Monday Morning Update 12/29/14

Top News

Cerner shares hit a 52-week high last week, closing Friday at $65.71 and valuing the company at $22 billion. The end-of-year rise sounds impressive until you examine the one-year share price graph that shows CERN shares rising 18.2 percent (blue) vs. the Nasdaq’s 15.6 percent (red), so it barely beat the Nasdaq composite index. 

Reader Comments

From Pango: “Re:  vendor employee provider experience. My company developed a rounding program where our software developers, project managers, product managers, and QA team members spent time observing a clinician in hospital departments. It was valuable because it provided insights into workflows and usability that we could not have understood other than by on-site observation. The programs were in place at several client hospitals and we maintained an active rotation of our team members who wished to participate.”

From Patti Melt: “Re: Epic. I just spent all day interfacing it to other systems. Since Neal Patterson says it can’t be done, should I buy a lottery ticket?”

From Urban Cowboy: “Re: Madison airport. If Epic is trying to eliminate consultant advertising within 50 miles of Verona, someone should tell the airport since it’s about all they have. With fewer implementations, they need all the help they can get.” Someone mentioned previously that perhaps the airport wasn’t within Epic’s rumored no-fly-ads zone since it’s a long cab ride, but Google Maps says it’s only 21.9 miles.

HIStalk Announcements and Requests

News is predictably (and thankfully) skimpy, so the biggest takeaway from this post is that you haven’t missed anything over the post-Christmas weekend.

Dave Miller, CIO of Optimum Healthcare IT and formerly CIO of University of Arkansas for Medical Sciences, sent out an email suggesting Christmas donations to the Salvation Army, recounting how as a child the organization got his family of seven through their temporarily homelessness. Bitdefender wouldn’t let me bring up Dave’s fundraising campaign page at OnlineRedKettle.org because of a phishing warning, but I matched Dave’s $250 donation online in honor of HIStalk’s readers. Salvation Army is my #1 overall charity choice, with DonorsChoose.org running a close second.

I’m ecstatic to report that three-quarters of respondents to my poll say they’re happier now than they were a year ago. New poll to your right or here: what is your overall impression of HIMSS? Click the poll’s “comments” link after voting to explain.

Last Week’s Most Interesting News

• The executive director of the Connecticut Health Policy Project observes that the state’s now-defunct HIE oversight organization spent $4.3 million in federal grant money without accomplishing anything.
• Pennsylvania’s HIE organization asks the state for $4.7 million to keep it running now that its ONC grants have expired and its efforts to bring paying organizations online and to solicit charitable donations have failed.
• The FDA announces plans to require drug manufacturers to publish prescribing information for professionals electronically on an FDA-maintained website, eliminating the paper versions.
• HTC Global Services acquires CareTech Solutions.
• Boston Children’s Hospital (MA) pays $40,000 to settle state charges over the theft of an unencrypted laptop, while Northwestern Memorial Healthcare Group notifies 3,000 people that their information has been exposed by the theft of an unencrypted laptop from an employee’s car.

People

Oneview Healthcare names Samir Batra (CareInSync) as VP of patient engagement.

Announcements and Implementations

TEDMED is offering a $1,000 discount for registrations completed by December 31 for next fall’s event, dropping the cost of the refundable, transferrable delegate pass to $3,950. This year’s event was split between San Francisco and Washington, DC and connected by video. No way I’m paying thousands of dollars to watch a big screen meeting from the other side of the country, but to each his own. The only names I immediately recognized from last year’s speaker list were swimmer Diana Nyad and Theranos CEO Elizabeth Holmes, neither of which would cause my hand to move toward my wallet.

Government and Politics

Jeb Bush will resign from the board of for-profit hospital operator Tenet Healthcare as he explores a 2016 Presidential run. He made $300,000 from that gig last year. Tenet is worth $5 billion, with CEO Trevor Fetter holding shares worth $42 million.

A Wall Street Journal report says that Medicare is hard to fix because the agency doesn’t want to restrict care, adding that new providers aren’t vetted and inspectors never visit provider locations to see if they are real. The article points out that 45,000 new providers sign up to deliver Medicare services every month and CMS doesn’t have the resources to vet them.

Technology

My most-used iPhone app is the outstanding, 99-cent MotionX GPS Drive navigation system. I just noticed that the company offers the also-99 cent MotionX 24/7, which includes a sleep tracker, step counter, heart rate monitor, and wake-up alarm, all integrated with Apple Health. I didn’t realize until I looked up their site that the company’s emphasis is on and quantified self rather than GPS navigation. It holds dozens of patents and licenses its technology to wearables vendors such as Nike. MotionX’s CEO and co-founder is Philippe Kahn, who invented the phone camera, founded the powerhouse 1980s software vendor Borland (Turbo Pascal, Quattro, TopSpeed/Clarion, dBase, Delphi, and Paradox), and earned simultaneous master’s degrees in mathematics and classical flute. I’m installing MotionX 24/7 now and will report back, but I can already see that it’s as well designed as I expected.

Since I mentioned my most-used iPhone app, here’s another highly used one on the phone, desktop, and laptop: the LastPass password manager and single sign-on utility, which allows me to log on to a single Web page and have instant auto log-in to everything I use online (and to easily and centrally maintain complex and mandatory-change passwords) from any device. It’s free for personal desktop use, or an extra $12 per year to run it from mobile devices.

This should annoy everyone smart enough to use their phone as a personal hotspot instead of paying $15 for crappy hotel Internet access: Marriott and its hotel lobbying group ask the FCC for permission to block tethering, using the extraordinarily stupid and self-serving excuse that guests might use their personal Wi-Fi connections to attack the hotel’s network, steal information from other online guests, or slow down the hotel’s Wi-Fi (all of which are arguments hotels should make for NOT using their own in-house networks, other than the fact that they profit handsomely from it). Microsoft and Google are urging the FCC to deny Marriott’s lame idea. Somehow cheap roadside hotels can offer free parking, Internet, and breakfast but the snootier, big-city ones milk their business travelers hard. Marriott’s Springhill Suites is still my favorite chain, though.

Other

The board of Massena Memorial Hospital (NY) approves spending $49,000 for a Medhost upgrade and $29,000 for a Meditech/LSS purchase. The CEO explained that the Medhost upgrade is required for complying with New York’s I-STOP mandatory electronic prescribing law, adding, “The last thing we want to do is end up sideways with the state and DEA. That would be extremely unpleasant.” 

Eric Topol, MD tweeted this graphic of his medical smartphone concept from his new book, “The Patient Will See You Now.” Amazon’s “look inside” preview contains generous sections of the book’s content – it looks good.

This YouTube video of Derby the dog running for the first time after being fitted for 3D-printed prosthetics has received 6.8 million views for its producer, 3D Systems. The company, based in Rock Hill, SC , is traded on the New York Stock Exchange and is valued at almost $4 billion even after shares dropped 64 percent in the past year.

The children of “American Top 40” host Casey Kasem, who died of dementia last June at 82, will share his hospital records with his widow, who is suing the hospital that cared for him. Kasem’s widow is the former Jean Thompson, who played Nick Tortelli’s curvaceous wife Loretta (with the “I Dream of Jeannie” hairdo) on “Cheers.”

The federal government upholds the firing of the head of the Phoenix VA, not because of the wait times scandal that erupted there, but because she accepted gifts from a consultant that included a family trip to Disneyland and Beyonce concert tickets.

‘Tis the season for intolerant lunatics: American Airlines removes a disruptive La Guardia passenger who was loudly berating the flight attendants and crew who had wished him “Merry Christmas.” The man, who wouldn’t calm down, said nobody should ever say Merry Christmas because not everyone celebrates it. His fellow passengers cheered when he was escorted off the plane.
 

UPMC’s Magee –Women’s Hospital (PA) gives keepsake Christmas stockings and caps knitted by volunteers to the parents of newborns who are in the hospital over the holiday.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/24/14

Top News

Healthcare workforce services vendor AMN Healthcare acquires Avantas, saying its clients need staffing forecasting analytics.

Reader Comments

From Sonoran Dog: “Re: Maricopa Integrated Health System. Veiled rumors from administration suggest it will have to shut down in July 2015 due to lack of funds after receiving a large bond in the November elections. Any truth to the rumors? A lot of us medical personnel are working hard to comply with every cost-cutting feature we can come up with to help.” Voters overwhelmingly approved a $935 million bond to upgrade the facilities of the 515-bed public health system that includes Maricopa Medical Center, the Arizona Burn Center, and the Level One trauma center. The CEOs of the four largest private hospitals in Phoenix (Abrazo, Banner, Dignity, and Scottsdale Lincoln) say the huge construction expense is unnecessary given the sufficient bed capacity already in place (theirs, of course.) Readers comments are welcome. Surely there’s little chance of MIHS shutting down given public support, but some sort of public-private partnership with the those other Phoenix systems would make sense.

From Czarina: “Re: vendor-provider contact. What do HIStalk readers suggest for giving vendor employees exposure to the clinical workflow and technical challenges that providers face? We want every one of our people to get out in the field, but just taking a hospital tour doesn’t seem to have much value. We’re considering encouraging volunteering, attending a local or national conference, or taking a clinician to lunch.” I should note that this isn’t a huge company, so their employees won’t overwhelm the local health systems. Ideas? I’ll be honest that in my health system IT experience, I wouldn’t see the benefit to my department in having vendor people underfoot so they could learn on my dime, so I would be somewhat resistant to committing. I like the idea of setting up a volunteer program specific to the IT department if the hospital is willing to support it – our desk-bound IT department people learned a lot just going out with the field services techs or sitting with the help desk people.

From HITPro: “Re: cyberdefense training system. Can’t mimic real-world health system security because it is virtually non-existent.” CyberCity, created to train federal government employees to defend against cyberattacks, had to artificially boost the security capabilities of its prototype hospital because it otherwise would have been “too trivial to hack.”

HIStalk Announcements and Requests

I’ll probably slack off a bit over the next week by posting less frequently. Merry Christmas, Happy Hanukkah, and Habara Gani (and if you don’t celebrate any of these holidays, those of us who do thank you in advance for respectfully tolerating that fact).

Acquisitions, Funding, Business, and Stock

Provider secure messaging app vendor GroupMD renames itself Flow Health, or at least that’s what I infer from the maddeningly vague company blog post announcing a change without really describing it. I probably shouldn’t be surprised given that Flow Health’s “About Us” page on its we’re-so-hip, scroll-happy website doesn’t list its founders, physical location, or history.

Sales

Porter Medical Center (VT) chooses Summit Healthcare’s data exchange platform to meet Meaningful Use Stage 2 Direct messaging requirements.

People

 

Explorys hires Greg Yarrington (Truven Health Analytics) as VP of operations and Patrick Wells (Deloitte) as VP of solutions.

Home medical equipment manufacturer Invacare appoints Cleveland Clinic CIO Martin Harris, MD as interim board chair following the retirement of Mal Mixon. The publicly traded Ohio-based company has 5,200 employees and a market value of $533 million, with Harris holding shares worth $327,000. The company’s share price has dropped 28 percent in the past year.

J. Robert Beyster, PhD, founder of SAIC and Leidos, died Monday at 90. He left his job working on nuclear submarines for Westinghouse in 1969 and founded SAIC at age 45.

Announcements and Implementations

The Cal INDEX HIE connects to Blue Shield of California via Orion Health.

India’s state of Telangana rolls out the country’s first healthcare app.

Sagacious Consultants announces an Epic report-writing annual subscription that provides a fixed number of hours each month with discounts of up to $50 per hour.

Government and Politics

The executive director of the Connecticut Health Policy Project says the now-defunct state HIE oversight organization (Health Information Technology Exchange of Connecticut, or HITE-CT) was shut down “after wasting $4.3 million in federal grants and four years without accomplishing anything.” She references a state auditor’s report that concluded that the organization was slow to react, couldn’t figure out how to fund itself, and failed to renegotiate a bad vendor contract it had signed with Axway and GE Healthcare. At its peak expense year of 2013, the organization paid $343,000 in salaries. Auditors also noted that some of the 20 members of its board often missed meetings, vacant board positions weren’t filled, and with zero revenue the organization couldn’t pay the paltry matching funds required by the federal government ($1 for each $10 in federal grant money received). The editorial’s author is correct: the only accomplishment of the group was to squander federal money.

Acting HHS Assistant Secretary Karen DeSalvo, MD writes a Huffington Post blog post welcoming home the US Public Health Service officers who returned from fighting Ebola in Liberia this past Saturday.

The FDA issues a proposed rule that would require drug manufacturers to provide prescribing information for professionals in electronic form, which would then be posted on an FDA reference site. Paper versions would no longer be allowed since they can’t be updated with new information, but manufacturers would be required to staff a telephone service that would send paper copies on request.

Privacy and Security

Mercy Medical Center  (CA) announces that a third-party transcription vendor unintentionally opened up its server to the Internet for several weeks, making the physician notes of 620 oncology patients visible in web searches. The hospital has apparently fired the responsible contractor.

The Michigan appeals court dismisses a privacy brought by 159 people whose medical records were unintentionally made available online by a contractor for Henry Ford Health System (MI). The three-judge panel ruled that an invasion of privacy claim isn’t valid unless the plaintiff’s actions are intentional.

Other

Time magazine profiles Qliance, a Washington-based nationally expanding concierge primary care practice that has lowered its cost to the point that it covers entire businesses (Expedia and Comcast) and even Medicaid groups for a flat monthly per-patient fee based on age. Billionaire investors include Amazon’s Jeff Bezos and Michael Dell. I really like this snip:

At the tangled heart of this dysfunction is Medicare, which by its sheer size sets the standards for insurance reimbursements. Specialists dominate the panel that sets its payment rates. Thus the system values surgeries, scans and other procedures more than it values checkups and management of existing conditions. West, a primary-care doc, explains it this way: “If I put in an hour with a patient, I will be reimbursed for one exam–the same payment I would get for seeing that patient for 11 minutes. Meanwhile, an ophthalmologist might perform three cataract surgeries in that same hour, and each surgery might be reimbursed at twice the rate of my exam. So that doctor is making six times as much money.”

And if the eye patient has questions after the surgery about her medicine or her recovery, the specialist’s office is likely to suggest that she consult with her primary caregiver. After all, neither doctor gets reimbursed for answering questions on the phone, so the chore is often traded like a hot potato. “We say primary care is critical to a healthier future,” West says, “but in every way we show value, it is at the lowest level.”

Doctors without Borders is using donated advertising on free medical imaging social network Figure 1 (“Instagram for doctors”) to recruit Ebola volunteers. The app automatically detects faces in submitted photos and blocks them for privacy and allows users to manually block other identifying features. Images are also moderated before posting to make sure they have been de-identified. The Toronto-based company has raised $6 million in funding and was founded by (a) a professor and writer with a JD and Columbia MBA; (b) an internist who describes himself as having an “above-average sense of humor and below-average physical fitness”; and (c) an iOS app developer.

A Harvard Business Review article called “The Antidote to Fragmented Health Care” contains as  one of its recommendations universal EHRs. It doesn’t define exactly what that means, but references the VA’s VistA, Kaiser’s HealthConnect, and the OpenNotes initiative. Looking back at all the money (taxpayer and otherwise) spent on EHRs and HIEs, maybe the better and cheaper alternative would have been to buy or create a nationalized EHR. Or, as I proposed years ago, mandate use of a standardize EHR database structure with rule-defined fields and let vendors compete based on the user interfaces and add-on capabilities they sell beyond the basic database-populating parts of the EHR.

Trustees of Regional Medical Center (SC) approve an extra $500,000 to implement Cerner’s document imaging system, with its president explaining that the hospital had underestimated the number of departments that would use the system and the volume of documents to be converted.

The annual report of the Pennsylvania eHealth Partnership Authority says its biggest challenge is funding (duh) after its ONC grant ran out earlier this year, when it asked for $1.85 million in state support. Now it wants $4.7 million for the next fiscal year, explaining that it failed to generate the charitable donations it expected, user fees that were supposed to start kicking in earlier in 2014 won’t start until mid-2015, and even then those fees “will not reach levels that contribute significantly to Authority sustainability until most HIOs are onboarded to the P3N in 2016.” Translation: we don’t don’t know how to run a business, every one of our plans and projections were wrong and have been scrapped, and it’s highly doubtful anyone will ever pay us for the services we may eventually offer. Therefore, taxpayers should provide a never-ending flow of money so a poorly conceived, ever-changing, and incompetently executed idea can be pushed onto a market that doesn’t want it.

An apparently serious study finds that the 30-day mortality rate of high-risk heart failure and cardiac arrest patients admitted to teaching hospitals is lower when cardiologists leave to attend national conferences. I remember reading years ago that death rates dropped when hospitals were closed due to strikes.

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Sponsor Updates

• Greenway Health releases version 3.1 of PrimeMOBILE.
• EDCO Health Information Solutions posts two new case studies involving its Solarity medical records scanning and indexing solution.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 12/22/14

Top News

HTC Global acquires CareTech Solutions. Both companies are in Troy, MI. I reported on November 24 (tipped off by a reader) that the Federal Trade Commission had approved the acquisition.

Reader Comments

From Vermonty: “Re: UVM and patient poaching. The fertility clinic’s staff accessed the EHR looking for candidates to contact and one of those patients complained, triggering an EHR audit that revealed the unauthorized access. Lucky for UVM it was fewer than 500 patients. UVM has filed complaints with the state and the medical society and is suing the practice. This will get ugly.” Unverified.

From The PACS Designer: “Re: health clinic of the future. Forbes had an interesting article about data inhaling, where patients and everyone in the health treatment process work from the same platform. The key element of the concept is everyone has ownership of the same data.” I didn’t get anything from it other than some very brief and generic pie in the sky thoughts, but to each his own.

Anonymous Reader Report: Being a Patient in my Own Hospital System

My husband has a tendency  for vertigo. We called 911 for a severe episode and he was taken to the ED at 10 p.m. They said the CT scan showed a brain anomaly (which our PCP later said was normal) and sent us to Hospital B at 4 a.m.  We ended up in the stroke unit, which we found out only because of the sign on the door – nobody told us. The neurologist said he was OK and discharged him. Radiology showed up at noon to do a test that we hadn’t been told about.

I started getting anxious at 4 p.m. and asked to see the hospitalist, but was told she was too busy. I paged the nurse supervisor and she could get no action either. At 9 p.m. I asked to speak to another nurse supervisor and again was told that the hospitalists was too busy. I gave up at 10 p.m and went home since my husband was feeling OK.

The next morning he was served a breakfast of straight sugar and carbs as a non-insulin dependent diabetic. Not surprisingly, his blood sugar showed a little high and they gave him insulin, which we objected to. At 9 a.m. the neurologist poked his head in wondering why we were still there after 24 hours of no contact with a physician. I again called the nurse supervisor, who finally did get the hospitalist to say he could go home.

HIStalk Announcements and Requests

Two-thirds of poll respondents say ONC should focus on interoperability, with less than 4 percent excited at the prospect of an ONC-run health IT safety center. New poll to your right or here: as 2014 draws to a close, are you personally happier now than a year ago?

Hot coffee was the easy winner in my poll asking which beverage readers most preferred to drink at work, racking up 56 percent of the vote. It was followed by water (16 percent) and hot tea (14 percent). The least-favorite drink from my list was non-diet soda, with only 2 percent of respondents favoring it.

Reluctant Epic User provided his own suggestion for those whose employer doesn’t provide free java: “Use only fresh, unground medium roast beans, get an AeroPress, a grinder, and a tea kettle. Leave the milk in the cows and the sweeteners at the chemical plant.” The $25 Aeropress coffee and espresso maker has 3,300 Amazon reviews and a rating of 4.5 stars, which sounds great other than it’s a bit of a pain compared to turning on the coffee maker, it makes only  four cups (which is probably really two of the size I like) per pressing, and you would have to keep the extra amount warm yourself.

Here’s the video from Ed Marx’s book launch last week for “Extraordinary Tales from a Rather Ordinary Guy.”

Last Week’s Most Interesting News

• An Advisory Board analyst’s review of Eligible Hospital attestation numbers for Meaningful Use Stage 2 finds that 66 percent that are eligible to attest have already done so, projecting that 95 percent will have achieved MU Stage 2 by the time information from the last quarter of 2014 is available.
• Consumer Watchdog urges Californians to opt out of the state’s HIE because the group hasn’t explained its privacy policy clearly.
• Sony Pictures warns that HIPAA-protected information from its health plan was stolen by the hackers responsible for its huge data breach.
• Karen DeSalvo gets a new employee as Vivek Murthy, MD, MBA is confirmed as surgeon general by the Senate.
• The FY15 Omnibus bill includes $32 billion for DoD health programs (including its EHR project) and $344 million for the VA to modernize Vista, but keeps ONC’s budget flat at $60 million instead of the $75 million it requested.

