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May 21, 2019 News 8 Comments

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ONC finds that interoperability among office-based physicians didn’t improve a bit from 2015 to 2017 even though more doctors used information from outside sources. The percentage who sent, received, and integrated the information didn’t change and only 10% of doctors participated in all four domains.

Only 30% of doctors received an electronic summary of care record, 20% were sent ED notifications, and hospitals provided electronic patient discharge summaries to just 25% of PCPs.

Here’s a tip for ONC. Just about every hospital uses Cerner, Epic, or Meditech. The fact that some hospitals are able to do the right thing using those systems means the challenge is not a vendor or technology problem – it’s that some providers just don’t want to do it, no matter how much their patients might benefit. Think about this when you anoint these foot-dragging health systems as the official steward of everybody’s overall health. The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it.

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In an accompanying report, ONC also finds that only about half of people were offered access to their online medical record in 2018, unchanged from 2017. About 60% of those looked at their information at least once. Most people said they have no need to view their online record.


Reader Comments

From AC: “Re: EHR internal timers and event log monitoring. Epic measures this. Customers should make sure they are getting an Executive Packet (Physician Well-Being section) and request access to Epic Signal. You should see if you can get Epic to interview with you on this topic or to share an overview. It might benefit their customers since not all of them take advantage of the tools available or even know about them.” I would like to hear more if someone from Epic or a client site is willing to share details. The study I cited suggests that tools like this can highlight EHR areas that could be streamlined and to quantitatively measure the impact of making system changes. It would also be interesting for an EHR vendor or its clients to compare the time and clicks required for specific functions across multiple health systems to identify best practices.

From Jack Ripa: “Re: HIMSS. Says investors are attending its conferences to follow trends.” MobiHealthNews (which is owned by HIMSS) runs a commercial from HIMSS TV (which is owned by HIMSS) that was recorded at HIMSS19 (which is owned by HIMSS) that says investors are finding value in attending conferences (that are owned by HIMSS). You, too have been (owned by HIMSS). Investors are there, of course, but I would assume everybody already knows that. Pro tip: despite appearances, the people wearing snappy suits are lightweights – the folks with real money (to whom the nattily attired genuflect) show up wearing clothes that are more commonly seen on golf courses and Applebee’s happy hour because they don’t need to impress anyone.

From Interview Analyzer: “Re: interviews. CEOs on occasion seem to get fresh ideas from your questions that I wonder, do they follow up with you afterward to pick your brain?” I’m pretty sure that my questions, while sometimes refreshingly off the wall or embarrassingly uninformed, have minimal business utility to someone who lives and breathes their particular niche. I attribute what you’ve read to: (a) interviewees who are being nice because they are HIStalk fans or who aren’t but hope to score flattery points; or (b) the interviewee being surprised at hearing thoughts from someone who lacks a verbal filter and who understands the race but has no horse in it. Neither party would have reason to continue the conversation offline and indeed that has never happened.


HIStalk Announcements and Requests

Readers recommended several folks for me to interview and that’s been fun. Let me know if you have suggestions of others who are interesting, doing good work, and confident enough to speak boldly about their area of interest.


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

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Private equity firm TPG sells its chain of cancer hospitals in India to oncology device and software vendor Varian Medical Systems for $283 million, proving that healthcare as a profit-driven industry isn’t just an American concept.

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Inova Personalized Health Accelerator invests an unspecified amount in Ireland-based Deciphex, which develops AI-powered digital pathology triaging applications such as Patholytix Preclinical.

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A Signify Research report finds that the EHR market in EMEA (Europe, Middle East, and Africa) is highly fragmented, with Cerner being the only vendor that holds a double-digit percentage of the region’s estimated $3.7 billion in annual spending.

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Google parent Alphabet’s Verily signs deals with several drug companies to display study recruitment ads to people who search for certain symptoms. Verily’s Project Baseline, launched in 2017, invites people to sign up (it’s a 12-minute online process) to contribute their research data, participate in surveys and focus groups, and test new technologies in working with partners Stanford Medicine, Duke University School of Medicine, and the American Heart Association.

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PatientsLikeMe founder Jamie Heywood expresses frustration that the federal government’s Committee on Foreign Investment is forcing the company to sell itself because its key investor is China-based genomics company ICarbonX. PatientsLikeMe is expanding beyond offering people a platform for discussing their conditions and symptoms with others with the same condition, now collecting their blood samples for AI analysis to understood more about human disease. Heywood says the government was concerned about exposing de-identified patient data to Chinese investors and insisted that the company prove that its work presented no national security risks.


