Monday Morning Update 12/16/13

From Epic Fail: “Re: Epic. During the Q&A portion of a talk by Bernard Tyson (Kaiser CEO) at Epic today, an Epic employee stood up in front of a full Epicenter and asked Mr. Tyson if he thought that Kaiser would consider selling insurance in the future.” I will generously assume that the interrogator was one of Epic’s youthful, perfect-SAT savants who performed a quick scenario analysis and was shrewdly suggesting to Mr. Tyson that Kaiser’s business model might need to adopt to ever-changing healthcare requirements by focusing on other aspects of the corporate portfolio beyond its extensive insurance offerings. Either that or it was the typical Epic 24-year-old philosophy graduate who knows nothing about healthcare, but who has gained unwarranted conversational confidence from telling hospital people how to run their businesses using knowledge obtained from reading software manuals.

From Sharing is Caring: “Re: Kaiser. I just got this and it is very interesting… revolutionary, in fact. We can now share patient information between any Kaiser and all of the major hospitals in the SF Bay Area that use Epic-Sutter, Stanford, UCSF, and Alta Bates.” Shared Epic information includes just about everything from the patient, encounters, and results, omitting only flowsheets, images, smart forms, and scanned documents.

From The PACS Designer: “Re: RSNA highlights. The 2013 RSNA featured an interesting shift in how radiologists can interact with patients. Aunt Minnie listed five areas that drew the attention from attendees. TPD was pleased to see informatics among the list of the top five categories presented in the list for radiologists to consider for adoption.” According to the writeup:

In the past, big iron scanner introductions drew the lion’s share of attention at McCormick Place. One of the defining characteristics of the “new normal” for the RSNA meeting, however, may be the continued prominence of imaging informatics software in the exhibit halls and the scientific program. Indeed, market interest in these technologies seemed to provide a rare sign of hope amidst the overall malaise that still seems to be plaguing much of radiology.

That radiology maturation seemed inevitable – it happened in lab, where the intelligence moved from the instruments to the software managing the information the instruments created. Imaging costs, radiation exposure, remote viewing, patient image sharing, and radiology efficiency are all key issues that smart software (rather than the latest and greatest scanner) can improve.

Even hospital people like HIStalk readers don’t pay attention to published hospital quality data when making medical decisions for themselves. New poll to your right: is the term “mHealth” obsolete or unnecessary? I think it’s not only meaningless (as is “digital health”) but also unnecessarily divisive as companies and people wall themselves off behind that label instead of jumping into the mainstream of just “health.” That’s not a criticism of the companies waving the mHealth banner – we’re having the same identity crisis in “healthcare IT” as well as it becomes clear that our horizons should be “health” and not just “healthcare” and we try to figure out how population health management and wellness fit among our stodgy billing and order entry episode-based applications. Somewhere among all of that self-imposed digital segregation are consumers-slash-patients wondering why we have to make everything so provincial, fragmented, and complicated.

My latest grammar pet peeve examples, provided without explanation since they are hopefully obvious: (a) I went away for a couple days; (b) So I read a new book; (c) I eat breakfast everyday in the backyard. I’m also still frustrated constantly by lame articles with supercharged headlines that make them sound useful and insightful when they clearly aren’t, leaving me to feel as though I wasted my time with the journalistic equivalent of trying to make a meal of air-filled Cheetos and instead ended up still hungry and with embarrassing orange gunk on my lips (I’m often led to those worthless articles by Twitterers and Facebookers who seem to love being the first to link to awful healthcare IT articles.)

