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Monday Morning Update 9/8/14

September 5, 2014 News 6 Comments

Top News

Another team officially joins the DoD EHR hunt: PwC, DSS, Medsphere, and General Dynamics, which will offer up VistA.

Reader Comments

From Bon Scott: “Meditech announcing organizational changes. It seems odd that the previous sales and marketing VP is now over services and the VP over an older product line is now in charge of sales and marketing. Think this is a sign of the times with Meditech and it coming across as desperate for change?” EVP Hoda Sayed-Friel (above) takes over implementation and support, VP Helen Waters moves over sales and marketing, and EVP Michelle O’Connor takes over all develpoment.

From OB: “Re: Denver fire department. Great idea — a mobile care unit that handles 911 calls that don’t require a patient to be taken to an ED. I was interested to read that ‘South Metro Fire also relies heavily on Colorado’s new electronic medical records network. The nurse or EMT can call up patient records on the scene to provide care that’s more like an office visit, and dispatchers can check recent medical histories to make sure they send ambulances to people who might really need one.’ Too bad that insurance is not paying for the service right now, hopefully that will soon change.”

HIStalk Announcements and Requests

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

Poll respondents see drugstore chains as having significant influence on healthcare going forward. New poll to your right or here: of which industry groups are you a member?

Maybe it’s just me, but I’m creeped out when after casually looking at someone’s LinkedIn profile, they send a message saying, “I saw you looked at my profile. May I help you?” Answer: no, because if I wanted help I could message you just as easily as you messaged me. I don’t really like having my profile views tracked, so I finally overcame my inherent laziness and went to Privacy Settings and changed “Select what others see when you’ve viewed their profile” to the “You will be totally anonymous” option (which surprisingly doesn’t require the hard-sold LinkedIn upgrade). Facebook could have an instant goldmine if they charged for the ability to see who has viewed your profile, just like Netflix will mint coin the moment they break the porn barrier.

Last Week’s Most Interesting News

CMS publishes updated Meaningful Use requirements with few changes from the original draft that drew widespread provider ire in requiring a full 365-day reporting period for 2015, meaning hospitals have to be ready to start in the next four weeks.
CVS continues its transition to a healthcare powerhouse by renaming itself CVS Health, emphasizing its offerings that include Minute Clinics for primary care and chronic disease management in partnership with health systems.
An apparently security weakness in Apple’s iPhone that allowed nude celebrity photos to find their way onto the Internet makes headlines just as the company prepares to announce several health-related offerings.
The White House announces a new CTO and deputy CTO from Google and Twitter, respectively, ending the streak of two US CTOs (Aneesh Chopra and Todd Park) who had strong healthcare backgrounds.

Webinars

September 11 (Thursday) 1:00 p.m. ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors. Registrants get a free electronic or paper copy of the book.

September 18 (Thursday) 1:00 p.m. ET. DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

Acquisitions, Funding, Business, and Stock

Asthma inhaler monitoring device vendor Propeller Health raises $14.5 million in Series B financing.

People

Chris Hogg (Practice Fusion) joins Propeller Health as COO.

Technology

Fascinating but scary: if you have a Google account, check out its display of where you’ve been lately, as tracked by (a) your Android phone’s GPS, or (b) your use of Google Maps.

Other

Apple adds a countdown clock for its September 9 announcements, also adding that it will stream live video from the same page. Nobody can top Apple when it comes to creating drama and excitement around product announcements. I can’t imagine a healthcare IT company doing anything like that, although Epic probably could if it wanted given its similar fanboy base and creative flair.

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.

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News 9/5/14

September 4, 2014 News 4 Comments

Top News

CVS Caremark changes its name to CVS Health as it also stops selling tobacco products in its 7,700 pharmacies. The company will take a $2 billion revenue hit in removing tobacco from its shelves, but the move obviously positions it more convincingly as a player in the general health market as it expands the number of its Minute Clinics from 900 to 1,500 in the next three years. CVS says it doesn’t plan to move Minute Clinic into full primary care as Walmart is doing, but will expand its chronic disease management services, which is not surprising given its recently announced care management relationships with several health systems and its transition to Epic.

Reader Comments

From Heathkit Assembler: “Re: Apple HealthKit. Here are the company’s specific developer requirements.” The “improving health” part might be just as easily skirted as HIPAA’s “treatment, payment, and operations” unless Apple defines it further.

From Just Nutz: “Re: Meaningful Use. Mr. H’s ‘Comatose’ was the perfect descriptor. CMS could have made 2015 more flexible. The 2014 period ends in 26 days, so people had already figured Stage 2 out if they were ever going to, and Stage 3 was pushed back but virtually no one cares about this today. The primary stressor for hospitals, the year-long reporting period that also starts October 1, was ignored despite thousands of comments urging CMS to address it as hospitals desperately try to get ready for 2015.” I’m glad Meaningful Use interest is finally fading. It was a necessary and ultra-expensive evil for getting poorly selling EMRs adopted, but it’s time to let the free market take back over and forget piecemeal provider bribes that often don’t provide the biggest bang for the patient outcomes buck.

From Nasty Parts: “Re: Explorys. I can confirm that they’re on the market. I hear GE, IBM, McKesson, and Medecision are the suitors.” Unverified.

From Beltway Bandido: “Re: DoD EHR. VistA is in the mix, being bid by DSS, PwC, and General Dynamics.” Dim-Sum told me they are pushing VistA, which has zero chance of getting anywhere for reasons that are surprisingly good.

HIStalk Announcements and Requests

This week on HIStalk Connect: Dr. Travis discusses Apple’s move into healthcare ahead of next week’s anticipated iWatch unveil. Qualcomm announces the 10 finalists in its $10 million Tricorder X-Prize competition. Ybrain closes a $3.5 million Series A to further development of a wearable device designed to help treat Alzheimer’s Disease. Three students from the University of Queensland in Australia win iAward’s Young Innovator of the Year award for a gamified mHealth app that helps children with cystic fibrosis.

This week on HIStalk Practice: Healthpointe announces a new urgent care telemedicine service. Veterans in Rhode Island share their health data with the VA via the state HIE. President Obama holds Estonia in high esteem when it comes to sharing digital health data. University of Toledo Physicians selects athenahealth solutions. The VA announces mobile versions of its most popular HealtheVet portal applications. Fall conference season – from open source to the cloud – gets into full swing. Thanks for reading.

Note to desperately idea-starved writers trying to sound hip and topical by riding pop culture coattails: articles like “What healthcare can learn from the passing of [fill in ‘Robin Williams’ or ‘Joan Rivers’ or any other recently deceased celebrity’s name]” are about as lazy, pointless, and lame as their titles suggest.

Listening: Dutch progressive rockers Knight Area, which sounds a lot like early 1970s Genesis. They will release a new album in October.

Acquisitions, Funding, Business, and Stock

Best Doctors acquires Rise Health, which offers a population health management platform. Rise Health’s CEO is Mark Crockett, MD (formerly of OptumInsight/Picis) and its president/COO is Connie Moser (with McKesson until a few months ago).

Clarity Health, which sells a referral management system, raises $1.89 million, increasing its total to $13 million.

Pain treatment analytics platform vendor Axial Healthcare raises $1.75 million in a Series A round. Paul McCurry, MD, formerly of MedSolutions, founded the Nashville-based company in 2012.

Google enters the pharma business with a drug company biotech partnership that will research age-related diseases at a cost of up to $1.5 billion.

Sales

Piedmont Healthcare (GA) selects Perceptive Software’s Acuo Vendor Neutral Archive.

Health Plan of San Mateo (CA) chooses Verisk Health’s payment accuracy suite.

Saline Memorial Hospital (AR) chooses Allscripts Sunrise. What a great hospital name – if it were located in Normal, IL it could be called Normal Saline.

Singing River Health System (MS) chooses Strata Decision’s StrataJazz decision support and cost accounting.

People

Nancy Brown (McKesson) joins Oak HC/FT as a venture partner.

As expected, the White House names Megan Smith (Google) as CTO, replacing Todd Park. Former Twitter lawyer Alexander Macgillivray is named as deputy CTO.

Announcements and Implementations

Elsevier will market Tonic Health’s patient data collection platform.

Flint Rehabilitation Devices launches MusicGlove, a Guiter Hero-type game that helps stroke and muscular injury patients regain hand function through music-paced repetitive exercise games.

MedAptus launches Provider Enrollment in partnership with Newport Credentialing Services.

Government and Politics

Former Senators Trent Lott and John Breaux sign on as lobbyists trying to convince the federal government to cancel plans to impose sanctions on a state-owned Russian bank in protest of that country’s activities in the Ukraine. As Lenin said, “We will hang the capitalists with the rope they sell to us.” The healthcare connection: the political guns-for-hire formed the Alliance for Connected Care to twist political arms on behalf of telehealth-invested companies such as CVS, Teladoc, and WellPoint.

Oregon and Oracle are suing each other over the Cover Oregon health insurance exchange, but even though the state is moving to Healthcare.gov for Medicare it will still need Oracle’s help to get its Medicaid part running. The snag: Oracle won’t give the state access to its servers or set up a new production environment. A consultant’s report says if Oracle doesn’t come to the table by Friday (September 5), the site won’t be ready for the next open enrollment period that starts in November.

HHS announces that a hacker breached a test server of Healthcare.gov in July and installed malware. Apparently it wasn’t a targeted attack, just the usual hack bot cruising, which HIStalk’s server defenses have blocked exactly 1,000 times today (as broken out by the graphic above) which means nearly every site on the Internet, including Healthcare.gov, is getting pounded even though they contain nothing of value. It’s unbelievable that any site can keep running given the endless creativity and resources hackers are willing to waste to penetrate pointlessly.

Other

Coming soon to an already economy-devastating US healthcare system: cancer drugs that cost $150,000 or more per patient per year and are required for the rest of a patient’s life.

The city council of Berkeley, CA approves a “charity cannabis mandate” that requires medical marijuana dispensaries donate at least 2 percent of their product to low-income residents, with the mayor arguing that marijuana is a medicine and everybody should have access to it. The response from the California Narcotic Officers’ Association: “Instead of taking steps to help the most economically vulnerable residents get out of that state, the city has said, ‘Let’s just get everybody high.’”

Someone tweeted that “assumptions are imperfect substitutes for data.” I might agree, but with several caveats:

Data are never perfect, complete, and free from bias, so there’s always a leap of faith even when data (including the “big” kind) are available.
You can lose your advantage (competitive or clinical) while waiting on the perfect set of data.
It’s hard to distinguish causation from correlation, subjecting any given data set to imperfection. As our hospital pathologist helpfully told me early in my career when I reviewed a patient’s chart for a committee, “He died with it, not of it.”
Sometimes intuition, experience, and people knowledge works better than data. The challenge is to determine which side of the fence a given situation falls on. Ideally, someone with that intuition, experience, and people knowledge is the one evaluating the data so you get the best of both worlds.
Healthcare straddles the fence above. Data analysis can provide new insight and help make treatment decisions, but only if wielded by expert clinician hands. You as a patient are just like other patients in not wanting to be managed by faceless payer or government algorithms cranked out from population health number-crunching that don’t take your own feelings, impressions, and beliefs into account. When it comes to the practice of medicine, art and science aren’t conveniently demarcated by a sharp line.
Bad decisions can (and often do) come from good data.

Weird News Andy calls this story from England “Meals on Wheels.” A new hospital uses a fleet of 12 robots to deliver patient meals, linens, instruments, and pharmacy items to the floors. Unrelated but interesting is the hospital’s response to patient complaints about small portion sizes, some of which found their way (with pictures) online: “We don’t know if it is a frail old man we are serving or a large rugby player so it’s up to each ward to know their patients and serve food accordingly.” WNA finds this a good story pairing: a company’s restaurant robot grinds beef and cooks it to order to create 360 burgers per hour, even slicing tomatoes and pickles simultaneously and placing the finished product in paper bags. The company’s co-founder says the machine isn’t intended to make fast food employees more efficient, but instead to eliminate them.

Sponsor Updates

NVoq announces the 2014 SayIt Healthcare Productivity ShowcaseFest, where 12 chosen healthcare professionals will work with the company’s SayIt speech recognition product to build and record a voice-optimized EMR Showcase. Nominations are due September 26.
GetWellNetwork Inpatient earns 2014 Edition Modular Inpatient EHR certification.
EDCO Health Information Solutions will host a session titled “An Unexpected Necessity – Indexing Software” at the AHIMA conference in San Diego on September 28.
Impact Advisors publishes a blog post, “Meaningful Use Final Rule.”

EPtalk by Dr. Jayne

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The Greenway Engage14 user group meeting kicked off today in Dallas. I’ve got a reporter embedded. Here are some of his preliminary thoughts.

“We are making our final descent into Dallas, where the temperature is 99 degrees and the local time is 8:04 p.m.” Maybe it is just me, but it felt like 324 degrees Kelvin when departing the airport. Greenway has chosen yet another Gaylord hotel, this time a short ($25 cab) jaunt from DFW. It is the official hotel of the Dallas Cowboys and there are some players milling around and mixing with the OB/GYNs. It is a huge complex. So far, no riots over MU2 have broken out. That being said, the gent next to me at the bar was here to cancel his contract — he was hoping to get to do so directly to Tee Green. He was upset about product performance and issues upgrading, describing 2014 as, “The year I will never recover from financially.”

I’ll be curious to see and hear some other opinions as the conference begins in earnest tomorrow. I remain skeptical of the premise that the annual way to educate and inform your best customers is to price gouge them at a hotel that is inconvenient at a time when most kids are just going back to school and many practices are becoming quite busy. For now, everyone is getting settled in for what should be a long weekend of wondering what happened to MU and where they go from here. Also, what happened to Vitera in all of this, their product wasn’t so bad …”

He plans to attend the opening night gala and snap some photos and get feedback from the trenches as the liquor flows. I perused the agenda to suggest some sessions for him. It seems they have ambitiously scheduled fitness classes on Friday and Saturday at 5:30 a.m. I noticed they left them off the schedule for Sunday morning, which is probably a good thing since their client event runs from 7 p.m. to 1 a.m. the night before. The agenda says the “Greenway team is famous for its dance moves,” so I’ll definitely be on the lookout for photographic evidence.

I don’t envy them with the updated Meaningful Use timeline being released the weekend prior. Attendees will expect Greenway staffers to be knowledgeable and ready to provide advice on their particular situations. I have to admit this is the first rule I’m not going to read in its entirety. Like Mr. H, I am kind of “over” MU and will wait for the CliffsNotes versions that I anticipate my vendors will send within a week or so.

I laughed as I went through my inbox. Right after the notification from CMS was this article from JAMA touting the benefits of “cognitively stimulating activities such as reading” as preventive against cognitive impairment. I think I’ll go for some 2048 instead.

As for my roving reporter’s comments about user group meetings in general, I’m sympathetic. Our primary vendor’s meeting continues to increase in cost, not only for the meeting itself, but for hotel and travel. We’ve had to cut back on the number of people we send and rotate attendees to make sure that everyone has the chance to go every few years. A couple of our staffers who really enjoy attending have gotten smart and submit a presentation every year in the hopes that they’ll be selected to speak and will get one of the coveted spots.

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Thanks to Dr. Travis for turning me on to NomadList, which appeared in a tweet about 25 promising startups. NomadList quantifies the best cities to live in when you can work remotely, providing info on cost of living, Internet speed, and weather. I know a couple of consultants who have a minimal home base and travel all the time whether they’re client-facing or not. I once had an EHR conversion done by a guy who admitted he was processing my data from the beach in Thailand. Top US cities include San Juan, Las Vegas, Austin, Dallas, and Park City.

If you’re a digital nomad, what do you think? 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.

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News 9/3/14

September 2, 2014 News 8 Comments

Top News

Experts speculate that a known vulnerability of Apple’s FindMyPhone app allowed hackers to download nude photos of celebrities from their synced iCloud accounts using a brute force password attack program. Apple buries the optional two-factor authentication option in technical documentation and allows unlimited password guesses. The company has released an emergency patch. The healthcare connection: the timing for Apple couldn’t be worse as it prepares to announce new health-related apps next week. They’ve apparently known about the problem for a long time.

Reader Comments

From 123456: “Re: The Advisory Board. Announced a hiring freeze on Friday, but didn’t call it that.” The internal email says, “For the coming months, we will prioritize staffing needs based on member impact and growth, which also means in some cases deprioritizing currently open positions and not filling them this year.” ABCO has been on a hiring tear and will add another 400 employees by the end of the year (for a total of 1,100 new hires in 2014), so that seems like a smart decision and good news for existing employees. It’s like having a table in a restaurant that’s turning away walk-ups. It would be a far less upbeat story if they were laying off, shrinking headcount by attrition, or growing too quickly by bringing on poor hires.

From Unbelievable: “Re: QuadraMed. Announced another reorganization today. Customers have expressed disappointment with the services team and the lack of experienced resources, contracting directly with former employees to achieve Meaningful Use.” Unverified.

