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News 5/21/14

May 20, 2014 News 2 Comments

Top News

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CMS and ONC publish a proposed rule that would slow down the Meaningful Use program by extending Stage 2 through 2016 (starting Stage 3 in 2017) and allowing providers to attest for FY2014 using a 2011-certified EHR. National Coordinator Karen DeSalvo, MD seemed to express concern that EHR vendors would not have their products certified under the 2014 criteria in time, referring to users would would miss the dates “through no fault of their own,” while the bill referred to “availability and timing of product installation, deployment of new processes and workflows, and employee training.” Public comment on the proposed bill will be open for 60 days. The proposed change follows CMS’s acknowledgment that almost no providers have attested for Stage 2 so far. CMS had also previously defined a easily claimed, one-year hardship exception for providers unable to meet Meaningful Use dates.


Reader Comments

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From Hogan: “Re: Centura. Their selection of Epic hurts Meditech since they are a large percentage of Meditech’s Stage 7 hospitals. In England, InterSystems was named vendor of choice against Epic and Meditech in a three-trust procurement called SmartCare. Epic won the clinical vote, but lost on price. It’s interesting that outside the US, Epic and InterSystems compete.”

From Topaz: “Re: health equipment innovators. I live in the Netherlands and a colleague is looking for help for his 16-year-old daughter Doreen, who is paralyzed. It is hard to get equipment in Dutch healthcare. Are companies in America looking for people to test their developments?” I created an online contact form for anyone who wants to get in touch.

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From Arborio MD: “Re: Health Datapalooza. I am so happy that Mr. H decided to go this year so we can all enjoy vicariously the platitudes from Vinod Khosla, who believes that 80 percent of doctors can be replaced by technology, and 20-cups-a-day coffee drinkers who in their garages and basements hope to disrupt healthcare and become millionaires overnight in the process. The sad part is that even respectable HIT leaders like Ed Park recognize the big schism between the promise of Big Data in healthcare and the reality. Last year athenahealth sent 40 people, while AMA – whose president, Dr. Ardis Dee Hoven, has not even heard of this conference — sent only one. I wonder how many docs toiling down in the trenches are even aware that a bunch of geeks are about to eat their lunch?”


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Healthcare Data Solutions. The healthcare-only Irvine, CA-based company offers databases of providers (physicians, dentists, PAs, NPs, pharmacies, hospitals, and EHR users); email lists and services;  and real-time physician verification for open payments, state license verification, and DEA/NPI validation. Customer testimonials on the company’s site vouch for its “great pricing,” “most dependable data,” and “data models [that] are a perfect fit.” EHR vendors use the company’s physician database for marketing and to determine if the provider has implemented an EHR. The company offers white papers, webinars, and database layouts on its site. Clients include MD Anderson, UC Irvine Health, Cedars-Sinai, NextGen,, and Philips. Thanks to Healthcare Data Solutions for supporting HIStalk.


Acquisitions, Funding, Business, and Stock


”Grey’s Anatomy” actor Patrick Dempsey invests an unspecified amount in startup CrowdMed, which crowdsources diagnoses using volunteer clinicians called “Medical Detectives.” PR from someone who used to play a doctor on TV may not be all that appealing to the real experts whose free labor fuels the business model.

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Cleveland Clinic forms a joint venture with telemedicine kiosk vendor HealthSpot and will integrate its product with the clinic’s Epic system.  


Sales

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Vanderbilt University Medical Center chooses Allscripts EPSi for financial planning.

American Samoa Medical Center will implement Medsphere’s OpenVista EHR.

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Atlantic Health System (NJ) selects TeraMedica’s Evercore Clinical Enterprise Suite for vendor-neutral archive storage of both DICOM and non-DICOM data.

Delaware Health Information Network will implement Halfpenny Technologies’ intelligent integration technology hub.

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Advocate Health Care chooses identity and access management systems from Courion.

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Avita Health System (OH) will implement NextGen Healthcare’s EHR, practice management, patient portal, population health EHR Connect, and ED solutions at its two hospitals.


People

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Karen Chapman (Northrop Grumman) joins Medicomp Systems as senior product manager.

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Phoenix Health Systems names Jim Griffith (Siemens Medical Solutions Health Services Division) as EVP/COO.

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Vocera announces that CFO William Zerella will resign on June 6 to become CFO of an unnamed pre-IPO consumer wearables company. Vocera also announced that Bob Zollars has transitioned from executive chairman to chairman of the board.  

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Terry Cameron (Emdeon) joins Recondo Technology as president and COO.


Announcements and Implementations

Beacon Partners will implement and offer advisory services to providers deploying Caradigm’s Risk Management and Care Management population health management products.

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Philips releases eCareManager 4.0 that includes acute care, part of its Hospital to Home telehealth program.

MyMedicalRecords adds three more patents to sue EHR vendors over: EHRs in clinical trials, online sharing of medical records, and legal records including power of attorney and wills. As you might expect, the announcement promises litigation rather than innovation: “MMR’s goal is to leverage its products and services and patents and other intellectual property to create working relationships with more companies in the biotechnology field so that patients and shareholders ultimately benefit.”

Pharmacy systems vendor PioneerRX will replace its existing drug database with Elsevier’s Gold Standard Drug Database.

Greater Regional Medical Center (IA) goes live on PeriGen’s PeriCALM.


Government and Politics

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The VA opens an investigation of the Gainesville, FL VA hospital after discovering that employees were keeping follow-up appointment schedules on paper instead of on the electronic system that made results visible to VA management.

House Oversight Chairman Rep. Darrell Issa (R-CA) chews out the CMS official in charge of fraud prevention for falling several months behind on delivering a report that will document the effectiveness of CMS’s fraud prevention software.


Other

The CEO of Massena Memorial Hospital (NY) blames Meditech’s LSS software, which he says “created some kind of strange numbers off the report,” for incorrect financial reports. He adds, “We’ve been experiencing over the last couple of months some significant issues with our LSS software system that was recently installed in a number of our physician offices.” 

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The AMA’s American Medical News shuts down after 55 years due to a 67 percent drop in annual revenue caused by declining circulation and ad revenue. The publication transitioned poorly to an online format and was hit hard by declining drug company advertising.

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In Australia, a review panel suggests that the personally controlled health record (PCEHR) be renamed to My Health Record, that participation be changed from opt-in to opt-out to increase enrollment from the current single-digit percentages, that physician usability be improved, and that doctors be paid incentives tied to meaningful use metrics and their contribution of patient data to the common record. The panel also recommends that the National eHealth Transition Authority be dissolved and its oversight role transferred to a group called Australian Commission for Electronic Health that would include clinicians and software vendors.

The City of New York temporarily halts its 911 communications project, which was supposed to take five years and cost $1.3 billion, now at the 10-year mark with estimated costs at over $2 billion.

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A Commonwealth Fund survey finds that EHR adoption by federally qualified centers more than doubled from 2009 to 2013, with 93 percent of them running an EHR and 75 percent meeting MU requirements. Most of them do CPOE, clinical documentation, and lab results, but only about half say their providers have access to clinical decision support beyond canned drug warnings. The FQHCs say their biggest EHR-related problems are undertrained staff and loss of productivity.

A former nurse at Houston Methodist Hospital (TX) files suit against the hospital and hopes to turn it into a class action, claiming that the hospital’s time tracking system deducts 30 minutes for lunch even when the employee’s duties preclude stepping away.

In England, the CEO of a hospital is criticized for describing hospital patient care errors in her tweets. She has only 200 followers and uses her account mostly to praise employees and promote hospital events, but had some such as, “Signed patient letter enclosing incident investigation report following medication error openness+learning essential feedback= improvement.”

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A care coordination “virtual health village” and single, real-time electronic health record for students of two Pennsylvania school districts has enrolled only 4,000 of 32,000 students, a quarter of the expected number. Health officials planned to make enrollment opt-out until attorneys from the school districts told them that HIPAA requires opt-in, meaning students have to request access. The schools used $850,000 in grant money to hire an outside vendor to create the exchange and connect it to the EHRs of local hospitals.

Weird News Andy calls this story “Wide-Eyed Wonder.” Texas doctors are working on an app that detects “white eye,” the opposite of the red-eye reflection effect that is normal when someone takes a flash picture. A white reflection is abnormal and indicate the possible presence of several eye problems, including a rare eye tumor.


Sponsor Updates

  • InstaMed releases its “2013 Trends in Healthcare Payments Annual Report” as a video.
  • CompuGroup Medical’s three EHRs earn ONC 2014 certification as Complete Ambulatory EHRs.
  • McKesson Total Payment achieves a CMMI Level 3 appraisal rating.
  • Arcadia Healthcare Solutions offers a white paper on pay-for-performance strategies.
  • Extension Healthcare is participating in an elite platinum sponsor two-year initiative of the National Coalition for Alarm Management Safety.
  • MissionPoint Health Partners (TN) and Hospital Corporation of America’s South Atlantic Division (SC/GA/FL) are awarded the 2014 Crimson Physician Partnership Award during The Advisory Board Company’s national Crimson summit in Orlando.
  • EBSCO Health’s Patient Education Reference receives certification as an EHR Module for inpatient and ambulatory settings.
  • Ingenious Med is named a Pacesetter by The Atlanta Business Chronicle.
  • Sagacious Consultants launches Sagacious Go-Live Success for hospitals and clinics at the go-live juncture with Epic.
  • Covisint launches its Certified Service Partner Program.
  • NantHealth SVP and iSirona founder Dave Dyell is named a finalist for Ernst & Young Entrepreneur of the Year award.
  • RazorInsights will incorporate TruCode’s Encoder Essentials into its ONE Enterprise HIS solution offering an integrated encoding solution with its HIS.
  • Walnut Hill Medical Center (TX) opens its doors with 75 Voalte smartphones following its iHospital initiative.
  • Valence Health launches Valence Partner Network to offer complementary solutions to its client base.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.
Contact us online.

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May 20, 2014 News 2 Comments

Monday Morning Update 5/19/14

May 17, 2014 News 15 Comments

Top News

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Robert Petzel, the VA’s undersecretary of health, resigns over allegations of falsified electronic wait time records at  the Phoenix VA hospital. The only benefit is political since Petzel had previously announced plans to retire this year. Arguably the VA and Kaiser have led the healthcare industry in innovation, quality management, and use of technology even though the VA is, like all federal agencies, a politically motivated money pit. The VA’s problem is the tsunami of returning veterans who were sent off in huge numbers to fight pointless political wars that left many of them physically and psychologically damaged, leaving the VA to pick up the healthcare pieces with minimal increases in funding. It would be interesting to see the VA’s volume and quality metrics over the past 10 years. The VA is the ultimate ACO provider that might be able to provide warnings about the hazards ahead to the ready-fire-aim pioneers charging down the path of managing populations even though their outcomes and cost effectiveness in managing individual encounters have been unimpressive.


Reader Comments

From Beth: “Re: IT productivity. I’m looking for better ways to measure and compare with other facilities. Do people use closed help desk tickets, number of network nodes, number of user accounts, adjusted patient days, or some other formula?” Leave a comment if you can help Beth. It’s always tough to benchmark IT as an entire department since hospitals configure it differently – outsource parts of it, include biomedical engineering or not, have field support in individual hospitals in the system that aren’t assigned to corporate IT, use external consultants for application support or training, etc. I’m always skeptical of benchmarking since it’s hard to find a two hospital IT shops that are mostly alike, not to mention that once metrics have been identified, everybody’s goal shifts to gaming them rather than actually improving service (see: VA patient scheduling.) It’s like school testing: the metrics are supposed to be a by-product of excellence, not the sole focus of the program where teachers teach run entire classes on how to pass standardized tests rather than comprehend reading and math. Maybe that’s a case for metric opacity vs. transparency – let an independent organization define and report the metrics as broad themes without telling anyone, including management, how they are measured. That keeps your help desk people from begging users on Friday to let them closed unresolved tickets so that Monday’s numbers don’t get them in trouble.

From The PACS Designer: “Re: Apple and biosensing. They have a patent for a pedometer that could be a biosensing device as well for an iWatch. Apple has hired biomedical engineers from Vital Connect, Masimo Corp., Sano Intelligence, and O2 MedTech.” The timing is good since the fitness tracking device craze is in full retreat, making it ripe to become just another part of your smartphone rather than a dedicated piece of hardware, much like portable music players. Few people want to pay $100 for a not terribly intelligent pedometer that needs to be recharged separately.


HIStalk Announcements and Requests

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The recent buzz about athenahealth’s prospects and share price was negative to one-third of respondents. New poll to your right: should ONC require certified EHRs to offer open APIs? You can elaborate further after voting by adding comments to the poll.

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Welcome to new HIStalk Platinum Sponsor Glytec. The Greenville, SC-based company is admirably focused on one big hospital problem: improving insulin management and glycemic control. Around 40 percent of inpatients experience hyperglycemia or hypoglycemia during their stay, which requires lot of clinician time and contributes to infection, length of stay, and mortality. Glytec’s Glucommander Suite is the only FDA-cleared glycemic management and surveillance system. It delivers physician-directed computer algorithms to both adult and pediatric patients and those on either IV or SC insulin. It offers one-click access to the patient’s chart in the EMR. GlucoSurveillance flags patients in real time who may require glycemic therapy, while GlucoMetrics Analytics monitors the success inpatient glycemic control initiatives. According to the VP of medical affairs of Sentara Healthcare, “If you aren’t using Glytec, you aren’t using the standard of care,” while University of Virginia’s consult team reported a length of stay reduction of over one full day in the first six months of using Glucommander. Thanks to Glytec for supporting HIStalk.

I found this just-published YouTube video by Sentara Healthcare describing  in a remarkably frank manner the problems it was having with glycemic control and how it uses Glytec’s eGlycemic Management system. It isn’t the usually glossy overview – the physicians in the video get into specific details, such as how they made EMR changes to drive some improvements but then “hit a wall.”

Listening: new Tori Amos.


Announcements and Implementations

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Health Datapalooza announces the speaker lineup for its June 1-3 conference in Washington, DC: US CTO Todd Park, HHS Secretary Kathleen Sebelius, AHIP CEO Karen Ignagni, author and surgeon Atul Gawande, athenahealth CEO Jonathan Bush, UK Secretary of State for Health Jeremy Hunt, and Time author Steven Brill, among others. I’ll be there, so you’ll read more about it on HIStalk. I don’t attend many conferences and in fact I don’t even hear about most of them (the appetite for HIT-related conferences is apparently ferocious given the number of people who seem to make a career of tweeting from them), so if there’s one you recommend that’s worth the time and money to attend, let me know.

Massachusetts Health Data Consortium elects four new board members: Frank Barresi (VP/CIO, Fallon Health); Julie Berry (CIO, Steward Health Care System); Joseph Frassica, MD (VP and chief informatics / chief technology officer, Philips Healthcare); and James Noga (VP/CIO, Partners HealthCare.)

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IBM announces that Modernizing Medicine is one of three partner companies that will release “Made with Watson” apps this year. The company offers specialty EMRs and is developing an iPad app that will guide physicians through a patient encounter to provide evidence-based medicine suggestions.


Other

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Constantine Davides of AlphaOne Capital Partners LLC has updated his HIT Family Tree that shows pretty much every company’s acquisition history over the years. It is fascinating, useful, and sometimes a bit scary when you see the number of acquired pieces and parts that make up a vendor’s “integrated” systems.

Apple and Google drop their smartphone lawsuits against each other and agree to work together on patent reform.

The Chicago business paper describes interesting hospital-doctor conflicts at 313-bed Swedish Covenant Hospital (IL) following the hospital’s firing of its chief of medicine after he and other of his independent practitioner colleagues joined a rival hospital’s accountable care organization. The issues: (a) new payment models make it difficult for doctors who practice at multiple hospitals to choose their loyalties; (b) independent doctors say they are forced to take ED call, but most of the patients they see there are sent to the hospital’s employed physicians; (c) the hospital is demanding that independent practices adopt EHRs that integrate with their systems, leading to concerns that the hospital will use the information in them to tell them how to practice medicine (which of course they will since that’s the whole point of analytics-powered population health management, which like most powerful forces can be used for both good and evil.)

The former president of the Philippines, now a representative, proposes creating an Electronic Medical Record Center (an HIE-like central records strorage center) under the Department of Health, with initial funding of $230,000 USD.

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Long Island Jewish Medical Center (NY) installs video cameras in all of its 24 operating rooms as a remote video auditing (RVA) system. Staff will check the cameras every two minutes to make sure the surgical teams take the mandatory pre-procedure timeouts and patient safety measures. The cameras will also be used to alert housekeeping of completed procedures so they can clean the room and as a video record that room disinfection was performed properly. The video can be monitored live throughout the OR and on smartphones. The system was provided by the hospital’s anesthesia contractor and Arrowsight, Inc., whose video system the hospital installed in 2011 to improve hand hygiene rates to nearly 90 percent (I’m picturing in-room loudspeakers from which emanate the stern voices of invisible handwashing video overlords who tell doctors to step away from the door and toward the sink.)

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Centura Health (CO) will replace Meditech with Epic, a good source tells me.

Police say they may make more arrests in the identify theft case at Albany Medical Center (NY), in which a nurse and her boyfriend have been arrested for using the Social Security numbers of over 100 patients to apply for credit cards, write bad checks, and file fraudulent tax returns.

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New tax returns filed by UPMC disclose that CEO Jeffrey Romoff was paid $6.6 million in 2012, with 30 other health system executives and physicians exceeding $1 million each in compensation. SVP/CIO Dan Drawbaugh makes the list with $1.6 million in 2012 income, a big drop from the $2.3 million he took home the previous year. UPMC is famously embroiled in a lawsuit with the City of Pittsburgh in claiming that it is a humble non-profit that should not contribute to the city’s budget by paying taxes.

Here is Regina Holliday’s keynote speech from the We Can Do Better conference from a couple of weeks ago.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.
Contact us online.

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May 17, 2014 News 15 Comments

News 5/16/14

May 15, 2014 News 2 Comments

Top News

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Medfusion files suit against Allscripts, claiming the company didn’t live up to its agreement to resell Medfusion’s patient portal to EHR customers of Allscripts. Medfusion says Allscripts owes it $5 million, with damages potentially tripling the lawsuit’s value. The lawsuit claims:

  • The companies signed a five-year agreement valid through July 17, 2014.
  • Allscripts delayed implementation and billing of the Medfusion portal for more than a year for some customers, creating an unpaid backlog for Medfusion and causing the companies to amend the agreement to require Allscripts to start billing new customers within 30 days. Medfusion says that backlog cost it more than $10 million.
  • Because Meaningful Use requirements were expected to boost demand for patient portals, Allscripts agreed to include the Medfusion portal in every new Enterprise and Pro deal it signed and market the product as its only portal solution.
  • Allscripts refused to integrate Medfusion’s online forms capability.
  • The companies amended their agreement to give Allscripts 55 percent of net revenue and recurring charges while Medfusion would get 45 percent.
  • Allscripts acquired Jardogs early in 2013 and announced it without warning at HIMSS13, where Medfusion was co-marketing its portal with Allscripts.
  • Allscripts started marketing the Jardogs product as its preferred solution (FollowMyHealth) before its contract with Medfusion ran out and also started converting customers waiting to have Medfusion’s portal implemented to the FollowMyHealth product.
  • Allscripts created marketing material that compared the FollowMyHealth product to Medfusion’s with the conclusion that its own product was better.
  • Allscripts stopped developing its end of any portal enhancements and blamed Medfusion when clients reported issues.
  • Medfusion accused Allscripts of breach on April 14, 2014, saying it had not paid $5.5 million worth of outstanding invoices. Allscripts, it says, sent payment of just under $1 million in response and disputed the remainder.
  • Medfusion says customers told it that Allscripts made misleading statements in trying to get them to sign three-year contracts with Allscripts, including that: (a) Allscripts had terminated the agreement due to Medfusion problems; (b) Medfusion was going out of business; (c) Medfusion wasn’t providing portal updates and the customer would have to implement the Allscripts product to qualify for Meaningful Use; and (g) customers would be invoiced for May even though Medfusion wasn’t invoicing Allscripts that month because of their dispute.

Reader Comments

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From Hobie Cat: “Re: Google Glass. Being handed out to all medical students at UC Irvine. The link made the rounds this morning with the subject, ‘Does this have HIPAA violation written all over it?’ Perhaps someone from UC Irvine can chime in with thoughts on how they’re approaching HIPAA. I’ll also be curious about how patients respond to this technology during rounds and the perception of a student talking to themselves and head nodding toward the ceiling to wake up Glass while in the room with the patient… ‘Just turning on the Glass, yo!’” The medical school says students in their first two years will use Glass during anatomy and clinical skills courses, while those in their third and fourth years will wear it during their hospital rotations, especially in the ED and OR. Google stores the information saved by off-the-shelf Glass, so in the absence of a business associate agreement with Google (which they probably won’t sign since it’s a consumer device) and because Glass doesn’t encrypt, I would say its use in patient care settings is a HIPAA problem. However, the UCI announcement says they are using proprietary software that is HIPAA compliant, probably the Pristine system they were piloting earlier this year, so they are trusting their vendor.

From TooMuchCoffee: “Re: UK’s Royal Devon. Going to Epic, although ‘affordability is a huge issue.’ At least they’ll get something that works – NHS spent billions on a failed decade-long project involving GE Healthcare and other vendors that produced nothing.” Royal Devon and Exeter NHS Trust chooses Epic as vendor of choice. It will now undertake a 12-week study to see if it can afford it.

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From Fighting Accountants: “Re: Northwestern telestroke team. Congratulations for winning the Innovation Award at their annual nursing fair. They save lives and improve outcomes where it wouldn’t otherwise be possible. Not all health IT is as painful as an EMR.”

From Joey Junior: “Re: Mayo. Heard any rumors about the Cerner-Epic faceoff?” I haven’t. I will defer to readers.

From Concerned: “Re: voice mail messages. I need HIStalk reader insight. A large academic hospital organization would like to store their voice mail messages on Exchange Server. I don’t feel that this is ideal, but does it actually violate HIPAA?” I’m sure an expert will weigh in, but my interpretation is that voice mails left by patients (which I assume is the content you are referring to) are not covered by HIPAA since they didn’t start out in electronic form, the provider didn’t listen to them initially, and nobody suggested the patient leave PHI-containing voice mails. Providers leaving messages for each other might be problematic, though, but the server is still inside the firewall and the messages can’t be forwarded outside or accessed without security credentials. I haven’t convinced myself, so let’s hear some other viewpoints.


HIStalk Announcements and Requests

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Several of the reader-submitted items you see here came from the all-purpose contact form, which accepts comments and attachments and whisks them straight to my inbox, where they may age gracefully until I get to them.

Highlights from HIStalk Practice this week include: Xerox fares poorly when it comes to state Medicaid management systems. GA-HITREC’s Dominic Mack, MD weighs in on the HIMSS 2014 Regional Extension Survey results. Physicians have differing opinions about the business model of CrowdMed, which is looking to turn a profit via crowdsourced medical advice. ONC approves ANSI for a second term as an approved creditor for its HIT certification program. Athenahealth finds itself in the same quagmire as Facebook and Tesla. "Anonymous" sends letters to 30 patients alerting them to the ease of stealing their medical information. A solo-practice physician becomes the first in New Jersey to attest for MU Stage 2, thanks to help from NJ-HITEC. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the state of patient engagement and questions whether the Patient Engagement Framework, developed by the National eHealth Collaborative and HIMSS, is an ideal tool for benchmarking progress. Researchers at Johns Hopkins develop a smartphone-based carbon monoxide breathalyzer that they hope will provide smoking cessation programs the tools to objectively measure smoking abstinence more easily. Cedars-Sinai Health System announces that it has formed a partnership with MemorialCare Health System to create a shared health technology VC fund called Summation Health Ventures

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Ms. Barnes sent this photo from her Mississippi kindergarten classroom, for which we as HIStalk readers provided write-and-wipe boards and markers (you can see them in front of the students) in response to her DonorsChoose grant request. She reports that the class is using them for practicing their writing and they wouldn’t have them otherwise because of district budget cuts.


Acquisitions, Funding, Business, and Stock 

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Oscar, a technology-powered startup that sells medical insurance only to New York residents so far, raises another $80 million in funding, bringing its valuation to nearly $1 billion.


Sales

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The VA chooses Agilex and Calgary Scientific for enterprise viewing of radiology images on a variety of devices.


People

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Applied Health Analytics hires Craig Smith (The Advisory Board Company) as president of its Coalesce consulting division.

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Lee Fowinkle (McKesson) joins InformedDNA as CTO.


Announcements and Implementations

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Mercy Hospital (MO) breaks ground on its four-story, 120,000 square foot, $50 million virtual care center that will house its 300 telemedicine program employees for remote management of ICU, stroke, cardiology, sepsis, radiology, pathology, nurse on call, and home monitoring.

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Health Care Cost Institute, a non-profit funded by UnitedHealth Group, will in Q1 2015 make available to the public medical claims data from private insurers, the first non-government healthcare pricing data to be released. Aetna, Humana, and Kaiser Permanente have signed on.


Government and Politics

HHS’s Medicare Fraud Strike Force charges 90 people, including 27 clinicians, for fraudulently billing Medicare for $260 million. The defendants were charged with a variety of activities that include paying pharmacy kickbacks, billing for undelivered products and services, charging the government for 1,000 unneeded power wheelchairs, and laundering money using Medicare beneficiary information. HHS also announced that it has indicted the Brooklyn surgeon who billed Medicare for $85 million worth of surgeries that he didn’t actually perform.

ONC chooses ANSI for a second three-year term as the accreditor of its certification bodies.


Innovation and Research

A study of primarily Iowa VA hospital ICUs finds that telemedicine didn’t reduce 30-day mortality rates or length of stay.


Other

A free, eight-week online course, “Exploration of SNOMED CT Basics,” runs through June 13 if you have time to double up on the video lectures to finish in time.