Sales

  • Camden Coalition of Healthcare Partners chooses ACT.md’s social determinants of health collaboration system, which will support its care model identifying high-utilization patients and visiting their homes to help with medications, transportation, and connecting with social services.
  • In England, Gloucestershire Hospitals NHS Foundation Trust will implement Allscripts Sunrise.
  • Baystate Health (MA) selects Artifact Health’s mobile physician query platform to give physicians a faster way to review records in its clinical documentation improvement program.
  • Central Ohio Primary Care will use Updox for document management and communications services.

People

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Greg Miller (Health Catalyst) joins TransformativeMed as chief growth officer.

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Hackensack Meridian Health hires Pam Landis (Atrium Health) as VP of strategic digital programs.


Announcements and Implementations

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Google releases an updated enterprise edition of its much-maligned Glass, promoting the product from its Google X skunkworks division to mainstream Google. The $999 Glass won’t be sold directly to consumers – its audience is companies that want to sell their productivity-enhancing industrial software. The new version has a beefed-up processor and runs on Android with easier API integration. Google’s blog post says that Sutter Health is a development partner, which probably relates to its use of (and investment in) the Augmedix remote scribe service.

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A new KLAS report on practice management systems for practices of 11 or more doctors finds considerable variation in performance even those systems have been around forever. Epic continues to lead in satisfaction by far as customers report lower A/R days and better cash flow, while NextGen Healthcare is steadily improving. Practices of 76+ doctors report growing dissatisfaction with Cerner, mostly due to the product itself, and only 40% of them expect to see improvement in the next year. Satisfaction with Athenahealth has also declined significantly as customers say the company’s changing culture has impacted product support. They also express uncertainty about the company’s merger with Virence Health. Greenway Health performed well in mid-sized practices and is improving.


Government and Politics

The TL;DR version of why Missouri is the only state that can’t figure out how to launch a prescription drug monitoring database: (a) politics; (b) a family doctor-state senator who keeps squashing legislative efforts over privacy concerns that he somehow links to federal meddling in gun ownership; and (c) proposed bills that would have made physician use of the system mandatory.


Other

A Harvard Business Review article describes how New York City Health + Hospitals uses data science to identify homeless patients and match them to community services. They look for patient records that contain:

  • A home address of a homeless shelter or hospital
  • The words “homeless” or “shelter” in the home address
  • 10 or more ZIP code changes in one year
  • Registration-collected “homeless” flags from those few facilities that record it
  • ICD-10 codes for homelessness in the problem list, diagnostic assessment, or billing record

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I’m a big fan of giving patients a way to communicate their self-assessed health status to clinicians via an electronic form. Patient-reported outcomes for early chemotherapy side effect detection is one example, where patients report how they’re feeling or problems they are having that can then trigger EHR alerts for quick follow-up. An oncology researcher found that cancer patients who were provided that method of feedback lived an average of five months longer than those who weren’t, which doesn’t sound all that impressive until you remember that chemo drugs that cost hundreds of thousands of dollars often can’t deliver even that modest life extension. This concept should be applied to routine encounters – why must doctors swoop into the exam room and immediately start reading an electronic or paper form for the first time to see why you are there and then ask you all over again, wasting a couple of the few minutes patients get? I can’t figure out why the SF-36 form with additional specific data collection isn’t used widely, other than (a) clinicians aren’t paid to review it; (b) providers aren’t really interested in a patient deep dive as much as cranking out billable work; and (c) providers are afraid of being sued for missing something that turned out to be important. I have never personally seen this form, or anything like it, used out there in the Wild West of healthcare’s front lines, suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall except as the rhetorical question part of exam room small talk.

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Analysis by US News & World Report finds that Washington, New Hampshire, and Minnesota are the best states overall when taking into account everything from healthcare to the economy. Dead last at #50 is Louisiana, which beat out fellow cellar-dwellers Alabama, Mississippi, West Virginia, and New Mexico. The public health implications are significant given the key role of states in driving public health, setting spending levels on social services, and creating and enforcing healthcare-related laws. You might also assume that telemedicine could be important if skilled clinicians agree with the conclusions and elect to live elsewhere.