Acquisitions, Funding, Business, and Stock

Healthcare technology services investor Carrick Capital Partners names retired Senator William H. Frist, MD as a special advisor.

Merge Healthcare shares hit a 52-week high Friday, closing at $3.59 and valuing the company at $344 million. Above is the one-year MRGE share price (blue, up 56 percent) vs. the Nasdaq (red, up 16 percent.)

Sales

MultiCare Health System (WA) joins Premier.

People

 

Huntzinger Management Group promotes Nancy Ripari and William C. Reed to partner.

CompuGroup Medical US promotes Chris Lohl to VP of R&D, ambulatory information systems.

Alice Peck Day Memorial Hospital (NH) hires Kristen Kneisel (Cornerstone Advisors) as AVP of information services.

Anthelio names co-founder Chick Young to its board.

Announcements and Implementations

Blood glucose tracking capabilities will return to the iPhone and iPad with the release of iOS 8.2, in which an Apple Health patch was added to support a measurement unit common in Europe (mmol/L) in addition to the US standard unit of mg/dL.

CIO Review names CitiusTech as one of “50 Most Promising IT Services Companies.”

Government and Politics

Rep. Renee Ellmers (R-NC) and 29 of her House colleagues urge HHS Secretary Sylvia Burwell to reduce the 2015 Meaningful Use Stage 2 reporting period from 365 days to 90.

Privacy and Security

Boston Children’s Hospital (MA) will pay $40,000 to settle charges brought by the state’s attorney general following the theft of an unencrypted, PHI-containing hospital laptop from a physician presenting at a conference in Argentina. The physician mistakenly thought he had erased the information of more than 2,000 patients and failed to follow BCH’s encryption policy.

Northwestern Memorial Healthcare Group (IL) notifies almost 3,000 people that their medical information was contained on an unencrypted laptop that was stolen from an employee’s car in October.

Other

An editorial in London’s The Guardian says that the Epic-related problems at Addenbrooke Hospital are “the latest installment in a long-running saga in which British public institutions display their inability to introduce complex IT systems without causing chaos and distress.”It adds that Epic’s user interface has progressed from “abysmal and dysfunctional” to “merely ugly” but at least it works. Update: a reader pointed out that the user interface comments were directed at the physician practice system, not Epic, thus the timeframe referenced in years vs. Epic’s October go-live. The article combined both the Epic issues and other healthcare software in general. 

I mentioned last time that I tried First Opinion, which offers free texting to physicians, and listed the pluses and minuses. Here’s an addendum: Dr. Kia did indeed text me back from India the next day to see how I was doing and we had a nice chat. I was impressed even though I don’t entirely see the point since non-US doctors can’t diagnose or prescribe.

Patient advocate and The Walking Gallery founder Regina Holliday is trying to raise $75,000 to create the Walking Gallery Center for Art and Healing in Grantsville, MD. Donate $10,000 and she’ll deliver a keynote address and workshop at your meeting.

A Black Book survey of small-hospital CFOs finds that revenue cycle system upgrades have been deferred in favor of ICD-10 and Meaningful Use projects. Two-thirds of small hospitals that said in 2012 that they would replace their RCM system still haven’t done so.

Nurses, doctors, and pharmacists (in that order) are named as the most honest and ethical professions (and this the most trusted) in a Gallup poll. At the bottom of the list are care salespeople and members of Congress.

A study finds that less than half of the recommendations of TV huckster-doctor Dr. Oz are supported by medical evidence, while 39 percent of his recommendations were not backed by evidence and 15 percent were contradicted by it. The authors conclude that TV doctors rarely address their own conflicts of interest.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/19/14

Top News

The research wasn’t all that great, but the methods were pretty cool. A Regenstrief study finds that half of urban clinic patients who were able to selectively hide parts of their EHR information chose to do so. That’s from a ridiculously small study cohort of 105 patients, so don’t get excited about the results just yet. What was interesting is that Regenstrief developed a system in which patients can lock clinicians out of specific sections of their own EHR information, such as as those involved sexually transmitted disease or mental health. However, the system also contains an audited  “break the glass” button that allows clinicians to override the patient’s preference in urgent situations. I like the elegance of that solution, although the challenge would seem to be adding granularity so that specific types of clinicians could see information without having to use the “break the glass” option (allowing a gynecologist to see the STD information, for example).

Reader Comments

From Sell Sider: “Re: JPMorgan healthcare investor conference in early January. Half of healthcare is there. HIStalk should have coverage or attendee Q&A or something.” The San Francisco conference is by invitation only, so I would have to rely on an attendee to write up their experiences. I’m up for it if someone is willing to share their experience. JPM covers all of healthcare, but I’m sure plenty goes on related to IT. Ben Rooks provided some background in an “Investor’s Chair” post five years ago (where has the time gone?) JPM is also one of the scumbag “too big to fail” banks that ripped off American taxpayers in creating the 2008 financial crisis through greedy speculation, earning it massive profits, $25 billion in bailout money, a $13 billion slap on the wrist, and no criminal charges.

From Tilde Squiggle: “Re: fertility clinic competition. Efforts to reduce cost appear to be stymied by The Man. What happened to free markets?” A dozen doctors and other professionals from University of Vermont Medical Center open a fertility clinic whose costs are 30 percent less than UVM’s, which is great for everybody except UVM, which is suing the group. UVM says the clinic’s employees have access to its EHR and could be using that information to poach its patients, which the clinic denies.

HIStalk Announcements and Requests

I’m interested in running a regular column by either a startup CEO or a venture capitalist who wants to share their keen insight and sharp writing skills with the world. Let me know if you are interested.

There’s only so many ways companies can try to stand out at the HIMSS conference. Most of them are expensive and don’t work anyway, so here’s an alternative: sponsor the highly anticipated HIStalkapalooza event. I’m offering three sponsorship levels: Platinum (includes 100 invitations for customers, prospects, and employees; an information table in the welcome area; and a private opera box for entertaining); Gold (50 invitations and an information table); and Silver (a private opera box and invitations for 12-14 guests). Sponsors at all three levels will be recognized at the event and on HIStalk before and after. I don’t usually announce the venue until later, but here’s the scoop: I bought out the entire House of Blues Chicago (just off the river on North Dearborn behind the Trump) and the deal includes the ultra-swanky, members-only Foundation Room. Your company is spending a fortune to exhibit at HIMSS, so spend a little bit extra and you’ll get major exposure to the industry’s movers and shakers who read HIStalk. Contact Lorre and she’ll send information, but hurry because we’re about to close the window on new sponsors. The event is break-even at best for me and is frankly a pain in the butt to put together (I swear every year that I’m done with it), but people seem to enjoy it and I got sucked back in again in a weak moment.

This week on HIStalk Practice: Compleat Rehab and Sports Therapy Center and Hot Springs Sports Medicine select Clinicient services. CMS consultants travel to Micronesia. Fremont Family Care receives the HIMSS Ambulatory Davies Award of Excellence. Sony and Snapchat get into smartglasses. Dr. Gregg pontificates upon pain, EMRs, and appreciation. Toby Sadkin, MD puts plans for EHR replacement in perspective.

This week on HIStalk Connect: Google Ventures goes all in on digital health, quadrupling its investments in the sector during 2014. Investment funds and startup accelerators focused on digital health companies are also on the rise. In Colorado, the Quality Health Network, one of the nation’s first health information exchanges, forms a trade group with 20 other HIEs to advocate for the struggling HIE industry and explore new revenue opportunities.

Acquisitions, Funding, Business, and Stock

Online doctor visit provider American Well closes an $81 million Series C round, raising its total to at least $128 million. I was thinking about the popularity of those $49 visits and had the same reaction as when I see two of four corners of major intersections taken up by chain drugstores and pharmacy-containing grocery stores: where are they getting all those professionals? The schools aren’t cranking out doctors and pharmacists any faster, and yet the retail demand for them keeps going up.

Analytics vendor Predilytics raises $10 million in a Series C round. I’m trying to stay interested in the analytics marketplace, but everybody and his brother are starting up companies with splashy websites and buzzword-laden assurances of competence. This one is a real company, but I suspect that the only revenue many of the newcomers will book will come from investors rather than customers. Check back on the HIMSS15 exhibitor list of analytics vendors three years from now and I bet 80 percent of them will have failed.

First Opinion, which offers 24×7 access to a permanently assigned physician via text messaging, raises $6 million in Series A funding. The service costs $9 per month for a guaranteed service level of 5 minutes, but is free otherwise. I downloaded the app, submitted a profile consisting only of age and gender, and was connected to Dr. Kia in India. Her profile didn’t say where she went to medical school, but it did offer that she has “1 kid” (I’ve eaten curry goat several times on Indian buffets, but I don’t think she was talking about that). I texted that I was sneezing and congested, which is true since I’m getting over a cold. She asked some questions that sounded like they were composed in advance by an English as a second language layperson to avoid wasting the doctor’s time. I received responses quickly, just like a real text messaging conversation except with oddly excited reactions to my responses (like “Alright!” and “Oh okay!”). Our conversation ended with a little personal note: “I love to take some chicken soup when I am down with a cold. With a dash of pepper the soup can make you feel much better.” She promised to check on me later and I did indeed eat (take?) a can of Progresso Light Chicken Pot Pie soup onto which I added many dashes of pepper, although in full disclosure I had already done that before I texted Dr. Kia. My analysis of First Opinion is reasonably positive, but the service has significant limitations:

Pluses

• The app was quick to install and use. It looks like text messaging, but it’s a separate app that vibrates the phone like a new text message when the doctor responds.
• Connection and the doctor’s response were nearly instantaneous.
• The doctor was about as interactive and caring as you can get when texting with a stranger half a world away.
• Her suggestions, while somewhat generic, were pretty good.
• Promising to check back later was a nice touch regardless of whether she actually does.
• I would have felt comfortable asking prevention-type questions: diet, exercise, etc.
• When I restarted the app, the previous conversation was still there, plus it offered to sync with Apple Health and push the information to Dr. Kia, which was pretty cool even though I don’t know what she would have done with it.
• I don’t know if I could have texted a photo of one relevant body part or another if the situation warranted (I was snickering at the idea of texting over something inappropriate and getting a computer-assisted “Oh okay!” from Dr. Kia.)

Minuses

• The doctors aren’t licensed in the US, so they can’t prescribe or diagnose. The user agreement suggests that even though you’re chatting with a doctor, they’re only offering personal, anecdotal suggestions and not medical advice.
• I’m not sure what happens for anything but the simplest conditions other than “contact your doctor,” like if I claimed to be coughing up blood or running a 104-degree temperature.
• The doctor has zero information other than age and gender, although perhaps she would have asked if she needed anything additional.
• She recommended decongestants and antihistamines without asking about allergies, hypertension, glaucoma, etc. A Walgreens pharmacist would have ruled those out before suggesting potentially conflicting non-prescription meds.

People

Quality Systems names Zachary Sherburne (Spectrum Brands) as global CIO.

LifeLabs Medical Laboratory Services hires Brian Forster (OntarioMD) as SVP/CIO.

Medfusion promotes Vern Davenport to CEO. Founder Steve Malik, who sold the company to Intuit and then bought it back, will stay on as executive chairman. The company says it has 10 million patients using its portal.

Announcements and Implementations

Premier, Inc. joins the Coalition for ICD-10.

Government and Politics

Tony Panjamapirom, PhD with The Advisory Board Company says hospital Meaningful Use Stage 2 attestation numbers are being misinterpreted to mean the program is failing. He says it’s true that only 35 percent of all Eligible Hospitals have met Stage 2 standards through December, but 66 percent of hospitals that were scheduled to attest in 2014 have done so. He concludes that the flexibility rule that allows hospitals to attest to Stage 1 requirements in 2014 if they have software problems means that 95 percent of hospitals will attest in 2014. The EP numbers are too preliminary to call since most of them will use the October – December 31, 2014 reporting period. In a nice finish, he says, “The MU program is not just about what providers can or should do. It is about all of us. We all need to keep in mind that the ultimate goal of the MU program is to promote better care and better health for consumers/patients, including ourselves.”Actually, the ultimate goal of the MU program was to defibrillate a wheezing US economy and get providers to buy EHRs they weren’t willing to spend their own money on, but I’ll go with Tony’s more poetic words.

Privacy and Security

The CEO of Sony Pictures was warned about IT security problems three weeks before hackers gutted its systems. The company had software problems that it blamed on software bugs and incompetent IT people, the CEO himself sent his passwords to his assistant in unsecured email, sensitive documents were stored unencrypted, and company policy required employees to keep too many old emails. An email from the CFO to the CEO (exposed, ironically, by the hackers) noted, “significant and repeated outages due to a lack of hardware capacity, running out of disk space, software patches that impacted the stability of the environment, poor system monitoring, and an unskilled support team.”

With regard to Sony, which is worse: (a) having such sloppy IT processes that a 100TB hack wasn’t noticed, or (b) buckling to demands and threats from anonymous hackers that a major film be pulled just because they invoked 9/11? As Newt Gingrich said in a tweet, “With the Sony collapse, America has lost its first cyberwar. This is a very very dangerous precedent,” although a waggish response tweet said maybe it’s Japan that lost since Sony isn’t an American company. Skeptics doubt that it was really North Korea behind the breach since the hackers didn’t mention the movie until later and the extent of the hack make it likely that it was initiated long before anybody heard about now-mothballed and apparently awful “The Interview,” of which no trace remains on the company’s site. In any case, if you needed further motivation beyond never-ending announcements of breaches and unencrypted laptops to review your organization’s security, this should do it.

Innovation and Research

A physician-authored editorial explains why most healthcare IT startups are neither disrupters or the Uber of anything: they are focusing on the wrong patients and wrong problems using technology that has limited ability to benefit the sickest and most expensive patients. He likes the Swasthya Slate diagnostic testing add-on for Android devices (which I was fascinated by and mentioned a few weeks ago) and the “hot spotting” concept of providing intensive outreach therapy to the most expensive patients.

Technology

This might make Dr. Jayne’s Christmas wish list: the $125 lab coat of travel vest company SCOTTeVEST, which contains 16 technology-enabled pockets, a system of distributing weight so that heavy pockets don’t pull, and a personal area network that connects headphones to pocketed devices.

Other

Consumer Watchdog urges Californians to opt out of the insurance company-backed Cal Index HIE, saying that it hasn’t explained its privacy policy clearly.

Lt. Dan writes a nice piece called “HIE 2.0: Data Exchanges Face Consolidation or Elimination” on HIStalk Connect. Lt. Dan (he’s a veteran and chose that nom de plume to avoid getting fired by his full-time employer) also writes the morning headlines on HIStalk, so if you like those — and many people do, according to my reader survey results — then he’s the guy to hat tip.

Epic claims it doesn’t market itself, but this DoD pitch on its site suggests otherwise. I get the feeling that Epic is bending quite a few of its previously sacred rules (lobbying, press contact, non-compete clause) to pretty itself up in vying for the massive federal contract.

I was thinking about continuity of care and EDs for some reason. It’s tough to be both an ED patient and an ED doc because it’s the medical version of speed dating. The patients show up unannounced, they are quickly evaluated based on mostly physical characteristics, and just enough medicine is practiced to patch them up and get them out the door quickly and into someone else’s office later for the tougher slog of managing their costly and lifestyle-crippling chronic conditions. The fact that EDs exist means that both patients and doctors accept several principles: (a) it’s OK that physician practices keep 9-5 hours and let someone else deal with problems that arise the other 16 hours of the day; (b) ED docs have confidence, misplaced or not, that they can safely and accurately decide who can go home vs. who needs to stay; and (c) patients assume that given their particular symptoms and their brief narrative, the faceless provider who may have access to little of their medical history can fix them up just as well as anyone else. We’re trying to move the industry toward doctors and patients having an ongoing, committed relationship, but patients who aren’t really sold on the benefit seem to prefer zipless, unemotional encounters via video apps, kiosks, and doc-in-the-box drugstore clinics (that in fact have only the box, not the doc). Either we’re polarizing toward two radically different kinds of encounters or some serious marketing needs to be performed to help consumers understand the value of each (never underestimate the power of convenience over everything else, as evidenced by the drive-through breakfast line at McDonald’s).

I was also thinking about labeling people as “patients,” which I struggle with every time I write. Are you a practice’s patient if you choose them as your PCP but haven’t seen them yet? If you were last hospitalized 10 years ago, are you still considered to be that hospital’s patient? We’re all patients at one time or another, so maybe the term should be retired in favor of something more descriptive of the many flavors of healthcare delivery. Or maybe less descriptive, since all patients are people or (arguably) consumers. My mental reaction to the word “patient” after decades of working in hospitals is, unfortunately, of someone who is dumped involuntarily into a confusing, paternalistic medical system that was designed for providers, not them, and where their job is to do as we tell them without complaining, wasting our time, or even participating so we can make everybody happy by sending them out the door at first opportunity. Even people who have spent a lifetime working in a hospital or practice feel vulnerable, marginalized, or poorly treated when forced into the temporary role of someone’s patient, no different than the rude awakening law-abiding citizens get when encountering the wrong side of law enforcement for the first time. I’m interested in hearing stories about what it’s like being a hospital employee who is hospitalized. I’ve only spent one night in a hospital and my reaction was somewhere between appreciation (toward caring individuals) and frustration (being treated impersonally like a widget and annoyed by the ever-present and sometimes smug inefficiency).

Lodi Health (CA) will affiliate with Adventist Health as the latter promises to invest $100 million in an EHR and to help the hospital meet earthquake requirements.

HIMSS runs yet another list of all-too-obvious (and self-serving) tips for attending its annual conference. Here are some from me.

• Don’t attend any educational sessions that feature even one vendor presenter because it will end up being a sales pitch. In fact, given the quality of educational sessions over the past years, seriously consider not going to any educational sessions.
• Bring a cheap external battery charger for your phone because it will run down trying to find a signal among a zillion attendees.
• Don’t make appointments to see vendors. You’ll regret having a fixed slot messing up your day, especially with it’s a 20-minute hike away. You’re the prospect – they’ll free up time when you show up.
• Don’t believe anything you see or hear in the exhibit hall.
• Use your phone’s tethering capability in the convention center for a better and faster connection. Use it in the hotel to avoid the ridiculous $15 per day charge tacked on to an already overpriced room (unless HIMSS negotiates free service again this year, which is nice.)
• Use the opportunity to pitch yourself for your next job. It’s a target-rich environment with all those companies and employees casting lustful glances at each other and it’s always nice to feel wanted even if you spurn the employment advances.
• Lunch options in the exhibit hall are poor, unhealthy, and overpriced (unless you’re enjoying the CIO-only luxury track for the same registration fee the rest of us peons pay for steerage class). Book a hotel that offers a free breakfast (if such a thing exists in Chicago), then graze through the day at booths giving away snacks.
• Load up on enough sticky notes, lip balm, and thumb drives to last until next year.
• Don’t hang around the exhibit hall until late in the afternoon just to get free happy hour food. The lines can be long and the snacks aren’t usually that great.
• Guys, don’t flirt aggressively with women working the booth. You’re putting them in an extremely awkward situation and as hard as it is to believe, they’re not that into you.
• Providers, don’t do anything you wouldn’t want your ED patients to see. They’re paying for your junket.
• Don’t wear a suit unless you’re at the C level because you’ll look like a self-important douchebag. On the other hand, don’t (even on the last day of the conference) show up wearing shorts or leading toddlers.
• Leave all the handouts you took just to be nice in your hotel room’s trash, along with your conference tote, badge, and other useless crap you accumulated. It’s not worth hauling home.
• Stop by the microscopic HIStalk booth, which is always in almost-affordable exhibit hall Siberia near the restrooms. It’s the size of a Yugo, but usually has fun people stopping by since it gets lonesome back there.

Weird News Andy says we should fight global warming by eating chocolate chip cookies. A new study answers the age-old question: where does the fat go when you lose weight? Answer: most of it is breathed off as carbon dioxide. The author says that doesn’t contribute to global warming because humans don’t exhale ancient carbon atoms.

Vince put together a Christmas special “CIO Letters to Santa.”

Sponsor Updates

• RazorInsights celebrates its Founder’s Day by donating solar-powered study lamps, books, and snacks to students in a school near Bangalore, India.
• HDS offers a white paper called “6 EHR Trends to Watch in 2015.”
• E-MDs becomes the first EHR to exchange provider information with the infectious disease registry of the Kansas Health Information Network, helping users comply with Meaningful Use Stage 2 requirements.
• EClinicalWorks congratulates Fremont Family Care (NE) for winning a HIMSS Davies Award of Excellence, the twelfth eCW user to win in the past seven years.
• Greenway Health will sponsor pro golfer Blayne Barber, who will wear the company’s logo on his shirts.