From CaptainSalty: “Re: Explorys. Apparently a large strategic player is deep in acquisition talks.” Unverified.

From Julia: “Re: 2014 CEHRT. A table on this page says the flexibility with MU2 reporting is for providers whose vendors have delayed 2014 Edition EHRT availability. But this chart implies you can choose Stage 1 criteria even though you’re using a 2014 CEHRT. Any insight?” I’ve lost interest in the Meaningful Use program, so I’ll let someone who follows it more closely answer. This latest round of tweaks exceeded my attention span permanently.

HIStalk Announcements and Requests

Citrix says they’ve fixed the GoToWebinar problem we had last week that locked some registered people out. We don’t trust their fix (in which they just rolled us back to the last good version), so we could use some help testing Wednesday (today) at noon Eastern. They say if we can get more than 32 people, we’ll be fine for our next live webinar on Thursday. To help us out:

Register for our test webinar (just your name and email address is fine – GTW requires both).
Jump on the webinar at noon ET Wednesday. You don’t even need to call in since we just need to see if we can get everybody logged on.
Just hang out there until Lorre sees more than 32 people on and gives the OK to log off. She might tell stories or something while we wait.

The word I replace most often in reader-submitted articles: “utilize.” It’s no better than the shorter and less pretentious “use.” Here’s another oddity I see in nearly every interview: instead of saying, “We wanted to see how the market reacted,” I usually get, “We wanted to see how does the market react,” making me wonder whether or not to use a question mark after the oddly phrased semi-question.

Webinars

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.

September 11 (Thursday) 1:00 p.m.ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors. Registrants get a free electronic or paper copy of the book.

Acquisitions, Funding, Business, and Stock

Compuware will be acquired by private equity firm Thoma Bravo from $2.5 billion after years of pressure from activist hedge fund operator Elliott Management, whose $2.3 billion offer to buy the company was rejected in December 2012.

Sales

University of Toledo Physicians (OH) chooses athenaOne.

People

News I missed from a few days ago: Rebecca Kaul, president of UPMC’s Technology Development Center and daughter of CEO Jeffrey Romoff, resigns three months after being given the chief innovation officer title. Her group developed several applications, including the ConvergenceMD tablet app, and invests in technology companies not owned by UPMC. VP and radiology informatics chief Rasu Shrestha, MD replaces her.

Forward Health Group names Laura Kreofsky (Seek LLC) director of client services.

Announcements and Implementations

The Department of Homeland Security goes live on eClinicalWorks at its 23 Immigration and Customs Enforcement detention facilities. Harris Corporation was the primary bidder.

The PACS Designer launches an Indiegogo campaign to fund development of his Solutions Whitebook that will cross reference ICD-10 codes to ICD-9.

Craneware launches Reference Plus to ease chargemaster maintenance and coding for critical access and independent community hospitals.

EDCO Health Information Solutions announces Version 3.5 of its Solarity medical record scanning and indexing software, which allows users to scan and send paper medical record components to HIM in as few as three clicks.

Spok announces Spok Mobile 4.0, the latest release of its secure messaging app that provides a user status indicator and free trial version.

Government and Politics

Am back home in Silicon Valley, and very excited to continue to serve our country in a new role! http://t.co/UQMFMKQvei

— Todd Park (@todd_park) September 1, 2014

The new US Digital Services posts its Playbook with 13 key plays and associated checklists and key questions for each :

Understand what people need.
Address the whole experience, from start to finish.
Make it simple and intuitive.
Build the service using agile and iterative practices.
Structure budgets and contracts to support delivery.
Assign one leader and hold that person accountable.
Bring in experienced teams.
Choose a modern technology stack.
Deploy in a flexible hosting environment.
Automate testing and deployments.
Manage security and privacy through reusable processes.
Use data to drive decisions.
Default to open.

Technology

A Wired article on how to make programming code “beautiful” explains at great length what seems like a fairly obvious method to avoid deadlocked rows, storing multiple versions, and tracking status changes: store the original row when added, then never update it directly, instead recording transactions that are performed on it such as “invoice status changed” and “line item added.” Sounds good except for the overhead required to look at the current state of the row, which would require replaying all the individual transactions created against it. Nobody likes seeing a “record lock” error, but they also don’t like waiting to see the information they requested.

Other

Chicago-area Northwestern Memorial HealthCare and Cadence Health merge to form a four-hospital, 19,500-employee, $3 billion organization.

A before-and-after study of 30 hospital-associated medical practices finds that EHR implementation in 2007-2009 was associated with increased revenue, but with fewer patients seen. It concludes that while productivity slipped with EHR usage, increased orders for ancillary procedures (not upcoding) increased revenue, leading the authors to speculate that doctors possibly “were taking better care of fewer patients.”

In England, the influential doctor who serves as Chief Inspector of General Practice says that hospitals and practices put patients lives at risk by not sharing electronic medical records. He says the “wall between hospitals and GPs” forces consultants to write letters describing recommended treatments instead of entering them into a shared medical record and prevents hospitals from seeing office-based lab test results. He also advocates giving patients access to their own records.

The Toledo newspaper reports that many area private practice doctors are signing up to become hospital employees, with one cardiology group reporting that cardiologists went from 85 percent in independent practice to 85 percent employed in just 18 months. It quotes a family practitioner who listed access to Epic as one of the reasons he went to work for a hospital, explaining, “A doctor in practice will never have Epic. They don’t sell that to small groups — it’s too expensive.”

Sponsor Updates

iHT2 releases a research report titled “Answers to Healthcare Leaders’ Cloud Questions.”

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.

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Monday Morning Update 9/1/14

August 30, 2014 News 4 Comments

Top News

CMS basically kills the comatose Meaningful Use program by publishing a rule that leaves the 365-day attestation period for 2015 unchanged, meaning hospitals must be ready to start in the next four weeks. The rule, released late in the afternoon of a Friday holiday weekend, ignores widespread recommendations to allow providers to attest for any three-month quarter of the year. The only benefit to providers is that Stage 3 is moved back a year to January 2017 and an extension of time for using 2011 CEHRT. The program has gotten so complex that I’m not sure anyone really understands it. Leave a comment with your reaction to the new rule, assuming you even care.

Reader Comments

From DrM: “Re: Apple’s privacy policy change for HealthKit. This is actually broader than just selling data. It extends to providing HealthKit data to any third party for any purpose other than providing health and/or fitness services, and even then they must obtain user consent. This precludes many secondary use scenarios, possibly even ones that might be beneficial to the user. I’m guessing this change was driven by their discussions with large healthcare organizations who likely told them that if they allow others to monetize or reuse that data, they won’t be putting their patients’ data into HealthKit and wouldn’t ask their patients to do so, either. Apple has a number of other hurdles to overcome to make their technology work for healthcare, but this would have been a quick deal-breaker for many if not most organizations.”

From Frogger: “Re: Castlight Health. I’m M&A trained and Castlight was a loser from the get-go. The who’s who of investors, big-name healthcare people, and investment bankers involved were desperately trying to save their investment with a much-publicized marketing campaign of an IPO. However, many of my colleagues with healthcare investment backgrounds (including me) can’t figure out what’s so attractive. It will be sure to die if Todd Park gives it CPR like Healthcare.gov, which is still being propped up by taxpayer dollars. Left on its own, it would perish by Christmas and still have 15 million uninsured, which was the CBO projection even if it had gone according to plan.” I dug through SEC documents trying to figure out how many CSLT shares Todd owns or if he’s sold them, but couldn’t find his name anywhere other than on the list of the shareholders of Maria Health that morphed into Castlight. He wasn’t a company executive, just a co-founder, so maybe his shares are held under a corporate name. I would think he had to divest to work for the White House, but I don’t know for sure.

From The PACS Designer: “Re: Windows 9. The Microsoft Threshold project, now known as Windows 9, has been rumored to be moved forward from 2015 to a possible launch in late September. It will be interesting to see how it will be sold considering how many users are still on Windows XP.” Everybody knows that every other major version of Windows is bad, which obviously includes the terrible decisions made about the user interface of the poorly-adopted Windows 8, such as the default Metro tile interface even for non-touchscreen desktops, the bizarre Charms bar, and the unintuitively hidden red X to close an open window. Let’s hope Microsoft doesn’t break the streak by rushing out a partially baked Windows 9. Rumors suggest that a Win 9 upgrade will cost somewhere between nothing and $20. I’ll add this: I’m on Windows 8.1 and I like it a lot since updates made the non-tile display standard. I’ve had no problems at all, and even its native Bitlocker encryption works flawlessly and invisibly. Individual Win XP users should definitely get off that creaky platform, especially since Microsoft will supposedly offer a great deal to move to Windows 9.

Reader Comments about HIE Costs

From an HIE president: “We partnered with the state’s department of health for important services that include public health feeds for Meaningful Use. When providers are forced by regulation to use the HIE, there’s no charge for access. However, those services are subsidized by the all-in participant fees, which are on average less than one-tenth the number you mentioned. Yes, our HIE hopes to make our services so valuable that everyone will use them, but since we are governed by providers that both set and pay the fees, I wouldn’t consider it milking for profit. Certain vendors have been speaking negatively about HIEs for years, telling customers, ‘You don’t need them – just buy my [incredibly expensive] software.’”

From an EHR vendor: “One state we work in was territorial. We were told that practices had to submit data via the HIE instead of directly to the state. The HIE moved very slowly and the state demanded more upfront data cleanup by the EHR, such as changing ‘Road’ to ‘RD’ or whatever. I think the state was threatened by the HIE’s approach and wanted to punish someone for it. Then there was a problem that the HIE wouldn’t talk to the state about, so the state called us, then the HIE blamed their HIE platform vendor and the state, the state blamed us and our clients, and our clients blamed us, all while the vendor didn’t respond. That vendor finally fixed the problem without any explanation or apology.”

From an EHR vendor: “I have really not found an HIE with a sustainable business model. They inherently believe they are providing value and believe that providers should line up and pay for it. I have not found that to be the case. We are finding more success in purpose-driven connections that generally bypass HIEs, partially due to their limitations in dealing with sensitive data and consents.”

From a hospital CIO: “The point of being held hostage is longstanding. I tried to make the point to the state HIE leaders that if you want to charge my organization, you need to do something I can’t do or do it more effectively. I had already automated interfaces to reference labs and e-prescribing, items the HIE was trying to sell me as added value. I told them they should remove my need to maintain never-ending state reporting changes in return for getting my ADT information, but they couldn’t seem to grasp the concept. They saw the health system’s participation in an HIE as an obligation.”

From a hospital: “The state HIE has told us repeatedly we need to pay full participation costs when we only need to send immunization data. This would have been around $675K annually. We have refused since there’s no reciprocal benefit to us. I know several of the state’s largest health systems are united with us in refusing to pay. The way to statewide HIE connectivity is through regional HIE collaboration.”

HIStalk Announcements and Requests

A third of poll respondents say their provider organizations are taking new security steps after the Community Health Systems breach. New poll to your right or here: how much impact will drug chains such as Walgreens and CVS have on healthcare in the future?

The HIStalk site had some malware added via SQL injection Friday afternoon. Sucuri, my excellent malware monitoring and remediation service, detected and removed it quickly, but it takes quite a while for the online services (especially Google Safe Search) to catch up and stop showing the “blocked” warning. It’s surprisingly challenging to keep the hackers out, even with a dedicated, hardened server with updated software. HIStalk, for example, has had 31,000 malicious access attempts blocked by yet another tool I use. After this incident, I’ve one more layer of security, a virtual proxy firewall that blocks several kinds of attacks.

The silver lining of the malware problem is that I found a great secure password management tool: LastPass. It will detect and store your Web-based passwords as you log in (encrypted on the web) and give a single-click access to any of them across multiple devices, including the iPhone. I updated my sites with new, complex passwords that I don’t have to remember – I only need to recall the master password that opens the LastPass web page in Firefox. You can even create a shared folder to share passwords with family members with real-time updates. It’s free, amazingly, and the premium version with extended mobile support is only $12 per year. It will change your life.

My idea for the HIMSS conference: Chicago’s not Black Rock City, but let’s go Burning Man and erect a giant figure of The Man (maybe he could look like Steve Lieber) that will be ceremoniously burned Wednesday night as a clothing-optional emotional purging of the week’s triumphs and frustrations. Then on Thursday, The Temple (the exhibit hall) can be immolated as the 15 people who stick around until then cheer.

Last Week’s Most Interesting News

Apple updates its privacy policy to prohibit health app developers from selling user data.
The Department of Defense issues the RFP for its $11 billion EHR project.
The VA issues an RFP for a new patient scheduling system.
Premier announces that it will acquire supply chain technology vendor Aperek.
The White House confirms that Todd Park will transition from US CTO to a West Coast-based advisory role, where he will recruit technology talent for government work.
Oregon files a lawsuit against Oracle over its mothballed $240 million health insurance exchange.

Announcements and Implementations

Philips announces the monitoring cost for its free Lifeline app for seniors — just $13.95 per month with no contract required. That seems like a good deal for independent elderly folks as long as they have a smartphone and keep it handy at all times.

Government and Politics

CMS’s Open Payments system is not only late going live, it also will exclude an estimated one-third of total payments drug and device manufacturers pay to doctors. CMS says physicians who are paid via contract research organization haven’t had time to verify the validity of their data, so it will be withheld from the September 30 go-live. System proponent Senator Chuck Grassley (R-IA) wasn’t happy with the news, saying, “CMS has had more than four years to figure everything out. It’s disappointing and irresponsible that so many basic questions are unresolved at this late stage.” CMS was supposed to release its rules for the system that reports payments for research, consulting, and gifts in December 2011, but didn’t get them out until February 2013. Adding to the site’s problems, CMS says the system’s operation will be interrupted at times from August 30 to September 5.

Vermont, which fired its health insurance exchange contractor CGI and brought it Optum to review the project, gets a black eye when Optum concludes that the state’s project ownership was lax and CGI didn’t feel accountable.

Technology

A ED doctor develops a smartphone app that can objectively measure whether a patient is experiencing genuine alcohol withdrawal. The patient simply holds the smartphone for 20 seconds, after which the doctor can tell if they’re faking it to get prescriptions. One of its developers is working on an app that objectively measure the redness of a patient’s face to determine whether rashes are getting better or worse. Of all the dopey medical apps out there, these seem like great ideas.

Other

AMIA will convene an invited group this week on “Harnessing Next-Generation Informatics for Personalizing Medicine.” I wouldn’t have named AMIA as the best organization to work on tailoring treatments to genomics and discovering the correlation between physiology and diseases and treatments, but at least they are looking ahead.

In Ireland, a large hospital’s laboratory will need to reinterpret and possibly redraw hundreds of blood tests when on of its systems crashes several times in August.

Executives of four private health systems that control 80 percent of the Phoenix, AZ market question whether taxpayers should pay around $1.4 billion to replace Maricopa Medical Center and other county health facilities. The executives say there’s no need to expand a tax district hospital when most patients are treated as outpatients and the existing systems have more than enough capacity. I’ll admit the building looks awful, as does most early 1970s architecture, where a lot of hospitals are trapped in time due to the sudden influx of Medicare money.

Siemens posted this pretty cool time lapse video of a trade show setup. I was in the HIMSS exhibit hall on setup days earlier this year and it was a madhouse of fast-moving motorized equipment, setup workers, employees in blue jeans, and mountains of shipping containers.

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.

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News 8/29/14

August 28, 2014 News 1 Comment

Top News

Apple updates its privacy policy to prohibit companies whose apps connect to its HealthKit platform from selling user data to marketing firms. The change comes just ahead of the expected announcement of new health-related iOS 8 capabilities, including Apple’s Health app. Deborah Peel, MD of Patient Privacy Rights reacted to the announcement by saying, “If Apple is really doing this, if they’re really saying to developers that you can only use the data for the specific purpose that app provides the user and that they can not share the data with anyone else without informed consent, that is the victory of victories. That’s what we’re seeking from all of the 100,000 of the companies that are now selling health data.”

Reader Comments

From Aruba Layoffs: “Re: Aruba Networks. Many talented people let go as healthcare technology spending is way down.” Wireless networking vendor Aruba isn’t healthcare specific. Both its revenue and earnings announced this week beat expectations, revenue is growing at 30 percent annually, and share price matches the Nasdaq at 25 percent growth in the past year. The company is, however, laying off 65 employees and moving 75 jobs to Oregon, India, and Ireland, but it sounds like that’s related to shifting resources to less-expensive locations rather than because of financial problems.

From Stephanie Reel: “Re: Star-Spangled Spectacular. I wonder if your readers would be interested in something that has everything to do with our nation, but nothing to do with our industry?” Baltimore celebrates the 200th anniversary of the National Anthem — written as Francis Scott Key observed the British bombardment of Baltimore’s Fort McHenry — with a week-long celebration September 10-16. It features visiting ships, a Blue Angels air show, a concert (Kristin Chenoweth, Melissa Etheridge, Denyce Graves-Montgomery, Kenny Rogers, Train, and the Baltimore Symphony Orchestra), festival villages, and of course fireworks. Stephanie is CIO for Johns Hopkins University and Hopkins Medicine – both campuses are worth a tour if you visit Baltimore for the celebration. You can bring the kids and take short side trips from the Inner Harbor to DC and Lancaster, PA along with seeing the Orioles play the Yankees that week.

