News 6/27/14

Top News

Philips will deploy clinical applications in a Salesforce.com-powered cloud environment that’s centered around patient relationship management. Two applications will be launched this summer, eCareCoordinator and eCareCompanion, which are collaboration platforms for monitoring chronic condition patients at home.  Philips says future offerings will incorporate information from EMRs, medical devices, home monitoring, and wearables. The platform will be open to developers to create add-on products.

Reader Comments

From Otto Complete: “Re: HTRAC East conference in Leesburg, VA. I attended this week and found it to be amazingly enlightening! Limited vendor involvement, zero exhibitors, and passion for IT improvement in our space, along with tremendous information sharing – these are just a few of the compliments I would give the conference. As you are a thought leader in our field, I wanted to be sure this group was on your radar.” I hadn’t heard of the group or conference, but they get points from me for being non-profit and for bundling meals (and an open bar) with the registration fee. The write-up says it’s invitation-only and limited to around 200 attendees, with minimal vendor participation and no exhibit hall.

From Demon Deacon: “Re: Wake Forest Baptist IT department. The CMIO and VP of clinical applications positions were eliminated and will be replaced with a chief clinical information officer.” Unverified, although a search of Google’s cache turns up the now-removed job posting that I assume they filled. They’ve had a lot of IT turnover after their horrific Epic implementation.

HIStalk Announcements and Requests

This week on HIStalk Practice: Avecinia Wellness Center CEO Unaiza Hayat, MD shares the details of successfully attesting for S2MU and the role good physician leadership plays in any implementation. HIE merger creates largest in Michigan. Nashville physicians show no love for Epic. Verizon gets into the telemedicine game. Maine Primary Care Association goes live with new pop health technology. Thanks for reading.

This week on HIStalk Connect: researchers with Sandia National Laboratory make headway on their work developing non-invasive ways of monitoring electrolyte levels. Google unveils Google Fit, a digital health developers’ platform that promises the same basic functionality that Apples HealthKit offers. San Francisco-based startup Grand Rounds raises a $40 million Series B round to expand its growing network of physician thought leaders who offer remote second opinions on complex cases.

Listening: Chicago-based Eleventh Dream Day, probably the best and hardest-rocking Midwestern band that nobody’s heard of thanks to their record label’s incompetence. Also: Queens of the Stone Age.

My latest reading peeves: (a) cutesy reporters who start off a healthcare technology story with, “The (technology name here) will see you now.”; (b) using “there” as the subject of a sentence; (c) clickbait headlines, tweets, and lame slide shows that will do anything to get you to click even though you will regret it almost immediately; (d) referring to doctors as Dr. John Smith, which doesn’t tell us what kind of doctorate John earned; (e) surveys that try to hide low participation by giving results only as percentages; and (e) as I try to ignore the flood of World Cup chatter, people who confuse spectating with exercising in referring to someone else’s athletic team as “we.” I’ll keep the porn analogy that popped into my head to myself.

Webinars

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

We’ve decided to post the recorded videos of our HIStalk Webinars on YouTube to avoid the playback problems some viewers were having. The webinar, Cloud Is Not (Always) The Answer, ran live this past Wednesday. Not only did Logicworks do a great job in taking our suggestions and input from two CIOs into account to perfect their content and delivery, running the recorded version from YouTube is cleaner and faster, with no signup required to start watching.

Acquisitions, Funding, Business, and Stock

CareCloud borrows $25.5 million from a growth capital lender. I’m never cheered by a company taking on debt just like I wouldn’t be thrilled about a relative signing up for a home equity loan, but I guess it’s good news to be found credit-worthy and to have your plan for using the money vetted by someone whose objectivity is inarguable given their interest (no pun intended) in being repaid.

Physicians Interactive, which markets life sciences products to physicians, acquires consumer health information site WebHelp.

Imprivata’s raises $66 million in its Wednesday IPO.

Sales

Central Florida Health Alliance (FL) chooses MModal for transcription technology and document insight.

Sutter Health (CA) selects Orion Health to build and deploy its HIE.

People

Mark Caron (Capital BlueCross) is named CEO of population health and analytics systems vendor Geneia, which is owned by Capital BlueCross.

The Jersey Health Connect HIE names Judy Comitto, VP/CIO of Trinitas Regional Medical Center (NJ), as its board chair.  

Secure email vendor DataMotion appoints Kathleen Ridder Crampton (United HealthCare Group) to its board.

Announcements and Implementations

Ivenix announces that it is developing a new smart IV pump that will feature a smartphone-like user interface, enhanced IT capability that includes Web-based EHR integration and analytics, and new pump technology.

Telehealth solutions provider AMC Health says it has integrated its system with Epic.

Verizon announces Virtual Visits, a secure video technology platform that allows consumers to connect with doctors. The company hopes to license the technology to health plans (i.e. doctor not included.)

The non-profit CCHIT, which exited from what it said was the unprofitable EHR certification business in January 2014, announces its new mission of selling developers advice on how to get their EHRs certified.

Biometric Signature ID announces its handwriting-powered identity authentication system for Epic. It seems that handwriting would not be reliable given that users would be “writing” with their fingertip on a small screen while standing up in most cases, but maybe they’ve figured it out. You can try cracking a “Go Verify Yourself” signature-powered access page on their site.

Government and Politics

A Bloomberg editorial says that the Affordable Care Act is drawing a disproportionate number of people with chronic conditions to sign up for health insurance, which could possibly drive insurance companies out of the market or force the President to try to bail them out (with questionable legality) as he promised upfront to get them to participate.

CMS claims that its much-maligned Medicare fraudulent claims detection system prevented $210 million in payments in 2013, its second year of operation. That works out to something like 0.02 percent of total payments, a fraction of the government-estimated $50-60 billion that CMS improperly pays each year, and less than a monkey throwing darts could turn up before hitting the Beltway by noon on the Friday before Independence Day.

Other

A Wisconsin high school loses its track coach to Epic, where he will become a project manager. He says, “I’ll be working to implement software, and going out to hospitals and clinics, visiting with doctors and nurses, and discuss their ideas and concerns with the developers at Epic … I’m no computer whiz. They say they want people who are able to distinguish themselves through their careers, and they’ll teach the rest. There will be a lot of learning.”

An editorial in Applied Clinical Informatics says that specifying advance directives should be easy and the resulting preferences should be stored by HIEs and shared via interoperability. It proposes an input sheet that looks like a US tax form in making the analogy that advance directives should be as easy as electronic filing of taxes. Misusing the term as “advanced directives” drives me crazy (you make them in “advance,” not “advanced”) so it was disappointing that “advanced” made an unwelcome appearance three times in the mostly-correct article. Note the subtle humor in identifying the form as 419, the police code for a “dead body found.”

A small (120 responses) AMDIS-Gartner survey of CMIOs finds an average annual salary of $326,000 in a range of $206,000 to $550,000. Respondents reported slightly less job satisfaction than last year, higher CMIO turnover, and an overwhelming preference for reporting to the chief medical officer rather than the CIO.

In Canada, a $300 million privacy lawsuit is filed against Rouge Valley Health System that alleges two hospital employees sold the names of 8,300 mothers of newborns to an investment who cold-called them to sell education savings plans.

Google CEO Larry Page says yet again that 100,000 lives would be saved each year by more healthcare data mining. He’s made that claim (without backing it) several times.

A Bloomberg article says that hospitals are starting to use consumer information from big data sources to target their at-risk patients for interventions, such as finding out which asthma patients are buying cigarettes or whether heart patients are allowing their gym memberships to lapse. Patients say hospitals making cold calls about health habits is intrusive, but hospitals say they need to aggressively manage their patients under new payment models.

A new KLAS report reaches an obvious conclusion: only Epic, Cerner, and Meditech are expanding their hospital EMR client bases. Actually I was surprised that Meditech was included since my perception is that they are falling behind rather than gaining, but I assume KLAS has hard data suggesting otherwise.

Sponsor Updates

• Validic will be featured by TEDMED 2014 as one of its chosen “transformative startups and the inspiring entrepreneurs that power them.”
• Optimum Healthcare IT will be featured in a June 29 episode of “21st Century Television” on Bloomberg Worldwide.
• Jeanette Ball, RN, PCMH CCE of CTG Health Solutions shares her experience working with western New York providers to create a PCMH framework in the Journal of Clinical Engineering.
• CareTech Solutions launches its website built on CareWorks CMS v4.1.
• ESD shares how to implement automated testing.
• Navicure partners with Acculynk to launch a customized payment platform for providers.
• Netsmart posts a white paper exploring the similarities and difference in PC and behavioral health.
• Allscripts receives 23 commitments for expanded Allscripts Sunrise solutions such as Ambulatory Care, Emergency Care and Surgical Care.
• Practice Fusion partners with Emdeon to offer automated health plan eligibility check in its EHR.
• Juniper Networks announces the capabilities and enhancements of its Next-Generation Firewall and SRX Series Services Gateways.
• The Advisory Board Company is profiled by a local news station for its community volunteer projects.
• Extension Healthcare discusses how EHR alerts have contributed to alarm fatigue and offers a two-part white paper on managing alarms to improve patient safety.
• Wellcentive client Children’s Health Alliance (OR) receives the Analytics All Stars Award for Population Health Project of the Year award.
• Albany Area Primary Health Care (GA) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.
• Divurgent offers a series of free conference calls on big data and analytics.

EPtalk by Dr. Jayne

It’s been a completely random week at work. Most of the practices we acquired earlier in the year have stabilized from a revenue cycle perspective, so it’s time to bring them up on EHR. Once the Independence Day holiday rolls by, it will be full steam ahead.

There have been a couple of last-minute glitches though, mostly involving providers behaving badly. There are always challenges when a practice has to change its culture, but I’ve not seen this many employed providers who don’t seem to remember that they’re employed.

Some of our operational leaders try to soften the blow by referring to them as “partners” or “associates,” but the bottom line is that they are employees. If we were partners, there would be shared decision-making and give and take. There would not be top-down leadership with requirements that must be adhered to. There would not be contractual obligations that require compliance with a host of regulatory items. There would not be penalties for failure to adhere to documented policies.