EPtalk by Dr. Jayne

I ran across this piece on facility fees today. For those who have not yet encountered them, you’re lucky. The basic theme is that when hospitals employ providers to work in an “outpatient department,” they are billing in a way that charges both a facility fee and a provider fee. This may occur even if the provider’s office is not within the hospital proper, but is still identified as a department of the hospital. The principle is that the charges are to cover what CMS requires of hospitals rather than offices. The problem is that patients wind up paying on two different deductibles.

This reminded me of something that is glaringly missing in most EHR systems – easy access to cost data for tests and procedures. Most systems have formulary information that displays pricing – even if it’s just $, $$, $$$, and $!$!$!$!$ like a restaurant guide. What we really need to keep costs down is that kind of information for everything we order, including laboratory and diagnostic testing. The proliferation of so many insurance plans and product offerings makes it technically challenging to display the information in a usable fashion without negatively impacting system performance. The difficulty is compounded by the way that some of the costs are less than intuitive.

For example, if I want a glucose level and a potassium level to monitor drug therapy, it’s actually cheaper to order a basic metabolic profile (seven tests that include the two I want) instead. Now I’m forced to order tests I don’t want and that might have incidentally abnormal values that lead to more tests and greater overall cost. How do you represent that in the EHR? We’re trained to only order tests if the results will change the plan for the patient or influence the outcome, but here we are being pressured to violate that for financial reasons.

There is also a generalized concern that having cost information at the point of care will influence physicians to withhold care rather than using the information as a tool to discuss the pros and cons of a particular approach with the patient to arrive at a mutual decision. Of course such a discussion also requires time that we don’t have during a typical office visit, which skews the cost curve even further. With the potential for Meaningful Use Stage 3 requirements about to be dropped on us, I don’t look for software vendors to spend their development dollars helping us solve this problem.

In other news, Glassdoor published its list of the Top 50 places to work as determined by employees. Interesting members of the top 10 include Google, Nestle Purina PetCare (bring your dog to work!), In-N-Out Burger, and Mayo Clinic. Although several major health systems and pharmaceutical firms made the top 50, health IT vendors were decidedly missing.

Speaking of lists, results are out for the subspecialty certification exam in Clinical Informatics. Although one of my protégés reported a pass, the other two have been noticeably silent. I’ve been keeping my eye out for the full list but haven’t seen one yet. Looks like AMIA still has last year’s cohort listed on their website. If anyone has the full list, I’d appreciate being pointed in the right direction. I’d like to have my celebratory champagne (or sorrow-drowning bourbon) at the ready.

I’ve written quite a bit about wardrobe choices for conference attendees and presenters. Several readers shared from The Atlantic a piece about physicians and their clothing choices. The author specifically mentions primary care and being somewhat put off when her new physician “clicked into the room in stilettos and a tailored expensive-looking suit.” Primary care physicians in our medical group run the gamut, from jackets and ties to wrinkled scrubs. The residency program faculty members who are women tend to favor Birkenstocks and broomstick skirts, which although stereotypical, seems to work for them. My favorite physician wears scrubs from competitor hospitals just to be ironic.

The author links out to a New York Times piece that discusses enclothed cognition, which describes the way clothing can impact thought processes. Researchers studying the phenomenon note that wearing a white coat that you believe is a physician jacket increases attention. Believing it belongs to a painter does not. Apparently it’s a subset of embodied cognition, where thought processes are based on physical experiences (including clothing) that can influence abstract concepts.

I had never heard of it using those terms, but admit it’s something I’ve experienced. Back in the days of pagers and being on call every third night during residency, it was almost a dressing ritual to receive sign-off from the outgoing call team. They’d hand off the code pager, the on-call pager, and any other pagers they might be holding while talking about the patients on the service. By the time you were done hearing about all the patients, you felt like you were wearing Batman’s utility belt and could handle whatever came your way.

At one of the offices where I see patients, the physicians wear matching scrubs and have desk space in a shared bullpen. As I pull on my white coat and head out to see patients, it’s like readying for a sporting event. Some days are definitely more of an athletic contest than others, that’s for sure. On the flip side, I’m a sucker for black-tie events – there’s just something about putting on a floor-length ball gown that is transformative, whether you spent your day knee-deep in flu patients or up to your eyeballs in EHR documentation. Add a pair of killer shoes and a little bling and it’s even better.

Are you ready for some holiday sparkle? Email me.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

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News 12/17/14

Top News

The massive Sony Pictures data breach forces the company to warn employees that hackers have their personal information (including Social Security numbers, government identifiers, and compensation information) as well as HIPAA-protected health information collected by the company’s health plans. Celebrity PHI was among the information downloaded, which should provide interesting gossip when it inevitably leaks out. A worksheet listing the company’s highest-cost health plan patients (above) was one of the documents hackers posted to the Internet as a warning. Sony Pictures hires a law firm to threaten newspapers and websites that might otherwise post embarrassing hacker-released information, a tactic that legal experts say probably won’t work since the publications would be obtaining the information legally.

Meanwhile, the movie that apparently stoked the ire of the North Korea-based hackers premiered in LA Thursday night, with early mediocre reviews of “The Interview” raising the question of whether it was worth it, especially since the breach exposed emails in which a Sony Pictures executive griped to peers that the film is “desperately unfunny.” At least the movie will get curiosity box office revenue. Perhaps as the ultimate closing of the loop, Sony Pictures can make a movie about its own breach, featuring the “minimally talented spoiled brat” Angelina Jolie. After all, she starred in 1995’s “Hackers” before donning jewelry containing Billy Bob Thornton’s blood and then finally rebranding herself into a pouty-lipped Mother Teresa. Sony Pictures could use the ticket sales to help pay for the fines, privacy lawsuits, loss of business from exposure of its trade secrets and intellectual property, and general damage caused by incriminating emails. If they survive, that is, which should be in serious doubt at this point. The job you should be glad you don’t have is that of David Buckholtz, SVP of corporate IT at Sony Pictures Entertainment, who will never work in that town again.

Reader Comments

From Shag Dancer: “Re: HIStalk. How long does it take you to write it?” I spend at least eight hours on Tuesdays and Thursdays, sometimes more and sometimes less on the Monday Morning Update, since I research and write every word. That’s only for the heads-down writing and not all the stuff in between … I’m a fast writer, but it takes forever to wade through all the meaningless junk that I don’t mention and to make sense of the sometimes poorly presented information that I do. My job as I see it is to make it look easy and to disguise a lot of work into a quick and entertaining read.

HIStalk Announcements and Requests

I decided to add a new subcategory called “Privacy and Security” to each post since breach and threat news is frequent. I’ve placed it below the “Government and Politics” section below.

I’m running an end-of-year special on promoted and produced webinars for those signed by December 31, so it’s a great time to contact Lorre to book a slot before the HIMSS conference.

Some company tossed a telephone book in my driveway this morning, reminding me that they still exist even though I haven’t opened one for at least five years (and when I did, I was only seeking pizza coupons). It reminded me of my first cell phone, which was not only large and sporting a walkie talkie type antenna, but also came with an downsized phone book for stashing in the glove box (where, curiously, no gloves have ever been placed).

Listening: new soulful and honest R&B crooning from K. Michelle. I listened unaware that she’s been in some trashy reality TV shows, thankfully, since the music soars despite her iffy career and lifestyle decisions.

I’m a recent coffee convert after years of making fun of Starbucks lines and bizarre morning rituals, so I need to know whether I’ve found belated enlightenment or whether I’ve instead crossed over to the dark side. Take my poll here – what do you enjoy drinking most at work? I usually hit all the hydration checkboxes with coffee, water, and soda in the mornings and I’d still find it hard to choose a favorite, although there’s nothing like coffee to get me going (and it’s not just the caffeine – there’s something about the warmth that just works). I’m not a snob about it, though – the giant $1 cup at McDonald’s is fine.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

December 18 (Thursday) 1:00 ET. Virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy,” a new book by “CIO Unplugged” contributor Ed Marx. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.

Acquisitions, Funding, Business, and Stock

Google’s venture capital fund is moving its investments from consumer Internet startups  to healthcare and life sciences, with a special interest in companies that focus on health data.

Orion Health completes its New Zealand IPO, raising $97 million.

Neos Technologies acquires wearables monitoring vendor AFrame Digital. I don’t know anything about the former except that it writes a bad press release, including misspelling its own name. I’ve only heard of AFrame when it received a 2011 NIH grant to study falls in the elderly. Its “About” page obscures whoever is involved with the company, so my initial “who cares” reaction is that two unsuccessful companies are trying (against all odds) to merge into one better one. I lose nearly all interest in a company whose website fails to (a) list its executives; (b) indicate the location of its headquarters; (c) showcase recent announcements; or (d) make it clear on the home page exactly what it does in a succinct, buzzword-free tagline or paragraph. If they can’t accomplish those trivial tasks, why would I want to buy anything from them?

Lightbeam Health receives an unspecified capital investment from former Allscripts executives Glen Tullman and Lee Shapiro.

A report published by Good Jobs First names Cerner as #3 on the list of companies linked to the Forbes 400 list of richest Americans (Neal Patterson at $1.55 billion) that have received more than $1 billion in subsidies from state and local governments trying to boost economic development. Cerner at $1.7 billion worth of taxpayer gifts trails only Intel ($5.9 billion) and Nike ($2 billion). I say blame politicians rather than the companies that were voluntarily offered taxpayer money for reasons that may or may not make good fiscal sense.

Singapore- based RingMD, which offers consumers live video access to a global network of doctors, will establish its North American headquarters in Charleston, SC in preparation for an expanded US presence. Former programmer and founder Justin Fulcher, who is 24, started the company with the financial support of the Singapore government.  

Sales

Massachusetts Eye and Ear (MA) chooses Medarchon’s Quarc for secure messaging.

Hunterdon Healthcare (NJ) will use secure communications from Practice Unite.

Genesys Health System (MI) signs up with PerfectServe for clinician communication.

People

Mary Jahrsdoerfer, PhD, RN (Philips Healthcare) joins Extension Healthcare as chief nursing officer.

Remote monitoring vendor Sentrian hires Lance Myers, PhD (Vivonoetics) as CTO.

Announcements and Implementations

The non-profit American Telemedicine Association launches an accreditation program for providers offering direct-to-consumer consultations, with the cost and requirements of the three-year certification disclosed only after submitting an application. Part of the package includes being able to use ATA’s accreditation seal and being listed in its consumer guide.

Allscripts certifies the Patient Engagement Solution of non-profit Healthwise for integration with its TouchWorks EHR.

Kaiser Permanente Hawaii launches a teledermatology service in which primary care physicians can send patient photos to dermatologists for diagnosis. 

The 300th hospital goes live on Medhost’s YourCareCommunity vendor-agnostic patient portal.

The folks at Forward Health Group got permission for me to use the above summary graphic from KLAS’s just-released “Population Health Performance” report in which Forward Health Group scored at the top of several categories and #2 overall. Phytel, Forward Health Group, and i2i Systems led the pack, while eClinicalWorks and McKesson were the only two vendors in the low-performing category.

Wellcentive joins the CommonWell Health Alliance.

Government and Politics

The Senate finally confirms Vivek Murthy, MD, MBA as surgeon general, filling a position that has been vacant for 17 months. President Obama nominated him in November 2013, but his statements labeling guns as a public health hazard drew opposition from the influential National Rifle Association, which ended up on the rare wrong side of a political decision.

Privacy and Security

An interesting study seems to suggest that patients think the specific use of their health information is more important than whether their consent was given in advance. That’s surprising given that our entire desired state is is driven by opt in/opt out via consent signatures. Respondents said research use is OK in most cases, but using their information for marketing (even with their consent) is not OK.

Clay County Hospital (IL) calls the FBI after receiving an extortion email demanding cash to prevent stolen patient information from being disclosed (of which a sample was included as proof of possession). The 22-bed hospital says its servers haven’t been hacked, which would suggest that responsibility rests, as it often does, with an employee.

Virginia Commonwealth University Health System (VA) notifies patients that the used CDs donated by one of its employees to a children’s art project contained PHI, including full clinical records and Social Security numbers. 

In Canada, Ontario’s privacy commissioner orders Rouge Valley Hospital to upgrade its computer systems, appalled that a year after several employees were found selling patient information, hospital still can’t review access records going back further than two weeks. A fun tidbit from the article: one of the employees who was selling information to Registered Education Savings Plans (RESPs) changed jobs and lost his access to the computer, after which he pulled the brilliant move of sending a formal request to IT asking to have his access restored so he could look up patient phone numbers to “sell them to RESPs in the course of his part-time employment.”

There’s something powerful about having outcomes graphed so starkly. Vickers says that there was a surgeon who saw that they were so far into the wrong corner of that plot — patients weren’t recovering well, and the cancer was coming back — that they decided to stop doing the procedure. The men spared poor outcomes by this decision will never know that Amplio saved them.

 

It’s like an analytics dashboard, or a leaderboard, or a report card, or… well, it’s like a lot of things that have existed in a lot of other fields for a long time. And it kind of makes you wonder, why has it taken so long for a tool like this to come to surgeons?

 

The answer is that Amplio has cleverly avoided the pitfalls of some previous efforts. For instance, in 1989, New York state began publicly reporting the mortality rates of cardiovascular surgeons. Because the data was “risk-adjusted”—an unfavorable outcome would be considered less bad, or not counted at all, if the patient was at risk to begin with — surgeons started pretending their patients were a lot worse off than they were. In some cases, they avoided patients who looked like goners. “The sickest patients weren’t being treated,” Vickers says. One investigation into why mortality in New York had dropped for a certain procedure, the coronary artery bypass graft, concluded that it was just because New York hospitals were sending the highest-risk patients to Ohio.

Technology

The CEO of Withings apologizes to purchasers of its Aura sleep device, acknowledging that in its rush to get the product on the market, the company left out important features such as heart rate tracking and the ability to view results immediately. They’re trying to fix some of the problems with updates.

Other

The Portland, OR newspaper covers the failure of a local interoperability project that started eight years ago, concluding that it didn’t work even though most hospitals are on Epic because: (a) hospitals bear the cost while insurance companies reap the benefit; (b) hospitals get paid for the procedures they perform rather than those whose duplication they avoid; (c) even information that is successfully exchanged doesn’t always make sense to the recipient. Thus reads the boilerplate RHIO epitaph.

A new Consumer Reports survey of recently hospitalized patients finds that those who didn’t feel respected by staff during their stay were 2.5 times more likely to experience a medical error, with an alarming 30 percent of those surveyed saying they actually did. A third of respondents say they weren’t treated like responsible adults, while 40 percent report that doctors and nurses interrupted them instead of listening. The article, which will appear in the February 2015 issue, suggests that patients choose a hospital carefully, invite doctors to sit down and talk, write things down, and bring along a trusted ally to help. I asked Consumer Reports about the survey’s methodology, with the positives being that it was a national representative sample with a high confidence level. The negatives that I can determine (without seeing the actual survey instrument that I asked for) are that patients self-reported whether an error occurred and nothing was mentioned about error significance (getting a daily aspirin an hour late might be reported as a medical error by some patients). Interesting but not surprising to me is that all of the lowest-safety, lowest-respect hospitals (listed above) are in big metro areas, with a heavy Chicago representation. As I always say, go to a big academic medical center if you require tricky diagnosis or surgery; otherwise, a mid-sized community hospital that does a lot of whatever you need is your best bet.

The latest article in the New York Times series “Paying Till It Hurts” reviews the cost of diagnostic tests, which it describes as “what liquor is to the hospitality industry: a profit center with large and often arbitrary markups.” Example: an outpatient EKG done by a community hospital’s technician took 30 minutes and was billed at $5,500, while the same test performed by a Harvard hospital and cardiologist over 1.5 hours was billed at only $1,400 (the article should have mentioned what the graph shows, that Medicare didn’t pay the funny money in either case, instead reimbursing around $400 for each). Eric Topol, MD summarizes the economic incentive as, “At many hospitals, the threshold for ordering an echocardiogram is the presence of a heart.”

The bonds of 109-bed Mayers Memorial Hospital District (CA) are downgraded, primarily because of EHR-related capital expenses and resulting lower cash collections. The hospital, which implemented McKesson Paragon, is down to 3.5 days of cash on hand.

A New Zealand coroner warns doctors to pay attention to the clinical warnings generated by their EHRs after ruling that a patient died after his doctor prescribed quinine inappropriately. The coroner also noted that hospital records aren’t available to physician practices.

In England, a lead nurse in an endoscopy unit hangs himself after expressing concerns about staff shortages and the introduction of a new hospital computer system that was causing a patient backlog, forcing him to work 80 hours per week.

Also in England, doctors at Royal Free Hospital warn that patients are being endangered by its implementation of the OpenText document management system that has created scanning backlog, causing patients to arrive for new visits while their paper records are still piled up in a scanning contractor’s warehouse. The hospital was bragging just a few months ago about the problems that OpenText solved in sending scanned records to its Cerner EPR system.

Duke University Health System (NC) hospitalist Ricky Bloomfield, MD provides the remote chronic monitoring billing codes he mentioned at his mHealth Summit session on Apple HealthKit: the new E&M 99490 for  monthly chronic care management ($42.60 per month) that could be combined with CPT 99090 or 99091 to yield $99.52 per month. He warns that nobody has actually tried billing Medicare or any other insurer using these codes yet, so it’s a work in progress.

Only in America: the family of an Ohio inmate who raped and killed a woman who was 30 weeks pregnant sues just about everybody for his painful execution that was performed using the untested two-drug combination of midazolam and hydromorphone. Named in the lawsuit are the manufacturer of the drugs (Hospira) and their distributor (McKesson), companies the family says should have known would cause suffering. In an interesting twist, a prison guard says the inmate told him before he died that his attorney urged him to feign suffocation with a prearranged “thumbs up” signal as the injections were started in the hopes that the governor would stop the execution.

Weird News Andy says, “They really do have skin in the game.” Scientists develop artificial skin for prosthetics that can feel warmth and other attributes. Or as WNA adds, “for Terminator v0.1.”

Sponsor Updates

I invited sponsors to send photos of their holiday activities since I like to put faces with company names. The folks from Direct Consulting Associates providing shots of their company gathering.

Employees of PerfectServe collected donations for the Florence Crittenton Agency in Tennessee, donating clothing and 10 suitcases for the agency’s “Wheels of Hope” campaign that allows children who arrive carrying their belongings in a trash bag to leave with their own suitcase.

• Visage Imaging posts its “RSNA 2014: Visage’s Top Five.”
• RazorInsights doubled its client base, increased revenue by 200 percent, and hired 80 new employees during 2014.
• GetWellNetwork Ambulatory earns ONC-ACB 2014 Edition Modular EHR Certification. The company also announces that CEO Michael O’Neil will present at the 2014 HIMSS Middle East Integrated Health Innovations Conference this week. 
• Nuance announces that KLAS rated it #1 for regulatory reporting in “Quality Management 2014: The Race Gets Closer.”

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 12/15/14

Congress Moves on Federal Appropriations Bill

Congress passes the Omnibus spending bill that will fund the government through September 2015. The ICD-10 deadline survived intact, but the bill does impose limitations and more oversight on the DoD and VA as they work toward modernizing and integrating their EHR systems.

Federal defense contractors find a new profitable business: Obamacare

In the last decade, HHS has risen to the #3 contracting agency in the government, outspending NASA and the Department of Homeland Security, and drawing the interests of major defense contractors like Lockheed Martin, General Dynamics, and Northrop Grumman.

Tenet ends bid to acquire five Connecticut hospitals

Tenet walks away from its efforts to buy five hospitals in Connecticut after state officials set strict mandates governing staffing, services, and pricing as a condition of the acquisition.

Health Insurers Brace for Last-Minute Rush

Consumers who enrolled in healthcare over Healthcare.gov last year have until Monday at 11:59pm to change plans, or they will be automatically re-enrolled in their existing plan. Thus far, only 720,000 of the five million 2014 enrollees have returned to select a new plan, leading to some speculation that the site will see a surge of activity on Monday.

Monday Morning Update 12/15/14

Top News

The trillion-dollar FY15 Omnibus bill includes $32 billion for DoD health programs that includes its new EHR implementation and $4 billion for the VA’s IT program that allocates $344 million to modernize its EHR. ONC will get $60,367,000 of the $75,000,000 it requested, the same amount it was given in 2013 and 2014. ONC had planned to increase headcount from 185 to 191 FTEs in 2015, some of that most likely intended for launching its planned but not yet approved health IT safety center.

