News 3/27/15

Top News

The Congressional Budget Office says the Medicare doc fix bill that passed the House Thursday and moves on to the Senate will add $141 billion to the federal deficit. The cheers you may have heard came from people getting the money, not those providing it. Somehow “reform” always ends up costing taxpayers more. At least nobody has slipped in another ICD-10 Easter egg like last time, although Congressman Gary Palmer (R-AL) tried to work in another one-year ICD-10 delay Wednesday that was rejected in committee.

Reader Comments

From Lemmy: “Re: Children’s Hospital Boston. The EMR is down, clinics are cancelling appointments, and the labs are sending samples out.” I contacted CIO Dan Nigrin, MD, who explains:

“We recovered yesterday (Wednesday) from an extended, unplanned downtime caused by a failed segment of a storage array for the database underlying our EHR, and which caused significant database corruption. As you would expect, the hardware was architected to be fully fault-tolerant with complete redundancy, yet nonetheless it failed us. So we’re still figuring out root cause with the vendor. We used our disaster recovery system and paper-based processes to run the operation. To be on the safe side, we postponed a few elective admissions (for less than 48 hours), but otherwise care was delivered normally at the hospital.”

From DoDEHR: “Re: US Coast Guard. Considering scrapping their $40 million Epic rollout as the DoD selects its vendor. Funding is frozen and USCG hasn’t gone live in any of its 42 clinics after four years with no dates projected. They are in danger of reverting back to AHLTA/VistA.” Unverified. 

From Booth Babe: “Re: HIMSS exhibitor tips. Can you recap those you’ve run before?” You can use the search box to find them, but here’s my #1: confiscate the cell phones of employees while they’re working the booth. They are hopelessly addicted and will start by slipping furtive glances at email, but before you know it, they will be heads-down immersed in screwing around instead of paying attention to the prospects milling around their expensive telephone booth. I’ve seen guys playing with their phones while standing at an airport restroom urinal, so I guarantee people (especially the shorter attention span younger ones) won’t make it through a multi-hour booth shift unless you remove the temptation. I also suggest making it clear that booth employees aren’t allowed to talk to each other unless they’re collaborating on an attendee question because they’ll end up socializing, with is a huge turn-off to a prospect who might want to ask a quick question or who has a reasonable expectation of being welcomed without feeling like they’re intruding. It’s depressingly easy to find expensive booths staffed by inattentive employees. If your carrot needs a stick enhancement, mention that every year I take candid photos of inattentive booth employees and it will be pretty embarrassing to be memorialized on HIStalk that way.

From Job Hunter: “Re: taking a new job. Can you give me the link to what you ran previously about company danger signs?” I don’t think I’ve ever run such a list, but I would try to steer clear of companies with these characteristics:

• The CEO is a well-traveled hack who has left a trail of corporate destruction behind him or her or is a private equity hired gun whose primary job is to boost the bottom line by whatever short-term means are necessary to get the company sold before the wheels come off.
• The CEO can’t be bothered to relocate to the city where most of the employees work.
• The executive job you’re being offered is not housed at the home office. Out of sight means out of mind, which is great until your ambitious peers conspire to stab your absent back.
• The company requires new hires to sign a restrictive non-compete agreement that will harm your ability to find their next job. My favorite strategy is from Dilbert: scan the non-compete into Acrobat, change the wording, then print it and sign it. Chances are the always-clueless HR department won’t notice that what you signed isn’t what they handed you.
• Budget and travel freezes are common. That means lazy executives don’t have a clue about what is essential, so they just penalize everybody equally regardless of corporate consequences.
• They’ve laid people off in the past couple of years. Layoffs are a symptom of executive failure (either in hiring choices or in strategy) and indicate that the company would rather jettison people who have been loyally working in their assigned roles instead of retraining them even though they have a lot of reusable positive attributes beyond specific product knowledge. That or they don’t have the guts to fire people for cause and instead conduct a layoff of losers.
• Executives with reserved parking spots. I loathe big shots  who think they’re better than everyone else.
• Your interviewer is late, distracted, or someone you wouldn’t hang out with after work. They’re on their best behavior during your interview, so it can only get worse.
• You get a vague answer when you ask what happened to your predecessor or the company declines to name them for fear you’ll solicit their honest opinion about why they left.
• Your prospective boss talks about himself or herself instead of you.
• Two people who are related serve on the executive team, especially if the position you are considering is also on the executive team. You, Sammy Hagar, serve at the pleasure of the brothers Van Halen.

HIStalk Announcements and Requests

I’m doing a video interview series at the HIMSS conference along with DrFirst and we need interviewees. We’ll probably ask simple questions, such as what interesting things you’re seeing at the conference or who has the best giveaways. Let me know if you’re willing to participate and we’ll set a time to connect in the exhibit hall.