I’m fortunate to have an implementation team that’s well-seasoned and grateful for its manager and her solid leadership. Since the team has had a couple of months without active deployment cycles, we front-loaded the calendar with some of the most difficult providers. That way they can get them done while they’re still fresh. The majority of the team agreed they’d rather save the best providers for last rather than having to look forward to all the difficult ones at the end.

From Stay Glassy San Diego: “Re: Dr. Chrono’s Glass app. Did you see it? They’re referring to it as the first wearable health record.” I did see, it but I’m not sure it’s actually a wearable record as much as a different way to interface with the record. Physicians can store a video of an office visit in the EHR but it’s not clear how that translates to discrete data or the other hoop-jumping we need for payers and incentive programs. I did find it interesting that media reports cite 300 of the 60,000 drchrono clients as users of the Glass app. They may have downloaded it, but given psychosocial and privacy concerns around use of Glass, I’d be surprised if that many were actually using it. According to the company website, users can sign up to be beta testers, which doesn’t exactly sound like widespread adoption to me. If there are any readers who have actually used it, I’d be happy to share your stories.

From App-e-tite for Destruction: “Re: Open Payments, did you look at any of the other government apps that were available? Some are amusing.” I was on a pretty focused expedition the other day but did have some time tonight to check out the Mobile Apps Gallery at USA.gov.  In addition to Apple and Android, they still offer content for BlackBerry. There’s an app to help you through the National Gallery of Art as well as one to locate alternative fueling stations for electric, biodiesel, CNG, and other non-gasoline vehicles. I spent some time playing with the FDA Mobile app, which has medication recalls and safety alerts as well as consumer updates. There’s also a radiation emergency app, one that manipulates census data, a rail crossing locator, and a ladder safety app to boot.

What’s your favorite government app? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/25/14

Emdeon to Acquire Capario to Enhance Its Revenue Management Platform

Emdeon will acquire Capario for $115 million in cash, incorporating Capario’s revenue cycle management product into its own Intelligent Health Network.

ZocDoc is raising $152M, bringing its valuation to $1.6B

ZocDoc, the physician rating and appointment booking website, is in the process of raising a $152 million funding round, according to a Delaware corporate filing.

Montana to notify 1.3 million of computer hacking

Officials within Montana’s health department are informing 1.3 million patients that a server containing personal health information has been compromised.

CSC Bids to Modernize the Health IT System for U.S. Military Personnel and Their Families

CSC announces that it will join Allscripts and HP in a joint effort to win the upcoming DoD EHR contract.

News 6/25/14

Top News

Emdeon will acquire Capario for $115 million in cash from its private equity owner Marlin Equity Partners, with Emdeon announcing plans to incorporate the CaparioOne revenue cycle management product into its Intelligent Health Network.

Upcoming Webinars

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Acquisitions, Funding, Business, and Stock

KPMG acquires Cincinnati-based Zanett Commercial Solutions, an Oracle partner and health IT consulting firm.

A new $152 million funding round for doctor-finding site ZocDoc values the company at $1.6 billion.

Second medical opinion site Grand Rounds raises $40 million in funding. The company charges $7,500 for an online review by a nationally recognized physician, while arranging an appointment with a specialist costs $200. The company says that its second opinion finds the original doctor wrong 60 percent of the time, giving employers more than a threefold benefit to their investment, which for companies of fewer than 1,000 employees is $10 each per month. The company also offers physician-to-physician consultation for hospitalized patients who demand a review by a recognized expert. It would be interesting to know how they choose the “top 3 percent of specialists in the nation.”   

IMS Health will acquire some product lines of Cegedim, which sell life sciences marketing solutions, for $520 million in cash. Cegedim’s Pulse Systems products for medical practices (PM/EHR, RCM, patient portal, patient kiosk) weren’t mentioned as being part of the deal.

Sales

St. Luke’s (MN) chooses Strata Decision’s StrataJazz for Decision Support.

Cerner signs a 10-year deal with existing customer Mission Health (NC) to work on unspecified innovation and population health projects.

University Health Shreveport (LA), UMass Memorial Medical Group (MA) and Baptist Memorial Health Care (TN) select Infor Healthcare financial solutions.

RegionalCare Hospital Partners (TN) will deploy Agilum Healthcare Intelligence’s BI solutions and services across its eight hospitals in seven states.

Verizon will provide AirWatch by VMware to its US enterprise clients.

People

M. Bridget Duffy, MD (Vocera) joins the board of scribe and EHR consulting vendor Essia Health, formerly known as Scribes STAT.

Athenahealth names Kristi Matus (Aetna) to the newly created role of EVP/chief financial and administrative officer.

Announcements and Implementations

Premier, Inc. launches PremierConnect Price Lookup, which will allow members and vendors look up pricing information for nearly 7 million contract items.

CSC will partner with Allscripts and HP in vying for the DoD’s $11 billion EHR replacement. CSC wastes no time in playing the card of Robert Wah, MD, its chief medical officer and newly installed AMA president.

The newly merged Great Lakes HIE and Michigan Health Connect choose Great Lakes Health Connect as their new name.

Government and Politics

Janet Woodcock, MD, director of FDA’s Center for Drug Evaluation and Research, says the agency’s Mini-Sentinel drug surveillance system that’s being piloted combines claims and EHR dispensing data from 18 large healthcare organizations in a common data model that its safety scientists can query with drug safety questions. It covers 153 million people, 4 billion drug dispensing episodes, and 4 billion patient encounters.

A South Dakota newspaper points out that small claims collection lawsuits for medical expenses often violate patient privacy since they list the services for which the patient owes the provider. One collections agency requests that each of its lawsuits be sealed to prevent casual electronic observers from prying into a given patient’s procedure codes.

Above is video from Tuesday’s 21st Century Cures digital health roundtable convened by the US House Energy & Commerce Committee. Among those speaking are Jonathan Bush (athenahealth), Jeff Shuren (FDA), Martin Harris (Cleveland Clinic), and Brian Druker (OHSU).

Other

Seven-bed Reagan Memorial Hospital (TX) says it was unable to pay its vendors after the only employee who knew how to issue checks from Meditech quit. They’re back on track after having Meditech train more people.

Above is Deborah Peel, MD of Patient Privacy Rights at TEDxTraverseCity on “Designing Technology to Restore Privacy” from a few weeks ago. She’s also starting a campaign, #MyHealthDataIsMine.

Fitch Ratings holds the rating on bonds of Beebe Healthcare (DE) at BBB-, one step above junk status, with EHR implementation contributing to its losses.

The State of Montana starts notifying 1.3 million people — more than the entire population of the state — that hackers got into a state health department server containing their medical information. A surprising amount of medical information was stored on the server, including “health assessments, diagnoses, treatment, prescriptions, and insurance.” Also on the same server: the bank account information of 3,100 department employees and contractors and 50 years’ of birth and death certificate information.

Parkview Health (IN) pays $800,000 to settle an OCR HIPAA investigation in which a retiring independent doctor who was transferring her patients to new practices found 71 boxes of medical records dumped in her driveway when she got home. The hospital says it has since replaced its insecure paper records with an EHR.

On Computerworld’s “100 Best Places to Work in IT 2014” in the “Large Organizations” category are Sharp HealthCare (#7), Texas Health Resources (#8), OhioHealth (#10), Carolinas HealthCare System (#20), Cedars-Sinai Health System (#21), Cancer Treatment Centers of America (#27), Children’s Hospital of Philadelphia (#33), Cerner (#37), Ascension Health (#39), HCA (#42), Kaiser Permanente (#45), and McKesson (#50). On the “Midsize Organizations” list are Miami Children’s Hospital (#8) and Genesis HealthCare System (#12). UHC takes the #2 spot in the “Small Organizations” category.  

A small (111 hospitals) AHA-sponsored survey finds that a third of the responding organizations don’t feel they have the right executive team in place to execute their strategy, with their biggest talent shortfall being in creating non-traditional partnerships, managing community and population health, and managing change. Just half have a CIO/CTO on the executive team, and only 20 percent say the CIO is always involved in making decisions. The report predicts the emergence of new executive titles that include chief population health manager, VP of cost containment, chief patient engagement officer, and VP of clinical informatics.

“No Matter Where,” a movie about HIEs in Tennessee, has a limited premiere in Nashville. The executive producer is Kevin Johnson, MD, professor of pediatrics and biomedical informatics at Vanderbilt University School of Medicine.

Sponsor Updates

• Black Book Rankings names Streamline Health’s Looking Glass ECM system as #1 in the “Document Improvement” category of “Financial Products and Services.” Also #1 in its category is PatientKeeper in the “Charge Master” and “Charge Capture” categories.
• Netsmart is providing CareManager to the Early Connections Network in Tennessee.
• Levi Ray & Shoup announces its MFPsecure pull printing software that enables secure delivery for Ricoh devices.
• Craneware earns HFMA Peer Review Designation for five products for the tenth consecutive year.
• Agilum Healthcare Intelligence introduces its new website and BI solutions.
• Health Catalyst posts a video demonstration of its new Financial Management Explorer.
• MedAssets introduces the first module of it revenue cycle analytics suite Contract Analytics during the 2014 HFMA National Institute in Las Vegas.
• Vital Images releases VitreaExtend advanced visualization solution that supports up to three simultaneous users.
• Navicure launches BillingBetter.com to connect medical billing companies and practices and provide education resources on billing.
• MedAssets unveils the next generation of Decision Support Costing and Contracting this week at the 2014 HFMA National Institute in Las Vegas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 6/23/14

Top News

HHS Secretary Sylvia Burwell reorganizes the staff of Healthcare.gov in preparation for the next open enrollment period that starts in November, hiring Andy Slavitt of Optum (above) as CMS principal deputy administrator. Optum helped fix Healthcare.gov after its disastrous rollout. Slavitt fills the vacant position that places him as second in command to CMS Administrator Marilyn Tavenner, replacing Jonathan Blum, who left the agency in April. Burwell also announced plans to hire a Healthcare.gov CEO and CTO.