From Jimmy John: “Re: HIPPA. I thought you would enjoy this magazine’s misspelling.” At least they were inconsistent from one line to the next amidst the click-baiting headlines – 50 percent right is better than none. They’re owned by HIMSS (or is that HIMMS?), as is the publication devoting 12 lazy paragraphs to a wandering, not-too-interesting story with the breathy “Generalissimo Francisco Franco is still dead tonight” style headline: “New HIPAA breach details remain vague.” The “new” breach occurred in June and details are “vague” because the reporter just cobbled together the story and quotes from wire reports.

HIStalk Announcements and Requests

School has started, so I sponsored some new DonorsChoose projects involving Teach for America teachers, doubling the impact of HIStalk readers since the Bill & Melinda Gates Foundation matched our contributions to fully fund them all. Teachers of DonorsChoose projects provide photos and updates, so I’ll have more later. What we as readers did:

Purchased headphones and whiteboards for Grades 3-5 of a highest-poverty school whose teacher is urging her students to take ownership of their education, accept leadership roles, and share knowledge in groups that include peer tutoring.
Bought 50 library books for a high-minority, high-poverty North Carolina charter school that has 100 percent college acceptance of its seniors.
Provided a listening center for a highest-poverty school in southern Kentucky, whose energetic English teacher is struggling with ninth graders who haven’t read a book in years, some of whom have learning limitations.
Bought six bilingual picture dictionaries for a middle school class of a highest-poverty school in New Orleans, whose large population of new students from Central America are working hard to learn English.

Meanwhile, I heard today from the teacher of a high school engineering class for which we bought a 3-D printer. He says he has had to redesign his lesson plans and projects for the better, the number of students in his classes has doubled, and he makes them think about, “How would you model that in the Replicator? What medium should we use?” He taught students the importance of scale and precision by having them create an iPhone case. He says, “I am overwhelmed with requests from the students about what is in the printing queue.”

This week on HIStalk Practice: Dr. Gregg shares a humorous take on voice recognition and “otto collect.” McGree Medical goes live on Epic’s Community Care EHR. HealthSpot prepares to install 100 telemedicine kiosks. Walgreens implements Greenway’s EHR in over 8,200 pharmacies. South Florida Medicine Director of PM Alyson Tiedeman shares her thoughts on managing IT across a large medical group. CarePoint Health System goes with eClinicalWorks for its medical practices. Results are in from the annual HIStalk Practice Reader’s Survey. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses health IT IPOs and speculates who the next batch of likely contenders might be. Peer60 analyzes the patient portal market and the varying levels of success health systems are having with each vendor’s offering. Skullcandy partners with USC to host a digital health innovation contest focused on encouraging development efforts at the cross section of health IT and music.

Encore did a great webinar Wednesday on “Enterprise Data – Tapping Your Most Critical Asset for Survival” that some registrants couldn’t view because of a GoToWebinar problem in its latest code update. You can watch it above or on YouTube. Jonathan Velez, MD (CMIO – Hartford HealthCare) and Randy Thomas (Encore) did a nice job and filled the 40 minutes with solid information.

Meanwhile, here’s a case study on how to be a crappy software vendor like GoToWebinar, owned by Citrix:

Don’t QA your new releases. Instead, outsource QA to your customers and then just roll them back to pre-broken versions when they call in problems.
Don’t notify customers of known problems, especially those that affect critical processes like viewing and recording webinars. Admitting failure will shake their confidence.
Instruct your support reps to quickly tell callers that their problem is a known issue. Everybody loves to hear it’s not just them.
Keep support callers on hold when they call the high-priority service number and play annoying messages throughout telling them how great support will be once they get through. This heightens their anticipation.
Propose illogical solutions, such as restarting a webinar already underway even though that would prevent anyone from seeing it. The support engineer will seem more skilled since no non-engineer would propose a similarly out-of-touch solution.
Ask customers to trust you in rolling back to old code versions, even when they have no way to verify that the change works (unless they have 100 friends willing to hop on an impromptu webinar to see if they can get in). You trust them to pay their bills, so the should trust you to release pretty good code.
Just give up, as did the person from Citrix who told me apologetically, “Maybe it’s time for you to find a new webinar provider.” This reverse psychology will make them want you even more.

I apologize if GTW’s bug locked you out of Wednesday’s webinar. The video above is perfect and worth watching.

Acquisitions, Funding, Business, and Stock

Craneware acquires Scottish patient access mobile systems vendor Kestros Limited, which has been selling primarily to NHS Trusts.

September 10 is a critical day for Castlight Health and its tanking share price: the lockup period ends and the pre-IPO shareholders will be able to sell up to 76 million shares, which closed at around $40 on IPO day in March but are now trading at less than $12. That’s a 70 percent haircut, but the company still has a $1 billion market cap on less than $30 million in annual revenue and huge losses. Maybe co-founder Todd Park can swing by on his new West Coast White House gig and apply Healthcare.gov-like CPR.

Sales

Robert Wood Johnson Health System (NJ) expands its relationship with NTT Data in selecting its Optimum RCM suite.

Kaweah Delta Health Care District chooses Access for electronic forms and patient signatures.

Marshfield Clinic (WI) standardizes on Client Outlook’s eUnity university image viewer and collaboration tool for its homegrown CattailsMD EHR.

Georgia Regents Health System (Augusta, GA-based GRHealth) signs a $400 million agreement to turn over its IT operation to Cerner, which it says will save it 15 percent of its operating costs annually and make its annual expense predictable. GRHealth operates Georgia Regents Medical Center and Children’s Hospital of Georgia. The system says all 132 employees will receive offer letters from Cerner. Cerner became interested in the arrangement last year when the system signed a $300 million clinical technology partnership agreement with Philips, indicating along with the Siemens acquisition that Cerner sees a future in merging IT systems with clinical monitoring.

Sunquest will expand its relationship with private pathology lab CellNetix to work on anatomic pathology workflow solutions.

People

Boston Software Systems promotes Steve Cohen to COO.

David Watson (Oracle) will be named CEO of the new California Integrated Data Exchange (Cal INDEX).

Announcements and Implementations

Walgreens the rollout of its Greenway Health EHR to all of its 8,200 locations, allowing its pharmacists to counsel patients and provide immunization and testing recommendations.

Aspirus Wausau Hospital (WI) announces an OR digital integration project that will feature a centralized OR hub equipped with touch-screen monitors that can display images from all devices and modalities. It will use Brainlab’s Buzz digital OR.

Sentry Data Systems announces its 340B Technology Backbone to help pharmacies manage their 340B drug purchasing programs.

Government and Politics

Bloomberg reports that Google executive Megan Smith is the top candidate to replace Todd Park as US CTO. Smith’s background is the Google X skunkworks lab, so unlike her predecessors Aneesh Chopra and Park, she has no healthcare experience. She is married to re/code technical reporter Kara Swisher, although they are separated.

Meanwhile, the White House confirms that CTO Todd Park will continue working for the White House after returning home to California, recruiting technical talent for government work in a new role of technical advisor. President Obama said in a statement, “From launching the Presidential Innovation Fellows program, to opening up troves of government data to the public, to helping spearhead the successful turnaround of HealthCare.gov, Todd has been, and will continue to be, a key member of my Administration. I thank Todd for his service as my Chief Technology Officer, and look forward to his continuing to help us deploy the best people and ideas from the tech community in service of the American people.”

Innovation and Research

XPRIZE names the 10 finalists competing for its $10 million Qualcomm Tricorder XPRIZE: Aezon (US), CloudDX (Canada), Danvantri (India), DMI (US), Dynamic Biomarkers Group (China), Final Frontier Medical Devices (US), MESI Simplifying diagnostics (Slovenia), Scanadu (US), ScaNurse (England), and zensor (Ireland.)

President Obama will champion ElectRx, a $79 million, five-year DARPA-run project to implant computer chips in troops and veterans to promote faster healing. The program’s manager describes it as “a closed-loop system that would work in concept like a tiny, intelligent pacemaker” to assess conditions and send electrical stimulation to induce healing. A related effort will detect mood changes associated with PTSD. I don’t know how they’ll deal with FDA approval.

Speaking at the American Legion National Convention in Charlotte, NC, President Obama said,

So we’re going to keep at this until we end this backlog once and for all. And as we do, we’re going to keep working to liberate you from those mountains of paper. We’ve got to move towards a paperless system — electronic health records that our troops and veterans can keep for life, and that could cut down on some of the bureaucratic red tape so that you’re getting the benefits that you’ve earned a little bit faster.

Technology

Korea-based medical wearables startup Ybrain raises $3.5 million in a Series A round. Its product isn’t the usual fitness tracker: the US-educated team has developed an electrical stimulation device that it says can combat the effects of Alzheimer’s when used at home for 30 minutes per day, five days per week. The company hopes to launch its service in early 2015.

Apple co-founder Steve Wozniak says he expects the company to create a market for wearables starting with upcoming announcements on September 9 that will likely include the iWatch. He says he expects fitness monitors to be involved and maybe an EKG display at some point, but in the mean time, he’s not a fan of the category:

I feel that wearables are a hard sell. They are go-betweens for your smartphone but are an extra piece and need special advantages that the smartphone doesn’t have, in my opinion. If they are just a Bluetooth go-between then it could wind up in the category of Bluetooth headsets: Fun to wear and show off for a day.

Discover magazine highlights three projects that owners of 3-D printers can perform to help people in need. Among them: use downloadable designs to print and assemble a prosthetic hand for someone who needs one, requiring around $50 in parts and 8-14 hours of printer time. The first e-NABLE conference will be held at The Johns Hopkins Hospital (MD) on September 28.

More on 3-D printing: in the UK, 12 NHS trusts are using 3-D printers to test implants before surgery to reduce cost and OR time, including bones for facial reconstruction surgery, hip replacements, and forearms. In China, surgeons implant a 3-D-printed vertebra in the spine of a 12-year-old cancer patient.

Other

Sharp HealthCare (CA) becomes the tenth of the 32 Pioneer ACOs to drop out of the program, saying that local wages rose 8.2 percent in San Diego but the Pioneer model doesn’t adjust payments accordingly.

Drug maker Bayer starts a healthcare accelerator for Europe-based companies, offering a 3.5-month program of mentoring, free office space in Berlin, and around $65,000 financial support, taking as much of 10 percent equity in return. The five startups chosen from 70 applicants are Cortrium (a device that measures temperature, activity, respiration rate, and EKG); PharmaAssistant (medication reminders via smartphone); Parica (vital signs analysis); FabUlyzer (measuring fat burned after exercise); and Cardimoni (checks heart rate and rhythm).

AMIA’s annual meeting will be held November 15-19 in Washington, DC. The early bird member registration fee of $795 ended Thursday, August 28, but it’s still discounted to $895 through October 23 (then $995). Keynotes will be Amy Abernethy, MD, PhD of Flatiron Health (I interviewed her last month) and National Coordinator Karen DeSalvo, MD, MPH, MSc. Ross Martin, MD will head up the talent show, which will provide a musically equipped stage and a house band for participants, who need only bring “additional instruments, props, and groupies.”

Cisco CEO John Chambers says the US and other developed countries will go bankrupt if they don’t fix their healthcare systems, adding that technology has a key role (although he seems to pay little attention to the caregivers on the other end of it):

The first thing that will happen is all devices on our bodies, in hospitals and in our homes will be connected. The second technological advance is video, which is the way people will prefer to communicate in the future. Video can connect any health care professional to any patient and to any specialist, all at tremendous speeds. You’ll be able to receive medical expertise 24/7. Health care applications will combine the technologies of cloud and big data, whether in the hospital or in your home. Video allows a different level of collaboration, and it offers security and privacy from your home. This is the Internet of Everything … in a typical hospital, there are nine to 15 different applications that were never designed to share information with each other. And without a common medical record that has the appropriate security and privacy built into it, moving data from one application to another is difficult … The end game should be connecting any patient to the best healthcare professionals in the world at any time, using video-driven, low-cost technology.

Greenway Health CEO Tee Green accepts his Ice Bucket Challenge, offering to make a donation to ALS Association for every employee who sends him a video of themselves doing the same.

Weird News Andy asks if Oompa Loompas were vegetarians because he never found them attractive: a study (of questionable scientific validity) finds that the healthy skin glow of people who eat high-carotenoid vegetables is more attractive than a suntan.

Sponsor Updates

Kyle Silvestro of SyTrue will participate in a panel discussion titled “How Cloud Based Solutions Allow for Improved Coordination of Care and Patient Satisfaction While Reducing Overall Costs of Billing”at the Radiology Business Management’s fall conference October 19-21 in Seattle.
GetWellNetwork CEO Michael O’Neil will facilitate a breakout session, “Interactive Patient Engagement and Activation Workshop: What’s in a Number?” and will present “ePatient Entrepreneur Story” at the Stanford Medicine X conference on September 4.
Craneware announces the appointment of Russ Rudish (Deloitte Touche Tohmatsu) to its board as non-executive director.
Emdeon launches its co-pay assistance program for retail pharmacies, Emdeon Easy Save.
AirWatch renovates and expands its former headquarters.
TeleTracking Technologies will launch multiple solutions at its client conference October 26-29 in Florida.
Sentry Data Systems shares how a Rand report clarifies the 340B program impact and provides steps to ensure its longevity.
NextGen announces that its ambulatory EHR V 5.8.1 has earned 2014 ONC HIT Cancer Registry Certification.

EPtalk by Dr. Jayne

Recent research at the University of Michigan finds that patients with low literacy and low comprehension of numerical concepts are less able to understand online lab results. The Internet survey of 1,800 adult patients looked at simulated diabetes results and whether patients understood if labs were within or outside of reference ranges. Less literate patients were also less able to determine when they should call their doctor, based on the data.

Researcher Brian Zikmund-Fisher is quoted as saying, “We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them.” At the other end of the spectrum, over three-quarters of patients with higher literacy skills could identify levels outside the reference range. He goes on to state the need for more research on the best ways to display lab data.

When we first started releasing lab results directly to patients, our physicians voiced concerns. Physicians wanted to hold the results until they could put a comment with them, as they had done in the paper world. Many of our physicians would mail the patient a copy of the test results with a handwritten “OK” or “great” or “double your Lipitor and see me for fasting labs in six weeks.” Our administration overruled the physicians.

Initially we received more phone calls about labs. Most physicians changed their behavior to start counseling patients about potential lab results at the time they were ordered or drawn to reduce the potential for calls.

That approach is fine when you’re counseling a patient on an existing diagnosis or if the labs in question are “maintenance” labs, although it adds a new dynamic to the visit that we don’t always have time for. Looking at other scenarios, I don’t think it’s the best approach when you’re dealing with a new diagnosis, particularly if it’s an emotionally charged one such as cancer or other potentially fatal conditions. I’d like to at least get to those patients on the phone first before they see the results on the patient portal.

Our results release in real time, so it puts the physicians in the position of “stalking” lab results in the evening and over the weekend, then frantically trying to get in touch with patients before they log on. An uncertain diagnosis is certainly stressful for the patient, but it also weighs heavily on the physician. Adding time pressure isn’t optimal for anyone, especially if the physician needs to consult with other members of the care team prior to talking with the patient.

National Health IT Week is almost upon us again, with the goal of raising “awareness of Health Information Technology’s power to improve the health and health care of patients across the nation.” When IT solutions are used to transform care and improve quality it can be a powerful thing, but when tools are employed without goals, accountability, or governance, it doesn’t make the world a better place. There are key themes for each day of the week:

Patient Engagement
Advancing Interoperability Through Meaningful Use
Advancing Interoperability Across the Care Continuum – Beyond
Advancing Interoperability Through Standards
Clinical Quality & Safety

I couldn’t help but notice that quality and safety are last on the list. I’m going to give ONC the benefit of the doubt and assume that they are building the week towards the most important aspect, but if that’s true, then it puts patient engagement towards the bottom.

Why do we seem to revere the means more than the ends? Email me.

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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News 8/27/14

August 26, 2014 News 10 Comments

Top News

The Department of Defense issues an RFP for its $11 billion EHR replacement. Dim-Sum brought up a great point in our conversation the other day: the government requires that a significant chunk of the bid be awarded to companies owned by women, minorities, and veterans. That means a lot of companies beyond the winning primary contractor and EHR vendor will earn business. Stay tuned for Dim-Sum’s September 18 HIStalk webinar. I didn’t think of it until this minute, but I bet he could provide a good overview of how to do business with the DoD – that would give small players time to get their ducks in a row.

