Monday Morning Update 7/23/18

Top News

In England, new Health Secretary Matt Hancock pledges his support for NHS modernization and announces $640 million in new technology funding. He touted virtual visits, barcode tracking, and electronic medication ordering.  

HIStalk Announcements and Requests

Poll respondents say Epic has the best CEO. HISJunkie says Meditech hasn’t grown, Brent Shafer is too new to judge, and Allscripts is a mess. Tripp Tart voted for Judy Faulkner in admiring her for keeping the company free of shareholder influence. Former Community CIO votes for Howard Messing since he also kept Wall Street out of the picture and is creating company growth again, while Epic’s growth is mostly due to its hospital customers acquiring more facilities.

New poll to your right or here: would you be OK with insurance companies using your harvested social, financial, and lifestyle data to approve and price your medical coverage?

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Decisions

• Schoolcraft Memorial Hospital (MI) switched from Evident to iSolved HR and payroll software in June.
• Divine Savior Healthcare (WI) will replace Evident with Athenahealth in fall 2018.
• Crisp Regional Hospital (GA) will replace Meditech HR with Kronos in 2018.
• North Country Hospital & Health Center (VT) replaced Allscripts Paragon with Athenahealth in April 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

People

Chronic Care Management, Inc. hires two former executives of its defunct competitor CareSync, Gurpreet Singh (CIO) and Marc Gauthier (head of enterprise business development).

Announcements and Implementations

Publicly traded rural hospital operator LifePoint Health is considering selling itself to a private equity firm for up to $6 billion, with the report sending LifePoint’s shares up 40 percent. LifePoint Health also operates 15 hospitals in partnership with Duke University Health System under the Duke LifePoint Healthcare brand.

Privacy and Security

LabCorp is close to fully restoring its systems after they went offline in a July 13 ransomware attack. The company’s security team detected the Remote Desktop Protocol attack and stopped it within 50 minutes, but by then, the SamSam ransomware had impacted 7,000 Windows-based systems and 1,900 servers. SamSam took Allscripts down earlier this year, reportedly also using RDP as its vector.

Members of a private Facebook group for sexual assault survivors find themselves trolled by new users who threaten to post the intimate details they had shared under their real names. The group was apparently created by an anonymous administrator who either had duped the members or whose account was hacked. The report by “Wired” notes a Facebook flaw that allowed this to happen – groups can be created by “pages” that aren’t tied to an individual’s profile, the same way Russian propagandists used the platform before the 2016 elections to keep themselves anonymous. I was going to play around with some Facebook group stuff but decided instead to try Microsoft Teams now that the company is offering a free tier and no longer requires members to use Office 365.

Singapore says hackers stole the information of one-fourth of its population, 1.5 million people, in an attack involving its SingHealth clinics. The hackers specifically targeted the information of the prime minister in the cyberattack that lasted from June 27, 2018 until it was discovered on July 4. They breached a specific PC and then elevated its account privileges to access the database.

Other

Epic’s campus is free of cranes for the first time in two decades as the company’s frenetic construction projects wind down, having expanded the campus to handle employee headcount that tripled to 10,000. Epic says that it may another set of buildings next year.

The local paper reports that Banner Health’s $45 million, October 2017 conversion to Cerner at its acquired Tucson academic medicine locations caused medical errors and staff frustration, although hospital officials said delays in patient registration, lab ordering, and medication ordering and delivery didn’t harm patients. The paper just received heavily redacted records of an Arizona Department of Health Services investigation. Banner says it made 100 improvements to Cerner this year, naming specifically changes in pharmacy processing, oncology administrative activities, and patient records access. The paper notes these items uncovered from various state investigation documents and meetings:

• The Tucson locations had a smooth transition when they originally implemented Epic, but moving to Cerner “provided fraught for some patients and staff,” with significant problems due to poor implementation planning and training.
• This was Banner’s first implementation in an academic medical center (the former University of Arizona Health Network) and its Cerner system couldn’t distinguish between a medical resident and an attending doctor.
• A near-miss infant overdose happened because Cerner was set up to order per-kg weight-based doses, while Epic had been set up as per-gram ordering.
• Banner’s CFO admitted to state officials last month that it underestimated Cerner’s data center and bandwidth requirements.
• Banner’s CFO says both revenue and clinical productivity have yet to recover from the Epic-to-Cerner switch nine months ago. He replied to a Regents member who expressed concerns about Banner’s Tucson reputation, “You and me both.”
• The article notes that Phoenix-based Mayo Clinic Arizona will replace Cerner with Epic on October 6.
• In other Banner news from Tucson, the health system cancels its nurse Magnet status, where under University of Arizona Medical Center’s ownership in 2003, it became the first Magnet-designated hospital in Arizona. Banner will continue Magnet participation at its Phoenix campus.

AP Stylebook neatly summarizes how publications should use the results of political polls, offering rules that also apply to healthcare IT:

• The existence of a poll isn’t in itself newsworthy.
• The poll results should disclose who paid for it, and if the poll was commissioned by an organization that benefits from its results, it is not newsworthy.
• Polls should include a description of their methodology and a list of the questions asked.
• The polled group should be randomly selected to make sure that every member of that population has an equal chance of being selected. Online polls are valid only if participants are randomly recruited, while polls of website visitors, a company email list, or Twitter should be avoided.
• The poll should state its margin of sampling error.
• Reporting on results from a poll’s subgroup – such as people of a certain age or location – may be meaningless if the sample size is small.

An interesting study finds that telling students to “find your passion” for a career is bad advice since most passions are grown from experience, not discovered. The danger of the “do what you love” argument is that it encourages people to give up too easily and move on to something else if they don’t receive immediate gratification.

This is where science and public health meet the reality of people who don’t value them or who think they are driven by conspiracies. The parents of 57,000 Texas public school students decline to have them vaccinated in the 2017-2018 school year for non-medical reasons. In a significant jump, some counties saw a 9 percent opt-out rate and nearly half of the parents of students at one Austin private school opted out of giving them vaccinations under the repeatedly scientifically disproven belief that vaccines cause autism and other diseases, with “vaccine choice” being viewed by some as resistance against overly intrusive government. Supporters of Texans for Vaccine Choice are mobilizing political activities, protesting with signs that say “The State Does Not Own My Children” and promoting “informed consent” in publishing anecdotal stories in which parents claim that the medical problems of their children were caused by vaccinations. Obviously their choice affects everyone as vaccines work for entire populations only when enough people receive them to create “herd immunity.”

A CNBC report notes that a roadblock to digital health company success is that apps always end up recommending that users see their doctors, which people don’t like doing and often can’t afford. That leaves apps as “a funnel or a stopgap rather than a revolution.” A cardiology fellow and digital health founder says, “All the things done well by digital health — they’re simple, fun, visual, with great user experience — are still missing from most clinical visits, so it remains pretty unpleasant to be a patient. To me, this gap gets closed by bringing the clinical experience up to the same standards as our digital health solutions.” That is pretty brilliant insight – imagine frictionlessly summoning a ride on Uber and then having a 2004 Pontiac Aztek show up an hour late with the meter already at $40 and the lost driver refusing to use the GPS.

Google, Facebook, Microsoft, and Twitter launch an open source Data Transfer Project that allows people to transfer their data from one online service to another (the technical overview is here). Healthcare wasn’t mentioned specifically, but it would be pretty cool if EHR vendors provided a similar capability in allowing patients who are seeing a new doctor to initiate their own transfer of data to the new doctor’s EHR, although questions would then arise about the lack of synchronization capability afterward.

Sponsor Updates

• Elsevier will offer its StatDX radiology diagnostic decision support tool through MModal’s Fluency for Imaging.
• Liaison Technologies partners with One Laptop Per Child.
• Pivot Point Consulting names Matthew Curtain director of business development.
• Sunquest will host its annual user group conference July 29-August 3 in Scottsdale, AZ.
• Vocera will exhibit at LeadingAge Florida July 29 in Kissimmee, FL.
• Mazars USA names Steven Herbst principal, health care consulting group.

Blog Posts

• Enhancing the Patient Experience with a Better Informed Consent Process (Access)
• Capitalize on Chaos: How to Zero in on Opportunity with Population Health (Medecision)
• Meditech introduces first fully FHIR-enabled CommonWell member (Meditech)
• The Future of EHR – Collaborate, Connect, Communicate. (Netsmart)
• Epic Revenue Integrity Assessment: Are You Capturing All of Your Charges? (Parallon Technology Solutions)
• Cloud TCO: The Soft Costs are the Hardest (CloudWave)
• How One VNA Uses mHealth to Boost Care Management and Coordination (PatientPing)
• Just How Rewarding is Your Patient Experience? (Patientco)
• Is Your Answering Service Disaster-Proof? (PerfectServe)
• Can Industry Outsiders Empower Patients Through Data? (Redox)
• Let’s Put the Value Back in Care (Sansoro Health)
• Hospital Revenue Cycle Teams Feel Financial Pain (The SSI Group)
• Patient safety is at stake: Will hospitals step up? (Voalte)
• 5 Reasons to Attend Ascend in 2018 (WebPT)
• 2018 Trends in Patient Engagement: Leveraging Technology to Engage Your Patient Community (WiserTogether)
• Highlights from #IEEEICHI2018 #ICHI2018: Using AI to synthesize information from the data chaos in healthcare (Wolters Kluwer)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

Weekender 7/20/18

Weekly News Recap

• A survey finds that both consumers and physicians recognize the benefits of virtual care, but few consumers have experienced it and few doctors offer it
• Tenet Healthcare considers selling its Conifer Health Solutions business for up to $2 billion
• LabCorp shuts down its nationwide computer network when it detects that a hacker has penetrated it and is trying to access patient records
• Draft CMS rule changes would make major changes to physician billing, the Quality Payments Program, EHR design in supporting simpler billing requirements, and telehealth coverage
• The VA creates a committee to oversee its Cerner implement that will be led by ONC Principal Deputy National Coordinator Genevieve Morris

Best Reader Comments

No one is commenting on the CMS announcement, I suppose because no believes they are serious, or capable of executing any part of this grand plan. (DZAMD)

As a former CFO at a university medical center, a ROI of $190m that requires a $180m investment is a no-brainer — that is the people moving ahead with it have no brains! Any project as large and complex as this has at least a 90 percent probability of being 20 percent (or more) over budget. Nor did I see a contingency allowance in the budget which would allow for any mistakes. Given that, I would need to see at least a 50 percent ROI before moving ahead. Good luck UW, you’ll need it. (HISJunkie)

The communication director for BJC needs a communication director for her own messaging. You START the public statement about how bad you feel for the people whose lives you just turned upside down. You don’t bury that sentiment after two lengthy paragraphs about “market forces.” This should be a PR no-brainer in today’s hyper-sensitive environment for businesses who face these tough decisions. (AreUKiddingMe?)

“If I were a CareSync investor.” Apparently CareSync got millions from a local county development fund. That makes the county taxpayers the investors. Good luck to them recouping any money. (Blocked by Gurus)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. B, whose classroom is in “one of the most dangerous cities in America” in New Jersey, as she describes it. She asked for puzzles, books, and STEM supplies for her after-school program in which students remain on campus until 6:00 p.m. She reports, “My students were so excited when our After School Fun box arrived! Thank you again for your continued support to our school and specifically my classroom. My students come from a city that will not define their future and it is because of donors like you that make them see the possibility this world has for them!”

