News 1/27/16

Top News

Leidos Holdings will acquire Lockheed Martin’s Information Systems & Global Solutions business — which includes its health IT offerings — for $5 billion, confirming earlier rumors.

Lockheed Martin is known in health IT circles as having created the first CPOE system in the early 1970s when the company was operating as Lockheed (it merged with Martin Marietta in 1995 and changed its name to Lockheed Martin) but the company sold the product to Technicon in 1971, when it was named TDS. Lockheed Martin recently won the VA’s appointment scheduling system contract, bidding Epic through its recently acquired Systems Made Simple subsidiary.

With the acquisition, Leidos will become the #1 government IT contractor by revenue, with annual sales of more than $10 billion.

Reader Comments

From Smartfood99: “Re: Frisbie Memorial Hospital (NH). Cerner couldn’t flip a MedSeries4 hospital – they are going with Meditech 6.1.” Frisbie’s CEO says they wanted a system that would work for their 112-bed hospital sold by “a vendor we could trust.”

From Eddie T. Head: “Re: integration with Epic’s hosted systems. I would be surprised if Epic ever agrees to host third-party products. As far as I know they have always maintained that they will host the Epic infrastructure of servers, but they will not take on the role of a customer’s IT department for anything else. If the server-to-server integration comment is correct, then it sounds like sabotage (either by malice, or by incompetence) on the part of McKesson.”

RxNorm Follow-Up

A reader asked us to find out what’s going on with RxNorm updates and code changes, which they say is causing quality measures to fail because CMS has not updated its eCQM value sets with the new codes. Jenn asked the NIH/National Library of Medicine what happens with VSAC and quality measures when RxNorm is updated:

The short answer is, nothing. But it really has nothing to do with RxNorm or any other code system. ONC/CMS (back in 2012) statically bound all of the CQM value sets to their respective code systems, so the content of those value sets is legally locked to whatever versions of code systems specified by an update. So for example, the last CQM update back in 2015 used Feb 2015 RxNorm I believe. Thus, the problem for implementers who want to use the newer, better content (Lovenox as injectable heparin) to meet the treatment criteria for a measure, but are bound to use an earlier version of RxNorm. This has been a known problem for years. The real issue is providers vs. implementers. Providers, of course, want the new content as it benefits them meeting the care goals. Implementers see too much risk in updating/floating value sets dynamically, especially those that are authored as list (extensional) to begin with rather than as rules (intentional).

Julia Skapik, MD at the eCQI Resource Center adds:

This topic is known to CMS and ONC—the use of a static value set associated with each measure means that dynamic code system changes post-publication will not be reflected in the value set. To this date, we have provided the guidance that it is permissible to map where appropriate to a similar code. Where there are no similar codes, however, there will be a gap in the measure. Rob McClure, cc’d above, has been working on a proposal with CMS to provide an interim update to the value sets in the middle of the measurement period with additions only that will fill out dynamic code changes (and potentially correct errors) that affect real-world value set and measure performance.

In response to the reader’s example of CMS not updating the code sets for Lovenox as an injectable heparin that causes the VTE measure for anticoagulant therapy to fail, ONC/NLM consultant Robert McClure, MD responded:

Her defining example is confusing. Enoxaparin (Lovenox) has been included in the VTE measure anticoagulant value sets, such as "Anticoagulant Therapy" OID: 2.16.840.1.113883.3.117.1.7.1.200 and "Low Molecular Weight Heparin" OID: 2.16.840.1.113883.3.117.1.7.1.219 (and there others), from the very first release in October 2012. So if this is a good example of what ever her concern is, I’m afraid I don’t get the problem. 

If I was to wildly guess (a dangerous thing to do with you playing man-in-the-middle) perhaps she is not familiar with the expectation that data submitted in support of meeting an eCQM may at times require mapping, say from a code representing a branded drug (like Lovenox) to the “general form” (Enoxaparin) using RxNorm as the submitted code system. Or some entity that she’s relying upon is not getting this job done well.

