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News 10/3/14

October 2, 2014 News 4 Comments

Top News

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CMS will miss its planned dates to move Healthcare.gov’s hosting to HP and instead will leave the site on Verizon’s infrastructure through the November to February enrollment season. CMS signed a contract last year to move off Verizon after a series of outages. Verizon has upgraded its servers and will offload some of the processing to Amazon Web Services, but testing suggests that users will still be forced into “waiting rooms” during peak use times.


Reader Comments

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From Disruptured: “Re: athenahealth’s More Disruption Please annual conference. This is my first time attending the conference. I’m here as a newly established partner in athena’s MDP program. Didn’t know what to expect when I signed up. The meeting has turned out to be a great blend of athena folks, customers, investors, and CEOs from young companies. Helpful sessions and a great opportunity to connect with investors, customers, and possible partners in a small, intimate environment. Athena has been a pleasure to work with, especially compared to other big PM/EMR companies.” 

From LND Generis: “Re: Allscripts. This is being emailed to clients. ‘Yesterday we communicated that there was a potential for affected data between FollowMyHealth and Allscripts EHRs. This would affect the Stage 2 View / Download / Transmit measure by indicating that some patients had viewed their chart, when in fact they had not.’” The purported support email says the information has been fixed but an urgent report update needs to be applied for those who are applying for MU Stage 2 for the first time.


HIStalk Announcements and Requests

This week on HIStalk Practice: WRS Health introduces new products for pediatric practices. Philips gains FDA clearance for new digital health applications. Quillen ETSU Physicians goes live on Allscripts. The Hutchinson Clinic implements a new telemedicine program. Code for America makes open-source health data a priority. Thanks for reading.

This week on HIStalk Connect: Rock Health reports that the digital health sector has raised $3 billion in VC funding so far in 2014. Basis unveils its next-generation activity tracker, called the Basis Peak. WiserTogether, a consumer health startup focused on pricing transparency, raises a $9 million Series B.


Acquisitions, Funding, Business, and Stock

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Cohealo raises $9 million in financing. The Boston-based company allows hospitals to share medical technology among multiple locations with online resource booking and equipment transportation.   

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Specialty EHR vendor Nextech acquires ophthalmology EHR vendor MDIntelleSys.

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Silicion Valley-based precision medicine data platform vendor Synapse will open a Philadelphia office.

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Israel-based MedAware, which offers machine learning-powered CPOE drug warnings, raises $1 million in Series A financing. Its self-learning product (“a spell-checker for medical prescriptions”) analyzes prescription databases to identify deviations from normal treatments prescribed for similar patients, although it’s not clear to me how it connects to the prescribing system.

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Athenahealth unveils its 60,000-square-foot Atlanta office that will house 200 employees initially and hundreds more later.

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A poorly sourced rumor, resurrected from a few months ago, suggests that Samsung may be talking to Nuance about acquiring the company, which would give Samsung control of the speech recognition technology used by Apple’s Siri.


Sales

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Scottsdale Lincoln Health Network (AZ) chooses Premier’s solutions for supply chain, performance, and technology solutions.

Greater Baltimore Medical Center (MD) selects Access web-based forms and patient signature capture.


People

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Nick Bonvino (CTG) is named CEO of Greater Houston Healthconnect.

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Peter Witonsky, formerly president of iSirona, is now president of the Ionic Division of St. Louis-based Asynchrony. The company seeks 100 engineers who know Ruby, Scala, C#.NET, Java, and mobile programming.

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Huffington Post profiles Laurie McGraw, president and CEO of Shareable Ink, in its “Women in Business” Q&A series.

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Consulting firm ICF Internation names John Guda (CSC) as SVP/GM of its commercial healthcare business.

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I missed this from the new Forbes 400 list of richest Americans: Terry Ragon, founder of InterSystems, is #390 on the list with an estimated net worth of $1.58 billion.


Announcements and Implementations

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The Memphis business paper profiles S2 Interactive, which sells software that optimizes tray setup and instrument sterilization in the OR. The company was founded by Larry Foster, RN.

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NextGen will offer its customers the Plexus IS Anesthesia Touch anesthesia documentation system.

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Two Philips chronic care management telehealth applications developed with Salesforce.com (care coordination and a patient portal) receive FDA 510(k) marketing approval.


Government and Politics

The VA says it will go live on a new commercial patient scheduling system by 2017 – originally announced as 2020 — and will choose a vendor that can meet its aggressive deadlines.

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CMS’s Open Payments database is live, but doctors are finding errors in the information submitted by drug companies. Glaxo admits that incorrectly assigned huge payments made to the National Cancer Institute to a single physician who says he is “shocked by the enormity of this mistake.” Glaxo says it fixed its error in September 2013, but CMS chose to bring Open Payments live with data (including corrections) covering only the first five months of the year. Critics also observe that the system is slow, doesn’t provide total payments, has no search function, doesn’t group corporate entities within a single drug or device manufacturer, and requires a lot of scrolling since the on-screen spreadsheets aren’t sized correctly for a browser. Commenting about the traditional tendency for CMS to make a mess of just about any technology project it undertakes, a former aide to Sen. Chuck Grassley whose bill created the database said, “It’s so complicated that it’s almost useless. It looks like data bombing and I don’t think the average American will find it useful. It’s disappointing.” I’ll go out on a fairly sturdy limb in stating that CMS might be the least competent of many incompetent federal agencies in putting in-house career bureaucrats in charge of opportunistic contractors (Healthcare.gov comes to mind).

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FDA releases a cybersecurity guidance document for medical device manufacturers.

Walgreens announces a partnership with the VA in which it it will immunize veterans and share its Greenway EHR information with the VA.

Defense Secretary Chuck Hagel gives the military’s underperforming hospitals six weeks to submit improvement plans, adding that military hospitals offer care comparable to the civilian health system but that’s not good enough. Hopkins patient safety expert Peter Pronovost, MD, PhD said hospitals in general are better at managing their bottom lines than patient care: “This is not unique to them. If you miss your budget, within a week you are in someone’s office. We have not applied that kind of rigorous discipline to quality and safety.”

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ONC posts a chief medical officer position. Jacob Reider, MD says in an internal memo that he will remain deputy national coordinator and that hiring a full-time CMO (Reider’s job before he became acting national coordinator and then deputy) is a commitment clinician relevance. People forget that it’s a sacrifice to work for ONC – the job pays a maximum of $157K per year (although there’s a potential unstated extra allowance for physicians), unreimbursed relocation to DC is required, and the application and selection process is tougher than in the private sector. I was thinking last week that I am too critical of government employees and politicians – if they stick with the job I call them career trough-lappers, but if they leave for the private sector I label them as opportunistic sellouts trading their influence for cash. 

ONC also lists the open position of director of the office of consumer ehealth, vacated in July by Lygeia Ricciardi.


Technology

This is bizarre, assuming it’s not a hoax. A company called Pavlok (a nod to the dog-testing Pavlov) will produce the ultimate fitness wearable, a $129 fitness band that delivers an electrical shock when the wearer misses fitness goals. The pain-loving founder’s experience includes hiring a woman off Craigslist to slap his face every time he launched Facebook, admitting that, “I have a weird slapping thing.”

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This is brilliant: a startup is developing an affordable sensor to warn people that food contains items to which they are allergic. It must be terrifying  for people who are highly sensitive to peanuts or other foods to have trust a restaurant waitperson’s assurance that a given menu item is OK for them to eat.


Other

Rock Health tweeted an exuberant message Wednesday that Kleiner Perkins was visiting, proudly observing that “none of these digital health entrepreneurs have a healthcare background.” I can’t decide if it’s sad or just insulting when the techno-weenies brag on their ignorance of the industry into whose face they brashly thrust their VC money and technologies fully confident that they’ve figured it all out from the cheap seats. My consolation is that their contempt will likely turn into humility (or more precisely, a quick redirect to some other seemingly lucrative bright shiny object) when, like their predecessors, they find that healthcare is a lot more complicated than a bunch of arrogant child-entrepreneurs can even begin to understand. I suspect that any of the rumpled CEOs or besuited VC schmoozers would run for the hills when faced with an actual patient or consumer whose medical needs can’t be identified or ameliorated by cute, imitative phone apps that lust to be the Uber or Facebook of healthcare in exploiting some minor niche while dodging the big problems that matter. The healthcare IT burial pit is full of companies both large and small that smugly concluded, “How hard could it be?” and later found out as they ran into one business-killing obstacle after another: insurance companies, the government as both the dominant payer and regulator, privacy, misaligned incentives, and even the most basic question: who is the healthcare customer? Most of us long-timers welcome humble newcomers with fresh ideas that focus on patients, but instead we seem to draw obnoxious brats and their rich uncles who have big iPhone-powered hats but no cattle.

Cedars-Sinai Medical Center (CA) revises its estimate of the number of patients whose medical records were stored on an unencrypted laptop that was stolen in June from 500 to 33,000.

JPMorgan says that a cyberhacking attack this summer exposed the data of 76 million households and 7million small businesses, although the stolen information was mostly benign, such as email addresses. The company had said previously that its increased security efforts would require 1,000 employees and $250 million per year.

Here’s a great Ebola-inspired EHR idea from Linda Pourmassina, MD: when a patient presents with fever, trigger a reminder to ask about travel history. At least Ebola gives otherwise health-indifferent consumers something to obsess over as the latest TV-touted epidemic du jour gains their engagement far more than the daily habits that will likely kill them (see: avian flu, swine flu, H1N1, and Legionnaire’s).

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The CEO of Clark Memorial Hospital (IN) announces that the hospital has no choice but to merge with Norton Healthcare because of huge losses causes by bad debt patients and the cost of unnamed software that I assume is its Allscripts Sunrise system.


Sponsor Updates
  • Voalte will integrate its Voalte One mobile communications solution with Spectralink’s Android-based handset and will sell and support the offering.
  • Impact Advisors is ranked as the top Enterprise Implementation Leadership Epic Partner by KLAS.
  • Verisk Health creates an infographic about the cost of claims errors.
  • Health Catalyst is offering a free PDF copy of its eBook, “Healthcare: A Better Way.”
  • Castro County Healthcare-Plains Memorial Hospital (TX) is implementing Holon’s CollaborNet HIE.
  • Forbes discusses how UnitedHealth’s acquisition of MedSynergies will strengthen its Optum division.
  • Nuance will participate in the Health Connect Partners Hospital & Healthcare IT convention in Chicago October 13-15.
  • Royal Solutions Group announces the integration of its kiosk platform with Merge RIS and OrthoEMR.
  • NoteSwift joins Allscripts developer program with a bridge between Allscripts Pro EHR and Dragon Medical.
  • ICSA Labs certifies HIStalk sponsors Healthtronics, Iatric Systems, Medseek, PatientSafe Solutions. Quest Diagnostics, Shareable Ink, and Wellsoft in September.

EPtalk by Dr. Jayne

October 1 has come and gone, forcing many organizations to make hard decisions about their participation in the Meaningful Use program. Several of our recent acquisitions are planning to attest for Stage 1 and this quarter is their last chance. It’s been quite a battle to even get them live on EHR in the most rudimentary fashion. Saying that we ran out of time to deliver the kind of workflow redesign needed for true clinical transformation is an understatement.

Our organization was a fairly early adopter of EHR. Our original employed practices went through an intense program of workflow analysis, development of policies and procedures to support new workflows and technologies, and continuous process improvement. We were “doing EHR” for all the right reasons and were seeing good outcomes. Practices that weren’t ready for the transition progressed through more slowly or chose to leave the group. Along came Meaningful Use, however, and we were forced to push everyone through the same funnel.

At this point we’re dealing with a subset of physicians who don’t care and aren’t ready, yet our administration has made it clear that we must make them succeed at any cost. Our operations team has responded by “reporting” them to death. They’re delivering a full spread of Meaningful Use reports to each physician, office manager, and practice lead every Friday in the effort to ensure compliance.

Unfortunately, what they’re not delivering is support for operational and practice policies and workflows to actually lead to a successful outcome. It’s the hospital administrator equivalent of yelling at your teenager for having a loud party, but refusing to stay home on Saturday night to ensure it doesn’t happen again.

My favorite nonsensical example of the week is a practice that is documenting in two EHRs as of Wednesday. Their old system isn’t certified and our employer refuses to pay for a data conversion, so they’re continuing to see patients in the old system while documenting the barebones data needed for Meaningful Use in the certified system. Penny wise and pound foolish – discovery alone on a single lawsuit from this patient safety nightmare would easily cost triple the amount we’d have spent on the conversion. Instead, we’re relying on the practice to abstract patient data on its own and transition “when the practice is ready.”

In other CMS-related news, the first round of Open Payments data has been released to the public. By the time I made it to the website, there were over 21,000 hits on the General Payment Data for 2013. I wanted to dig more deeply in the data, but the website was painfully slow and I didn’t have time to download the dataset before I had to run off to meetings. Some weekend entertainment, perhaps?

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As many of you know, my second language is Administralian. I have to admit this reader submission is a puzzler, and not the fun kind heard on Car Talk:

Our recently announced operating model reflects our transformation to an integrated technology company dedicated to building a software-defined network with an engaged, agile workforce whose well-being is a top priority.

I asked the reader what that might mean and received this response: “I wish I knew, because I’m being transformed into it, whatever it is.”

That, dear readers, is what happens when you allow buzzword-happy consultants to write communications snippets. I even tried to use my old-school English class skills to diagram the sentence but couldn’t make a go of it. Is the company using their engaged, agile workforce to build the network, or are they building a network that has the engaged, agile workforce as its members? Whose top priority is the well-being of said workforce and how will it be supported?

I feel bad for the employees at this company. If leadership is willing to economize the use of words to the point where they no longer make sense, leadership is also likely to over-economize in other areas.

Do you have a favorite example of Administralian? Email me.


Lorre’s Healthcare Analytics Summit 14 Report

Being a bit of a data and analytics geek, I looked forward to attending Healthcare Analytics Summit 14. I have attended enough conferences over the years to keep my expectations realistic since I have almost always been disappointed. Admittedly, I have a short attention span and often end up thinking about better uses of my time, but that wasn’t the case at HAS14.

Opening keynote presenter Billy Beane is an excellent speaker and the type of storyteller that I can connect with. He injected humor and anecdotes while taking the audience through formulating his hypothesis about using data and analytics to win baseball games to the outcomes and validation of his theory. He was a brilliant choice by Health Catalyst in creating optimism, a longing for similar outcomes in healthcare IT, and a vision that it is possible.

The next two speakers — Glenn Steele, Jr. MD, PhD, president and CEO of Geisinger Health System, and James Merlino, MD, chief experience officer, Cleveland Clinic — described how their organizations use analytics to transform healthcare and transform the patient experience, respectively. Their case study-like narratives reinforced that not only is it possible to improve outcomes with analytics in healthcare, it is already happening.

Google’s Ray Kurzweil rounded out the day with an enthusiastic discussion about the acceleration of technology is the 21st century and how we can expect that to impact healthcare and medicine.

Day Two brought fresh speakers with more case studies to reinforce the overarching message — data and analytics can transform care and improve outcomes. Breakout sessions were mostly interesting, but I didn’t leave any of them feeling like I learned anything I could use.

Before Health Catalyst CEO Dan Burton delivered the closing keynote, we viewed a 30-minute documentary, From the Heart: Healthcare Transformation from India to The Cayman Islands. It was impressive to see what health systems in other countries have been able to accomplish. It tugged at my heartstrings when one of the Indian cardiologists said, “The first question a mother asks is how much it (open-heart surgery to save her child’s life) is going to cost. The doctors are putting a price on human life.” After learning about how they were able to cut the cost of the surgery in half and maintain it, another physician drove the message home when he said, “The object of technology should be to bring cost down … In healthcare, technology takes the cost up. That can change only by a data-driven, facts-driven medicine where the decision making process itself is driven by technology.”

The logistics of the summit were unlike any I have ever experienced. There were genius bars staffed with technical people to help with everything from installing the custom application to providing directions. My HAS14 app froze and I raised my hand and had a technical person at my side within seconds. Pre-charged chargers the size of playing cards were placed at every seat to keep mobile devices running through the day

Analyst teams were present in every in every session to present real-time data gathered from participants. Attendees voted ahead of time on their seating preference at Wednesday night’s dinner – sitting with similar attendees, sitting with dissimilar attendees, or open seating. Table assignments were pushed out via the app before dinner. It seems like a small thing, but it demonstrated how gathering data could allow for real-time decision making and the ability to create a more desirable outcome based on it.

When Dan Burton took the stage during the opening keynote, he told us we would have the opportunity to learn from innovators in and out of healthcare and he promised there would be no long-winded CEO speeches. That was what Health Catalyst delivered. It was a fun, engaging, and informative summit. I left with a copy of their book, “Healthcare: A Better Way,” a few new connections, and excitement about the future of data and analytics in healthcare.

(Presentations and recordings from the conference are available to all online.)

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 Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 2, 2014 News 4 Comments

News 10/1/14

September 30, 2014 News 5 Comments

Top News

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UnitedHealth Group’s Optum division acquires MedSynergies, which offers physician practice billing and quality services. MedSynergies was founded in 1996 by a group of Texas ophthalmologists. Its board chair is Joe Boyd, whose history includes being GM of the healthcare practice of Perot Systems, board chair of Healthlink until it was sold to IBM in 2005, and board chair of Encore Health Resources until it was sold to Quintiles earlier this year. I interviewed him in 2012.


Reader Comments

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From CloudedCare: “Re: CareCloud. Recently laid off a number of their implementation team and the senior leader running that department. The venture debt must be creating pain or their onboarding process needs a revamp.” The company provided this response to my inquiry: “CareCloud is increasingly gaining traction among larger medical group clients, and optimizing our organization to best support their needs. This includes an expansion of professional services offerings and realignment of the team to deliver them.”

From Bloomington Onion: “Re: health system bond downgrades following EHR implementation. They always blame billing issues and reduced productivity due to revenue loss. I wonder how many of them expect it going in?” I would imagine most health systems expect a short-term jump in AR days, but not to the extent that would cause bond raters to question their financial outlook. Hospitals can’t seem to survive without constantly borrowing money and downgrades mean they pay higher interest rates.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Zynx Health, healthcare’s pioneer and leader in evidence-based clinical solutions. Solutions include ZynxAnalytics (pinpoints opportunities to reduce care variation), ZynxOrder (evidence-based order sets), ZynxCare (patient-focused plans of care), ZynxAmbulatory (evidence-based order sets for primary care), and ZynxEvidence (online library of clinical evidence guidelines, and quality measures). A brand new product is ZynxCarebook, a mobile platform that connects care team members and guides them to best practices with clinical evidence while making communications more efficient (the “virtual huddle” capability is a cool idea) and eliminating HIPAA concerns related to text messaging. ZynxCarebook stratifies discharge risks and suggests interventions as it supports care transition plan collaboration – clients have experienced a 22 percent reduction in 30-day readmissions, an 18 percent improvement in HCAHPS scores, a LOS decrease of 0.5 days, and a 40 percent increase in referrals of high-risk patients to post-discharge care management. Zynx is part of Hearst Health, which also includes First Databank, MCG, and Homecare Homebase. Learn more by signing up for a demo. Thanks to Zynx Health for supporting HIStalk.

I found this new Zynx Health video on YouTube, which features customer testimonials.

Listening: new from Sloan, an underrated Canada-based power pop band that’s been around for almost 25 years with no lineup changes and with all four members writing hook-heavy songs that sometimes sound like the Beatles (and still sound good even when they don’t).


