Monday Morning Update 3/14/16

Top News

The Senate’s HELP committee passes S.1101, the Medical Electronic Data Technology Enhancement for Consumers Health Act (MEDTECH), which exempts several types of software from the FDA’s oversight as medical devices. The bill would prohibit the FDA from regulating EHRs, provider administrative systems, lifestyle apps, clinical lab testing software, and clinical decision support systems that don’t involve medical images or physiologic monitors.

Reader Comments

From Blue Cheer: “Re: the PR firm’s case study on producing the HIMSS presentation of Jonathan Bush and John Halamka. The link you posted doesn’t work.” It appears the PR company pulled down the self-congratulatory article, but you can read “HIMSS 2016: The Power of a Well-Crafted Keynote” here via Google’s cache. It seems like glossy over-preparation using expensive PR people and the Athenahealth communications team, but at least J&J must have been well prepared.

From ac360: “Re: Community Health Systems. The newly promoted SVP/CIO appears to have been fired from EMC in 2002 for falsifying sales to earn bonuses and billing EMC work from a company he himself owned and not turning the money over to EMC. CHS must not have done much of a background check.” I’ll decline to comment since I don’t know anything other than what the 2002 WSJ article says. Firing someone  – like filing a lawsuit that is later dropped — carries a minimal burden of proof and deprives interested parties of the chance to hear both sides of the story.

From Roy G. Biv: “Re: QuadraMed layoff. It was a barely double-digit RIF in R&D. Still, the company is losing customers and losing ground, so you might assume that a lower R&D priority signals a lack of aspiration to market relevance.”

From Long-Suffering Epic Director: “Re: Epic support problems. Epic 2015 is not live yet and we’re spending more time supporting it than Production. We have to drop everything because someone broke something, frequently when we loaded an urgent patch that would fix something. Frontline support wasn’t lacking in initiative 10 years ago. The people Judy and Carl have delegated to us in recent years seem more arrogant and less knowledgeable. We don’t get discussion about the problem and what can be done to fix it – we get speculation of what might be possible in a future release and a mélange of thoughts about what’s available in Model, what Kaiser does, and why can’t we be more like Model. What really sucks is that’s there is no real option. We’re dealing with a monopoly in this industry and the monopoly knows it.”

HIStalk Announcements and Requests

It’s a toss-up whether employers get their money’s worth in sending people to the HIMSS conference. New poll to your right or here: what kind of keynote speaker would you most like to see at the conference? Vote and then click the poll’s Comments link to suggest specific people or to add a category that I missed.

From another poll I ran, two-thirds of respondents say their companies didn’t make any sales in the past year as a result of exhibiting at HIMSS15. I used to cross-reference the current year’s list of exhibitors with the one from the previous conference to identity the exhibitors that didn’t think it was worth it, that went out of business, or that were acquired and no longer exist under their previous name.

Welcome to new HIStalk Platinum Sponsor TelmedIQ. The Seattle-based company offers a secure healthcare communications hub that brings together physicians, nurses, care administrators, and clinical technologies to improve patient care coordination. TelmedIQ simplifies clinician workflow through real-time messaging, quick access to contacts and groups, and the ability to set up workflows so that messages automatically go to the right person at the right time. It integrates with EHRs, on-call scheduling systems, and other systems to make clinical information available with just a swipe and a tap. Customers can replace “page and pray” pagers by turning any Android or iOS device into a secure, two-way mobile pager that can handle image files, audio, and video messages to individual users or to groups. Practices can take also advantage of a cloud-based medical answering service for after-hours coverage. The company offers a white paper on best practices for mobile secure text messaging. Thanks to TelmedIQ for supporting HIStalk.

Only 75 folks signed my petition asking HIMSS to adopt an anti-harassment policy for HIMSS17, so I’ll accept that as an endorsement of the status quo of self-policing. I’m surprised, given the significant number of attendees and poll respondents who expressed discomfort at the actions of others at HIMSS16, but I will defer to the majority.

A bunch of people have emailed me to say that their entire teams were sick after the HIMSS conference, usually complaining of sore throat, congestion, cough, and fatigue. Conferences offer the double whammy of breathing recycled airplane air and being squeezed in for a week with glad-handing strangers. It’s like putting your kid in a new daycare, where the herd carries less-defended bugs. All large conferences have this problem, although Las Vegas is probably the worst offender since attendees are forced to mingle with endless casino patrons just to get to and from conference events. There’s no solution other than washing your hands often, carrying and using hand sanitizer, and drinking a lot more water than you probably did there (especially given what the concession vendors charge for it). The “fist bump instead of a handshake” thing from the swine flu outbreak a few years ago was a good idea from a microbial standpoint, but didn’t catch on because it looks like a carefully groomed hipness affectation.

Monday is not just the usual Pi Day of March 14 (3.14) – it’s also correct to five digits at 3.14.16, although maybe that’s not as impressive as March 14, 2015 at 9:26:53.

I get a bit annoyed when I’m looking up someone’s LinkedIn profile to get a photo or previous employment for something I’m writing and they use LinkedIn’s messaging function to email me, “I saw that you looked at my profile. Can I help you?” like they caught me sitting on the hood of their car or something. If that bugs you, too, go to LinkedIn’s Manage Privacy & Settings, click the link labeled “Select what others see when you’ve viewed their profile,” and click the last option to go into complete private mode.

People are griping that Hollywood Presbyterian Medical Center was wrong to pay ransomware hackers $17,000 because that will encourage more such activity, but I disagree. It’s exactly like settling a nuisance lawsuit, which hospitals do all the time – if you can walk away unscathed for 1/100 of the cost of taking the risk that you can prove yourself right, that could be a good business decision, especially since patients were being affected. Some thoughts:

1. The hospital’s systems had been down for more than a week, making it obvious that it couldn’t simply restore backups. Plus, the clock was ticking — ransomware usually sets a short time limit to pay up before the data is permanently destroyed and the amount increases every day until then. It’s a brilliant way to immediately monetize cyberhacking in a way that can scale infinitely.
2. The hospital’s lack of a technical defense was moot by then – no amount of 20-20 hindsight was going to get their systems back. They had only one option. It’s like losing a storage system and then finding that your backups can’t be restored, except in this case, the backups were available, but just not for free.
3. I doubt that the ransomware specifically targets hospitals, although I would be interested in how the software determines how much ransom to charge – maybe it’s based on the number of servers it finds on the network or something like that. No individual PC user would pay $17,000, so either the malware auto-detects the extent of infrastructure or the hacker manually steps in to determine the required toll.
4. The hospital is also darned lucky that the anonymous hackers didn’t just take their money and walk away without restoring its systems.
5. If the hospital didn’t completely rebuild its systems and networks, the hackers probably left themselves a back door by which to turn their one-time extortion license into a recurring revenue stream.
6. For every public report of ransom demands being paid, at least 100 companies keep it quiet since it’s bad PR and maybe even illegal to be paying cybercriminals. The only reason the handful of high-profile examples came out was because the affected organizations had to explain to their public customers why their physical services were limited. We would never know if a hospital was hit by ransomware and simply paid up quickly and moved on, just like we don’t know how many of them routinely pay off frivolous nuisance lawsuits.
7. Law enforcement isn’t going to be much help. They won’t be able to identify the hackers who are likely outside of US jurisdiction anyway and the amount of money demanded is too low to excite them.
8. Cybercriminals are getting smarter in distributing their malicious email attachments and Office macros in emails that include the personal details of the recipient, often getting even cautious users to open attachments that claim to be a Fedex shipping receipt or an invoice that includes their name or address in the email body. When the payout is as high as the $17,000 that Hollywood Presbyterian paid, it is economically feasible for hackers to target specific hospital employees, Google their personal details, and email them directly with convincing emails. It’s no longer safe to assume that malware-containing emails will be laughably poorly composed with misspellings, fractured English, and obvious scam themes involving Nigerian princes or big inheritances. Ransomware could conceivably kill conventional email in which anyone who knows an email address can send anything they want to the recipient.
9. Antivirus software vendors seem to struggle to keep up with malware variants. I was thinking that an enterprise solution might be to move all attachment-containing emails from untrusted senders (as defined by users) to a quarantine. Otherwise, once the email hits someone’s inbox, it’s probably going to be opened. A big challenge, though, is that anyone checking their personal email at work via a browser is bypassing much of the IT protective infrastructure. Ransomware can also be spread in from just visiting an infected website, perhaps leading us back to those early Internet days when IT departments used Websense or other filtering tools to block unapproved sites by default.
10. Health systems should be huddling together right now to develop best industry practices for combatting ransomware, including ways to make sure that backups and mirrored data copies aren’t infected. We’re going to see a lot of ransomware attacks in 2016.

More members of the Greatest Musical Generation have left us, with the fifth Beatle George Martin and the amazing Keith Emerson of The Nice and Emerson, Lake, and Palmer passing away last week.

Mr. Lincheck sent photos of the robotics makerspace he created in the library using the Lego Mindstorms kit we provided in funding his DonorsChoose grant request. He held a box-unpacking ceremony when it arrived, adding that the students “sqealed and oooed” with every flap that was opened and have since built several robotics items and “do not want to stop.” 

Also checking in was Ms. Norman from Utah, who is using the monitor and wall mount we provided to present students with information about graduation requirements, health screenings, and grades in multiple languages so she can “communicate to those otherwise that might have felt unappreciated or ignored.”

Last Week’s Most Interesting News

• McKesson sells its ambulatory PM/EHR products to E-MDs.
• Aetna lays off a significant percentage of employees working on iTriage and merges that business unit with its WellMatch business.
• A study finds that doctors spend 785 hours per year on quality measure reporting.
• Ambry Genetics makes the de-identified genetic data of 10,000 cancer patients available to researchers and decries the data-hoarding practices of its genetic testing competitors.
• The VA says it is reassessing its previous decision to stick with its self-developed VistA system, saying previous IT management failed to develop a sound strategic plan.
• A study finds that telemonitoring of discharged CHF patients didn’t reduce readmissions.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Acquisitions, Funding, Business, and Stock

Cleveland’s Global Center for Health Innovation, a taxpayer-funded project intended to to boost tourism in which HIMSS is the major tenant, hires an outside firm to try to fill the 15 percent of its space that is vacant. The new plan calls for the money-losing building to be used as collaboration space between providers and vendors. The Center’s upcoming events schedule lists only two short lectures.

UnitedHealthcare launches a startup health insurance company called Harken Health, which focuses on individual coverage with unlimited, no-co-pay visits to PCPs who practice in the health centers it owns. Harken Health offers its policies on Healthcare.gov to residents of Atlanta and Chicago and plans to expand. It offers health coaching and classes and says healthcare needs fixed because “For far too long, the healthcare system has valued efficiency over empathy.” It sort of feels like McDonald’s opening a farm-to-table fine dining restaurant in a carefully crafted marketing ploy intended to steal business back from nimbler and more creative competitors, but we’ll see where it goes.

Government and Politics

Reuters names its top global innovators in government, with HHS taking fourth place overall and earning the top spot among the six US winners because of the contributions of its research arms (NIH, CDC, FDA, and the Public Health Service). The VA was #12.

Oracle sues HHS, demanding that it investigate the failed Cover Oregon insurance exchange, which Oracle sued for unpaid bills and by whom it was sued in turn for creating a flawed exchange. The company says the state’s actions are politically motivated.

Privacy and Security

Four PCs at Canada’s Ottawa Hospital are infected by what sounds like ransomware. The hospital was apparently successfully in simply reformatting the hard drives of the infected devices.

Doctors treating the Germanwings co-pilot who intentionally crashed a passenger jet in the French Alps thought he was potentially dangerous due to his long history of psychiatric illness, but decided they could get in trouble for reporting him under Germany’s strict privacy laws. Doctors in general blame their reluctance to alert authorities on lack of a formal definition of “imminent danger” and “threat to public safety.”

Other

The folks from our nearby HIMSS conference booth neighbors Access sent over a photo of themselves temporarily kidnapping my standee for a photo op. Lorre says a lot of people dropped by our micro-booth to pose for selfies with the smoking doctor cutout, which amuses me in thinking of otherwise responsible adults beaming with their arms around cardboard.

A physician’s op-ed piece in the New York Times describes the feeling of reading the obituaries of patients who got so little of her time as a busy hospital resident, allowing her to see them as the people they were before they became patients. It made me wonder if one of the many standard intake and history forms shouldn’t ask more questions about the person filling them out – their accomplishments, aspirations, relationships, and values. The trouble would be that providers aren’t paid to read them, so they probably wouldn’t.

I’ll predict that we will hear a great deal this year about self-assessment health surveys. Consider the SF-36 health survey form, which asks people questions about their perceived level of health in covering areas such as their activity level, pain, and emotional issues. Insurers and providers need a non-encounter based early warning system for problems in patients whose health they are financially rewarded for maintaining. They could learn a great deal by asking these questions 2-4 times per year. Smartphone apps — instead of obsessing with conveniently measurable but nearly medically worthless data points such as steps walked — could administer an SF-36 type quiz at predetermined intervals to establish a baseline, then alert the user and their provider that their self-perceived health is slipping. Maybe the user automatically gets a coupon for a free Starbucks coffee or something like that for taking the time to give their provider an update. Creating such an app would be very easy, with little R&D required and no FDA issues to address. Patients know their health better than any EHR or provider, so it’s ridiculous to ignore their perceptions or to expect them to articulate them in a rushed office visit. This information would be a lot more useful than patient satisfaction surveys that end up being gripe sessions about parking lots, receptionist personality, and waiting rooms. 

Sponsor Updates

• TierPoint hosts a March Madness event March 18 in Charlotte, NC.
• Valence Health offers the business and technology roadmap it presented for provider-led health plan startups at the Provider-Led Health Plan Forum.
• Verisk Health will exhibit at Employee Healthcare Conference West March 16-18 in San Diego.
• Huron Consulting Group will exhibit and speak at the 2016 ACHE Congress on Healthcare Leadership March 14-17 in Chicago.
• WeiserMazars CEO Victor Wahba offers advice for young professionals.

Blog Posts

• OTC = Safe? Why We Need to Ponder Pediatric Dosing Issues, Part 1 (First Databank)
• Monthly Melton: Unexpected (T-System)
• Female Leaders at VitalWare Share on International Women’s Day (VitalWare)
• HIMSS16 was a hit. (Voalte)
• Avoiding CMS Penalties – and Capturing New Revenue Streams – Through Proactive Patient Outreach (West)
• How Social Services and Healthcare are Linked (Xerox)
• HIMSS Conference Takeaways (ZirMed)
• The Secrets to Deploying, Updating, and Maintaining Evidence-based Guidance (Zynx Health)
• Adopting – and Adapting – to the CJR Payment Model, Part 1: Before the Inpatient Stay (XG Health Solutions)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

News 3/11/16

Top News

As reported here as a reader rumor on Tuesday, McKesson sells its ambulatory PM/EHR products to E-MDs, including Practice Choice, Medisoft, Medisoft Clinical, Lytec, Lytec MD, and Practice Partner. Marlin Equity Partners, which acquired E-MDs in March 2015 and AdvancedMD in August 2015, says the newly acquired products will provide economy of scale that will allow the company to extend its brand.

McKesson acquired Lytec and Medisoft in its 2006 acquisition of Per-Se, the same year it acquired RelayHealth. It acquired Practice Partner in 2007. McKesson has been rumored to be shopping its Enterprise Information Solutions business, which includes Paragon, to potential buyers.

Reader Comments

From Busted Flush: “Re: HIMSS. I’m curious if you’ve heard from your readers that they contracted a cold or flu after the conference. I have a nasty cold that’s now in Day 3 and at least 3-4 people have told me they’re sick, too. Hundreds of handshakes, close proximity, and exchanging money at the concession stands may have exposed a significant number of attendees.” I’ve been annoyingly sick since the conference ended, with congestion, achy fatigue, a slightly sore throat, and frequent coughing and sneezing. Anybody else?

From Coolio: “Re: HIMSS rumors. Biggest one I heard was that IBM offered $65 billion to acquire Cerner.” That seems highly unlikely given that Cerner’s market cap is only $18 billion. On the other hand, IBM seems willing to overpay for anything that makes Watson look real.

From Pickle Loaf: “Re: EHR vendors signing an interoperability pledge at the HIMSS conference. Why didn’t you report that?” They signed a pledge, not a contract. The same vendors would also have signed a statement that they already aren’t practicing information blocking. It’s a little late to be seeking voluntary compliance after the horse carrying the HITECH billions has already left the taxpayer barn.

From Brandon: “Re: TrakCare. I just heard that a rehab facility in Saudi Arabia achieved EMRAM Stage 6. I haven’t run across this product in 15 years as a CIO and wondered if anyone knows about it?” InterSystems Trakcare is used in several countries, the US not being among them. InterSystems acquired Australia-based TrakHealth in 2007. It recently won Best in KLAS for non-US EHRs.