The Chicago-area nurses union National Nurses United launches a heavy-handed campaign against “experimental, unproven medical technology” (specifically, EHRs.) Much of it rings true, unfortunately, even the dot matrix printer.

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Roshni Nadar Malhotra, the only child of a technology billionaire from India, will spend $168 million to build a network of Johns Hopkins-affiliated health clinics starting in New Delhi. She says IT will be a key component.

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The Pittsburgh business paper reviews the federal tax forms of West Penn Allegheny Health System, noting that Allscripts was its second-highest paid contractor at $7.3 million.

Employees of a company that won a $1.2 billion HHS contract to process paper insurance applications from health insurance exchanges are staring at computer screens with nothing to do, a whistleblower claims. The whistleblower says the employees have been told to refresh their screens every 10 minutes to give the appearance that they are accomplishing something. Serco, the British contractor that won the big contract, is under investigation in England for overbilling the government. I wrote about the company in October 2013, including the patient harm it caused when it took over the largest pathology labs in England’s NHS in 2009.

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An editorial by Newt Gingrich on the VA’s problems says the VA and DoD need to integrate their IT systems (which is much more of a DoD problem than a VA problem):

Every effort to integrate Department of Defense and VA medical record systems has failed. The result has been an absurd process of transitioning from active duty health services to VA health services. At a time when you can instantly make airline and hotel reservations or get money from an ATM worldwide in seconds, it takes 175 days to transition a veteran’s care from the Defense Department to the Department of Veterans Affairs. The DoD and VA spent $1.3 billion to build a joint electronic medical record system for their health care services before the two secretaries announced in February that they were abandoning the effort. This is on top of the over $2 billion the Defense Department has spent on a failed upgrade to its own electronic medical system.

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The mHealth Summit opens its call for presentations for the 2014 meeting, due June 27. The meeting will be December 7-11 in National Harbor, MD.

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Interesting: a suspicious fire in the medical records department of a psychiatric hospital in Trinidad and Tobago erupts one month after the health authority requested copies of the hospital’s medical equipment purchasing records. The hospital, which is looking at EHRs, says it will have to create records by asking patients about their history. It hopes to make a second set of paper records for patients to take home.

Weird News Andy says when it comes to cancer vs. measles, it’s no contest for this patient. Mayo Clinic doctors try a desperate cancer treatment in injecting enough genetically modified measles virus into a female patient to inoculate 10 million people. The doctors say the use of viruses to fight cancer, known as oncolytic virotherapy, has been tried since the 1950s and in this patient’s case, seems to have worked.


Sponsor Updates

  • Extension Healthcare sponsors the National Coalition for Alarm Management Safety.
  • Capario shares five facts about eligibility verification.
  • Capsule’s Halley Cooksey relates the NFL draft to selecting a committee to evaluate technology.
  • PatientKeeper posts its summer conference event schedule.
  • Orchestrate Healthcare posts an article called “What is Healthcare IT Integration?”
  • HDS will attend MUSE on May 27-30 in Dallas.
  • Park Place International offers seven tips for project managers to get and stay organized.
  • Jennifer Crowley from MedAptus discusses the importance of time in the daily life of a provider.
  • The Outsourcing Center names Springhill Medical Center (AL) and Allscripts winners of its 2014 Outsourcing Excellence Award in the Best Healthcare category.
  • TriZetto will offer  grouping, edit, compliance and pay-for-outcomes logic from 3M in its NetworX Pricer and NetworX Modeler solutions.
  • Iatric Systems launches Business Associate Manager as a tool for compliance with the HIPAA Omnibus Final Rule.
  • Sentry Data Systems completes a Service Organization Control 3 examination.
  • Summit Healthcare joins the federal initiative for standards-based healthcare communication DirectTrust.
  • Black Book names ADP AdvancedMD, Allscripts, Aprima, Care360 Quest, eClinicalWorks, eMDs, Greenway, Kareo, McKesson, and Optum to its list of top EHR, PM, and billing vendors.

EPtalk by Dr. Jayne

I was excited to hear about HR 4077 , which would exempt physicians and other healthcare professionals from antitrust laws when they take part in contract negotiations with health plans. Although it doesn’t apply to Medicare, Medicaid, or other governmental payers, it seems like it could help independent physicians as they fight the big payers. Having been part of such a physician network in the past (although it was determined that we violated antitrust laws and our contracts were voided) it could be a help for many providers.

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My informaticist friend @techydoc tweeted a link to this healthcare data map last week. It’s amazing all the places our data goes, sometimes whether we want it to or not. Apparently one place data doesn’t go, however, is to my mom’s doctor appointment. Her physician recently moved from one practice location to another within the same physician group. Despite the fact that they’re on a common EHR platform and also have an HIE in place, she was told they had to key in all her information again. It’s a shame they didn’t catch her last name and give a better answer, because I implemented the EHR and HIE in question. Sounds like someone needs an in-service.

HIStalk Practice picked this up first, but I wanted to throw in my two cents on this study that concluded that costs rise when hospitals own physician practices. The data used for the analysis was for the period 2001-2007. It doesn’t take into account the shared savings plans that have come into play during the last six or seven years. There are also just too many confounding factors present. To get an accurate analysis, I think you’d have to have to control many more of the variables. Maybe in a couple of years we can get some robust data from Accountable Care Organizations that have both employed and independent provider participants.

From The Major: “Re: site visits. As usual, thanks for sharing. I have been through a site visit (as a consultant, and my client was the jerk) like that. We had an hour ride back from the site to his hospital, where I naively told him he wouldn’t learn anything if he didn’t listen and ask good questions.” Several readers wrote to commiserate about my recent site visit experience. I’m happy to report that I received a note of apology and a cookie basket for my staff. Either the CMIO understands his behavior wasn’t appreciated or one of his accompanying colleagues is trying to smooth things over for him.

From Oceans Eleven: “Re: site visits. A long time ago we were an early adopter of a particular vendor. Based on our success, we eventually did about 100 site visits over the first few years. What became apparent after the first few minutes with a couple of them was that they had no intention of signing with any vendor. Much to the chagrin of the sales guys, we immediately scaled back our planned agenda and sent them on their way to the beach, which was probably the covert reason for the visit.” I’ve looked at dozens of products over the years and that approach hadn’t occurred to me. I’m thinking the next site visit we do might have to consider geography as well as how similar the facility is to ours. Besides, it’s been a long winter and I’m feeling a little pale. I’m sure an increase in my Vitamin D would be beneficial.

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Anyone who has ever engaged in a friendly game of Office Bingo should appreciate this card, courtesy of a reader at Authentic Medicine. I used it during a recent pep talk from our chief medical officer. She was trying to explain why it was a good idea that all the experienced emergency physicians are being let go so we can replace them with cheaper independent contractors who don’t know our hospital or our patient population. Did I mention the emergency department is barely a third of the way through with a massive construction project that has required everyone involved to bend over backwards to preserve quality patient care? The hospital is transitioning in a little over a month – it will be interesting if nothing else since we’ll have new residents and new attending at the same time. I reached BINGO after barely a handful of sentences.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.

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May 15, 2014 News 2 Comments

News 5/14/14

May 13, 2014 News 7 Comments

Top News

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The Phoenix VA hospital that is charged with creating a secret waitlist to hid months-long treatment delays waited until the last minute to implement the electronic waitlist system whose VA rollout started in 2001. According to a former VA official, “Phoenix was one of the very last to deploy. Transition from a paper-based system to the electronic one was not handled well. From what I hear, there was a great deal of resistance from staff as well.” The electronic system was introduced to increase transparency and reduce paper-based mistakes.


Reader Comments

From KD: “Re: Epic. I heard a rumor they will buying InterSystems. Any chance you can get the lowdown?” I haven’t heard anything and my one possible source hasn’t responded. I’m highly skeptical. Arguments for: Epic customers pay a lot for InterSystems Cache’ licenses and Epic and its customers are heavily dependent on that company as a result. Arguments against: almost everything else. The companies have been working collaboratively together for decades, their founders are billionaires and don’t need the money, Epic has never done an acquisition and that would be a huge one, and both companies generally stick to their knitting (the exception being a couple of InterSystems application acquisitions years ago.) I can’t imagine this is true.

From Lee Brother: “Re: MU Stage 2. At a conference, John Halamka says most hospitals will either apply for an exemption or quit the program completely.” That’s likely given that only four hospitals have attested so far. Running your business is more important than running after government money that comes with strings attached.


Acquisitions, Funding, Business, and Stock

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Pharma commercialization services vendor Quintiles will acquire consulting firm Encore Health Resources, hoping to use real-time EHR information to give drug companies outcomes data. Houston-based Encore has 250 consultants.

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McKesson announces Q4 results: revenue up 25 percent, adjusted EPS $2.55 vs. $1.48, beating consensus estimates of both. From the conference call:

  • Technology Solutions revenue was down 1 percent on the quarter, up 5 percent on the year.
  • The company expects Technology Solutions revenue to “decrease modestly” in FY2015 because of declining Horizon business and “the impact of eliminating a low-margin product line.”

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The Advisory Board Company says in its earnings call that it paid $25 million to acquire HealthPost, a physician finder and appointment scheduling site that will be rolled into the company’s Crimson analytics offerings that are used by 1,400 hospitals. HealthPost has seven employees, seven customers, $1 million in annual revenue, and is break-even on the P&L side. According to Advisory Board Chairman and CEO Robert Musslewhite,

“HealthPost is a cloud-based ambulatory scheduling solution that enables health systems to reduce referral leakage and track new patients by using it. It does it with what we felt like was a market leading SaaS technology that enables physicians and consumers to identify the right provider of care, based on certain criteria, especially in terms of geography and it makes it a very easy one-click appointment booking experience for either the provider or the patient. So we’re excited about it. In terms of how we’re going to roll it out, it’s still TBD. I imagine we will have a program launch coming from it, then more news on that down the line. But your question — as your question indicate, its certainly very complimentary to a lot of the works that we do in Crimson Market Advantage and with our MRS acquisition from last summer.”

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WestView Capital Partners makes a minority growth investment in Meditech technology solutions provider Park Place International.

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Three Lawson Software founders will pay $5.8 million to settle insider trading charges related to the company’s 2011 acquisition by Infor.


Sales

Partners HealthCare (MA) will consolidate several laboratory, pathology, and blood banking systems in moving to systems from Sunquest.

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Saint Francis Health System (OK) will deploy Perceptive Acuo VNA. 

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University of Louisville Physicians (KY) selects Shareable Ink’s Anesthesia Cloud and ShareMU for 45 of its providers across 20 operating rooms.

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Vanderbilt University Medical Center (TN) chooses CitiusTech’s BI-Clinical health content and analytics.

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UW Medicine (WA) hires Versio (formerly known as ScribeRight Transcription Agency) to bring legacy ambulatory data into its new Epic system.


People

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Medfusion names Michael Raymer (MModal) as VP of solutions management.

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Predixion Software names Costa Harbilas (HP Software) as SVP of global sales and Terri Avnaim (Quest Software) as VP of marketing.

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Abington Health (PA) hires Jonathan Sternlieb, MD (Holy Redeemer Health System) as CMIO.

Greg Shorten (Allscripts) joins Shareable Ink as chief growth officer.


Announcements and Implementations

Nominations are open through Thursday for Mosby’s Superheroes of Nursing contest.

EClinicalWorks says that more than half (580 of 1,147) of Federally Qualified Health Centers use its products, four of them being Davies winners.

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Cerner’s community health work in Nevada, MO is profiled in the Kansas City paper, which points out that the healthcare IT market is maturing and the project can help generate consulting revenue for Cerner and enhancement of its Healthe Intent population health management software. According to Cerner’s population health VP, “It’s in the DNA of our company to have the vision and passion to fix what’s broken in health care. We’ve solved the data problem. Now, it’s not about what the doctor does. It’s about what the individual does.” According to an analyst of the all-important stock market, “Other than goodwill with the client, I’m not sure how they get paid for thinking about real-world population management.” The Healthe Intent system is running at two hospitals, one in Chicago and another in Vancouver, with a third to be announced.


Government and Politics

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The Massachusetts Health Connector health insurance exchange failed because the three state agencies involved didn’t communicate with each other, according to a board member of the $57 million site, which the state will be replacing. "There wasn’t a single point of management. It was poorly set up and it was this horrible combination where the contractor [CGI] would get different orders and would do none of them."

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North Carolina’s HHS signs a data use agreement with the NCHIE as part of a House bill that requires hospitals to submit the demographic and clinical data of Medicaid patients to the HIE, allowing DHHS to monitor services and patient safety.


Innovation and Research

Researchers develop a smartphone app that analyzes the voice tone of callers with bipolar disorder to provide an early warning of mood changes.

The SVP/MD of medicine and technology of medical device maker Medtronic says the company’s biggest competitor won’t be current players, but rather “will be Google. I am certain of it.” He cites Google’s $8 billion annual R&D budget and its recent work on a smart contact lens that can measure glucose levels. He adds about healthcare, "It’s where the money is. We’re spending 18 percent of the GDP on healthcare. Why wouldn’t they think that’s where they want to be? We spend more on healthcare than we do on manufacturing in the US, so everybody thinks it’s their destiny.”

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Venture capitalist Beth Seidenberg, MD of Kleiner Perkins Caufield & Byers offers advice for entrepreneurs trying to get a foothold in the tricky world of digital health:

  • Build interfaces to open up intentionally built data silos
  • Help customers make their own decisions.
  • Figure out a revenue model upfront.
  • Make healthcare apps social so users don’t get bored.
  • Include healthcare experts on the management team.

Other

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Confused about “correlation” vs. “causation” when a shoddily created study claims that Event A must have caused Event B because they happened together? See the chart above from a website devoted to ridiculous examples of “Spurious Correlations.”

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It seems there’s a national healthcare IT conference every week, and despite claims that everybody in healthcare is struggling financially, somehow those conference rooms (and $300 hotel rooms) keep filling up with attendees. I suspect many of those attendees just keep popping up at one conference or another since I don’t know many working people who have the travel budget and time off to support endless conference attendance. One conference I hadn’t heard of is running now: the National Healthcare Innovation Summit in Boston. It’s put together by HIMSS, apparently, since membership gets you a $700 discount on the $1,095 registration fee and the browser’s tab title is “HIMSS Innovation Summit.”


Above is a tweet from Microsoft HealthVault GM Sean Nolan, who says Meaningful Use complainers are “whiny.”

Financially struggling Cochise Regional Hospital (AZ) is fined for violating its license by not providing surgical services for two years, last cleaning its operating rooms in July 2012. The 25-bed hospital says part of its correction plan is to spend $2 million on an EHR. Its website touts its advanced technology from Empower Systems, which I’ve only mentioned once in HIStalk, in 2011 when the company’s CEO quit.

A report finds that at least 15 hospital executives in Connecticut were paid more than $1 million last year, including six from Yale New Haven Hospital alone. The VP of psychiatry at Hartford Hospital made $3.24 million.

The UPMC employee who sued her employer for a data breach drops payroll processor Ultimate Software Group from her suit, saying she was mistaken in thinking that UPMC used its services.

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University of Mississippi Medical Center CIO David Chou lists 10 technologies that are revolutionizing health IT:

  1. Smartphones
  2. WiFi
  3. BYOD
  4. Government mandates
  5. VoIP
  6. Social media
  7. Virtualization
  8. IP-based medical devices
  9. Mobile health
  10. Big data

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Johns Hopkins School of Nursing offers a free, five-week course (known as a MOOC, or massive, online course) on “The Science of Safety in Healthcare” starting June 2. Pay $39 and you get a certificate; add another $60 for CNE hours. Peter Pronovost is one of the instructors.

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Two tear-down analyses of Google Glass find that the $1,500 gadget contains either $80 or $152 worth of parts.

Weird News Andy questions, “Dim bulbs or bright lights?” Two British doctors refuse to use energy-saving light bulbs in their homes and instead stocked up on the obsolete incandescent types. One claims the bulbs cause sunburn-type damage over time, while the other worries about the possibility of cataracts and macular degeneration.


Sponsor Updates

  • Portland (OR) IPA certifies a pilot group of clinics for NCQA’s Patient-Centered Specialty Practice Recognition using the IRIS referral management system of Proximare Health.
  • Allscripts announces GA of Sunrise Surgical Care 14.2.
  • GetWellNetwork CIO David Muntz will deliver the keynote address at the DoD/VA Healthcare Summit in San Antonio, TX next week.
  • TriZetto will offer Enkata’s claims processing system to its consulting clients.
  • EDCO Health Information Solutions publishes a blog post, “True or False: Decentralized Records Scanning Reduces Chart Quality.”
  • A Beacon Partners blog post urges providers to use the ICD-10 delay to gain a competitive advantage.
  • Visage Imaging will demonstrate its enterprising imaging platform at the SIIM annual meeting in Long Beach, CA this week.
  • Holon discusses the use of HIE for for identifying and reducing ED frequent fliers in a recent blog posting.
  • Wolters Kluwer will sell POC clinical decision support solutions to nursing schools for use in their curriculum.
  • CliniComp will participate in the Association of Women’s Health, Obstetric and Neonatal Nurses 2014 Convention June 14-18 in Orlando.
  • Health Catalyst shares its history, goals, and direction.
  • AirWatch expresses its intention to continue working with BlackBerry.
  • Shareable Ink announces the members for its newly-formed Anesthesia Leadership Board.
  • ADP AdvancedMD offers a guide on how financial reporting is changing the way private practices operate.
  • Terry Edwards, CEO of PerfectServe, will speak at the WLSA Convergence Summit in San Diego May 14.
  • Arcadia Healthcare Solutions, Certify Data Systems, and CTG Health Solutions executives weigh in on the challenges of forming and operating an ACO.
  • Truven Health Analytics will provide technical support for CMS during the Testing Experience and Functional Tools demonstrations in Community-Based Long Term Services and Supports program.
  • CommVault extends its relationship with Microsoft to provide data management and protection.
  • Navicure achieves faster product development times by using of VMware vCloud Suite for provisional testing and development environments.
  • MModal opens a healthcare technology center in Bangalore, India.
  • Lexmark’s Perceptive Software passes all integration tests at the 2014 IHE North American and European Connectathons.
  • NextGen Healthcare earns its third Surescripts White Coat of Quality award.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.

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May 13, 2014 News 7 Comments

Monday Morning Update 5/12/14

May 10, 2014 News 3 Comments

Top News

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Catholic Health Initiatives files a lawsuit against an unknown hacker, hoping to convince Microsoft to turn over the identities behind several of its email accounts that were used to breach CHI’s systems from Pakistan. The John Doe hacker redirected internal emails to his or her own account and  took control of some of the organization’s domain registrations. The systems of CHI affiliate Franciscan Health System were compromised in March when employees were fooled by a phishing scam into providing their login credentials to a hacker site.


Reader Comments

From Iron City: “Re: reduced readmissions. These stories get a lot of attention, but it’s easy to overstate the gains on readmissions from situations where the same patients were simply kept in the ER or observation instead. That is cheaper and still a partial success, but not the same as avoiding the readmission cost completely.” That’s a good point. You would have to take a guess at which patients would have been readmitted, then examine claims data to see if they were treated in other hospital settings instead. Just looking at the overall readmission percentage wouldn’t provide the full picture. I also question the historical inability of hospitals to understand their true marginal cost of an admission vs. their average cost of an admission – putting one more patient in a bed for the night doesn’t necessarily trigger the same high expense as having a post-up cardiac surgery patient occupying a similar bed during that same night.

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From Blockade Runner: “Re: SuccessEHS. We are a FQHC with a grant to implement the product, which was bought by Greenway. The CEO failed to mention a long-term plan for it in a recent webinar even after saying it has 8,000 providers using it. We’re thinking about starting a search. We have specific needs for our UDS reporting and our sliding scale fees based on the Federal Poverty Line. Are any FQHCs using something that works?” My caution there would be to give Greenway a chance to address your concerns directly rather than reading too much into lack of encouraging news in a webinar. If you like their product, put your concerns in contractual T&Cs and see if they approve them – if not, your worst fears are probably justified.


HIStalk Announcements and Requests

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Three-quarters of poll respondents say doctors should be licensed nationally rather than by individual states. New poll to your right or here: athenahealth got a lot of stock market attention last week. What was your reaction, if any?

Listening: new from Atlanta indie-soul singer Curtis Harding, sweet 1970s-style horns over a hip-hop beat. One track even goes disco while managing to sound great. I’m also still playing a lot of Georgia grunge rockers Dead Confederate.


Acquisitions, Funding, Business, and Stock

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Friday’s market close share performance after Thursday’s earnings announcements: Castlight Health up 10 percent, Allscripts unchanged, Nuance down 3 percent, The Advisory Board Company down 2 percent.

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From the Allscripts conference call:

  • Quarterly bookings grew 26 percent, with recurring revenue making up 78 percent of the total.
  • The $3 million drop in revenue came from an unnamed outsourcing client that took its $20 million per year effort in-house.
  • Allscripts says constrained provider capital and a lack of enthusiasm for rip and replace projects will help it sell portal and interoperability products.
  • The company says the 10-year, $500 million agreement it signed with Xerox’s ACS subsidiary in 2011 has “challenging economics” and may require changes.
  • Paul Black says that hosting systems without owning any of the underlying infrastructure has “created a more virtual environment than we’re comfortable with” and that the company will be “much more active managers of our destiny.”
  • Black says he feels “pretty good” about the company’s functionality for inpatient, outpatient, revenue cycle, population health management, and patient portal.

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RadNet says in the earnings call that all of its 260 diagnostic imaging centers will be running eRAD RIS/PACS within a year. RadNet acquired the Greenville, SC-based eRad in September 2010 for $11 million.

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A site promoting Utah tech business profiles Health Catalyst, which it says will generate up to $100 million in revenue this year and will IPO in 18-24 months.


People

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Justin Barnes, VP of industry and government affairs at Greenway Medical, announced this week that  he’s leaving the company at the end of May. He tells our Jennifer Dennard that he’ll be stay busy over the summer with plans to start two companies (one of them in healthcare IT, with a nod toward consumerism, interoperability, and patient engagement), join a tech incubator, and continue his involvement with government issues in an unstated capacity. He says his Greenway departure is friendly and unrelated to its November 2013 acquisition by Vista Equity Partners or the April 2014 departure of Greenway President Matt Hawkins.

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Speaking of Matt Hawkins, who was CEO of Vitera when it was acquired by Greenway in November 2013 — he’ll be replacing Richard Atkin as president of Sunquest, according to internal sources.


Government and Politics

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The CEO of HMSA, Hawaii’s biggest medical insurance company, says the state should either shut down the Hawaii Health Connector insurance exchange site or let the federal government take it over. The exchange received $200 million in federal taxpayer money, spent $100 million developing the site, signed up just over 9,000 customers, and raised only $40,000 in user fees that were supposed to fund its ongoing operation. Hawaii didn’t really need the exchange at all since a state act requires employers to provide subsidized insurance to their employees.  In an interesting story twist, the state’s legislature passed a bill last week ordering HHC to kick out the insurance company members of its board, among them HMSA, which in that role oversaw the site’s creation and is now calling for its shutdown.


Other

Hospital music videos have probably reached the Peak of Inflated Expectations on Gartner’s hype cycle now that the marketing people are cranking them out for commercial benefit, but you might still be cheered up this Monday morning by HHC Elmhurst Hospital Center’s cover of “Happy.” Or not, since it probably drives cynics and pessimists crazy (although I’m both and I like it.) 

You also might be inspired (or not) by “Steve Jobs’ 13 Most Inspiring Quotes.” My favorites:

  • "Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart."
  • "I’m as proud of many of the things we haven’t done as the things we have done. Innovation is saying no to a thousand things."
  • "Being the richest man in the cemetery doesn’t matter to me … Going to bed at night saying we’ve done something wonderful … that’s what matters to me."

The Massachusetts House passes votes to eliminate a law that would have required physicians to demonstrate EHR competency or Meaningful Use certification as a condition of earning or renewing their medical licenses after January 1, 2015. The House voted to delay from 2017 to 2022 a requirement that all providers use EHRs that are connected to the state HIE.

An interesting patient-centered technology example on ReelDX: the mother of a patient records her toddler’s respiratory symptoms on her smartphone. The question: why can’t the video (or other media) be included in the EHR?

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Weird News Andy submits a spinning heart story from NEJM: a motorcyclist survives an accident in which his heart rotates 90 degrees due to air pressure in his chest. Doctors removed the air and the heart shifted back. And in a WNA-like story that he didn’t actually submit (yet), an English hospital admits that a man scheduled for an unspecified “minor urological procedure” was instead given a vasectomy.

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A UPMC employee sues the health system and a payroll processing firm after a data breach in which hackers filed fraudulent tax returns using the identities of UPMC employees. What’s unusual about the lawsuit: (a) the employee is only asking for identity theft protection, which is usually offered anyway, although she wants 25 years of it instead of the usual one year; and (b) UPMC isn’t a client of the payroll processing firm she sued, according to that company.

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Strange: Kosair Charities sues Kosair Children’s Hospital (KY), claiming the hospital is mismanaging its donations, while the hospital responds publicly that the charity isn’t giving it enough money. According to the IRS documents I found, the charity brings in $15 million per year, holds $163 million in assets, and gave the hospital $4 million in the most recent year. Hospitals are last on the list of charities I would support given the waste, mismanagement, and self-serving agendas I’ve seen firsthand in having worked for a few of them. Supporting hospitals isn’t the best way to support patients.

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Here’s a brilliant flow chart whose author I can’t credit because it is has been tweeted / retweeted / incorrectly retweeted so many times I can’t figure out its source. Someone shares my intense annoyance at pedantic blowhards who hijack the microphone after a conference speaker has opened the floor to questions that turn out to be eloquent expressions of self love. Use the microphone kill switch, moderators, or take responsibility for the trampling injuries that will result from the mad dash for the exits.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.