Acquisitions, Funding, Business, and Stock

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Hospital financial management software vendor Healthcare Insights will merge with NOMISe Systems, which offers hospital cost accounting and analytics software. Business will continue under the Healthcare Insights name.

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Forbes names its 400 richest Americans, with Microsoft’s Bill Gates leading the list at $81 billion of net worth. Facebook’s Mark Zuckerberg jumps to #11 as the company’s share price increase boosts his wealth to $34 billion, while the founder of the GoPro wearable video camera clocks in with $3.9 billion. New to the list is Elizabeth Holmes, the 30-year-old Stanford dropout who founded lab testing company Theranos and owns half of the company, which is valued at $9 billion. Patrick Soon-Shiong of NantHealth is #39 with $12 billion, while Epic’s Judy Faulkner is listed at #261 with an estimated worth of $2.4 billion. Cerner’s Neal Patterson comes in at #395 with $1.55 billion.

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Google Glass healthcare telepresence vendor Pristine raises $5.4 million in Series A financing.

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The state of Ohio offers CoverMyMeds $482,000 in incentives to execute its plans to add 116 jobs, move to a larger Columbus office, and create a $2 million training program for software engineers.


Sales

Christopher Rural Health Planning Corporation (IL) selects eClinicalWorks EHR for its 13 locations.

In England, Wrightington, Wigan and Leigh NHS Foundation Trust chooses Allscripts Sunrise.


People

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Connie D’Argenio, RN, MSN (Philips Healthcare) joins Huron Consulting Group as managing director of its healthcare practice.

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PerfectServe names Travis Hiscutt (CRI) as sales director for the southeast.

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Bimal Shah, MD, MBA (Duke University Health System) joins Premier Research Services as VP.

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Katherine Schneider, MD (Medecision) is named president and CEO of the Delaware Valley ACO (PA).

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The Cal Index HIE announces two new board members: Mark Savage (National Partnership for Women & Families) and Beth Ginzinger, RN, MBA (Anthem Blue Cross – above).

Morris Collen, MD died last week at 100 years old. He was the last of the seven original partners who created Permanente Medical Group, founded its Division of Research more than 40 years ago, and later embraced a second career as an a medical informatics expert after developing a health assessment tool in the 1950s that was automated as a patient screening tool. He said on his 100th birthday that his proudest accomplishment was his involvement with Kaiser’s EHR. AMIA’s annual excellence award is named after him.


Announcements and Implementations

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Cerner announces that its HealthyNow app with newly added Apple HealthKit integration is available to Sharp Health Plan members. It allows users to set health goals, earn rewards, share information with providers, and manage medication schedules.

MModal announces availability of computer-assisted physician documentation for its Fluency Direct speech recognition system. The cloud-based solution gives physicians feedback about possible documentation deficiencies as they type or dictate. 

Beaumont Medical Group (MI) goes live on Wellcentive’s PQRS Enterprise Solution, aggregating information from its Epic EMR.

Nuance expands its consulting services to include coding and abstracting compliance monitoring.

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HCA International will distribute physical therapy and pathology images using Picsara from Sweden-based Mawell. A pilot project found savings of up to an hour per day per clinician when physical therapy sessions were recorded and reviewed using video instead of writing and reading notes.

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Two North Carolina-based HIEs, Carolinas HealthCare System CareConnect and Mission Health Connect, will share their 3.5 million patient records. They will fill a need in the western part of the state since North Carolina’s first HIE, WNC Data Link, will shut down on September 30 after running out of money.

AirWatch debuts AirWatch Video, an enterprise application integrating content delivery network operators to secure companywide video initiatives.


Technology

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Dartmouth College will use a telehealth robot from Dartmouth-Hitchcock’s Center for Telehealth on the sidelines of home football games as part of a remote concussion assessment program.

HITRUST warns that the newly discovered Shellshock Unix shell vulnerability could be even more dangerous than Heartbleed since it gives hackers complete control of a server and thus the network on which it resides.

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Intel introduces the Basis Peak smartwatch that includes step counting, an optical heart rate sensor, sleep tracking, and smart phone notifications. It has a Gorilla Glass touch screen, works with both iOS and Android, is waterproof, claims a four-day battery charge life, and costs $199.

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Bizarre: Microsoft decides to name the new Windows release Windows 10, skipping a number. Every other Windows version is problematic, so maybe it’s hoping to dodge the bullet even though Win 8 was the disappointing follow-up to Win 7. The new version downplays the much-reviled Metro tile interface, brings back the start menu, and finally shows evidence that Microsoft understands that few users have or want touch screen laptops and desktops no matter how convenient it might be for Microsoft to design one OS for all platforms.


Other

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Alabama’s medical association registers its displeasure with ICD-10 with its “Top 10 Craziest ICD-10 Codes” social media campaign.

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The local TV station covers the rollout of the MedaVet app by Washington State University’s veterinary hospital, which allows pet owners to have around-the-clock access and review their care plans. The company’s site says the cloud-based service includes a customized site for the veterinary practice, creation of templates and health plans, incorporation of promotional and wellness information, a calendar of daily tasks with learning material and appointments, a shared health journal that shows task status with an optional photo, and a social support network. It costs $239 for up to three vets. What’s interesting is that the same company – MedaNext – offers care plans for humans, too.

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The local paper highlights the implementation by Floyd Memorial Hospital (IN) of CrossChx, a fingerprint-based biometric solution for spotting patient identity theft. Founder and CEO Sean Lane was an Air Force captain and NSA Fellow, serving five tours of duty in Afghanistan and Iraq before founding Battlefield Telecommunications Systems. CrossChx, which is based in Columbus, OH, says its solution is live in 28 health systems (of 61 signed) and that it has verified 6 million identities. 

The New York Times interviews Epic CEO Judy Faulkner in covering the challenge of EHR interoperability. She says the government should “do some of the things that would be required for everybody to march together,” adding that Epic created Care Everywhere only when it became clear that the government wasn’t going to go far enough.

A Toronto study finds that assigning patients to a post-discharge “virtual ward” (at-home care coordination, visits, care plans, home care, and follow-up) failed to improve the rate of readmission or death compared to just sending the patients home as usual. The authors suggest these issues caused the surprising failure of all that clinical attention to make any difference: (a) it was hard to get in touch with the patient’s PCP and their in-home support workers; (b) the variety of EMRs used made it hard to figure out who was doing what; and (c) the intervention was started after discharge instead of before.
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Amazing Charts apologizes for long customer support wait times, blaming a Meaningful Use services rush. Users unhappy after the company’s 2012 acquisition by Pri-Med are venting their frustration on the company’s discussion boards, with one summarizing, “AC has created these logjams by being unable to prioritize what is important, continuing to partner with NewCrop, releasing buggy new versions, and offering unlimited support for a flat price which may create abuse.” Users are also upset that the company is charging them to watch Meaningful Use webinars.

Beth Israel Deaconess Medical Center CIO John Halamka tells a local business group that, “The academic medical center is a dying beast,” urging those systems to reinvent themselves in the face of competition from retail clinics and community-based hospitals and practices.

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Walgreens CIO Tim Theriault, speaking at Oracle OpenWorld this week, says the company has distinct IT strategies for the retail and healthcare sides of its business. The retail initiatives are focused on a customer loyalty program, determining what items each store stocks, and using analytics and personalization to connect more closely with customers. For its healthcare business, the company plans to perform in-store lab tests and to exchange information with doctors and hospitals collected through its health cloud.

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Former Kaiser Permanente CEO George Halvorson says in a Health Affairs interview by healthcare expert Jeff Goldsmith that the organization spent $6 billion implementing Epic:

Halvorson: When I got to Kaiser Permanente, one of the things that I told the board was that we were going to do what I did when I helped build health plans in Uganda. We were going to have every single element of the care system connected electronically, so there would be no paper record.

Goldsmith: So you told them you wanted to catch up to Uganda?

Halvorson: I’m not kidding.  I actually learned in Uganda that to strip the whole process down to its most elegant essence was to have no paper anywhere. In Uganda, we couldn’t afford to pay a claim or for patients to show an ID card.

A New York Times article highlights hospitals that use out-of-network ED physicians who stick patients with huge bills even when the patient is careful to use an in-network hospital’s ED in a crisis. Texas lawmakers found that the state’s three largest insurance companies had no in-network ED doctors at all. The article points out that 1980s emergency medicine board certification pushed hospitals to contract out their ED coverage and bill the physician services separately. One patient observes, “It never occurred to me that the first line of defense, the person you have to see in an in-network emergency room, could be out of the network. In-network means we just get the building? I thought the doctor came with the ER.”

Weird News Andy says he plays golf like this, too. A previously profanity-hating grandmother recovering from a stroke finds herself swearing involuntarily when things upset her, including poor performance on the golf course. WNA also notes this story, in which coroners are determining whether high chlorine levels in the water supply of England’s second-largest hospital caused the deaths of two dialysis patients. Meanwhile, an anonymous WNA-wannabe contributes this story, in which surgeons saved a teen whose hair-eating psychological disorder caused her digestive system to be blocked by a world record nine-pound hairball.


Sponsor Updates

  • DataMotion announces that 37 EHR vendors have used its Direct secure messaging service to achieve 2014 ONC-ACB certification.
  • PatientSafe delivers three areas of consideration for bringing contextual communication to clinicians in a follow-up blog regarding clinicians struggling to find the context.
  • PMD announces that its mobile patient status verification is accelerating hospital reimbursements.
  • GetWellNetwork’s O’Neil Center publishes an e-book entitled“Patient Engagement: Beyond the Buzz” including ten interview and articles with provider perspectives and insider insights.
  • HealthEdge partners with NTT DATA to offer a migration program from TriZetto Facets technology due to Cognizant’s acquisition of TriZetto.
  • Judy Starkey (Chamberlin Edmonds & Associates) joins Streamline Health’s board of directors.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 30, 2014 News 5 Comments

Curbside Consult with Dr. Jayne 9/29/14

September 29, 2014 Dr. Jayne No Comments

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As a CMIO, I often feel my attention is all over the place. I’m dealing with clinical documentation needs for various constituencies while trying to ensure compliance with a host of federal, state, and other quasi-regulatory standards bodies. I’m also trying to implement tools to measure patient, physician, and employee satisfaction while maintaining my sanity in what seems like an upside-down healthcare world.

Given that background, you can’t imagine the serendipity I found when Dr. Andy’s recent CMIO Rant coincided with my weekend project to review E&M coding.

Due to some discrepancies in coding volumes after a recent ambulatory EHR upgrade, our compliance officers asked for a thorough review of the system’s E&M calculation tools. There are quite a few nuances to how the system codes and we’ve also had some recent coding education outside of the EHR, so I wasn’t convinced we weren’t dealing with another variable.

Our system is flexible and allows physicians to choose either 1995 or 1997 guidelines for each encounter. What if the recent coding class had physicians making different choices than they did previously? What if they were scared by the gloom-and-doom predictions of a RAC audit and undervalued their documentation?

I had been sitting for several hours with my trusty-rusty paper coding review forms, scoring visit documentation based on the guidance from our coding and compliance team. Once a visit was scored, I compared the results to the EHR’s calculations. Our EHR breaks down its coding suggestions parallel to E&M guidelines, so it is fairly easy to compare the bullets it counted vs. what I counted on paper.

Fortunately, our system does not advise on the level of Medical Decision Making, but rather requires providers to select that coding component. I can’t imagine how controversial the review would be if the EHR was prompting it.

There’s so much going on with HIStalk I tend to get behind from time to time. When I couldn’t handle any more bullet-counting, I took a break to catch up on HIStalk Connect and HIStalk Practice. Imagine my delight when I found Dr. Andy’s response to the AMA’s comments on EHR design. His first counter-request for the AMA is for them to help us fight “regulations that require overly detailed physician documentation, like the CMS E&M coding guidelines, which really set a floor of complexity below which we cannot sink.”

I laughed out loud, as I do every time I receive an email from CMS advocating their brand of “administrative simplification,” which has to be the biggest oxymoron ever. Just that morsel would have been enough to make my day, but then he covered their seemingly contradictory request for EHRs to lower cognitive workload while requiring them to enable dozens more tasks than we ever handled on paper. “Massive cognitive workflow” were the words he chose. Having had a 40+ patient clinic day this week, I can attest to the massive nature of the volume of information I had to process to care for them.

Note that I didn’t say data. Data implies the information is in the EHR or another accessible system that I could theoretically review. The reality is that physicians have to handle information on a much broader scale – the patient’s history, family members’ version of the same events, stories about what the patient read on Google, the physical exam itself, in-office testing, and more – on top of the actual electronic data available. Add to that mountain of information the fact that we’re now caring for patients in the office that would have been cared for in the hospital five years ago and it would be easy to become buried.

Reflecting on this massive cognitive workload inspired my new and improved “guidelines” for E&M coding. I didn’t have enough time (or martini fixings) to flesh out the entire scheme, so let’s confine our thoughts to established patient office visits.

Traditional E&M coding poses five levels of service – 99211, 99212, 99213, 99214, and 99215. The value of the visit (and thus the payments) increase as the level of service increases. Typically 99211 and 99212 are not used to bill actually physician services, so I threw them out. Talk about administrative simplification – I just slashed the number of things I have to think about by 40 percent.

Looking at the rest of the codes and what you have to have to justify documentation in the traditional coding construct, I identified some sample visits that were reflective of the codes even by conservative standards. They fell into nice groupings based on the amount of information the physician had to interact with during the visit. I’m not just talking about information that one would have to review, but also information one might have to deliver. Out of ten charts reviewed for each level of coding, I had a 90-100 percent concordance when using the “information burden” scheme to value my efforts.

Here’s how it works.

99213 – Now called “Mild Information Burden”

  • Patient has fewer than three issues he/she wants to be seen for today.
  • Patient has been seen at fewer than three healthcare facilities/providers in the last three months.
  • None of today’s issues will cause death or serious consequences if left untreated.
  • Determination of proper treatment requires review of fewer than three data sources (EHR, clinical data warehouse, HIE, antibiogram, CDC bulletin, guidelines website, Sanford guide, discussion with colleague, etc.)
  • Treatment requires fewer than three instructions, outside orders, or documents (patient education handouts, prescription, therapy order, referral, prior-auth, FMLA papers, etc.)
  • Visit requires less than 15 minutes for documentation.

99214 – Now called “Moderate Information Burden”

  • Patient has more than three issues he/she wants to be seen for today.
  • Patient has been seen at three or more healthcare facilities/providers in the last three months.
  • At least one of today’s issues will cause death or serious consequences if left untreated.
  • Determination of proper treatment requires review of three or more data sources.
  • Treatment requires three or more instructions, outside orders, or documents.
  • Visit requires more than 15 minutes for completion, including documentation.

At this point, based on my “rules of three” and the two levels of coding, you could quit. However, neither category covers what I had to manage for several patients seen in this week’s clinic. I decided to reserve the highest coding level for those special circumstances, but in keeping with the rules of three:

99215 – Now called “Severe Information Burden”

  • There are three or more non-office personnel in the exam room (patient, family members, children, interpreter, etc.)
  • Patient has been seen by facilities/providers that are members of three or more ACOs.
  • At least one of today’s issues will lead to hospitalization in the next three months.
  • There are three or more possible ways to treat one of today’s issues, depending on the patient’s insurance status and/or ability to pay for non-covered services.
  • More than three separate logins and passwords are required to access the data needed to care for the patient.
  • Visit takes long enough that it requires cutting three or more subsequent appointments short in order to catch up.

Maybe it’s just me, but those rules would be much easier to follow than what we currently have. I’d rather use my cognitive skills to deliver quality care and build relationships with patients than to remember whether I’m supposed to be documenting by organ systems or body areas. What does “expanded problem focused” mean anyway? Or “detailed”? I like to think that all my visits are detailed, if not comprehensive. Current E&M coding turns those perfectly good words into something incomprehensible.

Give it a shot – pull a couple of visits and see whether my proposed coding system holds up under the stress of your clinic day.

Do you dream of a world without E&M coding? Email me.

Email Dr. Jayne.

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September 29, 2014 Dr. Jayne No Comments

Monday Morning Update 9/29/14

September 27, 2014 News 3 Comments

Top News

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Apple’s HealthKit health data aggregation system and the apps that use it go live after being pulled previously from the initial iOS 8 rollout due to unspecified bugs. Some HealthKit-powered apps that are back in the App Store after the iOS 8.0.2 update are FitPort, MyFitnessPal, WebMD for iPhone, and Carrot Fit. HealthKit allows iPhone-collected fitness measures to be forwarded to other iPhone apps, brokering the exchange using the phone owner’s permissions of allowable data sources and destinations. That might be the most significant aspect of HealthKit – the consumer-patient is in charge of the collection and movement of information about them.


Reader Comments

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From Ben and Jerry: “Re: Chuck Podesta. Gone from Fletcher Allen, now CIO of UC Irvine Health.” Verified per his LinkedIn profile.

From WisconsinBeerGut: “Re: Epic to Cerner conversions. I’ve worked for Epic and consulting companies and I’m not aware of any clients that have replaced Epic. Some mergers to watch that involved Epic and non-Epic users are NorthShore-Advocate in Illinois and UAHN-Banner in Arizona.” Given Epic’s cost, you’d have to really hate it to contemplate spending money to replace it. That’s not the only reason that it keeps users, but it may be significant one.

From Ex-Epic: “Re: Cernover. Judy prides herself on the fact that Epic has never lost a customer to Cerner or any other vendor. There have been some small scale de-installs for various reasons unrelated to dissatisfaction with Epic and those of course get swept under the rug, but to my knowledge (and according to Judy) there has never been an Epic to Cerner move.”

From AtUGM: “Re: Epic’s app exchange announced at UGM. It envisions that hospitals will sell their self-developed apps. My organization has discussed this with Epic, but Epic hasn’t provided any way to do it other than as a spin-off, which we’re loath to do. Eclipsys had an app exchange and I don’t think it went anywhere. It would be great if you wrote a feature discussing these app development opportunities with the big companies and what it would take to actually be useful to those of us in the industry.” I assume that vendor-specific app stores work like Apple’s – the vendor skims 20-30 percent off the top and sells apps that meet their published requirements. I would be interest in hearing about anyone who’s actually bought an app from a healthcare IT vendor’s store. I would be worried about paying a lot for something that might be poorly supported or that won’t be enhanced regularly.


HIStalk Announcements and Requests

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Most poll respondents like the idea of a 90-day MU reporting period for 2015 instead of the 365-day version that is official for the moment. New poll to your right or here: is it OK for an EHR vendor to block system access to a late-paying practice or hospital? Leave a comment after voting with your thoughts.


Last Week’s Most Interesting News

  • Intermountain Healthcare joins the Cerner-Leidos-Accenture DoD EHR bidding consortium.
  • Hospital operator HCA announces its intent to acquire physician systems vendor PatientKeeper, signaling that it will remain a Meditech clinical system customer.
  • A government report exposes HHS-CMS infighting and incompetence as Healthcare.gov went down in flames at its launch last October.
  • ZirMed acquires predictive analytics vendor MethodCare.
  • ONC Chief Science Officer Doug Fridsma, MD, PhD resigns to become president and CEO of AMIA. 

Acquisitions, Funding, Business, and Stock

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Oncology data vendor COTA closes $3.7 million of a planned $7 million funding round. Most of the folks involved are from Hackensack University Medical Center’s cancer center.