Reader Comments

From Dingo Boot: “Re: HIStalk Practice. I took a break from reading but I’m back. A double dose of industry news there and on HIStalk gives me an edge, I think.” Thanks. Jenn is doing an amazing job on HIStalk Practice. She is contributing in other less-obvious ways and will most likely become more visible on HIStalk.

From The PACS Designer: “Re: the bionic pancreas. A new concept to help with Type 1 diabetes has been announced by Boston University. The bionic pancreas device uses uses a smart phone, glucose monitor, and insulin pump to automatically control blood sugar levels.” Quite a few groups were working on the concept, including University of Virginia, but what’s different about this device is that it can manage both high and low blood glucose because it is loaded with both insulin and glucagon. This one’s getting coverage because it was mentioned in a NEJM article describing results from a tiny study of 52 patients over five days. It avoids finger sticks by using a continuous glucose monitor and lets the patient describe what they just ate, such as a “typical breakfast” or “small bite.” Most interesting is that the system doesn’t know or care what type and dose of insulin the patient has been administering since it’s measuring blood glucose continuously – all it needs is the patient’s weight and their descriptions of meal size.  

HIStalk Announcements and Requests

Epic supports interoperability as well or better than its competitors, according to 75 percent of a large number of poll respondents (630). Quite a few thoughtful and informed comments were left on the poll, many of them non-anonymously. I’ll excerpt a few that are from real-life experience rather than the more common sideline Epic bashing or cheerleading:

I’ve worked with several vendors over the years and plenty of HIEs. At the end of the day, Epic connects to other Epic facilities or to non-Epic just fine. Epic to Epic is priceless and effortless. More than 50 percent of the patients in the US today are or will be using Epic when the current Epic pipeline is implemented. For organizations that are not Epic, we expect them to connect to a commercially available HIE or to the federal level HIE (eHealth Exchanged managed by Healtheway). We have no plans to connect our Epic system to other EHRs directly, not when the states and fed are encouraging and incenting us to connect to HIEs.

Epic has already built and tested connections to a wide variety of other vendors, so that implementation is rather easy. Epic notifies us when a new vendor connection is available and we are eager to proceed based on prior success. When configuration changes are found, Epic promptly addresses and tests changes, so there is no finger pointing or project delays. Epic is dedicated to interoperability in a way that I don’t see from a variety of other EHRs. Interoperability projects with Epic will be delivered in a fraction of the time and at a fraction of the expense of many other vendors

My experience with Epic and Direct messaging to date is less robust than some other vendors. At this point in time, Epic can only send and receive CCDA documents — other enclosures like notes, radiology reports, discharge summaries, .wav files — are unable to be sent from Epic to other EMRs. I have seen other EMRs be able to send us different types of information, including free text notes (like an email) and we cannot process them. So in this regard, Epic has lower performance than other vendors.

Our hospital connects with other Epic facilities, local, state and national government organizations and we are currently working on connecting with non-Epic entities. Whether we connect via Query/Retrieve or interfacing, Epic has always been extremely knowledgeable and helpful in assisting us to link to Epic or non-Epic entities.

Very impressed with Epic interoperability. They do it the best of any vendors we’ve had to work with. If we are frustrated its the lack of real standards across the industry. Id like to see true semantic interoperability.

Epic has the ability, but not the will to interface with other vendors. As one of those vendors, our customers are not getting what they need to support their workflows in specialty areas when Epic declines to provide interfaces to vendors supporting specialty areas.

New poll to your right (or here): have you as a patient had a video-based “visit” in the past year? Vote and then click the “Comments” link to describe.

Listening: new from Mali Music, also known as 26-year-old Kortney Jamaal Pollard from Savannah, GA. His heartfelt lyrics are always uplifting and often religious, while musically it’s mostly neo-soul with some light rap thrown in. It’s likely to polarize people who react strongly to some aspect of his work, which I did: I loved it. Coincidentally sticking with the Georgia theme, I’m also listening to the defunct, Athens-based Magnapop.

Saturday was the summer solstice, which means it had more hours of daylight than any day of the year. It also reminded me that Friday marked 11 years since I wrote the first HIStalk post. Several of the folks who have recently recommended me on LinkedIn have been readers since the beginning, or at least nearly so, with quite a few going back to 2005 or 2006. Thanks for reading regardless of how long you’ve been doing so. I’m lucky to be doing something that gets me so excited every single day that I can’t wait to get started.

Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Sales

Centegra Health & Wellness Network chooses Valence Health to provide infrastructure and support for its clinically integrated network.

Government and Politics

FDA publishes draft guidance stating that won’t enforce regulatory controls on Medical Device Data Systems (MDDS) because they pose low risk to the public and are important for advancing digital health. MDDS are medical devices that transfer data electronically (such as from a ventilator to an EHR), store and retrieve data (blood pressure readings), convert data using preset specifications (pulse oximeter data to printed form), display data (displaying a patient’s EKG), or store or communicate medical images. Only apps that control other medical devices would continue to be regulated. The 60-day comment period is open.

ONC will present a webinar on Thursday, June 27 at 1:00 ET on how to implement digital privacy notices on websites. PatientPrivilege won ONC’s contest to create compelling, easy to implement online NPPs – its example shows how one might look.

A Huffington Post article talks up Blue Button (and Humetrix’s iBlueButton) as a way for veterans to work around the never-ending DoD-VA EHR fighting, saying it’s easier for veterans to just download their own information and take it to whoever they’re seeing, including private practice doctors.

Other

Niko Skievaski, the guy behind “Struck by Orca: ICD-10 Illustrated” (you have more time to buy it now that ICD-10 is delayed) has made the Breadcrumbs knowledge management software available for free. Users can ask questions and receive answers from the health IT community, members of which earn reputation points from the moderators.

A BMJ essay says evidence-based medicine is having a crisis, postulating that its promise isn’t being met because: (a) drug and device vendors have hijacked the process by manipulating clinical trials and publishing only favorable research to create “evidence”; (b) the amount of available evidence is unmanageable for practicing physicians, even with technology help; (c) the low-hanging fruit of managing established diseases has already been picked and the emphasis has moved to industrial-scale screening that may involve unexpected opportunity costs or unintended consequences; (d) less-skilled or lazy doctors may treat by template rather than by using experience and judgment; (e) EBM gives bureaucrats a way to impose rules that marginalize the physician’s skill and eliminate the opportunity for the patient to be involved in the decisions made about them; and (f) EBM works best for a single condition, which isn’t usually the case. The authors plea for a return to “real” EBM that uses the physician’s judgment, involves the patient, resists the use of “evidence” created by special interests, and places ethical care as its highest priority.

I’m fascinated that Google just bought home security and camera vendor Dropcam for $555 million in cash. The Wi-Fi video service offers live streaming, two-way talk, alerts, and night vision. Naturally I was thinking about healthcare uses, such as monitoring processes (like in the OR, pharmacy, etc.) or as a patient advocate wisely unwilling to leave a loved one lying in a hospital bed surrounded by potential misadventure. The company has lots of competitors, but their product looks simple to set up and my interest was more in the concept rather than the specific product. On the Big Brother side of the argument, I can just see a clueless, overly controlling Dilbertesque IT director demanding that work-from-home employees have the camera trained on their chairs at all times.

A video from Missouri Economic Development highlights Cerner’s program to hire military veterans.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/2014

CMS urged to quickly finalize proposal to ease 2014 EHR meaningful use

The American Hospital Association writes a letter to CMS and ONC asking that they quickly finalize the more flexible EHR attestation rules outlined in its Notice of Proposed Rulemaking.

athenahealth Leads Industry in Meaningful Use Stage 2 Attestations

athenaHealth reports that its users represent 59 percent of the eligible providers that have attested for Meaningful Use Stage 2 so far, even though it only owns three percent of the practice market.

Providers Update Electronic Health Record Systems

As Epic Systems sweeps across North Carolina, the Wilmington Business Journal reports that 70 percent of the residents there now have charts in Epic.

Ad-Tech Entrepreneurs Build Cancer Database

The Wall Street Journal interviews Flatiron Health CEO Nat Turner. Flatiron is an data analytics startup that collects cancer treatment details and subsequent outcomes from cancer centers around the country, and then aggregates the information to evaluate what treatments work the best for different types of cancers.

News 6/20/14

Top News

The American Hospital Association urges CMS and ONC to quickly adopt plans that were identified in its Notice of Proposed Rulemaking that would give hospitals flexibility in the combinations of EHR certification and Meaningful Use stages that are permitted for 2014. AHA observes that the proposals are last minute given that the last FY2014 reporting period is July through September 2014 and the NPRM’s comment period won’t be finished until that reporting period is underway, meaning that “hospitals are essentially being asked to act on faith that the agencies will finalize these proposals as written while risking that they may not.” AHA also wants the 2015 reporting period shortened to 90 days and to avoid setting a firm October 2016 start date for MU Stage 3 given that “fewer than 10 hospitals and 50 EPs had attested to Stage 2” as of mid-May.

Reader Comments

From Clueless About HIT: “Re: magazine’s Top 100 ‘HIT’ vendors. Many represented their revenue from payers, life sciences, and government health as ‘HIT.’ This includes Cognizant, Optum, Infosys, TriZetto, Syntel, and Edifecs. Either these vendors are clueless about what ‘HIT’ means or they are deliberately misreporting. It also speaks volumes about publications that come up with these lists.” I never even look at those lists, to be honest. They’re great for the magazines who make them up to sell ads, but even if the numbers are accurate (and that’s obviously dependent on interpretation), who cares? Bigger vendors aren’t necessarily better vendors, and anyone who would make a buying decision based on a company’s annual revenue is likely to be disappointed. I think I’ll sell spots on a “Coolest Vendor” list and donate the proceeds to charity – at least some good would come from it.

