquisitions, Funding, Business, and Stock

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Valence Health will move to a new Chicago location as it plans to add 500 jobs by 2019.

Vince continues his 2014 review of health IT vendors in covering those that serve large health systems – Cerner, McKesson, Epic, Allscripts, and GE Healthcare.  


Sales

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Public Hospitals Authority of the Bahamas chooses Surgical information Systems for perioperative systems.


Announcements and Implementations

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EClinicalWorks subsidiary Healow announces integration with several wearable and fitness tracker products.


Government and Politics

Programming website GitHub is hit by a distributed denial of service attack from what appears to be the Chinese government, which is unhappy about GitHub tools that allow China-based users to bypass their government’s censorship.


Privacy and Security

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A TransUnion Healthcare survey finds that two-thirds of recent patients (with a heavy representation of younger ones) would avoid a provider that has experienced a data breach. Half of the consumers expect to be notified within one day of the breach (hopefully of its announcement rather than the actual event since it’s foolish to announce a breach before doing preliminary investigation) and about the same percentage expect a dedicated phone hotline and website to answer their questions.


Technology

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The local TV station profiles Seattle Children’s use of software from local startup Luum, which tracks how employees commute to work so that the employer can reward the use of sustainable transportation. Seattle Children’s gives employees a free fancy coffee if they don’t drive to work in a car.

Johnson & Johnson-owned medical device vendor Ethicon signs a collaboration agreement with Google to develop a robot-assisted surgical platform.

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I’m interested in a couple of new apps (Meerkat and Periscope) that allow someone to stream a video broadcast from their smartphones to their chosen Twitter followers. It would be kind of cool to watch a live stream of the HIMSS keynotes or to show a first-person view of what’s going on at HIStalkapalooza.


Other

The City of Baltimore uses its Netsmart EHR to remind employees who are treating heroin addicts to test them for HIV and refer them to HIV care if positive.

I missed this until @Farzad_MD tweeted it out: great investor advice presented as quotes from venture capitalist Paul Graham:

“What investors are looking for when they invest in a startup is the possibility that it could become a giant. It may be a small possibility, but it has to be non-zero. They’re not interested in funding companies that will top out at a certain point.  A startup is a company designed to grow fast. Being newly founded does not in itself make a company a startup. Nor is it necessary for a startup to work on technology, or take venture funding, or have some sort of  ‘exit.’ The only essential thing is growth. Everything else we associate with startups follows from growth.… To grow rapidly, you need to make something you can sell to a big market … If you want to start a startup, you’re probably going to have to think of something fairly novel. A startup has to make something it can deliver to a large market, and ideas of that type are so valuable that all the obvious ones are already taken…. Usually, successful startups happen because the founders are sufficiently different from other people – ideas few others can see seem obvious to them.

Weird News Jeff channels WNA in providing this family-unfriendly story. Two UC Berkeley researchers develop SmartBod, an adaptive biofeedback app that manages the most personal of wearables in order to guarantee a happy ending, tracks performance over time, and allows proudly sharing the results with social media. If that’s not enough, the last names of the scientists (who are in fact a couple) are Klinger and Wang.


Sponsor Updates

  • Zynx Health client Meritage ACO (CA) achieves successful reduction of at-risk patient readmissions.
  • Senator Lois Wolk (D-CA) recognizes Geni Bennetts, MD of WeiserMazars as one of the Third Senate District’s “Women of the Year.”
  • Huron Consulting Group will sponsor and exhibit at the 2015 Cancer Center Administrators Forum March 29-31 in Lexington, KY.
  • Verisk Health offers “How the Boomers will Change the Shape of Medicare.”
  • T-System President and CEO Roger Davis weighs in on EHR interoperability.
  • Shareable Ink names Chris Buckley as regional sales director of the year.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 28, 2015 News 5 Comments

News 3/27/15

March 26, 2015 News 6 Comments

Top News

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The Congressional Budget Office says the Medicare doc fix bill that passed the House Thursday and moves on to the Senate will add $141 billion to the federal deficit. The cheers you may have heard came from people getting the money, not those providing it. Somehow “reform” always ends up costing taxpayers more. At least nobody has slipped in another ICD-10 Easter egg like last time, although Congressman Gary Palmer (R-AL) tried to work in another one-year ICD-10 delay Wednesday that was rejected in committee.


Reader Comments

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From Lemmy: “Re: Children’s Hospital Boston. The EMR is down, clinics are cancelling appointments, and the labs are sending samples out.” I contacted CIO Dan Nigrin, MD, who explains:

“We recovered yesterday (Wednesday) from an extended, unplanned downtime caused by a failed segment of a storage array for the database underlying our EHR, and which caused significant database corruption. As you would expect, the hardware was architected to be fully fault-tolerant with complete redundancy, yet nonetheless it failed us. So we’re still figuring out root cause with the vendor. We used our disaster recovery system and paper-based processes to run the operation. To be on the safe side, we postponed a few elective admissions (for less than 48 hours), but otherwise care was delivered normally at the hospital.”

From DoDEHR: “Re: US Coast Guard. Considering scrapping their $40 million Epic rollout as the DoD selects its vendor. Funding is frozen and USCG hasn’t gone live in any of its 42 clinics after four years with no dates projected. They are in danger of reverting back to AHLTA/VistA.” Unverified. 

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From Booth Babe: “Re: HIMSS exhibitor tips. Can you recap those you’ve run before?” You can use the search box to find them, but here’s my #1: confiscate the cell phones of employees while they’re working the booth. They are hopelessly addicted and will start by slipping furtive glances at email, but before you know it, they will be heads-down immersed in screwing around instead of paying attention to the prospects milling around their expensive telephone booth. I’ve seen guys playing with their phones while standing at an airport restroom urinal, so I guarantee people (especially the shorter attention span younger ones) won’t make it through a multi-hour booth shift unless you remove the temptation. I also suggest making it clear that booth employees aren’t allowed to talk to each other unless they’re collaborating on an attendee question because they’ll end up socializing, with is a huge turn-off to a prospect who might want to ask a quick question or who has a reasonable expectation of being welcomed without feeling like they’re intruding. It’s depressingly easy to find expensive booths staffed by inattentive employees. If your carrot needs a stick enhancement, mention that every year I take candid photos of inattentive booth employees and it will be pretty embarrassing to be memorialized on HIStalk that way.

From Job Hunter: “Re: taking a new job. Can you give me the link to what you ran previously about company danger signs?” I don’t think I’ve ever run such a list, but I would try to steer clear of companies with these characteristics:

  • The CEO is a well-traveled hack who has left a trail of corporate destruction behind him or her or is a private equity hired gun whose primary job is to boost the bottom line by whatever short-term means are necessary to get the company sold before the wheels come off.
  • The CEO can’t be bothered to relocate to the city where most of the employees work.
  • The executive job you’re being offered is not housed at the home office. Out of sight means out of mind, which is great until your ambitious peers conspire to stab your absent back.
  • The company requires new hires to sign a restrictive non-compete agreement that will harm your ability to find their next job. My favorite strategy is from Dilbert: scan the non-compete into Acrobat, change the wording, then print it and sign it. Chances are the always-clueless HR department won’t notice that what you signed isn’t what they handed you.
  • Budget and travel freezes are common. That means lazy executives don’t have a clue about what is essential, so they just penalize everybody equally regardless of corporate consequences.
  • They’ve laid people off in the past couple of years. Layoffs are a symptom of executive failure (either in hiring choices or in strategy) and indicate that the company would rather jettison people who have been loyally working in their assigned roles instead of retraining them even though they have a lot of reusable positive attributes beyond specific product knowledge. That or they don’t have the guts to fire people for cause and instead conduct a layoff of losers.
  • Executives with reserved parking spots. I loathe big shots  who think they’re better than everyone else.
  • Your interviewer is late, distracted, or someone you wouldn’t hang out with after work. They’re on their best behavior during your interview, so it can only get worse.
  • You get a vague answer when you ask what happened to your predecessor or the company declines to name them for fear you’ll solicit their honest opinion about why they left.
  • Your prospective boss talks about himself or herself instead of you.
  • Two people who are related serve on the executive team, especially if the position you are considering is also on the executive team. You, Sammy Hagar, serve at the pleasure of the brothers Van Halen.

HIStalk Announcements and Requests

I’m doing a video interview series at the HIMSS conference along with DrFirst and we need interviewees. We’ll probably ask simple questions, such as what interesting things you’re seeing at the conference or who has the best giveaways. Let me know if you’re willing to participate and we’ll set a time to connect in the exhibit hall.

Welcome to new HIStalk Platinum Sponsor Engage. The Spokane, WA-based company, a division of Inland Northwest Health Services, is one of the largest Meditech hosting partners in the country and offers four service lines: hardware integration, hosting services, Meaningful Use, and professional services. Its 225 application analysts provide Meditech implementation and support to 130+ customers, among them some of the first hospitals to successfully attest for MU Stage 1 and Stage 2. Its infrastructure solutions include hardware refresh, virtualization, data migration, and data center migration, working with partners such as HP, NetApp, IBM, and BridgeHead. Engage provides its customers with a 24x7x365 US-based help desk that covers both infrastructure and application support. Thanks to Engage for supporting HIStalk.

This week on HIStalk Practice: MUS3 proposed rules take the air out of one rural physician’s HIT sails. The Physicians Alliance expands its Wellcentive partnership. A new study confirms that urgent care and retail clinics are overtaking primary care practices in terms of patient preference. Aledade partners with WVMI and Qsource to establish ACOs in West Virginia and Tennessee. One MD makes the case for pulling primary care out of the insurance system. Practice Fusion integrates with Medi-Span. New study finds that the ACA did not flood physician practices with appointments. Dr. Tom offers practices tips on thinking like retailers. Dr. Gregg snapshots the technology-induced workloads of today’s busy physicians. Thanks for reading.

This week on HIStalk Connect: Meaningful Use 3 preliminary rules are published and include some aggressive patient engagement goals. Researchers from Mayo Clinic analyze potential use cases for drones in healthcare. A new Rock Health report finds that women are still sorely underrepresented in health IT leadership positions. In England, the NHS launches a mobile app library with clinically-vetted mental health apps.

Listening: the fairly new rarities boxed set from Seattle’s amazing grunge rockers Soundgarden. If you like Black Sabbath (and how could you not?) then you probably like Soundgarden. And since I’ve already mentioned Van Halen, they (including on-again, off-again singer David Lee Roth) will be touring heavily starting July 5, mostly doing the amphitheater circuit, and releasing a made-in-Japan live album from their 2013 tour. I called it nearly perfectly on that last tour when I said on February 13, 2012 that I wouldn’t buy tickets for shows after mid-March because I expected them to storm off mad and cancel the tour and sure enough they did, although not until a few weeks after I predicted. Eddie’s voice is mostly shot (just like DLR’s kicks only go about knee-high these days) but he can still shred the guitar and he looks a heck of a lot better at a slightly chunky 60 than a couple of years ago when could have passed for a homeless crackhead. 


HIStalkapalooza

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Thanks to the fun folks at DrFirst who have volunteered to provide a videography team to cover HIStalkapalooza. That was one of the features we were going to eliminate since we are too buried in other event details to deal with it, but DrFirst is filming (not literally, since there’s no actually film involved) and will produce a YouTube video we can all enjoy after the fact. DrFirst’s stepping up so enthusiastically restored my enthusiasm and faith in humanity since I was pretty tired and frustrated dealing with all the not-so-fun parts of putting on HIStalkapalooza. They’re a fun bunch.

The only thing we haven’t arranged is someone to shoot still photos, so we will probably ask attendees to send us those they take.

I invited each of our event sponsors (which I’ve listed in a link box to your right for ongoing reference) to provide a little background on what they do and what they’re planning for the HIMSS conference and for HIStalkapalooza, which seems fair given that they are paying for your food, drinks, and world-class band. Here’s what the folks at Falcon Consulting Group have to say.

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Soaring into HIMSS15, Falcon Consulting Group looks forward to showing attendees and exhibitors alike that we are no ordinary flock of consultants. Falcon brings together specialized EHR technical and clinical talent, Big-4 operational and industry expert leadership, and avant-garde strategies and technological solutions. We are landing in a reserved meeting room inside the Lakeside Center Building (MP-7), and we would love for you to stop by and let us show you how we can help your organization fly to new heights. In the event has worn out your wings at the conference, we will also be hosting nightly events throughout Falcon’s home city of Chicago. For more information, contact Steven Stull at 312.751.8900 or by email.


Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 


Acquisitions, Funding, Business, and Stock

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Analytics vendor Ayasdi, which offers a healthcare-specific package for identifying clinical best practices among its other non-healthcare products, raises $55 million in a round led by Kleiner Perkins, increasing its total to $100 million.

Orion Health’s US sales leader Paul Viskovich describes what it’s like being a New Zealand-based company selling predominantly to a US market and opening an office in Scottsdale, AZ: “It’s hard. You’re not from here. You talk differently. It wasn’t possible for us to go meet the CIO of UCLA — it was a good day if we talked to the security guard. Healthcare as a whole is largely not good with innovators either, and when you combine those two things, it’s very difficult … Our teams are cross functional. People in New Zealand are also working on projects at the same time as people in the United States, and if you manage that correctly, it can be a real benefit.”