Reader Comments

From Medwreck: “Re: cloud. I’m on a life sciences panel for an upcoming cloud-based content management software conference. Will all healthcare hosting and apps go the way of the cloud at some point?” Yes, for the most part. Data center operation isn’t the core competency of providers, security challenges are exceeding local resource capabilities, access to bandwidth is nearly universal, and cloud providers can offer higher reliability and recoverability. Assuming the price point is comparable or favorable and the cloud provider offers solid service levels, it makes no sense for providers to run data centers, just as it makes no sense for them to run electrical generators or wells when electric and water companies can do it better and with the higher efficiency that specialization brings once the grid has been established. The exceptions will be applications from small vendors that don’t offer them via the cloud or charge excessively for that option, which won’t be the case for long because they’ll be out of business.

HIStalk Announcements and Requests

The CHS Heartbleed-related breach is getting a lot of interest. I’m putting HIStalk Advisory Panel reactions together for a post next week since I suspect many hospital IT people are scrambling to explain what it means to their peers. Please add your thoughts here if you work for a hospital.

Listening: masterful early 1970s progressive rock from Peter Gabriel-led Genesis (Phil Collins was just drumming in overalls then – it was later he moved out front to lead the band to bubblegumdom) and the even more talented but criminally underappreciated Gentle Giant and the brilliant Kansas. Forty-year-old music shouldn’t sound this good and the now-balding and rotund 64-year-old Gabriel shouldn’t have been quite so androgynously attractive in video from his early 20s.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.

The Breakaway Group created this fun intro to their September 11 webinar.

Acquisitions, Funding, Business, and Stock

Premier, Inc. reports Q4 results: revenue up 17 percent, adjusted EPS $0.34 vs. $0.29. The company also announced that it will acquired Raleigh, NC-based supply chain analytics vendor Aperek for $48.5 million. It’s Premier’s third acquisition so far this year and the announcement hinted at more to come, which CEO Susan DeVore suggested when I interviewed her last month.

AirStrip raises $25 million in funding. New investors include The Gary and Mary West Health Investment Fund, Leerink Partners, and AirStrip customers Dignity Health and St. Joseph Health.

Visage Imaging’s parent company, Australia-based Pro Medicus Limited, discusses FY2014 results.

Sunquest owner Roper Industries announces two medical acquisitions: Strategic Healthcare Programs (post-acute care analytics) and Innovative Product Achievements (surgical scrub dispensing).

Columbia City, IN-based supply chain software vendor Solstice Medical secures $2.5 million in funding, $1 million of that from a state investment program for potentially high-growth businesses.

Sales

Greater Hudson Valley Health System (NY) chooses Strata Decision’s StrataJazz for complete financials.

Baptist Health (FL) selects Explorys for analytics.

Flagler Hospital (FL) chooses MModal for speech-driven clinical documentation.

Integrated Health Network (NJ) selects eClinicalWorks EHR and population health management for its 45 practices.

North Carolina Pediatric Associates will deploy NextGen Ambulatory EHR, PM, and patient portal.

People

UPMC EVP/CIO Dan Drawbaugh will resign after 30 years with the health system to pursue unspecified other professional interests. SVP Ed McCallister will serve as interim CIO. Drawbaugh was one of the highest-paid non-profit CIOs in the country, earning $1.6 million in 2012.

Emanuel Medical Center (GA) promotes David Flanders from CIO to COO.

CMS names Kevin Counihan (Access Health CT) to the newly created position of CEO of Healthcare.gov. Connecticut’s exchange, built with minimal functionality to meet ambitious deadlines, was one of few state-developed exchanges that worked, to the point that other states with overly ambitious visions and questionable contractors asked it for help. Earlier this week, when asked if the federal government would benefit from Connecticut selling its services to other states, he said:

I think this idea about trying to keep things as efficient and cheap as possible, and simple as possible, has a lot of value whether it’s to a state or to the federal government. And, as I said, I just believe that this is about simplicity and ease in doing everything that either the states or the feds can do to make a complex purchasing decision easy as possible. If there’s opportunities within something that a state has, like Connecticut, I think the feds have to look at it.

Announcements and Implementations

Philips introduces its Lifeline smartphone-based medical alert app for seniors. I didn’t realize that Framingham, MA-based Lifeline Systems was founded in 1972 by a Duke gerontologist on sabbatical, was bought by Philips in 2006 for $750 million, and is now the number one medical alert service with 7 million subscribers.

The NextGen Share HISP solution earns DTAAP and EHNAC accreditation.

Caradigm will offer providers unlimited identity and access management for a single annual all-inclusive price that includes provisioning, single sign-on, and context management for an unlimited number of applications.

3M announces its Coding and Reimbursement System Plus (CRS+) coding system.

Lincor launches an Android-based TV system MediaLINC for education, entertainment, and clinical content delivered to hospital beds via standard HD TV sets.

Imprivata introduces enhancements to Imprivata OneSign Secure Walk-Away that include advanced 3D camera technology, video tracking, and facial recognition.

Government and Politics

The VA will open an RFP for a commercial patient scheduling system in September and will award a contract by the end of the year. VA CIO Stephen Warren says the agency will “acquire a commercial, off-the-shelf scheduling system,” but then oddly adds that it wants a system “tailored specifically for our Veterans.” (the VA always capitalizes “veteran” even though that’s incorrect).

A White House video profiles the first day at work of former Googler Mikey Dickerson, recently named the first administrator of the new US Digital Service under the White House CTO (the departing Todd Park is prominent in the video, sitting beside President Obama). Dickerson also helped revive Healthcare.gov. The government modeled the service after a similar UK one, but skeptics say a lack of clout will probably hamper this effort like it did a couple of previous open government initiatives that everyone has forgotten. Dickerson seems sufficiently nerdy, although working for the White House isn’t nearly as lucrative as banking Google stock options and DC is a very long way from the Silicon Valley. The President brags on camera about the small-team success with Healthcare.gov, not mentioning that its development was the exact opposite with pathetic CMS oversight, political meddling, and poor contracting practices — Todd Park wasn’t brought in until it blew up. It’s a fun video even if it propaganda for a White House program that probably will amount to very little (pardon the redundancy).

A New York Times article exposes Medicare’s nursing home rating as irrelevant, where plush amenities and unaudited self-reported statistics earn high marks for clinically dangerous facilities that have figured out how to game the system. One five-star home was fined the maximum state penalty after a killing a patient in a medication error and despite having twice the average number of consumer complaints and a dozen lawsuits from patients and families. In that facility, residents are often housed three to a room, quality employees are in short supply, and basic supplies are scarce. According to one resident, “If I fell down, they’d pick me up, but that’s about it.” Two-thirds of the 50 homes on a federal watch list for quality still have four- or five-star ratings due to their self-reported staffing and quality numbers.

Tuesday’s HITPC interoperability Workgroup Governance Subgroup suggests five problems (above) that ONC should address through policies or programs. Overall barriers for the quantity of information exchanged were named in responses (a) lack of a national provider directory; (b) inconsistent data sharing laws; (c) DirectTrust accreditation is not universal and is not inexpensive; (d) lack of a common trust bundle for HISPs; and (e) inconsistent data matching methods.

Former FDA Commissioner Andrew von Eschenbach says the agency is holding back innovation by requiring too much red tape for conditional drug approval and by not recognizing the possible benefits of drugs combined with medical devices or diagnostic tests. He also advocates using EHR data along with specific molecular patient characteristics to streamline pre-market testing and post-market surveillance.

Innovation and Research

An Indiegogo campaign for The Defender rape defense system raises far more than its $100,000 goal. It sprays pepper spray, takes a photo of the assailant, connects with a 24-hour response center, and sets off an alarm and flashing light.

Tennis ball boys at the US Open will wear Ralph Lauren’s Polo Tech Smart Shirt for testing as the company plans for a spring retail rollout. An accelerometer, gyroscope, and heart rate monitor are embedded in the shirt, with wires woven into the shirt’s fabric serving feeding them information.

Technology

MOVEO Foundation, which advocates for the use of virtual reality in surgical training, creates a video showing the use of the Facebook-owned Oculus Rift during surgery.

Microsoft claims at a partner conference that several hundred customers have switched from Google Apps to Office 365, displaying a slide of 15 organizations that include University of Colorado Health. Google researched those 15 and found quite a bit of Microsoft inaccuracy, including its listing of UC Health, which had never been a paid Google Apps user. University of Colorado Boulder uses Google Apps exclusively for students and is considering moving faculty to it. I’ll say this: I use Gmail and hate it and the entire Google Apps suite, vastly preferring Office 365 to Google’s ugly, quirky, minimally maintained, and unreliable apps. I use Gmail mostly to read other hosted email accounts, so I should probably just move to Outlook since it now appears to have a web client that doesn’t require a locally maintained Exchange server.

Other

Ice Bucket Challenges have jumped the shark, but are still fun to watch when it’s someone you know. Here is Matt Hawkins of Sunquest, calling out Tee Green of Greenway Health to ice up (or is that ice down?)

Health Affairs offers a short-term solution for the seemingly random pricing of the same test and procedure at different hospitals: cap payments at 125 percent of the price Medicare pays since that price is already adjusted by local cost of living. Then, they say it’s time to dump the AMA-supervised committee (RUC) of mostly specialists who set Medicare prices, which not surprisingly recommends paying more for procedures like they perform and less for primary care and prevention. Not many industries would let a trade group set government-paid prices.

A security expert analyzing the healthcare breaches such as that experienced by Community Health Systems says the suspected China-based group seems to be most interested in stealing oncology data, either to create knockoff chemo drugs or to try to address China’s cancer problems. Patients have already started filing class action lawsuits against the chain. Meanwhile, in more of an old-school breach, ProPublica uncovers the illegally hushed and still-unreported case in which an unvetted Chinese national was hired in 2007 to work in the Arizona Counter Terrorism Information Center and is believed to have returned to Beijing that year with the personal information of 5 million Arizona drivers. Lastly (for today anyway) the Chinese government announces plans to develop an operating system to eventually replace Windows, Android, and iOS.

The information of 595 patients of Steward-owned St. Elizabeth’s Medical Center (MA) is exposed when the personal laptop and thumb drive of a formerly employed physician are stolen from his home. Hospital policy prohibits storing PHI on personal devices. Neither were encrypted.

Greenville Health System (SC) will issue $91 million in bonds, with the proceeds partially used to pay $97 million in Epic implementation costs.

A New Jersey paper describes how for-profit hospital operators turn facilities around (note that IT isn’t on their list, for-profit hospitals being minimally interested in technology outside of the billing area in my experience):

Buy struggling or bankrupt hospitals cheap.
Hire well-connected political influencers to get the deal approved.
Sell the property to investors and lease it back.
Lay off employees, cut staffing, and use more per-diem workers, especially if buying a bankrupt hospital where union contracts can be renegotiated.
Squeeze vendors using corporate leverage.
Streamline and standardize care to get patients out the door faster.
Cut executive positions and salaries.
Improve billing and collections.

Fitness tracker Jawbone collects the sleep tracking data of its users (Quantified Someone Else?) and creates this analysis of the Napa earthquake, in which it could even tell how many users were awakened by tremors and didn’t go back to sleep that night. They could probably perform some interesting sexual metrics.

I was thinking about this on a plane recently when the guy in front of me kneecapped me by reclining his seat hard even before takeoff. An altercation between two United passengers forces the flight to divert for an unscheduled landing at O’Hare when a male passenger uses the banned Knee Defender gadget to block the seat in front of him from reclining so he can use his laptop, causing the angry woman in the seat to throw water on him. The irony is that both passengers were in extra-room seats. I can’t blame the guy – I’ve had my laptop screen jammed and nearly broken when the person in front of me decided to recline, which squeezed the laptop under the tray table latch.

Sponsor Updates

Nuance announces that users of its PowerShare Network have shared 3 billion medical images, with the number growing 30 percent per year.
PerfectServe announces the formation of its customer advisory panel.
Also making the Inc. 5000 list run here earlier is Direct Recruiters, Inc.
Wellcentive releases its 2014 PQRS application.
The World Economic Forum announces the selection of Health Catalyst as one of 24 global Technology Pioneers.
Versus discusses the hospital’s responsibility to prevent violence against healthcare workers.
Administrative Eyecare Magazine features Versus Technology client Key-Whitman Eye Center for its use of RTLS to increase patient volume while reducing wait times.
The Advisory Board Company recognizes four healthcare organizations for RCM improvements up to $8.2 million.
CareTech Solutions presents a case study titled “Maximize Uptime with Stretched Clusters” at VMworld 2014 this week in San Francisco.
Beacon Partners offers seven ways organizations can protect themselves against hackers.

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.

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Monday Morning Update 8/25/14

August 23, 2014 News 9 Comments

Top News

Todd Park will reportedly step down as US CTO but will remain a White House employee, moving back to the Silicon Valley to work on brokering relationships between technology companies and the federal government.

Reader Comments

From HIEway Robbery: “Re: HIEs holding registries hostage per Carl Dvorak’s testimony to ONC. Several CIOs have told me that HIEs have been allowed to use state-based immunization and public health registries to as a leverage point under Meaningful Use, forcing their health systems to join the HIE for up to several hundred thousand dollars.” Hospital IT people, please let me know if you’ve had such pressure applied. I promise to keep your details confidential, but I’d like to know the registry, state, and price quoted for HIE access. ONC needs to know that the generally noble idea of connecting to public health agencies as part of MU2 is being milked as a profit center by revenue-desperate HIEs if that’s the case. I’ve heard that one health system had to pay $700K to an HIE just to access the state’s immunization registry.

From Surveyor: “Re: Modern Healthcare’s top employers and Inc. 5000. These lists are a joke and your running the results is questionable.” I only mentioned in the Sponsor Updates which sponsors won. I don’t think the lists are a joke, but publications give awards to sell magazines and generate ad revenue, no different than those full-page airline magazine ads for “best steakhouses” or “best plastic surgeons.” Which means: don’t take them too seriously either as a reader or a winner. Let’s take a look at those two awards based on what I could find online. Readers with more information are welcome to chime in.

Modern Healthcare’s Best Places to Work

Participation is free, but companies are offered a detailed employee feedback report that isn’t (the price, however, is modest).
Information is self reported and not verified by the magazine.
The survey asks for the voluntary employee turnover percentage, but it’s not clear how that number fits into the rankings even though it’s arguably the best way to assess employee satisfaction.
A random number of company employees are surveyed directly using an adequate sample size from the entire employee database. The survey company was created specifically to conduct “Best Places to Work” programs across all industries and is a division of a publishing company.
My grade of the methodology: B+. The employee survey portion seems sound and is of sufficient depth, but online survey of company programs and benefits is self reported and apparently unaudited (but the company HR people who respond aren’t likely to game the system to win). I’d like to see the voluntary turnover number reported in the profile of the winners. I think the winners are probably doing a good job in how they manage their employees, but it’s easy to forget that most companies don’t participate. It’s not quite perfect, but as good as can be expected from a voluntary survey type program designed to simultaneously stroke the egos of winners and the magazine.

Inc. 500/5000 list of fastest-growing private companies

Information is self reported and not verified by the magazine.
Companies send in 2013 gross revenue vs. 2010 gross revenue and basic demographic information only.
Applicants have their short entry form signed by any CPA, financial analyst, or attorney. No proof of the claimed revenue numbers is required.
Companies could be losing a ton of money and still make the list as long as their gross revenue increased in the previous three years. Privately held companies aren’t going to disclose profits, so the magazine has to go with revenue alone.
Companies have to pay $150 to submit their information. The magazine pitches the exposure they’ll get as a result. They don’t indicate the number of applications received, but the 5,000 winners alone would generate 5,000 x $150 = $750,000 for very little work on Inc.’s part since they don’t verify the submitted information – they basically plug it into an Excel worksheet, sort by revenue growth percentage, filter by industry and a few other factors, and call it done.
My grade of the methodology: F. The entire premise of the award – that revenue growth is the single best measure of company success – is suspect enough, but choosing winners from fee-based unaudited company submissions is lazy. Winners aren’t necessarily even the fastest growing companies – only the fastest growing of those that dash off the quick information form and mail in their $150. I wouldn’t dock a company points for trying to generate some easy PR in return for an investment of $150 and the five minutes it takes to complete the application form, but I also wouldn’t necessarily think more highly of the winners, especially noticing that some of the highly-ranked companies have only an employee or two. I like seeing fast-growing companies, but I wouldn’t buy shares of a publicly traded company’s stock based on a one-time snapshot of unaudited revenue growth.

From The PACS Designer: “Re: iPad vs. Android L. The iPad monopoly may start to start to shrink with the Android L, scheduled for release in late October with a true 64-bit system.” I would argue that the iPad doesn’t have a monopoly even now, representing less than a third of tablets sold in Q1 2014. Samsung is gaining ground quickly and Lenovo is coming on strong in the past year, although tablet sales seem to be hitting the wall anyway since there’s not much incentive for people to trade up.

HIStalk Announcements and Requests

Nearly two-thirds of poll respondents thing Cerner is getting a good deal in buying the Siemens healthcare IT business for $1.3 billion. New poll to your right or here, for health system IT employees: is your organization taking new security steps in reaction to the Community Health Systems breach? I would be interested in hearing more … click the Comments link after voting.