HIStalk Announcements and Requests

This week on HIStalk Practice: ARcare CIO Greg Wolverton talks agility and mandatory EHR training. Virginia’s "people problem" gets in the way of HIE. Mobile access to EHRs takes a back seat to workflow. Physicians may be the biggest barrier to HealthKit’s success. Dr. Gregg pontificates on the inevitability of change. The Brookings Institution highlights the top challenges of Medicare ACOs. ONC leadership changes have some questioning the longevity of the Meaningful Use program. Thanks for reading.

This week on HIStalk Connect: Former National Coordinator Farzad Mostashari, MD, launches a startup that will focus on optimizing EHRs for primary care practices interested in joining an ACO. Dr. Travis discusses the promising but very new telecharting market. In an effort to keep up with Apple and Samsung, Google will unveil its new health data platform at next week’s Google I/O developers conference. Mr. HIStalk interviews Colin Konschak, CEO of Divurgent.

Listening: Birdy, the 18-year-old singer-songwriter from England who has recorded several international hits and contributed a track to “The Hunger Games.”

Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Acquisitions, Funding, Business, and Stock

BlackBerry reports a surprise quarterly profit and announces the Passport, which CEO John Chen says is either the world’s smallest “phablet” or its largest phone. It features a hardware keyboard at a 4.5-inch square display. The device will be marketed to healthcare users, which is a key target of the struggling BlackBerry.

Vocera opens an office in Dubai, UAE.

People

Fraser Bullock (Sorenson Capital) is elected chairman of the board of Health Catalyst, replacing David A. Burton, MD.  

Valence Health names Tony Gutierrez (Missouri Care) as VP of operations of its health plan division and Jack Risenhoover (Napier Healthcare) as VP of business development.

Kryptiq hires Jacquelyn Hunt, PharmD, MS (Bellin Health System) as chief population health officer.

AirStrip appoints Orlando Portale (Palomar Health) as chair of its newly created Innovation Advisory Board.

Announcements and Implementations

Aprima will offer dashboardMD’s performance management and BI reporting tools.

Kareo offers medical practices a guide for registering for the VA’s “Accelerating Access to Care Initiative,” which allows them to serve VA patients who can’t get appointments for primary or specialty care.

In England, Cerner launches a SaaS version of Millennium for smaller NHS trusts (under 500 beds) that can’t afford its system otherwise. The company says it’s similar to a US version used by 70 hospitals.

Athenahealth announces that its users account for 59 percent of the 485 providers who have attested for Meaningful Use Stage 2 even though its market share is les than 3 percent.

Hartford HealthCare’s Integrated Care Partners goes live with High Line Health’s Visual Analytics Platform for population health management and value-based care.

California Telehealth Network chooses HealthFusion’s MediTouch as its first EHR partner.

Government and Politics

Governors of several New England states say they will explore sharing prescription data to thwart doctor-shopping drug seekers who cross state lines. 

ONC will present a webinar on the FDASIA draft report on Friday, June 20 at 3:00 p.m. Eastern.

The US House Energy & Commerce Committee’s 21st Century Cures seeks guidance on how the vision of a digital health ecosystem (mobile apps, EHRs, cloud, and big data) can be realized to create new treatments and cures. Public input is solicited to cures@mail.house.gov. The group will convene a roundtable in Washington, DC on Tuesday that includes Jeffrey Shuren, MD, JD (director, FDA’s Center for Devices and Radiological Health), Martin Harris, MD (CIO, Cleveland Clinic), Jonathan Bush (president and CEO,athenahealth), and Joseph M. Smith, MD, PhD (chief medical and science officer, West Health.)

Innovation and Research

Apple files patent applications that include an iPhone receiving sensor data — including from at least one that’s worn and not part of the iPhone — and calculating a “personal scorecard” and triggering alarms.

Other

The Wall Street Journal profiles Flatiron Health, which gathers de-identified treatment and outcome data from cancer centers to give doctors visibility into how treatments are working for the 96 percent of patients with cancer who aren’t enrolled in a clinical trial. The 28-year-old co-founder, who with his Flatiron Health co-founder sold their advertising technology company to Google in 2010 for $81 million, says it was hard to get the cancer center CIOs and doctors to contribute information they considered proprietary. The company has 105 employees, has 200 cancer centers on board, and received a $130 million investment from Google in May 2014, using some of the money to acquire oncology EHR vendor Altos Solutions.

A survey by FICO (the former Fair Isaac) finds that 80 percent of people want to communicate with their providers via smartphone, while 76 percent would like medical appointment reminders and 69 percent say they want appointment scheduling and medication reminders.

Rady Children’s Hospital (CA) exposes the information of 14,000 patients when employee accidentally attaches a worksheet to emails sent to six job applicants.

A Huffington Post report calls out for-profit hospices that make up nearly 60 percent of the total, including 6,100-employee Vitas, which was bought out for $406 million in 2004 by the parent company of Roto-Rooter. Companies are accused of upcoding, sending marketers to find dying hospital inpatients to sign up quickly, enrolling patients at Medicare’s expense who were healthy enough to play golf, treating patients against their will, and having a high rate of safety and patient care violations. Experts say the problem is that Medicare pays set day rate, encouraging hospitals to enroll patients who don’t require their services and provide higher levels of services than the patient needs. Medicare’s data shows that non-profit hospice had an average length of stay of 69 days vs. 105 days for for-profits.

Fletcher Allen Health Care (VT) will change its name this fall to The University of Vermont Medical Center.

A North Carolina business paper mentions the status of EHR deployment in the state. Wilmington Health is about to go live with NextGen, New Hanover Regional Medical Center is expanding Epic to give inpatients access to MyChart, and Novant is expanding Epic use throughout its facilities. Tad Dunn, CIO of New Hanover, says 70 percent of the citizens of North Carolina now have a chart in Epic.

Sponsor Updates

• Connance announces the Analytically Optimized Revenue Cycle, predictive analytic and workflow strategies to increase cash 10-30 percent and reduce cost up to 25 percent.
• Elmhurst Clinic (IL) shares how its use of healthfinch RefillWizard has led to happier doctors.
• Nuance announces that Valley Medical Center (WA) gained $2.2 million in revenue by using its Clintegrity 360 clinical documentation improvement program.
• Fujifilm Medical Systems USA will demonstrate the latest version of its Synapse Cardiovascular and it Synapse Mobility mobile ap, which will allow viewing of non-DICOM information from its vendor-neutral archive in EHRs such as Epic, at the American Society of Echocardiography meeting in Portland, OR starting this weekend.
• Sagacious Consultants will participate in the HFMA ANI 2014 in Las Vegas June 22-24.
• Predixion is recognized as a Challenger in the Advanced Analytics Market by Hurwitz & Associates.
• Texas Pulmonary & Critical Care Consultants is experiencing increased doctor collaboration since going live on pMD Messaging.
• Texas Children’s Hospital shares how it improved appendectomy outcomes using Health Catalyst’s analytics solutions.
• InterSystems expands its New York City office.
• Aspen Advisors celebrates its eighth anniversary, adding 10 clients this year.
• Divurgent announces the addition of Cost to Collect service to its Revenue Cycle Management Practice solution.

EPtalk by Dr. Jayne

Quite a few readers responded to my recent Curbside Consult regarding a telemedicine solution a potential part of an employee benefits package. One made a very good point:

I read your recent op piece on the new “benefit” your HR department is trying to roll out to employees. I wondered what issue they were trying to solve, other than be on the “bleeding” edge of offering this service? If the employees have an access issue, seems like the first step would have been to meet with medical staff leadership and brainstorm alternatives. I’m just a CIO with no clinical background so I can’t bring a clinical perspective to the discussion, but the one that I always tell my colleagues I do have is that of a patient and how our decisions are viewed through those “lenses.” In this case, I wonder how someone I don’t know and have never met will understand me within the full context of my medical history and current environment and can deliver better quality and outcomes than someone who does.

That’s a very good point and one that was brought up to some degree in our committee’s discussion. It also makes a good point about IT solutions. In general, it’s good practice to understand the business problem you’re trying to solve prior to looking at vendors. In our case, the business problem is that we’re notoriously cheap. Our employees haven’t had raises in years (blamed on MU-induced belt tightening). Many of us suspect they’re trying to use this as a way to make up for what we’re lacking in salary or other retention perks. Another reader wrote:

As a long-time practice administrator in hospital systems, I totally agree with your reaction. The med exec committees will have a heyday and make life miserable for the hospital administrators. Aren’t we all trying to keep care within our own “families?”

Another physician reader referred to the story as, “Almost Dilbert material, except there are too many layers of absurdity.” I almost spit coffee on my keyboard as I read that because I had to withstand the pointy-haired boss in a previous life. The need for patient privacy was also a recurring theme:

At our facility, we have an aggressive strategy to significantly incent our employees to receive care within our network. The loudest noise we hear on this topic is what you alluded to – patient confidentiality. It is cited as the #1 barrier to our employees seeking care with us.

Readers also sent plenty of tips about nice seaside locations where I could consider practicing. It’s looking awfully tempting. Another travel-savvy reader sent me this article about the urgent care clinic that recently opened. Since the airport already has a liquor store in the baggage claim area, it was only a matter of time. They do offer hangover remedies including intravenous fluids, vitamin B12, and oxygen. I wonder if Chicago O’Hare will offer the same options for HIMSS15 travelers? Not likely.

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.

Mostashari Launches ACO Creation Company for Independent Physicians

Former National Coordinator Farzad Mostashari, MD, MSc announced this morning the launch of Aledade, a new company that will help independent physicians form Accountable Care Organizations. The Bethesda, MD startup is backed by $4.5 million in seed funding from Venrock.

Mostashari said in a statement, “Empowering doctors on the front lines of medicine with cutting edge technology that helps them understand and improve the health of all of their patients has been the mission that’s animated my career. That’s Aledade’s mission – and we’ve assembled the best possible team to guide our doctor partners to success in the ACO space.”

The company, which is not tied to any hospital or health plan, says it has initiated partnerships in four areas it has targeted – Delaware, Arkansas, Maryland, and New York City – and will use that experience to create a replicable model that will allow it to expand rapidly over the next year.

