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May 15, 2018 News 5 Comments

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Sutter Health confirms that some of its electronic systems remain down from an unstated problem that started late Monday. Sutter’s Epic system in at least some of its facilities as well as its public website are offline.

Some of the health system’s 24 hospitals have cancelled surgeries and gone back to paper during the downtime, but have access to Epic’s locally stored copy of patient information.

A spokesperson said late Tuesday that the downtime was caused by the activation of a data center fire suppression system.


Reader Comments

From Don’t Understand Investments: “Re: investors. Why don’t they put their money into companies that address problems like social determinants of health, public health, and mental illness? Those are the biggest issues we face.” Here it is in a nutshell:

  • The only goal of investors is to make a profit, preferably quickly with a rapidly scalable offering.
  • The only way a company can make a profit is to find willing customers who believe the benefits of its product or service (tangible or intangible) outweigh its cost.
  • Most health IT products can’t really boost provider profit other than by the nebulous ideas of capturing more market share or increasing productivity measurably (and hospitals are poor at labor management, so that’s a tough sell), so their pitch nearly always involves lowering cost. (An exception would be anything related to revenue cycle, where the massive amount of billing and collections activities makes even a small amount of skim lucrative as long as enough patients have insurance to make collection likely).
  • Lowering cost by reducing volume works for health systems only if they are paid at mostly capitated rates, where spending less means profiting more, or if they can keep non-paying patients out of their facilities. Most hospitals are still paid mostly as fee-for-service, which means they don’t want to reduce their big costs because they would also then be reducing their big revenue from patients who are insured. You don’t see a lot of hospital billboards trying to recruit more charity patients.
  • Other than consumer plays such as telemedicine, that leaves deep-pocketed, for-profit companies as the most likely technology customer – insurers hoping to reduce unnecessary care they have to pay for or drug companies trying to keep a lucrative market share. It’s no coincidence that nearly every startup’s unrealistically optimistic business plan carries the built-in expectation that insurers or drug companies will make it rain and then stick someone else with the newly added cost.
  • Consumers mostly can’t afford healthcare on their own, so their only value as a profitable widget is if they are insured. Charity care is a social construct, not a promising investment for VCs.
  • In summary, like most endeavors that involve societal good without having for-profit fingers stuck in the pie, investors have every reason to invest in something less noble that is more likely to be profitable. You would do the same with your money, then perhaps donate some of your profits to charity to help the many Americans who aren’t as fortunate in their interactions with our healthcare and economic systems.

From Skip Tumalu: “Re: EHR vendors and prescription pricing. I’ve heard that some insurers provide real-time prescription pricing to EHR vendors for physician use in helping patients get their meds filled, but in return they bar those EHR vendors contractually from displaying anyone else’s lower drug prices. That forces patients to buy medications from the payer’s own pharmacy benefits manager. Is this widespread?” Tell me anonymously if you’ve seen one of these contracts, or even better, send me a copy that I will redact.


HIStalk Announcements and Requests

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Welcome to returning HIStalk Platinum Sponsor Advisory Board, now part of Optum. The best practices firm combines research, technology, and consulting to improve the performance of 4,400 healthcare organizations. It offers research memberships, workforce surveys, consulting (medical group, IT strategy, revenue cycle, and its Clinovations implementation, optimization, and support services). Technology offerings include the Crimson product line (referral patterns, medical group performance, continuum of care, population health, surgical profitability), HealthPost (patient self-scheduling), IRound (real-time hospital experience and service recovery), and Audience Rx (consumer engagement). Consider doing what I’ve done for years in subscribing to the company’s “Daily Briefing,” which is the most information-packed, BS-free daily email healthcare newsletter I’ve seen and actually use to uncover news nuggets worth mentioning on HIStalk. Thanks to Advisory Board for supporting HIStalk.


