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Monday Morning Update 11/17/14

November 15, 2014 News 2 Comments

Top News

EHealth Initiative releases its “2020 Roadmap” as a preliminary private sector alternative to the federal government’s Meaningful Use agenda, obviously sensing as others have that ONC’s rapidly decreasing influence will leave a power void in the industry. Some of its points, all of which are aimed at the federal government:

Reward providers for outcomes (quite a few of the proposed activities involved incentive payments, with no suggestion that the federal handouts be curtailed).
Focus federal policy on interoperability.
Simplify quality measurement programs and standardize measures for quality, cost, patient satisfaction, and value.
Hold the October 2015 ICD-10 date firm.
Push Meaningful Use Stage 3 back.
Focus federal policy on the minimum necessary data requirements to manage the health of individuals and populations.
Encourage HISPs to publish their provider address directories.
Encourage the use of APIs to support core functions.
Put more emphasis on Direct-based capabilities, including awareness.
Encourage the use of REST and FHIR.
Shift EHR certification to measure what the market wants, including interoperability, safety, and security.
Consider post-acute and behavioral health providers in interoperability programs.
Help define the elements of a nationwide interoperability ecosystem, help overcome privacy and security barriers, and use government purchasing and regulatory clout to advance interoperability.
Align federal interoperability efforts across the DoD, VA, NIH, FDA, and CDC.
Improve patient and data matching capabilities.
Study the costs and benefits of letting patients control the use of their own information.
Create a data breach policy guidebook and a trust framework.

HIStalk Announcements and Requests

Nearly half of the respondents to my poll have withheld information from a provider because of medical records privacy concerns. New poll to your right or here: why did you leave your last job? You can elaborate further after voting by clicking the poll’s comment link. I especially like stories involving management incompetence since I’ve seen plenty of that.

Last Week’s Most Interesting News

The Institute of Medicine recommends adding 17 new mandatory patient social history data collection items, such as financial resources and social connections, to EHRs via the Meaningful Use program to give researchers more insight into social determinants of health.
UCSF School of Medicine Professor Bob Wachter, MD adds his voice to those calling for ONC to either be refocused on interoperability or shut down.
The UK’s Department of Health issues a broad and bold patient-focused health IT plan covering the next several years.
Reuters reports that the Federal Trade Commission is reviewing how Apple’s HealthKit manages and shares user health information, adding that Apple is considering hiring a health privacy expert.

Webinars

November 18 (Tuesday) 1:00 ET. Cerner Takeover of Siemens, Are You Ready? Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The Cerner acquisition of Siemens impacts 1,000 hospitals that could be forced into a “take it or leave it” situation based on lessons learned from similar takeovers. This webinar will review the possible fate of each Siemens HIS product, the impact of the acquisition on ongoing R&D, available market alternatives, and steps Siemens clients should take to prepare.

November 19 (Wednesday) 1:00 ET. Improving Trial Accrual by Engaging the Digital Healthcare Consumer. Sponsored by DocuSign. Presenters: B. J. Rimel, MD, gynecologic oncologist, Cedars-Sinai Medial Center; Jennifer Royer, product marketing, DocuSign. The Women’s Cancer Program increased trial accrual five-fold by implementing an online registry that links participants to research studies, digitizing and simplifying a cumbersome, paper-based process. This webinar will describe the use of e-consents and social marketing to engage a broader population and advance research while saving time and reducing costs.

Recent webinar videos on YouTube:

Keeping it Clean: How Data Profiling Leads to Trusted Data

3 Ways to Improve Care Transitions Using an HIE Encounter Notification Service

Acquisitions, Funding, Business, and Stock

Siemens says it will keep its healthcare unit, ending speculation that it wanted to sell that business as it did its healthcare IT and hearing aid divisions.

Cleveland Clinic creates a company and website to distribute its self-developed software and technology developed by the academic medical centers in its Healthcare Innovation Alliance.

Sales

Mercy chooses Emmi Solutions to provide patient information tools.

People

UnitedHealth Group announces executive changes that include adding to the duties of its Optum division CEO Larry Renfro, who was named vice chairman of UnitedHealth Group in charge of strategic and key client relationships. His responsibilities include OptumInsight, which is the software and consulting part of the business.

Ross Martin, MD, MHA tweeted out this picture from Sunday’s Fun Run at the AMIA annual meeting in Washington, DC. In the photo are Ross (AMIA), Danny Sands,MD (BIDMC), Tom Payne, MD (UW Medicine), and Bill Hersh, MD (OHSU).

Also from the AMIA conference: John Glaser of Siemens receives the William W. Stead Award for Thought Leadership in Informatics.

Announcements and Implementations

ONC released its 10-year plan Thursday. While it captured at a high level some of the same ideas expressed in eHealth Initiative’s “Roadmap 2020” report, it was less prescriptive and more self-congratulatory. I didn’t find much interesting in it other than its intention to define common data elements and to create a feedback loop between EHR-collected information and published quality information. The UK’s Department of Health digital strategic plan was a lot more interesting and patient focused than either of these in my mind.

Baystate Health (MA) opens the TechSpring healthcare IT incubator where it will work with vendors such as Premier and Cerner, funded by a $5.5 million grant from the Massachusetts Live Sciences Center.

Vanderbilt University will move Vanderbilt University Medical Center into a financially separate organization that can “act nimbly and more independently in a rapidly changing healthcare environment.”

Healthcare IT companies making the Boston Globe’s “Top Places to Work” list include Kronos, athenahealth, Philips, NaviNet, Imprivata, and Park Place International.

Wolters Kluwer Health launches the Consumer Education Center, which allows providers to create their own consumer health information website using the company’s medication handouts, drug interaction checker, and drug identification tool.

Government and Politics

A Securities and Exchange Commission investigation finds that CMS employees apparently tipped off investment firms that Medicare was about to increase provider payments 19 months ago, sending insurance company shares soaring two days before the decision was announced publicly. Investigators found that at least 456 CMS employees knew about the increase beforehand and believe that 44 investment funds made trades based on the information insiders provided. An internal CMS email says CMS struck a deal to raise Medicare Advantage payments in order to get Marilyn Tavenner confirmed as CMS administrator.

Meanwhile, a Washington Post investigation finds that HHS paid MIT economist Jonathan Gruber $400,000 to help design the Affordable Care Act even as the White House cited him as an unbiased expert who supported its plan. HHS paid him another $2 million to review Medicare’s prescription drug program. Gruber is best known for his comments from several recently discovered videos, including, “If you have a law that makes explicit that healthy people pay in and sick people get money, it wouldn’t have passed. Lack of transparency is a huge political advantage and basically call it the stupidity of the American voter or whatever … This bill was written in a tortured way to make sure the CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies.” Gruber help design the Massachusetts reforms that inspired the ACA, of which yet another video captures him saying, “The dirty secret in Massachusetts is the feds pay for our bill … Ted Kennedy … and smart people in Massachusetts had basically figured out a way to sort of rip off the feds for about $400 million a year.” The New York Times says at least CBO was clear on providing guidance on how to write the ACA legislation “in order to not move trillions of dollars of healthcare expenditures onto the federal budget.”

Technology

Reuters reports that early Google Glass developers and users appear to be losing interest in the product, which is still in beta with no announced rollout date. Of 16 Glass app developers, nine abandoned their projects because of poor business or device limitations, while three that were working on consumer apps refocused on businesses. Several key Glass developers have left Google and a funding consortium of high-profile VCs appears to have shut down.

Other

A Wharton School African forum called “Can Technology Enable Healthcare for All?” finds that simple technologies could improve poor conditions, such as giving expectant mothers cell phones and tracking vaccines with barcodes. A speaker said that Kenya Airways quickly deployed technology and protocols to limit the spread of Ebola, with a result of “Ebola is actually more feared in New York than Nairobi.”

The Columbus, MS paper describes the iPad-powered EHR created by local dentist Patrick Singley, DMD (on the left in the photo above) for his medical mission trips to underdeveloped countries. He has formed a non-profit organization and is offering the system to other groups.

In the UK, Cambridge-affiliated Addenbrooke’s Hospital says rumors of widespread problems with its $300 million Epic IT system are false, but admits a patient’s on-screen OR record was missing information and that surgeries have been postponed due to problems with blood transfusion analyzer interfaces.

“Remote Area Medical,” a film covering the non-profit volunteer medical relief corps of the same name, opens in New York on November 28 and nationwide December 5. It focuses on a single three-day clinic held at the Bristol Motor Speedway in Tennessee. Remote Area Medical was founded by former “The Wild Kingdom” host Stan Brock in 1985 to provide free medical clinics. Most of its work is in its home state of Tennessee, which is apparently the only state that allows volunteer doctors licensed in other states to practice.

Boston Magazine runs a feature on the completely solar powered 1966 Volkswagen Bus of Daniel Theobald, co-founder and CTO of patient check-in system vendor Vecna Technologies. He chose that particular vehicle to convert because it’s a “big open box” for experimentation and it was large enough to hold his wife and their seven children.

Sing along with Weird News Andy: “I am stuck on the MRI ‘cause the MRI’s stuck on me.” Two hospital employees in India are injured when one of them brings a patient’s oxygen tank into an MRI room, pinning both employees to the giant magnet for four hours as staff tried to turn it off. The hospital blames GE Healthcare for what it says was a malfunctioning switch.

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 11/14/14

November 13, 2014 News 7 Comments

Top News

The Institute of Medicine urges ONC and CMS to add additional social and behavioral health measures to EHR certification and Meaningful use criteria to allow researchers and health systems to uncover determinants of health. The unshaded items on the list above, involving 17 patient questions, would be new for most providers.

Reader Comments

From Flatus Maximus: “Re: ONC’s data matching project. I can’t believe that ONC thinks that these two (or anyone, for that matter) can solve this problem in two years given the huge legal an policy issues. I don’t think ONC understands that this is a socio-technical problem that requires more than a technology fix.” ONC and HIMSS bring in two people to solve the patient identity matching problem via HHS’s “Innovators in Residence” program that temporarily hires technologists to fix specific problems. Hired were Catherine Costa, RN (marketing director at PatientPoint) and Adam Culbertson (NIH biomedical informatics fellow). Political reality takes the obvious answer off the table: a unique consumer ID with biometric verification.

HIStalk Announcements and Requests

This week on HIStalk Practice: The Massachusetts eHealth Institute offers grants to spur EHR adoption among behavioral health and long-term care providers. New York inches closer to becoming the largest HIE in the nation. SCHIEx and GaHIN launch one of the first state-to-state HIE connections. Billings Clinic implements vein scanners. Envision Medical Group selects new Aprima RCM services. Florida Heart & Vascular’s IT Administrator details the tough time they’ve had with EHRs.

This week on HIStalk Connect: The Nokia Health Sensor XPRIZE competition concludes, with DMI Diagnostics taking the $525,000 grand prize. Samsung opens its SAMI health data SDK service to developers and showcases its new open design Simband prototype. Two Singularity University grads raise $12 million to launch a machine learning-backed population health platform. Ginger.io announces a handful of new research partnerships that will test its behavioral health app within a variety of remote patient monitoring initiatives.

Acquisitions, Funding, Business, and Stock

Australian telecommunications company Telstra’s health division acquires 2 percent of New Zealand-based Orion Health prior to Orion’s upcoming IPO that values the company at $725 million.

MMRGlobal, which makes a lot of its money licensing (via nuisance vendor infringement lawsuits) its PHR and other medically related technology, took in nearly $2 million in the most recent quarter, up 1,584 percent over last year. I interviewed CEO Bob Lorsch last year and asked him some pointed questions about the company’s business model – you can decide what you think about it.

Xerox invests in telemedicine kiosk vendor HealthSpot and will provide it with cloud hosting, system integration, and claims processing services.

The Portland, OR business paper highlights the $150 million venture fund of Providence Health & Services, which is looking for healthcare startups in telehealth, wearables, clinical applications, and e-commerce that seek up to $5 million. The fund is finishing due diligence on four unnamed companies. The fund’s partner explains, “The point isn’t just financial. Our chief investment officer could buy bonds. Our goal to make products and services that help our community, our patients, our members and providers.”

IBM invests an unspecified amount from its Watson investment fund in genetic testing company Pathway Genomics, which will develop a Watson-powered mobile app that will answer a consumer’s health questions by analyzing information from their wearables, genetic markers, and electronic health records.

Sales

Baylor Scott & White Health selects McKesson’s Performance Analytics, Analytics Explorer, and Pay-for-Performance for financial analytics.

City of Health and Science University of Turin, Italy chooses InterSystems TrakCare.

Wellmark Blue Cross and Blue Shield (IA) will implement employer reporting from MedeAnalytics.

Presbyterian Medical Services (NM) selects the analytics platform of Lightbeam Health Solutions.

Christus Health signs a five-year extension with Strata Decision Technology.

NantHealth licenses Streamline Health’s Looking Glass analytics to track populations and compare clinical effectiveness.

MaineGeneral Health (the combined words represent their conceptual mistake, not my typographic one) renews its Allscripts Sunrise and TouchWorks agreements and adds FollowMyHealth.

People

Nordic Consulting CEO and co-founder Mark Bakken will leave the company to start a venture capital fund in which he and Nordic will invest.

Ed Kopetsky, CIO of Lucile Packard Children’s Hospital Stanford (CA), receives the Distinguished Achievement Award of his alma mater, University of Wisconsin-Madison and its College of Engineering.

Allina Health announces that CEO Ken Paulus will retire at the end of the year, with President and Chief Clinical Officer Penny Wheeler, MD replacing him. She’s done quite a bit of work with their Epic and data warehouse systems.

Announcements and Implementations

Named to Deloitte’s “2014 Technology Fast 500” are DrFirst, Etransmedia, Imprivata, InstaMed, Kareo, Liaison Technologies, Qlik, VMware, and ZeOmega.

Silver Hill Hospital (CT) implements QPID Health’s Cohort App to product HBIPS behavioral health quality metrics and will work with the company to deliver a behavioral health portal.

Billings Clinic (MT) goes live on patient identification via palm vein scanning using technology from PatientSecure that is integrated with its Cerner system.

The medical school of Mount Sinai (NY) enrolls its first patient in a televideo-powered prostate cancer clinical trial, working with real-time patient management solutions vendor AMC Health.

The state HIEs of Georgia and South Carolina connect to each other with the help of technology partners Truven Health Analytics and CareEvolution.

Healthgrades launches a new version of its doctor search site that uses claims data to show users the level of experience a doctor has with a given procedure or diagnosis.

Intel-GE Care Innovations announces Health Harmony, a remote patient monitoring platform that aggregates information for clinician review and helps them collect the new $40 per month Medicare payment for chronic care management. The joint venture was started in January 2011. Only one executive remains of its original 10-member management team.

Novant Health (NC) joins the federal eHealth Exchange, adding that so far this year it has shared 148,000 patient records via Epic’s interoperability as well as a total shared record count of 38 million this year.

Government and Politics

UCSF School of Medicine Professor Bob Wachter, MD says the “accidental” Meaningful Use program has achieved its goals of putting stimulus dollars on the street and increasing EHR use, but says that Meaningful Use Stage 2 is an indication that ONC should be put out to pasture once it has handed out its remaining incentive money. He says it’s time to declare victory, move Meaningful Use toward encouraging API-driven interoperability, and let quality and clinical demands rather than government checklists drive the technology market.

CMS releases three free ICD-10 education resources that offer CME and nurse CE credits.

In the UK, the Department of Health’s National Information Board creates a wide-ranging, technology-focused policy draft covering digital health over the next several years. Highlights:

EHRs are used by 96 percent of doctors, but only 4 percent of them allow patients to see their information. All will be required to offer patient access by April 2015.
Technology has had minimal impact on the patient experience.
Interoperability is a big problem, as hospital systems are “impenetrable” and little electronic information exists for nursing home and hospice patients.
Hospitals and practices don’t integrate their services with mental health and social care.
Digital services should be the default delivery channel, with services such as appointment booking and prescription refill requests combined into a single information platform (an extension of NHS Choices) that requires citizens to verify their identity through the Government Digital Services IDA program.
Health-related apps and devices should be nationally accredited and service marked to encourage their adoption
Specifications will be published by April 1, 2015 for accessing NHS’s core systems, such as Spine and e-referrals.
NHS England will pilot technology in which patients will hold their electronic records and a personal budget.
A national pilot will give consumers a PHR that they control that is also available in real time to clinicians, which will also include their end-of-life preferences.
NHS will seek universal adoption of its healthcare ID number, which was introduced in April 2014 as the primary identifier in clinical correspondence.
NHS will propose that clinical systems adopt clinical structure standards developed by the Academy of Royal Medical Colleges.
The entire health system will adopt SNOMED CT clinical terminology by April 2020, while additional work with semantic web technologies will be undertaken.
NHS England will develop a standard for adopting the GS1 identification standard of patients, products, and places as well as RFID tagging.
NHS will reduce the number of organizations that collect patient information for purposes other than clinical care, moving by 2020 to process that requires patients to consent to having their data shared.
The Department of Health has created the role of National Data Guardian for health, which will lead efforts inform patients where their data has been used and the benefits they received as a result. Named to the role is Dame Fiona Caldicott, chair of the Oxford University Hospitals NHS Trust and a psychiatrist whose government-created committee reviewed the protection and use of patient information in 1997.
Technology made available under the General Practice Systems of Choice will be more selectively targeted to encourage integrated services, SaaS-based systems for new providers of primary care services, and innovative systems for non-hospital services.
IT investment will shift to investments that support older citizens, those with chronic conditions, and those being cared for informally.
NHS England will decide with the GPSoC contract ends in April 2018 whether it should continue or whether PCP payments should be increased to let them buy whatever systems they want as long as they meet data standards.

Also in England, the $6 billion fund created to reduce ED visits and readmissions of elderly patients is declared a “shambles” by auditors who say it probably won’t save NHS even one-third of the original $1.5 billion estimate.

A Reuters report says that the Federal Trade Commission has been meeting with Apple for several months to make sure the health information contained in HealthKit and Apple’s upcoming smart watch will be managed appropriately and not shared with third parties as was found to be the case with health and fitness apps from other companies. Sources say Apple is considering hiring a health privacy czar.

Innovation and Research

A study of Pennsylvania’s mandatory hospital patient safety reporting database finds that “advanced EMRs lead to a 27 percent decline in patient safety events.” I was predisposed to not liking the article because its overly cute title asks a question rather than states a conclusion (“Saving Patient Ryan – Can Advanced Medical Records Make Patient Care Safer?”) and its regurgitative academic meandering goes on for 40 painful pages. However, I originally assumed the authors didn’t look at individual hospital performance pre- and post-EHR, but I asked an expert in statistics to wade through the endless graphs and methods to tell me and he says they did, which is admirable. That still leaves a few weak links – underreporting of errors, failing to distinguish between how individual EHRs were implemented, and non-EHR confounders that make proving causation difficult – but overall it seems to be pretty solid as long as you trust the HIMSS Analytics database, which was built for selling data to vendors for marketing rather than research.

Other

India-based hospital chain Narayana Health, best known for performing high-volume and low-cost heart surgeries, opens Health City Cayman Islands in a joint venture with Ascension Health. It expects the 108-bed hospital, its first outside of India, to expand to 2,000 beds as it capitalizes on a location near (but not in) the US for medical tourism. The hospital chain prices its services in flat rate bundles and sends the patient a single, all-inclusive bill. The Cayman Islands hospital has a sophisticated EHR, its clinicians use Google Glass and smart watches to review information and communicate with patients as they round, and (most interesting to me) every patient gets a mobile tablet that is updated with their most current information. The chain is also a big user of telemedicine, where India-based command center doctors monitor patients all over the world. Health Catalyst created the video above that includes a profile of Narayana Health’s founder, philanthropist and cardiac surgeon Devi Shetty, called “the Henry Ford of heart surgery” by the Wall Street Journal. He also designed a comprehensive health insurance plan for poor farmers in India that costs 20 cents per month.

An interesting survey finds that Americans are increasingly worried about their electronic privacy, yet continue using the services they distrust (social media, text messaging, email, and cell phones) because they don’t see an alternative. They’re also willing to give up privacy in return for getting something free, such as providing personal information to use a website.

Texas Health Resources apologizes, creates a memorial fund, and pays an undisclosed settlement to the family of deceased patient Thomas Duncan for discharging him from its ED without making an Ebola diagnosis. Meanwhile, Duncan’s fiancée signs a book deal.

The former CFO of Shelby Regional Medical Center (TX) pleads guilty to falsifying the hospital’s Meaningful Use attestation in November 2012, earning it a $785,655 CMS payment. He faces up to five years in federal prison. The CFO, who rose from the position of maintenance worker, claimed the hospital used EHRs when in fact it remained mostly paper-based and entered minimal EHR information after discharge. He attested using the Social Security number of another employee who refused to put his own name on the form. The for-profit hospital, since closed, was one of six owned by Tariq Mahmood, MD, who was involved in the scheme and was found guilty in July 2014 of healthcare fraud, identity theft, and conspiracy. He threatened to fire coders who declined to falsify diagnosis codes and hand-wrote his own additions to patient records to maximize billing. The six hospitals were paid $18 million in HITECH money despite ongoing allegations of fraud from former administrators going back to 2008. CMS didn’t even know Mahmood owned multiple hospitals.

Spartanburg Regional Healthcare System (SC) celebrated Veterans Day by honoring 240 of its employees, volunteers, and contractors who are veterans. VP/CIO Harold Moore (second from left) was among the executives serving lunch. It looks like barbeque given the squirt bottles of what could be the mustard-based South Carolina style sauce that isn’t my favorite, but the picture wasn’t clear enough for definitive zooming.

Niko Skievaski polls some of his fellow Epic alumni to determine why they left the company, with results that aren’t too surprising since they are similar in most places: lack of work-life balance, technicians with poor people skills who are promoted into management, and lack of company appreciation. Meanwhile, copies of Niko’s “MU2 Illustrated” art book have arrived from the publisher and are ready to ship. His projects are often fun, marginally commercial, and reflective of his youthful optimism, so Lorre contributed some art and I wrote the book’s foreword. We’ll probably have a virtual launch party or something just for fun and maybe invite him to sign books at our microscopic HIMSS booth.

Weird News Andy gestated this story that makes his heart go pitter-patter. Doctors at a Florida hospital perform CPR for three hours trying to resuscitate a woman who had an amniotic fluid embolism (which has a fatality rate of at least 25 percent, up to 90 percent in some studies) during an otherwise successful C-section. The team called the family into the room to say goodbye after 45 minutes of a flat-line ECG, but just as they were pronouncing her, she spontaneously revived. The baby is fine and the mom is not only alive, but miraculously free of brain damage.

Sponsor Updates

MediQuant’s employees launch a fundraiser to help build a school in Sierra Leone, with a goal of $5,000. A fundraiser will be held tonight (Friday) in Broadview Heights, OH and donations are being accepted. Company President Tony Paparella spent two years as a Peace Corps volunteer in Sierra Leone and will personally match the funds raised. Tony also plays harmonica in the company band The DeCommissioners and their “Legacy System Blues.”
First Databank informatics pharmacists Joan Kapusnik-Uner, PharmD and George Robinson, RPh will present sessions on pharmacy informatics and drug terminology standards at AMIA’s Annual Symposium November 15-19 in Washington, DC.
TeraMedica will debut Evercore 6.0, the latest version of its vendor-neutral archive, at RSNA.

EPtalk by Dr. Jayne

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I’ve subscribed to multiple CMS mailing lists in an attempt to stay current as an Eligible Provider. It’s to the point, however, that it’s a rare day when I don’t hear from CMS when I open my inbox. This morning’s offering gave me chuckle, however, as CMS is “pleased to announce that the 2012 Electronic Prescribing (eRX) Incentive Program Supplemental Incentive Payments are now available.”

Originally I thought it was a typo, but yes, now that it’s November 2014, you can get your money for 2012. I hope no one switched jobs because payments are going as a lump sum to the taxpayer ID associated with the claims. I’m not sure why it takes 20+ months to figure out the payments, so feel free to clue me in.

I spent a couple of days earlier in the week at Ebola response training. Our hospital asked for physician volunteers and I was assigned to be one of the clinical documentation liaisons. Essentially my job would be to scribe documentation as the care team treats patients. We’ve not been designated as a primary response site, but are training anyway, which is probably a good thing.

It’s a bit of a strange feeling though to have your EHR skills valued above your clinical skills. Experiencing what our scribes deal with on a daily basis was also an eye-opener. I’m putting some thoughts together on how to improve their documentation protocols and workflows.

There are still exhibitor openings available at the mHealth Summit’s Consumer Engagement and Wearables Pavilion. Even better, if you need a sassy spokesdoctor to show off your wearables, I might know where to find a couple. You could also pick our brains on what primary care physicians really think about wearables and how we do or do not want to handle the volumes of data that can be produced as patients quantify themselves.