There is the possibility that Sanofi (they make Lovenox) has come out with a brand new formulation of enoxaparin that did not get into the value set. If that is the problem, then this is exactly the sort of thing we are working to determine a better solution for implementers then simply “mapping to something close that is in the value set." If she is aware of such things then I encourage her to provide very specific evidence of this so we can design solutions that really work. She should do this by participating, like thousands of her colleagues have done, in the CMS/ONC eCQM JIRA site (http://jira.oncprojectracking.org) and report the specific issues so we can get to specifics.

HIStalk Announcements and Requests

The HCI Group donated $1,000 to participate in my CIO lunch at the HIMSS conference, with which I funded these DonorsChoose grant requests:

• A document camera, speakers, and dry erase lapboards for Ms. Hardy’s elementary school class in Upper Darby, PA
• A document camera for Mr. Martinez’s high school math class in Delano, CA
• Three tablets for Mrs. Haley’s elementary school class in Waycross, GA
• Model rockets for Mrs. Elliott’s sixth grade class in Indianapolis, IN
• Electronic circuit kits for Ms. Mills fifth grade science classes in Spring, TX
• An iPad and gaming system for Mrs. Swords’ fourth grade class in Douglas, GA
• Machining tools for the robotics team of Mr. R’s high school class in West Covina, CA

Ms. Osborne says her South Carolina elementary school class is using the math games and materials we provided in their math centers.

I was excited about Black Sabbath’s final tour, but video from their “The End” tour stop in Chicago shows Ozzie singing so wildly off key that he ruins all the songs they otherwise played excellently. I think they’re making the right decision to hang up their inverted crosses after nearly 50 years.

HIStalkapalooza

HIStalkapalooza Sponsor Profile – Healthwise

Amplify the impact of your patient touch points with Healthwise health education, technology, and services. Easily integrated into episodic care, care coordination, automated programs, and patient portals, Healthwise solutions give you the ability to deliver tailored, meaningful experiences. Since 1975, Healthwise has been driven by our non-profit mission to help people make better health decisions. Visit us on the HIMSS show floor in booth #3617 and at our kiosk in the Population Health Knowledge Center. To find out more about Healthwise or to schedule a one-on-one meeting, visit www.healthwise.org/himss16.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

CMS inspectors have found problems at the Northern California laboratory of Theranos, according to unnamed insiders. Meanwhile, a Wall Street Journal investigation finds that not only is Theranos using its fingerstick technology for just one test, it’s also sending some of its samples out to reference labs instead of running the tests itself, apparently losing money on each (Theranos sells patients a test for $7 while paying UCSF $300 to run it). The article also reports that Walgreens has met with the company several times since October to discuss concerns about the Theranos stations in its California and Arizona drugstores and isn’t satisfied by the company’s responses. The since-fired CFO of Walgreens approved a loan of $50 million to Theranos without involving the drug company’s senior clinical executives and signed an agreement that Walgreens can’t easily escape from, although a negative CMS report might give them reason.

Specialty EHR vendor Nextech acquires SupraMed, which offers a PM/EHR for plastic surgeons.

Medical image exchange platform vendor LifeImage acquires its mammography-specific competitor Mammosphere.

Enterprise integration vendor Jitterbit, which offers a platform for developers to build and expose APIs, raises $20 million in a Series B funding round. It lists among its customers Dignity Health, Eisenhower Medical Center, and ZirMed. Prices range from $2,000 to $6,000 per month.

Kaiser Permanente will open an 800-employee customer service center and a 900-employee IT center in metro Atlanta.