From Flaming Dirigible: “Re: HIMSS keynotes. If HIMSS decided to ever truly think out of the box and invite an interesting speaker like Mike Rowe (the ‘Dirty Jobs’ guy) to do one of their keynotes, I might actually attend. I’ve been going to HIMSS for nearly 15 years and just don’t care about seeing yet another CEO or politician drone on and on.”

From Four Toppled Pillars: “Re: QuadraMed. A large reduction in force happened today.” Unverified. Googling “QuadraMed + layoff” returns 2,570 hits, however, so it wouldn’t be particularly shocking. I doubt sales of QCPR, standalone scheduling systems, Affinity Revenue Cycle, or even its EMPI have been brisk.

Sexual Harassment at the HIMSS Conference

Results of my poll asking whether HIMSS conference attendees experienced unwanted sexual overtures or comments that made them uncomfortable were as follows, with 274 responses:

• 14 percent of male respondents said yes.
• 42 percent of female respondents said yes.
• Overall, 22 percent of respondents say they were made uncomfortable at the conference.

I received several comments about the poll from female attendees. One says she was appalled at the “rampant misogyny” on display. I heard stories of (married) male executives aggressively pursuing female attendees, another offering to send nude photos of himself, and another who complained that he can’t stand listening to female presenters.

Obviously the conference has a problem with making all of its attendees feel welcome and safe in a professional environment. It also seems that the majority of complaints involve vendor executives.

What, if anything, should HIMSS do about it? My suggestions, assuming that HIMSS either hasn’t done any of the following or hasn’t done a good job of promoting its efforts:

• Publish a zero-tolerance Code of Conduct anti-harassment policy for HIMSS conference participants that includes not just gender, but sexual orientation, appearance, age, race, religion, and disability. This policy should cover all official venues – the convention center, hotels, and all sanctioned events. You agree to the policy when you register to attend or exhibit.
• Define the activities that are not permissible – verbal comments relating to the above, making suggestive remarks, and showing unwanted sexual attention, for example.
• Prohibit exhibitors from using sexually related images or suggestive attire as part of the exhibitor policy.
• Allow attendees to report incidents anonymously, naming names, and have someone available to investigate their reports promptly.
• Warn those for whom sufficient evidence exists that they have violated the Code of Conduct, then expel them on the second verified report. 
• Record complaints in a permanent database to identify repeat offenders.
• Allow attendees who feel unsafe or uncomfortable to easily request help from HIMSS, conference security, or hotel security. We’re healthcare IT people – surely there’s an app out there that can offers one-click requests for help.
• Offer easy access to safe rides and physical escorts when indicated.

It’s been said that the people who roll their eyes at policies like these probably aren’t the ones who make them necessary. Hundreds of conferences have addressed the issue directly despite hesitation about potential legal issues, so surely there’s a wealth of resources for HIMSS to use in ensuring a conference environment where everyone is comfortable. Just setting expectations would be a great start.

If you agree with these ideas, sign and promote my petition to HIMSS. I didn’t include Joyce Lofstrom’s email address since it’s not really fair to swamp her inbox every time someone signs the petition, but I’ll make sure the results are known. I’ll also report back if HIMSS has had something already in the works, which is entirely possible since they’re pretty sharp.

HIStalk Announcements and Requests

Ms. Yoder from Texas reports that her kindergartners are “the most excited they have ever been since receiving our DonorsChoose package … The Read and Solve Word Problem center has been the most effective. I use it when I pull small groups during M.A.T.H for my students who are struggling with addition and subtraction. The students being able to have a hands-on center to work on this concept has increased their understanding and allowed them to master it. The Unlock It center has been very popular as well. The resources being donated to our class has given my students a real world view of how generous people can be.”

Epic Reader donated $100 to my DonorsChoose project, which with matching funds provided math manipulatives for the Canton, TX first graders of Mrs. Boggs.

I went to the county health department today to get travel immunizations. It took two hours in what could have been done in maybe 45 minutes, most of it because the employees were baffled by their new EClinicalWorks system. Checkout took 30 minutes even though nobody else was present, so I can imagine the line if they were actually busy. They had put up a sign warning that they will close 45-60 minutes early if they’ve been busy because they have to catch up in the system before going home. I suspect they didn’t train their people well, and not to perpetuate stereotypes, they were mostly older folks who said they were using their first EHR after converting from paper. The nurse apologized for staring at the screen to type instead of looking at me, but she did OK.

This week on HIStalk Practice: Morehouse School of Medicine taps Dominic Mack, MD to lead its National Center for Primary Care. IOC selects GE Healthcare health IT for 2016 Rio Games. Summit Medical Group rolls out MModal’s new outpatient CDI tools. Allscripts integrates AssistRx’s e-prescribing software into its ambulatory offerings. Florida Orthopaedic Institute Business Director Larry Bronikowski offers best practices for health IT adoption. Physicians and IT professionals take top salary spots in annual Glassdoor list. Telemedicine expansion bill heads to Indiana governor’s desk. Health2047 CEO Doug Given, MD describes the AMA-backed organization’s plans to tackle physician pain points with technology.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Sales

New York’s Care Transitions program will use Netsmart’s CareManager for care coordination and care management.

People

GE Healthcare IT names Charles Koontz (CSRA) as president and CEO. He will also serve as GE Healthcare’s chief digital officer. Predecessor Jan De Witte will leave the company.

LifeImage names Frank Brilliant (Wolters Kluwer) as SVP of sales and partnerships.

Microsoft Kinect-powered tele-rehabilitation software vendor Reflexion Health promotes interim CEO Joseph Smith, MD, PhD to the permanent role.

Announcements and Implementations

GE Healthcare’s Centricity Practice Solution is chosen as the official EHR of the Rio 2016 Olympic Games.

Memorial Sloan Kettering’s surgery center goes live with Versus RTLS to monitor patient flow through 12 ORs via Glance-and-Go whiteboards with bi-directional Epic OpTime integration.

Ochsner Baptist Medical Center (LA) goes live with PeriGen’s PeriCALM clinical decision support system.

Government and Politics

The VA awards 21 IT infrastructure upgrade contracts totaling $22.3 billion.

Technology

A Cambridge, MA startup begins shipping a $200 seizure-warning wristband containing sensors for body heat, movement, and skin conductivity following a IndieGoGo fundraising campaign last year that raised $780,000. The wristband, which buzzes to warn the wearer of an impending seizure, can also measure stress. A researcher-only version offers real-time patient monitoring. The MIT scientist who co-founded the company also co-founded a startup that detects emotion by reading a person’s facial expressions via their smartphone.

Other

Doctors at Australia’s Port Augusta Hospital write a letter to its CEO demanding that its $315 million EPAS system (provided by Allscripts) be scrapped because it is endangering patients. They cite a case in which employees failed to notice that a woman who had just given birth was bleeding because they were “preoccupied with data entry.”  The doctors also claim that log-in takes up to seven minutes, nurses mark meds as given but they still show up as due, and long-discharged patients still display as being in the waiting room. The doctors conclude that while their previous complaints were dismissed as “resisting change,’ nearly all of them use EHRs in their private practices 100 percent of the time and would like EPAS replaced  “with something much better.” Doctors at Repatriation General Hospital complained last year that EPAS cut their productivity by 50 percent. SA Health says rollouts will continue, including at the new Royal Adelaide Hospital, due to open in November. 

Nordic made a short video of HIStalkapalooza that will probably take you back a few days. Looks like our Elvis had some dance moves, although as in his 1957 Ed Sullivan appearance, he’s shown only from the waist up.

A study finds that American workers rank dead last of 18 industrial nations in using technology to solve problems, with 80 percent of us unable to figure out an error caused by transferring two-column spreadsheet data to a bar graph. Experts note that the United States is the only country where people aren’t embarrassed to say they’re not good at math.

HIMSS sent a link to its HIMSS16 conference evaluation, which was really more like an on-screen focus group given that it contained 10 pages packed with questions. I’d like to see the metric of how many people clicked the link to start the survey but who then bailed out before completing it (I can say with confidence there was at least one).

HIMSS provides a touching story of homeless US Navy veteran Kevin Phillips (center, above), sponsored to attend the HIMSS conference by the Gateway chapter. A local group helped him buy clothes appropriate for a professional conference, but an unexpected airline change on the second leg of his flight placed him on a 2 a.m. connection that required a $25 checked bag fee that he didn’t have (he had only $11 in his pocket, just enough for the hotel shuttle). He couldn’t get help, so he started walking from Chicago back home to Fort Wayne, IN. Members of the Chicago Police Department picked him up, chipped in to pay his baggage fee, and gave him a ride back to the airport. He made it to the conference and is getting career coaching through HIMSS Veterans Career Services.

Sponsor Updates

• YourCareUniverse publishes a new whitepaper, “Closing the Loop Between Chronically Ill Patients and Providers to Reduce Readmissions.”
• Ingenious Med will exhibit at South by Southwest March 11-14 in Austin, TX.
• The local business paper profiles Leidos Health’s work with the VA in light of its merger with Lockheed Martin.
• LifeImage posts video interviews from the HIMSS show floor.
• Navicure will exhibit at the MA/RI MGMA – Westborough Meeting Payer Day March 17 in West Borough, MA.
• Netsmart will exhibit at the National Association of Psychiatric Health Systems March 14 in Washington, DC.
• NTT Data will exhibit at the IT Summit – Blue Cross and Blue Shield of North Carolina March 17 in Durham, NH.
• Obix posts new Ask the Expert and System Integration videos for its perinatal software solution.
• Oneview Healthcare will exhibit during Australian Healthcare Week March 15-17 in Sydney.
• CloudWave EVP Jim Fitzgerald discusses the reasons behind Park Place International’s rebranding.
• Experian Health will exhibit at AAHAM Florida March 10-11 in Palm Coast.
• Patientco releases a new e-book, “The Healthcare Provider’s Guide to Selecting a Payment Processor.”
• RelayHealth Financial reports claim denial trends.
• The SSI Group and Streamline Health will exhibit at the 2016 NC HFMA Annual Conference March 13-15 in Pinehurst.

Blog Posts

• Local SEO: Enhancing Visibility in Your Hospital’s Target Market (Influence Health)
• Three Opportunities to Enhance Payment Security at Your Practice (InstaMed)
• What Happened In Vegas – HIMSS 2016 Takeaways (Impact Advisors)
• The Evolution of Healthcare Messaging Apps: How Far Are We From a Slack for Healthcare? (TelmedIQ)
• What We Learned at HIMSS16: Top 10 Takeaways (Spok)
• FHIRside Chat: And Now, the Difficult Questions (InterSystems)
• What do Uber and Your Integration Operations Have in Common? (Liaison Technologies)
• The Year of the Hospitalist (MedAptus)
• 4 Ways to Reduce the Number of Patient Privacy Audits (Iatric Systems)
• #HIMSS16 – CHIME CIOs discuss optimization, data, and analytics (Nordic)
• Why Not Healthcare? (PatientKeeper)
• Four Ways PatientMatters Help with Hospital Culture Change (PatientMatters)
• RCM Companies Must Have Electronic Acumen (PatientPay)
• HIPAA regulation: The myths around integrating compliance and patient care (PerfectServe)
• HIT Interoperability: Look beyond the EHR (Lexmark)
• Phynd Technologies Takes Over Las Vegas (Phynd Technologies)
• #HIMSS16 – Learning, limboing, connecting, giving [recap] (Nordic)
• It Helps When Somebody Cares (PMD)
• Population Health Management: Improving Care Delivery Systems to Achieve Better Patient Outcomes (Sagacious Consultants)
• Product Management’s Perspective at HIMSS16 (Summit Healthcare)
• Surescripts Continues to Advance and Support Healthcare Interoperability (Surescripts)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.

EPtalk by Dr. Jayne 3/10/16

Good news from the people at Microsoft, who are listening to the user community’s pleas to return critical functionality for those using Office 365 on tablets. They’ll be adding back the ability to use the pen/stylus as a mouse. That makes me happy on multiple fronts, since not only will I be able to go back to previous workflows, but I won’t have to spend hours stripping my Surface Pro to return it to the store. There’s no ETA on the fix yet, but other than that recent failure, I really have been satisfied with my purchase.

Friday is the last day for providers and hospitals to attest for 2015 Medicare EHR Incentive Programs. If you’re on the provider side, I hope your attestation is long complete. I’ve been helping a client with a last-minute effort and we ran into a lot of issues, mostly on their side, but some with website slowness which I can only assume is due to volume. Fortunately, we finished their attestations last night and I can breathe easier going into the weekend.

Last-minute projects always make me cringe, but as a small business person, they are valuable. It’s a way to help clients in a pinch, which can bring considerable work in the future when they’re happy with your services and realize you saved their backsides. Several of my steady clients have met me while in dire straits and I’m happy to continue working with them. It can make the work unpredictable, though. I’ve been fortunate to have a couple of clinical informaticist friends that I can ask to help out when one of those situations hits or when I need coverage to take some real time off. It’s been an informal arrangement, though, and I’ve been on the fence about whether I should engage someone to work with me on a more dedicated basis.

Finding someone who knows the space in the same way I do but who isn’t already crazy busy or who doesn’t have a full-time job has been a challenge. There are a lot of inpatient CMIOs that are interested in branching out, but in order to service my clients, I needed someone with solid ambulatory experience who can also cover the softer disciplines like change leadership and team development.

After talking with multiple candidates and conducting a trial run, I’m happy to say that I officially have a partner. He’s one of my long-time mentors and I suspected that his recent retirement wouldn’t last long, so was glad to hear of his interest. It has been fun working together on projects. I’m sure that due to the difference in our ages and his more prominent career, some people might assume that I’m working for him. It’s a risk I’m willing to accept. However, my company logo (which involves a figure in a dress and stilettos with a briefcase) should make for a good icebreaker when he hands out business cards.

I’ve had quite a few emails from readers this week, which always makes me smile.

From Think Twice: “Re: MU. Your recent Curbside Consult describes all that is/was wrong with MU. Instead of ‘certifying’ systems, MU should have defined a data ontological framework, a file standard (standard XML/CCDA), and an information bus that all systems that handle PHI must comply with. In that world, we wouldn’t be certifying vendors, but rather required capabilities. It would have opened the door to innovation. I’m not sure how we would handle, app-app communication across the workflow (like SMART is supposed to address), but we’d still be much better off.  More importantly, this wouldn’t have dealt with how providers protect their data (just to keep patients inside), while using HIPAA to hide behind (another story!) Although Meaningful Use as we knew it is on the way out, there are plenty of regulatory and quasi-regulatory bodies waiting to take us to the next level as they drive towards value-based care and other buzzword-worthy initiatives. I hope they’re listening, and look at how much money has been spent vs. how many provider hours as being wasted. The recent piece on providers spending hundreds of hours keeping up with quality measures was telling (especially since we haven’t seen a commensurate uptick in patient outcomes). It may be too early to tell, but my sense from the trenches is that it hasn’t been worth it.”

From Keeping Up: “Re: HITECH. I read most of the HHS report. It’s the same garbage we hear every month about the ‘numbers’ of EPs and EHs that used a certified EHR. They may ‘use’ them, but do not attest to MU or any of the other BS. It’s the same stuff — we gave out $30 billion in incentives, EPs and EHs took that and paid it all and more to EHR vendors (they don’t say that), and it’s still a mess. The lack of vision of ONC and HHS about this is amazing to me. EPs and EHs were moving towards EHRs prior to HITECH, but instead, HHS and ONC made this artificial market. Sure, it moved the adoption needle, but to what effect? Now you have the same problems as before, but EHR vendors made a ton of money. That bubble is about to burst and it will be ugly.” He goes on to mention the lack of improved patient care, safety, security, efficiency, and costs worrying that providers will bear the blame. I don’t disagree – we’re already seeing practices who have more staff than they did five years ago but are less productive and feel like they are providing a lower quality of care. Certainly there are people who have been able to make it work, but not without a considerable amount of resources or without sacrifices at the financial or personal levels. He mentioned watching his peers leave practice due to the pressures and I’m seeing that in my community as well. Given the costs of training, the risk of burnout, and the constant external pressures, I don’t think I would recommend a career in medicine unless someone felt a true vocational calling.

