Weekender 4/13/18

Weekly News Recap

• FDA approves IDx’s AI-powered diabetic retinopathy screening system for use by PCPs.
• Theranos lays off most of its remaining employees, having cut its 2015 headcount of 800 down to around 20.
• Mayo Clinic offers voluntary severance packages to 400 transcriptionists whose it no longer needs because of speech recognition.
• The Coast Guard announces that it will piggyback on the DoD’s Cerner contract, with the additional contract cost yet to be determined.
• Netsmart acquires Change Healthcare’s home and hospice care software solutions.
• Facebook acknowledges that it tried to convince the American College of Cardiology to share de-identified patient data with it.

Best Reader Comments

I have to beg for de-identified data for EHR testing purposes, but Facebook gets it wholesale from a professional organization. If this isn’t a HIPAA violation, particularly with the re-identification plans, what is? And who can be called upon to get medical data protected properly? (Kitty)\

I’m not sure I’d want to pay for Facebook’s ad targeting or trust that they could re-identify data correctly. (1) Facebook flagged me with their African-American multicultural marketing flag. I am in fact a white Midwesterner who didn’t even encounter a black person until college, so even if they couldn’t tell from the hundred pictures they have of me, it’s not like I’m steeped in African-American culture. It’s very flattering that Facebook feels I empathize, but I’m pretty sure no actual person would identify me this way. (2) After I looked up Chicago the band, I got ads for weeks about events happening in Chicago the city. If this is representative of their big data skills, let’s hope that Facebook isn’t starting a self-driving car business anytime soon. (Midwest User)

While healthcare is much more complex than banking, the bankers had their game together very much earlier. I could travel 2000 miles and withdraw cash from my bank account in 1990. I would still have problems today to give a doctor 2000 miles away ANY electronic access to my medical records. (Fat Hertime)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request from Ms. O in Texas, who reports on her class’s use of a programmable robot. “My students are having a blast making our Lego robot. They learned quickly that they would need to talk to each other to figure out which part came next. Once this was established, the quick building began. They have loved putting this robot together so much that I do not think they realize how much they were learning. My students are using area and perimeter with the robot, along with following directions from pictures (no teacher help). Next they will be coding the robot to walk and move around. Thank you so much for bringing this activity to my students.”

We provided after-school STEAM project kits for Ms. P’s special needs K-5 class on a Native American reservation in Idaho. She reports, “After showing everything and talking about them, the students wanted to make slime first! I was so amazed at how much they listened to and remembered the information about polymers. The students have stepped up to the plate and have accepted the challenge to work together to figure things out. They are coming up with so many more ideas than I thought they would. They love to be able to take turns to be the teacher to explain their project. You are a hero to me and my students. They recognize that we wouldn’t have these things without your help.” 

I downloaded Facebook’s archive of information it knows about me (click Settings, then “Download a copy of your Facebook data.”) even though I do basically nothing on Facebook, rarely look at it, and don’t use Messenger or any app. The archive included:

• All contacts from my phone (the contact name I assigned and their phone number)
• Every login date and time
• Facial recognition data
• Messages
• Ads I’ve clicked
• A huge list of advertisers who uploaded a contact list with my info (a subset is above), an odd lot that included politicians from states I’ve never even visited, Dierks Bentley, drug companies, bands, and for some unknown reason, a ton of rappers. 

CB Insights mined its earnings call transcripts to see how often Wall Street analysts suck up to company executives while asking them questions and found that use of “great quarter, guys” peaked in 2008, although the most common compliment remains, “Congratulations on a great quarter.” I’m signing up to see how often analysts use trite terms in asking questions like, “Can you provide some color around that number?” 

Talkspace, which offers online counseling and therapy, claims it has 1 million users, is marketing services to employers, and is contemplating an IPO. A Verge review from late 2016 wasn’t complimentary, noting:

• Therapists are hired as 1099 independent contractors and bear all the responsibilities since the company says it’s not a medical provider. The company pockets half of their billed amounts.
• Talkspace owns the medical records of patients and therapists don’t have access to them once they’ve stopped working for the company, making the patient transition difficult.
• Therapists are required to follow scripts.
• The company set a rule that therapists could not complain about it internally on its Slack channels.
• Patients are anonymous, so therapists have no way to contact authorities if they appear to be a threat to themselves or others.
• Therapists say the company places client retention above all else.
• Talkspace’s terms of service agreement says patients should not make health or well-being decisions purely on their use of the service, which they add is not a substitute for face-to-face therapy sessions.

Kaiser Family Foundation SVP Larry Levitt notes that despite this short-term insurance plan’s name and choice of cover stock photos, it doesn’t cover mountain climbing injuries. The plan – of the type the Trump administration wants to roll out more widely – also doesn’t cover pre-existing conditions, prescriptions, pregnancy and childbirth costs, kidney disease, skin conditions, long-term care, sports injuries, or injuries incurred while under the effects of alcohol or drugs. The insurer also has no provider network, which I assume means that services will be billed as out-of-network visits with the patient being balance-billed – the plan pays a flat 150 percent of Medicare-allowable expenses and you’re on your own after that. I checked premium prices for a 30-year-old male in Chicago and they ranged from $88 to $177 per month with deductibles from $1,500 to $5,000. It may be better than having no insurance at all for some people (like those who don’t expect to actually require care), but make no mistake, those having it could be wiped out financially very, very easily from the unjustifiably high charges generated in a single hospital or ED visit.  

Japan-based drug maker Otsuka, whose antipsychotic drug Abilify is available in a “smart pill” form using technology from Proteus Digital Technology, has owned California winery Ridge Vineyards since 1986. The company says the winery is profitable, but its other use is for executives to entertain business partners during the JP Morgan Healthcare Conference in January.

BMJ Case Reports describes an ED patient who complained of dry heaves and thunderclap headache after eating one of the world’s hottest chili peppers in a contest, causing reversible cerebral vasoconstriction syndrome in his brain that could have caused a stroke or heart attack. The article didn’t mention his final standing on the leaderboard. 

Police file charges against a nursing student who was shadowing staff nurses at Lahey Hospital and Medical Center (VT) after he was caught hiding a video camera in an employee restroom. A housekeeper found the pen-sized device almost immediately. He wasn’t smart — a review of the camera’s contents clearly showed his face and ID badge as he recorded himself adjusting the camera’s angle to face the toilet.

Stat excerpts fun stories from the new book (due to be released on May 21) about Theranos, written by Wall Street Journal reporter John Carreyrou, who exposed the scandal:

• Theranos faked a demo of its non-functional technology to drug company executives way back in 2006, and when the CFO of Theranos heard about it and raised concerns, Elizabeth Holmes fired him on the spot.
• The head of the software development team bragged that he could write the company’s software faster in Flash, after which someone noticed a “Learn Flash” book on his desk.
• Elizabeth Holmes hired her brother – who had no obvious qualifications – as a product manager, after which be brought on several of his Duke University fraternity brothers to form what insiders called the “Therabros” or “The Frat Pack.”
• A former employee heard Holmes speak in a higher-pitched voice, leading them to speculate that she intentionally speaks in public in a low baritone to fit in with Silicon Valley’s male-dominated executive culture.
• Carreyrou writes that Holmes had a romantic relationship with Theranos President Sunny Balwani, breaking up with the man 20 years her senior only after she had to fire him as the company’s story began unraveling.

Bizarre: a plastic surgeon in Germany is arrested for unintentionally killing a woman he met online for sex by sprinkling cocaine on that particular part of his anatomy to which she was voluntarily providing oral attention.

In Case You Missed It

• News 4/13/18
• EPtalk by Dr. Jayne 4/12/18
• News 4/11/18
• Curbside Consult with Dr. Jayne 4/9/18
• Monday Morning Update 4/9/18
• What I Wish I’d Known Before … Serving on the Board of a Company or Non-Profit

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EPtalk by Dr. Jayne 4/12/18

I read a lot of press releases and this one from CMS particularly caught my eye this week. Normally a fairly bland and non-partisan source of news for all things CMS, the media relations group has really dialed up the rhetoric on this one. I don’t disagree that the Affordable Care Act is imperfect and we have a long way to go in achieving a workable and affordable system of healthcare in the US, but it feels like we’re losing the ability to participate in constructive discourse and everything is becoming polarized.

From Gone to the Dogs: “Re: burnout. My institution has dealt with this issue as it deals with many issues. The phrases ‘pennywise and pound foolish’” and ‘putting lipstick on a pig’ are perhaps the best descriptors.They’ve put together various wellness committees, invited speakers on mindfulness, and hired (costly) consultants on ‘improving communication.’ The most legitimately helpful thing they’ve done is have a puppy-petting party with a group of prospective guide dogs (which helps the dogs get socialized and relaxes the staff). At the same time, they continue to ratchet up required numbers of RVUs (on threat of contract non-renewal if targets aren’t met), throw people under the bus for any untoward events, display a general lack of supportiveness, etc. The broader burnout issues are also unchanged: insane regs, endless documentation requirements, frustrating pre-approval demands from insurers, and still trying to help really sick patients.” Our local high school invites a therapy dog agency to work with the students during finals week. I have to say, it’s hard to be aggravated when you’re staring at a cute puppy (unless that cute puppy just chewed the heel off your favorite pumps). The comment about RVUs is also particularly striking since we’re not supposed to be focused on visit volumes in the new world of value-based care. Keeping patients healthy and having fewer visits should be the goal, right? I still see RVUs as a metric in 90 percent of the organizations I serve.

Several readers sent their own “weirdest interview ever” stories.

My weirdest interview was with a major consulting firm. I had passed two telephone interviews and was flown out to have the final round of interviews with major players. I first met with president of the branch and he was bland and did not have many questions or comments (or energy). Then I met with one of their directors who had previously worked at another consulting firm that I had also worked at. He was a great interview and covered a lot of items. But the kicker was the last interview. This director sat down and nearly choked on her coffee when she realized that the date on my resume was when I graduated with my masters and not what she had assumed was my birth date! She didn’t believe I had any of the experience on my vitae, nor did she want to hire someone of my age. She excused herself and had security walk me out of the building. I’m not sure if she had many bad experiences with interviewing candidates, but security? At least I had a nice trip on their dollar.

I once interviewed for a position with an organization where the decision-maker shared a large office with another high-level person in the organization. Let’s call them Mr. Abbott and Mr. Costello. Mr. Costello would ask me questions, while Mr. Abbott, within earshot the whole time, was ostensibly engaged in other matters. But at different points in the process, Costello would call across the room to ask for Abbott’s thought or opinions. Abbott generally replied, “It’s your interview, I don’t know why you’re asking me,” or, “I don’t know – you should know that.” This went on for about 20 minutes or so, at which point I got up and said, “Thank you very much. I am not interested in the position” Costello had difficulty understanding why I abruptly made up my mind that this was not a place I wanted to work, but was apologetic. I don’t know where those two and the firm wound up, but I hope they started group therapy sessions as soon as I walked out the door.

That last story really resonates with me. As a candidate, when we attend interviews, we tend to be on our best behavior and I think we assume the people we are meeting with are likewise on their best behavior. I am sometimes left wondering that if what I have just seen is an organization putting their best foot forward, how wild it must be when they’re not trying.

From Crazy Ivan: “Re: tradeshow booths. This is my favorite ever. The only thing missing is the unmarked white van.” Every year one of my booth crawl BFFs and I fantasize about taking over one of the no-show booths at HIMSS and using the company’s name to create a fake business just to see if we can get prospects to stop by and chat. This year our delusion expanded to a couple of other people in our circle and the idea is gaining steam for next year. Another good reason to always check out the “little guys” on the trade show periphery – you never know who you’re going to find there.

From The Big Divide: “Re: this article. Would love to hear your thoughts. Is this a trend? It makes me nervous. Can’t help but believe it does deepen the divide in healthcare.” Concierge medicine is certainly a trend, although its market penetration varies across different regions of the country. I do see a fair number of direct primary care practices, many of which are priced in a way to be much more accessible to a broader swath of patients especially when those patients have a high-deductible health plan. The more accessible versions differ from typical concierge practices in that they’re more about cutting out the middleman (insurance) and providing value then they are about the white-glove service or 24×7 access than some retainer/concierge practices would be. I think the Michigan program especially raises concerns because of its association with a teaching hospital, and many teaching hospitals have a historical mandate to serve the underserved.

The hospital affiliated with my medical school had a “concierge floor” back in the day, where VIPs were cared for in swanky rooms with better meal service and no house officers. We only had a chance to breathe that rare air in the event of a code blue, when it was all hands on deck for the on-call team. They also sometimes had poorer outcomes because there were no house officers, which sometimes means less attention. Depending on the reason you’re in the hospital in the first place, not having interns and residents and students bothering you can be a bad thing.

On the other hand, when looking at concierge practices, they seem inevitable with the commoditization of medicine. One knows that when one purchases a Lamborghini, they will receive a different level of service than if they purchase a Chevrolet. People of means pay cosmetologists to come to their house to perform a pedicure rather than go to a salon. They have housekeepers rather than clean the bathrooms themselves. If the practice of medicine is no longer a calling but rather a business, why should it be any different than any other service? Even in a hypothetical single-payer system, there will always be people who are willing to pay more to get more. The question is whether we as a society are willing to commit to a minimal level of care for everyone else.

What do you think of concierge practices or direct primary care? Leave a comment or email me.

Email Dr. Jayne.

News 4/11/18

Top News

The Coast Guard, which previously failed in its attempt to go live on Epic, will instead implement Cerner as part of the DoD’s MHS Genesis project.

The DoD will revise its contract with primary contractor Leidos to incorporate the Coast Guard’s requirements. It says it won’t know whether the contract cost will increase until that work is finished.

The Coast Guard spent five years and $60 million – vs. the original budget of $14 million – trying to bring Epic live, only to give up and go back to paper after retiring the systems it was supposed to replace in early 2016.

Reader Comments

From Chance the Rapper: “Re: VA’s VistA. They should keep it, according to this poll.” The HIMSS-owned rag’s poll suffers from a multitude of problems that make its “keep VistA” conclusion useless beyond its intended clickbait purposes. Polls covering a detailed technical topic that generate a small number of responses from unvetted participants are pretty much worthless and certainly not something I’d splash all over social media. Most sites that run health IT polls intentionally hide how poorly they were designed and thus how questionable their results are.