Reader Comments

From George de Jungle: “Re: prescription information. I don’t like selling this data.” Drug companies are matching up “de-identified” (like that’s a foolproof method) prescription records with consumer website registrations to push targeted ads and to study physician prescribing behavior for marketing purposes. Example: Yahoo hires the medical information sales industry gorilla IMS to target ads to people who live in areas where specific medical conditions are common. None of this is new, of course – IMS and other companies have been doing similar work for years, but now have more (and more accurate) data to crunch. De-identifying data doesn’t earn anybody a dime except in avoiding HIPAA penalties, while re-identifying it through data matching is worth billions (guess which one IMS does?) HIPAA pre-dated the Internet and big data movements, having been around now for 18 years. While de-identifying patient data sounded swell back in those paper days, it is easily overcome by today’s sophisticated database techniques and widespread availability of electronic information. Americans make it worse when they squawk at how much they value privacy, but then voluntarily enter their most personal and valuable information to get access social networking or game sites without asking or caring how that information will be used. That leaves privacy as nothing more than an illusion held by people who aren’t aware of the degree of data plundering that’s done without their explicit knowledge or permission.

MHealth Summit Review
By Plato’s Charge

1. Keynotes. More vendor-agnostic than last year, no real revelations but a few anecdotes that didn’t suck. Grade: B+.
2. Exhibit hall (aka leper hall). Yuck. Companies with a ‘q’ or ‘z’ in their name that all looked alike. Many were missing from last year having run out of money. Reminded me of India – a few wealthy power brokers like Qualcomm and the vast majority were small and poor. Grade: F.
3. Breakout sessions. Panels were disorganized, lots of vendor pitches (some not too subtle, which was pure agony). Grade: D.
4. Overall, what was missing was users of these great technologies, methods (geez, wonder why?), and sessions focusing on what is needed (it’s reimbursement and credentialing, stupid). The reimbursement session was packed, but it sort of sucked. Overall conference grade: D+.

HIStalk Announcements and Requests

More than half of the respondents to my poll aren’t thrilled by going to work Monday mornings. The comments left suggest that major determinants are the quality of co-workers and the degree of direct contribution to a worthwhile mission. New poll to your right or here: what should ONC’s top priority be over the next few years? Your comments would of course add embellishment to your rather stark vote.

The first book of “CIO Unplugged” contributor Ed Marx has been released and we’re holding a virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy” this Thursday, December 18 at 1:00 p.m. Eastern. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.

Last Week’s Most Interesting News

• An Experian data breach forecast for 2015 warns that healthcare organizations will continue to be a major target.
• ONC issues its strategic plan for 2015-2020 that calls for moving from EHR adoption to information sharing.
• Alberta, Canada begins its search for a new EHR after an auditor’s report finds that the $260 million it already spent encouraged implementation of a larger number of systems that don’t talk to each other.
• Several dozen hospitals in Australia go to downtime after a storage controller software upgrade in a central data center fails.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

Ireland-based patient engagement vendor Oneview Healthcare raises $7 million to expand its presence in North America, where it hopes to win nine new contracts (along with six new customers in Australia) in 2015.

Sales

In England, NHS chooses IBM for its new Electronic Staff Record HR/payroll system, replacing the incumbent McKesson in a contract worth up to $600 million. The Oracle-powered McKesson system is one of the largest IT implementations in the world.

Government and Politics

OSHA orders Computer Sciences Corporation to pay back wages to two former nuclear power plant employees who were fired after reporting that the company’s EHR didn’t accurately track medical restrictions. CSC owned the occupational safety and health provider the power plant used.

A Kaiser Health News story called “Federal defense contractors find a new profitable business: Obamacare” notes that HHS’s business purchases doubled to $21 billion in the last decade and are rising, making it the #3 contracting agency, beating out NASA, Homeland Security, and the combined spending of Departments of Justice, Transportation, Treasury, and Agriculture.

A behavioral non-profit in Alaska will pay $150,000 to settle an OCR HIPAA investigation that concluded that desktop PC malware allowed a breach involving the information of 2,500 people. The organization also committed two unpardonable OCR sins: it didn’t conduct a risk assessment and hadn’t updated its security policies and procedures in years (and wasn’t really following its existing ones, either).

Jack Stick, chief counsel of the Texas Health and Human Services Commission, resigns following an investigation into his direction of $110 million in no-bid Medicaid fraud software contracts to 21CT, a defense contractor he favored for unstated reasons. In one case Stick convinced state contract managers to take a data warehouse contract away from Truven Health Analytics and give it to 21CT instead. The Austin-based 21CT had zero experience with Medicaid; a former business associate of Stick is 21CT’s official lobbyist. The company’s $90 million contract expansion has been cancelled.

Other

This week’s PostSecret contains two submissions that will give CIOs a chill, with #1 being entirely justified since IT apparently isn’t monitoring logs to detect employees who look at information for patients without having a need to know.

Tenet shelves its plan to buy five Connecticut hospitals when the state proposes saddling the for-profit operator with 47 restrictions on staffing, services, and pricing. Waterbury Hospital says selling out to a for-profit company was its only hope for survival, while the hospital’s unions and an advocacy group said Tenet’s unwillingness to agree to the state’s terms showed that the company’s primary interest was “to plunder Connecticut’s hospitals.”

Partners HealthCare (MA) loses $22 million in its most recent fiscal year after earning a $158 million profit last year, the first time it has lost money. Partners, the state’s highest-cost health system, took in $11 billion in revenue, but its Medicaid insurance plan lost $110 million. Partners blamed the insurance loss on new patients, expensive drugs, and problems with the state’s health insurance exchange.

Weird News Andy calls this “Billing billing fraud.” A doctor whose last name is Billing faces fraud charges in Canada. WNA laments that the doctor’s first name isn’t William or that it didn’t happen across the border in Billings, MT, but he’s hoping that his item gets Monday’s top billing.

Sponsor Updates

• The employee-funded charity of Cornerstone Advisors donates $10,000 to the foundation supporting three-year-old Juan Carroll, Jr., who needs a liver transplant. The charity will also support Campbell County Healthcare, La Rabida Children’s Hospital, and Crossroads Community Center with $1,000 donations.
• Cumberland Consulting Group partner Dave Vreeland publishes “PHM: Coming Soon to Health Systems Everywhere” in CIO Connection.
• Versus Technology announces that Microsoft’s Bill Crounse, MD will provide the keynote presentation at its user group meeting in Chicago May 11-13, 2015.
• A Florida TV station profiles Sarasota-based Voalte.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/12/14

Top News

Experian’s 2015 “Data Breach Industry Forecast” says increased EHR adoption, lax security, and the popularity of wearables will make healthcare an attractive target, although as in all industries the biggest security threat involves an organization’s own employees. The report also says that cloud-based user credentials are increasingly attractive to hackers, with a Twitter login being worth more on the black market than a credit card number.

Reader Comments

From Bimbo Ears at DOH Pa: “Re: Pennsylvania physician licenses. The Licensing Bureau deployed defective software that lost renewal documents for doctors, affecting hundreds if not thousands of doctors whose licenses expire 12/31/2014. The vendor is System Automation, which claims on its website to make government more efficient.” Unverified. I didn’t see anything mentioned.

From Joey Cheesesteak: “Re: Dr. Michael Rosenberg of Health Decisions. Dies in a Maryland jet crash.” Michael Rosenberg, MD, MPH, CEO and founder of the Durham, NC-based contract research organization for drug and device companies Health Decisions, died when the business jet he was piloting crashed into a house in Gaithersburg, MD, killing all three occupants of the plane and a mother and two young sons who lived in the house.

From Ink-Stained Wretch: “Re: Epic’s Judy Faulkner. She never does interviews, but came out of her cloister to speak with VentureBeat and attempt to debunk a critical New York Times story. Perhaps Epic is feeling pressure from the Hill, where Epic is widely blamed for the perceived failure of EHR stimulus and is associated with the unpopular Obama.” Keeping a low profile (or declining all media contact) is great until there’s a PR problem. It appears that Epic is worried about being perceived as an uncooperative vendor of closed systems, especially with the Department of Defense’s EHR bid on the line. I’m guessing the VentureBeat “interview” with Judy was actually a quick email response since only a few sentences were quoted. VentureBeat isn’t the ideal platform for convincing either the industry or the federal government that a New York Times article was unfair or inaccurate, but odd publications seem to get through to Judy every now and then to get a couple of sound bites in the form of a quick denial of statements made in other publications.

From Dr. Herzenstube: “Re: new federal health IT strategic plan. It’s actually a pretty quick read at only 28 pages and a bit less platitudinous than one might expect. One item of particular note is the prominent acknowledgement by ONC that the potential safety hazards of HIT need to be better understood and addressed. Among the high-level objectives for the five-year period is, ‘Increase user and market confidence in the safety and safe use of health IT products, systems, and services.’ The document notes, ‘Evidence suggests health IT improves patient safety; however, health IT products can also lead to medication errors and other adverse outcomes. Additionally, poor implementation or improper use of otherwise safe systems can also lead to adverse outcomes. Clinical and other health providers and individuals must be able to rely on health IT systems to perform safely.” The optimist in me appreciates ONC’s recognition that the federal government’s healthcare IT bailout program has had both positive and negative effects on patients. The cynic in me wonders if this isn’t a pitch for ONC to save itself from irrelevance by elbowing its way into the health IT safety business via its self-proposed Health IT Safety Center, which Congress seems unwilling to support financially or otherwise.

From ICD Lay No More: “Re: ICD-10. Someone started a petition on the White House website to “Implement ICD-10-CM/PCS on October 1, 2015 – no further delays.” The signature count so far is 239.

HIStalk Announcements and Requests

This week on HIStalk Connect: Happtique, a digital health startup that spent several years working to bring legitimacy to the mHealth market through its app certification program, is acquired by SocialWellth for an undisclosed sum. Doximity, the LinkedIn for doctors, hits 400,000 users, meaning that it has now penetrated more than 50 percent of the US physician population. Walgreens announces that it will partner with MDLive to begin offering telehealth visits through its digital health app. 

This week on HIStalk Practice: Health First selects PatientKeeper software. Allscripts inks an ePA deal with Express Scripts. Tandigm Health goes with Lumeris population health tech services. Johnson County Mental Health Center connects to the Kansas HIE. Wearables finally make it to the ear. Survey results highlight HIPAA’s education problem. Thanks for reading.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

McKesson launches a strategic venture capital investment fund that will take minority positions in early- and growth-stage companies, with rumored investment totals in the hundreds of millions of dollars range.

Diagnostic device vendor Welch Allyn acquires the assets of Omaha, NE-based remote vital signs monitoring technology vendor HealthInterlink, saying it will offer US customers the FDA-cleared mHealth solution.

Streamline Health reports Q3 results: revenue up 2 percent, EPS –$0.14 vs. –$0.50, missing analyst expectations for both. Above is the one-year share price chart of STRM (blue, down 40 percent) vs. the Nasdaq (red, up 19 percent).

Madison, WI-based health IT incubator 100health, announced less than a year ago, shuts down, with the former Epic employees who founded it refocusing their energy on one of its startups Redox, which is working on APIs to access EHR information. One of those founders, Niko Skievaski, says the incubator’s model of taking 5 percent equity in very early startups didn’t provide cash flow, questions arose about how investors would be repaid when companies exited, and the founders of the participating startups relied too much on the partners as day-to-day managers.

SocialWellth acquires what’s left of Happtique from Greater New York Hospital Association. The highly hyped application certification service Happtique outlived its questionable usefulness a year ago when some of the apps it had approved were found to have ridiculously obvious security flaws (like storing PHI as plain text). SocialWellth offers “balanced living apps” that it describes as murkily and buzzword-heavily as possible in the hopes of sounding like it offers whatever a prospect might want to buy:

DIGITAL HEALTH ENABLEMENT TOOL KIT. Delivering Connected Consumers with Contextualized Experiences. As a leader in consumer and prescriptive digital health, SocialWellth enables payers, providers, and employers by delivering a wide spectrum of white label experiences and facilitating a connected experience between members and their payers. SocialWellth enables the curation of digital health experiences by leveraging mobile health technologies that allow for integration and aggregation of all digital assets, which improve the overall consumer experience.

Sales

Hartford HealthCare (CT) chooses RightCare’s assessment, referral, and care coordination software to reduce readmissions.

Cook Children’s Health Care System (TX) chooses Strata Decision for budgeting, capital planning, long-range financial planning, rolling forecasting, and reporting.

Health First (FL) selects PatientKeeper charge capture, expecting to go live with 90 hospitalists in January with integration to its GE Healthcare systems.

University of Vermont Medical Center (VT) will replace pagers with Imprivata Cortext secure communications.

Banner Health (AZ) chooses Craneware’s Chargemaster Corporate Toolkit.

Physician management services vendor Women’s Health USA chooses athenahealth’s EHR, revenue cycle, and patient engagement services for its 250 providers. The companies will also jointly offer their bundled services to other physicians.

People

Jamie Coffin, PhD (Clarify Healthcare) is named CEO of ambulatory surgery software vendor SourceMedical.

Eric Poon, MD, MPH (Boston Medical Center) is named chief health information officer of Duke Medicine (NC).

MedAssets promotes Mike Nolte to president and COO.

ADP AdvancedMD hires Arman Samani (Medhost) as CTO.

MedSys Group appoints President Steven Heck as board chair, replacing Luther Nussbaum, who will remain on the board.

Leidos Health names Steven Russell (Quantros) as SVP of sales and strategic accounts.

Philip Loftus (Aurora Health Care) joins SSM Health (MO) as CIO.

Announcements and Implementations

Allscripts announces its eAuth electronic prescription prior authorization module for Express Scripts patients.

Summit Healthcare offers the Express Connect web services adapter, allowing its interoperability platform customers to connect to applications using universal standards such as HTTP, XML, SMIME, SOAP, and JSON.

Health Catalyst announces its collaboration with Microsoft centered around the latter’s Analytics Platform Services.

Microsoft profiles the use of its technologies for the volunteer cleft palate surgery missions of Operation Smile, including Windows 8-powered Asus tablets running a digital patient assessment system, Slainte Healthcare EMR, Office 365, and OneDrive for Business.

Time names “The Ebola Fighters” as its Person of the Year.

Government and Politics

Federal judges shut down a billion-dollar VA hospital construction project in the Denver area after finding that the poorly planned and managed project is so over budget ($400 million or more) that the agency can’t pay for. It’s the fourth huge VA construction project that failed to hit budget and schedule targets. The VA’s contractor says it is owed $100 million and suggests letting the US Army Corps of Engineers replace the VA in managing the hospital’s completion.

Other

The New Orleans newspaper features the recent HIMSS EMRAM Stage 7 accomplishment of Ochsner Medical Center – North Shore (LA), an Epic user.

A Madison news site profiles Epic’s 122-member culinary team, whose head chef says he’s “never worked with a more talented group of cooks,” of which only five have left since he arrived in 2009. He’s planning the opening of a new 51,000 square foot dining hall in May that will require 42 new team members to operate. The chef says kitchen working conditions are family friendly and nearly all menu items are made from scratch. This is the most interesting factoid to me: 80 percent of employees eat on campus at subsidized prices, saving the company $450,000 per day in otherwise lost productivity. That’s not so great for area restaurants, but brilliant in terms of keeping salaried employees at their desks longer.

Up to 40 hospitals in Queensland, Australia go to downtime procedures when a data center storage controller software upgrade fails. Some systems were set up to fail over, but those that weren’t include an endoscopy system that’s used by 33 hospitals.

Minnesota state investigators blame a resident’s death on a “cheat sheet” that incorrectly indicated DNR (do not resuscitate) and missing code status in the EMR. An aide notified nurses when she found the man gasping, but the licensed practice nurses who responded did not attempt to revive him because of confusion about his DNR status.

I like Practice Fusion’s eight tips for maximizing patient engagement while using a computer in the exam room.

Weird News Andy titles this article “Disappearing Docs.” Federal investigators find that half of the Medicaid providers listed in its directory either don’t exist or aren’t taking new patients.

A federal judge sanctions Aetna and its subsidiaries ActiveHealth Management and Medicity for the company’s response to a patent infringement lawsuit brought by HealthTrio. Aetna’s attorneys designated 90 percent of the 862,000 pages of information it submitted as viewable only by its own outside attorneys, which the judge declared to be “absurd.”

Guam Memorial Hospital says it received inadequate training for its October conversion to NTT Data’s financial system, causing the CFO to have an uncertain picture of the hospital’s financial situation. It’s asking the company to send people back on site for a month.

Orlando ophthalmologist Jack Parker, MD sues his office’s former medical software specialist (and former fiancee, who moved out of his mansion in September), demanding that she return her $60,000 engagement ring, $70,000 Porsche, and a dog he spent $3,500 to train. She responded, “It’s my stuff.”

Jordain Shlain, MD pens (or keyboards) a completely brilliant poem that sums up the practice of medicine over many centuries that could be turned into perfect music as in REM’s “It’s The End of the World as We Know It (And I Feel Fine)”. An excerpt:

Sponsor Updates

• Medicomp is integrating Quippe and the MEDCIN Engine with the Soteria clinical management system of Infocare in South Africa. Above are Medicomp team members Jay Anders, MD (chief medical officer), Dan Gainer (CTO), Jason Valore (senior manager of solutions), and Dave Lareau (CEO) at the Cape of Good Hope.
• Forward Health Group is designated as a “High Performing” vendor in a new KLAS report on population health performance, with a 100 percent “Would Buy Again” score and a top ranking in categories such as “Money’s Worth,” “Keeps Promises,” and “Ranked Client’s Best Vendor.”
• SyTrue and nVoq will jointly market their respective smart data platform and speech recognition systems.
• EDCO Health Information Solutions publishes a case study of the use by City of Hope National Medical Center (CA) of the company’s Solarity medical records scanning and indexing system, which is 50 percent faster than paper processing and adds HIM quality and productivity tracking.
• Impact Advisors publishes an article titled “Population Health Management – Development a Roadmap.”
• The HCI Group lists its “Top 10 Most Popular EHR Articles of 2014.”
• The CoCENTRIX Coordinated Care Platform receives ONC-ACB EHR Complete 2014 Edition Certification.

EPtalk by Dr. Jayne

My inbox has been humming since this week’s Curbside Consult appeared. In addition to getting quite a few comments about the original Forbes piece, readers have had a lot to say about the overall idea of fashion advice for conference attendees and presenters.

From Handbags Ta Di For: “Perhaps the mHealth ladies can purchase this ‘fussy’ purse. Space Cadet ?!?” Although it’s from Kate Spade, who is one of my favorites, it’s probably not going to make my holiday wish list.

From Roy G. Biv: “Is it my imagination or are two of those accessories a stethoscope and doctor’s bag?” Not exactly. I think it’s a fussy necklace and a pretty big satchel. I’m pretty sure neither an otoscope nor an ophthalmoscope has ever seen the inside of that one.

From Mountain High: “There is a lot to be said on this topic beyond the presentation at a conference. Do people care about the dress of their provider? Do people look at their doctors and expect a certain amount of dress? Our hospital has banned ties for clinicians, which has resulted in a hodgepodge of male dress, and has almost completely eliminated dresses/skirts for clinical women as well, which has resulted in an army of khaki pants. Since nurses are still clad in scrubs, what is the expectation of your provider, should they wear their white coat? Many of ours are not donning the lab coats as they just don’t like them (and they come in three horrendous sizes unless you wish to buy, wash, and maintain your own). Currently my otherwise well-dressed partner is wearing a white muu-muu, as the sizes of lab coats run from men’s large to Andre the Giant XXXXXL.” A close friend of mine works at a prominent integrated health system that shall remain nameless. Several years ago they lived through “hosiery-gate,” which started with complaints about male physicians wearing loafers without socks. It ended up requiring “hosiery for all personnel.” She protested the idea that the hospital should dictate wardrobe to that degree by wearing various combinations of crazy socks with dresses so everyone could see them. Her patients know she’s a free spirit and got a kick out of it but the administration was not amused.

From Mixed Marriage: “Can we please address the Dansko clog? There are now over 250 variations of them, from the basic black or brown, to the most artistic floral patterns. Does your hospital provide any shoe-cleaning service? Because it should. As an IT person, even though I limit my clinical area time to as little as possible, I still religiously clean and polish my shoes not to make them look good, but to eliminate bringing germs and hospital funk into my car and house. How many other people think that through?” If I’m going to wear clogs, my personal favorite is Medimex Plogs. They’re bleachable and you can even autoclave them, although I doubt my hospital would let me just throw them in. You do have to watch out, though, because some of them are vented on the sides, so if you’re going to be anywhere gooey, you need to wear shoe covers. They also have massaging nubbins on the inside which is great during a long shift in the ER.