From St. Elmo’s FHIR: “Re: LOINC. Regarding your comments on regulations requiring customers to use LOINC for reporting laboratory measures but not requiring lab vendors actually send the codes with the results, amen. This is one of the stupidest things that’s been done. Although you mentioned that interoperability isn’t going to change the culture of competitive advantage, eventually companies learn that interoperability isn’t in competition with this. My view is that the vendors have learned this – based on working with development teams – but it’s a time-to-market problem. The solutions they are working on today haven’t hit the market, but when they do, it will be clear that competitive advantage is built on interoperability.” As much as I’m a bit pessimistic about the future of medicine, I do want to have hope. The old adage of “knowledge is power” would seem to lead organizations to want to share as much as possible. There is a leadership training game I use called “Win All You Can,” which ultimately shows that the only way for everyone to prosper is for everyone to work together for the common good. I first ran into it during an outdoor leadership course and have used a variation of it ever since. Maybe we can get ONC to require knowledge of it (or something similar) in the next round of incentive or penalty programs.

Is interoperability really the answer? Will knowledge set us free? Email me.

Email Dr. Jayne.

HIStalk Interviews Dan Michelson, CEO, Strata Decision Technology

Dan Michelson is CEO of Strata Decision Technology of Chicago, IL.

Tell me about yourself and the company.

Strata has been around for 20 years. We work with roughly one-fifth of the hospitals in the country, 185 healthcare delivery systems. The focus of the company is to help healthcare providers drive margin to fuel their mission. We do that with a cloud-based platform that hospitals deploy on top of their ERP and EHR. That platform becomes essentially a Microsoft Office for the finance team.

The other day someone used the analogy that we are kind of the Intuit for the healthcare space and that’s a good way to think of it.  Health systems use our application for financial planning — including their long-range financial plan, operating budget, and capital budget — as well as their cost accounting, where we are #1 in KLAS. Also payer contract modeling, so they can understand their true cost and true margins as they negotiate bundled care contracts.

We have algorithms that identify opportunities to reduce cost by eliminating waste, reducing unnecessary variation, and reducing the cost of harm events. Then we provide the workflow for managing that cost out. What many companies have done over the last 50 years in revenue cycle management, we’re now doing around margin management in healthcare. A typical Strata client is billion-dollar healthcare system with eight hospitals, so the opportunity to make an impact is significant.

Do  hospitals accept responsibility for their significant role in ever-rising healthcare costs?

They do now. They didn’t three years ago. The world has changed.

Cost accounting has become a required core system on the financial side to prepare for a value-based world, just as population health has become on the clinical side. People need to know their cost to negotiate bundled care contracts. Not their charge-based cost, but their true cost and their true margins. Even if they’re going to be losing money in that contract, they need to know the levers that they can pull to drive margin over time to be profitable.

That’s in the fee-for-value world, but it’s also a requirement in the fee-for-service world. Over the last three years, the average reduction in inpatient admissions nationally is 2.2 percent per year. Couple that with the fact that hospitals are operating at 2 percent margins and one-third of them are unprofitable and that’s a pretty scary future.

With that kind of pressure on the top and bottom line, the one thing that they know they need to focus on is their cost. But it’s not about just taking 5 percent or 10 percent of their cost out and then moving on. We did some research and talked to 100 different organizations. Eighty-eight percent them had a cost reduction initiative in place. The range they were looking to take out was between $50 million and $400 million, but only 17 percent of them were successful in hitting that target.

For all the automation and technology that we have around revenue cycle, it is missing on cost and margin. To make this point, I often tell people that focusing more on revenue cycle is like trying to squeeze a raisin for a little bit more juice. Cost is a like squeezing a grape — there is a lot of opportunity right now.

We have clients with 600 people in their revenue cycle organization, but only six people who are involved with performance improvement and cost. Clearly that’s going to change now that the reimbursement structure has changed and risk-based contracts are coming into the mix. Roughly 80 percent of large health systems either have a health plan or are building one. Clearly they are going to be taking on risk. The only way they can manage it long term is to understand their return.

Hospitals I’ve worked in are careful about supply costs, but not so good at managing the big-ticket items of labor management and utilization management. How are hospitals approaching cost reductions?

The state of the art for what you just described is PowerPoint and Excel. The level of sophistication is completely absent.

People approach those problems that you mentioned — managing the cost of labor, supplies, and purchased services — episodically. They go after it at one point in time with one initiative. Contrast that approach with revenue cycle, which they are looking at every hour, every day, every week.

The best organizations are approaching it now as a continuous process. They’re not approaching it as, we’ve got take out 5 percent or 10 percent of cost. They’re saying, where do we need to eliminate waste? Where do we need to eliminate variation, or at least reduce variation, or reduce unnecessary variation? Where are we doing things, like harm events, that are making matters worse?

For example, Yale New Haven Health saved $150 million taking a quality-first approach and then tying cost to it via our cost accounting solution. If they have a harm event, a PSI, or HAC, they know exactly what that’s costing them on a macro level, or even with that individual incident. They know exactly what it’s costing them. They’ve created what they called Quality Variation Indicators, QVIs, and we’ve married cost accounting data to that. They went to their clinicians, and in a very integrative fashion between physicians and finance, they’ve had conversations about cost, resources, and waste.

They’ve done two things on top of that are interesting. One is there’s some gain-sharing. If the physicians are doing better and they’re managing their resources more effectively, the physicians have some upside. Then, they’ve embedded cost within order sets, so that when a physician is placing an order within Epic, they have the cost information and are aware of it.

When you took a flight to Las Vegas, you looked up the cost on a website. There’s no such thing for somebody who works in a healthcare institution. Where would you even go to find information on cost? Two issues are holding back that scenario. The information is not accessible. Even if it may exist somewhere, people can’t get it. Second, no one is accountable. If you’re paying for a flight, regardless of work or personal, you’re going to look at that cost and look at the alternatives. We haven’t done that for clinicians.

Opening up that conversation is an enormous opportunity, especially when you understand that 80 percent of the costs in healthcare are driven by physicians and their decisions. To not provide them that information and make it accessible is crazy.

Are hospitals more freely telling physicians exactly what their true incremental cost is if they order a given test, procedure, or drug?

They’re starting. Johns Hopkins embedded costs within order sets and they drove down volume by 10 percent. University of Miami showed physicians phlebotomy costs retrospectively, and just by sharing data, they were able to drive down volume by 25 percent. We’re in the early innings of that game, but take these examples and stitch them together and you can see a path.

In 2002, people said doctors weren’t adopting EHRs because they were technophobic. It’s not like we solved technophobia in the last 14 years — it turns out that that premise was never actually correct. Then once EHRs started getting used and people saw order sets, the reaction of physicians was that it was cookbook medicine. Now you’re telling me what to do? It’s pre-prescribed? Now, when is the last time you heard the term cookbook medicine? It’s been absent for the last three or four years. That premise was wrong as well.

Now we’re operating on the third premise –that doctors don’t know and don’t care about cost. Data proves that’s not the case. A study surveyed 503 orthopedic surgeons and gave them a simple challenge. Here’s 13 commonly used implantables — guess the cost. All you have to do is get within 20 percent. The got it right 20 percent of the time. This was at Stanford, Mayo … six academic centers.

Then they asked those same physicians, if you had the cost, would you incorporate the information in your selection of a device? Eighty percent said yes. That’s two out of 10 who get the information or could guess it correctly, and eight out of 10 would use it if they had it. That gap is an enormous opportunity.

We see that conversation changing, but it’s in the early innings. People are uncomfortable at first. If they approach it as a witch hunt and a condemnation — you’re an outlier, you spend too much, there’s got to be a problem — the clinicians will say, "My patients are sicker," and then obviously, “They’re more complex and they get better outcomes.”

You have to weave together the clinical and financial, which is starting to happen now, in order to make this work. The chief medical officer at Yale, Dr. Tom Balcezak, also calls himself the medical director of finance. We’re seeing that woven together more often in more places.

As people go after value, if the top part of the value equation is quality — and quality is defined as not only clinical outcomes, but also obviously the experience of care — and the bottom part of that equation is cost, how do you deliver value if you don’t know your cost?

Here’s the problem. Even for the organizations in the past that have provided cost information, it was done on a ratio of cost to charges. It was based on the charge master, which is fiction, then taking a percentage of that, which is a made-up amount. You’re taking fiction based on fiction. It’s no wonder that nobody, including doctors, really trusted the information.

The cost accounting process historically has been run two or three times a year. It only had inpatient information, not ambulatory or outpatient information. The actionability, the accuracy, the accessibility of the data just wasn’t there.

Strata has grown rapidly and was acquired a year ago by Roper Technologies. What has changed most in the company?

Let me first talk about Roper. Roper is a publicly traded holding company that operates very similar to Berkshire Hathaway. They make investments in companies, but they let them operate independently. Roper has been around for 110 years and they own 49 companies. I believe they’ve sold one company in that history of 110 years.

The acquisition gave us the opportunity to continue down the path we were on, but with a permanent home and even more support. They don’t get involved in operational or budgeting decisions. There’s no revenue synergy or cost synergy target. There was no integration team or transition team.

It was 14 months ago when we became part of Roper and it has been everything they promised and more. It really is an amazing place to bring your company if you want to have it have permanence and continue down the path that you’re on. It’s a perfect partnership we have with Roper. I mean that sincerely.

The biggest thing that’s changed in the company is the acceleration of decision support — which is the combination of cost accounting and payer contract modeling — and the movement of the product into becoming more of a platform. What Epic or another EHR is on the clinical side, we have become on the financial side – a single database solution for all of the core operations and analytics in finance and operations. For a CFO, it’s their financial planning, budgeting, and control system. It’s their cost accounting and decision support. It’s their cost and performance management application.

We added about two years ago what we call continuous improvement, which is the ability to not only identify cost reduction opportunities or ways to use your resources more effectively, but then also the project management on top of that. We have automated cost and margin management. Because of that, the company is seen as a strategic platform versus a tactical tool set, which is how it used to be seen.

Do you have any final thoughts?

There’s an opportunity to do a tremendous amount of good here by opening up this conversation in healthcare around understanding cost and how resources are used, providing a level of sophistication around it that has been largely absent. The last 10 years of healthcare IT has been focused on the clinical side of the house and we’ve received a great benefit from that. Now we can do things that we couldn’t do before, not only sharing information, but being able to look at quality.

Clearly there’s more work to be done on the clinical side, but the missing piece is now the financial side of the house. While we’ve had all this innovation on the clinical side, we’ve fallen behind on the financial side. Now is the time to address that. Many good things will come from us all collectively doing this work.

News 3/9/16

Top News

A study finds that physician practices spend 785 hours per doctor on the “unnecessarily costly” reporting of quality measures, totaling $15.4 billion annually. 

Reader Comments

From Spiffy Shades: “Re: McKesson’s ambulatory EHR/PM products. They are selling all of them to E-MDs.” McKesson will apparently exit the physician practice business by selling Medisoft, Lytec, Practice Partner, and Practice Choice to E-MDs. Marlin Equity Partners bought E-MDs in March 2015 and AdvancedMD in August 2015 to add to its MDeverywhere holding. It seems to have some synergistic plan for the hodgepodge of EHR/PM products of McKesson, which I speculate is slowly but surely divesting its way out of healthcare IT except maybe for RelayHealth.

From Robert Lafsky, MD: “Re: article on EHR free-text notes. One colleague wryly laments that a lot of doctors just use the EMR as a word processor and this is a good example. The inability to deal with structured fields seems endemic. Are we just doomed to wander the desert for 40 years until a new generation has replaced us?” A study of 26,000 electronic prescriptions that were sent to community pharmacies by community-based prescribers finds that in two-thirds of them, the prescriber placed information in the free-text field that should have instead been entered as discrete data. Nearly one in five of the prescriptions had free-text instructions that didn’t match what the prescriber actually entered. Another 10 percent of prescriptions were actually cancellation requests, sent either because the EHR vendor doesn’t support the standard cancellation message or the prescriber didn’t know how to use that function. More than half of the inappropriate free-text messages involved  insurance benefits or dispensing quantities. The authors conclude that EHR and e-prescribing vendors need to improve product design and usability testing, apparently holding prescribers harmless for using their software incorrectly.

From Dingo: “Re: HIMSS conference app. You should create one so that readers can connect with each other, see a sponsor event schedule, and find social events.” HIMSS had its own app, but I didn’t try it. I assume it focused on the educational session schedule. If you used that app, what did you like and dislike about it? If not, what kind of app would you use?

From Bill Earry: “Re: consulting companies. I’m a physician informaticist interested in exploring whether consulting is right for me. What are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems?” I’ve never been a consultant, so I’ll ask those who are to weigh in, especially physician consultants.

From I.C. O’Jay: “Re: innovation. It’s pointless talking to a health system CIO about innovative products. They have no interest or insight.” IT executive management is very much like public health. You’re trying to do the most good with the biggest impact given a limited budget and headcount. Do I vaccinate 1,000 children or launch a nutrition education program? Do I keep a marginal but inexpensive department system and use the money to fund a revenue cycle technology project? How should I prioritize the need to apply endless system upgrades and infrastructure projects to keep the lights on against some startup’s cool but unproven app? The hardest part about running an IT organization is enlightening departments, end users, and vendors about the constant constraints under which the organization operates – enterprise IT isn’t like buying an Office Depot computer or installing an iPhone app and it never will be. Part of the job involves watching well-meaning but naive users storm off in a huff because their shallowly-researched bright idea is not feasible given the organization’s budget, tolerance for risk, competing projects, and strategic focus. You say “no” a lot, and rightfully so. In fact, I might speculate that CIO success is predicated more on what projects they don’t undertake rather than the ones they do.

From NextGen Customer: “Re: the former hospital systems business sold to QuadraMed. During a recent conference call, a comment was made that QuadraMed bought NextGen for the customers and will not be making any enhancements. One individual said we will have to move to the other product. I contacted another NextGen customer and they said they had already been approached.” Unverified.

From Court Watcher: “Re: Epic v. Tata. There’s a new order on a motion for summary judgment. The court said there’s compelling evidence of unauthorized access by Tata’s employees over an extended period of time. The court found Tata guilty of violating the computer fraud laws and the Wisconsin computer crimes act. They also apparently violated their contracts.” I’ve written about this case a few times. Epic says Tata’s India-based employees claimed to be working for Kaiser Permanente in trying to slip into Verona-based classes and to download everything in the consultant portion of Epic’s UserWeb system for enhancement ideas for its Med Mantra hospital information system. Most of the legalese is over my head, but the Tata people seem to be real scumbags. People claim Epic is paranoid about protecting its intellectual property, but more than one example exists of people in a foreign company trying to steal Epic’s information to create a competing product.

From HIT Banker: “Re: HIMSS conference. For the last two years, one of our female junior staffers has been solicited by various male executives to join the guy in his hotel room. I wonder how much debauchery is going down behind the scenes at HIMSS? I would like to see a poll on this, although I doubt you would get honest responses. I might simply ask, ‘Did you do anything at HIMSS that you would not tell your significant other?’” What HIMSS attendees do as consenting adults is their own business, but I will modify your curiosity into this poll: did you experience unwanted sexual overtures or comments during the conference that made you uncomfortable?

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor PatientMatters. The Orlando-based company helps health systems transform the hospital patient’s financial experience with tools, training, and expertise to increase cash and lower debt as self-pay balances increase. The company focuses on seven specific areas of cash leakage: pre-registration and scheduling, ED, POS collection, patient advocacy, early-out, payment plans, and bad debt in transforming patients into educated consumers who can engage effectively. Specific tools include address verification, identity verification, eligibility, patient payment estimation, pay select, patient loans, statements, and a patient portal. One customer increased ED POS collections by 71 percent in three months, increased patient cash payments by 20 percent in six months, and decreased bad debt by 54 percent. Thanks to PatientMatters for supporting HIStalk.

I found this PatientMatters intro video on YouTube.

We fulfilled the DonorsChoose grant request of Ms. Jones from Georgia in providing her first grade class with an iPad, case, and headphones. She reports, “My students are excited about learning when they are handed an iPad, as if it was a treat or reward. Their little eyes light up and they become engaged in their learning and complete more tasks with a higher rate of success … when they are allowed to use the iPad, their confidence and self-esteem increases and more work is completed in a timely manner. This is mainly due to the immediate feedback after completing each assignment. This gives them a great sense of accomplishment.”

Also checking in was Ms. K from Tennessee, whose second graders are “having fun while learning” in using the seven math games we provided.

Listening: The Struts, Brit rockers that sound to me like a stew of Queen, Slade, and Quiet Riot. Then it’s off to some harder stuff from the amazing Avenged Sevenfold, to which I’ll be desk-drumming for the next several hours (especially since that particular song was dedicated to drummer The Rev, who died of a drug overdose in 2009 at 28).

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Acquisitions, Funding, Business, and Stock

The CEO of genetic testing company Ambry Genetics makes the de-identified data of 10,000 breast and ovarian patients available to researchers, bucking the trend of biotech companies that believe they compete on data rather than testing. CEO Charlie Dunlop is blunt about his motivations: “I have stage 4 cancer myself. I don’t care what goes down. This is what we’re doing at Ambry Genetics. We’re here to try to save the world, period." The AmbryShare website defines itself as, “It’s a chance to help stop data hoarding and unlock the promise of the human genome project.”