Listening: new from SOJA (Soldiers of Jah Army), an eight-piece DC-based reggae band. It’s not my favorite genre, but I like this since it sounds more like decent pop music instead of formulaic noodling by ganja-stupefied Rastafarians.

Last Week’s Most Interesting News

Chinese hackers steal the data of 4.5 million Community Health Systems patients, most likely enabled by outdated network software as vendors responded slowly to address the Heartbleed exploit after it was announced in late spring.
Oracle’s lawsuit against the state of Oregon says state officials should have hired a systems integrator to oversee the creation of its failed health insurance exchange, comparing Oregon’s project to an inexperienced company deciding to build a skyscraper without hiring an architect. The failed rollout of Healthcare.gov has been similarly attributed to CMS’s attempt to serve as its own project overseer.
CMS statistics show that few providers (and thus few vendors) are clearing the Meaningful Use Stage 2 hurdle, with the early trend suggesting that practice-based users appear to be moving from smaller vendors to Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
A New York Times article says CMS’s Medicare fraud prevention efforts are expensive and ineffective due to its poor management of private recovery audit contractors and the bogged down provider appeals process.
The private equity owners of revenue cycle vendor TriZetto are rumored to be shopping the company at a price of $3 billion.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

Announcements and Implementations

The Albuquerque business paper profiles Seamless Medical Systems, which will release SNAP Express RX on Monday. It’s an iPad-based patient self-history system for pharmacies (vaccines, immunizations, and medications). The company also says its SNAP Practice check-in system will be piloted at Houston Methodist Hospital starting in October.

Government and Politics

The state of Oregon finally files the lawsuit it has been threatening against Oracle, saying it paid Oracle $240 million to build the dysfunctional Cover Oregon health insurance exchange site. The Associated Press named the spectacular failure of Cover Oregon, which will be shut down, as the state’s top news story in 2013:

Once considered a national healthcare leader, Oregon produced the worst rollout in the nation of the new national health insurance program. While the crippled federal website eventually got up and walked, Oregon’s remained comatose, unable to enroll a single person online. The state had to resort to hiring 400 people to process paper applications. Officials lay much of the blame on the primary information technology contractor, Oracle Corp., and withheld some $20 million in payments. But state officials’ own actions played a role, too. In the face of disaster, they insisted on doing things The Oregon Way, clinging to a grandiose vision of creating a grand health IT system that would not only enroll new people in the national health insurance program, but also provide other vital services.

The personal information of 25,000 Homeland Security employees is compromised when hackers penetrate the systems of a federal contractor that performs security clearance. The contractor, USIS, says the cyberattack appears to be the work of an unnamed country’s government.

For-profit hospital operator Steward Health Care System (owned by a private equity firm) and The Boston Globe engage in legal wrangling over the hospital’s use of a patient’s medical records. The newspaper is running an in-depth feature about the man’s experience with the mental health system that Steward expects to be uncomplimentary to its hospitals, so it filed a lawsuit asking to be able to publicize the man’s records to tell its side of the story. The court said no. All of this happened before the article ran in Sunday morning’s paper and it appears that Steward’s heavy-handed actions were premature – the article touches little on the patient’s experiences at the chain’s Quincy Medical Center and Norwood Hospital and focuses more on the challenge of fitting mentally ill people into society so they can’t harm themselves and others.

Innovation and Research

Wired profiles Enlitic, a just-announced startup that will use deep learning algorithms to diagnose medical conditions. Data scientist founder Jeremy Howard says the company’s approach is different from that of IBM, which tries to teach Watson by feeding it textbooks that contain information that doctors already know vs. giving the computer raw data and letting it figure out the patterns that represent new knowledge. I’m not sure doctors need as much help diagnosing patients as computer people tend to think, but at least a small percentage of patient conditions are baffling.

Other

Cedars-Sinai Medical Center (CA) reports exposure of the information of at least 500 patients following the theft of a laptop from an employee’s home. The hospital says the device was not encrypted per hospital policy because of an installation mistake. The description of the employee’s job suggests that he or she has IT responsibilities since it includes “troubleshooting software used for clinical laboratory reporting” and requiring off-hours availability.

A peer60 report on patient portals finds that the most implemented are from Cerner and Epic, while those most often being considered by the 10 percent of providers who don’t have one are Cerner, Medfusion, Meditech, Epic, eClinicalWorks, and Medhost. Generally deficient functionality includes meeting the needs of specialists, EHR integration, appointment scheduling, streamlined enrollment, bill pay, and managing the information of patients under 18. It concludes that health systems can hit the 10 percent engagement threshold required by Meaningful Use Stage 2.

Jonathan Bush’s 1990s business idea as described in his book finally happens: EMTs are providing primary care services in the home instead of just giving 911 callers expensive rides to the ED for non-emergent issues. It’s a smart idea: the supply of relatively easily trained EMTs and paramedics exceeds the available jobs (often in fire departments) and most people would prefer being evaluated and treated at home, especially if the EMR/paramedic was in touch with a doctor via telemedicine as needed.

A University of Pennsylvania Health System study finds that urinary catheters were removed more promptly (presumably reducing the chance of urinary tract infections) when EHR provider reminders were replaced with an integrated homegrown alert that required fewer clicks to generate the DC order.

Interesting: improved guidelines and more widespread use of less invasive surgical procedures have reduced blood transfusions by a third and blood profits by 70 percent in the last five years. The Red Cross takes in nearly $2 billion of its $3 billion annual budget from selling blood and employs 17,000 of its 26,500 employees in its blood program, requiring layoffs and expense cutting. People don’t realize that their thoughtful blood donations are sold to hospitals for hundreds of dollars per unit, sometimes by for-profit blood centers that don’t exactly broadcast that fact, one more aspect of healthcare that doesn’t seem like it should be a business but very much is one.

An investigation of the corporate support services department of Health and Hospitals Corporation of New York finds that officials contracted with friends and neighbors for no-work temporary jobs and hired unqualified but connected employees. In one case, a supervisor who was also a minister performed a wedding in his office during work hours.

The individual is no longer an employee of Memorial Hermann. We cannot disclose any further information.

— Memorial Hermann (@memorialhermann) August 20, 2014

Memorial Hermann Southeast (TX) fires an employee after someone complains to it about a racist comment she posted on her personal Facebook, on which she doesn’t identify herself as a hospital employee. The hospital announced the employee’s firing on Twitter, ironically. According to a legal analyst, “People have the right of free speech, but employers can fire you for whatever they want in the state of Texas.”

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.

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Morning Headlines 8/22/14

August 21, 2014 News Comments Off

FBI warns healthcare firms they are targeted by hackers

The FBI issues an alert to the healthcare industry that hackers are targeting them following their breach of Community Health Systems.

Oracle Calls State’s Health Exchange Planning Akin To Building ‘A Skyscraper With No Architect’

Oracle blames Oregon officials for not hiring a systems integrator for developing its health insurance exchange.

AliveCor Receives First FDA Clearance to Detect a Serious Heart Condition in an ECG on a Mobile Device

The free app, which requires a $199 sensor, monitors ECG activity to detect atrial fibrillation.

HealthQuest Capital raises $110M for healthcare investments

The investment group plans to invest in medical devices, diagnostics, and healthcare IT.

News 8/22/14

August 21, 2014 News 10 Comments

Top News

The China-based hackers who stole the information of 4.5 million patients of Community Health Systems used the Heartbleed exploit for access, the first major cyberattack to do so since Heartbleed received major world attention in April 2014. Community Health Systems provides employee VPN access using networking equipment from Juniper Networks, which along with other networking vendors was slow to update its products in response to Heartbleed. The hackers were able to log in as employees in the weeks after Heartbleed was announced and before vendors updated their software. There’s a lesson to be learned: watch for unusual behavior from user accounts and certainly for huge data files being sent outbound. Meanwhile, the FBI issues a flash alert to healthcare firms, warning that that they’re being targeted by hackers.

Reader Comments

From Former SMSer: “Re: former Shared Medical Systems employees. A members-only Facebook group was started on August 15 and has 1,200 members. It is special to have so many warm personal connections 14 years after the Siemens acquisition.”

From Eek How? “Re: Ekahau. Let its president go and the VP of marketing walked out. The company has gone from 119 employees to fewer than 45 in the past year. WiFi-based RTLS still disappoints hospitals.” Unverified, but former CEO Mark Norris has updated his LinkedIn profile to indicate his immediate availability.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi digs deep into data on the EHR replacement market. Industry representatives weigh in on Walmart’s foray into primary care. Newt Gingrich makes the case for integrating mobile health tools into care for veterans. Greenway Health and Apple are granted patents, though for decidedly different innovations. A physician in Alaska gets creative when attempting to opt out of Meaningful Use. Azalea Health CEO Baha Zeiden dishes on the simplifyMD acquisition and the role of telemedicine in rural communities like his. Thanks for reading.

I talked today with the brilliant and articulate Dim-Sum, who knows everything about the Department of Defense and its impending choice of EHR vendors for its $11 billion EHR project. He graciously agreed (probably while grimacing at the arm-twisting Lorre and I were applying) to host one or more webinars on the topic. Mark your calendar for September 18 at mid-day for the first one, in which Dim-Sum will describe the DoD’s healthcare reach, current systems, relationships with contractors and other government agencies, and selection process. The webinars will be fun, slightly cynical, and highly educational to those of us who don’t really understand military health, as well as crucial to those with a vested interest in what will be one of the largest and most expensive government IT projects in the world.

Also in September: the virtual launch of Ed Marx’s upcoming book, “Extraordinary Tales of a Rather Ordinary Life.”

I’m always interested in hearing from providers who would like to be interviewed, write guest articles, or otherwise participate in HIStalk. Let me know if you are willing. I get plenty of volunteerism from vendor people, but not much from those working on the provider side.

Upcoming Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

Acquisitions, Funding, Business, and Stock

HealthPrize Technologies, which offers a medication adherence app, raises $3 million in its first institutional financing. Co-founder Tom Kottler’s first startup was MedAptus.

HealthQuest Capital raises a $110 million fund to invest in medical devices, diagnostics, and healthcare IT.

Aging services technology vendor Healthsense, which offers a remote monitoring system for chronic diseases, adds a $10 million funding round.

Vocera shares touched a 52-week low this week, closing Thursday at $8.48 and valuing the company at $216 million. Above is the one-year price of VCRA shares (blue) and the Dow (blue).

Sales

Saint Agnes Hospital (MD) chooses clinical alerting and secure texting solutions from Spok, also upgrading its hospital call center suite.

Baylor Scott & White Health chooses the Allscripts dbMotion HIE platform.

Baystate Health (MA) selects Premier’s PremierConnect Enterprise to support development of solutions within its Health Informatics & Technology Innovation Center, a co-working space and late-stage accelerator.

The Froedtert & Medical College of Wisconsin network chooses the analytics platform of Explorys.

Atlanta Gastroenterology Associates chooses Greenway PrimeSUITE EHR/PM.

People

Surescripts names Tom Skelton (Foundation Radiology Group) CEO.

Announcements and Implementations

PerfectServe opens an Atlanta office.

Forbes names Cerner to its list of the world’s most innovative large, publicly traded companies. Salesforce.com came in #1, and other familiar companies joining Cerner in the top 30 are Amazon, VMware, Red Hat, Stericycle, and Express Scripts. The ranking is derived from the somewhat questionable metric “Innovation Premium,” representing the degree that share price exceeds current business value.

SAS and 39-hospital Dignity Health (CA) will create a big data platform to reduce readmissions, create best practices for CHF and sepsis, and manage drug costs.

Greenway Health receives a patent for the function of automatically aligning billing codes with payer- and location-specific fee schedules.

AliveCor receives FDA clearance for its atrial fibrillation detection app that monitors ECG in real time and allows the user to email, print, and analyze their single-channel ECG records. The app is free, but the monitoring hardware costs $199.

UltraLinq’s cloud-based image management solutions will be available through athenahealth’s No More Disruption Please program.

Government and Politics

Oracle, in its lawsuit against the state of Oregon for not paying the company for its work on the state’s failed healthcare insurance exchange, says the state should have hired a systems integrator instead of trying to run the project itself. CMS made the mistake in trying to run the Healthcare.gov project without outside help.

CMS Administrator Marilyn Tavenner didn’t just accidentally delete Healthcare.gov-related internal emails as she claimed, although this request pertains to a largely dull conversation about training telephone reps handling manual insurance sign-ups after Healthcare.gov failed.

The FDA releases an API to allow programmers to access its MAUDE medical device problem database.

Other

Cerner CEO Neal Patterson not only dumps ice water over his head, he issues an Ice Bucket Challenge of his own to John Glaser, CEO of the Siemens health IT business that Cerner is acquiring. Glaser accepted the challenge.

As simultaneously cute and annoying as the virally spread ice bucket challenge videos are, this one is worth watching if you really want to understand the non-entertaining aspects of the disease as one of its sufferers takes the challenge and then explains how ALS affects him.

Jamie Stockton of Wells Fargo Securities provides updated slicing and dicing of CMS hospital attestation data through June 30. The significant Stage 1 vendors are (in order) Meditech, Epic, Cerner, CPSI, McKesson, and Medhost. Of the 10 hospitals that have attested for Stage 2, Cerner has four, Meditech and CPSI have two each, and Medhost and Allscripts have one each. Top vendors of the EHRs used by the 977 physicians who have attested for Stage 2 are, in order, athenahealth, Epic, and Practice Fusion, who have 97 percent of the Stage 2 attestations among them.

Economist Uwe Reinhardt writes a brilliant and remarkably compact criticism of the bizarre payment system of US healthcare. A tiny sample:

For starters, we allow our providers of health care – doctors, hospitals, pharmaceutical companies and other providers—to use classic price discrimination in the markets for their products and services. That tactic helps sellers to extract from buyers with different abilities or willingness to pay as much total revenue as can possibly be extracted from the buyers collectively … Altogether, the highly complicated cash flow resulting from this strange system of financing, flowing through so a myriad of capillaries, makes it almost impossible to hold any providers formally accountable for all of the moneys they receive. Somehow this rickety Rube Goldberg contraption of financing health care has worked in some fashion in this country, for over half a century. Many hospitals have thrived financially under it, while hospitals located in mainly low-income areas have struggled or gone under. And as a series of journalists—most recently Steve Brill in “The Bitter Pill”—have reported, this system also has put brutal financial stress on the budgets of many American households.

Aaron Carroll, MD, MS, a medical school professor and contributor to “The Incidental Economist,” explains why doctors have plenty of data problems without having to deal with patients sending them their fitness tracker information.

The Columbus business paper profiles CoverMyMeds, which is doubling in size every year while remaining profitable as a bootstrapped company.

Honored to meet doctors & Veterans with @RepAnnaEshoo at @VAPaloAlto, now using iPads to help treat Vets & families. pic.twitter.com/lOZwDT8KZu

— Tim Cook (@tim_cook) August 21, 2014

Apple CEO Tim Cook visited the VA hospital in Palo Alto, CA, tweeting a photo from the facility that is using iPads.

Massachusetts eHealth Collaborative President and CEO Micky Tripathi examines the EHR replacement market in an HIStalk Practice post:

The number of EHRs used to attest has dropped considerably from MU Stage 1 to Stage 2.
Customers are switching from smaller vendors to the benefit of Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
Athenahealth and eClinicalWorks are losing customers to Epic.
Allscripts lost more customers than anyone, most likely because of its retirement of MyWay, which boosted Aprima’s customer base.
Epic, Greenway, and athenahealth are the EHR vendors most acceptable both to larger practices as well as hospitals given their maturity,support, and product stability.

Burke Mamlin, MD of Regenstrief Institute pens a letter in response to the Indianapolis newspaper’s article on medical scribes, recommending caution since physicians don’t always review scribe EHR entries until after the fact, they don’t see clinical decision support recommendations, and they become dependent on the scribe. The letter describes Regenstrief’s vision:

Rather than using a scribe to reduce the computer’s role in the exam room, we envision the medical scribe’s role to increase the computer’s role. By using the scribe as a “Wizard of Oz” replacement for the keyboard and mouse, the computer can become an intelligent, anticipatory and active participant in the conversation between patient and physician. Physicians can become super-users as they learn from watching the scribe, there is less chance for errors when the physician is actively monitoring input, and benefits of real-time decision support will not be lost.

Weird News Andy finds this article interesting in that not only have an estimated 90 percent of hospitals and clinics lost patient data, the black market pays $50 per stolen medical record vs. just $1 for credit card information.