The Milwaukee paper profiles Epic with a potpourri of recycled facts:

• The company has 9,500 employees, up from fewer than 400 in 2000.
• The Verona campus has cost $1 billion and construction continues.
• The article claims that Epic departments don’t have budgets, there’s little hierarchy and few middle managers, and use of job titles is minimized.
• The company won 127 contracts in 2014 vs. 19 for Cerner.
• The article says the company is poorly equipped to deal with the criticism that goes hand in hand with its success, noting that its in-house communications team consists of one person and the company is run by limelight-shunning CEO Judy Faulkner, who has asked reporters not to run photos of her for fear that people will bug her at her favorite Madison ice cream shop.

Sales

Pikeville Medical Center (KY) chooses Medsphere’s OpenVista EHR.

Trinity Mother Frances Hospitals and Clinics (TX) chooses Stanson Health’s point-of-care recommendation system for appropriate use of medications, imaging, and lab tests.

Phynd Technologies announces sales of its provider management system to Premier Health (OH), Duke University Health System (NC), and Children’s Health (TX).

University of Iowa Health Care selects Oneview Healthcare’s interactive patient care system.

People

Cerner Chairman and CEO Neal Patterson notifies shareholders via an SEC filing that he was just diagnosed with a “treatable and curable” soft tissue cancer and will therefore be traveling less and attending fewer meetings as he undergoes treatment.

For-profit hospital operator Capella Healthcare promotes Vishal Bhatia, MD, MBA to SVP/CMIO.

Nashville healthcare entrepreneur R. Clayton McWhorter, who served as CEO of HCA in the 1980s, died Saturday at 82.

Announcements and Implementations

The California HealthCare Foundation will cease publishing its iHealthBeat daily technology news digest as of February 1 because “its exclusive focus on health IT no longer aligns with the programmatic focus of our work.” The newsletter was managed by The Advisory Board Company under contract to CHCF. I’m surprised that HIMSS didn’t buy it and fold it into its vendor-friendly publishing arm.

EHealth Ireland announces that available funding will allow it to increase its 288 FTE headcount by 47.

Vermont’s Depart of Labor notifies former and present employees of the South Burlington, VT office of Allscripts that they are eligible to apply for re-employment services if laid off.

Liaison Technologies launches its bone marrow transplant registry that includes one-click CIBMTR reporting.

CareSync joins Athenahealth’s More Disruption Please program, offering CMS Chronic Care Management program support services to providers.

Research software vendor Pulse Infoframe will use InterSystems HealthShare for interoperability.

Government and Politics

CMS encourages development in state Medicaid claims processing systems by permanently extending a 90 percent federal funding match for those systems. CMS is spending $5 billion per year on state Medicaid IT and estimates that 30 states are redesigning their Medicaid eligibility or claims processing systems. Cedars-Sinai CIO Darren Dworkin tweets that it’s a much bigger vendor opportunity than any population health app although it’s likely open only to large government contractors.

Blue Cross Blue Shield of Vermont calls for an independent review of the state’s Vermont Health Connect insurance exchange as errors force it to once again turn off the ability to enter “change of circumstance” situations. The state blames original contractor CGI and a consulting firm it hired that has since gone out of business. BCBS says exchange problems have prevented some of its customers from renewing their policies and doesn’t allow the company to reconcile its customer accounts. The exchange cost over $200 million to develop, nearly all of that paid by federal taxpayers.

A New York Times article describes the security-required modifications that are required before government officials (including the President) can bring mobile devices into the White House. A general who bought one of the first iPads in 2010 says DARPA technicians removed the device’s cameras, wireless chips, location sensors, microphones, and on-board storage capabilities, leaving him with “a pretty dumb iPad.” The article recounts a 2013 interview in which former VP Dick Cheney revealed that when his replacement defibrillator was implanted in 2007, his cardiologist insisted on disabling its wireless capability for fear someone might use it to assassinate him.

A Congressional Budget Office report finds that the federal government spend $936 billion last year on Medicare, Medicaid, and ACA subsidies vs. $882 billion on Social Security. The report warns about increased spending on mandatory programs and predicts that the federal deficit will increase.