Cerner announces a $300 million share buy-back program. Above is the one-year share price of CERN (blue, down 23 percent) vs. the Nasdaq (red, down 4 percent). Shares have dropped to July 2014 prices.

MedCity News confirms the rumors I ran here this weekend indicating that Aetna has laid off dozens of people working on its iTriage app. Aetna confirms the layoffs without providing numbers, adding that it plans to combine iTriage with its WellMatch price transparency app.

Scotland-based Craneware’s first-half profits rose 17 percent after strong sales and recurring revenue growth.

Sales

UC Irvine Health (CA) chooses Phynd to unify, manage, and share the data of its 25,000 providers across multiple IT systems.

People

Culbert Healthcare Solutions promotes Brad Boyd to president. Founder Rob Culbert relinquishes that role but remains CEO.

Nordic promotes Nicole Meidinger to VP of business development.

Announcements and Implementations

University of Texas M.D. Anderson Cancer Center (TX) goes live on Epic.

KPMG’s auditing practice will use IBM Watson to analyze customer resource allocation.

Experian Health adds its Patient Estimates solution to Athenahealth’s marketplace.

Government and Politics

ONC releases the Million Hearts EHR Optimization Guides, showing providers who use Allscripts, Cerner, or NextGen how to use their EHRs to manage aspirin therapy, blood pressure, cholesterol, and smoking cessation. ONC calls for other EHR vendors to develop guides for their products.

A Texas anesthesiologist and hospital owner is convicted of billing $10 million for supervising CRNAs when he wasn’t actually present. The government provided evidence that at the times he was supposedly working in the OR, he was actually (a) undergoing surgery himself; (b) flying on his private jet; and (c) traveling out of state. He also signed medical records attesting to the services he provided before the surgeries even started.

Wired profiles big data entrepreneur John Mininno, who has built a business around analyzing CMS-released claims data to find likely Medicare fraud, then finding an employee of the organization willing to file a whistleblower lawsuit in return for sharing any settlement. His programmers look for unusual patterns, such as providers who file a normal claim volume on a snowy day when they probably weren’t running at full capacity.

Privacy and Security

Philips launches the Netherlands-based Philips Blockchain Lab, which will explore the use of the cryptographic technology in healthcare.

An interesting article explains the motivation of shady people who post idiotic Facebook puzzles, pet photos, and emotional stories that beg users to “like them” or share them in some way. “Like-farming” attempts to rack up a ton of exposure, after which the original post is changed to either spam or malware links that pollute your own Facebook news feed as well as those of your friends in some cases. New South Wales police warned people last week of the phony contest above (posted under a fake Qantas Air account) in which Facebookers were urged to click “like” for a chance to win free travel.

A study of Android diabetes app privacy policies finds that 81 percent have no privacy policy at all and only 4 percent of them say they will ask users before sharing their data. Most apps shared insulin and blood glucose levels, and of those that offer a privacy policy, 40 percent don’t disclose that they share data.

A stolen, unencrypted laptop belonging to physician practice Premier Healthcare (IN) exposes the information of 200,000 people.

Other

Marketing firm Cramer brags about being hired by Athenahealth to create the HIMSS16 data sharing presentation of Jonathan Bush and John Halamka, developing the “relatable, human storyline,” creating a PowerPoint to “wow the audience,” and coaching the presenters through a “table read” and “two simulated on-stage rehearsals.”

A six-hospital study finds that monitoring discharged heart failure patients with telemonitoring, telephone calls, and health coaching had no effect on 180-day readmissions.

An ED doctor in England faces a disciplinary hearing after tweeting out tirades that include a proposed fine against “ambulatory neurotics with a few aches and pains” who call an “ambulance for a broken nail, an earache, period pain, not being able to sleep …” and who are “crippling the NHS.” He also tweeted, ““I’m sure ADHD is merely a polite term for a child who is just a little sh**”

Sponsor Updates

• Besler Consulting releases a new podcast, “The Relationship Between Physician Coding and Compliance.”
• Burwood Group becomes a Citrix Platinum Solution Advisor.
• Chilmark Research names Caradigm a top vendor among care management vendors.
• Premier is named to the “World’s Most Ethical Company” list for the ninth straight year.
• Spok will convert its Connect 16 annual healthcare communications conference to a series of one-day events held in six cities starting March 24.
• CitiusTech posts a new video profiling its partnership with IBM.
• CompuGroup Medical will exhibit at the National Association of Community Health Centers P&I Forum March 16-19 in Washington, DC.
• CoverMyMeds crosses the 500,000 provider account threshold, and is now integrated with over 500 EHRs.
• CTG recaps its time at HIMSS16. 
• HIMSS16 attendees help Divurgent raise $5,000 for Children’s Hospital of Nevada at UMC.
• EClinicalWorks will exhibit at AMGA 2016 Annual Conference March 10-12 in Orlando.
• The local paper looks at the ways in which API Healthcare is benefiting from its sale to GE Healthcare.
• Glytec CMO Andrew Rhinehart, MD reviews the American Diabetes Association 2016 standards of care in the latest Annals of Medicine.
• HCS will exhibit at the National Council for Behavioral Health Conference through March 9 in Las Vegas.
• SK&A publishes a report on EHR software usage in physician practices.

  Blog Posts

Blog Posts

• 3 Post ICD-10 Transition Solutions for Your Practice (AdvancedMD)
• Organizational Health Part 2 (Optimum Healthcare IT)
• How to Innovate Without Losing Control (AirStrip)
• What a HIMSS-sane week! (NextGen Healthcare)
• What does population health mean to you? The view from HIMSS16 (Forward Health Group)
• How do We Secure Mobility at the Speed of Innovation? (AirWatch)
• Optimization Governance (Impact Advisors)
• 8 Tips to Help You Transition From ICD-9 to ICD-10 (Aprima)
• Metabahn & HealthLoop chose Catalyze, but why? (Catalyze)
• Improving Your Financial Health Through Patient Engagement (Culbert Healthcare Solutions)
• Five Keys to Success Under the Oncology Care Model (ECG Management Consultants) 
• Marketing to Your Existing Clients to Drive Revenue (E-MDs) 
• Cisco and Extension Team Up to Tackle Modern Clinical Workflow Challenges (Extension Healthcare)
• Forms Beyond Your HER: Making it Possible for ALL Clinical Forms to be Paperless (FormFast)
• GenY4HIT – Reshaping Healthcare (Galen Healthcare Solutions)
• Insurance Carrier Setup Neglect: A Costly Oversight (Part 2 of 2) (Hayes Management Consulting)
• Epic Service Desk: Why Should an Organization Invest? (The HCI Group)
• How to Use a Volunteer Work Day (Healthgrades)
• Innovation at HIMSS is all About Interoperability (Healthwise)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.

Curbside Consult with Dr. Jayne 3/7/16

I’m still recovering from HIMSS, which really gave me a beat-down this year. What started as the usual sore throat and froggy voice from yelling over loud music and being exposed to smoke seems to be turning into something more. On top of that, my self-diagnosed broken toe is actually a pair of fractures.

Fortunately, I scheduled a fairly low-key week, so I am working from the sofa with my foot propped. I’m wading through quite a few press releases that were lost in the HIMSS shuffle. I know vendors like to save them up for the week, but then there is so much noise that they’re easily missed.

I’m also following up on some consulting leads. Although a couple of them are from actual healthcare delivery organizations, most of them are from vendors who like the idea of having a physician informaticist on call, but not necessarily having to keep them on the payroll.

I’ve enjoyed the flexibility of consulting as well as the variety. There are a lot of organizations that have problems they’re trying to solve or could benefit from some outside opinions. It’s actually a lot like being a family physician. Sometimes the problems are straightforward with obvious solutions like cold and flu symptoms. Other times the issues require a lot of analysis and diagnostic maneuvers as well as the possible intervention of other specialists. The “detective work” aspect of medicine is what attracted me to the field in the first place, so I’m glad to be able to put those skills to work in other arenas.

Having worked in the large health system space, I’ve also developed some pretty solid firefighting skills that I’m putting to use assisting a client with their 2015 Meaningful Use attestation. The deadline is Friday, and although they thought they were prepared, it turns out that their internal MU resource hadn’t really been doing much in regards to documentation. Unfortunately, this was only discovered after she left the practice. I’m helping one of their senior clinical leads understand what documentation they have, what they’re missing, and how to go about creating an attestation binder for each eligible provider. It’s not glamorous, but they’re very appreciative, so I’m enjoying the work.

ONC announced three challenges in conjunction with HIMSS. The first is for $175,000 and seeks consumer apps that use open APIs to help patients aggregate their information under their control. I saw the Humetrix iBlue Button app at last year’s HIMSS and gave it a test drive. It was straightforward and easy to use. I know there are other vendors as well, so I will be interested to see what this challenge yields.

The second challenge is for the same amount, but this time for improved user experience for providers. Eligible apps will use open APIs the improve clinical workflow.

I had worked with a vendor last year who had designed a slick-looking bolt-on documentation solution for providers. They were looking for vendor partners. I had to advise them that they’d be hard pressed to get vendors to play along with them since essentially the purpose of their product was to correct clunky and ugly workflows.

They were reluctant to admit that calling someone’s baby ugly isn’t the best way to build relationships. Instead, I advised them towards a more grassroots effort with either provider organizations or specialty societies. They’re still working on their approach. I hope to hear from them again soon, but maybe this challenge will spur even more innovation.

The third challenge is for $275,000 and supports the development of an “app discovery site” to help developers distribute their apps for providers to evaluate. The overall goal of the challenges is to leverage FHIR to build interest in open APIs while advocating user-focused innovation. I agree with them that improving in these areas is important, but don’t think we have enough money on the table yet to really move the needle.

My former health system employer decided to consolidate its clinical platforms primarily because it was tired of supporting 1,000+ applications. It feels a bit like we’re headed back in that direction — having to add on multiple third-party solutions to get the work given the increasing complexity of healthcare delivery. Not to mention that just having interoperable solutions isn’t going to motivate people to send data in a codified way that would make it truly useful.

We’re seeing issues with regulations that require customers to use LOINC for reporting laboratory measures, yet there is no requirement that lab vendors actually send LOINC codes with the results. This has put provider organizations in a bind. Although I’m grateful for the work that problem has provided my consultancy, we’d be better off if the codes were required as so many other things are.

Interoperability also isn’t going to change the culture of companies wanting to maintain competitive advantage. There’s too much at stake from a market share and financial perspective for most organizations to truly cooperate, whether they are on the vendor or provider side.

Like most patients, I’m still having to log into three or four different patient portals to track down my information. There is no incentive for the systems to share, and in some cases, the focus on accountable care organizations is making patient care less accessible as groups vie to maintain control over patients in an effort to control costs.

The Department of Health & Human Services recently released its annual Report to Congress, providing an update on the adoption of health information technology and the exchange of health information. Although it documents the progress that has been made, it also describes some key barriers, including:

• Lagging adoption by providers who were not eligible for incentives.
• Insufficient specificity of standards.
• Varying interpretation and implementation of government policies and legal requirements.
• Safety and usability issues.
• So-called “information blocking”

So far, the only real instances of information blocking I’ve seen are in the provider community, and range from lack of education in some smaller practices to activities that cry out for antitrust scrutiny. I haven’t seen much of a response to the Report, which was issued right before HIMSS. I’d be interested to hear what readers think about it.

Have you read the HHS Report to Congress? Email me.

Email Dr. Jayne.

Readers Write: Trend Watch: Innovation Forges On in the Provider Sector

Trend Watch: Innovation Forges On in the Provider Sector
By John Kelly

Provider organizations face tremendous innovation challenges. The success or failure of new systems and technology will depend on their ability to adapt and anticipate the impact of major industry changes. Looking ahead to a successful 2016, hospitals and provider organizations should still expect barriers to using EMR data, should be wary of the hype surrounding cognitive systems, and should prepare for a value-based care partnerships world where providers and payers share information in ways not imaginable until recently.

EMR data will not be fully liberated in 2016

Barriers that exist to move data in and out of EMRs will not abate in 2016, despite pressure. The business model of EMR vendors and real technological barriers will continue to thwart the goals of interoperability sought under the concept of Meaningful Use.

The good news is that providers and payers are establishing pockets of innovation using edge technologies to support better care and risk sharing based upon shared data, and the public outcry over data blocking from EHRs will eventually force vendors to adopt standard APIs. We can expect the personal health data train to gain momentum with hundreds of new market entrants, but not in 2016.

Don’t trust the hype around cognitive systems

Technology-based cognitive systems in healthcare are not in our immediate future. There is lack of clarity around the FTC’s rules regarding software that makes a medical decision — when do they have to be certified as a medical device? Without medical device certification, can the output of cognitive systems be loaded into an EMR? What about malpractice liability?

Analytics vendors and their customers have been tentative in applying the technology to direct patient care, and counter to what other prognosticators believe, this liability and the fear of the unknown will slow down the cognitive market in the US.

ACOs will invest in payer technology

Successful ACOs will require the technology to support all-payer data ingestion. They will need to see the patients as a single population, but within the context of separate payer contracts. These organizations are beginning to invest in the technology that payers have used for years to successfully acquire and integrate claims data with their population health registries.

If providers are to succeed assuming risk, it will be by employing a highly-focused health management approach that addresses the specific risks associated with specific populations of patients. Population and risk analytics infrastructure requires capital investment beyond the reach of many small and mid-size provider organizations. To encourage providers to assume greater risk for performance, payers will offer shared information exchange platforms that augment provider capabilities with analytic services.

Accountable care continues to evolve

Healthcare market transformation will gain momentum in 2016 and provider organizations should also consider the following:

• Most first-generation ACOs will fail because they don’t know what it means to truly manage risk. They do not have the ability or will to modify how they treat patients. CMS, commercial payers, and the provider community have to figure out how to hold providers harmless on what they can’t control while also rewarding them for doing the things they can do well, then help them bet on their ability to delivery consistently on their promises.
• 2016 will see an assault on post-acute care providers, who until this point have long been profitable even as many provide little relative value. This will affect nursing homes, outpatient rehabs, and even vendors who sell to post-acute care providers. The release of Medicare data for public research, particularly in the area of Medicare fraud, combined with the high-profile budget line for post-acute care will accelerate the move to overhaul the post-acute care industry.
• Finally, don’t expect a change in administration to affect CMS innovation. Regardless of the 2016 Presidential election outcome, payment reform will continue, primarily both macro-economic reasons, but importantly as well, the political reality that both parties favor fundamental reform.

John Kelly is principal business advisor at Edifecs of Bellevue, WA.

Readers Write: The Many Flavors of Interoperability

The Many Flavors of Interoperability
By Niko Skievaski

As the shift towards value-based care persists, the demand for data is as hot as ever. That means the term “interoperability” will be thrown around a lot this year. Let’s describe the various flavors in which it will inevitably be discussed. I’ve seen many conversations become confused as the context for the buzzword is mixed. Here’s an attempt at outlining the various i14y use cases. (Can we start abbreviating it like we do i18n?)

Interoperability for Care Continuity

This is the iconic use case that first comes to mind. Chronically ill patients with binders full of paper records and Ziplocs bulging with pill bottles. As patients bounce around town seeing specialists, they often need to repeat demographic data, med lists, allergies, problems, diagnoses, prior treatment, etc. The solution to this use case calls for ad hoc access to a patient’s data at the point of care. A provider’s chart doesn’t necessarily need to be synced to all other providers in the disjointed care team. Rather, the data needs to be available upon request from the relevant provider.

New payment models have fueled demand for this solution. In a fee-for-service world, redundant tests actually brought more income to the health system,  whereas in value-based models, excessive costs are eaten by the organization. This aligns the provider and patient by incentivizing only the tests and treatments that have the highest likelihood of impacting the patient’s health. Understanding the value of any given treatment also requires looking across a wide set of patients. This brings us to the second use case.

Interoperability to Measure Value

In order to understand how to pay for healthcare based on value, we must make an attempt to measure the impacts to health: a patient’s health is a function of the healthcare they receive as well as a slew of other variables. Estimating this relationship requires a magnitude more data than we’ve traditionally measured. Beyond knowing the diagnosis and treatment, we’d need to control for behavior, family history, comorbidities, prior treatments, etc. Basically everything we can know about a patient’s health. And that’s for a single patient. To build a model, we’d need this information from a large sample of patients to determine the impact of each of these variables. But as treatments are provided to patients and we receive more results, we’ll need to be updating our models to refine their accuracy over time.