Mostashari will serve as Aledade’s CEO. His co-founders are EVP Mat Kendall, formerly ONC’s Director of the Office of Provider Adoption Support, and CTO Edwin Miller, formerly VP of product management for CareCloud.

Aledade will offer primary care doctors services to form an ACO that include on-site clinical support, EHR optimization, implementation of an integrated data and technology platform, quality reporting, provider benchmarking, real-time ADT notification, identification of high-opportunity patients, and patient outreach.

Mostashari adds in a company blog post, “I have also found my cause. It’s to help independent primary care doctors re-design their practices, and re-imagine their future. It’s to put primary care back in control of health care, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind. It’s to promote new partnerships built on mutual respect, and business arrangements that will truly reward them for the value that they uniquely can bring- in better care coordination, management of chronic diseases, and preventing disease and suffering. It’s to achieve lower cost through better care and better health. ”

News 6/18/14

Top News

Nuance is reported to be discussing a sale of the company to Samsung, with shares rising nearly 10 percent Monday and a bit more on Tuesday on the rumor. One might speculate that the recent addition of two of Carl Icahn’s people on Nuance’s board may have heightened the money-losing company’s interest in finding a buyer. Samsung already uses Nuance’s voice technology in its devices (as does its arch nemesis Apple, for which Nuance provides Siri), but would probably have little interest in Nuance’s considerable healthcare businesses that includes Dragon speech recognition, transcription, clinical documentation and coding, and image sharing. Highly paid Nuance CEO Paul Ricci ($78 million compensation in three years and shares worth $60 million) swelled Nuance with a bunch of acquisitions in two main sectors (healthcare and mobile) and has declined to focus its corporate strategy despite lackluster results, while Icahn likes selling off individual parts to create shareholder value. It will be interesting to see whether cash-rich Apple will be threatened enough by the rumored Samsung interest to make overtures of its own for the $6 billion market cap Nuance or perhaps part of it if Nuance is willing to break it up.

Reader Comments

From Joe: “Re: rumored Nuance acquisition talks. Ironically Domino’s announced its Nuance-powered ‘order your pizza by voice’ app today. There’s probably a ‘Pete’s a delivery boy’ misrecognition joke in there somewhere.” Domino’s, which like Walgreens and other retailers is making technology an integral part of its product, says that typing characters is becoming obsolete and its app (which features order-taker “Dom”) will differentiate it from competitors. It’s refreshing to see how non-healthcare companies use technology to improve their business and customer experience given obvious, non-government mandated incentives (i.e., profit) to do so.

From KayCee: “Re: Epic. I asked Epic about whether their name should be capitalized.” KayCee inquired of Epic, “Only Mr. HIStalk seems to be defending the position that an all-caps reference reflects ignorance” and asked the company’s position. Epic’s response from spokesperson Shawn, who said the email was forwarded to him because, “We don’t have a marketing department,” states “EPIC” was used in an old version of the logo, but that was changed in the late 1990s and “Epic” is correct. I enjoyed Shawn’s erudite conclusion, which is more tolerant than mine: “Without judging whether it represents ignorance or an historical homage to our early years, we’re pretty forgiving and accepting of the misuse.” I will stubbornly point out that Shawn said that writing EPIC constitutes “misuse.”

From Art Vandelay: “Re: Walmart opening clinics. The mind begins to work when combining this with information from Castlight Health: there is no state exchange or ‘caid expansion, Austin, TX has very expensive office visits but isn’t representative of the state, Walmart enters with a low-cost alternative. Most large health systems aren’t worried about retailers like Walmart, CVS, and Walgreens entering the market. It is less about primary care and more about interrupting their ecosystems for chronic care management – how will the data come back, will they use similar protocols, will patient education materials and the plan of care align.” Walmart will open its second and third company-owned clinics in Texas, expecting to expand that to a dozen this year in a pilot project. They will offer primary care services for $40 and will treat insured Walmart employees for just $4, but they won’t take private insurance, only Medicare and Medicaid down the road. The clinics will be staffed by nurse practitioners and managed by workplace clinical operator QuadMed.

HIStalk Announcements and Requests 

Lorre has a lot of webinars going on and could use more CIO-type reviewers to fill out a quick evaluation form after watching a recording of the rehearsal that lasts about 30 minutes. I will send a $50 Amazon gift certificate as my thanks (or just my thanks to the folks who can’t accept them because of employer policy). Let me know if you can help out every now and then. I provide each Webinar presenter with three reviews of their practice session — two from CIOs and one from me – to make their live day webinar the best it can be in terms of educational value and in keeping my short attention span engaged. If you’d like to present a webinar, I’m all ears for that, too – I’m up for anything that is educational and interesting to readers.

Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Speaking of webinars, Steve Blumenthal’s abstract for his EHR contracts one was witty, so we suggested he do a video introduction. I can’t help but snicker every time I play it, especially when I see his fake smarmy, “Oh, I just noticed the camera was running five feet from my face” introduction. He’s a good actor and funny (even by non-lawyer standards), so it should be a good webinar.

Acquisitions, Funding, Business, and Stock

Cost management systems vendor Equian, which changed its name from Health Systems International a few weeks ago, completes its acquisition of AfterMath Claim Science, which offers data mining cost analysis solutions to payors. 

Consulting firm VeritechIT acquires Health Technology Solutions, a one-employee consulting firm run by Terry Grogan, acting CTO for Temple University Hospital (PA). It appears from VeritechIT’s bio page that Michael Feld — listed as founder, president, and CEO – is also acting CTO of Lancaster General Health System (PA).

Medical device maker Medtronic acquires competitor Covidien for $42.9 billion in cash and stock, giving Medtronic a convenient excuse to move its headquarters out of US tax jurisdiction to Ireland even though the company’s name will continue as Medtronic and its “operational headquarters” will remain in Minneapolis. Several companies have taken the acquisition route to evade the 35 percent US corporate tax rate that’s one of the highest in the world, the only method remaining to accomplish that since US laws now prohibit a company from simply moving its headquarters offshore to pay a lower tax rate (12.5 percent in Ireland). The deal also gives Medtronic a place to spend the $14 billion of foreign profits it has parked offshore to avoid paying US taxes.

From the Streamline Health Solutions earnings call:

• President and CEO Bob Watson apologized for the late financial report, caused by a change in CFOs, a change in audit firms, and completion of an internal controls audit required by the company’s market capitalization.
• The company is offering the commercialized version of analytics software it acquired last year from Montefiore Medical Center.
• In a refreshingly honest announcement, Watson said the company erred in taking on work to help its clients go live faster in hopes of being able to recognize more revenue from the backlog, which Watson said didn’t really help and cost the company twice as much as expected. He concluded, “An outside consultant stepping into XYZ health system doesn’t have the innate natural knowledge of how that health system’s IT infrastructure is organized and therefore cannot be that helpful. So that was our plan that didn’t work.”
• Sales of computer-assisted coding solutions were delayed after the “disastrous” results experienced by early adopters of “some of our well-known competitors.”
• The acquisition of Unibased Systems Architecture resulted in one new Q1 sale and renewals worth a total of $10 million.
• The company’s products have been renamed within the Looking Glass family nameplate and underlying analytics platform.

Healthcare benefits electronic payment systems vendor Evolution1 will be acquired by corporate payment solutions vendor WEX for $532.5 million in cash. The Fargo, ND-based Evolution1 has 300 employees.

Sales

Children’s Hospital Los Angeles (CA) and Wisconsin Statewide Health Information Network (WI) choose Orion Health’s Rhapsody Integration Engine.

The FHP Health Center (Guam) selects eClinicalWorks.

Thibodaux Regional Medical Center (LA) will implement Health Catalyst’s Late Binding Data Warehouse and Analytics platform.

People

Practice Fusion names Robert Park (Chegg) as CFO.

Dan Baker (NextGen) joins Remedy Informatics as SVP of sales.

HealthStream hires Tom Schultz (Infor) as SVP of sales and promotes Michael Sousa to SVP of business development.

Payment financing company CarePayment names Craig Hodges (Emdeon) as CEO. Outgoing CEO Craig Foude will stay on as board chair and managing partner for Aequitas Capital, founder and owner of the company.

Announcements and Implementations

Aesynt, the former Pittsburgh-based McKesson Automation plus its acquired Health Robotics, says it signed 18 IV automation contracts in Q4. Those are for the former Health Robotics i.v.STATION hospital IV room products.

The Central Texas division of Baylor Scott & White Health goes live on API Healthcare’s ShiftSelect.

Memorial Hermann (TX) launches Wolters Kluwer UpToDate Anywhere for its 12 hospitals and 5,000 affiliated physicians.

Government and Politics

The VA will issue an RFP next week for a commercial patient scheduling system to work within VistA, with its CIO saying that while VistA’s clinical system is “one of the best out there,” its non-clinical modules haven’t kept up. He also says that current events make it obvious that the new system will include extensive auditing features to review changed appointments. The VA gave up on a previous attempt to build its own scheduling system a few years ago and nothing seemed to happen with the open source Health eTime app that won the VA’s scheduling system competition last fall.

Health IT Now says HITECH has paid $24 billion to subsidize information-hogging EHRs and wants HHS to make data sharing (at no extra customer cost) a certification criterion. Health IT Now is a coalition of patient groups, providers, employers, and payers – it claims that Aetna, American Cancer Society, AHIMA, IBM, Intel, Oracle, the US Chamber of Commerce, and a few health systems are members – whose agenda involves promotion of interoperability standards, Meaningful Use changes to emphasize lower cost and improved outcomes, innovation and increased use of telemedicine, and medical licensing that spans state boundaries. I first reported on the group in mid-2007, saying, “The founding members include a couple of former Congressmen ([Nancy Johnson and John Breaux] and a cross section of influential medical, professional, and other organizations. I don’t think I’ve heard anything from them since (their “About” page claims “we will continue a formidable education agenda in 2012”), so while I agree with their platform, I don’t think it’s having much of an impact inside the Beltway. The only named employee is Executive Director Joel White, a former Congressional staffer who omits the group from his LinkedIn profile and instead list himself as President and CEO of Horizon Government Affairs, which sells political services and operates four other non-profit coalitions: Council for Affordable Health Coverage, Rare Disease Legislative Advocates, Prescriptions for a Health America, and Newborn Coalition.