From Firehydrant: “Re: Ascension. Cerner is possibly a victim of Ascension incompetence and political back-stabbing. Ascension IT has eliminated 20+ CIOs and 30+ directors as they drive strategy from St. Louis. They’re focusing on talent from Express Scripts. A recent all-hands webinar was marred by heckling staff using pseudonyms, with executives threatening to eliminate chat tools if the staff can’t be trusted.” Unverified.

From Someone Formerly of NextGen: “Re: NextGen. Tweeting to hire new talent. Two days after they announced their $300 million credit with JP Morgan, they laid off 60 people, some of them key individuals in charge of implementing the new vision of NextGen. Depending on how they recovered from last year’s mass exodus of veteran sales professionals, this puts them at a 2-3 percent reduction of workforce.” Unverified. But I’ll say in the company’s defense that layoffs are common in health IT (especially the publicly traded ones like NextGen / Quality Systems) and companies are always cutting back headcount in some areas while expanding in others. It’s too bad that employees assigned to a particular project are often let go, but that’s the easiest way out for executives. QSII shares have lagged the Nasdaq for years, shedding 23 percent in the past five years vs. the Nasdaq’s 116 percent gain. The only QSII executive who’s been with the company longer than three years is the HR VP (who’s also the only woman among the six executives). CEO Rusty Frantz said in last month’s earnings call that “85 percent of our effort is focused on monetizing our existing client base” and that “the replacement market’s a tough place right now,” with obvious hope placed on the August 2017 acquisition of physician practice analytics vendor EagleDream Health as well as the new sales force he brought in.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Allscripts repositions its care and referral management system (the former ECIN, relabeled as Care Management) under CarePort, the outcomes technology vendor it acquired in October 2016. I interviewed CarePort co-founder and CEO Lissy Hu, MD in February.

Healthfinch raises $5.7 million in a funding round.

Theranos lays off most of its remaining employees following SEC fraud charges and ahead of a likely bankruptcy filing, leaving around 20 employees left vs. the 800 it had in late 2015.

Sales

HealthlinkNY selects the Quality product of Diameter Health, which is certified for more of NCQA’s e-clinical measures than any other firm.

Freeman Health Systems (MO) will conduct an extended pilot of Mobile Heartbeat’s MH-CURE secure smartphone platform after completing a pilot in Freeman Hospital West’s cardiology department.

Waverly Health Center (IA) will replace Allscripts Paragon with EClinicalWorks.

People

Omnicell hires Scott Seidelmann (Candescent Health) as chief commercial officer. He founded radiology workflow technology vendor Candescent in March 2015 and sold it to Envision Healthcare in August 2017.

Dennis Shin (The Advisory Board) joins oncology precision medicine software vendor Syapse as chief commercial officer.

Announcements and Implementations

Phoenix Children’s Hospital (AZ) reports that its use of Medicomp’s Quippe Clinical Documentation has increased clinician productivity and enhanced documentation quality while nearly eliminating its $1 million annual transcription costs.

Netsmart announces MyUnity, a cloud-based EHR for home care and senior living providers. It’s being demoed this week at the company’s CONN18 user conference in Phoenix.

Phynd integrates Healthwise’s clinical taxonomy into its Provider Information Management solution.

AMA and its Integrated Health Model Initiative launches an interoperability challenge – sponsored by Google – that calls for ideas on: (a) how patient-generated data can be moved from their mobile devices into physician workflow, and (b) how physician-generated data can be sent back to the patient’s device for action. Prizes are offered, but in the form of one-year Google Cloud credits instead of cash. Residents from anywhere in the world can participate except those countries labeled by the State Department as sponsoring terrorism (North Korea, Iran, Sudan, and Syria) and those in Canada, Mexico, and Brazil (I’m not sure how they got on the wrong side of the AMA to be lumped in with terrorist countries).

Video visit provider Doctor On Demand will enhance its lab ordering services via Change Healthcare’s network, which will allow patients to work with their doctor to choose the closest in-network lab location.

Inovalon launches services for clinical data extraction and natural language processing for its value-based care platform.

Government and Politics

FDA caved to pressure from emotional patients and families two years ago in approving the expensive new drug Nuplazid for Parkinson’s diseases psychosis despite several studies that showed it ineffective at best and dangerous at worst. Now the adverse events reports are piling up.

CMS issues its 2019 insurance exchange rules, with Administrator Seema Verma loading her quotes and tweets with political derision in referring to “the harmful impacts of Obamacare” and “the previous Administration’s one-size-fits-all approach.” States will be given more flexibility in defining Essential Health Benefits, insurer risk adjustment will be tweaked, states will be allowed to request a lower Medical Loss Ratio for insurers to stabilize their markets, and the SHOP insurance program for small businesses will be moved from the exchanges to individual insurance agents. Verma said in a tweet that insurance premiums doubled in states that participated in the federal exchange even as fewer choices were offered, requiring regulatory reform.

Privacy and Security

The congressional testimony of Facebook CEO Mark Zuckerberg  suggests that Facebook’s platform is so complex that even the company didn’t know how it could be abused. He said:

• Facebook versions through 2014 allowed companies to create quizzes that would give access to the information of the quiz-taker’s Facebook friends even though those friends hadn’t given permission and weren’t alerted.
• Facebook learned from a newspaper story that a personality quiz developer had shared user information with Cambridge Analytica, after which that developer was banned and forced to delete the data.
• Just two weeks ago, the company found out that a feature that allows looking someone up by their phone number and email address “was abused” by linking public Facebook information to their phone number.
• Access to user data will be removed for apps that a given user hasn’t run for three months.
• Apps will only be able to see user name, profile photo, and email address.
• Users will see in their News Feed which apps they’ve authorized to use their data and whether Cambridge Analytica extracted their information.
• Facebook will restrict use of some APIs, such as for groups and events.
• Advertisers will have to confirm their identity and location before running political and issue ads.
• Zuckerberg vows that “advertisers and developers will never take priority” over “bringing the world closer together” even though they are Facebook’s customers.
• Some of the mostly elderly, non-technically savvy members of Congress seemed clueless about Facebook, with 84-year-old Senator Orrin Hatch (R-UT) asking Zuckerberg, “How do you sustain a business model in which users don’t pay for your services?” Zuckerberg couldn’t help smiling as he responded: “Senator, we run ads.”
• Zuckerberg had to explain several times that Facebook doesn’t sell data, it only uses it to target ads.
• Pressed hard on whether he would support a law requiring that users of any web service opt in before their data is used, Zuckerberg finally said yes.

As someone tweeted, above is a suddenly relevant 2003 article from The Harvard Crimson.

Other

A Black Book survey of 19,000 physician practices finds that small-practice doctors who use specialty-specific EHRs are the happiest EHR customers. Leading the satisfaction pack are AdvancedMD, Drchrono, Epic, NextGen, Netsmart, Modernizing Medicine, and SIS Amkai. Other satisfaction leaders are T-System EV (emergency medicine), Praxis EMR (family practice), Surgical Information Systems (general surgery), DocuTap (urgent care and occupational medicine), and PointClickCare (geriatric medicine). The survey also found that while most practices regularly use basic EHR capabilities, those with six or fewer physicians rarely use electronic messaging, clinical decision support, interoperability, and patient engagement.

Mayo Clinic offers voluntary separation packages to 400 transcriptionists as technology replaces them even before it goes live on Epic.

Scientists propose defining Alzheimer’s disease by biological signs that can be observed 15-20 years before the first dementia symptoms are seen, a change that will greatly increase the count of people with the disease. They’re hoping to improve outcomes by starting treatments before brain damage has occurred. The researchers hope to get more patients enrolled in pre-symptomatic stage studies, but don’t recommend that people get tested on their own since there’s no available Alzheimer’s treatment.

A Health Affairs blog post says that only 15-20 percent of Baby Boomers will be able to afford the long-term care services they will begin consuming on a massive scale in the next 10 years. It adds that Medicaid will be stretched as the default insurance for half those people, also noting that less-wealthy Boomers will have to get used to the idea of sharing rooms in old facilities.

This is the kind of careful editing that makes me comfortable sending $3,500 off to Pune to buy a Global Hospital Information Systems Market Report.

Sponsor Updates

• AdvancedMD will exhibit at ASCRS April 13-17 in Washington, DC.
• Agfa HealthCare acquires French e-health specialist Inovelan.
• Arcadia will host Aggregate2018 April 18-20 in Boston.
• Forbes names Direct Consulting Associates to its Best Professional Recruiting Firms of 2018.
• The Hospital Association of Southern California partners with Collective Medical to bring members cost-saving identification and support of frequent ED utilizers.
• CoverMyMeds will exhibit at the AAP Annual Conference April 12-14 in San Diego.
• Meditech certifies infrastructure provider SYSDBA as the only systems integrator for Africa and the UK.
• Spok executives will participate in upcoming events that include AONE, the AMDIS PCC Symposium, and the AHA Leadership Summit.
• Dimensional Insight will exhibit at the ACO & Payer Leadership Summit April 12-13 in Palm Beach, FL.
• EClinicalWorks will exhibit at the AAOE 2018 Annual Conference April 14-17 in Orlando.
• Ellkay exhibits at the ACMG Annual Clinical Genetics Meeting April 10-14 in Charlotte, NC.
• The HCI Group publishes a new case study, “Luke’s Goes 7 for 7 on HIMSS EMRAM Stage 7.”
• InstaMed will exhibit at the Office Practicum User Conference April 12-14 in Orlando.

Blog Posts

• Successfully Moving from Best-of-Breed to an Enterprise Lab System (Optimum Healthcare IT)
• The Importance of Governance in Aligning the Financial with the Clinical (Leidos Health)
• Healthcare CIOs Say Lift and Shift to the Cloud Not on Their Radar (Datica)
• A Proven Program for Managing 3-Day Rule Waiver Patients (CarePort Health)
• What Inspired You to Become a Nurse? (CareSync)
• CIO Chat – Russell Branzell, CHIME (Huntzinger Management Group)
• Reimbursement for Care Plans: The Cancer Care Planning and Communications (CCPC) Act (Carevive)
• The Digital Conundrum (CTG)
• 5 Biggest Resume Mistakes (CTG)
• Dimensional Insight Book Club: The Digital Doctor (Dimensional Insight)
• A Holistic Approach to Relationship Management (Docent Health)
• 11 Ways to Make Sure Your Contract Management Process is Meeting Your Organization’s Needs (Hayes Management Consulting)
• Translate Social Determinants of Health into Actionable Intelligence (HBI Solutions)
• Embracing Technology 2.0 – Preparing for the Future that is Now (Huntzinger Management Group)
• How a content services platform improves your Five-Star Quality Rating (Hyland)
• Seeing Is Believing: Thoughts from a first-time HIMSS attendee (Meditech)
• Advancing interoperability in today’s healthcare ecosystem (Imprivata)
• Three CRM Trends Impacting the Healthcare Market in 2018 (Influence Health)
• Airline Pilots & Doctors: What Can We Learn to Decrease Burnout? (Kyruus)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

Curbside Consult with Dr. Jayne 4/9/18

It was a strange week in my little health IT world. I had my first prospective client call to ask about an “extension” in MIPS data submission. Although CMS extended the deadline from March 31 to April 3, my client had confused the deadline with the federal income tax deadline and thought that you could file an extension to get an even longer time to report.

Sorry, folks, but if you haven’t submitted by now, you’re out of luck. We’re in the 2018 reporting year, so if you haven’t started to get your plan ready, you need to dust yourself off from 2017 and head into the new year.

I also went on the strangest job interview of my life. I had been introduced to this potential position by a mutual friend who works for the medical group in question. The backstory I was given was this — a mid-sized medical group is looking for a blended CMIO / clinical role to complement existing CMO and medical director positions. The group is growing and realizes that they need more administrative leadership to move them through programs such as MIPS and to assist with managed care contracting and their transition into the ACO space.

It sounded right up my alley. The recruiter from the group validated the role by sharing a job description, doing a phone screen interview, making sure we were in the same compensation ballpark, and then scheduling me to come meet with the group.

My first conversation was to be with the group’s physician president, who apparently was “called away.” He didn’t give advance warning to the interview team, which is never a good sign. I was left sitting in a hallway for 20 minutes while they scrambled to find someone else to fill the time block, who of course was unprepared for the meeting and didn’t really know what the role was about. They were, however, a provider, so they could tell me what practice with the group was like, which was important since this role would involve a certain amount of time in clinic.

From a few things he said, though, it sounds like the president gets “called away” quite a bit, which sounds like either poor time management skills or a certain level of chaos that requires the group president to sort it out.

From there, I met with some nursing team representatives who told me more about the clinical aspect of the job as well as some of the pain points they hoped that the new CMIO role would help address. The discussion was candid, the interviewers were friendly, and I felt it was a good opportunity to share my philosophy of clinical practice as well as how I think teams best work together.

They handed me off to members of the informatics team, who met with me over lunch. It was a mix of interviewing and grilling, with many questions about whether I would try to restructure the informatics team or change how their jobs work. There were a lot of very pointed questions about how I work with technical resources. One analyst flat-out asked if I would automatically take a physician’s side in the event of a disagreement between the physician and IT.

The analysts seem to be a good group of people. Although they’re pulled in many directions, I think they are excited about the possibility of someone helping with governance and making sure they are doing well-considered projects rather than reacting to squeaky wheels or shiny objects.

From there, I met with the COO, who talked me through some of the nuts and bolts of the organization and how much she thought the new role would interface with the financial and operational aspects of the organization. It sounded like there has been some friction in the past among operations, IT, and the clinical stakeholders as they decide how to prioritize scarce resources and how they decide which initiatives to pursue as they create their annual planning and strategic roadmaps.

At this point, none of this was surprising or out of the ordinary compared to other interviews I’ve been on, except for the missing interview with the group president. At the end of the talk with the COO, she let me know that I’d have a brief break and then would be able to meet with the president, who had rearranged another meeting to accommodate our interview. It sounded good, so I grabbed a cup of tea and made some notes about what I was thinking so far about the position.

An assistant came by to escort me back to a conference room, which seemed a little strange that we’d meet there rather than in the president’s office. Regardless, I headed in and sat down. That’s where the wheels fell off.  Apparently, the group president wasn’t on the same page as anyone else about this new position. I’m sure my face betrayed what I was thinking about what I was hearing.

The conversation was fairly one-sided. It essentially sounded like he isn’t in support of the position, implying that the people I’d talked to weren’t supposed to be advocating the position I was interviewing for. He said that someone shouldn’t just get to “walk right in and be a leader of this organization,” but rather needs to be a staff physician first and considered for a leadership position only if he or she “falls in the top 25 percent of our productivity curve.” However, any potential CMIO would need to first be a medical director, then given a chance for a promotion if they prove they can “walk the walk.”

