News 3/7/14

Top News

The Defense Health Agency, established in October 2013 as a successor to TRICARE, requests $1.6 billion to support its health IT systems in 2015. It also wants $91 million for R&D to develop a new EHR by 2017 and $68 million to integrate its systems with those of the VA. Meanwhile, the VA’s 2015 budget requests include $269 million for EHR development.

Reader Comments

From TooMuch Coffee: “Re: WA state healthcare insurance exchange. You mention that 15k applications are stuck in limbo. I agree that’s not great, but they have signed up around 500k successfully. The site basically works, unlike OR and HI sites.” I’ve written about Oregon’s struggling exchange, so here’s the story on Hawaii’s: it received $204 million in federal funding, went live two weeks late due to software problems, has enrolled fewer than 5,000 people (at a cost of about $46,000 each), and has already been declared unsustainable without ACA rule changes since few potential customers and insurers are interested and it’s supposed to be self-funding its $15 million annual operating budget with 2 percent of the take. Meanwhile, the US Government Accountability Office says it will audit Oregon’s exchange, which cost $304 million and hasn’t enrolled a single person without manual help.

From Concerned: “Re: UHN in Toronto. Can anyone confirm that they are replacing QuadraMed EHR with Cerner?”

From Nobody Knows: “Re: value-based risk contracts. Is there a resources that details which payers and providers are engaging in them vs. those doing fee-for-service? I’ve tried AIS, HIMSS Analytics, and Billian’s and so far, no dice. Even a high-level report would be nice.”

HIStalk Announcements and Requests

This week on HIStalk Practice: You won’t want to miss the summary of my chat with eClinicalWorks CEO Girish Navani, who shares his thoughts on the MU program, population health, and health information exchange, plus provides an estimate of the company’s valuation if it were to go public. Despite the growing number of  employed physicians, work still needs to be done to integrate physicians and develop performance-based reward programs. The pay gap between primary care providers and specialists narrowed in 2013. I recap some vendor announcements from last week and muse on various HIMSS sights and sounds, including the future of Practice Fusion; Allscripts and its new tag line; what’s driving Aprima’s recent growth; and, the hot topic of ICD-10. Thanks for reading.

This week on HIStalk Connect: Samsung unveils the Galaxy S5, which integrates with both its two new smart watches and its new activity tracker. Basis, the maker of the B1 activity tracker, is acquired by Intel for a rumored $100 million. The FDA is looking for a vendor to develop social media analytics tools.

On the Jobs Board: Chief Market Strategist – Healthcare, EHR Tester, Epic Activation Consultant.

Welcome to new HIStalk Platinum Sponsor CompuGroup Medical. You see the count of big global customer numbers in their graphic above and the owner-led and publicly traded company is expanding its US sales. Offerings include CGM Clinical (integrated PM/EHR), CGM DAQbilling (PM), CGM webEHR (EHR), CGM webPRACTICE (PM), and CGM Enterprise (PM/EHR for community health centers); LIS, outreach, and reference lab solutions; the eSERVICES Patient Portal, EMEDIX Reimbursement Solutions, and the SAM disease management platform. The new CEO of CGM US is Norbert Fischl, who has an interesting background as leader of the company’s Northern European region, managing director of a software company, McKinsey consultant, and an Internet entrepreneur. Thanks to CompuGroup Medical for supporting HIStalk.

Here’s another update on one of our DonorsChoose projects that was paid for by the top-of-the-page ads. The 35 freshman girls in the Illinois high school taught by Teach for America teacher Ms. Schwartz are using the notebooks and colored pencils we provided to create College Bound Journals. They will fill them with goals, thoughts about their futures, and information they gather about college campuses and majors. You can see in the photo sent by the teacher that they’ve already started.

More remote mug sightings.

Anne-Marie wasn’t able to get way from the family medicine practice she manages to attend the HIMSS conference, so she made her own mug. She says it’s not nearly as cool as the original, but I disagree.

It’s time for the once-yearly HIStalk Reader Survey. It’s quick and I use the results to plan the entire next year of HIStalk, so I would really appreciate your taking five minutes or less to give me some guidance. I’ll sweeten the pot by randomly drawing three responses to receive $50 Amazon gift cards. Thanks in advance – most of the good ideas I’ve put in place came from responses to this survey.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q4 results: revenue up 4.1 percent, adjusted EPS $0.28 vs. $0.25, beating estimates on both.

Clinical prediction software vendor Health Outcomes Services completes a $5 million financing round. CEO Jim Wilson has worked for McAuto, EDS, and Cerner and was president of Craneware before joining HOS.