I’m a big fan of my Garmin, but I’m pretty sure my doc just wants to know that I run at least five days a week as opposed to knowing what route I chose and what my lap split times were. My EHR vendor is starting to integrate personal tracker data and what we’re seeing come in is far more than we would ever want to see.

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It’s possible that being at some vendor events last week has given me trade show fever. Although I wasn’t initially looking forward to the upcoming HIMSS conference — the keynote lineup certainly didn’t help — I found myself today dusting off last year’s Social Schedule Pocket Guide so I can keep my eye out for noteworthy happenings and interesting events.

For anyone making his or her first trip to the big show, HIMSS is offering a series of “HIMSS15 Unveiled” webinars for attendees to learn about the event’s education, exhibition, and networking opportunities. Learning objectives for the webinars promise to “identify the latest initiatives designed to enhance the attendee experience.” I’m hoping those initiatives involve mid-afternoon martinis and massage therapists at the end of every exhibitor aisle.

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The holidays are approaching and I’m already dreading the dinner table conversations. In addition to the usual topics of Medicare and Social Security, we also have the recent elections as a potential discussion thread. To make things even better, the Supreme Court has agreed to hear King vs.Burwell, which addresses insurance premium subsidies under the Affordable Care Act. Thinking about those combinations almost makes me wistful for my favorite holiday table topic: health conditions of people that aren’t at the table.

Are you starting to plan for HIMSS? Have any suggestions for the holiday table? 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 11/12/14

November 11, 2014 News 9 Comments

Top News

HHS’s Office for Civil Rights issues a bulletin covering HIPAA privacy obligations in Ebola-type emergency situations. It bends the HIPAA rules a bit, clarifying that a provider can share patient information “with anyone” as needed to prevent an imminent public health threat, but points out that media disclosure is limited to acknowledgment (not announcement) that an Ebola patient is being treated and a statement of their condition, provided that the patient has not expressed a preference otherwise. That means hospitals can’t release an Ebola patient’s name unless a reporter asks about that patient specifically, in which case the hospital can acknowledge their presence and condition.

Reader Comments

From The PACS Designer: “Re: Dropbox. It can now operate inside Microsoft Office.” Office users can edit their documents directly from Dropbox and share them from inside Office apps, which are now free for iOS users and as such are residing at the top of the App Store popularity lists. Gartner predicted previously that standalone file storage and sync would be dead within a few years, emphasizing that users don’t want to screw around with a separate app like Dropbox as much as they just want to save and share within their software of choice. The competitive landscape gets murkier with Microsoft’s recently announced unlimited storage for Office 365 users, which you might expect would take Dropbox (and certainly the lagging #2 Box) out of the picture entirely. That doesn’t even factor in Google, which offers free basic storage and a full terabyte for $10 per month. The differentiators for healthcare should be: (a) the provider’s willingness to sign HIPAA business associate agreements; (b) enterprise-grade audit trails and permissions to give the IT department some degree of control; (c) controlled sharing within the enterprise only; and (d) APIs that allow vendor and self-developed apps to store information in a HIPAA-compliant manner in the cloud to eliminate the most common breach exposure of misplaced unencrypted devices. Vendors offering only consumer-grade storage will find it hard to survive commoditized competition, especially at the ridiculous valuation levels given to the top few.

From Lysandra: “Re: our new company infographic. I thought you might want to run it on HIStalk.” I hate infographics, which dumb down already easily understood factoids into simplistic picture for those folks whose lips tire from reading more than three words. I don’t trust anyone, particularly an anonymous infographics creator, to tell me how I should think by packaging up often questionable information into a pretty graphic, urging me to not worry about the trees they have dismissed in providing their own description of the forest.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Stella Technology. The San Jose, CA-based company offers consulting and technology services and has strong domain expertise in HIE — its tagline is “exchange, coordinate, and collaborate.” They can help with Meaningful Use, ACOs, registries, patient engagement, remote monitoring, systems integration, messaging, provider and patient identity management, consent management, public health reporting, and Direct Secure Messaging. They are experts on interoperability standards for messaging, documents, and semantic interoperability. They can assist HIEs with architecture, emerging technologies, analytics, governance, business and marketing plans, privacy, and stakeholder engagement. The company offers turnkey products as well: Caredination (a communications and handoff tool that connects the care team with patients as they move among care settings) and Clinical Staging Database (an extensible relational store with a canonical clinical data model). Integration Toolkit will be introduced in 2015. You might know some of the executive team since the CEO, CTO, implementation SVP, and founder were all involved in leading Axolotl (now Optum) through its 2010 acquisition. Thanks to Stella Technology for supporting HIStalk.

Thanks to Elsevier, which will be co-sponsoring HIStalkapalooza at HIMSS15. I’ll have more sponsors to announce later, but in the meantime, I still have openings for companies that want to co-sponsor or to book a private box for entertaining guests (which includes much-coveted tickets to the event itself). The amount of support will drive the number of people I can invite since events are a lot more expensive per attendee than you might think when you’re offering an open bar, dinner, and a topnotch band (I still have fantasies about a cheap outdoor barbeque and keg party instead). Email me if your company is interested in participating in HIStalkapalooza.

HIStalk readers funded the purchase of English/Spanish picture dictionaries to help students in Ms. Weigand’s Louisiana middle school class who are newly arrived in the US (with a matching grant from the Bill & Melinda Gates Foundation via DonorsChoose.org). Ms. Weigand, a Teach for America teacher, sent the photo above of students using the dictionaries.

Webinars

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

November 18 (Tuesday) 1:00 ET. Cerner Takeover of Siemens, Are You Ready? Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The Cerner acquisition of Siemens impacts 1,000 hospitals that could be forced into a “take it or leave it” situation based on lessons learned from similar takeovers. This webinar will review the possible fate of each Siemens HIS product, the impact of the acquisition on ongoing R&D, available market alternatives, and steps Siemens clients should take to prepare.

Acquisitions, Funding, Business, and Stock

Telehealth provider MDLIVE acquires Breakthrough Behavioral, which offers online behavioral health counseling. Former Apple CEO John Sculley is mentioned as being investor of the $49 per visit MDLIVE, but then again he’s best known for firing Steve Jobs from Apple and we know how that turned out.

Specialty EHR vendor Modernizing Medicine secures $15 million of a planned $20 million funding round.

Healthcare.com, which benefits from the mistyped web addresses of people looking instead for Healthcare.gov, raises $7.5 million in Series A financing for its health insurance policy search engine.

Premier announces quarterly results: revenue up 15 percent, adjusted EPS $0.33 vs. $0.31, beating Wall Street expectations for both. From the earnings call:

The company’s revenue growth was fueled by its SaaS-based informatics products, particularly its population health management offerings that include contributions from recent acquisitions Aperek and TheraDoc.
Premier has 3,400 hospital customers representing 68 percent of community hospitals.
The company is developing the first surgical home collaborative with the American Society of Anesthesiologists in 43 hospitals.
President and CEO Susan DeVore says the company’s Aperek acquisition is critical in supporting the supply chain management need of members, while TheraDoc’s offerings will be integrated with PremierConnect to drive further clinical surveillance solutions.
The company is using technology from its Meddius acquisition to integrate ambulatory information across diverse EHRs in a given health system.
Premier continues to review potential acquisitions in the areas of supply chain, pharmacy, alternate site, physician preference, care management, risk stratification, ambulatory data, and population health management.
DeVore said of the demand by customers to unleash EHR value, “We do hear from our members that they are frustrated with the difficulty in connecting disparate vendors, disparate transactional systems, and EMRs and they’ve spent a lot of money installing EMRs. They are looking for more efficient ways to get data… it is driving not only our SaaS based-subscriptions, but our PremierConnect Enterprise as Mike discussed and the advisory services that wrap around it because remember it’s not just the technology, but it’s how do you take those insights and how do you actually reduce cost or improve quality. We are hearing actually a lot more from our members now too, something Mike mentioned, which was this need for data scientists, and data managers, and data governance and all the complexities that go with data, which we can provide as a service.”

Sales

Sundance Behavioral Healthcare System (TX) chooses HCS Interactant Revenue Cycle, Financial, Mobile, and Insight.

Mercy Health (OH) expands its Explorys relationship by adding Risk Models and Value-Based Care Program Framework.

Catholic Health Initiatives (CO) chooses Allscripts Hosting Solution for its TouchWorks EHR. CHI signed a $200 million hosting and IT management contract with India-based Wipro just over a year ago, so that status of that deal isn’t clear.

Humana chooses Valence Health’s tools for population health management.

The VA selects Jive Software’s collaboration tools to share medical best practices.

People

Neiman Marcus hires Sarah Hendrickson (Children’s Medical Center of Dallas) as its first VP/chief information security officer.

Joe Norris moves from interim to permanent CIO of New Hanover Regional Medical Center (NC).

Awarepoint promotes Tim Roche from CFO to CEO.

Carl Smith (Best Doctors) joins CompuGroup Medical US as GM of the laboratory division.

The FCC names informatician Chris Gibbons, MD, MPH of Johns Hopkins Bloomberg School of Public Health as distinguished scholar in residence, where he will contribute health IT, analytics, and population health expertise.

Accretive Health names Dave Mason (RelayHealth) as chief strategy officer.

Announcements and Implementations

Mitchell County Hospital District (TX) connects to the Texas Tobacco Quitline using Holon’s CollaborNet HIE platform.

Allscripts adds secure patient payments capability from TrustCommerce to its FollowMyHealth patient engagement platform.

Xconomy profiles Madison-based startup HealthMyne, which appears from its poorly descriptive website to be doing something with merging diagnostic images and text to make them searchable.

Appointment reminder technology vendor Talksoft introduces the ability for hospitals and practices to develop brand-specific iPhone and Android apps that use its technology.

Kronos will integrate technology from TeleTracking to offer an integrated staff management solution that uses TeleTracking’s Capacity Management Suite for real-time patient volume data.

Non-profit health decision information vendor Healthwise announces that its materials have been used 1.5 billion times as of Tuesday morning.

Government and Politics

The American Medical Association just won’t give up its griping about Meaningful Use. It now demands that penalties be eliminated and that the Meaningful Use program be refocused on interoperability. In other words, nobody complained when taxpayers threw $25 billion at providers (including AMA’s members), but now that they have to start earning it, it’s unfair. AMA also voiced its support for FSMB’s previously published telemedicine policy — more details in my interview with Alexis Gilroy, JD, who served as a subject matter expert to FSMB.

Two HIV-related government sites finally start using SSL encryption for web- and smartphone-based user sessions. A security expert drily notes the irony that HHS enforces HIPAA, yet wasn’t protecting confidential patient information.

A movement claiming to be grassroots (without providing details) urges that Congress support the nomination of Vivek Murthy, MD as surgeon general. He was nominated a year ago but wasn’t confirmed because of his stated beliefs that guns are a health hazard.

Other

Farzad Mostashari, MD tweeted out the comment he left on the New York Times article that described how hospitals make it hard (and expensive) for patients to get copies of their own records. His comment wasn’t approved, so his screen shot is the only record.

A federal investigation finds that clinical staff attending to Joan Rivers failed to notice her deteriorating condition and didn’t start CPR until several minutes afterward. The report says her anesthesiologist initially documented that she was given 300 mg of propofol, but changed the record afterward to note a 120 mg dose instead, saying that the initial dose documentation was a mistake caused by double-clicking the default value. I’ve seen doctors falsify documentation (both paper and electronic) after making a mistake, so it will be interesting to see if the wrong dose was actually given and not just charted.

Anthem Blue Cross customers in California receive wellness emails that contain their private information in the subject line, with an example of: “Don’t miss out — call your doctor today; PlanState: CA; Segment: Individual; Age: Female Older; Language: EN; CervCancer3yr: N; CervCancer5yr: Y; Mammogram: N; Colonoscopy: N.”

The summary graphic from KLAS’s just-released EHR interoperability review shows Epic and athenahealth leading the pack in contributing to the success of their customers. Meanwhile, KLAS corrects Politico’s overhyped headline that proclaimed “KLAS to Epic: Stop Putting Words In Our Mouth.” KLAS simply said that Epic’s claim as being #1 for interoperability isn’t technically correct since KLAS issues separate reports for interoperability and HIE, but it clarifies that “KLAS never had any such discussion with Epic to stop putting words in KLAS’s mouth.” So if you’re keeping score at home: KLAS corrected Epic, Politico dumbed it down incorrectly, then KLAS corrected Politico.

A law firm’s telemedicine survey (and obligatory cute results infographic) is getting exposure from sites that aren’t paying attention to how the survey was performed. The conclusions seem insightful on first glance: 90 percent of organizations are implementing telemedicine and 36 percent expect 10-30 percent usage among patients within three years. Those glossy conclusions inspired ecstatic headlines from some sites anxious to summarize uncritically, but what they missed is that only 57 people responded (of an unstated number of surveys sent, making calculation of the response rate impossible) and job titles and organization types were all over the place. Example: only 52 percent of respondents were from hospitals, which means that big, seeming bold and authoritative insights were drawn from only 27 hospital respondents. The survey also asked questions that no single respondent was likely to have answered correctly given that they covered technology, reimbursement, and strategic planning. It’s embarrassing that people cover lame surveys as news, much less without critiquing their methodology.

HIMSS makes iffy choices in its “extraordinary roster” of HIMSS15 keynotes. Greg Wasson, president and CEO of Walgreens, gets the Monday morning slot, which in my mind should be reserved for someone with selfless healthcare-related accomplishments that might inspire non-profit provider attendees instead of a $14 million per year big-company CEO. At least Wasson is a pharmacist by training and has only ever worked for Walgreens, starting there as a pharmacist intern, and the company’s use of IT in its retail setting is nothing short of brilliant. Tuesday’s keynote is the CEO of Humana, which hasn’t always been a beacon of patient-focused healthcare practices, while President George W. Bush gets pushed back to an awful Wednesday 4:30 p.m. slot. HIMSS seems to be moving toward having for-profit CEOs as keynotes, having done the same with the mHealth Summit in the past two years — Aetna CEO Mark Bertolini got the prime spot in 2012 even as his underlings in Aetna’s healthcare IT vendor companies were setting up their booths in the exhibit hall and the same thing happened in 2013 with Qualcomm’s CEO as the opening keynoter.

Canada is observing the first Digital Health Week this week, although the only events scheduled appear to be some tweet chats and webinars.

Brigham and Women’s Hospital hires an SVP/chief business development officer to launch a consulting service, saying it needs “new sources of revenue in order to sustain our precious mission.”

Wellcentive establishes a $1,000 scholarship for a military veteran attending medical school.

A 30-year-old Madison, WI woman tries to avoid bankruptcy caused by her cardiac arrest at 29, when an ambulance mistakenly transported her to out-of-network St. Mary’s Hospital. She’s stuck with a $50,000 bill instead of the $1,500 one she would have owed as a patient of in-network Meriter Hospital three blocks away. Blue Cross Blue Shield paid $156,000 of her $254,000 tab for a 16-day stay and the hospital reduced her balance owed to $10,000, but she still has to pay the other bills that included out-of-network physicians, the ambulance ride, and therapists. She can’t afford to get married until she sees what numbers her various providers make up.

Weird News Andy sends his greetings as follows: “Their has bin found a vieres that makes u less smart. LOL.” Scientists determine that a virus found in lake algae shortens human attention span, although even they aren’t quite sure why that’s important.

Sponsor Updates

CIO Review names DataMotion to its “20 Most Promising Healthcare Consulting Providers” list for its Direct Secure Messaging solution.
Gartner recognizes VisionWare in its “Magic Quadrant for Master Data Management of Customer Data Solutions” for the sixth consecutive year.
Visage Imaging will demonstrate its Visage 7 Enterprise Imaging Platform along with its integration capabilities at RSNA.
PDR Network will exhibit at and sponsor iPatientCare National User Conference (NUCON 2014) November 14-16, exhibiting its PDR Brief and PDR Search patient drug education solutions.

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 11/10/14

November 8, 2014 News 3 Comments

Top News

Allscripts shares dropped 15 percent Friday after turning in underwhelming revenue, earnings, and sales numbers after the market’s close Thursday. From the earnings call:

CEO Paul Black admitted that “we would have liked to have delivered a stronger performance.”
The company says it’s making big investments in remote hosting capabilities, but that effort has hurt short-term profitability.
CFO Richard Poulton said, “It’s not lost on us that the stock has gotten beaten up a little bit. It’s something we’re talking about.”
Black says Q4 is always a strong quarter and expects that to continue.
Of the DoD EHR bid, Black said, “They’ve made some very specific requirements in the RFP response that you have an innovative and interoperable platform with world-class content, workflows, and an open systems architecture. So we feel very good about where we are.”
Black said the hospital EHR business is all replacement sales now, adding, “The folks that are looking at the next 10 years are looking at organizations who have thought through and have invested in a long-term strategy and approach to having an open systems approach to and a very robust set of offerings for the multitude of caregivers that exist in a total population health-centric environment as compared to a traditional environment from the past years.”
Black said reduced sales don’t mean things have stalled, but rather that Q3 is always slower except for last year.
Black said the company won’t break out population health management sales as an overall percentage even though that’s the greatest demand area, saying, “We wanted to make sure our client base did not think that we are abandoning our foothold of being a core systems provider of EHR and rev cycle management solutions.”

HIStalk Announcements and Requests

It’s a fairly even split among a large number of poll respondents as to whether CommonWell will have a significant impact on interoperability. It’s also interesting to see which IP addresses brought out the vote, with the big ones being CommonWell members McKesson and athenahealth as well as non-member Epic. New poll to your right or here: have you ever withheld information from a provider because of medical record privacy concerns?

Tuesday is Veterans Day, set aside to honor every person who has served in the US Armed Forces. If you served, thank you. If not, this is a good day (like every day) to thank someone who did. Military members don’t get to choose the locations or causes for which they are asked to put their existence on the line, which makes their service even more selfless. I observed the upcoming holiday by reading and enjoying “The Last of the Doughboys: The Forgotten Generation and Their Forgotten War,” in which the author interviewed the last World War I veterans before they all died shortly after, being 100 or more years of age. It’s not just a recap of World War I (which like the Korean War, tends to get lost in the shadows of World War II and even Vietnam), but rather a reminder of what it’s like to be on front lines that are full of confusion, irrational leadership, and the horrors of war.

Last Week’s Most Interesting News

Cerner and Epic exchange barbs about Epic’s interoperability capabilities and what CommonWell’s interoperability contribution will be.
The 2015 work plan of HHS’s Office of Inspector General indicates that it plans to extend its audits to include cloud-based EHR services and vendors as well as hospital downtime readiness.
Allscripts is hit with several negative news items: poor quarterly results that send its share price south, a $9.7 million judgment against it in a lawsuit brought by Etransmedia for deceptive trade practices, and public reports of Sunrise system problems at South Australia Health.
The Medicare physician fee schedule for 2015 adds several telehealth payment items and relaxes the EHR requirements for earning Chronic Care Management monthly checks.
The HIT Policy Committee reports that total Meaningful Use payments have reached $25 billion.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q3 results: revenue up 5.5 percent, adjusted EPS 0.34 vs. $0.31, beating expectations for both.

The Advisory Board Company announces Q2 results: revenue up 12 percent, adjusted EPS $0.43 vs. $0.31, beating earnings expectations but falling short on revenue. Shares dropped 11 percent Friday on the news. Above is the one-year share price chart for ABCO (blue, down 22 percent) vs. the Nasdaq (up 18 percent).

CompuGroup Medical US will move its headquarters from Boston to Phoenix on January 1.

Orion Health chooses Scottsdale, AZ as the North American and UK headquarters of its population health management division, expecting to hire 100 people within a year and up to 400 over the next three years. Incentives pushed Scottsdale past Nashville, Atlanta, and Raleigh.

Truven Health Analytics will acquire life sciences stakeholder management software vendor Heartbeart Experts. I spent several unsuccessful minutes perusing the company’s website to try to figure out what they do, which led me to conclude that it would probably be clear if I needed its services.

Sales

Envision Medical Group (MI) chooses Aprima’s RCM services.

Rite Aid will pilot the use of HealthSpot’s telemedicine kiosks in some of its Ohio markets.

People

Rick McCarthy, CIO of St. Vincent’s Health Services (CT) and a retired US Navy commander who served as a CIO and ran a medical unit in Afghanistan for a year, will deliver the keynote Veterans Day address in Trumbull, CT on Tuesday.

Jay Deady (Awarepoint) joins Recondo Technology as CEO.

Announcements and Implementations

The 2014 Midwest Fall Technology Conference will be held November 12-14 in Chicago, organized by six Midwest HIMSS chapters. It’s offering a hefty provider registration discount in order to hit its desired 50-50 ratio of providers to vendors.

Georgia Health Connect launches as a regional HIE using technology from Liaison Technologies. It plans to connect to the Georgia Health Information Network.

Government and Politics

The Massachusetts medical board makes its final recommendations for a law going into effect in January 2015 that will require all physicians to demonstrate EHR proficiency and Meaningful Use skills. The final wording hasn’t been approved, but proposed regulations would require physicians to meet one of the following:

Participate as an EP in Meaningful Use Stage 1.
Be employed, contracted, or credentialed by a hospital that is participating in Meaningful Use Stage 1.
Complete a three-hour accredited CME program on EHRs.
Sign up for Massachusetts Health information Highway.

Innovation and Research

A study finds that EHR information paired with human resources system data can be used to measure the value added by individual nurses, finding that individual nurse performance explained 7.9 percent of the variance in patient clinical condition changes. It concluded, not surprisingly, that a nurse’s educational level and work experience correlated positively.

Technology

Iodine releases a Google Chrome browser extension that displays the definition of a medical term when the user hovers over the word on any web page.

Other

A New York Times article describes the difficulty that a featured patient had in getting his own medical records from the hospital, as it turned into a six-week ordeal of snail mail, phone calls, $100 in copying fees, and an eventual physical trip to the hospital to wait for a stack of paper documents to be handed over. A Harvard professor blames competition, saying that medical records are held hostage to prevent patients from going elsewhere. Former National Coordinator David Blumenthal, MD, weighs in: “When hospitals talk about HIPAA or charge for releasing records, what they’re really saying is, ‘I don’t want to do this and I have to find an excuse.’”

In the UK, a survey finds that 71 percent of citizens aren’t aware that they’ll be able to review their own medical records online by April as promised by the Patient Online initiative spearheaded by Health Secretary Jeremy Hunt. Only 3 percent of practices offer online access at the moment, but all are supposed to be ready by April. Doctors are worried about the time they’ll spend explaining medical records to patients given that 75 percent of patients want records written in plain while only 21 percent of doctors agree. The survey found that percent of doctors say the medical record is a reference tool for their use, not something intended for patients.

The widow of IDX co-founder Robert Hoehl donates $5 million to a variety of Burlington, VT non-profits.

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 11/7/14

November 6, 2014 News 14 Comments

Top News

The 2015 work plan of HHS’s Office of Inspector General includes several EHR-related items beyond the usual Meaningful Use payment audits. OIG will audit the security of cloud-based service providers (including EHR vendors) and will review the downtime policies of hospitals. OIG’s future efforts “may consider the significant challenges that exist with respect to overseeing expenditures for health IT, the interoperability and effective sharing and use of health care data for medical care, and emergency preparedness and response.”

Reader Comments

From Zippy: “Re: Alameda Health System. The outgoing CEO removes the blame for its financial problems from Siemens Soarian.” The five-hospital system’s CFO told its board last month that its financial meltdown was caused by its $77 million Siemens/NextGen implementation, but the outgoing CEO says the system’s own managers — not Siemens — caused its problems. He specifically blamed two unnamed former health system executives.

From Sauerkraut: “Re: Siemens. The hearing aid business sold for more than twice the HIT business with lower revenues and the usual higher multiples of software businesses. Perhaps Ben Rooks can explain.” Singapore-based Siemens Audiology Solutions posted $860 million in 2014 revenue and just sold for $2.68 billion, or three times revenue. The healthcare IT business had about $1.2 billion in annual revenue and sold for $1.3 billion. I would guess the revenue multiples are based on profitability, market position, and future prospects rather than revenue. My impression is that Audiology is a turnkey business while Health Solutions is a slightly shabby fixer-upper with a reputation problem. There’s also the issue of having few qualified buyers, which would have kept the price down and given Cerner a clear shot at picking it up for a bargain basement price.

HIStalk Announcements and Requests

This week on HIStalk Connect: Microsoft and Jawbone unveil new fitness trackers, Microsoft in an attempt to capitalize on the digital health trend and Jawbone trying to differentiate itself in the emerging smartwatch market. Rock Health raises its next investment round and announces that it will fund accepted startups with a $250,000 seed round. Google revamps its Flu Trends platform to include CDC data in an effort to boost accuracy.

This week on HIStalk Practice: Healthcare buzzwords reach a "tipping point." DuPage Medical Group begins offering e-visits. The Eye Institute of Utah implements a new patient portal. Portland’s healthcare IT accelerator scene doubles. 5 O’clock Records rebrands. ONC launches a new innovation challenge. Thanks for reading.