From Selfish: “Dr. Jayne, I think you have it all wrong. Everyone knows the real reason that people – especially women – go to conferences is to network and be seen. It’s not about learning or selling or presenting. I mean, really, do people actually listen to all 55 minutes of a conference presentation? Of course not. While we are pretending to listen, we are really asking ourselves if the presenter’s hairstyle would look good on us or if we could pull off that color scarf. Everyone knows that what really matters is whether one’s eye shadow is coordinated with their belt. After all, we live in the world of Instagram, Facebook, and Match.com, where image is everything and where we spend hours a day just looking at pretty pictures. Don’t be fooled people: all those mHealth folks aren’t staring at their iPhones looking at medical apps – they’re checking Instagram to see how many likes they got for their latest selfie.”

I’m giving this reader the inaugural Jonathan Swift “Modest Proposal” award for using satire to make us think. For many attendees, networking is the only reason to go to a conference. Whether you’re looking for your next opportunity or wanting to solidify or renew business relationships, looking successful is a key part of the event. For those that are addicted to social media, it is taken to a whole new level. Of course HIMSS is the granddaddy of “see and be seen” events and I’m certainly no stranger to critiquing fashion, shoes, or booth attire at the show.

I’m still receiving feedback as I write this and have even received a special guest post photo essay straight from the halls of the mHealth Summit. Stay tuned for Monday’s Curbside Consult. You won’t want to miss it.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/10/14

Top News

ONC issues its Federal Health IT Strategic Plan 2015-2020, which will serve to set the stage for the Nationwide Interoperability Roadmap that will be released early next year. The 28-page plan, open for comments through February 6, is the result of input from 35 government agencies. It describes the government’s strategies to achieve five goals, which include improving interoperability, patient engagement, and the expansion of IT to parts of healthcare that have been without it, such as long-term care and treatment of the mentally ill.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock 

MetaMD acquires Patient Education Programs, including its Digital Diabetes Educator tool and an interactive educational game for kids with sickle cell disease.

Texas Medical Center and Village Capital select a dozen startups to participate in their inaugural VilCap USA: Health IT 2014 assessment program. The two highest-ranking startups will walk away with $50,000 each at the end of the three-month program.

National Research Corp. acquires Digital Assent and launches the DA-developed Reputation tool, enabling healthcare organizations to collect, display, and syndicate authentic patient ratings and reviews across owned and affiliated websites.

Avizia merges with Emerge.MD to offer hospitals a complete telemedicine platform consisting of Avizia’s telehealth devices and video conferencing tool and Emerge.MD’s telemedicine software. The combined company will continue under the Avizia name.

Sales

Greenville Health System (SC) selects Healthier Populations Solutions from Orion Health to support its population health and ACO initiatives. GHS is in the midst of a five-year, $97.2 million, system-wide Epic implementation.

Major Hospital (IN) implements the Diagnotes secure texting system across its facility, which includes 89 beds and 300 clinical staff.

Torrance Memorial Medical Center (CA) rolls out the Allen Technologies Interactive Patient System at its new Melanie and Richard Lundquist Patient Tower. The hospital hopes to implement the system across its 446 beds once all of its TV systems have been updated.

Paladina Health (CO) selects the eClinicalWorks Care Coordination Medical Record for population health management. The primary care provider, a subsidiary of DaVita Healthcare Partners, already uses eCW’s EHR.

E+CancerCare (TN) installs Equicare CS oncology patient management software at 13 of its outpatient cancer care centers. Implementation took just three months.

Announcements and Implementations

CareFusion and Kit Check, both players in the medication administration space, partner to connect their hardware, software, and RFID solutions for improved medication handling from pharmacy dispensing to OR point of use.

BlackBerry partners with NantHealth to develop the NantOmics Cancer Genome Browser, its first app. Slated for availability early next year, the app will connect a physician’s Blackberry Passport with a NantHealth system that analyzes tumors and recommends treatment options.

Vector Oncology integrates its Patient Care Monitor with Flatiron Health’s OncoEMR to give oncology care providers an easier way to gather and view patient-reported symptoms at the point of care. Lee Schwartzberg, MD, president and CMO of Vector Oncology, will serve as a medical advisor to Flatiron Health during the partnership.

Vital Care announces that its HealthPatch MD wearable biosensor is now available for use in clinical trials in partnership with Medidata. The sensor can be used with Medidata’s Clinical Cloud platform and mobile app for patient-reported outcomes.

Walgreens offers consumers in California and Michigan access to MDLive physicians through its Walgreens mobile app. The new tool, which will be rolled out to additional states in the coming months, builds on the app’s Pharmacy Chat feature launched last year. (Check out Lt. Dan’s thorough recap of the news at HIStalk Connect.)

Research and Innovation

Five researchers at the University of Texas Health Science Center at Houston School of Biomedical Informatics receive $7.3 million in grants to improve healthcare and biomedical discovery through the use of healthcare IT. Projects underway include patient safety research, enhancing the use of EHRs in research, developing software to make EHRs more user-friendly, and using analytics to improve heart-disease care.

Government and Politics

MIT professor and former Healthcare.gov consultant Jonathan Gruber apologizes profusely for his recent “foot-in-mouth comments” on healthcare reform during a House Oversight and Government Reform Committee hearing on the ACA. CMS Administrator Marilyn Tavenner also took advantage of the hearing to apologize for overstating the number of Healthcare.gov enrollees. Both, likely with tails between their legs, reiterated the party line that the ACA has been a success thus far. 

People

Naomi Fried (Boston Children’s) joins Biogen Idec as vice president of medical information, innovation, and external partnerships.

Joel Shu, MD (Jersey City Medical Center) joins Catholic Health Services (NY) as vice president of clinical transformation and population health.

Non-profit Healtheway announces its 2015 Board of Directors.

Other

The Brookings Institution offers a roadmap for effective unique device identifier implementation. The 94-page document offers recommendations on integrating UDIs into provider systems such as EHRs, administrative transactions, and patient-directed tools.

The local paper profiles Mayo Clinic’s (MN) big data research partnership with UnitedHealth Group. Two-year-old Optum Labs is the nation’s largest and most comprehensive healthcare database, and includes de-identified claims data from 150 million UnitedHealth customers spanning the last 20 years. It will eventually be linked to 44 million medical records, including 5 million from Mayo.

This article puts Epic’s interoperability efforts (or lack thereof) in the spotlight, focusing on the journey of customer Legacy Health (OR). CIO John Kenagy puts things in perspective: “No vendor solves this problem completely. There’s a natural inclination to blame Epic because they’re just a big target.” Judy also weighs in: “One hundred percent of our customers that are live with our EHR are also live with our Care Everywhere software built in. We have even gone back and retrofitted it into old versions so that every one of our customers can send and receive to others, to anyone who uses industry standards, whether they use Epic software or if they use other vendors’ software who also follow the standards.”

UVM Medical Center (VT) deploys two Xenex Germ-Zapping Robots in its ORs to the tune of $100,000 each in an effort to reduce HAIs. The hospital, which won the 2014 Partnership in Prevention Award for its HAI elimination efforts, plans to deploy them next in isolation rooms.

A clinician bemoans the state of NHS IT (and its interference with her gambling habits), eloquently fuming that, “It’s not just the doctors who struggle; the ageing bones of the crumbling hardware system creak ever louder as it cranks up to process another new data load.”

President Obama makes a guest appearance on The Colbert Report, poking fun at himself and Healthcare.gov.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 12/8/14

Top News

Alberta, Canada begins its search for a new clinical information system after a auditor’s report found that the $260 million it spent on EHRs resulted in systems that don’t talk to each other, requiring the continued use of faxing to exchange information. Progressive Conservative Member of the Legislative Assembly says, “Do we realize we need to have data exchange standards before we start adding systems? We need systems to talk. It blows my mind.”

Reader Comments

From Not My First Rodeo: “Cottage Health System in Santa Barbara, CA. Going Epic. Recently hired a project director and is moving quickly to hire FTEs from other regional Epic customers.” Somewhat old news, I think, given that Cottage’s bond rating agency mentioned the planned Epic expense in its July ratings report.

From The PACS Designer: “Re: Chartcube. It will enhance your presentations of spreadsheets. Collaborate with colleagues using your iPad to focus on the really important elements of your spreadsheets.”

HIStalk Announcements and Requests

I hereby acknowledge the will of the people in proclaiming Atlanta as the official “Healthcare IT Capital of the US.” Atlanta’s health IT network and civic pride turned out the vote with 45 percent of the 1,600 votes cast (including mine). Congratulations to the “Home of Peach Trees and HIT” (the only peach trees I know there are the 100 or so streets named that, but surely they must grow somewhere among all the concentric asphalt rings). New poll to your right or here: do you look forward to going to work Monday mornings? Vote and then click “Comments” to explain.

It’s a very slow news season and that situation will likely continue over the next few weeks. I could do as the industry rags do and simply pad out this post with endless paragraphs covering non-newsworthy topics, crank out poorly thought out editorials that say nothing new, or pretend that pointless announcements deserve extensive coverage and an easily churned out backstory containing mostly unrelated historical facts. However, I’ve decided (as I always do) that instead I’m going to avoid wasting your time and mine and give you a few minutes (and me a few hours) of your life back. I promise I haven’t omitted anything important and I will continue to be verbose when events warrants. Meanwhile, I’m going to take the rare opportunity to get off the computer and hopefully do something fun.

Last Week’s Most Interesting News

• A new JASON report prepared for the federal government says the health IT systems market is moving in the right direction with regard to interoperability, but that initiatives are not complete because systems sometimes only export entire documents, omit patient information, or provide APIs whose use is contractually limited to customers rather than entrepreneurs.
• HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources).
• ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.
• Madison’s alternative weekly newspaper says that Epic has backed down from its plan to extend its non-compete term from one year to two for employees who quit to join consulting firm Vonlay after its acquisition by Huron Consulting Group.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers, executives, and clinicians, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

The Cleveland paper profiles CoverMyMeds, whose CFO predicts it will become a billion-dollar company. The company, with annual revenue of $50 million and growing, doubled its headcount this year to 140 and expects to double it again in 2015 after an undisclosed investment by Francisco Partners. I interviewed co-founder Matt Scantland a couple of months ago.

Sales

Everyday Health chooses Validic to integrate consumer data into its digital health and wellness platform. Validic announces several more new customers, including WebMD and UPMC, that increase its client population from 80 million to 100 million. The company is presenting and exhibiting at the mHealth Summit this week.

Other

A brilliant example of for-profit, non-peer reviewed “journals” that publish articles for a fee: two “predatory” scientific journals accept for publication an article containing indecipherable, randomly generated text as submitted by three authors, all of them characters from “The Simpsons.”

The Coalition for ICD-10 responds to the ICD-10-sarcastic comments of a generally IT-whiny AMA President Robert Wah, MD (who has an informatics background and served as deputy national coordinator of ONC, yet somehow now hates everything about healthcare IT) in saying that seemingly wacky ICD-10 codes have good reasons for their use. Example: “Sucked into a jet engine” might seem eye-rollingly hilarious unless you spend 18-hour days on a Navy ship flight deck trying to avoid doing just that. I have to say that I’ve been hoping someone would give Wah (and the AMA) a good spanking for his ridiculous, self-serving rhetoric  and the group did exactly that:

Dr. Wah complains about the number of codes and the detail in ICD-10 but fails to mention that much of the additional specificity in ICD-10 was at the request of medical specialty societies. Nor does he mention that there are no ICD-9 codes for many critical healthcare issues. There is no code to report and track Ebola. There are inadequate codes for tracking service-related health problems for our veterans. There are no codes to help us research sports-related concussions among young athletes. It’s hard to understand why the AMA is not demanding that this kind of information be available in our national data.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/5/14

Top News

HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources). Working with HL7 will be athenahealth, Beth Israel Deaconess Medical Center, Cerner, Epic, Intermountain, Mayo, Meditech, McKesson, Partners HealthCare, SMART from Boston Children’s, and The Advisory Board Company. HL7 says the group will create FHIR-based EHR data sharing API specification by the spring of 2015. The big news here: (a) the second JASON report called for a big vendor to propose an open API standard instead of waiting around for the government to do it; (b) FHIR and APIs are a heck of a lot better than today’s document-based interoperability standards and probably better than the customized jungle that the HL7 standard has become; and (c) getting Epic, Cerner, Meditech, and McKesson together at the same table covers nearly all of the hospital EHR market and Epic, particularly, is a key member given its non-participation in CommonWell (and Epic and Cerner already have customers using APIs).

I asked an expert who shall remain unnamed to summarize Project Argonaut:

Project Argonaut is beginning the hard work of not only formalizing the API calling sequence (the easy part and something most vendors already do), but to formalize a set of vocabulary objects – Problems, Allergies, Notes, etc. with controlled vocabularies and predictability. To make FHIR really work, both must be done well. If FHIR succeeds, it will allow third parties to create an “app” and be able to run it in any FHIR-compatible system without the meet and map exercise with each implementation. What we’ll need to do with FHIR is to ensure people don’t get ahead of themselves and customize the “resources,” otherwise we’ll be back in the same boat as HL7 v2. FHIR is at the peak of inflated expectations. It will be great as a minor plug-in where there’s a UI or visualization, but not so great for machine-to-machine communication where one of the endpoints might not always be reliable for high-volume transfers at scale – some of the simpler web service configurations can be horribly inefficient, like making separate grocery store trips for each item on your list. There may be audit and security issues as well.

There is no immediate connection, but over time, CommonWell could add services that are based on the FHIR standard that the Argonauts are trying to speed up. For example, CommonWell today uses XCA to move CDA documents around, but that can be cumbersome if all the doctor wants is to get a list of known allergies from some other site. FHIR makes the later query much easier than using XCA to move a "fake" document that contains only allergies. So, CommonWell will benefit from the success of the Argonaut work (assuming it’s successful!) But otherwise, there is no direct connection, though some of the same people are involved with both.

Reader Comments

From Ken L. Ration: “Re: HIMSS. Our designer got a good laugh from this HIMSS15 promotional graphic. One thought it was an attempt to be edgy, but the general consensus is that it’s a marketing fail.” I think it’s an insightful graphic: those benzene ring-shaped items are probably snowflakes burying HIMSS attendees who would much rather be almost anywhere else — Chicago came in seventh of 11 desired HIMSS cities last time I surveyed, with the clear winners being San Diego, Las Vegas, and Orlando.

From Roy G. Biv: “Re: physician billing services. Do health systems keep using them after implementing Epic? Could you ask your readers if, for instance, the keep using athenahealth’s PM and billing service post-Epic?” Readers have been duly notified – responses are welcome.

From HIT5982: “Re: Medhost. Let 71 people go Wednesday all at once. HR cleaned out their desks while they were being told. I was one of them – I worked in the department division (EDIS, Patient Flow, perioperative) and was told the emphasis will shift to Enterprise (clinicals, financials, patient access, revenue cycle). Departmental sales were down this year.” Reported by two readers. I reached out to the company for a response but didn’t receive one. Nothing says Christmas like being laid off.

I shall digress and pontificate on the topic of layoffs. I’ve seen both sides over the years: (a) I was literally on my way out the door before getting a last-minute reprieve in my one and only vendor job many years ago, where layoffs every quarter were a given as executive bonuses became threatened by poor financial numbers mostly due to their own poor decisions; and (b) I have personally marched at least 20 people out of the hospital IT department through a gauntlet of their peers as I served as judge, jury, and executioner for high-level decisions that I neither made nor agreed with. Both situations were largely created by clueless, spreadsheet-circulating executives who were shockingly indifferent to the havoc they were wreaking on the lives of people and their families. While some of the folks who get axed deserved it and should have been canned a lot sooner, many of them had been given perfectly fine performance evaluations but were singled out for factors beyond their control: changing organizational strategy, their own demographics, higher salaries that they had been voluntarily offered to them, and doing their jobs every day instead of kissing executive butt and backstabbing their co-workers. Readers regularly send me personal stories about being cut loose and I always provide the same response: you’ll be better off in the long term because who wants to work for a company that lays people off? To people all over the industry who have to face the holidays (and their families) with uncertainty, fear, and feelings of personal inadequacy for whatever reason, I am truly sorry. It will get better.

From Pierre Dukane: “Re: slimy companies. This site [URL omitted] charges consultants $300 per quarter to be on the ‘elite’ list for go-live job notifications, using information it gathers from other members and online job postings (duh). The ‘About’ page doesn’t say who runs it and the domain registration information is blocked. I can’t believe people pay for this garbage. Also, an HIT consulting firm’s recruiter is sending emails offering entry into a gift certification drawing if they ‘forward any email you receive from another recruiter or company regarding current opportunities or referral incentives.’ What happened to working the old-fashioned, honest way? No wonder clients and consultants feel so negatively about consulting firms.” It wasn’t hard for me to track down the operator of site you mentioned, which doesn’t seem to be offering much for $1,200 per year. But hey, it’s a free country, and he’ll either get business or he won’t depending on the value he provides. I’ve had both good and bad experiences with recruiters that I’ve either hired or been placed by, but I agree that quite a few questionably motivated people see it as nothing more than making easy money by matching Resume A to Job Posting B. Nearly everything in life can be explained by supply vs. demand.

From Elsa: “Re: BJC’s core clinicals replacement. Vendors were to have been notified Friday. I was shocked that it wasn’t Cerner – my source says it’s Epic. Not sure how they’ll justify the cost when they laid off staff, cut charity care, and froze raises.” Unverified.

From Not Quite: “Re: JASON report. ONC is putting a lot of stock in it, but it’s a fake that is partially plagiarized from Wikipedia. The report lists many references, but fails to list Wikipedia, from which many things were copied. ONC should ask for our money back!” No report should ever reference Wikipedia since it’s not a vetted reference, but hopefully the JASON folks cited their primary references properly, at least where a source contained something that isn’t common knowledge.

HIStalk Announcements and Requests

Voting for the US capital of healthcare IT has been heavy, with Madison leading the pack and Nashville and Boston pulling up as a distant second and third. Voting ends this weekend – my poll is here.

This week on HIStalk Connect: Data scientists with athenahealth are monitoring the onset of the 2014-2015 flu season and note an early uptick in flu-related visits. Google is said to be revamping the internal components of Google Glass in an effort to boost battery life. Personal genome testing startup 23andMe will begin selling genetic tests in Canada and the UK after a year of trying and failing to secure FDA approval for US sales. 

This week on HIStalk Practice: Payers in Colorado build online claims data-sharing tool for physicians. HIPAA compliance at physician practices is found to be woefully lacking. Gila River Health Care goes with NextGen, while Advocate Community Partners selects eClinicalWorks. Practice Fusion VP argues for net neutrality, while Amazon takes advantage of lightning-fast consumer Internet connections. AMA winner Nancy Adams asks, “Interoperability? How about achieving operability first?” Thanks for reading.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

Integrated payments network vendor InstaMed raises $17 million in a private placement, $2 million more than it was seeking.

Sales

Rio Grande Valley Health Alliance (TX) and Lakewood Health System (MN) choose Lightbeam Health Solutions for population health management. I interviewed CEO Pat Cline a few months ago. 

Western New York’s HEALTHeLINK HIE chooses Stella Technology’s clinical data access technology for analytics and reporting.

Children’s Hospitals and Clinics of Minnesota chooses Strata Decision’s StrataJazz for decision support and cost accounting.

Granite Health Network (NH) selects athenahealth’s athenaCoordinator Enterprise Population Manager.

The Medical Center at Bowling Green (KY) chooses ProVation Medical for its cardiac cath lab.

People

CompuGroup Medical US promotes Navid Asgari to VP of service and support for its ambulatory information services division.

Announcements and Implementations

Lehigh Valley Health Network (PA) announces that its physician group will move to Epic.

Levi, Ray & Shoup announces release of a new user interface for Epic users of its VPSX output management solution.

Imprivata announces OneSign 5.0, a new version of its authentication and access management product.

Children’s National Health System (DC) opens an Innovation and Learning Center to house Bear Institute, its partnership with Cerner. The announcement is confusing, but I think it’s just a new physical space to house the existing project, which was announced just over a year ago.

CareSync launches its Chronic Care Management service that allows providers to earn Medicare’s monthly CCM payments.

Perceptive Software launches Perceptive Interact for Google Apps, which allows users to integrate Gmail content into Perceptive Content for review, routing, and collaboration.

Government and Politics

ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.