People

ArborMetrix appoints former CMS administrator and FDA commissioner Mark McClellan, MD, PhD (Brookings Institution) to its board.

Idea Couture hires James Aita (Medicomp) as head of healthcare solutions.

Bart Foster, founder and CEO of self-service medical kiosk maker SoloHealth, is replaced by Chairman Larry Gerdes (both above.) The company’s CFO has also resigned and an undisclosed number of employees have been laid off. Gerdes sold transcription vendor Transcend Services to Nuance for $300 million in 2012. One of SoloHealth’s investors is healthcare IT long-timer Walt Huff, the “H” in HBOC, where Gerdes was an executive from 1977 to 1991.

Tamyra Hyatt (McKesson) joins Azalea Health as VP of marketing.

Announcements and Implementations

The New York eHealth Collaborative and the Partnership Fund for NY call for applications for participation in the second class of the  NY Digital Health Accelerator, where 10 early- and growth-stage companies will each receive mentoring and $100,000 of investment capital.

North Dakota officials announce the official rollout of the state’s HIN, which will connect all of North Dakota’s hospitals by the end of the year.

The US Army deploys a software upgrade to its battlefield Medical Communications for Combat Casualty Care EMR, also known as the MC4 system, that includes an upgraded operating system, enhanced security, and patient safety improvements related to allergies and medication history.

Government and Politics

HHS includes $75 million in its 2015 budget for ONC, a $14 million increase over last year.

ONC updates its Health IT Dashboard to include a Rand Corporation-prepared review of literature on the impacts of HIT, with a focus on MU functionalities.

Analysis of full-year 2013 MU attestation data by Wells Fargo Securities finds that 92 percent of hospitals stuck with the same vendor for at least two years. Meditech, Allscripts, and Siemens topped the list of hospitals that stayed the vendor course, Cerner and CPSI were average, and Healthland, McKesson, and HMS lagged. It also finds that small hospitals seem to be dropping out in big numbers by the third year, perhaps because they’ve paid their EHR costs in the first two years and don’t want to deal further with MU complexity.

Innovation and Research

Hospitalization rates declined at nursing homes that used after-hours telemedicine services, according to a Commonweath Fund-sponsored study. Researchers estimate that the use of telemedicine services could net Medicare a $120,000 savings annually per nursing home.

Technology

Azoi announces Wello, a $199 case that turns an iPhone into a monitor for blood pressure, ECG, heart rate, blood oxygen, temperature, and lung functions.

Other

Epic, Orion, and Siemens earn the highest customer satisfaction scores in a KLAS survey on HIE solutions. Overall provider satisfaction with HIE solutions has dropped an average of eight percent since last year.

Becker’s Hospital CFO looks back at hospitals whose bond ratings have been downgraded by Moody’s Investors Services because of EHR-related budget problems: (1) Health East Care System (MN), which is spending $145 million on Epic; (2) Community Medical Center (MT), which is having cash flow problems after installing Cerner and NextGen; (3) Saint Luke’s Health System (MO), implementing Epic for $200 million; (4) Scott & White Healthcare (TX), seeing increasing costs with Epic; (5) Washington Hospital Healthcare (CA), having increased costs and a negative margin after implementing Epic; (6) Robinson Memorial Hospital (OH), with losses partially attributed to its Allscripts Sunrise implementation.

Bloomberg News calls Mount Sinai Hospital (NY) “a heart surgery factory with obscene levels of pay,” claiming the hospital coaches patients to feign heart attack symptoms in the ED to get their stents covered by insurance, earns referrals from doctors with financial ties to the hospital, and pays its head of interventional cardiology $4.8 million per year. The head of another New York interventional cardiology program summarizes, “You essentially have physicians combing the streets of Staten Island, Queens, Brooklyn, and Bronx looking for patients they can screen on a treadmill to feed into the cath lab, where the big reimbursement comes.”

In Canada, Pierre Le Gardeur Hospital cancels all elective procedures after experiencing an unspecified computer system problem.

Weird News Andy has his ear to the UK ground in noticing this story, in which the British public reacts to news that a marketing company used a 47 million-record hospital data extract to target Facebook and Twitter ad campaigns. Another company was found to have loaded the entire database to Google’s servers to create interactive maps. The Hospital Episodes Statistics database had been made available by the government to researchers and approved private companies. The government has a PR nightmare on its hands because de-identification is hard to describe to laypeople who react to “my hospital records are on the Internet.”