Much of this data is stored in an electronic health record over the time period a patient was cared for by that health system. But it’s likely missing data from care outside of that health system. And beyond that patient, how could we combine this record with a sizable population to make a predictive (or even representative) model? Even at very large health systems, limiting their records down to the few who have a rare diagnosis for a given sex and age, the sample set can become insignificantly small.

This i14y use case requires large sets of longitudinal data, rather than single patient records in an ad hoc query. Current attempts at producing such data sets have been extremely resource intensive and normally centered around research efforts focused on a single diagnosis in a de-identified manner. We’ve also seen rampant consolidation in the industry, partially driven by the notion that taking care of larger and larger populations of patients will enable more accurate estimations of value.

Interoperability to Streamline Workflows

This i14y use case has been around since before the term garnered widespread adoption in healthcare. HL7 was created back in 1987 to develop a standard by which health data could be exchanged between the various systems deployed at a health system: electronic health records, lab information systems, radiology information systems, various devices, and pretty much everything else deployed in data center. These systems are most often tied to a centralized interface engine that acts as a translation and filtering tool bouncing transactional messages between each.

So problem solved, right? Not quite. Over the past few decades, health systems have customized their HL7 deployments just as isolated communities evolve a language into a dialect. This proves problematic as each new software application adopted by the health system requires extensive interface configuration and the precious FTE that entails. Interface teams are increasingly the most backlogged tranche of the IT department. As health systems search for more efficient ways to deliver care, they’re more often turning to cloud-based software applications because of the dramatically reduced infrastructure costs and mobility.

This use case likely requires upgraded infrastructure that allows a health system to efficiently connect with and communicate with cloud applications. The customized HL7 dialects will need to be replaced or translated into something consistent and usable for cloud applications. HL7, the organization, is currently developing FHIR as a much needed facelift to a graying standard. In the coming years we look forward to seeing more FHIR adoption in the industry, and hope to avoid the level of customization we have seen with HL7v2 — although initial feedback and documentation from EHR vendors is not promising.

Interoperability to Engage Patients

This is likely the most interesting need for i14y because of its potential. Patients don’t currently walk into doctor’s office and demand that their health data be electronically sent to applications of their choosing. But then again, where are these applications? The inability for patients to authorize API access to their health data has undoubtedly stifled the development of innovative applications. Instead, new application creation has focused on the B2B space in search of enterprise revenue.

If a patient could download an app on their phone and authorize it to pull their medical history, an army of coders would mobilize in creating apps to engage patients as consumers. Application adoption would be holistically democratized and new apps would get to market instantaneously, as opposed to the usual 18-month B2B sales cycles. Applications would be developed to help patients decipher the complexities of care, track care plans and medication adherence, and benchmark against others with similar comorbidities. They could effortlessly download and store their records and be the source of truth. They could contribute their records to research banks that would be willing to pay for their use. Widespread adoption of patient authorized access to health data would almost make the other i14y use cases moot.

Luckily, we’re getting closer. There’s mention of its mandate in MU3. One of the challenges is solving for the chicken-or-egg problem. We need enough widespread adoption of a single authentication framework and data standard to simultaneously sway the development community and health systems to adopt. MU3 seeks to force the right hand side of that equation, however failing to mandate a prescriptive framework or standard in its current draft while wavering in its timeline. As written, it’s possible that health systems can comply with differing technology making the problem only slightly better.

I’m optimistic as accelerating demand has spurred i14y innovation across the sector. HL7 is rapidly organizing support around FHIR and SMART. Incumbent integration engines are stepping up their game and outside integrators are rapidly moving into healthcare. Startups are sprouting to tackle pieces. Some health systems are proactively standing up their own i14y strategies. EHR vendors are vowing to adopt standards and roll out tools to encourage application development. I don’t doubt that we’re beginning to see the fruits of the solutions that will be adopted in the years to come. But it’s on us — as providers, technologists, developers, and patients — to continue the rally cry by demanding i14y now.

Niko Skievaski is  co-founder of Redox.

Monday Morning Update 3/7/16

Top News

The VA is reassessing whether VistA has a long-term place as its EHR and has halted some of its VistA modernization steps following a business case analysis ordered by new VA leadership. The VA says it requested $40 million less in 2017 VistA modernization money because it will focus instead on making its existing systems interoperable.

According to Assistant Secretary for Information and Technology LaVerne Council (photo above), “We want to take a step back and look at what we really need an EHR and a healthcare system to do. There are multiple needs that are different than in 2014 around the area of women’s health, the Internet of Things, and how we manage private sector care.”

House Appropriations Chair Hal Rogers (R-KY) wasn’t happy with the VA’s testimony to the committee, saying, “We’ve been at this for 10 years and we’ve given you billions of dollars. I’m hearing muckety-muck here. I don’t know what you’re saying. Apparently, you’ve not made your mind up yet about whether you’re going to replace VistA with something off the shelf. Is that right or wrong? Yes or no?”

Council replied that the VA hasn’t decided yet, blaming her VA predecessors for not developing a sound plan but extolling the virtues of the VA-DoD Joint Legacy Viewer. She joined the VA in July 2015 after retiring as corporate VP/CIO of Johnson & Johnson.

Council also says that a visual overlay to the VA’s 30-year-old patient scheduling system may eliminate the need for its planned $690 million replacement depending on how the VA-wide rollout in April is received.

Reader Comments

From Vegas Blues: “Re: healthy health conventions. Is it a foregone conclusion that we can’t eat healthy at a Las Vegas conference venue?” Plenty of sugary snacks, fatty sandwiches, and coffee were available, but I didn’t see much fruit or unprocessed food. It’s a fine line between providing what attendees want vs. what’s good for them, however. The H in HIMSS stands for healthcare, not health. It’s like McDonald’s, which offers a lot of healthy food that nobody orders, earning it scorn for the choices its customers make.

From Jardin: “Re: delegating computer tasks to non-physicians. The Senate unanimously passed this because, according to the committee chair, ‘hospitals and providers dread EHRs’ and “MD documentation is burdensome.’ After a year-long review that included HIMSS and physician lobbyists, Congress proposes a solution that adds costs, introduces errors, and eliminates many EHR benefits. After spending billions on health IT, we’re regressing back to the e-secretary model, pushing the burdens of the same EHRs to scribes or RNs. Nurses continue to be invisible in the law. Why isn’t there an industry outcry to actually fix the problem instead of just passing it off?”

From Flaming Introvert: “Re: HIMSS conclusions. As a near-entry level vendor employee, this is my second HIMSS and I’m not sure if I love it or hate it. It’s upbeat and our customers provided positive feedback about our changes and their needs. It’s refreshing to connect with patient advocates, even if most conversations end with the defeatist consensus of, ‘It really sucks, but what can we do about it?” Low point was getting to HIStalkapalooza too late for the shoe judging – I don’t normally parade around in six-inch heels without potential ROI. Maybe that same sentiment applies to HIMSS overall – it continues to yield enough return to induce me to participate, but I’m always glad to get home.”

From Bonus Room: “Re: iTriage. Just laid off 33 employees and CTO Patrick Leonard is leaving.” Unverified. I haven’t seen any official announcements from the medical question and doctor finding app vendor that’s owned by Aetna. However, the report came from a non-anonymous iTriage employee.

From Love American Style: “Re: Epic’s 2015 release. I’m a project director for an Epic customer. We are still in the testing phases and the severity and number of patches at this point in the release cycle has been unprecedented. Patient safety problems, patches that break workflows, performance problems all abound. Things I would have expected Epic in prior years to have nipped in the bud long before now.” Unverified.

From Delled: “Re: Michael Dell at HIMSS. He’s my hero, but I was stuck in the overflow room for his keynote. The moderator was so bad that people left in droves like the session was over. At one point Dell had to remind the moderator that he was supposed to ask a specific question. Finally I worked my way to the front against the crowd streaming for the exits, and at the end when he was leaving the stage, I asked to shake his hand (photo attached). He ignored me.” Michael Dell would have been an awful choice to keynote even if he wasn’t trying to sell out Dell’s pitiful healthcare offerings so he can finance his $67 billion passion for computer storage in acquiring EMC. EMC owns VMware, which has watched its shares drop 40 percent and has laid off 800 people since Dell came sniffing. Other than funding Dell Medical School, his healthcare accomplishments are zero or less, hoping desperately to sell Perot Systems for the same price he paid in 2009, backpedaling on the the idea that the future is in services rather than hardware.

Here’s my formula for becoming a highly-paid, well-received HIMSS keynote speaker, not inspired by Michael Dell since I didn’t attend any HIMSS keynotes:

1. Be famous for any reason. Healthcare relevance is unnecessary and even detrimental – the goal is to raise the spirits of attendees by making them think they are as cool, rich, good-looking, or smart as the celebrity podium-gripper.
2. Negotiate a speaking fee of several hundred thousand dollars, making sure to insert contractual clauses requiring approval of the introduction and the freedom to sell whatever product or service the speaker offers on the side.
3. Arrange travel to minimize the time hanging out with the insufferably fawning organization people who hired you and who therefore think they’re entitled to face time or the privilege of escorting you through the exhibit hall that makes you glaze over.
4. Announce to the worshipful masses how utterly delighted you are to be in their midst, carefully omitting the fact that you could have attended any time you wanted in previous years if your delight didn’t carry a price tag.
5. Begrudgingly allow a high-ranking executive of the group running the conference to (a) hug you before or after your speech; (b) ask carefully scripted softball questions after the stage is reset into a fireside chat type configuration; and (c) annoy the audience by prattling on instead of letting you talk as you’re being paid to do. At least moderator verbosity prevents audience members from asking their own pointed questions that might result in an unfortunate, life-ruining off-the-cuff answer. After the friendly chat, allow the executive to magnanimously present your foundation with a big check above and beyond your personal speaking fee.
6. Have your hired copywriter modify the harmless, standard speech you’ve given dozens of times to conventions ranging from car dealers too the Bowling Proprietors’ Association of America, penciling in four seemingly insightful anecdotes as provided by the people writing the check that are sure to make the audience feel that you understand them even though you have no idea what they actually do. You don’t  have to review the scripted comments in advance – they will be right there in front of you on the Teleprompter per your contractual requirement.
7. Include a handful of humorous, self-deprecating, name-dropping insider anecdotes to allow geeky non-profit IT people to live your celebrity life vicariously and to brag afterward that they briefly shared your aura.
8. Be vaguely motivating in a boilerplate-type way that won’t require actually thinking up something new, extolling the generic virtues of teamwork, leadership, doing what you love, and being true to oneself.
9. Close with over-the-top accolades that defer glorification to whatever the audience members do for a living, telling them that they are the real heroes even though (a) they’re paying to see you and not vice versa, and (b) you just made more money in 60 minutes than they make in a year.
10. Go straight offstage to a limo with the engine running to minimize unpaid downtime before the next cookie-cutter speaking gig.

HIStalk Announcements and Requests

A little more than half of poll respondents doubt that Athenahealth and eClinicalWorks will become major inpatient systems vendors. Skeptical says that if eCW’s entry into inpatient is like its interoperability solutions, “we should expect major-league hype and minor-league results.” Vote Early and Often says eCW employees stuffed the ballot box and the company can’t service enterprise customers that expect project discipline and management maturity. Frank Poggio says it’s too late – the market has been sewn up by Cerner and Epic with Meditech, the only small-hospital vendor, losing ground. It’s All Good says there’s a long history of companies aspiring to be what they aren’t (Allscripts) and that eCW should stick to ambulatory.

New poll to your right or here: HIMSS attendees, will the hard-dollar benefit of your attendance cover your employer’s cost to send you within one year? Click the Comments link after voting to explain.

Here’s an extra, reader-requested poll for HIMSS15 exhibitors: in the year that has elapsed since, did you make a sale that you wouldn’t have made had you not exhibited?

Ms. Livingston says her New Mexico elementary school students “have the idea that they don’t deserve what the schools that have more money enjoy having” and therefore are having great fun with math story books we provided in funding her DonorsChoose grant request.

Also checking in was Mrs. Jochum from Nebraska, who sent photos of her students using the Osmo learning systems we provided.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Sales

Sixty-nine bed Madison Memorial Hospital (ID) will implement Cerner at a cost of $6 million upfront and $86,000 per month in maintenance fees. They chose Cerner over Epic and their incumbent vendor Meditech.

Virtua Health System (NJ) chooses Epic, which apparently beat Cerner in offering a replacement for Siemens Soarian.

Steward Health System chooses Imprivata Cortext for provider communication across its nine hospitals.

Aurora Health Care (WI) chooses Strata’s StrataJazz as its full financial analytics and performance platform.

People

Healthgrades hires C.J. Singh (Backcountry.com) as CIO.

Ross Martin, MD assembled video good wishes for Deloitte’s Chris Brancato, who is recovering from unfortunately eventful spine surgery that has left him hospitalized and therefore unable to attend the HIMSS conference. Some of the greetings were recorded at HIStalkapalooza.

Announcements and Implementations

CPSI announces a program by which its revenue cycle customers can apply their additional revenue toward buying its Evident Thrive EHR with no upfront costs. CPSI shares have rallied a bit in the last few months, beating the Nasdaq slightly by increasing 3 percent in the past year.

Health Catalyst arranges its product roadmap around nine subject areas.

Intelligent Medical Objects will work with Northwestern University’s medical school to support pharmacogenomics clinical decision support through creation of terminology to support concepts such as “ultra-rapid metabolizer of clopidogrel.” IMO will make the results available to members of the federally funded eMERGE consortium at no cost.

Vital Images launches an ACO imaging analytics solution and announces a personalized HIE/EMR viewing platform.

Privacy and Security

The personal information of all employees of Main Line Health System (PA) is exposed when one of them replies to a spear phishing email.

Innovation and Research

Mass General’s “Ambulatory Practice of the Future” calls for undergraduate and graduate engineering students to compete for $400,000 in prizes for creating innovations in primary care (technology, instrumentation devices, etc.) Pre-proposals are due April 18, 2016. Ten finalist teams will be awarded $10,000 and the top three winners will receive $150,000, $100,000, and $50,000. Last year’s winner was Hemechip, a point-of-care diagnosis device for sickle cell disease.

Other

The HIMSS16 final attendance count was 41,885, down 3 percent from last year’s 43,129. This is the first time I can recall attendance going down year over year unless maybe it was in 2000 due to the Y2K scare. Possible reasons I came up with:

• Industry hangover from MU and ICD-10.
• Fatigue with the novelty of having the federal government drive so much of the conference agenda.
• Lame keynote choices.
• Election year uncertainty.
• A move to immediately valuable vendor user group meetings instead of a massively broad conference that is more useful to providers who are shopping products.
• A cutback in travel funds from vendors anticipating a market slowdown.
• Questionable return on investment for both providers and vendors.
• An increasingly less-useful education track that favors just pushing attendees into the exhibit hall nonstop.

A reader sent a link to the Sands Expo’s brochure describing its “green “ practices conference planning tool that should relieve HIMSS attendees worried about the lack of obvious recycling efforts. Interesting facts from it:

• The Sands Expo facility earned LEED Gold certification for existing buildings.
• Meeting rooms are equipped with sensors that control energy-efficient lighting.
• Onsite solar panels address some of the energy requirements.
• The convention center recycling rate is 80 percent, with waste sorted at both on-site and off-site recycling stations.
• Leftover food is made available in the employee dining room with the unused amount composted and sent to a local pig farm.
• Carry-out and concession serviceware is compostable.
• The entire property is smoke free except for the casino and 6 percent of guest rooms.
• The facility offers volunteer opportunities to conferences exhibiting that include helping with soap and shampoo recycling, creating Clean the World hygiene kits from recycled materials for locals in need, helping sort donated products for the local food bank, packaging nutrition bags for senior citizens in poverty, packing food in backpacks for local children, boxing meals for after-school programs, and volunteering with Opportunity Village to support those with severe intellectual disabilities.

HIMSS barely missed what would have been a huge PR scoop as the Denver Broncos announce that Peyton Manning will retire, just two days after his HIMSS conference keynote.

An 86-year-old woman accidentally strangles herself to death when her medical alert bracelet, which did not have a breakaway clasp, gets tangled in her walker.

Weird News Andy advises people to “Don’t Worry, Don’t Be Happy.” A study finds that joy – along with anger, grief, and fear – can cause emotional stress that contributes to takotsubo (aka broken heart) syndrome. 