Meditech finally issues its 2013 annual report that was due 11 months ago but was held up following revenue recognition changes. Revenue was down a bit from 2012 at $580 million, but net income rose to $133 million (that’s an enviable margin). Neil Pappalardo owns nearly 41 percent of the company, or about $680 million worth. The directors and officers of the company have been around forever, with the newest hires among their ranks having joined the company 24 years ago.


People

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FCC Director of Health Initiatives Matt Quinn leaves the agency for a job with Intel.


Announcements and Implementations

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CareSync announces version 2.5 of its personal medical records system, which adds the ability to collect and track information from 80 health and fitness apps such as Fitbit and Withings blood pressure cuffs.

CVS Health announces new MinuteClinic affiliations with University of Maryland Medical System, UTMB, and UAB.


Government and Politics

An investigation finds that HHS paid WebMD $14 million to promote the Affordable Care Act.


Other

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Glucose monitor manufacturers and the FDA express concern that the technologically sophisticated family members of diabetes patients are hacking the devices to make them more useful, partially because FDA takes forever to approve manufacturer-requested changes. A group of engineers, many of them parents of diabetic children, modified a glucose monitor to send readings to a website so that parents can monitor their children who are away on sleepovers.

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A Premier study of ACOs finds that while most are improving care using basic internal systems such as EHRs, patient registries, and data warehouses, they struggle with bringing in data from external sources and providing patient-facing technologies. The key obstacles are interoperability problems and cost.

Penn Medicine (PA) has developed 75 apps, including the MedView physician portal and new Connexus patient data display app.

Weird News Andy provides a non-weird item: US hospitals aren’t prepared to handle Ebola-related patient waste since no disposal packaging has been approved, causing waste management companies to refuse to accept it. Emory University Hospital finally convinced Stericycle to accept 40 bags of infectious waste by first autoclaving it, but only after CDC brokered a deal.

Death rates dropped at two English hospitals that moved from paper-based vital signs charting to using the VitalPAC electronic system that provides warnings when patients are deteriorating. The hospitals developed the “early warning score” software with a vendor.

Here’s the more traditionally odd Weird News Andy article, which he titles “Give It a Shot.” The state nurse’s union sues Brigham and Women’s Hospital for requiring employees to get a flu shot after voluntary efforts failed to move the needle (pun intended) above 77 percent participation vs. 90 percent success in peer hospitals. State law prohibits hospitals from requiring employees to get a flu shot even though several hospitals require it as a condition of employment.  


Healthcare Analytics Summit 14 Report 

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I attended Health Catalyst’s Healthcare Analytics Summit 14 last week, my first visit to Salt Lake City. Note: in the interests of disclosure, the company comped my registration fee although I paid my own expenses otherwise. I took the photo above from my room’s balcony, by the way – a very brief rain shower kicked up on a sunny afternoon and created a double rainbow over the City-County Building.

The Health Catalyst folks were hoping for around 100 attendees and ended up with 500. The event was held in a beautiful five-star hotel, the Grand America, which had surprisingly reasonable prices and outstanding service. Rooms, food, and meeting facilities were excellent.

Salt Lake City apparently is not quite as Mormon Church-driven as I naively expected since you can actually get ethnic food and alcoholic beverages, although some odd rules are in place (as explained to me, you can’t order drinks without buying food, so you pay $2 for a bowl of peanuts to allow you to order a beer). Good restaurants were an easy walk away, everything from tapas to tacos (my choices: Green Pig Tavern, Eva, Himalayan Kitchen, Caffe Molise, and Tin Angel Cafe). It’s a lot smaller city than I would have guessed – around 200,000 residents – and the mountains create an attractive backdrop. I checked out a rehearsal of the Mormon Tabernacle Choir that was inspiring. The weather was a lot hotter than I expected. My overall impression of the city was favorable, although since I don’t ski, I’m not sure I would have a non-business reason to return.

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The event logistics were unparalleled. Plenty of Health Catalyst folks were on hand to direct people, answer questions, and even run a Genius Bar-type setup to help attendees use the cool app developed for the conference, which allowed interactive voting, reacting to speakers, and connecting with fellow attendees. I happened to chat with the guy whose company developed the app while walking to a session and he said it was built specifically for this conference. If it can scale, it would be pretty cool for larger conferences as well.

Presenters included Glenn Steele, Jr. MD, PhD, president and CEO of Geisinger Health System; James Merlino, MD, chief experience officer, Cleveland Clinic; Mike Leavitt, former Utah governor and former HHS secretary; Ray Kurzweil, director of engineering, Google; Penny Ann Wheeler, MD, president and chief clinical officer, Allina Health; and Charles Macias, MD, MPH, chief clinical systems integration officer, Texas Children’s Hospital.

A bizarre press restriction prevents me from even mentioning the name of the keynote speaker, although you can see it here. That’s too bad because I would have gushed about how entertaining and surprisingly relevant he was, and my fellow attendees seemed to agree given their highest rating of his keynote from all of the first day’s sessions. It was a bold choice by Health Catalyst. I enjoyed his talk more than any keynote I’ve ever heard. He would make an outstanding HIMSS keynote presenter, much better than the drones they’ve propped up on stage lately.

My least-favorite speaker was Mike Leavitt, who always struck me as a lightweight political journeyman turned opportunistic lobbyist. He rambled and misspoke to the point that I was checking email for most of his presentation. Everybody else did a great job, although I might have dialed back the presence of Health Catalyst people on the podium a bit if the intention was to engage attendees who don’t necessarily have a Health Catalyst connection. It got a bit confusing since three of the folks involved are from the same family (Burton) and were introduced with both past and present titles as the company made changes over the years, so I couldn’t keep track of who’s who as they came and went from the podium over the two days. I didn’t get a whole lot from the three breakout sessions, so for me the value was in the keynotes.

Health Catalyst used information collected from the app to announce some interesting (and sometimes creepy) facts gleaned from audience responses, such as that Android users were most likely to blow off the breakout sessions after attending the keynotes. Every session included several instant poll audience questions and a team of analysts presented the results immediately as the presenter paused. That was pretty cool and a nice touch to connect presenters with the audience.

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I should also note that this was neither a user group meeting nor a selling opportunity. The presenters for the most part were vendor-neutral and talked about using data in general, not Health Catalyst’s products in particular. I also applaud the company for really thorough preparation right down to the minor points of quality of the handouts, stage setup, and food and break logistics. Also a high point was distribution of an internally written book that I’ll be reading cover to cover. They really have a lot of good information to share that transcends their products alone.

Some of the memorable points of the conference from my perspective:

  • It’s clear that the hasty move to electronic medical records and health apps is creating more data than anyone understands. We’re at the exploratory stage, trying to figure out which of thousands of data points are relevant in predicting outcomes or triggering interventions. This is exciting. We are surrounded by data that we don’t yet know what to do with, but the first glimmers of success are coming out.
  • A lot of people, including many of healthcare’s leaders, aren’t convinced that the industry should be data driven. Not only does the “medicine as an art vs. a science” argument arise, but leaders often have personality types that value bold decisions based on emotion, history, gut instinct, leading through relationships, and valuing consensus over facts. As was said several times in the conference, it takes courage to use data, especially when it tells us something we don’t want to hear or that requires unsavory actions.
  • Becoming a data-driven organization requires two attributes. The first is fairly simple from the non-IT point of view – collecting and analyzing the information. The second is having the organizational willpower to do something with it. Facts alone don’t change anything – leadership is required.
  • Better care costs less. Analysis nearly always shows that the highest-cost organizations deliver lower-quality care. The upside of this is that we can improve care and outcomes without spending a penny more than we already do as a society, provided we have the will to do it.
  • As the unnamed keynote speaker pointed out, people mimic those who are having success. The organizations improving care and reducing cost through the use of data will find their competitors raising the bar by doing the same. Nobody wants to be in the higher percentiles of cost or the lower percentiles of quality, so as competitors eye each other warily, it’s likely that they will raise the boats for everyone.
  • Everybody has a data warehouse. Most of them don’t provide useful information.
  • You can’t selectively intervene on individual patients by using claims data. By the time you take action, the high-cost patients have costs trending back down and you’ve missed the opportunity.
  • People seem to love QlikView as a data analysis and presentation tool. I noticed several presenters from provider organizations were using QlikView dashboards.
  • An interesting thought from one presenter: “We don’t take a quality assurance or compliance approach.” In other words, it’s not effective to chase the 2.5 percent of outlier providers. Instead, move the 80 percent even higher since improving the already-good majority has a much greater overall impact.
  • The maturity progressions looks like this: data reporting –> data analysis –> decision support –> predictive analytics.
  • “Predictive analytics without actions an interventions are useless.” You can predict things you don’t care about or are reluctant to act on.
  • The most relevant health factors involve socioeconomics. Healthcare delivery organizations can’t fix those.
  • The wisdom of crowds still has value even in an analytics-driven organization.

I give this conference a high grade. The logistics were superb, the size and scope was just right, the value was significant, and the speakers were well chosen and interesting.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 27, 2014 News 3 Comments

DoD EHR Update from Dim-Sum 9/26/14

September 25, 2014 News 2 Comments

 

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Between 2000 and 2003, Harvard Business School published a case study on Toyota industrial engineering processes in a hospital. Toyota collaborated with Beth Israel and LEAN Healthcare was born – now that was a great and interesting collaborative. Well defined and the results were quantifiable!

Collaboratives can add value; even ones that may not sound great at first could prove to define and refine standards, improve care, and actually enable better quality controls for care. If you like collaborative approaches, take a look at what has been done between Deloitte and Northern New England Accountable Care Collaborative (NNEACC). The solution is called Insight. After mentioning that new collaborative, I cannot help but remember a strange and poorly constructed one. How can anyone forget the ill-fated relationship between Philips and Epic that ended in 2006?

I can think of one specific collaborative that has promised the world and delivered almost nothing (see NwHIN). However, after a cursory read of the DHMSM Team Leidos article about a collaborative effort linking Cerner’s mega client Intermountain Health on governance structure, I began to think of what other collaboratives I would want to accentuate and/or at least commoditize so that I might differentiate my team to compete for the DHMSM opportunity. IBM will certainly throw in an Epic-esque client that has provided the groundwork for improvements across the Epic stable of solutions. I even think CSC and Allscripts might find their favorite client pet co-development.  I think I like Collaboratives.

One has to wonder, what was the primary edict for the collaborative, and what measurable outcomes have been reported – indicating value? To what extent have the monies invested into the collaborative been shown to improve profitability or improve PQRS results? I am not against collaboratives so much as I have a real desire to understand how some of them were stood up and made financially viable, why some dissolved, and most evolved with grand entrances into the market only to die a death of irrelevance. I think I like Collaboratives.

I for one like the New York eHealth Collaborative and the Massachusetts eHealth Collaborative, and not just because they have the word collaborative in their name. I think they are practical entities that leveraged historical regional extension centers, where money was initially provided by public funds and, through attrition and maturation of models and adoption challenges, the collaboration actually had to collaborate. They had to collaborate to survive. These collaboratives had to figure out smart ways to make their collaborative viable. Their challenge, unlike Intermountain Health (for Cerner) or Kaiser (for Epic), is that they had to work with disparate and competing entities, clinicians that were not incented by what their crosstown rivals did. The collaborative’s cross regions that did not in and of themselves support huge populations, and yet they wanted to know how their colleagues worked in other parts of the state, in rural, suburban, and urban environments.

Sounds remotely like the military HIT that we have grown to appreciate and fear. I like those collaboratives because they have to work together even though they are in a “coopetition” mode. (They were built to compete, to differentiate their medical specialty, and yet they know that cooperation has to occur for a peaceful co-existence and patient-first mentality. Thus the term “coopetition.”)

Honestly, I wish Team Leidos, Accenture, and Cerner would chat up their HealtheIntent population health tool, and what can be done to improve care coordination, quantify targeted chronic-disease management, improve appropriate care measurements, lower readmissions, and provide dynamic quality measures that actually act as a catalyst for patient engagement. Maybe Team Leidos could express its thoughts on how to turn prescriptive, descriptive, and predictive analytics into actionable analytics – impacting care and quality of life? Why not share its philosophical thoughts on data liquidity and how that could be the conduit for improved EHR and research data mining? Take the time to share their approach to research – we know IBM will reference Judith’s Cogito – so compete.

Maybe I am being harsh. I guess I am all too aware of how collaboration in the federal government has not always worked out very well. The best example of a collaboration was between the VA and DoD to share – or rather to transition – the EHR for a service member en route between active duty into veteran’s care. The best analogy: “Imagine spending the day as a cub scout during a camp out, eating gummy bears, enjoying hot dogs roasted over an open flame and masticating pounds of beef jerky on the three-hour canoe trip!” That was the planning for the debacle between DoD health and VA health – now imagine being stuck in the tent all night with those boys – that is pretty much the result of DoD/VA EHR interoperability – a smelly tent!  Not sure if there is a lesson in that story, but after reading it aloud, I smiled.

The good news is that at least DHMSM competing teams are looking to grab practical experience and applying it to the DoD HIT environment. Any collaboration with organizations that embrace HIT standards is a great thing. Any collaboration that shows that the HIT development vendor actually possesses a veracious understanding of governance structure – bully for them. Any collaboration that can accentuate the divine path to full-on proactive adoption, well then … that is Heaven. I like the move, and expect to see a lot more collaborating.

Inasmuch as I like the collaboration with Intermountain Health, I really would like to hear more about lessons learned from Accenture’s effort in Singapore. Cerner should express lessons learned from its NHS efforts. After all, Cerner had to work with Fujitsu (sort of the equivalent of our service integrators in and about the Beltway). Fujitsu is a less-than-stellar example of HIT consulting talent that was appointed by the NHS to implement, integrate, and manage the regional program. Maybe a white paper on nexus process and data touch points that could improve continuity of care with an eye on improving outcomes and lowering readmissions would be helpful and germane.

DHMSM is about transition and data liquidity. The DoD will not get excited with the commercial version of efforts to move from fee-for-service to value-based care. However, the DoD will perk up and pay attention to care coordination – so focus on the client and similar client experience and their deficits, lessons learned, and what new approaches improved adoption and workflow. One should remember that the DoD has stated on several occasions – mostly during Hill meetings – that the DoD does want to be more innovative like Kaiser (code for Epic). Cerner probably sees Intermountain Health as its Kaiser, so why not leverage that as a collaborative? I just hope Cerner can provide the depth of white papers and analysis of pre- versus post-Cerner in Utah and a lesser extent Idaho. That would be good news for the DoD.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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September 25, 2014 News 2 Comments

News 9/26/14

September 25, 2014 News 1 Comment

Top News

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Intermountain Healthcare (UT) joins Cerner and Leidos in their bid for the DoD’s new EHR system. Intermountain will provide clinical governance of solutions and workflow to be proposed for the $11 billion Defense Healthcare Management Modernization Initiative (DHMSM). Intermountain is in the process of implementing Cerner’s EHR and revenue cycle solutions across its 22 hospitals and 185 clinics. The move is no doubt yet another feather in the cap of Cerner President Zane Burke, interviewed this week in the local paper: “It’s a really interesting time. We have a lot of work left in front of us, but I love the position we’re in and the clients that we have on the journey with us. It’ll be a lot of fun.”

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Dim-Sum, HIStalk’s intrepid DHMSM insider, shares always entertaining and thought-provoking insight into the Intermountain “collaborative.” A snippet:

“After a cursory read of the DHMSM Team Leidos article about a collaborative effort linking Cerner’s mega client Intermountain Health on governance structure, I thought of what other collaboratives I would want to accentuate and/or at least commoditize so that I might differentiate my team to compete for the DHMSM opportunity. IBM will certainly throw in an Epic-esque client that has provided the groundwork for improvements across the Epic stable of solutions. I even think CSC and Allscripts might find their favorite client pet co-development. I think I like collaboratives.”


Reader Comments

From Chris Jaeger, MD: “Re: Sutter Health’s HIE discussions with Orion Health. As Sutter Health’s CMIO and executive sponsor of its HIE efforts, I can state without a doubt that the following post is false:
From Deal Breaker: “Re: Sutter Health. Stops discussion with Orion Health after its HIE project goes on for nine months. …”
Our collaborative relationship with Orion and related HIE efforts have never stopped – to the contrary, we continue to make great progress while also actively planning the next phases of establishing robust data exchange with those that share in the care of our patients.”


HIStalk Announcements and Requests

This week on HIStalk Practice: Athenahealth looks for the next great startup. TekLinks partners with Greenway. Doximity goes live in Utah. Physician practices in Texas take home quality improvement award for use of HIT. Physicians feel slighted by CMS thanks to attestation "glitch." Healthcare.gov costs more than originally thought. Physician executives have options when it comes to standing desks. Thanks for reading.

This week on HIStalk Connect: Dr. Travis analyzes the non-traditional roles that cloud-based computing has found in healthcare thus far, and speculates on its future. Researchers in Paris are working with 3-D video cameras to create virtual reality-based surgical training aids. Virtual visit provider Teladoc raises a $50 million Series C.


Acquisitions, Funding, Business, and Stock

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Allscripts and Citra Health Solutions (formerly Orange/MZI) announce a partnership to make their services available to each other’s customers. Citra, which provides consulting services and technologies for providers and payers, unveiled its new name and branding at the Allscripts user group meeting last month.

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ZirMed acquires predictive analytics vendor MethodCare and announces plans for a Chicago-based Healthcare Analytics Center of Excellence led by MethodCare staff. Moving forward, MethodCare will operate under the ZirMed name.

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Conifer Health Solutions agrees to acquire physician practice business solutions vendor SPi Healthcare for $235 million. SPi CEO John O’Donnell will join Conifer’s senior management team, reporting to President and CEO Stephen Mooney. The transaction is expected to close in Q4 2014.


Sales

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North Philadelphia Health System (PA) selects Medhost’s inpatient EHR for implementation at St. Joseph’s Hospital and Girard Medical Center.

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Beaufort Memorial Hospital (SC) selects the Access Passport online forms solution to take its paper-based accounts payable, human resources, and administrative documentation processes digital.


Announcements and Implementations

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Community Hospital (NE) goes live on a patient portal from Relay Health.

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Children’s Healthcare of Atlanta joins the Georgia Health Information Network. CHOA has integrated GaHIN’s Georgia ConnectedCare product into its Care Everywhere HIE application, which it launched earlier this year to facilitate data sharing with other providers using Epic.

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Kennedy Health System (NJ) adopts the MedAptus Professional Charge Capture Solution for hospitalists at its three acute-care facilities.

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Sightseeing.com announces the availability of the MyMedicalRecords PHR to its customers. The PHR will offer travelers access to their medical records and such documents as passports, birth certificates, immunization records, and insurance policies.

Practice Fusion announces that its customers will soon be able to order, manage, and receive lab test results within its EHR through Quest Diagnostics. Physicians will also have the option to share test results with patients through the Patient Fusion portal.


Research and Innovation

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A survey of 62 ACOs reveals that poor interoperability between organizations remains a big barrier to improving clinical quality. Additional findings include:

  • 100 percent of respondents find access to data from external organizations challenging.
  • 95 percent find interoperability of disparate systems to be a significant challenge.
  • 90 percent feel the cost and ROI of HIT has become a key barrier to further HIT implementation.
  • 88 percent face significant obstacles in integrating data from disparate sources.
  • 83 percent report challenges integrating technology analytics into workflow.