He then proceeded to explain that the medical director positions were “stipend positions” on top of a full clinical schedule, which basically means the job would be a 1.25 full-time equivalent. Being anything less than a full-time clinician would be non-negotiable.

I wasn’t sure I heard it right the first time since my brain was still trying to wrap itself around being at the top of the productivity curve, which is terminology I haven’t heard since value-based care started picking up speed. Most of the interviews I’ve been on describe evaluating physicians based on metrics that are scored for clinical quality, patient satisfaction, access, chart completion, cost of care, etc., but not outright productivity. I asked a few questions around that and it sure sounded like their docs are being incented on a cross between RVUs and clinical quality scores, but it wasn’t clear.

By this point, given the total disconnect between the group president and the rest of the people I had talked to, I knew this wasn’t going to be a process I wanted to take forward. Clearly this gentleman didn’t understand how CMIOs and other leadership-level physicians are usually brought into an organization. Can you imagine a hospital CMIO being told that he or she needed to work his way up through the ranks and maybe then he or she would get a shot at the C-suite?

I can’t help but believe that at some point during the conversation my mouth was agape. The rest of the interview ping-ponged around for awhile until the recruiter came back to pick me up and close out the day. She asked what I thought and I threw out some vague comments about it being an interesting opportunity and there being a lot to think about.

I’m not sure if they know how off-script their leader was or what was going on, but at this point, I don’t care if I hear from them or not. I hope they get their act together before they “interview” the next guy or gal (I use that term loosely considering how the day ultimately went). I can laugh about it after a glass of wine, but in retrospect it was rather bizarre.

What’s the weirdest job interview you’ve ever been on? Leave a comment or email me.

Email Dr. Jayne.

Monday Morning Update 4/9/18

Top News

Facebook acknowledges that it deployed interventional cardiologist Freddy Abnousi, MD, MBA, MSc (who was then working at Stanford) to try to convince hospitals to give the company anonymized patient information. Facebook was planning to re-identify the medical information of those patients by matching their records to its own data trove, which it claims was to be used purely for medical research purposes.

Facebook has put the project on hold as it deals with its Cambridge Analytica privacy backlash.

The American College of Cardiology was on board, with its interim CEO explaining the research benefit of shipping patient data to Facebook. ACC was apparently aware that Facebook planned to re-identify its data simple database-matching  (“hashing”) techniques.

Abnousi’s LinkedIn shows that he spent 18 months as a Google Distinguished Scholar and remains an innovation advisor to the American College of Cardiology. It also says he has been “leading confidential projects at Facebook” since August 2016.

We can probably excuse Facebook for intruding on the privacy of its users since that’s what Facebook does. Who’s going to call ACC and Abnousi to task for trying to broker a deal for selling patient information knowing that it would not remain anonymous?

I couldn’t find anything online about whether ACC or its contributing hospitals inform patients that their data will be used or allows them to opt in or out, so I assume it falls under HIPAA’s “treatment, payment, or operations” free pass.

Reader Comments

From Apparent Irony: “Re: Ascension WI. Abruptly paused its Cerner OneChart implementation on Tuesday and let go all of the clinical associates on the project unless they can reclaim their former role. No severance and no word on when the project will be resumed.” Unverified.

HIStalk Announcements and Requests

Most poll respondents aren’t using LinkedIn to find employees or jobs, read/publish articles, or exchange messages, but rather to just see what friends and former colleagues are doing. Quite a few don’t use LinkedIn at all. A couple of readers find it useful to prep for the HIMSS conference (to see who works where) or for monitoring competing vendors. Another’s smart job-hunting strategy was to see who previously held the open position to gain knowledge about the company or to look up current and previous employees to understand the technologies they use.

New poll to your right or here: do you think your de-identified patient data is safe from being re-identified?

I received a few responses – some positive, some not — to What I Wish I’d Known Before … Serving on the Board of a Company or Non-Profit.

This week’s question involves choosing an EHR consulting firm.

Welcome to new HIStalk Platinum Sponsor Collective Medical. The Draper, UT-based company’s lightweight, interoperable PreManage platform for providers or health plans closes the communication gaps that undermine patient care. Care teams trust it to identify at-risk and complex patients, facilitate collaboration, and provide real-time event notification to improve their outcomes. Hospital care teams get actionable care plan information as well as workflow-driven, point-of-care insights for social determinants of health, prescription histories, and advance directives. Its EDIE (Every ED Instantly) presents information from all ED visits to avoid unnecessary work-ups, cost, and under-informed treatment decision. The company’s nationwide network is engaged by every national health plan, hundreds of hospitals, and tens of thousands of providers. The end result is streamlined transitions of care, improved coordination across diverse care teams, and fewer unnecessary admissions. Thanks to Collective Medical for supporting HIStalk.

Webinars

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Here’s the recording of last week’s webinar titled “Succeeding in Value-Based Care Via a Technology-Driven Approach,” sponsored by Health Fidelity.

Acquisitions, Funding, Business, and Stock

An Alabama federal judge rules that 36 Blue Cross Blue Shield insurance plan licensees violated anti-trust laws in creating their longstanding agreements to avoid competing with each other in their respective geographic areas, thus using their clout to reduce competition and raise prices.

A Kaiser Health News investigation finds that drug companies are spending nearly twice as much on patient advocacy groups than direct lobbying, benefiting as group members testify before Congress, organize letter-writing and social media campaigns, and repeat company-issued talking points, all activities that don’t have to be reported as lobbying by the sponsoring company. The American Diabetes Association accepted $18 million of drug company money last year even as those companies repeatedly hiked the price of insulin, often in lockstep with each other.

Decisions

• Auburn Community Hospital (NY) went live with Philips Interspace Cardiovascular on April 7.
• Fayette Regional Health System (IN) will switch from Evident to Athenahealth in 2018.
• Enloe Medical Center (CA) will go live with Epic on April 29.
• Northern Inyo Hospital (CA) will switch from McKesson to Athenahealth in 2018.
• MultiCare Deaconess Hospital (WA) will go live with Epic in summer 2018,

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

People

Gillie McCreath (Oliver Wyman) joins Mazars USA’s healthcare consulting group as principal.

The White House hires Adam Boehler (CEO of investor-backed home care vendor Landmark Health) as director of the CMS’s Center for Medicare and Medicaid Innovation.

Government and Politics

Texas Agriculture Commissioner and former rodeo cowboy Sid Miller appoints Rick Redalen, MD (self-styled as “The Maverick Doctor”) to the state’s Rural Health Task Force, about which the Austin newspaper observes:

• Redalen formed software companies ExitCare (patient education, sold to Elsevier in 2012) and Quest Global Benefits (healthcare cost control). He is an advocate for telemedicine, which is offered by the latter company and thus presents a potential conflict of interest.
• Redalen donated heavily to the campaign of Miller, who wrote, ““I want to thank my good friend, Dr. Rick Redalen (AKA Dr. Maverick) for the wonderful work he is doing in helping educate the people of our country about the threat of four more years of ObamaCare. Rick is recognized around the world for being an innovator in healthcare technology. He is an important advisor to me and my State Office of Rural Health and is a strong supporter of #DonaldTrump.”
• His medical license was suspended by the medical boards of three states, one of which cited his “psychiatric and drug problems.”
• Redalen married his 15-year-old former stepdaughter after his wife (her mother) committed suicide. He had pleaded guilty to hitting the mother with a rifle butt and pointing a weapon at deputies, then later was convicted of perjury for lying about the girl’s whereabouts.

Privacy and Security

Steve Long, CEO of ransomware-hacked Hancock Health, is hitting the speaker circuit to provide digital defense advice, presumably to hospitals that, unlike his, (a) haven’t been hacked; and (b) if they were, wouldn’t pay a hacker the demanded ransom and thus encourage further such activity. I might well have done the same if I were in his shoes, but I don’t think I’d feel qualified to advise others.

Other

Cardiologist, digital health expert, and HIMSS board member David Scher, MD weighs in on using digital health data for clinical trials, making these points:

• Some clinical studies have shown that using fitness trackers didn’t deliver the expected weight loss.
• Few new wearables are being marketed, but existing ones are being used more intensely, such as in his own practice, where Holter monitors have mostly been replaced with wearables.
• Wearables haven’t had much impact on clinical trials because the information they collect – such as vital signs –- is primitive and mostly irrelevant, not to mention that including wearables makes studies more complicated.
• Moving wearables into the clinical trials realm will require collecting more information, such as electrolyte levels, hydration, and body temperature.
• The massive amount of data created by wearables can cause the FDA to scrutinize studies more closely and it’s hard to apply analytics to sort out the data deluge.
• The cost of clinical trials (and thus the profit of clinical research organizations) will go down in the next 10-15 years as wearables will collect and report information in the background

Vince and Elise cover Athenahealth, EClinicalWorks, and Meditech, which occupy positions #4-6 in their list of top vendors by annual revenue.

Sponsor Updates

• Logicworks reports record revenue growth as the market for managed cloud services dramatically expands.
• MedData and PatientKeeper will exhibit at the Society of Hospital Medicine Annual Meeting April 9-10 in Orlando.
• OmniSYS will obtain access to immunization registries from Scientific Technologies Corporation that will allow pharmacy customers of its Vaccine Management System to improve vaccination rates.
• Magnolia Regional Health Center CMIO Amanda Finley explains how their Meditech EHR has helped care teams diagnose and treat ED patients.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the KY Bluegrass HIMSS Spring Conference April 12-13 in Florence, IN.
• News: OmniSys and Scientific Technologies Corp. announce strategic partnership
• Parallon Technology Solutions provides Meditech training and go-live support for Ohio Valley Medical Center and East Ohio Regional Hospital.
• Experian Health will exhibit at HFMA Oklahoma April 12-13 in Oklahoma City, OK.
• PerfectServe will present at AONE 2018 April 14 in Indianapolis.
• QuadraMed will exhibit at the 2018 ILHIMA & MoHIMA Joint Annual Meeting April 11-13 in St. Charles, MO.
• The SSI Group will exhibit at the Colorado HFMA Annual Conference April 11 in Westminster.
• Surescripts will exhibit at the OP User Conference April 12-14 in Orlando.
• Wellsoft will exhibit at the Texas Organization of Rural and Community Hospitals event April 10-12 in Dallas.

Blog Posts

• Interoperability 2.0 – Creating a Holistic Model of Care (Medicity)
• HIMSS hype or health IT promise: We had 500 people weigh in … (Medicomp Systems)
• Science Fiction Becomes Reality: Digital Pill Transmits Data via Phone App (Liaison Technologies)
• 6 Ways to Build Muscle Memory for Emergency Management in Healthcare (LiveProcess)
• Achieving the healthcare triple play: Improving clinician engagement, patient care and appropriate utilization – Part 4 (LogicStream Health)
• HITRUST on Amazon Web Services (AWS) (Logicworks)
• Liberation 2018: What We Learned From Today’s Healthcare Visionaries (Medecision)
• How new nursing roles are shaping the future of healthcare (Meditech)
• It’s Stress Awareness Month – Collect More, Stress Less! (Navicure/Waystar)
• Advances in Speech Technology (NVoq)
• Healthcare is personalized – your healthcare group’s software should be, too (Experian Health)
• National Doctor’s Day 2018: Saluting the Superheroes Who Wear White Coats (PatientSafe Solutions)
• Using Payment Plans to Accelerate Patient Revenue (Patientco)
• How Many Visits Does it Take to Get an ACL Done? (Redox)
• Moving From Clicks to Conversation: Finally Analytics You Can Use (Salesforce)
• Robots and AI in Healthcare Advancing Rapidly (The SSI Group)
• Improve lab efficiency and revenue following a healthcare M&A (Sunquest Information Systems)
• Surescripts to the Food and Drug Administration: Tap Into Tech to Hinder Opioid Misuse and Diversion (Surescripts)
• Internal care coordination is named a top patient safety issue. (Voalte)
• Ending Physician Burnout: It’s Time for Physicians to Take Back Control of Their Environment and How They Deliver Care (Vocera)
• What to Expect at Ascend 2018 (WebPT)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

What I Wish I’d Known Before … Serving on the Board of a Company or Non-Profit

That the Robert’s Rules of Order my Dad had occasionally instigated at the dinner table would be so yearned for when pandemonium decimated meetings run by the unaware.

How critical it is to have goals and milestones. We are over a year into a new non-profit and just now getting a board of directors in place. If I had it to do over again, I would sit down at a organizational meeting and put 4-5 big goals on a sheet of paper or electronically with a timeline.

How few of the non-profit board members read the written materials sent before the meeting.

I wish I had known more about the company’s ability to actually focus on, and be accountable to, their strategic mission. This relates to the balance of operational needs, strategic directives/promises, and monitored deliverables.

After being on the executive team of a large hospital and taking up a board spot on a non-profit, I wish I had remembered how little impact (rightfully) the board has on operations. It’s frustrating to offer suggestions and get ignored.

That I would quickly come to hate the comment “we’re all volunteers” as an excuse for why people couldn’t get things done and no one was held accountable.

How complex the interpersonal relationships can be and how much of an impact those interpersonal relationships can have of the function or dysfunction of a board.

How much I would have enjoyed it and how much I learned from a management / leadership standpoint. No kidding. Maybe it’s the non-profit organization itself or the fact that my fellow board members are easy to work with and for the most part share similar goals for the organization. I am going on 12 years serving for this organization in some capacity (eight years on the board) and I love every minute of it. One day I will have to step aside and let another person get as much out of it as I have.

I joined the board of a non-for-profit charity to give back. I didn’t realize just how much giving I’d be doing and what the annual give/get really meant.

I wish I’d known that I’d be working with some other board members who were only on the board because they were busybodies and had no intention of reading relevant documents, including legal depositions, that we needed to make decisions on and vote. Ugh. Never again!

The backstory on infrastructure acquisitions and their political import. Local politics are horrific.

Weekender 4/6/18

Weekly News Recap

• Orion Health Group announces a cost-cutting program and reorganization following release of poor annual results that sent shares down to a 52-week low.
• The State Department issues an RFI for an EHR following its failed attempts to install Epic as part of the Coast Guard’s halted implementation.
• GE Healthcare sells its health IT offerings to Veritas Capital for $1.05 billion in cash.
• Former VA Secretary David Shulkin disputes White House statements that he resigned, indicating that he was fired and thus raising legal questions about President Trump’s right to choose the DoD’s Robert Wilkie as his interim replacement and the possibility of legal challenges of any documents that Wilkie might sign such as the on-hold contract with Cerner.

