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July 7, 2015 News 7 Comments

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CMS caves to the AMA’s withering and never-ending criticism of ICD-10 by agreeing, in a joint announcement, to create a year-long transition period in which CMS will: (a) pay claims even when their ICD-10 codes aren’t specific enough; (b) allow non-specific ICD-10 codes to be used for PQRS reporting; (c) provide advance payments to physicians if CMS has ICD-10-related problems that cause a claims backlog; and (d) assign an ICD-10 ombudsman and communication center for triaging physician-reported ICD-10 problems. Hospitals should take note: it was AMA rather than AHA pulling CMS’s strings, so hospitals (rather surprisingly) get nothing from the new uneasy detente. That also means that ICD-10 information will be of marginal value for the first year given that full specificity is optional (I assume that was done to allow ICD-9 to ICD-10 crosswalks). On the bright side, AMA is now on board with the ICD-10 transition that takes effect October 1 and hopefully most EHR vendors won’t need to resort to a crude compliance crosswalk anyway. It’s not really a full grace period as some sites have suggested – submitted claims must still use valid ICD-10 codes starting October 1.

Reader Comments


From HIT Wannabe: “Re: getting electronic copies of your medical records. Isn’t this required by Meaningful Use as a core objective? Let me get this straight. The former leader of ONC, who personally oversaw payments to providers when he knew they weren’t in compliance, now asks the public to bring their non-compliance to light. If a hospital can’t provide electronic copes, they should be audited immediately and taxpayer funding should be returned with a penalty.” MU is by attestation, not investigation. It also doesn’t take into account how hard it is to actually get records regardless of the MU technology. Farzad’s idea is that we all become mystery shoppers to see what it’s like for a non-IT savvy patient, which is really the only way to do it since you can’t request record copies from providers you haven’t actually seen. The remaining question is, assuming the process is a disaster for a given provider (which is nearly certain), who do the mystery shoppers report to? Maybe ONC should have an anonymous MU compliance line or online form.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor Evolent Health. The 750-employee, Arlington, VA-based value based care services company — co-founded by UPMC Health Plan and The Advisory Board Company — works with health systems and physician organizations in 25 markets to implement tailored clinical programs, patient engagement tools, specialized care teams, network optimization, back-office infrastructure and analytics, organizational governance, and EHR optimization. Its Identifi solution coordinates and measures value-based care in providing data integration, clinical and business content, EHR optimization, and specific end user applications. It offers a free population health technology requirements checklist gleaned from its experience working with providers across the country as well as a Medicare ACO Cheat Sheet. CEO of the newly IPO’ed company is Frank Williams, previously chairman and CEO of The Advisory Board Company. Thanks to Evolent Health for supporting HIStalk.

I found this Evolent Health testimonial by James Porter, MD, SVP/chief medical officer of Deaconess Health System, on YouTube.

My saga to obtain an electronic copy of my records from a Stage 7, MU2-attesting medical center continues 10 days after my initial (mandatorily faxed) request. It’s the usual hospital lack of follow-through and understanding of policy, as the HIM person I called after not hearing back said the hospital sends only paper records to patients – only physician practices can get an electronic copy. I politely mentioned that the hospital happily took Meaningful Use money and therefore should be able to send me an electronic version, so I’ve been escalated to her supervisor who will supposedly be in touch. Meanwhile, I realized that since they’re an Epic-using facility, I should be able to create a MyChart account and download the records myself, but for some reason my visit isn’t showing up even though the labs and charges from it are there. I sent a MyChart secure message that the hospital claims will elicit their reply within two business days, of which one has gone by without a peep. I’ve worked in health systems most of my life and this experience confirms my overall insider assessment of that experience: most everybody in big hospitals and practices is polite, but often uninformed, hampered by the invisible bureaucracy, or incompetent.

Health IT investments seem to be tapering off, which is perfectly logical given that some pretty lame companies nobody’s heard of took in a bunch of questionable investor money. It’s kind of a shame that the sites and groups got so pee-your-pants excited over the big money rolling in and used that as a success metric rather than actual company accomplishments or patient benefit. However, I am a devout disciple of the Gartner Hype Cycle and we’re probably entering the Trough of Disillusionment overall as we bottom out on the slope of Peak of Inflated Expectations, I’m ready to start seeing the success (the Slope of Enlightenment) that some small percentage of them will have in moving the healthcare needle somewhere down the road.


July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.

July 22 (Wednesday) 1:00 ET. “Achieve Your Quality Objectives Before 2018.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; Dennis Swarup, VP of corporate development, CitiusTech. The presenters will address best practices for building and managing CQMs and reports, especially as their complexity increases over time. They will also cover quality improvement initiatives that can help healthcare systems simplify their journey to value-based care. The webinar will conclude with an overview of how CitiusTech’s hosted BI-Clinical analytics platform, which supports over 600 regulatory and disease-specific CQMs, supports clients in their CQM strategies.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.