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WEDI releases the results of its ICD-10 Industry Readiness Survey, which finds that vendors, payers, and providers have made some progress in preparing for the October 1, 2015, transition, but not nearly as much as likely needed for a glitch-free switch.


People

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Jim Dowling (QuadraMed) joins Qpid Health as vice president of sales.

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Michael McDermott, MD (Radiologic Associates of Fredericksburg) takes on the role of CEO at Mary Washington Healthcare (VA) beginning January 1, 2015.

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Bob Taylor, DO (Greenway) joins Clinical Architecture as CMIO.

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Ryan Witt (Juniper Networks) joins ClearDATA Networks as vice president of growth and innovation.

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Steven Steinhubl, MD (Scripps Translational Science Institute) joins Vantage Health as chairman of the board.


Technology

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This article covers the debut of Spruce, an app that lets users privately share photos and medical information with dermatologists, and then receive in-app treatment. Baseline, Cowboy Ventures, and Kleiner Perkins Caufield & Byers contributed $2 million to the launch in initial seed round financing.


Other

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Samsung, the Children’s Fund, and Columbia University announce at the 2014 Clinton Global Initiative Annual Meeting a two-year partnership to develop the Samsung Innovation Center at the Children’s Health Fund. The center will focus on advancing access to and quality of healthcare for medically underserved children through telehealth and other strategies.


Sponsor Updates

  • Intellect Resources describes Ochsner Health System’s (LA) challenges and results of its Epic implementation.
  • Connance will share how the University of Rochester Medical Center increased its charity care dollars while reducing bad debt during the HFMA Region 2 Fall Annual Institute October 22-24 in New York.
  • ReadyDock discusses the vulnerability of mobile devices to virtual and pathogenic attacks in a recent blog post.
  • Aprima and First Databank offer electronic prior authorization through Surescripts connection.
  • Etransmedia shares how a pediatric cardiology practice was able to reallocate resources after working with Etransmedia’s RCM team to automate its front office.
  • Billian’s HealthDATA shares 10 recent healthcare CIO placements.
  • CareSync rolls out V2.5, which combines wearables data with medical records using integrations through Validic partnership.
  • Craneware will host its first Revenue Integrity Summit October 14-16 in Las Vegas.
  • Greenway becomes the first ambulatory information provider to have a solution recognized as a Validated System by Healtheway’s eHealth Exchange Product Testing Program.

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EPtalk by Dr. Jayne

Our hospital recently hosted a healthcare career day for middle school students. We’re in an economically depressed part of town with some serious socioeconomic issues, yet fully realize we’re going to need dedicated and well-educated healthcare workers to deal with the challenges we’ll continue to face. The goal of the day was to expose them to various opportunities either directly in or supporting healthcare. They were able to visit various areas of the hospital, including sterile processing, the laundry, patient care floors, engineering, and an operating room.

Some students were grossed-out by the idea of direct patient care, but were interested in engineering or IT, which is a good thing. It takes an army of people to keep an institution of our size going and often those jobs are independent of patient census or case mix, which is a good thing for job security. The highlight of the day for many was being able to see one of the air ambulances land and speak with the flight crew.

As a member of hospital administration, my role was to shepherd a group of students through various stations set up throughout the hospital, where they could talk directly to staff and learn about their jobs and how they contribute to the healthcare team. As is predictable with students in that age group, frequent questions included: “What’s the grossest thing you’ve ever seen? What’s the worst injury you’ve ever seen?” My favorite question was, “Is the stuff that happens on Grey’s Anatomy really true?” which made me wonder why a parent was letting a 10-year-old watch a show about sex-crazed doctors.

At one point, the air ambulance pilot received a question about emergency situations. He told the student his question was in the top 10 list of things he didn’t want to experience, to which the student responded “What’s number one?” I had to give him full credit for that one. I kind of tuned out after that because I was thinking about what I’d put on my own top 10 list of things of things I never want to happen.

I’ve experienced some things in my IT and practice careers that would definitely make that list:

  • Someone accidentally activated the fire suppression system at our corporate data center. Because we were using Halon, the building had to be vented by the local fire department with their positive-pressure ventilation equipment. This took about eight hours for a building the size of our data center. Unfortunately, our “hot backup” failed due to a defective network switch, requiring all practices to go to paper.
  • A local road crew cut the T1 line to my office. Luckily, we equipped key staff with wireless cards and network hot spots, so it wasn’t that big of a deal.
  • With my first EHR, the clinical documentation workflow went through a “locking” process as the provider finalized the note. This was after the provider reviewed the documentation on screen. Unfortunately, during the locking process some kind of character limit went into effect, causing the documents to truncate. When patients returned for their follow-up visits, their plans (at the bottom of the documents) were missing critical elements. Nothing makes your blood run cold like reading “Counseled patient on…” and having that be all that remains of your highly detailed patient plan.
  • Vendor sunsets a product that actually supports your workflow and that your staff likes, transitioning you to a product that is not yet ready for prime time. This has now happened to me twice.

None of these are quite as scary as having rotor failure on your helicopter or having the landing pad collapse underneath you, but in our world they’re pretty unnerving. What’s on your top 10 list of things you never want to happen? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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September 25, 2014 News 1 Comment

News 9/24/14

September 23, 2014 News 1 Comment

Top News

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Hospital operator HCA announces that it will acquire privately held physician systems vendor PatientKeeper. Terms were not disclosed. I spoke to PatientKeeper President and CEO Paul Brient ahead of the announcement. “HCA is a longstanding customer of our view-only portal, our clinical review tool,” he said. “Now HCA will deploy all of our software – CPOE, clinical documentation, and medication reconciliation – over top of their Meditech systems. They will invest to make it even more useful to their doctors.” Brient will serve as CEO of PatientKeeper, which will be operated as a wholly-owned subsidiary of HCA. Its 160 employees will continue to work from company headquarters in Waltham, MA, supporting the company’s 58,000 physician users. The acquisition is expected to close by the end of the year.


Reader Comments

From Garbanzo Being: “Re: HCA. Will remain on Meditech and not transitioning to Epic or Cerner as has been rumored. PatientKeeper helps extend the life of Meditech for HCA.” HCA didn’t say that specifically, but PatientKeeper President and CEO Paul Brient hinted to me that HCA likes PatientKeeper over Meditech better than Epic, suggesting that its Epic experiments have concluded and the go-forward platform will be Meditech. He didn’t mention whether HCA will do a Meditech 6.0 upgrade, the challenge of which sent them sniffing around Epic in the first place.

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From King Biscuit: “Re: Office Practicum. Announced to clients that they acquired EHR/PM vendor Workflow.com. Odd since OP is a small company and it’s a competing product. The email suggests a move away from a pediatrics-specialty product and possibly a wholesale platform change.” I don’t know anything about Workflow.com except that it founded by Packy Hyland, who also founded Hyland Software (now Onbase by Hyland).

From Shannon: “Re: 3M’s CAC 360 Encompass R2 (Release2). Has numerous major problems. Coders not happy using it. 3M is currently merging their 2 NLP platforms — will this be too late for ICD-10 implementation date? Will the other CAC vendors be able to capitalize on this weakness?” Unverified.

From Deal Breaker: “Re: Sutter Health. Stops discussion with Orion Health after it HIE project goes on for nine months. Is this the reason there are not any US reference sites for Orion all accounts travel to Canada and New Zealand?” Unverified. I think a site visit to New Zealand would be pretty great since I’ve heard it’s spectacular there and they (unlike much of the world) love Americans.

From All Hat No Cattle: “Re: Cernover. Don’t forget that Integris in Oklahoma (12 hospitals) is moving to Epic, too. Care New England in RI now Epic outpatient. How long until CHI moves across to Epic for their remaining sites on Cerner like KentuckyOne?” I tried to muster an argument that at least some sites have moved from Epic to Cerner, but I was just speculating since I couldn’t name any. The Cernover list is a bit one sided, so chime in if you know if an Epic-to-Cerner move that wasn’t triggered by a health system acquisition and standardization.

From Bob White: “Health 2.0. Lots of innovative companies there, although they all start to sound alike after a while.” The conference gets lots of people excited even though 95 percent of the startups there will sink without a trace because they aren’t that sharp, are underfunded, are poorly managed, or let their technology arrogance override their healthcare ignorance. I wish them all well, but I don’t have the patience to watch Darwinism in action as they desperately try to find pilot sites, customers, or acquirers before they run out of runway. My interest picks up once they hit $5 million in annual revenue because once they get that big they probably won’t disappear entirely.


HIStalk Announcements and Requests 

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Welcome to new HIStalk Platinum Sponsor ZeOmega. The Plano, TX-based company, founded in 2001, offers the Jiva population health management platform to payers, providers, and value-based care organizations. A recent client success is Indiana health plan MDwise, which reduced readmissions by 66 percent and length-of-stay by 65 percent, saving $6.5 million per year with Jiva. Jiva is scalable and stable with redundancy and recovery built in and the new release adds more capabilities to support accountable care and value-based health delivery models in integrating workflow, analytics, content, and communication capabilities. The folks there would be happy to do a demo for you. Thanks to ZeOmega for supporting HIStalk.


Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

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Royal Philips NV announces plans to split into two companies – one devoted to lighting, the other to healthcare and consumer goods that will operate under the HealthTech name. The announcement follows in the footsteps of similar moves made by rival Siemens last year.


Sales

Community Health Center of Southeast Kansas and Health Partnership Clinic (KS) select eClinicalWorks EHR and RCM for their 12 combined clinics.

Catholic Health Services of Long Island (NY) chooses Connance predictive analytics and vendor management technology.

Sheltering Arms Rehabilitation Center (VA) deploys Strata Decision’s StrataJazz as its financial platform.


Announcements and Implementations

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North Country Hospital becomes the first in Vermont to go live on the state HIE. Larger hospitals like Fletcher Allen Health Care will be online by the end of the year.

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Waterbury Hospital (CT) integrates TigerText secure messaging into its Cerner EHR. The hospital has also been in the news due to rumors of a possible takeover by Tenet Healthcare Corp.

Surescripts announces the addition of four pharmacies and three EHR vendors to its Immunization Registry Reporting service.

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The Bronx RHIO selects Direct secure messaging services from DataMotion for its affiliated healthcare organizations. The Visiting Nurse Service of New York and SBH Health System (NY) are among the first to use the service.

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Zynx Health launches the ZynxCarebook mobile platform to help streamline coordinated care efforts between inpatient and after-care providers.


Government and Politics

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White hat hackers from the HHS inspector general’s office report that their attempts to break into Healthcare.gov earlier this year alerted them to a “critical vulnerability.” Their attempts to exploit it were thwarted due to defenses already in place.

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Representatives Diane Black (R-TN) and Peter Welch (D-VT) introduce the ACO Improvement Act. If passed, the act would permit ACOs to use remote-patient monitoring and store-and-forward technologies for delivery of images to providers far away.

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Alaska’s Department of Health and Social Services files a lawsuit against Xerox for "failing to timely and adequately implement the [Medicaid payments] system and failing to timely and accurately pay Alaska providers." The state is seeking $46.7 million in damages, and has already shelled out $154 million in advance payments to providers to help see them through the Xerox delay.


Research and Innovation

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Ali Parsa, MD creator of the UK-based Babylon subscription health service, announces that he is prepared to take the Babylon app to the Middle East and Africa to reach populations with little reliable access to healthcare, but high adoption of smartphones. "We are now looking at parties who have a large customer base, such as supermarkets, big public institutions, mobile phone companies, and newspapers,” he says. "If people can go into Tesco and by an iTunes card, why can’t they buy a Babylon access card?"


People

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Mark Hyman, MD (The UltraWellness Center) joins the Cleveland Clinic as director of its new Center for Functional Medicine. Patrick Hanaway, MD (Institute for Functional Medicine) will serve as the center’s medical director.

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Jeff Pate (W Squared) joins Aegis Health Group as executive vice president of business development.

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White House CIO Steve VanRoekel resigns to join the USAID, where he will work as a senior adviser in the fight to halt the Ebola outbreak.

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Doximity hires Emily Peters (Uncommon Bold) as VP of marketing communications and Peter Alperin, MD (Kelvin) as VP/GM of connectivity solutions.  

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Bruce Brandes (Valence Health) is named managing director of Martin Ventures. 

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ONC Chief Science Officer Doug Fridsma, MD, PhD resigns to become president and CEO of AMIA.


Announcements and Implementations

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Billings Clinic (MT) is implementing just-released Caradigm Quality Improvement to identify gaps in care and make improvements in clinical workflow at point of care.


Other

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Construction company DIRTT makes news for using open-source software from the classic video game Doom to design hospital wings and office spaces. CEO Scott Jenkins says the system will help hospitals that want to reconfigure a room’s wall panel quickly for patients with different needs, or to accommodate new technology.

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Apple CEO Tim Cook announces that the company’s new “spaceship” headquarters in Cupertino, CA, will be the “greenest building on the planet.” Scheduled to open by the end of 2016, the new HQ will be powered exclusively by wind and solar energy.

CompuGroup Medical locks Full Circle Health Care (ME) out of its EHR system in a billing dispute. The financially struggling practice admits that it stopped paying its maintenance fees 10 months ago after CompuGroup bought its original vendor HealthPort and increased monthly fees from $300 to $2,000. The practice has moved to a new EHR and wants access to its old system for 48 hours to copy patient records that will otherwise be unavailable, putting patients in danger, but says CompuGroup installed a “phone home” kill switch without its knowledge that won’t let the practice log on even in read-only mode. CompuGroup makes the analogy that people who don’t pay their electric bill have their power shut off eventually. Meanwhile, the patients get to enjoy being used as human shields as the vendor and customer bicker. Someone should have read their contract more closely before signing it, I suspect.

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Weird News Andy summarizes this story as “Three’s a Crowd.” A Florida woman pays $20,000 to have a third breast added, saying she wants to make herself unattractive to men so she wouldn’t have to date any more (as WNA says, hasn’t she heard of just turning men down?) The real reason is likely her stated dream of starring in an MTV reality show, with possible titles being rich in punning opportunities. WNA notes that the story has been declared a hoax (not surprising given the obviously ‘shopped picture), but that shouldn’t stand in the way of its entertainment value.


Sponsor Updates

  • Arcadia Healthcare Solutions will demonstrate a new version of its Arcadia Analytics solution at Health 2.0 this week. It uses Informatica technology to integrate information from 20 EHR and claims systems to report on reporting for performance management, cost and utilization analysis, and patient outreach and care planning.
  • Amerinet signs a new agreement to offer VitalWare revenue cycle technology to its members at negotiated pricing.
  • Alan Rosenstein, MD, an expert in disruptive physician behavior, posts a PerfectServe article titled “Emotional Intelligence – Understanding Patient, Staff, and Physician Needs.”
  • DocuSign publishes a blog post titled “BAAs and Beyond: Meeting the September 22 HIPAA Deadline.
  • Shareable Ink will work with students from Bentley University on user interface design.
  • Park Place International achieves SSAE 16 Type II standards compliance for OpSus Cloud Services.
  • EClinicalWorks CEO Girish Navani joins a panel discussion at Health 2.0’s annual conference to discuss how technology is improving the patient experience.
  • US News and World Report indicates that 96 percent of Honor Roll hospitals in its “Best Hospitals and Best Children’s Hospital’s 2014-2015” use Wolters Kluwer Clinical Drug Information.
  • Gritman Medical Center (ID) is live on AtHoc’s emergency communication solution.
  • Validic announces a 20 percent increase in its digital health ecosystem with new integrations including hospitals, health systems, payers, pharma, and wellness companies.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 23, 2014 News 1 Comment

HCA To Acquire PatientKeeper

September 23, 2014 News 4 Comments

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Hospital operator HCA announced this morning that it will acquire privately held physician systems vendor PatientKeeper. Terms were not disclosed.

HCA Chief Health Information Officer Jim Jurjis, MD said in the announcement, “HCA is investing in advanced, forward-looking informatics approaches to healthcare to improve usability, quality, effectiveness, and efficiency of care. The acquisition of PatientKeeper is an important step in that direction. It gives us important influence in the layer of the electronic record that the doctor sees, creating an innovative platform for workflow improvement.”

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I spoke to PatientKeeper President and CEO Paul Brient ahead of the announcement. “HCA is a longstanding customer of our view-only portal, our clinical review tool,” he said. “Now HCA will deploy all of our software – CPOE, clinical documentation, and medication reconciliation – over top of their Meditech systems. They will invest to make it even more useful to their doctors.”

Brient will serve as CEO of PatientKeeper, which will be operated as a wholly-owned subsidiary of HCA. Its 160 employees will continue to work from company headquarters in Waltham, MA, supporting the company’s 58,000 physician users.

Brient confirmed that PatientKeeper will continue to market its products (Charge Capture, Clinical Results Review, CPOE, eSignature, Medication Reconciliation, NoteWriter, and SignOut)  to prospective clients. “There will be no change except the board members will be from HCA,” he said.

The acquisition is expected to close by the end of the year.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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September 23, 2014 News 4 Comments

Morning Headlines 9/22/14

September 21, 2014 Headlines No Comments

Behind the Curtain of the HealthCare.gov Rollout

A report from the US House Committee on Oversight and Government Reform portrays dissent between CMS and HHS before and after the failed rollout, with internal emails providing evidence.

Can a Computer Replace Your Doctor?

New York Times reporter (and physician) Elisabeth Rosenthal says everybody likes the potential of technology, but results haven’t been impressive and other fundamental questions should be answered first.

Building Mature Medical Software, McKesson Cardiology Achieves CMMI Level 5

The Israel-based development organization earns the highest possible rating in the Capability Maturity Model Integration framework.

CMIO Rant … with Dr. Andy

Andy Spooner, MD, CMIO of Cincinnati Children’s Hospital Medical Center, offers eight recommendations for the AMA to consider instead of complaining about EHRs.

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September 21, 2014 Headlines No Comments

Monday Morning Update 9/22/14

September 20, 2014 News 4 Comments

Top News

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”Behind the Curtain of the Healthcare.gov Rollout,” a report from the US House Committee on Oversight and Government Reform (the committee is wildly anti-Democrat, but still interesting) contains fascinating details of the internal panic once CMS realized they were in way over their heads right after Healthcare.gov went live and failed. It concludes that infighting between CMS and HHS forced the development team to work through US CTO Todd Park, with CMS attempting to hide security exposure, keep HHS in the dark, and insist on a full site launch instead of a phased approach. Some fun snips from internal emails the committee dug up as HHS and CMS people duked it out electronically, sometimes using their private rather than government-issued email accounts:

  • [Unidentified HHS employee]” “Your leadership only wanted to hear beautiful music … clearly these people are not smart enough to pull it off … you could definitely see the CYA moves coming a mile away.”
  • [Unidentified HHS executive, referring to CMS Deputy Director of IT Henry Chao]: “I grow wear of the bull#### passive/aggressiveness of Henry … the other way to do this is through a complete covert ops mission to unseat the CMS FFE rules engine.”
  • [HHS CTO Bryan Sivak, pictured above]: “It’s all negative. I’m going to embark on a campaign to declare victory without fully launching.”
  • [HHS CTO Bryan Sivak, responding to an email in which CMS admitted that the site could not handle more than 500 concurrent users]: “Anyone who has any software experience at all would read that and immediately ask what the f## you were thinking by launching.”
  • [HHS CTO Bryan Sivak, responding to US CTO Todd Park’s claim that the site’s problems were all related to user volume even though officials knew that wasn’t the case]: “This is a f###ing disaster. It’s 1am and they don’t even know what the problem is, for sure. Basic testing should have been done hours ago that hasn’t been done.”
  • [HHS CTO Bryan Sivak]: “1. Bad architecture. 2. Not enough testing. Pretty simply really.”
  • [HHS CTO Bryan Sivak, replying to the former HHS employee who transferred to CMS and suggested she might not be much help]: “If you don’t get access, I’m probably going to start being a little bit of a d###, which will give you ample opportunity to badmouth me and gain the trust of people at CMS.”
  • [CMS employee, in urging that Healthcare.gov code be removed from open source repositories]: “This Github project has turned into a place for programmers to bash our system, submit service requests (!), and now people have started copying Marketplace source code that they can see and making edits to that.”