Webinars

May 16 (Wednesday) 1:00 ET. “You Think You Might Want to Be a Consultant?” Sponsor: HIStalk. Presenter: Frank Poggio, CEO/president, The Kelzon Group. Maybe you just got caught in a big re-org and don’t like where things are headed, or, after almost a year of searching for a better opportunity your buddy says, “You’ve got decades of solid experience and you’re a true professional, you should become a healthcare IT consultant.” Now you start thinking, “This could be my ticket to success. I know the healthcare industry and can show people how to do things right. The sky’s the limit!” Not so fast. Consulting offers many advantages, and many pitfalls. This webinar will discuss both the rewards and the risks of moving into a full-time consulting role, as an independent, or part of a large firm. It will present a checklist you can apply to assess whether consulting is a good fit for you, and present the ground work necessary to be a successful consultant.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Elliott Management scolds Athenahealth’s board publicly for failing to respond to its $7 billion acquisition offer, adding that it knows Athenahealth has received acquisition interest from other parties as well. Elliott’s offer letter said Athenahealth’s value has been hurt by executive turnover, low margins, product execution, quality of service that fails to meet its “grand vision,” and poor financial forecasting and guidance. It also says former GE Chairman and CEO Jeff Immelt was a poor choice for Athenahealth’s board chair and questions why the company hasn’t hired a full-time president since promising to relieve CEO Jonathan Bush of that additional responsibility nine months ago.

Crowdsource investing platform RedCrow is focusing on early-stage healthcare startups and has partnered with Cleveland Clinic, but that’s not nearly as interesting as this: one of the co-founders is Jerry Harrison, former guitarist of long-defunct band Talking Heads.


Sales

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Colorado’s CORHIO HIE will use Verato’s patient matching technology.

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In Bulgaria, Puls Hospital joins TriNetX’s clinical trials research network.


People

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Phynd hires Prashant Gharpure (Xpanxion) as CTO, Cathy Jones (Nuance) as VP of sales operations, and Keith Belton (Belton Strategies) as VP of marketing.

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HIMSS hires Charles Alessi, MD (Public Health England) as chief clinical officer of HIMSS International and Bruce Steinbert (Big White Wall) as EVP/managing director of HIMSS International.

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Retired HIMSS CEO Steve Lieber’s victory lap continues as he joins recruiting firm Quick Leonard Kieffer to assist with executive search in the oddly titled position “of counsel,” of which that company has several.


Announcements and Implementations

Market research firm Kalorama names Cerner as the global EHR market leader with a 17 percent market share, followed by Epic at 9 percent and Allscripts at 6 percent, although: (a) the company doesn’t disclose the methodology behind the $4,000 report; (b) they don’t say what they mean by “market share” (I’m guessing annual sales, which would be a SWAG for privately held companies that don’t release that information and not the same as market penetration or number of beds or providers); and (c) the author’s credibility is questionable given her quote that Epic is “acquiring technology” for physician practices (apparently unaware that Epic has never made an acquisition) and listing Kronos as a EHR vendor (perhaps confusing the labor management systems vendor with actual EHR vendor DrChrono).

LifeImage launches LITE (LifeImage Transfer Exchange), an API-powered interoperability platform for sharing medical images and other clinical information.


Government and Politics

A GAO investigation commissioned under the 21st Century Cures Act finds that patients are sometimes charged more than HIPAA allows for copies of their medical record. Two patients interviewed were charged over $500 for a single request, one had to pay $148 for a PDF copy, two were told they couldn’t get their information unless they paid a subscription fee, and one was charged a retrieval fee by the hospital’s release-of-information vendor, which is explicitly prohibited under HIPAA. Investigators also found that providers were often unaware of the patient’s right to their records or that the federal government limits the allowed fees. GAO asked HHS OCR how it handles patient access complaints and the results are not surprising – providers are basically never penalized but instead are given “technical assistance” that, at least in my personal experience with filing a complaint about a hospital that refused to give me my records electronically in saying they aren’t required to do so, lets the provider off without doing anything.