Sales

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Six-hospital Cone Health (NC) chooses Phynd to manage its 16,000 physicians in a single provider profile that crosses Epic and ancillary systems.


People

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Jitin Asnaani (Athenahealth) is named executive director of CommonWell Health Alliance.

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The Integrated Healthcare Association hires Jeff Rideout, MD (Covered California) as president and CEO.


Announcements and Implementations

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Seniors Wireless announces TeleMed Assist, a $30 per month, contract-free program ($40 for couples) that offers unlimited 24×7 access to physicians by telephone or video. Being a cynic and wondering how all these virtual visit companies will find reasonably competent doctors willing to take calls in real time, I’m picturing those 1990s 976-number dial-a-porn services where the hot Brazilian dominatrix you’re talking to is actually an obese, hirsute, 60-year-old Medicaid recipient whispering sweet nothings with Cheetos breath and a genetically confused grandchild on her knee while watching the muted “Jerry Springer Show.” I would be interested to talk to a physician who provides services through companies like this since I’m curious how it works.

Practice Fusion adds the Medi-Span drug database from Wolters Kluwer Health to its free EHR.

The Florida HIE announces that 200 hospitals have signed up for its event notification service for admissions, discharges, and ED visits.

GetWellNetwork announces that it added 58 new facilities and 10,000 new beds in 2014, with a 13 percent growth in employees to 250.


Government and Politics

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Even the ever-optimistic and supremely knowledgeable John Halamka and Micky Tripathi seem to be fed up with the endless Meaningful Use parade, concluding of the latest MUS3 and certification requirements:

”… each incremental proposal is tolerable, but the collective burden is making practice impossible … the sheer number of requirements may create a very high, expensive, and complex set of barriers to product entry. It may stifle innovation in our country and reduce the global competitiveness for the entire US health IT industry by over-regulating features and functions with complicated requirements that only apply to CMS and US special interests …  The certification criteria are often not aligned with what EHR users ask for. In some cases, the criteria are completely designed to accrue benefits to people who aren’t feeling the opportunity cost … There needs to be a very public discussion with providers as to who should prioritize EHR development — ONC and the stakeholders they’ve included or EHR users.“

I’ll add my counterpoint, however. Providers who whine about irrelevant and burdensome MU requirements can ignore them completely, but rarely do. You sold your soul to the federal government, but you can buy it back by accepting the Medicare penalty and then start following your own agenda instead of someone else’s. MU money is either worth it or it’s not – your participation indicates that you think it is, and that acceptance drives the user-unfriendly development agenda of EHR vendors. You don’t even need to use an EHR at all if you truly (questionably) believe it has a negative impact on quality or revenue – it’s your business and your patients. I cite “Lost Boys” in reminding that a vampire can enter your home only if you invite them.

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A great tweet from US Surgeon General Vivek Murthy, MD, MBA: “The levers for health aren’t in hospitals, they are in communities.” What Vivek didn’t tweet: “On the other hand, the hospital levers are raking in untaxed billions and thus they have little incentive to make communities healthier.” In the US, “public health” is export-only compassion and outreach to all who need help; domestic healthcare services delivery is a big business dominated by special interests that threatens to bankrupt the country; and never the twain shall meet.

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Rep. Phil Roe, MD (R-TN) reintroduces a bill that would require the DoD and VA to develop a shared EHR using criteria established by a temporary panel that would be given 90 days to complete its work. The contract winner would get a flat $50 million upfront and then $25 million per year for five years to develop and implement the custom system, which Roe says would complement the $1 billion already spent by the DoD and VA in trying to create the integrated EHR. My opinion: the DoD-VA interoperability challenge is more about willingness and less about technology (the same as in the civilian world made up of uncooperative competitors, in other words). Those groups, despite how ridiculous it seems to taxpayers, distrust each other and refuse to stoop to each other’s level for the good of the serviceperson turned veteran. Perhaps they should be assessed a 1 percent CMS-type annual budget penalty for failing to interoperate.

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Here’s an interesting quote from the head of DoD’s DHMSM project: “I’ve visited a number of facilities that have gone through this, and their message routinely is, it’s all about the change management and the training. It’s not about the tool. It’s about how you use that tool.” Maybe that’s a hint that DoD will choose whichever of the three bidding groups offers the best training, implementation, and optimization services rather than just the best EHR.

The Economist calls out inept US government financial management as chronicled by the GAO, including $125 billion in improper Medicare payments in the last fiscal year. The Brits seem to be enjoying our admittedly questionable DoD-EHR dual (or dueling) EHR projects:

”The GAO has few kind things to say about the government’s approach to information technology (IT), on which it plans to spend $79 billion in this fiscal year. Fragmented data storage and needless duplication have wasted billions of dollars. For example the Department of Defence—which accounts for around half of federal discretionary spending, and so may well not notice when billions of it vanish like loose change between sofa cushions—and the Department of Veterans Affairs are both now developing, from scratch, two separate electronic health-record systems, even though they will basically serve the same people. But the most common problem with the government’s IT ventures is a mix of grand ambitions and incompetence, as the launch of Healthcare.gov in 2013 handily showed.”


Technology

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Michael Archuleta, IT director at 25-bed Critical Access Hospital Mt. San Rafael Hospital (CO), tweeted out this photo in announcing that the hospital’s server infrastructure is 99 percent virtualized. Nice.

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Amazon announces unlimited consumer cloud storage for a flat fee of $60 per year with a free three-month trial.


Other

Among the reasons University of Mississippi fired its chancellor is the medical center’s signing of contracts without board approval, with an audit finding that its EHR RFP process in which Epic was chosen contained incomplete cost breakdowns.

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An article by three prominent radiology informatics leaders questions whether IT centralization and standardization has caused radiologists — who were among the first hospital informatics practitioners — to lose control of the domain. It says early and profitable hospital radiology departments were able to hire clinical IT specialists that the IT department didn’t have, giving those departments the technical freedom to innovate that has since been revoked. The authors suggest that subspecialist informatics radiologists find a place at the hospital IT table despite current underrepresentation. My experience is similar – the other pioneering clinical departments (lab and pharmacy) integrated well into the IT environment because of share order entry systems that were used by a general audience, while radiology had its own pseudo-IT systems that were used by minimally visible doctors and techs working alone in dark rooms, often ignoring sound IT processes. The above graphic is correct – IT’s focus is on reduction of corporate risk exposure through standardization, centralization, and budget control, which usually extinguishes rather than encourages innovation. Whether that’s good or bad depends on whether you have a visionary CFO (is that an oxymoron?)

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Reading Health System (PA) reorganizes its IT department and eliminates 33 positions after completing its $150 million Epic implementation.

Eighty percent of the 1,000 children and teens who have used Kurbo’s $25 per month weight management app and email-based coaching service have lost weight, the company says.  

Group brainstorming meetings don’t work, says Harvard Business Review. Reasons: people expend less effort when working within a group, introverted and less-confident attendees participate less, stellar performers are dragged down to the level of the least-competent ones, and groups larger than 6-7 people have logistical problems getting everyone’s ideas on the table.


Sponsor Updates

  • A family practice improves hypertensive control rates from 78 percent to 94 percent in the year after implementing Forward Health Group’s PopulationManager.
  • The Health Management Academy partners with MedCPU to identify solutions to overcome point-of-care challenges.
  • ZeOmega Founder and CEO Sam Rangaswamy describes how ZeOmega’s acquisition of HealthUnity positions the company.
  • A new Healthcare Data Solutions case study confirms that pharmacies using its Prescriber Validation Subscription Service have saved millions in potential hydrocodone fines.
  • Ivenix produces a video that highlights how its Infusion Management System is designed to help nurses improve patient safety and workflow efficiency for infusion therapy.
  • Hayes Management Consulting offers “10 Tips to Create a Workflow Manual That Your Users will Love.”
  • Valence Health announces that its Further 2015 annual conference will be held in Chicago September 23-25.
  • Galen Healthcare Solutions CEO Jason Carmichael welcomes the new GHS leadership team in the latest company blog post.
  • Impact Advisors offers early impressions of Meaningful Use Stage 3, plus looks at data center trends.
  • Healthwise offers “Creating a Group Health Culture Where Shared Decision Making is the Norm.”
  • LifeImage posts “Medical Image Exchange for Cardiology Care.”
  • InterSystems writes “Salty Cookies, Sweeter Outcomes: Shared Healthcare Decision Making.” 
  • The Atlanta Journal-Constitution names Navicure as one of its “Top Workplaces” for the second year in a row.
  • The New York eHealth Collaborative will exhibit at HxRefactored April 1-2 in Boston.
  • The latest episode in Nordic’s Making the Cut video series covers preparing for cutover and the role of operational management.
  • Patientco offers “Supergroup: Connecting the Stakeholders of Healthcare for a Rockin’ Future.”
  • Porter Research posts a blog on networking at HIMSS 15.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 26, 2015 News 6 Comments

EPtalk by Dr. Jayne 3/26/15

March 26, 2015 Dr. Jayne 1 Comment

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I read with interest Mr. H’s summary of Chicago’s April weather over the last several years. One of my friends was in Chicago this week and posted pics of snow. Right now I’m still planning a ball gown for this year’s Histalkapalooza, so I’m crossing my fingers against rain, snow, sleet, hail, and slush. I do have an opera length coat at the ready, but I am not looking forward to figuring out how to pack it all. The fact that I’m thinking about HIMSS planning right now underscores the fact that I’m procrastinating the continued reading of the Meaningful Use Stage 3 documents that were released last Friday.

I’ve only received a couple of pre-meeting mailers, but there have been a couple of ads in healthcare IT publications that caught my eye. Sponsor ChartMaxx is giving away some Chicago pizzeria gift baskets in their “Grab a Slice of the Windy City” promotion. Winners could receive a gift basket and pizzas delivered to their home – sign me up for that one. The two mailers I did receive both mentioned Apple Watches, but I’m not an iPhone girl, so they didn’t engage me. Additionally, one had my title wrong and another botched the address. It never ceases to amaze me when a mail merge goes awry or that people don’t proof things before they go out.

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Speaking of proofreading, I wonder if 1-800-Contacts realizes that their most recent mailing provides a possible time-travel option for customers? Although it was mailed earlier this month, it invited me to place an order through January 2013. I guess it’s not just conference marketers who can’t get it straight, but I’m wondering if I can call and see if they’ll honor their 2013 pricing.

Procrastinating on the Meaningful Use documents also means catching up on journals this week. I’ve been doing a better job of keeping the pile on my entryway table to a minimum, but still am not current. A blurb about using Fitbit devices to predict recovery from back surgery caught my eye, however. Researchers at Northwestern University, New York University, and the University of California-San Francisco are looking at patient activity four weeks prior to a procedure and six months after. Preliminary data shows that patients not only reach their pre-procedure activity level after about a month, but continue to increase to levels that weren’t possible prior to surgery. Although they’re only looking at a subset of spine surgery procedures, I like the idea of capturing that data to model real-world results.

I’m glad I went through the journal pile because nestled in the back pages of American Family Physician was a “Patient Oriented Evidence that Matters” (POEM) segment answering the question of whether computerized decision support systems linked to EHRs improve patient outcomes. The ‘not really’ response cites a recent meta-analysis and I’m glad I read the original article. It was a little less pessimistic than the “bottom line” summary provided in the POEM. I printed a couple of copies of the actual paper to keep on my desk because I’m sure someone will bring the summary in next week as support for why we should not have an EHR. I’ll be ready when they do because at this point EHRs are not going away, but I do love a good medical literature spitting match.

Going back to January in the stack, I also found reference to an editorial in the Annals of Family Medicine that talks about allowing medical students to use EHRs so that they’ll be ready for later phases of training such as residency. Our students get a lot of experience with EHRs in our academic hospitals, but very little when they’re on their community-based rotations. The barriers cited by our sponsoring physicians include licensing issues with EHR vendors, lack of dedicated training for students, inability to separate student documentation from rendering physician documentation, and the transient nature of clinical rotations. Most of these were echoed in the editorial, which also mentions the need for students to learn how to manage populations using registries and other analytic components of EHRs.

I’ll be interested to see how the current generation of medical school and residency grads use EHRs after completing their training. In many parts of the country, we’re to the point where students may not even be exposed to paper charts. In my area, even our community free clinics are using EHRs. I’d love to do a study of new physician interactions with patients in an EHR-enabled exam room vs. physicians who transitioned from paper charts.

Got grant money? Email me.

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March 26, 2015 Dr. Jayne 1 Comment

HIStalk Interviews Jay Savaiano, Director, CommVault

March 26, 2015 Interviews No Comments

Jay Savaiano is director of worldwide healthcare business development for CommVault.

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Tell me about yourself and the company.

CommVault is a data and information management company. Not only do we move data for purposes of data management for backup recovery, archive duplication, replication, disaster recovery, and continuity planning, at the same time, we take an index of all the associated content within that data so it can be used for e-discovery, information management, legal situations, any other reason that you feel that you would want to search against all your data in your environment from an unstructured perspective.

 

You hear a lot about big data, but hospitals already create a lot of data they don’t use. What examples have you seen where a hospital found something useful in what they already had?