Sponsor Updates

• Vonlay concludes an Epic engagement with Aspirus (WI).
• Physicians Interactive and McKesson Patient Relationship Solutions will jointly deliver Coupons on Demand, which will provide clinicians access to online cost-saving offers for medications.
• Kinston Pulmonary Associates (NC) will implement NextGen PM and EMR from TSI Healthcare.
• InterSystems joins the Global Alliance for Genomics and Health.
• Gastroenterology-specific EHR provider gMed will add medical content from Health Language to its system.
• E-MDs releases details on its June 5-7, 2014 User Conference and Symposium in Austin, TX.
• CIO profiles ICSA Labs, which is now the largest government-approved EHR testing and certification body.
• Hardin Memorial Hospital (KY) reports improved clinical response times since integrating telemetry alarms with Voalte smartphones.
• Divurgent raises $5,000 during HIMSS for the Florida Hospital for Children.
• RazorInsights ONE-Electronic Health Record achieves Stage 2 ONC certification.
• Daniel Flanagan, executive consultant for Beacon Partners, discusses in the company’s blog his recommendations to ensure a clearinghouse is ready for the ICD-10 transition.
• MedAssets estimates that its latest National Sourcing Collaborative event will drive $5 million annually in added value for its participating clients.
• Connance expands its patient-pay solution to include predictive analytics and additional platform reporting and consumer engagement functionality.
• On the company’s blog, MEA | NEA CEO Lindy Benton explains the significance of electronic submission of medical documentation (esMD) and health information handler (HIH).

EPtalk by Dr. Jayne

One of my fondest memories from medical school is working the ER during Mardi Gras. I sewed up more than one reveler who didn’t really need anesthesia because they were already feeling no pain. I chuckled when one of my former classmates sent me this story about the germs residing on Mardi Gras beads. Who would have thought that beads that have been thrown around in the midst of public drunkenness might have germs? I wonder if there’s an ICD-10 code for that? Maybe there’s one for choking on the baby in the King Cake as well.

One thing I found lacking at HIMSS was the presence of wearable devices (other than on attendees). I didn’t see much vendor promotion or anything cool enough that I’d consider it (although watching people try to interact with Google Glass was pretty funny). I don’t have any experience with Fitbit, but after reading this article I heard about on Twitter, I might consider one just to have this app. The Sleep Tracker Hack, which emerged from the recent Netflix Hack Day, helps a viewer find her place after sleeping through streaming media. I just might know someone who has fallen asleep in the middle of re-watching “Grey’s Anatomy” for the last several weeks. Unfortunately the hack was part of an internal hackathon, so it may never see the light of day.

I believe in patient engagement and making health-related technology accessible to patients, but there’s such a thing as going too far. I was reading a piece about the Bellabeat Connected System that turns a smart phone into a fetal heart monitor. It also mentioned the Huggies “TweetPee” that sends a tweet when the baby wets its diaper. Seriously? Unless your infant has a urologic problem, I’m not sure tracking urination on social media will do much more than drive followers crazy.

One of my favorite HIMSS connections reached out earlier this week to ask if I would be willing to help mentor a physician who would like to join the CMIO ranks. When I first started out, I had no one to look to for advice, so I was happy to oblige. One of his questions was what I think is the most important CMIO function. I’m not sure I can pin down a single one, but one of the most important in my book is being able to be the peacemaker among IT, the operations folks, and the physicians. Certainly there are other constituencies, but those are the three that tend to be the most contentious.

I’m still surprised that nearly a third of health systems still don’t have a CMIO. The organization where my mentee works falls into that category, but at least they understand that they need to work towards filling that role even if they aren’t ready to admit they need an honest to goodness CMIO. Whether we’re called Medical Directors or Directors of Informatics or Physician Champions, we can still help organizations move forward.

His hospital is currently struggling with physician engagement and clinical oversight, so it makes sense that a physician would be uniquely positioned to assist. He’s not highly techy, but I think that’s OK – if we can master anatomy and pathophysiology, we can learn enough about networks and software to be meaningful participants. The key is knowing who our experts are and being willing and able to leverage them appropriately.

He’s worried that his hospital isn’t really ready to formalize physician leadership in the IT space. There have been comments made about fears that the CMIO “will come in and boss IT around because he’s a physician” or that he will preferentially take the physicians’ side in arguments. I’m encouraging him that even though his role is emerging,  he should ensure that  it’s well defined and that leadership is prepared to support him. Without those elements, the risk of frustration will be fairly high for all involved.

At this point, I think he’s wise to negotiate for a formal position, but I’d recommend going for something part time that lets him dip his toes in the waters of clinical informatics without locking in at an organization that might not be as ready to move forward as he thinks they might be. That will buy him some time to work on professional development and to build the skills he’ll ultimately need if he wants to make a career of this. I’ll keep you posted as I hear from him. I’m looking forward to remembering what it was like to be young and idealistic before the CMIO life started beating me down.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.