CMS posts its 2017 Medicare EHR Incentive hardship exception application, due March 15 if EPs are involved or April 1 for just eligible hospitals, with these allowable reasons:

• Lack of Internet access.
• An EHR destroyed by natural disaster.
• Practice or hospital closure or bankruptcy.
• Problems with EHR vendor certification delays, decertification, or other vendor-caused delays.
• Lack of control over locations that fall short of 50 percent of patient encounters.
• For EPs, a practice that does not offer face-to-face interaction.

Privacy and Security

Insurance company Centene announces that it can’t find six hard drives containing the information of 950,000 members.

NIST invites companies to provide products and technical expertise to help develop use cases for IV pump security.

Titus Regional Medical Center (TX) finally regains access to its EHR more than a week after its servers were locked by ransomware. The hospital says it did not pay the money demanded and that the FBI is investigating. The Dallas Area Rapid Transit Authority was also recently infected with ransomware that demanded payment of $63,000 to restore access to encrypted files. DART declined to pay and was able to recover most files from backup copies, but some information was lost and some online services remain unavailable. The FBI stated a few weeks ago that it might make sense for some businesses to pay the ransom demanded, which was the case with at least one police department and a sheriff’s office that have paid to get their files back. The hackers behind the CryptoWall ransomware creation tool recently upgraded their product with a redesign of the ransom note.

Two organizations — New Jersey Cybersecurity and Communications Integration and Cell and National Health Information sharing and Analysis Center — create a third-party reporting and notification system in which the state’s hospitals can share cyberattack information anonymously.

Other

Apparently the unnamed health IT vendor who ran this ad in the Las Vegas Craigslist values its customers about as much as it does women in seeking a “booth girl” whose primary attribute is appearance.

The inquiring mind of Weird News Andy wonders whether a drug that can cure fear will work in cases of pharmacophobia, iatrophobia, and phagophobia.

Sponsor Updates

• Burwood Group packs 100 winter coats, hats, and gloves for the Boys & Girls Club of America during its annual company retreat.
• The local paper features CareSync in its roundup of local entrepreneurial ventures.
• The local paper features Healthfinch in its feature on “Madison startups to watch in 2016.”
• Qpid Health’s quality reporting solution achieves ONC HIT 2014 Edition Modular Ambulatory EHR Certification.
• Huntzinger Management Group hires Jay Boylan and Bill Ehrman as regional sales directors.
• EClinicalWorks is recognized as having the highest market share among cloud-based EHR vendors.
• Versus creates a dedicated clinical solutions department of RNs. 
• Stella Technology is supporting ConCert by HIMSS and conducting demos of the Interoperability Test Tool (ITT) at the IHE NA Connectathon this week in Cleveland, OH.
• Elsevier Clinical Solutions will host the New England HIMSS Social March 1 at HIMSS16.
• Frost & Sullivan recognizes the EClinicalWorks cloud-based EHR for highest market share.
• FormFast will sponsor the HIMSS Midwest Gateway Chapter networking event January 28 in St. Louis.

Blog Posts

• Reflections on 2015: Paving the Way to Value-Based Care (Medicity)
• Take Full Advantage of EPCS (AdvancedMD)
• Cybersecurity: New Area for Mobile Medical App Compliance, Part 2 (AirStrip)
• Intermountain Healthcare Puts Mobile Security at the Top of 2016 Priorities (AirWatch)
• Legacy Data Management Services: Archiving (Impact Advisors)
• Content Interoperability: Achieving Clinical Data Quality Success (Stella Technology)
• It is possible to identify 30% more Transfer DRG underpayments (Besler Consulting)
• 7 HIT Trends to Watch in 2016 (Culbert Healthcare Solutions)
• Touchworks 15.1: Note Enhancements (Galen Healthcare Solutions)
• HIT Challenges in Transition: Moving Toward a Clinically Integrated Network (Hayes Management Consulting)
• Using a Care Team Model to Drive Patient Engagement (Healthwise)

Contacts

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