The big part of it is the unstructured data. It’s easy enough when you have a solution that has a database back end and you want to search for “Jay Savaiano.” You can search for “Jay Savaiano” and you can get all the data from that solution. What you don’t get is the unstructured data that resides in your environment — Excel spreadsheets, Word documents, PDFs, all this content that’s residing out there that you don’t have an actual database that indexes all the pieces.

That’s the challenge any time we bring up dark data to the healthcare space. We have a ton of it and we don’t know what’s in it. It’s what scares us the most.

We understand exactly what’s in the EMR. We can search that all day and get all the data points we needed. It’s all those unknowns that are the scary part, especially all the way out to the edge, all the way out onto a laptop. Not knowing what type of documents that any one particular individual has — whether it’s a doc or whether you’re in a hospice scenario — data resides on those edge devices that can be snagged.

That’s always everyone’s concern, even from a perspective of what’s in email. How many times is a doc or an individual taking something, attaching it to an email, and sending it to their Yahoo account? Those are always the concerns of not knowing if PHI is all of a sudden traversing outside of the network, going to unsecured areas that leave them open to issues.

An examples would be outright broad compliance. To tap into that unstructured content, especially even in an email scenario. A situation such as an employee who is also a patient. That individual has taken data from the organization, emailed it outside to themselves to their Gmail account, and now all of a sudden there’s an issue from an employment perspective with that individual. They’re trying to come back and say they weren’t treated fairly or anything that could have been brought up. We’ve had organizations that have gone back and done searches against all the email content as well as the unstructured content that resided on their laptop that was on the edge and be able to understand all the data points of possibly where they opened up the organization to step outside of compliance and not be properly managed across the board.

The flow of what we do is taking data and ingesting it and moving it to support the needs of data management. At the same time, fully indexing the content to be able to make sure it’s queryable and searchable is one fluid component of having a complete data and information management strategy. Not just in the data center, but all the way out to those edge devices.

 

The examples that you’re giving are mostly from a compliance and regulatory retrieval type aspect. Is that the focus of the product or are there other elements such as clinical data searching?

It is more of a compliance-based play. It’s backup and recovery at its core. You have a data management component, but at the same time, organizations have to buy two or three other products to do the indexing of their email so they can turn around and do e-discovery and search. Or they have to buy another product to take and ingest any of the unstructured data that sits out there in shared directories or in private directories. Then they have to buy another product to turn around and support the laptop backup, the edge-based backup, or going all the way out to the iPhone for that matter. They sign up with a variety of different products.

Our whole strategy is one common architecture. It is just that core product. We’ve expanded the technology to be able to support cross platforms into all those areas. We go into environments and we’ll work with their data from a virtualization perspective as well as from a physical perspective. We’ll support their Epic environment, their McKesson environment, and their Allscripts environment, but you can minimize the silos that comes with a number of those solutions from a data perspective.

Too many times McKesson or Allscripts has made recommendations that our organization should buy X hardware and install it and it needs to run on this virtualization platform and run it. You get these data silos that, from an operational aspect, become very challenging in healthcare, which is already challenging when you have hundreds of clinical applications that IT is trying to support. We just minimize that overhead on the back end.

 

What CIO mindset has to change when they start thinking about using the cloud?

Too many times when organizations are utilizing the cloud, they’re looking at it as just a target for data. Whether they’re going to push data to it to support a disaster recovery scenario or they’re looking to utilize cloud-based solutions so edge-based components can connect. A clinician can push data up from their laptop and access it on their iPhone or access it on their iPad and get other content. This is with unstructured data once again. All the structured data. Everybody has applications. Epic has applications for the phones and all those devices.

Too many times you have cloud vendors that have to create another silo of data. In order to get the data up into those cloud vendors, you’re creating some sort of replicated copy that pushes that data up to the cloud and doesn’t work fluidly with the existing data policies of what you’re trying to do.  In a scenario of, you’re trying to archive content off, and before you actually archive the content out of whatever that content might be, you create another copy of it. That copy then gets pushed out to the cloud as opposed to just tiering that content at its root of what you’re looking to send out and putting that other copy fully out in the environment. Not creating multiple sets, multiple copies in the data center local as well as pushing a replicated copy out to the cloud. You want the application to be able to bring it back in fluidly and not just have another copy that’s residing out there.

 

What will the health system data center of the future look like?

It will have a lot of cloud components. That’s evident by a lot of the solutions are evolving more and more into SaaS-based models. Software as a service is pretty consistent in this space more and more, especially within the EMR space. I don’t ever see that there will be a limitation in the fact of the clinical applications and how they continue to grow. It’s not that you can ever run into just having a server shop. There’s always going to be, in any of the ‘ologies, specialization. Associated with specialization comes specific applications to support the clinical needs of those particular ‘ologies. There’s still to this day constantly new apps that are created that are a little more specific, that are a little more detailed, that a cardiology department would prefer to have in their environment that some of the larger entities won’t be able to take on. It will always be a dynamic growth. There will always continue to be multiple applications.

 

Infrastructure is back on the strategic list for health systems because of big data needs, system breaches, and mobile workforce requirements. How are CIO’s responding to those needs?

With a lot of those challenges around the infrastructure, organizations are trying to play catch-up. They are challenged. That’s why simplification of the application set is always a positive piece. That’s why people are interested in talking with us and what we do because it is simplification. It is not adding multiple layers to do an operational component. They have enough complexities with the clinical applications and the dynamics of what those pieces need. To add to that mix with an overly complex infrastructure with operational tools that run on top of that infrastructure only exacerbates the problem to the HIT organization that has to manage and operate the solutions to support the clinical environment.

It’s always top of mind and that’s why we’re having so much momentum and so much growth in the healthcare space, not just in the US, but  globally as well. We have HIPAA but across the board. Everyone sees that as the direction that they need to manage and maintain from a compliance standpoint in their given country. The EU has their approach just as much as you have the compliance components that they’re attempting to do in South America. That has definitely driven some organizations to want to minimize the issues of operational and infrastructure, to start to simplify that, as opposed to making it more complex like the clinical applications continue to do.

Do you have any final thoughts?

We’re seeing a lot of points around the whole BYOD piece. The bigger concern becomes the BYOC component, the “bring your own cloud.” Everybody can sign up for a free 5 gig of their local provider. We’ve had a number of organizations that want to start to collapse that and start to bring that back inside. It has a lot to do with that compliance component of the unstructured data, because when you have any of those free 5 gigs, it is only unstructured data that usually gets pushed up into there. Spreadsheets with patient information, PHI residing in it, documents that are really more in the unstructured context. We’ve seen a lot of conversations that come up around that.

Another area is retention policies. The challenge with healthcare is there’s a variety of policies that are out there depending on the age of the patient and the retention of the data, but because the policies are so tiered and varied and they’re very specific to a patient, it becomes challenging to turn around and do anything when it comes to retention. With that, the retention policy for basically everybody we talk to seems to be forever. They don’t just have retention policies for the age of the patient or if the patient is deceased after a certain amount of time. This just complicates that data growth in the data center. That means data is never going to pare down –it’s only going to get bigger and larger. The data centers can only house so much. It comes back into that cloud message of how do you drive that one.

I work with the ISVs in the clinical app space. I work with the servers, the Epics, the Meditechs, all these organizations. I will say that the conversations have picked up more to the fact of understanding how to support retention and how to pare data off, where in the past, it was really the brute force approach of, " The data’s going to get bigger, so just throw more storage at it." Now the conversation has shifted to the fact of, "How can we truly start to minimize storage costs for our customers?"

We have more and more conversations that are, in business development, at a partnership level with those ISVs in the clinical app space as well, not only on the EMR but on the PACS space, to come up with an approach of, how do you truly start to let them pare data off? How can we have content-aware policies that aren’t just policies that you set against a date and say, "After three years, we’re going to push it over here?" Specifically, it’s three years old and it’s for a 40-year-old male who tore his ACL because we’ve haven’t seen that particular patient in 10 years — now we’re going to take and move that data.

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March 26, 2015 Interviews No Comments

Morning Headlines 3/25/15

March 24, 2015 Headlines 1 Comment

Fake patient data could have been uploaded through SAP medical app

SAP fixes an SQL injection vulnerability in its mobile EHR that allowed hackers to access and insert erroneous records into patient charts.

98.2 Percent of Participating Providers Using athenahealth’s EHR Have Successfully Attested for Meaningful Use Stage 2

Athenahealth reports that 98 percent of its customer base has attested for MU2. The company is also announcing that it will extend its ICD-10 and MU guarantees to also include PQRS and Shared Savings Program support.

This is why you shouldn’t believe that exciting new medical study

Vox analyzes medical research findings over the years, finding that only six percent of published medical studies are well-designed and relevant enough to influence patient care, but that despite this the number of published studies has increased 300 percent in the last 25 years.

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March 24, 2015 Headlines 1 Comment

News 3/25/15

March 24, 2015 News 9 Comments

Top News

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A brief preliminary statement from the American Hospital Association on the Meaningful Use Stage 3 draft says the government “continues to create policies for the future without fixing the problems the program faces today,” referring to the 2015 flexibility rules. Nobody else has had much to say about the draft, probably because it’s mind-numbingly long, was released late on a Friday yet again, and is increasingly irrelevant to providers who realize the strategic advantages they lost just to collect relatively small taxpayer handouts.


Reader Comments

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From Opie: “Re: RelayHealth. Is in negotiations to sell their nursing call center and care management business to a private equity firm. The division has struggled with the business model and profitability for many years. The business has lost several key management members over the past year and they have deployed Rod O’Reilly to make a determination if McKesson can grow RelayHealth or if they should sell the entire business.” Unverified.

From Clinic Director: “Re: MU audit hell update with 96 of our 139 Epic-using providers audited. CMS was responsive and the auditor, Figliozzi and Company, offered to instead perform a fast-track pilot sample. If a EP doesn’t meet MU, the sample will be expanded, but if all EPs in the sample meet MU, the remaining audits will be cancelled and all EP payments will be released. Since we had already gone through so many audits, the remaining audits were cancelled. Great news!” I was impressed with the professional and reasonable response of Peter Figliozzi and CMS following up on the practice’s request. Well done all around.

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From HIStalk Fan: “Re: BJC. Their website finally confirms their Epic project.”


HIStalk Announcements and Requests

Let us review 2009’s stellar “HITECH: An Interoperetta in Three Acts” by Ross Martin, MD, MHA and The American College of Medical Informatimusicology. Ross usually makes an inspired appearance at HIStalkapalooza, so perhaps you’ll see him on stage there.

I rarely look at readership stats, but for some reason noticed that Monday’s page views were the second-highest in the seven months since I had to switch stats counters, with 11,084 page views and 8,291 unique visits. January 20 had 13,509 page views for reasons I don’t understand since I hadn’t posted anything unusual.

I don’t consume many healthcare services since I’m healthy (and having worked forever in hospitals, I’m anxious to avoid them), but a recent experience reminded me of why the billing process is so frustrating to consumers. I went to the ED in March 2014 after being urged to go there by the urgent care center doctor (who was of questionable clinical skill) checking out my dizziness that turned out to be nothing, was kept overnight and tested endlessly because I had insurance and the malpractice-wary hospital was reluctant to send me on my way without commendably trying to answer the unanswerable (via a head CT, nuclear stress test, and tons of labs and EKGs, all of which showed nothing abnormal). I received the first bill from the hospital’s contracted ED doctor service nine months later in December 2014, which claimed I needed to pay $1,500 immediately since my account was being reviewed for collection due to the non-response of my insurance company. I left phone and email messages for the ED doctor billing company and was promised a quick response that still hasn’t come. I contacted my insurance company, whose nice lady said the ED doc billing company hadn’t even requested my medical records until nine months after my visit, which violates some sort of policy or law, so they basically told them to take a hike. The insurance company said they would talk to the ED doc billing service, so we’ll see what happens. I have to wonder what’s going on with that billing company that it took nine months to send a bill, but again, inefficiency abounds in healthcare.  

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What I dread most at the HIMSS conference: as a non-coffee drinker, I’ve always made fun of the mile-long line at Starbucks, which looks like a well-dressed morning rush at the methadone clinic. I’ve started drinking coffee in the morning, so I’ll have to decide if I want or need it badly enough to stand in that line myself. Thank goodness for in-room coffee makers.

The process of getting an HIStalkapalooza invitation hasn’t changed since 2008 – watch for the extensive notices in HIStalk, sign up, and hope you get picked before we run out of spots. Sponsor support allowed me to invite 1,400 people this year vs. 600 last year. Great, I thought – unlike last year, maybe I can get some actual work done instead of arguing with entitled people who think they should have been invited psychically since they didn’t otherwise express interest until after registration was closed. This year’s invitations went out and Lorre has already received over 100 emails from people requesting (sometimes demanding) additional invitations for guests, clients, and executives. They will all be politely turned down as will walk-ins that night – the count has been turned in, badges are being printed, and I’m on the hook personally for the $200 per attendee event cost if we run over our guarantee (like if the traditionally high no-show rate drops unexpectedly below the SWAG estimate we’ve built in). The massive HIStalk organization is maybe two FTEs total and we’re buried in our own pre-HIMSS work, so we don’t have time to individually debate the clearly explained process that 95 percent of people seemed to follow just fine. Last year I was so disgusted I was just going to give some whiner my ticket and hit a bar alone instead, which isn’t off the table for this year either.