Telehealth vendor Dictum Health’s Virtual Exam Room and VER-Medic are featured in Discovery Channel’s new show “Sharkwrecked,” where paramedics used it to monitor the health of participants at the show’s shooting location in the Bahamas. Producers blew up a boat in the ocean, then left two men floating with sharks for two days to see what happens in simulating a real-life (yet rather far-fetched) situation. Just in case anything in Shark Week sounds like actual science, the network eliminated all doubt by featuring budget-friendly, D-list celebrities like Ronda Rousey and the massive Shaquille O’Neal, whose fear-overcoming shark dive might well trigger tsunami warnings.

Something I learned about the Chrome browser today after months of pondering instead of simply Googling: yellow lines stacked in the scroll bar show where the most recent search term appears on the page. Remove the search term from the search box and they go away, but otherwise you can scroll to one of the lines and then you’ll see your search term highlighted in yellow in the page text.

A woman is charged with breaking into Westmoreland Hospital (PA) on two occasions to steal soda, once by guessing the ICU door’s access code to enter its conference room, from which she left with a backpack full of drinks. The woman says she regrets her arrest since it might impact her ability to return to her paralegal studies, explaining, “I was thirsty, and it was really late at night, and there are no convenience stores really in my neighborhood. I just thought I’d get some soda. I didn’t think it was this big deal.”

British Airways responds to a customer’s tweeted complaint by asking him to provide his personal information “to comply with GDPR,” which the dimwitted customer (among others) does by tweeting it right back at the company and to the world. A security expert baffled at why the company would try to solve problems on Twitter instead of asking the customer to call in. He also notes that British Airways allows customers to check in online only if they disable their browser’s ad blockers, after which it sends their information to many third parties.

In England, a 63-year-old NHS doctor who is upset about his pension investment losses sends messages to his financial advisor threatening to kill himself, then uses a “hire-an-assassin” site on the dark web to order the advisor killed. The National Crime Agency detected his activity while investigating the Chechen Mob’s site, finding that the doctor had chosen the first of four predefined options: kill the man, beat him, set his car on fire, or set his house on fire. The doctor entered the advisor’s address but didn’t pay the $5,000 fee, leading him to plead not guilty of attempting to solicit murder.

Catholic Health Initiatives collaborates with AHA and Mass General to develop a set of IICD-10 codes that allow providers to document sex and labor exploitation.

I’m not sure if this is an Amazon success or failure, but the company’s website was so busy in the first few minutes of  this week’s Prime Day that its servers bogged down, forcing IT staff to deploy a stripped-down home page and to shut off international access. The company’s auto-scaling feature apparently also failed, requiring manual server spin-up and the need for “looking at scavenging hardware.” Prime Video was slowed, Alexa experienced outages, and warehouse employees weren’t able to prepare orders. Experts say that Amazon may have a bug in its auto-scaling service, but they nevertheless marvel that all of the Amazon sites remained up despite unprecedented volume. The company’s Sable computational and storage system processed 64 million requests per second under last year’s less-busy Prime Day.

The 63-year-old chief of cardiothoracic surgery at Jersey City Medical Center (NJ) is commissioned as a US Navy Reserve commander after receiving an age waiver for his in-demand skill. Tyrone Krause, MD, who was sworn in by his Navy ensign daughter, said, “Why don’t I just relax and sit in my back yard and drink some beer? But that’s not my style. I’ve always been on the move. And hopefully I’ll always be on the move.”

In Case You Missed It

• News 7/20/18
• EPtalk by Dr. Jayne 7/19/18
• HIStalk Interviews Mudit Garg, CEO, Qventus
• News 7/18/18
• Curbside Consult with Dr. Jayne 7/16/18
• HIStalk Interviews Eric McDonald, CEO, DocuTap
• Monday Morning Update 7/16/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 7/20/18

What can health systems do to encourage physicians to embrace virtual care?

A Deloitte physician survey finds that while both consumers and doctors recognize the benefits of virtual care, most consumers haven’t had a virtual visit and only 14 percent of doctors offer them.

CEO Gawande’s first task: a road trip to hear firsthand about workers’ health challenges

Atul Gawande, MD — head of the still-unnamed healthcare joint venture among Amazon, Berkshire Hathaway, and JPMorgan Chase — will embark on a cross-country listening tour to gauge the healthcare concerns of employees at the three companies.

Survey: Progress on Patient Safety Slowed by Ineffective Technology, Healthcare Professionals Say

A Health Catalyst survey on patient safety efforts across care settings finds that ineffective IT combined with a lack of real-time alerts is the biggest impediment to reducing medical errors.

News 7/20/18

Top News

A Deloitte physician survey finds that while both consumers and doctors recognize the benefits of virtual care, most consumers haven’t experienced a virtual visit and only 14 percent of doctors offer them.

The most commonly implemented virtual care technologies are email / patient portal consultations, physician-to-physician consultations, and virtual visits. Adoption was in the single digits for remote care management and coaching, remote patient monitoring at home or in other facilities, and integration of wearables.

The factors listed above do not include the big ones that doctors can’t control — reimbursement and licensing. You can bet that they would be quick to offer those services if adequately paid to do so or if per-visit fees were eliminated under value-based care payments and an in-person visit actually cost the practice money.

Reader Comments

From DisCerner: “Re: Banner Health. CIO Ryan Smith has tendered his resignation and a posting is up for SVP/CIO on Banner’s site.” The job is posted here, although Ryan is still listed as CIO on the company’s executive page. His career was with Intermountain until he joined Banner in October 2013. He was paid $900K in the most recent year. The tax filings also indicate that Cerner was Banner’s third-highest paid independent contractor at $47 million. 

From Email Privilege: “Re: HIPAA. I was emailed a receipt after paying online that included my name, account number, date of birth, and telephone number. Should they not just have the account number and amount paid because of HIPAA?” All of those fields, as well as your email address itself, are elements of PHI. However, your use of the provider’s portal probably could be taken to indicate your consent for communicating by email (I bet that was listed in its terms of service). It’s also not illegal to send PHI by email – HHS’s only requirement is that the provider “apply reasonable safeguards,” of which encryption would be one even though the rule doesn’t specifically require it as far as I know.

From Avuncular Robert: “Re: McKesson’s outpatient pharmacy point-of-sale system. It’s been down for over 24 hours and their service desk is blaming Amazon Web Services. It is a huge headache – we’ve had to go back to the old cash box process.” I reached out to McKesson, which provided this response:

We are aware of the situation that affected a subset of our customers and impacted their operations for the past 24 hours. Though point-of-sale services were impacted, the dispensing of medication was not affected. We have resolved the issue and have informed customers of next steps. As always, we appreciate our customers’ support and thank them for their patience and cooperation.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor EPSi. The Allscripts-owned, Chesterfield, MO-based company is the industry leader in health system integrated financial decision support, budgeting, and planning. More than 900 US hospitals — including nine of the top 10-rated hospitals, 128 IDNs, and 40 global academic facilities — rely on EPSi for data-driven insight into managing costs and improving their long-range financial performance, as well as addressing requirements created by value-based care, bundled payments, accountable care, and continuum of care. The company’s just-launched, cloud-based RealCost financial decision support and analytics system allows health systems to quickly gain deeper cost insights and empower informed decision-making. Check out case studies from Texas Children’s Hospital, University of Kentucky Healthcare, and UMC Health System. Thanks to EPSi for supporting HIStalk.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Stat reports that Atul Gawande, MD — head of the still-unnamed healthcare joint venture of Amazon, Berkshire Hathaway, and JPMorgan Chase — will embark on a cross-country listening tour to gauge the healthcare concerns of employees at the three companies. Those conversations will likely fuel the nonprofit’s business plan, which could include a digital primary care solution, according to Mount Sinai Health System Chief Population Health Officer Niyum Gandhi. “I wouldn’t put it past them to … test it on all their employees first before they go broadly to market. I mean, if anybody could do it, it would be them. But they’re going to have to do things that are at national scale, which there just aren’t quick wins on.”

Tenet Healthcare considers selling its Conifer Health Solutions business to UnitedHealth Group in a deal that could be worth $2 billion. Tenet hired Goldman Sachs last December to help it divest Conifer as part of a $250 million cost-reduction initiative that it aims to wrap up by year’s end.

Vyera Pharmaceuticals, known as Turing Pharmaceuticals under the infamous leadership of now-incarcerated pharma bro Martin Shkreli, reports Q1 losses of over $1 million thanks to declining sales of Daraprim, the drug Shkreli infamously raised the price of by over 5,000 percent when he acquired it in 2015. Vyera is considering changing its name to Phoenixus, no doubt in an effort to shed its former association with Shkreli and revitalize slumping sales.

Announcements and Implementations

NYU Langone Health (NY) implements Omnicell’s automated medication management software and dispensing cabinets at its new inpatient hospital.

Northwestern Memorial Healthcare (IL) selects HealthSource release-of-information technology from Ciox.

AdvancedMD releases a redesigned version of its AdvancedInsight financial reporting suite for private medical practices.

People

Adam Boehler, director of the Center for Medicare & Medicaid Innovation, takes on the additional HHS role of senior advisor for value-based transformation and innovation.

Sales

• Methodist Hospital (KY) selects cloud-based backup and recovery software and services from CloudWave.

Other

A Health Catalyst survey on patient safety efforts across care settings finds that ineffective IT combined with a lack of real-time alerts is the biggest impediment to reducing medical errors. A lack of adequate staffing and budget is a close second.

Sponsor Updates

• Formativ Health is recognized as the Gold Winner in the startup categories of both the CEO World Awards and the Globee Awards
• RxBenefit Clarity, a prescribing decision support solution developed by CoverMyMeds and RelayHealth Pharmacy Solutions, will be adopted by a dozen health systems that use Epic, Allscripts, and other EHRs.
• EClinicalWorks Director of Interoperability Strategy and Business Development Tushar Malhotra joins the CommonWell Health Alliance Board of Directors.
• FormFast and Kyruus will exhibit at the AHA Leadership Summit July 26-28 in San Diego.
• The Jacksonville Business Journal recognizes The HCI Group as one of the city’s fastest growing companies for the sixth year in a row.
• Optimum Healthcare IT publishes an infographic ttitled “3 Keys to Change Success.”
• Impact Advisors promotes April Smith to principal.
• InterSystems will exhibit at the Defense HIT Symposium July 24-26 in Orlando.
• CoverMyMeds announces that its RxBenefit Clarity prescribing decision support tool, developed with RelayHealth Pharmacy Solutions, will soon be used by 250,000 providers via new integrations with a dozen EHRs and Epic health systems.