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May 10, 2014 News 3 Comments

News 5/9/14

May 8, 2014 News 5 Comments

Top News

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Google Ventures invests $130 million in oncology data platform vendor Flatiron Health, which will use some of the money to acquire oncology EMR vendor Altos Solutions. The two 20-somethings who founded Flatiron Health sold Google their online advertising platform for $81 million in 2010. They knew nothing about advertising or healthcare before starting their companies. Their first Flatiron oncology rollout was in 2013. It’s a lot of money, so let’s hope Google’s investment outcomes exceed their healthcare ones.


Reader Comments

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From Dave Miller: “Re: UAMS. We are now live fully everywhere on Epic. It has gone really well, with just a few of the usual minor bumps (printing, security, scanning, etc.). I think this has been the best of my three Epic go-lives (University of Chicago, Carle Foundation Hospital, now UAMS). I guess you can teach an old dog new tricks. We also did enterprise speech recognition, device integration, and barcoding among other things. We went from a HIMSS Stage 4 to a Stage 7 (application in process). My lab team made me an honorary member of the Beaker team with the shirt above, maybe because I am a former med tech.” Dave is vice chancellor and CIO of University of Arkansas for Medical Sciences in Little Rock. Congratulations to the team. I told Dave he has more Epic experience than some of the consultants out there.

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From Joe: “Re: IBM’s Watson. I followed your link from HIStalk and got a Chat Now window on IBM’s page. I’m curious about Watson in healthcare, so I accepted. See the transcript – I decided to open with a (perhaps obtuse) nod to Alan Turing, which I figured any good IBMer should appreciate. Touchy, touchy! Or maybe they have an algorithm that indicates anyone skirting around Turing Test references is clearly a cycle-wasting tire kicker.” I replied to Joe, “Maybe the IBM rep was indeed a Turing fan and decided to prove in the most definitive way possible that he’s not a computer!” Joe says he’ll try again, asking, “Did you kill our previous session because you ARE a computer, or you are a human trying to PROVE that you’re not a computer?”

From Trey Hermanos: “Re: athenahealth. Can somebody tell me how many providers athenahealth has on their network? An article says 37,000, but Jonathan Bush said 52,000 at a recent conference. Their implementation is a breeze compared to others, but in their quest for growth and relevance, they risk losing the 1-10 doc practices that made them what they are today, the practices that aren’t getting decent service and call-backs from their account managers. They gave their award for improved patient experience to Target’s clinics, the same corporation that compromised the identities of millions. The company doesn’t think you need to see a doctor for ‘small things,’ a view held by many despite the fact that the knowing when something is simple or not requires skill and sophisticated knowledge. A recent article called ‘Nurses are not Doctors’ said you have to know a lot to do primary care – the Target and Walgreens clinics are there to sell what’s on their shelves. There is no respect for knowledge and we spoil our patients the way we spoiled our kids to the point they have no coping skills and grow up entitled. Athenahealth must feel undervalued and not appreciated enough, sort of like primary care.”

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From HIT ESQ: “Re: patent troll. A company called Presqriber is filing a massive number of patent infringement cases against EHR vendors. It has no Google hits except these cases. Its patient is for an ‘Interactive Medication Ordering System.’ They appear to be the first major patent troll in a few years.” The patent is from 1998, so I bet someone bought it from a defunct vendor (“Poetry” is referenced as the system name, which had some California pharmacists and urgent care people involved and is presumably long gone) and hopes to milk vendors for go-away money. They hit all the majors in their list of 20 except one – Epic, who has a history of launching a full-scale legal counteroffensive on patent trolls. HIT ESQ also called attention to two class action lawsuits brought against Cerner for claimed labor standards violations, which although I can’t pull up the documents since I don’t have access to the PACER system, usually means a salaried employee claims they should have been paid for overtime because they were misclassified and should have been hourly. 


HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: A report finds that higher payer doesn’t necessarily equal higher job satisfaction. Another says the physician industry generates $26 billion in sales revenue and supports $15 billion in wages and benefits. Northwestern Memorial Physicians Group and Northwestern Medical Group merge to form the second-largest physician group in Chicago. A trio of ophthalmologists turns to crowdsourcing to fund their digital physician on-call answering system. A study uncovers the fact that hospital prices and privately insured patient spending increase when hospitals acquire physician practices. A physician pleads with Forbes editors to get RAC bounty hunters off his back. Arizona Care Network and Northeast Medical Group launch separate ACO initiatives with payers. Don’t write athenahealth’s eulogy just yet –several company partners make product announcements. 

This week on HIStalk Connect: Google continues its move into healthcare, as it grows its team of A-list genetic scientists working on its Calico moonshot project. Google also led the massive $130 million Series B funding round of oncology data analytics startup Flatiron Health. In other non-Google related news, PatientsLikeMe CEO Jamie Heywood discusses the details of its recent Genetech deal. 

Listening: new from Brody Dalle, the former (female) lead singer of The Distillers.

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Want to get in touch? I created a new contact form that covers everything I could think of. Submissions go straight to my inbox (which is usually overloaded, so keep expectations modest.)  There’s a link at the top of this page, too.


Acquisitions, Funding, Business, and Stock

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Castlight Health reports Q1 results in its first report as a publicly traded company: revenue up 339 percent, adjusted EPS -$0.72 vs. –$1.19, beating on revenue but missing earnings estimates by a mile. The company, whose market capitalization is around $900 million, had revenue of $8.4 million and lost $24 million in the quarter. Shares have dropped nearly 75 percent since CSLT’s March IPO, which some analysts called at that time “the most overpriced IPO of the century.” Castlight Health was founded in 2008 by Todd Park (White House CTO and athenahealth co-founder), Bryan Roberts (Venrock), and Giovanni Colella, MD (RelayHealth). Shares that rocketed to $40 on IPO day are now worth around $10 less than two months later.

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Allscripts reports Q1 results: revenue down slightly, adjusted EPS $0.07 vs. $0.09, missing expectations on revenue.  

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Nuance reports Q2 results: revenue up 5.5 percent, adjusted EPS $0.28 vs. $0.34, beating expectations on both.  

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The Advisory Board Company reports Q4 results: revenue up 15 percent, adjusted EPS $0.34 vs. $0.34, beating expectations on both.

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Hedge fund manager David Einhorn sent athenahealth’s stock price reeling this week when he said his firm has shorted the company’s shares because athenahealth is a faux cloud vendor whose real business is unsexy business process outsourcing that doesn’t deserve high share valuation. He didn’t just blurt it out – his slides from the investor conference presentation summarize his analysis:

  • The company has failed to meet its 30 percent organic growth target for 2013, analysts have cut revenue expectations for the next two years, and earnings estimates keep going down.
  • He says ATHN and some of the friendly analysts who cover it use a lot of buzzwords in describing what the company does, hoping to make it sound cooler and deserving of high share price, instead of what it is – an efficient business process outsourcer similar to lower-margin companies like MedAssets and Accretive Health.
  • The valuation numbers of Morgan Stanley, which also happens to be ATHN’s largest shareholder, are shaky (although that company might also question Einhorn’s negative analysis since he, too, is providing supposedly unbiased information that could move ATHN share price in a personally beneficial direction.)
  • Einhorn questions Morgan Stanley’s assumption that athenahealth’s inpatient business will jump from 0 to 40 percent of its revenues and that it will launch an inpatient revenue management service that will bring in $2.5 billion a year.
  • The report says Epic is unbeatable in hospitals and will expand into other markets, including gaining ground with hospital-acquired small practices that might otherwise be athenahealth prospects.
  • He says that HITECH is winding down and practices that wanted EHRs have already bought them, with Kareo, eClinicalWorks, and CareCloud offering lower-priced RCM and EHR products as athenahealth competition.
  • Capitation would hurt athenahealth, he says, because providers would be paid upfront and wouldn’t need its help.
  • He predicts a worst-case share price of $14 vs. then-current $127 (now $107), saying ATHN is like the 2004-era WebMD.

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Meanwhile, Jonathan Bush said Thursday that Einhorn doesn’t understand the company, which he then compared to Uber, Airbnb, and Amazon. He added, “The right price of athena is … completely out of my pay grade,” but told also CNBC that he’s sure ATHN is a $1,000 stock and then said, “Who cares about net income?”

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Streamline Health will acquire the assets of cost and spend management solutions vendor CentraMed.

Cedars-Sinai Health System (CA) and MemorialCare Health System (CA) form Summation Health Ventures, a healthcare IT development fund that will seek startups not only for potential return, but their capability to create technology that the hospitals can use.


Sales

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Lake Taylor Transitional Care Hospital (VA) will implement HCS Interactant for its LTACH and SNF service lines.


Announcements and Implementations

An engineer who helped develop ride service Uber launches Pager, which allows Manhattan residents to request an off-hours telephone consultation or house call from participating doctors. Telephone calls cost $50 (of which Pager skims $10), while house calls run $300 and the company keeps $50. Like Uber, Pager is thinking about surge pricing, raising charges when demand is high. It has only 20 doctors participating during its launch testing period. He should have chosen a less-generic name: Uber was always easy to find, but I couldn’t locate anything on Pager despite extensive Googling.

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Policy documentation software vendor PolicyMedical will integrate with the Access electronic forms system.

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Hybrent announces a medical supply ordering application for clinical staff.

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Mandi Bishop, Nick Kypreos, and Lauren Still put together Team FloriDUH to create open source data visualization tools. They’ve been invited to compete at Health Datapalooza in Washington, DC June 1-3 and have formed a non-profit foundation to distribute tools they build. They are hoping to raise $10,000 in a Medstartr project that starts Friday, May 9 to cover travel costs and extend their product offerings.


Government and Politics

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HHS Secretary Kathleen Sebelius, who I assumed was long gone but apparently isn’t, leads a thinly veiled cheer for the Affordable Care Act in touting its supposed benefits as analyzed from HHS’s databases: a tiny reduction in readmissions and a nine percent drop in hospital-acquired conditions in 2011-2012 and a claimed 15,000 lives and $4 billion in healthcare spending saved. President Obama’s nominee to replace Sebelius, Sylvia Burwell (above), faced her first Senate confirmation hearing Thursday and received near-universal compliments, even from Republicans.

New York-Presbyterian Hospital and Columbia University will pay $4.8 million to settle charges related a 2010 privacy breach in which the medical information of 6,800 patients was exposed when a CU physician-programmer tried to deactivate a personally owned server he had connected to NYP’s network, opening up the patient information it contained to the Internet. The error was discovered, as it always is, by someone Googling individuals and turning up inpatient clinical information. Neither organization had checked the server’s security, conducted a risk analysis of all systems, or developed policies and procedures for database access. It’s the largest HIPAA fine ever.

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Health Information Technology Exchange of Connecticut will be shut down since the HIE has spent its federal grants without accomplishing a whole lot.


Other

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A former Epic intern and employee who worked directly for Judy Faulkner for a time writes about his experience in a Madison online publication. He says Judy isn’t reclusive, just more interested in tending to her company and its customers than gabbing with reporters. He anguishes over whether the company spends too much on fancy buildings. He says Epic is good place to work because it quickly jettisons underperforming employees, but wonders if it shouldn’t hire more experienced people even if Judy’s long-held belief is that she can turn a new college grad into an “Epic person” in three years while experienced hires would take twice as long.

Weird News Andy reacts to this story by saying, “Mmmmm, bacon.” Scientists question the 1950s study that claimed saturated fats cause heart disease, saying the researcher chose specific countries that would prove his point, used small sample sizes, and studied one country during Lent when nobody was eating meat or cheese. The Wall Street Journal essay by the author of a pro-saturated fats book says that funding by Crisco’s manufacturer, Procter & Gamble, made the American Heart Association a national force and the group later spearheaded a move to vegetable oil for a “healthy heart” even though proof was lacking.


Sponsor Updates

  • Alan Worsham (Sutter Health) and Joe Schmidt (Emory University School of Medicine) join Culbert Healthcare Solutions as practice directors.
  • InterSystems TrakCare gains the largest share of non-US hospitals and is named a clear leader by KLAS.
  • Perceptive Software’s Larry Sitka will speak on breast tomosynthesis and John Hamdor will present on image-enabled EMR management at the SIIM14 conference.
  • Tampa General Hospital (FL) is live on Wolters Kluwer UpToDate Anywhere integrated into Epic.
  • Extension Healthcare releases a two-part white paper to aid hospitals with compliance with clinical alarm safety.
  • Capsule Tech celebrates National Nurses Week by posting celebrations and nurse-focused activities on the company’s blog.
  • Merge’s Mark Bronkalla explains the service model of PACS shifting to enterprise IT in a recent blog posting.
  • Gwinnett Medical Center and Connance will co-present at the Healthcare Business Insights’ Spring Member Retreat on “How Revenue Cycle Can Change Patient Loyalty.”
  • ICSA Labs certifies 29 vendors in April, including HIStalk sponsors Iatric Systems, Quest Diagnostics, and Orion Health.
  • Netsmart advocates for behavioral health providers on Capitol Hill.
  • Visage Imaging offers a NVIDIA case study in connection with a video detailing the architecture of the Visage 7 Enterprise Imaging Platform.
  • Aspen Advisors Founder and Managing Principal Dan Herman and principal Jody Cervank discuss IT’s impact on operations, clinicians, cost and productivity at a regional VHA COO/CFO Joint Affinity Group.
  • Ashish Shah and Brian Ahier of Medicity discuss the landscape and future direction of data exchange networks in a recent article.
  • Carolinas HealthCare System shares how Medicity was instrumental in its HIE CareConnect success.

EPtalk by Dr. Jayne

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We hosted a site visit at the office yesterday. It’s been a long time since we’ve done one and I had somewhat forgotten what an adventure they can be. We’ve been a reference site for our ambulatory vendor for years, but because of everything going on with upgrades, Meaningful Use, and ICD-10 preparation, we had taken a break.

We’re old pros at site visits since we were early adopters of EHR and had put our ambulatory physician practices through an accelerated implementation that was not only rapid, but successful. We had only been live for a few months before the vendor started asking us to host site visits. Initially I was naïve enough to think it was simply because we had done a great job. Only later (after I swiped our vendor contract from an unattended filing cabinet) did I learn that our CFO had leveraged potential site visits against discounts on our initial software purchase. I’m glad he was confident in our potential abilities!

Our formula for site visits is pretty standard. Our local vendor exec and the prospect’s vendor exec bring the entourage to our corporate headquarters. We start with a presentation on the history of the physician group and our ambulatory project. We share some fairly detailed information about our methodology, decision making, and implementation processes and then talk about results we’ve achieved over the years.

Although most of the groups that visit us ask to go to the practices and shadow physicians, we have a strict policy of not allowing it. We make that clear when the site visit is scheduled. The disruption to patient care is aggravating to our physicians, and if I was a patient, I wouldn’t want a bunch of visitors looking over my doctor’s shoulder and asking questions about the software.

Instead, we invite some members of our clinical advisory board to join the group for lunch. Most of them will have their laptops or tablets with them, which allows for hands-on discussion of workflow or how they handle challenges. Not all of them are serious fans of EHR, but they usually provide a balanced perspective.

Although members of the vendor sales team are usually present, they’ve learned to just sit back and let it unfold. There have been a couple of account reps that tried to jump in and camouflage deficiencies in the product, but being on the receiving end of our evil eye usually shuts them up. We’re completely open about what the clinical and billing systems will (and won’t) do. Most of the reps have learned that prospects appreciate that level of candor.

We’ve had some visitors that were squeamish about having the vendor in attendance. When that’s the case, we’re happy to kick the vendor people across the street for coffee. Other visitors have tried to beat up on the vendor with them in the room in the hopes of increasing their negotiating power by making the product seem deficient.

My favorite site visit was a couple of years ago. The revenue cycle director and I are good friends and have done so many talks together that we decided to mix it up and do each other’s parts in the presentation. I’m not sure the prospect fully understood the humor of what was going on, but the sales execs could barely keep straight faces as I chatted about denial management and my billing colleague started talking about clinical quality.

Even though we’re somewhat contractually obligated to host site visits, our vendor has never asked us to hide anything or to portray anything other than our real experience. They’ve been respectful when we simply have too much on our plate and understanding when we refuse to do them because we’re waiting for delivery of code that’s been delayed and we want to make a point. We actually have fun doing them since we get to tell our story and we’re proud of what we’ve accomplished in an industry that’s still in its relative infancy.

You never know how visitors are going to behave in a site visit until they start talking. This one was one of those doozies.

It was a bit of an unusual visit to start with. The visitors were already live on our vendor’s platform, but had “paused” their implementation. They were coming to us to see an example of a success story and to hopefully learn ways to improve when they restarted their project. They are a high-value client, so a vendor VP and some other execs came along for the ride. Although they had provided us the back story beforehand, it was interesting to watch the visiting CMIO explain that his initiative was essentially a failure / money pit without actually admitting as much.

We set the stage with our group’s profile, which was similar to theirs when we started our project. We went through our financials, success metrics, clinical quality indicators, and then jumped into the discussion of our implementation methodology and physician adoption strategy. No matter what platform you’re on, the latter two are critical in my book. Implement faster than your organization can handle or slower than it needs and you have a mess. Fail to think about physician adoption and you have the same mess, but exponentially larger and more painful.

Barely two slides into our EHR implementation presentation, the visiting CMIO started interrupting. Every time I would talk about how we did something, he would jump in with a counterargument about why that wasn’t a good idea. I would talk about how we implemented our pilot practices in phases and he would explain that in his master’s coursework, they had discussed that phased implementations are a mistake. I’d talk about how we brought laboratory and document interfaces live with the billing system (months before EHR) to pre-populate charts and he’d argue with me about medico-legal risk. I would say the sky was blue and he would try to tell me it was brown.

I thought I was holding it together pretty well in the face of his bad attitude, but I had to work to not laugh at my co-workers, who kept darting their eyes around to see how people were reacting to his bluster. I spotted a sidebar conversation that I knew was probably an attempt to guess how long I was going to let him continue his boorish behavior. The sales execs were increasingly agitated and tried to redirect him without being adversarial, but no one from his hospital tried to intervene.

Finally, I reached my breaking point. You can make fun of some of our user engagement strategies. You can think we’re goofy at times with how we do team building and change management. But don’t diminish the product of thousands of hours of hard work by our staff and end users, especially when you’ve got your own project on hold and your vendor is flying you around the country trying to help salvage your implementation. And definitely don’t try to tell us our strategy “can’t possibly be effective” when we have brought hundreds of physicians live successfully with no real revenue impact to them.

I gave him my best “steely-eyed missile man” look – the same one I give medical students when they appear particularly unprepared and which has been honed by years of craziness in the ER. I simply said I guessed we didn’t have anything to really teach them and handed the presentation controller to my revenue cycle colleague.

She’s usually the master of the poker face, but this time her expression said it all. I thought I heard a couple of people suck in their breath, but they were drowned out by the sound of the vendor VP choking on his breath mint.

To her credit, my colleague rapidly advanced through the rest of my slides and dove right into the wonders of the central business office without missing a beat. I caught a couple of smirks among our site visit guests, so I’m encouraged that there is hope for them even though their boss is clearly a jerk. The CMIO seemed to be trying to figure out what had just happened and started sputtering and trying to backtrack, but my colleague pressed ahead. I’m betting our vendor won’t be inviting him to any other client sites any time soon. I’m hoping our next guests leave their confrontational physicians at home.

Are you a reference site? Have any good stories? How do you deal with adversarial visitors? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 8, 2014 News 5 Comments

News 5/7/14

May 6, 2014 News 12 Comments

Top News

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Comments from hedge fund manager David Einhorn send shares of athenahealth down nearly 14 percent Tuesday after he tells investment conference attendees that ATHN is one of a few “bubble stocks” trading at high valuations for no good reason. He added that athenahealth really isn’t a cloud vendor deserving of high share price multiples since its main role is as a business process outsourcer of mundane back-office physician practice tasks. He also said that athenahealth’s promotional videos are full of buzz words and that “Epic’s dominance will only grow” as “the undisputed winner from the fragmented IT market.” He predicted the company’s shares will drop 80 percent. Above is the one-year chart of ATHN (blue) vs. the Nasdaq (red), with shares closing Tuesday as Nasdaq’s fifth-largest percentage decliner.


Reader Comments

From Bratman: “Re: Vonlay acquisition by Huron Consulting. The acquisition price was $35 million, all cash, and was a 1.2 times multiplier on revenue. There were several interested acquirers. The price may have ended up lower since Epic forced the Vonlay owners to modify the terms of the Vonlay-Epic agreement to extend the non-compete for former Epic employees from one year to two years. Epic required this change before it would agree to transfer the Vonlay agreement to Huron. The legality of forcing Epic employees into non-compete agreements they never knew about or agreed to is definitely up for debate and the length of the new non-competes likely makes them unenforceable. Epic seems to be using its power to try to minimize employee attrition and limit the supply of certified third-party consultants.” Unverified.

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

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QPID Health raises $12.3 million in a Series B funding round and adds a board member from New Leaf Venture Partners.

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Radiology outsourcer Alliance HealthCare Services acquires the assets of OnPoint Medical Diagnostics, which offers a cloud-based scanner quality control system used by 81 hospitals, for $1 million in cash and two years’ of royalties.

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Huron Consulting Group closes its acquisition of Epic consulting firm Vonlay of Madison, WI.

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Pittsburgh-based teledermatology technology vendor Iagnosis raises $2.8 million from angel investors.

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Xerox will acquire ISG Holdings, which offers workers’ compensation software systems under the StrataCare and Bunch CareSolutions brands, for $225 million.


Sales

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Valley General Hospital (WA) chooses Medsphere’s OpenVista EHR for its 68 beds.

Alere Accountable Care Solutions will build a community-wide HIE for Whittier Independent Practice Association (MA).

Emerald Physicians ACO (MA) selects the eClinicalWorks Care Coordination Medical Record.


People

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Oneview Healthcare names Jeff Fallon (Fallon Strategy) as president, North America.

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ESD hires Cinthia Tenorio, LPN (Lake Health System) as CDI practice director and John Ortego (CTG) as Meditech practice director.

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Tracy Gregory (Linguamatics) joins SyTrue as chief scientist.

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Patrick Clark (Vonage Business Solutions) joins Wellcentive as CFO.

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Accenture CEO Jorge Benitez will retire from the company at the end of August.


Announcements and Implementations

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MModal announces enhancements to its Fluency Flex mobile dictation application for iOS devices.

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In Australia, Sydney Children’s Hospital Network announces plans to use commodity software for its telemedicine program, including Lync videoconferencing and Skype video calling, both from Microsoft.

RadNet goes live on Nuance PowerScribe 360 at the first of its 250 imaging centers and 27 practices.

Advocate Medical Group of Chicago (IL) implements Forward Health Group’s PopulationManager and The Guideline Advantage.

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Propeller Health earns FDA approval for the new generation of its inhaler-measuring asthma monitoring system.

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St. Joseph’s Hospital Health Center (NY) goes live with Epic.

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Zoeticx makes available an API that it says will allow developers access to “any EMR system.”


Government and Politics

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Massachusetts announces that it will abandon its $57 million CGI-built health insurance exchange website and hire hCentive, which developed three other state marketplaces, to build a new one. The state also says that just in case that doesn’t work, it will just join the federal exchange in November. Massachusetts isn’t sure if it will need to ask the federal government for more money than the $174 million it already received since it is disputing its CGI contract, but the “dual track” option it chose (the sequel to its disaster movie) will cost another $100 million.

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CMS reports that only 50 doctors and four hospitals have successfully attested for Meaningful Use Stage 2 through (or “thru,” as the slide says) May 1. CMS also reports that it has approved 66 of 72 applications for hardship exceptions.

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Michelle Consolazio of HHS tweeted this photo of the HIT Policy Committee thanking outgoing member and Epic CEO Judy Faulkner, who has been replaced as its vendor representative after four years by Cerner CEO Neal Patterson.

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The talking heads in this hysterically partisan and sensationalist Fox News program seem exceptionally clueless yet smugly superior about nearly everything, but Jesse Watters (I don’t watch TV, so I don’t know who he is) outdoes himself at the 12:40 mark when talking about the VA wait list controversy by declaring, “They’re still using paper records at the VA. They’re not even computerized yet.” That’s embarrassing no matter what your political persuasion, but of course he only plays a journalist on TV and can’t be expected to differentiate between disability claims forms and medical records.

National Coordinator Karen DeSalvo, MD says her husband, also a doctor, uses a “clunky” EHR. A bit of Googling suggests that her husband is (or at least was) an ED doc at Lakeview Regional Medical Center in Covington, LA, so perhaps his clunky EHR could be identified. I assume it’s Meditech since it’s an HCA hospital.


Innovation and Research

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MedStar Health (DC) will co-locate some of its employees in the offices of DC-based incubator 1776, connecting the health system with technology startups to arrange pilot projects. MedStar will also provide education for the 20 percent of 1776’s companies that deal with healthcare.

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IBM names 25 finalists in its Watson Mobile Developer Challenge. Those that are healthcare-related include GoGoHealth (telemedicine), Ultramatics (personalized health answers), Ringful Health (patient-physician communication), GenieMD (health management), Biovideo (information for expectant mothers), and Sense.ly/MyIdealDoctor (medical information).


Other

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Community Hospital (IN), which is treating the first US patient to be infected with Middle East Respiratory Syndrome (MERS), used its Versus RTLS system (along with video surveillance recordings) to identify employees that had come in contact with the patient, earning a mention on the local TV news report. Hospital CMIO Alan Kumar, MD says, “We can tell down to the second how long they were in contact with the patient, and how long they were in the room, and provide data to CDC.” According to the state’s health commissioner, “MERS picked the wrong hospital, the wrong state, and the wrong country to try to get a foothold.”