Reader Comments

From LL Fauntleroy: “Re: Cerner shops. The number of major ones that have pulled the plug to go with Epic (the industry term is ‘Cernover’) is the best-kept secret in health IT since neither the company nor clients announce it. Some I know from the last couple of years. Loma Linda, Dallas Children’s, Stanford Children’s, University of Utah, John Muir Health System, Connecticut, etc. There are also hospitals pulling the Cerner plug in Australia (Royal Children’s) and elsewhere around the world. There are also a number of shops that run Cerner inpatient but Epic outpatient, or Epic rev cycle, and are rumored to be considering switching, such as Northwestern. Why doesn’t HIStalk write about this?” I’ve written about those of which I’m aware, which is most of these, but I have to depend on readers to tip me off since I’m not omniscient. HIMSS Analytics could verify this trend (if it is one) or identify other Cernovers (or “Epicstinguishes” since surely a few health systems went the other direction), but they aren’t about to tell me for free.

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From SoCalSurfLegend: “Re: Prime Healthcare. Three of their southern California hospitals are implementing Epic. Prime is adamant that they will not use consultants. How long before they realize it can’t be done? I’ll set the over/under at three months considering that Prime’s ownership group is the cheapest bunch around.” Unverified. Prime Healthcare’s majority owner is Prem Reddy, MD, an India-born cardiologist who has made a fortune buying and operating financially aggressive hospitals and is known as a generous philanthropist. His wife, daughter, and son-in-law are doctors.

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From BJ Hunnicutt: “Re: BJC. My sources say Cerner won the demo round. Allscripts lacked functionality and the reps interrupted their own demo team to inject irrelevant information, while Epic seemed stale and self-important. BJC uses Allscripts inpatient at two academic campuses, Allscripts ambulatory for the medical school faculty clinics, the FollowMyHealth portal, NextGen for employed physicians, McKesson Horizon at the community hospitals, both Cerner and Horizon lab, and Soarian financials. They also have a homegrown clinical data repository and a massive interface support staff to keep it running. The McKesson Horizon situation is probably a key driver. I make Cerner the favorite because of their strong demo and existing relatively new Soarian backbone, plus the two other major health systems in town (SSM and Mercy) have Epic and BJC won’t want to look like they’re jumping on the bandwagon late.” Unverified. BJC’s site says the IT department has a $200 million annual combined budget and 800 employees who specialize in “clinical-based software solutions, integration of disparate systems, and expert systems intended to support caregivers in clinical practice.” Headcount assigned to that middle one seems entirely justified given the apparently lack of appetite for standardizing systems.

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From The PACS Designer: “Re: Windows 9. Microsoft announces September 30 as Win 9 day, with a new Start menu, a virtual desktop feature, and a notification center.” Better get out early to camp out a spot in line. Oh, wait, that’s Apple. It’s pretty bad when the most exciting new feature of a highly touted new release is to restore functionality idiotically removed in the previous one.


HIStalk Announcements and Requests

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It’s a 55-45 respondent split on whether Apple will have any influence on health and healthcare. Steven Davidson, MD added this comment to his vote: “Apple is the baby boomer tool of choice. Consumers, aka activated, engaged patients are growing in number and power and will adopt tools that enable/enhance their power. Apple wants to be that tool vendor and is the first major (well maybe Nike, but they’re giving up) consumer brand to offer a mostly complete as it is tool set. I think their presence is important and I think the hospitals still don’t get it–with a small number of notable exceptions.” New poll to your right or here: should the MU 2015 reporting period be reduced to 90 days?

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Welcome to new HIStalk Gold Sponsor Phynd. The Kearney, NE-based company offers a cloud-based platform that synchronizes provider data from all of a hospital’s IT systems into a single profile, allowing hospitals to accurately answer the question, “Who are your doctors?” that includes billing address, communications preferences, licensing, internal system IDs, exclusionary lists, and contracting. It uses a patent-pending Universal Provider Profile (UPP) for all 3 million US providers, making it easy for frontline users to add a new provider on the fly, also supporting custom fields and taxonomies on any topic and from any IT system. Data quality can be easily determined by each provider’s UPP Score. Folks at Yale-New Haven Health recently did a presentation on how Phynd solved their problems involving 7,000 Epic users and 40,000 referring physicians: outdated credentialing information, endless calls to get updates, manual lookups, and lack of auditability of updates. Thanks to Phynd for supporting HIStalk.

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Mr. Fraustro, the California teacher whose classroom got a 3-D printer courtesy of HIStalk readers, provided some photos of it in use. He says the students were excited when they fired it up for the first time and saw the flashing lights, heard the sounds, and smelled the printing filament and realized it exists beyond YouTube videos.

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Andy Spooner, MD of Cincinnati Children’s Medical Center wrote another great “CMIO Rant” posts on HIStalk Practice, this one rebutting the AMA’s list of EHR problems with things they could be doing instead of complaining about technology.

Listening: new from Train, complete with their trademark clever lyrics despite a dangerous turn into “background music for work” territory. Extra points for the jangly “I’m Drinkin’ Tonight.” Decent for a band that’s been plugging away for 20 years and is down to just two original members.


Last Week’s Most Interesting News

  • Congresswoman Renee Elmers (R-NC) introduces a bill that would allow providers to choose any three-month reporting period in 2014 for Meaningful Use reporting instead of the full-year mandate otherwise scheduled to begin October 1.
  • Apple pulls HealthKit-dependent apps from the App Store after finding unannounced bugs in HealthKit that will take at least two weeks to fix.
  • The American Medical Association and then its president take shots at poor EHR design and usability.
  • Former Kaiser Permanente CIO Phil Fasano joins insurance company AIG in the newly created position of EVP/CIO, with KP VP named as interim CIO as the national search for Fasano’s replacement begins.
  • Outsourcer Cognizant announces plans to acquire TriZetto for $2.7 billion.
  • An app developer trade group asks HHS via Congressman Tom Marino (R-PA) to make it easier for them to understand and comply with HIPAA requirements, some of which predate the iPhone.
  • Epic holds its UGM with over 18,000 attendees on hand in Verona, WI.
  • Illinois-based systems Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system, with a stated expected benefit being the sharing of electronic medical records between their respective Cerner and Epic systems.

Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

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Providence Health & Services launches Providence Ventures, a $150 million venture capital fund that will invest in companies focusing on online primary care access, care coordination and patient engagement, chronic disease management, clinician experience, analytics, and consumer health. It will be led by a former Amazon publishing executive. Providence will also create an internal innovation group to help it collaborate with early-stage companies, run by newly hired VP Mark Long (above), who was formerly CTO of Zynx Health.

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Identity and access management technology vendor Ping Identity receives $35 million in venture funding, bringing its total to $110 million.  


Announcements and Implementations

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The Tel Aviv, Israel-based McKesson Cardiology development group earns CMMI Maturity Level 5, the only FDA-regulated medical device software organization to achieve the highest software process improvement rating. I assume that’s the former Medcon that McKesson acquired for $105 million in 2005.


Other

Cerner and athenahealth say they, like Epic, are working on integrating their systems with Apple’s HealthKit. People seem excited about that for some reason.

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A New York Times article calls out “drive-by doctoring,” where surgical patients receive bills from clinicians called in without the patient’s approval, often billing them at out-of-network rates. A disk repair patient was billed $117,000 by an out-of-network “assistant” neurosurgeon he had never met. Another patient complained that plastic surgeons billed him $250,000 to close an incision and a “parade of doctors” dropped by regularly post-op without mentioning that they were billing him every time they said hello. The article points out that the US has more neurosurgeons per capita than other countries and Medicare is paying them less, so they attend seminars on “innovative” coding and convince other surgeons to fraudulently declare emergencies that require their services. This is bizarre to me: the hospital sent a surgical patient’s blood tests and ECG to an out-of-network lab.

New York Times reporter Elisabeth Rosenthal, who is a Harvard-educated physician (and who also wrote the article above about drive-by doctoring), rightly calls out the silliness (and profit-seeking motivation) of entrepreneur Vivek Wadhwa proclaiming that, “I would trust an A.I. [artificial intelligence]” over a doctor any day” since AI provides “perfect knowledge.” Leave it to technologists to utter some of the stupidest imaginable statements about healthcare, exhibiting their lack of knowledge about medicine and putting unwarranted faith in the inaccurate perception that given endless amounts of unaudited data and enough computer horsepower to churn through it, better outcomes will automatically be obtained (let’s match Watson against a skilled physician instead of a “Jeopardy” contestant in treating an elderly patient with multiple chronic conditions and see who wins). Rosenthal makes great points: (a) slick technologies, including fitness trackers, haven’t affected outcomes or costs; (b) “health” can’t be easily defined with the knowledge we have today; (c) it’s easier to collect data than to know what it means, such as whether low testosterone levels in men are relevant; (d) people die even when their data points are perfect; and (e) it’s easy to find measurable abnormalities in patients who are fine, leaving the choice of treating the measurement or the patient. She concludes that some but certainly not all medical outcomes can be affected by collecting more information:

One central rule of doctoring is that you only gather data that will affect your treatment. There are now devices that track the activity of your sympathetic nervous system as a measure of stress. But what do you do with that information? Other devices continuously monitor breathing for wheezing that isn’t noticed or audible. Does that matter? Some studies have shown that continuous monitoring isn’t useful for children hospitalized with bronchial infections.

If you were dieting, would stepping on the scale 1,000 times a day help you lose weight? Or consider the treatment of an abnormal heart rhythm. It’s true that constant monitoring for a few days can be highly useful to identify the pattern and what provokes the attacks. After that, though, for many patients a wearable cardiac tracker might simply record normal beats that normal people experience all the time, increasing anxiety for many patients.

The Minneapolis paper profiles Peter Kane, founder of two failed healthcare IT businesses (ProcessEHR and Phase-1Check), who since started  a co-working space.

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Weird News Andy has thoughts about this story, in which a since-fired 33-year-old female nurse is accused in a lawsuit of initiating “unsolicited sexual relations” with a 60-year-old male ICU patient waiting for a heart transplant, which the man claimed had happened with other patients. WNA’s analysis: “Was she so inept that his heart rate didn’t go up, or did alarm fatigue prevent someone from investigating?”


Sponsor Updates

  • Validic will announce new clients, integration partners, and connectable fitness devices at the Health 2.0 Fall Conference this week. The company will sponsor a Codeathon and participate in panel discussions.
  • Wellcentive will demo its population health management solution at the Health 2.0 Fall Conference.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 20, 2014 News 4 Comments

News 9/19/14

September 18, 2014 News 14 Comments

Top News

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Apple removes HealthKit-powered apps from the App Store on iOS 8’s launch day Wednesday, stating that an unspecified HealthKit bug will keep those apps offline for at least two weeks. Some app developers are reportedly scrambling to remove HealthKit dependencies from their products to avoid loss of momentum.

I upgraded my iPhone 5 to iOS 8 Thursday hoping to fix an ongoing “no SIM installed” error. While the Health app is present, it only supports basic data entry (body measurements, sleep, vital signs) until connected to source apps, so nobody’s going to get excited about that. It does offer a new Medical ID option so that users can enter emergency information (allergies, meds, contacts) that can be displayed on the iPhone’s emergency dialer screen when needed. Reader Is-It-The-Future-Yet says that feature could have “more impact than anything HealthKit or the silly watch is going to do to actually impact care,” although my observation is that you would still need a medical alert bracelet since first responders aren’t going to check your phone on the off chance you’ve entered something important there.


Reader Comments

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From St. Louis Cardinal: “Re: BJC. Looks like they’ve gone out to the market for EMR replacement. Order of demonstrations: Allscripts, Cerner, Epic.” Demos were completed four weeks ago. I don’t remember what they’re using, although I know they chose several Siemens Soarian apps a few years back and I think they have some Allscripts products as well.

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From MD Backle: “Re: Amazing Charts. Thought you might enjoy this email ad, in which they misspell EHR three times (twice as ERH, once as HER) plus misspell ‘it’s’ as ‘its.’ They need some proofreading!” Hopefully their programmers are better keyboarders than their salespeople.

From A Reader: “Re: KLAS report on Epic consulting, released as hordes of consultants are at Epic UGM. It would be great to hear your input on the report.” I don’t have access to KLAS reports, so I generally don’t bother mentioning them since there’s not much I can say having read only the teaser press release that intentionally discloses little of the expensive report’s contents.


HIStalk Announcements and Requests

We’re already planning for HIStalkapalooza at HIMSS15 in Chicago. We’ve booked an amazing (huge) venue, hired a band, and started planning the details that will ensure that this will be the best and biggest HIStalkapalooza ever. Contact Lorre if your company wants to participate as one of five sponsors who will get great benefits like event recognition, a private hosting area, a welcome/display space on the main floor, and a bunch of invitations to share with prospects, customers, or employees. We needed to exert more control and decided to forego the “single sponsor” approach, although we might still consider it if a company agrees to our terms in making it a great experience for attendees. I like this approach (which companies have suggested for years) because the event’s sponsors can make a big impression in front of a huge audience without having to bear the full effort and expense.

This week on HIStalk Practice: One family physician sticks up for EHRs. Dr. Gregg provides perspective on Meaningful Use. Alisha Smith shares last minute prep tips for the HIPAA Omnibus deadline. Research shows Apple won’t reach critical mass for world healthcare domination any time soon. Elation EMR CEO Kyna Fong discusses the importance of physician shadowing. New Jersey Physicians ACO goes with eClinicalWorks. Brad Boyd offers strategies for onboarding financial systems. Thanks for reading.

This week on HIStalk Connect: Keas raises a $7.4 million Series C to help expand its employee wellness platform. 6Sensor Labs announces a $4 million seed round for a portable food analyzer that can detect gluten and potentially other allergens. Researchers at the European Respiratory Society’s International Congress present study findings suggesting that lung cancer patients have measurably warmer breath, a characteristic that may lead to innovative new screening tools. 


Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Our secretive government health IT expert Dim-Sum delivered an amazing webinar Thursday on the Department of Defense’s $11 billion EHR project. We had large attendance and lots of questions in covering the EHR vendors and prime contractors that are bidding, the military health system’s structure, the opportunities for companies to do business as subcontractors, and the strengths and weaknesses of the competing teams (CSC-HP-Allscripts, IBM-CACI-Epic, Leidos-Accenture-Cerner, and PWC-GDIT-DSS.) It’s more like a conversation since we didn’t use slides, but it held my attention throughout and I highly recommend it to anyone with even a casual interest in how several billion of our taxpayer dollars will be spent or how our military members will be cared for. Thanks to the brilliant Dim-Sum for delivering a frank, funny, and highly useful presentation. 


Acquisitions, Funding, Business, and Stock

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Medseek changes its name to Influence Health to reflect its mission to influence consumer choice, brand loyalty, and health behaviors before, during, and after healthcare encounters.

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Larry Ellison will step down as CEO of Oracle. The 70-year-old company founder will be replaced by co-CEOs promoted from within, Mark Hurd and Safra Catz.

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China-based Internet and e-commerce vendor Alibaba conducts the highest-yielding IPO in the history of American stock exchanges, raising $22 billion and valuing the company at $168 billion. The company made tentative moves into healthcare IT in the past few months with an investment into a Hong Kong-based pharma software vendor.

Perceptive Software, fresh off a move to a new headquarters building, announces layoffs and the closing of  its offices in Beverly, MA and San Francisco.

Cerner gets Federal Trade Commission approval to acquire Siemens Health Services with early termination of the waiting period, keeping the acquisition on track for Q1 2015.


Sales

Central Clinical Labs selects Liaison EMR-Link to integrate lab results into the PointClickCare long-term care EHR.

People

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Kaiser Permanente names SVP of Enterprise Shared Services Dick Daniels as interim CIO, replacing Phil Fasano.

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Baptist Health System (AL) promotes CMIO Chris Davis, MD to CIO/CMIO. He has served as interim CIO since June.


Announcements and Implementations

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Sunquest and Partners HealthCare establish a strategic alliance to develop a next-generation genomic information system. Sunquest will make an investment in GeneInsight, a Partners-owned company that offers software for genetic testing reporting, results delivery, and collaboration.

The Denver Office of Economic Development names Aventura as a Denver Gazelle high-growth company.

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Holyoke Medical Center (MA) goes live on T-System’s EV physicians documentation system.

Dallam-Hartley Counties Hospital District (TX) implements Holon’s CollaborNet HIE.

Identity and access management solutions vendor Tools4ever will use technology from Boston Software Systems to automate its solutions.

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High Point Regional Health (NC) begins its implementation of Epic, which will replace Allscripts outpatient and McKesson inpatient now that the health system has merged into UNC Health Care. According to High Point’s COO, “This is one of the main reasons we sought out and merged with UNC, that is, to be able to take advantage of centralized resources, and high on that list was Epic. For us, it’s a great opportunity because it is becoming the default, go-to system in the state.”


Government and Politics

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Congresswoman Renee Ellmers (R-NC) introduces the Flex-IT Act that would allow providers to choose any three-month quarter for 2015 Meaningful Use reporting, explaining,

Healthcare providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.

The Meaningful Use Program has many important provisions that seek to usher our health care providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.

The Flex-IT Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.

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Mikey Dickerson, the former Google engineer brought on as administrator of the White House’s US Digital Service, says Healthcare.gov was a mess when he was called in to fix it as part of the “tech surge.” There was no system status dashboard, so “there was no place to find out whether the site was up or down except for watching CNN,” none of the project’s 55 contractors were tasked with maintaining uptime, and nobody seemed surprised or anxious that the site was down since government projects fail regularly. He explains his job change: “We have thousands of engineers working on picture-sharing apps when we already have dozens of picture-sharing apps. These are all big problems that need the attention of people like you. These problems are important, and fixable, but you have to choose to take them on. This is real life. This is your country.” I noticed that his LinkedIn profile lists his previous government-related service as “No Fancy Title, Thanks.”


Technology

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The Portland, OR business paper profiles startup ReelIDX, which offers platform for creating, managing, and sharing medical video content. It emphasizes recording the patient encounter for patient education and clinician review.


Other

Three North Carolina health systems – WakeMed, Wake Forest Baptist Medical Center, and Vidant Health – create a shared services company to reduce costs, with WakeMed’s CEO saying the systems hope to reduce their individual Epic operating costs and training efforts.

The Helsinki, Finland newspaper writes up “Apotti – a patient data system that costs more than a children’s hospital.” The government chose CGI and Epic as vendor finalists to develop the new system and expects to name the winner in early 2015. Total costs are estimated at $555 million.


This tweet from Epic’s UGM seemed to polarize the Twitterverse – do the disproportionate Epic-to-Epic numbers support or dispute Epic’s interoperability claims?