Blog Posts

• A ‘reverse’ chatbot helps med students hone their diagnostic skills (Elsevier Clinical Solutions)
• Revenue Integrity: A Unifying Force Overcoming Compliance Challenges (Hayes Management Consulting)
• Healthcare IT Leaders Series: Tanya Townsend (Part One) (The HCI Group)
• Huntzinger Earns High KLAS Rankings in the HIT Assessment & Strategic Planning 2018 Report (Huntzinger Management Group)
• Transition to Change Readiness (Optimum Healthcare IT)
• Simplify Troubleshooting your IT Healthcare Virtual Architecture with Goliath Technologies (Goliath Technologies)
• Did You Know? 6 Ways to Make Physicians’ Lives Easier (Spok)
• Top Go-Live Blogs You May Have Missed (Leidos Health)
• You’ve Detailed Your Last Wishes, and Only Your Care Navigator Knows Them (PMD)
• QPP Proposed Rule for 2019: An Overview (Impact Advisors)
• Applying content services to complete your EHR (Hyland)
• Find Hidden Patterns with Role-Based Behavioral Analysis (Iatric Systems)
• Palm vein biometrics solution ensures positive patient identification and reduces duplicate medical records at University of Utah Health (Imprivata)
• Speaking Up: Healthcare Marketing in the Age of Voice Search (Influence Health)
• Making the Care Connections That Matter Most in Rhode Island (InterSystems)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 7/19/18

Every fall, providers across the country are required to update their ICD-10 codes in order to be compliant for services performed on or after October 1. A quick review of this year’s changes offers some insight about healthcare and culture in the US.

New codes were added for elevated lipoprotein(a), postpartum depression, and newborns affected by maternal use of opioids and other substances. Other codes help document forced labor and sexual exploitation. The one I found most disheartening was Z28.83, Immunization not carried out due to unavailability of vaccine. It’s unfortunate that practices that want to administer vaccinations can’t do so for a variety of reasons – manufacturing shortages, cost of supplies, cost of appropriate storage, and more. Vaccines are one of the most clinically-proven and cost-effective services we can provide, and access should be universal.

I appreciate the book recommendations that readers have been posting in response to my recent Curbside Consult. Bill Gates has also been recommending books over the last eight years, and they’ve been compiled into a list by Quartz.  Many of them address public health issues, including:

• “Dirt and Disease: Polio before FDR” (Naomi Rogers)
• “House on Fire: The Fight to Eradicate Smallpox” (William H. Foege)
• “Infections and Inequalities: The Modern Plagues” (Paul Farmer)
• “The Fever: How Malaria Has Ruled Humankind for 500,000 Years” (Sonia Shah)
• “Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver” (Arthur Allen)
• “The Checklist Manifesto: How to Get Things Right” (Atul Gawande)

As a confirmed Atul Gawande fan-girl, I’ve read the last one, but will add the others to my list for when I need something substantial to counter my summer reading diet of chick-lit.

I have to admit that I was pulled in by the headline “Pay Bump for PCPs Fails to Drive Medicaid Participation.” Looking at data for 2013 and 2014, when payments increased under the Affordable Care Act, researchers didn’t see an increase in the number of physicians willing to accept Medicaid patients or the number of Medicaid patients seen by the cohort of 20,000 physicians. It should be noted that the boost only took the payments to the Medicare amount, not all the way to the amount paid by commercial insurance carriers. If Medicaid payments were increased to that amount, I think you’d see a boost, but not a tremendous one.

Medicaid patients are some of the most challenging to treat due to concomitant social and resource issues. Providers and their practices spend a large amount of time trying to coordinate care, identify subspecialists who are willing to consult on Medicaid patients, and trying to figure out how to improve outcomes and quality of life while dealing with issues such as unemployment, lack of transportation, low health literacy, poverty, overutilization of emergency services, and more. Providing those additional services costs money, which is one reason (besides low payments) that providers limit their care of Medicaid patients.

The article goes on to mention a possible solution with advanced payment models, including risk-adjusted capitated payments with bonuses for outcomes and cost-control. This would only work if you also provided the other necessary economic and social supports that complex patients need in order to successfully navigate our healthcare system.

In other news, LA Care Health Plan is throwing $31 million at efforts to recruit primary care physicians in a move to reduce physician shortages at safety net clinics that see its 2 million members. LA Care Health Plan is publicly operated and understands that physicians are more likely to choose employment with larger organizations such as health systems rather than opt for the smaller salaries often paid by clinics and health centers. They’re targeting younger physicians through grant programs, medical school scholarships, and loan repayment programs and are intentionally not recruiting physicians already serving in the county or working with underserved populations. Additional moves include salary subsidies, signing bonuses, and payment of relocation costs. The latter two are fairly standard for physicians in a highly sought-after specialty, so it’s a bit surprising that they’re just adding them now.

Focusing on loan repayment doesn’t incentivize some older physicians, who have had theirs paid off for some time. I know quite a few seasoned family physicians who would be willing to move to a more meaningful care environment if the compensation was right. However, when loan repayment comes from grant and other funds, potential employers are not able to compensate with a higher salary for physicians without loans, and the recruiting falls apart. Employers are eager to trumpet “total compensation” except for when employees do the analysis. I have several colleagues who don’t take health benefits from their employer, which is a substantial savings for the organization, but were unsuccessful in negotiating higher salaries to offset the change in the total package. Finding the right physicians will reduce turnover and save them money in the long run, so I wish LA Care Health Plan the best of luck.

As we swing into another hurricane season, the Food and Drug Administration has formed a Drug Shortages Task Force to address shortages of medically necessary drugs. Our practice is still contending with supply chain issues impacting IV fluids, which manufacturers continue to attribute to Hurricane Maria’s assault on Puerto Rico. We’re also short on local anesthetics, injectable anti-nausea medication, and several injectable antibiotics. It’s nerve-wracking to have to use a drug that you’re not familiar with that is the only available substitute for something you need. I hope they can find some long-term solutions quickly.

This one almost snuck under my radar, but the FDA has given its first approval to a drug for smallpox treatment. Smallpox has been considered eradicated since 1980, and I hope it stays that way. There aren’t any human clinical trials due to the lack of disease, but it has proven effective in animals. It has also been shown to have no severe side effects during human safety tests. The drug has been in development since 2001 and approval went to Siga Technologies, which developed it under a federal contract. Smallpox is a nasty disease, killing a third of those infected. Although research stockpiles remain in Russia as well as at the Centers for Disease Control and Prevention in Atlanta, there is concern that gene hackers could create strains for release. For those of us without the telltale vaccination scars on our arms, it’s a terrifying thought.

What disease do you fear the most? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/19/18

UnitedHealth Is Among Suitors Circling Tenet’s Conifer Business

Tenet Healthcare considers selling its Confer Health Solutions business to UnitedHealth Group in a deal that could be worth $2 billion.

HHS Secretary Azar Announces Senior Advisor for Fourth Departmental Priority

Adam Boehler, director of the Center for Medicare & Medicaid Innovation, takes on the additional HHS role of senior advisor for value-based transformation and innovation.

Israel grants $33 million to GE, Medtronic, Change Healthcare to boost R&D

Israel’s Innovation Authority will award $33 million over six years to Change Healthcare, GE Healthcare, and Medtronic as part of a program to attract digital health companies to the country.

HIStalk Interviews Mudit Garg, CEO, Qventus

Mudit Garg, MSEE, MBA is co-founder and CEO of Qventus of Mountain View, CA.

Tell me about yourself and the company.

Qventus is an AI platform. We work with hospitals and health systems to help them manage their day-to-day operations. I’m one of the founders and CEO of the company. My background for the last 10-11 years has been in healthcare operations, specifically in lean process improvement. I’m proud of that. I started a few technology companies and spent time at McKinsey & Company’s healthcare practice. I’m an engineer by background.

How can data and dashboards be made useful to frontline people as they are making operational decisions?

That was one of the biggest prompts to start the company. The first time I walked into a hospital, I was struck by two things. One, how the managers and caregivers did whatever it took to provide care. Second, maybe because they cared so much and because the system was dependent on them doing these heroic acts day after day, the system itself never developed. My perhaps biased view in the beginning was that data could help folks be more prepared and to require fewer of these heroic acts.

We are comfortable in the conference room thinking all we want about dashboards and information, but in the moment when people are busy, nobody has any time to do something about it. Nobody logs into a dashboard. Nobody has time to read through a graph or a report and understand it. That was the earliest insight into the way of using data that we learned from.

We started talking a lot about what was needed in 2013. We said, what makes it so hard in healthcare operations? Typically the answer came back as, half my patients are unscheduled, we don’t know how long they will stay in the hospital, and the resources they will need is unknown. Predicting would be great.

It’s an often-used buzzword, but we started using machine learning tools back in 2013. My co-founder and I both had a background in it. We started predicting.

But we learned that predictions by themselves are sometimes counterproductive. While an average manager doesn’t have time to stare at a dashboard, they also don’t have time to interpret a prediction. A nurse we worked with at that time said, I don’t have time to figure out 30 percent chance do this, 40 percent chance do that. If my GPS said it’s a 30 percent chance to take a left, 40 percent chance take a right, I would toss it out the window. I have more load than I do while I’m driving. Just make it simple.

The goal of the product is not to expose more data, but to take those things that a really good manager would do. A really good manager in an emergency department anticipates. They say, things are getting really bad, I had better have my lab manager start doing X or start prioritizing these things. I had better tell the house supervisor to prioritize some beds. By doing those things two, three, or four hours in advance, they can get ahead of the situation. But that only happens when they have a calm environment where they have the time and capacity to look ahead and solve those problems.

Our product’s goal is to take away that mental load — the data processing, the evaluation of options — and to offer a suggestion in the moment as a message, discussion, or into the workflow in some way.

Hospitals usually have some internal expert they call in when they have a problem, but are lost when that person isn’t available. It would seem that once a hospital has formalized the decision-making process, it would be easier to then enhance it.

Absolutely. An excellent manager has to look at data and make sense of it. That depends on that manager’s time. What judgment they apply depends on that manager’s experience. All those things create inconsistencies.

But in that ED example I gave, the system would be saying, it’s Monday after Thanksgiving. The patients in the waiting room are much sicker. Dr. Smith is working and he tends to he tends to order more labs, but our lab is really slow right now. Based on all of this, we will run out of capacity in the next three hours.

Then the hospital can connect those subject matter experts. Gather the lab manager, house supervisor, and charge nurse and say, “Here is something that we see. We suggest you do this.” Let them have a workforce huddle on that discussion topic and do something about it well before the problem becomes bad.

Who would typically serve as the internal champion of that kind of real-time monitoring?

The executive sponsor often ends up being someone like a chief operating officer or a chief nursing officer. But the internal champion often comes from the lean groups in the hospital. They are the ones who have seen the day-to-day problems, are trying to improve them, are trying to build a system around them, and are connected enough to the day-to-day problems. They can be good champions. Oftentimes department heads will see these challenges, such as the medical or nursing director of the ED.

Those are the internal champions who want this to become a part of the system. The executive sponsors typically are the chief operating officer or the chief nursing officer, who are day-to-day focused on these problems and who jump in to help when things don’t go well.

What is the physical and operational manifestation of how your product gets used in a average hospital?

The ideal end state of the product is that there is no physical manifestation. The ideal end state is that it is invisible, like a really good assistant or someone who is helping you have the insight. It just disappears into the background and brings in the right information at the right time. That’s why it is like virtual air traffic control.

The product has three parts. The most important one brings the insight into the moment. It tells you, this patient in room 434 is likely to get admitted. We don’t have an admit order. We probably won’t have one for the next three hours, but let’s start preparing the bed. Or, this patient is likely to leave without being seen, or that we’re going to have a bad situation with this patient. It’s processing these insights in the background and delivering them in the moment — on a Vocera device, on a secure messaging device, or whatever the right mechanism might be.

Our system provides situational awareness, a sort of mission control. It can be in the break rooms or the huddle rooms, where people can have meaningful information displayed to help them understand the situation. Some of these nudges can be shown at that same place.

The last part is being able to understand the data to see where changes need to be made. An average department will get insight in the moment when they need to do something.