Best Reader Comments

I would love to see more physicians embracing their role as leaders on a large, heterogeneous care team rather than technicians who operate in isolation and are subject to forces beyond their control. I don’t think many physicians perceive themselves as clinical leaders, but if they did, they could find many resources available that help teach the necessary principles and skills. (Adam K.)

I have to think that the big IDNs like Kaiser Permanente that use Epic and offer genomic testing to certain sectors of their patient population will be doing big things with data mining as more and more people in their populations have their genomes sequenced. If they could get to the point where they had 2 million people with genomic records married with multi-year structured data like what gets captured in Epic, it might be possible to discern some interesting patterns. If you add in the possibility of analyzing the gut biome, too, I have to think that we’ll be seeing an acceleration in discoveries and an improvement in targeting therapies – true personalized medicine. (CanHardlyWait)

National approaches are fraught with dangers to personal privacy and have a predisposition to stifling innovation. There’s also no good way to handle changing priorities – e.g., if a state reduces its opioid problem and has something else more important that it feels it needs to fund, the state approach allows it to focus on their state needs. A federal approach (e.g., like Meaningful Use) tends to be a one-size-fits-all, which we know is not good. Find a way to address these and you’ll find me supportive of national consolidation. What I am in favor of is a national approach to the issue with the ability to share state-level information with minimal cost or impact on workflow. (Joe Schneider, MD)

Interoperability is extremely valuable if done the right way. However, physicians and institutions must first learn to trust each other or the value is diminished. If one facility does a CT, MRI etc. and the next facility insists on repeating the test because they only trust their own techs, there is diminished return with increased patient frustration and patient cost. (Barbara)

The current PDMP process is a bad process. Improvements will only make a better bad process. The logical approach is to scrap the current submission process and move to real time using modern standards submission such as the NCPDP standards. (David)

You would not have to look very far to find some very large healthcare IT vendors being run by teams of middle-aged white men with zero software experience who all come together from company XYZ with light healthcare delivery experience. IV bag and alcohol swab logistics are very important, and while they are in fact delivered, they are definitely not healthcare delivery. Little diversity. Exorbitant compensation. Meager results. And still we wonder why. (ellemennopee87)

Watercooler Talk Tidbits

Teacher Ms. E in New York asked for a library of 30 books via DonorsChoose, saying that her kids “have the cards stacked against them because they are minorities from the South Bronx” and asking in her request, “Could you be the ‘somebody’ that helps?” HIStalk readers were indeed that somebody who funded her project. She reports, “Thanks to you, my students are now able to read new books from popular series such as ‘Fly Guy’ and ‘Elephant and Piggie.’ They are spending any free time they have in the classroom reading the books with their buddies and I am so excited that they are now part of our classroom library. Thank you so much for supporting my students. Donors like you are truly the best and we appreciate your generosity immensely!”

Also checking is Ms. F, who asked for take-home STEM activities for hew New Mexico classroom of 48 students. She says, “These math games have been such a fun and exciting addition to our math classroom. When they came in, the kids were amazed and couldn’t wait to play. It is truly a blessing to have supporters that understand that kids should enjoy learning and want to help make it possible. Now that we have learned how to play most of the games in class, I am getting ready to check them out to students to take home and play with their families next week. When I told them that they could borrow the games they were astonished and very excited for the opportunity. Thank you again for making this possible.”

Listening: last year’s solo release from former Megadeth guitarist Marty Friedman, whose music covers more genres than just metal shredding, although he does that really well. His band explodes with energy, especially Kiyoshi Manii, who is one of the most aggressive and technically competent bass players I’ve heard (not even considering that she’s a tiny Asian female). I’m also enjoying the recent reunion of Seattle-based hip hop band Common Market, celebrating the 10-year anniversary of its fabulous album “Tobacco Road.”

Forbes notes that Humana has offered to buy Kindred Healthcare’s home division for $800 million as Humana itself is rumored to be the subject of acquisition talks with Walmart. If both transactions go through, that would allow Walmart to extend beyond the walls of its pharmacies and retail clinics into the homes of patients.

Drug maker AbbVie buys itself five more years of monopoly pricing for the  world’s top-selling drug Humira, paying off a second company to refrain from marketing a cheaper version. Humira’s price has increased from $19,000 per year in 2012 to $38,000 today, generating annual sales of at least $18 billion. US patients pay multiples more than those in other countries, of course, nearly triple what those in France, Japan, and Norway are charged.

Also related to drug pricing: Bloomberg notes the success of a pair of Chicago consultants who teach drug companies the tricks needed to raise their prices by up to 4,000 percent. Their recommended methods include pressuring health plans to keep paying, using specialty pharmacies, covering patient co-pays, use analytics to find insurance policy holes that will support price hikes and to target likely prescribers, and providing big bonuses to aggressive salespeople. The consultants started as executives for a struggling drug company that has raised the price of one product from $500 to $2,500 in five years, earning the company’s CEO a single-year payday of $93 million. 

Surgeons at Memorial Hermann ask a brain surgery patient to play her flute during the operation so they could tell if they had fixed her hand tremor problem, which they did.

This seems entirely pointless, yet something Millennials would pay for. Lydian Dental offers concierge dentistry serviced out of designer RV-like clinics on wheels in trying to make dentist trips “fun.” The oh-so-hip design team also specified staff uniforms of workout pants and tee shirts bearing quippy phrases (“all up in your grill” and “nice mandibles”), instruments that remain hidden until needed, and iPads with Dre Beats headphones. The target market of the four-clinic company is clear given its smug use of insufferable hipster terms such as “aspirational,” “curate,” “touchpoints,” and their hope to “transform a transaction into an experience.” They will probably succeed – recall that endless studies have shown that Millennials don’t care how restaurant food tastes, it’s how enviable it looks when posted to Instagram that keeps them coming back.

Bizarre: a woman takes an Ancestry.com DNA test that predicts a “parent-child” relationship with the former OB-GYN who had treated her parents for infertility. The doctor had suggested a fertility procedure in which the mother would be inseminated with a mixture of sperm from her husband and a donor who met their specifications for height, eye color, and hair color. Apparently the doctor decided that the ideal donor was himself.

In Case You Missed It

• News 4/6/18
• EPtalk by Dr. Jayne 4/5/18
• Readers Write: Will PDMPs Remain a Vital Tool in the Opioid Response, or a Costly Burden?
• HIStalk Interviews Mark Savage, Director of Health Policy, UCSF’s Center for Digital Health Innovation
• News 4/4/18
• Curbside Consult with Dr. Jayne 4/2/18
• Monday Morning Update 4/2/18
• What I Wish I’d Known Before … Retiring or Career Downsizing

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
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• Sign up for email updates
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EPtalk by Dr. Jayne 4/5/18

I appreciated this article shared on Twitter earlier this week by Farzad Mostashari. He noted, “This particularly resonates – much of the physician anger and burnout is due to cognitive dissonance between how to make a living & doing what they know would be better for patients.” Although the article deals with the larger issue of fee-for-service vs. fee-for value, many of us deal with the micro versions of this on a daily basis. It’s more than just being caught between two payment models. We deal with countless requests for medications and tests that are of questionable value, but are caught between ordering the requested therapy and risking poor patient satisfaction scores that might impact our livelihood, or potentially risking outright patient anger.

In my current clinical situation, I don’t receive any financial boost from ordering more tests, but there is a perceived reduction in medical liability when more tests are ordered. This is common in emergency medicine and urgent care, as we are less able to rely on our knowledge of the patient and their history as we evaluate a problem. There is a pressure to practice defensive medicine that is independent of the compensation issues (although one could argue to that a lawsuit would be financially devastating, so there is indeed a financial reason to practice defensive medicine.)

I would love to be able to sit and explain to patients what they need to do to be well, or avoid injuries, or why they don’t need a medication or a CT or any other testing. However, since coding needs to be accurate and undercoding is as inappropriate as overcoding (at least according to the compliance audits I’ve had at my last three employers), that would mean that I should bill the time spent under the appropriate “counseling and coordination of care” code — which would likely be perceived as padding my bill — vs. billing a less-costly visit for a “treat ‘em and street ‘em” approach.

In this situation, how do you quantify the value of a physician sitting with you and counseling you? The reality is that this service isn’t valued in our current healthcare paradigm. Such interpersonal interactions are now to be delegated to ancillary providers in a team-based approach to care. However, the physicians are now financially liable for the results and outcomes of those patient interactions along with other treatment strategies.

This puts a tremendous amount of pressure on clinicians, regardless of where they fall on the care team. Being liable for the behavior of others is something that most of us are only willing to assume through the bonds of marriage or parenthood. In my community, this assumption of responsibility is one of the prime reasons that clinicians are resistant to value-based care. The article notes that, “many physician organizations have concentrated their energies on maintenance of the fee-for-service status quo, rather than providing a unified professional focus on improving health and creating value.” Although I don’t doubt that this is a real phenomenon, I’m not seeing it in the primary care organizations I’m working with.

I wholeheartedly agree that if you’re ordering more tests or drugs or whatever because it increases your reimbursement and not because it’s the right thing for the patient, you’re doing it wrong. But in real life, there is a fine line involved in figuring out what the right thing is for the patient. What do you do with the 88-year-old diabetic who might live another 10 years? How aggressively should you treat their diabetes? Do they need multiple medications or should they be allowed to relax their diet in their remaining years? Can their medications be reduced to save money in a fixed-income situation? There’s not a lot of data out there for patients in this age group, so how do you apply the evidence?

It’s not easy to point at a given clinician and discern their motives for a particular course of care with a particular patient. Perhaps in this situation, the patient’s spouse is significantly ill, the relatively healthy patient is the primary caregiver, and being aggressive makes sense because there are actually two patients in the picture. Or perhaps this patient has other issues, such as dementia, that might impact treatment and might make a relative “undertreatment” the better option. Unfortunately, our current understanding of data sometimes lumps these patients in the same category. Are you undertreating because it’s the right thing to do for the patient, or because spending less will give you a bigger bonus? Are you overtreating because the patient is demanding it, or because getting lower hemoglobin A1c scores gives you a bigger bonus? These are the forces that are shaping physician-patient interactions across the country and also shaping the data requests and dashboards that they’re requesting from the IT side of the house.

In addition to evolving physician sentiments about value-based care, we need a wholesale cultural program to educate patients and families about the cost of care and what they can do for themselves at low cost and with high return. It’s not as simple as enrolling patients in high-deductible health plans and expecting them to be able to sort it out. We expect patients to be educated consumers, but we don’t provide the level of education needed to really change behaviors. Patient advocacy organizations and patient engagement movements help, but there is just such a tremendous need.

Our state recently voted to require CPR training prior to high school graduation. Additionally, I’d love to see the state-required health classes include material similar to what is taught in the state-required personal finance class. Let’s talk about the future value of money vs. the future value of health in the context of preventive medicine. We teach students how to write a check – let’s teach them how to read an Explanation of Benefits document. Let’s teach them what a deductible is and how in-network and out-of-network works before they wind up with unanticipated medical bills that set them up for medically-related bankruptcy.

If we’re going to ask physicians to completely reject fee-for-service medicine as the article suggests, then let’s make sure we’re setting the system up for success. Not just with their patients, but with the value-based care scoring system. I recently worked with a practice that is coping with state and payer requirements that are just different enough from the MIPS-related clinical quality measures that they can’t use their certified EHR for reporting. They’re having to pay a not-insignificant amount of money to have custom reports created, as is every other practice that plans to participate in these programs.

What waste. Wasn’t the Meaningful Measures initiative supposed to help with this? After watching what this practice is going through, and knowing there are many other organizations in the same boat, I’d like to see rulemaking to halt the promulgation of any more programs like this until they’re brought into alignment with a single set of standards. That might actually get the naysayers on board as we work towards one set of common goals rather than multiple paradigms.

This is an exciting time to be in healthcare IT because we have the power to engineer solutions to help solve some of these problems. If you’re in industry, you have the potential to streamline workflows and put data at the point of care so all of the clicking becomes meaningful, but it might take some money that would make shareholders say “hmmm.” If you’re on the operations or health system side, you have the power to financially incentivize your providers to embrace value-based care, but it’s going to take boldness and bravery. If you’re a provider, you have the knowledge to research the evidence and determine whether you’re in the new game or not. And if you’re a patient, you have the opportunity to vote with your feet and your pocketbook if you want to embrace value.

It will be interesting to see what the next few years hold. There will be ups and downs. but if nothing else, it’s guaranteed not to be boring.

What do you think about payment and delivery model changes? Is your technology keeping up? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Will PDMPs Remain a Vital Tool in the Opioid Response, or a Costly Burden?

Will PDMPs Remain a Vital Tool in the Opioid Response, or a Costly Burden?
By David Finney

David Finney is a partner with Leap Orbit of Columbia, MD.

New battle lines are being drawn in an important corner of the nation’s broad fight to control the opioid epidemic. Health IT professionals should sit up and take notice.

Much quiet maneuvering has been taking place for months, particularly among a number of large and well-connected technology vendors sensing a windfall. But with the recent signing into law of the $1.3 trillion federal omnibus spending package, the debate about what the future should look like for prescription drug monitoring programs (PDMPs) has burst into the open.

PDMPs — which are state-based systems for tracking and analyzing the prescribing and dispensing of controlled substances — have existed in some form for a century. Over the last 10 years, they have become more technologically sophisticated and are frequently pointed to as a critical (and mostly non-controversial) tool in the opioid response. Today, 49 states, the District of Columbia, Puerto Rico, and Guam have established PDMPs, while in Missouri, a PDMP instituted by St. Louis County serves most of the state’s population.

In an increasing number of states—over 30—clinicians and pharmacists are required by law to check their PDMP prior to prescribing or dispensing any controlled substance. Though enforcement is so far minimal, failure to do so could result in suspension or loss of license. Among other emerging techniques, many states now also send unsolicited reports to prescribers, using PDMP data, demonstrating that their prescribing habits are outside the norms for their specialty.

The federal government has encouraged these policies with a steady and increasing stream of grant funding to states to cover software development, licenses, and IT staffing. Not surprisingly, the private sector recognized the opportunity. Appriss, a private equity-owned firm that got its start helping states monitor sex offenders, has been the chief beneficiary of this flow of government dollars achieving a near monopoly in the state PDMP market by, among other things, acquiring its two largest competitors.