Someone tweeted out this fascinating article from March called “Sinkhole of Bureacuracy,” which describes the 600 federal government employees who push paper in the abandoned limestone mine run by Iron Mountain in the middle of nowhere in Pennsylvania at a cost of $56 million per year. Previous federal government automation efforts of the government’s retirement program failed despite spending well over $100 million. A former employee described the manual process as, “I used to chase people for months — literally — for one signature on one piece of paper. You want to talk about an egregious waste of taxpayer money? … On a daily basis, we would get from five to 50 e-mails, asking everybody to take time out of their day to search their desks for case files.” The article says the old mine is legend in the federal government, quoting former CTO Aneesh Chopra as calling it “that crazy cave.”

Massachusetts says it has repaid most of the $2.1 million in Medicaid EHR incentives that were incorrectly given to 19 hospitals that were identified by the HHS OIG. The state blamed requirements that are hard to understand and hospitals that reported incorrect data to the federal government.

Innovation and Research

A small study finds that a computerized symptom questionnaire that was turned into a History of Present Illness narrative using computer algorithms created a better HPI than physicians doing it themselves.

Other

Hospitalists at two Oregon hospitals form a union, hoping to remain as hospital employees rather than being outsourced to a national firm.

A review of a tiny sample of the 100TB (!!) of data hackers took from Sony finds medical information, in the form of doctor letters for medical leaves of absence. The responsible hacker group, possibly from North Korea, has posted some of the information publicly, including salaries, scripts, and video files of unreleased Sony movies. The hackers also released a Word document titled “Passwords” that some idiot Sony executive had used to store all of his computer passwords and credit card information. Sony was burned by hackers in 2011 who stole credit card numbers and took down its PlayStation network for weeks. 

New York police arrest radiologist James Kessler, MD, MPH for copying the information of 97,000 patients of his former employer onto a portable hard drive with intention of starting a competing business.

Singer and cancer survivor Melissa Etheridge, just announced as a keynote speaker for GE Healthcare’s Centricity Live user conference, creates a line of prescription-only “cannabis-infused fine wines” that provide “a delicious full body buzz.”

Sponsor Updates

• An Imprivata video provides an overview of electronic prescribing of controlled substances.
• HCS provided 50 tickets to the Los Angeles screening of the overwhelmingly positively reviewed Glen Campbell documentary “I’ll Be Me” in support of Alzheimer’s awareness. The company will be contributing to the Salvation Army through the holidays on behalf of its clients.
• DataMotion earns accreditation as a Certification Authority and Registration Authority from DirectTrust.org and EHNAC, allowing it to issue and manage digital certificates in addition to its role as an accredited Health Information Service Provider.

EPtalk by Dr. Jayne

ONC will hold its annual meeting February 2-3, 2015. The email announcement caught my eye in mentioning that “the two-day meeting will gather over 1,200 health IT fans,” but on the registration website, it had been toned down to “health IT partners.” The event includes “an exciting panel of ONC’s former National Coordinators,” according to the email. I’m not sure if that’s enough of a draw to convince me to head to Washington in February. If you’re planning to attend, keep us in mind for rumors and newsy tidbits.

GE Healthcare announces its Centricity Live 2015 meeting April 29-May 2, 2015 at the Walt Disney World Dolphin Resort. Keynote speakers include Atul Gawande, Melissa Etheridge, and LeVar Burton. That lineup looks pretty good compared to some I’ve seen. I stayed at the Dolphin a couple of nights before HIMSS and it’s in a minimally mousey part of the Disney compound. Given the recent weather in my neck of the woods, I’m sure by April I’ll have a complete deficiency of Vitamin D, so if anyone wants a sassy traveling companion, let me know.

My good friend Anjali called last week asking for a favor. The annual Christmas Party at her hospital (it’s a faith-based institution, hence the name) was looming. Her husband had to travel and she didn’t want to go alone. She’s run three half marathons with me and has had my back in countless clinical situations, so how could I say no? She works at a hospital across town where I only know a handful of medical staff members, so I was looking forward to a holiday party where I could have a couple of glasses of wine without being interrogated about our EHR.

We were a little late heading out. She had picked up a dose of flu vaccine from the local retail pharmacy and was planning to vaccinate her daughter. The pediatrician’s office was already out of vaccine and the pharmacy won’t vaccinate children under 8 even with a physician’s order, so she decided to get creative. Unfortunately, she’s a surgeon with few pediatric vaccine skills, so I was persuaded to step in.

It’s a sad commentary when you have to work the system to vaccinate your child. Most parents don’t have that option, but I was happy to help. Needless to say, that vaccine won’t be making it into the state immunization registry, but I did email her the Vaccine Information Statement so I don’t run afoul of the feds.

The tables were packed when we arrived. We grabbed the first open space we found. We were next to a husband/wife physician couple – she’s a radiologist on staff and he’s an internal medicine physician elsewhere in town. The odds of a physician conversation (regardless of setting) eventually turning to EHRs and healthcare IT is nearly 100 percent if you talk long enough, and tonight didn’t disappoint.

The radiologist is pretty happy with the hospital’s system. She appreciates being able to view the entire patient chart when there are questions about what an ordering provider hopes to achieve with a diagnostic test. She also enjoys not having to help the radiology staff decipher cryptic physician handwriting.

Anjali told them she preferred handling patient messages from home after her daughter goes to bed rather than having to stay in the office. A couple of other people chimed in and I thought for a brief moment that the EHR love fest might continue in the spirit of holiday togetherness.

The bubble was burst when the internal medicine physician started complaining about his EHR. He complained of the burden of data entry with little return. He said he didn’t understand why there wasn’t any data exchange with other practices or hospitals or why he doesn’t have access to reports on his patients’ health status.

I asked a couple of questions about his practice and his system and was able to deduce that he is actually on my hospital’s platform, through our affiliate subsidy program. Anj picked up on this as well and gave me a little eyebrow raise. She knows I led deployment of our private HIE more than six years ago and that our users regularly exchange data between owned and affiliate practices as well as our multiple hospitals.

She’s also on the same ambulatory EHR although on a different platform, so was able to provide some positive counterpoints to keep him from going too far. I didn’t want to reveal myself as the owner of the platform due to the potential for turning a holiday gathering into a debate, so I excused myself for another glass of wine.

Most of our providers are satisfied with our system and are seeing the benefits of our patient registries, actionable reports, and interoperability. I’m going to need to get to the bottom of why his practice isn’t having a good experience and figure out what we need to do to get them to the same level satisfaction. I’ve reached out to our affiliate program manager so that I can review his implementation documentation and support tickets to try to identify what might have gone awry. I just wish I had heard about it through or formal processes rather than as an aside at a party.

Anj has never seen me in full Administralian mode and told me she was impressed at how I kept my cool while the physician was ripping apart the system I’ve spent the better part of a decade implementing, optimizing, and personally ensuring that practices receive value for their efforts. I must say I haven’t always been unflappable in these situations, but they have become easier over time. I’ve learned to pick my battles and not let situations get out of control.

We did enjoy some seafood and a nice string quartet, as well as good conversation with other physicians.

Have any strategies for enjoying the company holiday party? Email me.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 12/3/14

Health Data Outside the Doctor’s Office

National Coordinator Karen DeSalvo, MD publishes a blog post touting a JASON report that HHS commissioned to explore “how to create a health information system that focuses on the health of individuals, not just the care they receive.”

Electronic patient records systems not ‘good enough’, says NHS CIO

In England, David Walliker, CIO of Liverpool Women’s NHS Foundation Trust says that he will pursue an electronic document management solution, rather than upgrading to a modern EHR, because the current systems available from CSC, Cerner, and Meditech are not yet viable options for the hospitals specialists.

Epic Systems backs down on noncompete clause

Epic backs down from an earlier decision to up its non-complete cause from one year to two for any recently departed employees that were trying to join Vonlay, a local health IT consulting firm. The employees in question had already left Epic and had only signed a one-year non-compete when they were hired.

Promoting Innovation; Protecting Patient Safety: Advancing Use of Technology in Health Care

The Bipartisan Policy Center will live stream a six-hour meeting on Wednesday called “An Oversight Framework for Assuring Patient Safety in Health Information Technology.” Speakers include National Coordinator Karen DeSalvo, MD, and McKesson CEO John Hammergren.

News 12/3/14

Top News

An ONC blog post by Karen DeSalvo, MD called “Health Data Outside the Doctor’s Officer” references a new JASON report titled “Data for Individual Health” (JASON is a highly regarded independent science advisory group run by DoD contractor MITRE Corporation). The report addresses the steps needed to move to “a system focused on health of individuals rather than care of individuals” in creating a learning health system. Some of its recommendations:

• HHS: take action on previously created reports and measure progress.
• HHS: adopt interoperability standards and incentives.
• HHS: support open API standards and pay providers more (the report suggests a 0.25 percent bonus in CMS’s Hospital Value-Based Purchasing Program) for using “ecosystem-friendly EHRs” that follow those standards.
• HHS: encourage non-profits (such as disease-specific advocacy groups) to mark consumer apps with their stamp of approval to increase their adoption.
• Joint Commission and professional schools: add informatics training requirements.
• FDA: loosen control of product services that could be construed as practicing medicine, for example, allowing apps to report their information to both provider and consumer as a risk mitigation strategy.

With regard to interoperability, JASON says the market is moving in the right direction and specifically notes that Epic (which the report says is regarded as “among the most closed systems”) has announced that it will develop APIs to allow external programs to interact with its systems. However, it says that initiatives are not complete because systems sometimes only export entire documents, omit patient information, or provide APIs whose use is contractually limited to customers rather than entrepreneurs. The new report suggests that the government encourage “an incumbent vendor with significant market share” to propose an open API standard to encourage the market leaders to step forward rather than being forced to follow a competitor-proposed standard. It also says FHIR is a significant improvement over CDA document-based exchange.

Reader Comments

From Enumerator of Legumes: “Re: Laurens Albada. You mentioned that he appears to have left as CFO of Greenway Health. He’s now managing director of financial services with the consulting group of Vista Equity Partners, Greenway’s owner.” Verified, according to his LinkedIn profile. That’s a nice move up.

HIStalk Announcements and Requests

Reminder: I’m collecting questions for CommonWell. If you want more information about its interoperability technology or strategy, send me yours. 

“Utilize” has been at the top of my “most annoying words” list for a long time since it is just a needlessly complicated way to say “use.” However, its top position has been recently threatened by “leverage,” which in a remarkable coincidence is yet another pompously pointless way to say “use.” Give marketing people their way and system users will be renamed “leveragees.”

Listening: Green River, an obscure mid-1980s hard-rocking Seattle band that arguably created what would later be known as grunge. They’re angry and armed with loud guitars that require me to provide air drums accompaniment. Two of the members later formed the similarly intense Mudhoney. I’m also enjoying the amazing Dinosaur Jr., late 1980s indie rock that remains fresh (and loud).

Webinar

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

Microsoft acquires 18-month-old, 20-employee Accompli — which developed a slick, free, Exchange-enabled smartphone email management app — for $200 million. I’ve tried it with my Gmail accounts and it has some nice features, such as smart messaging organization, easy calendar access, Dropbox enablement, and one-swipe conversion of an incoming email to a calendar event. I don’t know how Accompli planned to make money other than by being acquired, so maybe it cleverly noticed Microsoft’s mobile email weakness and figured MSFT would eventually wave money in its direction with hopes of renaming it Outlook Mobile. Accompli had raised only $7 million of VC money in its short history, so that’s quite a score.

Madison’s alternative weekly newspaper says that Epic has backed down from its plan to extend its non-compete term from one year to two for employees who quit to join consulting firm Vonlay after its acquisition by Huron Consulting Group. The paper says that Epic got involved with the acquisition at the last minute by insisting that Huron not hire any Epic employees within two years of their resignation from Epic, meaning Epic would be enforcing a requirement to which its employees hadn’t agreed. The article says local speculation is that Epic is beginning to fear being held liable for violating antitrust laws, especially after Silicon Valley software engineers filed a successful class action against big-name tech companies for conspiring to not poach each other’s employees. According to the paper, Epic has also warned consulting firms that they can’t put up Madison area billboards or advertise within 50 miles of its Verona no-fly zone, also extending its workforce control by giving hospital clients maintenance fee discounts for honoring Epic’s non-compete agreement. Epic’s only official response to the non-compete issue was, “This is being reverted to a one-year term. We’d rather not comment on the policy as a whole.”

Sales

Gila River Health Care (AZ) chooses NextGen’s ambulatory PM/EHR.

Advocate Community Providers (NY) chooses eClinicalWorks for population health management and interoperability to support its Delivery System Reform Incentive Payment program for 437,000 patients.

Grand View Health (PA) chooses Cornerstone Advisors Group to upgrade its Meditech Client/Server 5.6 system to 6.1 and to support its early adoption of Meditech’s web-based ambulatory product.

People

Anthelio Healthcare Solutions names Gary Trickett (Allscripts) as SVP of IT services.

Anthony Caponi is named VP of healthcare IT at Direct Consulting Associates.

Allana Cummings (Northeast Georgia Health System) joins Children’s Healthcare of Atlanta as CIO.

Payer software vendor Healthx names Sal Gentile (TriZetto) as CEO.

Announcements and Implementations

MedAssets will use Procured Health’s data intelligence and workflow solution in its product value analysis services.

Jackson General Hospital (WV) goes live with CrossChx’s SafeChx biometric patient identification solution in its registration area.

NextGen connects its Share platform with Merge Healthcare’s iConnect Network to allow NextGen Share users to send orders to Merge systems and receive images back.

The American College of Radiology and Massachusetts General Hospital (MA) will use Nuance’s PowerShare Network to present clinical guidelines in radiologist workflow and to automate PQRS data collection.

Ricoh will offer Levi, Ray & Shoup’s VPSX software to its healthcare enterprise output management customers.

Hosted infrastructure vendor SingleHop had me all impressed with their announcement that they would sign Business Associate Agreements with healthcare customers, at least until I hit the part of their press release that said HIPAA is “also known as the HITECH act.” Close enough for government work, I suppose, and it is kind of confusing.

EHR vendor CureMD chooses DrFirst’s EPCS Gold to add e-prescribing of controlled substances (EPCS) to its system. DrFirst reports that EPCS volumes jumped by 200 percent in the most recent three-month period, likely boosted by New York’s I-STOP mandatory e-prescribing requirement for all drugs beginning March 27, 2015.

Lawrence Memorial Hospital (AR) goes live with electronic forms from Access.

PeriGen is awarded a patent for its software that assesses fetal descent in helping OB-GYNs determine when it’s appropriate to perform a C-section delivery. I really like the company’s laser-sharp focus on fetal monitoring and the innovations it has introduced there. One of my favorite interviews was with CEO Matt Sappern a couple of years ago, when he succinctly explained the company’s products as, “Our ability to apply technology to what has been a subjective part of labor and delivery is important. Probably 80 percent of medical malpractice comes back to bad interpretation of the fetal monitoring strip. We’ve figured out a way to apply technology to help interpret that strip. ” 

Boston-area Gillette Stadium, home of the New England Patriots, announces plans for an upscale, expensive, members-only end zone suite that will be called Optum Field Lounge, named for the healthcare IT division of UnitedHealth Group that’s sponsoring it.

Government and Politics

The Bipartisan Policy Center will live stream a six-hour meeting Wednesday titled “Promoting Innovation; Protecting Patient Safety: Advancing Use of Technology in Health Care” with participants that include Karen DeSalvo from HHS and McKesson’s John Hammergren. The former is not surprising; the latter, a bit so.

Technology

Google Glass is a consumer bust that hasn’t even made it out of beta status, but it appears that Intel will get involved in selling it to enterprises, according to a Wall Street Journal report. A new Intel-powered version of Glass will be released next year and Intel will promote it to workplaces that include health systems. The new Glass is expected to have a longer battery life because of Intel’s power-conserving chips.

Victoria’s Secret launches a sports bra that includes hidden heart rate monitor sensors.

Dropbox will launch its business API on Wednesday, which will allow third-party developers to create enterprise applications on top of the storage service using their own rules for security, compliance, and workload integration.

An investigation by cybersecurity firm FireEye finds that an apparently US-based hacker group called FIN4 is using email phishing (without the usual obvious mistakes made by non-native speakers) to obtain insider information from 100 publicly traded companies, two-thirds of them in healthcare and pharma, that it then uses to play the stock market. Two of the identified targets are unnamed healthcare providers. The hackers embed VBA code in a copied document that mimics the Windows authentication prompt, leading the user to think they’ve lost their network connection and need to log on again. Those credentials are then used to probe the victim’s email for useful information and then to use that account to send compromised documents to colleagues at other firms. They even create Outlook rules to delete incoming emails containing words like “hacked” or “malware” that might have been sent as warnings from associates or IT departments. Recommended security actions include disabling Office VBA macros, blocking specific domains the group uses, and checking OWA logins from known Tor exit nodes since real users don’t use Tor (an anonymity network) to read email.

Other

USC cardiologist Leslie Saxon, MD provides some fascinating quotes in discussing her rather startling recommendation that patient biometric data should be placed on Facebook for doctors to review and share.

Oftentimes, you’ll see a patient and they have a vague symptom. You see them for 0.00001 percent of their life and you have to contextualize, use your experience, do some guesswork and diagnostics to understand what’s going on. Your car has over 100 sensors. They’re wireless, it’s continuously monitoring itself and telling you when it’s going to get sick, providing you with this A.I. so people’s cars don’t break down as often any more. One of the things that’s really interesting about digital health and sensors is that we haven’t seen a lot of the data that’s being captured before, so we’re not sure how to contextualize it. I’ve been doing cardio electrophysiology for over 25 years. Now that I’m monitoring some of my patients all the time, I don’t know what some of this stuff means. We’re going to have to build these data sets, track clinical events, then go back and contextualize it—say, oh, okay that was a sign of that.

In England, the CIO of Meditech client Liverpool Women’s NHS Foundation Trust says EHRs from CSC, Cerner, and Meditech can’t handle hospital specialty areas such as neonatology and OB-GYN and he’s putting efforts instead into implementing the open source Alfresco electronic document management system. He says, “As long as you’re seeing all the information pertaining to a patient, why should I put it in a single box and sacrifice the good things on the specialist systems so it’s all in one place? I think I could do a lot more good for patients with the money it would cost.” Once Alfresco is live, Microsoft Sharepoint will get the boot because he says it’s too expensive. Alfresco is available as a free online trial or download.

In Australia, Royal Children’s Hospital, which will go live on a $41 million Epic implementation in 2016, is looking for a medical device integration vendor.

The Russian economy continues to tank (no pun intended) beyond mass doctor layoffs and hospital closures as sagging oil prices and Western sanctions apply a double chokehold, with Apple raising prices up to 25 percent to offset the devalued ruble, which dropped 6 percent against the dollar on Monday alone and 42 percent in the past year. That puts the ruble as the world’s worst-performing currency behind only the subject of its aggression, Ukraine. Food prices are skyrocketing and banks have restricted the swap of rubles for other currencies. Up to 10,000 healthcare reform protesters took to the Moscow streets Sunday morning, carrying signs saying “Save money on war, not doctors” and demanding that the city official in charge be fired.

Highland-Cashiers Hospital (NC) mails letters to 25,000 patients explaining that its HIM contractor TruBridge made a configuration mistake that opened up some of their information to the Internet.

A literature review finds that while HIE usage probably has reduced ED visits and cost in some cases, no studies have been conducted that prove any particular benefit even though the government has subsidized their operation with $600 million in taxpayer money.

Several children’s hospitals will offer their patients televisits with Santa in the eighth year of the Cisco Santa Connection program that uses the company’s Telepresence system.

Bizarre: a corporate guy buys a USB-chargeable e-cigarette from an eBay user in China. He plugs it in and the cigarette phones home and plants malware.

Sponsor Updates

• TeraRecon offers an upgrade program for its enterprise imaging customers.
• Perceptive Software is demonstrating new features of its Acuo Vendor Neutral Archive and the newly announced Clinical Archive this week at RSNA. 
• University of Arkansas for Medical Sciences reports significant nurse time savings from using Capsule’s SmartLinx to send medical device data to Epic.
• PerfectServe posts a blog entry titled “Evolving Healthcare: Six New Realities for the C-Suite.”
• Extension Healthcare CEO Todd Plesko will present a session on alarm management at the mHealth Summit in National Harbor, MD December 7-11.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 12/1/14

Top News

Cloud solutions provider 8K Miles Software Services acquires 30-employee Epic consulting firm SERJ Solutions. 8K Miles says it will use the newly acquired expertise to create cloud-based healthcare solutions. I was curious about SERJ’s self-proclaimed marketplace difference, which it describes as follows: “Through our unique and multi-faceted approach, SERJ is able to ensure your EHR implementation is successful by providing strategic and subject matter expertise, software tools to increase productivity and provide an immediate return on your investment, and a proven post-implementation support model.  We are committed to our clients, every step of the way.” Here’s a challenge: name one consulting firm’s “why we’re different” statement that suggests that they really are different in specific ways. I’m not saying there aren’t any, just that they are rare. 8K Miles is headquartered in San Ramon, CA and has an office in Chennai, India, which might explain why all seven members of its leadership team have Indian names. Meanwhile, even though 8K Miles declined to announced what it paid for SERJ, its CEO tells a financial site in India that it paid what I think is $2.5 million cash (if I did the conversion from Rupees Crore correctly) plus a potential earnout, with SERJ taking in annual revenue of $6.4 million.