DoD releases the third and near-final draft of its $11 billion DHMSM EHR solicitation, removing the veterinary medicine requirement, eliminating required use of any particular development methodology, and making the contract performance-based. Vendors will have a chance to ask questions on Industry Day next Tuesday, June 24, which would be fun to write up if you’re going.

Innovation and Research

Microsoft announces Azure Machine Learning, available in July, that will allow users who store data in its Azure cloud to use drag-and-drop predictive analytics. Potential healthcare uses include scheduling, reducing readmissions, and anticipating disease outbreaks.

Other

Research by The Commonwealth Fund finds that the US health system is not only the most expensive among 11 developed nations, it is also the worst, coming in dead last in access, efficiency, equity, and healthy lives, primarily due to the lack of universal healthcare coverage and support for the patient-physician relationship. The report also calls out the stubborn resistance to using healthcare IT. The bright spot, the report says, is that the Affordable Care Act is improving access and the system is moving toward more value-based payments. Methodology footnote: the study was done by surveying around 3,000 US residents with a self-rated health status of below average and recently treatment for a serious problem that involved at least one hospitalization, so the sample size wasn’t very large and the results reflected patient perception more than hard measures. The president of The Commonwealth Fund is former National Coordinator David Blumenthal, MD, so naturally the report pays disproportional attention to EMRs. Still, nothing in the results is all that surprising since it measures overall health of a cross-section of citizens, not just the specific healthcare outcomes of the more privileged among us.

The Wall Street Journal profiles Dignity Health’s use of Google Glass for clinical documentation, which it claims allows physicians to double the amount of time they can spend with patients. Dignity is using software from startup Augmedix to send Glass-collected information and commands to the EMR. It’s a small pilot started in January 2014 – the CMIO and two other docs – but they say manual EMR entry was reduced from 33 percent of their total time to 9 percent.

An apparent tornado damaged several homes and an elementary school within a mile of Epic’s Verona, WI campus Tuesday morning, but nobody was hurt.

Overlake Hospital Medical Center (WA) gets a S&P bond ratings upgrade to A, primarily due to completion of its Epic implementation.

In China, Internet giant Alibaba, which has more sales than eBay and Amazon combined and is planning a US IPO, unveils a 10-year plan to disrupt China’s notoriously backward hospital system with online payments, patient scheduling, e-prescribing, hospital transfer, insurance claims management, and eventually wearables and other prevention technologies. The company had released a patient self-scheduling application for 600 hospitals last year to fix the eight-hour process of getting an appointment, but the government shut it down over privacy concerns (not mentioning that the site competed with the government’s own online service). The announcement of Future Project is here, although you should probably be able to read Chinese since Google translates it as, “Today, Alipay announced a program called ‘future hospital.’ Payment was originally conducted in hospitals, registered, classified ad will be transferred to PayPal platform. The implementation of this plan is completely far away from us, section house, ‘said the doctor chase behind the ass, give praise it pro’ story can become true?” And in other breaking news, all your base are belong to us

Alexian Brothers Health System (IL) cancels plans to form an accountable care entity to manage Medicaid patients, saying it’s too hard to connect the 10 EHRs used by 80 percent of the doctors, not even counting those that might have been added to the network later. The ACE would have been required to connect 60 percent of its network to the Illinois HIE within 15 months, include 100 percent within 30 months, and file electronic summaries of care for 70 percent of the network within 15 months.

CHIME’s Keith Fraidenburg tweeted out this photo of Tim Stettheimer presenting at the CHIME/AMDIS CMIO Boot Camp at Ojai, CA this week. Attendees are welcome to send me a write-up about the experience.

Pittsburgh insurer Highmark stops paying higher physician chemotherapy fees devised by hospitals buying oncology practices and then billing out drugs at the much higher hospital outpatient rate. Other insurers are trying to hold down oncology costs by paying oncologists a stipend to use less-expensive (and less-profitable) chemo regimens or bundling all treatment costs into a flat payment. Brand name chemo drugs cost an average of $10,000 per month, giving physicians a financial incentive to use more expensive ones as insurance companies haven’t protested for fear of losing oncologists in their network.

Mary Milroy, MD, the new president of the South Dakota State Medical Association says EHRs add an hour of busy work to a doctor’s day, adding that, “The systems we use are cumbersome, designed by IT people and not medical people. The huge problem is they don’t communicate.” Her clinic uses NextGen, another practice she covers uses Epic, and the local hospitals use Epic and Meditech. She says none of them talk to each other.

HIMSS Analytics has issued a new report about cloud computing, but with that ever-blurring line between whether HIMSS is a member organization or a vendor, you can’t download it without providing your email address, telephone number, job title, and other contact information for the inevitable sales cold call. I’m still not clear on how HIMSS managed to change HIMSS Analytics from a for-profit subsidiary to part of the non-profit HIMSS.

Non-profit patient advocate group Stupid Cancer launches an Indiegogo campaign to raise $40,000 to develop its free Instapeer app, which will connect young cancer patients to other patients, survivors, and caregivers.

In England, Health Secretary Jeremy Hunt says new guidelines calling for hospitals to list the name of each patient’s doctor over their bed is a “huge step forward for patient safety” since it’s not always clear where the medical buck stops. A spokesperson for a patient group said writing names on a board is fine, but that won’t accomplish much if the doctor doesn’t stay in touch with the patient.

Sponsor Updates

• Regenstrief Institute joins ConvergeHEALTH by Deloitte, a real-world evidence and analytics consortium.
• SD Times names InterSystems and its Cache’ system as one of the software industry’s top 100 innovators in the Database and Database Management category..
• RelayHealth announces that RelayHealth Financial has bolstered RelayAssurance Plus 5.0, providing transparency into your claims lifecycle.
• AirWatch by VMware opens registration and lineup of analyst speakers for the AirWatch Connect Global Tour 2014 in Atlanta, London, and Sydney.
• McKesson launches Benchmark Analytics service to provide custom reports and consultation to optimize performance.
• GetWellNetwork CEO Michael O’Neil discusses the CDC Morbidity and Mortality report on the cost of cancer survivorship with a local journal.
• Kareo and Falcon EHR partner to provide cloud solutions to nephrology practices.
• Gartner names Informatica as a Leader in the 2014 Magic Quadrant for Structured Data Archiving and Application Retirement.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 6/16/14

Top News

Cumberland Consulting Group will announce Monday that it has acquired Cipe Consulting Group, a 50-consultant, Seattle-based EHR and RCM consulting company. Franklin, TN-based Cumberland has 230 consultants.

HIStalk Announcements and Requests

 

Responses to my poll about meeting attendance in the next year indicate that it’s the HIMSS conference (33 percent) and vendor user groups (26 percent) well out front, followed by CHIME (9 percent) and then a scattershot of other meetings with low percentage numbers. New poll to your right: how well does Epic support interoperability compared to other EHR vendors? After you vote, click the “Comments” link at the bottom of the poll to explain why you think so.

Things you can do to help me with HIStalk: (a) read HIStalk Practice and HIStalk Connect; (b) support my sponsors by checking out their ads, reviewing the listings in the Resource Center, and using the RFI Blaster for any consulting needs; (c) review the archived educational material on HIStalkU; (d) send me anything readers would find useful – people I should interview, conferences I should attend, and of course news, rumors, and fun stuff; and (e) tell people you know about HIStalk since I don’t advertise and nobody will hear about it otherwise. Thanks for reading HIStalk even though I started writing it in 2003 just for myself and it was mostly that way for years.

Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Acquisitions, Funding, Business, and Stock

Streamline Health Solutions reports Q4 results after a delay involving an auditor change and an internal controls audit: revenue down 3 percent, EPS –$0.14 vs. –$0.63.

Announcements and Implementations

IT gets the blame (at least from non-IT people looking for a scapegoat) for the failed $31 million Cerner implementation at Athens Regional Health System (GA). The hospital’s chief medical officer says users weren’t well trained and the CIO was holding back information, while Cerner claims IT was running the project without getting users involved. The CEO and CIO were forced out after physicians protested.  My suspicion is that the medical staff docs were already mad at administration over something unrelated, refused to participate, then capitalized on go-live challenges to get the CEO fired. The CIO was probably collateral damage since an IT system was the claimed problem.

Government and Politics

Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA) ask unnamed stakeholders for ideas on how the use of government healthcare databases can be expanded. Chuck asks a lot of questions and writes a lot of letters, but that’s usually the last you hear about it.

Vanderbilt University Medical Center’s Eric Boehme, associate director of informatics, worries that the already-complicated Meaningful Use timetable could take an unexpected turn between the recent Notice of Proposed Rule Making and the actual rule, as in what happened with ICD-10. He also takes an interesting long view: “This is all too late and too little. MU is in trouble. Two powerful committees in Congress asked for a pause for MU to evaluate the success of the program and to emphasize the lack of true interoperability. ONC has lost a significant portion of its funding as the stimulus money dries up. Recently, some members of Congress questioned how much ONC should regulate HIT. ONC National Coordinator, Farzad Mostashari, CMS Administrator, Marilyn Tavenner, and the HSS Secretary, Kathleen Sebelius have all resigned.”

Other

A Wall Street Journal editorial by patient safety expert Peter Pronovost, MD, PhD of Johns Hopkins Medicine urges consumers to “Beware Bad Data About Hospitals” in the current “Wild West” environment in which “there are greater protections about what claims we can make about toothpaste than a hospital or measurement organization can make about quality of care.” He recommends creating the equivalent of a Securities and Exchange Commission to oversee development and use of quality indicators. Until then, he suggests that consumers use only composite scores such as those from The Leapfrog Group and Consumer Reports. He concludes with a simple plea: “There really is very little useful information on pricing. There should be.”

An unnamed IT system goes down at Fletcher Allen Health Care (VT) Friday morning, forcing the hospital to go to paper.