As hospitals centralize and and have larger deployments, there is an interesting role to play for a centralized place. In General Stanley A. McChrystal’s book “Team of Teams,” he talks about how the traditional image of command-and-control came to fail. The military started it, but in the most recent war, we struggled with that approach. They had to rebuild it and dismantle the command-and-control approach. He talks about the importance of spreading shared consciousness throughout the frontline people who are experiencing the situation and who have the most knowledge in the moment.

Our job is to spread the context, consciousness, and best knowledge to the people in the moment who are about to make that decision. While there’s a role to play for the central manifestation in escalation and awareness, the ideal situation is one where the information and the shared consciousness is going to the front lines. That’s how our product works.

Your site allows looking up any hospital’s efficiency index as calculated from publicly available information. What metrics might improve in using your system?

Our product is in 60 or 65 hospitals. Patient flow is a big use case — in the ED, inpatient, and OR. Length of stay, as you can imagine, is a really important metric, because it’s one of the most important measures of affordability and survivability for an organization to be profitable on Medicare patients. Length of stay is a big one on the inpatient side.

Length of stay is important in the ED, but so is patient satisfaction. The number of patients who are leaving without being seen is important.

On the operating room side, they look at efficiency — how much time it takes to turn a room, how many of the rooms are being used, whether supplies are being used appropriately, and how well patients are being informed throughout.

Then we have use cases for pharmacy and outpatient clinic access. In pharmacy, how to manage the drug spend. In outpatient access, how can the health system, with the resources it has, provide patients with quick access to care?

These metrics are beneficial regardless of the payment mechanism or the healthcare system’s economic model. As an example, one hospital freed up about a million minutes of patient wait time in their ED when they deployed the system. That helps them provide care to more patients in the community with the same resources. That lowers the cost, helps the hospital, and helps the patients. Regardless of the economic model, it helps both the health system and the patient.

Where do you see the company’s future being?

I grew up in India. We have in the US healthcare system the best clinicians, some of the best equipment, some of the best therapies. What’s holding back the potential of our system is oftentimes is the ability to execute on the processes day-to-day consistently and reliably, without placing an excessive burden on the people who provide it. If we can do that, if we can create a mechanism where it doesn’t take the heroic effort to provide that consistency and reliability, we can do that across every aspect of delivery of care. Whether it’s your experience in the unit, how well informed you are, your billing, or your staffing. Whether its in the emergency centers, in urgent cares, or in outpatient clinics.

My hope is that we can provide the infrastructure to allow for consistent, reliable execution of the clinical practices we know. Managing the logistics around delivery of care so that the human connection, and the calm that we can provide to people while delivering the care, is feasible. That’s my hope. I’m hopeful that we’ll be able to play a meaningful role in bringing that about.

Morning Headlines 7/18/18

Nashville health-tech company buys data-analytics firm, changes name

PlayMaker CRM acquires post-acute market intelligence and analytics vendor ViaDirect Solutions and renames itself PlayMaker Health.

Promoting Telehealth for Low-Income Consumers

FCC will propose to fund a $100 million “Connected Care Pilot Program” that would promote using telehealth among low-income families and veterans by providing affordable broadband service.

Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

Insurers are buying the lifestyle information of hundreds of millions of Americans from data brokers and then running it through algorithms that predict how much that person’s healthcare will cost.

UnitedHealth posts big profit jump but sees room to improve

UnitedHealth Group reports Q2 results: revenue up 12 percent, EPS $2.98 vs. $2.32. Its Optum segment booked $1.8 billion in profit on $25 billion in revenue for the quarter.

News 7/18/18

Top News

LabCorp shuts down its entire computer network when it detects that a hacker has penetrated its systems and is trying to access patient records.

The company says via an SEC filing that test processing and customer access was limited over the weekend. It will take several days to bring all systems back online, the company says, causing delays in results reporting.

LabCorp hasn’t yet said whether PHI was compromised.

The company does not use Twitter or Facebook, but its LinkedIn profile and its website don’t mention the outage.

Reader Comments

From Another Allscripts Casualty: “Re: Friday the 13th Allscripts layoff. Our VP used a lot of corporate jargon words like ‘synergy’ and ‘socialize the discussion’ to describe the streamlining process in which basically each manager had to remove one employee slot, even those with teams of just a handful of people. Team managers were notified only 30 minutes before the heads rolled. The cuts were not performance based, so producer worker bees were let go instead of middle layer fat. The McKesson EIS acquisition brought in a lot of overlapping people and I expect another round late this year or early next as more people are trained to be cross-functional. Allscripts is like the mythical Hydra – every time they lop off a head, another acquisition causes 10 more to pop up, and management is never lopping the right heads. I think some of the people at the top have a good idea of where they want to take the company, but the inertia of herding cats keeps them in the same rut.” Unverified. I’m not as confident that the company has a solid, rational strategy other than making undisciplined acquisitions that sometimes work out great (Netsmart, DbMotion) and sometimes just fizzle out quietly. That’s been the strategy all along, but other than a burst of investor enthusiasm that sent shares on a tear in 2000 (peaking then at more than six times today’s share price), it’s been a market-lagging stock that made headlines for mostly the wrong kind of reasons as it also came late to the post-MU EHR consolidation party by finally announcing that it would develop a new product, which is new territory for a company known for buying instead of building. Even with all that acquisition activity, Allscripts has a market cap of $2.2 billion, around 1/10 that of Cerner and one-third of Athenahealth’s market value. It has made some good deals, though – it paid just $185 million to buy the health IT business of a desperate and perpetually HIT-clueless McKesson, then sold off just the content management part to Hyland for up to $235 million.

From Fact Checquer: “Re: Allscripts. You mentioned the new EHR product Avenel. I find no mention of it on the company’s site.” It’s not listed on the physician EHR page with TouchWorks or Professional, but I found by Googling that it has its own site that says “machine learning” a lot and offers only a “contact us for more information” form. 

From Bjorn To Be Wild: “Re: HIStalk theme music. I don’t know when you added it, but I love it. It improved an already wonderful daily morning reading and coffee experience.” I put up the prog rock “HIStalk Theme” a few weeks ago. That musical style isn’t to everyone’s taste, so I’m considering commissioning a light jazz sort of tune for a more mellow experience. It’s surprisingly inexpensive (in the $100 range) to have custom music created to spec.

From RN Data Maven: “Re: National Guidelines clearinghouse shutdown. A tragic loss of a resource for practitioners to access evidence-based clinical practice guidelines. Fear of evidence-based scientific research or short-sighted funding decisions?” AHRQ says it can’t come up with the $1.2 million to keep the site running and thus took it down this week, but the non-profit ECRI – who managed the site for AHRQ — will bring it back in the fall with enhancements as a fee-based service. Some speculate that the site was doomed once then-Congressman Tom Price, MD (who later became HHS Secretary for a few months) demanded that AHRQ remove a study that was critical of a drug sold by one of his campaign donors.

HIStalk Announcements and Requests

Lorre has a backlog of inquiries for my annual “summer doldrums special” on new sponsorships and webinars, but she would still be happy to chat.

I was thinking today that Karl Marx’s “opiate of the masses” is no longer religion – now it’s actually opiates.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

UnitedHealth Group reports Q2 results: revenue up 12 percent, EPS $2.98 vs. $2.32. The company’s UnitedHealthcare insurance business took in $46 billion as membership increased to 49 million people. Its Optum segment, which provides pharmacy benefits management and technology services, booked $1.8 billion in profit on $25 billion in revenue for the quarter. 

Nashville-based post-acute care CRM software vendor PlayMaker CRM acquires post-acute market intelligence and analytics vendor ViaDirect Solutions and renames itself PlayMaker Health.

Sales

• CoxHealth (MS) chooses Kyruus to provide a digital provider directory and patient-provider matching technology for its website and call center.
• Southwest Mississippi Regional Medical Center selects Phoenix Health Systems for outsourced IT management and support.
• Australia’s Canberra Hospital and University of Canberra Hospital will implement Alcidion’s Electric Patient Journey Board to reduce length of stay and improve patient flow from the ED.

Announcements and Implementations

Health Catalyst launches a patient safety surveillance system and applies to become an AHRQ-certified Patient Safety Organization (PSO) that can offer clients a litigation-free environment for data analysis. The trigger-based system cost $50 million to develop. The company says EHRs offer limited surveillance capabilities and, unlike a PSO framework, are legally discoverable.

CompuGroup Medical launches its ELVI telehealth product.

Behavioral Health Network of Massachusetts goes live on ZeOmega’s Jiva population health management.

Government and Politics

NIH Director Francis Collins, MD, PhD pitches IRhythm’s Zio arrhythmia monitoring patch for detecting unknown atrial fibrillation, although noting that while the results may get patients to visit their doctor and begin anticoagulant therapy, its long-term benefit in reducing strokes, ER visits, and hospitalizations remain unproven. Collins concludes that the clinical trial was interesting because high-risk patients were recruited by email, had the patches mailed to them, then mailed them back at the end without having met a researcher face to face. Less exciting is the fact that we have yet another high-powered diagnostic tool to detect diseases that we as a country can’t afford to treat because we refuse to control healthcare costs — those newly ordered anticoagulants cost $15 per tablet, meaning someone will be paying $5,000 per year for the rest of each new patient’s life, although maybe that’s cheaper than treating the subset of them that would have otherwise had strokes.

FCC will propose in its August meeting to fund a $100 million “Connected Care Pilot Program” that would promote using telehealth among low-income families and veterans by providing affordable broadband service. Up to 20 providers that serve low-income populations would receive up to $5 million in funding in partnership with a broadband services provider.

Privacy and Security

In Canada, home care provider CarePartners is hit by ransomware, with the hackers contacting CBC News with samples of the patient information they have stolen (the samples alone involve 80,000 patients).The cyberintruders, who say they found unpatched software that allowed them to penetrate the systems, are demanding unstated “compensation in exchange for telling them how to fix their security issues and for us to not leak data online.”

Change Healthcare introduces a kill switch for its HealthQX value-based care analytics suite that allows customers to instantly revoke access to their data as long as two of its authorized operators issue the command from separate locations as part of a “bring your own key” capability.

Other

A Quest Diagnostics survey finds that healthcare has made little progress toward value-based care since last year. More than half of health plan executives think physicians don’t have the tools they need to succeed under VBC arrangements, while 61 percent of doctors say their EHR doesn’t contain all the information they need to deliver patient care.

In Australia, 20,000 people opt out of sharing data with its My Health Record online system on the first day of the three-month opt-out period.

Western State Hospital (VA, rebranded from the more memorable Western State Lunatic Asylum) realizes that it hasn’t followed state laws allowing it to destroy the records of patients 10 years after their last date of service, forcing a three-year records review in which a single HIM employee examined 6,000 reels of microfilm dating back to the 1800s. And you thought your job was dull.

A New York Times report notes that rural hospitals are not only closing at alarming rates, they are eliminating OB services to the point that fewer than half of US rural counties still have hospitals that deliver babies. It notes that loss of OB services means that fewer women receive prenatal care due to the time and cost of traveling further, more of them deliver prematurely, infant mortality increases, and EDs deliver babies the best they can.