HIStalk Announcements and Requests

Half of the respondents to my poll say they’ll use less IT-related consulting in 2015 as they did in 2014, with 14 percent predicting they’ll use more. New poll to your right or here, in a repeat of my 2011 poll that named a clear and possibly surprising winner: which city has the strongest claim to call itself the US capital of healthcare IT? Perhaps the winning metropolis will arrange an official and expense-paid visit for the award-bearing HIStalk delegation.

Some folks involved with CommonWell Health Alliance have offered to answer questions from HIStalk readers after seeing several comments here. Send me anything you’d like to know about its technology, plans, business model, or anything else and I’ll get their response.

This week on HIStalk Practice: MediGain acquires Millennium Practice Management Associates. HIE-sponsored patient portals face an uphill adoption battle, while Epic’s portal wins rave reviews. Notes from the Health IT Leadership Summit. Dr. Gregg offers “It Do and It Don’t” observations on the impact of MU. Drchrono integrates biometric authentication into its EHR. James Stevermer, MD answers five questions. PracticeFusion docs see almost zero patient demand for wearable data integration. MD Mama puts being thankful in perspective.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

Listening: new from Brooklyn-based power pop band Nude Beach, which sounds like Tom Petty singing lead for The Replacements. I’m also revisiting concert video from the best live band in the world: Sweden’s The Hives, featuring the singer Mick Jagger wishes he could be, Howlin’ Pelle Almqvist.

Last Week’s Most Interesting News

• ECRI Institutes includes missing or incomplete EHR information in its “Top 10 Health Technology Hazards for 2015”
• CMS extends the 2014 Meaningful Use attestation deadline from November 30 to December 31 because its attestation software wasn’t ready in time.
• Beth Israel Deaconess Medical Center (MAI) pays $100,000 to settle a state complaint involving an unencrypted stolen laptop.
• In Canada, a Montreal newspaper agrees with the health minister that the province’s $500 million EHR project is “an abysmal failure.”
• Emdeon announces that it will acquire Change Healthcare for $135 million. Change Healthcare markets a benefits management system focused on helping employees make the most of their health benefits,

Acquisitions, Funding, Business, and Stock

Vivify Health receives a reported $15 million in Series B funding. The Plano, TX-based company offers remote patient monitoring and care coordination tools.

Vista Equity Partners will buy British software vendor Advanced Computer Software Group for $1.14 billion. The company’s healthcare-related offerings include a community-based EHR and software for home care, ED, and long-term care.

People

James Parks, former CIO of Box Butte County General Hospital (NE), is sentenced to three years in prison for storing child pornography on his hospital PC, discovered by his own IT staff who were investigating a hospital-spread virus that originated on his device.

Announcements and Implementations

Johns Hopkins Nursing magazine covers the September switch of Johns Hopkins Bayview Medical Center from skilled nursing facility to specialty hospital, which including moving it from paper to Meditech.

GE Healthcare announces keynotes for its Centricity LIVE 2015 user conference, April 29-May 2, 2015 in Orlando: Atul Gawande, MD, MPH (surgeon and author), Melissa Etheridge (singer-songwriter), and LeVar Burton (actor, director, and the guy who wore what looked like a car air filter over his eyes in “Star Trek: The Next Generation”).

Innovation and Research

VGo telepresence robots, tablet devices, network equipment, and software from Vecna Cares are sent to Ebola treatment units in Liberia, moving paper-based recordkeeping to electronic. Robotics researchers hope the telepresence robots can serve as interpreters, deliver supplies, decontaminate equipment, and bury deceased Ebola patients.

Technology

An MIT Technology Review article titled “Google Glass is Dead; Long Live Smart Glasses” says interest in Glass has rapidly evaporated as Google has lost key personnel and failed to advance the product from geek beta experiment to consumer mainstream. The article says Glass’s biggest problem is the way “Glassholes” look wearing the device and concerns by those nearby that they are being unknowingly recorded. The article says the technology is fine, but the form factor needs to evolve so that the technology is hidden within the glasses instead of being perched like a prism on top of them, perhaps even being incorporated into a contact lens. It’s a tough break to have developed an entire business around an orphan product that may never make it out of beta. Meanwhile, disillusioned Glass Explorers are trying to unload their devices on eBay for less than the $1,500 they ponied up to get preview versions.

Other

Gilbert Lederman, the former director of radiation oncology of Staten Island University Hospital (NY) will pay $2.35 million to settle Medicare fraud claims. He is best known for (a) his hospital commercials that ran on New York radio; (b) pestering a dying George Harrison to sign his son’s electric guitar; and (c) turning his office walls into a self-promotional billboard, as described by New York magazine as, “the kind of celebrity shrine you see in Italian red-sauce joints.”

An internal email provided by a reader contains more details on the Epic outage following its October 26 go-live at England’s Cambridge University Hospitals Foundation Trust.

University Hospitals (OH) fires an employee for inappropriately accessing the electronic medical records of 692 patients.

At least 5,000 Russians, many of them doctors, march through Moscow to protest a healthcare reform plan driven by sagging oil prices and Western sanctions that would eliminate up to 10,000 physician jobs and close 28 hospitals and clinics in the next few weeks. Proponents say the actions are necessary to enact President Vladimir Putin’s pledge to increase physician salaries to twice that of the average employee by 2018.

An Annals of Family Medicine editorial written by ADFM’s Education Transformation Committee says medical school graduates require EHR competence that can be gained only by first-hand experience, recommending that supervised, patient-centered EHR use be added as an Entrustable Professional Activity even though some medical schools bar such access since students aren’t allowed to bill for their services.

The always-entertaining folks at pMD post Thanksgiving-related ICD-10 codes on their blog:

• W61.42XD – Struck by turkey, subsequent encounter (drily noting, “If you find yourself confronted with a live turkey, you may want to rethink your Thanksgiving strategy”).
• W29.0 – Contact with powered kitchen appliance, subsequent encounter.
• K21.9 – Gastro-esophageal reflux disease without esophagitis (aka “heartburn and indigestion).
• W52.XXXA – Crushed, pushed or stepped on by crowd or human stampede, initial encounter (a Black Friday special).
• W22.02XA – Walked into lamppost, initial encounter (alcohol-fueled parade mishaps).

The career development team at Besler Consulting ran a Thanksgiving food drive for the South Brunswick, NJ food pantry.

Also running a holiday food drive, this time a virtual version: Aprima employees are collecting money for the fifth year for Metrocrest Social Services, which serves communities near the company’s offices in Carrollton, TX. They like the “virtual food drive” idea because the organization pays less than retail and can provide fresh foods instead of just canned goods. Last year Aprima’s employees provided more than six tons of food, double that of the previous year. 

Vince Ciotti’s inaugural CLAS Report names Epic #2 in a very important category, with the billionaire-led company losing to a thousandaire who packs a size advantage.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 11/26/14

Top News

 

ECRI Institute announces its “Top 10 Health Technology Hazards for 2015”:

• Setting medical alarms incorrectly.
• Incorrect or missing information in EHR and other IT systems.
• IV line mix-up.
• Inadequate sterilization of surgical instruments.
• Ventilator alarms incorrectly set to warn of disconnection.
• Improper use and failures of patient-handling equipment such as lifts.
• Inadequate training on robotic surgery systems.
• Inadequate cybersecurity for medical devices and systems.
• Lack of hospital resources to manage medical device recalls and software updates.

Reader Comments

From Tank Girl: “Re: consulting downturn. Implementation staff augmentation business is tough and rates are down. Strategic IT consulting is good if not on an upswing.” A couple of readers made similar observations – the hardest-hit companies are those that were just reselling go-live bodies without adding much value otherwise.

From Smitten: “Re: Karen DeSalvo’s closing address at AMIA. A remarkable performance. She walked up to the podium in front of several hundred, spotlight in her face, a stapled speech or whatever it was in hand, but no matter. Without glancing at it once, she spoke close to 30 minutes straight, without hesitation or stumbling, and lost neither the story nor the passion. She lacked neither humor or emotion. National Coordinator is nice, but if this woman does not become Surgeon General, then we’re missing a gift-wrapped package on our doorstep. Count this as a wager.” I didn’t see video from her AMIA talk, but here’s her TedXNOLA presentation from 2010.

HIStalk Announcements and Requests

It appears that a spammer is spoofing the email address Imprivata used early this year for HIStalkapalooza announcements. I’ve been getting a ton of junk mail from histalkapalooza2014@imprivata.com with a purported fax link that’s actually a malware page. Obviously you don’t want to click the link even though the return address belongs to a company offering secure communications technology.

Holidays are good times to recognize the contributions of employees, so consider my “Beacon of Selfless Service” award. Managers, peers, and customers can nominate a non-management employee (vendor or provider) who went above and beyond. I’ll also be running recaps of holiday-related company good deeds or celebrations over the next few weeks, so feel free to send those along, preferably with a photo or two.

Apple’s iOS offers a nice option to disable auto-play videos when visiting a site over a cell connection. Every browser should have the option to suppress auto-play videos (including not just Flash-based video, but HTLM5 too). I haven’t found anything that works reliably yet, so I’m still jumping a foot in the air when I click a story on a new or sports site and the video I didn’t want to see starts playing automatically and loudly. I really dislike auto-play video.

Acquisitions, Funding, Business, and Stock

CareTech Solutions provided a statement following my Monday report that the FTC granted its approval for an acquisition by IT/BPO outsourcer HTC Global Services: “CareTech Solutions has made an ‘Intent to Sell Filing’ with HTC Global Services, a Troy, Michigan based global provider of IT solutions and business processing outsourcing. We are now undergoing the necessary administrative process that goes along with this filing. At this time, there is currently no agreement.”

HIMSS acquires the Online Journal of Nursing Informatics, a free, quarterly, online-only journal produced by team of volunteers.

Streamline Health Solutions gets a $10 million credit facility.

Nuance reports Q4 results: revenue up 6.4 percent, adjusted EPS $0.33 vs. $0.30. Healthcare sales rose 7 percent to make up 47 percent of Q4 revenue. Chairman and CEO Paul Ricci said in the earnings call that revenue is growing and operating margins are stabilizing after two years’ of decline.

Covisint will depart the Detroit building of its former parent Compuware, moving its headquarters and 250 employees to Southfield, MI after choosing Michigan’s incentive package over offers from Austin, TX and Raleigh, NC.

Sales

Robert Wood Johnson University Hospital extends its Allscripts Sunrise contract through 2020 and will use TouchWorks as the EHR for its network.

Memorial Healthcare (MI) will replace pagers with Imprivata Cortext.

Kennedy Health System (NJ) chooses eClinicalWorks Care Coordination Medical Record and Electronic Health Exchange.

Announcements and Implementations

Scottsdale Institute releases an IT strategy report from a CIO roundtable at its September summit, sponsored by Impact Advisors.  I didn’t see anything surprising or particularly insightful in its recommendations from eight big-system CIOs to support hospital consumerism:

• Focus on the patient and family experience
• Maximize use of patient portals
• Implement e-visits and telemedicine
• Improve use of mobile technology
• Develop a retail strategy
• Improve IT security via standards and user training
• Implement analytics carefully
• Reduce variability
• Develop software in-house as needed to fill gaps

Lakewood Health System (MN) will participate in the Medicare Shared Savings ACO of Essentia Health (MN) and will use its Epic EHR under Epic’s Community Connect program. Lakewood went live on McKesson Paragon in 2012.

TransUnion Healthcare announces that the KLAS’s new patient access report rates the company as the highest-performing vendor for its patient pay estimation and propensity to pay solutions.

University of Iowa Hospital and Clinics wins the enterprise Davies award. They’re on Epic.

Government and Politics

CMS extends 2014 Meaningful Use attestation deadlines for hospitals from November 30 to December 31, primarily because CMS didn’t get its own software ready in time to meet the original date.

The CEO of 49-bed Magnolia Regional Medical Center (AR) tells its board that the hospital had to return $287,000 in HITECH money after undergoing a Meaningful Use audit.

A draft bill created by Senators Orrin Hatch (R-UT) and Michael Bennet (D-CO) would limit FDA’s jurisdiction over EHR and other medical technology that its authors label as having low risk to patient safety.

Innovation and Research

A literature review concludes that corporate wellness programs increase employer healthcare costs while providing no net health benefit.

Technology

Proof that Twitter’s user interface is somewhere between baffling and maddening: Twitter’s CFO accidentally tweets out to the whole world (instead of his intended individual recipient) an acquisition-related message.

Other

In England, a county review of the $300 million Epic implementation of Cambridge-affiliated Addenbrooke’s Hospital finds that ED performance dropped 20 percent after go-live and the ED had to go on diversion after the system went down on November 1. Hospital executives have been denying significant problems, admitting only minor problems with a blood transfusion analyzer interface. Chief Clinical Officer Afzal Chaudhry, MBBS,PhD (above) says the implementation is going well given its large scope.

Eight hospitals and several practices went back to paper for several hours Monday when a data center power surge took down the IT systems of Eastern Maine Healthcare Systems (ME), which had eliminated 40 IT positions a few weeks ago to reduce annual expenses.

The Cincinnati business paper covers University of Cincinnati Medical Center’s eight-patient clinical trial in which tablet-powered systems from Intel-GE Care Innovations are being used to monitor discharged liver transplant patients.

An article written by a former advertising executive and Presidential speechwriter five days before he died of prostate cancer on October 31 describes the fighting between his oncologist and insurer over his treatment. He said he and his doctors followed every rule of Health Republic / MagnaCare, but the insurance company refused to pay after waiting five months to claim his doctors were out of network, ignored his calls, blamed him using for incorrect physician codes, and said his doctors were lying to him about being in network.

For I know now how this company really feels about their customers. It was perfectly expressed in the letter I received last week when they tried to explain why they were turning down my oncologist’s request for that critical cancer test. It was, of course, a form letter. Very legal. “The request for outpatient medical services has been reviewed and has not been certified.” But they gave themselves away with a very strange sentence—their only effort to acknowledge me as a human being. It read: “Member is over 85 year old and continues to smoke.” So, that’s it. According to my insurers, I have already lived too long. And because, until recently, I enjoyed my two or three cigarettes a day, I am a bad boy who is not worth the cost of keeping alive. No wonder they won’t pay.

The medical license of a New Mexico OB/GYN who is also the incoming president of the state medical society is suspended after charges that he had sex with patients and his employees, was inebriated while seeing patients, left a woman in labor so he could have sex with another patient, and wrote “inappropriate notations of a personal nature into certain patient medical charts.”

Weird News Andy says “8 Million a Second” isn’t Judy Faulkner’s salary, but rather the number of bacteria that are transferred during an intimate kiss, with the result that romantic partners share the same “microbiota” on their tongues for at least hours after kissing and and sometimes permanently. WNA also cites another study in which kissing was found to chemically reduce stress and increase bonding, also observing found that men prefer “sloppy” kisses as a prelude to amorous activity because those kisses transfer testosterone.

Sponsor Updates

• Salar’s clinical documentation and billing solution, TeamNotes, earns Meaningful Use 2 certification.
• Fujifilm announces that it has installed 4,000 Synapse PACS, making it the most widely used medical informatics vendor.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 11/24/14

Top News

Beth Israel Deaconess Medical Center (MA) will pay $100,000 to settle a state complaint over the 2012 theft of a laptop that contained the health information of 4,000 employees and patients. The attorney general said the hospital broke the law in failing to encrypt the device. CIO John Halamka says the hospital has since started encrypting all devices and requires employees to verify annually that their personal devices are encrypted.

Reader Comments

From Sam Lawrence: “Re: CommonWell. I read through their website to understand what exactly they offer and was unsuccessful. Tons of reference to ‘services’ and appears to be written entirely in vague marketing-speak. What can the two endpoints exchange? CCDAs? Discrete data? If so, what data? Can it be viewed and pulled directly into the EHR at either end? Do users have to query for data or is it passively making connections behind the scenes? Maybe this is coming, but instead of some fluff quotes, I’d like to understand what the provider actually gets and how it’s helpful.” Their website has specific use cases and refers to documents that members receive, so I assume it’s really just non-members who are still in the dark. CommonWell gets a pass for their hastily prepared HIMSS13 publicity rush, but for a group that talks a lot about transparency and openness, they aren’t very good at either when it comes to explaining their business model, technology, and the status of their offering to the industry as a whole (they’re kind of like Epic in that regard, in fact). The latest announcement looked like a committee-edited PR fluff piece. I suppose that’s inevitable when you ask several EHR vendors to collectively agree on anything. Loftily stated benefit to mankind notwithstanding, I fully expect that McKesson and Cerner expect to make money or gain competitive advantage from their participation, so I would just like them to say so.

From Donald: “Re: health IT consulting. We’re seeing a huge downturn. Rates are down a bit and opportunities are way down. Every consultant and recruiter I’ve talked to says the same thing.”

From Mr. Ron Anejo: “Re: health IT consulting. The market is dead. Very few large implementations remain, providers aren’t chasing MU $, and uncertainty surrounding possible repeal of the ACA has Medicare heavy hospitals and health systems freezing spending. In speaking with many consultants, they’re terrified because recruiters are no longer calling them 10 times a day with offers and aren’t sure how long they will be without work. Supply (consultants) definitely outweighs demand for services right now — consulting firms should be able to drive down pay rates and hospitals should push for lower rates.”

From Deborah Kohn: “Re: ICD-10 phase-in. I contacted Sue Bowman, AHIMA’s Senior Director, Coding Policy and Compliance (Public Policy & Governmental Relations), who confirmed and articulated what I suspected. Per Sue: It’s not just a matter of accepting both code sets – someone has to process the codes, be able to analyze and compare data, etc. With different providers on different code sets, it would be a nightmare. And there is also the matter of coordination of benefits. Our healthcare delivery and reimbursement systems are too inter-connected to allow different entities to use different code sets for the same date of service.” CMS is abound with botched, expensive IT projects (Healthcare.gov being just the most visible one), so I wouldn’t be optimistic that the checks will keep flowing without interruption. Here’s a free tip for mainstream reporters looking for a big story: start sleuthing around in the spring to see how confident CMS’s contractors and project people are about their ICD-10 readiness and how thoroughly they’ve tested. I bet they, like providers, just moved on to something else while waiting out the year-long delay.

From Jello Biafra: “Re: CareTech Solutions. Has it been sold to Mr. Madhava Reddy?” Weekend confirmation is hard to get, so I’ll stick with facts: (a) the Federal Trade Commission approved on November 20 the acquisition of CareTech Solutions, Inc. by Madhava Reddy; (b) Madhava Reddy is president and CEO of IT/BPO outsourcer HTC Global Services; and (c) both companies are located in Troy, MI.

From Dan: “Re: Dr. Oz. Invites fans to send him questions via Twitter, getting gems such as ‘I just got my flu shot — when can I expect to develop autism?’" America’s favorite daytime TV huckster doctor should have known better to take to the Twitterverse given the flack he takes for touting bizarre miracle drugs and refusing to have his children vaccinated. My favorite questions asked of him: (a) “What has been your most profitable lie for money so far?”; (b) “Is snake oil gluten free?”; and (c) “Why have you not been censured or fired from Columbia Surgery for conduct unbecoming a physician, scientist, and gentleman?”

From The PACS Designer: “Re: Office 365 sharing. The Garage Series for Office 365 ProPlus highlights a nice upgrade called shared computer activation, which can enhance productivity for multiple users of any computer.” It uses Remote Desktop Services to allow multiple users to connect to the same remote computer simultaneously to run Office 365 ProPlus programs like Word or Excel. It was announced using hospital nurses as an example.

HIStalk Announcements and Requests

Most poll respondents left their most recent jobs because of problems management could have resolved, with 50 percent saying they didn’t like management, were overworked, or lacked opportunity. A surprising 9 percent said they were fired from their last position. New poll to your right or here for hospital or practice people: how much IT consulting will you use in 2015 vs. 2014? Vote and then click Comments to explain – I’m curious about what seems to be a consulting downturn and I’d like to learn more.