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Durham County, NC commissioners vote to give Lincoln Community Health Center $500,000 to install Epic, half the amount it requested. The $2 million implementation would allow the clinic to connect with Duke University Health System’s Epic system. Commissioners suggested hitting up Duke for more than the $1 million it offered toward the cost, with one saying, “In the big scheme of what’s been invested at Duke, between $500 million and $700 million, this additional half a million, I would hope they would be able to absorb that and do what needs to be done.”

Investor Lisa Suennen (“Venture Valkyrie”) writes a blog post about the recent Health Evolution Partners Annual Summit that is brilliant in both insight and wit.

And this group of people, who know everything there is to know about how we got into such a healthcare system mess (because they helped create it) and what has got to be tackled to fix it (even if not how to do that exactly) is dealing with quite a conundrum. They are caught in a vortex where they have to straddle the old world and new world—the land where healthcare decisions are mostly still driven by volume and not quite ready to chuck it all for a world based on “value.” … it is impossible to train the entire hospital to act in two completely different ways based on the patient who shows up. You simply can’t run two different workflows and two different case management programs and two different follow-up programs efficiently. Most of the time the actual caregivers in a hospital—physicians, nurses, etc.—don’t even have a clue in what insurance program or risk-pool the patient is enrolled; certainly no one is yet handing out bar-coded wrist bands that tell the caregiver whether to minimize or maximize services, based on the financial motivation (I hope).

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Points from the 2014 HIMSS Regional Extension Center Survey, with 37 of 60+ RECs (which have received $677 million in taxpayer support) responding:

  • Nine out of 10 say their #1 business issue is staying alive, with several respondents saying financial sustainability isn’t possible or isn’t something they’ve planned adequately.
  • One-fourth of the RECS say they won’t be viable by the end of the year, and half of those that say they’ll survive expect state grants to keep them solvent.
  • Three-fourths of them want more ONC grants to keep afloat.
  • One-fourth of the respondents say they will partner with other RECs to ensure their viability.
  • Staffing ranged from two to 80, with an average of 23 FTEs.
  • The #1 services priority is providing information services related to business intelligence and data warehouses, while optimizing EHRs and providing Meaningful Use services came in right behind.

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Fitch downgrades the bonds of Centegra Health System (IL), blaming its acquisition of physician practices and its EHR rollout (McKesson Paragon, I believe) for “light operating profitability.”

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Blue Cross Blue Shield of North Dakota fires its CEO right after the company reports an $80 million loss largely due to problems in its Noridian Healthcare Solutions subsidiary, which developed Maryland’s failed health insurance exchange website. Paul von Ebers had vowed Thursday to improve the organization’s financial position by reducing administrative overhead, which its board took to heart in unanimously voting Monday to fire him effective immediately.

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Guess which vendor is looking for a marketing director? Wrong … it’s HIMSS, trying to find someone to help push its many publications.

@deansittig tweeted out a link to an Epic promo-type video by Lucile Packard Children’s Hospital Stanford (CA) that is well done, but I liked the one above better.  

Some hospitalists at the annual conference of the Society of Hospital Medicine focus on IT issues, urging their peers to “establish ourselves for the informatics role we have taken” by earning informatics subspecialty board certification.

Weird News Andy intones that “exercise can kill you.” In Portland, OR, a naked man doing pushups in the middle of the street at 4 a.m. is run over and killed by a car, with predictable toxicology results pending. WNA can’t keep his hands off his Oregon as he files another story that he calls, “is there a governor in the house?” as ED doc and Oregon Governor John Kitzhaber jumps out of his limo to perform CPR on a collapsed woman (WNA wonders he couldn’t spare some compressions for Cover Oregon.)

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The family of a Miami doctor sues the driver of the Lamborghini in which he died when it crashed into a car stopped at a light at over 100 miles per hour two weeks ago. The driver, the founder of a vodka company, was drunk when he and the doctor left the Versace Mansion after discussing investments. The non-practicing doctor had a vodka company, too, going by the nickname Dr. Vodka.


Sponsor Updates

  • Deloitee’s Harry Greenspun, MD is interviewed about mobile health devices on Federal News Radio.
  • Strata Decision Technology, MedAssets, and Prominence Advisors are named to Becker’s “150 Great Places to Work in Healthcare.”
  • Helen Figge with Alere Accountable Care Solutions discusses how to still meet requirements for MU Stage 2.
  • Capsule’s Michelle Grate explores healthcare as a complex adaptive system and explains why it matters.
  • Beacon Partners recommends five steps for developing a CDI program as part of preparation for ICD-10.
  • Voalte releases a white paper offering three key elements to secure physician texting.
  • Advanced Data Systems will integrate Merge Healthcare’s iConnect Network with its MedicsRIS.
  • Truven Health reports that premature or low-birth weight infants funded by Medicaid cost nine times more than uncomplicated newborns.
  • T-System’s Elizabeth Morgenroth offers three reasons to start documenting for ICD-10.
  • Aventura CEO John Gobron discusses awareness computing bringing intelligence to the clinician workflow at the Healthcare IT Institute in Sarasota, FL.
  • Cottage Hospital (NH) reports that it has saved over $100,000 in interface fees since going live on Summit Healthcare’s interface engine.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 6, 2014 News 12 Comments

Monday Morning Update 5/5/14

May 4, 2014 News No Comments

Top News

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Blue Cross Blue Shield of North Dakota partially blames its poor 2013 performance on newly implemented EHRs of providers that delayed their insurance claims submissions, which it says caused it to underestimate the value of those claims. I didn’t realize until reading the CEO’s discussion that Noridian Healthcare Solutions is a subsidiary of BCBS of North Dakota. Noridian built the failed Maryland health insurance exchange and was fired from its $193 million contract in February. Maryland has hinted that it may sue Noridian in hopes of getting back some of the $55 million it has already paid toward Noridian’s five-year contract. North Dakota’s insurance commissioner says the agency is watching BCBSND to make sure it doesn’t try to increase insurance premiums in the state to cover Noridian’s projected $17.8 million loss. Every time I hear that name I think of Veridan Dynamics from “Better Off Ted.”


Reader Comments

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From Guillermo del Grande: “Re: CIOs. Here’s a list of “A Few Things CIOs Should Know (Or Think About).”

  • If you want the FDA to regulate EMRs but have a service level agreement of two days for major fixes, you may want to learn about software development models. If you have to ask what a software development model is, how did you get to be a CIO?
  • FDA requires waterfall development. This is not Niagara Falls.
  • How many of the good EMRs use waterfall any more? Here’s a hint: not many. Most are agile. EMRs are more complicated than a medical device. How many different medical devices connect to your EMR? Do you even know? Do you feel like testing every scenario per medical device that connects to your EMR? Do you think your vendor does that?
  • Are you afraid to let developers and your IT people watch healthcare and the software in action? You’re not agile. You’re going over the waterfall in a barrel.
  • If your SLA is two days, but you require a change control meeting that only happens every two days, and then a software testing process that takes two days, and then another change control meeting, and then only migrate changes once a week, you may have a problem.
  • How long does it take your vendor to fix a minor issue? You should be asking this question before you buy.
  • What makes you think your IT staff can fix a problem in a SLA period when you don’t know if it’s something your IT folks can do or it’s something the vendor has to do?
  • Do not try to manipulate an IT staff or a vendor into repairing your highest priority by only reporting that item. IT staff have lots of end users. Vendors have lots of customers and sometimes will fix issues only if lots of different customers are seeing them.
  • If you think a problem made it to the field because the software testers at the vendor didn’t find the issue, you don’t know much about how software companies. Remember that story about the guy who had his heart burned out of his chest a few years ago because of a bug? If not, look it up on HIStalk — it was a known issue for 10 years. Ask your vendor how many known issues they have in their tracking system. Hint: they’re not all reportables.
  • The Supreme Court is reluctant to take new cases and software developers are reluctant to fix bugs for many of the same reasons and use some of the same processes.
  • “Not a customer workflow” is heard at many a vendor to defend not fixing a bug, often before there are any customers.

Thoughts on FSMB’s “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine”

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The Federation of State Medical Boards is a Euless, TX-based non-profit trade association that represents all US medical boards that license physicians. It does not make regulations directly, but state boards usually adopt its recommendations.

Key points from its report include:

  • Telemedicine is defined as requiring videoconferencing. Encounters conducted via telephone or email are not telemedicine.
  • Physicians must be licensed in the state “where the patient is located” because physicians are licensed by individual states.
  • A physician-patient relationship must exist, but it can be established using telemedicine technologies.
  • The physician must document the patient’s history. Having the patient complete an online questionnaire doesn’t count.
  • The physician should obtain the patient’s informed consent, including a description of the security features of the telemedicine technologies being used.
  • The physician must make themselves available following the encounter.
  • The physician may not promote services for which they are receiving payment or benefits.

The intention of the group is clear. It wanted to prevent providers from selling prescriptions online. Nearly all of the wording restates requirements that are already in effect for traditional physician-patient encounters, clarifying that those requirements hold true for telemedicine-based encounters. The policy attempts to prevent online-only practices by prohibiting misleading websites, undisclosed financial relationships, and running an online consultation service simply to sell drugs online.

The only significant (but unsurprising) recommendation is that physicians must hold a license in the state where the patient is physically located during the encounter. That also is no different for traditional medical practice – an ED doctor in Florida can see vacationing patients from anywhere in the world from a Florida-based hospital, but he or she can’t travel to those other states to treat the same patients at their homes unless licensed there.

The most positive development for telemedicine supporters is that the model policy allows patients to be managed entirely by telemedicine without an in-person component.

The negative aspects of the model policy are:

  • FSMB isn’t a particularly transparent organization and didn’t disclose the members of the work group or who it consulted to develop its proposed policies. It also did not provide a way to incorporate industry or patient feedback.
  • Doctors already diagnose and treat patients by telephone and email, but those options are not considered telemedicine in the model policy, although it doesn’t limit or prohibit them. That would suggest that nothing changes for those visits, although future questions may come up involving payment for services.
  • Doctors must be licensed in the state where their patients are located, which isn’t even accurate in some cases (military physicians.)
  • It doesn’t address the desirability (nor should it have, most likely) of national rather than state-by-state licensure of physicians or an expanded reciprocity program that would make it easier to practice across state lines. That’s the biggest clash between telemedicine proponents and state regulatory boards, whose revenue and power come from overseeing in-state professionals and (arguably) protecting them from competition.
  • It calls for requirements that exceed those of non-telemedicine encounters, such as prohibiting randomly assigning patients to physicians (which EDs, walk-in clinics, and other services do routinely) and requiring that the medical records of patients be reviewed before treating them (which urgent care providers can’t do by definition.)

The conclusion is that telemedicine proponents wanted a policy that opened up state borders and encouraged innovative care, while FSMB’s goal was to prevent unethical doctors from running pill mills and online medical scams.


HIStalk Announcements and Requests

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A commendable 37 percent of poll respondents use an activity tracker at least five days per week. New poll to your right: should doctors be licensed nationally instead of state by state? It’s an important question if you think telemedicine can improve the efficiency and geographic reach of physicians.

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

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Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

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Vocera announces Q1 results: revenue up 10 percent, adjusted EPS –$0.14 vs. –$0.07, beating expectations for both. VCRA shares were the second-largest NYSE percentage losers on the news, shedding 14.7 percent. From the conference call:

  • The company released the Vocera Collaboration Suite and an expanded Vocera Care Experience in the quarter.
  • It opened a development shop in India.
  • President and CEO Brent Lang called hospital spending “challenging” as hospitals wait to see where changes in patient population and healthcare reform go.
  • He quoted a report that says 97 percent of hospitals don’t believe their nurses have the right tools to determine the availability of caregivers and that consumer-grade smartphones aren’t working well for hospitals.
  • Lang mentioned a tentative US Army study in which use of Vocera’s system provided a 12-month payback.
  • The alarm management system it gained with its mVisum acquisition in January 2014 will be launched this summer.
  • Lang said the company will pursue more acquisitions.

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Evariant, which offers a patient marketing platform, raises $18.3 million in a Series B funding round.

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Hc1.com says it will create 175 jobs in central Indiana over the next five years, having just received $3 million in state tax credits. I can’t really tell what the company is selling since the site is a mess of buzzwords and vaguely feel-good statements behind one of the worst company names I can imagine (shades of 1999), but it seems to be a customer relationship management system for outreach labs and radiology practices.

General Dynamics will lay off at least 645 Utah-based call center employees it had hired under a CMS contract to take Healthcare.gov related inquiries about insurance.

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CPSI announces Q1 results: revenue up 5 percent, EPS $0.69 vs. $0.63. From the conference call:

  • The company installed financial systems in nine hospitals and clinical systems in 12.
  • Add-on sales made up 26 percent of total revenue
  • The company expects to gain ground with MU Stage 2 as “a number of our competitors continue to struggle with obtaining certification for their software, as well as struggling with the installation and usability of their software in the small hospital market.”
  • Its new ED module will GA in Q3.
  • CEO Boyd Douglas says that while Epic and Cerner talk about moving into smaller hospitals, CPSI isn’t seeing much of that, mostly just their usual small-hospital system competitors (Meditech, McKesson Paragon, and Medhost, I assume.)
  • The Leerink Swann analyst managed to say “sort of” four times in one question, also using that annoying verbal crutch twice in a follow-up question.

Sales

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The Defense Health Agency awards Leidos a $70.7 million, sole-source contract to support its EHR systems for the next 11 months.

Nashville-based MindCare Solutions signs the first customer for its tele-behavioral platform and provider network, Genesis HealthCare, which will offer remote psychiatric services to its 400 skilled nursing facilities.


Announcements and Implementations

New York State Immunization Information System will use Blue Button to make records available to the parents of patients.

AMIA calls for nominations for its 2014 awards for informatics leadership, nursing informatics, informatics health policy contributions, and informatics innovation. Winners won’t necessarily be the best, just the best who pay AMIA dues: a key selection attribute is “demonstrated commitment to AMIA through membership.”

The Boston Business Journal profiles Alere Accountable Care Solutions, mentioning that it will offer its care management, connectivity, and analytics systems in Europe. I interviewed CEO Sumit Nagpal in October 2013.


Government and Politics

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President Obama makes fun of Healthcare.gov at the White House Correspondents Dinner on Saturday, saying that he has replaced his campaign slogan “Yes We Can” with “Control-Alt-Delete.” Near the end of his presentation, he pretended to have problems with a video and former HHS Secretary Kathleen Sebelius got a cameo as she rushed to the podium to fix it. The President’s last words of the evening, after thanking the press and uttering the obligatory “God Bless America,” were “Thank you, Kathleen Sebelius.” Other than following the party line, I question whether the fired Sebelius did anything worthy of that level of adulation.


Other

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A Minneapolis cardiologist, intrigued by the use of scribes in the ED, tries them in his cardiology clinic. The four doctors he studied were spending all but two minutes of their average 13-minute patient visit working on the computer. Turning that work over to scribes shortened the visits to nine minutes, but beyond that efficiency gain, patients got seven minutes of that as face-to-face time, nearly four times as much compared to non-scribe visits. The doctors saw 60 percent more patients using scribes, boosting revenue by $206,000 in 65 clinic hours. Patient satisfaction was unchanged, which is nice for making a case for scribes but not so nice for the doctors — all that extra face time apparently didn’t impress patients.

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Dr. Andy’s HIStalk Practice rant on the problem list is drawing interesting comments from his physician peers. Example: why can’t the problem list attribute cause and effect, or allow attaching meds to specific problems (or more than one problem?)

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The dean of the new Dell Medical School at the University of Texas (I wonder who paid for that?) says that while Austin is behind in a competitive biotech industry market, “Areas like digital health and informatics, no one owns that right now. That is an area that’s rapidly growing and ultimately it will win and be a huge area … Companies who handle personal data see that health is a huge frontier and represents a huge economic engine, but no one has been able to innovate the platform that scales to a huge field … There are companies waiting to do that, but no one is inviting them in. We can do that.”

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Mineral Community Hospital (MT) reports to its board that its NextGen implementation resulted in unplanned upgrade-related downtime and a 45-day delay in sending bills out for the 25-bed hospital.

A man Googling for CPAP machines for his sleep apnea notices that unrelated Google searches start displaying ads for those devices, leading him to complain to the Office of the Privacy Commission of Canada that targeting ads based on a health-related search constitutes a privacy violation. The office agrees after an investigation, determining that the practice not only violated its advertising guidelines, it also violated Google’s own policies that state the company won’t use health-related browser cookies to target ads. Google blames some of its advertisers and says it will improve its training and monitoring programs.

New York State Insurance Fund blames a software upgrade after the medical records of 20 worker’s compensation patients are to the wrong attorneys.

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Bizarre: a mother is awakened by the sound of a man’s voice in her sleeping 10-month-old daughter’s room screaming, “Wake up, baby.” She runs into the room and sees the camera of the video baby monitor turn toward her as the hacker who is controlling the camera starts screaming obscenities at her. The woman’s Foscam IP camera had been updated to fix a security flaw, but she didn’t know about it. The conclusion is that the Internet of Things will give hackers a lot of household (and hopefully not hospital) gadgets to play around with.


Sponsor Updates

  • The Health IT Quality Solutions Program of Quest Diagnostics certifies iPatientCare’s EHR as a Silver Quality Solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 4, 2014 News No Comments

News 5/2/14

May 1, 2014 News 4 Comments

Top News

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Defense contractor ManTech International will acquire 7Delta, which provides healthcare IT contracting to the VA, DoD, and HHS. ManTech wants a piece of the VA’s Transformation Twenty-One Total Technology program, for which 7Delta has won more task orders than any other vendor.


Reader Comments

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From Matthew Holt: “Re: HIMSS Analytics interview. Can the HIMSS PR people just stop with the BS? How many times do they have to say that they are a ‘cause-based, mission-based organization?’ This guy is selling market research to IT vendors and HIMSS non-vendor ‘members’ are all providers feeding at the federal teat. None of them are helping the starving in Africa. HIMSS has been on an acquisition tear in the conference and media business, including doing some extremely uncharitable activities towards its competitors there (not to mention the way they treat their vendor clients.) And Steve Lieber got paid $900K in 2011 and presumably over $1m by now. I’m a capitalist, I have no problem with anyone making money in healthcare while trying to change the world for the better, and I support the idea of more IT being a good thing. But seriously, who are they trying to fool with this rhetoric?” I seem to remember that HIMSS Analytics was originally set up as a for-profit subsidiary of HIMSS when it was first acquired many years, but something (presumably the IRS) forced a change. HIMSS is like hospitals: somehow it keeps minting more and more money and using it to buy for-profit companies (conference organizers and publishers, mostly) and then suddenly declaring them to be non-profit. The annual conference generates a ton of cash that can only go so many places: big salaries (check) and acquisitions (check). Or the less-obvious choice: HIMSS could scale its income to its expenses rather than vice-versa.

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From Boy Wonder: “Re: Allscripts. The company sent an email to its portal users saying Medfusion caught the the company off guard with its announcement.” Medfusion announced this week that an unspecified payment dispute will force it to shut down access to its portal by Allscripts customers as of May 31, 2014 unless they sign a new contract directly with Medfusion. The Allscripts email reassures those users that they can be live on the Allscripts FollowMyHealth portal (the former Jardogs product it acquired in March 2013) by October 1 if they commit by May 31. The bottom line is that those 30,000 users have to make a commitment to one of the companies within four weeks, and if they choose Allscripts, they’ll have to try to strike their own deal with Medfusion to keep their portal running until they can make the switch. The Tullman-era Allscripts made a colossally bad decision to redistribute Medfusion’s portal instead of developing or acquiring its own, making both the company and its customers vulnerable to the actions of an external vendor. Allscripts predecessor Misys made a similarly bad decision in licensing a customer version of iMedica (now Aprima) that Allscripts resold as MyWay before retiring it and leaving those users in an equally unpalatable position through no fault of their own. In both cases, Allscripts gets a black eye for putting its customers in a jam and then trying to migrate them to another Allscripts product to fix it.


Dim-Sum provides the usual cryptic and amusing update of the Department of Defense’s commercial EHR system selection process, or as he or she describes, “Status and latest rumors in the halls of bedlam, located right K Street.” This is a huge many-billion dollar deal and the only insider reports I’ve seen are coming right here from Dim-Sum, so thanks for the update.

May 2014

  1. DHMSM competitive teams are almost in place.
  2. Themes are being discussed, ideas are being circulated and people are starting to wonder, “Why did I pick this team?”
  3. CACI, where are you, and has anyone seen where Harris, SRA, and yes even CGI went?
  4. HP is getting press and nobody knows why. I bet you wish you thought of the Newseum “experience” (outstanding job by IBM/Epic, or should it be Epic/IBM?)
  5. Whatever you do, IBM, do not mix Epi-BM for your team moniker. That is a bad connotation in healthcare.
  6. GDIT is sitting on the sideline with Northrop Grumman watching in awe as their fellow poobah Lockheed has found functional and willing partners in Siemens and Athena. Good luck, best of breeders! Lockheed please note: Boston is an academic mecca, you will be comfortable there. Now the firm in the Philly suburb, whatever you do, do not wear a Redskins tee shirt — Eagles fans will hurt you.
  7. CSC is trying to figure out how they can make a cloud in the shape of an EHR – fun!
  8. Accenture is still confident, proof positive that their strategy was focused on any large EHR vendor in the Central time zone. Personally, I like the combination – well done, Jim and Ken – airline tickets are cheaper to Kansas City anyway. Kansas City, sadly, is located 70 miles south of the airport.
  9. Teams are congealing. However, smalls are scrambling and the ones invited to the table are excited. They tend to pontificate upon their vast knowledge of the current environment and then wonder if that is something to brag about.
  10. IBM, can you please bring back the Blue Man Group for an epic focused percussion’ fest? That would be very cool, and yes, the pun was intentional.
  11. There will be an online course for all participating COTS vendors explaining  cutting edge Kyrgyzstan interoperability standards like FTP, as well as expressing how each and every hospital across the Military Health System has one single positive attribute — they serve heroes. Outside of that, the technology is fair to awful.
  12. Had some initial thoughts about themes for each team:

    IBM / EPIC: “Judy and Watson, sitting in a tree, K-I-S-S-I-N-G!”
    Lockheed / Athena, Siemens: “We build planes, ships, and missiles. How tough a nut can healthcare be?”
    Accenture / Cerner: “DHMSM is like an onion — lots of layers and lots of tears.” Sorry, Accenture, my kids are watching Shrek.

More in June…


HIStalk Announcements and Requests

I hear through murky sources that a huge acquisition will be announced Friday morning (by “huge” I mean “you won’t believe it.”) I’m skeptical, but also receptive to being tipped off early if you are knowledgeable of the supposed deal. The fact that I’ve heard it only once suggests that my caution is well placed.

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The latest “CMIO Rant” from Andy Spooner, MD is on HIStalk Practice where he addresses “The Problem List: Foe or Enemy?” complete with screen mockups. His first rant was “The Great Prescription Pad Race.”

Highlights from HIStalk Practice this week include: Medfusion parts ways with Allscripts over payment disputes. The EHRA opposes ONC’s proposed 2015 voluntary EHR certification criteria. A National Quality Forum panel finds pay-for-performance programs unintentionally worsen disparities between rich and poor. Forty percent of physician practices are looking to replace their EHRs, while those struggling to improve collections are taking on more aggressive billing strategies. Researchers find that almost one-third of patients fail to fill first-time prescriptions. 2014 MU incentive payments indicate a potential slow-down in EP participation. Thanks for reading. This week on HIStalk Connect: NIH announces a series of grants aimed at spurring mHealth research focused on chronic disease management, remote patient monitoring, and telemedicine. Doximity, often described as LinkedIn for doctors, announces a $54 million Series C round. Israeli startup Consumer Physics launches a Kickstarter campaign to fund a handheld digital spectrometer that it claims can scan food and calculate calorie and nutritional content. Dr. Travis discusses the 10-year horizon of connected health devices and the implications that they could one day have on healthcare overall.


Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

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The Kuwait Investment Authority takes a $100 million position in Patrick Soon-Shiong’s NantHealth. I wasn’t paying attention to the company’s logo placement on the page above and thought that the female on the left was sporting a Hiawatha-like Native American headdress.

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Merge Healthcare reports Q1 results: revenue down 20 percent, adjusted EPS $0.04 vs. –$0.01. From the earnings call:

  • The ICD-10 delay moves up window during which hospitals may consider upgrading their imaging systems.
  • The company’s MU2 certifications give it opportunities with ambulatory radiology and orthopedic customers.
  • Merge improved its Epic integration and avoided an issue involving provisional patents.
  • Merge’s eClinical OS clinical trials system has 18,000 users.
  • The company will introduce a retinal screening product for diabetes and glaucoma patients, with the target customer being hospitals that are bearing risk.

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Streamline Health announces that its Q4 and FY2013 results will be delayed until the end of May as the company’s new auditors review its internal controls. The company says three unnamed go-lives will contribute recurring revenue beginning in Q2 and it booked a new sale for one of the products it obtained in its $6.5 million acquisition of Unibased Systems Architecture in February 2014.

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Etransmedia Technology acquires Medical Billing Solutions, expanding its geographic presence placing it in the top 10 large scale RCM services business.

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Athenahealth announces that CFO Tim Adams will leave the company to take the same role with electronic commerce vendor Demandware, naming VP/Controller Karl Stubelis as acting CFO.


Sales

New York City Health & Hospitals chooses UpToDate from Wolters Kluwer Health for mobile clinical decision support.

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Citizens Medical Center (TX) chooses electronics forms management from Access.


People

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IBM names Keith Salzman, MD (CACI International) as CMIO for IBM Federal, which hopes to sell Watson and other technologies to the federal government for healthcare use.

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Health Data Specialists promotes Bill Chandler to national accounts manager.

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TriZetto announces John McAuley (PatientPoint) as president of its provider solutions business.

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John Thornbury, a highly awarded hospital IT leader in England, died on April 28.


Announcements and Implementations


St. Vincent’s Medical Center (CT) goes live with Cerner, according to a tweet from the hospital’s CEO.