I was clearing out space on my phone for an iOS upgrade, which forced me to decide which apps to delete since some are data hogs. My “can’t live without” survivors are below. What are yours?

Yelp. Probably my most-used app.
Motion-X GPS Drive. The best GPS I’ve used and the only paid app on my list, although it barely qualifies at 99 cents.
Slydial. lets you call someone’s cell phone voicemail directly in case you just want to leave a message without talking to them.
Airline apps. American is my most-used one.
GateGuru. Helps me find decent airport food and check an airport’s flight board.
OpenTable. I will sometimes make a restaurant reservation an hour before eating just to make sure there’s a table waiting, plus I trust the reviews and lists (I often also look at TripAdvisor).
Uber. I use it occasionally, although I’ve been burned expensively a couple of times by the surge upcharge.
Kindle. I don’t mind reading books on my phone’s small screen.
Spotify. I subscribe to Premium so I can play music offline.
Speedtest. I check Internet speed the moment I set foot in a hotel or house where I need to work, although usually I can’t do much more than swear and fret at Stone Age speeds (less than 3 Mbps down and 1 Mbps up).

Listening: new indie folk from Portland, OR-based The Decemberists, which sound a bit like R.E.M. Peter Buck has played on some tracks, although not on their pretty good cover of my favorite R.E.M. track, “Cuyahoga”.

Webinars

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

November 19 (Wednesday) 1:00 ET. Improving Trial Accrual by Engaging the Digital Healthcare Consumer: How to Increase Enrollment with Online Consents and Social Marketing. Sponsored by DocuSign. Presenters: B. J. Rimel, MD, gynecologic oncologist, Cedars-Sinai Medial Center; Jennifer Royer, product marketing, DocuSign. The Women’s Cancer Program increased trial accrual five-fold by implementing an online registry that links participants to research studies, digitizing and simplifying a cumbersome, paper-based process. This webinar will describe the use of e-consents and social marketing to engage a broader population and advance research while saving time and reducing costs.

Acquisitions, Funding, Business, and Stock

Aspen Advisors will be acquired by healthcare management consulting firm Chartis Group, with Aspen’s Managing Principal Dan Herman joining the board of Chartis.

Allscripts announces Q3 results: revenue up 4 percent, adjusted EPS $0.06 vs. $0.05, missing analyst expectations for both. Shares dropped sharply in after-hours trading following Thursday afternoon’s announcement, down around 15 percent to levels not seen since early 2013.

Meanwhile, activist hedge fund Blue Harbour Group increases its ownership in Allscripts to 7 percent of the outstanding company shares, up from 5 percent. Blue Harbour Group says it avoids public shareholder fights by investing only in companies that welcome its ideas for unlocking value, happy to make money from share price appreciation rather than selling off parts piecemeal. Its Allscripts ownership stake looks like around $170 million worth, right in line with its stated sweet spot of $100-$200 million. Allscripts shares have dropped 7 percent in the past year and 38 percent in the past five years.

Healthgrades acquires digital marketing form COCG to enhance its strategic marketing services for hospitals.

Siemens reorganizes its remaining healthcare lines into a separate business as it suggested it might do several months ago, which won’t do much to squelch the rumors that it wants to sell of the whole package and get out of healthcare completely. Siemens just announced that it will sell its hearing aid business for $2.7 billion. It previously sold the HIT business to Cerner and its microbiology line to Beckman Coulter. Like GE, Siemens is putting big money into energy-related product lines.

Francisco Partners invests an unspecified amount in medication benefits network provider CoverMyMeds.

Shares in Merge Healthcare hit a 52-week high Wednesday, having jumped 33 percent in the past two weeks. Above is the one-year MRGE share price (blue, up 23 percent) vs. the Nasdaq (red, up 18 percent).

The Department of Defense awards Fulcrum a five-year, $13.9 million contract to update the systems used by DoD’s year-old Richmond, VA EHR testing facility and to open a second health IT testing center in West Virginia. Both will support DoD’s DHMSM EHR replacement project.

Global Healthcare Exchange will acquire Atlanta-based procurement software vendor Vendormate.

Etransmedia wins a multi-million award in its deceptive trade practices lawsuit against Allscripts. An arbitration panel ruled that Allscripts convinced Etransmedia to buy MyWay EHR licenses in advance to improve its own financial performance, but then “deliberately sabotaged” MyWay sales by retiring the product in October 2012, leaving Etransmedia holding millions of dollars in unsold licenses. Etransmedia has since developed its own Connect2Care product.

Sales

Beaumont Health System (MI) chooses PHYND’s Provider Population Management Platform for 20,000 physicians.

Rhode Island awards 3M the analytics contract for its All-Payer Claims Database that will aggregate claims and provider data to publish consumer-facing quality and cost information.

The VA will add two service networks to its Philips eICU program, expanding its ICU remote monitoring service to 1,800 beds.

People

Prison health provider Corizon Health names Andy Flatt (HealthSpring) as CIO.

Fogo Data Centers hires William Esslinger, Jr. (Esslinger Tech Law) as CEO and board member.

Peter Dolphin (PatientKeeper) joins Advanced Practice Strategies as EVP of sales.

National Library of Medicine Director Don Lindberg, MD will retire in March 2015 after more than 30 years on the job. He was also the first president of AMIA.

Announcements and Implementations

Cerner CEO Neal Patterson says in a blog post that the company will provide CommonWell services to its clients at no charge (after a “nominal setup fee”) through January 1, 2018. He adds that CommonWell will make its interoperability services available at a low cost, passed through from participating vendors to their clients. He emphasizes that CommonWell will never sell data.

A new startup, MD Revolution, launches RevUp, which allows providers to collect Medicare’s new $40 per month chronic care management payment through team-based monitoring of a user’s fitness device data. The HealthKit-enabled RevUp supports provider-user messaging, personal health coaching, and an unspecified level of integration with EHRs. It appears that the company provides all of the coaching services. Founder Samir Damani, MD, PharmD is a Scripps cardiologist. Also on the executive team is CIO Jean Balgrosky (former Scripps SVP/CIO) and SVP of Business Development Parker Hinshaw (founder of maxIT). The company’s page also neatly summarizes the requirements to collect the monthly payment that starts in January 2015 — 20 minutes of non face-to-face care of Medicare patients with two or more chronic conditions. .

Blood Bank of Alaska implements Mediware’s blood center management and donor recruitment systems.

Government and Politics

An ONC survey finds that most consumers (75 percent) are concerned about the privacy of their medical records whether paper or electronic, but few (less than 10 percent) are worried enough to withhold information. Three-quarters of respondents want their providers to use EHRs and share their information with their other providers. Survey pluses: it was a random-dial telephone survey that removes online-only and self-selected participant bias and it had a good number of responses, but the folks willing to take a cold-call survey may not be representative. Survey minus: it was conducted last year.

CMS postpones its eHealth Summit, scheduled for December 5, until further notice.

Innovation and Research

The Wall Street Journal highlights companies that are working on diagnostics that can detect Ebola quickly, including BioFire Defense (which I wrote about quite a bit last week), CorGenix Medical (a $15 non-instrument system that works like a home pregnancy test), Chemnio Diagnostics Systems (a $10 finger-stick test), and OraSure Technologies (which is considering development of a mouth swab-based test like the one it offers for HIV).

A nine-hospital study finds that use of a structured patient handoff procedure among medical residents was associated with a 23 percent reduction in medical errors and a 30 percent drop in preventable adverse events. Residents used a mnemonic-driven checklist for both oral and written handoffs.

Technology

Microsoft announces free versions of Office for the iPhone and updated versions for the iPad, with Office for Android coming soon.

Qualcomm Life Director of Business Development Kabir Kasargod urges wearables developers to move from activity trackers to the real healthcare industry:

Go from the children’s table to the grown-up table. If you’re serious about this, embrace the FDA. Learn how HIPAA works. Make sure it’s connected to the [electronic medical record] and that all the health laws are observed. There’s a tremendous dearth of innovation here. I would move away from fitness and go hardcore into health. That’s where the money is.

Other

A Pennsylvania business paper profiles Pittsburgh-based Health Monitoring Systems, whose service monitors hospital EHR information to provide real-time outbreak information to public health departments.

PayPal co-founder and early Facebook investor Peter Thiel says he is skeptical about healthcare IT, big data, and cloud computing.

Epic responds to Cerner CEO Neal Patterson’s calling the company “immoral” for being an interoperability “black hole” among EHR vendors at Cerner’s user group meeting. Epic’s statement:

Epic is No. 1 for interoperability performance as ranked by actual users surveyed by the highly respected firm KLAS. Epic can interoperate with any other electronic health record that meets government standards, regardless of vendor. We support open standards rather than private platforms such as CommonWell that further privatize and monetize exchange of health information.

A Health Affairs blog post by MedStar Health’s influential informatics expert Peter Basch, MD says the Meaningful Use program is impeding interoperability by its rigid, metric-driven approach that fails to meet the needs of providers and patients. He adds that EHRs don’t work well for advanced primary care models that emphasize chronic disease management and care coordination and observes that today’s version of interoperability makes matters worse by more widely spreading clutter-filled summary of care and visit summary documents.

S&P downgrades the bonds of Wake Forest Baptist Medical Center (NC) because of large receivables write-offs and the high ongoing expense of its Epic system.

PeaceHealth (WA) ends affiliation talks with Ocean Beach Hospital (WA), with PeaceHealth’s CEO saying his organization is too busy and too far over budget on its Epic implementation to take on a new hospital.

The tweets of Scripps cardiologist Eric Topol, MD have the highest signal-to-noise ratio of just about anybody even though he gets a bit app-happy at times, so I enjoyed this interview, in which he made some interesting points. He’ll be delivering a keynote presentation at the Digital Health Conference 2014 November 17-18 in New York City.

Patients will help diagnose and monitor themselves using algorithms, leaving doctors to focus on treatments.
Continuous monitoring will allow patients to stay at home, reducing hospital usage.
Virtual visits can help with the difficulty involved in getting a PCP appointment, which he says requires a six-week lead time in Boston.
A major shift to virtual visits will reduce trips to the doctor’s office.
Patients will bear much of the responsibility and cost of their health.

Weird News Andy expects this story to fill a void. A bus driver in Egypt attempts to dodge a mandatory urine drug screen by submitting a sample from his wife and is surprised to hear from officials, “Congratulations, you’re pregnant.”

Sponsor Updates

RazorInsights publishes a company video, a brilliantly done history that includes founder interviews.
Surgical Information Systems names Indiana Orthopaedic Hospital (IN) as a Center of Excellence.
HCI group posts “Meaningful Use to Meaningful Care” by William Bria, MD and Robert Steele, RN.

EPtalk by Dr. Jayne

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The November 30 deadline for eligible hospitals to report for the 2014 Medicare EHR Incentive Program is fast approaching. I haven’t been on the attestation site lately, but I am told that the 2014 Flexibility Rule options are available. If that doesn’t work, you can still apply for a hardship exception, but if you’re just now figuring out that you need one, I feel for you.

Speaking of Meaningful Use, several providers at my hospital forwarded links to articles about the dismal attestation statistics, demanding that we consider “stopping this nonsense” and “get back to practicing real medicine.” They’re not alone, although most national groups are focusing on shortening the reporting period for 2015 and adding additional flexibility. CHIME, the AMA, MGMA, and of course HIMSS are among the loudest voices.

With the Flexibility Rule slowing some organizations’ upgrade schedules, CMS also made some updates to the final 2015 Medicare fee schedule. Primary care practices can report Chronic Care Management codes on whatever certified EHR they were on as of December 31 of the previous calendar year, rather than being required to use 2014 CEHRT. Additionally those services can be billed using a CPT code instead of a G code. I’m not sure why that’s an advantage, but provider groups seem happy about it.

If you have nothing else to do this weekend, it’s 1,185 pages of glory and includes summaries of comments received while it was under consideration. Comments are being accepted through December 30 and it goes into effect January 1, so read up. Any document that includes five and a half pages of acronym explanations is bound to be a hit.

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I’ve been recovering this week from a Continuing Medical Education conference. I’m not a huge fan of Las Vegas, but it seems like a lot of conferences are held there. After learning about dermatological diseases in a drab hotel ballroom for two days, a conversation in the row ahead jogged my memory that the NextGen One user group meeting was starting at the tail end of my trip. A quick call to Bianca Biller confirmed that she was also in town, which improved my spirits. In addition to being one of the smartest revenue cycle experts I know, she is also the most fun.

She warned me that tight security was keeping non-registered people out of the conference center, but was able to score me a pass to the Navicure client event on Monday at the Hard Rock Live. I was feeling a little giddy when I got carded at the door until I realized they were carding everyone. We arrived fairly early, but the party was already in full swing. The Atlanta-based band was fantastic and it was fun to watch medical practice folks kick back to Journey and James Brown covers. Since MGMA had wrapped up a few days earlier, she said there were a lot of vendors staying over, so we headed out to hit a couple more get-togethers. We ended up with the obligatory wild and crazy taxi ride, during which Bianca received a marriage proposal from the cabbie.

We dialed it down a notch and stopped by the Intelligent Medical Objects suite at Mandalay Bay for a glass of wine and some much-needed time off our feet. There we ran into one of Bianca’s nurse informaticists, who lured us to the casino with the promise of riches to come. I was content to watch others gamble and to do some people watching – the number of folks still in Halloween costumes several days after the fact was pretty entertaining. Although I missed MGMA this year, I felt like I at least got my party fix and that will hold me until HIMSS.

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My new nurse friend was the big winner of the night, where I was lucky to walk away with the same $20 I started with. The Cerner conference was also this week, but I haven’t heard anything about it.

Do you have conference pictures or a crazy taxi story? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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News 11/5/14

November 4, 2014 News 9 Comments

Top News

The HIT Policy Committee reports that 93 hospitals have been paid Meaningful Use Stage 2 payments through September vs. nearly 4,000 that earned Stage 1 money. EPs had 2,282 MUS2 attesters vs. 266,067 who earned Stage money. None of that matters much since attestation runs all the way through 2015 and there’s not a lot of reason for providers to jump on early, but critics will miss that point in calling MUS2 a failure early in the game. The total of the Meaningful Use money handed out so far exceeds $25 billion.

Reader Comments

From Popinjay: “Re: Remedy Informatics. Has apparently shut down, according to customer QOPI.” Oncology quality assessment organization QOPI cancels its fall reporting round, saying it has no choice after technology provider Remedy Informatics “unexpectedly ceased all business operations on October 21.” The Salt Lake City-based company, which provide registry and research informatics products, hasn’t responded to my inquiry. I interviewed CEO Gary Kennedy several years ago and was impressed with the technology, but the company’s business model changed a couple of times since then.

From Remy C: “Re: [company name omitted]. The company, one of the larger former-Epic consulting firms, is losing faith from its partners after ‘spreading itself too thin.’ Two of its staffing partners are withdrawing from offering subcontracts after the company’s problematic attempt at adding go-live support.” I’ve removed the company names since the rumor is so vague that there’s no easy way to confirm it, but I’m more interested in the overall trajectory of Epic consulting firms anyway. Epic go-live support would seem to be a good business line as long as there’s enough of them to keep people working.

From Walkin’ Dude: “Re: Neal Patterson’s keynote speech at Cerner Health Conference Tuesday. He skewered Epic (without naming them) by saying that it’s immoral that they use their closed system for competitive advantage. He sais CommonWell will cover 50 percent (of patients? data? visits?) and that he’s reasonable sure Meditech will join and add another 25 percent of market share. He said that Epic, with 30 percent of the market share, is a data sharing black hole.” That’s Neal above on the right, sharing the CHC podium with John Glaser from Siemens Health Solutions, which will become part of Cerner early next year. Neal said GPS devices are an example of what can happen when proprietary standards are opened up.

HIStalk Announcements and Requests

Listening: reader-recommended indy folkers The Accidentals, two newly-graduated female high school students from Traverse City, MI who have written 45 songs, played 500 shows, scored two movies, and play 13 instruments between them.

Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

Acquisitions, Funding, Business, and Stock

Drug information provider PDR Network merges with LDM Group, which improves medication adherence by connecting patients, prescribers, and pharmacists via personalize messaging. PDR says its network will now include 250,000 prescribers and 16,000 retail pharmacies. Former LDM Group President and CEO Mark Heinold is named CEO of PDR, while former PDR President and CEO Richard Altus will join majority shareholder Lee Equity as operating advisor.

Aetna will acquire Chicago-based retail health insurance platform vendor Bswift for $400 million to extend Aetna’s proprietary insurance exchange strategy.

CPSI announces Q3 results: revenue up 14 percent, EPS $0.83 vs. $0.66, beating revenue estimates but missing on earnings. Above is the one-year share price chart of CPSI (blue, up 3.8 percent) vs. the Nasdaq (red, up 17.8 percent). President and CEO Boyd Douglas (above) said in the earnings call that 38 of the 200 hospitals that have attested for Meaningful Use Stage 2 are CPSI users, placing it behind only Epic. CFO David Dye, responding to an analyst’s question about CPSI’s KLAS scores, said, “Our KLAS scores have been hit or miss now for 25 years. We don’t have particularly good relationship there. But I’ll put our performance up against anybody else who’s been ahead of us over that time frame” and says the company’s churn rate is at an all-time low. Dye said in answering a question about CPSI’s CommonWell participation that it’s not opening up sales opportunities, but adds, “It’s probably a bit cheesy to say that we all did this out of the goodness of our hearts, but I think it’s closer to that. I think it’s going to help us with new business. I will say that we’ve got some competitors in our space that haven’t joined yet, and that we certainly aren’t afraid to mention that when we’re talking to the potential hospital clients. But to say that we expected and/or now expect that to benefit us competitively, I think would be a stretch … we didn’t think the government was ever going to do it.”

Imprivata announces Q3 results: revenue up 41 percent, adjusted EPS –$0.16 vs. –$0.34, beating earnings expectations and meeting on earnings.

Physical therapy EHR vendor WebPT acquires WebOutcomes, which offers an online outcomes tracking tool for PT/OT.

Release of information vendor Healthport, which entered into an agreement last week to be acquired by a New Mountain Capital investment found, announces its merger with competitor Supna Healthcare Solutions.

Truven Health Analytics acquires JWA Consulting, which offers Lean consulting that Truven will pair with its data analytics and consulting capabilities.

CVS Health reports Q3 results: revenue up 9.7 percent, adjusted EPS $1.15 vs. $1.06, beating expectations for both in a quarter in which it changed its name from CVS Caremark halted tobacco sales.

In Canada, Clearwater Clinical raises $2 million in funding. The company, founded by an ENT surgeon, offers Clearscope (smartphone video recording for endoscopy) and Shoebox (an iPad-powered hearing tester). Mayo, Hopkins, Mass General, and CHOP are among its listed clients.

Sales

St. Mary’s Hospital (CT) chooses Imprivata Cortext for clinical communications.

Campbell County Health (WY) chooses Cornerstone Advisors to lead its Meditech Pathway Implementation project.

People

Don Reed, VP/CIO of Crozer-Keystone Health System (PA), receives a lifetime achievement award from the Philadelphia business newspaper.

UPMC’s Children’s Hospital of Pittsburgh names Srinivasan Suresh, MD, MBA (Children’s Hospital of Michigan) as CMIO.

Jim Gibson (Jimenez Consulting Solutions) joins Hayes Management Consulting as VP of strategic services.

GetWellNetwork CIO David Muntz is awarded CHIME’s Board of Trustees Legacy Award.

Announcements and Implementations

Cerner will integrate data from the smart glucose monitor of Livongo Health, launched by former former Allscripts CEO Glen Tullman in September 2014.

EHR vendor Amazing Charts announces GA of its new practice management system.

NextGen announces at its UGM a mobile version of its patient portal, native iPad EHR support, a population health management solution, a HISP Direct Secure Messaging connectivity offering, and a cloud-based version of its EHR/PM systems that will be released in 2015.

Government and Politics

CHIME uses CMS’s new (and very early, like election returns an hour after the polls close) Meaningful Use Stage 2 numbers (17 percent of hospitals, 2 percent of EPs) to again urge the agency to reduce the 2015 reporting period from 365 days to 90 days. Parent organization HIMSS jumps with a melodramatic stretch in suggesting that raising the bar on taxpayer EHR handouts “hinders our nation’s ability to improve the quality, safety, cost-effectiveness, and access to care.”

An ONC-commissioned report finds that providers participating in accountable care models are hindered by lack of EHR interoperability, with more work also required on analytics and clinical decision support systems.

HHS names Anjum Khursid, MBBS, MPAff, PhD (Louisiana Public Health Institute) as the public health representative to the HIT Policy Committee.

Innovation and Research

Microsoft opens the preview release of Skype Translator, which performs real-time speech translation between users. Translation is a big and expensive problem for hospitals, so it could be interesting.

Microsoft again – the company opens up unlimited OneDrive storage for Office 365 customers (Home, Personal, and University users – coming soon for Business).

Cerner will break ground on its $4.45 billion Three Trails campus in south Kansas City on November 12.

Technology

Nudge launches Nudge Coach, which combines information from a person’s wearable devices into a single “Nudge Factor” number that doctors can quickly review. The company was formed by two 2010 Wofford College graduates who played semi-pro soccer together.

Butterfly Network raises $100 million to create an iPhone-sized ultrasound scanner that it says will be as cheap as a stethoscope.

A three-subject study finds that Google Glass creates blind spots in the eyes of users.

Other

University of Colorado Health CMIO CT Lin, MD performs a non-model version of “House of the Rising Sun” for hospitals going live on Epic, recorded at UGM. He didn’t mention his ukulele when I interviewed him in April.

In Australia, the opposing political party says the April 2016 opening of New Royal Adelaide Hospital at risk unless the government fixes its Allscripts Sunrise patient management system, rollout of which was put on hold in July following billing and medication errors, physician complaints, and lack of funds due to higher than expected legacy system maintenance costs. South Australia Health hinted originally that it might sue Allscripts because of rollout delays, but now says it expects to resolve its issues with the company privately

The Wall Street Journal covers EHR vendors that are adding Ebola-specific functionality. It profiles Mass General, which is using a new application from its own EHR-searching spinoff QPID Health that matches patient symptoms and travel history to alert users of potential infection.

In Canada, William Osler Health System holds its second competition for students to develop Android patient experience apps next week, offering a $10,000 first prize. Last year’s winner created HosNav, which gives diagnostic testing patients parking directions, way-finding, and test preparation instructions.

A Boston news service highlights big Massachusetts campaign donors, with InterSystems billionaire founder Terry Ragon topping the list with $3.3 million in contributions to Democratic super PACS and candidates.

Novant Health (NC) will demote 150 medical secretaries to medical unit receptionists and cut their pay up to 10 percent following its EHR implementation that eliminated the position’s most complex task — order entry. The local paper notes that the timing could have been better given that executive retirement plan changes caused recent eye-opening lump sum payouts, such as the $8.2 million paid to CEO Carl Amato in 2013, of which $6.1 million was pension related.

A poorly written article in The Michigan Daily covers the student health service implementation by University of Michigan Health Systems of what it calls a “filing system” and then “MiChart,” not only misspelling MyChart but confusing the Epic patient portal with the provider-facing inpatient and ambulatory modules. The article says 50 percent of patients are using MyChart, but only 5 percent are using it to schedule appointments.

Odd: a six-foot, iPhone-shaped monument honoring Steve Jobs at a St. Petersburg, Russia university is taken down, with an executive explaining that the announcement by Apple CEO Tim Cook that he is gay violates Russian law as “a public call to sodomy.”

Sponsor Updates

Strata Decision Technology is named a winner of the Chicago Innovation Awards.
ZirMed will host its user group meeting November 10-12 in Louisville, KY.
EClinicalWorks, Greenway Health, PerfectServe, RazorInsights, Sandlot Solutions, and Shareable Ink are named to CIO Review’s “20 Most Promising Healthcare Tech Solutions Providers 2014.” The publication’s “20 Most Promising Healthcare Consulting Providers” includes DataMotion, Leidos Health, and TrainingWheel.
ESD wins a CHIME CIO Fall Forum award for best video.
KLAS ranks Premier’s ACO advisory services as #1 in best overall performance.

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 11/3/14

November 1, 2014 News 7 Comments

Top News

CMS adds a scope of service element to the final version of the Medicare Physician Fee Schedule for Calendar Year 2015 that would require providers who bill for Chronic Care Management services (a new reimbursement item) to use certified EHRs and patient-centered electronic care plans for demographics, problem list, meds, allergies, and a structured clinical summary record, using that technology to manage care transitions. The schedule also provides payment for several types of telehealth visits, including annual wellness and psychotherapy.

