Monday Morning Update 8/3/15

Top News

England’s Monitor regulatory program is investigating the $300 million Epic rollout and overall financial management of Cambridge University Hospitals NHS Foundation Trust. Cambridge was Epic’s first UK client, with the 10-year, $250 million contract announced in early 2013. 

Reader Comments

From Military Medicine: “Re: DoD EHR bid. Your estimate of 10-20 percent of the total contract value going to Cerner is a bit high from what I’ve heard – it might have been as low as 9-15 percent, which is why Cerner cautioned investors not to get overly excited about their potential revenue and profit. I also suspect Leidos won’t be all that excited about rolling out a new solution since they have the lucrative contract to maintain the old system – they will let the government delay at every step they can bill for working on both systems at the same time.” Leidos its later spinoff SAIC have been paid billions to create and support the DoD’s AHLTA, the renamed Composite Health Care System that wags say stands for “oh, hell, let’s try again.” Leidos has incentive to milk AHLTA for as long as possible while simultaneously collecting checks for its new project work. Using the low end of that range, Cerner’s cut of the rumored $1.7 billion in guaranteed money over 10 years would be only $15 million per year, which given Cerner’s annual revenue would indeed not be an investor-cheered windfall.

From Grunt in Green: “Re: DoD EHR bid. For those who say this is the world’s largest HIT procurement, 60 percent of DoD care is handled by civilian delivery systems under TriCare, so quite a few systems are already larger than DoD, including Kaiser for sure and probably Sutter and Providence.”

From Bang a Gong: “Re: DoD EHR bid. I hope everyone watches closely as Leidos goes over their $1.7 billion bid, then blows through the $2.6 billion in contingencies, and then keeps right on running up the project’s tab while simultaneously renewing their sustainment contracts for AHLTA. By the time they realize how far over this will go, they’ll be beyond the point of no return and will have to finish it, even with huge overages, to avoid an even bigger NPfIT debacle.” Of that I have little doubt since government IT projects never come in on schedule and at the original cost estimate.

From UberUser: “Re: Uber’s user rating added in the latest update. Lots of HIS consultants and vendors use Uber. I wonder if anyone has attained the elusive 5.0 rating? I have a 4.7 with 50 rides, so I probably got a 1 from a guy I complained about.” I checked mine and it’s 4.9. I’m a bit less enamored than I once was with Uber due to (a) frequent surge pricing that makes me suspect that it’s more reflective of company need for profits rather than the demand for rides; (b) drivers who cancel the arranged ride because they don’t want to travel that far to pick me up; (c) lack of drivers in some areas so that you can’t get a ride at all; and (d) imposition of minimum pricing in some cities and when traveling from some airports such that it’s cheaper to just get a cab or an airport limo. I miss Uber when it’s not available, though, such as in Las Vegas, where cab driver protests and the city’s powerful taxi lobby (which includes two former Nevada governors as lobbyists) got Uber shut down awhile back, although I hear it may return. I tried to use Uber in Seattle and only Uber Black (not Uber X) is available at the airport, with the $50 flat rate charge to downtown being $5 more expensive than booking a car on the spot, which in my case turned out to be a stretch limo for the flat $45.

HIStalk Announcements and Requests

Eighty percent of poll respondents check their work email or voicemail at least once per day while on vacation, most just a handful of times, but 12 percent admit that they do so nearly constantly. New poll to your right or here: what factor was most responsible for the Leidos-Cerner-Accenture DoD EHR win?

Readers continued to seek information on the DoD’s EHR project Thursday, when HIStalk pages were displayed 17,000 times in 12,000 unique visits, beating the all-time record set the day before. Since then, though, newsworthy “news” has been close to non-existent. Today’s post is short, but includes everything important — there just isn’t much of it post-DoD announcement and I won’t waste your time with faux news.

Here’s a tip to folks running tiny (or even one-person) companies: it’s pompous to call yourself CEO when you don’t really have many executive duties. I hereby create an industry rule: you can use the title “president” once you’ve hit five employees, but you can’t brag on being “CEO” until you have 25 employees. Fewer than five employees makes you a “principal” or “owner” or whatever else you like the suggests roll-up-your-sleeves work rather than jetting off to board meetings or delivering weighty speeches.