Sponsor Updates

• Huron Consulting Group and Strata Decision Technology announce a partnership to create a value-based care transition solution.
• NextGen Healthcare integrates CareSync CCM into NextGen Ambulatory EHR and will offer the product to its customers who want to perform and bill chronic care management services.
• Aventura chooses HealthCast as its single sign-on partner.
• Catalyze will add support for Microsoft Azure to its HIPAA compliance platform as a service.
• The Advisory Board Company offers case studies from four health systems that saved $4 million using its Crimson performance analytics program.
• Nordic will offer its customers visual analytics from Qlik Sense.
• NextGen Health integrates inMediata’s inBanking payment reconciliation solution with its practice management system, allowing payments to be electronically reconciled against banking deposits.
• VMware integrates Imprivata’s user credentialing and messaging products into its Workspace One provider digital workspace.

Blog Posts

• #HIMSS16 – Where are we on the journey to value-based care? (Nordic)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

Dr. Jayne’s HIMSS16–Thursday

I was able to sleep a bit later this morning – no breakfast meetings or client calls. Trying to determine which sessions I want to catch has been an exercise in frustration. It feels like most of the ones I’m interested in all occur at the same time.

While I was looking at the short list of possibilities for today and eyeballing what I missed, it struck me that some submitters were much better at creating eye-catching titles than others. Some of my favorites:

• Patient Engagement: No Diamond Ring Required
• Five States, 700 Physicians, and Four Best Practices for HIEs
• Just Press Print: Challenges in Producing EHRs in Litigation
• Patient Identification: Biometric or Botched
• How to Avoid Getting Sued by Your Cyber Risk Insurer
• Rise of the Medical Scribe Industry – Risk to EHR Advancement
• Hard Truth about a Soft Go Live

A couple of the sessions I was particularly interested in happen to occur on Friday, so I’m looking forward to finding them online. I’m also looking forward to reviewing “What Do You Do When Your Improvement Project Fails” because it’s near and dear to my heart. When I went for my Lean Six Sigma certification, my first project was a complete and total bust. It ended up being a good thing, however, since it led to the creation of an upgrade methodology that I still use today, but it was definitely painful at the time, not to mention embarrassing.

I had mentioned yesterday about the lack of recycling (or discussion of single stream management) and a reader commented that there were signs near the waste receptacles. I made a more concerted effort to notice today and still didn’t find any more than I had already seen. The conference center did have divided bins (waste vs. cans/bottles) that I saw previously and failed to acknowledge, but most of the bins I saw in the exhibit area were unmarked.

My hotel had no mention of recycling whatsoever. They did mention on the express check-out card that they don’t issue paper bills for environmental reasons. Still, I needed a paper copy for reasons of my own and the desk clerk actually scolded me, saying I’d receive it via email by the end of day. It’s midnight in my world and I still haven’t seen it, but I guess in Vegas time they have a couple more hours.

I noticed some bachelorette-appearing ladies coming out of Treasure Island in what appeared to be last night’s clothes. They were sporting some adult-themed balloon hats and I’m just sorry I wasn’t fast enough to get a picture. It’s a good thing that what happens in Vegas stays in Vegas because they were looking pretty rough. Perhaps they were headed up the street to White Castle for some hangover therapy. I didn’t remember seeing it on the strip last time I was here, but the strip can be overwhelming and things are easily missed.

I did a last-minute swing through the exhibit hall and heard quite a few comments about people getting ready to head out. I do wish I had more time to see more products and attend more sessions, but staying through Friday wasn’t an option. I’m not thrilled about the schedule shift that occurs when HIMSS is in Las Vegas and it seems like others aren’t so thrilled either. Next year we’re back in Orlando, which is challenging for its own reasons. I wish HIMSS would reconsider other options for the meeting.

The show floor was still fairly busy although nothing like opening day. I had equal numbers of reps who were smiling and trying to engage people walking by as compared to those who were looking pretty bored. I popped down to Hall G to see a couple of specific vendors and ended up running into someone I hadn’t seen in ages and chatting took up most of my remaining time.

It takes a lot of discipline to try to see everything and do everything at HIMSS. I’d like to blame my broken toe for slowing me down, but I think the whole event is almost too much. Thanks again to Edifecs and their #WhatIrun for literally making it possible for me to limp my way through the week in comfort.

I was fortunate again this year to have a vendor executive offer to share his car to the airport, allowing me to bypass the taxi queue craziness and providing a nice chat on the way. I enjoyed getting his thoughts on the industry and the move to value-based care. The airport was surprisingly low key and I made it through security in record time, for which I was grateful.

During my flight, I was able to catch up on the unbelievable amount of email that had come in during the week. One was from a PR firm correcting me for not using their client’s full name in my mention. Although I appreciate their position and their diligence to the brand, I hope they understand that (a) HIStalk is not my full-time job; (b) sometimes we write quickly and on the fly; and (c) during HIMSS, I usually end up writing at 1-2 a.m. after hitting the show all day and at least three or four vendor events each night. An email from a different vendor used the analogy of “a tree falling in a vast, cold, poison-ivy infested forest” gets my compliments for best prose of the day.

Weird News Andy wins the award for best fashion advice in the “What Not to Wear” category, sharing a piece explaining the perils of wearing shoes with gun-shaped heels and bullet-shaped accents.

I also received a note from a vendor exec apologizing for missing HIStalkapalooza. Apparently there was an EHRA dinner and awards ceremony that overlapped and they couldn’t make it to Mandalay Bay before the doors were closed. Another physician reader who did attend asked if I had any photos of her team and John Halamka doing the limbo at HIStalkapalooza. I am very sad to say that I do not, but if anyone does, please share.

What has been the best part of HIMSS? Email me.

Email Dr. Jayne.

From HIMSS 3/3/16

From Idiosyncratic Reaction: “Re: change. Thought you would like this.” It’s perfect.

From Civil Discourse: “Re: HIStalkapalooza. I realize that some people like loud music, but I would rather see a provider-only get-together that facilitates making contacts and having more in-depth conversations with peers.” The tug-of-war between “it’s a party” and “it’s a networking event” started in the event’s second year in 2009, but since then, HIStalkapalooza has evolved more into a party and attendees are self-selecting knowing that’s the case. Maybe there should be a two-hour, provider-only networking event before the regular HIStalkapalooza starts, or even a separate event entirely. The downside is that just putting on HIStalkapalooza consumes lots of time for weeks beforehand and I’ve assumed that the conference provides ample networking opportunities already. I’m open to ideas.

From Mutually Assured Destruction: “Re: HIMSS16 observations. See if these resonate.” Here’s what MAD submitted:

• Best new addition to HIMSS Annual Conference. HIMSS Living Room. We attend the annual conference for the networking and it’s such a pleasure to be able to connect in a comfortable space with food for sale and a nice mix of comfortable seating, mini conference tables, etc. I had more ad hoc face-to-face meetings in two days than in months of scheduled meetings, and the hallways weren’t lined with floor-sitters trying to rest their weary feet.  Well done, HIMSS!
• Most interesting tone change. I’ve noticed throughout my HIMSS lifetime that each year, a different villain was blamed for problems with health IT. One year it’s physicians who wouldn’t accept change. Next year it was health system administrators who wouldn’t budget more than 3 percent of spending on HIT. Then the government for issuing unworkable mandates. Then health IT vendors whose EHRs weren’t user friendly enough. It was very refreshing to hear Karen DeSalvo say, (paraphrasing) “Let’s stop the blame and shame and look for solutions.”
• Biggest irony. That a conference focused on developing solutions for improving the nation’s health is hosted in a location where daily exposure to second-hand smoke is unavoidable. Anyone with even the mildest asthma condition spent the week wheezing and coughing. I know there are only so many venues that can handle the HIMSS annual conference, but if we never return to the Vegas Strip it will be soon enough for me.
• Biggest stressor/biggest regret. Being a no-show at HIStalkapalooza because of a last-minute work command performance conflict, knowing I’ll be blacklisted next year.

From High Pitch: “Re: HIMSS session on cognitive computing. It was a pure Watson vendor pitch. Don’t they have a customer who is willing to speak on behalf of the success they’ve had?”

Four hospitals in Israel were infected with ransomware in the past month alone.

Dignity Health will expand its use of Cerner.

Some of the DrFirst roving reporter interview videos from HIMSS16:

• Politico’s David Pittman’s prediction of key themes at HIMSS16
• Mark Mixon discusses privacy and security in rural community hospitals
• Linda Stotsky: insights on the future of clinical decision support
• Healthcare lawyer Matt Fisher discusses security and privacy on social media
• What Parkview Medical Center does to protect privacy and security

Lots of folks were wheeling suitcases through the casino this morning and packing up their exhibits this afternoon, foretelling the usual poor attendance at Friday’s sessions. It will be cold where a lot of people are going, with these highs Friday: New York 39, Boston 36, DC 43, Atlanta 59, and Chicago 38. Las Vegas will be sunny and 80 degrees.

Overheard: “I’m a hospital business analyst. I stopped by the booth of Borda RFID to get product information. The rep didn’t want to let me in the booth. I tried to get some collateral and she told me I couldn’t have anything because it was for CIOs who were coming by later. She made me put it down. I pointed out my CIO across the aisle and said, ‘Notice that his bag is empty while mine is full. Guess who initiates product investigation at my hospital?”

I spent the morning wandering downstairs Hall G, walking slowly and offering eye contact at each booth to see which vendors were paying attention:

• I had great coffee and a brownie at BridgeHead.
• CaptureProof explained their secure patient-provider photo, video, and comments exchange.
• Doc IT Solutions is a first-time exhibitor. They offer document management and said they’ve done great this week.
• Oblong Mezzanine is a telepresence-like visual collaboration conference room setup that is realistic and allows impressive image manipulation via a wand, almost like in “Minority Report.” It’s being used by Mercy Virtual. Their full-scale mock conference room was nicely done. They say it’s being used by tumor boards and other groups that need a lifelike virtual meeting setup. This was the coolest thing I saw today.
• Stibo Systems is a master data management vendor that serves 34 of the top 50 retailers in the world. They said MDM is not yet widely known in healthcare, but interest is growing.
• IMAT Solutions offers tools to normalize and aggregate data in real time for reporting.
• DataMotion Health equips providers with the ability to let their patients download their data.

I ran across this booth in the Hall G maze. Pretty cool.

I checked out FormFast, which had an iPad-powered self demo. They offer electronic forms, barcoding, and data collection, including online consents.

The folks at Netskope were giving away this book, which is actually very good. Netskope’s tools allow companies to find situations where PHI or other sensitive information is being sent to unauthorized cloud services, which its studies have shown happens in 21 percent of healthcare organizations. The average healthcare organization uses 1,017 cloud apps. The company’s technology allows creating policies for each risky activity. They offer a free cloud risk assessment.

That’s all I have for the moment. I left mid-afternoon today because I’m super tired (probably like everyone else). I’ll wrap up anything I have left to say about HIMSS16 this weekend. Safe travels home, everybody.

Dr. Jayne’s HIMSS16–Wednesday

If I thought yesterday was an overwhelming 16 hours of HIMSS-related events, today was even more packed. I started the day with a couple of standing client calls. It’s important for those of us that are here to remember that for the rest of the health IT community, time marches on and no one really cares whether we’re at HIMSS or not.

Fortunately, both of my clients are doing well and the calls were brief, allowing me to use the time zone change to my advantage and still make it to the exhibit hall close to opening. Crowds seemed lighter today and I felt much less like I was trapped in a salmon run.

I had the opportunity to check out Aprima’s new patient portal, which was aesthetically pleasing with very little clutter. They have solid features and are planning to add more during upcoming releases. We had a good discussion about the difficulties of developing a patient portal, including the requirements for proxy users and the difficulty of handling data for pediatric patients. They definitely understand the challenges and I’m looking forward to seeing how their product evolves over the next year.

One of the other areas I focused on today was Chronic Care Management documentation for ambulatory EHRs. For those of you not in that space, Medicare came out with a new billing code last year that allows providers to bill an additional $42 per month for care management services for patients meeting certain criteria involving chronic diseases. Each vendor seems to have its own spin on how to handle the documentation (there are time thresholds that must be met) as well as how to identify patients for the service in the first place.

I didn’t see any vendor with as robust documentation as I would have liked to, but that reflects the slow uptake in the market for the new code. Patients have to consent to enrollment and usually end up paying around $8/month in coinsurance, so adoption has been slow in some markets.

I met up for lunch with a handful of my favorite women and one of them was packing these fetching flats for later in the day. Due to my broken toe from earlier in the week, I’ve had to resort to some less-fashionable shoe choices, but it was nice to live vicariously through her.

I was also busy today attending sessions. Most of them were sparsely attended and it didn’t seem like the rooms were particularly well matched to the number of attendees. I’ve been to several other conferences where attendees are asked to register their session preferences in advance to the planners can right-size the rooms for the expected audience. One presenter commented that this was the largest room he’s ever spoken in especially given the number of people present. I think there were about 20 people in a ballroom that would seat several hundred. He did a great job with his material, but included a couple of off-color jokes, which would have been better left unsaid.

I haven’t been able to hit nearly the number of sessions I had planned. Rumor has it that HIMSS will be posting the sessions to their website so we can complete the continuing education requirements after the fact. Hopefully they’ll be posted soon because I’d like to cross Maintenance of Certification off my list for the rest of the year. I had the chance to connect with a couple of fellow clinical informaticists and swap war stories, which is one of the main reasons I like to come to meetings like this.

I always love Epic’s artwork, including this bottle-cap wearing unicorn and a musical cow. I overheard a couple of attendees commenting about the adult coloring books at Aventura. Kudos to them for tapping into a current trend and having a give-away that was definitely out of the box.

I’ve been plagued by dry skin on this trip, requiring a trip to the store for better moisturizer. I forgot my lip balm at the hotel so spent a bit of the afternoon scouring the hall for another tube. NextGen didn’t disappoint with their high-end giveaway and the mesh bag will be perfect for corralling cords in my bag. I know Mr. H mentioned the apparent lack of recycling and I’m always happy to see something I can reuse. I know some hotels do recycle and do the sorting for you, but I haven’t seen anything about that practice on the signage at the expo center or at my hotel.

IMO had some technical tee shirts at their booth. I’ll be enjoying mine as I continue to hit the treadmill during the rest of the winter. They also hosted a reception tonight at Hyde, located right on Lake Bellagio. The views of the fountains were stunning and I was impressed by the understated elegance of the event.

Tonight seemed like the busiest night for vendor events, with offerings from Nordic, Athena, NextGen, Greenway, and a host of others. It seemed like the events were shorter this year than in the past, with many of them only scheduled for two hours. The tight timeline and spread-out nature of the venues made it difficult to get to all of them although I did give it a fighting try.

I’ve never been able to make it to a Greenway event because it usually conflicts with HIStalkapalooza, but due to the date shift this year I finally made it happen. I’m glad I did because it was the best party of the night. Held at the OMNIA nightclub at Caesar’s, it featured a good selection of food and some sassy bling-handled cake pops. The DJ had the party hopping and it continued well past the published end time, with wait staff continuing to circulate for drink orders and offering water to those of us that were starting to wind down. Their photo booth was busy all night, and since it was open and in the middle of the action, we got quite a few laughs.

I met up with a good friend for a nightcap, although I didn’t get to stay as long as I wanted. Luckily he understood my need to go back and finish writing as well as to try to catch up on the hundreds of emails I haven’t been fielding for the last few days. Jet lag has definitely set in but I hope to sleep in a little tomorrow.

Dr. Jayne’s HIMSS16 Tuesday

Today provided a full 16 hours of HIMSS-related fun, starting with a questionably planned breakfast meeting that was way too early for a post-HIStalkapalooza morning. As usual the party was tons of fun, with lots of celebrity sightings and more than my fair share of time on the dance floor. Party on the Moon never disappoints, and I was glad to share the night with some good friends, connect with last year’s Secret Crush, and meet some new people.

Props to Dr. Eric Rose of IMO for his blue suede shoes.

These boots were also fetching. After catching a late night snack and some must-needed rest, I hit the exhibit hall along with apparently everyone else. The crush of people moving through the expo center was unreal, with long lines for breakfast and coffee.

I started my day with a Greenway demo. I’m focusing on population health during this visit and give full credit to the product specialist, who asked a lot of good questions about what I was looking for and immediately recognized that I was more knowledgeable than the average bear, jettisoning her standard presentation to tailor it to my needs.

After hitting a few more booths, I headed over to Medicomp to play the new improved version of Quipstar. This year they are featuring their Quippe Clinical Lens product, which was easy to use. The Green Team was victorious, making this my first win at Quipstar. The team was made of audience members as well as the core group of Evan Frankel (4ealth Consulting Group), Maria Luoni (NextGen Healthcare), Bonny Roberts (Aventura), and Debbi Gillotti (nVoq) as well as several audience members. I was pleased to see quite a few HIStalk readers in attendance as well.

I was able to get a quick behind-the-scenes tour of the operation behind the Quipstar show and learned the answer to one of the biggest mysteries of our time.

Sunquest had the first sponsor sign I spotted.