This is important as the White House dismantles ACA protections that prohibit insurers (including those who sell through employers) from denying coverage for pre-existing conditions or charging sicker people higher premiums. A ProPublica report finds that insurers are buying the lifestyle information of hundreds of millions of Americans from data brokers that includes race, educational level, TV habits, clothing size, net worth, credit, and social media activity, all of which are run through algorithms that predict how much that person’s healthcare will cost. The article notes that while the information is ostensibly used to manage population health, it could also be applied to premium pricing formulas. Experts say that while insurers can’t blatantly discriminate (at least for now), they have cherry-picked the healthiest people by choosing their geographic coverage based on population data, or as one data salesperson said, “God forbid you live on the wrong street these days.” An excerpt:

[LexisNexis] said it uses 442 non-medical personal attributes to predict a person’s medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people’s cell phone numbers, criminal records, bankruptcies, property records, neighborhood safety, and more. The information is used to predict patients’ health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy, and their stress levels. People who downsize their homes tend to have higher healthcare costs, the company says. As do those whose parents didn’t finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won’t share its methods and hasn’t published the work in peer-reviewed journals.

In New Zealand, an internal health board report finds that hospital generators failed to kick on after a power line was cut, with battery back-ups having just four minutes of power left when the power came back on. My experience with generators is not reassuring – even with regular testing and fuel monitoring, the switchover always seem to fail. What’s your experience?

In England, a nurse assistant is charged with fraud after submitting timesheets indicating that she had worked 242 shifts in 20 months instead of her actual 10, for which she was overpaid $66,000. She claimed that she thought she was entering the times she was available for work instead of logging her actual time. She had asked her manager to help her, which might have provided yet another clue to the manager that her entries were incorrect. The judge noted that the hospital makes such fraud easy.

Bizarre: a hospitalized prisoner who eats metal objects such as catheter clamp, thumbtacks, and screws racks up $1 million in medical bills, then is admitted under 24-hour watch to Loyola Medical Center in a stay that has added $500,000 to his tab as taxpayer-funded hospitals try to keep him from being admitted to their facilities and the hospital presses the prison for payment. The prisoner is a 6-foot, seven-inch former basketball player who has previously threatened hospital employees. The sheriff bluntly but accurately explains:

We have a guy right now that has cost us — has cost all the people in this room — close to a million dollars in health bills because he constantly eats the jail. Across the country, the easy thing to do was cut mental health services, and they’ve done it. So people don’t get better. They don’t get treatment. They go to jails and prisons and emergency rooms.

Welcome to a country run by lawyers. In Las Vegas, Mandalay Bay Hotel’s corporate parent MGM Resorts International sues 1,000 concert-goers injured in the Route 91 Harvest festival shooting last year, hoping to force a decision that it can’t be held liable because it hired a security firm that was certified by the Department of Homeland Security for protecting against mass injury. A lawyer representing some of the victims says the company – which also owns the concert venue — is “judge shopping” in trying to push any case into federal instead of state court.

Sponsor Updates

• PatientKeeper publishes an e-book titled “Attending to Physicians: Why Healthcare Must Focus on Improving Physician Experience” and a video titled “PatientKeeper Charge Rescue Service.”
• Buffalo Business First profiles Hamish Stewart-Smith, CTG’s managing director of sales for its North American healthcare business unit.
• Huntzinger Management Consulting Group earns high rankings in the KLAS HIT Assessment & Strategic Planning 2018 report.
• FDB releases a new video to help people understand how its Opioid Risk Management Module supports safer opioid risk management and prescribing.
• Divurgent publishes its “Windows 10 Upgrade Benchmark Report.”
• Optimum Healthcare IT publishes a white paper titled “Change How You Approach Change in Healthcare.”
• Dimensional Insight VP George Dealy earns CHIME’s CFCHE credential.

Blog Posts

• Why your practice needs positive online doctor reviews (AdvancedMD)
• Meditech EPR Gives Rotherham a Clearer View of Healthcare Data Efficiency (Meditech)
• What 146 C-suite executives told us about their top concerns – and how they’ve changed this year (Advisory Board)
• How Analytics Can Help Combat the Opioid Epidemic (Dimensional Insight)
• Learn what it takes to be compliant on the cloud with our free self-assessment (Datica)
• Standardizing Industry Framework: The Necessity and Methodology of Aligning Care Coordination Models (CarePort Health)
• The Evolving Scope of Practice for Pharmacists (CoverMyMeds)
• How Analytics Can Help Combat the Opioid Epidemic (Dimensional Insight)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

Morning Headlines 7/17/18

Walmart Names Humana Veteran to Run Its Health and Wellness Unit

Sean Slovenski (Healthways) joins Walmart as SVP of health and wellness.

Cerner to grow Dublin research hub

Cerner will add 50 new R&D jobs at its Dublin hub, home to its IP development team.

Joe Harpaz Joins Modernizing Medicine as President and Chief Operating Officer

Modernizing Medicine brings on Joe Harpaz (Thomson Reuters) as president and COO.

Lab Corp. (LH) Detected Suspicious Activity on its Information Technology Network

LabCorp works to restore full system functionality after detecting suspicious activity on its IT network over the weekend.

Curbside Consult with Dr. Jayne 7/16/18

I’m a voracious reader and enjoy many kinds of literature. I’m part of a book club, largely composed of women in healthcare IT, that meets monthly via Webex to talk about a good read. I see hundreds of manuals, summaries, and business documents come across my desk every year.

Given all these things, I’m a firm believer in the concept that words mean something. Unfortunately, I don’t think this belief is shared by some of our fellow travelers in healthcare IT. We may understand how a claim needs to be properly formulated for it to be paid, or a lab result so it can be delivered through an interface, but sometimes we fall short in the realm of communicating with people.

Almost every end user has complained about user guides or technical manuals at one point in their career. There are hazards in trying to convert a technical process into something that clinical people can follow, or that distracted physicians are willing to sit and read. My first EHR vendor put out a 1,000-page user manual that was nearly unreadable and would rival any piece of federal legislation for its sleep-inducing properties. They blamed its size on the included screenshots, but part of it was the overly-wordy description of a complicated documentation system that was a hybrid between legacy green screens and something more graphical.

My undergraduate institution’s English department has a program in technical writing. I’m surprised they don’t turn out more than the one or two graduates who earn degrees each year because it should be a skill that is in demand.

The language of healthcare itself often gives physicians something to chat about in the physician lounge. “Reimbursement” implies that someone is getting paid back for something  in an amount equal to a previous expenditure. It’s fancier than saying “payment” and tries to mask the transactional nature of the business of healthcare. Many physicians agree that those reimbursements don’t adequately cover the time, effort, supplies, and overhead required in delivering the service, especially when looking at payers such as Medicaid. Can you imagine your HVAC contractor or auto mechanic talking about reimbursement for their time as opposed to just delivering a bill for services rendered?

I also hear physicians complaining about marketing campaigns directed towards them, and there are certainly plenty of those to make fun of. We’ve grown out of having photos of physicians playing golf and fishing as a proxy for the free time that technology solutions are going to give them. Instead we’re depicting them in the office seeing patients, which is where they belong, but that does agree with how physicians see themselves working increasingly long hours. There’s greater emphasis on showing physicians and providers of various demographics, old and young, male and female, and of diverse racial and ethnic backgrounds. Although vendors have done better with some of their pictorial efforts, there are still issues with the words they use.

One of my bigger pet peeves is the overuse of the word “holistic.” Newsflash for marketeers: holistic means something that has parts that are interconnected and that the whole is greater than the sum of the parts. A holistic approach to a problem does not mean providing a laundry list of solutions that a client might want to purchase in order to solve a business problem. Holistic also has a certain connotation in medicine that I think vendors fail to understand. A reference to holistic medicine often implies complementary and alternative therapies, non-western medicine, naturopathy, and other modalities. Depending on the beliefs of the physician you are marketing to, use of the word holistic can either be a blessing or a curse. Beyond that, if your “holistic solution” doesn’t provide any benefit beyond that of its parts, then it’s not holistic and you just look confused about how you are describing your offering.

Other words that have lost their sparkle include innovative, novel, revolutionary, and cutting-edge. Everyone claims that their solutions and offerings fall into these categories, to the point where the words no longer have meaning. I had a rep recently pitching a tabletop lab analyzer machine which was similar to the one we already have in the office. He acted like it was something groundbreaking when there are multiple competitors in the field that offer similar devices. The real difference between his offering and others was the price point, which in his case was a disadvantage. Costing almost twice as much as the nearest competitor might be novel, but the data trying to show it as a better device wasn’t going to swing us into buying 36 of them.

Then there are the folks who are killing us with mostly meaningless buzzwords: artificial intelligence, blockchain, synergy, cloud-based, mobile, virtual reality, and more. I think people assume that if they include one of those words in an email that it means people’s ears will perk up and they will instantly be attentive. I think we’re all hyped out on many of those terms, at least until there is proof that their respective technologies can really make a difference.

Words also have meaning with interpersonal communication. I see far too many emails where people respond rapidly and appear that they may have done so without thinking. It feels like people are so concerned with moving messages out of their email boxes that they’re just flinging information back and forth without proofreading or making sure their responses make sense.

I see emails where someone has asked multiple questions and the response addresses only one of the points, or where it’s clear that someone wasn’t reading for comprehension. There are emails that are full of nonsense words – talking about circling back to review deliverables and determine which items are deal-breakers and the like. I once saw an email about “prioritizing show-stoppers” prior to a go-live. By definition, if they are show-stopping defects, aren’t they all of equal priority since they will bring the go-live to a screeching halt? It was worth a number of laughs, so I can’t make too much fun of it because it made several of us smile.

I’m a firm believer that people who are strong readers are better writers. If you’re responsible for creating content, writing blogs for your company, or preparing user guides and manuals, when is the last time you read something non-work-related? I want to challenge people in those roles to read a good book and see if it changes your frame of mind or if it positively influences your work.

What’s the last good book you’ve read? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Eric McDonald, CEO, DocuTap

Eric McDonald is founder and CEO of DocuTap of Sioux Falls, SD.

Tell me about yourself and the company.

My background is computer science and mathematics. I founded the company about 15 years ago. We have created an electronic medical record, practice management system, and strong business analytics solution for the on-demand space. That’s also known as the urgent care space, but it is morphing and changing into more what we call on-demand care.

What does that on-demand marketplace look like and how is it changing?

It has been known historically as the urgent care space. The term “urgent care” gives the impression that the patients’ needs are urgent. But realistically, this space is all about convenience and delivering a service to an on-demand society. Over the last half-decade to a decade, we have become more of an on-demand society. This part of healthcare has realized that and shifted its services to meet those needs. Not just in offering convenience and walk-in services, but also with the services themselves.

Historically, people thought of urgent cares as being urgent only and not offering primary care or other services. But now urgent cares are doing that. We’re seeing this shift to more of on-demand care versus urgent care. We’re seeing pediatricians and primary care docs move into this on-demand space and change their business model. Those things have led DocuTap to recognize that this is broader than just urgent care. It’s about being a technology company focused on on-demand care.

Who owns these on-demand centers? How many of them are operated by health systems?

Historically there has been a division between retail care — CVS’s MinuteClinics — and the tried-and-true urgent cares. In the urgent care world, about 25 percent are owned by health systems, Over the last half-decade, that has shifted by two to three points one way or another, but it hasn’t dramatically changed. You have seen a larger presence by corporations, larger chains like MedExpress, American Family Care, NextCare, or FastMed. Those continue to grow to take a larger percentage, probably 40 percent of the market.