AMIA joins the Commission on Accreditation for Health Informatics and Information Management Education to develop accredit master’s programs in health informatics.

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Faculty of the School of Biomedical Informatics at Texas Medical Center don hats to celebrate National Health IT Week.

A clickbait Venture Beat article titled “EHR giant Epic explains how it will bring Apple HealthKit data to doctors” takes 16 paragraphs to state the obvious: user information from iOS’s HealthKit can be grabbed by Epic’s MyChart (with the patient’s permission) and then populate Epic. It misses the real challenge as to what happens on the Epic side, not only in the form of alerts or actions, but what clinicians are supposed to do as a result. The challenges aren’t technical:

  • The data that an iPhone can collect is basic and not all that useful diagnostically except perhaps trended over time (such as a gradually increasing weight).
  • Most app developers won’t get FDA approval to add logic that would find the one piece of potentially useful information out of thousands of data points, so that means tons of useless and unreviewed junk will get dumped into Epic.
  • Providers aren’t paid to watch consumer-captured information. Even now patients could email their doctor with logs of weights, blood pressure, and blood glucose, but doctors aren’t paid to read them. It’s also not clear who should be watching the information – PCP, specialist, nurse, or someone else?
  • Healthcare is designed around encounters, not monitoring. App developers don’t understand that medicine isn’t as digitally right or wrong as their world – most of us as patients want to be treated as individuals, not worksheets of measures limited by the convenient availability of sensors.
  • Hospitals and practices may decline to allow patients to send them information since that accepts responsibility for doing something with it. Nobody wants to get sued for malpractice for missing one abnormal measure.

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Steven Stack, MD, president-elect of the AMA, says EHRs are immature, expensive, and poorly designed. He adds that poor EHR usability is a significant driver of physician dissatisfaction. He doesn’t explain why AMA’s members greedily and voluntarily bought those systems despite their faults hoping to pocket a few dozen thousand dollars in free MU money. The market is where it should be, at the intersection of supply and demand, and perhaps the AMA should be convincing its members who are providing the demand as customers instead of scolding the companies that meet it. It’s like complaining that you hate Taco Bell while waiting in line to get your daily bean burrito. Stack has done committee work for ONC, was involved with the PCAST Report (that mostly touted Microsoft as the answer to all healthcare IT problems), and is on the board of eHealth Initiative (which includes quite a few vendor members). He’s always been a usability critic.

At least 15 children die in Syria after receiving UN-provided measles vaccine, with a preliminary WHO report speculating that medics accidentally gave the muscle relaxant atracurium instead of the vaccine since the drugs are packaged in similar vials and were stored in the same refrigerator.

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A security publication finds medical records on sale in bulk on a black market Internet site, apparently stolen from a Texas life insurance company’s applicant database. The writer bought records and verified their accuracy, with prices as low as $6 for each “fullz,” slang for a complete set of records that the buyer can use to open fraudulent credit card accounts, access bank accounts, or take over someone’s identity.

UCSF surgeon Wen T. Shen says he’s embarrassed for patients to see his lack of typing skills, but doesn’t like the alternatives:

Wait until after the patient leaves to start charting (impractical given our clinic workflow); hire a medical scribe to do my documentation for me, as detailed in a recent New York Times article (not happening with recent budget cuts); use the nifty speech-to-text dictation device provided to all clinicians (feels extremely weird and off-putting to do this in front of patients); actually learn to type (old dog/new tricks, dwindling brain plasticity).

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Weird News Andy says, “I <3 this password,” although he adds that it might be tough to get into your phone to dial 911 during a heart attack. Researchers develop an authentication method that uses wristband-detected ECG patterns as “the perfect password,” although people with fibrillation might not be ideal users.


Sponsor Updates
  • Nordic announces that it has earned the top ranking among Epic implementation support and staffing consulting firms in a new KLAS report. Also named in the report is Orchestrate Healthcare, the highest ranked vendor-agnostic consulting firm in the implementation support and staffing category.
  • ADP AdvancedMD’s EHR earns ONC-ACB certification as a Complete EHR.
  • Huntzinger Management Group recognizes its clients and IT professionals for National Health IT Week.
  • Access provides Normal Regional Hospital (OK) with giveaways to help celebrate National Health IT Week.
  • EClinicalWorks names several ACO clients that are generating savings after deploying its CCMR.
  • ESD’s Phil Sierra discusses the value of healthcare IT in a recent blog.
  • Etransmedia shares a video about its success and growth.
  • SRSsoft is participating in the American Society for Surgery of the Hand conference in Boston this weekend.
  • Truven Health Analytics and National Business Group on Health partner to facilitate an improved Employer Measures of Productivity, Absence and Quality program.
  • AirWatch by VMware offers instant support for devices running on iOS 8.
  • An Imprivata survey finds that 65 percent of hospitals will use Virtual Desktop Infrastructure within two years and 84 percent of those will add single sign-on.

EPtalk by Dr. Jayne

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The physician lounge was buzzing this morning with the news of HR-5481, the “Flexibility in Health IT Reporting Act.” If passed and signed into law, it would allow providers to report 90 days rather than a full year in 2015.

I have to say my pulse quickened when I saw it. Congress set precedent with their ICD-10 push. This one might have less of a chance, however, since it’s not being tacked onto another high-profile bill. Maybe we can hook it to a bill everyone can get behind, such as the “We Love Mom, Apple Pie, and America Act.” If this passes, it just might defibrillate Meaningful Use, moving it from “mostly dead” to “slightly alive.”

In other bandwagon-jumping news, the American Medical Association releases a paper on setting “Priorities to Improve Electronic Health Record Usability.” I’m not a big fan of the “blame the EHR” game since there are so many more factors that influence usability, user behaviors, and generally how the health system runs. Rather than putting all of our eggs in the proverbial basket and assuming that if we just “fix” the EHR everything will be awesome, let’s look at the other issues that cause slowness and waste in health care.

My laundry list includes E&M Coding, obnoxious precertification requirements placed on physicians without good reason, The Joint Commission requirements, RAC audits, payer audits, Meaningful Use, other certification body requirements, and numerous non-value-added steps throughout the day. I could go on, but it would be aggravating. Although some of these have been shown to improve outcomes, many are just nuisances. Let’s take a multi-pronged approach and stamp out ALL poor usability, not just that of the software variety.

Back to the AMA, they again sent Medicare reimbursement codes for end-of-life care discussions to CMS for consideration. I’m in favor of efforts that would actually help physicians be paid for non-procedural work. We don’t die well in the United States. TV and media paint a picture of heroic lifesaving measures where everyone recovers fully, but don’t ever show patients with poor outcomes. The last time this came up, the scare tactics around “death panels” crushed any hope of approval.

As a primary care physician, one of the best things I can do as part of our partnership is talk to you about end-of-life care, getting your wishes out in the open and ensuring you have a support system that can carry them out when the time comes. Unfortunately, this isn’t for just Medicare patients. We need a national dialogue (heck, our EHRs all have prompts for it anyway) for patients of all ages. Young women die in childbirth, people are in horrific accidents, and overall stuff just happens.

I had some nurses make fun of me when I rolled into an outpatient surgical procedure with my healthcare power of attorney and living will at the tender age of 31. As a physician, I don’t want “everything” done and am firmly convinced there are things worse than passing on. Unfortunately, there’s no way commercial payers will cover this service until Medicare takes the lead or until patients pay out of pocket.

Until then it’s just one more thing we have to do without compensation, like keeping your diagnosis list maintained in both SNOMED and ICD-9 and explaining ethnicity to elderly people who have no idea why we would need to gather that type of information. I’m expected to share all data, but patients can pick and choose what I see, potentially placing them at risk. Proponents of MU argue that the potential of up to $44K worth of incentive payments effectively compensates us for all the extra work, but it doesn’t even scratch the surface.

I’m interested to hear what else we should ask Congress to fix for us while they’re at it. Got an idea? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 18, 2014 News 14 Comments

News 9/17/14

September 16, 2014 News 5 Comments

Top News

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Several member organizations — including HIMSS, CHIME, AHA, and AMA — urge HHS Secretary Sylvia Burwell to shorten the 365-day 2015 Meaningful Use reporting period to 90 days. The groups say they are “incredibly concerned” that the full-year reporting period will kill the Meaningful Use momentum, pointing out that only single-digit percentages of providers are ready for Stage 2 with only 15 days remaining. Meanwhile, Burwell focuses on more important issues – writing her first HHS blog post, in which quite a bit of Presidential butt is kissed.


Reader Comments

From Hospital IT’er: “Re: GE Centricity HIS. We have been getting calls from GE asking us when we’ll get off their platform. It is clear to me that they are going to abandon the product line sooner rather than later.” Unverified.

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From Teddy Lemur: “Re: Tuesday’s CMS/ONC Meaningful Use webinar. One of the most confusing I’ve attended. If you were to try and create a decision tree based on whether the site is an EH/EP/CAH, their Stage, their Year, site’s first year of attestation, date of attestations, site’s mix of certified EHRs, EHR’s level of certification,  etc., etc., it would rival the family tree of European royalty for the last 700 years. How would you like to be a MU auditor and try to judge a site’s 2014 attestation a year or two from now? It’s time to figure out how to best achieve the MU program’s future goals. Better patient care, anyone?”  


Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

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Outsourcer Cognizant will acquire TriZetto for $2.7 billion in cash from its majority owner, London-based private equity firm Apax Partners. I reported on August 19 that Apax was hoping to flip its 2008 investment of $1.4 billion in TriZetto, which earns $190 million in annual profits, for $3 billion.

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Craneware announces FY2014 results: revenue up 3 percent, EPS $0.34 vs. $0.33.

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Readmission software vendor RightCare Solutions raises $4 million in funding.

QPID Health will move to a larger Boston headquarters building and open a West Coast office in Carlsbad, CA.


Sales

Flagler Hospital (FL) chooses Allscripts dbMotion to connect community EHRs.

Oncology device and software vendor Varian Medical Systems will deploy the Infor Cloverleaf Integration and Information Exchange Suite.

In England, Wrightington, Wigan and Leigh NHS Foundation Trust names Allscripts as its preferred EHR vendor. Allscripts acquired Oasis Medical Solutions in July 2014 to improve its position as a single-source vendor to NHS Trusts in pairing that company’s patient administration system with Allscripts Sunrise.

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Willis-Knighton Health System (LA) selects Merge’s enterprise cardiology and interoperability solutions.


People

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Phil Fasano (Kaiser Permanente) joins insurance company AIG in the newly created position of EVP/CIO. His pre-Kaiser background was in the financial sector.

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Joining Phil Fasano in leaving Kaiser Permanente for AIG is Madhu Nutakki, KP’s VP of digital health, who has taken the role of CTO of data, innovation, and advanced technology at AIG.

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Brad Allen (Lumeris) joins ESD as regional VP, as does Aaron Johnson (The Morel Company).  

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Patientco names Jared Lisenby (Greenway Health) as VP of sales.

John Volanto, VP/CIO of Nyack Hospital (NY), is named interim CEO after the resignation of David Freed.


Announcements and Implementations

Surescripts adds four pharmacy benefit management companies and six EHRs to its electronic prior authorization service.

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Registration for HIMSS15 is open along with hotel booking. Early bird registration (through the end of January) is $745. A new (and somewhat odd) option is the free Conference Plus Pass, which allows Sunday pre-conference attendees to move from one session to another during breaks, which would be a benefit primarily if the one you paid $325 for is a dud and you’re willing to roll the dice.

Billian’s HealthDATA makes its searchable Vitals hospital news and RFP feed available at no charge.  

Siemens will offer its customers patient financing programs from CarePayment.

InstaMed and Coalfire release a white paper covering the security of payment cards in healthcare.

Infor announces CloudSite Healthcare, providing its solutions via Amazon Web Services as a subscription service.


Government and Politics

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A trade group for healthcare app developers asks Congressman Tom Marino (R-PA) to influence HHS to change HIPAA regulations, saying they are “mired in a Washington, DC mindset that revolves around reading the Federal Register” or “hiring consultants to explain what should be clear in the regulation itself.” It adds that small-scale app developers have few resources to help them understand their HIPAA responsibilities. The letter asks HHS to (a) publish a HIPAA FAQ for app developers; (b) update HHS’s HIPAA technical documentation, which in some cases pre-dates the iPhone; and (c) participate in developer-focused events.

A GAO report will call out security vulnerabilities in Healthcare.gov, warning that they will persist until fixed. GAO says CMS didn’t finish security plans, didn’t perform adequate security testing, failed to enforce password strength requirements, didn’t secure some of its infrastructure from Internet access, and failed to create a failover site.


Technology

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Stanford University Hospital and Duke University Health System will pilot the use of Apple’s HealthKit for tracking patient information. Stanford will send two pediatric diabetic patients home with an iPod Touch to record blood glucose levels, while Duke will track basic vital signs for some unannounced number of cancer and cardiac patients. Both health systems use Epic, with Stanford saying it hopes to be able to trigger alerts from the patient-provided blood glucose levels that will be sent back to the patient via Epic’s MyChart. It’s not much of a commitment by either organization and little detail was provided, so I assume it’s just a couple of university people playing around with Apple’s technology just because they can, possibly (or not) to eventual patient advantage.

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IBM is desperately seeking new nails for its Watson hammer that has failed to hit its sales numbers, now packaging it as Watson Analytics.

In Canada, volunteers at Bruyere’s Saint Vincent Hospital develop a headband-powered computer navigation system for quadriplegics using open source tools and consumer-grade parts. A quadriplegic resident of seven years says, “It makes life interesting. When you are in bed, it’s boring. If you can go online, you can go anywhere. With Google Maps, I can go on virtual tours.” She also uses the technology to connect with family via Skype.


Other

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The American Medical Association lists eight recommendations to make EHRs better:

  1. Design systems to enable physician-patient engagement, with fewer pop-up reminders and complicated menus.
  2. Allow physicians to delegate tasks.
  3. Track referrals, consults, orders, and lab results automatically.
  4. Modularize system design for easier configuration.
  5. Create tools that provide more context-sensitive, real-time information beyond overly structured data capture.
  6. Open up systems for interoperability.
  7. Link EHRs to patient apps and telehealth to support digital patient engagement.
  8. Build in capabilities for users to send product feedback and problem reports to vendors.

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HL7 tweeted out this photo of the brilliant and always-entertaining “Father of HL7,” Ed Hammond of Duke University.

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Eastern Maine Healthcare Systems (ME) will eliminate 43 IT jobs, about 12 percent of the department’s headcount, hoping to avoid a $100 million shortfall by 2019.  

Kaiser Permanente Hawaii launches an internal medicine residency, touting in the announcement its HealthConnect system.

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A Wisconsin newspaper is amused in its coverage of Epic UGM, reporting that Judy Faulkner joked that health IT acquisitions will accelerate and Epic will buy GE and rename it General Epic. She said, “The greatest users of electronic health records are the patients.” The photo above was tweeted out by David K. Butler, MD.

Weird News Andy says this is one of his “pet” peeves among vets of the animal kind. A Colorado veterinarian pleads guilty to charges of unauthorized practice for using creams on humans.


Sponsor Updates

  • PerfectServe will exhibit at MGMA and the ACPE Fall Institute.
  • Impact Advisors is included in Modern Healthcare’s “Largest Revenue Cycle Management Firms.”
  • MedAptus announces that approximately 4,000 charge capture and management suite end-users have rolled out its ICD-10 software upgrade.
  • Allscripts offers a short list of dos and don’ts of clinical IT deployment based on a new Alberta Health Services case study.
  • Consulting Magazine names Aspen Advisors, Deloitte Consulting, and Impact Advisors to its “2014 Best Firms to Work For” list.
  • The Massachusetts eHealth Collaborative receives ONC HIT 2014 Edition Modular EHR certification from ICSA Labs.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 16, 2014 News 5 Comments

Monday Morning Update 9/15/14

September 13, 2014 News 6 Comments

Top News

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Illinois-based Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system with 16 hospitals, 45,000 employees, and $6.5 billion in annual revenue. The CEOs of both systems say more mergers or acquisitions are likely as hospital consolidation continues. They also touted the benefit of shared electronic medical records and future plans to roll out more patient-facing technologies. I would bet that NorthShore’s Epic will eventually become the new standard, replacing Advocate’s Cerner system.


Reader Comments

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From Core Consumer: “Re: Apple and Epic. Apple used Epic screen shots in their HealthKit presentation. There’s no doubt that the companies signed a partnership agreement. Just because details weren’t announced doesn’t mean it didn’t happen.”

From The PACS Designer: “Re: Office 365 Garage Series. With the focus these days on security, Microsoft in their Garage Series wants everyone to know where the Office 365 improvements will be to enhance user performance, collaboration, and connectivity.” I’m surprised Microsoft hasn’t crowed more loudly about Apple’s iCloud breach.

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From Smooth Operator: “Re: Kaiser CIO Phil Fasano. Kaiser confirms that Phil has resigned. There’s all sorts of internal discussion on who will be named interim CIO.”


HIStalk Announcements and Requests

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HIMSS and CHIME are the organizations most often joined by poll respondents. New poll to your right or here: what influence will Apple have on health and healthcare? Vote and then click the Comments link on the poll to elaborate further.


Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

We ran a couple of great, well-attended webinars in the last few days. Here’s “Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success.”

This is last week’s “Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success.”


Sales

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The Amerigroup Texas Medicaid health plan will use analytics from Treo Solutions, which was recently acquired by 3M Health Information Systems.


Announcements and Implementations

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Australia’s leading interactive patient care vendor, Hills Health Solutions, will distribute patient engagement technology from Lincor Solutions. The agreement was signed during a trade mission visit to Australia by officials from Ireland, where Lincor is based. The company’s touch-screen offerings for both wall-mounted and mobile devices include clinician EMR access, audio and video patient calling, entertainment, patient education, surveys, and meal ordering.

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Visage Imaging is sponsoring the full-day New York Medical Imaging Informatics Symposium this Thursday, September 18 at New York City’s Marriott Marquis. The $70 registration fee includes a sushi lunch and up to 6 AMA PRA Category 1 credits.

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National Decision Support Company releases an Epic version of its ACR Select evidence-based imaging appropriateness module that includes not only the decision support rules, but also recording utilization data that can be reported from Clarity and Reporting Workbench.


Government and Politics

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Nevada votes to shut down its Nevada Health Link health insurance exchange and move to Healthcare.gov after a problematic rollout and the firing of contractor Xerox, who had a $75 million contract to build the site. The state announced plans in May to use Healthcare.gov for at least a year, but decided last week to make the switch permanent.


Other

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The weather this week in Verona, WI for Epic UGM attendees: highs in the mid-60s, lows in the low 40s, sunny all week other than a chance of rain Monday morning.  The local paper and TV stations are warning commuters of significant traffic delays through Thursday. The folks at Madison-based Nordic wrote up “10 ways to make the most of your 2014 Epic UGM experience.”

The Yakima, WA paper covers EMR use by doctors who aren’t thrilled by it. One is the chief medical officer of Community Health of Central Washington, who says doctors are using up to half of the already-brief patient encounter to work on the computer and complains that EHRs weren’t designed by doctors. Another doctor says EHRs can improve care and patient relationships if doctors stop their foot-dragging and give patients the benefit of real-time lab results and e-prescribing. 

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Bonds of SoutheastHEALTH (MO) are downgraded with a negative outlook after the hospital loses $39 million in 2013 because of revenue cycle problems caused by its Siemens Soarian implementation.

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”The Onion” covers telehealth.