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Former VA CIO Roger Baker – now an independent consultant — comments on the military’s report that called out extensive problems with its MHS Genesis pilot sites, saying:

  • The VA will have an even tougher time installing Cerner than the DoD given that VistA is #1 in user satisfaction while the DoD’s AHLTA is dead last.
  • Military physicians have to follow orders, but VA doctors have more autonomy about system changes and are more likely to express dissatisfaction.
  • The firing of former VA Secretary David Shulkin left the VA without a strong Cerner champion who is willing to spend political capital to get the job done.
  • Most big government IT projects fail, with Baker warning, “VA needs to remember that the probability they’re flushing that $16 billion down the toilet is actually greater than 50 percent.”
  • All that aside, Baker thinks the VA has gone too far down the Cerner path to reconsider despite the DoD’s report.

Privacy and Security

A Black Book survey of 680 provider organizations finds that 96 percent of their IT security professionals worry that hackers are outpacing their ability to maintain information security due to flat budgets and lack of staffing. One-third of executives whose organizations recently bought cybersecurity solutions say they did so blindly and 57 percent of IT management respondents say they don’t even know the full extent of available solutions for mobile security, intrusion detection, attack prevention, forensics, and testing. Thirty-two percent of organizations didn’t scan for vulnerabilities before an attack and one-fourth of them haven’t performed measurable cybersecurity assessments.

Sheriff’s deputies arrest an underage high school student for hacking into his high school’s computer system to change grades. He set up a replica of the school’s website, spent five minutes sending a phishing email asking teachers to log in, then used the credentials they entered on his site to log in to the real system himself. Officers tracked him down at his parents’ house by getting a warrant to obtain the IP address of the fake website from his web host, then used an electronics-sniffing dog (who knew?) to find the flash drive he had hidden in a tissue box (a lot of good jokes are awaiting your creative ribaldry).


Other

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A new KLAS report on interoperability in England’s NHS finds that data-sharing is rarely integrated with physician workflow and the exchange of structured data is uncommon, with one-third of organizations displaying external information via a separate EHR tab and another one-third using a standalone portal. Other challenges include unstructured data, inconsistent formatting, and missing data. The most significant barriers to interoperability are lack of standards, unwillingness to share, vague information governance, and a lack of understanding across care setting. The most widespread sharing is via HIEs, of which InterSystems and Cerner are the top vendors.

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New York Times-owned Wirecutter looks at online therapy providers and rates Amwell tops, followed by Doctor On Demand. Amwell’s sessions run $59 to $99 for cash-paying customers seeking help for anxiety, OCD, PTSD, depression, or life transitions.

Newly released tax forms indicated that UPMC paid 32 executives $1 million or more and 10 of those more than $2 million in FY17.  I couldn’t find its CIO’s salary in the non-searchable PDF, but it was a large document and I might have missed it.

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Forbes profiles money-losing ED and anesthesiology outsourcer Envision, which is taking heat for increasing healthcare costs through out-of-network billing (62 percent of its bills vs. a hospital average of 26 percent) that increases cost more than 100 percent in hospitals that hire it. A stock short-seller claims Envision’s business model is a “scam,” claiming that it pays physician groups cash upfront to lock them in at below-market rates for up to 10 years and thus is capitalizing salaries and then using its cash flow to sign up new practices. Envision blames high-deductible insurance plans, inadequate insurer payments to ED doctors, and the fact that EDs have to evaluate all patients regardless of ability to pay.

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My favorite newfound healthcare expert is Austin Frakt, PhD, a professor and VA policy director who is a fun writer contributes to The New York Times. His latest piece on why healthcare costs took a dramatic upward turn versus other developed countries in 1980 even as life expectancy started declining is getting extensive exposure, but I also like his informal speculation about the cause:

Maybe our health system caters to the wealthy. As their incomes grow, so does their demand for ever more expensive, high-tech care that is only marginally better than what came before. Political and social influence being what it is, they get it, but we all pay for it. The share of our economy going to healthcare grows. But outcomes for the vast majority of the population with lower incomes don’t improve as much, because more high-tech, expensive, low-value healthcare isn’t what they need as badly as they need higher wages, better education, better housing — things provided by other social programs that the healthcare budget is consuming.