Reader Comments

From BigDeal: “Re: Epic lawsuit against Tata. Filed quietly Friday evening.” Epic sues India-based Tata Consultancy Services, seeking an injunction and damages for what it alleges is misuse of Epic’s confidential information. The lawsuit claims that Tata’s people downloaded information from Epic’s UserWeb in an “elaborate campaign” that could give that company an advantage in its project to develop a competing product. Epic’s lawsuit says that a Tata employee based in Portland, OR downloaded at least 6,477 documents from an India-based IP address after claiming to be a Kaiser employee and using a KP.org email address. Epic says that it questioned the employee and he first claimed that he didn’t download anything, but when presented with the audit log, admitted that he shared his UserWeb credentials with two other Tata employees. The lawsuit says Epic won’t identify the material it claims Tata stole unless the court grants a protective order to keep it out of the public record.

HIStalk Announcements and Requests

Ebola diagnosis is made harder by reliance on a patient’s self-reported history and a lack of hospital preparedness, poll respondents said, with only a small percentage blaming the EHR. New poll to your right or here: CommonWell Health Alliance is 20 months old – what will be its impact on interoperability? Add a thoughtful comment to impress others that you’re not just a reactionary poll-clicker.

Yes, it’s November already. The clocks have been turned back all over the US, excluding non-observers Arizona, Hawaii, and a few counties in Indiana. Stalwart hospital IT people gained an hour Sunday to make up for the sleep they lost in babysitting their systems just in case something went wrong. Thanksgiving (and thus RSNA shortly afterward) is three weeks from Thursday.

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

Listening: new goosebump-inducing blood harmonies from Indianapolis-based Lily & Madeleine, who sing together as only sisters can. They sound eerily similar to First Aid Kit, which is a good thing.

Last Week’s Most Interesting News

McKesson announces that its RelayHealth unit has signed a multi-year agreement as the technology provider for CommonWell Health Alliance.
Google X Life Sciences says it hopes to bring a swallowed sensor to market within five years that can detect molecular-level health problems.
California’s attorney general issues her 2014 breach report that says healthcare lags only retail in exposing the information of individuals, largely because many provider organizations don’t encrypt mobile devices.
HHS, responding to negative industry reaction to a nearly complete loss of ONC leadership over the past few months, announces that Karen DeSalvo will continue to oversee ONC’s work even while reassigned as Acting Assistant Secretary for Health.
CCHIT announces that it has shut down effective immediately after losing its primary revenue source by exiting the certification business in January 2014.
The first UK hospitals go live on Epic.
Reuters suggests that Salesforce is about to make a major push into healthcare.

Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

Recordings of recent webinars are available on YouTube:

Electronic Prescribing of Controlled Substances Is Here. What Should You Do?
Data Governance – Why You Can’t Put It Off
Using BI Maturity Models to Tap the Power of Analytics
Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success
Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success

Acquisitions, Funding, Business, and Stock

A New Mountain Capital fund acquires release of information vendor HealthPort. CompuGroup bought the company’s IT solutions business for $24 million in late 2010 as HealthPort had been rumored to have been exploring both an outright sale of the company and an IPO.

Castlight Health reports Q3 results: revenue up 238 percent, adjusted EPS –$0.18 vs –$1.58, beating analyst estimates of both. Shares dropped nearly 4 percent Friday after Thursday’s announcement. Above is the one-year CSLT share price (blue, down 69 percent) vs. the Dow (red, up 8 percent).

People

Oncology decision support vendor COTA names Eric Schultz (Quantia) as CEO.

Announcements and Implementations

Philips extends its Lifeline medical alert service to Lifeline GoSafe, a mobile service that uses multiple GPS location technologies to locate users who need help while away from home. A press of the button initiates two-way communication with the monitoring station via AT&T’s network. The system also automatically detects falls and places a call for help. Monthly services starts at $55. I’m a lot more interested in technology like this than wearables that monitor questionably useful body data.

Cleveland Clinic’s annual “Top 10 Medical Innovations” list includes only one healthcare IT-related item, but it came in at #1: mobile stroke units in which ambulances connect with hospital-based stroke neurologists via broadband-connected video. The list’s track record from prior years is pretty good: it previously included private sector HIEs (2009), telehealth-based CHF monitoring (2011), mobile device apps (2012), and big data analysis (2012).

Government and Politics

A report from the HHS OIG finds that Medicare keeps paying for expensive prescription drugs after the patient has died, following a CMS policy that allows prescriptions to be filled at its expense for up to 32 days after death. The report urged an immediate policy change, saying that post-death prescriptions “clearly are not medically indicated.” Some of the drugs are expensive and are feared to have been diverted to the black market. CMS says it’s fixing the problem. Perhaps there’s an ICD-10 code for normal respiration — not holding your breath.

Technology

Google fine tunes its Flu Trends tool to include CDC data, acknowledging research from earlier this year that showed that the accuracy of Google’s own “big data” approach was improved when combined with even bigger data.

Nintendo creates a health division and is working with sleep disorders product vendor ResMed to develop a “quality of life” sleep and fatigue tracker that it will sell as a subscription service. The hand-sized device will use microwave-based sensors to collect information from the bedside. It won’t be available for several months. ResMed announced its S+ product a month ago that offers “the world’s first contactless sleep sensor.” Its bedside monitor measures breathing, body movements, and room conditions, sending the information to apps that track sleep scores and recommend changes. Nintendo says the health division, which appears to include the Wii Fit and Brain Age, will be profitable in the 2015/2016 financial year.

Other

Dean Sittig and Hardeep Singh observe in a Future Medicine editorial that too many factors exist to make comparison of one EHR vs. another possible in comparative effectiveness research, proposing instead that they be evaluated by how they’re used in the field. They provide some examples, although I found them to be insufficient to picture the possibilities the authors envision. I would also see more value in using that kind of framework to assess how a given user implements their EHR of choice since in hospitals at least, the new/replacement market has consolidated into just A and B – Cerner and Epic, with some Meditech in the mix for smaller, non-academic health systems, reducing the need to compare the short list of products. My bottom line: treat EHRs as the ubiquitous medical tool or device they have become by letting providers make their own choices, but then hold them accountable for the patient outcomes that result, no different than for a patient monitor or IV pump that can’t be evaluated in a vacuum other than for safety and usability. All the certifications, rankings, and independent evaluations don’t mean a thing if a hospital implements a highly regarded system without seeing improvements in outcomes measures – otherwise, why bother? (other than to rake in more revenue) I never cease to be amazed that hospitals rarely publish their pre- and post-EHR quality metrics after spending dozens or hundreds of millions of dollars to implement systems they assured would do exactly that. The article’s examples:

Convert free-text entries using natural language processing instead of forcing users to choose from drop-downs.
Perform drug-lab interaction checks at the point of care and not just during order entry.
Assess the usefulness of on-screen clinical warnings by measuring how often the provider cancels the order that triggered the alert.
Evaluate whether implementing Meaningful Use data entry requirements improves outcomes.

Epic will pay $5.4 million to settle a class action lawsuit brought by 45 quality assurance employees who claimed they should have been paid overtime wages. Each employee will be paid for their clocked hours plus 3.7 hours per week in assumed off-the-clock time. Money left over in the fund after the employees and attorneys have been paid, if any, will be donated to Access Community Health Centers.

Awards given at CHIME’s Fall CIO Forum:

Neal Patterson, chairman and CEO, Cerner — Industry Leader Award
Truman Medical Centers, Kansas City, MO — CHIME/AHA Transformational Leadership Award
Frank Fear, VP/CIO, Memorial Healthcare, Owosso, MI and Iatric Systems – Collaboration Award
Intermountain Healthcare and VMware – Collaboration Award

Researchers find that less than half of the dermatologists listed in the Medicare Advantage provider rosters of insurance companies are actually available. Forty-six percent of doctors were listed twice, 18 percent weren’t reachable, 9 percent were dead or retired, and 9 percent weren’t accepting new patients. The average wait for a new patient appointment was 46 days.

More on Epic’s newly built hosting data center: it was started a couple of years ago, but wasn’t announced until the recent UGM. It’s online now and being used to host client build copies. Live client hosting will start next fall. A hosted Epic option is not good news for Cerner since that’s a big differentiator for them.

A former patient registration specialist at Parkland Memorial Hospital (TX) will plead guilty to Medicare and Medicaid fraud, accused of using insurance information from the hospital’s computer system to bill the government for services he claimed to have performed for 3,000 patients in his home health business. He also bribed patients with cash, food, and gift cards to perpetuate his scam . His wife and business partner, a Baylor nurse, was accused of looking up patient information from the hospital and falsifying clinical documentation.

Interesting: the cash-strapped, currency-controlling socialist government of Venezuela implements food rationing, requiring grocery store customers to verify their ID via fingerprint biometrics to limit black market resale in neighboring countries. The government does the same at gas stations, scanning windshield bar code stickers to prevent people from filling up on $0.01 per gallon, government-subsidized gasoline and driving next door to Colombia to resell it for $4.50 per gallon. The country finished worse than the US in WHO’s ranking of healthcare systems, coming in at #54 vs. our #37 (even Cuba finished #39).

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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News 10/31/14

October 30, 2014 News 3 Comments

Top News

Booz Allen Hamilton acquires Boston-based Epidemico, stating its intention to delve deeper into population health analytics and following the recent trend of consulting companies getting into the software business. The company – a 2007 spinoff of Boston Children’s Hospital, Harvard Medical School, and MIT – analyzes large population health datasets to look for problems such as disease outbreaks, drug safety problems, and supply chain vulnerabilities. The company’s HealthMap shows disease outbreaks and alerts, which surely caught the Ebola interest of suitors. One of the founders, Clark Freifeld, is a PhD candidate and was a software developer at Boston Children’s, now apparently working for MIT Media Lab.

Reader Comments

From Capezio: “Re: CMS MU request website. Any idea why they took it down? We used it to get MU clarification until a week or two ago. A message says to use CMS’s main site instead, which has been improved but is infrequently updated and doesn’t cover emerging issues. Can you find out if this is a temporary hold or whether it’s gone for good?”

From The PACS Designer: “Re: end of Windows Server 2003 support. Just eight months away — migration planning should already be in the works.”

From Blue Hawaiian: “Re: service management best practice. Would love to see more. Healthcare seems slow to move in that direction, just as it was for quality management best practice (aka patient safety) for so many years.” It would be fun if a CIO with expertise on this topic would write something up about what they’re doing.

From See Sh*t: “Re: CCHIT. Funny that they’re leaving their minimal assets to the HIMSS Foundation.” My macro view is that HITECH money is losing impact and the hangers-on created to tap into it (certification bodies, HIEs, RECs, even ONC itself) are finding it tough to pay the bills as the taxpayer trough dries up. As I said in reacting to CCHIT’s bizarre January 2014 announcement that it would exit the certification business and turn into a thought-leader non-profit with unstated revenue streams, “The most recent Form 990 I could find was from 2011, at which time it was paying Chairman Karen Bell $409K, Executive Director Alisa Ray $250K, and five other employees over $100K. It would seem to me that given CCHIT’s genesis, mission, and name, it should just go away rather than trying to morph itself into the already overcrowded thought leadership business. It probably would if HIMSS wasn’t riding in on a white horse to save it, not surprising given that HIMSS formed CCHIT (along with partners AHIMA and NAHIT) in 2004.” Consulting firms and software vendors have already moved on from MU to the next government-incented shiny object: analytics and population health management, emboldened by the continued willingness of providers to focus their entire agenda on whatever Uncle Sam is writing checks for at the moment.

From Sponsor President: “Re: your site. You mentioned our company in a post that just went out a few minutes ago at 10 at night Eastern time. I’ve received 12 emails in the past 15 minutes. You are the best marketing value in all of HIT.” I appreciate that, although all I’m doing is putting out concise, factual information that I think is relevant and readers are free to use it however they like. Their response means the company has interesting offerings.

From Tipper: “Re: Epic. This week, Judy Faulkner said, ‘We do not like to participate with organizations that are going to sell the data because we’ve always felt the data is confidential. That’s another thing that has always bothered us about CommonWell.’ This seems to be CommonWell’s response.” A CommonWell blog post says the notion that it would sell data is “absurd” and “especially inaccurate,” adding that it will never sell personal health data and in fact as a broker doesn’t even have access to clinical data. The post adds that CommonWell will charge fees of 0.1 percent of each member’s annual revenue above and beyond membership dues.

HIStalk Announcements and Requests

This week on HIStalk Practice: Day 1, 2, and 3 show updates from MGMA. Dr. Gregg takes healthcare IT to the land of Oz. MGMA members show no love for Medicare’s quality reporting programs. Spring Creek Family Medicine goes live on its eCW patient portal. HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers Chicago’s newest digital health accelerator, Matter, and its first class of startups. Google unveils its newest X Labs project: a nanoparticle-filled smart pill programmed to enter the blood stream and search for early-stage cancer tumors. Fitbit releases two new activity trackers and a full blown smartwatch with a focus on health metrics. Salesforce is rumored to be optimizing its customer relationship management platform as an outreach and population health tool.

Welcome to new HIStalk Gold Sponsor Clockwise.MD, which is also sponsoring HIStalk Practice. The Atlanta-based company’s online reservation system lets patients skip the wait – they make an appointment (online or mobile), show up on time knowing their place is reserved, and then watch the wait times and queue order in real time on an iPad (I really like that idea – nothing is worse that fuming in a crowded waiting room wondering if you’ve been forgotten). Providers users gain interesting benefits: they can fill in their less-busy schedule times, keep patients informed about wait times via automatic text messages, and target delayed patients via a real-time dashboard so that appropriate customer service actions can be taken (like furtively slipping a slowly fuming Mr. H a current-issue Popular Science magazine that will otherwise age for months in the practice’s climate-controlled magazine cellar until it’s ripened enough for the waiting room coffee table). Here’s a fun idea: when a patient cancels their appointment, the open slot is broadcast by text message and whoever jumps on it first can take that appointment. The company’s founder and CEO is Mike Burke, who founded informed consent system Dialog Medical and sold it to Standard Register in 2011. Thanks to Clockwise.MD for supporting HIStalk and HIStalk Practice.

A quick YouTube search turned up this brand new Clockwise.MD explainer video.

My task following Dim-Sum’s amazing HIStalk webinar “DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project” (over 1,000 people have watched the YouTube recording) was to see if there’s interest in the sub-topic of military theater medicine, and if so, to enlist experts from Epic, Cerner, and Allscripts to join Dim-Sum in a follow-up webinar panel discussion. He doesn’t have a horse in the DoD’s EHR race, but is passionate about the topic as a military health advocate and veteran. Your thoughts are welcome.

Acquisitions, Funding, Business, and Stock

Lockheed Martin will acquire privately held government health IT provider Systems Made Simple for an undisclosed sum. The company does a lot of work for the VA and had $278 million of revenue in 2013.

From the McKesson earnings call:

The company’s quarterly revenue was $45 billion.
John Hammergren says he’s pleased with improved margins in Technology Solutions business, although revenue was down 6 percent in the quarter.
Hammergren says CommonWell Health Alliance is demonstrating real-world interoperability progress in adding new members, and running four successful pilots.
Hammergren said of the Technology Solutions business that “We’ve had the biggest challenge with in the EMR kind of space,” repeated that growth won’t return to previous levels until the transition from Horizon to Paragon is complete, and says that McKesson’s imaging business has been hurt as customers focused on buying products to meet Meaningful Use requirements.

In an apparent admission that CommonWell’s work will be commercialized as he hinted in the last earnings call, Hammergren said in the McKesson earnings call that CommonWell has signed “a multiyear agreement for nationwide commercialization of the services, with the core services being provided by RelayHealth.” I don’t know if CommonWell is the altruistic, non-profit, vendor-driven interoperability project it claims to be or a way for McKesson to sell RelayHealth services through Epic-scared EHR competitors anxious to launch a pay service for interoperability. The fact that it came up in McKesson’s earnings call suggests that the company is looking forward to new RelayHealth revenue.

BIP Capital sells its original fund’s stake in Ingenious Med to another private equity firm for a nine-fold gross return, but will continue to hold company equity in a second Fund.

Merge Healthcare posts Q3 results: revenue down 6 percent, adjusted EPS $0.05 vs. $0.02, beating expectations for both.

MedAssets turns in Q3 results: revenue up 5.6 percent, adjusted EPS $0.34 vs. $0.31.

IBM and Twitter, both desperately seeking new revenue sources, announce a partnership in which IBM will analyze tweet data for “business decision-making.” I don’t have access to big data that would support my theory that this project will go nowhere – tweets are such a uncategorized, free-text mess that surely no sane business would pay IBM to sell it Twitter-powered business advice.

MedStar Health (MD) expands its Cerner relationship with a seven-year agreement.

Sales

North Shore-LIJ Health System (NY) chooses Explorys for Hadoop-based analytics and risk models.

St. Luke’s University Health Network (PA) picks Nuvon for medical device integration.

People

Member engagement software vendor Healthx names Michael Gordon (iTriage) as chief product and strategy officer.

Voalte hires Suzanne Shifflet (ONR, Inc.) as CFO.

Randy K. Hawkins, MD (Glytec) joins Connance as chief medical officer.

Eric Johnson (Informatica) joins DocuSign as SVP/CIO.

Announcements and Implementations

Allscripts introduces Sunrise Mobile Care, an iPhone/iPad app that lets nurses review and input patient information (allergies, vitals, I&O) with alerts and bi-directional updates from Sunrise. It’s curious that the vendor claiming to be the most “open” (whatever that means) supports only Apple devices.

Kaiser Permanente adds what it calls “medical selfie” capability to its patient portal, which allows patients to securely send digital pictures to their doctor for review. A copy also goes into their patient record. Patients can also send PDF files, such as scans of work-related forms that require the doctor’s signature.

RazorInsights will offer its laboratory information system customers instrument interfaces and workflow tools from Data Innovations.

In India, the renovated Sir HN Reliance Foundation Hospital will deploy Google Glass to its ED doctors, who will be able to review the patient’s history (including images) without looking away. SAP connected Glass to the hospital information system for two-way information exchange. According to SAP, “With the help of the Google Glass, doctors can attend to multiple patients, engage with them and see almost twice as many patients during the rounds. Doctors can take accurate notes on the Google Glass itself. The data is stored automatically and can be accessed when required.” Another hospital in India is creating a Glass-powered telemedicine application.

EClinicalWorks chooses Exostar’s ProviderPass SaaS-based identity proofing and second-factor credential authentication to meet the DEA’s e-prescribing requirements for controlled drugs. The company uses Experian-provided identity challenge questions or live webcam video.

In Canada, Nova Scotia’s Meditech hospital information system will go down next Tuesday and Wednesday for a software upgrade, with hospitals and clinics shutting down all non-emergency services, including surgeries, lab work, and diagnostic imaging.

Audacious Inquiry and Johns Hopkins Community Physicians sign a collaboration agreement to enhance the company’s encounter notification service.

Government and Politics

Former Massachusetts “Obamacare czar” Sarah Iselin, who in February was drafted to try to save the failed Massachusetts Health Connector health insurance exchange, quits to become executive-in-residence at Optum, which was awarded a no-bid contract to fix the exchange. She says there’s no conflict of interest since she hasn’t been involved in the project for the past six months, she was hired before Optum got the business, and technically she worked for the governor rather than Health Connector.

FCW covers the odd open source pitch of PricewaterhouseCoopers and General Dynamics in bidding on the $11 billion DoD EHR contract by offering up VistA, the very mention of which probably causes Pentagon brass to make mock retching sounds given that the VA developed it. They wouldn’t even interface to it, so the odds they’ll implement it surely are near zero, especially when they want a commercial system whose single vendor is committed to supporting and enhancing it. PwC and GD obviously were late to the taxpayer-funded party and found all the available EHR dance cards filled (those bidders that chose Meditech and Siemens later pulled out of the running). If the bid were being handicapped as a Presidential election, it would be Epic (Democrat), Cerner (Republican), Allscripts (Libertarian) and VistA (Green Party).

The AMA should probably just call up Sylvia Burwell instead of issuing a daily statement about ONC, but for what it’s worth (not much), AMA says it’s happy (or at least as happy as AMA can get) that Karen DeSalvo will still lead ONC in whatever fashion HHS decides is necessary to prevent pundits from predicting ONC’s impending irrelevance. It feels like HHS panicked at the ONC-negative response to her transfer and came up with a lame “she’ll do both jobs” excuse.

The House Science Committee on Science, Space, and Technology subpoenas former US CTO Todd Park to describe the security capabilities of Healthcare.gov.

The United States sues New York City and CSC for Medicaid billing fraud, claiming that the city used the default settings of CSC’s billing system to bypass Medicaid’s secondary payor requirement and used generic ICD-9 codes that they knew Medicaid would pay more quickly.

Technology

The 100-researcher team of Google X Life Sciences is developing a Tricorder-like early warning disease detection system in which patient-swallowed sensors send notice of tracked nanoparticles to a wristband. The project is being run by a renowned molecular biologist who used to work for LabCorp, in partnership with MIT, Stanford, and Duke. He says that healthcare is reactive and transactional, with diagnosis – especially for cancer – coming too late once symptoms are apparent (he calls this the “wait until you feel a big lump in your chest before you go to the doctor” approach). He also suggests that the big data possibilities could be enormous as therapies can be targeted to molecular profiles. This is tied into the company’s Baseline Study, in which it is attempting to quantify the measurements that signify good health. The technology is nearly ready for human testing, a flurry of new patents will come out in the next month, and the company expects widespread usage in 5-10 years. Google will license the technology as they did for their smart contact lens. Another Google group, Calico, is attempting to extend longevity, which he explains as, “We’re helping you live long enough so Calico can make you live longer.”

A Canada-based startup receives approval to sell its on-demand DNA testing device in that country, where frontline providers in any care setting (including pharmacies) can instantly determine whether a patient should receive the anticoagulant drug Plavix based on a known genetic problem that renders it less effective. More test types will follow. The company has earned FDA approval to sell its product in the US, but only to hospitals. The device costs $9,000 and each test is $225, but the company says it will tweak the price to make it affordable.

Microsoft announces Microsoft Health, a platform and app for collecting information from fitness wearables, planning to eventually add connectivity to share the information with providers via HealthVault. It claims its Intelligence Engine will provide insights such as fitness performance by time of day and after meals. In other words, it’s Microsoft’s answer to Apple’s Health and HealthKit with equally limited capabilities given that the information it can collect isn’t worth a whole lot except to quantified self fitness fanatics –your doctor doesn’t really have the time to monitor your step count or sleep patterns that have minimal immediate effect on the current problem list.

I’m not excited about Microsoft Health, but Microsoft also announces its $199 Microsoft Band, which is immediately available (kudos for not pre-announcing stuff that won’t be out for months – looking at you, Apple Watch). Kudos, too, that Band works with Android and iOS devices in addition to Windows-based mobiles and includes a GPS, heart rate monitor, and a two-day battery life vs. the imaginary Apple Watch’s one-day charge. It also uses a Bluetooth phone connection to display text messages, emails, and social media updates. It looks like a winner to me, with the only real competition being Apple (its fanboys are both loyal and patient) and Android Wear. I haven’t been tempted by any fitness tracker since my Fitbit Force was recalled, but Microsoft Band seems worth a look for those willing to pay for extra capabilities beyond the usual tarted-up pedometer.

Other

A piece in Madison’s hippie weekly (as I always call those left-leaning papers that feature mostly music reviews, sex-related ads, and pathetically predictable anti-establishment rants) covers Epic without saying anything new or insightful except one thing: the company confirms that it has built a data center in Verona for client hosting. That’s a pretty big deal: Cerner has gained many small or remotely located customers (and made a lot of money) from its remote hosting services, while Epic, like Meditech that inspired it early on, has stubbornly avoided the obviously smart move of making its systems available as a service to let hospitals avoid the capital costs and personnel requirements of running it from their own data centers. That policy made sense when Epic sold only to academic medical centers with big IT budgets and big IT egos, but now that it’s moving down-market, hosted systems are likely to be a hit. I’ll follow up for more information.

The iMDsoft Metavision software bug that was characterized in a risk assessment as being potentially lethal to ICU patients in Australia turns into a political issue. Opposing political parties in Queensland debate the extent to which patients have been warned and invoke unpleasant memories of Queensland Health’s 2010 payroll system implementation, in which IBM turned a $5 million fixed-price bid into a billion-dollar project with a little help from company-friendly bureaucrats (which got the company banned from future Queensland work). It’s one of three health-related examples that come to mind when enumerating the biggest IT debacles in government IT history, along with England’s NPfIT and Healthcare.gov. Meanwhile, iMDsoft says Queensland Health is testing a fix it provided, explaining somewhat mysteriously that the problem came up during testing, perhaps tactfully declining to throw its client under the bus for their role in going live with a known problem.

Cerner expects 11,000 participants from 26 countries at its annual conference in Kansas City, MO next week, with attendance up 20 percent over last year.

Columbiana Family Care Center (OH) closes temporarily after the computer system of its owner, Salem Regional Medical Center, goes down after an unspecified software problem.