Welcome to new HIStalk Platinum Sponsor Proximare Health. The 10-year-old Savannah, GA-based company improves the referral process, with 3,000 users processing 25,000 referrals per month through its clinical rules-powered IRIS (Internet Referral Information System). The result: referrals are made to the most appropriate service, the appropriateness is validated from the Web-based system, eligibility and authorization are verified, patients are prioritized by condition, clinical documentation is managed, and results are shared among a patient’s providers. IRIS was built with the help of clinicians from nearly every specialty at Cook County in Chicago, who were trying to solve access challenges by making sure referrals were clinically appropriate, with the referral process managed by (and supported by) clinicians instead of a non-clinical utilization management department. Cook County’s results: (a) referral processing time was reduced from three months to 5.5 days; (b) 22 percent of the referrals were rejected as inappropriate; (c) referral volume increase sevenfold with fewer employees needed to manage it. Check out the short  videos covering order entry, rules engine, scheduling, document and results sharing, patient messaging, appointment preparation, interoperability, and business intelligence. Thanks to Proximare Health for supporting HIStalk.

Proximare had lots of its own YouTube videos, but I found one created by Portland IPA on how it uses the IRIS referral management system.

My first-generation iPad is getting long in the tooth to the point it can’t run newer versions of apps. I don’t use it enough to justify spending $499 on an iPad Air or even $299 for an iPad mini, so I did my research and instead bought an Asus MeMo Pad HD 7 for $119 from Office Depot on Friday. It’s amazing how much technology you get these days for so little money and in a thin, 10-ounce package: a high-definition display, super fast performance with 1 GB of DDR3 memory, front and rear cameras, dual speakers that sound really good, 10-hour battery life, highly responsive touch, 16 GB of storage, and a Micro SD card reader slot for cheap storage expansion. A seven-inch screen is plenty big when you have an HD display — even tiny text is crisp and playing a YouTube HD movie will just about take your breath away (I’ll use it to watch movies on planes, I’m sure.) Picking up my old iPad now is like hefting a yellowed, weighty encyclopedia volume from 1970. The MeMo Pad feels every bit as satisfying and well designed as my iPhone and Android is just as easy to use as iOS. Thank you, Google, for developing an economical and powerful alternative to the OS wares of Apple and Microsoft.

Cerner announces a $217 million share repurchase program. As a review, those programs involve companies using their cash to buy their own shares (which they often consider undervalued) on the open market. Or at least that they’ve announced plans to do so – companies don’t always follow through. Those purchases take shares off the market, which increases earnings per share even though overall earnings haven’t changed. They also increase executive bonuses tied to earnings per share at the expense of reduced cash that might have been spent on R&D or acquisitions. In other words, share repurchase programs don’t mean a thing despite the feel-good message that “we love our stock so much that we’re buying it ourselves.” Above is the five-year performance of CERN vs. the Nasdaq.

Jamie Stockton of Wells Fargo Securities provides the above slice-and-dice of hospital Meaningful Use attestations through 10/31/13. Meditech leads by far in total and net number of attestations, while Epic, Cerner, and McKesson have the highest percentages of clients successfully attesting. Trailing the pack in client percentages are Healthland, Siemens, and Allscripts.

Duke University Health System goes live with Strata Decision Technology’s StrataJazz for capital and long-range financial planning. 

A former IT director of The Advisory Board Company pleads guilty to defrauding his employer of $100,000 by approving the payment of invoices to a sham company he created for that purpose.

Barron’s says athenahealth’s stock drop late last week was due to concerns raised at the company’s investor meeting: (a) CEO Jonathan Bush announced that he will take a two-month leave next year; (b) the company guided next year’s earnings expectations down; (c) the company’s use of flattering but unusual financial measures that have given it a “thin-air valuation” of $5 billion; (d) athenahealth’s statement at the investor meeting that it will double its market opportunity by selling inpatient clinical software to hospitals and by doing so will “undermine the foundations” of Cerner and Epic; (e) the company has little choice for selling to hospitals because they are acquiring its practice-based customers and replacing athenahealth’s products. Athenahealth’s hospital plans apparently involve pre-certification and referrals.

Weird News Andy titles this story as “Now that’s what I call a gestation period,” although he notes that “the train never left the gestation.” Doctors find that an 82-year-old woman with stomach pain has a 40-year-old fetus inside her.

Here’s Vince’s Christmas edition of HIS-tory.

Contacts

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

More news, HIStalk Practice, HIStalk Connect.