With 42 state contracts, Appriss has done what monopolists do, bidding up contract prices and seeking to monetize every aspect of the data it controls. Given the commitment by states and the federal government to “do whatever it takes” to address the opioid epidemic—including supporting PDMPs with ever-increasing grant funds—PDMP administrators may grumble, but otherwise few people have stopped and taken much notice.

Few, that is, except for several large healthcare and technology interests (increasingly those are one and the same) and the Washington lobbyists who work for them. Acting no doubt out of a genuine desire to positively impact the opioid epidemic, and also sensing a business opportunity, these interests have quietly been pushing Congress and the Trump administration to rethink the federal government’s traditional support of PDMPs and “modernize” them.

How to do this? By awarding tens, if not hundreds, of millions of dollars in new federal contracts to one or a small number of firms to facilitate the flow of PDMP data at a national level. This new network would leverage existing prescription data feeds that support e-prescribing and third-party payment. Initially, this network might complement and enhance state PDMPs, but in the longer term, it seems likely to make them redundant.

By all indications, the federal omnibus spending bill and subsequent signals from federal officials and lobbyists seem poised to deliver on this new model. Not surprisingly, Appriss is worried. In recent weeks, it has launched a marketing campaign of its own to highlight the benefits of the current state-based approach to PDMPs and the interstate gateway it developed in collaboration with the National Association of Boards of Pharmacy.

Why should health IT professionals care? Frankly (and functionally), whether the nation continues with a states-based model for PDMPs or a federal one probably won’t make a big difference to end users at hospitals, ambulatory practices, retail pharmacies, or other healthcare facilities. The more timely data offered by the federal model may offer some marginal benefit, but states have already been moving in that direction. In either case, though, the outcome is likely to hit the bottom lines of these organizations in a big way.

Already, as prescribers and dispensers are required by law to consult PDMP data, their IT departments face pressure to deliver the data to them in more workflow-friendly ways. Appriss has gladly obliged by presenting hospitals and health systems across the country with steep per-user, per-month fees to access the data it controls via its state contracts via APIs or single sign-on. These fees can reach seven figures per year for some health systems. A federally facilitated approach is likely to look no different—it would use established e-prescribing networks, whose business models are well known, to deliver PDMP data into the workflow. What all of these businesses likely understand is that the last mile into the prescriber and dispensers’ workflow could be the most lucrative aspect of PDMPs.

A few states are attempting to buck these powerful forces. They take the view that PDMPs are a public utility, and as such, PDMP data should be widely and democratically made available to anyone who has an appropriate use for it. In Maryland, Nebraska, and Washington, this has meant collaborating with a statewide health information exchange to publish open APIs and support a range of standards-based integration techniques for bringing PDMP data into the workflow. California’s PDMP, with support from the legislature, is also in the midst of an ambitious initiative to make open APIs available to all of the state’s healthcare institutions.

These states support a nascent ecosystem of third-party technology providers and system integrators that are inventing new ways to present PDMP data to those who need it, when they need it. Companies—and I count my own among them—are demonstrating real innovation that can make a difference in fighting the opioid epidemic. The earnest competition also keeps us honest and hungry and should ultimately drive down cost. If more take notice, these states may present an alternative to the models being pitched by more powerful interests.

HIStalk Interviews Mark Savage, Director of Health Policy, UCSF’s Center for Digital Health Innovation

Mark Savage, JD is director of UC San Francisco’s Center for Digital Health Innovation in San Francisco, CA.

Tell me about yourself and what the Center for Digital Health Innovation does.

I am the director of health policy at the Center for Digital Health Innovation at UC San Francisco. The Center, in some ways, connects a lot of different parts at UC San Francisco, both on the academic side and on the medical center side, trying to build in digital health and innovation within digital health.

Folks may not know this, but UC San Francisco has a deep history in the precision medicine initiative, well before President Obama announced it in his State of the Union. UC San Francisco has done a lot of work on HL7 standards, before the Meaningful Use Program, and the 2015 edition of Certified EHR Technology. We’re one of the top-ranked medical centers in the nation, according to US News and World Report.

We have an interesting mix of delivery systems. We have a medical center, but we also staff the county hospital for the underserved here in San Francisco County and we also staff the veterans’ hospital. We’re a part of an accountable care organization. We bring in lots of different perspectives, bringing together the quality and evidence-based approach of a leading research university.

The Center for Digital Health Innovation works at the center of that to try to build some of that research and effort into systems that can be used by the nation, and indeed the world, going forward.

What was the reaction to your blog post that said EHRs will never be a comprehensive health record as some vendors have claimed?

There’s a lot of people who say, “Yes, that’s exactly what we need. That’s exactly what I believe.” Our blog said “connected health record” and that we’re not alone in thinking that way. We’ve seen from the responses that, indeed, we’re not alone.

I’ll speculate that it’s because that is indeed what the nation needs. We need to be connected. That’s why there’s so much focus on interoperability, as we said in the blog. Standalone EHRs are not meeting the national imperative. Interoperability is a national imperative, according to Congress and the 21st Century Cures Act, and that’s because they need connected health records.

A complete electronic health record and a connected health record are not mutually exclusive. Somebody was saying to me the other day, is it a comprehensive health record or a connected health record? Those aren’t mutually exclusive. You get to the comprehensive and complete health record by being interconnected with all the other sources. I realize from the blog title that sometimes people might think it’s one or the other, but really it’s the connections, the learning health system, that gets us to the true national completeness.

Our complicated health system results in patient information being scattered all over the place. How much of the problem is due to technology rather than it being a reflection of a system that isn’t very logical?

Let me back up even just a little bit further. We are in the midst of some pretty significant systems change and culture change in health information exchange in the United States today. The HITECH Act in 2009 launched us on an absolutely necessary trajectory, an overdue trajectory. So many other parts of our national landscape, our daily lives, are electronic. Finances, commerce, voting, education. But at the time, not really health information and healthcare. So Congress passed the HITECH Act and we have moved a long way in the past nine years, with adoption rates going from, say, 10 percent to around 90 percent.

We know from systems change in other major industries in the country that it’s not perfect. It doesn’t go as smoothly at the beginning as we would like. But that is the nature of building an interstate freeway system or building a national water system. Those kinds of things take some time at the beginning.

That’s in part what’s going on now. We are transitioning to an electronic health information exchange system. It’s not just the technology. It’s not just the logic. It’s trying to bring those things together.

Congress has talked about interoperability because there needs to be better connectivity among the systems. Our lives, our health, our healthcare, and our health data are in motion. We need the connections among those different systems in order to provide the care that people need. And actually, to back up, from treating people at the point of, say, the emergency room and moving more towards prevention and wellness.

Were you surprised by the emphatic announcement at the HIMSS conference by Seema Verma and Jared Kushner that providers have to give patients timely access to their data?

I didn’t have any advance notice that Jared Kushner would be there, but the things that they said are imperative. They’re necessary. Patients and individuals need access to their health data. They have a right to it under HIPAA.

In my career, I’ve been pushing for that for quite some time, both at the policy level and at the implementation level, including building in the capacity to view, download, and transmit one’s health information in the Meaningful Use Program and now the Advancing Care Information piece under MACRA. The innovation in the 2015 Edition of Certified EHR Technology to say that patients also ought to be able to have access through applications using application programming interfaces—the kinds of applications that people are using every day on their smartphones.

Health information exchange is finally catching up with the way that the real world is working for consumers and individuals in the rest of their lives. This is absolutely important. We’ve been pushing for that for a long time. Those kinds of statements meet a need. They speak to it. They speak to a need that patients and consumers have.

I very much look forward to seeing the details of that, though, because I will say that most of the advances that I have seen so far for the reality of patient access to their health information has come through the 2015, the 2014 Edition of Certified EHR Technology, and the Meaningful Use program now under MACRA. Those are the programs that these same announcements said are going to be rolled back. The details will be important. We have to make sure that those capacities remain in place so that patients have genuine access to their health information.

Joe Biden’s op-ed piece says HHS should crack down on providers who won’t give patients an electronic copy of their information within 24 hours of their request. How should the federal government define information blocking and what should they do to eliminate it?

The definition of information blocking is pretty complicated. It gets into a lot of different legal requirements that are already out there. Providers and technology vendors are obliged to comply with the law.

If you don’t mind, I’ll flip around not to focus on information blocking, but to focus on the affirmative. How do we help ensure that there is information flow? That’s one of the major reasons for the blog talking about connected health records — to get people into the mindset of thinking that they don’t just hoard or lock up or collect everything in their own respective electronic filing cabinets, but instead, think about this as the teamwork that it really is.

No one doctor knows everything about a patient. We have referrals to specialists all the time. We end up in emergency rooms and in hospitals when the unexpected happens. We go to laboratories. We go to pharmacies. We travel. Sometimes our care is provided in a state or a nation that’s far from home. We have a teamwork understanding and approach to healthcare, and now with the focus on precision medicine and genomics, we are thinking about how even more pieces of the healthcare system should be working together as a learning health system.

That requires connections and a connected health record for us to move forward. Something as simple as shared care planning, for example, between a doctor and her patient. You have family caregivers. You have these different pieces. We need an electronic platform where each of the members of the care team can plug in the new pieces of information and everybody gets that communication, understands what the change is. Everybody is on the same page and the data are updated seamlessly. That is information flow.

From that perspective, if we’re thinking that way, we don’t really need to be thinking about information blocking any more, because we’re not trying to hoard the data, we’re trying to improve the patient’s care.

What are the challenges in making that happen technically as well as presenting the information to avoid overwhelming a provider?

One of the key things to do is to make sure that certified EHR technology goes into effect quickly. The API access that I was talking about earlier, so that people can access their health information through their smartphones and can use it to make decisions about their health and care. That was supposed to go into effect no later than January 1, 2018, but it was delayed by another year to January 1, 2019. We can’t be putting off the very thing that will make access for patients and individuals much easier and help them to share their information with people who are responsible for their care.

We also need to be building in what you might call bi-directional access. This is not just one way access to health information. Patients have a lot of important information to contribute. Even things as simple as letting the doctor know, did the patient get better or worse after the doctor’s visit?

I remember being at an AMIA policy conference, maybe four years ago, and somebody said from the back, “You know, the single most important piece of information that is missing from the electronic health record is whether the patient got better or worse. That’s the fundamental outcome.”

That’s a good example of what is not a connected health record, where you don’t have the connection between the information that the doctor has and the information that the patient has. That critical information. We need to be building in patient-generated health data. The ability for patients to get key data to doctors, because doctors need access to that data, too. Access is not just a one-way issue. Doctors are missing access to very important information and that connected health record is a way to make that possible.

What incentives will encourage organizations to share that patient information in a central manner and then bring in the patient-reported information for their own decision-making?

When Joe Biden has spoken from the stage about the situation, his personal experience, he talked about how the information should have flowed and did not. When a patient is in an emergency room, the patient should not have to worry about whether one provider or another is thinking competitively about whether they’re going to disclose the health information needed in order to make sure that no allergies are suddenly triggered or that no unnecessary and dangerous tests are ordered. We cannot be thinking that way around people’s health. Patients do not expect that. Consumers do not want that.

I understand what you’re saying, that people are thinking around business models. But the national imperative around healthcare is one where we’ve got to be working together. That’s why the HITECH Act was passed back in 2009. That’s why Congress worked very hard to align incentives and created an incentive program where doctors said, yes, they would accept the incentives in order to adopt and use, meaningfully, for the benefit of patients and the nation, electronic health records, and that it’s not OK to hoard data. I’m not speaking to the important point of preserving privacy and security of health information, but sharing for purposes of treatment, payment, operations, public health, and individual access in a private and secure way. Absolutely that’s what must be happening.

News 4/4/18

Top News

GE Healthcare will exit the health IT market by selling its revenue cycle, ambulatory care, and workforce management software business to Veritas Capital for $1.05 billion in cash.

Veritas Capital’s previous health IT acquisitions include Verisk Health (2016, renamed to Verscend) and the healthcare unit of Thomson Reuters (2012, sold to IBM for double its acquisition price in 2016).

GE Healthcare joins previous healthcare IT acquisition-fueled dabblers (McKesson, Siemens, Misys, Sage) in wrecking a bunch of acquired companies and then cutting and running when the expected massive profits didn’t materialize. Or as I wrote a long time ago, “conglomerate vendors that seem to be happy milking the wrinkled, desiccated udders of their thinning herds of malnourished and badly aging cash cows,” to which I added further back in 2006, “ Healthcare IT customers carry little weight with toe-dippers. Are GE brass more worried about the flatlining former CareCast or sagging toaster sales at Wal-Mart? Does patient safety come up in Siemens corporate meetings as often as power generators?”

Reader Comments

From Penultimate: “Re: EMRs as a research database. I looked at the article you linked to in your tweet about conglomerate vendors. That took me to the one where you predicted that EMRs linked to genomic data and social determinants of health would give drug companies valuable information they would be willing to pay for.” I forgot about that piece from 2006, in which I said, “Drug companies and device manufacturers need the data that lives in your clinical systems. How else will they be available to target research to a very narrow range of patient types, maybe even those with a rare genomic profile? It could help them identify appropriate research subjects, design post-marketing surveillance, study population-based outcomes, and catalog adverse events. The information you provide could either be de-identified or made available only if individual patients opt in. The benefit to patients is access to a wider variety of treatments and protocols, most likely free to them if tied to a research project.” Your inquiry led me to look at the other editorials I wrote long enough ago that I can enjoy them as something new.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Qventus. The Los Altos, CA-based company’s AI-powered technology – which serves as virtual air traffic control for hospital operations — helps healthcare teams turn data into action and action into results. Its real-time decision management platform improves efficiency, patient experience, and clinician satisfaction by predicting issues, recommending immediate actions, alerting the right team members, and coordinating response. Success stories include El Camino Hospital (reduced falls by 39 percent), Stanford Children’s Health (increased patient satisfaction by 18 percent), Mercy Hospital Ardmore (reduced patients who left the ED without being seen by 55 percent), and Mercy Hospital Fort Smith (reduced unnecessary lab tests by 40 percent). Hospitals have rolled out countless dashboards and analytics reports from competing companies without success because those on the front line still have to make operational decisions with incomplete insight. The company’s platform is quickly deployed, easy to use, and easy to integrate with EHRs. Check out your own hospital’s efficiency ranking. Thanks to Qventus for supporting HIStalk.

Here’s a Qventus intro video I found on YouTube.