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The Permanente Medical Group CEO Robert Pearl, MD lists five reasons healthcare IT isn’t widely embraced:

  1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
  2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
  3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
  4. EHRs provide clinical value, but slow physicians down.
  5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

My list might instead be:

  1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
  2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
  3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
  4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
  5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.

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California HealthCare Foundation covers the Cerner implementation of Los Angeles County’s Department of Health Services, which will replace several siloed systems that require photocopying paper charts to transfer a patient from one of the county’s hospitals to another. Harbor-UCLA Medical Center goes live first on November 1.

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Tampa General Hospital (FL) fires an employee who it identified from audit logs as having printed the facesheets of several hundred surgery patients without authorization.

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An oral surgeon in Pennsylvania creates a public outcry when he lays off an employee of 12 years because he says her cancer (ovaries, liver, and pancreas) will leave her unable “to function in my office at the level required while battling for your life.” The doctor claims his intentions were noble: he laid her off so she could collect unemployment during treatment, he says, after which time she’s welcome to come back to work.

A hospital in England bans use of the term “computer on wheels” or “CoW,” fearing that patients might be insulted in hearing a nurse ask a colleague to “bring that CoW over here.” They like “workstation on wheels” better. A cynical employee said patients weren’t the problem, but rather hospital executives tired of hearing employees complain that the computer system is a “right cow” to use.

Here’s another example, along with bathroom scales in the homes of obese people, that having health data is not the same as using it: McDonald’s admirably posts calorie counts for every menu item and offers low-calorie choices like salads, apple slices, yogurt parfaits, and bottled water, but nobody buys the healthy items – they’re lining up for 600-calorie milkshakes masquerading as coffee and the 1,200-calorie feed trough known as the Big Breakfast. It would be interesting to calculate the annual death toll from both kinds of malnutrition – over and under.

Weird News Andy declares this story to be “efficient drug operation.” Federal agents arrest two employees of the Bronx VA hospital for using its mailroom to receive packages of cocaine mailed from Puerto Rico.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 13, 2014 News 6 Comments

News 9/12/14

September 11, 2014 News 2 Comments

Top News

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Former Allscripts CEO Glen Tullman launches Livongo Health, which will offer diabetes monitoring that includes an FDA-approved interactive glucometer and analytics. The company received a $10 million investment from General Catalyst. Its leadership team is sprinkled with former Allscripts people.


Reader Comments

From Vendor_Neutral: “Re: Apple. After months of being annoyed by misleading blog posts about Apple and Epic’s alleged partnership, I went back and watched that portion of WWDC this morning. Here is the direct quote: ‘We’re also working with leaders in health care applications like Epic Systems, now they provide the tech that enables hospitals serving over 100 million Americans, and so now with their integration with HealthKit, patients at these leading institutions will be able to get closer in sharing their information with their doctors.’ That’s all they said! NOTHING about a ‘partnership.’ They merely got early access to HealthKit. Let it be known that that is it.”

From Kaiser Roll: “Re: Phil Fasano. Resigned as CIO of Kaiser Permanente as announced in an email from CEO Bernard Tyson.” Unverified.


HIStalk Announcements and Requests

This week on HIStalk Practice: ABQ Healthcare Partners goes live on Allscripts. American College of Physicians outlines why MDs hate EHRs. Amazing Charts, athenaClinicals, and Meditouch vie for best EHR title. Research shows that primary care practices that create their own patient portal adoption strategy earn strong participation. The American Telemedicine Association grades states on telemedicine reimbursement and physician practice standards. Thanks for reading.

This week on HIStalk Connect: Apple unveils its long-awaited smartwatch, which will track activity and heart rate, but still falls short of what many were expecting for health features. The Mayo Clinic announces that it will work with IBM on a project that will use the Watson supercomputer to help analyze patient charts and match them with relevant clinical trails. Wellframe, a Boston-based startup, raises an $8.5 million Series A for its smartphone-based patient education and reminder tools.


Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

Google acquires Lift Labs, which makes a sensor-powered stabilizing spoon that helps people with tremors eat normally.

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Streamline Health Solutions announces Q2 results: revenue down 17 percent, EPS –$0.14 vs. -$0.07. Above is the one-year share price chart of STRM (blue) vs. the Nasdaq (red).

Privacy monitoring vendor FairWarning announces first-half results that include 104 percent growth in existing-customer revenue, 6,500 healthcare facilities as clients, and 64 hospitals running its SaaS-based product.


Sales

Capella Healthcare (TN) chooses Medhost’s YourCareLink to submit information to state public health reporting agencies.

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Phoebe Putney Health System (GA) selects Harris Corporation’s FusionFX Provider Portal.

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Evans Army Community Hospital (CO) will deploy AtHoc’s emergency communication solution.

Community Health Network (IN) will link its community Epic, Cerner, and Meditech EHRs through Health Catalyst’s Late-Binding Data Warehouse and Analytics Platform.


People

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Jack Janoso is named CEO of Fairfield Medical Center (OH). He was promoted from VP/CIO to CEO at Sharon Regional Health System (PA) before taking the new job.

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Beaumont Health (MI) — formed via the merger of Beaumont Health System, Botsford Health Care, and Oakwood Healthcare – names Subra Sripada as chief transformation officer of the 10-member executive team. He was previously chief administrative and information officer at Beaumont Health System.

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David Sides (iMDsoft) joins Streamline Health Solutions as EVP/COO.

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Boston Software Systems promotes Matthew Hawkins to EVP of healthcare strategy and sales.

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Jay Anders, MD (McKesson) is named chief medical officer of Medicomp Systems.


Announcements and Implementations

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Gillette Children’s Specialty Healthcare (MN) goes live on the Versus Advantages Clinic patient flow system.

AirWatch introduces AirWatch AppShield to provide security and management capabilities.

MModal launches an outpatient medical coding service.

Elsevier chooses Clinical Architecture’s Symedical terminology management system for its InOrder order set tool.

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MetroChicago HIE goes live with 31 hospitals using technology from Sandlot Solutions.

A Health Catalyst-sponsored survey of CHIME members (70 respondents) finds that analytics is the highest-priority IT investment, followed by population health and ICD-10.


Government and Politics

ONC announces that it will make minor tweaks to its 2014 certification criteria instead of rolling out voluntary 2015 criteria as previously planned. It will also name certification criteria by their year of approval going forward and will discontinue the “Complete EHR” certification.


Technology

Samsung pokes fun at this week’s somewhat anemic (and health-free) announcements from Apple, which seems to be morphing into Microsoft as it (a) pre-announces a product that won’t be available for a long time; (b) enters an existing market (smart watches) instead of creating a new one; and (c) fails to meet expectations in not talking about its rumored Health offering, possibly because of (a) limited stage time given the urgency of discussing fashionable watches and enlarged iPhone screens; (b) the moving target nature of whatever it’s going to eventually do, or (c) poor timing given that iCloud was just hacked.

Researchers from MIT and Georgia Tech find that Google Glass can measure pulse and respiration using its built-in gyroscope, accelerometer, and camera. You could say it’s for people who wouldn’t be caught dead wearing Glass.


Other

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The American Telemedicine Association reviews the telemedicine-related physician practice and licensure standards of all 50 states. The components included physician-patient encounter (are in-person initial visits required are are more restrictive standards in place); telepresenter (does the law require someone to be physically present with the patient during the session); informed consent (is the patient required to sign off differently than for in-person visits); and licensure (does the state offer out-of-state licensure reciprocity, exemptions for physician-to-physician consultations, and conditional licensure). Twenty-three states and DC earned an A grade, 27 got a B, and one (Alabama) had the lowest composite score and a C grade.

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Billionaire doctor Patrick Soon-Shiong makes the cover of the September 29 issue of Forbes, whose reporter seems as confused as the rest of us over whether he’s a genius, a blowhard huckster, or both. It points out that despite his spending $1.3 billion of his own money to acquire a bunch of unrelated technology companies (most notable in healthcare IT: iSirona), his grand ideas for “solving” healthcare are vaporware so far even as a rollout to Providence Health & Services is planned. The article mentioned Soon-Shiong’s tendency toward wild hype and his historic, greedy shafting of business partners, investors, and family members (“more of a wheeler-dealer than a scientist.”) Forbes concludes that his Nant-related holdings (including NantHealth) are worth $7.7 billion and he will start running IPOs next year, with NantHealth being the first.

Several publications are running breathy news items that Epic has hired a lobbying firm, none of them crediting HIStalk as their source since I reported it here on August 14 as tipped of by a reader who follows federal lobbying registrations.

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Epic’s user group meeting starts Monday, with 10,000 attendees riding buses from hotels as far away as Wisconsin Dells to get to Verona. Meanwhile, the company is again named the largest employer in Dane County, WI with 7,400 FTEs.

In the UK, breast cancer screening vans are upgraded with satellite links to allow employees to enter and access patient information and to send images directly to hospitals.

The family of Joan Rivers will reportedly file a $100 million lawsuit against the for-profit endoscopy clinic where she died during a throat operation, claiming the clinic allowed one of the doctors to perform an unplanned biopsy that should have been done in a hospital instead.

Weird News Andy titles this story “Moob.” In England, a man complains of gender discrimination when NHS turns down his request for cosmetic breast surgery to correct a lopsided condition caused by gynecomastia. “Women get boob jobs on the NHS but I can’t get help,” he says, while NHS maintains that they don’t pay for surgery that has no demonstrable health benefit.


Sponsor Updates

  • MedAssets issues a call for speakers for the 2015 Healthcare Business Summit April 7-9, 2015 in Las Vegas.
  • Connance presents a video case study of the challenges and successes of Carolinas HealthCare System (NC) after implementing its revenue cycle solution.
  • Billian’s HealthDATA offers its Vitals hospital news and RFP feed free to the public.
  • Aventura will participate in the SE conference of the HIMSS Summit in Nashville September 16-17.
  • The CDC and Premier release research indicating that unnecessary hospital antibiotic use costs $163 million.
  • Chilmark Research names Wellcentive a “Standout” Vendor in Product and Market ratings in Population Health Management Analysis.
  • Health Catalyst shares the results of its recent survey of CHIME members which indicates analytics is their top priority.
  • Aspen Advisors highlights its framework and recent engagements with organizations that are realizing the full value of their EHR.
  • Frost & Sullivan recognizes GE Healthcare IT with an innovation award for Centricity Financial Risk Manager.

EPtalk by Dr. Jayne

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It’s amazing how varied my work as a CMIO can be at times. Hot on the heels of some ridiculous implementation escapades, I’ve had a week of actually enjoyable work. I started the week attending a web-based focus group for one of our vendors. They did a great job putting it on and I give them an A-plus for facilitation skills.

The task at hand was to review some mock-ups for updated Patient-Centered Medical Home workflows. Instead of just throwing us into the content, they took the time to talk with the group about our existing workflows, including the good aspects as well as the challenges. The moderator made sure everyone was participating with a good mix of calling on people and letting them volunteer.

Web meetings are always hard, especially with a group of attendees that don’t really know one another. Someone is always trying to talk over the group or failing to mute themselves while they’re banging around their office, but we didn’t have any of that.

Only after they heard our needs did we see the mock-ups. It was an effective strategy because you didn’t have people throwing out all kinds of additional needs because they hadn’t thought it through. We were validating our needs against their ideas rather than being reactive.

Additionally, their mock-ups were well done with real-world scenarios. I’ve seen samples from other vendors where it looks like they just chose random drugs from a reference book, but these were spot on. I appreciated the fact that they prepared for us rather than asking us to imagine how it would be for the scenarios we see every day.

Usually after a four-hour web meeting I’m ready to bang my head against the wall (assuming no martinis are available), but I was actually a bit sad to see this one end. We’re regrouping in a few weeks, however, so that gives me something to look forward to.

Following the focus group, I was able to use the fact that my boss is out of town and our standing one-on-one is cancelled to do some belated spring cleaning in my office. It’s amazing how much junk accumulates. I’m ashamed to say I found a bunch of marketing collateral from HIMSS that I shoved in a drawer six months ago and promptly forgot. Sorry, marketing folks, I won’t be following up. But the cool Mylar folding wine bottle drip-proofer attached to one packet was a nice find.

Today I was able to spend some time mentoring a relatively new physician champion at one of our hospitals across town. Although he has a great deal of knowledge on the inpatient side, he’s just starting to get involved in ambulatory projects. He’s also studying for the clinical informatics board exam next month, so we talked about tips and tricks.

His facility is relatively new and has always been paperless, so it will be interesting to see how he does working with physicians who are transitioning from paper to EHR at the same time they’re transitioning to being employed. I’ve shared some of my horror stories, but from the expression on his face, I’m pretty sure he thought I was making them up. I can’t wait until he has a war story of his own.

The most fun thing about working with him is showing him some of the cooler features of our EHR. I spend so much time listening to physician complaints about how bad it is and how computers are ruining the practice of medicine that it was good to get an outsider view of its capabilities. He’s had formal training from the vendor, but taking that knowledge and applying it to a real-world practice workflow when you’re being interrupted by phone calls, nurses popping their heads through the doorway, and the mounds of paper that inhabit our “paperless” offices is another thing.

The best part of the meeting was when he asked what websites I would recommend to help him learn more about the IT landscape. I get an “F” on my mentor report card because I unfortunately couldn’t tell him about HIStalk. Hopefully he’ll stumble upon it or maybe one of the other informatics staff will recommend it, but it’s always a surreal experience when my worlds almost collide.

Got an alter ego? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 11, 2014 News 2 Comments

News 9/10/14

September 9, 2014 News 11 Comments

Top News

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Apple announces the iPhone 6 and the larger-screen iPhone 6 Plus; the Apple Pay mobile payments system that uses fingerprint ID; and the Apple Watch (not named the iWatch after all)  that connects to its Health app as well as to Apple Pay. The Apple Watch, which requires an iPhone connection, won’t be available until next year and will start at $349 with a choice of 18 styles. Health-related watch functions include step counter, pulse tracker, calories burned, activity monitor, time in a seated position, and fitness goals. In other words, it fell way short of the pre-announcement hype, with no mention of HealthKit or the expected Mayo Clinic involvement, maybe because Apple’s high-profile iCloud celebrity nude photo breach made the timing inauspicious. It’s just as well — doctors aren’t sitting idly by anxious to watch streams of mostly meaningless sensor-collected patient information that doesn’t tell them anything they don’t already know. The people who think patient sensors are going to change medicine are naive; we don’t even monitor 95 percent of hospitalized patients because it doesn’t provide actionable information.


Reader Comments

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From Medwreck: “Re: BoxWorks. Attended the Box user conference last week. This HIPAA-compliant cloud-based storage company is making a big push into IDN/healthcare provider world to fill in the gaps for sharing ‘unstructured’ health/patient content which the company estimates entails 15-30 percent of all shared healthcare content. They list Stanford, MD Anderson, and St Joseph Health (CA/TX) as clients. The idea of sharing unstructured content — areas that the EMR vendors may have missed — is a very interesting area ripe for growth.” It’s funny to me how Box and other companies try to fancy up their offerings to sound more strategic, letting the marketing and product management people go wild in renaming its file-sharing service as “global content collaboration.” I have that already – it’s called email (actually in my case it’s called Dropbox and is also called “free”). Box and similar services seem like an odd way to share content within an organization, and sharing outside the organization would require designing something that looks more like an integrated, context-aware function within an EHR or other system vs. a “log on and download your document” approach that’s more like a physician portal.

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From Erasure: “Re: Mission Health, Asheville, NC. Just quietly announced layoffs with $50 million in cuts needed. Ouch.” The 11,000-employee (before the layoffs, anyway) health system announced ambitious plans a month ago to boost revenue by $10 million in the next fiscal year and cut expenses by $42 million, based on its expectation of $500 million in reduced hospital volume over the next 10 years. Meanwhile, Modern Healthcare apologizes for claiming in an August 11 cover story that Mission Health CEO Ron Paulus received the biggest raise of any not-for-profit hospital executive in 2012, with the magazine saying it didn’t know that the numbers it cited were a year old and the previous salary figures it compared against covered only a four-month period.

From Otto von Bismarck: “Re: Siemens Medical. Rumors abounding again that it will be picked up by Samsung.” Samsung was rumored to be interested in the medical device business of Siemens when the company first suggested that it would shed some of its business units.

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From FranktheTank: “Re: SRS. Cut 20-25 people on Monday.” Unverified, but reported by more than one reader. The company has not responded to my inquiries. 


HIStalk Announcements and Requests

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We as HIStalk readers bought a listening station a couple of weeks ago for Ms. Anderson’s highest-poverty Kentucky classroom via DonorsChoose.org. She sent the photo above with this report: “Student engagement has tremendously increased. Now, they are no longer intimidated by a longer novel. I am so appreciative of your generous donation … They will become stronger readers as a result of your willingness to invest in education.” Thanks to the Bill & Melinda Gates Foundation, which matched our contribution in fully funding the project.

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I suggested to Amy Gleason of CareSync that she give one HIStalk reader a free plan in return for a write-up of their experience with it. Email Amy if you’d like a free One-Time Health History (normally $99), where the company will obtain your medical records from all of your providers, summarize your visits, create a Comprehensive Health Timeline, and offer smartphone-powered health services.


Webinars

September 11 (Thursday) 1:00 p.m. ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.


Acquisitions, Funding, Business, and Stock

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Sandlot Solutions raises $23.3 million in funding, $17 million of it from Lemhi Ventures and the remainder from existing investors North Texas Specialty Physicians and Santa Rosa Holdings.

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Wellframe, which offers care protocol and alerting software, closes $8.5 million in Series A financing.

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Mednax completes its previously announced acquisition of revenue cycle management services vendor MedData.


Sales

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Henry Mayo Newhall Hospital (CA) chooses Mobile Heartbeat’s CURE smartphone communications app for clinicians after completing a pilot in which nurses reduced their footsteps by 38 percent.

MedStar Health (DC) selects AirStrip for labor and delivery patient monitoring.

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University of Utah Hospital (UT) will purchase PeriGen’s PeriCALM L&D solutions.


People

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Mark Janczewski, MD, MPH (Medical Networks, LLC) joins Systems Made Simple as senior clinical informaticist.

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Real-time surveillance systems vendor VigiLanz names Patrick Spangler (Healthland) as CFO.

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Bivarus, a Chapel Hill, NC-based analytics software vendor, names David Levin (Clinipace Worldwide) as CEO.


Announcements and Implementations

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TrueVault releases a software developer’s kit for connecting apps to iOS 8 in a HIPAA-compliant manner.

Toshiba establishes a big data project with the radiation oncology department of Johns Hopkins Medicine (MD), hoping to create technologies to individualize cancer treatments based on similarities to other patients.

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PerfectServe releases Version 4.0 of its communications platform to the App Store, which includes the ability to add multiple attachments (such as photos) and  a redesigned user interface.


Government and Politics

The white hat hackers who warned Congress that Healthcare.gov was insecure before its launch are, not surprisingly, a bit sarcastic now that one of the site’s test servers has been breached. High profile hacker Kevin Mitnick tweeted, “Didn’t we just warn these guys at Congress a few months ago?” A security expert told a House committee before Healthcare.gov went live that, "I don’t understand how we’re still discussing whether the website is insecure or not. It is; there’s no question about that. It is insecure — 100 percent." New information suggests that someone accidentally connected the test server, secured only by the manufacturer’s default password, to the Internet.