I was thinking about the overuse of the word “disruptive,” usually by startups trying to convince investors and prospects that their lack of size and market traction is only temporary. I’d like to see the adjective reserved for companies that not only have the self-assessed potential to disrupt, but have actually done it.

Listening: YelaWolf, small-town rap from Gadsden, AL. I need to listen more to make sure I really like it, but my first impression is positive (other than his apparent need to have his hand planted firmly in his crotch for emotive rapping).


Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 


Acquisitions, Funding, Business, and Stock

Humana reconfigures some of its existing population health businesses under the Transcend name: Transcend, which will offer management services (the former Humana MSO) and Transcend Insights, the IT group (the former Certify Data Systems, Anvita Health, and Nnliven Systems).


Sales

Continuum Health Alliance (NJ) selects Caradigm for population health management.

MedStar Mobile Healthcare (TX) chooses the Infor Cloverleaf Integration Suite.

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Maury Regional Medical Center (TN) will implement Professional Charge Capture from MedAptus.


People

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Galen Healthcare Solutions promotes Jason Carmichael to CEO , Mike Dow to CIO, Erin Sain to COO, and Justin Campbell to VP of marketing.

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Paul Holt (Quality Systems) joins NantHealth as CFO.

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Englewood Hospital and Medical Center (NJ) names Dimitri Cruz (North Shore Long Island Jewish-Lenox Hill Hospital) as VP/CIO.

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Barnabas Health (NJ) hires Stephen O’Mahony, MD (Norwalk Hospital) as CMIO.


Announcements and Implementations

The Physician Alliance (MI) expands its rollout of Wellcentive’s population health management solution.

Athenahealth says 98.2 percent of its AthenaOne users successfully attested to Meaningful Use Stage 2 in 2014. It also extends its MU and ICD-10 guarantee program to PQRS reporting and MSSP quality measures.

Hearst Health and the Jefferson School of Population Health of Thomas Jefferson University create a $100,000 award for outstanding achievement in managing or improving wellness.


Privacy and Security

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SAP fixes bugs in its EMR Unwired mobile clinician app that would have allowed hackers to add phony information or change existing data.


Innovation and Research

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I missed this item from a few weeks ago: Walgreens adds information from PatientsLikeMe to its personal health dashboard, allowing people who are taking a particular medication to see what side effects others have reported. Most side effects are subjective and questionably attributed to a drug that has no physiologic rationale (“Tylenol makes me hungry”), so this development is both brilliant and worrisome as patients may fail to consider that every drug has side effects, most side effects are rare and transient, and the prescriber has already weighed the risk vs. benefit. Yelp is great for finding a restaurant based on the sometimes iffy reviews of people you don’t know, but I’m not sure the science of medicine is improved by patients reacting to anecdotal reports.


Technology

Robert Wood Johnson Foundation gives Partners HealthCare a $468,000 grant to help people choose, buy, and use fitness trackers to create a personal fitness plan, which will be followed by a study of volunteer users that will look at outcomes. .


Other

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Richmond-based lab vendor HDL will pay $50 million to settle DOJ charges that it gave doctors $20 per blood sample in kickbacks. HDL made hundreds of millions of dollars running cardiac biomarker tests, claiming that it paid doctors only because its competitors did. The company’s three co-founders pocketed $50 million in distributions in three years, while the two owners of its contracted marketing company personally took home $173 million.

Vox questions whether the dramatic rise in medical studies leads to ungrounded public enthusiasm for miracle cures, nearly all of which never pan out. Stats: only 6 percent of submitted single-study journal articles are accepted; of 49 highly cited studies, 14 were later proven wrong or had less impact than originally thought; and 85 percent of annual global research spending is wasted on studies that are poorly designed or redundant. It partially blames news outlets that don’t understand that “new” isn’t definitive when it comes to medical research – it’s the old, unexciting studies that have been validated by further research that change the human health.

Someone tweeted out this brilliant article that has healthcare startup implications, “The Battle Is For The Customer Interface.” Uber doesn’t own cars, Facebook doesn’t create content, and Airbnb doesn’t own real estate. “These companies are indescribably thin layers that sit on top of vast supply systems ( where the costs are) and interface with a huge number of people ( where the money is). There is no better business to be in … Our relationships are no longer with the service providers … In the modern age, having icons on the homepage is the most valuable real estate in the world, and trust is the most important asset. If you have that, you’ve a license to print money until someone pushes you out of the way.”  


Sponsor Updates

  • RelayHealth Financial announces a new version of its RelayAccount online patient billing solution.
  • Meritage ACO (CA) announces that it has lowered its readmission rate to 10.2 percent using an evidence-based hybrid care model and ZynxCarebook care transition on mobile devices.
  • Impact Advisors posts “Meaningful Use Stage 3: Summary & Early Impressions.”
  • ADP AdvancedMD offers “6 facets of patient safety within a small private practice.”
  • Capsule Tech will exhibit at the HIMSS Middle East Conference and Exhibition March 31 – April 1 in Riyadh, Saudi Arabia.
  • Clinical Architecture offers the last installment of its blog series on precision medicine, plus a thorough summary of Stage 3 Meaningful Use objectives and measures.
  • Clockwise.MD Founder Mike Burke shares what he’s learned in the startup world at the #30in30 event at Atlanta Tech Village.
  • CompuGroup Medical will exhibit at the AMGA 2015 Annual Conference March 23-26 in Las Vegas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 24, 2015 News 9 Comments

Readers Write: Ignorance of the Major EMR Software Vendors is Not Bliss

March 23, 2015 Readers Write 10 Comments

Ignorance of the Major EMR Software Vendors is Not Bliss
By Tyler Smith

11-6-2013 12-24-41 PM

We in healthcare IT have found ourselves in a pretty sexy industry. You know that is true when Silicon Valley is practically banging down the doors to get in and KPCB’s John Doerr states that he would really like to see an open source competitor to Epic created. Damn, so Valley money admits it is losing to a slowly built behemoth in Madison – not a brand spankin’ new startup it missed an angel round on.

Needless to say, HIStalk’s Startup columns are a quite timely addition to the blog. I particularly enjoyed reading Marty Feisenthal’s explanation of the elite JPM conference. Having heard about the conference from banker friends (not HIT colleagues), his column removed much of the mystique. Being a fellow Atlanta resident and having visited the Atlanta Tech Village before, I also have greatly appreciated Michael Burke’s articles on the experiences of an HIT founder in Atlanta.

I recently co-founded a startup that aimed to bring efficiency to the Epic staffing arena by using very simple tools already in place in other industries. I do not want to call it the Uber of Epic staffing – for fear of sounding like a hack – but the basic idea was a connection platform with ratings for Epic certified consultants. While we have put the project on hold due to some shakeups on our technical team and also due to slow buy-in from provider organizations (our target clients), the pause in the action has given me time to reflect on the current state of HIT startups – particularly those looking to nibble on the enterprise EMR vendors’ scope of services.

Along with Mr. H and most readers here, when anybody from the outside comes and brings a new idea to the HIT table, I am usually skeptical. For starters, most entrants do not understand the complexity of the hospital / provider organization buyer or the provider organizations’ importance in the system. In theory, I love the idea of patient advocacy and patient-centric apps, but if providers or the systems that house them aren’t buying it, you better have something that patients see as life or death (read: an HIV curing drug, not a sleep tracking app) if you want them to fight the entrenched stakeholders for you or with you to make your startup relevant or widely used to truly create positive clinical outcomes.

Secondly and most importantly, many of these outsiders do not understand the current state of the EMR vendor landscape, and if they do, they arrogantly think they can steal market share while the enterprise systems watch from the sidelines. True, Epic and Cerner’s UX can appear very basic from an end user stand point and it often appears that the enterprise systems do not appear to be covering even close to all the functions that could be automated in a hospital or healthcare delivery organization. However, it would be naïve to think that these vendors have no big plans to tackle all of these remaining un-automated functions in the near future. When they do, unlike many of the new startups, these vendors will be able to simply make an additional sale to their already heavy client lists instead of having to undergo the arduous process of breaking down the doors to just get on the approved software vendor list at a major healthcare system.

The truth is that healthcare IT is a B2B market, not a consumer market. Organizations do not make purchasing decisions overnight, and thus while an app may actually do something better than an organization’s EMR, it better be a lot better for a healthcare provider organization to consider even meeting with the startup’s sales team.

This is not to say that I think that clinical apps which could be potentially developed and which will lead to improved clinical outcomes should not be attempted. What I am really saying is that before delving into development, HIT startup founders should take a much more serious look into EMR current state.

Even more importantly, startups should also consider what logical next steps vendors will be taking in their product offerings and research timelines as the massive implementation phase winds down and optimization becomes a priority for the vendors’ in house development teams. If there really is a competitive advantage which the startup has over these behemoths in the development of an EMR related application, then by all means go for it. But if not, it is probably best developing something far outside of the current or near future EMR vendor scope.

Easy for me to say as I sit on the sidelines and consult on EMR projects, I know. And you can object and say I’m siding with the status quo. Regardless, it pays to do your homework on the massive vendors. They aren’t going to crumble and they certainly aren’t going to let their clients get on products that encroach on their turf without a very solid battle.

In closing, I would ask any hopeful HIT entrepreneur: what is your startup doing that an established EMR vendor could not accomplish without a system update or by adding a new application which would seamlessly integrate with their current lineup?

Tyler Smith is a consultant with TJPS Consulting and co-founder of Hitop.co.

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March 23, 2015 Readers Write 10 Comments

Startup CEOs and Investors: Niko Skievaski

Selling to a Health System Is Like Breaking Your Arm
By Niko Skievaski

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"Selling to a health system is like breaking your arm." I’m speaking with J. Simpson over a Chick-fil-A in the sticky mist of the three-story fountain at MD Anderson in Houston. Many things purchased for UT System’s health campuses come across her desk at the UT System Supply Chain Alliance, MD Anderson Cancer Center included.

"When you break an arm, the cast will be on for six weeks. There are plenty of things you can do to aggravate it and extend the pain, but there’s really nothing you can do to get rid of it faster. Sometimes you never really recover."

She’s referring to the notoriously crippling 12-18 month sales cycles in healthcare enterprise sales. You crack your ulna on the way into the sales meeting. If you’re lucky, you’ll get a purchase order in 12 months. However, most of the time you’ll be looking at up to 18+ months, if you get through at all. The problem is rooted in one thing that startups know very little about: budgets.

The budget for an upcoming fiscal year is approved about a month before that prior year ends. A month before that, department managers submit their budgets up the chain. And another tick before is when they start making "first cuts," where they generate a wish list of expenses for the next year, rank, then start hacking away. This process highlights the opportunity costs. If you want that toy, you’ll have to put down the others.

What this means for us is that if we haven’t already gotten a resilient thumbs up by first cuts, we’re not going to get allocated in that budget cycle. Hence, 12-18 months. Operational budgets are negotiated by employees at every level, and contrary to entrepreneurial optimism, there is no extra play money in the budget. For the most part, we’re talking about businesses that run an extremely tight ship with increasingly small margins. So what can we do?

  1. Ride the cycle. It’s pretty easy to find out the fiscal year of most of these organizations. Check out Guidestar.org. Most hospital systems operate as non-profits, hence the razor-thin budgets. Search for the hospital, click the “financials tab,” and voilà! Fiscal year-end minus three months gives you your target close date. Use this knowledge to allocate your time effectively as you work your pipeline. If you just missed a lead’s cycle, change your flight and drop in on someone else.
  2. Avoid the cycle. I’ve been describing the operational budget process. Things like that sweet software licensing contract you’re selling end up here. The other way they spend money is in the capital budget. These are one-off, large purchases of equipment or buildings (and the things that go inside them). If you can package up your offering as a one-time expense, you might be able to dodge the cycle. Otherwise, if you can get the purchase under $5K, you can bypass budgets all together. Those purchases can typically get swiped, invoice-free, on the department head’s corporate card. However, those cards are a one-shot-deal, so don’t count on using this for recurring revenue.
  3. The pilot close. The idea is to sell a free pilot, contingent on being written into the budget next time. This is a slight variation on the usual pilots we see pitched. Try to time your pilot so that your evaluated in time to get into the upcoming cycle. The most important part here is that your pilot has a definitive close date (the “initial term” in contract lingo), a point when you can ask them to shit or get off the pot. Identify the metrics, date of measure, and what it will cost you to give it away for free for a while. Negotiate this up front with the pilot terms. This smooths the process along and makes it much more likely to be included next go-round.
  4. Stop selling to enterprise health systems. Think of another revenue model that won’t be fraught with such dire peril. For instance, Lily Truong has an amazing gadget that you shove in your ear to (gently) drill out your ear wax. It’s 100 times better than a Q-Tip and less invasive than the normal saline flushes that pediatricians frequently push on terrified toddlers (and I’m not going to mention that weird candle thing). Wouldn’t all the clinics and children’s hospitals want to get their hands on one? Maybe, but Truong’s business will likely fail before she could get through the sale. Rather, she’ll ditch the cycle and bring her gadget into patients hands directly through sales off her site and consumer retailers. It’s a shame that the best tools won’t be used for the job in the doc’s office, but at least you can pick one up at the corner drug store and the innovation wasn’t wasted. Maybe that was an easy example, but I’ve seen people spend months trying to close enterprise deals when there’s a better buyer just around the river bend.