Orchard had some cute stress-ball giveaways. I plan to surf the hall tomorrow with one of my favorite people, who has gathered up some of last year’s giveaways and plans to return them to their vendors. We’ll see how that goes.

I spotted my secret crush in the exhibit hall sporting his sash with his bright orange Aventura shoes. I’m just glad he got the sash back at the end of the night, since there were multiple people wearing it at different points at HIStalkapalooza.

I spent lunch catching up with a start-up vendor, who is not exhibiting but who is conducting meetings at HIMSS. Given the cost of booth space and other amenities, I’m not surprised by this approach. The hall hosted several happy hours this afternoon – Webair with their “Doctors, DR, and Drinks” event as well as Orion and Greenway. I participated in a vendor focus group which was very interesting, then headed for a quick shoe change and purse swap before the second night of events.

In the afternoon I hit the Intelligent Health Pavilion, located in the subterranean exhibit hall. I was surprised by how much buzz was going on there, and ran into a friend that I hadn’t seen since 2009. It was good to catch up in person. I also spotted these snazzy wing tips.

Dell hosted a client event at Bellagio’s Bank nightclub, which was hopping. Practice Insight had a subdued but classy event at the Platinum Hotel. We also hit the Imprivata event at Beer Park at Paris. The band was great and they had not only a photo booth, but someone hand-rolling cigars. Next it was off to the Bourbon Room at the Venetian to connect with friends old and new. Renewing relationships is the best part of HIMSS and I hope to connect Wednesday with someone I haven’t seen in almost six years. It’s been too long.

From HIMSS 3/2/16

From Bonus Question: “Re: HIStalk. How big is your team? How many events people do you have? Where is your headquarters?” I always have to laugh when someone thinks I have an HIStalk team, like it’s a real business instead of just doing what I love doing. Jenn and I write, Lorre handles sponsor stuff and webinars. That’s the whole team. We don’t have events people – Lorre spends a lot of time arranging HIStalkapalooza. Our headquarters location is our computer screens.

From Cereal Killer: “Re: CMIO lunch. Why didn’t you have one this year?” I’ve only had one of those lunches, which was at least year’s conference since McCormick Place had a HIMSS Bistro setup near the show floor that’s not available in Las Vegas. I should have realized that the Venetian and Palazzo have lots of restaurants I could have booked, but I always forget that while HIMSS controls every hotel and conference room for miles during conference week, it doesn’t insist on managing restaurant space (yet).

From Sirius: “Re: HIMSS booth dress and food fest. One may be more appropriate versus appealing.” I’ve noticed that booth food is a lot less available than in years past, but Iron Mountain has put out some impressive spreads, including the chocolate-dipped fruit I saw today.

From Digital Probe: “Re: Hall G exhibitors. They could sponsor HIStalk for a year and get tons more exposure than a three-day booth setup that nobody sees.” I feel sorry for companies that paid dearly to exhibit in the downstairs Hall G without understanding how little traffic it gets and how crammed in the tiny booths of unknown companies are. As I overhead from one attendee, Hall G attracts companies whose business model avoids competing with Epic and Cerner (he claims there are 30 companies down there demonstrating instant messaging), but of which 40 percent will be defunct within a year.

From Cherry Pie: “Re: booth eye candy. Your news item had a photo of attractive dancers and you’re complaining about booth babe eye candy? Please!“ This comment made me angry. I had included a photo that Party on the Moon took from their stage that showed the male singer and four females that included singer Kelsey Chandler in costume, captured during one of their amazing numbers and posted by the band to their Facebook. Cherry Pie apparently is happy to insult Kelsey by suggesting that her primary contribution is her appearance, which is absurd if you had heard her singing Monday evening. CP’s smug opinion doesn’t help the cause of talented women who are free to look, dress, and behave however they like. I know CP probably fancies himself a progressive man, but he’s not doing women any favors by insinuating that attractive ones must have been chosen just for their looks – that’s just as maddeningly sexist as actually hiring subjectively attractive women over more qualified but subjectively less-attractive ones. You’re either gender blind or you aren’t and I doubt Kelsey needs your approval of her choice of dress, showmanship, or vocal talent.

Looks like from the preliminary HIMSS estimates that conference attendance down quite a bit from last year. I hope that’s true – I’d like to see HIMSS worry about it enough to eliminate some of the practices that might be turning people off. I’m happy to provide my own list.

Stop by our Booth # 5069 Thursday at 11, when we’ll have your HIStalkapalooza hosts Barry Wightman and Jennifer Lyle on hand to say hello. Barry is director of marketing at Forward Health Group, where he deals with software-assisted outcomes, but he’s also a published book author, voiceover talent, fiction editor, and rock musician. Jennifer is founder and CEO of Software Testing Solutions, which helps health IT software vendors accelerate end-user delivery (and therefore revenue recognition) via automated testing, whether it’s for interoperability interfaces, middleware, outreach software, or LIS applications, cutting testing time from weeks to days. They would be ecstatic to see some HIStalkapalooza attendees drop by.

I’d like to give a shout-out to the folks who are minding the store while the rest of us are screwing around at the HIMSS conference worrying about which party to attend. My conclusion is this: the folks here can’t be all that important if their organizations run seamlessly in their absence. People who don’t travel much think it’s glamorous and fun, so those here can score points by emailing back to work and thanking the people who stayed behind.

I really appreciate the vendors and CIOs who participated in my CIO lunch on Wednesday. Lorre reports that everyone seemed to enjoy themselves, the food and Maggiano’s were great (I paid for lunch, just in case someone thinks it came out of the money donated), and Dana Moore says he’ll write a description of what each sponsor talked about for me to run later. I funded a lot of projects from the proceeds, with every dollar donated going directly to helping a lot of classrooms, teachers, and students that needed some financial assistance. A vendor executive who is setting up a family charitable foundation told me he had DonorsChoose vetted and they passed with flying colors, which isn’t surprising given their near-perfect Charity Navigator scores. The CEO, a former teacher, takes a very low salary.

Speaking of DonorsChoose, Epic QA donated $50, to which I applied matching funds as well as some personal money to purchase a library of 25 biographies for Mrs. Hale’s third grade class in Indianapolis, IN. She responded almost immediately, “From the bottom of my big, third grade teacher heart, THANK YOU! Thank you so much for taking the time to help get my students biographies that are kid friendly and engaging. They will be so excited to read about people from the present and past. I can’t wait to see their faces when I tell them we have so many new biographies to choose from.”

Ross Martin, MD, MHA was too busy changing jobs and houses to perform at HIStalkapalooza like we originally planned. However, I had a sash made for him, which he picked up in our booth today. He made a great Elvis here at our 2012 event.

Nordic’s Aaron Mann dispels the notion that HIStalkapalooza is just a party, explaining that a chance encounter is actually pretty likely when you have a room full of the industry’s coolest people.

DrFirst filmed Jonathan Bush doing his Donald Trump imitation at HIStalkapalooza.

Here’s an HIStalkapalooza flashback video from the 2012 Las Vegas event, hosted by the amazing ESD. I watch this every few months since I really like the music and the atmosphere it captured. For trivia buffs, we held this one at the since-closed First Food & Bar restaurant in the Palazzo. Let’s hear your memories and comparisons if you were there.

DrFirst captured John Halamka accepting his HIStalk Lifetime Achievement Award on stage. He won several awards Monday evening. I’m a big fan.

I will never like this product name, formed by leaving out the “t” in “quantum.”

Chris Miller of the DoD led a discussion about their EHR project. He said military users demanded an integrated system and that DoD is happy making configuration decisions instead of leading technical design sessions for self-development.

A CEO suggested that I take a look at Novarad’s VNA. That’s not my strongest area of expertise, but it was simple to understand and their services agreement covers maintenance and disaster recovery. The zero-footprint viewer running on Google Chrome was cool. Users can upload any document from a network-attached drive and store it in designated patient folders in the VNA.

Is it just me or is it bizarre that in this day and age, Las Vegas apparently doesn’t recycle? I didn’t see any blue trash cans.

I watched a kiosk demonstration at the Fujitsu booth and pondered this question about biometric security since they offer palm vein scanning ID systems. People have rightfully observed that if biometric credentials are stolen, there’s little recourse since users can change passwords but not their fingerprints or palm vein patterns. Here’s my idea. In both cases, all that’s stored by the scanning system is a set of mathematical inferences from the image, not the image itself. Why not allow each vendor to develop their own ID matrix from the hundreds of available data points? Maybe Vendor A takes the mathematical representation of the palm vein scan and uses 25 data points of their choosing to construct a verifiable user ID, while perhaps Vendor B uses a different 52 data points to string together their own ID characteristics. That form of “encryption” allows each vendor to positively ID patients using characteristics that are meaningless outside their own environment, making it pointless to steal the entire biometric database because it doesn’t work on other systems. Even if Vendor A gets breached, they can simply choose a new algorithm and convert existing profiles, immediately locking their own systems back down while preserving the ability to keep using biometrics without noticeable patient impact. Interoperability of biometric ID is unnecessary – it’s perfectly fine for individual IT systems to positively ID patients from their individual, proprietary subset of the entire biometric scan.

A reader told me about this 2013 TEDMED video by ZDoggMD on testicular self-examination, set to the crotch-grabbing music of Michael Jackson. It’s brilliant. “I’m checking out my nads in the mirror.” He was on stage at HIStalkapalooza with Jonathan Bush.

HIMSS Media was doing a live radio show from the exhibit hall. I can’t imagine that anyone was actually listening.

CareTech had their “mission control” display out. Pretty cool.

Allscripts had quite a few people in their booth today.

The coolest product I saw was from EchoPixel, which is exhibiting “blended reality” in the HP booth. It’s a fuzzy monitor image above because it’s 3D, but putting on the 3D glasses makes it shockingly real for clinicians to look at diagnostic images spatially, practice their procedures, and interactively pick up and move objects like implantables to plan surgeries. Not only was it super cool, the friendly lady showing it was Janet, who has a biomedical engineering PhD from Cal Berkeley (she was shyly embarrassed a little when I noticed the credentials on her business card and starting gushing like a star-struck fan). It was an outstanding product demonstrated by a really cool engineer. You should see it before the exhibit hall closes Thursday.

Epic’s booth sign claims that moving from Cerner or Allscripts increases profitability.

Cerner strikes back in pointing out that Banner bought University of Arizona Health Network and promptly announced plans to replace Epic with Banner’s Cerner systems. UA had made a bit of a mess of it, with project budget overruns being one of several reasons it had to sell out to Banner.

Hall G is a lot of tiny booths of mostly unknown companies. I’m sure there’s some good stuff down there, but it was sort of depressing down there in the basement, especially knowing that companies paid dearly for a low-traffic location.

Legacy Data Access made their point with a dinosaur. Pretty cool.

I asked NTT Data about Bob the amazing magician they have in their booth. Apparently he’s about to retire, but they’re hoping to lure him back next year. I commented that I saw him doing absolutely unreal things in talking about the deceased relatives of some HIMSS attendees watching his performance – they said that in the demonstration shows he did for their employees, several left the room crying after his apparent contact with their family members who have passed on. I wouldn’t have believed it myself, but I strongly recommend that you see him Thursday and decide for yourself. I thought I was going to have to physically support my fellow HIMSS attendee whose deceased grandmother Bob described in amazingly precise detail despite knowing nothing more than her name.

Thanks, LifeImage, for the cool backup battery for electronics.

Our booth neighbors Stericycle Communications have been tolerant of our never-ending parade of visitors. Stop by and have your picture made with Elvis – it will make their day. They’re nice people.

I don’t understand how either of these neighboring companies are still in business.

I heard the hall-filling sound of singing and found Anthelio’s Sinatra imitator cranking up his backing music to very high levels. You could hear him 20 rows over. I’m sure neighbors complained given the strict HIMSS rules on sounds or activities that detract from other exhibitors, so I’m certain they had to turn it down. He was OK.

I saw quite a few vendor people eating lunch in their booths out in the public areas. Bad idea. Attendees are either going to feel they’re intruding or they’re going to get hungry. You’re on stage when you’re in your booth on the time clock, so act like it.

Every year I’m amazed at how customer-indifferent the people working the Microsoft booth are. I stopped by today as the only person in front of four Microsoft employees standing in in front of some notebooks and Surface Pro devices. Two immediately walked away chatting together as I stood there trying to make eye contact, while the remaining two talked among themselves in studiously avoiding eye contact until I finally left. They really are self-important geeks who shouldn’t be allowed within 100 yards of prospects or customers, yet every year I experience the exact same treatment in their booth.

Medecision’s mentalist was sporting a cool suit.

I was happy not to see the distractions of previous HIMSS conferences like people pretending to be statues, dozens of booths baking cookies, and golf simulators. Here’s the odd thing, though: nearly every vendor was giving away pens, but I couldn’t find a single one offering anything to write on. I really needed a notepad.

I found myself pondering why low-level vendor employees have to wear company shirts while on HIMSS booth duty, while their richly compensated bosses don suits instead. Shouldn’t the company’s highest-paid person be proudest to work there?

The HIMSS “Ask Me” people are really friendly and helpful. Kudos to them.

Overheard: “Todd Park left Athenahealth with $40 million in shares to go to work as HHS CTO. Federal service requires liquidating such holdings, but since the government then recognizes the proceeds as tax free, Todd avoided paying the many millions of taxes that would have otherwise been due on the $40 million stock sale. I’m not saying he took the job for just that reason, but the man knows how to work a spreadsheet to his advantage.”

Cerner’s booth had an open feel, complete with a journey through various healthcare settings.

The DoD EHR project got some podium and booth time.

Epic claims to not have a marketing department, but someone there is doing a pretty good job of stating the company’s case.

From HIMSS 3/1/16

From Organized Thyme: “Re: leap day. We were impacted by a large documentation management system vendor that would not allow us to scan in yesterday. Rumor has it that every one of their customers in the US were impacted.  Can you believe that in 2016 a medical software vendor could not program to handle leap year day? Their workaround was to have us hold all documents from 2/29/16 and scan them on 3/1/16.” That is indeed hard to believe. Luckily (or not), we’ll all be dust by 2100, when the usual leap year logic is skipped on the “every 100 years” exception schedule.  

From Thrill Me: “Re: HIMSS. One of my pet peeves is when companies hire female eye candy for booths.” The only way to pick them out is to engage them in product conversation since being attractive and talented certainly aren’t mutually exclusive, but I honestly saw only one person in the exhibit hall today who even looked as though they might be a booth babe. I think those days are happily gone. I’m also thrilled that companies aren’t even shy about putting obviously valuable geeks out on public display, like guys with long, gray ponytails or technologists who can’t look someone in the eye. However, I wish clueless vendors would stop putting non-clinicians in scrubs and white coats – that’s an insult to their target audience, obviously one of the stupidest things you could do in trying to move product.

From Pshaw Y’all: “Re: HIMSS. A gentleman with a HIMSS badge was walking through the Mirage lobby with a shuffled, stuttered walk. A woman stopped him, noticed his eyes, and realized he was having a stroke. She dropped her bags, ran to the front to get paramedic help, and returned to be with him. Several others had noticed, including myself, and from behind assumed it was a disability. It took a special person to stop, look at his eyes, and help.” It’s likely that few of the big-bucks people at the conference would have any idea what to do if faced with a patient in distress, or even if they did know, whether they would actually deign to render aid. Kudos to whomever that person was. You want a clinician and not a bureaucrat when you have a medical need. I had a funny HIStalkapalooza sash made for Jonathan Bush that read, “I CPR’ed some random guy,” but let’s face it – when that homeless guy went down on the San Francisco sidewalk, it was former Army medic and New Orleans paramedic JB who pushed the gawking suits out of the way and resuscitated the guy. Strokes are scary, so let’s hope our fellow conference-goer had a good outcome.

HIStalkapalooza

Lorre had at least 1,000 email exchanges with people wanting individual attention for HIStalkapalooza in the last few days – wanting to bring a guest, wanting to come even though they didn’t sign up, wanting to bring a colleague who wasn’t invited. She was literally sitting in the green room 15 minutes before the event started still furiously trying to keep up with event-related emails. Today started the in-person versions, of which this one was unfortunately typical in the “how exactly do I answer this?” manner:

• (Some guy who ran up to Lorre in the hall): “You ruined my HIMSS conference. You didn’t invite me to HIStalkapalooza.”
• (Lorre): “Did you sign up?”
• (Guy): “I didn’t know I had to. I got all this crap from HIMSS and didn’t see an invitation.”
• (Lorre): “Do you think we invite every HIMSS attendee? Do you even read HIStalk? The invitation process hasn’t changed in eight years and we explained it every day for weeks starting in early January.”
• (Guy, indignantly): “I read every post carefully.”