Listening (and watching): “Long Time Running,” an outstanding documentary streaming on Netflix that covers the bittersweet 2016 farewell tour of Canadian rock band The Tragically Hip after singer-songwriter Gord Downie was diagnosed with terminal brain cancer (he died a year later). The super-talented group has been intact since 1986 and the members agreed early on to share all songwriting credits (a la the Doors) to avoid dissent. The band’s love of country and affinity with their fellow Canadians (including Prime Minister Justin Trudeau, who appeared in the film) was a joy to watch, albeit with envy.

I had a routine appointment with a specialist today and saw the usual pointless form entry repetition first hand. They copied my insurance card, but I still had to manually write the information down on their paper form. Same with my referring doctor’s information. Every form asked me again for name, date of birth, age, and current date (apparently nobody was able to subtract B from D to calculate my C). Form fields weren’t big enough for the information requested. I had to sign in on the clipboard upon arrival, and of course I could see every person’s name and doctor. Then after filling everything out – medical history, family history, meds, social habits, etc. – the MA in the exam room asked me the same questions all over again so she could enter it into the EHR. However, healthcare is so defiantly and illogically inefficient that this process seemed streamlined and sensible in comparison.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Enterprises; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populateeions holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Acquisitions, Funding, Business, and Stock

Orion Health Group announces poor annual results and implementation of a cost-saving restructuring as it reorganizes into three business units – Rhapsody, population health, and hospitals. Share price hit an all-time low on the New Zealand stock Exchange following the financial report, reducing the company’s market cap to $100 million.

Ninety-two of the 104 doctors of Charlotte, NC-based Mecklenburg Medical Group sue Atrium Health (the former Carolinas Healthcare System) to leave the health system and operate independently following contract changes that reduced the practice’s RN staffing levels, centralized triage and reception functions at a call center, reduced compensation, and added a non-complete clause that prevents doctors from practicing with a 30-mile radius for a year after leaving.

Humana, MultiPlan, Quest, Optum, and UnitedHealthcare launch a pilot of a blockchain-powered project to improve provider directories.

Walmart to be in acquisition talks with PillPack, an online pharmacy that packages individual doses into reminder packs. The rumored price is in the $1 billion range.

The Nashville paper confirms an item a reader submitted a few days ago – Microsoft is suing Community Health Systems for breaching its software licensing contracts.

Hyland completes its acquisition of Allscripts OneContent (the former McKesson Horizon Patient Folders), transitioning its Alpharetta-based employees and 350 customers.

Sales

• Illinois Rural Community Care Organization chooses Cerner HealthIntent for population health management.
• Physicians’ Clinic of Iowa chooses the cloud-based EClinicalWorks v11 for its 84 providers.

People

McLeod Health (SC) promotes Matt Reich to SVP/CIO.

PatientPay hires Vikram Natarajan (Medfusion) as CTO.

Connected health technology vendor ResMed hires Bobby Ghoshal (Brightree, owned by ResMed) as CTO.

Susan Pouzar (Harris Healthcare) joins Genesis Automation Healthcare as VP of sales.

Neal Schwartz (Cerner) joins MedeAnalytics as COO.

Announcements and Implementations

ROI Healthcare Solutions launches a staffing and recruitment outsourcing organization called ROI Resource Group.

St. Charles Health System (OR) will go live on its $80 million Epic system next week, less than a year after choosing the company’s products. 

Population health management solutions vendor Casenet releases its TruCare Opioid Toolkit, which provides a patient assessment, an evidence-based care plan, and education materials.

Government and Politics

President Trump’s proposed CMS operating budget would eliminate funding for insurance exchanges.

Politico notes that the State Department has issued an RFP for a new EHR. It was previously collaborating with the Coast Guard to implement Epic until that project failed. The State Department is specifically interested in how an EHR would provide shared services opportunities with the DoD and VA, which would seem to point to Cerner as the most likely choice among the few capable vendors.

Kentucky passes a law prohibiting federally certified radiologists from interpreting X-rays in black lung compensation claims, allowing only pulmonologists to make those assessments. Of Kentucky’s six certified pulmonologists, four work for coal companies or their insurers.

Privacy and Security

Cloudflare launches 1.1.1.1, a brilliantly named DNS service that improves network performance and privacy (and maybe gain access to geo-blocked content, if that’s your thing). I’ve used DNS proxies before and they work fine, so I took a couple of minutes to set this one. It’s working invisibly, which is exactly what you would expect. 

Other

A Harvard Business Review article says the US spends too much of its healthcare dollar on low-value services that offer minimal clinical benefit, blaming: (a) limited effectiveness data for everything except drugs; (b) doctors make money from performing low-value services that they often can order themselves with payments protected by lobbyists; (c) patients lack the information to make their own decisions or to hold their doctors accountable. It notes that some high-value therapies are underused strictly because they are expensive, such as gene therapy and hepatitis C treatments. The authors propose using the capital markets to give insurers compensation when a patient’s early, expensive treatment results in savings for another insurer (like Medicare) down the road.

Sponsor Updates

• Medecision launches Aerial CarePlanner 360 that supports person-centric care.
• Meditech publishes a video in which hospital customers describe how they benefit from using Meditech.
• HCS will exhibit at and sponsor the NALTH Sprint Clinical Education & Annual Meeting in New Orleans on April 5-6.
• Aprima will exhibit at the OKMGMA Conference April 5-6 in Oklahoma City.
• Bernoulli Health will exhibit at SWUGM 2018 April 6 in Phoenix.
• CompuGroup Medical will exhibit at the ACMG Annual Meeting April 11-14 in Charlotte, NC.
• Everest Group recognizes Conduent as a leader in healthcare business process outsourcing.

Blog Posts

• HIMSS hype or health IT promise: We had 500 people weigh in… (Medicomp Systems)
• Center Stage Executive Spotlight: Shafin Kalyan, Executive Director, Ancillary Services (Optimum Healthcare IT)
• Black Book recognizes Nordic for highest client satisfaction in Epic IT Advisory Services (Nordic)
• Save the Date for Connect 18: The New Frontier of Healthcare Communications (Spok)
• How new nursing roles are shaping the future of healthcare (Meditech)
• 5 Tips for Creating a Successful IT M&A Playbook (Impact Advisors)
• How Integrated Healthcare Systems Impact the Patient Experience (Access)
• The Calm After the Storm (AdvancedMD)
• #BTheBestUCanB – Supporting two talented athletes, showcasing integrated and connected care (Agfa Healthcare)
• Medical Practice Billing Challenges and Some Suggestions to Overcome Them (Aprima)
• Measuring Quality Measures (Arcadia Healthcare Solutions)
• Top 2018 Trends in the Use of Healthcare AI (CareSync)
• Innovation: The Key to Fixing Prior Auth (Change Healthcare)
• How Specialty Tailored Templates Can Help Improve Your Practice (ChartLogic)
• Healthcare Interoperability: Are We There Yet? (Clinical Architecture)
• Patient Engagement, Cybersecurity, AI and More: Health Themes at HIMSS18 (CoverMyMeds)
• Developing a Strong Workforce as We are Faced with Competing Priorities (Culbert Healthcare Solutions)
• Takeaways from the 2018 Gartner Data & Analytics Summit (Dimensional Insight)
• Navigating Healthcare through Today’s Cybersecurity Landscape (Divurgent)
• Switch Survival Toolkit – Part 1: Discovery (DocuTap)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

Curbside Consult with Dr. Jayne 4/2/18

Spring is here, or at least sort of. We’ve had 17 straight days of rain, finally followed by one sunny day that was decent enough to migrate from the treadmill to the streets. The daffodils were blooming and everything was greening up, and then we got the April Fools’ joke of snow. Still, the transition to spring is a good one and hopefully the snow won’t stay around for long. Watching the outdoors perk up tends to give people energy to take on new projects and embrace new things. In that spirit, I’m going to offer some challenges to the healthcare IT leaders out there.

Challenge #1

Look through your library of applications and find a feature that you’re not using but that might benefit your users. Maybe it’s a feature that you didn’t need at the time it was created, so you didn’t implement it. Since then, your business might have changed, or maybe healthcare in your community changed, and it might be a good thing to roll out now. We also see organizations not implement features because they’re forced to upgrade on a specific timeline and don’t have time to address everything that comes with a new release.

I often challenge organizations to do this and the results can be impressive. One group originally shied away from allowing user-level personalization even though the EHR supported it. They were afraid that allowing users to reorganize icons and set too many preferences would make it difficult for the help desk team to provide support. Over time, the lack of willingness to allow user personalization hampered workflow, leading to many meaningless clicks that didn’t contribute to an individual user’s workflow. Even where personalization was allowed, it wasn’t encouraged – the majority of physicians didn’t have user-specific medication favorites that they could use to quickly enter drug orders nor did they have links to their preferred patient education materials. (Some of them were even still pulling paper photocopies from a file cabinet.)

If you’re really nervous about rolling out a feature, consider piloting it, perhaps selecting one clinical division or practice location to use a new feature. This allows you to not only complete a proof-of-concept exercise, but to ensure your training and implementation approach is solid before you roll it to the rest of your organization. Although sometimes we will see a failure, in most cases new features that are carefully rolled out will be embraced and can save end users time and frustration.

In addition to user personalization features, other features we often see put on the back burner: e-prescribing; e-prescribing of controlled substances; real-time eligibility checking; patient portal appointment scheduling; online statements and bill pay; secure messaging; clinical decision support; and condition-specific documentation favorites.

Challenge #2

Review your policies, procedures, and processes and find one that isn’t required and doesn’t add value, then eliminate it. In observing clinical workflows, I often find data collection points that aren’t used and no one questions why they are gathered. Maybe it was a grant that your practice had three years ago that wasn’t renewed; maybe the data is now automatically fed from another system (such as registration or the bed board system) and no longer needs to be collected separately in the EHR.

I often suggest that organizations review their patient intake forms and look for redundancy. At a recent physician office visit, I was asked to write my pharmacy information on three separate sheets of paper. It was clear that the office had evolved their intake forms, but had done so in a siloed fashion. The “front desk registration sheet” asked for it, the “clinical history” sheet asked for it, and they “why are you here today” sheet asked for it. For a returning patient where only the “why are you here today” sheet might be filled out, that might make sense, but for a new patient filling all three sheets out, it was a bit much. Not only does asking for data multiple times irritate and inconvenience your patients, but it increases the risk of error as people are overwhelmed and are copying information multiple times.

In a typical clinical / financial workflow analysis, I usually find close to a dozen processes that could either be eliminated or benefit from significant streamlining. Processes that can be eliminated often grow from distrust of electronic systems. For example, making patients verify paper copies of their history forms even though they just filled them out online within the past 48 hours and already electronically attested to their accuracy. Or making patients completely fill out new patient paperwork annually rather than printing them a copy of their current information and asking them to confirm and update.

Other processes might be unrelated to patient flow but important to business. I see a lot of waste in processes that organizations use for shift scheduling, time-off requests, expense reimbursement, and more. I also see a lot of policies that are “required by HIPAA” or “required by OSHA” that are truly nothing of the sort. Make sure if something is “required” that it really is, unless you want to be called out on it.

Challenge #3

Spend time as a leadership group reviewing organizational values. There are a lot of mission statements and vision statements out there, but in many cases, they are so remote from day-to-day business operations that they’re not having any influence on how people work or how they interact with patients or other clients. I still remember the mission statement of my first EHR project at Big Medical Center – probably because we actually believed it and lived it on a daily basis, rather than just seeing it posted in the hallway or once a year in some slide deck. If your vision has gotten hazy or cloudy, maybe it needs an update. If people don’t know what the mission is, then your corporate culture might need some attention.

Organizational values should be more than just a plaque on a wall somewhere. They’re more than a logo or brand statement. Values should be easily understandable and should guide the actions of people doing business whether with internal customers, patients, family members, or anyone else. If you find people in your organization conducting themselves outside of the values, be open to addressing it rather than taking the easier road of letting it go by or being glad it’s not happening on your team.

Spring is here and it’s a great time to make a change. Is your organization up to the challenge? Leave a comment or email me.

Email Dr. Jayne.

Monday Morning Update 4/2/18

Top News

The White House insists that VA Secretary David Shulkin resigned, disputing Shulkin’s own account of being fired. Shulkin did not submit a resignation letter and wasn’t allowed to return to his office after being told he was being replaced.

The reason: firing Shulkin would have automatically made VA Deputy Secretary Thomas Bowman – with whom the White House has clashed over VA privatization– the VA’s acting secretary. Claiming that Shulkin resigned allowed the White House to hand pick the DoD’s Robert Wilkie as acting secretary.

There’s a health IT aspect in play. If Wilkie signs the VA’s Cerner contract as acting secretary, it could be challenged on the grounds that he isn’t serving in his role legally.

Shulkin said on Sunday’s “Meet the Press,” “I came to fight for our veterans and I had no intention of giving up. There would be no reason for me to resign. I made a commitment, I took an oath, and I was here to fight for our veterans.” He was emphatic in saying on another Sunday talk show that, “I did not resign,” adding that he was told in a telephone call from White House Chief of Staff John Kelly shortly before President Trump tweeted that he was nominating White House physician Rear Admiral Ronny Jackson, MD to replace him.

HIStalk Announcements and Requests

Two readers responded to my Vietnam Veterans Day pondering if anybody still actively working in health IT was deployed there. Checking in were: 

• Navy Petty Officer John Humm
• Army Intelligence Specialist Vince Ciotti

The most common online sources used by poll respondents to find a doctor are their insurer’s provider list, Healthgrades, and Google Reviews (that last one was surprising to me), although “none of these” was the #1 answer. Commenters mentioned that most doctors have few reviews with relevant details, also noting that insurance company lists are outdated, fail to describe what types of patient that doctor sees, and are full of doctors unwilling to accept new patients. A reader suggests going the other direction – ask around for recommended doctors and then call them up to see if they accept your insurance. 

New poll to your right or here: what’s your most-valued use of LinkedIn, if any?

I received fascinating responses to my question about “What I Wish I’d Known Before … Retiring or Career Downsizing.”

My next question involves what you wish you’d known before serving on the board of a company or non-profit. I see quite a bit of the latter on LinkedIn profiles and I’m interested in how that works.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Acquisitions, Funding, Business, and Stock

Japan’s Panasonic Healthcare Holdings renames itself to PHC Holdings.

Personalized health and benefits solution vendor Accolade raises $50 million in a Series F funding round, increasing its total to $217 million.

People

Consulting firm 314e hires Douglas Herr (Leidos Health) as SVP.

Government and Politics

California’s attorney general sues Sutter Health, claiming the health system violated antitrust laws in using its market dominance to force insurers to sign “all or nothing” contracts at inflated prices and to charge unreasonable out-of-network prices.