Acquisitions, Funding, Business, and Stock


Emdeon will acquire health plan payment analytics vendor Altegra Health for $910 million. It was one of several health IT companies being rumored a few weeks ago as seeking buyers, along with Precyse Solutions, Mediware, Edifecs, and Caradigm.


Accretive Health CEO Emad Rizk had $20.5 million in compensation for his first year on the job, nearly all of it in the form of stock and options. The CFO of the struggling and NYSE-delisted company made $3.1 million, while the COO was paid $6.1 million. The company lost $80 million in 2014 after Minnesota’s attorney general went after it for predatory patient collection practices that included sending people into ED treatment rooms to get credit card swipes and interrupting surgeries to pester patients for payment.


PipelineRX raises $9.1 milliion in funding to expand its telepharmacy services, where its employee pharmacists remotely process medication orders for hospitals that need coverage or help reducing medication turnaround time.


OCHIN chooses CareAccord, the state of Oregon’s HIE and HISP, for Direct messaging.

The Indiana State Department of Health selects LiveProcess as its emergency management platform for 144 hospitals.



Arcadia Healthcare Solutions names Richard Parker (Beth Israel Deaconess Care Organization) as chief medical officer.


The White House recognizes patient advocate and CareSync COO Amy Gleason, RN as one of nine “Champions of Change” for precision medicine in a Wednesday ceremony.

Announcements and Implementations


Cerner and University of Missouri extend their healthcare collaboration, which includes the Tiger Institute for Health Innovation, for another 10 years. They will add the Tiger Institute Leadership Academy to host industry peers and place new emphasis on mobile healthcare and population health.


Cleveland Clinic’s Lutheran Hospital (OH) pilots Uniphy Health’s physician engagement and secure communication platform.

CoverMyMeds launches a paid training program for 20 .NET and Java web developers who want to learn the Ruby on Rails programming language in taking jobs at its Columbus, OH location. The company commissioned a 9,000 square foot, 160-foot tall roadside display inviting Java developers to “find a better cup of coffee,” of which I could unfortunately find no photo (a big PR opportunity missed for the company that would have required only a snapshot).

DataMotion launches API access to its Direct Secure Messaging and SecureMail services for third-party developers.

Government and Politics

ONC posts an invitation for developers and vendors to submit health IT certification testing procedures, tools, and data that ONC will consider as alternatives to existing certification criteria.


The Cincinnati newspaper finds that CMS’s National Provider Identifier (NPI) database of physicians — and the many third-party systems that use it — is a mess, with tens of thousands of keystroke errors, and more alarmingly, an abundance of apparently intentional changes that hide the checkered past of some of the physician registrants since doctors can change any of their information CMS has on file. The paper reported the problems it found to CMS, who blew it off by telling them to contact individual physicians to correct any errors they noticed (of which there are 35,000 for New York alone). Mistakes are important because consumer information sites like Healthgrades and Vitals.com use the number to display information about a given physician. The paper found that of 100 mismatched NPIs in Florida, 30 percent belonged to doctors who had been disciplined or criminally convicted, with their incorrect license numbers conveniently pointing in every case to a blemish-free doctor.

Rep. Steve King (R-IA) proposes an amendment to the 21st Century Cures bill that would delay Meaningful Use penalties and rebate EPs for any penalties already levied.

Privacy and Security


A Italy-based security software company that counts the FBI among the customers of its snooping software tells users to stop using its product after its own systems are hacked, with all of the company’s files leaked to the Internet. The hacker tweeted, “I’ll write up how Hacking Team got hacked once they’ve had some time to fail at figuring out what happened and go out of business.” Experts suspect that the company’s system administrators used weak passwords, some of them variants of the word “password.” The leaked files, which were not encrypted, revealed that the company’s software has an undocumented “back door” that would let it enter customer systems and, most interestingly, the published information shows who uses its software and exactly who they’re using it to spy on.

Innovation and Research

A California Healthline report highlights Way to Wellville,  a year-old health technology project run by technology investor Esther Dyson that will try to address the public health problems in a rural California county and four other US locations. They’re using IBM Watson to target more Medicaid signups and hope to use iPhone collaboration and Fitbit monitoring. The county’s public health officer seems skeptical in how Silicon Valley types can parachute in and change the county’s culture.



BBC News covers hospital-focused mobile apps Medxnote (secure messaging), Imprivata Cortext (secure messaging), Sensium Healthcare (wireless patient monitoring patches), Gauss Surgical Triton (estimates blood loss from photos of surgical swabs), and a Sarasota Memorial Hospital beacon-based wayfinding app.

Microsoft will award five, $100,000 grants to university and non-profit researchers to develop uses for its HoloLens mixed reality computer. Submissions are due September 5, 2015.