The co-chair of the Institute of Medicine committee that was critical of taxpayers footing the $10 billion per year cost of graduate medical education says the political reality is that such funding will continue, but should be refocused to supported needed physician specialties and opened up to providers other than teaching hospitals. She added that two-thirds of the taxpayers’ money is spent on indirect medical education, which was arbitrarily created by Congress in response to the complaints of hospitals that DRGs would underpay them, adding that she doesn’t believe in paying more without necessarily getting more value or services when healthcare is moving toward a value-based system.


Technology

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A fun article debunks the claims of calorie-counting wristband maker Healbe, which as the article says “put the scam in scampaigning.” The Russia-based company’s hilarious activities include (a) touting its self-conducted research studies that monitored five patients for five days; (b) claiming American investors who never materialized; and (c) announcing that Memorial Sloan Kettering  Cancer Center was a test site when the hospital said they’d never heard of the company. Early App Store ratings are scathing: one user reports that the only unit of measure supported for entry of weight is “feet,” with the helpful reviewer adding an opinion that the app is “a piece of garbage.” Note the spelling “mesurement” in the above screen shot.


Other

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The Federal of State Medical Boards completes its voluntary model policy for individual states that would make it easier and faster for doctors to obtain licensure in multiple states. As with FSMB’s model telemedicine policy, the location of the patient determines the state of jurisdiction.

A small-scale December 2012 survey of attending internists (many of them residents) finds that using EHRs cost them an average of 48 minutes per clinic day, with a surprising one-third of respondents saying that looking up patient information in the EMR takes longer than with paper charts. The VA’s VistA system resulted in the lowest time loss. The authors suggested questionable alternatives: “use of scribes, standing orders, talking instead of email.” Also questionable is the subjective nature of the 48-minute average, along with the fact that no distinction was made as to when the system went live — how would they remember their time loss if go-live was years before or before they started their residency?

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Harvard School of Public Health gets a $350 million donation from one of its alumni, Hong Kong billionaire Gerald Chan, who made his fortune by founding a private equity firm and working in his father’s real estate business. HSPH is the #3 ranked public health program in the country, following Johns Hopkins and University of North Carolina – Chapel Hill and finishing ahead of University of Michigan – Ann Arbor and Columbia University.

Two John Muir Health campuses go to paper and briefly divert ambulances when their Epic system goes down intermittently Monday.

Yet another study proves that the US is #1 in one important healthcare category: administrative overhead, which eats up a fourth of all of our massive healthcare expenditures, far ahead of #2 Netherlands at less than 20 percent. On the other hand, the odds are high that those whose salaries fall into that “overhead” category see themselves as critical.

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The new dean of the Dell Medical School, scheduled to open in 2016, says the school will focus on healthcare technology. “In general, we are sort of driven by the notion that health care isn’t what it should be … One example of that is how slow and difficult it’s been to have technologies be integrated within the healthcare industry. One example I like is that I can find a restaurant and, right now, know the quality of it and how it’s rated and be able to book a table anytime today. Now try to do something even close to that with a physician. That’s true throughout the healthcare system and it impacts the way that we provide care — the physician-focused care. A lot of the problems we have could be dealt with by technology — on email, on the phone, and with pharmacists and practitioners. So it’s trying to take a step back and to say, ‘What’s the health care plan that we would really want if we could blow up our system, and what pieces need to be in place for us to achieve that?’”


Sponsor Updates

  • Verisk Health’s “Moving Healthcare Forward” conference is underway this week in Scottsdale, AZ with presenters that include former HHS Secretary Mike Leavitt. Attendees will also create food packages for local community members through Desert Mission.
  • Sagacious Consultants launches an Epic report writing service featuring hourly billing and no contract required.
  • PerfectServe President and CEO Terry Edwards writes a blog post titled “Learning from the Airlines and Banks.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 9, 2014 News 11 Comments

Monday Morning Update 9/8/14

September 5, 2014 News 6 Comments

Top News

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Another team officially joins the DoD EHR hunt: PwC, DSS, Medsphere, and General Dynamics, which will offer up VistA.


Reader Comments

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From Bon Scott: “Meditech announcing organizational changes. It seems odd that the previous sales and marketing VP is now over services and the VP over an older product line is now in charge of sales and marketing. Think this is a sign of the times with Meditech and it coming across as desperate for change?” EVP Hoda Sayed-Friel (above) takes over implementation and support, VP Helen Waters moves over sales and marketing, and EVP Michelle O’Connor takes over all develpoment.

From OB: “Re: Denver fire department. Great idea — a mobile care unit that handles 911 calls that don’t require a patient to be taken to an ED. I was interested to read that ‘South Metro Fire also relies heavily on Colorado’s new electronic medical records network. The nurse or EMT can call up patient records on the scene to provide care that’s more like an office visit, and dispatchers can check recent medical histories to make sure they send ambulances to people who might really need one.’ Too bad that insurance is not paying for the service right now, hopefully that will soon change.”


HIStalk Announcements and Requests

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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Poll respondents see drugstore chains as having significant influence on healthcare going forward. New poll to your right or here: of which industry groups are you a member?

Maybe it’s just me, but I’m creeped out when after casually looking at someone’s LinkedIn profile, they send a message saying, “I saw you looked at my profile. May I help you?” Answer: no, because if I wanted help I could message you just as easily as you messaged me. I don’t really like having my profile views tracked, so I finally overcame my inherent laziness and went to Privacy Settings and changed “Select what others see when you’ve viewed their profile” to the “You will be totally anonymous” option (which surprisingly doesn’t require the hard-sold LinkedIn upgrade). Facebook could have an instant goldmine if they charged for the ability to see who has viewed your profile, just like Netflix will mint coin the moment they break the porn barrier.


Last Week’s Most Interesting News

  • CMS publishes updated Meaningful Use requirements with few changes from the original draft that drew widespread provider ire in requiring a full 365-day reporting period for 2015, meaning hospitals have to be ready to start in the next four weeks.
  • CVS continues its transition to a healthcare powerhouse by renaming itself CVS Health, emphasizing its offerings that include Minute Clinics for primary care and chronic disease management in partnership with health systems.
  • An apparently security weakness in Apple’s iPhone that allowed nude celebrity photos to find their way onto the Internet makes headlines just as the company prepares to announce several health-related offerings.
  • The White House announces a new CTO and deputy CTO from Google and Twitter, respectively, ending the streak of two US CTOs (Aneesh Chopra and Todd Park) who had strong healthcare backgrounds.

Webinars

September 11 (Thursday) 1:00 p.m. ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.


Acquisitions, Funding, Business, and Stock

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Asthma inhaler monitoring device vendor Propeller Health raises $14.5 million in Series B financing.


People

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Chris Hogg (Practice Fusion) joins Propeller Health as COO.


Technology

Fascinating but scary: if you have a Google account, check out its display of where you’ve been lately, as tracked by (a) your Android phone’s GPS, or (b) your use of Google Maps.

Other

Apple adds a countdown clock for its September 9 announcements, also adding that it will stream live video from the same page. Nobody can top Apple when it comes to creating drama and excitement around product announcements. I can’t imagine a healthcare IT company doing anything like that, although Epic probably could if it wanted given its similar fanboy base and creative flair.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 5, 2014 News 6 Comments

News 9/5/14

September 4, 2014 News 4 Comments

Top News

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CVS Caremark changes its name to CVS Health as it also stops selling tobacco products in its 7,700 pharmacies. The company will take a $2 billion revenue hit in removing tobacco from its shelves, but the move obviously positions it more convincingly as a player in the general health market as it expands the number of its Minute Clinics from 900 to 1,500 in the next three years. CVS says it doesn’t plan to move Minute Clinic into full primary care as Walmart is doing, but will expand its chronic disease management services, which is not surprising given its recently announced care management relationships with several health systems and its transition to Epic.


Reader Comments

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From Heathkit Assembler: “Re: Apple HealthKit. Here are the company’s specific developer requirements.” The “improving health” part might be just as easily skirted as HIPAA’s “treatment, payment, and operations” unless Apple defines it further.

From Just Nutz: “Re: Meaningful Use. Mr. H’s ‘Comatose’ was the perfect descriptor. CMS could have made 2015 more flexible. The 2014 period ends in 26 days, so people had already figured Stage 2 out if they were ever going to, and Stage 3 was pushed back but virtually no one cares about this today. The primary stressor for hospitals, the year-long reporting period that also starts October 1, was ignored despite thousands of comments urging CMS to address it as hospitals desperately try to get ready for 2015.” I’m glad Meaningful Use interest is finally fading. It was a necessary and ultra-expensive evil for getting poorly selling EMRs adopted, but it’s time to let the free market take back over and forget piecemeal provider bribes that often don’t provide the biggest bang for the patient outcomes buck.

From Nasty Parts: “Re: Explorys. I can confirm that they’re on the market. I hear GE, IBM, McKesson, and Medecision are the suitors.” Unverified.

From Beltway Bandido: “Re: DoD EHR. VistA is in the mix, being bid by DSS, PwC, and General Dynamics.” Dim-Sum told me they are pushing VistA, which has zero chance of getting anywhere for reasons that are surprisingly good.


HIStalk Announcements and Requests

This week on HIStalk Connect: Dr. Travis discusses Apple’s move into healthcare ahead of next week’s anticipated iWatch unveil. Qualcomm announces the 10 finalists in its $10 million Tricorder X-Prize competition. Ybrain closes a $3.5 million Series A to further development of a wearable device designed to help treat Alzheimer’s Disease. Three students from the University of Queensland in Australia win iAward’s Young Innovator of the Year award for a gamified mHealth app that helps children with cystic fibrosis. 

This week on HIStalk Practice: Healthpointe announces a new urgent care telemedicine service. Veterans in Rhode Island share their health data with the VA via the state HIE. President Obama holds Estonia in high esteem when it comes to sharing digital health data. University of Toledo Physicians selects athenahealth solutions. The VA announces mobile versions of its most popular HealtheVet portal applications. Fall conference season – from open source to the cloud – gets into full swing. Thanks for reading.

Note to desperately idea-starved writers trying to sound hip and topical by riding pop culture coattails: articles like “What healthcare can learn from the passing of [fill in ‘Robin Williams’ or ‘Joan Rivers’ or any other recently deceased celebrity’s name]” are about as lazy, pointless, and lame as their titles suggest.

Listening: Dutch progressive rockers Knight Area, which sounds a lot like early 1970s Genesis. They will release a new album in October.


Webinars

September 11 (Thursday) 1:00 p.m. ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.


Acquisitions, Funding, Business, and Stock

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Best Doctors acquires Rise Health, which offers a population health management platform.  Rise Health’s CEO is Mark Crockett, MD (formerly of OptumInsight/Picis) and its president/COO is Connie Moser (with McKesson until a few months ago).

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Clarity Health, which sells a referral management system, raises $1.89 million, increasing its total to $13 million.  

Pain treatment analytics platform vendor Axial Healthcare raises $1.75 million in a Series A round. Paul McCurry, MD, formerly of MedSolutions, founded the Nashville-based company in 2012.  

Google enters the pharma business with a drug company biotech partnership that will research age-related diseases at a cost of up to $1.5 billion.


Sales

Piedmont Healthcare (GA) selects Perceptive Software’s Acuo Vendor Neutral Archive.

Health Plan of San Mateo (CA) chooses Verisk Health’s payment accuracy suite.

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Saline Memorial Hospital (AR) chooses Allscripts Sunrise. What a great hospital name – if it were located in Normal, IL it could be called Normal Saline.

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Singing River Health System (MS) chooses Strata Decision’s StrataJazz decision support and cost accounting.


People

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Nancy Brown (McKesson) joins Oak HC/FT as a venture partner.

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As expected, the White House names Megan Smith (Google) as CTO, replacing Todd Park. Former Twitter lawyer Alexander Macgillivray is named as deputy CTO.


Announcements and Implementations

Elsevier will market Tonic Health’s patient data collection platform.

Flint Rehabilitation Devices launches MusicGlove, a Guiter Hero-type game that helps stroke and muscular injury patients regain hand function through music-paced repetitive exercise games.

MedAptus launches Provider Enrollment in partnership with Newport Credentialing Services.


Government and Politics

Former Senators Trent Lott and John Breaux sign on as lobbyists trying to convince the federal government to cancel plans to impose sanctions on a state-owned Russian bank in protest of that country’s activities in the Ukraine. As Lenin said, “We will hang the capitalists with the rope they sell to us.” The healthcare connection: the political guns-for-hire formed the Alliance for Connected Care to twist political arms on behalf of telehealth-invested companies such as CVS, Teladoc, and WellPoint.

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Oregon and Oracle are suing each other over the Cover Oregon health insurance exchange, but even though the state is moving to Healthcare.gov for Medicare it will still need Oracle’s help to get its Medicaid part running. The snag: Oracle won’t give the state access to its servers or set up a new production environment. A consultant’s report says if Oracle doesn’t come to the table by Friday (September 5), the site won’t be ready for the next open enrollment period that starts in November.

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HHS announces that a hacker breached a test server of Healthcare.gov in July and installed malware. Apparently it wasn’t a targeted attack, just the usual hack bot cruising, which HIStalk’s server defenses have blocked exactly 1,000 times today (as broken out by the graphic above) which means nearly every site on the Internet, including Healthcare.gov, is getting pounded even though they contain nothing of value. It’s unbelievable that any site can keep running given the endless creativity and resources hackers are willing to waste to penetrate pointlessly.


Other

Coming soon to an already economy-devastating US healthcare system: cancer drugs that cost $150,000 or more per patient per year and are required for the rest of a patient’s life.

The city council of Berkeley, CA approves a “charity cannabis mandate” that requires medical marijuana dispensaries donate at least 2 percent of their product to low-income residents, with the mayor arguing that marijuana is a medicine and everybody should have access to it. The response from the California Narcotic Officers’ Association: “Instead of taking steps to help the most economically vulnerable residents get out of that state, the city has said, ‘Let’s just get everybody high.’”

Someone tweeted that “assumptions are imperfect substitutes for data.” I might agree, but with several caveats:

  • Data are never perfect, complete, and free from bias, so there’s always a leap of faith even when data (including the “big” kind) are available.
  • You can lose your advantage (competitive or clinical) while waiting on the perfect set of data.
  • It’s hard to distinguish causation from correlation, subjecting any given data set to imperfection. As our hospital pathologist helpfully told me early in my career when I reviewed a patient’s chart for a committee, “He died with it, not of it.”
  • Sometimes intuition, experience, and people knowledge works better than data. The challenge is to determine which side of the fence a given situation falls on. Ideally, someone with that intuition, experience, and people knowledge is the one evaluating the data so you get the best of both worlds.
  • Healthcare straddles the fence above. Data analysis can provide new insight and help make treatment decisions, but only if wielded by expert clinician hands. You as a patient are just like other patients in not wanting to be managed by faceless payer or government algorithms cranked out from population health number-crunching that don’t take your own feelings, impressions, and beliefs into account. When it comes to the practice of medicine, art and science aren’t conveniently demarcated by a sharp line.
  • Bad decisions can (and often do) come from good data.

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Weird News Andy calls this story from England “Meals on Wheels.” A new hospital uses a fleet of 12 robots to deliver patient meals, linens, instruments, and pharmacy items to the floors. Unrelated but interesting is the hospital’s response to patient complaints about small portion sizes, some of which found their way (with pictures) online: “We don’t know if it is a frail old man we are serving or a large rugby player so it’s up to each ward to know their patients and serve food accordingly.” WNA finds this a good story pairing: a company’s restaurant robot grinds beef and cooks it to order to create 360 burgers per hour, even slicing tomatoes and pickles simultaneously and placing the finished product in paper bags. The company’s co-founder says the machine isn’t intended to make fast food employees more efficient, but instead to eliminate them.


Sponsor Updates

  • NVoq announces the 2014 SayIt Healthcare Productivity ShowcaseFest, where 12 chosen healthcare professionals will work with the company’s SayIt speech recognition product to build and record a voice-optimized EMR Showcase. Nominations are due September 26.
  • GetWellNetwork Inpatient earns 2014 Edition Modular Inpatient EHR certification.
  • EDCO Health Information Solutions will host a session titled “An Unexpected Necessity – Indexing Software” at the AHIMA conference in San Diego on September 28.
  • Impact Advisors publishes a blog post, “Meaningful Use Final Rule.”

EPtalk by Dr. Jayne

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The Greenway Engage14 user group meeting kicked off today in Dallas. I’ve got a reporter embedded. Here are some of his preliminary thoughts.

“We are making our final descent into Dallas, where the temperature is 99 degrees and the local time is 8:04 p.m.” Maybe it is just me, but it felt like 324 degrees Kelvin when departing the airport. Greenway has chosen yet another Gaylord hotel, this time a short ($25 cab) jaunt from DFW. It is the official hotel of the Dallas Cowboys and there are some players milling around and mixing with the OB/GYNs. It is a huge complex. So far, no riots over MU2 have broken out. That being said, the gent next to me at the bar was here to cancel his contract — he was hoping to get to do so directly to Tee Green. He was upset about product performance and issues upgrading, describing 2014 as, “The year I will never recover from financially.”

I’ll be curious to see and hear some other opinions as the conference begins in earnest tomorrow. I remain skeptical of the premise that the annual way to educate and inform your best customers is to price gouge them at a hotel that is inconvenient at a time when most kids are just going back to school and many practices are becoming quite busy. For now, everyone is getting settled in for what should be a long weekend of wondering what happened to MU and where they go from here. Also, what happened to Vitera in all of this, their product wasn’t so bad …”

He plans to attend the opening night gala and snap some photos and get feedback from the trenches as the liquor flows. I perused the agenda to suggest some sessions for him. It seems they have ambitiously scheduled fitness classes on Friday and Saturday at 5:30 a.m. I noticed they left them off the schedule for Sunday morning, which is probably a good thing since their client event runs from 7 p.m. to 1 a.m. the night before. The agenda says the “Greenway team is famous for its dance moves,” so I’ll definitely be on the lookout for photographic evidence.

I don’t envy them with the updated Meaningful Use timeline being released the weekend prior. Attendees will expect Greenway staffers to be knowledgeable and ready to provide advice on their particular situations. I have to admit this is the first rule I’m not going to read in its entirety. Like Mr. H, I am kind of “over” MU and will wait for the CliffsNotes versions that I anticipate my vendors will send within a week or so.

I laughed as I went through my inbox. Right after the notification from CMS was this article from JAMA touting the benefits of “cognitively stimulating activities such as reading” as preventive against cognitive impairment. I think I’ll go for some 2048 instead.

As for my roving reporter’s comments about user group meetings in general, I’m sympathetic. Our primary vendor’s meeting continues to increase in cost, not only for the meeting itself, but for hotel and travel. We’ve had to cut back on the number of people we send and rotate attendees to make sure that everyone has the chance to go every few years. A couple of our staffers who really enjoy attending have gotten smart and submit a presentation every year in the hopes that they’ll be selected to speak and will get one of the coveted spots.

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Thanks to Dr. Travis for turning me on to NomadList, which appeared in a tweet about 25 promising startups. NomadList quantifies the best cities to live in when you can work remotely, providing info on cost of living, Internet speed, and weather. I know a couple of consultants who have a minimal home base and travel all the time whether they’re client-facing or not. I once had an EHR conversion done by a guy who admitted he was processing my data from the beach in Thailand. Top US cities include San Juan, Las Vegas, Austin, Dallas, and Park City.

If you’re a digital nomad, what do you think? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 4, 2014 News 4 Comments

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