Hopefully some of these strategies will help. I’d like to thank Jess for dropping some knowledge on us youngsters. And to pad her resume, she’s likely one of the only people in any purchasing department who has actually done sales for a startup. It’s a breath of fresh air knowing there’s at least one out there, right?

Niko Skievaski is co-founder of Redox.

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March 23, 2015 Startup CEOs and Investors 2 Comments

Monday Morning Update 3/23/15

March 21, 2015 News 13 Comments

Top News

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HHS, CMS, and ONC publish proposed rules for Meaningful Use Stage 3 and 2015 Edition EHR certification criteria. The announcement was posted as a Word document, bizarrely, and late on a Friday afternoon as is always the case. The Stage 3 rule is here and 2015 certification criteria here. Your comments are welcome, both here (any time) and at the Federal Register links (by May 29, 2015). I’ll be honest in saying that I’m so sick of the topic that I haven’t even bothered to read either document. I’m sure the many special interest groups will call out the parts they find objectionable and thus are probably the most needed. Feel free to chime in on parts you find interesting or surprising.


Reader Comments

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From Yours in Nomenclature: “Re: SNOMED-CT MOOC. It’s going to happen. I might sign up since my work bumps against it.” The College of St. Scholastica offers a free massive open online course (MOOC) called “Exploration of SNOMED-CT Basics”  that starts April 20. Registration stays open until May 18 since the student just needs to finish the course by June 15. It offers 12 AHIMA CEUs. The instructor is Mike Grove, PhD of Accenture.

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From Paul: “Re: Epic’s Deep Space architecture award. While I must congratulate Judy, I just left Verona with a sense of dismay at what our organization has been putting up with to build this place — north of $400 million by estimates — for a forum we’re only visiting once a year.” I think they should have concerts there. It would be fun to go to Verona for training and then walk over to see Rush or U2.


HIStalk Announcements and Requests

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Two-thirds of poll respondents don’t think Congress will insert another surprise ICD-10 delay into SGR legislation, a belief that seems well founded in the draft versions presented so far. New poll to your right or here: which company do you trust least to make information exchange common and inexpensive? Of course I’m fascinated to learn why you voted as you did, so click the “comments” link afterward and explain.

I’ve emailed the 13 CMIOs who expressed interest in attending my HIMSS conference lunch on Tuesday, April 14. I still have a handful of spots left. I don’t often volunteer to pick up the lunch tab, so it’s a rare opportunity.

I’m really getting annoyed at half-wits who think it’s hilarious to use “FHIR” as “fire” in creating a lame pun for a headline or tweet.

Listening, as I was taking an extended drive and used Siri’s “what is this song” option to get the titles of the radio tracks I liked best as I constantly scanned: Christian rocker Matthew West’s “The Motions,” The Smashing Pumpkins with “Today,” a forgotten classic by the indefatigable Butthole Surfers, “Pepper,” new from Incubus, and my favorite song (nearly 40 years old) of the amazing Electric Light Orchestra.


HIStalkapalooza

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HIStalkapalooza invitations have been emailed. Spam filter problems are rampant these days, so I’ve added a second level of checking: see this page, which lists who was invited in a somewhat de-identified format (first three letters of the last name, comma, and first two letters of the first name). We cannot accommodate walk-ins or guests, so the security people will admit only those who are on their full registration list. Some sponsors didn’t submit their guest lists in time, so if you’re being invited by one of the event sponsors and aren’t on the list, you should be getting an invitation directly from that sponsor.

I’ll take a second to again thank the HIStalkapalooza sponsors that are making it possible for a large number of folks to attend the event. Several of those listed are going above and beyond, with Sagacious, for example, running guest check-in and badge printing and Elsevier managing the traditional red carpet entrance. These companies are springing for dinner, drinks, and entertainment, so it seems reasonable that you click their links in return to see what’s new with them.

Platinum Sponsors
Elsevier
Santa Rosa Holdings

 
Gold Sponsors
Divurgent
Sagacious Consultants

Silver Sponsors
Aventura
CommVault
Falcon Consulting Group
Greenway Health
PatientSafe Solutions
Sunquest
Thrasys
Validic

Speaking of red carpet, here are skeletal details of the ever-popular HIStalkapalooza fashion awards, where your hot shoes will be burning down the avenue (Dearborn Street in this case). We’ll have four winners: best shoes male and female and then best overall appearance, also male and female, which will earn the HIStalk King and HIStalk Queen sashes, since like high school, we overly emphasize appearance because it’s all we have time to evaluate. Plan to enter early (maybe 6:45 to 7:15) via the red carpet, where our distinguished judges will cast their critical eyes feetward and then full body. Your regular host Jennifer Lyle of Software Testing Solutions serve as expert along with one of our patient scholarship winners Amanda Greene, who was involved with the red carpet at the Oscars this year and who works with fashion magazines. We’ll bring the four winners up to the stage to be sashed.


Last Week’s Most Interesting News

  • A proposed Congressional SGR “doc fix” bill would make health IT interoperability a national priority to be achieved by the end of 2018 and proposes to penalize those who intentionally obstruct it.
  • A contracting billing company’s employee falls victim to a phishing scam, exposing the information of 14,000 patients of Sacred Heart Health System (FL).
  • Cerner and Athenahealth chide Epic via Twitter for its non-participation in CommonWell following its negative comments about the organization in congressional testimony.
  • Premera Blue Cross discovers that hackers have had access to its 11 million patient records since May 2014.
  • Meditech reports full-year 2014 results that include an 11 percent drop in revenue and profits that were reduced by 7 percent, although the company had previously restated its financials and that change may have affected the totals.
  • CHIME offers a $1 million prize for an idea or technology that increases patient ID matching from the current 80 percent to 100 percent, although presumably members of Congress who could enact national patient identifier rules are not eligible.
  • Implementation of New York’s mandatory e-prescribing law is delayed for a year, to March 27, 2016.

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 


Acquisitions, Funding, Business, and Stock

Vince Ciotti has been tracking vendor annual revenue for decades. Here’s the first installment as he introduces the episodes to follow. He confirms the feeling I’ve had that HITECH goosed company revenues for a couple of big years, but that has tailed off and left a lot of software and consulting vendors scrambling to resize themselves appropriately.  


People

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Valence Health hires Kai Tsai (PwC Consulting) as EVP of consulting services and strategic initiatives and Mary C. Anderson, MD (Rush University Medical Center) as medical director of population health.

Karen Wavra (Allscript) joins Beacon Partners as Cerner practice director.


Announcements and Implementations

The headline “El Camino says goodbye to paper medical records” wasn’t written during its TDS implementation in the 1970s – it describes El Camino Hospital’s (CA)  $125 million move to Epic.

Surescripts names 24 health systems and technology vendors for its “2014 White Coat of Quality Award” for electronic prescribing.


Government and Politics

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This is a scary graph. Healthcare is the highest-employing industry in 35 states.

An editorial in the Burlington, VT paper applauds an announcement by the governor that if Optum can’t get the state’s insurance exchange working by October, he’ll shut it down and move to the federal exchange. The state will have spent $198 million in federal taxpayer dollars by the end of 2015, with unimpressive results following screw-ups by CGI that resulted in its replacement by Optum.

Acting VA CIO Stephen Warren says that even though the DoD is shopping for a commercial EHR, the VA will stick with VistA because it was developed for patient care rather than built around billing as were commercial systems.


Technology

Good Morning America goes inside Apple’s secret fitness lab, where employee volunteers tested various sensors and technologies over the past two yeas without knowing their work was for the development of Apple Watch.


Other

A Virginia Peninsula newspaper points out that the region is one of the first in the country in which all competing health systems (Bon Secours, Riverside, Sentara, and Chesapeake Regional Medical Center) use the same EHR, Epic in their case. Like a lot of newspapers and marginally informed pundits, this article mistakes HITECH as being part of the Affordable Care Act, but this one takes it a step further in proclaiming that hospitals didn’t start testing EHRs until the 1990s and that just two major players remain (Cerner and Epic, forgetting about still-common but somewhat fading Meditech).

UnitedHealthcare runs a cute commercial that features an ICD-9 code and virtual visits.

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Bob Wachter, MD, pitching his new book, writes a New York Times editorial whose content he summarizes via Twitter as “Why health IT is so bad and how to make it better.” The former was mostly anecdotes and I didn’t see much of the latter: his suggestions are: (a) train doctors to focus on the patient, not the computer; (b) create new ways to practice provider teamwork in the absence of a shared chart; (c) create federal policies that promote interoperability; (d) increase collaboration between academic researchers and software developers. Doctors may hate EHRs, but all it took was $44,000 in federal money to get them to use them. My argument would be that doctors should redesign the encounter system so they don’t need to use computers at all unless they need its help — doctors are the only professionals (accountants, lawyers, psychologists, plumbers) who key their own information into the computer instead of focusing entirely on the paying client sitting in front of them, and not only that, do most of their keystroking for the benefit of someone other than themselves. You could argue that medicine is the only profession that is practiced as a team, which might hit Bob’s second point, but I’d still say bring on the scribes and let doctors be doctors and not the medical equivalent of the grocery store checkout clerk. Everybody agrees that the information needs to be recorded, but it’s not reasonable that the highest-paid professional in the medical food chain be the one doing it.

Bob Wachter tweeted out an interesting excerpt from his book as he quoted National Coordinator David Brailer responding to the question if ONC would shrink itself as the HITECH money runs out. “Bureaucracies don’t retrench,” Brailer said. “ When a bureaucracy that starts out as the Candy Man runs out of candy, it goes dark and turns into Regulatory Man.”

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Anyone who attended HIMSS09 in Chicago saw the weather change from a near-blizzard on Sunday to pretty good later in the week. Here’s what the not-so-bad weather looked like at O’Hare on April 12 of previous years (the Sunday opening day of this year’s conference):

2014: low 42, high 69, rain 0.43 inches.
2013: low 34, high 45, trace of snow.
2012: low 40, high 66, no precipitation.
2011: low 36, high 68, no precipitation.
2010: Low 48, high 63, no precipitation.

The family of a Virginia radio personality who died after routine hernia surgery is awarded around $2 million from the hospital and its PCA pump manufacturers. Nurses mis-programmed the pump and delivered five times the ordered dose of narcotic, which just about everybody agrees was because of the device’s complexity, although the manufacturer claims the nurse hadn’t been properly trained, didn’t monitor her patient, and waited eight minutes after finding the patient unresponsive before calling for help.

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This photo, which a paramedic took surreptitiously as a California ED doctor grieved after his 19-year-old patient died, has received a lot of Internet attention after being posted on social media. Minutes later, the doctor had moved on to his next patient with his game face on. It’s a good reminder that a hospital is just a very clean hotel with a lot of expensive executives and non-clinical hangers-on – lives get saved, as they do on the battlefield or in an ambulance, by a well-trained fellow human who is willing and able to help.


Sponsor Updates

  • Shareable Ink’s ShareQuality technology is featured in Nashville Medical News.
  • Voalte CEO Trey Lauderdale shares his belief that “With Apple ResearchKit, mHealth Springs Forward.”
  • Zynx Health will exhibit at the 2015 Population Health Colloquium March 23-25 in Philadelphia.
  • The SSI Group and ZirMed will present at the Region 4 Mid-Atlantic HFMA Education Conference March 24 in Baltimore.
  • Verisk Health will exhibit at the AMGA Annual Conference March 23-26 in Las Vegas.
  • Xerox Healthcare asks, “Does Better Healthcare Require Better Patients?”
  • Sunquest Information Systems will exhibit at the 2015ACMG Annual Clinical Genetics Meeting March 25-27 in Salt Lake City.
  • PMD offers “Telemedicine: The Work of the Gods.”
  • MedAptus, PatientKeeper, and Passport Health will exhibit at the AMGA 2015 Annual Conference March 23-26 in Las Vegas.
  • The local business paper interviews Quest Diagnostics CEO Steve Rusckowski about the company’s recent successes and future plans.
  • MedData will exhibit at the OHIMA Annual Meeting & Trade Show March 24-25 in Columbus, Ohio.
  • MEA I NEA CEO Lindy Benton discusses the importance of improving practice communications on eHealth Radio.
  • Navicure posts “Price Transparency: What does it have to do with Patient Engagement?”
  • NVoq offers how to “Avoid Those ‘Few Extra Clicks’ and Improve EMR Workflow.”
  • Nordic releases the second episode of its HIT Breakdown podcast entitled, “What does a great population health program look like?”
  • Park Place International publishes a blog on “Winders Server 2003 End of Life and Active Directory.”
  • Orion Health and Sandlot Solutions will exhibit at the 12th Annual World Health Care Congress March 22-25 in Washington, D.C.
  • NTT Data will exhibit at the CIO Summit March 22-24 in Chicago.
  • Perceptive Software’s In Context blog addresses “Hospital IT: Beyond the EHR.”
  • BBC’s Click Tech program features the Oneview Healthcare solution used by UCSF Medical Center (CA).