A tiny study by direct-to-consumer genetics testing company 23andMe finds that patients whose genetic tests suggest a possibility of Parkinson’s disease who also report symptoms of the disease can be accurately diagnosed via a video visit with a neurologist, also noting that all of the 50 patients were correct in their self-diagnosis of having the condition. The company also announced $79 million in new funding (of $150 million sought) as it moves toward drug development.


I updated Monday’s post with a response from Cerner about a reader question about Meaningful Use support for the former Siemens legacy products, but here it is again for those who didn’t happen to re-read the original:

Before the acquisition, Siemens Health Services communicated to its clients in person that they would continue to support MedSeries4 and Invision for clinicals and financials, as well as Eagle, but wouldn’t support the clinical components of Invision or MedSeries4 for Meaningful Use 3. Cerner affirms that communication. Additionally, we are providing new regulatory enhancements and other operational excellence improvements for MedSeries4, Invision and Eagle financials, and we have existing client support commitments on all three solutions that extend into the next decade that we will continue to honor.


The PBX of the Grand Junction, CO VA hospital goes down for several days, losing voice mail messages and leading the hospital to suggest that patients use myHealtheVet secure messaging instead.

A Bloomberg report finds that the Cystic Fibrosis Foundation charity, which funded a drug company’s research in return for royalties the drug generated, eventually earned $3.3 billion by selling the drug’s rights to an investment company, providing the charity with more research money than the American Cancer Society, American Heart Association and American Diabetes Association combined. Now the issue is whether patients can actually afford the two drugs it funded given that each costs around $300,000 per year. The foundation’s CEO says the drugs are overpriced, but he doesn’t think drug companies would be developing comparable drugs if they generated only $10,000 per patient per year.

A report commissioned by the World Health Organization finds that the organization lacks the capacity and culture to deal with global health emergencies such as Ebola, where it failed to raise awareness until nine months after initial reports. The report also suggests that WHO members pitch in to create a $100 million disease outbreak fund.


Here’s the best deal of any conference I’ve seen lately: Valence Health will hold its Further 2015 value-based care conference (for its clients and providers in general) in Chicago, September 30 – October 2. Attendees get two nights at the Loews Chicago downtown (the Expedia price for those nights is $389 per), meals, the conference, and entertainment. I enjoyed Chicago enough during HIMSS to think that sounds like a pretty good trip with an easily added weekend for those looking for an early fall break.


CVS Health, which stopped selling tobacco products in its stores last year, resigns from the US Chamber of Commerce after reports surface indicating that the organization was trying to squelch anti-smoking laws all over the world. The Chamber responded by saying it doesn’t support singling out individual industries even though it does not support smoking.


Weird News Andy hopes that an especially hot corner of hell is reserved for Detroit-area oncologist Farid Fata, MD, who admits that he intentionally treated several hundred patients for cancer they didn’t really have so he could bill Medicare for $34 million in unneeded treatments. The doctors, whose practice was the state’s largest cancer practice with offices in seven cities, faces up to 175 years in prison during sentencing hearings this week

Sponsor Updates

  • ADP AdvancedMD offers “Become much more productive and profitable with AdvancedInsight” and recognizes winners of its AdvancedBiller awards.
  • AirStrip wins San Diego’s MetroConnect Prize, a program that helps businesses pursue foreign markets.
  • Aprima will exhibit at the Michigan MGMA Summer Conference July 16 in Boyne Falls.
  • Besler Consulting offers a “Bringing Clinical & Finance Together” podcast.
  • HCI Group posts “Healthcare 2025: Improving Care by Embracing Risk and Accepting Change.”
  • Clockwise.MD graduates from the Atlanta Tech Village.
  • CoverMyMeds offers “Maryland Prescribers: What You Need to Know About the Electronic Prior Authorization Mandate.” 
  • Galen Healthcare offers “Interface Engine Migration Success Story: JCAPS to Orion Rhapsody.”
  • The HCI Group asks “Are you ‘Ready’ to Go-Live? 5 Key questions to ask prior to Go-Live.”
  • Healthfinch offers “Adherence to Care Plans Remains Challenge for Practices.”
  • Impact Advisors offers “The Good, the Bad and the Ugly of Meaningful Use Stage 3: Objective 5 – Patient Electronic Access to Health Information.”
  • InterSystems publishes “Urban Rabbits: Why Context Matters in Analytics.”
  • Lifepoint Informatics will exhibit at the Sunquest User Group Meeting July 13-17 in Scottsdale, AZ.


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

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Currently there are "7 comments" on this Article:

  1. Re: “Re: getting electronic copies of your medical records. Isn’t this required by Meaningful Use as a core objective?”