The Chinese engineer charged with stealing proprietary MRI programming information from his former employer GE Healthcare and sending it back to China will plead guilty to stealing trade secrets, facing 10 years in prison, a $250,000 fine, and deportation.

It’s not completely health IT related, but Genentech angers hospitals by changing the way it distributes three cancer drugs – Avastin, Herceptin, and Rituxan – to six regional distribution centers rather than the usual drug wholesaler, citing the need to increase drug supply chain security. Hospitals say they won’t be able to get those meds daily as they always have so they’ll have to stockpile the expensive drugs, they’ll have to rely on overnight shipping companies in emergencies, they will lose traditional discounts, and on the data side won’t get wholesaler-provided benchmarking information and convenient 340B accounting. Similar events have happened on the consumer side, where drug companies declare an expensive item a specialty drug, meaning patients have to get their supply from mail-order pharmacies that focus on expensive drugs for chronic conditions.

Louisiana state health officials tell doctors planning to attend a New Orleans tropical medicine conference this weekend to stay home if they have visited Liberia, Guinea, or Sierra Leone within the past 21 days. The conference, ironically, was to feature presenters talking about their work in fighting Ebola in Africa, but now those experts won’t be allowed to attend. The letter admits that even infected people don’t spread the disease if they aren’t showing symptoms, but adds that, “We see no utility in you traveling to New Orleans to simply be confined to your room.” Science and politics just don’t mix.

California’s attorney general issues her 2014 data breach report, which finds that the number of records exposed in healthcare breaches was higher than in all other sectors except retail. The AG points out nicely that healthcare is an outlier because most of its breaches involved stolen hardware that wouldn’t have been a breach at all had their owners simply encrypted the devices. Here is my advice to healthcare CIOs: if you aren’t encrypting all laptops because you haven’t asked for the money, you should be fired. If you aren’t encrypting all laptops because administration won’t give you the money, you should quit. Either way your name is going to be up in quite embarrassing lights when someone loses a laptop (probably after violating a hospital policy in taking it home after storing PHI on the local drive) and your boss has to sheepishly admit to the local community that it wasn’t encrypted. On the bright side, that one exposure usually results in the board coming up with encryption project money, albeit after the fact.

Sponsor Updates

Forward Health Group will participate in the IHI National Forum on Quality Improvement in Healthcare December 7-10 in Orlando.
Clinovations shares Dennis Glidewell’s thoughts on areas of opportunity in the revenue cycle in Ask the Expert.
IHT2 announces the speakers and topics for Health IT Summit Houston December 10-11.
EClinicalWorks signs an additional 37 CHCs and FQHCs.
Washington Business Journal names GetWellNetwork to its “50 Fastest Growing Companies of 2014.”
CareTech Solutions will discuss hospital website security threats at the 18th Annual Greystone.Net Healthcare Internet Conference November 3-5 in Scottsdale, AZ.

EPtalk by Dr. Jayne

Cleveland Clinic announces its list of top medical innovations of 2015. Since the list was compiled by people in the patient care trenches, it’s not surprising that it was heavy on drug and treatment technologies and light on health IT.

We hear a lot about alarm fatigue, so I was interested to see this article on “decision fatigue” as showing that physicians prescribe more antibiotics later in their workdays, even when the drugs may not be appropriate. It’s a research letter that doesn’t have the same weight as some other studies, but it is interesting nevertheless. I know I get tired at the end of a full day of seeing patients and definitely don’t feel as sharp as when I start. I’d be interested to see an analysis of allergy and interaction alerts stratified by time of day and how our physicians reacted to them.

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I had the privilege of moderating a hospital community forum last Saturday morning. I posted some of the questions/comments in Twitter, but I can’t say I’m a fan of live tweeting. I was impressed by the level of patient engagement (and the knowledge) around Ebola. To be fair, there were plenty of questions about other key community health priorities, including diabetes and a couple of questions about childhood vaccinations.

Discussing a disease for which there is no vaccine in the same session as diseases for which there are vaccines that people refuse was a bit surreal. A couple of the attendees mentioned the polio scares of the 1950s and hearing the perspective of people who watched their schoolmates become ill and disabled was moving. I found this NPR piece the other day that talked about the polio vaccine trials and why they could never be done today. If nothing else, we live in interesting times.

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I finally registered for HIMSS this week. I waited too long last year and am happy to report that there are still plenty of good hotels left. Although I’m not crazy about Chicago as a site for conferences, it’s a fun town. I’m already scheming with a good friend for some potential pre-conference fun and am keeping my eye out for just the right HIStalkapalooza shoes (although this charming Louboutin handbag is a little out of my price range).

In the Breach of the Week, hundreds of medical records were lost when they blew out of the back of a truck in Omaha, NE. Apparently the medical waste disposal company didn’t secure them properly. I was impressed by volunteers that were helping pick them up, even reaching into a storm sewer to gather documents. The news report indicates they were on their way to be “stored” in Lincoln, NE which makes the fact that a waste disposal company was transporting them a bit curious.

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I’m off to CME this weekend and have blown my conference budget for the year. I wish I had saved up some cash to attend the mHealthSummit in December and particularly the Gala Reception for Disruptive Women in Healthcare. If nothing else, it would be a great opportunity to pick up swag and take pictures for my desk that would drive my boss crazy. Maybe someday I’ll make the list of Disruptive Women to Watch.

Who are your favorite disruptive women? 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 10/29/14

October 28, 2014 News 3 Comments

Top News

An ONC blog post says that National Coordinator Karen DeSalvo, MD will continue to lead ONC while under reassignment as Acting Assistant Secretary of Health, saying she will continue to chair the Health IT Policy Committee and work on ONC’s Interoperability Roadmap. ONC seems to be trying to reassure observers of its leadership exodus in adding, “The team that is ONC is far more than one or two leaders. The team of ONC is personified in each and every individual – all part of a steady ship and a strong and important part of HHS’ path toward delivery system reform and overall health improvement.”

Reader Comments

From Pedro Fumar: “Re: hospital handwashing video. This kind of thing gives me a douche chill, but I’m sure it can be effective.” It’s awful but annoyingly hard to turn off, sort of like “All About That Bass,” but anything that elicits an obscure “Arrested Development” reader quote is OK with me.

HIStalk Announcements and Requests

Jenn’s magnificent daily MGMA conference recaps on HIStalk Practice will make it feel like you’re there, especially if you actually are. I’m enjoying them.

Welcome to new HIStalk Platinum Sponsor TransUnion Healthcare. The 46-year-old Chicago-based company offers patient-centric patient access and collections systems that create a better, more transparent financial experience and reduce bad debt. Hospital solutions include ID and address verification, eligibility, patient payment estimation, ability to pay determination, medical necessity, and charity care determination. For collections and reimbursement, the company offers insurance coverage discovery for self-pay accounts, reimbursement optimization, Medicaid re-verification, presumptive charity care, and claims statusing. Most of these services are offered through strategic partners as well. TransUnion also offers data breach services – they will get a campaign up and running within two days that provides a case manager to identify and report fraud, notify affected patients, provide customer notification templates, and optionally stand up a toll-free telephone breach hotline. TransUnion has a #1 KLAS-ranked solution, five HFMA peer-reviewed solutions, 1,000 hospital clients, 75 partners, and 500 million consumer credit histories under management. Thanks to TransUnion Healthcare for supporting HIStalk.

Listening: new from Johnny Marr, who was the other songwriter (with Morrissey) of The Smiths and guitarist for Modest Mouse. It’s not amazing and his singing isn’t great, but he gets a pass for being a semi-legend.

Acquisitions, Funding, Business, and Stock

Optum will acquire Alere Health for $600 million, with Alere President and CEO Namal Nawana stating that the company wants to focus on the rapid diagnostics market. The Alere Health business includes clinical decision support, care management, home monitoring, and connected device technologies acquired over the years from DiagnosisOne, MedApps, and Wellogic.

Revenue cycle and analytics solutions vendor MediGain receives $38 million in funding from Prudential Capital Group.

Portland, OR-based Bright.md closes a $1 million funding round to further develop its telemedicine platform. Co-founder Ray Constantini, MD was formerly a regional medical director for Providence Health & Services.

Bellevue, WA-based corporate wellness platform vendor Limeade receives a $25 million investment from Oak HC/FT’s venture fund. That might be the best startup name ever, chosen purely because it’s memorable though irrelevant.

IBM shares have dropped sharply in the past few weeks. Above is the one-year share price of IBM (blue, down 11 percent) vs. the Dow (red, up 7 percent). Maybe they can get Watson to develop a new corporate strategy (or maybe they already did).

Sunquest parent Roper Industries announces Q3 results: revenue up 7 percent, adjusted EPS $1.55 vs. $1.42, missing expectations on revenue but beating on earnings. Chairman, President, and CEO Brian Jellison said in the earnings call, “We had great performance, just great performance in both Sunquest and MHA. Sunquest continues to drive execution around the Meaningful Use implementations and upgrade which is finally getting us out at some of the backlog that we had experienced last year with Sunquest. So productivity is up sharply here.”

In New Zealand, Orion Health registers for its IPO of $119 million, valuing itself at around $792 million. However, the company declined to provide financial information in its prospectus, which the COO justified by saying that only a third of its revenue is recurring, making forecasts unreliable due to its ongoing reliance on big-dollar new sales.

McKesson announces Q2 results: revenue up 36 percent, EPS $2.79 vs. $2.30, beating analyst expectations for both. Horizon Clinicals continued to drag down the Technology Solutions segment, whose revenue was down 6 percent.

CCHIT has shut down effective immediately after 10 years and will donate its assets to the HIMSS Foundation.

Cerner co-founder Cliff Illig joins Neal Patterson as the second Cerner-created billionaire as the company’s shares hit an all-time high that values it at $22 billion.

Sales

Beaufort Memorial Hospital (SC) replaces pagers with the Imprivata Cortext communications platform.

Palmetto Primary Care Physicians (SC) selects the eClinicalWorks EHR and care coordination system for its 250 providers and 34 locations.

Priority Management Services (LA) chooses HCS Interactant for three of its long-term acute care facilities in Louisiana and Texas, which will implement the company’s revenue cycle, financial, EMR, mobile, and Insight modules.

Wake Forest Baptist Medical Center (NC) chooses Omnicell pharmacy, nursing, and analytics tools for medication management.

Agnesian HealthCare (WI) joins Premier, Inc. to make group purchasing, supply chain analytics, and ASCEND available across its enterprise.

People

Experian promotes Scott Bagwell to president of Experian Health.

Payment solutions vendor Altegra Health names Bob Drelick (Lovelace Health System) as CIO.

Analytics vendor Clearsense hires former PeaceHealth CIO Ryan Ball as CEO.

David Miller (University of Arkansas for Medical Sciences) joins Optimum Healthcare IT as CIO.

Announcements and Implementations

Emdeon announces retirement of the CaparioOne technology platform brand, replacing it with Emdeon One following its just-completed $115 million acquisition of revenue cycle vendor Capario. The company also added a denials management service to the system.

CareCloud launches an analytics suite for its medical practice users.

Cambridge University Hospitals-affiliated Addenbrooke’s Hospital and The Rosie Hospital go live with Cambridge’s $355 million Epic system, stated to be the first Epic go-live in the UK.

SCI Solutions releases a new version of its Schedule Maximizer enterprise scheduling system.

Vocera launches two products — appointment reminders and delivery of 12-lead ECGs to physician smartphones — and announces new EHR integration with its Vocera Collaboration Suite.

ADP AdvancedMD launches a patient portal, financial dashboard, and mobile e-prescribing capabilities.

Government and Politics

An AMA statement says that the mass departure of ONC officials “leaves a significant leadership gap which could jeopardize the growing momentum around interoperability,” adding its stump speech components that EHRS are “poorly performing” and that ONC should follow its recently announced framework to improve Meaningful Use.

Perhaps self-proclaimed public health expert New Jersey Governor Chris Christie should be focusing on this instead of traveler quarantines: 98 percent of New Jersey’s hospitals have been fined for readmissions, by far the largest percentage in the US.

Meanwhile, The New Yorker runs a satirical piece called “Christie Sworn In as Doctor”:

Dr. Christie said that, beginning on Monday, he would begin a series of random “house calls” to check New Jersey residents for Ebola and assign them for quarantine. “I can usually diagnose someone with Ebola in under a minute,” Dr. Christie said. “Even faster if I don’t actually see them.” The doctor said that before moving forward with his plan to quarantine scores of New Jersey citizens he suspects of having Ebola, he consulted with other prominent epidemiologists, including Dr. Rick Perry of Texas.

An MGMA survey of 1,000 medical practices find that around 85 percent of them think Medicare’s quality reporting programs detract from patient care and reduce physician productivity. More than three-quarters of respondents say the programs are too complicated, irrelevant to specialty care, expensive to implement, and include unachievable thresholds.

Innovation and Research

A Netherlands university graduate student designs a defibrillator-carrying drone that can be quickly dispatched in response to 911 calls. The device’s GPS allows it to land at the patient’s location, where it will initiate a live video session with emergency services to provide instructions. The student says the drone’s faster response (since it isn’t impeded by traffic) will increase the heart attack survival rate from the current 8 percent to 80 percent. He estimates that the “flying toolbox” will cost $20,000, but adds that it will take a few years to fine-tune its object avoidance system. It’s also not legal to fly automatically directed drones in his country.

Other

St. Bernard Parish Hospital (LA) blames Healthland’s systems for its failure to collect $3 million, with the CEO explaining, “We have two systems, a billing system and a patient system, and those two systems didn’t communicate with each other.” The hospital’s lawyers are negotiating with Healthland to get some of their money back.

The CVS and Rite Aid pharmacy chains stop accepting the week-old Apple Pay, joining several large retailers that are developing their own mobile payment network to avoid paying Apple Pay’s 1.5 to 3 percent fees. They likely also have an unstated interest in continuing to collect data on shoppers using systems they control, possibly reacting to this Apple statement to consumers: “We are not in the business of collecting your data. So, when you go to a physical location and use Apple Pay, Apple doesn’t know what you bought, where you bought it, or how much you paid for it,” which of course is because it really can’t since it only knows who was paid and how much, not what items were purchased.

Cerner’s Neal Patterson pays $200,000 for the prize-winning steer at the American Royal Association’s Junior Premium Livestock Auction fundraiser. No word yet on whether he pardons it like a White House Thanksgiving turkey, turns it into a freezer full of beef, or sends it to Judy Faulkner to live out its days grazing on Epic’s farm.

CHIME’s Leslie Krigstein tweeted out this picture of conference attendees volunteering at the San Antonio Food Bank.

Queensland, Australia’s health minister releases a report stating that iMDsoft’s Metavision ICU software, installed at nine of its hospitals, creates a 60 to 90 percent chance of contributing to a patient’s death in the next 30 days. The report, citing several near misses, says that “monitoring of patient records by pharmacists has revealed several potentially serious prescription errors specifically caused by the system.” Queensland Health is manually overriding the system and reviewing charts daily for problems while waiting on a vendor fix.

Jenn picked up this fascinating tidbit on HIStalk Practice: University of Texas Southwestern Medical Center is using Tabasco sauce in its Ebola precautions training for employees. Mock Ebola patients are anointed with hot sauce to simulate their bodily fluids, and if the skin of doctors and nurses burns as they remove their protective apparel, they know immediately that they’ve done something wrong. I use a similar technique to validate my hand-washing after chopping jalapenos for salsa, usually receiving a painful reminder of my sub-par technique conveniently close to the bathroom sink.

Weird News Andy likes the idea of an announced iPhone-powered cancer detection device, adding his intrigue that the company is also release 3D-printable versions of the sample trays it requires. It’s interesting, but surely will never see the light of day in the US unless a bigger company with money to spend on FDA-required studies buys it.

Sponsor Updates

T-System client Dosher Memorial Hospital (NC) completes its pilot of a new version of EV that includes ICD-10 capabilities.
Medhost is showcasing its emergency care solution at ACEP14 this week in San Antonio.
Hamilton General Hospital (TX) meets Meaningful Use Stage 2 requirements using Medhost solutions to pull Q2 2014 data.
Health City Cayman Islands is featured in a documentary “From the Heart: Healthcare Transformation from India to the Cayman Islands.” Appearing is Dale Sanders, former CIO of Cayman Islands Health Services Authority, now SVP of Health Catalyst.
BJC HealthCare (IL/MO) is live on ZeOmega’s population health management solution Jiva.
Consulting Magazine recognizes Paula Elliott (Impact Advisors) and Nicola Johnson (Deloitte Consulting) in its “8th Annual Women Leaders in Consulting Awards” list.
ZirMed announces its User Group Conference and Partner Forum theme November 10-12 will be “Shatter Expectations.”
Craneware will co-present with NorthBay Healthcare at the 2014 HFMA MAP Event in Las Vegas on November 3.
Levi, Ray & Shoup will participate in the 2014 SAP TechEd && d-Code event in Berlin, Germany November 11-13.
Sutter Health (CA) describes how Validic helped get patient/client steps, heartbeat, and sleep patterns into Epic.

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 10/27/14

October 26, 2014 News 8 Comments

Top News

From the Cerner earnings call:

Bookings hit an all-time Q3 high at $1.1 billion and backlog increased to $9.34 billion.
The company predicts that its margins will drop from around 25 percent to the low 20 percent range due to the Siemens acquisition, but expects them return to normal by 2017.
Cerner expects the Siemens acquisition to close on February 2, 2015.
Adjusted EPS was $0.42 per share. The company expects a post-Siemens earnings growth of 27 percent. I’m not much of a stock analyst, but that seems to indicate an EPS jump to around $0.53, and with 341 million shares out, that means the acquisition will add $38 million of profit per quarter or around $150 million per year, meaning the acquisition will pay for itself in no more than eight years. I expect it will be perhaps half that time given the opportunity to upsell and convert existing Siemens customers. Cerner would have to make as many mistakes as Siemens did to mess up this deal given the fire-sale price they paid.
The company says it is committed to “having the most open EMR.”
Cerner says best-of-breed registry suppliers aren’t getting value because they haven’t aggregated clinical and financial information across systems, leading some of them to look to Cerner’s offerings.
The company expects the DoD EHR selection to occur in the first half of 2015 and the contract to be signed in the second half.
Cerner observes that Siemens offers to the global market “relatively low-end solutions” that “played at a little bit of a lower end in terms of scalability,” giving the company a chance to put Millennium in place outside the US.
President Zane Burke suggests that non-Soarian legacy Siemens users (Invision, MedSeries4) have a three- to five-year horizon (“horizon” being related to “sunset.”)
CFO Marc Naughton explains the Soarian opportunity: “When you look at a Soarian client, their clinical solutions were not very broad. They were focused on EMR orders and a very core set of solutions. All of those clients are paying a third party — in many places a niche supplier — a fair amount of money for their ancillary solutions. One of the key rationales for this business, obviously, and the reason we want to retain that client base is, like for like, exchanging Millennium for Soarian. We have a lot of additional solutions we can sell onto that base.”
Zane Burke stated, “I don’t see Meaningful Use driving any buying behavior today.”
Burke says that population health could be bigger market than EHRs.

Reader Comments

From Tony M: “Re: Psychology Today article. Says EHRs are a farce.” A sleep medicine doctor writes a not very convincing anti-EHR piece that still manages to make a few good points. He wanders around in fretting (usually anecdotally) about health vs. healthcare, privacy breaches in healthcare and other industries, wasted physician time inputting EHR information, and lack of interoperability. Where he misfires is in failing to identify the real problem: EHRs drive billing (I assume he’s not against billing for his services) and therefore reflect the requirement of those who write the checks, not those who send the invoices. He takes a turn toward the bizarre in his concluding recommendation: give taxpayer money to public health schools to create non-profit EHR companies that will license EHRs from “civilized countries that have worked cheaply and effectively for decades.” Hopefully he is sincere about the “working cheaply” part since he would be doing just that in running an EHR that works in Denmark or Australia – unless he launches an all-cash practice, he’s not going to see a dime of revenue. It is nearly always the case that those complaining about the clinical intrusion of EHRs are confusing the symptom with the disease and the disease isn’t easily cured – the US healthcare system is a world-class, special-interests disaster and EHRs were designed to support it effectively. Doctors are smart but were unwisely obedient over the past few decades – they turned healthcare over to insurance companies, government, and profitable non-profit healthcare systems without a peep, but now misdirect their ire toward whatever’s sitting right in front of them rather than the far more complex hole they compliantly helped dig themselves into.

From Moderated: “Re: anti-EHR comments. I think we’ve heard enough of the same parroting anti-EHR crowd, both about THR and otherwise.” It’s actually a crowd of one. The same poster users a variety of phony names – Not Tired of Suzy RN, Jenny Dimento MBA, Gopal Singh MD, Keith McItkin PhD, and several others. Sometimes I approve his or her comment if it adds value or is entertainingly strident, but often I delete it because I agree that the incessant “bring back paper charts” droning gets old.

From Country Coder: “Re: EHRs and Ebola. Everybody is glomming on with their uninsightful insights. Anything to get your name in the papers even if it’s not related — I’m calling it the Tori Spelling effect.” Tori Spelling has zero chance of getting Ebola, but that doesn’t stop her from turning a case of bronchitis into possible Ebola infection as she coincidentally shows up at Cedars-Sinai right before her new reality show premieres. The TV rags claimed “quarantine,” but she was really just put with other feverish, coughing patients until they decided to admit her for some reason, just in time for her to tweet out a dramatic message complete with photo. I would bet money she uttered the word “Ebola” enough times to make sure she wasn’t just sent home where the cameras aren’t. She pulled the same stunt a couple of weeks ago in falsely claiming she was pregnant in a teaser for the new show. I can never figure out how celebrities can “check themselves” into a hospital while everybody else who is really sick gets sent home because their insurance won’t pay for an admission.

HIStalk Announcements and Requests

The vast majority of poll respondents don’t think the names of Ebola patients should be publicly announced. New poll to your right or here: what is the weakest link in diagnosing Ebola in the ED based on travel history? (I say “travel history” specifically since unfortunately in the absence of such history, no immediate and accurate diagnostic method exists). Vote and then click the “Comments” link to pontificate further.

Welcome to new HIStalk Platinum Sponsor Healthgrades. The Denver-based company’s online provider database – searchable by disease, condition, or procedure – is used by a million people per day who are making trusted, informed decisions about their care in choosing the right provider, more than half of whom follow up by scheduling a physician appointment. The company just enhanced its free physician search to let consumers choose factors that are important to them, such as experience, the quality of the hospitals in which they practice, and patient satisfaction. It also offers services to hospitals that include business intelligence, marketing, and clinical communication solutions that increase consumer and physician engagement and improve service quality and utilization. I interviewed President Jeff Surges a few weeks ago, who told me, “We’re going to be releasing a lot of data and analytics about our ratings in the fall and using very expressive ways to show how our methodologies can partner with quality and outcomes within a hospital.” Thanks to Healthgrades for supporting HIStalk.

I always cruise YouTube to research new sponsors and found this recently posted 15-second Healthgrades TV commercial.

Listening: new from Brooklyn-based The Budos Band, instrumental Afro-Soul that sounds like sweet, funky 1960s horns and wah-wah guitar without the vocals — think the opening theme from “Hawaii Five-0” or “The Horse” by the underappreciated Cliff Nobles – although it sometimes moves into psychedelic rock territory with molten guitar and a smoke-filled room backbeat. They’re on Daptone Records along with the equally magnificent and musically similar Sharon Jones and the Dap-Kings. I’ll also be listening to Cream (and possibly West, Bruce & Laing and Manfred Mann) in noting the death of bassist Jack Bruce at 71 on Saturday.

Last Week’s Most Interesting News

ONC loses its two highest-ranking officials as HHS transfers National Coordinator Karen DeSalvo, MD to acting assistant secretary for health and Deputy National Coordinator Jacob Reider, MD announces his resignation. COO Lisa Lewis, whose non-medical, non-technical background is federal government administration, is named acting national coordinator.
HIMSS moves its 2019 convention from Chicago to Orlando after a squabble triggered by a guarantee given to RSNA that it gets the lowest available Chicago hotel room rates.
Details of the treatment given to Ebola patient Thomas Duncan by the ED of Texas Health Presbyterian Hospital Dallas show several inconsistencies with earlier reports, with contributions to the missed diagnosis including that a nurse’s failed to follow policy in telling the ED doctor about the patient’s travel to Africa, the doctor missed the nurse’s travel note in a nearly empty Epic patient record, and the patient provided conflicting history and symptoms.
HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program to move providers to value-based, patient-centered, coordinated health services, with health IT playing a key role.
The move away from document-based EHR information exchange to API-driven interoperability starting with Meaningful Use Stage 3 gains momentum as ONC and industry groups announced support for the change.
A survey of 14,000 RNs finds widespread dissatisfaction with EHRs and the IT departments that help choose and support those systems.