Sponsor Updates

Craneware will hold its first Revenue Integrity Summit October 14-16 in Las Vegas.
HCS participates in LeadingAge Center for Aging Services Technologies (CAST) EHR 2014 Selection Portfolio.
Ingenious Med employees complete their third annual 100-day team-centric Thrive Challenge.
Andrew Borland, Wellcentive’s director of architecture and research, is interviewed on Atlanta Business Radio.
The SSI Group adds contract management to its RCM offerings.
Aspen Advisors, Clinovations, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Encore Health Resources, Hayes Management Consulting, Health Catalyst, Iatric Systems, Impact Advisors, Imprivata, Intelligent InSites, Nordic, Santa Rosa Consulting, and The Advisory Board Company are named on Modern Healthcare’s 2014 Best Places to Work in Healthcare list.
Besler Consulting, Clinovations, CompuGroup Technologies, Cornerstone Advisors, CoverMyMeds, CSI, Cumberland Consulting Group, Divurgent, eClinicalWorks, ESD, Etransmedia Technology, Forward Health Group, GetWellNetwork, Health Catalyst, Health Care Software, Healthcare Data Solutions, Impact Advisors, Imprivata, Informatica, Ingenious Med, Patientco, pMD, Santa Rosa Consulting, SRSsoft, Strata Decision Technology, HCI Group, and Wellcentive are named on the Inc. 5000 Fast Growing-Growing Companies 2014 list.

EPtalk by Dr. Jayne

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One of my CMIO duties is to periodically review the patient care protocols in our EHR and recommend updates and additions. Evidence-based guidelines have been a part of our organization for almost two decades, but they’re constantly evolving. I like to do a comprehensive review every year, but there are always guidelines that change on the fly.

Occasionally, it seems like every day brings a new recommendation for screening or treatment. Some of the updates are relatively straightforward, but others can be quite controversial.

This year my review process took a twist. Our organization wants to start building financial information into our care protocols, including the cost and accessibility of various services according to the patient’s insurance coverage. Most payers are fairly transparent about what they do or don’t cover. Sometimes, however, the nuances between different plans offered by a given payer tends to make me a little crazy.

In addition, our state legislature has mandated coverage for certain services, but most of the laws were written to apply when patients enroll in a plan after the law goes into effect. For patients who are on older or existing plans, they may not be covered for the services until they change jobs or their employer changes plans or payers. We have some large regional employers who self-insure and somehow they seem to skirt some of the payment requirements as well.

Medicare has always been the steady player as far as knowing what will be covered and how. The payment guidelines are transparent and usually follow along with other federal guidelines. This year we have a bit of a wrinkle since the Medicare Evidence Development and Coverage Advisory Committee has decided not to cover CT screening for lung cancer, which is a “B” grade recommendation by the US Preventive Services Task Force. I read the commentary from their meeting and they cite the American Academy of Family Physicians, which feels the evidence is insufficient to recommend for or against the test.

This is where it gets really fun. In accordance with the Patient Protection and Affordable Care Act, marketplace insurance plans and many private plans are required to cover the screening with no out-of-pocket costs to the member. However, the law does not specifically state that Medicare is required to pay the full cost to Medicare beneficiaries. Instead of being able to do some relatively clean development around the USTSPF “A and B Recommendations” list, we have to continue with the patchwork approach.

Quite a few guidelines have been revised for 2014 and more are under revision, so this project is definitely the gift that keeps on giving. I’ll be taking my recommendations to our clinical quality committee in the next week or so and then the development team can get to work. I’ll also be giving a report of my findings to our managed care negotiation team so we can try to leverage better coverage for the services we find most clinically appropriate.

Got guidelines? 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.

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Morning Headlines 8/21/14

August 20, 2014 News Comments Off

US hospital hack ‘exploited Heartbleed flaw’

A cybersecurity firm claims that the theft of information on 4.5 million patients of Community Health Systems was performed using the Heartbleed exploit. The firm says CHS used network equipment from Juniper, which was slow to correct software vulnerabilities.

Cerner lands on Forbes’ most innovative companies list

Forbes names Cerner #22 on its list of large, publicly traded companies that invest in innovation.

SAS to build cloud-based big data analytics platform for Dignity Health

Analytics software vendor SAS will create a big data platform for Dignity Health to support care planning, value-based reimbursement, and outcomes and value performance analysis.

Wearable Intelligence is raising $8.4M for Google Glass for doctors

San Francisco-based Wearable Intelligence has raised $7.9 million of its goal of $8.4 million from investors that include Google Ventures and Andreessen Horowitz. Its Google Glass technology displays information from EHRs,clinical alerts, and real-time information from patient monitors.

Morning Headlines 8/20/14

August 20, 2014 News 1 Comment

Community Health Systems data hack hits 4.5 million

Chinese hackers hit the for-profit operator of 206 hospitals for the identities of 4.5 million patients.

Apax seeks $3 billion sale of healthcare IT firm TriZetto : sources

The private equity firm is rumored to be seeking a buyer for revenue cycle vendor TriZetto in the $3 billion range after taking the company private for $1.4 billion in 2008.

White House won’t reveal documents related to ObamaCare website security

CMS and the White House refuse to turn over documents related to the security capabilities of Healthcare.gov, citing HIPAA concerns.

A Medicare scam that just kept rolling

Medicare paid $8.2 billion for power scooters, many of them for patients who had no medical need for them.

News 8/20/14

August 19, 2014 News 1 Comment

Top News

For-profit hospital operator Community Health Systems says it was the victim of a cyberattack in which the demographic information of 4.5 million patients of its 206 hospitals was stolen. The attack, which occurred in May and June, appeared to originate in China. The FBI is investigating. Community Health Systems is in the Fortune 500 with $7.2 billion in annual revenue and a pending $3.6 billion acquisition of Health Management Associates, which would make the company the largest for-profit hospital operator in the US.

Reader Comments

From Changing Wind: “Re: Orion Health. With the upcoming IPO, employee bonuses are being changed from four times a year to once, holding cash at the expense of their employees.” According to a forwarded email from Orion Health CEO Ian McCrae, “As part of the Board and Management review of the company measures and targets, a decision has also been made to move the frequency of the Company Incentive payment to annual, which aligns with the personal component of the Short Term Incentive. This change now aligns us with what is common market practice and also takes into account the recognition that the achievement of the revenue target is heavily reliant on our performance in the second half of this financial year.”

From Anonymous Tipster: “Re: Carl Dvorak’s testimony. To hear Mr. Dvorak complain about their customers bearing the cost of participating in data exchange governance mechanisms while spending many millions of dollars on Epic and then during verbal testimony claim that Epic is the underdog of the EHR industry made me laugh.“

Acquisitions, Funding, Business, and Stock

Private equity firm Apax Partners LLP is looking for a buyer for payer and revenue cycle vendor TriZetto, according to rumors. Apax took TriZetto private in 2008 for $1.4 billion and hopes to sell it for up to $3 billion. TriZetto made $190 million in profit in the most recent fiscal year.

Inc. profiles the British doctor who founded hospital workflow software vendor Medisas and the expensive, lengthy process involved in getting a visa to set up shop in this country.

Clinician rounding app vendor Listrunner raises $500,000 in seed funding from independent physician investors. A trial version of the app is free.

Physician services group Mednax will acquire revenue cycle management vendor MedData. I’m hoping new ownership doesn’t interrupt the delicious flow of fresh-baked scones that MedData provided in the exhibit at HIMSS14 since they were a high point of the conference.

Sales

MultiCare Health System (WA) chooses Infor’s human capital management system.

People

Surgical Information Systems promotes Jonathan Lujan to EVP of North American sales for SIS and AmkaiSolutions.

Paul Sinclair (Allscripts) joins Beacon Partners as VP of business development.

Ford Phillips, who has worked in healthcare IT for 38 years, has written a short story collection about growing up in a small town in southern Illinois called “East of the Sun and West of of the Moon.”

Announcements and Implementations

KPMG will use Blue Cross Blue Shield claims information from Blue Health Intelligence, along with the CMS claims database, to enhance its service offerings.

A Baltimore technology site profiles Maven Medical, an eight-employee startup that offers a medical procedure price transparency app that helps doctors choose cost-effective tests based on average Medicare reimbursement rates.

Self Health Network raises $5.6 million to further development its patient communications and private social network platform that supports patient-clinician communications, personal health records, home monitoring device data collection, and caregiver alerts.

Accelerator Rock Health signs three new corporate sponsors: Abbott, Blue Shield of California, and Deloitte.

Two Michigan senior living facilities implement the Visibility Resident Care call system, powered by Versus Technology’s RTLS.

Government and Politics

The White House denies a Freedom of Information Act request filed by the Associated Press that asked CMS to disclose records related to the security capabilities of Healthcare.gov. CMS refused to turn over the documents, claiming that doing so could violate HIPAA by making it easier for hackers to access consumer information. A legal expert comments, “Here you have an example of an agency resorting to a far-fetched privacy claim in an unprecedented attempt to bridge this legal gap and, in the process, making it even worse by going overboard in withholding such records in their entireties.”

Premier, responding to a call from the Senate Committee on Finance for ideas that would make healthcare data more useful while maintaining privacy, says that ONC should mandate open APIs for data access as recommended in the recent JASON report. Other suggestions: open up access to government-related claims data, allow researchers access to EHR information, and provide incentives for interoperability that includes patient matching.

A Washington Post investigation finds that Medicare has paid $8.2 billion buying power wheelchairs and scooters for patients, many of whom didn’t need them. Companies, many of them set up by immigrants who became overnight millionaires, paid recruiters to get Medicare patients to participate in the scam. One patient found it odd that the medical equipment company that claimed he couldn’t walk had second-floor exam rooms with no elevators. Medicare put out fraud alerts, but kept paying, required by law to pay most claims within 30 days and reviewing only about 3 percent of them before paying. Medicare is a bit wiser, so criminals are moving on to selling drugstore shoe inserts as $500 orthotics and prosthetic arms and legs for patients in Puerto Rico who have no record of amputations.

Other

A Brookings blog post says HIEs are “Facebook for doctors,” with three factors that encourage doctors to use them: (a) receiving referrals; (b) being located where other communications channels are limited, such as in rural areas; and (c) peer influence.

In Australia, South Australian Health argues with Allscripts over lack of functionality in its Sunrise billing module, falling short so far over exchanging lawsuits.

Sponsor Updates

Billian’s HealthDATA discusses five hospital hiring trends in the C-suite.
Kareo CMIO Tom Giannulli will speak at the UBM Medica’s Practice Rx conference September 19-20 about the role technology plays in improving patient care.
Medhost announces that Cottage Hospital (NH) has attested for Meaningful Use Stage 2.
CoverMyMeds doubles its employee count and is expanding into a larger office space.
Quantros will showcase its Pharmacy Safety Suite of Solutions at the NACDS Total Store Expo 2014.
Navicure launches Navicure Payments that enables clients to estimate and secure patient financial responsibility and collect balances before service and after adjudication.
South County Radiologists (MO) selects McKesson Business Performance Services for its 14-physician practice.
The Advisory Board Company explains how it became a “Best Place to Work.”
DocuSign publishes a blog entry, “Fuel the Digital Revolution in Life Sciences with SAFE-BioPharma.”

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.

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Morning Headlines 8/19/14

August 18, 2014 News Comments Off

Community Health says data stolen in cyber attack from China

The for-profit chain of 206 hospitals says the information of 4.5 million patients was stolen, possibly by hackers with links to the Chinese government.

Microsoft cloud service Azure restored after partial outage

The hosting platform for cloud-based applications went down in multiple centers Monday evening, but the issue has since been resolved.

When Patients Read What Their Doctors Write

NPR covers the OpenNotes project with an opinion piece from an ED doctor and author.

Morning Headlines 8/18/14

August 18, 2014 News 1 Comment

Health IT Policy Governance Subgroup

Epic President Carl Dvorak testifies on the company’s position and progress on interoperability.

M*Modal Announces New Board

MModal CEO Duncan James resigns and a new board is named two weeks after the company emerges from Chapter 11 bankruptcy

Pervasive Medicare Fraud Proves Hard to Stop

A New York Times article says HHS’s fraud prevention efforts are minimally effective because the agency doesn’t manage private contractors well and provider appeals have overwhelmed the system.

Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysis

Monday Morning Update 8/18/14

August 16, 2014 News 9 Comments

Top News

Epic President Carl Dvorak testifies at an ONC HIT Policy Committee interoperability governance subgroup hearing. Some of his points:

Epic’s Care Everywhere exchanges 4.6 million C-CDA documents each month with 26 non-Epic vendor systems, 21 HIEs, 29 HISPs, and 28 government agencies. Its connections to other organizations carry 20 billion transactions annually to 88 public health agencies, 18 research societies, 51 immunization registries, and 17 research registries. This, Dvorak says, portrays a broader definition of interoperability than just exchanging patient summary documents.
Dvorak said providers who receive Meaningful Use money should be required to participate in a national list of exchange-ready participants.
Epic recommends that Meaningful Use Stage 3 add eHealth Exchange standards for unplanned transitions of care.
Epic suggests allowing multiple trust verification services since DirectTrust is too expensive for some organizations.
Dvorak says data exchange should be simplified for data used only for patient treatment and not for the “payment and operations” part of HIPAA where information is often sold or redistributed to business associates.
Epic says ONC should give patients control of information sharing with a simple opt-in/opt-out option and let patients who want finer control to use their own personal health record instead.
Epic customers are reporting that state and local HIEs are demanding payments that exceed their connectivity value and that some are trying to pass laws requiring providers to pay their full fee just to access state immunization registries. Epic says immunization and public health reporting should be free to users and paid for by the states, and providers in states that refuse to do so should get an exemption from those Meaningful Use requirements.
Epic urges ONC to be wary of “political agendas and commercial competition” in assessing interoperability, adding that if ONC wants to get a true picture, they should encourage health care systems to voluntarily report their interoperability statistics directly to ONC.

Also testifying at the subgroup meeting, CORHIO Executive Director Morgan Honea said one practice was quoted $50,000 to connect to its network. He also said independent providers and small health systems should get Meaningful Use money for connecting to HIEs since they have little incentive otherwise.

Tim Burdick, MD, CMIO of OCHIN, said that data are tethered to one EHR and one patient portal, giving an example of a cancer patient who has to log into the patient portals of six organizations to see her information, then send messages to the other five asking them to update their EHRs. He says that most of the 22 states in which OCHIN operates have their own technical standards and they are often outdated, vague, or impractical (example: data standards for immunization registries required 15 different interfaces.) He said that his organization struggles with connecting to specialized registries as MUS2 requires because not only is every state different, some registries are run by drug and device companies and require each participating doctor to pay a monthly fee or make them agree that the patient data they submit can be sold or used for any purpose. He says it’s hard to match Direct addresses to specific providers because some of them work for multiple organizations and it’s not clear whether each role has its own Direct address or what happens when that doctor stops working at that location. He finished by suggesting that ONC rate organizations that are using HIE best practices, which he calls “Yelp for HIE vendors.”

Reader Comments

From HIErarchical: “Re: new insurance company-sponsored HIE in California. This has CalRHIO 3.0 written all over it. The program came from the president of UCLA, where former CalRHIO head Molly Coye, MD is chief innovation officer. She has surfaced to restart what was thrown out in 2010.” CalRHIO’s ambitious California-wide RHIO plans were thwarted in early 2010 when the state created a new entity that paired CalRHIO with a competitor with whom it had fought over HITECH money. CalRHIO, like former National Coordinator David Brailer’s Santa Barbara project, talked a lot but accomplished little – it brought one county’s EDs online. The chair of the newly created Cal Index HIE, which is funded with $80 million from Blue Shield of California and WellPoint’s Anthem Blue Cross, is the president of UCLA’s health system.

From Information Governor: “Re: information governance. I’m curious whether organizations have an information governance policy as described by a recent AHIMA white paper.” AHIMA recommends that hospitals define information as a critical business asset that is managed using published standards and the appropriate resources. Two-thirds of survey respondents said their organizations haven’t developed that kind of strategy. The most interesting part to me was the information life cycle management of electronic information, including accuracy, access, protection against loss, preservation for legal holds, managing data deletion, and plan for technology obsolescence. Actually, maybe even more interesting was the section on information controls: documentation requirements, downtime planning, data definitions, software testing, how information is corrected, and how data quality is measured. The survey went out only to AHIMA members, which may have skewed the results. Leave a comment if you’d like to describe your organization’s efforts.

From Lodi: “Re: EMRs and quality improvements. You are a hospital IT person. Why do you always question study results proving that EMRs improve care?” Because the studies prove no such thing. It’s appalling to me that the people who conduct those studies, many of whom have a vested interested in being EMR cheerleaders, misstate their results as proving causation rather than correlation. Clueless reporters then add another layer of obfuscation by writing punchy but flat-out wrong headlines. I believe that hospitals using EMRs have better outcomes. I also believe that hospitals that have bigger profits, prettier buildings, cafeteria sushi bars, and showcase helicopters also have better outcomes. I’m throwing down a challenge to anyone who claims EMRs improve outcomes: show me your data.

HIStalk Announcements and Requests

Cerner handily won the vote of which EHR vendor is best equipped to support population health management, although the IP addresses of respondents suggest that a huge percentage of the nearly 1,500 votes it received came from inside the company. Cerner contacted me to say they didn’t encourage ballot box stuffing, but non-Cerner voters nonetheless left scathing poll comments upon seeing the results, one of whom suggested giving the win to Epic by default (who also had some homers clicking away, with 62 of its 216 votes.) Let’s move on to a new poll to your right or here: is it a good deal for Cerner to buy the Siemens HIT business for $1.3 billion? Vote and then click the Comments link to expound further. Add some insightful comments and I bet some healthcare publications will use the results for further articles since information is otherwise scarce.