The no-show rate was high as usual, but Eventbrite check-in allows us to give those folks lower priority if I decide to do an event next year.

Thanks once again to our HIStalkapalooza sponsors that made the event possible:

Athenahealth
Clinical Path Consulting
Elsevier
Experian Health
Forward Health Group
Fujifilm
Healthwise
NEC
NextGen Healthcare
PatientSafe Solutions
Sagacious Consultants
Validic
Wellcentive

Also deserving special recognition is Ashley Burkhead of Santa Rosa Consulting, who jumped energetically into the fray when our registration sponsor fell through. She and her team organized the entire process staffed the check-in area. We’ve had bad experiences with companies whose people weren’t well prepared or who couldn’t understand that nobody gets in without an invitation, causing long lines and an uncertain headcount, but the Santa Rosa people handled it perfectly. She earned Lorre’s seldom-won admiration. One guy who hadn’t signed up to attend actually emailed Lorre to praise the fact that Ashley’s team refused to let him in even though he tried to bribe them with $200 in cash.

I appreciate our hosts Barry Wightman of Forward Health Group and Jennifer Lyle of Software Testing Solutions. All the nerve-wracking details are easier to work through knowing that I have two experienced and skilled people running the stage show.

I’ll be getting more photos and videos through the week and will share them then.

Party on the Moon posted some photos on Facebook that they took from the stage. Dennis the band leader and guitarist says they love playing for the HIStalkapalooza crowd. They fill the dance floor with their first notes and never slow down until that final song where the big horn section kicks in one last time.

The super helpful and fun folks at PatientSafe Solutions not only provided an HIStalkapalooza photographer, they burned the midnight oil to turn them into this cool video.

Here’s a couple of band shots from Nordic.

Validic sent over this photo of the evening’s big HISsies winner, John Halamka, spending time in their HIStalkacabana. John said on stage that winning the Lifetime Achievement Award can only mean that he’s done and has nothing to look forward to.

Here are your HISsies winners from last night.

A newsy item: Mayo Clinic’s financial report indicates that it plans to spend $1 billion over five years to implement Epic.

I compared Uber vs. a taxi covering the same Las Vegas route of a handful of miles. Uber was half the price, plus they don’t insult passengers by charging a flat $3 per credit card swipe. That’s almost as obnoxious as the mandatory Las Vegas resort fees that can almost double the cost of a cheap room. I also noticed that Uber is smart enough to give you a choice of which hotel entrance you’d like for pickup.

Walking through the convention center this morning was dangerous, as attendees got their HIMSS legs. People were stopping short to stare at their phones in wonderment, veering across people walking straight ahead, slowing everyone down in trying to drink coffee while afoot, and hitting the brakes in high-traffic areas to glad-hand suddenly spied old friends. If the halls were highways and attendees drove like they walk, the death toll would be massive.

Caradigm provided really nice backpacks this time around. A significant portion of them might actually be packed back home instead of filling up hotel trash cans. Nice job.

I feel like I’ve accidentally wandered into a restricted area when I go down to the lower level restrooms, which requires navigating uncarpeted, battleship gray stairs under harsh fluorescent lights.

The most brilliant conference giveaway in history: Lifepoint Informatics was handing out those little 5-Hour Energy bottles.

DrFirst is filming a HIMSS interview series. Above is one of the series of videos, to which more will be added in the coming days. 

HIMSS Conference Random Observations and Photos

The first booth I checked out was Oneview Healthcare, which offers an interactive patient system. They’re booth is close to that of GetWellNetwork, oddly enough, so you can compare their systems easily.

Athenahealth’s escalator ad is clever.

MedData wasn’t allowed to bake scones in the hall this year, but they have retro candy and craft beer. I had a Lemonhead and an IPA, although not simultaneously.

How quickly imitative trends die: I saw maybe two Farzad-style bowties the entire day as his former legion of fawning fanboys apparently moved on to other forms of unoriginal behavior.

The YourCareUniverse people gave me an overview of their product, which offers a consumer health site, a patient portal, and a personal health record.

The VGo Robot people say they’re bringing out a stethoscope that can capture and send data.

I’m always surprised to see these guys coming back since I’ve still never heard of them selling anything in the US after years of trying.

Epic’s outside booth signs were based on fun song titles. Bravo to the Monty Python reference.

The most interesting product I saw today was West’s patient engagement platform that can provided outreach for routine care, transitional care, or chronic care. It’s a nice UI in which organizations can define pathways with timed actions such as sending a survey, doing medication reconciliation, or sending an appointment reminder. The provider can bulk review performance and exceptions. Patient contact can be by phone, mobile or IVR. It’s purely technical tool that should work great for automating ongoing patient contact to make it easier to identify outliers.

Jama Software has nothing to do with the medical journal, offering requirements tracking and collaboration for critical development projects such as working on FDA-regulated software.

Arcadia was showing a Data Quality Scorecard Analysis that plows through data looking for incorrect data assumptions, rule patterns, and database composition.

Summit Healthcare was showing its Enterprise Downtime Viewer.

My iPhone takes crappy pictures, especially if it’s steamed up in my sweaty pants pocket, but this sign indicates that Access was generous in offering to provide latte to its fellow exhibitors, with the only restriction being that its booth guests get served first. I really like these people – we always talk barbeque (some of their folks are on competition teams), they got where they are by self-bootstrapping and hard work, and they have fun. Check out their display case showing manual methods of document delivery vs. their electronic imaging – the crashed drone with (fake) human hair attached made me laugh out loud.

Merge Healthcare was demonstrating its cardiology system database analyzed by its new owner, IBM Watson. A cardboard sign attached under the monitor said “Work in Progress.” I imagine quite a few more of those signs could probably have been deployed throughout the exhibit hall.

Sunquest had its new logo in place. I sat through a session by Rob Atlas on Sunquest Diagnostic Communities and its precision medicine applicability. It connects to EHRs, collects all patient lab orders in a Clean Orders Hub, and checks for duplicates or other problems before filing them away in a repository.

It’s easy to miss the downstairs Hall G and its mishmash of small vendors, educational institutions, and special interest groups, but there’s a DeLorean down there in the CrossChx booth.

Hyland had a replacement magician, which crushed my HIMSS spirit until I saw the astonishing one at NTT Data’s booth. He was snarky in doing the usual eye-popping tricks, but then delved into telling people things there’s no way he should be able to know about their deceased relatives. He was amazing and NTT’s Larry Kaiser was the perfect deadpan foil. This is a must-see – email if you take the time to see him and aren’t impressed.

Park Place International features its new name, CloudWave.

Practice Fusion’s booth was dead. The reps were huddled in a circle, looking inward for strength as the out-of-runway company goes down in flames around them.

Meditech had more reps on the phone as a percentage than any booth I had seen by mid-morning, but the other vendors caught up quickly. I tweeted a joking observation that some booths looked like they were demoing cell phones rather than software.

The food both lines were long by mid-day, sending me fleeing downstairs to Hall G seeking sustenance. Which I found: there’s a food court type setup with no lines and plenty of seats. I scored three spicy chicken tacos, black beans, Spanish rice, and a great salsa bar with homemade pico gallo for $12. It was surprisingly good, although my first bite of chicken was so surprisingly zesty that I gulped down half of my $3.25 can of Diet Coke.

NantHealth’s booth was pretty dead. About all they had to show was a big-picture video about the cancer moonshot.

MedCPU’s booth was a lot bigger and the company is riding the wave of its fresh investment and implementation by UPMC. They’re one to watch since UPMC had tried to develop similar text-mining technology years ago (the MARS system) and should have expertise as well as cash to offer.

I watched an interesting presentation from a Mass General molecular pathologist on managing genomics data, presented by InterSystems. They’re using Cache to store 300 TB of genomics data collected from just a few thousand patients over three years. They’re planning to build decision support tools around the data since it’s too hard for an oncologist to digest at the point of care. InterSystems is one of the most quietly brilliant (and quietly but massively successful) healthcare IT companies.

Greenway’s booth was quiet, but they had a nice happy hour late in the afternoon.

The hot booth furnishing this year: carpet that looks exactly like a hardwood floor. I also noticed that the multi-year transition to light green as the favored branding color is apparently nearing completion. 

Forward Health Group had HealthLinc CEO Beth Wrobel speaking in their booth. I interviewed her a few months back. She says her FQHC wants to “put a face on the denominator.” She says anyone can run FHG’s systems and the only decision to be made is how to integrate it into workflows. She says commercial insurers are their worst payer by far and hopes to use FHG’s data to convince them it’s in everybody’s best interest for them to provide more funding.

Also in the FHG booth was industry long-timer John Holton (Atwork, Scheduling.com, SCI Solutions). He’s doing some HIT investing and advising these days. 

HCI Group was talking about their Securonix system, which offers security behavior profiling, a policy engine, and a risk engine.

I was about to joke to the lady pouring Black Box wine that its vintage must be Friday when I noticed that the company was more clever than I – its name is Black Box Network (no relation).

I was really surprised to not be overwhelmed by vendor buzzwords like analytics, big data, population health management, and patient engagement. Those concepts were mostly just worked into product value propositions instead of being shouted from the rooftops. That leaves me without an obvious HIMSS16 theme so fare.

Overheard Conversations

• “Of course former US CTO Aneesh Chopra is stumping for interoperability. He now works for vendor Hunch Analytics, which makes money ‘unleashing data sets’ that it can’t get unless other vendors share them.”
• “No vendor does population health management well. Nobody even knows what it means yet.”
• “Epic is killing the standalone lab system business.”
• “EClinicalWorks is the least interoperable vendor. The rumor is that CMS is looking into its data-sharing practices.”
• “Meditech is really as much of a real estate company as an HIT vendor. They are the second-largest commercial real estate owner in Massachusetts.”
• “Karen DeSalvo doesn’t care about doctors or EHRs. She’s just using them as a steppingstone to being elected to Congress.”
• “I only come to HIMSS because of HIStalkapalooza.” (Jonathan Bush)

From HIMSS 2/29/16

I shouldn’t really title this post “From HIMSS” since I’ve done nothing conference-related today and have no plans to. Finally I’ve cracked the code that has eluded me so long on how to enjoy HIMSS – stay away from the fray as much as possible.

I mentioned that I rented a large, luxurious house for $200 per day and filled it with family and friends (all female) helping out with HIStalkapalooza tonight. Two of them are in their 20s and another is in her teens, so they’ve had a blast hanging out in the pool and hot tub, playing music and giggling. They weren’t impressed with the Strip, so last night we took them to the real Las Vegas – downtown around Fremont Street.

I can’t remember the last time I had so much fun. I chose for us the old-school $9.99 prime rib dinner at the California Hotel, which was just fine and even included a great salad bar. One of the girls decided to treat us to a bottle of wine and the barely English-speaking cocktail waitress brought back an alarming 1.5 liter bottle of Cabernet (equivalent to two normal bottles). I tactfully offered to pay since I was afraid it might be an unexpected $120 budget-buster for our young friend, but it was actually only $38.

Then we spent a couple of hours at the Fremont Street Experience enjoying the cover bands on stage (one Beatles, one rock), watching the zip line riders flying overhead, and drinking beer in the street. The girls had a ball posing for pictures with street performers. The neon alone is worth the trip. The top-rated Las Vegas restaurant on Tripadvisor is Andiamo Steakhouse in the the D hotel and Hugo’s Cellar in the Four Queens isn’t far behind – both are in that area. The Strip is like a sterile mall whose every feature is designed to extract cash elegantly from wallets, while downtown is a formerly decrepit but now quirky business district that has roared back to life.

Tonight the girls get to dress up in their Rent the Runway dresses and help out with HIStalkapalooza. They have been excited for days.

This morning everybody except me headed over to the convention center to pass out the booth signs I had made for sponsors who wanted to display them. Then they’ll head over to House of Blues to make sure they are ready for tonight’s HIStalkapalooza. I ate leftover pizza for breakfast and hit the hot tub. I just noticed that my cheap Timex watch didn’t recognize that it’s Leap Day, so I almost dated this post as 3/1/16.

I’ll catch up on a few news item to lighten my load tomorrow since I’ll be tired after being out late tonight.

Divurgent hires Bert Reese (Sentara) as VP of portfolio management and innovation.

Epic signs an agreement to give its users access to Tableau Software-powered analytics dashboards and workbooks.

Healthwise integrates its patient education content and tools with Salesforce Health Cloud.

UPMC takes a majority position in MedCPU, will lead a new $35 million funding round, and will become a MedCPU customer. 

EClinicalWorks will implement inpatient software systems in up to 300 hospitals in India. I didn’t realize that its main business there is inpatient software, which might explain the company’s recently announced plans to develop inpatient software for the US market.

Health Catalyst raises another $70 million in a Series E funding round co-led by Norwest Venture Partners and UPMC, increasing its total to $222 million.

Dr. Jayne from HIMSS 2/29/16

Usually the travel day to HIMSS is uneventful and this year didn’t start any different. I boarded my flight at O Dark Thirty and settled in to watch some software training videos that my client had created, since I knew there was a good chance they’d put me right to sleep. After a nice nap, it was time for email clean up.

I must have missed this before, but CMS has extended the Medicare EHR Incentive Program hardship deadline until July 1, 2016. If you haven’t submitted your application yet and want to avoid adjustments to your 2017 Medicare payments, you have plenty of time.

I touched down in Las Vegas right around the start time of the Hot Chocolate 15k run, which had multiple roads closed. Fortunately I had a taxi driver with a great personality, which made the delay tolerable. Although the roads were closed, I never saw any actual runners.

Speaking of runners, I mentioned previously that Edifecs has their #WhatIRun campaign live. I’m flattered to have my profile posted under the healthcare leaders section and appreciate their willingness to keep me anonymous.

For those of you who pop over to take a peek, yes, the comment about the refrigerator is true. Once I arrived at my hotel, I found out that my promised (and paid for) early check-in had been pushed back an hour. It was difficult to find somewhere to hang out that wasn’t completely smoke filled, which reminded me why I am not a huge fan of Las Vegas.

Once I finally received my room keys, I was quite surprised (as was he!) to find a naked guy who had apparently just stepped out of the shower. The front desk was apologetic and reversed my early check-in fee and also upgraded my room. It wasn’t their fault, though – the guest had checked out before he was actually ready to depart, so let that be a good lesson to only check out when you’re ready and also to use the privacy lock.

Once I was settled, I enjoyed the opportunity to get outside and actually see the sun since there is still snow on the ground in my world. I’m always saddened to see the panhandlers on the elevated walkways. Although it’s a complex problem, one man today was clearly having a psychotic episode outside the Palazzo. Hotel security were keeping an eye on things since he was accosting pedestrians. I hope he gets the help he needs.

The fountain at the Wynn was getting some maintenance and I imagine electricians who own dry suits are in demand across down. Registration was smooth, although there was a snafu with picking up bags and materials. At the registration area, they were telling people to come back in three hours to get everything. I decided to wander around the meeting areas and found the bag desk a few dozen yards away, fully stocked and ready to distribute. There were several people headed to the CHIME golf outing toting their clubs.

I stumbled across this Sunday session, featuring AMA president Steven Stack as well as Nancy Gagliano from CVS Minute Clinic and some others. From the time I saw it to when I returned to snap a photo, they had added the “free” to the signage. I registered and chatted with some of the staffers, who were very enthusiastic about their mission. I popped in for a bit and didn’t learn anything new, so headed back out for some more sun.

I connected later in the day with Dr. Lyle and some of his Healthfinch colleagues, who were on their way to a get-together at the Palazzo. My favorite part of HIMSS is catching up with people that I may only see once or twice a year. The rest of the evening was spent with friends old and new, as we christened the Southbound Greyhound as Dr. Jayne’s Official Drink of HIMSS16. (I personally like to muddle in a few blueberries, but there were none to be had.) Note to the bartenders at Treasure Island: you might want to stock in a few more bottles of Deep Eddy Ruby Red. You’re going to need them.

I was trying to unwind this morning in preparation for this evening’s big events, but despite the privacy sign on the door, the housekeeper opened the door without knocking. I always use the privacy lock, so she wasn’t able to get in, but it was annoying, especially since it was barely past 8 a.m. I know they’re in a hurry to turn over rooms, but I’m not checking out today and I did have the sign on the door.

I’m going to meet up with a good friend for lunch and lay out the battle plan for the week. Unfortunately I’ll miss the opening keynotes due to HIStalkapalooza prep, but I don’t think I’ll be missing anything earth-shaking.

For the rest of you prepping for the big night, may I suggest the liquor section at Walgreens, which has the Pedialyte thoughtfully displayed with the Ketel and Tito’s. I’m looking forward to the dance-floor stylings of Matthew Holt as we Party on the Moon. See you there!

Email Dr. Jayne.