Welcome to new HIStalk Platinum Sponsor Engage. The Spokane, WA-based company, a division of Inland Northwest Health Services, is one of the largest Meditech hosting partners in the country and offers four service lines: hardware integration, hosting services, Meaningful Use, and professional services. Its 225 application analysts provide Meditech implementation and support to 130+ customers, among them some of the first hospitals to successfully attest for MU Stage 1 and Stage 2. Its infrastructure solutions include hardware refresh, virtualization, data migration, and data center migration, working with partners such as HP, NetApp, IBM, and BridgeHead. Engage provides its customers with a 24x7x365 US-based help desk that covers both infrastructure and application support. Thanks to Engage for supporting HIStalk.

This week on HIStalk Practice: MUS3 proposed rules take the air out of one rural physician’s HIT sails. The Physicians Alliance expands its Wellcentive partnership. A new study confirms that urgent care and retail clinics are overtaking primary care practices in terms of patient preference. Aledade partners with WVMI and Qsource to establish ACOs in West Virginia and Tennessee. One MD makes the case for pulling primary care out of the insurance system. Practice Fusion integrates with Medi-Span. New study finds that the ACA did not flood physician practices with appointments. Dr. Tom offers practices tips on thinking like retailers. Dr. Gregg snapshots the technology-induced workloads of today’s busy physicians. Thanks for reading.

This week on HIStalk Connect: Meaningful Use 3 preliminary rules are published and include some aggressive patient engagement goals. Researchers from Mayo Clinic analyze potential use cases for drones in healthcare. A new Rock Health report finds that women are still sorely underrepresented in health IT leadership positions. In England, the NHS launches a mobile app library with clinically-vetted mental health apps.

Listening: the fairly new rarities boxed set from Seattle’s amazing grunge rockers Soundgarden. If you like Black Sabbath (and how could you not?) then you probably like Soundgarden. And since I’ve already mentioned Van Halen, they (including on-again, off-again singer David Lee Roth) will be touring heavily starting July 5, mostly doing the amphitheater circuit, and releasing a made-in-Japan live album from their 2013 tour. I called it nearly perfectly on that last tour when I said on February 13, 2012 that I wouldn’t buy tickets for shows after mid-March because I expected them to storm off mad and cancel the tour and sure enough they did, although not until a few weeks after I predicted. Eddie’s voice is mostly shot (just like DLR’s kicks only go about knee-high these days) but he can still shred the guitar and he looks a heck of a lot better at a slightly chunky 60 than a couple of years ago when could have passed for a homeless crackhead. 

HIStalkapalooza

Thanks to the fun folks at DrFirst who have volunteered to provide a videography team to cover HIStalkapalooza. That was one of the features we were going to eliminate since we are too buried in other event details to deal with it, but DrFirst is filming (not literally, since there’s no actually film involved) and will produce a YouTube video we can all enjoy after the fact. DrFirst’s stepping up so enthusiastically restored my enthusiasm and faith in humanity since I was pretty tired and frustrated dealing with all the not-so-fun parts of putting on HIStalkapalooza. They’re a fun bunch.

The only thing we haven’t arranged is someone to shoot still photos, so we will probably ask attendees to send us those they take.

I invited each of our event sponsors (which I’ve listed in a link box to your right for ongoing reference) to provide a little background on what they do and what they’re planning for the HIMSS conference and for HIStalkapalooza, which seems fair given that they are paying for your food, drinks, and world-class band. Here’s what the folks at Falcon Consulting Group have to say.

Soaring into HIMSS15, Falcon Consulting Group looks forward to showing attendees and exhibitors alike that we are no ordinary flock of consultants. Falcon brings together specialized EHR technical and clinical talent, Big-4 operational and industry expert leadership, and avant-garde strategies and technological solutions. We are landing in a reserved meeting room inside the Lakeside Center Building (MP-7), and we would love for you to stop by and let us show you how we can help your organization fly to new heights. In the event has worn out your wings at the conference, we will also be hosting nightly events throughout Falcon’s home city of Chicago. For more information, contact Steven Stull at 312.751.8900 or by email.

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

Acquisitions, Funding, Business, and Stock

Analytics vendor Ayasdi, which offers a healthcare-specific package for identifying clinical best practices among its other non-healthcare products, raises $55 million in a round led by Kleiner Perkins, increasing its total to $100 million.