UK’s General Medical Council investigates 30 doctors for unsafe online prescribing after several patients died after being ordered narcotics from online visits. A recent report found that online doctors prescribed opiates and antibiotics without performing due diligence and failed to notify the patient’s PCP in some cases. 

Other

Patent filings from Amazon and Google suggest that their digital assistants could do a lot more than obey pre-programmed commands, suggesting their potential uses to monitor voice and telephone conversations to get ad-serving ideas for both parties involved and listen to body sounds to detect potential medical situations.

An HBR article by Bob Wachter, MD (USCF) and Jeff Goldsmith, PhD (University of Virginia) says the way to reduce physician burnout and increase quality of care is to improve billing-dominated, 1990s-technology EHRs that are “performing several tasks, badly.” They recommend that:

• Caregivers create a “portrait of the patient’s medical situation at the moment,” limited to a fix number of characters to force a concise recap similar to a tweet.
• The patient portrait is frequently updated under rules that also define who is responsible for doing so.
• The patient portrait is used as the patient’s “wall” whose updated information is used as clinician groupware.
• Data importing is limited to prevent chart bloat, with minute-by-minute comments automatically deleted a la Snapchat.
• Voice- and gesture-based interfaces should replace keyboards and mice, including voice-powered order entry and information recall.
• Order entry should provide clinicians with costs and risks.
• Patients should be able to enter their own information remotely.
• EHR value should be enhanced with artificial intelligence.

Readmissions dropped by half after Intermountain Healthcare implemented its “Partners in Healing” program, which places family members on a patient’s care team to prepare them to provide post-discharge care.

Epic did its usual home page makeover for April Fools’ Day (which I’ve spelled correctly).

Vince and Elise continue their look at 2018’s largest vendors by revenue and digging deeper into Cerner, Epic, and Allscripts. 

Sponsor Updates

• Research and advisory firm SiriusDecisions recognizes Huron Consulting, Imprivata, and Vocera as winners of the 2018 Return on Integration Awards.
• WebPT becomes the first rehab therapy EHR to achieve Platinum Standard ISO Certification.
• WiserTogether and Myewellness partner to provide wellness solutions to employers and employees.

Blog Posts

• Building a Brand with Creative Copywriting (Salesforce)
• Blockchain Healthcare Disruption in 2018? (The SSI Group)
• HIMSS18 Panel Gets Candid About Prescription Price Transparency (Surescripts)
• Ending Physician Burnout: It’s Time for Physicians to Take Back Control of Their Environment and How They Deliver Care (Vocera)
• More Than a Number: Personalizing Patient Care in Your Growing Therapy Practice (WebPT)
• What does the C-suite want? (Philips Wellcentive)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

What I Wish I’d Known Before … Retiring or Career Downsizing

Clearly the hit on the paycheck is the first thing that comes to mind. But honestly, when I look at ROI between continuing to work and no longer working, it makes it all worthwhile. Which is to say, the incremental difference in the paycheck to continue to work does NOT offset the pain and retiring and giving up that paycheck was the right thing to do. As much as I enjoyed my job in the latter years, it was not so much because of my managers, but because I figured out how to make it work. I’m glad to be retired honestly. And don’t even miss the paycheck!

Wish I had known devastating effect of having your life and ego wrapped so tightly around the work you’ve done or who you do it for. Working for a prestigious company gives you an identity to colleagues, friends, and family. When that goes away, part of you goes with it. You quickly realize that you no longer have a big name attached to big resources.

How much I would miss the daily interactions and problem-solving. The sense of trying to accomplish something as part of a team is difficult (impossible?) to recreate sitting at home. Also, my failure to create a meaningful alternative hobby during my (limited) spare time while working. Be sure to get an engaging interest outside of the office and family.

Perfect time to pick up a new hobby such as programming, web / app development. If you already know a computer language, learn a new one. There are some amazing new tools to play with out there: Python, SQL, Angular, MongoDB, Web2Py, etc. All free, open source. Pure fun. Expanding your mind to new levels, not to mention acquiring some needed skills as well. As the song goes:

“Go ask Alice
I think she’ll know
Remember what the dormouse said
Feed your head
Feed your head”

https://www.youtube.com/watch?v=WANNqr-vcx0

I went from working full-time to retirement in two days. Wish I would have / could have worked part-time for a while to ease myself into it. I also should have tried harder to find another job before I retired. Biggest reason I decided to go when I did (which was about three years before what Social Security considers full retirement age) was because of an insufferable department director and an incompetent CIO, both of whom were gone roughly a year after I retired. But it’s all good now. I love retirement.

Although the finances are OK, I think I’d like to have built up a little bit more reserve and know how busy I’d be. It has been nearly 10 years since leaving the workforce. Time is spent on things that I never even thought about doing (genealogy research is a huge time-suck), and at the same time, being more “available” for whatever short- or long-term project needs to be done among friends and family versus trying to squeeze it into weekends. Some of these (house fix-up) projects span a few weeks, others a few years. Have not been bored at all, but also have not had time to take a nap, which was a weekly thing after a 65-hour work week.

I wish I’d known how much I would enjoy downsizing my career from being a large system CIO. The quality of life improvement made me realize how much I was missing, and not having to constantly play politics was a huge relief. Having said that, I do miss a lot of the people that I worked with, truly some dedicated professionals who are really trying to make a difference in healthcare.

That once you have a “5” in front of your age, you suddenly become the least desirable applicant for any job in your profession. It seems employers think that once you hit 50, all your knowledge disappears. I would never have downsized had I known that I could never go back.

I retired “early” primarily because I was on the verge of burning out, both professionally and personally. So it’s more what I did know before retiring and that I had prepared myself for the transition. Best move I ever made. I am a recovered workaholic and quite content.

I haven’t done it yet, but an planning on getting off the corporate (software vendor) rat race as soon as my youngest graduates high school in three years. I’ve been through countless acquisitions, layoffs, VC, PE, and makeovers over my entire career. It takes its toll. Career downsizing will be a sacrifice, but selling the house, not buying a new car, and moving back to Florida and living out on the slow lane near the beach is my dream. My advice to the young up and comers: the price is not worth the prize.

I wish I had known before retiring that retirement REALLY would be one more of life’s major change experiences, similar to entering kindergarten, going away to college, beginning the first job, getting married, having a baby, getting a divorce, losing a loved one through death, etc. No matter how much I planned or expected certain events to occur, it was (and is) challenging.

Even though I had prepared myself before retiring, I was surprised at how quickly I became irrelevant.

Weekender 3/30/18

Weekly News Recap

• South Australia reportedly halts the rollout of its troubled, Allscripts-powered EPAS systems.
• President Trump fires VA Secretary David Shulkin via Twitter and nominates as his replacement White House Physician Rear Admiral Ronny Jackson, MD, who has no significant management experience.
• Investors in the largely defunct lab startup Theranos sue the company, hoping to get some of their money back from the proceeds of selling the company’s patents and by going after the rumored $100 million fortune amassed by former President Sunny Balwani.
• FDA says it will expand its digital health pre-certification program to more companies by the end of the year.
• Finger Lakes Health (NY) pays a hacker an unnamed sum to recover its systems after a week of ransomware-caused downtime.
• Israel announces plans to make the health data of its 9 million citizens available to researchers and private companies for work on preventive and personalized medicine.

Best Reader Comments

Can someone explain the value of LinkedIn? It’s handy when looking someone up at times, but the amount of spam and vendors asking to make a connection is overwhelming. (2 antisocial?)

Women tend to use LinkedIn differently – more privacy settings and fewer public announcements, posts, or interactions. I wouldn’t be surprised if this extends to other aspects of online identity, like being less likely to email Mr. HIStalk to notify him of a promotion. (People/ LinkedIn)

Market Research Study Reader Feedback

Reader Steve works for a market research company and applauds my calling out of offshore firms whose reports – written in nearly undecipherable fractured English — fail to notice that companies they cover have been acquired or have exited the market. He provides this commentary.

I’m increasingly seeing the industry plagued by “report factory” outsourced studies. As you rightly state, the model seems to increasingly involve investment in masses of PR on every topic and keyword imaginable, yet always with high growth forecasts to entice busy health tech execs and VC’s desperate for data to reach for their Amex. More interesting is that if you dig into many of these firms, their report announcements are copycat replicas (same forecast title and keyword, just different company name).

Here are five quick pointers to aid in calling BS on these cowboys.

1. Contact the analyst behind the report. A quick email conversation or phone call is the quickest way to know (a) if they know what they are talking about, and (b) if they even exist. Also check their LinkedIn / Google press mentions. Good analysts should build up a reasonable online presence of industry press mentions and well-written market insights.
2. Ask for a detailed view of how the data is put together. The best analysts and firms are acutely aware of the accuracy of their data and both the pros and cons of their chosen methodology. I expect every party that is seriously interested in my research to grill me on methodology behind it.
3. Beware of big growth rate headlines. Markets go both up and down. I’m still yet to see one of the report factories putting out PR showing a market decline.
4. Buying market research should not be a single interaction. You are buying a report, but also included should also be analyst time and support to help you disseminate the information, ask questions, and mine the knowledge of the author. The best analysts I know are not just good at producing reports and PR, but as advisors to their customers. Avoid firms where analyst access is restricted or interaction is limited to an account manager or salesperson.
5. Question timelines. Good data and insight takes time to put together. Market research based on primary research (vendor or consumer) involves investment financially as well as established industry relationships. There are rarely shortcuts that can be made. Compiling a high-quality, detailed report on complex markets is not possible in a few weeks. Short timeline reports usually resort in low quality, mistake-laden research or a very expensive bookend.

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. F in West Virginia, who asked for programmable Lego robots for her special needs high school class. She reports, “We have been very busy learning about coding. My students have learned the hard way that you must follow ALL directions in order or your creation will not work. I get excited when they come in and show their classmates what they have done and what they have learned. When their creations run, they are so proud of themselves, and when they don’t, my students don’t get frustrated (which is a really big deal) —  they just look to see what they did wrong. Thank you for making learning exciting for my students and for building skills and confidence!”

First grade special education teacher Ms. M from North Carolina says of the math games we provided, “My students have a hard time grabbing these new math concepts, but I have learned that learning through play makes retention much easier. The students are showing signs of understanding and they are able to focus on the problem at hand. Some have even told me they did not want my help, that they wanted to try to figure it out themselves, now this blew me away. I am ever so grateful for your generosity with this project and this great new way for my kiddos to learn math concepts.”

The US Attorney’s Office wants to take millions of dollars and several replica cars as part of its investigation into their Cleveland owner’s for-profit addiction treatment companies, which submitted $49 million in Medicaid claims in 29 months of which $31 million was paid. The reproduction cars, which were used in Hollywood movies, include a 1981 DeLorean from “Back to the Future,” a 1959 Cadillac hearse from two “Ghostbusters” movies, and a Batmobile replica.

A California OB-GYN on the first day of his medical malpractice trial rushes to the aid of a prospective juror who is undergoing cardiac arrest, raising concerns that the doctor’s actions might bias jurors in his favor. More interestingly, James Nilja, MD is one of several former drummers for rock band The Offspring and is rumored to have suggested the band’s name. He parted ways with the band in 1987, with front man Dexter Holland explaining in a blog post that, “He was so intent on getting into medical school that he didn’t really even practice with us much, which is part of why he‘s not our drummer any more … I hope his patients don‘t find out that he once helped write a song called “Beheaded!” Here’s video of the now-doctor playing in the band in 1987.

In Case You Missed It

• News 3/30/18
• EPtalk by Dr. Jayne 3/29/18
• News 3/28/18
• Curbside Consult with Dr. Jayne 3/26/18
• HIStalk Interviews Nancy Ham, CEO, WebPT
• Monday Morning Update 3/26/18
• What I Wish I’d Known Before … Being Admitted to a Hospital or Being Seen in the ED

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

EPtalk by Dr. Jayne 3/29/18

The obnoxious post-HIMSS vendor behavior I mentioned last week is getting worse. One vendor was already harassing me, having left messages every day or two by both phone and email. After a week of this, one might assume that your potential sales lead is cold and give it up. This guy hasn’t gotten the message, though, and is now leaving messages that don’t even mention the company name. Maybe it’s intentional, like I will assume he’s someone I know and return the call, or maybe it’s just sloppy. But, “Dr. Jayne, it’s Dave. I’ve been trying to reach you. I’ll try again tomorrow if I don’t hear from you” isn’t terribly professional. I recognize the number from last week’s harassment and you’re not going to hear from me.

My suggestion for salespeople: if your lead seems cold, leave one last message and include who you are and what you have to offer, then give it a rest. “Hi, Dr. Jayne, it’s Dave Smith from HotVendor. You might remember speaking to us at HIMSS about our new retina-scanning drug inventory system. We’ve tried to reach you and I know you’re busy, so if you’d like to connect, you can reach me at 888-555-1212 or by email at DaveSmith@hotvendor.com and we thank you for your time.” That message is more likely to get filed for the next client I run into that needs your particular solution.

A few other vendors have called but all have left reasonable messages, so no complaints about those. Also, plenty of emails even from vendors I don’t remember talking to or visiting. Those are interesting, because I almost always visit their website to play the “what was I thinking” game to try to remember if they caught my eye with their advertising, booth presence, or product. Even with the website, sometimes I can’t figure out what a vendor really does. That always makes me chuckle, so it’s a good mood booster.

Speaking of websites, Mr. H mentioned the announcement of Canvas Medical entering the primary care EHR fray. I had mentioned them a few weeks ago, but not by name. I received a mailing from them pre-HIMSS, but they didn’t mention HIMSS and weren’t there. I thought the timing was odd and would have wanted to look at their product. I’ve checked their website a couple of times in the last few weeks because they did get my attention and found it not ready for prime time, with the blog page having several “lorem ipsum” type placeholders. It looks like they cleaned it up in preparation for yesterday’s actual launch, which is good, but makes me question why they did a direct mail piece directing users to the website if they weren’t ready to roll.

I pulled out the original mailing that I had filed in the “keep an eye out” category. I noticed that they use “EMR” rather than “EHR” to refer to their product. Not sure if that is intentional, but might be since it doesn’t look like they offer a patient portal or maybe they just don’t mention it. They’re up to six practices mentioned on the website,  but one is using the Medfusion portal (along with “non-secure email and Skype”), three appear to have no patient portal, one kicked me over to ihealthinterview.com, and the remaining practice doesn’t seem to have a website. The company is very small and I don’t see anything about certification, which makes it a no-go for many practices. They do offer a MIPS guarantee, stating “if you receive a negative adjustment, we will cover it,” but it’s not clear how they’re executing this. Having worked with a startup EHR that died a rapid death due to lack of certification, I wish them well.

