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April 28, 2016 News 5 Comments

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HHS issues a Notice of Proposed Rulemaking for the long-awaited Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will replace the Meaningful Use program in moving clinicians to payment based on value starting in 2017. The Merit-Based Incentive Payment System (MIPS) sets Medicare payments based on quality, use of technology, clinical practice improvement, and cost. Physicians participating in alternate payment models such as CPC+ and the Next-Generation ACO will be eligible to receive bonuses without participating in MIPS.

A CMS blog entry from CMS Administrator Andy Slavitt and National Coordinator Karen DeSalvo says Meaningful Use boosted EHR usage, but adds, “We remain a long way from fully realizing the potential of these important tools to improve care and health.” HHS says incorporating Meaningful Use in the MIPS program in a program called Advancing Care Information will “make it more patient-centric, practice-driven, and focused on connectivity.”

Slavitt and DeSalvo’s article says Advancing Care Information will:

  • Simplify physician reporting by eliminated all-or-nothing measures.
  • Provide flexibility for doctors to choose the most applicable measures.
  • Emphasize interoperability and the right for patients to access their own information through APIs.
  • Reduce the number of measures from 18 to 11.
  • Exempt doctors from reporting if EHR technology isn’t applicable to their practice.

The article sheds light on the technology focus going forward:

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.

The proposed HHS changes would affect only Medicare payments to practices. Nothing will change for hospitals and Medicaid program participants.

The full text of the 962-page proposed legislation is here. The Advisory Board Company posts a good summary.

Here’s a new three-minute HHS video for consumers that describes delivery system reform.

Reader Comments

From Richard Paula: “Re: texting of orders. The May 2016 Joint Commission Perspectives will contain a revised statement on texting orders, ending the ban enacted in 2011. It reinforces the fact that texting can be an expedient method of patient care. The secure texting platform must have:

  • A secure sign-on process
  • Encrypted messaging
  • Delivery and read receipts
  • Date and time stamp
  • Customized message retention time frames
  • Specified contact list for individuals authorized to receive and record orders

It requires text orders to be complete, dated. timed, confirmed, authenticated, and documented in the medical record.” Rich is CMIO of Shriners Hospitals for Children. This is a pretty big deal as companies whose messaging product can’t integrate with EHRs to complete the order loop now find themselves at a significant competitive disadvantage.

From Marshal: “Re: Meditech. Delta Regional in MS has signed to replace Cerner with Meditech. Salem Regional Medical Center in OH has signed with Meditech to replace their McKesson Horizon system. Cerner was the other finalist in that bid.” Unverified. 

From Graham: “Re: Coast Guard EHR. I saw that Politico just replayed your coverage from last October. The Coast Guard won’t say if a particular provider’s software caused the issues. What’s your take on where accountability resides? Sounds like mismanagement at a project level by USCG themselves, but Epic paying back $2.2 million on a $14 million award isn’t immaterial, either. It gets even fuzzier with the InterSystems component coming in later and then Leidos / Apprio / Lockheed.” The Coast Guard cited unstated problems with the implementation, seemingly blaming itself for a lack of consistent workflows and ongoing scope expansion, while outsiders speculate that it handled the product selection poorly and that Epic and Leidos may have bid too low to  meet the Coast Guard’s expectations.


Meanwhile, Epic uncharacteristically posts its side of the Coast Guard story, saying its software was originally ready for go-live in 2011, but Coast Guard changes such as hardware procurement delays, vendor changes, data center changes, and a government accounting investigation of the Coast Guard’s method of payment threw the schedule off. The Coast Guard’s storage area network was also lost twice, once from corruption and once after someone from Leidos deleted it. Epic says the go-live was rescheduled for October 2015 and was on track until the Coast Guard cancelled it the month before for unstated reasons. Epic says it was paid in full and the Coast Guard did not ask for a refund.

HIStalk Announcements and Requests

I’m interested to learn what sort of EHR prototype the VA is creating in exploring the idea of replacing VistA with what sounds like another self-developed product. Let me know if you can provide information, on or off the record.