Orion Health’s US sales leader Paul Viskovich describes what it’s like being a New Zealand-based company selling predominantly to a US market and opening an office in Scottsdale, AZ: “It’s hard. You’re not from here. You talk differently. It wasn’t possible for us to go meet the CIO of UCLA — it was a good day if we talked to the security guard. Healthcare as a whole is largely not good with innovators either, and when you combine those two things, it’s very difficult … Our teams are cross functional. People in New Zealand are also working on projects at the same time as people in the United States, and if you manage that correctly, it can be a real benefit.”

Sales

Six-hospital Cone Health (NC) chooses Phynd to manage its 16,000 physicians in a single provider profile that crosses Epic and ancillary systems.

People

 

Jitin Asnaani (Athenahealth) is named executive director of CommonWell Health Alliance.

The Integrated Healthcare Association hires Jeff Rideout, MD (Covered California) as president and CEO.

Announcements and Implementations

Seniors Wireless announces TeleMed Assist, a $30 per month, contract-free program ($40 for couples) that offers unlimited 24×7 access to physicians by telephone or video. Being a cynic and wondering how all these virtual visit companies will find reasonably competent doctors willing to take calls in real time, I’m picturing those 1990s 976-number dial-a-porn services where the hot Brazilian dominatrix you’re talking to is actually an obese, hirsute, 60-year-old Medicaid recipient whispering sweet nothings with Cheetos breath and a genetically confused grandchild on her knee while watching the muted “Jerry Springer Show.” I would be interested to talk to a physician who provides services through companies like this since I’m curious how it works.

Practice Fusion adds the Medi-Span drug database from Wolters Kluwer Health to its free EHR.

The Florida HIE announces that 200 hospitals have signed up for its event notification service for admissions, discharges, and ED visits.

GetWellNetwork announces that it added 58 new facilities and 10,000 new beds in 2014, with a 13 percent growth in employees to 250.

Government and Politics

Even the ever-optimistic and supremely knowledgeable John Halamka and Micky Tripathi seem to be fed up with the endless Meaningful Use parade, concluding of the latest MUS3 and certification requirements:

”… each incremental proposal is tolerable, but the collective burden is making practice impossible … the sheer number of requirements may create a very high, expensive, and complex set of barriers to product entry. It may stifle innovation in our country and reduce the global competitiveness for the entire US health IT industry by over-regulating features and functions with complicated requirements that only apply to CMS and US special interests …  The certification criteria are often not aligned with what EHR users ask for. In some cases, the criteria are completely designed to accrue benefits to people who aren’t feeling the opportunity cost … There needs to be a very public discussion with providers as to who should prioritize EHR development — ONC and the stakeholders they’ve included or EHR users.“

I’ll add my counterpoint, however. Providers who whine about irrelevant and burdensome MU requirements can ignore them completely, but rarely do. You sold your soul to the federal government, but you can buy it back by accepting the Medicare penalty and then start following your own agenda instead of someone else’s. MU money is either worth it or it’s not – your participation indicates that you think it is, and that acceptance drives the user-unfriendly development agenda of EHR vendors. You don’t even need to use an EHR at all if you truly (questionably) believe it has a negative impact on quality or revenue – it’s your business and your patients. I cite “Lost Boys” in reminding that a vampire can enter your home only if you invite them.

A great tweet from US Surgeon General Vivek Murthy, MD, MBA: “The levers for health aren’t in hospitals, they are in communities.” What Vivek didn’t tweet: “On the other hand, the hospital levers are raking in untaxed billions and thus they have little incentive to make communities healthier.” In the US, “public health” is export-only compassion and outreach to all who need help; domestic healthcare services delivery is a big business dominated by special interests that threatens to bankrupt the country; and never the twain shall meet.

Rep. Phil Roe, MD (R-TN) reintroduces a bill that would require the DoD and VA to develop a shared EHR using criteria established by a temporary panel that would be given 90 days to complete its work. The contract winner would get a flat $50 million upfront and then $25 million per year for five years to develop and implement the custom system, which Roe says would complement the $1 billion already spent by the DoD and VA in trying to create the integrated EHR. My opinion: the DoD-VA interoperability challenge is more about willingness and less about technology (the same as in the civilian world made up of uncooperative competitors, in other words). Those groups, despite how ridiculous it seems to taxpayers, distrust each other and refuse to stoop to each other’s level for the good of the serviceperson turned veteran. Perhaps they should be assessed a 1 percent CMS-type annual budget penalty for failing to interoperate.

Here’s an interesting quote from the head of DoD’s DHMSM project: “I’ve visited a number of facilities that have gone through this, and their message routinely is, it’s all about the change management and the training. It’s not about the tool. It’s about how you use that tool.” Maybe that’s a hint that DoD will choose whichever of the three bidding groups offers the best training, implementation, and optimization services rather than just the best EHR.