The remaining urgent cares are provider owned. An ER doc decides to throw up a shingle and do it himself, and he’s maybe got one to three clinics. Or primary care docs who have changed their model to be more of an on-demand care as a hybrid between primary and urgent care.

That makes it tough to identify how many urgent cares are out there. Some clinics are primary care during the day, and then from 5:00 until 9:00 p.m., they become an “acute care urgent care.” By definition, it’s probably not an urgent care, but it really is. A number of these facilities are at times acting as an urgent care. You also have clinics or facilities that don’t offer x-rays or do laceration repairs, which are the basics that you would expect to have in urgent care.

The high-end number is about 10,000 urgent cares across the country. If you’re looking at a tried-and-true, pure-play urgent care, it’s probably 7,500 to 8,000 locations. That does not include retail clinics like MinuteClinic, which has been separated from urgent care because of their limited scope of service. They don’t have x-ray. They’re not going to manage a laceration. If you fracture something, they will not be taking care of those needs. But those would be expected in a visit to an urgent care. 

Retail clinics are limited in scope to sore throat, cough, earache, and maybe your flu shot. You got a half a dozen things that are going to be common in retail, which is different from urgent care. Having said that, I believe that will potentially shift over the next five years.

What are the technology needs of an urgent care center?

One of the challenges with a hospital-based system is that they are built to manage every specialty, every service. It’s one solution fits all, which means that it’s going to be clunkier. It’s hard to develop software that works well for every specialty. I learned early on that the best way for the company to be successful is to find one niche and be the best in it. When it comes to urgent care, it’s all about speed. How do you get patients in and out as fast as possible? When all we do is urgent care, it makes that simple.

When you start looking at the additional services that an urgent care needs — such as their revenue cycle management services, like billing services — there are some intricacies with urgent care that a hospital system is going to ignore, which impacts their revenue. We have robust data analytics, and when you’re dealing with consumers, you need to understand some of those consumer trends.

The marketing aspect plays into this. The urgent care space is consumer focused, whereas orthopedics and cardiologists aren’t. The tools that we deliver need to have a consumer play in ways that others don’t. When we talk about patient engagement, it will be very different than an oncologist or an ortho.

What kind of information exchange with other providers is typical for an urgent care center?

Interoperability, where you’re downloading information into the urgent care, is usually less important, because they’re usually acute visits such as for a sore throat or fracture. It’s less important for those providers to be aware of what’s going on. What’s important is that we get the information from this acute visit back into the health system or the mother ship. The most common interface is pushing data from our software back into systems like Epic or Cerner.

Having said that, there are situations where the hospital or health system is willing to let us pull that down as a patient walks in the door, but we wouldn’t ever keep those in sync. We would wait for a patient to walk in and do it on an on-demand basis.

How are urgent cares broadening their services?

One of the biggest buzzwords and the most important item within urgent care is patient experience. At the very onset, being able to remotely register from your phone, put your name in the queue, and wait at home or wherever you need to be instead of in the waiting room. The system will automatically text you when it’s your turn to be seen. You essentially walk right on back. Being able to remotely register and take a picture of your insurance card and driver’s license does it all for you and enhances that experience.

Our clients are embracing those items to enhance the experience. When that patient walks in, they’re going to be able to get in and out of that clinic in probably 40-50 minutes, under an hour for sure. The services that are rendered can be anything from acute-related items — sore throat, earaches, fractures – to proactive preventative items related to their care. Diabetic care, an annual physical, and “primary care lite” services. You’re going to see more moms that are using urgent cares as their pediatricians. Whether it’s pediatric care, primary care lite, or truly urgent fracture-related or lacerations stuff, you’ll see all of those happening within urgent cares.

How do you see the market and your company changing in the next 3-5 years?

We have to be very nimble. We have to assess our clients’ needs every year and shift as quickly as we can and stay ahead of them. That is hard to do because they are also quick and nimble. Many of our clients are backed by venture capital or private equity firms, which means that they’re growing quickly. They’re going to change their business models quickly if needed. It’s a tough niche to be in because it’s constantly changing and it’s changing quickly.

Do you have any final thoughts?

We got lucky. Sometimes people think that it’s crystal ball-ish, but in reality, we picked an amazing niche within healthcare. It will be fun to see how the urgent care space continues to evolve and changes how healthcare is delivered. It will push other specialties to be more consumer focused and to pay more attention to an enhanced patient experience.

Five or 10 years from now, we will look back as a healthcare industry and see that the urgent care space — which will be referenced as on-demand care — has changed how providers interact with their patients. There will be a higher expectation to offer an enhanced patient experience. Patients will have more control than they have had historically. I couldn’t be more proud of the niche we’re in, what it’s doing for healthcare, and DocuTap’s role in it.

Morning Headlines 7/16/18

CMS Proposes Historic Changes to Modernize Medicare and Restore the Doctor-Patient Relationship

CMS issues a massive draft set of rule changes that it says will reduce provider administrative burdens, encourage price transparency, revamp the longstanding E/M codes to a single code in which physician payment is driven by time spent or medical decision-making required, and paying for virtual visits.

VA Establishes Office of Electronic Health Record Modernization to Support Transition From Legacy Patient Data System

The VA creates an Office of Electronic Health Record Modernization to oversee its Cerner implementation, to be headed by ONC Principal Deputy National Coordinator Genevieve Morris.

Billings Clinic employee’s email hacked during overseas travel; breach affects 8,400 people

The email account of an employee of Billings Clinic (MT) is hacked while he or she is traveling overseas, exposing the information of 8,400 people who were mentioned in the employee’s emails and attachments.

Blount Memorial Hospital to get medical records backup system following computer problems

Blount Memorial Hospital (TN) sets aside $30,000 to purchase a medical records backup system for its physicians group after unexpected computer downtime in May resulted in the cancellation of numerous appointments.

Monday Morning Update 7/16/18

Top News

CMS issues a massive draft set of rule changes that it says will reduce provider administrative burdens, encourage price transparency, revamp the longstanding E/M codes to a single code in which physician payment is driven by time spent or medical decision-making required, and paying for virtual visits (although at a very low rate).

CMS Administrator Seema Verma said in an announcement, “Today’s proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients. Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care. This Administration has listened and is taking action. The proposed changes to the Physician Fee Schedule and Quality Payment Program address those problems head-on, by streamlining documentation requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need.”

Reader Comments

From Another Allscripts Casualty: “Re: Allscripts layoffs Friday the 13th. Follows the voluntary early retirement program. I don’t know the numbers, but it definitely involved US-based support for ProEHR, ProAPM, and interfaces. Knowledgeable staff were released and offshore customer support will become even more prevalent.” Unverified, and I didn’t even bother asking because Allscripts always declines to comment on personnel issues. Another reader says he heard 70 folks were let go. I was thinking that as I write this, I don’t even have a good mental picture of what Allscripts has become – a distant fourth-place inpatient EHR vendor; seller of badly aging EHR/PM systems but with a newly developed product in the wings; acquirer of fire-saled unrelated products like Paragon, Practice Fusion, and NantHealth; or a pseudo HIT mutual fund trying to tap-dance investors into a buy-and-hold stupor by promising a better future involving genomics and population health? Even that master-of-none pandering to financial markets hasn’t worked out great – since Paul Black hired on in December 2012, MDRX shares are up just 13 percent vs. the Nasdaq’s 149 percent gain and Cerner’s 49 percent jump. Let’s hear from you, however – what has Allscripts done well and not so well and what would you do first thing if installed as King or Queen of Allscripts for a day?

Speaking of Allscripts, I just noticed a subtle change in the company’s logo to make the L’s look like they’re rising and to darken the font. The change was made sometime in April or early May, according to cached copies of the page. Hopefully the rationale for the change made it worth what must have been a significant cost to swap it out everywhere. While I was looking over their site, I also noticed that seven of eight executives are male, as are nine of nine board members, which is high even in man-centric health IT.

From Banty Rooster: “Re: KLAS’s EHR global market share report. Cerner signed the most contracts and more beds than InterSystems, yet KLAS positions ‘rapid growth’ for InterSystems while Cerner ‘lagged.’ The chart doesn’t seem to match the narrative.” I think KLAS struggled to characterize Cerner since it’s the only one of the top vendors that sells multiple systems that it targets to specific geographic regions, and half of its 2017 global contracts and a pretty big chunk of its new international bed count came from sales of its I.S.H. Med system instead of Millennium. I know basically nothing about I.S.H. Med other than Cerner inherited it with its acquisition of Siemens Health Services, which had bought the SAP-based system from Austria’s T-Systems (no relation to the US-based T-System as far as I know). KLAS’s summary from the full report: “Over the past five years, Millennium has not grown as quickly as its primary competitors. Cerner has slowed Millennium’s growth by limiting it to targeted markets, offering I.S.H Med in additional markets around the globe, and marketing their non-EMR platforms (like HealtheIntent). Those who do choose Millennium like its broad functionality and flexibility.”

From Measly Metric: “Re: population health. The tools are promising, but where’s the process?” My take on population health is simple – one of the biggest threats to your health is getting pulled into the bosom of the US healthcare “system” and having your insurance milked and your body tinkered with, most often to your detriment even with good intention as uncoordinated experts blast their diagnostic and therapeutic guns in ready-fire-aim fashion. PHM sounds like a good idea as long as doctors get paid only if you stay well, but otherwise, many people would remain healthier by steering a wide path around financially motivated doctors and hospitals whose “health” expertise (versus “healthcare services sales”) is minimal. Whatever you do, try not to be admitted to a hospital, because the dangers there – both clinical and financial — are staggering. I’ve seen them firsthand as a member of various hospital committees that review the plethora of errors, lack of coordination, and outright bad decisions — the reality of regular medical mayhem versus the proudly displayed crystal awards in the tasteful lobby is jarring. Executives fresh off an admission to their own hospital – even in luxury suites with piles of extra attention – invariably marvel among peers at how lucky they were to escape without permanent harm.

HIStalk Announcements and Requests

Virtual visits haven’t kicked much of a dent in the health IT universe, with 83 percent of us never having participated in one (and I generously included “telephone” in the category). Judy says Doctor On Demand costs her just $5 on her employer’s plan and she has avoided at least three ED/urgent care visits as a result. Carla loved a Sunday afternoon session for an infection. Allen says his insurance covers only office visits, making me wonder why employers wouldn’t embrace them to keep employees productive instead of wasting half a day driving and waiting. Jim loves MD-Live for routine issues and care in rural areas, noting that he was able to choose a highly qualified doctor from a list instead of paying retail clinic prices that now cost about as much as a PCP visit but that mostly use NPs/PAs instead of doctors.

New poll to your right or here, which popped into my head while I was thinking about Allscripts: who is the best CEO among the largest inpatient EHR vendors? Vote and then click the poll’s “comments” link to explain what “best” means to you and why your choice qualifies.

Listening: Australian singer-songwriter Courtney Barnett, an interesting combination of blandly delivered but smart, observational lyrics paired with her stripped-down guitar. Sample lyrics: “Tell me I’m exceptional and I promise to exploit you” and “I think you’re a joke, but I don’t find you very funny.” She’s one of those musicians whose modest singing and instrumental skills transform into something great just because it’s her words and her unpretentious, non-computer enhanced knack for saying what everybody feels. Music goes through predictable cycles where audiences finally rebel against corporately backed, wildly overproduced mindless mainstream pop, and when it happens again, Courtney will be ready.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

Previous webinars are on our YouTube channel. Contact Lorre for information.