The vast majority of 514 poll respondents (92 percent overall, including 90 percent of the females and 93 percent of the males) think it’s a bad idea for HIMSS to publish a separate website and newsletter for women in healthcare IT. Sandra says the goal is to be separate but equal rather than separate but separate, while NoHorseInThisRace says its a disservice for HIMSS to be “peddling its clickbait drivel” specifically at women. Lisa says she might take an occasional look but since the issues and concerns are the same for everyone, the choice of content the site will promote will be interesting. Long Disappointed by HIMSS adds that, “The comment made on HIStalk is appropriate – look no further than the board.” The women’s interest stories so far is lame – it’s anything related to Karen DeSalvo, third-party stories on gender pay gap, and mentions of people who have been promoted who happen to also be female.


Ms. Anderson’s Arizona fourth graders, especially her special education students, have used the electricity and magnetism kits we provided in funding her DonorsChoose project to complete her standards-based assignments while having fun.

image image

Also checking in is Ms. Isaacs, whose Indiana second graders are using the 16 sets of headphones we provided to participate in an online literacy program, which she saves “gives our class the opportunity to focus on what we are learning rather than the other students around us.”

This week on HIStalk Practice: Thirty-six practices sign up for CancerLinq’s oncology analytics. Raleigh Orthopaedic Clinic settles with OCR to the tune of $750,000. AMA partners with IDEA Labs to support student entrepreneurship in healthcare IT. The American Telemedicine Association aims to broaden the Rural Health Care Connectivity Act. Reliance ACO COO Gene Farber highlights the role of CCM in coordinated care. UniVision gets into telemedicine. Vice President Joe Biden set to spice up Health Datapalooza. CDW’s Jonathan Karl offers advice on how to promote positive outcomes with communication and technology.


May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


A RBC Capital Markets analysis says Quality Systems / NextGen issued investor updates Wednesday indicating that it will focus on streamlining management, building up the business of the HealthFusion PM/EHR it acquired in January for $165 million, and cutting costs furthers. Analyst Dave Frances expresses skepticism on the downbeat business changes announcement given a shrinking market share in QSI’s core business, adding that, “We remain unconvinced that HealthFusion and Mirth are the answer.” Quality Systems says it will stop development on its NextGen Now product immediately, taking a $32 million charge and confirming that it will reduce headcount by 150 as I previously reported from reader rumor reports. The cloud-based NextGen Now PM/EHR was announced in November 2014 and was supposed to be launched in 2015.

A New York Times op-ed piece says Theranos wasn’t a product of Silicon Valley hype – the company pitched to top life sciences venture capital firms whose doctorate-heavy investment teams were put off by Theranos trying to appear cool while keeping the technical details intentionally vague. Those VCs also noted that Theranos hadn’t published in peer-reviewed journals and that the company’s board was made up of mostly old politicians with zero healthcare experience. The company’s investors were non-Silicon Valley types who were apparently less discerning.


Leidos announces Q1 results: revenue up 5 percent, adjusted EPS $0.72 vs. $0.67. Chairman and CEO Roger Krone says in the earnings call it’s on track to bring the DoD’s MHS Genesis Cerner project live at two facilities in the Northwest by the end of the year, but Leidos will also continue making money supporting the old system for another 8-10 years until the Cerner rollout is finished.


Athenahealth announces Q1 results: revenue up 24 percent, EPS $0.34 vs. $0.24, beating analyst expectations for both. ATHN shares are up 13.3 percent on the year.


Spok reports Q1 results: revenue down 6 percent, EPS $0.17 vs. $0.18. The SPOK share price is down 12.9 percent compared to a year ago.


Vocera announces Q1 results: revenue up 12 percent, EPS – $0.14 vs. –$0.17, beating analyst expectations for both. VCRA shares are up 7.8 percent in the past year.


MedStar Health (MD) chooses provider data management and scheduling software from Kyruus.

UK Healthcare selects Voalte for caregiver secure messaging.


image image

Medfusion hires John Juzaitis (ZirMed) as chief revenue officer and Michelle Murray (EDM Americas) as VP of marketing.


Brigham and Women’s Health Care (MA) promotes Adam Landman, MD to CIO.


Caradigm promotes Neal Singh to CEO. He replaces founder Michael Simpson, who has left the company.