I asked readers whether their employer requires them to share hotel rooms for group travel. The results: only 12 percent of respondents said yes, which is about the same percentage as reported in other national surveys. The numbers were the same for both vendor and provider employees. My thoughts:

Vendors theoretically save their customers money by forcing the rank and file to share rooms, but the frugality often ends when executives are involved as the lavish salaries and stock options dwarf the cost of a few hotel nights. Customer costs never go down, and it’s likely that customers of the room-sharing vendors pay just as much.
I would bet anything that company executives don’t share rooms. I’m not a fan of policies that only apply to people in the trenches.
A better option would be to book single rooms in cheaper hotels and provide group transportation to the event’s location.
The “two same-sex people should be comfortable and safe as roommates” idea is a dated concept that makes incorrect and stereotypical assumptions about sexuality and body image.
A shared employer isn’t enough reason for me to be comfortable with forced cohabitation with someone I barely know.
I’m a big fan of asking employees if they will share rooms instead of insisting they have to. That gives people who are uncomfortable with the idea for any reason a discrete way to opt out.
Lawyers would salivate at the chance to represent someone exposed to sexual harassment or violence because of employer-mandated room sharing.

Last Week’s Most Interesting News

Epic hires a lobbying firm, breaking from its long-held claim of having nobody assigned to sales, marketing, and government relations roles.
Free EMR vendor Practice Fusion raised the ire of practice customers and hopefully the awareness of other cloud-based system users in reminding those customers to insist on access to local copies of their data for downtime situations.
A survey of ACOs finds that most have only basic IT systems.
Massachusetts says it will spend more money to fix its struggling health insurance exchange website rather than move to Healthcare.gov.

Acquisitions, Funding, Business, and Stock

Cerner shares (blue) are up nearly 12 percent since the company announced that it will acquire the healthcare IT business of Siemens on August 5, but they still lag the Nasdaq (red) over the past year.

People

MModal announces that CEO Duncan James will resign from the company, which exited Chapter 11 bankruptcy two weeks ago. MModal has also brought in a new board.

Government and Politics

The New York Times reviews the government’s Medicare fraud efforts that cost $600 million per year, concluding that the 90 percent of fraud isn’t caught because HHS doesn’t manage the private recovery audit contractors it uses very well. The article says hospital pushbacks and extensive appeals have nearly completely shut down recovery efforts and cases can take up two years to get in front of a judge. It also notes that RAC bounties are so high that the companies paying fraudulent claims are sometimes the same companies paid to investigate them.

Other

I missed this: Health Information Technology Exchange of Connecticut died a quiet death on July 1, 2014 when a new state budget bill repealed the creation of several quasi-public agencies, of which HITE-CT was one. Nobody seemed to notice or care, so that probably says it all.

In Canada, B.C. Emergency Health Services drops its $2.8 million ambulance electronic patient care record a year after it was supposed to go live, saying that, ”the vendor was unable to meet our business requirements.” The vendor was Interdev Technology.

A study of 2011 California data finds that hospitals charged between $10 and $10,169 for the same lipid panel lab test. The same author previously found that the list price for an uncomplicated appendectomy prices ranged from $1,500 to $187,000. Nobody pays list prices except the uninsured, who obviously wouldn’t be able to afford the ridiculous prices even if they wanted to pay. Healthcare prices are even more irrelevant than the inflated nightly rates listed on the back of hotel room doors.

In a relevant story, a man who went to the ED of for-profit Bayonne Medical Center (NJ) to have them look at a finger he had cut days before is billed $9,000 for a tetanus shot and a bandage. The hospital’s CEO says it went out-of-network for the insurance company because of low payments and that it needs high ED charges to survive. The insurance company says the CarePoint Health-owned hospital is deliberately gouging consumers by dropping out of networks since New Jersey law requires the insurance company to pay for ED services anyway. The insurance company settled with the hospital for $6,640, and after the local TV station picked up the story, the hospital wrote off the balance owed by the patient. It’s ridiculous to put in-network verification responsibility in the hands (no pun intended) of a patient seeking emergency treatment, or to ask every employee who walks in the door whether they are in-network since hospitals always have private doctors and contractors running around who issue their own bills.

The top 10 executives at the non-profit Blue Cross and Blue Shield of Alabama made more than $1 million each in 2013, doubling their 2011 pay. The president and CEO made nearly $5 million.

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.

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News 8/15/14

August 14, 2014 News 18 Comments

Top News

A survey of 62 ACOs finds that many lack tools for risk management and patient engagement and haven’t made much IT progress in the last year. Every respondent said they have problems getting data from external organizations as they struggle with interoperability, workflow integration, and infrastructure maintenance. Few of them use secure messaging, referral management tools, self-scheduling, remote monitoring, smartphone apps, or telemedicine. Most do not coordinate care via an HIE.

Reader Comments

From Bucolic Splendor: “Re: Practice Fusion. Was down most of the day Wednesday, a major catastrophe for practices all over the country. Nobody really believes their explanation.” Practice Fusion blames its multi-day downtime on unnamed third parties, their data center partner, and a “global Internet brown-out.” Strangely, some users could access the system on their phones only, others could get on with the Safari browser but not Chrome, while some users said they could get partial access by turning off Shockwave. Users ripped the company in Facebook messages for not answering the support line and failing to provide updates as their practices sent patients home without treatment. The bottom line: get SLAs from your cloud-based vendors (so the burden of reviewing their infrastructure is theirs, not yours) and make sure you have a local information retrieval option since even Internet connectivity itself isn’t guaranteed. The cloud is great except when it isn’t and then you’d give anything to have that under-the-desk server back. Some user comments:

“I just had a consultation with a patient I only see once monthly and I had no idea what we talked about last time.”
“Don’t care about your acquisition since I can’t see my patient charts!”
“Practice Fusion deleting comments & removing unfavorable forum threads is a BAD IDEA. One step away from charging for negative reviews. Spend more time on keeping the system up, and less time combing your social rep.”
“It is amazing how many people there are out there who is getting a superb free handout and then bite the hand that feeds them. And you are supposed to be professionals. Give me a break. Go out and actually pay for another premium service. Then you will have every right to bitch when things go wrong.”
“I see lots of photos of team-building games and fun … and bravo for that … but it appears there is less emphasis, as David Stewart suggested, on building infrastructure and contingency plans. Your suggestions to have a backup server and hub do us no good when the problem in on your end.”
“We may be looking for another EMR system. I’ve been relatively happy with the program when it functions, but the lack of adequate support has challenged our practice more than once.
“Although it is free to medical provider, some huge advertisers are paying big dollars and are the ones allowing it free for us. I hope they are aware of this inconvenience.”
“For everyone that is frustrated, how long have you been with PF? How many times has it gone down? I’ve been with them for 3 1/2 years and had a total of 4 hours of unplanned down time.”
“I am OK with a Day or 2 of outages, but this is a wake up call to how much we rely on you. Next time it might be a security issue and we are helpless to do anything about it. I would feel better knowing that if there is a catastrophe, I at least have a backup that I can use to go forward with. Maybe even a paid option – like $50 a month to be able to do a daily backup to my local computer.”

From Reluctant Epic User: “Re: new Epic patent. I’m surprised the patent examiner thought that was novel for a Level of Service user interface.”

From Details … Details: “Re: Habersham Medical Center. With Meditech’s industry-leading 800+ attestations, it would seem that there might be some missing information here.” I don’t doubt that a bit – it was the client that said it was a software problem. However, they also fired the IT director, so that plus Meditech’s lack of attestation problems elsewhere seems to put the blame on the hospital.

From ShoezyQ: “Re: sharing hotel rooms. At the Allscripts user group meeting and annual sales meeting, the company requires employees to share hotel rooms. Maybe they should just send fewer people if they can’t afford the rooms. Can you ask your readers? I would never share a room with a colleague.” I’m with you. I bet Paul Black isn’t bunking up with Jim Hewitt at a Motel 6 and coordinating bathroom times, apologizing for snoring, and agreeing on the TV channel, so the policy is just for the “little people” who weren’t born with a suit on. It’s a pretty cheap company that requires employees to work a company event (which probably also means putting in a ton of excess unpaid hours away from home) and then forces them into steerage to save a few bucks. Maybe the peons could cook ramen noodles in their room’s microwave to save even more money. My strategy would be: (a) ask if you can apply your half-room cost to a single room and pay the difference for your privacy; (b) say you have sleep apnea and use a very loud CPAP machine that will keep your roomie up all night; or (c) find a new employer who values your dignity over their dollars. Meanwhile, I will ask readers as you requested: take the poll here and feel free to explain your employer’s policy via a comment.

From John Britton: “Re: Cerner acquires Siemens. I am the CIO at a medical center that uses Cerner as our primary EMR as well as their Smart Room technology. We also use Siemens MedSeries4 for General Financials (AP, MM, GL). In 2010 we became one of the first Cerner ‘smart’ hospitals when we went live with this technology in 2010. Since then, I’ve had a front-row seat to the work Cerner has done to connect medical devices to the EHR through their CareAware ecosystem. Avoiding duplicative data entry and preventing errors are some of the biggest benefits of this approach. I think Cerner’s acquisition of Siemens will only accelerate their work to connect different data sources to the EHR. It might also help get closer to realizing more comprehensive interoperability and data sharing models between disparate information platforms using initiatives currently underway like the CommonWell Health Alliance.” John is CIO of Fisher-Titus Medical Center in Norwalk, OH.

HIStalk Announcements and Requests

This week on HIStalk Practice: HHS spends precious man hours (and taxpayer money) attempting to find emails related to the Healthcare.gov rollout. ONC launches a website to collect feedback on its interoperability roadmap. HIPAA worries cause OBs to remove baby pictures from their office walls. Dr. Gregg explains how HIT leads to HID. The Healthcare Administrative Technology Association opens for business. Investors outline their attraction to healthcare IT firms in Nashville. Square’s new appointment-booking feature poses potential HIPAA concerns for small practices. Thanks for reading.

This Week on HIStalk Connect: HealthMap, a Boston Children’s Hospital and Harvard Medical School collaboration, combines public health data, Twitter data, and Google news alerts to track the recent Ebola outbreak with greater accuracy than the World Health Organization. Apple is reportedly in discussions with Allscripts, Johns Hopkins, Cleveland Clinic, and Mount Sinai to generate support for its HealthKit rollout. Validic raises a $5 million Series A round that it will use to expand its digital health integration engine and grow its customer base.

The first book written by ”CIO Unplugged” Ed Marx of Texas Health Resources will be released in late September. Watch for details of the upcoming virtual book launch for “Extraordinary Tales of a Rather Ordinary Life: How Applying Common, Everyday Principles Can Lead to Uncommon Results” on HIStalk.

Listening: new from The Gaslight Anthem, a hard-rocking New Jersey working class band that sounds like Springsteen backed by the Ramones. Also: new hard rock from the latest of several incarnations of Fuel from Henderson, TN – none of the 16 people who have played in the four-piece band’s 21-year history were in it continuously, but they always sounded good.

I had a cool customer support experience today with one of our webinar tools. I had opened a ticket since the company basically rewrote the web-based software without instructions or updates to the knowledgebase. The support rep emailed me a screen capture movie showing how to do what I needed to do, even having a little one-way chat with me as he stepped through it. It would have taken him three times as long to write out the steps instead of just turning on Camtasia or whatever capture software he used to dash off a quick video. That was both brilliant and personal, exactly what you want from a support tech.

BOSS Award Winner – Riton Khan

Several people nominated Riton Khan for the HIStalk Beacon of Selfless Service (BOSS) Award. Riton is an HISP/iNexx deployment engineer with Medicity.

Adam Rossback of the Ohio Health Information Partnership said in his nomination, “Riton spent countless hours working with me to establish HISP integration with our organization to allow 30+ hospitals to attest for July MU2 attestation.” Donna Maxey of Healthcare Access San Antonio says Riton went above and beyond his job description by working through EMR integration issues with her clients, adding, “Whenever I felt my client was stuck, no matter what the issue was, I asked for a meeting and Riton would send me a screen shot of his calendar. He allowed me to pick any open day/time that the client’s vendor was available. I have yet to work with any vendor employee that is that transparent so that my clients could get the project done on time.” Several other of Riton’s customers added their accolades.

Congratulations to Riton for his excellent work, which makes him entirely deserving of both the thanks of his customers and the BOSS Award.

You are welcome to nominate a non-management individual for BOSS Award recognition.

Webinars

Acquisitions, Funding, Business, and Stock

MedAssets will acquire consulting firm Sg2 for $142 million in cash.

Private equity firm GTCR will invest up to $200 million Cedar Gate Technologies, which it will form with former Medco CEO David Snow, who will add $20 million of his own money and serve as CEO. The company plans to “build a transformative company in the healthcare information technology industry by acquiring outstanding healthcare data and analytics businesses and accelerating their growth.” Snow is hardly an entrepreneur – he’s worked his whole career running giant insurance companies, although he’s on the board of a couple of startups.

Geneva Healthcare, which offers a pacemaker data management platform that also integrates with other medical devices, raises $1.8 million in financing.

Sales

Princeton HealthCare System (NJ) selects Premier’s integrated supply chain, performance, and technology services.

In England, West Suffolk NHS Foundation Trust signs for Cerner Millennium. I think they went live a few years ago on iSoft’s Lorenzo (now owned by CSC) as part of the now-dead NPfIT. You may infer from the hospital photo that despite having the superior healthcare system, NHS doesn’t suffer from the Edifice Complex of aggressively billing Medicare and using the otherwise restricted profits to erect huge, artistically stunning buildings whose exteriors can’t be viewed by the sick people inside their walls but that stroke the egos of the proud community and the executives in charge.

Azalea Health signs up the physician groups of two Georgia hospitals for its EHR and RCM systems, Dorminy Medical Center and Irwin County Hospital.

Wake Forest Baptist Medical Center (NC) chooses Tonic Health’s patient survey system.

National physician specialty services company Sheridan Healthcare chooses VitalWare’s iDocuMint ICD-10 code assignment and bill preparation tool for its 2,800 providers.

Basset Healthcare (NY) chooses Strata Decision’s StrataJazz as its complete financial platform.

Urology Centers of Alabama adds Greenway’s PrimeRCM revenue cycle solution, joining its PrimeSUITE EHR/PM system.

People

Louis Leibhaber (Fundamental Succcess LLC) joins WeiserMazars as director of the healthcare group.

Asif Ahmad, CEO of Anthelio Healthcare Solutions, is appointed to the board of orthotics vendor Hanger, Inc.

People Magazine profiles the family of MedAptus employee Jennifer Crowley, whose six-year-old son Padraig has been diagnosed with stage 4 neuroblastoma, the same rare childhood cancer that killed her infant son in 2006. Friends have started a fundraising page to help cover the family’s medical bills. Padraig was started immediately on chemotherapy and will have a long stay at Memorial Sloan Kettering.

Larry Covington, former CEO of Unibased System Architecture, died earlier this week at 75. Services will be next Friday, August 22, in St. Louis.

Announcements and Implementations

Allscripts will integrate Clinical Architecture’s terminology management system, Symedical, with dbMotion.

Two Texas hospitals are using Holon’s CollaborNet HIE platform in a state-developed pilot project to refer smokers to a free telephone-based smoking cessation program. Annual referrals jumped from seven to 1,254 after the single-click electronic system was put in place.

4medica announces the release of the first laboratory PHR licensed by MMRGlobal, which is curious in that paying off a patent troll is bragworthy.

The non-profit Healthcare Administrative Technology Association launches to provide advocacy and member education to practice management system stakeholders.

Impact Advisors joins the Epic-IBM team in pursuing the Department of Defense’s EHR bid.

Allscripts and Netsmart will partner to co-develop solutions for their acute care and behavioral health EHRs, respectively.

Nordic announces that it has worked with 100 Epic-using organizations, about a third of all Epic clients. That’s double the company’s 2012 total.

Government and Politics

HIMSS EHR Association responds to a request from the Senate Finance Committee asking for comments about the availability of patient data vs. the need for patient privacy. The association says the biggest barrier to using existing data effectively is lack of a patient matching strategy, although it stopped just short of suggesting implementation of a national patient identifier.

CMS reactivates its Open Payments system for reporting drug and device company payments to doctors 11 days after taking it offline. Data problems had misattributed some of the physician payments.

HHS says CMS Administrator Marilyn Tavenner inadvertently deleted emails related to the failed rollout of Healthcare.gov, explaining that she receives so many emails that she regularly hits her Outlook inbox limit and has to clear space. They added that she is supposed to forward or copy the emails for retention as the law requires before deleting emails, but she sometimes forgets. The National Archives and Record Administration says they can probably recover most of the internal emails since they would have been saved by their recipients, but those going to outside addresses may be gone for good. HHS has spent 23,000 staff hours so far trying to retrieve the emails in response subpoenas from Rep. Darrell Issa (R-CA), chair of the House Oversight Committee, so that’s a million-dollar plus delete key.