Another item that reached the end of the line was the proposed merger between Providence St. Joseph Health and Ascension that would have created the largest hospital operator in the US seems to be over. It appears the organizations will work independently to restructure, feeling that a merger would have taken attention away from the need to restructure as health care deliver moves away from hospitals. Both systems also appear to want to continue to grow, with Ascension acquiring Chicago-based Presence Health earlier this month, even as its CEO told employees via video last week that it will focus on outpatient care and telemedicine.

Ascension has already slashed spending over the last couple of years and plans to save more money by “aligning its pay practice,” which I can tell you from experience at other health systems won’t involve bringing underpaid workers up to the level of their peers. The employee communications mentioned that executives have already taken pay cuts and hinted that employees would be asked to do the same. I touched base with one colleague in an IT-related department and people are already buffing their resumes.

I read with interest Mr. H’s comments on privacy and security and figuring out how much Facebook and Google know about us. I’m relatively “off the grid” despite my being immersed in the tech industry. The fact that I don’t use location services on my phone unless absolutely necessary and rarely identify where I am makes it trickier to know where I’ve been. Since I got new Internet service, my PC thinks it’s in Wisconsin for some reason, so that adds to the mystery as well. If Facebook really wanted to understand our preferences and make sure we saw marketing, maybe they’d give us features such as “hide posts about recipes even if they’re from people we like” and “hide pictures of abused animals.” I have a couple of people I dearly love, but they post so much in these two categories, I worry that I’ll miss something important from them.

Speaking of missing something important, I had the unsettling experience this week of learning somewhat via Facebook that a colleague had passed away. Someone had posted earlier in an email group that we’re part of that he had no-showed a meeting on Monday, which was unusual for him, and wondered if anyone had heard from him. I had corresponded with him last month about an upcoming meeting, but hadn’t heard anything since. One group member had met with him on Friday and things seemed fine. A few hours later, another email popped up with a screenshot from his Facebook page, where someone posted “Can’t believe the news, RIP.” Since he joined the gig economy as an independent contractor, it’s not like there was a corporate office that would notify his customers, so I guess finding out this way makes sense. Emerging technologies and scattered social networks make for some uncharted etiquette waters at times. My condolences to his loved ones, wherever they may be.

Email Dr. Jayne.

News 3/28/18

Top News

FDA will expand its digital health pre-certification pilot program by the end of the year, taking on more companies beyond the 10 current participants.

FDA says it regrets labeling the project as a “pilot” since it is more of a co-development project that will allow app vendors who earn FDA’s pre-certification to fast-track getting their products to market. 

Reader Comments

From Headcounter: “Re: your ‘People’ section. Today, 100 percent of those listed are men and your overall ration is about nine to one male. I can’t give you a pass any longer. Many women are powerful in this field, but for some reason don’t get the same recognition. Maybe your criteria are male-centric and you need to adjust them?” As the messenger you’ve just shot, allow me to explain my criteria for reporting job changes: (a) full-time VP positions and above, and (b) either the hiring company is one I’ve heard of or the new hire has enough industry history so that readers will likely know him or her (few readers would care about a health IT company hiring an HR VP from a local bank). My sources of information are press releases, someone notifying me directly, or LinkedIn if the person is connected to me. Any gender imbalance you see in the People section reflects the industry, not my coverage of it. That solution lives far above my pay grade.

HIStalk Announcements and Requests

My favorite response so far to “What I Wish I’d Known Before … Retiring or Career Downsizing” notes the impact of “an insufferable department director and an incompetent CIO.” What say you on the topic of getting off the career treadmill?

I’m having a post-HIMSS swag fest in wearing a great Cantata Health sweatshirt and sampling Ellkay flavored honey (the chocolate is way dangerous, but I wouldn’t kick the cinnamon, vanilla, or Himalayan salt versions out of the kitchen either).

In another post-HIMSS moment, I now know what Brianne and Lorre were doing with the Polaroid cameras in our booth – inviting visitors to have their photo taken with the Smokin’ Doc and to write their messages to me on the result. Thanks to the 100 or so folks who participated. Lorre sent me the album in which she mounted the photos in and I’m pretty sure I’ll page through it often since this hobby (sitting alone trying to fill an empty laptop screen with something interesting while remaining anonymous) makes it easy to feel disconnected and to forget that actual people are on the other end. Now I can see them.

Here’s a fun fact told to me by a guy who has used repeated “trial subscriptions” to SiriusXM to get years of service for free (which I’m not advocating). Email servers usually ignore periods to the left of the @ sign, so you can sign up with “thisisme@myserver.com” and then sign up again later with “thisis.me@myserver.com” in looking like a new subscriber while still receiving the confirmation emails.

A fun item I found: Pushbullet, an app and Chrome extension (versions are also available for Firefox and Windows) that automatically mirror your phone’s notifications and SMS messages to your computer and also let you exchange text messages, links, and files right from your computer’s browser to a phone. I didn’t know I needed it as a minimal phone user, but since I’m on Android, I kind of do.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Announcements and Implementations

Gay dating app Grindr will send its male users reminders to get an HIV test every 3-6 months, give them directions to the nearest testing site and allow non-profit testing centers to advertise their services at no charge.

Apple announces a new 9.7” IPad that will start at $329 for the 32 GB model. It lacks some of the advanced features of the Pro, but still has the Retina display, the A10 Fusion chip, and Apple Pencil support. It appears to be targeted to schools since it was announced at an education conference and schools get modest discounts. The IPad Mini 4 — like the clearly obsolete Macbook Air — makes even less sense than it did before since its display is just 7.9 inches and it costs $70 more, although with 128 GB of memory.

Primary care technology vendor Canvas Medical announces GA of its EHR, claiming that its autocomplete-powered documentation is three times faster than the top three EHRs, requires 80 percent fewer clicks, and eliminates the need for separate population health management software. Pricing starts at $599 per month. CEO Andrew Hines used to work for Practice Fusion. The company appears to have about a dozen employees, which isn’t many when you consider ongoing support, further development, and keeping all those bosses of non-concierge doctors (insurers and the government) happy. Cascade Family Practice (WA) was quoted in the announcement, but I notice that its patient portal is still Athenahealth.

Privacy and Security

A fascinating article describes how scammers make a fortune using Facebook (and so does Facebook) by using Facebook’s targeting software to push affiliate ads based on location and language, often buying phony Facebook accounts to keep the ads going. The king scammer — a 31-year-old whose dubious career accomplishments have made him one of Poland’s richest people at a net worth of $180 million (and a billboard purchaser, above) — says Facebook sends a mixed message by claiming to shut down suspicious accounts while it also sends company reps to scammer conferences to encourage them to buy more ads. He admits that affiliates – companies that pay him a percentage of sales when his ad for their product is clicked — are stealing from the poorest people, but says the real problem is a capitalistic society that is based on convincing people to buy things they don’t need. His next idea is creating a cryptocurrency that will turn his business into a billion-dollar company.

I don’t know who Dylan Curran is, but click these links he provided in Twitter to see just how much Facebook and Google know about you:

• https://www.google.com/maps/timeline?pb (every place you’ve been with your phone turned on).
• https://myactivity.google.com/myactivity (your search history from every device combined).
  https://adssettings.google.com/authenticated (your profile as provided to advertisers).
• https://www.youtube.com/feed/history/search_history (every YouTube search you’ve ever performed).
• https://takeout.google.com/settings/takeout (where you can download your entire Google history). Dylan’s 5.5 GB file contained bookmarks, emails (including deleted ones), contacts, Google Drive files (including deleted ones), photos taken, calendar, businesses from which goods were purchased and the items bought, websites create, phones owned, pages shared, and how many steps he took each day.
• Facebook also offers a download that includes every message sent, files sent or received, phone contacts, audio messages sent or received, a list of topics it thinks you’re interested in based on your Facebook interaction.
• Windows 10 enables by default tracking location, installed apps, when the apps were used, access to the webcam and microphone, emails, calendar, call history, files downloaded, photos and videos, and search history.

The Dallas paper profiles the regional security monitoring center of Blue Cross Blue Shield of IL, MT, NM, OK, and TX. The 200-analyst, 24×7 center looks for foreign access and unusual member activity. It’s run by SVP/CISO Kevin Charest, PhD, who held a similar job with UnitedHealth Group and was CISO of HHS. He was also previously a VP of Greenway Medical and a US Army captain. 

Finger Lakes Health (NY) pays an unspecified sum to to bring its systems back online after a week of ransomware-caused downtime.

Other

The CFO of Medical Center Health System (TX) blames its credit downgrade to a worsening local economy and the hospital’s Cerner implementation, which he says “has really hurt us from an accounts receivable standpoint.” The previous CFO attributed the hospital’s 2017 bond downgrade to the $55 million it spent on Cerner.

A poll finds that high costs caused 40 percent of Americans to skip doctor visits, prescribed tests, or treatments in the past year. Around 30 percent said they had to choose whether to spend their money on medical bills or on necessities such as food, heating, or housing, while respondents who faced with healthcare expenses used up their savings (36 percent), borrowed money (32 percent) or saved less (41 percent). Half said the were billed for services they thought their insurance covered and one-fourth of respondents had a medical bill turned over to a collections agency.

NC-based mental and behavioral services managed care provider Cardinal Innovations Healthcare sues former CEO Richard Topping for the $1.68 million he convinced the organization’s board to pay him in the severance agreement he drew up himself. Cardinal’s investigator also claims that former CIO Pete Murphy committed wrongdoing by helping Topping download 1.5 GB of confidential company information a few days before he was fired. The two were apparently planning to launch a privately backed competitor to Cardinal. “I can’t wait until we’re rich,” Murphy said in an email to Topping. The other fired executives who received severance were Murphy ($740,000), the COO ($690,000), and the chief medical officer ($684,000). Topping and Murphy have since started the DC-based Shao, described on LinkedIn as “a technology partnership between health plans and telecom carriers to provide plan members with digital connectivity and the tools to maximize that access for better health and wellness.” The most interesting aspect of this is that fired CEO Topping has impeccable credentials – he earned a JD degree, an MPH from Harvard, was a judge advocate in the US Army, served as legal counsel for Brigham and Women’s Center for Bioethics, and was a US Department of Justice trial attorney.

Belgium-based Materalise earns FDA approval for its 3D printing software that creates anatomical models for planning surgeries.

This offshore market research company’s $4,450 report predicts “incredible” (7.3 percent – is that incredible?) growth for the LIS market, although one might question its qualifications even beyond the fractured English — it lists products from McKesson (sold to Allscripts last year) and Eclipsys (sold to Allscripts in 2010 – Eclipsys had acquired SysWare in 2006 but its LIS seems to be defunct). You get the feeling that the report won’t actually be written until someone orders a copy.

A Brigham and Women’s ICU doctor observes in a New York Times article that patient end-of-life wishes are often not respected because clinicians don’t see them in the moment of need. Reasons: the advance directives are buried in the EHR progress notes and lack of interoperability means that the preferences won’t be seen if the patient falls ill away from home or after transfer to a nursing home. The author likes the idea of patients being able to maintain their own advance care planning documentation on a smartphone app, but wishes that “the EHR isn’t just a clunky online version of a paper chart but actually a tool to help us do our jobs better.”

A small interview study of patient portal users finds that two-thirds of them viewed test results that did not contain an explanation from their doctor, triggering frantic phone calls (sometimes after office hours) and online searches as the patients tried to get more information. The authors conclude that just posting test results on a patient portal without context isn’t adequate. A Kaiser Heath News article describes an internist who checked her husband’s patient portal with his permission and found from it that he had widespread metastatic cancer, after which she kept rebooting her computer and rechecking it in disbelief (he’s OK now).

Sometimes I run across bizarre items that earn the Weird News Andy seal of approval even though WNA didn’t send them to me. Here’s one: surgeons in India determine that a woman’s eye and nose pain are being caused by the wriggling of a 2.5 inch worm lodged right behind her eye, which they remove via nasal surgery. Larvae of the Lua Lua worm (also known as the African eye worm) are spread by biting flies and live under human skin. You can thank me later for not including the BJM Case Reports photos.

Sponsor Updates

• Boston Software System publishes a white paper titled “EHR Migration Guide.”
• Solutionreach integrates its patient relationship management system with Epic and adds its app to Epic’s App Orchard.
• CSI Healthcare IT employees volunteer with Habitat for Humanity as part of its Gives Back program.
• The Sequoia Project re-elects Surescripts Chief Administrative, Legal, and Privacy Officer Paul Uhrig to its board.
• Fortified Health Security partners with Beach Health System to strengthen its cybersecurity program.
• HealthcareNow Radio interviews Aprima COO Neil Simon.
• Chiropractic software vendor EZBIS will integrate Ability Network’s all-payer RCM application into its practice management system.
• Optimum Healthcare IT publishes an infographic titled “EHR Trends – Usage and Adoption.”
• CenTrak empowers IoT solutions in the Australian healthcare sector.
• CTG publishes a new case study, “Inova Health System Relies on CTG for Post-Implementation Helpdesk Solution in a Production Environment.”
• Heather Espino (Centura Health) joins Culbert Healthcare Solutions as Epic manager.
• Dignity Health features Docent Health on the cover of its Hello Health magazine.
• Meditech publishes a case study of patient engagement at Ontario Shores Centre for Mental Health Sciences, which uses Meditech’s patient portal to improve recovery, improve patient self-assessment scores, and reduce appointment no-shows.

Blog Posts

• Keep Relationships from Going Stale (Access)
• Evolve Beyond Museum Relics in Your Practice (AdvancedMD)
• Make EPCS Compliance Easier, Protect Yourself and Your Patients (Aprima)
• How Digital Health Succeeds and Fails – Datica at SXSW (Datica)
• Refreshing Reads: 4 must-read blogs to help you avoid clinician burnout (Meditech)
• CarePort’s New Digs: Come Grow With Us (CarePort)
• Healthcare Advanced Computer Power: Robotics, Medical Imaging, and More (CareSync)
• HIMSS18: Wrap-Up and Charity Raffle Winners (Clinical Architecture)
• 3 Things Healthcare Organizations Can Outsource Now for Lower Costs, Better Care (Conduent Health)
• Meditations on HIMSS18 (Diameter Health)
• How Hospitals are Innovating and Adapting for the Future (Dimensional Insight)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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