Government and Politics

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CMS proposes increasing Medicare payments by 1.3 percent overall for FY2015 for the 3,400 acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program and that have met Meaningful Use EHR requirements. Hospitals that haven’t met Meaningful Use would lose 0.675 percent of the proposed increase.  

ONC releases a 30-second promotional video about Blue Button.

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The VA says it will develop the next generation of its VistA EHR with the help of contests and challenges. Former VA guru Tom Munnecke is unimpressed: “It is not clear how the government owning all submissions in a contest will attract the best in the field. It is unlikely that many people would be interested in spending time and money to enter a contest where they give away their intellectual property.”

The Health IT Policy Committee will hold a May 7 public hearing in Washington, DC to review ONC’s certification process. It seeks input on allowing anyone to submit test cases so that certification measures real-world scenarios.

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HHS didn’t want the Congress-mandated ICD-10 delay in the first place so it’s hardly shocking, but a proposed 1,700-page rule changing Medicare payments seems to confirm that ICD-10 will be implemented at the earliest date allowed by law – October 1, 2015. It could be that someone just updated the pre-delay document and forgot that Congress mandated only the earliest date, not the actual date – it’s only a proposed rule. The same document also spells “HIPAA” as “HIPPA,” so even the federal government gets confused.


Other

Most physicians order unnecessary tests and procedures if their patients insist, but they also agree that ordering such tests and procedures is a big problem. They think doctors are better equipped to solve the problem (58 percent) than the government (15 percent), according to the telephone survey funded by the Robert Wood Johnson Foundation.

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Athenahealth VP Kyle Armbrester explains the company’s More Disruption Please program:

Our unique spin is that, because we take a percentage of net collection, we don’t actually partner with technology companies. We partner with outcomes companies like ourselves. So to be a part of the More Disruption Please program, we give our partner the scorecard, and that scorecard shows how they’re either driving more revenue to the doctors for doing the right things, or decreasing operational inefficiencies inside the providers’ workflow, or helping to improve patient and provider outcomes.

I’m always fascinated when family members riot and destroy hospital infrastructure after an unfortunate patient outcome (which doesn’t usually happen in the US, thankfully.) In Pakistan, a mob riots at a hospital, trashes the place, vandalizes cars in the parking lot, and beats up doctors and other employees after an appendectomy goes wrong and the patient ends up on a ventilator. Five days later, doctors haven’t declared the patient dead, and I wouldn’t either given the situation.

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Microsoft gives in on its “no more updates for Windows XP” policy after the Department Homeland Security warns people to stop using Internet Explorer until the company fixes a security hole present in versions 6 through 11 that “could lead to complete compromise of the affected system.” The company says it will issue a one-time-only Windows XP auto-update to fix the vulnerability.

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CHIME tweet out this photo of its 1994 Board of Trustees. Who can name them all?

Weird News Andy calls this story “Well Shut My Mouth.” Pediatrics nurses in a Saudi Arabian hospital are caught taping the mouths of babies shut to stop them from crying.


Sponsor Updates

  • First Databank will present new safety guidelines for pediatric dosing at the 2014 Pediatric Pharmacy Conference April 30-May 4 in Nashville, TN.
  • NC HIE upgrades its Orion Health Direct Secure Messaging.
  • Ingenious Med will integrate Entrada’s dictation and content fulfillment technology into its charge capture platform.
  • A report names Allscripts, Health Catalyst, McKesson and Verisk as key players in the population health management market.
  • HCS will lead a discussion on LTCH CARE data set changes at the NALTH meeting in Washington, DC this week.
  • Gartner names Validic in its 2014 Cool Vendors for Healthcare Payers report.
  • Health Catalyst announces speakers and topics for the Healthcare Analytics Summit 2014, to be held September 24-25 in Salt Lake City, UT.
  • DrFirst expands its Rcopia e-prescribing with electronic prior authorization functionality from CoverMyMeds.

EPtalk by Dr. Jayne

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Mr. H already scooped me on this one, but the Federation of State Medical Boards (FSMB) recently adopted “Policy Guidelines for Safe Practice of Telemedicine.” My gut reaction is that this is just another way for licensing boards to extract more money from physicians by requiring additional licensure. My second response in actually reading the document (numbered line by line such that it reminded me of a deposition) is that there seems to be a whole lot of self-importance going on here. The seven-and-a-half page document has a Preamble, for goodness sake.

Physicians have been practicing by telephone and using secure messages for years, but apparently now we need to codify new standards just because there is technology involved. News flash: all the old standards (HIPAA, standard of care, ethics, etc.) already apply.

Some of the policy’s contents are very much common sense:

  • The need for a “credible physician-patient relationship.” I suppose they’re trying to prevent physicians from turning into so-called pill mills, but then again they haven’t done a great job of preventing those in traditional face-to-face medicine. A quick look at the number of dishonest physicians selling work excuses and gratuitous prescriptions for controlled substances proves that.
  • Adherence to privacy, security, consent, and safety principles. Again, already in force simply because we’re physicians.
  • Proper supervision of non-physician clinicians.

On a subsequent read, however, several other provisions caught my eye.

  • “Where appropriate, a patient must be able to select an identified physician for telemedicine services and not be assigned to a physician at random.” Isn’t this exactly what happens when a patient presents to the emergency department, an urgent care, or many public health clinics? They are seen by the next available physician. They don’t get to pick and choose. Same thing with the assignment of patients to managed Medicaid panels, at least in my state. Again, not a lot of choice there and often a random assignment. Why should telemedicine be treated any differently?
  • “A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located.” Again, this feels like a money-grab. I practice in a border town. The idea that I should have to get a different state license to practice telemedicine on a patient when I can see them in person with the license I already have if they’re willing to hop in the car, bus, or train is preposterous. What is magical about telemedicine that I should have to prove my competence to another state board?
  • “The practice of medicine occurs where the patient is located.” I tend to think the practice of medicine occurs where my brain and ears are located – where I can hear, understand, and process the patient’s story. In medical school, we learned that 80 percent of the diagnosis comes from the history. The exam just confirms it and provides additional information when it is unclear. I guess the FSMB is now going to turn that old adage on its head. What if my patient sends me a camera phone picture of her rash (via a secure patient portal message using Certified EHR Technology) while on her beach vacation? Do I need a Florida license now because that’s where the patient is? The policy seems to say so, per Page 4, Lines 3-5 and 13-14. Maybe those line numbers were handy after all.
  • “The maintenance of preferred relationships with any pharmacy is prohibited.” Excuse me? I have had preferred pharmacies my entire career. I prefer Mom and Pop shops rather than chains, especially when they know their stuff and don’t try to sell my patients aisles of junk food, questionable candy, and outdated cosmetics. I really prefer a pharmacy that doesn’t tell the patient, “The physician never sent your script” when they’re too busy to check the secondary screen on their prescribing software. I agree with the follow-up sentence that physicians shouldn’t send scripts to a specific pharmacy in exchange for benefits if we’re talking about SIGNIFICANT benefits (oh yeah, there’s a typo on Page 7, Line 23) but really, no preferred pharmacy? Does the fact that the Mom and Pop down the street brings a physician homemade cookies during the holidays make her unduly coerced? After all, that’s a benefit. What if the physician also takes them cookies because she’s grateful they are so meticulous with her patients’ scripts? Does that negate the benefit?

In this day and age with the mobility of our society, mobility of physicians, and the technology at hand, it seems more and more preposterous that individual states should continue to license physicians individually and/or without a greater degree of reciprocity. There are all kinds of problems with physicians being disciplined in one state and just going for a license in another state. Why not have a national licensure process? I suppose a counter argument would be that Medicare has a single provider identifier but still can’t correctly identify fraud, but that’s another story.

I really like their closing paragraph. Here’s a winner: “…physician remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral)…” Why should this be unique to telemedicine? Isn’t this something we grapple with on a daily basis, patients who come in wanting a script or referral they don’t need? What about those that want a test “because Medicare pays for it” whether they need it or not? Often our remuneration is ultimately based on whether we comply, either through patient satisfaction scores or the simple fact that they will vote with their feet. On the flip side, what about aesthetic medical services? Aren’t those ultimately driven by patient-desired outcomes? Especially ones like this recent find for aesthetic foot surgery.

On its face, this policy regulates us too much in regards to telemedicine, but perhaps I’ll go a little Jonathan Swift and suggest that maybe we’re not regulated enough in regards to everything else. It’s like saying we’re going to regulate wine in a box but not in a bottle. At this point, the policy is “advisory” so states can take it, leave it, or modify it.

What do you think about the FSMB’s plans for telemedicine and telemedicine technologies? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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May 1, 2014 News 4 Comments

News 4/30/14

April 29, 2014 News 6 Comments

Top News

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MModal files its plan to exit Chapter 11 bankruptcy by August 15. The company provided a statement: “MModal is pleased to have reached this important milestone in our financial restructuring process. The proposed Plan of Reorganization reflects the previously announced agreement the company reached with the controlling majority of its lenders and bondholders that will dramatically reduce the company’s debt, strengthen its balance sheet, and provide it with significant financial flexibility.”


HIStalk Announcements and Requests

ICD

Bonny from Aventura provides an Charles Schulz-powered illustration of the ICD-10 situation that will resonate with many people.

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I noticed these signs in a doctor’s office today. It seems that all forms of customer-insulting emphasis are represented: capitalization, bolding, underlining, and massive deployment of exclamation points (always five except for the laptop message, which ends with an unprecedented six exclamation points for those undeterred by inferior numbers.)


Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)


Acquisitions, Funding, Business, and Stock

4-29-2014 7-29-41 AM

Physician networking site Doximity closes a $54 million Series C fundraising round, planning to expand into Canada and to add other healthcare professionals, such as nurses.

4-29-2014 1-47-30 PM 

Truven Health Analytics acquires Fortel Analytics’ predictive healthcare fraud technology, which will be integrated into Truven’s payment integrity solutions.

4-29-2014 11-29-53 AM

General Atlantic commits $125 million to Alignment Healthcare, which offers a care coordination solution.

4-29-2014 1-49-40 PM

Alere reports Q1 results: revenue down three percent, adjusted EPS $0.55 vs. $0.53, missing revenue expectations. The company also reported that its Health Information Solutions segment experienced a decline in net product and services revenue from $134.2 million a year ago to $123.7 million.

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Press Ganey acquires Dynamic Clinical Systems, a patient-reported outcomes services and solutions provider.

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Infor completes its acquisition of substantially all the assets of GRASP Systems International, a provider of automated patient acuity, workload management, patient assignment, and consulting services.

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Consumer engagement provider Accolade acquires konciergeMD, which offers a platform for care plan adherence.

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For-profit hospital operator HCA discloses in its earnings call that it took in $30 million in EHR incentive money in Q1 vs. $39 million in 2013, incurring EHR-related expenses of $43 million and $26 million, respectively, meaning it spent exactly the same as it made in the two years. Seems like quite a coincidence.

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Roper Industries says in its earnings call that its Sunquest operation experienced “double-digit revenue growth” due to improvements in its implementation process and expects to have a “quite an exceptional year in 2014.”

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A German business magazine predicts that Siemens will announce on May 7  the elimination of 5,000 to 10,000 jobs and the merging of its four main divisions (industry, energy, healthcare, and infrastructure/cities) to create a flatter hierarchy.


Sales

Craneware wins a seven-year, $3.8 million contract with an unnamed US hospital group for its Chargemaster Corporate Toolkit.

Southern Illinois Healthcare, MBB Radiology (FL), Radiology Imaging Associates (CO), Southwest Diagnostic Imaging Center (TX), St. Paul Radiology (MN), and Washington Radiology Associates (VA) and 13 other organizations select Merge Healthcare’s iConnect Network interoperability platform for clinical data exchange.

CHE Trinity Health will implement Verisk Health’s Provider Intelligence solution and DxCG platform to manage its national population health management initiatives.

4-29-2014 9-48-17 AM

The board of trustees of Cumberland River Hospital (TN) approves $156,644 in upgrade costs to allow the hospital to update its CPSI software to meet Stage 2 MU requirements.

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The University of Arizona Medical Center will use services from Besler Consulting to identify Medicare Transfer DRG underpayments.

Kettering Health Network (OH) selects Wolters Kluwer Health’s ProVation Order Sets.

University of New Mexico Medical Group chooses StrataJazz from Strata Decision Technology for budgeting and planning.


People

4-29-2014 1-53-45 PM

Castlight Health appoints Ed Park (athenahealth), brother of co-founder and US CTO Todd Park, to its board.

4-29-2014 1-55-41 PM

Symphony Technology Group promotes Al Vega to president/CEO of Symphony Performance Health.

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Jonathan Perlin, MD, CMO will step down as chair of ONC’s HIT Standards Committee. He will be replaced by Jacob Reider, MD of ONC.

MEA|NEA appoints Scott Hefner (Jopari Solutions) VP of sales.


Announcements and Implementations

4-28-2014 3-24-39 PM

Practice Fusion launches a population health management offering in collaboration with drug manufacturer Merck, giving practices a real-time dashboard that compares a provider’s patient vaccination rate with the rates of other Practice Fusion providers.

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Regional Medical Center Orangeburg (SC) goes live on Cerner’s patient portal.

Central Illinois Health Information Exchange, Lincoln Land Health Information Exchange, Illinois Health Exchange Partners, and MetroChicago Health Information Exchange connect their health information exchanges, which collectively serve 63 hospitals.


Government and Politics

4-29-2014 1-17-28 PM

CMS releases an interactive search tool to streamline access to Medicare provider payment data.

The GAO appoints three members to the Health Information Technology Policy Committee: Christop U. Lehmann, MD, American Academy of Pediatrics (representing vulnerable populations); Neal Patterson, Cerner (representing vendors); and Kim Schofield, Lupus Foundation of America’s Georgia chapter (representing consumers and patients.) Paul Tang, MD of Palo Alto Medical Foundation was reappointed as physician representative.


Innovation and Research

Physicians reviewing EHRs carefully read the impression and plan section, but only quickly scan details on medications, vitals, and lab results, according to a study published in Applied Clinical Informatics. Researchers recommend optimizing the design of electronic notes to include “rethinking the amount and format of imported patient data as this data appears to largely be ignored.”

Brigham and Women’s Hospital chooses four companies in its “shark tank” competition for pilot projects: Twine Health (collaborative chronic disease management), MySafeCare (patient and family reporting of safety concerns), Healo (remote monitoring of wound healing), and Tenacity Health (peer health coaching.) 


Other

The Federation of State Medical Boards approves telemedicine guidelines that include a policy to apply the same standards of care for remote medical encounters as for in-person encounters. The guidelines also call for physicians to care for only those patients located in their licensure coverage areas, establish a credible patient-physician relationship; and adhere to safety and privacy principles.

A Boston Globe columnist names Nuance Communications CEO Paul Ricci as the most overpaid executive in Massachusetts based on his compensation of $87 million over the past three years, during which time the company’s share price dropped 16 percent.

4-28-2014 9-44-15 AM

Medfusion ends its relationship with Allscripts “due to unresolved payment disputes” and gives the 30,000 Allscripts users of its patient portal until May 31, 2014 to sign a contract directly with Medfusion. The termination is hardly a surprise given Allscripts acquisition of the competing Jardogs product last year.

Boston Medical Center (MA) terminates its transcription contract with MDF Transcription Services after discovering that the records of 15,000 of its patients are visible on the company’s Internet server.

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St. Joseph’s Hospital Health Center (NY) discloses in a prospectus offering to sell $68 million worth of junk-quality bonds to pay for a new power plant and EHR system that it will probably be sued over claims that a disruptive surgeon slapped and verbally abused anesthetized patients going back to early 2012.

Rural hospitals are considering EHR implementation assistance as one reason to affiliate with a larger organization, hoping to earn financial incentives or avoid penalties.

University of Mississippi Medical Center (MS) CIO David Chou recounts what it’s like when a hospital loses Internet connectivity and access to cloud-based applications. The article mentions that low adoption rates prevented using Twitter and Facebook for communication during the outage, which I assume means by smartphone cellular since nobody could get to those sites otherwise (although they could use self-hosted Yammer instead if Microsoft still offers that.)

A San Francisco Examiner opinion piece by an orthopedic surgeon complains about his hospital’s use of the “all-pervasive Epic” system, which he says has caused doctors to focus on the computer instead of the patient and has sterilized the medical record to the point of uselessness. He seems to blame the system for the behavior of its users, saying it only improves care “from the point of view who want to watch data from across the room” while he prefers to “talk to the patient” and be a “hands-on doctor,” neither of which as far as I know is prohibited among Epic users.

UPMC (PA) will partner with one of three unnamed companies to sell analytics software it developed to benchmark costs per individual physician. UPMC says it spent $5-12 million to develop the system, which it claims has reduced its readmissions by 37 percent.

4-29-2014 1-06-39 PM

A state audit reveals that a former IT consultant with the University of Iowa Hospitals and Clinics illegally sold $57,000 worth of hospital computers to staffers and friends between 2005 and 2013. A woman tipped off the IT department after trying to get technical support from Dell for a laptop the consultant gave her, only to be told that it was registered to the hospital.

Weird News Andy (“Weird News You Can Use”) finds this ironic: hundreds of attendees of the national Food Safety Summit in Baltimore get food poisoning. WNA is also transported by this story, in which doctors trigger vivid memories of a patient’s childhood as they stimulate areas of his brain with electrodes in trying to determine the cause of his epilepsy.


Sponsor Updates

  • McKesson launches Managed Mobile Services to simplify mobile device management.
  • iHS2 releases a research report entitled “Healthcare Security: 10 Steps to Maintaining Data Privacy in a Changing Mobile World.”
  • Craneware and its customer Southeastern Ohio Regional Medical Center will discuss the future of patient access at the National Association of Healthcare Access Management 40th Annual Education Conference May 16 in Hollywood, FL.
  • Independent auditor LBMC confirms that PerfectServe has achieved Service Organization Controls (SOC) 2 Type II of its security and privacy controls.
  • Allscripts recognizes its customer Carson Tahoe Health (NV) for attesting for MU Stage 2 using Allscripts Sunrise.
  • Medhost adds high-availability disaster recovery and remote monitoring and management to its managed IT service offerings.
  • Shake IT Baby is the theme for Impact Advisors’ annual Impact Palooza April 30-May 2 in Scottsdale, AZ.
  • William J. Leander, SVP for Santa Rosa Consulting, will discuss value-based healthcare at next month’s MUSE 2014 International Conference in Dallas.
  • Allscripts profiles Unity Health System (NY) in a blog post and discusses how dbMotion’s HIE technology helped Unity achieve better outcomes.
  • Liaison Healthcare partners with AOD Software to connect its long-term provider customers with lab and imaging vendors on the Liaison EMR-Link hub.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 29, 2014 News 6 Comments

Monday Morning Update 4/28/14

April 26, 2014 News 9 Comments

Top News

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Cover Oregon waves the white flag and shuts down its $248 million health insurance exchange website without having enrolled a single citizen. The state will convert the site for Medicaid enrollment for an additional $35 million (federal taxpayers will pay 90 percent of that) and everything else will be turfed off to Healthcare.gov. The only winner is Oracle, which was paid $134 million even though the state says the company failed to deliver what it promised. The folks who run Cover Oregon, who seem to think their credibility emerged unscathed, say it would have cost $78 million to fix the disaster it oversaw but only $5 million to piggyback onto Healthcare.gov, which it could have done on Day 1. The money Cover Oregon wasted, like that of other states that decided they could build their own sites slightly less incompetently than the federal government, is pretty much gone since the site was to have paid for itself via a tax on insurance company sales.


Reader Comments

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From The PACS Designer: “Re: Google Ara. Google’s approach to the next smartphone will be a modular one called Ara from Google’s ATAP (advances technology and projects) group. By allowing the Android phone to be constructed to a controlled style, it will let developers limit what a user can do with the smartphone. This should be of interest to those who want to reduce BYOD usages in institutional settings.” It’s an interesting approach, like taking tablets back to the IBM-compatible PC days when you could buy components from anybody and just plug them in. I suppose the upside is that your phone will have a long life cycle since it’s really just a core board that accepts components. On the downside, Google excels at building ugly, frustratingly non-standard products (Gmail) and Apple and Samsung phones are selling just fine even if they are rendered obsolete after only two or three years. Not to mention that Google has no retail stores from which to sell and support consumer hardware. I’m no expert, but this project has “bust” written all over it, which seems to be a regular occurrence among the Googlers these days.

From Ex-Epic: “Re: Epic. Has been sending a team of people to Denmark (Copenhagen) for a few months now on regular sales/early stage implementation meetings. Haven’t seen it mentioned here with the other international sales mentioned lately.” I mentioned in November 2013 that Epic would be providing systems for all of eastern Denmark.


HIStalk Announcements and Requests

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Most poll respondents don’t think any differently about HHS after it released Medicare physician payment information. New poll to your right: do you use an activity tracker such as FuelBand or Fitbit at least five days per week? My sense is that the wearables fad is over – the devices don’t measure a whole lot given their cost and walking still isn’t fun or practical for many people – they don’t need discouraging electronic reminders that they failed to meet their goal.

Listening: new from Stream of Passion, because I can go only so long without needing some Dutch progressive-opera metal (fronted by a female singer from Mexico for some reason.)

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I support DonorsChoose projects that help classrooms in need, and in return, I get nice thank-you emails and photos from the teachers who appreciate the support. I realize I haven’t mentioned the most satisfying part – receiving letters from the students themselves. This particular project was for remanufactured toner cartridges and file drawers for a total cost of $187 as donated by HIStalk on behalf of readers. One of the students said, “I’m grateful that you donated to us because some teachers don’t have any printing supplies and my teacher was one of those people, but now he’s not, so I’m thanking you.” This is from a highest-poverty school in Mississippi, where the teacher (Mr. Delperdang, a Teach for America teacher )was spending his own money printing classroom materials from home.  


Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.


Acquisitions, Funding, Business, and Stock

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From the Cerner earnings call:

  • The company’s backlog increased to $9.24 billion. For non-investment types, “backlog” refers to products or services that have been sold, but whose revenue hasn’t been recognized due to accounting principles. In non-manufacturing businesses like healthcare IT, backlog is a good thing because it represents sales that haven’t shown up as income yet but will down the road. Backlog isn’t positive for manufacturers because it means your factory isn’t cranking out widgets fast enough, meaning you’ll need to make big capital investments to increase capacity or else your customers will find another vendor.
  • Sales revenue increased 4 percent, but the big jump was in services at 25 percent. Cerner is very good at generating that kind of recurring revenue without having to go through the grueling process of finding new customers, especially ones who are also considering Epic.
  • The company sold zero new ITWorks or RevWorks deals, and in fact “have not added a full RevWorks client in recent quarters.” Cerner just can’t seem to get anything right when it comes to financial software and services.
  • 25 percent of the quarter’s bookings were to non-Millennium customers. That’s a big deal – obviously the company is taking business away from someone else’s customers.
  • The company says the ICD-10 delay will give a slight boost to its revenue cycle business because some prospects were on a software hold while focusing on ICD-10. They didn’t mention that if that’s true, business will take the same slight downturn next year when ICD-10 looms again.
  • Revenue from sales outside the US dropped 16 percent, mostly because of reduced low-margin hardware numbers.
  • Cerner’s highly publicized deal with Intermountain Healthcare was summarized as pushing trigger events in front of clinicians, with the challenge being to turn the processes Intermountain has developed into “self-contained diagnostic, treatment, outcome, and reimbursement containers” that “replaces the claim in the fee-for-service world” and that can be used in non-Cerner systems. Sounds great if it works, which has never been the case in any example I can recall where a big-name hospital’s rules were benevolently sprinkled down like holy water on bowing masses of less-blessed hospitals.
  • The company mentioned HIMSS exhibits that showed “elegant graphs that purport to provide great insight into the data,” but that unless you can put that information in front of the physician in real time, “you’re just reporting the news vs. making the news.” That sounds inherently true, but the reality isn’t quite that dramatic – a hospital could use an analytics system to find potential areas of improvement (right down to the individual physician) and then use its order entry/clinical decision support system to build in guidance make it easier for physicians to do the right thing. Hospitals have plenty of capability built into the systems they already own without chasing yet another Intermountain project that seems to work for nobody except Intermountain. Every hospital I’ve worked in had plenty of information that could have improved outcomes and cost – what they lacked wasn’t technology, but rather the willpower to make the significant percentage of cowboy doctors follow the agreed-on rules. They needed competence and leadership, not more information to ignore.
  • Concluding the Intermountain hype was a statement saying that the most exciting part of the partnership is to sell Cerner consulting services.
  • The company still claims it can steal some Epic clients who have reached EMRAM Level 7 “because they don’t feel like the solution they have will suit their future needs.” I would think the best chance of that happening would be to undercut Epic’s maintenance costs, but Cerner didn’t mention that.
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Tee Green, CEO of Greenway Health, provided HIStalk with this statement regarding the departure of President Matt Hawkins (above),who came over from his previous role as CEO of Vitera when Vista Equity Partners bought Greenway and combined the two companies in November 2013:

Matt Hawkins was instrumental in driving the growth and operational efficiencies at Vitera Healthcare, helping position that organization to combine with Greenway Medical Technologies and SuccessEHS to form the company Greenway Health is today. As Matt prepares to assume a new leadership role outside of Greenway, we’re very excited for him and wish Matt and his family nothing but the best. As Greenway moves forward, our priorities remain the same: to continue supporting and enhancing our solutions and to help our customers remain efficient and financially strong as they deliver care that improves the health of their patients and whole patient populations.


Sales

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Texas Health Resources will deploy the AirStrip One clinical mobility solution throughout its system.


People

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Joshua Seidman, PhD (Evolent, ONC) joins Avalere Health as VP of the newly created Center for Payment and Delivery Innovation (according to the press release) or Center for Delivery System System and Payment Innovation (according to his LinkedIn profile.)