Innovation and Research

A HIMSS Analytics telemedicine study finds that … well, we don’t know what it finds since they provided a six-page teaser that only included the table of contents. That’s probably enough since the response rate was only 2.7 percent, so any generalization would be suspect.

Speaking of HIMSS Analytics, they should know better than to make this speculative leap even though clueless reporters do it constantly. They did the usual lazy test of mashing up some clinical quality data with their own EMR Adoption Medical scores and found that mortality was generally better in EMR-using hospitals. What the study couldn’t find – despite the headline stating otherwise – is that the EMR cause the improved outcomes. Why couldn’t they use the same detailed Healthgrades data and compare it to each hospital’s EMR go-live date from the HIMSS Analytics database and see if mortality improved afterward? It’s just absurd to try to claim that because EMR-using hospitals have better outcomes that the EMR should get all the credit. The same study found that sepsis mortality rates were higher in EMR-using hospitals, so if you feel an infection coming on and you believe this report, you should seek out any randomly chosen hospital that still uses paper charts.

It was love at first sight between Gartner’s Hype Cycle and me years ago. Here’s a current version, which says mobile health monitoring is about to start moving up the Slope of Enlightenment. Big data and Internet of Things are still years away from matching their hype.

The Michael J. Fox Foundation and Intel announce their collaboration to objectively analyze data created from wearable devices to determine the progression of Parkinson’s Disease.

Technology

Apple quietly adds another healthcare expert to its payroll: Divya Nag, founder of StartX Med, an accelerator to commercialize Stanford research. The beta version of iOS 8, released last week, includes support for spirometry data, an option to display medical ID on the lock screen, and health privacy options.

Other

Epic officially breaks from its long-held “no marketing or government relations” position by engaging lobbying firm Card & Associates, run by the brother of the former White House chief of staff under President George W. Bush, as it seeks the DoD’s EHR bid.

Beth Israel Deaconness CIO John Halamka says the hospital is almost ready for Meaningful Use Stage 2’s September 30 deadline, but is struggling with the 10 percent transitions of care threshold since few other providers, especially small physician practices, are capable of receiving the hospital’s information electronically. He adds, “On some days it feels that we have the only fax machine in town and thus it’s hard to fax.” That’s going to be everybody’s problem — so few providers are ready for Stage 2 that the go-getters don’t have anyone to exchange information with.

Former Allscripts CEO Glen Tullman says patients don’t want more engagement with their chronic diseases – they want less engagement so they can get on with their lives. He says that pushing patient engagement is a patronizing approach that will kill off all the technology startups that haven’t made a dent in managing illness anyway. He adds that words such as “tracking,” “monitoring,” and “intervention” are disempowering because they suggest a loss of independence and that nobody’s going to analyze their own data or look up ways to be healthier. Not everything Glen said when he was at Allscripts made sense, but this does.

An article in The Atlantic says that big data from expectant women is being used for both good and bad: good for analyzing fetal DNA to uncover genetic problems, bad because marketers are using it to find purchasers of pregnancy tests and other products so they can launch aggressive marketing campaigns that hope to turn their offspring into long-term customers. Crafty data brokers use browser cookies, page view histories, Facebook posts, and online purchasing histories to build marketing profiles that are sold to any willing buyer. An example is the father who complained to Target that sending coupons for maternity clothing to his daughter encouraged teen pregnancy, only to find that Target knew something he didn’t: she was already pregnant.

Torrance Memorial Physician Networks blames its EMR for allowing one of its doctors to code “homosexual behavior” in a male patient’s problem list. The patient, who is suing the doctor and practice for emotional distress and libel after seeing the entry in his chart after the hospital said they would remove it, says the doctor argued that the medical community is still not sure whether or not homosexuality is a disease. The man’s chart was coded with ICD-9 code 302.0, “ego-dystonic sexual orientation,” a code that was retired in 1987 to describe someone who’s unhappy with their sexuality. According to a spokesperson, “Due to the highly complex software used in creating an electronic medical record, the incorrect code continued to exist in an electronic table only. As a result, this incorrect diagnosis code was included on a paper copy of the record, which was provided only to the patient.”

It’s surprising how much technology is being developed around the medical marijuana industry, but then again the financial alignment is clear. A radiologist and clinical owner develops CannaScan, a real-time, cloud-based validation system that allows Massachusetts police departments to verify that people found with marijuana have been issued a valid prescription. Massachusetts doctors were previously charging patients for ID cards, which the Department of Health found unethical, leading to CannaScan’s claim that it allows the “Good Guys to Weed Out the Bad.” The doctor says the software allows better care coordination and real-time patient management since it supports videoconferencing, scheduling, and notifications, or as he calls it, “A Clinic in the Clouds.”

Weird News Andy utters one of my favorite Monty Python lines in titling this article “I’m not dead yet.” A hospital in Australia apologizes for faxing death notices for 200 still-breathing patients to their family doctors, saying someone accidentally changed the templates involved. At least it’s not just the US healthcare system that’s keeping long-abandoned technology such as pagers and fax machines alive.

WNA also likes a story he calls “a knife on his mind.” A man in China taking a stroll feels pressure in his head, not realizing the cause until a shopkeeper points silently at the five-inch kitchen knife protruding from his skull. It had fallen from the balcony of a high-rise. He’s OK.

Sponsor Updates

NextGen describes the three tiers of the Patient Centered Medical Home.
The Meditech Solutions Group within Dell adds DataMotion Direct secure messaging to its portfolio of services.
CompuGroup Medical US and Teche Action Clinic (LA) team up to celebrate the 2014 National Health Center Week.
Levi Ray & Shoup announces the release of its Virtual Session Printer Agent.

EPtalk by Dr. Jayne

I attended a CME seminar this week which was actually pretty fun. It was good to get away from the grind of the IT world and remind myself why I became a physician in the first place.

Although most of us continue to have grumbles about payers, conflicting recommendations, and of course EHRs, we also have great stories about our patients and what it means to care for them. The course was on delivery of culturally competent care, which is pretty far away from what we usually deal with in the IT trenches.

Several of the physicians I met were interested in the fact that I gave up a busy solo practice to go into the world of IT. Many were from cities of a size that they may not have dedicated physician IT resources and were interested in how they could get more involved in the decisions that impact their practices and how they care for patients. Most were employed, although there were a few solo holdouts.

A couple are in direct-pay practice situations which I think is a very interesting solution to many healthcare issues. The patient sees the doctor, a fee is assigned, and the patient pays. If the patient wants to submit to insurance, they are given information about the visit so they can self-file. Although one uses EHR, the others don’t. All of them have opted out of Medicare and Medicaid. At least for now, all are happy.

It was strange to talk to physicians who aren’t dealing with MU attestation or the risk of audits. That’s become so much of our world lately. It was invigorating to see whether the grass is greener on the other side or not. I’m not interested in hanging up my IT hat, but I certainly would consider that model if I went back into a continuity-type primary care practice. It reminds me of the physician I saw when I was a kid.

Of course not being connected has its disadvantages. I don’t think I’d take it that far. I like the benefits of EHR too much to go back entirely.

Speaking of e-prescribing, I mentioned that I enrolled in the free Allscripts eRx product through the National ePrescribing Patient Safety initiative. Although the registration process was easy, I still am not set up to e-prescribe. Apparently they need to verify my NPI number. First they asked me to fax proof of my NPI, which I don’t have – I don’t have the original enumeration letter from way back when. I also don’t have a fax machine.

I asked if I could email it. They said yes, but again I need to provide proof. They helpfully directed me to a website where I could look myself up and find my NPI number, which I already knew and submitted to them. I’m not sure why they couldn’t go to that website and verify that the number I provided matches my name, but instead sent me 12 emails and called the office multiple times to tell me to go take a screenshot of a public website and email it to them.

I was finally able to find time to do that and sent it off, so hopefully they’ll get me set up soon. In the meantime, the system isn’t that useful since we don’t have a demographic interface to it and everything has to be manually keyed. Looks like I’ll be going back out to look for other vendors regardless of the outcome with the NPI.

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From The Grey Goose: “Re: Allscripts user group meeting in Chicago. My kind of town! Check out this view from my hotel room.” I wasn’t sure initially if this picture was real or from a postcard, but I can only hope I have such a great view when I’m in town for HIMSS. This will be an interesting HIMSS for me since we’re in the middle of consolidating our systems. By the time it rolls around, we’re likely to be under contract with a new vendor. That will put a whole new spin on things.

The Allscripts user group meeting is in full swing and purports to have a Thursday night client event with bands Styx and The Gin Blossoms performing. Sounds like a great time and I hope some of the attendees share pictures. I’m off to the airport now. It will be good to sleep in my own bed before handling the torrent of emails that flooded in while I was away.

What’s your favorite vendor user group client event? 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.

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News 8/13/14

August 12, 2014 News 3 Comments

Top News

The White House creates the US Digital Service, a new program that will recruit the “country’s brightest digital talent” to provide strategic guidance on major IT projects like Healthcare.gov and iEHR. Mikey Dickerson, an ex-Google engineer credited with saving Healthcare.gov, has been tapped to run the service. As a deputy federal CIO, he will work with similarly titled Lisa Schlosser in her role of policy, agency oversight, and accountability. The new service will ultimately consist of 25 experts brought in on two- to four-year term appointments to help agencies plan, improve, and fix IT programs. It will be financed with existing funds in 2014, and scale in 2015 as outlined in the President’s FY 2015 budget.

Acquisitions, Funding, Business, and Stock

Cerner jumps to the top spot of the Kansas City Business Journal‘s Top Private-Sector Employers List due in large part to the addition of 1,550 local employees in the past year. That’s not counting the 16,000 it will need to hire to fill its planned $4.5 billion Three Trails Campus, or the unknown number it may create in the coming years as a result of the Siemens acquisition.

National staffing company Jackson Healthcare acquires Sullivan Healthcare Consulting, which focuses on improving the performance of the hospital perioperative suite through surgery benchmarking, scheduling, staffing, sterile processing, and surgery IT implementation. SHC will serve as a complementary service line to Jackson Healthcare operating companies Premier Anesthesia and Jackson Surgical Assistants.

Hospital administrators at Emerson Hospital (MA) attribute the facility’s operation-margin gains and service-line upticks to an increase in outpatient services. Though IT upgrades in the mammography department have led to the need for fewer patient visits, referrals from other places for Emerson’s new, higher-quality mammographies have made up for the decline.

Healthcare IT firm Priority Consult acquires business intelligence and analytics software developer Balanced Insights to form Cordata Healthcare Innovations. The new company will use Balanced Insight’s technology as a starting point for a new generation of patient navigation and tracking applications. Priority Consult president and CEO Gary Winzenread will serve as Cordata’s president and CEO, while Balanced Insight founder and CEO Tom Hammergren will serve as CTO.

Population health and workflow technology company Acupera secures $4 million in financing from Lightspeed Venture Partners. It will use the Series A funding to scale its product development team and add to its customer implementation group.

People

Travis Crenshaw (United Surgical Partners International) joins Foundation Healthcare Inc. (OK) as CIO.

Announcements and Implementations

University of Colorado Health selects Zix Email Encryption to provide consolidated, secure email to 18,000 users across its system, which includes University of Colorado Hospital, Memorial Health System, and Poudre Valley Health System.

Allegheny Valley Hospital (PA) becomes the first in the state to equip its paramedic team with iPads. The pilot project has so far enabled AVH ER physicians to observe 12 patients on their way to the hospital. The hospital paramedic team will present the results of the project to the Pennsylvania Department of Health, which is considering rolling out similar programs across the state.

Providence Medical Center (KS) selects the GroupOne Health Source One Rate platform of medical billing and EHR implementation services for 40 of its providers. PMC will use the OneRate platform to facilitate integration of physician practices into its multi-specialty network across the greater Kansas City area.

UnityPoint-Allen Hospital and Black Hawk-Grundy Mental Health Center in Iowa announce they will begin electronically sharing patient records early next year.

St. Joseph Mercy Health System launches a telemedicine service from MDLive that provides real-time physician appointments 24 hours a day, seven days a week via video, phone, or app. Patients are connected with a SJMHS or MDLive physician who can offer treatment evaluation and advice, and e-prescriptions.

Halifax Regional (NC) launches the HalifaxHealthLink patient portal, which follows the successful rollout of the FollowMyHealth portal for patients of Roanoke Clinic, Roanoke Valley Internal Medicine, and Halifax Regional Cardiology.

The Willis-Knighton Physician Network (LA) selects InteliChart’s Enterprise Patient Portal to serve as a single portal solution for its system of network clinics. Physician Network Administrator Greg Gavin noted that “[a] vendor-neutral patient portal that provides a single source solution for our patients as well as a consistent brand across the entire Willis-Knighton System were top priorities in selecting a solution” to improve communication, coordinate care, and facilitate patient healthcare goals.

Government and Politics

ONC launches a website designed to collect feedback on its proposed interoperability roadmap. Stakeholders have until September 12 to provide their thoughts and comments, after which ONC will present aggregated feedback to the Federal Advisory Committee for its input and recommendations. An updated version of the roadmap will be posted for public comment early next year.

Research and Innovation

Creative England announces a £1m fund for small and medium enterprises in the North, Midlands, and Southwest regions designed to stimulate creative and digital innovation in UK healthcare. Four new programs will open as part of the fund. The first is the West Midlands Interactive Healthcare Fund, which will offer five £50,000 investments to support projects that focus on improving quality of care, caring for people with dementia, supporting people with long-term conditions, and data visualization. Applications will be assessed on a rolling basis and the fund will close on Oct. 31, 2014.

A new report finds that using a touchscreen EHR to support and monitor a national antiretroviral therapy program in Malawi faced challenges similar to that of EHR adoption in the U.S.:

Implementing a point-of-care EHR has been more challenging than initially anticipated.
The success of a POC system ultimately depends as much on a commitment from system users as on the technologies employed.
Poor adherence to system use will result in incomplete data.
Health workers will not adopt a system if they do not find sufficient value in it. Consequently, the primary challenge is to identify and address the value proposition for the user. This is an iterative process that requires a commitment to regular and ongoing dialog with the users if this paradigm shift to POC system use is to be sustainable.

Technology

Reports surface that Apple is in HealthKit development talks with providers at Mount Sinai, Johns Hopkins, and the Cleveland Clinic, as well as with Allscripts. Cleveland Clinic CIO William Morris says the clinical solutions team is experimenting with HealthKit’s beta and is providing feedback to Apple. Representatives from the other three organizations have not yet chimed in.

Simple Medical Software Inc. releases the SimpleRounds app to help providers better communicate and collaborate on patient care. Developed by SMS founder Rubén Zamorano and Manuel Martinez, MD the app features secure text messaging, billing manager, physician directory, rounds manager, patient census, and sign-out manager.

Other

The local paper highlights the new $1.3 billion Parkland Memorial Hospital, one of the first “digital hospitals” in the U.S. The hospital, set to open in May 2015, will feature $80 million worth of digital technology including touch-screen way finding kiosks, smart beds, baby tracking devices, and hand-held communication devices for nurses, as well as an integrated digital system controlling nearly every aspect of its operations. CIO Fernando Martinez points out the hospital will be similar to a smart home: “All the digital devices in a smart home can talk to each other because they’re connected to a common hub. That’s not unlike what we do, only we’re much bigger.”

Irish health service officials find that the number of patients waiting more than a year for hospital treatment surged 600 percent between December 2013 and May 2014. They have not formally addressed the spike, but have noted they are addressing the issue “in the face of significant financial challenges.”

Jersey City Medical Center (NJ) reveals that a computer disk containing 2011 Medicaid patient information was lost in June when a package sent via UPS failed to arrive. The unencrypted disk contained an undisclosed number of patients’ names, and many of their Social Security numbers and birth dates.

This article highlights the success of the Maryland Chesapeake Regional Information System for our Patients (CRISP) HIE, which has seen patient searches by providers jump from under 10,000 in late 2012 to nearly 55,000 as of last month.

Sponsor Updates

Capsule discusses why timing is everything with vital signs.
Rochester Regional Health Information Organization (NY) and HealtheConnections RHIO of Central New York are live on eHealth Technologies’ Image-Enabled Results Delivery.
The Advisory Board Company offers its ready-to-present slides on the surgical services market trends for 2014.
OhioHealth upgrades its Infor Cloverleaf solution to V6.0.
Aventura client Hunterdon Healthcare System’s Greg Melitski will explain how they met their ED workflow challenges at the Optum Client Forum in Chicago, August 18-21.
Streamline Health is participating in the Allscripts ACE 2014 Conference, which kicks off today.
Wolters Kluwer ProVation offers a white paper entitled “ICD-10: The Gift of Time.”
Black Book names Allscripts “Best of the Best” Ambulatory EHR vendor for interoperability.

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.

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