Some interesting comments from last week’s poll:

• Laid off. Other hand-picked layoffs included people who had worn out their welcome at the company after on-the-job injury, bereavement, and of course, cancer.
• Competition was eating our lunch nationally, and their response was to constantly cut staff and raise prices; classic short-term thinking.
• The software company where I worked for many, many years sent me to India to train developers. After I returned, the company decided they didn’t need the experienced local staff and our jobs were outsourced to India.
• I left, not because I was unhappy or underpaid at my last job, but because I saw an large challenge in my new job… this new job came a’-calling and the offer was intriguing. Essentially the same money, but in a warmer climate. The job though was to start a program from scratch, accelerate it as quickly as possible. I wanted to see if I could do it.
• When I turned in my notice, management went after me. They contacted Epic to look into if I might be trying to go into consulting. Epic found I was. My management told them to blackball me in an attempt to get me to stay. The job which I was to start in a few weeks disappeared. The site and recruiter were told by Epic that they could not do business with me since I was leaving an active installation, which was untrue.
• Individuals in management roles tended to be those who stuck with the company the longest, rather than individuals who were talented or forward-thinking. There was no official training that management received, as far as we knew, so most managers didn’t know how to grow their team members or keep them at the company (most managers had no idea how to handle HR issues either, like what to do when an employee told them they wanted to quit).

I was frustrated at not being able to see a journal article because it’s behind the paywall of a for-profit journal publisher. My conclusion: journals should continue providing a service in vetting and editing submitted research articles, but perhaps the authors should pay a submission fee and let everybody read the resulting article for free. That would serve several purposes: (a) it would reduce the number of crap articles that are accepted only because the journal is desperate for content; (b) journals could stop accepting ads if they haven’t already, or they could all start running ads as long as the editorial process is separate; and (c) human knowledge would be diffused to everyone, not just high-paying subscribers. That’s especially true of articles written from government-sponsored research or by government employees: why should I as a taxpayer have to pay to see them? It’s the author that gets bragging rights and personal benefit, so let them pay. I’d also like to see an impartial panel of experts grade the methodology, originality, and applicability of each article, which might shame sloppy authors or journals into not wasting reader time.

Listening: new from Gerard Way, the former singer of My Chemical Romance. Not bad, although MCR was a lot better.

Last Week’s Most Interesting News

• CVS Health announces plans to open a 100-employee technology development center in Boston that will create consumer-engaging technologies and work with health-related startups.
• EHealth Initiative’s “2020 Roadmap” calls for the federal government to refocus Meaningful Use on interoperability, get EHR vendors to offer API access to their systems, and align federal agency interoperability efforts.
• Cleveland Clinic creates Adeo, a for-profit company and website that will sell software developed by it and academic medical centers in the Healthcare Innovation Alliance.
• Emdeon announces that it will acquire consumer engagement tools vendor Change Healthcare for $135 million.
• A Salesforce blog post describes how Johns Hopkins Healthcare is using its platform to manage high-risk patients, seemingly confirming a big healthcare push by the company.
• UPMC takes a $9 million gain by selling a procurement systems software company it created to a private equity firm.

Webinars

Webinar recordings recently added to YouTube:

Improving Trial Accrual by Engaging the Digital Healthcare Consumer. 

Cerner Takeover of Siemens, Are You Ready? Vince and Frank have hit over 1,000 YouTube views in four days, giving them a good shot at surpassing Dim-Sum’s all-time record.

Government and Politics

Karen DeSalvo tweeted out this farewell photo with Jacob Reider in a nice gesture. They have something in common: both are doctors who used to work full time for ONC.

Technology

US News profiles Health Heritage, developed by NorthShore University HealthSystem (boy, do I hate that multiply conjoined words name created by marketers run amok – why create a dumb name that 99.9 percent of your customers couldn’t spell in a bar bet?). It’s a genomic decision support system that combines family history to information from Epic, developed by the founder of Apache Medical Systems. Of 3,000 people who signed up and downloaded their NorthShore information, 13 percent were flagged as being high risk for cancer.

Other

An Advisory Board survey lists the reasons doctors are worried about retail clinics:

• They will siphon off the profitable and more easily managed simple cases.
• Patients don’t understand the value of provider continuity and will seek convenient access instead.
• Retail clinics will move up the food chain in offering ever-expanding services that threaten the medical group model.

My reaction as a patient:

• If a practice can’t survive without cranking through expensive but mindless sore throat and fever encounters that trigger an automatic (and often clinically inappropriate) antibiotic prescription, then we have too many practices.
• Providers haven’t in most cases demonstrated the value of continuity to their patients, treating each encounter like an impromptu hooker visit where the patient describes what they have and what they want in 10 furtive minutes of bartering and eventual consummation of a clumsy balance of compassionate care and bare-knuckle capitalism.
• If retail clinics can threaten the overpriced, underperforming, and often patient-indifferent healthcare system and that system refuses to change, then I’ll happily go to Walgreens or CVS where I get treated like paying customer and can park for free close to the door. I feel perfectly safe as long as the provider (whether it’s a PA, NP, or telemedicine doc) knows when to turf me off to experts when they’re in over their head.

It’s really odd to me that retail clinics made a big splash, were seemingly on the verge of extinction, and now are seen as a big threat to entrenched providers (the “odd” part being why it took so long).

Florida’s Blue Cross Blue Shield company installs a HealthSpot telehealth kiosk in its Miami center to allow members to access doctors from Miami Children’s Hospital. HealthSpot even did a nice job Photoshopping MCH’s logos onto stock photos of its device.

In Canada, a Montreal newspaper’s editorial says Quebec’s EHR project is “an abysmal failure,” adding that its health minister agreed in an interview. The project was supposed to cost $500 million US and be finished by 2010, but is now targeting a $1.4 billion cost and 2016 completion date. The editorial blames the variety of EHRs that were approved (nine for practices, four for hospitals) that can’t exchange information.

Weird News Andy says this article on the privacy-invading possibilities of 90-minute DNA criminal profiling creates should also have addressed potential medical uses, such as finding genetic disorders that mimic MS or identifying people with genetic sensitivity to warfarin or chloroquine.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 11/21/14

Top News

Emdeon will acquire Change Healthcare for $135 million. The company offers consumer messaging, lookup, and education tools to improve engagement.

Reader Comments

From Former McKesson: “Re: McKesson reorg. McKesson Technology Solutions has another big reorg, the third in three years, this time in the MCCA business unit. MTS has lots three good GMs in the past 12 months and middle managers are fleeing.” Unverified. An attached internal email from Jeff Felton, president of McKesson Connected Care and Analytics, says that several RelayHealth business lines have been combined into McKesson Connectivity & Analytics under Ken Tarkoff and that several reporting changes have been made.

From Judge Smails: “Re: country club brawl, with a healthcare IT twist.” Police responding to a 911 call break up a fistfight at the tony Boston-area Weston Golf Club, started when the club’s president ordered jeans-wearing guests to leave the premises because of their dress code violations. The club president who apologized and then resigned was Tom Ferry, president and CEO of hospital software vendor Curaspan. I interviewed him a couple of years ago. I’m siding with him: people everywhere (restaurants, cruises, meetings, etc.) are offended at the idea that clearly stated dress-related rules might inconveniently apply to them and being loudly obnoxious usually gets them a quiet exemption.

From Mike Kovner: “Re: Medicare ACO Shared Savings Program results. CMS has posted the Performance Year 1 final financial reconciliation and quality performance results for all MSSP ACOs with 2012 and 2013 agreement start dates. Kudos to the 52 ACOs that produced real savings and met the threshold for clinical quality measures. Memorial Herman ACO was the big winner with a $28M earned Shared Savings payment, followed by Palm Beach ACO with $19M. Tough break for the six ACOs that produced savings but did not meet the quality threshold, leaving real money on the table.” Mike sent over a detailed worksheet that I’m sure he would be willing to share.

From Ohio MD: “Re: ICD-10. We’re a busy orthopaedic EP. Both 5010 claims and HCFA 1500 can handle both code sets, so why not allow a phase-in over several years? There’s no way to do end-to-end testing since you can send a claim to CMS, but you don’t get payment, and no other payers allow testing as far as I know. Plus getting signed up for CMS testing is an absolute nightmare, especially for small providers.” Readers are welcome to weigh in: is a hard compliance date for ICD-10 necessary? CMS has had plenty of time to prepare with the one-year delay, so why can’t it start accepting either version now?

From Sinking Ship: “Re: [consulting firm name omitted]. Earlier this week rumors were spreading that the company has over 50 percent of its consulting staff on the bench due to poor performance by the sales teams.” Unverified and likely not possible to verify, so I left the large company’s name out. Maybe the sales team is underperforming, but I believe we may be seeing a downturn in the healthcare IT consulting business in general due to fewer go-lives and government meddling with ICD-10 dates and Meaningful Use tweaks. That could be my own incorrect perception from talking to a couple of folks. If you’re on the front lines, tell me what you think.

HIStalk Announcements and Requests

This week on HIStalk Practice: Greenway, CVS, and Quirk open new facilities. CMS Compare websites come under GAO’s fire. Pediatrician Sapna Mukherjee, MD discusses her use of HIT at her concierge practice. Healthcare.gov sees fewer glitches than several state-run exchanges. Seacoast Orthopedics & Sports Medicine physicians achieve MUS2. ONC welcomes several new staff members. Thanks for reading.

This week on HIStalk Connect: Harvard public health researchers launch a heart health calculator that evaluates lifestyle choices rather than blood pressure and cholesterol levels.  Walgreens rolls out on demand lab tests across its 8,200 facilities. Cue, a digital health startup making smartphone-based lab analyzers, raises a $7.5 million Series A.

Acquisitions, Funding, Business, and Stock

Valence Health receives a $15 million growth equity investment, raising its total to $45 million.

A questionable Fortune article called “Digital healthcare investments soaring again. Here’s why.” spends most of its pointless meandering talking up Castlight Health, which is hardly the poster child for why digital investments should be soaring. All of those sharp investors who jumped all over Castlight right after “the most overpriced IPO of the century” have seen their investments shed 72 percent of their value in just seven months (blue) vs. the Nasdaq’s gain of nearly 11 percent (red) over the same period as the company continues to lose big money. Castlight is still mysteriously worth $1 billion, or 28 times annual sales.

Sales

Providence Health & Services chooses NantHealth’s Clinical Operating System and eviti|Advisor for genomic analysis and evidence-based cancer treatments.

Providence Anesthesiology Associates (NC) chooses TigerText secure messaging.

WellSpan Health (PA) selects the Visage 7 Enterprise Imaging Platform.

People

 
EHR scribe provider Essia Health names Anita Pramoda (TangramCare) to its board and William Moore (4medica) as CFO.

Dave Morgan (Vista Consulting Group) joins Greenway Health as CFO. He apparently replaces Laurens Albada, but I’m not quite sure since the company’s leadership page lists Morgan but Albada still has a leadership profile that lists him as CFO. I haven’t seen any announcements either way, so I’m going with Dave.

Announcements and Implementations

CommonWell Health Alliance announces (in a poorly written press release that makes it impossible to figure out what they’re actually announcing) that is offering its services to a broader market, that RelayHealth is its technology provider, and that Aprima and CareCloud have signed up as members.

Greenway Health will open a technology development center in Cobb County, GA in early 2015 that will create 150 jobs.

Revenue cycle and coding products vendor VitalWare launches VitalABN, a medical necessity validation tool that automates the Advance Beneficiary Notice of Noncoverage process.

MModal announces that its Fluency for Image Reporting can notify radiologists of documentation deficiencies in real time.

Johns Hopkins Medicine and Premier will collaborate on educational, clinical, and analytics projects.

A Salesforce blog post suggests that its rumored healthcare push is underway as it describes how Johns Hopkins Healthcare is using the company’s platform in an engagement program to keep high-risk patients out of the ED and to coordinate the schedules of home care workers.

GE Healthcare, a 50-50 joint venture partner in Caradigm along with Microsoft, will resell Caradigm’s single sign-on and context management solutions to integrate anatomic pathology information systems.

Merge Healthcare launches Merge One,  a cloud-based, transaction-priced solution for ambulatory radiology sites that includes PACS, RIS, financials, universal viewer, cloud archive, document management, and analytics.

Government and Politics

Newly discovered emails from former CMS COO Michelle Snyder say her boss, CMS Administrator Marilyn Tavenner, used threats and tantrums to insist that Healthcare.gov be launched on time no matter what. Snyder retired weeks after the failed launch. Meanwhile, the House Committee on Science, Space, and Technology gets its subpoena-powered audience with former US CTO Todd Park on Healthcare.gov. Republican members hammered away, while the ranking Democrat member apologized to Park for making him a  target for Affordable Care Act venting and said it will make it harder for Park to carry out his current job of recruiting wealthy technical entrepreneurs to federal government work once they see how he was treated.

The GAO says the consumer transparency tools created by CMS aren’t user friendly and fall short on cost and quality information. HHS agrees.

Another GAO report finds that the VA violates its own policy in failing to push out critical OS patches to desktops and laptops within 30 days.

CMS forms the Office of Enterprise Data and Analytics and names Niall Brennan as its chief data officer.

HHS’s OIG lists the agency’s top challenges for FY 2014, one of which calls for HHS to make sure that Meaningful Use policies align with its goals and reflect “the changing health IT landscape,” adding that HHS should provide guidance on adoption, Meaningful Use, and interoperability and that HHS, CMS, and ONC stay focused on privacy, security, and fraud prevention.

Vermont cuts ties with economist Jonathan Gruber over his unflattering comments about lack of transparency in passing the Affordable Care Act. The state is ending Gruber’s economic modeling contract in which he bills his time at $500 per hour and that of programmers at $100 per hour. He and his associates collected more than $6 million in federal and state grants and contracts and he’s still working on an NIH project that will pay him $2 million.

Innovation and Research

Two University of Windsor researchers say their newly patented predictive software can monitor EEG waveforms and give someone with epilepsy a 17-minute advance warning that they’re about to have a seizure, although they studied only 21 patients. They also recognize that while it would be nice to let an epileptic know they need to pull their car over or surf one last wave before hitting the beach, it won’t do much good unless someone develops a portable, continuous EEG monitor (waterproof, in my second example).

 
 
Finalists in Harvard’s Health Acceleration Challenge are Twine Health (personalized treatment plans),  Boston Children’s Hospital’s I-PASS (care team communication), Bloodbuy (a Priceline-like bidding system for hospitals to buy blood products), and Medalogix (predictive identification of patients as candidates for palliative care).

Technology

The city of Cleveland will reportedly announce Friday that the Euclid Avenue area, home to several health-related organizations and vendors and locally branded the “Health-Tech Corridor,” will get 100-gigabit fiber optic broadband connectivity courtesy of a federal grant that will pay for it.

Apple publishes WatchKit tools and guidelines to help developers move their iPhone apps to Apple Watch.

A Santa Barbara, CA group that treats homeless people from temporary clinics it sets up in public parks uses a self-developed mobile EMR running Microsoft Access on $200 Chromebooks and a Wi-Fi hotspot. Its author says, “I do not have nearly as many coding options to control both the styling and the function as I would if I had coded the platform from scratch. What we gained was security, instant accessibility of all past charts for a patient, legibility, more detailed records, more accurate reporting, and much more.”

Other

Botsford Hospital (MI), which recently merged with Beaumont Health System and Oakwood Healthcare to create  $3.8 billion system, will replace McKesson Paragon with Epic, which is used by the other members of the new system.

Colorado RHIO announces that its Regional Extension Center will no longer offer free services now that its ONC grant has run out. The REC will be replaced with a fee-based services division. I would opine that dwindling Meaningful Use activity makes it even more unlikely (if that’s possible) that providers will spend their own money on its services.

A Truven Health Analytics-NPR poll finds that 75 percent of Americans see an EHR-using doctor, 68 percent are OK with having their de-identified health information shared with researchers, but only 22 percent would let their doctor or insurance company review their credit card transactions or social media information even if it might improve their health. More than half the respondents claim they have reviewed their information as kept by their provider.

EClinicalWorks CEO Girish Navani writes an Entrepreneur article called “The Case for Never Selling Your Company,” saying that eCW “is, and always will be, a privately-held company. I have no interest in selling it, regardless of any offer I may get. In addition, we don’t use investor cash or spend money we don’t have.” He says selling a company often changes its founding principles, threatens its longevity, and takes away the independence of its leaders.

Sponsor Updates

• Wellcentive SVP Mason Beard and CTO Kirk Elder accepted a finalist plaque for the Intel Innovation Award at the 2014 Health IT Leadership Summit in Atlanta on Thursday.
• T-System is providing free flu T Sheets that include the latest CDC guidelines to all providers
• NextGen Healthcare earns top ranking among healthcare IT vendors providing outsourced billing / RCM.

EPtalk by Dr. Jayne

I received a fair amount of reader feedback about this week’s Curbside Consult on proposed measures for Meaningful Use Stage 3.

From Ski Dude: “I enjoyed your article on MU Stage 3. Ever so true, as an IT consultant and patient I find the overly inquisitive requirements to be a burden. I have a customer, a primary care physician group with approximately 120 providers, that has a spread sheet for all the metrics they need to capture and for whom they have to report them. It is a 17 x 160 cell grid. I’m sure it’s costing these providers way more than they’ll gain in incentives or lose in reimbursements just trying to collect all the data and deliver it to the 17 data consumers.” I’m right there with you on that. Back before MU, we had approximately 20 metrics that we were tracking for providers as part of our internal Clinical Score Card. Every one of them was evidence-based and had a direct impact on patients: influenza vaccination, colorectal cancer screening, diabetes screening / glucose control / foot exams, etc. that had a real return on investment, either financial or in reduced patient morbidity and mortality.

Now we’re tracking hundreds of measures, some of which have not been directly proven to benefit patients. I wonder what our Institutional Review Board would think about the fact that our entire patient population (not to mention all of our staff) is part of an unapproved research project involving human subjects?

I’ve been asked to judge a local science fair this year. Looking at the packet of rules and regulations, what MU is doing to the healthcare community wouldn’t even pass muster for the seventh grade.

I received a couple of replies that surprised me, generally stating that the proposed measures didn’t go far enough to allow providers to make significant advances in MU3. Various suggestions included: tying the payments to actual data scores (not merely reporting the data); requiring HIE exchange on each and every patient visit; and requiring interfaces with data reported by patient mobile devices and apps.

If MU wasn’t already on its deathbed, I’m sure including those factors will push it into full arrest. It’s not that many of us disagree with these ideas, but including them in MU3 without significant financial support and adequate time to plan, code, test, and implement the features just makes them untenable. Not to mention that there is little evidence that wholesale implementation of these features (especially if it’s at the expense of tried and true population health work) may not have significant demonstrable benefit.

I also received one comment that made me smile.

From Thoughtful, Albeit Weird: “Great Column on MU3. It made me think of this: When you brought your car in for repairs, you would have to provide information to the counter person on how you had driven your car and when. What about the other cars in the house? Did you have an accident in the past couple of years? Parking or speeding tickets? What kind of gas do you use? When your mechanic is working on your car, would they have to check the brake, power steering, coolant, and other fluids and document the findings? Tire pressure? Document the state of the belts and hoses? What was the brand of brake shoes they installed? Why did they use that brand and not a different one? When they replaced the brake fluid, did they document that the old fluid was properly drained and that no water was in the line? Did they scan the brake fluid they installed? Did the software automatically check it was of the approved type for the car? If they did have to document these things the cost of every visit would have to go up because of the time involved in documenting these items (not to mention the purchase of the system they use to do the documentation) which leads to fewer customers seen per day. Instead, they use a sheet of paper with checkboxes that they give you (probably so they don’t get sued if something happens to your car). The government is setting the map for the marketplace instead of letting the market do it. I do not favor that approach.”

There are so many comparisons you can make here. At the hair salon, did my stylist counsel me on the risks and benefits of adding highlights and lowlights to my hair? Did he warn me that my elderly grandmother would think reddish lowlights to be tacky? Did he suspect that my wanting to change my color was a potential sign of emotional distress? Did he arrange follow up evaluation on exactly WHY I wanted a different color? Did he caution me that being a blonde might not actually mean that I would have more fun? Did he scan the bar code, document the lot number, and record other information about the chemicals in case there is a recall? Did he conduct a time-out prior to actually applying the color to make sure he had mixed the right combination and to ensure I was fully aware of what I was getting myself into?

Of course I’m just being sassy, but if you look at most industries that we depend on or use regularly, if they were being run like healthcare IT (not to mention healthcare in general) it would be like living in a dystopian sci-fi movie.

How do we stop the madness? Or should I change fields and start designing that hair stylist tracking software? Email me.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.