Webinars

Imprivata put on an excellent webinar last week on electronic prescribing of controlled substances. We had a lot of engaged attendees, but if you weren’t able to participate, the YouTube video contains the complete 49-minute webinar, including the Q&A. The presenters cover the DEA rule, which requires EMRs to be certified and providers to use two-factor authentication (along with other technical requirements). New Yorkers should be especially interested since the I-STOP act requires EPCS starting in March 2015. HIStalk webinar questions can be directed to Lorre.

Acquisitions, Funding, Business, and Stock

Small practice software vendor Kareo lands $15 million in funding, raising its total to $47 million.

Cambia Health Solutions, which has held a few health IT investments in its portfolio of companies, is creating a collaboration space that it hopes will draw healthcare startups and providers to Seattle to launch pilot projects. It won’t be an incubator or accelerator – which the company says are hard to implement in healthcare – but will “raise all the boats in the Puget Sound market around healthcare.”

A Reuters article says that Salesforce will make a big push into healthcare, hoping to create a $1 billion annual business despite the lack of success it and other technology companies have in similar attempts. The company’s healthcare head, whose background is as a drug company CIO, says they see a growth opportunity in care coordination, patient engagement, and analytics.

Government and Politics

The states of New Jersey and New York an involuntary 21-day quarantine on healthcare workers returning from West Africa via Kennedy and Newark Liberty International Airports, even those who are free of Ebola symptoms. The “just to be safe” actions in which spacesuit-wearing workers quarantine and burn everything touched by people guilty only of a history of travel aren’t exactly calming a media-frenzied populace that is much better at being illogically scared than at understanding science. “We are no longer relying on the CDC standards,” said New Jersey Governor Chris Christie, who along with New York Governor Andrew Cuomo made their decision without consulting New York City’s health department. The first person detained, a nurse returning from work for Doctors Without Borders, says Newark airport officials treated her rudely, barked questions at her, reacted happily in claiming she had a fever that she was later found not to have, and forced her into an unheated tent wearing paper scrubs (rudeness, incompetence, and lazy union indifference were my strongest memory of my one international arrival at that airport, so I’m not exactly shocked.) She’s tested negative twice for Ebola but New Jersey is still locking her up for the full 21 days. She says healthcare workers are being treated like “criminals and prisoners.”

Good luck containing the outbreak to Africa if US-based aid workers face detention in return for helping there. If possible exposure is reason enough to lock people away, are all the Bellevue doctors and nurses going to be be quarantined for three weeks? Farzad Mostashari says it best: “Politicians suck at making public health decisions, especially when the public has lost their mind.” I’ll say it again: fast identification of potential Ebola carriers will be impossible if and when it starts spreading within US borders and the travel history becomes worthless, so someone better come up with a fast, early diagnostic tool since we can’t lock up everybody up for three weeks just because they have a fever.

Update: in timely news, FDA just approved fast-tracked tests that can detect Ebola in one hour, which is a huge development with all of this hysterical Dark Ages quarantine nonsense. Salt Lake City-based BioFire Defense, a University of Utah spinoff, already won a $240 million defense department contract to turn its FilmArray product into a biological warfare detection system. It analyzes saliva or blood for genetic markers. The test has already earned FDA approval for respiratory and GI conditions. The instrument costs $39,500 and the tests are $129 each. Government comments suggest that the Ebola test may already be in use in Africa. I’m not clear from the product information if there’s a lag time between exposure and detection, which would be important in using it to detect pre-symptomatic infections.

Meanwhile, in New Jersey, New York, and everywhere else, use of the vaccine that protects against a far greater virulent killer – influenza – is optional (Governor Christie effectively vetoed a New Jersey bill earlier this year that would have required healthcare workers to get a flu shot, although he does urge everyone to get one). Contagious outbreaks can be contained only through herd immunity, meaning you need a critical mass of the overall population to be vaccinated to stop the spread and protect the unvaccinated. I got my flu shot yesterday – you’re welcome. Not making the headlines among the Ebola hype is that the first child of the 2014-2015 US flu season died the week of October 4; over 100 babies and up to 50,000 people overall died of influenza in the 2013-2014 season, although public health reporting tools have overlap between influenza and pneumonia that probably throws the count off.

HHS posts Karen DeSalvo’s bio page for her new job. I thought of another reason HHS might have moved her into the position. Her predecessor, Wanda Jones (who was also in the “acting” role) holds a public health doctorate but isn’t an MD — the Assistant Secretary for Health has always been a medical doctor, at least was in recent years. Another HHS problem: the US has had only an “acting” Surgeon General since mid-2013, when the NRA stalled the appointment of the President’s nominee, Vivek Murthy, MD, MBA because he has labeled guns as a public health problem. Acting Surgeon General Boris Lushniak, MD, MPH has kept a low profile during the Ebola scare, so perhaps HHS wanted to have an MD who is credible, visible, experienced in actually practicing medicine, and free of political baggage. Whether the selection reflects HHS’s placement of ONC in its food chain is up for speculation.

Other

The family of a 12-year-old New Mexico student accused of shooting two of his classmates sues University of New Mexico Hospital after it told them that at least eight people inappropriately accessed his medical or mental health records.

Uber runs a one-day promotion called UberHEALTH in which customers in Boston, New York, and Washington DC could tap an app button to have a flu shot administered in their homes at no charge. The idea was suggested by a Harvard epidemiologist, who adds that “the model of delivering healthcare by car service could work to provide basic preventive care.”

A fascinating New York Times article profiles the decades-long work of psychologist Ellen Langer, whose experiments suggest that aging and the course of life-threatening diseases are influenced by how old the individual feels as triggered by their surroundings and the perceptions of others. In other words, to some extent you really are as old as you feel.

Partners HealthCare CEO Gary Gottlieb announces that he will resign with five years left on his contract to run the Partners in Health non-profit, just as his current employer faces unprecedented scrutiny of its expansion plans and its high pricing. He says he will take a pay cut from $2.6 million to $200,000 and will leave without a golden parachute.

Weird News Andy finds this story infectious, as scientists in China find a virus-killing penicillin in honeysuckle plants. WNA admits that he rarely sees bees and hummingbirds with the flu (although they possibly flew up the flue, he quips) but questions whether his employer will allow proof of honeysuckle tea consumption instead of a flu shot.

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 10/24/14

October 23, 2014 News 11 Comments

Top News

HHS Secretary Sylvia Burwell transfers National Coordinator Karen DeSalvo, MD, MPH, MSc to the position of acting assistant secretary for health — it oversees public health, including the Office of the Surgeon General — in response to the Ebola threat. DeSalvo replaces Wanda Jones. ONC COO Lisa Lewis (above) is named acting national coordinator, effective immediately. Ms. Lewis’s background is in grant management for ONC and FEMA, so her non-clinical, non-technical experience will contribute to ONC’s identity struggle in a post-Meaningful Use world. I would expect HHS to launch a search for a permanent and well-credentialed national coordinator quickly since its internal personnel stores have been recently depleted (assuming that DeSalvo’s move is permanent, which isn’t the stated case so far, which otherwise means Lewis may be keeping the seat warm for some time).

Jacob Reider, MD would seem to have been the obvious choice for interim national coordinator since he is deputy national coordinator, but he confirms with me that he has resigned, having promised to his family several weeks ago that three years of commuting to DC was enough. That leaves only Jodi Daniel and Kelly Cronin from Farzad’s 10-member team of a year ago, at least barring any additional announcements.

Reader Comments

From Frank Poggio: “Re: Karen DeSalvo reassigned from ONC. If this does not signal the end is near for the MU fed program, I do not know what would. She was there for maybe six months, came up with the grand revelation that interoperability is a bus, issued a voluminous dissertation on what was wrong, then headed for the hills! Can’t wait to see ONC /DHSS press releases on what a great job she did.” ONC was all over the Ebola issue even though the EHR turned out to be non-contributory at THR, so DeSalvo’s interest and Katrina-related public health background put her in the right place at the right time. Physicians with practice experience and an MPH from a decent school will find many job opportunities as the industry matures from encounter management to population management. I think ONC’s best purpose once they’ve either handed out all the MU money or caused providers to lose interest in receiving it would be to (a) retool EHR certification to encourage interoperability and issue standards accordingly, and (b) run with the idea of the healthcare IT patient safety center if they can get Congress to fund it. They got EHRs out in the field, now it’s time to focus on using them for patient rather than provider benefit.

From The PACS Designer: “Re: ultrasound emergency wireless app. Samsung has demonstrated an ultrasound wireless application for emergency situations. A test showed that life saving could be achieved through the immediate sending of ultrasound images to emergency departments from ambulances.” That’s a good reminder that sometimes creating new data elements isn’t as important as moving the existing ones around more effectively to increase their value to a wider audience.

From Barry Black: “Re: Wellogic. Alere has divested the former company that was Alere Accountable Care Solutions.” Alere acquired Wellogic, founded in 1993 in late 2011. I interviewed President and CEO Sumit Nagpal a year ago. Alere ACS offers a PHR, EHR, HIE, decision support, analytics, and wellness and health coaching platforms. The company provided this response:

Based on strategic review by a leading consulting firm, Alere made a decision to refocus its energies on its main business market — diagnostics. As a part of this strategic refocus, Alere chose to divest certain assets, including those in connected health and health management. Alere ACS was the cornerstone of the Alere connected health strategy, and during its Alere tenure, enjoyed great investment that were mutually beneficial to Alere and Alere ACS — including tens of millions of dollars of enhancements to its core HIE platform. Alere ACS has now successfully separated from Alere into a new entity that will operate independently. This new entity has received a significant commitment of support and capital that will ensure continued operations and a sizable R&D investment for short- and long-term success. The new unit will continue to focus on the connected health market, including integrations with various diagnostics, mobile devices, and home monitoring opportunities. The new entity is financially robust and is armed with the necessary resources to achieve and support better healthcare and financial outcomes for the healthcare system. Executive leadership, engineering, and professional services remain unchanged.

From Lazlo Hollyfeld: “Re: non-competes. No rank-and-file employee should be subject to these agreements, and certainly not for two years.” Jimmy John’s, which is my least-favorite sub chain next to Quizno’s and not in possession of any obvious meat and bread secrets, slips a two-year non-compete clause into its employment agreement that prohibits its $8 per hour sandwich makers and delivery drivers from working not only at competing sub chains, but for any business located near one of its locations that makes 10 percent of its revenue from sandwich sales. Lawyers in a class action suit say the chain’s 2,000 locations mean that an employee who quits can’t work in an area covering 6,000 square miles. It’s like every non-compete that claims to cover non-management employees: a load of repressive corporate crap dreamed up by paranoid management that wouldn’t withstand five minutes of scrutiny in court, existing only because non-management employees don’t have the time and money to challenge it.

From Deanna: “Re: Plato’s Cave. Made me think of you and why your contribution to HIT is so much better than anyone else’s. You have been outside the cave.” The outgoing editor of The Wall Street Journal’s CIO Journal says he left journalism to work for Oracle because “journalists are at least twice removed from the essence of what they write about … I also don’t want to watch technological evolution while imprisoned in a cave, forced to take someone’s word for how it’s made and how it’s used. I want to observe it for myself.” Diligent writers often do a good job covering complicated subjects of which they have zero first-hand experience for experts who live it every day, but I get annoyed when they get lazy and just dutifully reword press releases or stray over that already generous line and start editorializing or delivering podium speeches based entirely on their cheap-seats view, like a couch potato sports fan yelling instructions to a professional football coach or a secluded porn watcher providing relationship advice.

From Clinic EHR Director: “Re: Epic staff rates. Most of the information out there is overpriced, inaccurate, or both. A friend put together a survey and will publish it free. I would love it if this could be made available to as many people in the industry as possible.” The Epic salary survey is here and the results will be published here.

From P.O. Garth: “Re: HIStalkapalooza. Just curious what night it will be?” This might set the record for the earliest inquiry about an event that’s still almost six months away. HIStalkapalooza will be Monday, April 13, 2015. It will be the best HIStalkapalooza, the last, or both since I’ve decided to take the planning out of a single sponsor’s hands and instead run it myself with the help of Lorre and Jenn and the financial support of five sponsors yet to be chosen (let me know if your company is interested – you’ll get lots of exposure and invitations). Last year was the breaking point for me since ticket demand far exceeded supply and people I wasn’t able to invite got personally rude even though I spend months every year from late summer to spring sweating details for no personal benefit, leading me to swear that I was done with it. For Chicago, the facility, band, and menu are all under contract – it should be pretty great. If it’s the last one, it will at least be legendary.

HIStalk Announcements and Requests

This Week on HIStalk Practice: the DoD’s DHMSM RFP deadline is pushed back — again. Qualis Health achieves MU goal. Jerry Broderick suggests three questions to ask before joining an employed physician network. Tennessee Primary Care Association implements new pop health/analytics tools. HP interviews Rob Tennant, SVP of government affairs, MGMA. Modernizing Medicine co-founders win leadership award. Check out the HIStalk “Must-See” Exhibitors Guide for MGMA 14. Thanks for reading.

This week on HIStalk Connect: Doctors Without Borders is developing an SMS-based Ebola screening tool to engage with the local West African population. HealthTap announces that it has created a national telehealth platform that will provide virtual visits for $44 per session. XPRIZE announces 11 finalists in the Nokia Health Sensor Challenge.

Listening: new from Cold War Kids, bluesy indie rockers from Long Beach, CA.

Acquisitions, Funding, Business, and Stock

NextGen parent Quality Systems reports Q2 results: revenue up 9 percent, adjusted EPS $0.13 vs. $0.22, beating revenue expectations but missing on earnings. Above is the one-year QSII share price chart (blue, down 39 percent) vs. the Nasdaq (red, up 13 percent).

Cerner announces Q3 numbers: revenue up 15 percent, adjusted EPS $0.42 vs. 0.35, falling short on revenue expectations but meeting consensus earnings. Above is the one-year CERN share price chart (blue, up 6 percent) vs. the Nasdaq (red, up 13 percent). The breathy reports of $XXX billion of healthcare IT startup investment hide the fact that most of the publicly traded HIT vendors aren’t exactly killing it on Wall Street, which the irrationally exuberant cheerleaders will spin as evidence of the changing of the guard rather than the historically difficult HIT business climate.

Patient self-service app vendor Phreesia raises $30 million in funding.

North Bridge Growth Equity becomes a majority stake owner in patient encounter platform vendor Ingenious Med with an undisclosed financial investment.

Sales

Logicworks will host the Massachusetts Health and Human Services Virtual Gateway portal.

Wyoming Medical Center (WY) selects Wolters Kluwer’s ProVation MD Cardiology for structured reporting and coding in it catheterization labs.

DeKalb Medical (GA) selects Connance’s Patient-Pay Optimization program to improve productivity and improve patient experience.

People

MModal names Scott MacKenzie (Experian Health) as CEO and board member.

Health Data Consortium, the group that runs Health Datapalooza, names Chris Boone, PhD (Avalere Health) as executive director.

HDS hires Bradley Johnson (Caradigm) as senior executive of business development.

Announcements and Implementations

Strata Decision launches cloud-based StrataJazz Continuous Cost Improvement to help providers reduce waste and inefficiency.

Greythorn launches a healthcare IT salary survey and will donate $1 for each survey completed to Autism Speaks Foundation.

Long-term care EHR vendor HealthMEDX announces its iCare POE mobile care management system.

Valley General Hospital (WA) goes live on Medsphere’s OpenVista.

HSHS Medical Group (IL) launches a pilot that will test the use of Apple Watch, due out next year, in its medical home program.

Government and Politics

HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program to move providers to value-based, patient-centered, coordinated health services, saying that healthcare IT will be a key component. Among the suggested strategies is daily review of EHR quality and efficiency information. Specifically listed is secure, standards-based, bi-directional communication with other providers.

Three industry notables (Dean Sittig, David Classen, and Hardeep Singh) propose in a JAMIA article that ONC’s planned HIT Safety Center (a) create a post-marketing HIT patient safety event surveillance system; (b) develop policies and procedures for investigating those events; (c) design random safety assessments of large providers; and (d) advocate HIT safety. The surveillance function would look at system failures, inadequate design, improper user configuration or usage, interface problems, and missing or unimplemented safety-related features. I would be happy if someone would just implement an easy way (on-screen button?) for providers to communicate safety concerns directly to vendors with a CC: to a safety center. Several organizations (some of them governmental) claim to have such a system, but none get significant use because end users don’t know about them or aren’t willing to complete a pile of paperwork that doesn’t benefit them directly.

The Department of Homeland Security is reviewing possible cybersecurity flaws in medical and hospital devices (including IV pumps and cardiac devices) that could make them vulnerable to hackers, stating its intention to work with vendors to correct software problems.

Other

HIMSS will move its 2019 convention from Chicago to Orlando in a dispute over hotel room rates, citing its unhappiness that the RSNA conference obtained a “favored nation” clause that guarantees it the lowest room rates for events held from April through November. I surveyed readers in early 2013 about their preferred HIMSS conference cities and Chicago finished near the bottom, with only 6 percent choosing it as their favorite — New Orleans, Atlanta, Dallas, San Antonio, and Boston did as poorly or worse, while San Diego, Las Vegas, and Orlando topped the list. Chicago is easily my least-favorite convention city (even though I like visiting it otherwise) due to overpriced and indifferent hotels, surly union workers, poor public transportation to McCormick Place, and the near-certainty of cold, dreary weather in April (which of course exhibitors love since it keeps attendees inside looking at booths). HIMSS scratched its home city’s back by holding the conference there in 2009 after pushing the usual date back several weeks to avoid blizzards (which didn’t work), pulled the conference out again because of union-driven high costs of exhibiting at McCormick Place, and then ill-advisedly decided to return in 2015. Too bad their squabble comes too late to move HIMSS15 somewhere else.

Interesting: scientists nearly 10 years ago came up with an Ebola vaccine that was 100 percent effective in protecting monkeys, but the $1 billion plus cost of bringing a drug with minimal sales potential to the US market sent it to the shelf, where it remains.

A Diagnosis article by the aforementioned Dean Sittig and Hardeep Singh, along with Divvy Upadhyay, looks at the treatment of Ebola patient Thomas Duncan at Texas Health Presbyterian Hospital Dallas, reviewing the patient’s record to find several discrepancies in THR’s announcements:

The patient presented with a temperature spiking to 103 degrees, dizziness, GI symptoms, headache, and a self-reported pain score of eight on a 10 scale, contradicting hospital reports that his initial symptoms weren’t severe.
The nurse documented his recent travel to Liberia.
The ED doctor prescribed Tylenol and antibiotics (the article didn’t question why he or she prescribed antibiotics for vague symptoms that could be non-infectious or viral, but antibiotic overuse and resistance is a topic for another day).
The authors speculate that the ED physician chose predefined phrases from EHR-suggested drop-downs that misled caregivers who read the notes later.
They also speculate that the hospital is located next to a high-immigrant population area that a county commissioner termed “a little Ellis Island” that could have caused employees to miss the red flag of “a black man with a foreign accent who reported he came from Liberia and presented with serious ‘flu-like’ symptoms to an ED which reportedly had received CDC and county health department’s guidance as early as July 28th, 2014.”
The article points out that clinicians often misdiagnose or miss common clinical conditions and it’s not the EHR’s job to replace their critical thinking and history-taking skills.
It adds that doctors tend to ignore nurse-generated documentation, both on paper and in the EHR. Sad, but true.

THR previously submitted to Congress a timeline of Thomas Duncan’s ED visit with some interesting items:

Triage didn’t start until an hour after the patient’s arrival at 10:37 p.m. – he was sent to the waiting area (in contact with everybody else there) and wasn’t taken to the treatment area for for nearly 90 minutes.
The ED physician accessed the triage nurse’s report at 12:27 a.m., but the travel history question hadn’t been asked yet since it wasn’t the triage nurse’s responsibility.
The patient first reported his travel history to Liberia in a 12:33 a.m. question from the primary ED nurse, but she didn’t pick up on the importance of his answer and ignored the EHR prompt to verbally relay it to the ED doctor (big-time fail there).
Audit logs show that the ED doctor reviewed the Epic sections that included the patient’s travel history several times between 12:52 and 1:10 a.m. Remember that at that point, the EHR should have been basically a single screen of information since all that had been documented was triage, the primary nurse’s initial workup, and a few vital signs. Specifically in Epic, the authors say, that includes screens for: ED lab results, Visit Navigator, related encounters, flowsheet, allergies, home meds, and ED patient history, all of which should have been pretty much blank.
The doctor later reviewed the patient’s history in which he said he was a “local resident,” had not been in contact with sick people, and had not experienced GI symptoms (contradicting the triage nurse’s recording of his chief complaint – in other words, the patient gave incorrect and misleading information for some reason).
The ED doctor discharged the patient with a diagnosis of sinusitis (not sure where that came from) and abdominal pain.

My conclusions: (a) Epic worked as it should have although the ED doctor still missed crucial information despite spending a lot of time looking at what should have been minimally populated Epic screens and possibly not the patient himself; (b) the hospital should have been asking travel questions at triage, which THR has since required; (c) the ED nurse missed an obvious red flag and broke hospital policy by documenting in the EHR but not reporting the travel information verbally; (d) the ED doctor either missed what should have been plainly obvious travel information or failed to note its relevance; (e) the patient told the ED doctor a very different story than he had told the nurse previously, eliminating or changing information that would have put the ED doctor on alert. All of this points out how unprepared the hospital was for detecting possible Ebola patients despite public health warnings, along with their lack of urgency to put new policies in place. My bigger conclusion: hospitals are not good at all with issues related to public health, and public health departments don’t seem to have the influence to drive sound infectious disease policy out of their ivory towers to the front lines.

BIDMC CIO John Halamka, MD proposes that clinical documentation, which was designed for billing rather than care coordination, be redesigned around a team-based, story-oriented structure that eliminates redundancy, inaccuracy, and copied-pasted text that doesn’t convey (or even hides) the patient’s story. It resonates with me because I’m getting increasingly frustrated that EHRs are superior to paper in every way except that one – the tendency to generate a lot of worthless but structured information that masks the sometimes obvious issues, meaning those EHRs make care worse instead of better. It’s time to reclaim the EHR from administrators, bureaucrats, CMS, and malpractice attorneys and give it back to patients and clinicians. Halamka writes on his blog:

Imagine if the team at Texas Health Presbyterian jointly authored a single note each day, forcing them to read and consider all the observations made by each clinician involved in a patient’s care. There would be no cut/paste, multiple eyes would confirm the facts, and redundancy would be eliminated. As team members jointly crafted a common set of observations and a single care plan, the note would evolve into a refined consensus. There would be a single daily narrative that told the patient story. The accountable attending (there must be someone named as the team captain for treatment) would sign the jointly authored Wikipedia entry, attesting that is accurate and applying a time/date stamp for it to be added to the legal record.

After that note is authored each day, there will be key events — lab results, variation in vital signs, new patient/family care preferences, decision support alerts/reminders, and changes in condition.

Those will appear on the Facebook wall for each patient each day, showing the salient issues that occurred after the jointly authored note was signed.

With such an approach, every member of the Texas care team would have known that the patient traveled to Dallas from West Africa. Every member of the care team would understand the alerts/reminders that appeared when CDC or hospital guidelines evolved. Everyone would know the protocols for isolation and adhere to them. Of course, the patient would be a part of the Wikipedia and Facebook process, adding their own entries in real time.

A study of ICU patient alarms finds that each occupied bed generates 187 audible alarms per day, many of them false alarms related to arrhythmia. It suggests that hospitals reduce alarm fatigue by reviewing their alarm settings and consider changing some alarms from audible to text messages.

A woman who tried to kill herself by gouging out her eyes with a pencil sues LA-USC Medical Center, saying that one of its nurses took a picture of her and shared it with a friend who then posted it on a shock website.

Weird News Andy fiddles around with this story, in which a concert violinist plays his instrument on the operating room table as neurosurgeons implant a “brain pacemaker” to correct his otherwise career-ending tremors. The surgery team monitored the patient’s movements via a three-axis accelerometer as he played and they inserted electrodes into his brain to make sure they hit the right spot. It worked: three weeks later, he was back on stage with the Minnesota Orchestra.

Sponsor Updates

Yale New Haven Health System (CT) implements SSI Group’s Audit Management solution.
Predixion Software CEO Simon Arkell is named “Outstanding CEO” for a mid-sized company by the Orange County Technology Alliance.
PerfectServe President and CEO Terry Edwards writes a blog post called “Prioritizing Communications to Improve Care Coordination.”
AOD Software and Imprivata partner to provide a secure communication platform for the senior healthcare market.
Medical Economics names ADP AdvancedMD, Allscripts, Aprima, CompuGroup Medical, e-MDs, eClinicalWorks, GE Healthcare, Greenway, Kareo, McKesson Specialty Health, NextGen, Optum, Quest Diagnostics, and RazorInsights to its “Top 50 EHRs” list.
MedAptus will integrate Entrada’s dictation recording technology with its Pro Charge Capture solution.
Truven Health Analytics introduces Interactive Reporting, which helps health plans analyze account-specific cost, use, and quality.
Perceptive Software will introduce Medical Content Management at RSNA 2014.