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 21, 2015 News 13 Comments

Morning Headlines 3/20/15

March 19, 2015 Headlines 7 Comments

A bill to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate

A new bill in Congress calls for the permanent repeal of the SRG, but also names health IT interoperability a national priority to be achieved by the end of 2018.

Graphical Display of Diagnostic Test Results in Electronic Health Records: A Comparison of 8 Systems

AHRQ publishes a study comparing the differences in how laboratory results are displayed across eight EHR systems. The study was based on 11 criteria for the proper display of lab data. None of the vendors met all 11 criteria, and some deficiencies were misleading enough to have a significant, negative impact on patient safety.

The inside story of how Apple’s new medical research platform was born

Apple reportedly began working on ResearchKit in 2013, having been inspired by a MedX presentation by Stephen Friend, MD on the future of medical research. During  his presentation he describes his ideal platform, “Here you have genetic information, and you have what drugs they took, how they did. Put that up in the cloud, and you have a place where people can go and query it, [where] they can make discoveries.” Apple VP of medical technologies Mike O”Reilly was in the audience.

Epic System’s auditorium, contractor win national award

Epic’s new 11,000 seat, space-themed underground auditorium has been named the best new building in America in the over $200 million category.

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March 19, 2015 Headlines 7 Comments

News 3/20/15

March 19, 2015 News 18 Comments

Top News

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The House’s proposed doc fix SGR bill includes a requirement stating that “Congress declares it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018” and orders HHS to take action if interoperability metrics aren’t reached that could include Meaningful Use penalties and EHR decertification. The bill would also require providers to declare that they that they haven’t restricted interoperability as part of their attestation (that sounds tricky to interpret). It also calls for studying the creation of an EHR feature comparison website. Other language in the proposed legislation addresses data usage and telemedicine, so it’s pretty heavy in IT-related language. Now the political sausage-making begins, hopefully without someone’s ICD-10 Hail Mary sneaked in as time expires.


Reader Comments

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From Data Driver: “Re: Demand-Driven Open Data (DDOD). I’m cautiously optimistic about this new mechanism to open and track government data requests. I say ‘cautiously’ because I’ve seen competent people in HHS’s ‘Entrepreneur in Residence’ program have their projects stymied by unspecified limitations.” HHS’s DDOD program, launched in November 2014, lets startups, providers, and researchers tell HHS (via online use case requests on Github) what data or APIs from CMS, NIH, CDC, and FDA they would like to have. Requests are prioritized by potential cost savings and input from data users, and if approved, the requestor works with HHS to manage its development as a project. Some interesting use cases: retrieve Medicare pricing by CPT, create a consolidated registry of marketed medical devices, export FDA’s drug warning letters to data format, and create a de-identified claims dataset for tracking utilization and quality.

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From Brutus: “Re: Standard Register. I haven’t seen any news on its implosion. The CFO resigned in January, they got booted from the NYSE, and now they’ve filed Chapter 11. They bought iMedConsent from Dialog Medical awhile back and seemed to be making a slow transition from their paper forms business.” They’ve announced restructuring plans to sell the company to a turnaround-focused hedge fund for only $275 million. Standard Register’s electronic healthcare offerings include electronic forms, document capture, electronic consent, electronic storefronts, medication history, discharge follow-up, and workflow. The company bought Dialog Medical for $5 million in 2011.

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From Sturges: “On the noise around Epic and the Senate interoperability hearing, everyone is missing one piece: who asked the question on CommonWell to Epic’s Peter DeVault?  The answer: Tammy Baldwin, US senator from Wisconsin. Judy is one of her largest political donors. So, Epic (and/or Brad Card, their lobbyist) planted the question with Baldwin’s staff. Baldwin is happy to help a large donor. Epic’s DeVault provides his rehearsed, untruthful reply. It is typical Washington." Senator Baldwin is not only Judy’s heaviest-supported politician (Judy’s campaign contributions are listed are above), Senator Baldwin was one of five members of a Congressional delegation that in 2011 wrote a letter to the Department of Defense urging it to consider buying Epic, which seemed cheeky at the time, but now Epic is one of three finalists for the DoD’s $11 billion EHR project and the free VistA is off the table.

From MrSoul: “Re: Spartanburg Regional Medical Center (SC). They’re going Epic, replacing GE Centricity in the clinics and McKesson Horizon inpatient. That means Bon Secours St. Francis, GHS, and Spartanburg Regional will all be Epic soon. No Epic jobs on their site yet.” Glassdoor is now showing some Epic jobs at Spartanburg Regional.


HIStalk Announcements and Requests

This week on HIStalk Connect: Health Catalyst raises a $70 million Series D round to expand its data analytics platform. Google secures a patent for a wrist-worn system that will search for and then attack cancer cells in the bloodstream. 23andMe announces that it will begin using its genome database for drug discovery research. HealthTap introduces RateRx, a platform for doctors to rate the effectiveness of medications.

This week on HIStalk Practice: Austin Regional Clinic gets into virtual visits via CirrusMD. Mettrum Health launches physician portal for medical marijuana services. AHIP attempts to one-up the AMA in Chicago. VSee helps telemedicine go galactic. Jerry Broderick outlines how practices can give themselves a leg up when it comes to capturing physician commitment. HHS and PwC look back at ACA hits and misses. Zobreus Medical takes its EHR to Kickstarter. Physician optimism around mobile apps may be naive.


Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 


Acquisitions, Funding, Business, and Stock

Clinical trials software vendors CentrosHealth and Clinical Ink merge.

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The Houston business paper profiles seven-employee Medical Informatics Corp., which offers the FirstByte alarm management program and says its real-time clinical decision support application should pass FDA approval and enter the market in this year.

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IBM invests an unspecified amount in Modern Medicine, which is working on Watson-powered ambulatory clinical decision support.


Sales

Washington’s Department of Social and Health Services chooses a hosted version of Cerner’s Millennium and revenue cycle for three psychiatric hospitals.


Announcements and Implementations

Premier announces PremierConnect Supply Chain to manage a health system’s entire purchasing process including, real-time supply analytics, online sourcing, catalog management, and materials management. Test sites included Adventist Health and Fairview.

Cerner and Intermountain announce implementation of iCentra — the EHR/PM system they’ve been working together to develop — at two hospitals and 24 clinics, with the rest of Intermountain going live through 2016. The announcement says the collaboration makes iCentra “more unique” (which is grammatically horrifying) than competing EHRs.


Government and Politics

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California tax authorities and Blue Shield of California are criticized for failing to disclose that the insurance giant’s non-profit status was revoked seven months ago before people starting signed up for insurance on Healthcare.gov. The state’s insurance commissioner applauds, saying Blue Shield charges excessive rates and doesn’t operate any differently than for-profit insurance companies. The organization paid its CEO $4.6 million in 2011 (and has declined to say what it has paid him since) and spent $2.5 million for a San Francisco 49ers luxury box last year. Blue Shield’s just-resigned public policy director is running a public campaign to convert the insurer to  a for-profit company that could be worth up to $10 billion and use the money for safety net care. The questions raised could be logically extended to health systems that don’t pay taxes despite billions in income, millions in surpluses, and the highest executive salaries in the non-profit world.


Privacy and Security

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Sacred Heart Health System (FL) notifies 14,000 patients that their information was exposed when the email account of a contracted billing vendor’s employee is hacked. Please, well-intended writers and self-appointed experts – stop yammering about encrypting data at rest (which wouldn’t have prevented any of the recent big breaches) and focus on phishing attacks. They aren’t as easily detected as earlier primitive attempts that featured laughably poor English and poorly disguised links that would fool only the least computer-literate employees. Phishers have become convincing in luring even intelligent people into clicking official-looking links or opening malware attachments that claim to be faxes, legal documents, or password reset links. That doesn’t even account for phone phishing where smooth-talking people convince employees to divulge passwords. Encryption is worth zero if someone steals the password of an employee who has data access.


Innovation and Research

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An AHRQ-funded review of how eight inpatient EHRs display lab values finds inconsistency and graphical limitations, with the authors suggesting that ONC beef up certification criteria. Some EHRs failed to include the patient’s birthdate, a description of the value being displayed, or a data legend.

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Clinicians and technologists in Vermont join to create MEDSINC, a mobile app for poor countries that allows users with no medical training to input information about a sick child and then receive suggested treatment options based on local conditions. The app was envisioned by UVM pediatrician Barry Finette, MD, PhD and built by Physicians Computer Company co-founder John Canning with input from 10 university pediatricians who reviewed WHO protocols and evidence-based research. Testing at UVM suggests that pediatricians and the app agree 94 percent of the time vs. the 80 percent agreement typically found when two board-certified pediatricians review a case. Field deployment in Bangladesh begins later this year. The developers say it might eventually land in the US provided they can get through the FDA’s process. They’ve formed a company called ThinkMD.  

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A report says Apple decided to move ahead with ResearchKit in September 2013 after one of its executives heard a Stanford MedX talk by Stephen Friend, MD, PhD, a  former drug company oncology SVP who co-founded Seattle-based non-profit Sage Bionetworks that provides tools for large-scale, transparent biomedical research. It says Friend decided to work with Apple rather than Google or Facebook because as a hardware manufacturer, Apple won’t sell data.


Technology

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Don DeCoteau is developing BellaVista, an EHR-agnostic, native client (iOS, Android, and JAVA-supported desktop) that displays clinical results with a framework to integrate QR codes, real-time medical device streams, videoconferencing, and voice-based ordering and documentation. He’s got it running with the VA’s VistA to illustrate that the client can work with any EHR that offers an API for accessing clinical information. Don is looking for early adopters.

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A New York Times Magazine article pokes fun at people who worship “optimization” because it’s easier to appease their “inner bean counter” than to develop talent or ambition also takes on the Apple Watch in comparing it to the Stalin Gulag’s computer-driven optimization of “maximum work given minimum food”:

After time keeping, the watch’s chief feature is “fitness tracking”: It clocks and stores physiological data with the aim of getting you to observe and change your habits of sloth and gluttony. Evidently I wasn’t the only one whose thoughts turned to 20th-century despotism: The entrepreneur Anil Dash quipped on Twitter, albeit stretching the truth, “Not since IBM sold mainframes to the Nazis has a high-tech company embraced medical data at this scale. And yet what attracts me to the Apple Watch are my own totalitarian tendencies. I would keep very, very close tabs on the data my body produces. How much I eat. How much I sleep. How much I exercise and accomplish. I’m feeling hopeful about this: If I watch the numbers closely and use my new tech wisely, I could really get to minimum food intake and maximum work output. Right there in my Apple Watch: a mini Gulag, optimized just for me.


Other

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It’s fun to have a sideline seat for the public vendor interoperability squabbling generated by the Congressional testimony of Epic’s Director of Interoperability Peter DeVault, who disclosed upon direct Senatorial inquiry this week that Epic charges customers $2.35 per patient per year to send data to non-Epic systems. Athenahealth’s Jonathan Bush says he’ll pay Epic’s $1.4 million fee to join CommonWell, while Cerner calculates the many millions Epic receives from its data sharing tollbooth. Meanwhile, as reader Where’s Waldo suggests, we can take one important issue off the table right now if McKesson’s John Hammergren will simply state in writing that his RelayHealth business (CommonWell’s technology provider) will never sell data, which is different than having CommonWell itself say it won’t sell data. Hammergren has seemed awfully excited when describing CommonWell to investors.

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A KLAS report on small-practice (1-10 doctors) EHRs puts Cerner at the top for broad market vendors in a fairly stunning turnaround, with PCC topping the specialty category (pediatrics in its case). Bottom-ranked and trending hard in the wrong direction are NextGen, Allscripts, and McKesson. McKesson leads the pack in clients planning to replace its product at 43 percent, while PCC has the highest planned retention at 98 percent. Small-practice customers in general say their EHR vendors spend too much time chasing Meaningful Use and ICD-10 rather than delivering customer-suggested enhancements. Users of Greenway Intergy, NextGen, and McKesson called their vendors out as having “black-hole syndrome” where support loses or ignores their tickets or fails to follow up. Customers of Allscripts, eClinicalWorks, and Bizmatics complained that the support reps often don’t speak English very well and one NextGen customer reporting that he’s tired of getting calls from overseas at 3 a.m. The biggest complaint by far of customers planning to replace their EHRs is poor usability (although those same EHRs had the same poor usability when those same customers bought them, so those customers are more to blame than anyone). 

A random telephone survey (which raises validity flags every time even if you ignore the leading questions that are asked or days and times calls were made) finds that 75 percent of respondents think their providers should be able to share their information, while 87 percent don’t think either providers or patients (i.e., themselves) should have to pay for it. Most respondents also said they love puppies and their country (wait, I made that part up). The real way to tell if data sharing is important is to ask people (a) if they’ve switched providers who don’t or can’t share information, and (b) would they pay extra for it.

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Epic’s underground Deep Space Auditorium is judged the best new building in America in the over $200 million cost category, with the Madison-based contractor that built it also winning a top award.