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My Medical Records Saga Continues

I faxed my request for a copy of my medical records to the hospital on June 26. This past Friday, five weeks later, an letter-sized hospital envelope came in the mail with my name and address handwritten on it with no indication of what was inside. I opened it up and there was my visit summary, contained on two pages front and back as printed off from the hospital’s Epic system. The hospital didn’t include a greeting or explanation or anything to indicate why they had sent the copies – it was just the two pages in an envelope with the hand-scrawled address, which was a long way from being professional. I was surprise they didn’t include a marketing or personal message knowing that most people request their records because they’re going to seek care elsewhere or file a lawsuit, either situation being an excellent time to engage positively with the patient.

Last Week’s Most Interesting News

• The Department of Defense chooses the team of Leidos, Cerner, Accenture, and Henry Schein for its EHR implementation project.
• McKesson CEO John Hammergren says in the company’s earnings call that “we have been struggling in the hospital IT business.”
• Rep. Renee Ellmers (R-NC) introduces the Flex-IT 2 act that would delay Meaningful Use Stage 3 until at least 2017.
• An investment fund co-founded by Harvard professor and disruption author Clayton Christensen invests $8.4 million in care coordination vendor ACT.md, whose platform was developed by Zak Kohane, MD, PhD and Ken Mandl, MD, MPH from the informatics department of Harvard’s Boston Children’s Hospital.
• NantHealth Founder Patrick Soon-Shiong, MD takes his cancer drug firm NantKwest public, valuing his holdings at $1.6 billion, 33 times the amount he paid for the company a year earlier.
• UMass Memorial Health Care (MA) says its implementation of Epic will cost $700 million over 10 years, the health system’s largest capital expense ever.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Sales

Department of Vermont Health Access chooses eQHealth Solutions for population health management technology.

People

Gretchen Tegethoff (TechExec Advisors) is named to a newly created CHIME VP position overseeing its for-profit CHIME Technologies. The business apparently charges vendors an enrollment fee and then takes a percentage of each sale made to CHIME members. Even HIMSS isn’t so brazen as to pimp out its dues-paying members for a percentage piece of the sales action.

Announcements and Implementations

Allscripts Sunrise user National Institutes of Health Clinical Center attains HIMSS EMRAM Stage 7.

Privacy and Security

FDA advises hospitals not to use Hospira’s Symbiq infusion pump following a Homeland Security warning that it is susceptible to attacks from hackers who could gain access to a hospital’s network. It’s the first time FDA has issued a cybersecurity-related medical device product warning. Hospira had been phasing out the Symbiq pumps since 2013, when FDA raised product quality concerns.

Innovation and Research

An Institute of Medicine report titled “Transforming Health Care Scheduling and Access: Getting to Now” lists patient scheduling best practices that include having the scheduler delve deeper into the patient’s need, give the patient options for appointment times, and providing alternatives to a clinician visit.

Other

I was talking to an ENT surgeon last week and asked him about his EHR. He says his office uses the NextGen practice management system, but gave up on its EHR because it was too cumbersome and slow. He said he enjoys e-prescribing, but uses a standalone product instead because NextGen’s module isn’t workflow friendly. It sounds as though he might be better served with a specialty EHR.

Ten leukemia patients in Australia receive half the intended dose of cytarabine due to what sounds like an incorrectly created order set.

Former Kaiser Permanente semantic interoperability expert and former HL7 board member Robert Dolin, MD surrenders his medical license following his September 2014 sentencing for possession of child pornography.

Rocky Mountain Health Plans rolls out its MyDigitalMD video visit service with a funny parody video called “Save the Hipsters.”

Weird News Andy calls this a “s-s-s-selfie.” A man poses for a photo with a rattlesnake in Yellowstone National Park, with his resulting snakebite requiring a five-day, $150,000 hospital stay for treatment and antivenin (which only one company makes at $5,000 per vial.) That reminds me of an old snakebite joke you probably know whose punch line is, “He says you’re going to die.”

Contacts

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

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