    Actually, it’s required by law, independent of Meaningful Use. It makes no difference if a healthcare provider participates in the government EHR Incentive Program(s) and gets “MU dollars” or not. If they maintain an electronic record with your data, you have a right under HIPAA (termed “Right to Access”) to get an ELECTRONIC (not paper) copy of that data. http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/

    So, a hospital saying “we don’t do that” when you ask for an ELECTRONIC copy of your record from their EHR is basically saying “we don’t follow the law”. It might then be good to ask them for a full list of the laws for which they have issued themselves an exemption – maybe they are also off the hook (by self-declaration) for building safety, FDA rules, other parts of HIPAA, etc.

    Being part of Meaningful Use means that the EHR they are using is certified to be capable of sending clinical summaries (CCDs) via Direct Messaging and is either already capable or is a simple no-cost-configuration away from being able to send your CCD from their EHR to a consumer-facing application of your choice, like Carebox. And they’ve attested that they know how to do this, and actually do this to whatever threshold levels MU sets. In other words, it means there is no technical obstacle to them obeying the letter and the spirit of the law in the best way possible – just a policy/procedure issues (in this case, the hospital has an illegal policy, as noted).

    Another wrinkle here is that it’s been reported (I heard this from Farzad, I don’t recall the source and the exact statistics) that the majority of hospitals attesting for MU dollars exempted themselves from some of the criteria related to sending patients their electronic records by claiming that they qualify for an MU exemption that says that if NOBODY ever asked for a copy of their records, you don’t have to meet the threshold MU sets for percentage of patients getting such records. If (and I don’t know one way or the other) this hospital claimed such an exemption then of course that is now a problem as well since we know that at least one person (Mr. H) has now asked (though this hospital may also have self-exempted themselves from the laws pertaining to lying to government agencies when applying for taxpayer money). If they didn’t claim this exemption, I don’t know how they could meet the MU thresholds with that policy in place. So, either way, I suspect they have an MU problem as well.

    Still, I think we should just try to get them (and countless others like them, no doubt) to obey the law first, and then check into the MU audit implications as a next step…

  2. The saga of the attempts to get your records makes me cry. We have an internal policy of no more than 3 business days to get any records request turned around, unless there is a significant reason (such as a doctor wanting to review the record before it goes out) that would cause a delay. The longest that I can remember us delaying is 7 business days. And our policy is that everything goes out electronic unless there is a specific request for paper. We have branded flash drives for the purpose. We can print the entire record to PDF and have it ready in about 30 minutes.

    And we deliberately had employees request electronic copies of records during our attestation so that we didn’t claim the exemption. We didn’t want 0/0 in that field; we wanted numbers.

    Mr H: Would it be possible for you to collect all of pieces/parts of the saga into a single page that we can point someone to? Being able to demonstrate the timeline on it, aside from the hoops you’ve had to jump through, may be the most striking thing about this.

  3. Re:. Farzad’s idea is that we all become mystery shoppers to see what it’s like for a non-IT savvy patient, which is really the only way to do it since you can’t request record copies from providers you haven’t actually seen.

    So here we go again. In my forty years in the Health finance/IT world I can’t count number of times a bureaucrat creates a bunch of regs, then leaves and becomes a consultant who promotes penalties if you do not met regs, while selling his consulting services to met the regs. Happened in 70’s with Health Planning, 80’s with DRGs and on and on.

    This industry is expert at doing it to themselves…remember the core of ONC criteria came form CCHIT which was started by HIMSS with big vendor money. Farzad just took it and ran with it.

  4. Here’s a nasty competitive vendor tactic I expect to see in the not to distant future. Say you are vendor X and you compete with vendor Y. You know that vendor Y is installed in Hospital B, so you get a physical in Hospital B, then ask for a electronic copy of your med rec. As is the case with Mr. H you do not get a copy for whatever reason (could be the hospital’s fault, or the vendor’s system, or both). You do not really care since the MU rules say both the vendor and provider must comply.

    So you do what Farzad said – report the vendor and provider to the ONC AA since the vendor was certified for the VDT criteria (patient portal) and the provider attested to it. Now the AA must do an audit of vendor Y and the provider, and the AA must issue a public notice that there has been a complaint and both are under investigation. Would make for a great story on your next competitive sales call and even if not true drive your competition crazy!

    Oh what a wicked web we weave with regulations that are ever expanding…

  5. To MU Provider:
    The link only allows a query against products and vendors. I didn’t see anything that I could choose to determine if ACME Physicians of Mudville, or Dr. John Doe of Mudville, NY has attested for MU. Those are my providers of service.

  6. Re: CoverMyMeds launches a Ruby on Rails training program: Thanks for sharing with your readers. Admittedly, the billboard picture wasn’t easy to find outside of social. We updated the page you linked to and included a picture. Also, worth noting that the program is available to experienced developers in Columbus and the Cleveland area, where we also have an office, as well as remote candidates.

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