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I missed this story that illustrates how healthcare price competition should work if you buy the idea that care is a commodity. SSM Health will charge just a flat $25 for a questionnaire-based, call-back virtual physician visit. It appears to be a white-labeled service from Zipnosis. I wondered where the country would get enough pharmacists when chain drug stores were popping up on every corner, so with that fear proven to be unfounded, I can now wonder whether we have enough doctors to staff telemedicine services. Probably so given puzzlingly modest adoption, although being a telemedicine doctor must be like working as an Uber driver except the money is good, you can work from home in your pajamas, and your car stays clean (note to self: patent the idea of telemedicine surge pricing). It sounds potentially dehumanizing as a doctor, however, since the only important outcomes involve volume, patient satisfaction, and not getting sued since the patients have low-acuity needs that are being addressed episodically. Maybe it will devolve into those 1980s 1-900 telephone services for sex and psychics, although the objective there was to keep callers on the line with the meter running (there’s another note to self in maximizing profit from chatty patients). 

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An interesting study finds that the overconfidence of wealthy people makes everybody think they are more competent than they really are, proving that “fake it until you make it” and some level of snobbishness works, especially in one-off situations such as job interviews. I’ll add an unresearched postulate – executives often think they are smarter and more insightful than everyone else just because someone put them in charge, causing them to overvalue lone-wolf instinct instead of underling-assembled facts and analysis (I wrote about this way back in 2006 in describing what I called “Man of Action Syndrome.”)


Sponsor Updates

  • Dimensional Insight will exhibit at the 2019 MUSE Inspire Conference May 28-31 in Nashville.
  • Bluetree will exhibit at the HIMSS Southern California 2019 Annual Healthcare IT Conference May 23 in Los Angeles.
  • CarePort Health will exhibit at ACMA Northern California May 28-29 in Napa.
  • The Chartis Group publishes a paper titled “EHR Benefits: Unlocking the Secrets of Successful Organizations.”
  • Authority Magazine profiles Collective Medical CEO Chris Klomp.
  • CoverMyMeds will exhibit at the 2019 CMSC Annual Meeting May 28-June 1 in Seattle.
  • Hunt Scanlon highlights Direct Recruiters’ integration with sister company Direct Consulting Associates.

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Currently there are "8 comments" on this Article:

  1. Great comment on the interoperability incentives. My experience having been a patient across at least 5 health systems the last few years, I agree technology is not the issue.

    I’ve also seen providers demand full records, while I know they don’t look at them, when a summary I could download from MyChart for them would be just fine.

  2. Liked – “The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it.”

  3. Re: EHR internal timers and event log monitoring

    Cerner has this as well, it is called the Lights On Network. A current customer can log into LON (Lights On Network) and look at all of their timers, usability metrics, playbook scores as well as compare themselves to other like-sized Cerner Customers. It is a very useful tool if you choose to use it. You can see how many clicks it takes to fill out documentation, the amount of time a physician takes for a particular process and you can drill down into the individual users to determine who may be struggling or not even using the system. It is a very underrated tool.

    • That’s good to hear. So the major vendors have worked on this and provided tools. The question now becomes are organizations using them, and if not why not? It seems like they could really help with provider satisfaction as well as performance for the organization. Tools like these are part of the reason why they’re paying multi-million dollar contracts to EHR vendors.

      • As someone that actually tried to dig into the details of Epic’s signal data, I quickly became underwhelmed. No click counts, so interesting that Cerner has that. It maybe makes sense if you very broadly compare physicians or focus on a few key areas, but even that seems like it requires a lot of explanation for why this says this or that says that. Their timing data seems off and this was our main impetus for looking at Signal in the first place. I hesitated to even show providers who I knew were going to erupt upon seeing a graph that said they spent 6 minutes in the evening hours documenting. There are also inherent challenges in it counting outpatient only data.

        In the end, I could probably explain many of the things showing up in the data, but it didn’t offer enough to truly personalize training to a provider and it seemed to be more cost efficient to just refresh all rather than trying to explain Signal data.

        With that said, I know Epic is evolving Signal and continues to work to make it better and I think one day it will be a helpful tool.

        • I don’t believe they give you raw click numbers yet (only PEP/NEAT score), although I think Feb 2019 release is bringing more data to Clarity. Also they probably only turn on the logging for set periods to get a sample as it can get pretty large to have on all the time for all providers. So if you happened not to work after hours during that week it won’t show it. I get your point though, it probably takes a lot of explanation of what exactly they’re measuring/when/how, etc..

    • We use Cerner’s Lights On and Advance data extensively. There is a wealth of valuable information and it is continuously enhanced.

  4. ” suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall except as the rhetorical question part of exam room small talk.” Oh so true! Even with annual physicals, I have to interrupt my physician from his “check the box” questions to tell him how I am doing!







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