Sponsor Updates

  • Change Healthcare releases InterQual 2018, which includes AutoReview automated real-time medical review using EHR data.
  • Formativ Health wins a Silver Stevie Award in the Startup of the Year category at the American Business Awards.
  • TriNetX will present at the ISPOR 2018 annual meeting May 19-23 in Baltimore.
  • Access publishes an e-book titled “7 Signs It’s Time to Upgrade Your EMR.”
  • The Center for Plain Language honors Healthwise with its Grand ClearMark Award.
  • Arcadia will exhibit at the Greater Oregon Behavioral Health Spring Conference May 16-18 in Bend.
  • Meditech EVP Helen Waters is named to Health Data Management’s “Most Powerful Women in Healthcare IT.”
  • Bluetree Network will exhibit at the Minnesota HIMSS Spring Conference May 22 in Minneapolis.
  • CompuGroup Medical will exhibit at the AUCH Annual Primary Care Conference May 17-18 in West Valley City, UT.
  • Columbus CEO features CoverMyMeds CEO Matt Scantland.
  • Culbert Healthcare Solutions will exhibit at the Centricity Live 2018 User Conference May 16-18 in Las Vegas.
  • Cumberland Consulting Group will exhibit at the CBI Medicaid and Government Pricing Congress May 21-23 in Orlando.
  • Elsevier collaborates with the International Association of Forensic Nurses to enhance forensic nursing content.
  • EClinicalWorks will exhibit at the 2018 Star Ratings & Quality Improvement Summit May 21-22 in Championsgate, FL.
  • Hayes Management Consulting and InterSystems will exhibit at Centricity Live 2018 May 16-18 in Las Vegas.
  • Healthwise will present at ZeOmega Connections18 May 23 in Plano, TX.
  • The Chartis Group publishes a white paper titled “Are You Overlooking the Power of Technology to Address Your Mission-Critical Imperatives?”
  • Imprivata’s marketing team receives the SiriusDecisions 2018 ROI Award at the SDSummit for their use of account-based marketing.
  • InstaMed will exhibit at the HFMA Region 1 Annual Conference May 23-24 in Uncasville, CT.
  • Kyruus will present at the Millenium Alliance Patient Experience Transformation May 17-18 in Dove Mountain, AZ.

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    Currently there are "5 comments" on this Article:

    1. I’ve said it before here and will say it again. In the case of a disaster like Sutter Health is experiencing with its EHR and other electronic systems being down, State or regional HIEs are a real DR/BC option to access clinical information!! Here’s a video showcasing this in scenario WI – https://youtu.be/zmWewfDsUOo

      • Please explain how this HIE would function better as a DR/BC option than the “locally stored copy of patient information” that they are already using? Also explain how the HIE would have more or more up to date information than the near real time copy that they’re already using.

        • I did not claim that an HIE would replace a healthcare organization’s DR/BC, but is an option to be considered. In this event the DC was down for an extended period of time and could only assume “locally stored” backups are unavailable; unless the EHR dumping out paper copies of your clinical records? Not likely though. Now consider the case where an EHR scheduled upgrade/maintenance does not go as planned and is down/rolled back. You enact the DR/BC plan or wait for the system to come back online. One other example, ransom ware, which we’ve already seen in the past 18 months cripple a number of organizations. During these real life down situations providers, care managers, etc. need access to clinical information. HIEs can be an effective tool in presenting this clinical information immediately.

          I will concede that not all HIEs function the same, but in WI – many systems, hospitals, clinics, and others are sending (near) real-time ADTs, CCDs, Lab results, Radiology reports, Transcription reports, EKGs, etc. directly from their EHRs (regardless of which EHR) to WISHIN (http://wishin.org/Home.aspx) – this exchange of clinical information is happening all across the country. In the event of a disaster, not only would the HIE have access to the latest EHR information sent to the HIE prior to a disaster, but the HIE would have EHR-agnostic clinical information from many other organizations!

          That is my rationale why HIE should be considered as an option when reviewing DR/BC plans. HIEs have proven to be a viable and effective DR/BC solution during disasters for healthcare not only in WI (as shown in the YouTube video above), but in Houston during the August 2017 floods, Michigan during the lead water incidents

    2. “…given that VistA is #1 in user satisfaction while the DoD’s AHLTA is dead last.”

      That begets the question:

      Why not take VistA from the VA and install it at DoD instead of AHLTA ?







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