People

New Ascension-owned process automation vendor Agilify hires Doug Thompson (NextStep Solutions) as president.

Government and Politics

The VA creates an Office of Electronic Health Record Modernization to oversee its Cerner implementation, to be headed by Genevieve Morris, who is on loan from ONC as principal deputy national coordinator.

Privacy and Security

The email account of an employee of Billings Clinic (MT) is hacked while he or she is traveling overseas, exposing the information of 8,400 people who were mentioned in the employee’s emails and attachments.

Other

JAMIA President Doug Fridsma, MD, PhD says in a BMJ editorial that medical students should be taught health informatics. 

The New York Times looks at a town in Mexico whose ongoing water shortages encourage residents to drink cheap, readily available Coca-Cola, of which the locals consume an average of a half-gallon per day. Public health has suffered, with the diabetes mortality rate jumping 30 percent in three years. Residents complain that the local bottler pays little for the water it uses and that money goes directly to the federal government in a sweetheart deal. A local activist neatly summarizes Coke’s business model as, “Coca-Cola is abusive, manipulative. They take our pure water, they dye it, and they trick you on TV saying that it’s the spark of life. Then they take the money and go.”

As a regular Waze user, I’m happy to see that the Google-owned GPS app will give cities access to its massive amount of traffic and driving data to support real-time emergency notifications and long-term infrastructure planning.

Sponsor Updates

• LogicStream Health releases a new podcast, “How data analytics, data democratization and clinical process improvement are helping to increase innovation and control costs in healthcare.”
• Mobile Heartbeat adds Amplion’s Alert nurse call system to its MH-CURE clinical communications and collaboration smartphone app.
• Santa Rosa Chief Strategy Officer William Leander shares his presentation from HFMA titled, “Seven Critical Aspects of a Successful BI & Analytics Program.”
• Summit Healthcare raises $3,900 for A Gift for Teaching, this year’s Heart of MUSE Foundation recipient.
• Surescripts releases a new video, “Technology: A Prescription for a 21st Century Health Crisis.”
• Optimum Healthcare IT is named as one of Jacksonville, FL’s list of fastest-growing companies for the third consecutive year.
• Mazars employees volunteer at local communication organizations across six states for the company’s fourth annual “Days of Service.”
• ZappRx will exhibit at Integrate 2018 July 23-25 in Philadelphia.
• ZeOmega releases a Jiva customer success video featuring MCG Health.

Blog Posts

• 4 Areas to Consider During the Transition to Value-Based Care (Pivot Point Consulting)
• Not Your Average Call Recording Solution (Vyne Medical)
• Kentucky Medicaid Work Requirements Halted (MedData)
• Finding the Perfect Pace for Product Launches (Medecision)
• Tips and lessons learned for a successful clinical EHR implementation (Meditech)
• After implementation of electronic health records, design rises (Medicomp Systems)
• Getting Back to the Basics with RCM 101: Healthcare billing cycles (Waystar)
• Implementing the Second Electronic Health Record Part II (Netsmart)
• Nachos Neurosurgery (NVoq)
• Epic Ad Hoc Consulting: What to Consider (Parallon Technology Solutions)
• 3 steps to use patient feedback and elevate the customer experience (Experian Health)
• Event Recap: PatientPing and the Connecticut Hospital Association Roll Out Stories to CT Hospitals (PatientPing)
• A Billion Reasons to Celebrate! (Patientco)
• Interdependence Day (PatientKeeper)
• An Exploration of the Past, Present, and Future of Meaningful Use (PokitDok)
• 5 Tips for Choosing the Right Rounding Tool (PatientSafe Solutions)
• Will Industry Outsiders Save Healthcare Dollars Through Data? (Redox)
• Ambulatory Surgery Center Financial Outlook and Structure (The SSI Group)
• The Top 5 Things You Need to Know to Set Up Summit Exchange (Summit Healthcare)
• Medical laboratories can add value to newly consolidated organizations with the right technology platform (Sunquest)
• Three Key Steps for Every Provider Interaction, as a Physician Liaison – PRM (SymphonyRM)
• Patient safety is personal. (Voalte)
• Informed Hope: Hardwiring Compassion in Healthcare (Vocera)
• Employee Engagement: Your Most Important Business Initiative (WebPT)
• The payer-provider trust gap narrows as ‘payvider’ deals take off (Philips Wellcentive)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

Weekender 7/13/18

Weekly News Recap

• Facebook fixes security holes that allowed third parties to harvest the names and email addresses of people who signed up for its private groups, triggered by a breast cancer group’s concern
• A new KLAS report covering non-US EHR activity finds that Epic doubled its relatively small market share in 2017, InterSystems continued its rapid growth, and Cerner experienced moderate activity
• Cerner partners with and takes a $266 million equity position in value-based care operator Lumeris
• AdvancedMD acquires competitor NueMD
• England’s health secretary Jeremy Hunt takes the foreign secretary job vacated by Boris Johnson, with the country’s culture secretary taking over as health secretary in a major government shakeup

Best Reader Comments

The biggest challenge to telemedicine is the lack of insurance coverage. Medicare (which also sets the rules for most commercial payers) has a very limit set of originating sites (locations where the patient can be during the visit). The AMA is scared to death of how this technology could negatively affect their urban/ suburban member’s pocketbooks. (Former Community CIO)

Don’t forget one independent assessment [of University of Washington Medicine’s plan to move to a single EHR] was done showed no benefits after 10 years. If you don’t think part of new savings comes from staff, you haven’t read the notes. We lost millions of dollars last year and staff reduction is the plan to fix the problem. (JoblessInSeattle)

$190M in benefits on a $180M project seems pretty convenient. How much staff are they [UW Medicine] cutting? Are these numbers real? (EpicITStaffer)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. Z in New York City, who asked for a solar bag and solar beads for a STEAM project. She reports, “Exploring solar energy concepts can be challenging. With the materials that have been provided by this grant, my students explored new concepts, conducted hands-on activities, and had a great time learning. Students focused on solar energy, which is the most abundant renewable energy source. We conducted our investigations outside in our schoolyard. Students constructed necklaces and bracelets using the solar beads and were truly amazed by the color changing reaction by the sun. We also used the solar balloons which flew like hot air balloons, except we used the sun’s energy as the heat source. Thanks again!”

A jury orders Johnson & Johnson to pay $4.7 billion in damages to 22 women who sued the company for failing to warn them that its baby powder increases the risk of ovarian cancer because it may contain asbestos. The company says it will appeal, as it has successfully done in several similar lawsuits, and complains that the women were allowed to sue in Missouri even though most of them don’t live in that state.

HIMSS recaps its well-received HIMSS18 session titled “Boston Strong: Lessons Learned from the Boston Marathon Bombing” by former Boston Police Department Chief Daniel Linskey.

Boston Children’s Hospital achieves near-miraculous recoveries by infusing mitochondria from a patient’s healthy tissue into their ischemia-damaged hearts or lungs. The experimental procedure is credited with saving the live of Avery Gagnon (pictured above), whose post-open heart surgery ischemia was immediately resolved, allowing her to be taken off ECMO. Researchers say the procedure’s low risk make it potentially useful in every major heart surgery as well as in treating other organs and diseases.

A Texas couple whose six-year-old daughter requires around-the-clock medical care due to a chromosomal disorder considers divorcing to qualify the child for Medicaid as they are overwhelmed by $15,000 in annual out-of-pocket medical costs on top of expensive insurance premiums on a family income totaling $40,000.

Bristol-Myers Squibb Children’s Hospital (that a hospital would be named after a drug company tells you a lot about US healthcare) rehomes the 16-foot-tall statue of Geoffrey the Giraffe that had stood in front of the former headquarters of the defunct Toys R Us.

A Memphis woman sues her dermatologist after he greeted her during her visit with, “Hi, Aunt Jemima,” which he later admitted to reporters was a “misspoken blunder.”

This former Iowa Methodist Medical Center pharmacy technician is clever (maybe unintentionally so) in his apology to hospital patients whose injectable narcotics he swapped out with sterile water so he could use them himself — “I’m sorry for the pain I caused them.” The lawyer for several patients who are suing the hospital over the incident added his own possibly unintentional humor in declaring, “He hurt a lot of people.” The former tech will ache for his 30 months in federal prison to pass quickly.

A man is charged with using the identity of a New Jersey doctor to bill an insurance company for $1 million in medical services using a made-up practice name and an empty, unlocked office’s address. United Healthcare paid him $46,000 before a woman noticed that her insurance was being billed for services she hadn’t received.

California dermatologist Sandra Lee, MD – whose pimple-popping videos have earned her 3.9 million YouTube subscribers, a just-premiered TV series, and the sobriquet Dr. Pimple Popper – launches an Operation-like board game titled Pimple Pete whose objective is to extract the most fake zits. Life must be good in America if millions of people have time to be entertained by pimple videos and doctors who were trained as healers at great taxpayer expense can make a career of creating them.

Bizarre: Michael Jackson’s former doctor – ex-cardiologist and now ex-convict Conrad Murray, who served time for accidentally killing the singer by injecting him with propofol for insomnia in 2009 – claims Jackson’s just-died father Joe chemically castrated MJ as a pre-teen so his voice wouldn’t change.

In Case You Missed It

• News 7/13/18
• EPtalk by Dr. Jayne 7/12/18
• Readers Write: Augmented Intelligence: Virtual Assistants Come to Healthcare
• HIStalk Interviews Dan Burton, CEO, Health Catalyst
• News 7/11/18
• Curbside Consult with Dr. Jayne 7/9/18
• Monday Morning Update 7/9/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
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• Sign up for email updates
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• Contact Mr. H

Morning Headlines 7/13/18

Facebook recently closed a loophole that allowed third parties to discover the names of people in private, ‘closed’ Facebook groups

After prompting from healthcare technologist Fred Trotter, Facebook eliminates a privacy setting that allowed third parties to glean the names of users who participate in private, closed Facebook groups.

Cue Announces $30 Million Funding Contract from U.S. Department of Health and Human Services’ Biomedical Advanced Research and Development Authority

HHS awards Cue Health a $14 million contract to develop app-based flu-testing kits for the home and office that will include virtual consult and prescribing capabilities.

Chairman Roe, Ranking Member Walz Name Lawmakers to New Subcommittee on Technology Modernization

The House Committee on Veterans’ Affairs names members of the subcommittee that will oversee the VA’s Cerner implementation.

News 7/13/18

Top News

Facebook eliminates a privacy setting that allowed third parties to glean the names of users who participate in private, closed Facebook groups.

The company also shuts down the Grouply.io Chrome extension that was designed to allow marketers to harvest such information on a large scale.

The latter problem was discovered by the moderator of a group for BRCA-positive women who worried that their potential breast cancer information could be shared with insurance companies, with the extension’s behavior documented and reported to Facebook by healthcare technologist Fred Trotter.