EPtalk by Dr. Jayne

I’m always excited to receive reader mail, although I’m terribly behind on answering it. I have a couple of blogger / author friends and am convinced HIStalk has the best readers out there. That was proven this week when several of you wrote offering advice for my friend’s oncology RFP conundrum. I appreciate the input and have forwarded your thoughts.

Weird News Andy weighed in on last week’s discussion of mood-altering wearables, sharing that it “depends on who is wearing them and what else they are wearing. Mrs. Weird has an effect on my mood no matter the other variables.” I hadn’t thought of wearables in that context when I was writing last week, but that’s an important point. Despite the mass integration of technology in all facets of our lives, I still don’t understand people who wear Bluetooth headsets constantly, let alone people wandering around with Google Glass in social situations. I wonder how much we miss of the world around us because of our devices.

Reader Foie Gras wrote about this year’s Clinical Informatics board certification exam: “Thanks for your description of last year’s experience. I took the exam this past week and I want a do-over! I feel like I studied very very hard, reviewed the AMIA course, took lots of notes, and am experienced in the field, but there were definitely questions on the test with terms I did NOT know and even on some of the topics I’d studied up on. I felt they asked a very nuanced question that I just couldn’t feel comfortable with. A bit frustrating after quite the marathon and sprint of studying. Here comes the two-month wait. I really don’t want to have to study for that thing again (although yes, I learned a ton studying for it and it was really enjoyable at times.)”

I heard similar feedback from other colleagues who sat for the exam this year. Preparing for board certification can be arduous, but being able to find some enjoyment in it says something about the personality traits of those who stay in medicine. I share the frustration about some of the terminology (particularly eponyms) used on board exams. If it walks like a duck and quacks like a duck, and actually is a duck, is the fact that it’s a Baikal Teal vs. a Carolina American Wood Duck really relevant if the question is asking how many feet it has?

I enjoy leisure reading much more than I enjoy reading CMS regulations or (heaven forbid) the Federal Register, so I was excited when a colleague left a copy of “Doctored: The Disillusionment of an American Physician” on my desk. Sandeep Jauhar is a New York cardiologist. I was familiar with his first book, “Intern.” The sequel was a pretty quick read and explores several healthcare dynamics from the last two decades: the fall of fee-for-service reimbursement, providers who order diagnostic testing for their own enrichment, and fragmentation of patient care.

Although I haven’t had to deal with some of the scenarios he encountered after leaving fellowship, I’ve experienced enough of them to share some of his feelings of disillusionment. In addition to being about the “mid-life crisis” facing medicine since the creation of Medicare in the 1960s, it also covers his own mid-life crisis, which makes some sections a little difficult to read. Still, I appreciate his candor and his willingness to stick his neck out as he shares his story.

I’m used to getting a variety of mailers and postcards from vendors and recruiters, particularly around HIMSS and other conferences. I was surprised this week to get a recruiting postcard from Uncle Sam. I’m sure the mailing was set up weeks ago, but the statement “because of the wide scope of the Army’s activities, you may have the chance to see and study diseases that are not usually encountered in civilian practice” to be very timely. Some of my best friends are currently or have been military physicians. I am grateful for their service and for the sacrifice of everyone serving in all branches of the military. Veterans Day is approaching, so make plans to thank your colleagues, neighbors, and family members who have served.

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 10/22/14

October 21, 2014 News Comments Off

Obama’s Ebola czar declines to testify

Newly appointed Ebola czar Ron Klain declines a request to testify before the House Oversight Committee over the government’s Ebola response thus far. The hearing, scheduled for Friday, will be just his third day on the job.

NCCN Chemotherapy Order Templates to be Integrated into Epic’s Electronic Health Record

Epic will integrate the evidence-based chemotherapy order templates from the National Comprehensive Cancer Network into its Beacon oncology product.

Athenahealth to expand at Ponce City Market

Athenahealth will expand its Atlanta, GA offices, adding 20,000 square feet immediately, with plans to add an additional 40,000 square feet in 2016.

News 10/22/14

October 21, 2014 News 6 Comments

Top News

California Republican Darrell Issa, chairman of the House Oversight and Government Reform Committee, plans a hearing Friday to look into the Obama administration’s handling of the Ebola crisis. Newly appointed Ebola response coordinator Ron Klain has declined to testify, likely given that it will be only his third day on the job.

Webinars

Acquisitions, Funding, Business, and Stock

Care coordination platform developer CareSync secures $4.25 million in Series A financing led by Founder and CEO Travis Bond, Tullis Health Investors, CDH Solutions, and Clearwell Group. You can read my recent interview with Bond here.

Athenahealth makes plans to expand its brand-new Ponce City Market office in Atlanta. Filings suggest the company could expand by another 40,000 square feet by July 2016.

HealthStream reports Q3 results: revenue up 32 percent, EPS $0.12 vs. $0.08, and announcement of a new patient interview center in Nashville, TN that is expected to create 200 jobs.

TeamHealth Holdings acquires PhysAssist Scribes for an undisclosed sum. PhysAssist will operate as a separate division of TeamHealth under its current leadership.

Announcements and Implementations

National Comprehensive Cancer Network will integrate its chemotherapy order templates into Epic’s Beacon Oncology Information System. The templates will link to NCCN.org, affording end users access to relevant NCCN guidelines.

Cleveland Clinic (OH) and Mayo Clinic (MN) are the latest providers to deploy HealthSpot telemedicine booths. Cleveland Clinic has installed two at Marc’s retail pharmacies in Ohio. Mayo Clinic has placed one at its Austin, MN campus, and anticipates deploying more at private employers next year.

Children’s Specialized Hospital (NJ) and BluePrint Healthcare IT launch the first implementation phase of a new patient-centered medical home model with corresponding software. CSH will use BluePrint’s Care Navigator technology as its main communication and education tool during the process.

Tufts Medical Center and Specialists On Call partner to establish the Tufts Medical Center TeleNeurology program, which will provide community hospitals in Massachusetts with new neurology support options.

Sales

Lahey Health (MA) selects supply chain, performance, advisory, and analytics services from Premier Inc. and Yankee Alliance Supply Chain Solutions.

HealthInfoNet, the State of Maine’s HIE, selects the Symedical system from Clinical Architecture to enhance terminology management and data normalization. HealthInfoNet will also use the system to manage access to mental health- and HIV-related information, which requires additional legal protections in that state.

People

Senator William Frist, MD and David Snow, Jr. (Medco Health Solutions) join TelaDoc’s Board of Directors.

Baptist Health (KY) promotes Polly Bechtold, RN to regional director for clinical IT at its Paducah and Madisonville hospitals. Sharon Freyer, RN will serve as Baptist Health Paducah’s interim CNO.

Jennifer Anderson (Tenet Practice Resources) joins the North Carolina Healthcare Information and Communications Alliance as executive director. She succeeds Holt Anderson, who will retire at the end of this month.

GNS Healthcare names Bill Thornburg vice president of product management, Jim Dutton vice president of product development, and Lance Stewart vice president of payer business development.

Research and Innovation

A study of 142 cardiac patients equipped with C3 Nexus heart rate monitors at Bon Secours St. Francis Medical Center (VA) finds that just 4 percent of those patients were readmitted to the hospital within 90 days. The company is looking to expand its customer base with hospitals and payers in Texas and Arizona.

Clinical Genome Resource launches the Genome Connect patient portal as part of a NIH genetic research initiative. The portal, developed by a team of Geisinger Health System (PA) investigators, serves as a repository for lab data and patient-entered health information to assist providers and researchers in better understanding genetic variants and their impact on health.

A new study finds that participants who used Castlight Health’s Enterprise Healthcare Cloud Software platform to search for healthcare services saw lower costs for laboratory tests and advanced imaging services compared to those participants that did not.

Other

The local paper profiles Resolution Care, which aims to improve in-home palliative care in rural areas via house calls or virtual visits. Michael Fratkin, MD founder of the project and St. Joseph Hospital’s (CA) Palliative Care Program, will launch an Indiegogo campaign next month to raise $100,00 for the project.

Local radio profiles the Kentucky HIE’s progress in rolling out a statewide patient portal developed by NoMoreClipboard. Five facilities are participating in the pilot phase of the myhealthnow portal, which is expected to go statewide by the end of the year.

Kenneth Mandl, MD of Boston Children’s Hospital and Harvard Medical School, points out in a JAMA article that EHRs and workflow aren’t the only problems when it comes to screening for Ebola: “Compounding the problem is that public health, largely absent from the table in defining requirements, remains mostly locked out of the point of care, barely able to exploit the newly deployed health information technology infrastructure. Five years after the enactment of Meaningful Use, public health officials still reach clinicians and hospitals through traditional dispatches and media alerts.”

The mock @CzarOfEbola Twitter account spotlights the frustration many Washington insiders have expressed with the continued leadership of Tom Frieden, MD at the CDC, and appointment of “Ebola Czar” Ron Klain.

The local business paper details the somewhat strange trip a group of Nashville, TN healthcare leaders took to Cuba. Scott Mertie, president of Kraft Healthcare Consulting, noted that, “even though the technology is a little bit behind, they’re still doing advanced medicine. I think in general the population seems very happy with their health care,” adding that may be because they "just don’t know what else is out there."

Sponsor Updates

Nuance partners with eClinicalWorks to offer cloud-based speech recognition with eClinicalTouch for the iPad, and eClinicalMobile for iPhone and Android.
Health Catalyst shares “factoids” from its Summit due to a high volume of requests.
NextGen Healthcare and InterSystems enable Missouri Health Connection to provide on-demand bidirectional data exchange with clients.
Medicity shares a video of CORHIO’s providers discussing how their HIE has helped improve patient care and streamline workflows.
Elsevier releases the first multidisciplinary, general medical reference digest of from its new Clinics Collections series.
Health Catalyst introduces a white paper for a systematic approach to transform healthcare.
Gartner names the Cache’ data platform from InterSystems a Leader in the Gartner Magic Quadrant for Operational Database Management Systems.

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 10/20/14

October 18, 2014 News 7 Comments

Top News

Texas Health Resources takes out full-page ads in local newspapers to bolster its community image, with CEO Barclay Berdan admitting that “we made mistakes” and adding that Thomas Duncan’s travel history was documented in the EHR but “not communicated effectively among the care team.”

Meanwhile, the cruise ship passenger that triggered an Ebola scare at sea (for questionable reasons) that resulted in the ship’s return to port has been identified as the lab director of Texas Health Presbyterian Hospital Dallas where Thomas Duncan died. The lab director voluntarily quarantined herself in her ship’s cabin and has since been found to be free of the virus.

In the aftermath of its mistakes (of both clinical and public relations varieties), Texas Health Presbyterian Hospital Dallas is reported to be a “ghost town” with two-thirds of its 900 beds empty and its average 52-minute ED wait time down to zero. THR spokesperson Dan Varga, MD states that doctors whose offices are near the hospital are having up to 60 percent of their appointments cancelled as patients refuse to get close to hospital property, treating it as though it were Chernobyl instead of the building that previously housed a contagiously sick patient as it does 365 days per year. The economic impact will probably be significant.

Reader Comments

From British Bulldog: “Re: Ascribe. The UK-based company’s CEO and founder, Stephen Critchlow, has resigned, almost a year since Ascribe was acquired by EMIS. Rumour has it that this could spell the end for Ascribe’s Health Application Platform, its flagship software platform.” The company announced Critchlow’s departure to devote “more of his time to his other business interests” on September 29, 2014, while the rest of the statement is unverified.

From Government Mule: “Re: ONC chief medical officer. Jon White from AHRQ took the job according to his LinkedIn profile.” Actually he lists his position as interim CMO (at least in the current version of his profile), which was announced early this month as a part-time commitment while the search is underway.

From GoVols: “Re: [company name omitted]. The CTO resigns, then gets talked out of it by board member. Sales, marketing, and BD team, once 15 strong, is now down to just a few and more layoffs are rumored. No significant sales this year and the fourth sales VP was recently fired. Everyone still here wonders what the BOD is thinking.” I’ve removed company and executive names since no company is going to confirm statements like these, but I’ll keep an eye on what happens there.

From Insidehr: “Re: athenahealth’s Ebola screening tool. Good to hear the athena clients are ready to treat those Ebola patients when they show up for the primary care visit. Sometimes that group would benefit from the concept of less is more.” It’s interesting that everybody is rushing to cobble together electronic tools that perform the most basic function – display a warning if a feverish patient says they’ve been to Africa lately. I think we can assume that even the least-competent nurse in America would go on alert in that case even without an EHR prompt, so its main value isn’t evaluating the patient’s response, it’s reminding someone to ask them the question in the first place, which is also probably not really necessary.

Additionally, the value of crude tools like online questionnaires will be eliminated if the virus starts spreading from people who haven’t traveled but instead were exposed to someone else who has, perhaps unknowingly. It’s like those early HIV/AIDS questions that asked about same-sex contact, blood transfusions, or exposure to prostitutes – they helped make a few diagnoses in the absence of anything more accurate, but the real accomplishment was developing specific lab tests since patient reports aren’t always reliable, symptoms are vague, and other transmission methods may be involved. A lab person can jump in, but I think the ELISA test works for both HIV and Ebola, the main difference being that a two-day wait time for positive diagnosis is OK for HIV but potentially disastrous for Ebola. When it comes to stopping pandemics, it’s at least equally important to develop diagnostic as well as therapeutic technologies.

HIStalk Announcements and Requests

More than two-thirds of poll respondents don’t like idea of an ONC-run health IT safety center. Reader lgro said in a comment that ONC struggles with the logistics of its current areas of responsibility and worries about another HIPAA-like program that doesn’t add value, while Doug points out that the health IT safety center was proposed as a public-private partnership rather than an ONC-controlled body and may provide value in preventing FDA from stepping in due to lack of progress. New poll to your right or here: should the names and medical details of Ebola patients be divulged publicly?

Last Week’s Most Interesting News

The American Medical Association sends CMS a blueprint for a redesigned Meaningful use program, adding its criticism of document-based interoperability protocols such as C-CDA.
Several groups add to the drumbeat urging CMS to slow down the Meaningful Use program and to refocus certification on interoperability, privacy and security, and quality reporting.
Texas Health Resources executive Daniel Varga, MD says the organization modified its Epic setup and workflow after Ebola patient Thomas Duncan was discharged from one of its EDs, adding little clarity to the original report and subsequent denial that the nurse’s documentation was missed because of an EHR setup problem.
A paper from the National Bureau of Economic Research says that HITECH was largely ineffective for spurring hospital EHR adoption since most hospitals were already using them.
HITPC agrees that current document-based interoperability approaches should be replaced by programming APIs provided by vendors of certified EHRs. That would be a dramatic shift, especially if ONC requires such access for EHR certification.
California HealthCare Foundation releases a report covering health accelerators, find that they are excessive in number, unproven in benefit, and potentially harmful in hyping startups that have a minimal chance of market success.
Alameda Health System (CA) says a disastrous $77 million Siemens Soarian-NextGen implementation has exhausted its cash and available credit.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center; David Ting, founder and CTO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

November 5 (Wednesday) 1:00 Eastern. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

Acquisitions, Funding, Business, and Stock

From the athenahealth earnings call:

Jonathan Bush says the company is growing, but with growing pains.
Epocrates is a turnaround in progress and it’s taking longer than the company expected to improve the situation due to major cultural and technical issues.
Epocrates is moving toward “more of an edutainment relationship where we’re constantly rotating through a set of FDA-approved and clinically appropriate messages for doctors that makes a business act more like a recurring venue business and one-off.”
The company added 2,800 athenaClinicals physician users, but at a high expense.
Bush says the challenge of the Enterprise business – which he calls “bipolar” since the company never knows when a big organization will finally sign up – is that internal hospital departments aren’t nearly as interested as the outpatient areas in opening up patient access.
Bush says it’s hard to sell to academic medical centers: “Nobody gets fired in academic medical. There is no financial mandate. They have got many, many revenue sources, many, many reasons for revenue — the research, the teaching. So that clarity of bottom line is not there. There is somebody in charge of the bottom line who is very clear, but they have grown up an institution that is used to money showing up … an open healthcare network doesn’t help you if you happen to have the highest rates in town … You are not thrill that the doctor and the patient can see the other ones, click on it and rob you of that high-margin encounter … the guys who resist us the most are institutions like Partners, Mass General, where they have historically high rates … and they are terrified of being picked apart.”
“We are right now in the midst of trying to seed a couple of the major national consulting firms with the idea that its time to change lily pads. That you don’t want to be the last strategic consultant that advise the board of directors to plump down $0.5 billion on a closed system. The problem is there’s a lot of revenue that goes to those firms that way and so we have been working it.”
Bush expresses frustration in working with (and ultimately bypassing) hospital CIOs, declaring, “Typically the CIO has worked very hard to build board-level access and a great huge budget surrounding the idea of his own data center and his own servers and his own programmers. He is sort of craft brewing milky beer and doesn’t want anybody to compare him with the pros from Dover.”

Above is the one-year share price chart for ATHN (blue) vs. the Nasdaq (green).

People

University of Virginia Health System hires Michael Williams, MD (North Shore-LIJ Health System) as its first CMIO.

HealthMEDX names Chris Dollar (Henry Schein) as COO.

Government and Politics

A HIMSS response to NIST’s cybersecurity RFI says healthcare providers are too focused on HIPAA compliance and should evaluate their overall security instead, adding that NIST should publish a target state for providers to measure themselves against.

Former National Coordinator David Blumenthal, MD says that Texas Health Resources, in first stating but then denying that an EHR flaw caused it to discharged Ebola patient Thomas Duncan, is part of an “inglorious pattern in human behavior” that causes providers to seek scapegoats when something goes wrong. He also says EHRs are the lightning rod for provider challenges because they use them constantly in daily work while other problems seem to be “distant thunder,” but he adds that users are justifiably frustrated with EHR usability and interoperability.

Other

I don’t automatically believe reports from Black Book Rankings, especially when they don’t itemize their methodology, but their survey of 14,000 RNs who use hospital EHRs claims the following results that I don’t doubt a bit:

Hospital nurse EHR dissatisfaction stands at 92 percent.
EHR workflow disruption reduces job satisfaction, according to 84 percent of respondents.
Nine of 10 nurses say CIO and their executive peers choose EHRs based on price or Meaningful Use performance rather than their usefulness to nurses.
Nine of 10 nurses say the EHR interferes with nurse-patient interaction and 94 percent say it hasn’t helped nurses communicate with other clinicians.
Three-quarters say the EHR has failed to improve the quality of patient communication.
More than two-thirds of RN respondents label their IT departments as “incompetent” in their EHR knowledge.
A hospital’s EHR is one of the top three criteria for choosing a workplace according to 79 percent of respondents, with top-rated systems being Cerner, McKesson, NextGen, and Epic. The lowest satisfaction scores were for Meditech, Allscripts, eClinicalWorks, and HCARE. This statement alone raises a red flag given that eCW doesn’t offer an inpatient EHR, HCARE is (I believe) HCA’s implementation of Meditech, NextGen’s EHR is used mostly by very small hospitals and isn’t likely to have had enough respondents to be judged on inpatient use alone, and McKesson’s users weren’t broken out among Horizon, Paragon, and its other products. The survey’s biggest flaw is not breaking out practice site – ED, ICU, surgery, ambulatory, general med-surg nursing, etc., all of which use broadly (and often incorrectly) labeled “EHR” systems differently.

An interesting article by Clinovations SVP Steve Merahn, MD says that “unstructured” is a bad term when referring to data because it contains the built-in bias that all data should be structured, when in fact the only reason “structuring” data into convenient pigeonholes is necessary is because our ability to analyze information is otherwise limited. He draws a parallel to earlier observations about Internet content vs. data, which is similar to EHR-contained checkbox results vs. useful clinical information:

Content has a voice. It is written to communicate ideas, make a point, convince. It is personal.
Content has ownership. Someone created the note from their perspective of authorship as defined by their levels of authority and responsibility.
Content is intended for a human audience, for human senses to process.
Content has context. Even the most objective content contains lexical, syntactic, and semantic clues about where the reader should focus their attention — what was important and what was not.

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 10/17/14

October 16, 2014 News 1 Comment

Top News

Dan Varga, MD, chief clinical officer of Texas Health Resources, testifies to a House subcommittee inquiring into its handling of Ebola patient Thomas Duncan that THR has changed its screening procedures to ask travel-related questions first thing in the ED and to make the patient’s travel history available to all caregivers. THR modified its Epic configuration to (a) make the Ebola screening tool more visible; (b) to ask more Ebola-related screening questions; and (c) to display pop-up instructions if any of the screening questions are answered positively. The wording of his statement suggests (in my interpretation, anyway) that the original problem wasn’t because the ED doctor couldn’t see the patient’s nurse-captured travel history, but that the questions weren’t asked at the proper time.

Reader Comments

From Kaiser’s Role: “Re: Kaiser’s Georgia Region. Being taken over by the Southern California Region and presumably not doing so well. They did this several years ago with the Mid-Atlantic region, sending all kind of docs there to take over.” Verified, according to an internal Kaiser email from Chairman and CEO Bernard J. Tyson.

From Spock’s Beard: “Re: Greenway’s Meaningful Use dashboard. Has been down for weeks, meaning clients can’t run Stage 1 or Stage 2 reports even though we’re two weeks into the final 2014 reporting period. As of yesterday, support says it will be another 2-4 weeks before the dashboard is ready.” Greenway Health SVP of Product Management Mark Janiszewski provided this response:

Due to a high volume of Greenway PrimeSUITE customers using the new cloud-based reporting / dashboard solution through our PrimeDATACLOUD, we’ve seen dashboard service disruptions that have impacted a small number of our customers. To meet customer requirements for Q3 attestation, the cross-function Greenway Meaningful Use Service Team worked with customers and supplied them with the information needed to attest for the Q3 90-day attestation period. To prepare for a higher volume of customers planning to attest in Q4 and in 2015, we’re currently making enhancements and performance improvements to the PrimeDATACLOUD environment. This maintenance window is expected to last until the end of October. During the maintenance period, we’re making the MU Dashboards available on a regular basis to all customers using the system, enabling them to track their progress towards attestation goals. In addition, we continue to on-board customers who need to attest for Q4 as well as 2015. The Greenway MU Service team continues to engage directly with all affected customers to provide updates as well as help guide them through the MU process. Greenway Health is committed to ensuring that all eligible providers using our solutions who are planning for MU attestation have the required information in time.

From Mr. Drummond: “Re: Ebola patients. Are we getting close to HIPAA violations in going public about patient identities, photos, condition, and travel patterns?” It would seem like a clear-cut violation if the information is disclosed by a provider without the patient’s consent but that wasn’t the case with the first Texas patient, whose information apparently came from the family. Still, just because the family has disclosed a patient’s information wouldn’t seem to give a hospital the green light to repeat it. HIPAA allows providers to disclose PHI to public health agencies, but not as a warning to the general public – there’s no HIPAA clause that allows disclosing PHI for the perceived public good, at least as I interpret it. However, CDC is also not a covered entity, so it can presumably release whatever information hospitals give it without running afoul of HIPAA, although it could still be sued for general privacy reasons. Going public with patient-specific details might bring forth more people who have been exposed, but it also might discourage exposed patients from stepping forward into the media (not just medical) limelight. My overall opinion is that the public has an unnaturally keen interest in salacious details that media will find a way (legal or otherwise) to feed using public health interest as an excuse. It’s also fishy to me that the first infected nurse spoke glowingly about Texas Health Resources via the THR media people – she may well be expressing her feelings honestly (albeit unnecessarily), but having her employer’s handlers issuing the statements encourages skepticism.

HIStalk Announcements and Requests

This week on HIStalk Practice: athenahealth creates an Ebola risk assessment algorithm for its EHR. Palmetto Primary Care Physicians taps eGroup to help it install IT in South Carolina’s first gigabit community. ONC adds a dozen primary care physicians and administrators to its Health IT Fellows Program. Ability Network acquires MD On-Line Inc. See our Must-See Exhibitors Guide for MGMA 2014. Thanks for reading.

This week on HIStalk Connect: Dr. Travis explores the potential ROI that can be generated from implementing online self-scheduling tools for patients. Patient engagement startup Welltok raises $25 million of a planned $37 million Series D. The NIH announces $32 million in grant awards that will be used to further big data research in healthcare.

Welcome to new HIStalk Platinum Sponsor FormFast, the leading provider of process automation solutions for hospitals (electronic forms and signatures, workflow, and content management) that integrate with existing systems to add functionality and streamline processes. FormFast has been providing electronic workflow solutions since 1992 with 1,000 hospital customers that are gaining efficiency, improving task coordination, reducing supply costs, and eliminating errors (webcasts and case studies are here). Thanks to FormFast for supporting HIStalk.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center; David Ting, founder and CTO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

Revenue cycle solutions vendor Ability Network will acquire competitor MD On-Line.