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KentuckyOne Health (KY) names Doug Jones (Providence Health & Services) as regional CIO.


Government and Politics

The AMDIS listserv brings up an interesting CMS attestation calculation quirk: any measure that requires “more than” a specific percentage actually requires the next-higher whole number percentage. You fail if you hit 50.4 percent on a measure that requires “more than 50 percent” since CMS rounds down to 50 percent and you didn’t exceed that. It’s bizarre that they round numbers at all.

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The HIMSS EHR Association offers its comments to ONC’s proposed 2015 EHR certification criteria:

  • Early notice of proposed changes helps vendors prepare, but doesn’t address the real problem — certification rules are changed too often.
  • Vendors would have less than a year to build 2015 requirements into their products, so they want the edition labeled as 2016 rather than 2015.
  • Vendors can’t spend all of their time chasing certification requirements – they also have to consider customer requests and other government-mandated changes.
  • ONC underestimates the cost for vendors to keep up with its requirements – EHR says the real cost numbers are 10 times those ONC puts out and the 2015 criteria will be more than 15 times more expensive than ONC claims.
  • EHRA doesn’t think certification should be required for anything other than providers collecting HITECH money – certification should not be broadly expanded.
  • EHRA says it’s not reasonable to put the electronic clinical quality measures in 2017 edition certified software – there’s not enough time left.   

Innovation and Research

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Brigham & Women’s Hospital (MA) will hold Pilot Shark Tank on Monday, where entrepreneurs are invited to pitch their ideas to hospital doctors and nurses who can approve a pilot project. Finalists are CareMon (3D optical patient monitoring), Constant Therapy (iPad-based stroke rehab therapy), Healo (remote monitoring of wound healing), Home Team Therapy (PT programs for home), MySafeCare (patient and family reporting of safety concerns), Revvo (bio-adaptive exercise bike), Tenacity Health (peer health coaching), Twine Health (collaborative chronic disease management), VerbalCare (patient-caregiver communication), and Vital Score (Apgar-like scoring of unhealthy behaviors that contribute to chronic illness).


Technology

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In the least-surprising news of the week, Google+ goes comatose as its leader quits, its teams are reassigned, and the groups working on its Hangouts and photo features are moved under the Android operating system. Only Google could have designed product even clunkier and more confusing than Facebook except without the first-mover advantage and network effect that keep Facebook popular (at least for now.) Nobody wanted to use it as a Facebook alternative, so maybe at least some of its expensively developed parts can be salvaged for something useful. People wants EHRs to be as simple to use as Facebook, so maybe Google could drag up the moldy source code for Google Health and kludge something together that would turn two flops into one success.

Most electronic hospital  equipment can be taken over by hackers,according to a study by healthcare provider Essentia Health: IV pumps can be changed over the network, Bluetooth-powered defibrillators can be triggered at will, and unsecured medical images can be viewed by anyone, for example. The Essentia team also found that they could reboot some devices to force them back to factory defaults and that many pieces of equipment are connected directly to the Internet instead of being inside the firewall, allowing any hacker to simply plug into an available hospital jack and start finding devices to hack. A key finding is that EHRs accept data from unauthenticated devices, so bogus information could cascade into more harmful treatment decisions.

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More speculation on why Nike stopped manufacturing its FuelBand activity tracking hardware: the software portion (NikeFuel) may end up on Apple’s iWatch or other wearable platforms.


Other

Security experts say the hacker network that calls itself Anonymous may be responsible for a series of cyberattacks launched against the website of Boston Children’s Hospital (MA), which left patients and clinicians unable to use the hospital’s portal (the site is down as I write this Saturday afternoon). The group had demanded that the hospital fire the head of its child abuse prevention unit after a high-profile custody battle in which the hospital filed medical abuse charges against the parents of a 15-year-old female patient who was later placed in the state’s custody. Anonymous found itself embarrassed two weeks ago when it launched attacks against Israel-based sites, but Israeli hackers launched a counterattack by tracking the IP addresses of the Anonymous members and hacked their computers, including hijacking their webcams to snap and publish photos of the not so Anonymous members.

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Athenahealth announced last week that it was dropping its membership in the HIMSS EHR Association, which it says “ostensibly” represents EHR vendors in federal policy debates. The company says it “never really belonged there in the first place” because EHRA is dominated by non-cloud EHR vendors and athenahealth isn’t really an EHR vendor but rather a services company (a debatable point.) Athenahealth (a) doesn’t like that EHRA pushes for more vendor-friendly federal policies (longer timelines, lower bars) and (b) wants CMS to name vendors whose customers seek hardship exemptions while EHRA “presses just as hard to protect its members from the consequences of their failures by opposing any such disclosure.” EHRA decided not to wage press release warfare with athenahealth, but says its membership diversity creates value and credibility and while it’s sorry to see athenahealth leave, some of the company’s statements are incorrect (specifically the one claiming that EHRA opposes hardship exemption transparency, about which I could indeed find no stated EHRA position.) Athenahealth also says it takes too much time to explain to people why it regularly disagrees with its own trade association. My opinion: athenahealth voluntarily joined EHRA hoping to gain something from it (DC influence, publicity) and is quitting for the same reason (publicity and hoping to differentiate itself competitively from its former fellow members, especially after ATHN announced unimpressive quarterly result last week). Customers don’t care one way or another, and with the company’s size, it can do its own Washington glad-handing. Every member of CommonWell Health Alliance (except Sunquest) is also a member of EHRA, so maybe athena should storm off from that group as well.  At some point, a large, publicly traded company crosses the line from “disruptor” to “disruptee” and athenahealth may be getting close.

ECRI Institute’s listing of healthcare IT data integrity as the #1 problem facing healthcare organizations includes specific examples: data entry errors, missing or delayed delivery, accepting incorrect default values, copying and pasting, using both paper and electronic systems, and incorrectly attributing device data to the wrong patient. It recommends assessing clinician use, improving testing, offering better training, and giving users an easy way to report system problems they see.

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Athenahealth’s Jonathan Bush and business writer Stephen Baker team up to write Where Does It Hurt?: An Entrepreneur’s Guide to Fixing Health Care, available May 15. Sounds interesting except that JB’s incessant verbosity makes it tough to convince free milk drinkers to plunk down cash to buy the cow.

Strange: a New York doctor is sued for stiffing the Scores strip club for $135,000 worth of lap dances in four visits over 10 days. He claims he was drugged by club employees and disputes that he was even present despite security camera video suggesting otherwise. A Scores spokesperson said of the cardiologist, “If I had five dancers dancing for me, I’d be in the ICU. He’s a heart doctor – I guess he’s got a good heart.”


Sponsor Updates

  • Liaison Healthcare enhances its EMR-Link EHR interoperability solution with Meaningful Use Stage 2 capability.

Switching from a Cloud-Based EHR Vendor

I mentioned a while back about hearing from a physician practice that was finding it next to impossible to extract EHR information from their cloud-based EHR to move to a different system. I offered to write about the experience from the points of view of both the vendor and the practice. Here is a summary of the communication, which should provide lessons learned for both customers and vendors.

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From Matthew “Toby” Cox, MD, MPH, Families First Pediatrics, South Jordan, UT

  • We started with ADP AdvancedMD in April 2011, but found it didn’t meet our needs and we are switching to the peds-specific PCC EHR.
  • ADP Advanced MD claimed on their website that they won’t hold data hostage – they will provide an encrypted hard drive with all data plus mapping and documentation within one week for $1,250.
  • We paid $1,250 on January 30, 2014 and received a thumb drive several weeks later. The new vendor, PCC, says the new information is a comma-separated value file that makes no sense.
  • After several weeks of getting no response, ADP AdvancedMD (whose national headquarters is less than a mile from our practice) sent a technician, who said the file the practice was given was incomplete. Another file was supposed to be sent, but wasn’t.
  • Three months later, we still have no usable data and the ADP AdvancedMD representative suggested pulling up every patient chart and printing a PDF.

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Response from Jim Elliott, VP of marketing, ADP AdvancedMD

  • The delay was due to a process issue that has been resolved.
  • The ADP AdvancedMD rep hand-delivered the 4.5GB data file that can’t be split into smaller files readable by Access or Excel because records are sorted by date of service and that would break up a patient’s chart.
  • The practice had set up templates and each field they used can only be defined by the practice since the system doesn’t “know” how they are being used.
  • The new vendor, PCC, understood the layout and required no further changes.

From Dr. Cox

  • Nobody from ADP AdvancedMD told us in training that when we added items to templates that we were adding “codes” that would complicate the data extraction process.
  • Our last EHR conversion from another vendor at least gave us individual patient PDFs that could be accessed by a menu button – not ideal, but usable.
  • The practice management data extract from ADP AdvancedMD was perfect. Only the EHR information is a problem.
  • I asked ADP AdvancedMD during their sales pitch about our access to our data if we decided to leave since it seemed unusual that they were offering a month-to-month contract. Their salespeople said we would have access to the data and be provided a hard copy of it. I was not savvy enough at that time to probe deeper into this as I took their word for it (dammit Jim, I’m a doctor, not a computer data specialist!)

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From a programmer at Physician’s Computer Company (PCC)

  • We never indicated to ADP AdvancedMD that we found their extract usable. The limited guidance we received was weeks later and only after repeated requests.
  • We do vendor conversions every week and have done every major vendor. This is the only one that we have not been able to convert.
  • Anyone on ADP AdvancedMD who thinks they can switch vendors is deluded.
  • Here is a consecutive snippet … it’s the same date of service for the same patient, but it’s a random mix of stuff.

From Dr. Cox to ADP AdvancedMD

  • If you were handed that data file, how would you import the information into Advanced MD step by step?
  • Has anyone every successfully imported that information into another system?
  • Is a bulk export to an industry-standard layout (CCD/CCR/CCDA) possible?
  • Can a mass export to PDF be done as a last-ditch effort to get patient information into their new system?

From Jim Elliott to Dr. Cox

  • There were communications gaps between the two vendors. ADP AdvancedMD spoke to PCC’s technicians and understood that the new vendor had everything needed to convert.
  • ADP AdvancedMD is still a few months away from delivering the capability to bulk export to CCD or CCR, but it can be retrieved from individual patient records.

The practice’s information is still not available in their new system three months after their initial request and payment and Dr. Cox is worried about the clinical impact to patients of missing three years’ of their data.

My suggestion: regardless of whether your EHR vendor is a traditional or cloud-based one, ask them now (not later) for the names of former customers who successfully migrated off their platform with all data intact (which will prove that it’s at least possible). Or, far less desirably, ask for a sample extract with documentation.

I’ll also ask the technical folks who work for EHR vendors to weigh in on the data snippet above. Would your company be able to migrate intact, complete patient records using a file with that layout? It looks to me as though the individual items are identified using free text and non-standard codes that would be meaningless outside the source system.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 26, 2014 News 9 Comments

News 4/25/14

April 24, 2014 News 4 Comments

Top News

4-24-2014 3-29-28 PM

Cerner delivers strong Q1 numbers: revenues up 15 percent, adjusted EPS of $0.37 versus $0.33 a year ago, both in line with analyst estimates. The company also reported its $910.2 million in bookings was an all-time number for a first quarter.


Reader Comments

4-23-2014 11-18-55 AM

From Haberdash: "Re: Matt Hawkins. Greenway sent an email to customers saying that President Matt Hawkins is on the way out.” The note, which was sent Tuesday, indicates that Hawkins is leaving the company to pursue “an exciting new leadership position outside of the company.” The departure of Hawkins, who was CEO of Vitera Healthcare prior to the Greenway/Vitera merger, could be unsettling for any Intergy customers already concerned about Greenway’s long term product strategy. I emailed the company Wednesday for a comment but have not yet received a reply.


HIStalk Announcements and Requests

4-24-2014 2-25-32 PM

inga Mr. H is out and about today so I am flying solo. I am not sure what he’s up to but since I’d like to be sitting on a beach with an umbrella drink, I’m just going to pretend he’s doing something fun like that.

Some highlights from HIStalk Practice this week include: EHR vendors could learn from Surescripts’ “alliance of foes” model. The AMA reminds providers to order their ICD-9 codebooks for 2015 now that ICD-10 has been temporarily shelved. CVS MInuteClinic surpasses 20 million patient visits since opening its first in-pharmacy site in 2010. Rushed physicians create frustration and tension for both patients and providers. Orthopedists were the most highly compensated physicians last year. Wikipedia trumps Google Flu Trends and the CDC in tracking flu outbreaks. Dr. Gregg promotes “multiview” as a necessary EMR feature. Thanks for reading.

This week on HIStalk Connect: Nike shuts down its Fuelband activity tracker line, cancels plans to introduce a new tracker this fall, and eliminates 55 of the 70 staff members in the activity tracker business unit. Twitter announces the winners of its #BigData grant program, half of which were healthcare-focused research projects. In an otherwise neglected market, eCaring raises a $3.5 million Series A for a simplified health journal designed to help seniors age in place by trending for changes in physical or behavioral health and alerting appropriate caregivers.

 

 


Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.

 


Acquisitions, Funding, Business, and Stock

4-24-2014 5-59-20 PM

VMware reports Q1 results: revenues up 14.2 percent and adjusted EPS of $0.80 vs. $0.74, beating estimates.

4-24-2014 6-00-20 PM

Kaufman Hall, a provider of financial consulting services and software for healthcare, acquires Axiom EPM, a provider of financial performance management software for healthcare and other industries.

4-24-2014 6-01-16 PM

Huron Consulting Group enters into an agreement to acquire the assets of Vonlay.

4-24-2014 6-03-27 PM

Quest Diagnostics posts Q1 numbers: revenues down 2.3 percent and adjusted EPS of $0.84 vs. $0.89 a year ago, missing estimates. Quest blames an unusually harsh winter that deterred people from going to its centers for tests.

4-24-2014 6-04-08 PM

NexJ Systems acquires Liberate Ideas, developer of a point-of-care patient education solution.

4-24-2014 12-56-39 PM

Owlet, developers of a smart baby bootie monitor that measures a child’s heart rate, raises $1.85 million from multiple firms, including ff Venture Capital and Eniac Ventures.

Heart Corporation expands its Hearst Health group and Zynx Health division with the acquisition of CareInSync, the developer of a mobile platform for provider-patient communications.

4-24-2014 4-07-22 PM

CTG attributes its 22 percent drop in Q1 profits on lower revenue from its healthcare technology services business. CEO James R. Boldt says the lower revenues are the result of hospitals delaying EMR and other IT implementation projects as they manage Medicare cuts from a year ago.

HealthStream reports Q1 results: revenues up 29 percent and flat earnings of $0.07 per share, beating revenue estimates but missing on earnings.

 


Sales

4-24-2014 2-56-27 PM

Crozer-Keystone Health System (PA), Tahoe Forest Health System (CA), Capital Health (NJ) and Hocking Valley Community Hospital (OH) will implement the InteHealth Patient Portal.

Michigan Health & Hospital Association Keystone Center will use RegistryMetrix from ArborMetrix at 60 hospitals to capture OB data and measure clinical performance.

4-24-2014 2-59-17 PM

Johns Hopkins Health System selects Carestream Health’s Vue PACS system.

Southern Illinois University HealthCare selects Allscripts TouchWorks EHR for its physician clinics.

4-24-2014 3-46-20 PM

SCL Health System will implement Stanson Health’s clinical decision support system.

 


People

4-24-2014 5-20-42 PM

Population health management and patient engagement provider Rise Health names Connie Moser (McKesson) president and COO. Moser replaces Mark Crockett, MD, who will remain as CEO, and Fred Croft, who will shift to CFO.

QPID Health forms an advisory that includes David W. Bates, MD (Brigham and Women’s Hospital); John D. Halamka, MD (Harvard Medical School); Julia Adler-Milstein (University of Michigan); and Robert M. Wachter, MD (University of California, San Francisco).

4-24-2014 6-46-47 AM

Extension Healthcare hires Jill Vavala (CareFusion) as CNO.

4-24-2014 6-57-58 AM

Covisint names Michael Keddington (McDermott & Bull Executive Search) SVP of worldwide sales.

4-24-2014 5-22-01 PM

The NCQA appoints Michael S. Barr, MD (American College of Physicians) EVP in charge of leading the organization’s research, performance measurement, and analytics efforts.

4-24-2014 1-51-06 PM

David J. Bensema, MD moves from CMIO to CIO for Baptist Health (KY).

4-24-2014 2-31-56 PM

Essia Health names Rachel Leiber (Providence Health & Services)  to lead the company’s EMR implementation services division.

4-24-2014 2-50-55 PM

Accretive Health CEO Stephen Schuckenbrock will step down from the troubled company when his contract expires October 2.  Last month the company was delisted from the NYSE after failing to file restated financial reports from 2012.

 


Announcements and Implementations

4-24-2014 10-03-27 AM

The Greater Houston Healthconnect network and the Austin-area Integrated Care Collaboration establish health information sharing through the Texas Health Services Authority’s HIETexas.

4-23-2014 2-53-30 PM

American Health Network implements eClinicalWorks Care Coordination Medical Record for population health management to manage its three ACOs in Ohio and Indiana.

Via Christi Health (KS), which is owned by Ascension Health, will go live on its $85 million Cerner system June 1 across all of its Wichita hospitals and clinics.

Behavioral Health Information Network of Arizona leverages NextGen’s Mirth Connect platform to become the first statewide behavioral health information exchange in the country.

4-24-2014 5-24-10 PM

Lady of the Sea General Hospital (LA) goes live with T-System’s EDIS EV.

4-24-2014 3-50-31 PM

The W. W. Caruth Jr. Foundation awards Parkland Center for Clinical Innovation (TX) a $12 million grant to establish the Dallas Information Exchange Portal to connect Parkland Memorial Hospital with local social service agencies.

 

 


Government and Politics

HHS says two entities have collectively paid almost $2 million to resolve potential HIPAA violations following the theft of unencrypted laptop computers.

The House Appropriations Committee approves a 2015 budget plan to that would hold back 75 percent of the VA’s requested funds to upgrade its EHR until Congress is convinced the DoD and VA are making progress in their efforts to share EMRs.

4-24-2014 2-42-29 PM

CNN reports on the Phoenix VA Health Care System and how delays in scheduling appointments has led to 40 deaths. The report also reveals details of a scheme by VA managers to hide the scheduling delays in order to improve official scheduling metrics. A retired VA doctor claims that the health system maintained a “sham” waiting list that was shared with Washington officials that showed timely appointments, as well as a real but hidden list with wait times of more than a year. To create the secret list, staff entered appointment details into the computer, printed the screen, but did not save what was entered. Patients remained on the secret list until the scheduled appointment was within 14 days, then details were transferred  to the sham list and the hard copy was shredded. The US House Veterans Affairs Committee is now investigating.

4-24-2014 2-39-30 PM

The FBI warns that healthcare systems and medical devices face an increased risk of cyberattacks because private health data has a higher financial payout on the black market than credit card numbers.

 


Other

4-24-2014 6-16-30 PM

The chairman of the board of supervisors for Riverside County Regional Medical Center (CA) takes Huron Consulting to task and questions its lack of progress fixing the hospital’s financial woes. Huron, which is six months into a $26 million dollar engagement, was hired to implement cost-saving initiatives to address the hospital’s $83.2 million cash shortfall, but so far the deficit has only been cut $1.2 million. The hospital’s CFO defended Huron’s work, noting that the company’s efforts have already contributed to $9 million in savings, but declining patient traffic during the same period has resulted in a $12 million decline in revenue.

4-24-2014 1-56-25 PM

The Department of Labor predicts a 22 percent increase in the number of jobs for medical records and health information technicians between 2012 and 2022.

Health IT, care coordination, and drug shortages lead an ECRI-complied list of top 10 patient safety concerns for healthcare organizations.

4-24-2014 4-12-58 PM

Forty percent of physician practices are looking to replace their existing EHR, according to a Software Advice report. Among buyers replacing their EHR product, the most common replacement reasons: the current solution is too cumbersome and/or integration is needed between applications.

A Rhode Island court issues a consent decree saying that the state’s EHR database CurentCare must be more transparent and offer patients more privacy protection. The ruling stems from a 2010 lawsuit filed by the ACLU that charged the state’s department of health didn’t spell out clearly or publicly enough how patients could remove or change their own records from the database.

A quaky lawsuit out of Oregon: a woman sues her mother’s neighbor after the neighbor’s pet duck attacked her. The duck ambushed the woman without provocation, causing her to fall, break her wrist, and sprain an elbow and shoulder. The victim, a retired nurse, is seeking $275,000 for pain, suffering, and other damages.

 


Sponsor Updates

  • Elsevier will market Stanson Health’s CDS alerts and analytics solutions.
  • IDC Health Insights names Wellcentive a leader in its MarketScape report on US population health management vendors.
  • Merge Healthcare releases iConnect Retinal Screening for identifying and diagnosing patients with diabetic retinal disease.
  • Quest Diagnostics recognizes Liaison Healthcare’s EMR-Link solution with its Quality Solutions Certification for meeting or exceeding HIT quality standards for secure clinical lab ordering and results reporting.
  • BESLER Consulting will market the MedAptus charge capture management suite to its clients and MedAptus will promote BESLER’s revenue recovery and compliance services.
  • McKesson Business Performance Services adds outpatient and inpatient facility coding services to its coding and compliance portfolio of services.
  • CommVault enhances its PartnerAdvantage program for channel partners to accelerate revenue growth and simplify collaboration.
  • Quest Diagnostics acquires the remainder of Steward Health Care System’s (MA) outreach laboratory services operations and will provide testing services to providers previously serviced by Steward.
  • iHT2 posts highlights from its Atlanta Health IT Summit.
  • Imprivata hosts its HealthCon 2014 conference May 4-6 in Boston.
  • Aspen Advisors shares a white paper on building a technology roadmap to support an organization’s value-based model.
  • Orion Health and two of its customers will discuss how state public health agencies can expand the use of integration engines to prepare for quality reporting during the Public Health Informatics Conference April 29-30 in Atlanta.
  • Health Catalyst opens registration for the 2014 Healthcare Analytics Summit September 24-25 in Salt Lake City.
  • Aspen Advisor principal Jim B-Reay offers tips for keeping the mind fresh in  CHIME’s CIO Connection.

EPtalk – by Dr. Jayne

I caught up with one of my medical school buddies this week as she was passing through town on the way to the class reunion that I’m skipping. She’s a primary care doc turned informaticist as well, so the opportunity to talk shop with someone who has walked a mile in the same virtual shoes as me was exciting. We got to chatting about the Flip the Clinic initiative which aims to “re-imagine the medical encounter between patients and care providers.”

The website has a variety of information on “flips” in categories like communication, design, education, empowerment, etc. The idea is that by making the clinical interaction better, patients will be healthier and providers happier. Although I like the idea it’s a little hard to get on board without some objective evidence that these interventions will make a difference. Some of them are straightforward: reducing noise in the healthcare environment, or removing physical barriers between patients and the office staff. Others are more abstract such as reforming the broken payment system. I think it’s great to have a discussion but I’m not seeing how some of these concepts will translate into practice, especially for those of us who are in employed models.

My former classmate and I have both struggled with being employed physicians and our inability to get buy-in from administrators when we want to try innovative maneuvers. Administrators frequently want proof that we’ll have positive return on investment but fail to realize not all returns are monetary. It’s difficult to try to find energy to fight the status quo when all the forces surrounding us (MU, CMS, HIPAA, and the rest of the alphabet soup) seem designed to stifle any attempt to think outside the box.

It’s going to take more than concerned individuals to truly Flip the Clinic. Organizations will need to address culture issues and there will need to be institutional buy-in before change can begin. The commitment needed to actually have that level of change take place, let alone “stick” and become hard-wired is something that very few of us can muster right now.

From Demo Dave: “Re: replacement systems. I sold EHR systems to physician groups for 15 years, all before MU started to skew the market. At least 30-35 percent of the systems I sold were to practices looking for additional functionality that was already in their existing system. These practices simply never learned to utilize the capabilities of their existing systems. When an administrator told me their existing EHR was lacking functionality or reporting, I simply smiled and confirmed what they wanted in a new system. I then focused demonstrations and implementations to meet their needs.” Many EHRs have gotten to the point where they have more features than users can understand let alone incorporate on a daily basis. Anyone who thinks they can learn a system with a few days of training and never think about it again is woefully shortsighted. Having workflow validation and optimization visits at 30, 60, and 90 days post go-live can help – any bad habits can be corrected and new features can be regularly introduced to those users who are ready for them. Customers should also consider actually reading the user manual and other documentation before they throw the proverbial baby out with the bath water.

Most of our readers know I enjoy a good cocktail and also love to travel, so I was intrigued by a story on NPR that talked about powdered liquor. I should have read it right away rather than bookmarking it for later – when I returned it had been updated stating it’s not actually legal in the US. Apparently I’ll have to go to Japan, Germany, or the Netherlands to check out the options.

Speaking of the need for a stiff drink, there’s still a fair amount of chatter about the release of the Medicare payment data. The newest Coda-a-Palooza challenge  calls for developers to leverage that data to “help consumers improve their health care decision-making.” I’m a professional, I understand what the Medicare data does and does not reflect, yet I still struggle to think of ways that the data can be useful in consumer decision-making. The site says the data “shed significant light on how physicians actually work.” Excuse me? How does data on Medicare payments explain how I care for patients? Maybe I’ll understand better in June when the winners are announced. In the mean time, any explanations that you can send my feeble post-call brain?

Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

smoking doc

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April 24, 2014 News 4 Comments

News 4/23/14

April 22, 2014 News No Comments

Top News

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Continua Health Alliance, mHealth Summit, and HIMSS launch the Personal Connected Health Alliance to represent the consumer voice in personal connected health to ensure that technologies are user-friendly, secure, and can easily collect, display, and relay personal health data.


Reader Comments

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From Less Disruption Please: “athenahealth. Friday was a tough day. Their outage was apparently due to catastrophic loss of power. It took out email, production, and backup sites. At least they apologized.” Unverified.


Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.



Acquisitions, Funding, Business, and Stock

4-22-2014 11-36-25 AM 

AdverseEvents, a healthcare informatics company focused on drug safety and side effects, closes $2 million in Series A financing.

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Informedika changes its name to Health Gorilla.

Lexmark reports that revenues for its Perceptive Software division grew 38 percent in the first quarter.


Sales

4-22-2014 11-44-46 AM

Evangelical Community Hospital (PA) selects dbtech’s eFolder solution for enterprise content management.

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Griffin Hospital (PA) will implement athenaCoordinator Enterprise.

UMass Memorial Health Care (MA) will integrate Luminat’s end-of-life directives platform into its EHR.

Alder Hey Children’s Hospital (UK) selects Summit Healthcare’s interface engine technology.

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Missouri Baptist Medical Center will deploy the Vocera Communication System.



People

4-22-2014 11-21-15 AM

EHR/PM provider Pulse Systems appoints Richard Ungaro (RU Investment) SVP of operations.

4-22-2014 11-22-32 AM   4-22-2014 11-23-32 AM

NoteSwift hires Stan Swiniarski (Nuance) as VP of products and Art Nicholas (Nova Dynamics) as VP of sales and business development.

4-22-2014 12-20-58 PM

MediTract, a provider of automated contract management solutions, appoints Ed Caldwell (Emdeon) SVP of sales and marketing.

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CMS Principal Deputy Administrator Jonathan Blum, the administration’s top Medicare official, will resign effective May 16.

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Cancer Treatment Centers of American names Kristin Darby (Tenet Healthcare) CIO.


Announcements and Implementations

Athenahealth reports that 95.4 percent of its participating providers successfully attested for MU Stage 1 in 2013. The company also resigns from the HIMSS Electronic Health Records Association (EHRA) trade association saying it “never really belonged” since it is neither an EHR company nor a software vendor.

Maine’s HealthInfoNet HIE offers providers access to the state’s Prescription Monitoring Program through the HIE’s portal, giving clinicians a single sign-on to both systems.

Children’s Hospital of Philadelphia and Virtua (NJ) integrate their imaging systems as well as CHOP’s Epic and Virtua’s Siemens EHRs to give both health systems access to each other’s radiology reports and diagnostic images.

4-22-2014 12-34-36 PM

Prince Mohammed Bin Abdulaziz Hospital in Saudi Arabia deploys Cerner after a nine-month implementation.


Government and Politics

CMS officials are considering whether to keep Accenture as its long-term prime contractor for the the HealthCare.gov website or seek a potential replacement. A “sources sought” notice posted by CMS says the agency is looking to see if any small businesses owned by veterans or minorities might be suitable candidates.


Other

Use of Epic’s Care Everywhere HIE tool helped four EDs within Allina Health (MN) reduce duplicate tests and procedures, according to a study published in Applied Clinical Informatics.

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Boston Children’s Hospital (MA) partners with Etiometry to analyze information from ICU patient monitors to display a Stability Index.

Weird News Andy says patients have to pay for expensive ICU stays, but maybe this isn’t the best way. Police arrest a female ICU patient after a tip from hospital staff that she was receiving many visitors who stayed only 1-2 minutes. She was dealing heroin from her bed.


Sponsor Updates

  • Kinetic Data names CareTech Solutions its Innovator of the Year for its innovative use of Kinetic Data products.
  • Craneware enhances its supply management solution Pharmacy ChargeLink to include additional worklist functionality, benchmark pricing, and automated dosing tools.
  • PaySpan will integrate MEA|NEA’s electronic claim attachment capabilities into its healthcare reimbursement platform.
  • McKesson observes Earth Day with a Green Week celebration that focuses on informing employees about the company’s efforts to reduce its environmental footprint and engaging employees in environmental efforts.
  • Wolters Kluwer Health releases the Medi-Span Medicare Plans File, which provides indicators to designate coverage under Medicare Part B and/or Part D.
  • Holon explains why HIE implementations in rural healthcare can trump those in urban settings in a company blog post.
  • The Advisory Board Company shares an infographic  that highlights how progressive organizations are focusing on primary care providers to achieve volume and quality goals.
  • Surgical Information Systems updates its industry, client, and anesthesia events calendar.
  • Aperek will participate in the SMI Spring 2014 Forum in Phoenix April 29-May 1.
  • Halim Cho, Covisint’s director of product marketing will discuss the cloud’s disruptive power to transform enterprises at the May 5 Forrester Forum for Technology Management Leaders in Orlando.
  • John Marshall, SVP and GM for AirWatch by VMware, offers his enterprise mobility market perspective in an interview.
  • Shareable Ink’s founder and CTO Stephen Hau organized a Boston Marathon team that raised over $750,000 for last year’s bombing victims.
  • Netsmart opens registration for its CONNECTIONS2014 conference October 6-9 in Anaheim, CA.
  • The Orion Health Patient Portal v.4.0 achieves ONC HIT 2014 Edition Complete EHR Certification through ICSA Labs.
  • Navicure adds 300 new clients representing 1,225 providers in the first quarter and posts a 19 percent increase in revenues versus a year ago.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 22, 2014 News No Comments

Monday Morning Update 4/21/14

April 19, 2014 News 8 Comments

Top News

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UPMC (PA) says that the information of 27,000 of its employees was exposed in a February breach and the hackers have filed fraudulent tax returns for 788 of them so far. A lawyer seeking class action status of his lawsuit asks the obvious question: why did the breach involve only 27,000 of UPMC’s 62,000 employees? The attorney points out that UPMC first claimed that only 20 employees were affected, then 322, and now 27,000, obviously concluding that all employees may be at risk despite the announcement. The tax scam is a smart one since the IRS, like HHS, pays first and asks questions later.


Reader Comments

From Weary CIO: “Re: branding. I have background in market research and healthcare IT branding is useless. It works in retail, so marketers in vendor companies use it to have something to do. They come up with thin and useless stuff like logos on napkins because if they don’t, they are out of a job. If marketing is what you do, that’s what you do. Private industry is more acutely aware that overhead positions are more vulnerable to reductions so they have to try to stay relevant. Waste creates so many employment opportunities!” I had questioned offline to Weary CIO the value of expensive signage and “branded” items at events when I rarely notice them. My enjoyment of HIStalkapalooza was unaffected logos on lampshades.

From Down Boy: “Re: athenahealth. Down Friday – all sites, communications, interfaces, etc. Confirmed with hospitals and practices in CA, MO, SD, NH, and ME.” Unverified.

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From Locked Box: “Re: athenahealth. Their ‘More Disruption Please’ program was supposed to be a collection of companies offering easily integrated products that would give athena customers functionality the company doesn’t offer, which would support innovation by giving those companies access to customers. In return, the companies would offer a discount to their customers, lowering the barrier to innovation. Now athenahealth has changed the program to a revenue share model, which is a 20 percent tax on interoperability for us and our customers, which is why we joined. We are leaving the MDP program.”

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From Excelsior: “Re: JASON report. HHS’s report is similar to the 2010 PCAST report, including calls to represent health information as ‘atomic data with associated metadata.’ Two people involved in the PCAST report were also involved in the JASON report: Craig Mundie and Sean Nolan, both of Microsoft.” The report says “the entire health data infrastructure will be crippled” without better interoperability and recommends that EHR information be stored using common mark-up language and that EHR vendors should open up their systems via APIs that allow third parties to build on them with new applications. EHR vendors aren’t likely to embrace this concept enthusiastically given that the report recommends architecture that can “provide a migration pathway from legacy EHR systems,” but of course their EHR customers would need to apply pressure on their vendors to make it happen anyway since government reports have zero bottom line impact. Other findings:

  • Meaningful Use criteria “fall short of achieving meaningful use in any practical sense,” mostly having replaced faxed machines with electronic delivery of page-formatted records that patients can’t access directly.
  • Current EHR interoperability work hasn’t developed opportunities for entrepreneurism.
  • HHS could take an active role by using future Meaningful Use stages, starting with Stage 3, and certification to force an open software architecture. ONC should publish standards to accomplish that within one year.
  • Researchers need better access to EHR data.
  • Meaningful Use Stage 3 should require vendors to develop, publish, and verify APIs that allow searching their systems with semantic harmonization and vocabulary translation. System acquisitions by the VA and DoD should require those published APIs.
  • EHR-powered fraud detection tools should be developed.

From Guillermo del Grande: “Re: consultants. Here’s a list of ‘Things Consultants Wish Their Customers Knew.’”

  1. Very few consulting companies have a bench.
  2. If you post a position with six different vendors, a consultant with a resume on Dice will receive six different calls.
  3. If you yell at a consultant for looking at Facebook, chances are that’s why you need a consultant in the first place.
  4. Trying to find someone with seven years of experience in an application that’s only been around for five years probably won’t end well.
  5. If people can’t manage in the operations side, what the hell does putting them into the IT department going to accomplish?
  6. Recruiting firms are really good at making phone calls and searching job boards. This is pretty much it. Many consulting firms are actually recruiting firms.
  7. If you are going to be managing consultants, please do not panic when they know more than you about the application that you scraped through getting a certification in, and then ignored for several months before deciding you needed to augment your staff.
  8. If you want the FTE to learn from the consultant, you may want to see if the FTE has a pulse and an IQ.
  9. If you fire four consultants in a row, chances are that it’s not them, it’s you.
  10. Two hiring managers with a feud fighting through hiring consultants and making them mess with each other is annoying, expensive, and somewhat common.
  11. Yes, consultants have faults. Thank you for pointing them out every morning. Why did all your FTEs leave again?

HIStalk Announcements and Requests

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The White House is most responsible for the ACA-related failures such as Healthcare.gov that led HHS Secretary Kathleen Sebelius to resign, according to 47 percent of poll respondents. New poll to your right: do you feel better or worse about HHS after its release of Medicare physician payment information? I felt worse: the lawsuit-mandated release of the data reminded that like pretty much all federal programs, taxpayers should be appalled at how their money is being spent, the cost of the self-protecting bureaucracy required to spend it, and the remarkably breezy oversight that expensive bureaucracy provides in return. Not to mention that Medicare payment rules are so convoluted that even they can’t figure out when they (meaning we) are being defrauded. HHS is like the IRS in that regard and I don’t trust either of them to enforce politics-embedded rules that nobody understands.

Listening: new from Atlanta-based melodic hard rockers Manchester Orchestra.


Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.


Acquisitions, Funding, Business, and Stock

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From the athenahealth earnings call:

  • The Epocrates team “continued to struggle on new booking attainment” and missed revenue targets with an eight percent reduction since the acquisition. The company is looking for a VP of sales.
  • The company started using the Net Promoter Score and fell short of its goal with a 44.7 vs. planned 47.3 (vs. a high 70s score for Amazon and Apple.)
  • The company urged investors to look at full-year results instead of quarterly.
  • In admitting that athenaCoordinator’s planned “one percent of system revenue” model was not followed in its first two sales, Jonathan Bush said that the company was desperate to get those sales and had no references for the prospects. The plan remains to collect a percentage of health system collections.
  • The company blamed an increase in its AR days to health plan deductible resets, slower patient payments, vacation days, bad weather, and a weaker flu season.
  • Low-margin real estate investments hurt gross margin.
  • Bush says an obstacle to the company’s growth is that consulting companies can’t earn fees from its implementation, so it will be “repositioning ourselves around the larger process improvement for the health system around coordination and care that actually will generate very productive, useful as oppose to wasteful consulting fee in the interest of the consulting firms.”

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Here’s a one-year view of ATHN’s share price (blue) vs. the Nasdaq (red).

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Healthbox, which runs medical accelerator programs, raises $7 million in expansion funds. One of its investors is Intermountain Healthcare. The company also announces that it will launch Healthbox Solutions to showcase healthcare IT products to hospitals.


Government and Politics

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A ProPublica analysis of the CMS physician payments database finds that doctors previously charged with fraud and Medicare overbilling continue to make big money from the program. Medicare paid a psychiatrist who was arrested and barred from the Medicaid program in 2011 $862,000 in 2012. Sen. Chuck Grassley (R-IA) said Medicare and Medicaid programs need to communicate since, “The new transparency makes it harder to ignore when doctors who harm patients or defraud taxpayers in one program face no consequences in the other program” (how about a little bit of interoperability push there?) A doctor who was convicted of paying patients via his charity to use his pain clinic was paid $500,000 in 2012 for treating 80 patients despite his pending 50-month prison sentence and $3.5 million fine, but his lawyer claims his conduct didn’t cost Medicare anything because somebody would have treated the patients even if it wasn’t him. A Michigan oncologist charged with misdiagnosing patients with cancer so he could bill them for unnecessary treatments was paid $10 million by Medicare in 2012. Pay-and-chase is working really well for criminals.


Innovation and Research

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The consumer wearables fad seems to be over as Nike fires 55 of the 70 members of its FuelBand team and cancels the planned fall release of a new model. Nike says it wants to focus on software, not hardware. Most likely they realized that (a) high-tech versions of a $5 pedometer not only don’t usually motivate anyone except those who are already motivated, and (b) spending money to bring out new hardware versions is risky now that the competitive field has opened up. FeulBands may die off just as quickly as those once-ubiquitous yellow Livestrong wristbands that people couldn’t trash fast enough once the headlines forced them to belatedly realized what a scumbag Lance Armstrong is. There’s a Nike connection there too – they used to make Livestrong-branded products until Lance finally admitted that he’s a cheater and a liar.


Technology

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John Gomez from Sensato provides suggestions on dealing with the Heartbleed SSL vulnerability, warning that hospitals “have an obligation to deal with it because it is a serious threat to privacy.” Even Healthcare.gov is telling users to change their passwords. John’s suggestions:

  • Inventory systems that use SSL or similar encryption.
  • Ask  technology partners providing services through an information or hosting agreement (HIE, hosting companies, portal vendors, kiosk vendors) for certification that they have determined that they are not vulnerable to Heartbleed.
  • Ask HIPAA business associates to provide documentation of how they have eliminated their Heartbleed risk, especially companies who use online system to collect patient payments for billing or collections.

Other

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T. J. Samson Community Hospital (KY) announces that 49 employees will be laid off and all employees will temporarily have their pay reduced due to effects of the Affordable Care Act and “the costly rollout of an inadequate software program.” That system is Siemens Soarian, which the hospital purchased in February 2012. Interim CEO Henry Royse says that Soarian “is still costing the hospital tens of millions of dollars in unrecoverable bad debt, consultant fees, and lost productivity” a year after it went live. He specifically says the implementation was rushed, Soarian can’t connect to its practice management systems, it can’t produce needed operational reports, and the hospital has been unable to send bills for 60-90 days at times. The hospital implemented Soarian to earn Meaningful Use payments.

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Fast Company profiles SharePractice, which it describes as “a Yelp for medical treatments” in allowing physicians to review the success peers have had with specific treatments. The company calls its iPhone app “experience-based medicine.” The founder is a Naturopathic Doctor who works for San Francisco-based Care Practice, opened “like one would open a neighborhood restaurant with a focus on patient experience and developing a compelling identity and brand in a tough urban marketplace with fewer and fewer doctors.”

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The outpatient clinics of Salem Health (OR) will begin their pilot with OpenNotes on Monday.

The CEO and CTO of Mississippi-based Samarion Solutions, which sold long-term care IT systems, are indicted for defrauding investors.

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A study finds that US healthcare isn’t expensive because we use so much of it – the problem is that we pay the highest prices in the world for drugs and hospital procedures. As patients, it’s not altogether our fault that US healthcare is so expensive and produces unimpressive results for the impressive outlays. A day in the hospital costs less than $500 in Spain, $1,300 in Australia, and $4,300 here (and $13,000 for hospitals in the 95th percentile.)

A New York Post article names the highest-paid doctors in New York City, with two from Mount Sinai Hospital’s medical school topping the list: a urologist paid $7.6 million and a spine surgeon who made $6.9 million. The medical director of Consumer Reports Health summarized, “Whenever I see compensation data in health care, I’m stunned and nauseated. I’m embarrassed for the profession.”

In England, a review of a woman’s death after inpatient surgery finds that she was screaming and vomiting in her room afterward, even begging her children to call an ambulance to remove her from the hospital. Her doctor did not respond, the investigation found, because he was in the hall outside her room playing a video game.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 19, 2014 News 8 Comments

News 4/18/14

April 17, 2014 News 3 Comments

Top News

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Nuance confirms its acquisition of Accelarad (reported on HIStalk  last weekend) and the immediate availability of the newly branded Nuance PowerShare Network.


Reader Comments

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From Worth HIT: “Re: tradeshow blooper. At HIMSS Middle East, 3M’s booth described a new service offering, ‘Coding and Groping Quality.’ Go to love the high-tech fix … white tape.” The sign is full of inconsistencies: “groping” and “intelligence” are the only words not capitalized, “ICD-10” also appears as “ICD10,” some random commas found their way onto the page, and some lines end with periods while others don’t. You’re gonna need a bigger roll of tape.

From Pure Power: “Re: your 2009 thoughts about EHR data. Worth looking at again.” Well, here you go then, as I was referring five years ago to a research study about using EHR data in nephrology:

I don’t have access to the full text of the article, but I truly believe that once the pain of getting EMRs running as data collection appliances is over (meaning we’ve got data collection clerks known as doctors and nurses in place, which is the “pain” part), the benefit will be incredible. This article apparently deals with having nephrologists automatically consulted when the EHR finds problems. There are other benefits. You could do society-improving medical research by just slicing and dicing data from millions of patients, at least the parts of it that aren’t just clinical-sounding billing events that are useless or even misleading. You could find candidates for research trials. Patients could be followed over many years, even as they move around and use the services of a variety of providers. And for individual patients, there could be great value in putting research findings into the hands of front line doctors. Not to mention giving patients a platform whereby they can participate in their own care and add non-episodic information related to lifestyle, personal health assessment, etc. Clinical systems will not save time, as clinicians know – they exist to create data whose value mostly accrues to someone else. My advice to providers: much of your future income may be based on the data you create and the ownership in it you retain. Don’t be like the Native Americans and let greedy outsiders buy your land for trinkets.


HIStalk Announcements and Requests

A few highlights from HIStalk Practice this week include: US physicians produced $1.6 trillion in direct and indirect economic advantage in 2012. Steven Posnack creates a fun proof of concept graph that matches Medicare payment data with MU incentive payments. Boston doctors prescribe bike riding. AAFP’s president points out the disparity in compensation between family practice physicians and specialists, as evidenced by the recent release of Medicare payment data. CMS offers guidance on the Attestation Batch Upload option. A urology practice employee sends details on 1,114 patients to a competing practice to help the competitor solicit business. Thanks for reading.

This week on HIStalk Connect: Nuance acquires image-sharing vendor Accelarad, which will power a new cloud-based image and report exchange platform that integrates with its existing transcription product lines. In England, the NHS kicks-off a campaign to use telehealth and mHealth apps to reduce ED visits. The Mayo Clinic is funding a medical research assistant app designed to help consumers responsibly look up their symptoms and conditions. Dr. Travis recounts past mistakes the health IT industry has made with EHR data exchange and questions whether the same mistakes are being made with newer payment and care delivery models.


Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.


Acquisitions, Funding, Business, and Stock

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Athenahealth announces Q1 results: revenue up 30 percent, adjusted EPS $0.12 vs. $0.38, missing analyst estimates for both.

4-17-2014 1-32-11 PM

Liaison Technologies raises $15 million in funding.

4-17-2014 1-33-22 PM

HCA subsidiary Health Insight Capital makes an equity investment in Intelligent InSites.

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One Medical Group, a 27-location practice that heavily promotes its use of healthcare IT in providing care, raises $40 million in growth capital, bringing its total to $117 million.

4-17-2014 1-03-43 PM

Great Point Partners makes a “significant investment” in Orange Health Solutions to finance the acquisition of MZI Healthcare, developers of EZ-Cap and other technologies for ACOs and IPAs.

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CareCloud reports that it added 170 clients in Q1.


Sales

4-17-2014 11-40-01 AM

Australia’s Royal Children’s Hospital in Melbourne awards Epic a $48 million contract.

4-17-2014 1-35-35 PM

Sisters of Charity of Leavenworth Health System (CO) selects Allscripts EPSi as its financial decision support system.

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University Health System (TX) will deploy PeraHealth’s PeraTrend real-time patient status system, which calculates a score of acuity called the Rothman Index.


People

4-17-2014 11-51-46 AM

Crain’s Cleveland Business names Cleveland Clinic CIO Martin Harris, MD as its CIO of the year.

4-17-2014 1-26-32 PM

Healthcare data analytics firm GNS Healthcare hires Mark Pottle (N-of-One/Optum Insight) as CFO.

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Aventura names Bill Bakken (Nordic Consulting) COO.

NaviNet promotes Sean Bridges to CFO, Sridhar Natarajan to VP of software development, and Thomas Smolinsky to VP/CISO.


Announcements and Implementations

4-17-2014 11-43-55 AM

Steward Health Care System launches the StewardCONNECT patient portal based on Get Real Health’s InstantPHR patient engagement platform.

4-17-2014 11-44-47 AM

Park Nicollet Health Services (MN) will implement StrataJazz from Strata Decision Technology for cost accounting, contract modeling, long-range financial planning, and rolling forecasting.

4-17-2014 11-36-53 AM

The Patient-Centered Outcomes Research Institute (PCORI) provides an update on its $100 million initiative to develop the National Patient-Centered Clinical Research Network that was originally announced in December. PCORI’s executive director Joe Selby, MD outlines details on governance, data security, privacy, and interoperability as participants work to build a database of 26 to 30 million EHR records in support of retrospective clinical research.

4-17-2014 12-03-32 PM

The 25-bed Dan C. Trigg Memorial Hospital (NM), which is owned by Presbyterian Healthcare Services, implements Epic.

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The Whitman-Walker Clinic (DC) is implementing Forward Health Group’s PopulationManager and The Guideline Advantage.

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Cincinnati’s fire department rolls out Tempus Pro, a real-time vital signs monitoring system developed for battlefield use that allows hospital-based physicians to monitor patients being transported by ambulance.

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Mayo Clinic and startup Better announce a $50 per month membership-based app that includes a symptom checker, health information, and access to a personal health assistant.


Government and Politics

4-17-2014 10-50-49 AM

The HHS’s OIG warns that some state Medicaid agencies may be putting patient health information at risk by outsourcing administrative functions offshore.


Innovation and Research

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A VA survey of 18,000 randomly chosen users of its My HealtheVet system finds that a third of them use Blue Button, with three-quarters of those saying its main value is collecting their information in one place. Barriers to adoption were identified as low awareness and usability issues.

HIMSS Analytics says that healthcare IT systems with the highest growth potential are bed management, ERP, and financial modeling.

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TechCrunch profiles One Medical Group, which has raised $117 million (the latest funding announcement is above) in funding to create a new kind of technology-powered medical practice, with its custom-developed EHR and portal offering appointment scheduling, refills, lab results, and access to a patient’s records from any of its 27 locations. Patients pay $149 per year for access and can use their health insurance.


Other

It’s not exactly health IT related, but appalling: Yahoo fires its COO of only 15 months after he fails to improve the company’s advertising revenue. He didn’t get a bonus because he didn’t make his numbers, but he still walked out with a severance check of $58 million.

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The Bloomberg School of Public Health at Johns Hopkins University tweets that it has exceed 1 million enrollments in its free Coursera courses. Starting soon: Community Change in Public Health, Mathematical Biostatistics Boot Camp 2, The Data Scientist’s Toolbox, Getting and Cleaning Data, Exploratory Data Analysis, and The Science of Safety in Healthcare.

BIDMC CIO John Halamka, MD offers common sense HIPAA-related tips to hospitals using patient data for fundraising:

  • Disclose fundraising activities in the Notice of Privacy Practices and include clear opt-out provisions
  • Manage the data centrally and don’t allow departments to create their own databases
  • Allow only experts to query the database and create views that respect the “need to know”
  • Keep audit trails
  • Provide tools to eliminate the need to query clinical systems directly

Interesting facts from an article on clinicians who use social media in the OR:

  • A Texas woman died during a low-risk surgery because the iPad-using anesthesiologist didn’t notice her decreasing blood oxygen levels until she turned blue
  • Nurse anesthetists and residents were distracted in 54 percent of cases, most often because they were on the Internet
  • 56 percent of perfusionists admitted to talking on their cell phones during procedures, and only about half thought it was dangerous to text during surgery
  • A quote from anesthesiologist who studies unfocused OR staff: “Airline pilots don’t allow themselves to be distracted by social media because they themselves do not want to die. To replicate that in healthcare, we’d have to say if there’s a wrong-site surgery or other error, we will shoot everybody in the OR.”

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UNC Healthcare (NC) reduces patient volumes as it adjusts to its April 4 Epic go-live.

A seventh grader undergoing cancer treatment “attends” classes in his school more than 1,100 miles away from Children’s Hospital of Philadelphia by using VGo, an audiovisual-equipped robot he can steer down the school hallway and into classrooms as he says hello to classmates. The same VGo robot is used by hospitals for patient monitoring  and telemedicine.

Weird News Andy calls this story “Doc on the Run.” An Arkansas gynecologist allegedly takes smartphone pictures of his patients without their consent while they are in the stirrups. Police investigating a patient’s complaint find her photos on the doctor’s phone, but don’t initially find him (and thus WNA’s headline). Since then, however, he has been arrested and charged with video voyeurism.