A female pediatrician in England accuses a gym chain of “blatant sexism” upon finding that she couldn’t enter the women’s dressing room because the gym’s security system assumes that anyone with a “Dr.” title is male.

An Internet domain company challenges a policy under which the new .doctor domain will be issued only to medical doctors who provide evidence of their credentials, saying it’s not fair to PhDs and companies with “doctor” in their name, such as Rug Doctor.


Sponsor Updates

  • PatientSafe Solutions President and CEO Joe Condurso publishes “Liberate and activate EHR data with mobile tools for clinicians and patients.”
  • InterSystems releases a white paper entitled, “Data Scalability with InterSystems Caché and Intel Processors.”
  • Intellect Resources posts a new blog on “Identifying Your Career Motivators.”
  • Hayes Management Consulting Offers “3 Ways to Minimize Anxiety During an EHR Implementation.”
  • HDS posts “The Push for Pull Marketing in Healthcare.”
  • InstaMed offers “Why Healthcare Needs Apple Pay.”
  • E-MDs will exhibit at American Academy of Orthopaedic Surgeons 2015 March 24 in Las Vegas.
  • Galen Healthcare Solutions introduces Web Access for VitalCenter in its latest blog.
  • Ingenious Med blogs about “The Future of Innovation.”
  • Healthwise will exhibit at the World Health Care Congress March 22-25 in Orlando.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 19, 2015 News 18 Comments

Morning Headlines 3/18/15

March 17, 2015 Headlines 1 Comment

Premera Blue Cross Says Cyberattack Could Affect 11 Million Members

Premera Blue Cross discovers that 11 million of its patient records have been compromised by hackers, with bank account information and clinical data among the exposed information.

High Value Health IT: Policy Reforms for Better Care and Lower Costs

A Brookings Institute report recommends that the Meaningful Use program focus on supporting payment reform, and improving outcomes and interoperability.

Medical Information Technology, Inc. Form 10-K

Meditech reports 2014 annual results: revenue down 11 percent to $517 million. Sales revenue dropped 26 percent, but impact on total revenue was partially offset by a $10 million increase in service revenue.

Health Catalyst Raises $70 Million to Fuel Product Development

Data analytics vendor Health Catalyst raises a $70 million Series D investment round on a $500 million valuation, instantly becoming the next rumored health IT IPO.

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March 17, 2015 Headlines 1 Comment

News 3/18/15

March 17, 2015 News 11 Comments

Top News

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Seattle-area Premera Blue Cross discovers that hackers have had access to the demographic, clinical, and claims information of 11 million people going back to May 2014. The FBI is investigating. The organization describes the attack using the mandatory adjective “sophisticated” that hints at a higher level of corporate competence than the incident suggests.  


Reader Comments

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From EMRAMfan: “Re: Radboud University Medical Center. It is the first in the Netherlands and the third in Europe to achieve HIMSS Stage 7.” They use Epic, I believe.

From Questionable Content: “Re: LinkedIn discussion email (aka ‘spam’). Of the 13 article headlines, ONE has a title that isn’t a question. I’m not sure when media coverage of the healthcare industry ceased to be researched articles that took a position and became this regurgitated series of questions with no value added whatsoever, but it’s painful. This is why I read HIStalk.” Titling an article with a question is lazy, especially when the article fails to answer the question it asks (which is almost always). It’s a combination of lazy readers as well as lazy writers – someone must be reading this drivel, which is probably due to social media-shortened attention spans. If an article doesn’t tell me something I truly needed to know, it wasted my time and I’ll hold a grudge. I also avoid opinion pieces written by people whose lack of relevant credentials suggests that they should be reading rather than writing.


HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Surescripts. The company backs up its tagline of “How Healthcare Gets Connected” by connecting 900,000 providers (including 95 percent of pharmacies and 400 hospitals) and 270 million patients. Its network processes 7 billion transactions and a billion electronic prescriptions each year, integrating with 700 EHRs. It’s also one of just 105 US companies with ISO 27001 security, the highest level possible. Surescripts offers automated clinical messaging, CompletEPA EHR-integrated electronic prior authorization, electronic prescribing (including controlled substances), immunization registry reporting, aggregated medication histories from pharmacy and claims data, and a patient portal with secure messaging. Thanks to Surescripts for supporting HIStalk.

I found this Surescripts overview video on YouTube.

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Our HIMSS conference patient scholarship winners have finally lined up their Chicago housing. FormFast has graciously volunteered to donate a hotel room (and a very nice one at that) so that our winner from France won’t have to couch surf as she was planning. Medicity also provided a room as I mentioned earlier. The five ladies are getting a lot of attention from vendors wanting their time and asked my advice, which was this: keep companies at arm’s length during the conference since it’s easy to be swayed and I don’t want them to lose their activist fire. Their job is to be somewhere between inquisitive and politely disruptive in representing the interests of patients. They came up with the #HIStalking hashtag if you want to follow their activities on Twitter.

We’re wrapping up our HIMSS guide, but only a fraction of sponsors have submitted their information (booth number, giveaways, events, etc.) Once it’s done, it’s done, so this is your last chance (until HIMSS16, anyway) to contact Jenn to get listed if your company sponsors HIStalk.


Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 


Acquisitions, Funding, Business, and Stock

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Health Catalyst raises $70 million in an oversubscribed Series D round, increasing its funding total to $170 million and valuing the company at over $500 million. An IPO seems inevitable.

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Diabetes management app vendor Glooko raises $16.5 million in a Series B round.

A federal judge allows a proposed class action lawsuit to proceed against Epocrates for failing to disclose change in its drug company advertising contracts. The lawsuit claims that Epocrates, which was acquired by Athenahealth for $300 million in 2013, tried to boost its doctor alerting business after its IPO by implementing a “use it or lose it” policy that forced drug companies to buy new sponsored alerts in the hopes of propping up sagging revenue.

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Meditech files its 2014 annual report, with full-year revenue down 11 percent and profit down 7 percent. Service revenue increased, but product revenue took a 26 percent dive. Revenue and net income slid back to 2010 levels. Neil Pappalardo owns 42.7 percent of the company, which values his stake at around $700 million.  


Sales

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The US Navy selects Carestream’s PACS for its 1,000-bed USNS Mercy hospital ship.

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Memorial Sloan Kettering Cancer Center (NY) selects Versus RTLS to improve patient flow at its urgent care center, extending its implementation beyond the initial two outpatient clinics.


People

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Recondo Technology hires Alicia Hanson (MedAssets) as SVP of business development, Jamie Oakes (Adreima) as RVP of sales, and Kevin Kenny (Allscripts) as VP of strategic sales/east.

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In-home medical assessment vendor CenseoHealth moves Executive Chairman Kevin McNamara to CEO and names David Brailer (Health Evolution Partners, an investor in the company) as board chair.

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Geisinger Health System’s XG Health performance improvement company names Marcy Stoots, DNP, RN (EHR Transformation Associates) as general manager of EHR apps.

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Indiana HIE promotes John Kansky to president and CEO, a role he has held in an interim capacity since June 2014.


Announcements and Implementations

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Labor and delivery software vendor PeriGen joins the CommonWell Health Alliance.

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CHIME pre-launches a National Patient ID Challenge, offering a $1 million prize for a solution that increases patient ID matching from 80 to 100 percent. It will be interesting to see how CHIME puts together a million dollars (from vendors, I’d have to guess) and who owns the winning solution.


Government and Politics

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A WEDI survey finds that a third of respondents haven’t heard of Blue Button, but the survey methodology is shaky: (a) it drew only 274 responses and the method of recruiting respondents wasn’t specified, which I assume means it was an online, self-selecting survey; and (b) nearly half of the respondents were technology vendors or from “other” categories beyond government and providers, which makes you wonder why they responded at all or why their responses were used (most likely answer: because throwing those responses out would have left a ridiculously small sample). I don’t understand the point of asking non-providers how their PHRs work or whether they’re using Direct. I see other sites writing decisive articles with headlines such as “Blue Button Awareness, Personal Health Record Usage Grows” and  “Blue Button protocol for easy EHR transfers fails to gain traction,” but rest assured neither conflicting conclusion can be drawn from this skimpy and poorly collect data. Let’s hope the federal government doesn’t actually use this report for anything (or pay WEDI for producing it).

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HHS’s Office of Inspector General publishes its annual “Compendium of Unimplemented Recommendations,” listing the top 25 cost and quality items OIG has recommended that HHS has ignored. The two IT-related items are to improve the Transformed Medicaid Statistical Information System and to get ONC and CMS to collaborate on addressing EHR fraud vulnerabilities.

New York’s RHIOs ask for $45 million in the state’s 2015-2016 budget.

An analysis of around 100 health insurance plans offer to New Yorkers via Healthcare.gov finds that nearly none of them offer out-of-network coverage. The report blames the unintended consequences of a 1992 state law that required insurance companies to cover anyone who wanted insurance regardless of their health but didn’t require individuals to buy insurance, sticking insurance companies with the cost of treating a high proportion of chronically ill patients.

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The Senate’s Committee on Health, Education, Labor, and Pensions convened a hearing Tuesday titled “America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care.” AHIMA President Angela Kennedy gave a personal account of how lack of interoperability makes it harder to care for her children. Epic Director of Interoperability Peter DeVault, pictured above, testified that the company charges $2.35 per patient per year to send data to non-Epic systems. He said Epic declined to join CommonWell because it would have cost millions of dollars and the company was asked to sign a non-disclosure agreement, which Epic took as meaning that CommonWell had something to hide (like planning to sell data, he gave as an example) and the “lack of transparency didn’t sit right with us.” Instead, Epic connects to Healtheway’s Carequality connectivity network and urges CommonWell to join it. Cerner issued a statement in response to DeVault’s comments: “Today’s rhetoric is a slap in the face to many parties working to advance interoperability. It was discouraging to hear more potshots and false statements when it’s clear there is real work to be done. We’re committed to CommonWell as a practical, market-led way to achieve meaningful interoperability.”

The House is finalizing a permanent SGR Medicare payment fix at a cost of $200 billion over 10 years, with taxpayers paying $140 billion and high-income seniors paying $60 billion in new Medicare costs.

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CMS releases its physician referral data sets.

A Brookings Institution report says the Meaningful Use program should be refocused on value and outcomes rather than specific technology requirements and that ONC should take a more active role in creating interoperability standards. 


Privacy and Security

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Microsoft will offer enterprise-grade biometric security (fingerprint, eye, or face) in Windows 10. What it won’t offer in Windows 10: Internet Explorer, which will finally be killed off in favor of a newly written and so far unnamed browser shown in the prototype above.


Innovation and Research

In China, a health district and technology company jointly open the country’s first cloud hospital that connects 100 healthcare organizations and 226 “cloud doctors” who see patients in virtual diagnosis rooms and send prescriptions electronically to pharmacies.


Technology

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Banks that were anxious to jump on the Apple Pay electronic payment system are now complaining about fraud rates that are 60 times higher than with traditional credit cards, mostly because Apple made it so simple to sign up for credit that thieves can easily use stolen credit card numbers without being caught. Apple Pay was ironically designed to reduce fraud by making it impossible to steal credit card numbers, but banks receive minimal customer information from Apple that would help them detect fraud and have been too scared of Apple to speak up.

Botswana is delivering broadband and telemedicine services to remote areas via unassigned TV band frequencies.


Other

A study of questionable validity and applicability finds that hospitals with fewer readmissions have more user-voted stars on Facebook, with the authors concluding that social media ratings correlate with traditional hospital quality measures. The many sites that confuse correlation with causation should therefore urge all hospitals to enlist volunteers to rate them highly on Facebook to improve their readmission rates.

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University of Pittsburgh, UPMC, and Carnegie Mellon University form the Pittsburgh Health Data Alliance to perform research and to commercialize products.

Venture capitalist and Uber investor Bill Gurley says he’s passed on over 100 healthcare technology business plans because healthcare is driven by regulation and subsidies rather than market forces. “It’s asinine,” he says, adding that the government used HITECH money to interfere with the market’s low demand for EHRs.

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A study finds that medical residents are underpaid (average salary: $47,000 per year) because they are willing to work for less for a prestigious hospital that has limited openings. Here’s a fun fact I didn’t know that’s timely given that Friday is national medical residency match day: the two men who developed algorithm that matches graduating medical students with residency programs based on their mutual interest won a Nobel Prize in economics for their program, which is also used to match kidney donors and to assign students to public schools. Doctors are also aware that the program underwent a complex modification in the 1990s to try to match married medical students to residency sites that would accept them together.

Coca Cola admits that it paid dietitians and bloggers to write posts recommending Coke as a healthy snack.

Bizarre: a New Jersey doctor charged with selling oxycodone prescriptions for up to $3,000 attempts to hire someone to burn down his office (and the incriminating records in it) in return for an oxycodone prescription.

Weird News Andy critiques a study finding that loneliness shortens life as much as obesity or smoking, with WNA analytically pondering, “What about lonely, drunk, fat smokers?” However, he then retracts his call for further research after reading a scientific study that concludes that we have too many scientific studies.