The Detroit newspaper profiles Sorie Kanue, a former Michigan State football standout and team captain (playing safety) who worked in IT after college and then went to nursing school. He has been named nurse of the year twice at Detroit Medical Center’s Heart Hospital and is working on his MSN.

Fortune profiles Elizabeth Holmes, who as a Stanford sophomore in 2003 founded blood diagnostics company Theranos, which now has 500 employees and a valuation of $9 billion. When questioned by her professor about why she wanted to start a company, she answered, “Because systems like this could completely revolutionize how effective healthcare is delivered and this is what I want to do. I don’t want to make an incremental change in some technology in my life. I want to create a whole new technology, and one that is aimed at helping humanity at all levels regardless of geography or ethnicity or age or gender.” The company’s product can run dozens of tests from a single, tiny sample of blood drawn via pain-free finger stick, and the company’s app supports its pledge that “we believe you have the right to your own health information” and “answers at the speed of digital.” Test cost is as little as a tenth of what hospitals charge. Walgreens will put the company’s labs in many of its drugstores, but Theranos is also working with UCSF, Dignity Health, and Intermountain. Holmes says patients don’t have 40-60 percent of lab test orders drawn because of the pain or inconvenience involved.

”The Daily Show” invites a group of Google Glass fans to defend their worship of the technology, include one woman who claims that she was a victim of a hate crime because she wore Glass into a bar and filmed fellow patrons without their permission, eliciting their angry taunts as she cursed at them and announced while recording, “I want to get this white trash on tape for as long as I can.” The same woman’s neighbors had previously filed a restraining order against her for recording their private conversations. She and her fellow Glassholes probably should have stayed home: after hearing that Glass early adopters are called Explorers, the host responds, “Magellan was an explorer. Chuck Yeager was an explorer. You guys have a %&@! camera on your face.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 6/13/14

Top News

ONC announces that Chief Privacy Officer Joy Pritts, JD has resigned after four years on the job.

Reader Comments

From Anonymous Tipster: “Re: Wayne Tracy on VistA. I agree it would be a tragic shame to see VistA replaced. Unless Epic were to make some dramatic changes in its approach to interoperability, this could be a disaster for the VA. Anyone who has ever suffered through a migration to Epic could tell you how difficult this can be from a workflow perspective (not to mention cost overruns). You think there’s backlog now? Remember the iEHR project that died? It’s an election year and the money is rolling in big time from lobbyists  — maybe Epic will even begin to divert some of its campaign dollars to Republicans).” The DoD’s IT efforts have been financial disasters, with AHTLA and its predecessors rumored to have cost $10 billion. The VA has done very well with VistA, but its more recent efforts involving government contractors (BearingPoint’s CoreFLS at Bay Pines) were spectacular failures, so there’s no guarantee that VistA wasn’t a one-trick pony. It’s also true that DoD and VA don’t agree on anything despite their common responsibility in caring for active service members who eventually (hopefully) become veterans. Kaiser had to pull the plug on its IBM-developed system that cost hundreds of millions of dollars and replace it with $4 billion or so worth of Epic, so that’s an interesting IBM-Epic partnership (I can’t imagine Epic letting IBM tell its 25-year-olds how to implement.) Add replacing VistA to DoD’s $11 billion project and you’re probably talking about $30 billion worth of overruns, delays, and potential patient harm as the VA and DoD are forced to smoke their first-ever HIT peace pipe – that number has substance since the DoD walked away from iEHR because it was going to cost $28 billion and nothing involving the federal government ever comes in on budget, especially if the military is involved. Britain’s failed NPfIT has been called one of the most expensive government IT projects in history at around $17 billion, so we’ll beat that for sure. One final thought: Epic’s Judy Faulkner and InterSystems’ Terry Ragon are already healthcare billionaires as sole owners of their hugely successful private companies — an IBM-Epic DoD deal would certainly raise the numeric placeholder in front of their billions.

From Expandable Beltway: “Re: DoD bid. Cerner is teamed up with Accenture.” Unverified. I am getting anxious to hear what Dim-Sum has to say. Lorre would love to get him or her to present a webinar on the DHMSM topic, for which I would even arrange one of those voice-changing gadgets.

From Cool Runnings: “Re: Benefis EHR RFI. They use Meditech inpatient and replaced LSS with NextGen a few years ago. NextGen is taking a hit in Montana – a small hospital sued them, Bozeman Deaconess is rumored to be switching from Meditech/NextGen to Epic, and Community Medical Center in Missoula is merging with Billings Clinic, which very likely means a move from NextGen to Cerner Ambulatory.  I’ve heard that Benefis is talking to athena, but may be leaning toward looking for an integrated solution instead of just an ambulatory switch.” Unverified, but I should have checked Meditech’s online customer list, which would have told me that Benefis runs its soon-to-be-gone systems.  

HIStalk Announcements and Requests

It’s time to say goodbye to Inga, who has moved on to greener pastures after seven years of contributing to HIStalk and HIStalk Practice. She finished working on the sites in April and has finally tied up her last loose ends. Rumors that she is launching a healthcare shoe division of Christian Louboutin may or may not be unfounded, but we will wish her well in any case. Jennifer Dennard took over writing HIStalk Practice several weeks ago, while Lorre is happily handling the non-writing HIStalk chores.

This week on HIStalk Practice: ONC’s 10-year vision statement on interoperability prompts CommonWell to up its game. Several trade associations line up with telemedicine-related requests for new HHS head Sylvia Burwell. ARcare receives the HIMSS Analytics Stage 7 Ambulatory Award. Epocrates ranks number one again. HIT Policy Committee meeting numbers show $24 billion in MU incentive payments so far. Jim Morrow, MD gives healthcare IT its due as an independent physician. Wesley Medical Center docs face employment ultimatums. Northern Virginia launches the HeaLiXVA HIE. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the concept of patient ownership of health data, its benefit to public health in general, and the role that Apple and Samsung will play in advancing the concept. ZocDoc expands its business model to include corporate wellness services. Autism Speaks signs a deal with Google to create a database that will store 10,000 fully sequenced genomes in the cloud, where researchers across the globe can access the data.

Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

Acquisitions, Funding, Business, and Stock

Imprivata sets terms for its $75 million IPO that values the access management company at around $400 million.

KeyBanc downgrades shares of CPSI, saying that Healthland is strong in the small-hospital market and that Epic’s Community Connect program is making it a competitor there as well.

Elsevier acquires Amirsys, which offers clinical decision support and learning tools for radiology, pathology, and anatomy that will be integrated with the Elsevier Clinical Solutions suite.

Mediware acquires Harmony Information Systems, whose systems help state and local agencies track long-term care policies.

Sales

The State of Vermont signs a six-month $5.69 million contract with OptumInsight for evaluation, remediation, and operations support for its health insurance exchange.

In England, Oxford Health NHS Foundation Trust awards a five-year, multi-million pound contract to Advanced Health & Care to develop an EHR that up to 3,500 clinicians will use on iPads. Oxford Health provides services for mental health, home care, children and family, and substance abuse.

Irving, TX-based USMD chooses the population health management platform of Lightbeam Health Solutions for its ACO and other risk-based programs. I interviewed Lightbeam CEO Pat Cline three weeks ago.

People

IMDsoft names Lars-Oluf G. Nielsen (Epic) CEO.

Announcements and Implementations

Estes Park Medical Center (CO) goes live on Medhost EDIS.

UPMC (PA) will deploy 2,000 Microsoft Surface Pro 3 devices to deploy its Convergence app, which UPMC says it first tried to roll out on the iPad without success. Convergence, developed by UPMC and Caradigm, gives clinicians a single view of UPMC’s Cerner and homegrown applications and suggests and monitors compliance with clinical pathways.

Nevada, MO, Cerner’s testbed for healthy communities, gets a new playground courtesy of the company and the Nevada Parks and Recreation Department.

Government and Politics

CMS reassures taxpayers that the workers who were sleeping on the job at the call center of Serco (which has a $1.25 billion Healthcare.gov contract) are busier now that the site is actually working.

Jon Stewart makes fun of the June 9 testimony of Assistant Deputy VA Under Secretary Philip Matkovsky, in which Matkovsky says in in the deadest of deadpans, “Our scheduling system scheduled its first appointment in April of 1985. It has not changed in any appreciable manner since that date.”

It isn’t just the VA that has an appointment problems. England’s NHS backlog hits three million patients who are waiting for appointments, not even counting six trusts that couldn’t report data because of computer problems. Still, NHS squeaked by in meeting the requirement that it treat 90 percent of patients within 18 weeks. As with the VA, increasing demand could cause NHS to start missing its goals routinely.

OpenFDA was possible only because the agency used a startup’s technology to turn its document backlog into discrete data. Captricity uses a combination of optical character recognition and crowdsourcing the unreadable parts by giving human reviewers “shredded” sections so they don’t see entire Social Security numbers or full names, preserving confidentiality. Pricing runs around 15 cents per page.

Innovation and Research 

Device maker Medtronic says every person will eventually want sensors implanted in their bodies that will generate data for self assessment, remote monitoring, and disease management. The company is testing a pill-sized cardiac pacemaker and has already released the Linq insertable cardiac monitor that’s the size of a AAA battery and uses cell technology for remote cardiac monitoring.

Other

Via Christi (KS) asks for patience as it tries to recover from slowdowns caused by its Cerner Millennium go-live, with one patient reporting a 12.5-hour wait to get from the ED to a bed.

A McKesson-sponsored report predicts that value-based payments will double within five years, to two-thirds of the total.

AMA approves guidelines recommending that limitations on physician payments for providing telemedicine services be removed as long as a valid patient-physician relationship has been previously established, the physician is licensed in the patient’s state and follows that state’s laws, and standards are followed the same as for in-person encounters.

CHIME and AMDIS announce an alliance in which CHIME will provide health IT support to AMDIS and AMDIS will provide physician informatics advice to CHIME. The organizations recently jointly offered the CHIME/AMDIS CMIO Boot Camp, modeled after CHIME’s longstanding CIO Boot Camp.