Athenahealth reports Q3 results: revenue up 26 percent, adjusted EPS $0.27 vs. $0.29, meeting expectations for both. The company’s $293 million Epocrates acquisition from January 2013 continues to drag down the bottom line as the unit’s quarterly revenue dropped 27 percent to less than $10 million.

Analytics vendor Viewics raises $8 million in funding.

Telepharmary kiosk vendor MedAvail completes $30 million in Series C funding.

Consumer rewards-based wellness platform vendor Welltok raises $25 million of a planned $37 million funding round.

Sales

Marin General Hospital (CA) chooses MModal for clinical documentation software and services.

People

James R. Boldt, chairman and CEO of Computer Task Group, died unexpectedly on October 13 at 62. He led CTG into the healthcare IT provider services market after taking the role in 2001.

Just-resigned GE Healthcare CEO John Dineen is named fund advisor to private equity operator Clayton, Dubilier & Rice.

Paul LaVerdiere (Iron Mountain) joins ESD as regional VP.

Announcements and Implementations

Elsevier launches Mosby’s Home Health Care, which provides content for home health nurses. The company also announces that it will provide free access to its ClinicalKey reference site to healthcare and disaster aid workers battling the Ebola outbreak in Liberia, Nigeria, Sierra Leone, and Guinea

Regional Medical Imaging (MI) goes live with Merge Notifi for patient appointment reminders.

Predixion Software releases Predixion Insight 4.0.

Evangelical Community Hospital (PA) goes live with Nursenav Oncology’s patient navigation workflow system. The company offers patient tracking, assessments, reporting, and a patient portal.

HIPAA compliance platform vendor Catalyze puts its 25 model HIPAA policies for “a modern cloud healthcare company” online as open source.

DrFirst announces October 28 availability of its electronic prior authorization service Patient Advisor ePA+SM, which will integrate multiple sources starting with CoverMyMeds.

Government and Politics

A paper from the National Bureau of Economic Research says that HITECH was largely ineffective for spurring hospital EHR adoption, having fast-forwarded usage by only two years at a cost to taxpayers of $48 million per new EHR-using hospital (as opposed to the majority of hospitals that earned HITECH payouts for just using what they already owned). I wasn’t willing to pay $5 to read the full paper, especially since it’s a draft version, but I suspect I would have issues with its methodology even though its conclusions seem reasonable. Paying hospitals (and doctors, which the report didn’t cover) to keep using systems they had already purchased was of questionable taxpayer value, but then again much of the $787 billion ARRA program was equally iffy from a value perspective.

Organizations including the AMA, MGMA, and Premier urge HHS to refocus Meaningful Use certification on interoperability, quality reporting, and privacy and security. The groups also want HHS to slow the Meaningful Use program down and to encourage innovation and the development of new clinically-focused healthcare technology.

The Treasury Department is trying to fix an HHS-created technical mistake that allows employers to offer employee health insurance that doesn’t cover hospitalization.

Technology

Apple announces that OS X 10.10, also known as Yosemite, is available as a free upgrade to MacBook users.

Other

The Robert Wood Johnson Foundation launches “Data for Health,” which will convene public meetings in five cities (Philadelphia, Phoenix, Des Moines, San Francisco, and Charleston, SC) to learn how data can improve health.

Rob Lamberts, MD writes on his site that the Epic-created transition of care documents the local hospital keeps sending are 12-14 pages of “computer vomit” that don’t indicate the primary diagnosis or an indication of who ordered newly resulted lab tests or why. He concludes:

The purpose of these documents is, instead, to document that they have performed a vital function of the "ACO" (accountable care organization): performed transition of care to the PCP. Hospitals are rewarded for doing this kind of thing … My job is to include this vomit in my computer system for posterity, confusing future generations of people who look at these records. This brings me back to my belief that computerizing an idiotic system does not help anyone; rather, it simply allows idiocy to be performed with much greater efficiency, at a greater volume, and dissipating it to more unsuspecting victims. This is what you get when care is about checking boxes or submitting codes. You get information that is useful only for the sender, not the receiver.

The web domain dealer who bought Ebola.com in 2008 will put it on the market for at least $150,000, saying the site is drawing 5,000 page views per day from people who just type the address into their browser to see what’s there. The site contains unrelated Ebola news items cribbed from other sites, a “donate”link to Doctors Without Borders, and a notice that “Ebola.com Is For Sale.”

Navy doctors treat what may be the first known case of Google Glass addiction, in which a serviceman who was being treated for alcoholism was found to be using the device for 18 hours per day. He suffered from involuntary movements, cravings, memory problems, and dreams that he saw as though he was watching them through Glass. The head of the Navy’s addiction program says always-on wearables such as Glass allow users with psychological problems to escape from reality and to seek frequent neurologic rewards.

Weird News Andy says she makes Nurse Ratched look good. A nurse in Italy is suspected of killing 38 patients by injecting them with potassium because she found them or their relatives annoying. Co-workers say she also gave patients laxatives at the end of her shift so that next-shift nurses would be stuck with the effects, while a newspaper reported that she took smartphone pictures of herself standing next to a deceased patient she is suspected of killing.

Sponsor Updates

HCS is sponsoring and exhibiting at the LeadingAge Annual Meeting in Nashville October 19-22.
SCI Solutions launches a company blog with an introductory post by CEO Joel French.
HIMSS Analytics says in its latest “Essentials of the US Hospital IT Market” that computer-assisted coding applications will experience increased hospital growth.
Vishal Agrawal, MD, president of Harris Healthcare Solutions, will participate as a panelist on “innovations in Access and Population Health” during the Scottsdale Institute 2014 Fall Forum.
Clinovations interviews Will Hodges regarding service line management vs. physician employment.
BlueTree Network challenges Vonlay-Huron to a food drive challenge to see who can raise the most meals or funds for meals from November 5 through December 3.
Levi, Ray & Shoup will participate in the 2014 SAP TechEd && d-Code event in Las Vegas October 21-23.
Imprivata reports that 100 European organizations have confirmed rapid adoption of virtual desktop infrastructure for single sign-on.
NoteSwift announces availability for Allscripts TouchWorks EHR.
NTT Data is named to the Winner’s Circle in the 2014 SAP Services Blueprint Report.
The Advisory Board Company discusses the threat of Ebola to healthcare workers in a recent blog.
Lifepoint Informatics unveils its patient access portal this week at G2 Lab Institute 2014.
HTMS, an Emdeon Company, launches Coverage Scout to assist in calculating health plan rates and federal subsidies.
Ingenious Med announces that three members of its mobile development team took first place in the Mobility Live Hack-Back Invitational.
The keynote address of eClinicalWorks CEO Girish Navani will be streamed live from the 2014 National Conference on October 17.
Louis Stokes VA Medical Center (OH), Orange City Area Health System, (IA) and Mercy Hospital Fairfield (OH) are live with Extension Engage to manage clinical alarms, alerts, and patient-centric text messaging.

EPtalk by Dr. Jayne

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My apologies for not mentioning eClinicalWorks in my recent shout-out of fall conferences. Their National Users Conference kicks off October 17 in Orlando. From the pictures of last year’s event, it looks to be a lot of fun. If you’re attending, we love a good party, so do tell how it’s going and share your photos.

I received a fair amount of reader response (and a handful of vendor solicitations) after this week’s Curbside Consult on transitioning to mandatory e-learning as part of EHR implementation. We already went live, so I’m not looking for a vendor (although you can bet I’m going to file your contact information away in case our system tanks and we need a replacement). Others wrote about their own experiences. The general consensus is that short segments with focused content are best and that unless mandated, user adoption can be less than stellar. E-learning seems to be most popular for workflows that aren’t overly complex but require more than a PDF to explain. So far we haven’t had any major glitches and people are logging on and completing the curriculum, so I’ll remain cautiously optimistic.

The most intriguing healthcare IT tool I’ve seen recently is called The NNT. For readers who are not statisticians, NNT is the “number needed to treat” and represents the number of patients who would have to use a treatment for one person to benefit. If the NNT is low, that means you don’t have to treat a broad population to deliver benefit. If it’s high, the likelihood of the patient in front of you benefiting is low. In addition to providing NNT data, the website also uses a color-coded header bar to indicate treatments that make sense and those that don’t. Thanks to Wired for profiling the site.

It’s not exactly healthcare IT, but it does involve health care and IT giants. Several colleagues asked my opinion of Facebook and Apple offering egg-freezing as part of their benefits plans. Having cared for many women during their pregnancies, I can tell you that freezing eggs and using them later doesn’t change the other risks that pregnant women face when they’re older. Regardless of their motives, I’m glad it’s available for people who need it for medical reasons, such as young women undergoing cancer treatments. On the other hand, I’m still waiting for my own company to cover services many people take for granted, so I’m a little jealous.

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A shout-out to Dr. Travis and his recent mention of startup Thync, which aims to develop a device that can aid in shifting the wearer’s mood. Since it is worn on the head and uses ultrasound waves to trigger brain changes, I’m not sure I’d be a fan. For mood-altering wearables, I prefer the sparkly kind.

What kind of wearables alter your mood? 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 10/15/14

October 14, 2014 News 5 Comments

Top News

The AMA issues a Meaningful Use blueprint that calls for CMS to:

Waive penalties for providers that hit a 50 percent threshold.
Pay incentives for meeting a 75 percent threshold.
Make three unpopular measures optional: View/Download/Transmit, Transitions of Care, and Secure Messaging (or as an alternative, set thresholds at less than 100 percent).
Eliminate thresholds and menu vs. core requirements.
Add Stage 3 measures that are more appropriate for specialists.
Continue hardship exceptions for anesthesiologists, pathologists, and radiologists given their tiny attestation numbers and their use of systems provided by hospitals that don’t care all that much whether they can attest or not. AMA also wants a hospitalist exemption for those who treat large numbers of observation patients since they don’t qualify as hospital-based EPs in that setting.
Leave the measures in place that HITPC suggested removing, but allow providers to qualify by meeting any 10 measures.
Loosen the hardship exception requirements by expanding the definition of “unforeseen circumstances” and exempt hospitalists and physicians who are eligible for Social Security by the end of 2015.
Revamp EHR certification to cover only interoperability, quality reporting, and privacy and security.
Eliminate the requirement that only licensed clinicians can enter orders.
Create standards for electronically passing data between EHRs and registries in a standard format, eliminating the need for middleware.
Focus Stage 3 standards on coordination of care and new payment models rather than on data collection.

The AMA’s document also calls out C-CDA as causing interoperability problems, saying that ONC mandates its use in Stage 2 even though it has had “very little real world testing, nor was it balloted or approved for standardization by HL7” and therefore is still a draft standard with “wild variation in technology versioning.” It urges that ONC not repeat the same process of jumping on untested standards starting with Stage 3.

Reader Comments

From Media Horse: “Re: Abraham Vergese, MD’s comments about EHRs interfering with patient care. He was the keynote speaker at athenahealth’s user conference a few years ago. It was a good speech about preserving the patient-doctor relationship, but it’s interesting that he spoke for a company that’s in essence a billing company with an attached EHR. I’m not suggesting that he’s a hypocrite, but I’m sure he was paid well.”

From Number Six: “Re: Health Data Warehousing Association conference in Portland, ME last week. I was impressed by the all-volunteer organization’s conference and the low registration fee of under $500 for 2.5 days. It was held in MaineHealth’s really nice conference center and had about 170 attendees. No vendors, just data people giving concrete details of what they’re working on in their institutions. Utah presented how they incorporate PROs into Epic and Altrius had a talk on predictive modeling, which was then covered in a ‘Sharing’ session on Day 2 since it was obvious that their specs could be implemented at other places. I highly recommend the conference HIStalk readers. Next year’s meeting is in Grand Rapids.”

From Always Be Closing (Offices): “Re: CompuGroup Medical. Closing the Boston office and terminated the sales VP and several sales reps.” Unverified, but the report is from a non-anonymous insider.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center; David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

Lifestyle healthcare technology vendor Alphaeon Corp. acquires Utah-based TouchMD for $22 million. TouchMD’s apps allow plastic surgery and OB-GYN practices to educate patients on their services to “increase consultation closings at the time of service and added procedures beyond the consultation, resulting in increased practice revenue.”

Sales

Beaver Dam Community Hospitals (WI) will deploy eClinicalWorks across its eight locations.

People

Andrew Gelman, JD will step down as SVP of corporate development for PDR Network to run a family business, but says he will keep his hand in healthcare with occasional consulting.

Facebook CEO Mark Zuckerberg and his physician wife donate $25 million to the CDC for Ebola control.

University of Arkansas for Medical Sciences promotes Rhonda Jorden to vice chancellor for IT and CIO.

ONC names Lucia Savage, JD (UnitedHealthcare) as chief privacy officer, replacing Joy Pritts, who resigned in July.

Announcements and Implementations

Mobile Heartbeat will integrate EMR and waveform data from AirStrip’s One platform into its care team smartphone app.

Eskenazi Health (IN) will use technology from Indianapolis-based Diagnotes to alert its brain center coordinators when patients are admitted, discharged, or transferred from hospitals as reported to the state HIE.

Personal health records management app vendor Hello Doctor claims it has “gained access to an API” that gives it “access to 52 percent of clinics and hospitals in the US.” That sounds suspicious since there’s no single API out there that covers multiple vendors, leading me to believe that perhaps they’ve connected to Epic in some manner and are using the “52 percent” statement incorrectly to refer to organizations rather than patients.

Allscripts will offer Shareable Ink’s documentation solution for surgical and clinical documentation for Sunrise.

Government and Politics

Rep. Renee Ellmers, RN (R-NC) issues a statement saying she’s pleased that CMS extended the Meaningful Use hardship exception after admitting that its submissions website wasn’t working correctly, but repeats her request (made via her proposed Flex-IT Act) that CMS reduce its 2015 Meaningful Use Stage 2 reporting period from 365 days to 90 days.

Beth Israel Deaconess Medical CenterCenter John Halamka, MD says the White House should choose someone from DC rather than Silicon Valley in replacing departed US CIO Steven VanRoekel:

I always support the federal government, but bold new ideas get lost in the complexity of procurement, contract management, and getting stakeholders to agree. Navigating the US government is difficult and complicated, and an outsider from Google or Facebook is likely to be eaten alive. Only an insider can navigate the process while offering new ideas and approaches.

HITPC’s JASON Report Task Force will deliver its conclusions today (Wednesday), proposing that current interoperability approaches should be replaced with an API-driven model starting with Meaningful Use Stage 3. It disagrees with the JASON report’s conclusions that such an approach requires new clinical and financial systems, that the market has failed in its failure to advance interoperability, or that a newly mandated software architecture is required. The task force advocates that ONC create a public interoperability API and encourage its use via the Meaningful Use program.

ONC names 12 providers as health IT fellows.

Executives of California’s health insurance exchange are questioned about its contracting practices as a state senator claims the organization practiced cronyism in awarding dozens of no-bid contracts, some of them to a company whose owner has close ties to Covered California’s executive director.

The chief of staff of New York City’s medical examiner’s office quits following a $10.9 million no-bid, sole-source contract award to a ICRA Sapphire, whose software has cause bodies to be mishandled or lost. The city has been paying for the system using Homeland Security grants, having awarded what one lawyer called a “lifetime contract with constantly increasing costs and poor results” and hiring the India-based company’s rep as the ME office’s CIO. The previous CIO and his girlfriend were arrested for embezzling $9 million in FEMA grants intended for tracking the remains of 9/11 victims. The just-resigned chief of staff had been promoted to the position even after getting caught stealing an airplane’s exit handle from the 9/11 debris to take home as a coffee table souvenir.

Technology

Philips Healthcare begins Netherlands hospital trials of a wearable COPD monitoring sensor that collects information on physical activity, respiratory indicators, and sleep disturbances.

A reader called my attention to Xenex, whose xenon-powered pulsed UV devices (“Germ-Zapping Robots”) can disinfect hospital rooms in a few minutes, a timely topic given Ebola. Two of the company’s executives hold doctorates from the Bloomberg School of Public Health at Johns Hopkins University, while the other two were involved with Rackspace Hosting.

Google is testing a search feature that would allow people who are Googling medical symptoms to click a “talk with a doctor now” link.

Breathometer integrates its $100 Breeze personal breathalyzer with Apple’s HealthKit.

Other

The Brookings Institution presumably publishes intelligently written and authoritative articles on occasion, but this lame piece called “Could Better Electronic Health Records Have Prevented the First American Ebola Case?” isn’t one of them (maybe Farzad was the only person there who knew anything about healthcare IT). Its insight is zero, its valid points are few, and its flaws are many:

It doesn’t answer the question its sensationalistic headline asks.
It is based on a preliminary report that an EHR setup decision caused Texas Health Presbyterian Hospital Dallas to discharge the Ebola patient from its ED, which turned out not to be the case according to the hospital.
It gets the hospital name wrong even though it’s right there on the page to which the article links.
It wanders all over the place about EHR privacy, cost, and “voluminous files,” then meanders into healthcare policy issues, health IT competition, and a proclamation that an undefined “many”are skeptical about EHR value and the government should therefore fund outcomes research (which is already underway).

Anna McCollister-Slipp, the co-founder of an analytics company and Tricorder Xprize judge who also has Type 1 diabetes says she’s tired of waiting for digital health to flourish, pointing out that:

Even hospitals that took Meaningful Use money won’t allow patient-sourced data to be imported into their EHRs.
Most of the health apps were designed for people who are already healthy.
Her academic medical center does not offer online EHR access, doesn’t allow electronic communication with its physicians, and won’t provide her endocrinologist with the software that would allow him to load her glucose monitoring data to his computer.
None of her doctors use electronic scheduling, none offer online lab results retrieval, and only one accepts electronic refill requests.

A Pennsylvania legislator questions UPMC (PA) about its ability to send records of Highmark insurance patients to new providers when they lose access to UPMC’s hospitals on January 1. UPMC CIO Steven Shapiro says they can transfer records electronically within 24 hours, but Highmark claims UPMC will be sending faxed documents instead. UPMC uses Cerner among its variety of systems, while Highmark-owned Allegheny Health Network is moving to Epic.

Reuters covers the growing telemedicine market in China, which the government is supporting to overcome the rural-urban medical expertise gap. A report says doctors in China spend 13 hours per week online, with 80 percent of them using mobile phones.

CDC and ONC will present a webinar on Thursday, October 16 at 1:00 – 2:30 p.m. Eastern to encourage providers and EHR vendors to work together to develop Ebola screening tools. CDC’s Ebola team will present its detection algorithms and travel history / medical signs checklists.

NBC medical correspondent Nancy Snyderman, MD admits that some of her crew members broke a voluntary Ebola quarantine in going out for takeout food after returning from Liberia, where the group had been in contact with an Ebola-infected freelancer. New Jersey health officials reacted to her admission by making the quarantine mandatory. She declined to say whether she herself was one of those involved as several locals who spotted her indicated.

Sponsor Updates

Predixion Software joins the Salesforce Analytics Cloud ecosystem.
Greenway Health’s SuccessEHS is prevalidated by NCQA to receive 27 points in auto credit toward PCMH 2011 scoring.
Frost & Sullivan names Validic to its 2014 Best Practices Award for Customer Value Leadership.
First Databank’s collaborative research paper is selected as a finalist in the Best Paper Competition by the American College of Clinical Pharmacy.
The Jacksonville Daily News discusses the history of military healthcare IT solutions and calls RelayHealth a “pearl.”

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 10/13/14

October 11, 2014 News 3 Comments

Top News

Opponents of California’s Proposition 46 – which would quadruple the maximum allowed pain and suffering medical practice award, mandate drug and alcohol testing of physicians, and require that physicians and pharmacists look up controlled substance prescription patients in the little-used CURES drug abuser database – launch a voter campaign suggesting that the CURES database would be vulnerable to hacking. Many of the coalition’s members are healthcare providers and member organizations.

Reader Comments

From Bob Loblaw: “Re: Stanley Healthcare. The complete incongruity of this reputable firm flirting in the healthcare arena was probably the need for one or more of its executives to have something to say at the cocktail circuit. None of the senior managers has healthcare experience and many of the clinical experts were jettisoned in the inevitable rightsizing. Their attempt to force the amalgamation of security organizations, furniture companies, a cart company, and a grossly overpromised acquisition of an Israeli company have resulted in a monster of Frankenstein proportions. RIFs have begun and Stanley Healthcare will be absorbed into Stanley Security.” Unverified.

HIStalk Announcements and Requests

It’s a 53-47 “no” vote on President George W. Bush as HIMSS15 keynote speaker. New poll to your right or here: should ONC create and run a national health IT safety center? The Comments link on the poll allows you to expound further.

Last Week’s Most Interesting News

NantHealth raises another $250 million in funding from the government of Kuwait and rounds out its executive team with several new hires.
GE Healthcare CEO John Dineen resigns, replaced by John Flannery, whose extensive GE experience includes none related to healthcare.
Ochsner Health System (LA) says it is the first of Apple’s beta sites to go live with HealthKit-Epic integration.
CMS reopens the EHR hardship exception period through November 30, 2014.
Walmart announces plans to sell health insurance in its stores and its ambition to become “the number one healthcare provider in the industry.”
Facebook may create online health support groups and supporting health-related apps.
Texas Health Resources reverses its statement that its Epic setup allowed Thomas Duncan to be discharged from its hospital without being recognized as a potential Ebola patient despite his statement that he had just arrived in the US from Liberia.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center; David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

Shares of Streamline Health hit a 52-week low as the company’s market capitalization drops to under $70 million. Above is the one-year performance of STRM shares (blue) vs. the Nasdaq (green).

Government and Politics

Internal documents suggest the overall cost of the Massachusetts health insurance exchange is much higher than the figure provided last week by Governor Dev Patrick. Temporary Medicaid plans for citizens who were unable to use the failed website will cost state and federal taxpayers $700 million, raising the exchange’s total cost to nearly $1 billion.

Innovation and Research

California HealthCare Foundation creates a downloadable healthcare accelerator database, saying that demand for accelerators is increasing even though evidence is skimpy that their members will be successful or that the accelerators add value. An expert says the accelerator success rate is about one out of every 7-10 companies. The report adds that while entrepreneurs like joining one or more accelerators, the need to join a second highlights the failure of the first, and that anyone with “ loft-like space, an unlimited electrical supply, some former entrepreneurs, and a good network of local supporters” can start their own accelerator. It concludes that the recent rash of newly announced accelerators may end up doing more harm than good this early in the hype cycle and many of them will not survive. The report lists six accelerator models:

Independent companies, profit or non-profit, that take equity from participants (Rock Health, Healthbox).
Enterprise-based, where companies provide help only to startups building a product that they themselves might want to use (Microsoft, Boston Children’s Hospital, Optum).
Product-specific to expand use of a particular platform (athenahealth’s More Disruption Please).
Economic development funded by governments or organizations to promote local job growth (100health, DreamIt Health, New York Digital Health Accelerator).
University-affiliated programs that may primarily involve technology transfer (UCSF’s Catalyst, Boston’ Center for Integration of Medicine and Innovative Technology).
Collaboration programs that connect large corporate partner sponsors to startups (Health XL, Avia).

Other

Daughters of Charity announces that it will sell all six of its California hospitals to for-profit Prime Healthcare.

An infectious disease physician who with a colleague treated the third Ebola-infected patient in the US says that only one of the doctors entered the patient’s room to minimize contact, while the other observed via two-way video and documented in the EHR. She adds, “We joked about who had the easier job, since writing notes and orders in an electronic medical record can be a formidable task.”

Alameda Health System (CA) says it has run out of cash and used up all of its credit trying to recover from a $77 million Siemens Soarian and NextGen implementation that “did not go as well as planned.” The system’s new CFO says, “The system makes it difficult to collect the right information that you need to bill a claim and makes it hard to identify what kinds of errors are occurring. …. It’s very disjointed right now. A lot of mistakes are being made.” A physician adds, “There’s not a single part of the hospital — inpatient, outpatient, ER — that has fully functional (electronic health records).”

Kaiser Permanente is working on supply chain redesign, hoping to reduce duplicate inventory, increase patient care time of nurses, and manage expired and recalled items. They are also scanning product ID barcodes into the EHR so that product effectiveness can be reviewed electronically afterward.

Physician and professor Abraham Vergese says in an interview with Eric Topol, MD that technology is infringing on the patient-physician relationship:

It is taking us away, and society will judge us poorly about 20 years from now. They’ll look back and say, "You were complicit. Why did you let Epic and all these electronic medical records rule your life? You actually signed up to learn the new ICD codes and plug them in. Exactly what did this do for patient care?" And the answer is that it did nothing for patient care. It did everything for billing. I feel like the lone piper saying this, but it is clear that we are all feeling the frustration of being forced to do things that have nothing to do with patient care. They are all about billing.

Contacts

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

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