Sponsor Updates

  • The Indiana Hospital Association endorses Besler Consulting’s Transfer DRG Recovery Service for its members.
  • HealthMEDX CEO Pam Pure will present at this week’s NextGen Health Care Symposium on “Advancing Transitional Care”  in Indianapolis, IN. I couldn’t help but notice as I scrolled down the list of speakers that only three of the 26 are female, so bravo to Pam for being one of them.
  • Caradigm Provisioning earns certification for use with FairWarning’s Ready for Identity Management program.
  • A Forward Health Group video describes its work with Northwestern Medical Center.
  • PerfectServe posts “Real-time healthcare: Preventing the need for immediacy from eroding quality.” 
  • Zynx Health joins the NPSF Patient Safety Coalition.
  • ZeOmega posts “The Five Pillars of Population Health Management: Data Aggregation and Integration.”
  • The Chartis Group publishes “Local, Regional, and Beyond: Clarifying the Role of Academic Medical Centers.“
  • Divurgent and Sensato will host “Hacking Healthcare 2015” March 24-26 in Long Branch, NJ.
  • Culbert Healthcare Solutions will exhibit at AMGA 2015 Annual Conference March 24-26 in Las Vegas.
  • CommVault posts a blog about “Learning from Emailgate” and the challenges of information management.
  • CareSync CEO Travis Bond is interviewed in the Health Data Consortium’s latest blog.
  • Anthelio Healthcare Solutions CEO Asif Ahmad will be featured on Fox Business Network March 22 at 11:30 a.m. ET.
  • Bottomline Technologies will exhibit at Microsoft Convergence 2015 through March 19 in Atlanta.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 17, 2015 News 11 Comments

Morning Headlines 3/16/15

March 15, 2015 Headlines 1 Comment

Cuomo approves delay in electronic prescriptions

New York Governor Andrew Cuomo signs into law a bill that will delay mandatory e-prescribing requirements for doctors in the state, calling the delay a win for patient safety and explaining, “The fact that many software companies are not ready for e-prescribing could have resulted in patients’ inability to fill their prescriptions.”

Missed Connections: A Nurses Survey on Interoperability and Improved Patient Care

West Health publishes a survey of nurses measuring the impact that integrated medical devices would have on patient safety, finding that 90 percent of hospitals report having six or more medical devices that could integrate with an EHR, but that only one-in-three hospitals actually have interfaces in place to exchange data.

HealthKit and Human Subject Research

Apple publishes its standards for developers connecting to its HealthKit API. Storing health data on iCloud and sharing data with third-parties are both banned. Apps are also required to maintain a privacy policy.

Is France’s envied health care system threatened?

In France, doctors are protesting as the country moves from a business model where patient’s pay doctors directly for care, to one that involves insurance companies paying doctors for health services.

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March 15, 2015 Headlines 1 Comment

Monday Morning Update 3/16/15

March 14, 2015 News 5 Comments

Top News

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New York Governor Andrew Cuomo signs legislation delaying the state’s mandatory electronic prescribing law for one year to March 27, 2016, the same bill he giddily approved in 2012. “This is a victory for patient safety,” said plastic surgeon Andrew Kleinman, MD, president of the state’s medical society. Assembleyman and pharmacist Roy McDonald says 98 percent of the state’s pharmacies were ready to receive all prescriptions electronically, but the Drug Enforcement Administration and EHR vendors waited until too late to begin their preparations.


Reader Comments

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From Jeff Steiner: “Re: Memorial Hospital at Gulfport.  I wanted to respond to a story posted about our hospital’s bond rating change ‘due to a Cerner EHR conversion that inflated accounts receivable and jumped AR.’ Memorial Hospital is in the midst of exciting work and tremendous growth. We are undergoing a $65M expansion project spread over the next two fiscal years (with no planned debt). We are living with revenue pressures from Medicare and Medicaid due to changes in their reimbursement methodology. We’re a busy organization and are facing plenty of market pressures and dynamics like so many of our peers. We wanted to add clarity to the ‘100 days in A/R’ comment. This includes a mix of prior non-Cerner systems and Cerner. This snapshot was a 90 day post live look where MHG was on Cerner’s solutions at our fiscal year end.  We look forward to our partnership with Cerner and a very productive relationship.” Jeff is CFO of the hospital.

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From Castro’s Cousin: “Re: Banner Health. A high-placed source says it will replace Epic with Cerner at recently acquired University of Arizona medical center and clinics. Official announcement won’t drop until summer.” Unverified, but expected.


HIStalk Announcements and Requests

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Sixty percent of poll respondents say they don’t feel welcome and appreciated when interacting with their preferred hospital. Donald says the service he gets is good because it’s a rural area, while OutsourcedMom says she feels too welcome, as in “like a spider’s web of financial ruin.” New poll to your right or here: will ICD-10 be delayed again by Congressional action? I get nervous when I see Congress talking about an SGR fix since that is where an unknown politician slipped in the last delay. It doesn’t matter what the experts think should happen – none of the lobbyists who whisper in Congressional ears have a vested interest in wanting the rollout of ICD-10.

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Here’s a generous offer from HIStalkapalooza Gold Sponsor Divurgent. Divurgent gets a bunch of tickets in return for their sponsorship, but graciously offered to donate all but a handful of them them to HIStalk readers who might otherwise be unable to attend if we sell out. I will execute their largesse as follows: if you haven’t already signed up to attend, do it here. I’ll guarantee that the first 50 folks to sign up will get an invitation courtesy of Divurgent, with just one exception: I’m not going to give a bunch of invitations to people from the same company just because a secretary was ordered to sign everybody up. You might think, “Nobody would do that,” but at least two companies signed up 30+ people each to attend, which seems ridiculous since the point is to get a lot of readers there, not to have me (and the event sponsors) pay for someone’s company party. Thanks to Divurgent, who clearly is sponsoring the event to support HIStalk rather than for their own benefit.

I have a few spots left for CMIOs (or physicians working in a CMIO-type role) interested in attending a lunch with peers Tuesday of HIMSS week. It’s near the exhibit hall, so the time commitment is minimal unless you just want to hang out. The signup form is here. Thanks to the company that offered to sponsor the lunch even though I turned them down – it was a nice gesture, but I’d rather spend $500 out of my own pocket than to give the impression that I’ll do anything as long as some company pays – I get those offers pretty often and I usually decline.


Last Week’s Most Interesting News

  • Apple releases its smartwatch and ResearchKit.
  • Stanford University says 11,000 people signed up for one of its research studies within the first 24 hours of the release of Apple ResearchKit.
  • Epic’s Judy Faulkner tells a reporter that she will sign over all of her Epic shares to her private charitable foundation when she dies or decides to turn over control, with her intention being to guarantee that the company will never be taken public.
  • Two big academic medical centers in the Netherlands stop their implementation of the former Siemens Soarian, expressing concern about how Cerner might handle the product with its Siemens acquisition.
  • Oregon finally shuts down its health insurance exchange, which due to technical problems never enrolled a single customer despite its $284 million cost.
  • FDA issues draft guidance on using electronic informed consent in clinical studies.

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 


Acquisitions, Funding, Business, and Stock

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The Indianapolis business paper profiles Hc1, which just raised another $14.4 million from angel investors, increasing its total to $28 million. The 100-employee company’s revenue doubled each of the past three years and is expected to triple to $35 million in 2016. The company’s Healthcare Relationship Cloud offers collaboration, CRM, and analytics. I don’t see any healthcare experience on the executive team other than the chief medical officer – most of the folks came over from the founder’s previous company, ChaCha, which offers human-guided, text-message based search using freelancers (seemingly unsuccessfully – it looks like not much is happening there and the company has scaled back over the years). Despite a lack of healthcare background, CEO Brad Bostic seems to get it: “When I order a book on Amazon.com, they treat it like a life-or-death situation if they deliver it to me. But if I go to a healthcare situation, where it actually is life or death, I get treated like a number. This is a really big deal. It’s a big game-changer about, how do you treat patients like individuals?”

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Eko Devices receives $2 million in new funding and will begin clinical trials at UCSF of its Eko Core digital extension for analog stethoscopes.

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The business paper in North Carolina’s Triangle area profiles seven-employee Polyglot Systems, which raised $1.4 million in equity financing as part of its deal with First Databank to distribute the company’s medication instructions. The proceeds will be used to integrate Polyglot’s product with EHRs.


People

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NYU Langone Medical Center names Paul Testa, MD, MPH as CMIO, a position he had held as interim since September 2014.

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CTG hires Cliff Bluestein, MD, MBA (Dell Services) as president and CEO.


Announcements and Implementations

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Divurgent and Sensato produce a white paper titled “Cyber-Security in Healthcare: Understanding the New World Threats.” It contains an interesting quote from a hospital CIO: “The reason no one bought your service was that, frankly, if we found out about security holes, then we would have to fix them. It is easier to react after the fact than to convince everyone we need to do something before it happens.”


Privacy and Security

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Apple publishes its app store guidelines for HealthKit for human subject research. Apps will be rejected if they store a user’s information in iCloud, fail to include a privacy policy, or provide diagnosis or treatment advice. The app developer must also agree not to use data for advertising or to share it with third parties.

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Healthcare IT attorney Nicholas Terry says the White House’s draft wording of the “Consumer Privacy Bill of Rights Act” may have HIPAA implications since it no longer specifically excludes HIPAA covered entities, meaning that health systems could become responsible not just for keeping the information they collect private, but for collecting it responsibly. Terry adds that the FTC’s “data minimization” concept may clash with ONC’s interoperability efforts and could limit selling data to third-party brokers. The proposed policy would be enforced by FTC and the attorneys general of individual states. The bill would also preempt the laws of states that may already have stronger privacy laws on the books given that it doesn’t specifically prohibit selling consumer information to data brokers without their permission.


Other

Philly.com’s story on unemployment in the Malvern, PA area originally contained wording suggesting that Cerner is laying people off after its acquisition of Siemens Health Solutions, but for some reason that section of the story was removed and no Cerner reference remains.

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A West Health Institute poll of nurses about medical device interoperability concludes (via the mandatory cute infographic) that almost all nurses say they would spend more time with patients if freed up from dealing with medical devices and think those devices should share data with EHRs automatically, while half of the nurses say they’ve seen a medical error due to lack of device coordination. Nurses, not surprisingly, think their own uninterrupted time is the most important factor in improving patient safety and most of them think that manually documenting device information creates errors and delays. West Health calls for ONC to add medical device information sharing to its interoperability roadmap, for FDA and HHS to recognize open standards for medical device communication and to provide guidance to manufacturers, and for Congress to provide “adequate incentives” for developing and using interoperable medical devices.

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Stanford physician and author Abraham Verghese says in his keynote to the American College of Cardiology that doctors should rediscover the humanity of practicing medicine and the non-technical benefits of the medical encounter ritual, saying that EHRs have obliterated the stories of patients as the typical ED physician spends nearly half of their time working on a computer. He explains, “EMR has nothing to do with your heart or your patient’s heart.”

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The local paper covers the financial woes of Southeast Health in Cape Girardeau, MO. Billing problems caused by the hospital’s Siemens Soarian implementation as well as that system’s $15 million per year operating cost earned it a bond ratings downgrade in 2013. New CIO Mike Nichols is planning to take advantage of the Siemens acquisition to move to Cerner Millennium. The health system spells their name “SoutheastHEALTH” in the apparently misguided belief that marketing by misspelling is the secret to organizational success. You have to squelch the creatively bankrupt marketing people when they babble nonsense like the words they put in the former CEO’s mouth for the hospital’s annual report: “This is not simply an evolution in name alone. We are a far-reaching network of providers and facilities uniting to provide a regional system of healthcare services.” Sounds good except they’re going broke as they lay people off, with the board chair explaining, “Back here, in the old model, we got paid for doing things. In the future, that’s not how a hospital will be paid. Unfortunately, we are sitting in a spot in the middle, because that model hasn’t been explained to us yet.” 

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Doctors in France protest health reform, unhappy that under proposed changes they’ll be paid by insurance companies instead of having patients hand over cash directly. They say insurance companies will control both doctors and patients and doctors don’t have the clerical staff to manage the reimbursement paper trails. Patients now pay $25 in cash for a visit and are reimbursed by either the social security system or the patient’s insurance company. A doctor who is leading the protest warns that France’s healthcare system, which he says is the best in the world, will “end up like in the UK” where patients who don’t pay upfront don’t mind wasting the doctor’s time “for any old reason.” He adds, “If we change the system, it will be whichever insurance company pays me, who is responsible. The Social Security service will say to me, Mr. Henry, you are prescribing too many antibiotics. You are prescribing too many pills and sending people for too many tests. They will tell me I have to prescribe less. I will no longer be free to ask the question, what is the best thing for the patient’s health? I will no be longer be independent.”


Sponsor Updates

  • Medicity publishes “The Challenges and Benefits of Interoperability.”
  • Xerox Healthcare publishes “Survey Says: Your Patient is Unhappy.”
  • Voalte asks that “Nurse Leaders, Please Step Up!”
  • PMD covers “The ‘Choreographed’ Care Model.”
  • Oneview Healthcare highlights the ways in which a “New Study Establishes that Activated Patients Cost 31% Less.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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March 14, 2015 News 5 Comments

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Reader Comments

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