Sponsor Updates

  • PMD releases pMD Messaging, a secure text messing solution for providers that is integrated with the company’s mobile charge capture application.
  • Surescripts awards DrFirst and 31 of its EMR partners that have integrated Rcopia e-prescribing software within their EMR with its White Coat of Quality Award.
  • The Professional Association for Customer Engagement presents nVoq with its 2014 Technovation Award for demonstrating superior technological innovation and leadership in customer engagement.
  • CCHIT certifies that PatientKeeper v8.1 software is compliant with the ONC 2014 Edition criteria as an EHR module.
  • Netsmart joins Carequality, a collaborative formed to accelerate health data exchange, as a founding member.
  • The Omega Management Group awards RelayHealth Financial its NorthFace ScoreBoard Awards for excellence in customer service and support.
  • O’Reilly Strata RX Conference posts a wrap-up video from its Strata RX 2013 conference.
  • GetWellNetwork announces details of its GetConnected 2014 conference in Chicago June 3-5.
  • Deputy National Coordinator Jacob Reider, MD will deliver the keynote address at the 2014 Aprima User Conference in Dallas, TX August 8-10.
  • Craig Greenberg, associate practice director for Beacon Partners, suggests in the company’s blog five areas of focus for improving and sustaining cash flow.
  • Capsule Tech will exclusively resell in North America Clinical Vigilance for Sepsis software from Amara Health Analytics.
  • A local news station highlights Jane Phillips Medical Center (OK) and its use of PatientTouch for nurse communications and patient documentation.
  • Orion Health co-sponsors the Fifth National Accountable Care Organization Summit June 18-20 in Washington, DC.

Highlights from the Atlanta iHT2 Health IT Summit
By Jennifer Dennard

This was my third year in a row attending the Health IT Summit in Atlanta. It continues to be a great experience.

The conference, hosted by the Institute for Health Technology Transformation (iHT2), was held at Georgia Tech’s Academy of Medicine. It was an intimate gathering of providers, government healthcare reps, and vendors, with a few lab and pharma folks thrown in for good measure.

The topics of discussion both on stage and during networking breaks have moved over the last two years from Meaningful Use and EMRs to accountable care and patient engagement. Providers are concerned with:

  • Finding the right leadership (including physicians) to implement and champion IT projects.
  • Establishing trust between hospital executives and departments, including trust in the data they review.
  • Analytics.
  • Business process reengineering and Lean Six Sigma.

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Mary Jane Neff, senior director of regional IS; Katheryn Markham, VP of IS planning; Lynda Anderson, senior director of regional IS, all of Kindred Healthcare.

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Thea-Marie Pascal, certified Epic clinical documentation application coordinator; Susan Still, RN, Epic ASAP lead application coordinator; Makeba Lippitt, certified Epic clinical documentation application coordinator, all of Piedmont Healthcare.

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The panel on "Transforming Health Care Through HIE: Driving Interoperability" featured (from left to right) moderator Kimberly Bell, executive director, Georgia Health Information Technology Extension Center at Morehouse School of Medicine; panelists Eddy Brown, VP of business development, TeraMedica; Steve Sarros, VP/CIO, Baptist Health Care; and Sonya Christian, CIO, West Georgia Health.

The keynote presentations were solid, though a high bar was set a few years ago by Naomi Fried, chief innovation Officer at Boston Children’s Hospital (MA). My favorite session was the last, with West Georgia Health’s CIO, CFO and director of nursing all participating on the same panel, answering questions about workplace culture, Lean Six Sigma, and patient safety.

Ten companies exhibited, among them Merge Healthcare, TeraMedica, VMware, Information Management Consultants, and Jvion. Nicole Cirillo from LabCorp explained how patients can review their own lab results through its portal (Georgia is not a right-to-know state.) LabCorp now offers its own portal through which patients can, with guidance from their physicians, access results.


EPtalk by Dr. Jayne

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I had a run-in with one of our employed physicians yesterday. Some of these folks are really starting to wear me down. He’s been with us for a while, and unfortunately the EHR we purchased for our large multispecialty group many years ago does not have specific content for his specialty.

We knew this when we implemented him. We gave him the ability to use speech recognition to essentially dictate all of his office visit documentation except for orders, physical exam, and review of systems, which must be entered discretely. His staff enters other discrete data for patient history, allergies, etc.

Most of our other physicians (even those who do have content for their specialties) would kill for this arrangement. Still, it’s not enough for this guy, who demanded that I come to his office and personally shadow him to see how deficient the system is. I’m trying to win hearts and minds, so I agreed to go out. Rather than take the opportunity to show me how he sees patients and let me assess what his needs truly are, he preferred to spend the time we had standing in the hallway complaining about templates.

It turns out he has been using internal medicine templates to try to document his visits because he doesn’t like the dictation arrangements. He has the option to either dictate in the exam room with the patient present (many of our surgical consultants like this because it gives another opportunity for the patient and family to hear the diagnosis and plan of care one more time and ask questions), to release the patient to checkout and dictate in the exam room after the patient leaves, or to go to his administrative office to dictate. He has his own reasons why each of these is inadequate, but doesn’t have any suggestions for what he wants.

Of course, the internal medicine templates are completely overkill for what he’s trying to do. He has to weed through primary care clinical protocols and other information that’s not relevant to his specialty and feels frustrated. I reminded him that we didn’t train him to do this, that we recommended he use a specialty set that’s closer to his own instead, but he doesn’t like those either.

Most of our other specialists who don’t have content for their specialties are perfectly happy to dictate because it changed their workflow minimally from the paper world. Our primary care docs would love to be allowed to dictate as much as these guys can, but unfortunately for them, we need discrete data from more parts of the chart to meet payer incentive programs and other quality initiatives that we’re working on.

I’m not sure what he really wanted to get out of the visit other than to vent, which is fine, but it doesn’t change anything as far as documenting in the EHR. He wasn’t interested in any of the options I had to present and isn’t going to change his opinion. He doesn’t want a scribe. He doesn’t want to point and click. He doesn’t want to dictate. He doesn’t want a pen solution like Shareable Ink. His continued push-back (going on two years now) is an exercise in futility.

As I was driving back to my office, I got to thinking about that. This is a physician who deals regularly with patients who have life-altering injuries and conditions that cannot be fixed. His specialty is centered on helping people maximize the functionality they currently have and to compensate for what they have lost. He’s very good at what he does, yet he can’t see his EHR issues with the same perspective he uses when treating patients – helping them use what they have to the best of their abilities and not dwelling on what they don’t have or have never had.

We learn in medical school and residency to identify when interventions are futile. We call the code when there’s no hope of getting the patient back. We don’t perform surgeries when they’re not going to improve the patient’s condition. We understand that there are limits to technology and our ability to treat and cure. We’re pretty good at helping patients understand the options when they’re faced with a lack of good choices.

When it comes to limitations in information technology, however, we’re struggling mightily with the thought of applying those same concepts. The EHR of the future is going to look a lot different than what we have today – just like the laparascopic surgeries we do now are completely different from the open surgeries we did in the past. Maybe in the future we’ll beam your gallbladder out of your abdomen instead of having to cut you at all. But for the time being, we have to work with what we have as best as we can. We have to realize there are limits to everything. There’s no psychic module for EHR that’s going to document directly from your thoughts, at least not for now.

Fighting is good when it’s appropriate, but at some point, we have to realize when it’s futile and either accept our current situation or move on. I’m not sure what else to do with or for this physician since we’ve not been able to make him happy as long as we’ve been trying. I suspect there are other factors at play that have nothing to do with EHR, but they’re not within my realm to tackle. We’ll keep reinforcing his options, pair him up with peers that are successful, and encourage him. Until he’s ready to leave the group or retire, I’m not sure what else we can do.

Well, I guess there’s one more thing we could do – pastry therapy. I just dropped a little surprise at his office to thank him for his time yesterday. A girl can hope.


Contacts

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

More news: HIStalk Practice, HIStalk Connect

 

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April 17, 2014 News 3 Comments

News 4/16/14

April 15, 2014 News 8 Comments

Top News

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FDA left unanswered questions about its FDASIA report, such as how to submit the comments the report solicits. The agency announces a free, three-day public workshop May 13-15 at NIST in Gaithersburg, MD that will also be presented via webcast. Comments on the FDASIA report can be left here.


Reader Comments

From Lois Lane: “Re: short label names for ICD-9, CPT, and MS-DRGs. Any source for these other than an EMR vendor?” If anyone knows, please leave a comment.

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From Guillermo del Grande: “Re: signs that whoever is talking about Epic doesn’t know what they’re talking about.” GDG’s list:

  1. “Model the Model”
  2. “EPIC”
  3. They think NVTs are actually meaningful.
  4. They ask where they can buy Epic stock.
  5. They wonder why Epic doesn’t hire doctors and nurses to help improve their product.
  6. They don’t know that the god-awful screen they are looking at is customizable.
  7. They think Epic was born as a billing product.
  8. They don’t know real people work there, just implementers.
  9. They actually think there’s no internal politics at Epic.
  10. They think Epic’s the only software running a MUMPS descendant.

From Bill Kilgore: “Re: VerbalCare. I think you might like these guys. Very cool product.” Inpatients get an VerbalCare icon-driven tablet instead of the 1950s-era call button, allowing them to choose the icon describing their need instead of just pushing a call button or trying to communicate through a drive-through quality speaker-microphone. Employees can receive and acknowledge requests on their smartphones or from a central console. The interactions are also tracked for later analysis. VerbalCare offers a commitment-free pilot. Everything looks good except they spelled HIPAA as “HIPPA” on their site, which is almost unforgivable. You should at least correctly spell the name of the requirement with which you are claiming compliance.


HIStalk Announcements and Requests

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Ms. Dayton, a Teach for America teacher in Arizona, sent pictures and her thanks to HIStalk readers for supporting her magnet school sixth graders by providing them with math stations. She explains, “You have truly transformed my classroom. My students now look forward to math and enjoy the time spent playing the wonderful games that you donated. On a daily basis I hear from my students, ‘Ms. Dayton, can we play the games today?’ or ‘Ms. Dayton, can we skip writing and do math all day?’ I hear these things because of you!”


Upcoming Webinars

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.


Acquisitions, Funding, Business, and Stock

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Truven Health Analytics acquires Simpler Consulting, a provider of Lean enterprise transformation services to healthcare, government, and other commercial organizations.

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Struggling BlackBerry invests in Patrick Soon-Shiong’s NantHealth. The companies are jointly developing a smartphone optimized for viewing diagnostic images, scheduled for a late 2014 release.

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Vocera opens an innovation center in Bangalore, India.


Sales

4-15-2014 11-28-31 AM

Lahey Health (MA) selects Phytel’s population health and engagement platform in support of its ACO.

Dialysis Clinic, Inc. will implement Sandlot Connect and Sandlot Dimensions from Sandlot Solutions for care coordination and analytics.

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Shenandoah Medical Center (IA) will deploy Allscripts Sunrise solutions for its 78 beds.

The 260-provider Phoebe Physician Group (GA) selects athenahealth for EHR/PM and care coordination.

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Citizens Medical Center (TX) will implement T-System’s EV emergency department information system and Care Continuity patient transition management solution.


People

4-15-2014 11-32-14 AM

Explorys appoints Tom Chickerella (Vanguard Health) COO.

4-15-2014 1-11-16 PM 4-15-2014 1-12-15 PM

Precyse promotes Christopher A. Powell from president to CEO, replacing company founder Jeffrey S. Levitt, who will assume the role of executive chairman of the board.

4-15-2014 12-41-48 PM image 

ESD promotes John Alexander to testing practice director and hires Mia Erickson (Epic) as Epic practice director.

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CHIME names George McCulloch (Vanderbilt University Medical Center) as EVP of membership and professional development.

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Edifecs names Dave Arkley (Parallels, Inc.) CFO and Michiel Walsteijn (Oracle) EVP of international business.

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Health Data Specialists promotes Angie Kaiser, RN to clinical informatics officer.

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Donna Scott (McKesson Health Solutions) joins USA Mobility as SVP of marketing.

MHealth Games names investor Keith Collins, MD as its board chair. He was at one time CIO of the University of Massachusetts Medical School.

Medicomp appoints Michael Cantwell, MD (National Library of Medicine) to its MEDCIN terminology team.

Healthcare technology services provider CitiusTech names Gary Reiner and Cory Eaves (both of its recent investor General Atlantic) to its board.


Announcements and Implementations

4-15-2014 11-38-14 AM

Kids First Pediatrics Group (GA) integrates PatientPay’s electronic billing and payment solution with its Greenway PrimeSUITE practice management system.

Memorial Community Hospital & Health System clinics (NE) will transition to Epic starting June 25.

The HEALTHeLINK clinical information exchange launches an automated syndromic surveillance state reporting service.

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North-Shore-LIJ (NY) rolls out the Allscripts FollowMyHealth patient portal for its Plainview and Forest Hills hospital patients.

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Geisinger Health Plan (PA) implements Caradigm Care Management for population health.


Government and Politics

4-15-2014 11-58-28 AM

CMS introduces a Code-a-Palooza Challenge to encourage developers to create apps that use the new Medicare payment data to help consumers improve their healthcare decision-making.

4-15-2014 1-46-19 PM

CMS, which has been strangely quiet about the implementation delay for ICD-10, finally acknowledges the legislation but notes only that it “is examining the implications of the ICD-10 provision and will provide guidance to providers and stakeholders soon.” Meanwhile, CMS still lists October 1, 2014 as the date ICD-9 will be replaced by ICD-10.

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ONC invites voting for ideas submitted in its Digital Privacy Notice Challenge, which include games, responsive templates, a Web widget, and an NPP generator.


Innovation and Research

Meaningful Use of EHRs was not found to be correlated with performance on clinical quality measures in a study published in JAMA Internal Medicine. The  research compared quality scores of 540 physicians affiliated with Brigham and Women’s Hospital who achieved MU with those of 318 physicians who did not. Critics note several factors making the validity and applicability of the study difficult to evaluate, including the fact that MU quality metrics are so specific that they exclude many patients with particular conditions.


Technology

4-15-2014 9-16-13 AM

inga_small Google files a patent for a contact lens system that would include a built-in camera and could potentially be used as an alterative to Google Glass. That’s technology I could embrace since I don’t see myself as one of those nerdy hipster-types that Dr. Jayne and I continually made fun of as we walked the HIMSS exhibit floor.

Awarepoint introduces an RFID tag that monitors room humidity.


Other

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The Coalition for ICD-10, an industry advocacy group whose members include CHIME, AHA, and AHIMA, calls on HHS to establish October 1, 2015 as the new ICD-10 implementation date.

The Oklahoman looks at the soon-to-be-launched Oklahoma City-based Coordinated Care Oklahoma HIE and the more established Tulsa-based MyHealth Access Network and considers the impact of having two competing networks in the state. It’s a scenario that will undoubtedly be repeated numerous times in coming months as funding disappears for older HIEs and newer organizations emerge.

An InstaMed report on trends in healthcare payments finds that patient payments to providers jumped 72 percent from 2011 to 2013, with the average amount increasing from $110.86 to $133.15.

Attorneys specializing in representing whistleblowers in healthcare pounce on the newly published Medicare data to search for evidence of fraud.

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Travelers who pass through Madison, WI’s Dane Country Regional Airport (MSN) can now enjoy free Wi-Fi courtesy of Nordic.

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The SMART project at Boston Children’s Hospital, which has been pretty quiet since its big “EMRs should work like smartphone apps” announcement four or so years ago, names a 14-member advisory board to promote its mission.

inga_small I paid a visit to my neighborhood ER over the weekend. Despite being the patient, I couldn’t help but check out their use of IT systems. It’s a boutique ER attached to a surgery center about two miles from my house. I was the only patient at the time (good to know that all my neighbors had better things to do on a Saturday night.) In terms of IT, what surprised me the most was the lack of it, at least at the point of care. They must have some sort of EMR because they printed out all my information from a visit last year, but everyone who treated me used pen and paper to note my vitals and whatnot. At discharge they handed me a generic patient education sheet with aftercare instructions, but no details on what meds they gave me (I recall one was a narcotic) and no medication information sheet warning me about possible side effects. They advised me to follow up with my regular doctor, but I’m now realizing that in my narcotic-induced haze I didn’t ask anything about the results of the tests from my blood draw. I’m sure if I had gone to the ER at the big chain hospital another 10 minutes away I would have left with more complete information, but I chose (and probably would again) the more convenient ER that otherwise provided good care. For all the great stories we constantly share about the amazing strides in automating healthcare, I’m sure there are just as many anecdotes that serve as a reminder that we are not “there” yet.


Sponsor Updates

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  • Talksoft Corporation makes its appointment reminder app Talksoft Connect available for Android devices.
  • Columbus CEO magazine profiles CoverMyMeds in an article highlighting characteristics of top workplaces.
  • The AHA exclusively endorses MEDHOST PatientFlow HD patient flow management solution.
  • LifeIMAGE celebrates the growth of its network, which connects 533 hospitals and has exchanged 1.1 billion images over the last five years. 
  • Health Catalyst releases a free eBook that explores common approaches to data warehousing in healthcare.
  • AdvancedMD introduces the 1.5 version of its iPad app.
  • A NueMD ICD-10 survey conducted prior to the official delay shows that the majority healthcare professionals participating wanted the ICD-10 transition to be pushed back or canceled.
  • The Boston Business Journal ranks Nuance number two on its list of  top publicly traded Massachusetts software companies based on its $5.2 billion market capitalization.
  • Kareo CMIO Tom Giannulli will discuss the role of technology in improving patient care at UBM Medica’s Practice Rx conference May 2-4 in Newport Beach, CA.
  • Madhavi Kasinadhuni, consultant for The Advisory Board, explains the importance of measuring care episodes and not just individual encounters when identifying missed revenues.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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April 15, 2014 News 8 Comments

Monday Morning Update 4/14/14

April 12, 2014 News 3 Comments

Top News

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The New York Times says the White House decided that Kathleen Sebelius needed to go as HHS secretary after her “wooden” appearance on “The Daily Show with Jon Stewart” in October (during which Stewart speculated openly that Sebelius was lying to him about Healthcare.gov) and the pressure she was getting from Republican members of Congress. The President waited until last week until the Healthcare.gov crisis was over to give her the hook, with the Times calling it a “slow-motion resignation.” It may be a first that a Cabinet member was forced out because of a TV show appearance and for antagonizing the other party. Even her carefully orchestrated Rose Garden farewell speech was marred by technical difficulties – she stumbled because her notes were missing a page. I don’t expect much to change with her replacement – Congress and the White House can’t keep their hands out of what HHS is doing, so the Secretary’s job is to announce big changes rather than to propose them (and to be the President’s unusually obedient lap dog in Sebelius’s case.)


Reader Comments

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From Anon: “Re: Wipro. Remember how they were going to save the day with low cost IT managed services? Won a $200m contract with Catholic Health Initiatives? Big problems. They can’t even keep Microsoft Exchange running, service applications, HR system, let alone CHI’s various EHRs. Unplanned downtime is becoming a daily occurrence.” Unverified. CHI signed the deal with the India-based Wipro in March 2013, saying it expected to save $42 million over five years.

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From NoPicis: “Re: Picis. Just been in a meeting where complaints were ventilated on Picis not being MU2 certified. Nobody at Picis took the time to let their customers base know about their non-compliance.” Unverified. I contacted Picis/Optum but didn’t hear back. ONC shows Picic products as being certified under 2011 criteria.

From Pokey: “Re: Cerner-Intermountain partnership. The baby has a name!” The project will be called iCentra, which is how I would picture Brits pronouncing “eye centre” based on how they spell it.

From Biller: “Re: 1500 format. On April 1, 2014, CMS has required the use of new formats to submit bills, replacing the 1500 format. Our vendor was desperately unprepared and did not have the code to make the change.  And when they did, systems were crashing like cars in a sleet storm. Were the other vendors of billing systems so unprepared?” Readers: if you had this problem, leave a comment and name your vendor if you like.

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From Mark: “Re: Oconee Medical Center (SC). A Paragon site, about to be absorbed by Greenville Health System, which is moving to Epic.”


HIStalk Announcements and Requests

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It was political maneuvering that caused the ICD-10 delay, according to more than half of poll respondents. Anydoc had a good comment: “For sure, the lack of both provider and vendor readiness in an election year. One could easily imagine the backlash in November elections after a year of debating at nauseum the failures of Healthcare.gov compounded by providers frustrations with payment delays, lost productivity, etc. only one month before going to the polls.” New poll to your right: who is most responsible for the ACA failures like Healthcare.gov that led Kathleen Sebelius to step down?

Saturday is my grammar pet peeve day. Topping my list this week: people who write “it’s” as a possessive. Please, I know it isn’t logical, but the possessive form is “its” so just live with it, OK? Also driving me crazy: people who say “thanks but no thanks” thinking it’s cute, which requires double the number of syllables to say precisely the same thing as just “no, thanks.” OK, one more: using the word “very,” which when used often is either superfluous (“very interesting”) or incorrect (“very unique.”)

Listening: Superdrag, a decent, defunct alterna-pop band from Knoxville, TN. Not to be confused with my favorite Superchunk, which is better, non-defunct, and in fact celebrating their 25th anniversary.

I had HIStalk and the other sites migrated to a much larger server this weekend. It’s a dedicated one running a four-core Xeon processor, 16GB of DDR3 memory, a terabyte of 7,200 rpm disk, an identical second drive just for backups, MySQL databases running on a 120GB solid-state drive for extra speed, and 20TB of premium transfer. OS is CentOS Linux 64 bit and Litespeed. HIStalk keeps growing and response time was slowed at times when hundreds of readers were on at the same time, so the new server should be fast with plenty of capacity for continued growth.


Upcoming Webinars

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.


Acquisitions, Funding, Business, and Stock

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A lifeIMAGE blog post says Nuance will enter the image sharing market in a Monday announcement that it will acquire “a small, Atlanta-based company.” I hear (unconfirmed) that company is Accelerad. KLAS ranked the company’s SeeMyRadiology.com #1 in image sharing in November 2013. It’s an odd business for Nuance to be entering, but shareholder pressure to deliver better results may have made diversification attractive for either strategic or accounting reasons even though it strays from the company’s traditional core mission of speech recognition and consumer apps (Dragon, Siri, and software for scanning and PDF editing.)

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Medical cart maker Enovate Medical will expand its Murfreesboro, TN headquarters, with plans to create 410 jobs in the next five years.


People

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Vermont Commerce Secretary Lawrence Miller, who was tapped to rescue the state’s Vermont Health Connect health insurance exchange after a rocky rollout, is named as the governor’s point person for healthcare reform. His previous background: he founded a brewing company and ran a business that sells pewter jewelry. Meanwhile, the state auditor will investigate Vermont Health Connect and its struggles with vendors Oracle and CGI after a consultant blamed the site’s problems on politics and inexperienced leadership. Vermont has up to $170 million in federal money to spend, gave CGI a contract worth $84 million, and has paid $54 million so far for a crippled site.


Announcements and Implementations

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Penn Highlands Healthcare (PA) goes live on its patient portal, or actually “portals” in the plural since the some are Cerner, some are NextGen, and others don’t appear to be from either vendor.


Government and Politics

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HIMSS loves Kathleen Sebelius and any other politician who helps divert taxpayer money into HIT vendor and provider pockets, so naturally they gave her a laudatory send-off, saying “the health IT community was blessed” to have her running the department overseeing HITECH payments (and plugging its own EMR Adoption Model in its praise.) I’m suspicious of anybody who refers to a “community” without defining it or explaining how they know what that “community” thinks, especially since most members of the health IT community are citizens paying the ever-rising taxes needed to fund HITECH, Healthcare.gov, and Medicare. Personally, I’m not feeling all that blessed.

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The State of Maryland threatens to sue Noridian Health Care Solutions, the $85 million prime contractor of its health insurance exchange.


Technology

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April 15 is more than just tax day for nerds jealous at their peers wandering around wearing Google Glass: anybody can buy a $1,500 Glass for that day only without being part of the Explorer program. The downside: it could go into commercial production soon at a lower price and possibly with better features.

The Heartbleed bug in OpenSSL that has exposed web server information (including passwords, credit card numbers, and potentially patient information) for years on two-thirds of the world’s websites was caused by programming error that wasn’t caught by the QA review of the small, open source project, according to the German developer who identified the exploit.


Other

The American Medical Association releases a laundry list of warnings about correlating Medicare payments information to physician incomes. A subset:

  • The information could contain errors and CMS doesn’t allow doctors to report inaccuracies.
  • Claims filed under a given National Provider Identifier can include services rendered by residents or other healthcare professionals.
  • Payments include the cost of physician-administered drugs, which are low margin for doctors.
  • Physician payments are actually practice payments that must also cover practice overhead – the physician doesn’t just pocket the Medicare check.
  • Medicare’s coding and billing rules vary over time and even by location.
  • Doctor’s don’t make all their income from Medicare.

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A JAMA editorial by Farzad Mostashari, MD and colleagues from The Brookings Institution says that each primary care physician is in essence a CEO in charge of $10 million in annual revenue, that being the overall annual healthcare spending of the average practice’s 2,000 patients. It concludes that PCPs are underused and that physician-led ACOs will work better than those run by hospitals, but that success has been limited because practices haven’t spent enough on IT or on practice transformation services. It warns PCPs that they will lose control if they just continue with business as usual or sell out to hospitals. I’ll go with that: if you want to encourage efficiency, save money, and improve health and not just episodic healthcare services delivery, the last group you’d want to talk to would be hospitals.

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Cleveland Clinic, which anyone who has walked its halls can tell has always treated a cash-paying Middle Easterners, will open a 364-bed hospital in Adu Dhabi, with CEO Toby Cosgrove, MD saying, “We look at it as our petrodollars coming home to Cleveland.”

I missed this announcement from earlier this month: ECRI Institute Patient Safety Organization launches a partnership to identify and learn from health IT safety issues. Among the collaborating organizations are HIMSS, AHIMA, AMIA, ISMP, and AMDIS. Several experts serve on its advisory panel, including David Bates, MD (Brigham and Women’s), Peter Pronovost, MD, PhD (Johns Hopkins), and Dean Sittig, PhD (UT Health Science Center at Houston.)


Contacts

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

More news, HIStalk Practice, HIStalk Connect.

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April 12, 2014 News 3 Comments

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