The Economist calls out inept US government financial management as chronicled by the GAO, including $125 billion in improper Medicare payments in the last fiscal year. The Brits seem to be enjoying our admittedly questionable DoD-EHR dual (or dueling) EHR projects:

”The GAO has few kind things to say about the government’s approach to information technology (IT), on which it plans to spend $79 billion in this fiscal year. Fragmented data storage and needless duplication have wasted billions of dollars. For example the Department of Defence—which accounts for around half of federal discretionary spending, and so may well not notice when billions of it vanish like loose change between sofa cushions—and the Department of Veterans Affairs are both now developing, from scratch, two separate electronic health-record systems, even though they will basically serve the same people. But the most common problem with the government’s IT ventures is a mix of grand ambitions and incompetence, as the launch of Healthcare.gov in 2013 handily showed.”

Technology

Michael Archuleta, IT director at 25-bed Critical Access Hospital Mt. San Rafael Hospital (CO), tweeted out this photo in announcing that the hospital’s server infrastructure is 99 percent virtualized. Nice.

Amazon announces unlimited consumer cloud storage for a flat fee of $60 per year with a free three-month trial.

Other

Among the reasons University of Mississippi fired its chancellor is the medical center’s signing of contracts without board approval, with an audit finding that its EHR RFP process in which Epic was chosen contained incomplete cost breakdowns.

An article by three prominent radiology informatics leaders questions whether IT centralization and standardization has caused radiologists — who were among the first hospital informatics practitioners — to lose control of the domain. It says early and profitable hospital radiology departments were able to hire clinical IT specialists that the IT department didn’t have, giving those departments the technical freedom to innovate that has since been revoked. The authors suggest that subspecialist informatics radiologists find a place at the hospital IT table despite current underrepresentation. My experience is similar – the other pioneering clinical departments (lab and pharmacy) integrated well into the IT environment because of share order entry systems that were used by a general audience, while radiology had its own pseudo-IT systems that were used by minimally visible doctors and techs working alone in dark rooms, often ignoring sound IT processes. The above graphic is correct – IT’s focus is on reduction of corporate risk exposure through standardization, centralization, and budget control, which usually extinguishes rather than encourages innovation. Whether that’s good or bad depends on whether you have a visionary CFO (is that an oxymoron?)

Reading Health System (PA) reorganizes its IT department and eliminates 33 positions after completing its $150 million Epic implementation.

Eighty percent of the 1,000 children and teens who have used Kurbo’s $25 per month weight management app and email-based coaching service have lost weight, the company says.  

Group brainstorming meetings don’t work, says Harvard Business Review. Reasons: people expend less effort when working within a group, introverted and less-confident attendees participate less, stellar performers are dragged down to the level of the least-competent ones, and groups larger than 6-7 people have logistical problems getting everyone’s ideas on the table.

Sponsor Updates

• A family practice improves hypertensive control rates from 78 percent to 94 percent in the year after implementing Forward Health Group’s PopulationManager.
• The Health Management Academy partners with MedCPU to identify solutions to overcome point-of-care challenges.
• ZeOmega Founder and CEO Sam Rangaswamy describes how ZeOmega’s acquisition of HealthUnity positions the company.
• A new Healthcare Data Solutions case study confirms that pharmacies using its Prescriber Validation Subscription Service have saved millions in potential hydrocodone fines.
• Ivenix produces a video that highlights how its Infusion Management System is designed to help nurses improve patient safety and workflow efficiency for infusion therapy.
• Hayes Management Consulting offers “10 Tips to Create a Workflow Manual That Your Users will Love.”
• Valence Health announces that its Further 2015 annual conference will be held in Chicago September 23-25.
• Galen Healthcare Solutions CEO Jason Carmichael welcomes the new GHS leadership team in the latest company blog post.
• Impact Advisors offers early impressions of Meaningful Use Stage 3, plus looks at data center trends.
• Healthwise offers “Creating a Group Health Culture Where Shared Decision Making is the Norm.”
• LifeImage posts “Medical Image Exchange for Cardiology Care.”
• InterSystems writes “Salty Cookies, Sweeter Outcomes: Shared Healthcare Decision Making.” 
• The Atlanta Journal-Constitution names Navicure as one of its “Top Workplaces” for the second year in a row.
• The New York eHealth Collaborative will exhibit at HxRefactored April 1-2 in Boston.
• The latest episode in Nordic’s Making the Cut video series covers preparing for cutover and the role of operational management.
• Patientco offers “Supergroup: Connecting the Stakeholders of Healthcare for a Rockin’ Future.”
• Porter Research posts a blog on networking at HIMSS 15.

Contacts

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

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