Anita Pramoda (Owned Outcomes and former Epic CFO) joins the board of Health Catalyst, replacing EVP/Co-Founder Steve Barlow, who remains on the executive team.

Announcements and Implementations


The first four apps that use Apple’s CareKit developer’s framework are released to the Apple Store as the open source CareKit itself is also released to GitHub. The apps are Glow Nurture (fertility tracking), Glow Baby (maternity), One Drop (diabetes monitoring), and Start (depression medication tracking).



Here’s a cute “Take Our Daughters and Sons to Work Day” photo from Karen DeSalvo’s office from @Commanda4aCure.


The FDA rejects the application for a drug-device combination, or so-called “digital pill,” to monitor drug adherence. FDA had already cleared the use of Proteus Digital Health’s technology in existing drugs, but wants to see more data before allowing Otsuka Pharmaceutical manufacture it as part of its Abilify antipsychotic medication. Proteus has raised $334 million in 10 rounds of funding, adding $50 million earlier this month.


A man sues Snapchat and the 18-year-old driver who rear-ended his car at 107 miles per hour while taking a selfie, leaving him with brain damage. The teen admitted that she was speeding while posting to earn a Snapchat “speed filter” trophy icon for recording her speed with her photo. After the crash, the teen took a photo of her bloodied face and labeled it “lucky to be alive.” Snapchat says it gives users a warning not to use its speed filter option while driving.


This TV screen grab will resonate with everyone annoyed by poorly timed Windows 10 update nagware messages.

Sponsor Updates


  • Employees of Impact Advisors attending the company’s annual meeting in Orlando delivered 150 teddy bears to patients at Florida Hospital for Children.
  • Florida Hospital (FL) reports decreased mortality and a $72.5 million increase in appropriate reimbursement after rolling out Nuance’s Clinical Documentation Improvement embedded, with the next step being to embed Nuance Clintegrity CDI within Cerner Millennium.
  • Bernoulli will exhibit at the at the American Association of Critical-Care Nurses’ 2016 National Teaching Institute & Critical Care Exposition (NTI), May 16-19 in New Orleans.
  • Intelligent Medical Objects will exhibit at the IHealth 2016 Clinical Informatics Conference May 4-7 in Minneapolis.
  • MedData will exhibit at the Louisiana Chapter HFMA Annual Institute May 1-3 in Lafayette.
  • Orchestrate Healthcare will help Pertexa integrate its Radekal physician productivity tool for hospital use. The tablet-based product expedites the clinical encounter, reducing visit time by up to 30 percent.

Blog posts


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Currently there are "5 comments" on this Article:

  1. “The secure texting platform must have”…

    Erm, at that point it’s not called texting, it’s just messaging. We have language because we can agree on what words mean. This is like saying I want this horn section of the orchestra to be composed of violins and cellos.

  2. Delta in MS was Meditech Magic before moving to the Cerner hosted system. Doesn’t surprise me they would go back to Meditech.

  3. I like the simplicity of the CMS payment gigs. And how Slavitt and DeSalvo hang on to the potential of EHRs. How many years now? Just wonderin.

  4. @2: We have language because we can derive meaning of utterances through past experience of potential meanings of utterances developing a web of interrelated concepts, contextual clues of other surrounding utterances to determine which specific potential meaning might be intended in this situation, and an underlying framework of syntax we’ve constructed in our minds based on observation of language usage in others. If someone says a word in a given context meaning concept A, and most people can derive concept A from hearing that word in a given context, then concept A is a definition of that word. Etymology doesn’t prescribe meaning, or else we’d all still be speaking Proto-Indo-European.

    In this case, “to text” means “to send a message over the SMS network or other similar networks that have begun to supplant SMS”. It’s idiomatic, not literal; there’s no more reason to object to it than there is to cable cords not being made out of rope. “Messaging” would be a valid alternate term, but usage of the term “texting” provides greater specificity in that it implies the specific underlying protocol of messaging used. Similar to how “messaging” would be a valid but more generic alternate term for “email”, “phone”, or “mail”.

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Reader Comments

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  • Mr. HIStalk: I agree for a class, where an ongoing relationship is important -- you'll be spending time with the instructor and fello...
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