Reader Comments

From Dockside: “Re: BJC HealthCare Information Services. Laid off 68 employees and 45 contractors Wednesday following the Epic rollout on June 2 at the remaining facilities. Health Information Partners (HIP), the internal group responsible for the Epic implementation (a joint venture with BJC and Washington University) did not seem to suffer any layoffs. We knew this would be coming at some point, but in our opinion it was handled very poorly. People were told individually and were given an hour to remove their personal items prior to being walked out. Those on PTO were given the news by telephone and told not to return to the office – their personal items were shipped to them. Those of us who were left finally received an email saying what was going on just after 4:00 pm Wednesday. Any semblance of the ‘family’ culture that originally came from the hospitals pre-merger has pretty much been wiped out and replaced with the typical cold corporate culture.” I reached out to June Fowler, BJC SVP of communications, marketing, and public affairs, who confirmed Wednesday’s elimination of about 10 percent of the health system’s IT workforce. She provides this statement:

Market forces are driving all healthcare organizations to deliver patient care services in new, more efficient, and more cost-effective ways. BJC’s positioning for sustained long-term success in response to these pressures will rely increasingly on information technology and IT expertise for innovative solutions. As a business enabler, IT must increase focus on strategic priorities and align work and resources in support of these priorities. Reprioritizing the work towards improved system stability, strengthening of information protection, and disciplined execution requires changes in the IT staffing structure. This realignment includes an adjustment of skills and capabilities required in IT and will eliminate some current positions. In some cases, new job roles and responsibilities will be created to enable improved capabilities and assure accountability for execution as well.

To adjust staffing levels to meet current priorities, we made the difficult decision to reduce the IT workforce effective July 11. The workforce reduction affects 68 employees and 45 IT contractors.

We recognize any action that results in job loss has a significant impact on employees and their families. There is a comprehensive compensation and outplacement support package in place to assist those who are directly affected by this necessary action. The BJC human resources team is working closely with these affected colleagues to support them through this transition. The reduction initiates action towards a major transformation of our delivery capabilities where IT will realign resources to deliver against BJC’s most strategic intents.

From Plebe: “Re: health IT influencer blogs. What do you think of this site’s list?” It’s not up to me to decide who influences whom, but I checked out the 32 sites and found that: (a) 13 are no longer online; (b) nine rarely post anything; and (c) the remaining 10 write something at least occasionally. I’m not getting into a quality debate on the content of those 10, but for most, their rather simplistic articles wouldn’t seem likely to influence anyone who themselves have actual influence.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president Emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

On-demand birth control delivery startup Nurx raises $36 million in a funding round led by Kleiner Perkins. The San Francisco-based company, which has raisd $41 million since launching four years ago, also offers access to anti-HIV medication and plans to offer at-home HIV testing lab kits.

Alphabet’s Verily health business will partner with medical device company ResMed to apply sleep data to study the health and financial impacts of undiagnosed and untreated sleep apnea. I’m not sure how that will work since ResMed mostly sells CPAP equipment that would be prescribed only after a positive diagnosis for sleep apnea.

Analysts predict that health IT company Henry Schein will downsize after a regulatory filing hints at plans to increase efficiencies. The Melville, NY-based company spun off its animal health business in April and announced a joint dental software venture with Internet Brands last week.

Epic Systems founder and CEO Judy Faulkner climbs three spots on the latest Forbes list of richest self-made women, proving that the “extreme fame leverage” of list cover girl Kylie Jenner (#27) isn’t necessary to achieve a net worth of $3.5 billion and the #3 ranking behind women involved in ABC Supply and Little Caesars (does anyone actually still buy awful Little Caesars pizza except as evening-out sustenance to be left for the kids and babysitter?)

People

Eric Pupo (Accenture) joins Columbia University Irving Medical Center as CIO.

Divurgent hires Sarah Sample-Reif (Modis) as VP of client services.

Sales

• Hospital management company Candor Healthcare will implement MedSphere’s CareVue Cloud EHR at Rock Regional Hospital (KS) early next year as part of a facility-wide roll out that will include ChartLogic’s EHR and RCM software and services.
• Benefis Health System (MT) selects patient self-scheduling and EHR integration software from MyHealthDirect.
• Eagle Physicians & Associates (NC) opts for real-time patient care alerts from PatientPing.
• MemorialCare Health System (CA) chooses RTLS-based patient workflow technology from Vizzia Technologies.

Announcements and Implementations

Virginia Hospital Center goes live on Bernoulli Health’s clinical surveillance, analytics, and medical device integration software.

CompuGroup Medical announces GA of Electronic Videoconsulting.

PatientSafe Solutions develops an app for rounding and clinical communications.

Allscripts, Athenahealth,  CareCloud, and DrChrono users can offer patients appointment scheduling through Alexa using Nimblr’s virtual assistant, Holly. Integration with Epic is scheduled for Q3.

CipherHealth introduces patient engagement technology for ACOs, including targeted outreach and care coordination tools.

Healthcare Growth Partners publishes its always-brilliant midyear health IT market review. It notes:

• Despite $29 billion in health IT investment since 2014, broad impact on care delivery, cost, and outcomes has been muted, but value is accruing.
• Healthcare’s IT spending as a percentage of revenue is close to the average across all industries at 3.5 percent, but still runs about half of what banking and securities companies spend.
• That healthcare IT spending, however, has been spent on infrastructure and by providers switching from one EHR or billing system to another, gaining little improvement in cost and quality.
• M&A activity for smaller companies have three points at which value is assigned – proof-of-concept (the product can be sold and deployed commercially, with annual revenue less than $1 million); growth scalability (the company shows signs of profitability and growth scaling, with revenue $5-10 million), and mature scalability (the company takes on real infrastructure and begins to show strong profitability, with revenue $20 million and up).
• HGP’s HIT Index gained 25.7 percent in 2017 and added another 21.6 percent in the first quarter of 2018.
• Leading the Q1 HIT performance in share price change are Tabula Rasa Healthcare (up 128 percent), Connecture (up 116 percent), Evolent Health (up 71 percent), and Teladoc (up 67 percent). 
• Bottom-performing in the Q1 HIT index are Inovalon Holdings (down 34 percent), Invitae (down 19 percent), Oneview Healthcare (down 19 percent), and Allscripts (down 18 percent).
• Health IT IPOs have dried up completely, with zero in 2017 and so far in 2018.

A new KLAS report on non-US EHR activity finds that Epic gained 16,000 beds in signing six contracts in 2017, more than doubling its small, non-domestic market share as concerns about high-profile problems at Cambridge’s implementation in the UK faded. InterSystems continued its rapid growth, especially in smaller, multi-hospital organizations, while Cerner’s growth was moderate and lagged its primary competitors. The early days of the UK’s Global Digital Exemplar program has seen only four new contracts signed, of which Epic earned two, System C one, and Allscripts one.

Virginia Hospital Center (VA) goes live on Bernoulli One for clinical surveillance, medical device integration, and real-time analytics.

Advisory Board’s annual survey of health system CEOs finds that their top concern is preparing for sustainable cost control and creatively reducing expenses, followed by finding diversified revenue streams. A fast-growing #5 was meeting rising consumer demands for service.

Government and Politics

The House Committee on Veterans’ Affairs names to the subcommittee that will oversee the VA’s Cerner implementation Rep. Jim Banks (R-IN, chairman); Rep. Conor Lamb (D-PA, ranking member); Rep. Jack Bergman (R-MI);  Rep. Mike Coffman (R-CO); and Rep. Scott Peters (D-CA).

HHS awards Cue Health a $14 million contract to develop app-based flu-testing kits for the home and office that will include virtual consult and prescribing capabilities. The company announced a $45 million Series B funding round earlier this week. Diassess has been awarded a $10 million contract to develop a similar kit, though its focus will be on creating a disposable, battery-powered device for use during public health emergencies.

Privacy and Security

Public health officials in Nashville, TN discover that the PHI of thousands of HIV patients was accessible to all employees on a Metro Public Health server for almost nine months. The database, typically accessed by a small group of physicians, is used to track and help patients living with HIV.

Children’s Mercy Hospital (MO) faces its fourth data breach-related lawsuit, this time pertaining to an email phishing scam discovered in January that potentially exposed the data of 63,000 individuals. Children’s Mercy faced another suit from the same firm over a 2017 breach involving the PHI exposure of 5,500 patients. Two additional lawsuits involved the theft of paper records from employee vehicles.

Fortified Health Security releases its mid-year cybersecurity report, noting that 28 percent of breaches so far this year involved an email attack.

Other

The FDA issues recalls on 39,000 Medtronic implantable heart devices after the company alerts providers that the devices need software updates to avoid potentially adverse events.

In England, the Royal College of Surgeons calls out the NHS after discovering the health service is still using 9,000 fax machines despite a nationwide push to convert to digital technologies. “NHS hospital trusts remain stubbornly attached to using archaic fax machines for a significant proportion of their communications,” says RCS chair Richard Kerr. “This is ludicrous. The NHS cannot continue to rely on a technology most other organisations scrapped in the early 2000s.”

UC Health describes its central data repository for all six UC Health systems at its Data Day in San Diego, noting these points:

• The scientific method of asking questions and then making observations is becoming obsolete as ample data already exists, with the bottleneck not being the gathering of information, but rather “asking the killer questions.”
• UC Health’s tools include UC-Rex, a search engine for anonymized patient information, and Epic’s SlicerDicer, which creates patient cohorts from EHR data.
• Studies now start with looking at what has happened to patients clinically, then getting IRB approval to dig deeper.
• Information that is being added to the data warehouse includes patient satisfaction and survey results, hospital operations data, claims data, and eventually genomics data.
• Data analysis includes looking at how physicians spend their time and looking for potential burnout risk factors.

CNBC reports that Amazon and Xealth, a digital prescribing and analytics startup, are in talks with several health systems to develop bundled medical product recommendation and delivery services for patients just before discharge.

Weird News Andy is proud as a peacock that New Zealand scientists have performed the first 3-D, color X-ray on a human.

Sponsor Updates

• CarePort Health extends its discharge planning and referral management software agreement with Jackson Health System (FL), and helps JHS integrate its software with the hospital’s Cerner EHR.
• Elsevier Clinical Solutions will exhibit at the APC 2018 Annual Meeting July 15 in San Diego.
• EClinicalWorks will exhibit at the 2018 FSASC Annual Conference July 18-20 in Orlando.
• Optimum Healthcare IT publishes a video describing SkillMarket, software to manage EHR go-live resource evaluation, compliance, and scheduling.
• Meditech publishes a case study titled “The Clatterbridge Cancer Centre NHS Foundation Trust Transforms Cancer Care.”
• IMAT Solutions will exhibit at HealthImpact East July 18-20 in Washington, DC.
• Butler Health System (PA) achieves 97-percent patient-matching accuracy using solutions from LexisNexis Risk Solutions and Occam Technologies.

Blog Posts

• EHR Training: Don’t Forget These 7 Areas (The HCI Group)
• Making Preventive Healthcare Services a Priority (Healthgrades)
• 2 truths and 1 lie: Healthcare and fax machines (Hyland)
• Using Education to Get Patients Back in the Office (Solutionreach)
• The Top Three Keys to Preventing a Cyber-Attack (Iatric Systems)
• The Power of Analytics in Diagnosing Physician Burnout (Dimensional Insight)
• Timely Filing: Optimizing Revenue Cycle Team Performance (Impact Advisors)
• The US House of Representatives passes The EPCS Act (Imprivata)
• Healthcare CRM Use Case Beyond Marketing: Provide Patients with Post-Discharge Follow-ups (Influence Health)
• For Your Eyes Only: Data Privacy and Best Practices (InterSystems)
• 3 Key Themes from the 2018 Healthcare Call Center Times Conference (Kyruus)

Contacts

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