Georgia Regents University will host the week-long NLM Georgia Biomedical Informatics Course September 14-20 at the Brasstown Valley resort in Young Harris, GA. Applications are due July 7. The nationally known faculty will teach change agents (biomedical educators, medical administrators, faculty, and others who don’t have knowledge of the field but who can spread the word) how to apply informatics solutions such as clinical informatics, big data, and telemedicine to their delivery, research, and education challenges. Enrollment is limited and competitive since the National Library of Medicine will pay for the registration, travel, housing, and meals of those accepted.

For $2,500, you can buy a report containing a SWAG at the size of the EHR market over the next four years in which the authors clearly don’t have a clue about data precision and presentation. Either that or they are very good at estimating the market to within 0.004 percent. I don’t see them trumpeting proof of previous accuracy.

A hospital in France blames a drug delivery robot’s computer bug for sending $15 million worth of drugs to the incinerator in the past five years.

An English hospital apologizes for the death of an 11-month-old baby whose acute appendicitis was not diagnosed because the samples for ordered tests were not delivered to the lab. A Trust spokesperson said that the pathology computer system has been upgraded to flag specimens ordered but not received.

Castlight Health co-founder Giovanni Colella, MD (formerly of RelayHealth), says big data rather than government intervention is needed to fix healthcare. He recommends: (a) companies should analyze the claims data from their health plan to see what they’re paying for; (b) gag clauses prohibiting the release of price contracts between insurance companies and providers should be abolished; (c) the government should allow the private sector to use Medicare claims data and physician quality data; and (d) price, utilization, and quality data should be made publicly available in the absence of a compelling reason not to.

More from Castlight Health: the company releases interactive maps showing national in-network pricing for lipid panel, PCP visit, head CT, lower back MRI (above, which ranged from $676 in Fresno, CA to $2,635 in Sacramento, CA, just 171 miles away by car.)

Sponsor Updates

• Healthland will offer its hospital customers Meaningful Use Manager of Iatric Systems to help with their Meaningful Use attestation.
• Grinnel Regional Medical Center (IA) reports a seven percent increase in cash collections, 79 percent of payments made via self-service, and 124 saved hours per month in a two-year review after its go-live with Patientco’s payment automation solution.
• Impact Advisors and the Scottsdale Institute publish a report from the CIO Summit on IT Cost Management and Value Realization.
• Sixteen medical innovations were showcased at Premier, Inc.’s Innovation Celebration in San Antonio, TX this week.
• Quest Diagnostics certifies MedicsDocAssistant EHR v. 7.0 from Advanced Data Systems as a Silver Quality Solution under its Health IT Quality Solutions Program.
• Janssen Diagnostics collaborates with Halfpenny Technologies to provide specialized reporting for HIV/AIDS healthcare.
• GetWellNetwork recognizes several providers for using its solutions to improve care at GetConnected 2014 in Chicago, IL.
• Hills Health Solutions signs a distribution agreement to make Lincor’s interactive patient engagement technology available in Australia and New Zealand.
• Craneware and Centura Health (CO/KS) will co-present best practices of charge capture during HFMA ANI 2014 in Las Vegas June 24.
• InstaMed shares how its Premium Payments solution has changed the consumer payment process.
• Medfusion publishes a white paper on creating patient value through portals.
• Gartner names Covisint a Leader in Identity and Access Management as a Service.
• PeriGen CNO Rebecca Cypher will discuss fetal heart rate interpretation at AWHONN 2014 in Orlando June 14.

EPtalk by Dr. Jayne

This has been a rough week in the healthcare IT trenches. Our medical group has been in acquisition mode again, resulting in the addition of several new specialties. Unfortunately, this time around our EHR vendor doesn’t have content for any of them.

Luckily we’ve been through this enough to have a process in place. Our implementation team sends out a staffer or two to observe the practice’s current state workflow and documentation style. This is essentially a reconnaissance mission. We try to blend in and to avoid having the practice ask us a lot of questions while we gather data.

The team then comes back and makes a presentation to the implementation manager, the application team manager, and me to talk about what their current process looks like and how much we’ll be able to handle with the EHR as-is, without any additional development. Depending on the specialty, it’s hit and miss.

For example, when we added vascular surgery, we were able to handle 95 percent of their needs because we have both general surgery and cardiovascular content. On the other hand, when we’ve added certain pediatric subspecialties, we’ve had to get creative with what we choose to offer them. Vendors haven’t quite figured out that children are not just little adults and it’s not as easy as just having them use adult content with the same specialty name.

For example, pediatric cardiology deals with care for children who have had a variety of surgical procedures that are largely unspoken of in the adult cardiology world. On the flip side, there isn’t very much coronary artery disease or many triple vessel bypass surgeries among the pre-adolescent set.

Often we’re working with physicians who are used to dictating their notes and having them transcribed. We’ve had good success at putting them in our EHR “core” templates for documenting histories, assessments, and plans, but we augment the “story” part of the visit with voice recognition. It’s a hybrid approach, but it prevents us from doing costly development that will only be used by a handful of physicians. It also provides for physician satisfaction in that they’re used to being able to include a detailed narrative in their visit documentation.

We encountered a rare bird this week, however: a subspecialist who seriously believes she’s going to be happy with point-and-click documentation. She wants us to build a whole herd of custom screens for her. She dictates on the hospital system at present and has no previous experience with discrete data.

In our experience with other physicians of the same subspecialty, it’s generally not worth building custom screens. They tend to change their minds before the content is even built. If they don’t change their minds, once they see it, they decide it’s too “clicky,” and 90 percent of the time they end up dictating anyway.

We had our follow-up meeting with her today. We ran through the options and asked her to try some typical click-by-click workflows in the general medicine templates just to get a feel for what it would be like. She wasn’t terribly proficient, so we had her try voice recognition within the system. She did fairly well with that. It was clear to the team that she’ll likely do better with that kind of hybrid approach. The subspecialist was unconvinced, however.

We moved to our next tactic,  which is to ask the physician to use our recommended workflow for a couple of months and then decide if we still need custom content. It was obvious that she was not buying what we were selling. She told us we were just being difficult and didn’t want to do what she asked. She then accused us of trying to skimp on her content for budgetary reasons.

We explained the history with other physicians in her specialty, even trying to show her the content we had previously built that her peers had abandoned. She didn’t want to see that either, but made it completely clear that she expected us to build custom content for her alone. I knew we weren’t going to win this discussion, so we agreed to go back to the office, brainstorm other solutions, then meet up in a few weeks.

In debriefing with the team in the car, we’re not sure what to do for her. We have more than a decade of experience doing this. We know what works and what doesn’t work. However, we have a physician with no EHR experience (and no track record as an end user – she won’t even use the hospital system) who is demanding a certain course of action. My team asked what we should do.

My thoughts went into doctor mode. It feels like the scenario where a patient is demanding an antibiotic where none is indicated, or insisting on a procedure that could potentially be more risky than it is worth. The patient in this case is arguing with the IT-equivalent of our professional medical opinion as to the course of care. In the medical world, we wouldn’t be bullied into doing something that is not of benefit. Not to mention that building clicky screens for a provider who has never been exposed to that documentation style is a recipe for unhappiness.

Our plan is to bring some of her soon-to-be colleagues in the same subspecialty with us to our next meeting and hope that their shared experiences will steer her in the right direction. We’d like her to make the choice herself without us having to flat out reject her request, but I’m not sure how we’ll handle it if she doesn’t start to get on board with our advice. Being new to the group, we know her level of trust of our team is low and her experience with EHR is minimal, so that seems like a logical approach.

I never like disappointing people. It’s always difficult to have those conversations with patients when you deny their requests. It’s doubly challenging when you’re dealing with a peer who might be more senior than yourself, and particularly difficult when they’re in a seemingly more prestigious subspecialty than your own.

In other parts of the physician universe, we’re also dealing with some significant Meaningful Use issues where physicians are requiring retraining and a lot of hand-holding. This was just one more thing to add to the mounting heap of stress.

I polled a couple of my CMIO peers on how they handle these situations. They didn’t have too many better answers. For all our readers on the implementation and content side, what’s your take? Is there a silver bullet solution? Email me.

Contacts

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

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News 6/11/14

Top News

 

Our intrepid beltway reporter Dim-Sum has been telling us for months that IBM and Epic are pitching for the DoD’s $11 billion EMR contract, which IBM now confirms in announcing its intentions. Heading the project will be IBM CMIO Keith Salzman, MD, MPH, who was an Army doc for 22 years. Dim-Sum’s reports have been minor masterpieces of puns, semi-obscure references, and teasing hints, but I just realized that even his or her phony name is yet another one: the bid falls under DHMSM (DoD Healthcare Management Systems Modernization). I suspect we will get a June report shortly, but in the meantime, you might want to refer to his or her updates from March 5, March 28, April 9, and May 2 now that their accuracy has been confirmed (he or she reported here that it would be IBM-Epic two months ago.)  

Reader Comments

From Big Sky: “Re: Benefis Health System in Montana. Has an RFI out for EMR replacement.” Unverified. I don’t know what they’re running for inpatient, but they finished a huge NextGen ambulatory rollout a couple of years ago.

From Speechless: “Re: HIMSS chapter speakers. We are putting together a panel discussion for the fall on healthcare IT innovation. If you could choose one or two East Coast speakers, who would they be? We’re thinking of a progressive hospital CIO, someone interesting from one of the incubators, and a provider-side innovation leader.” Let’s crowdsource it with HIStalk readers – leave a comment with your suggestion or if you’d like to volunteer to present (or you can email me.) I’ve been a HIMSS chapter program chair and it’s hard to get good non-vendor speakers.

From Demon Deacon: “Re: Wake Forest Baptist Medical Center. Successfully launched Epic Inpatient for the Lexington Medical Center, which was the last Wake Forest hospital to go live.” Congratulations to WFBMC for getting the job done despite some disastrous (and preventable) early missteps that cost the health system a lot of money and credibility. My fellow barbeque fans might consider a site visit given that Lexington, NC has the highest ratio of pits-to-people in the country and one joint (Lexington Barbeque, aka “Honey Monk’s”) fed world heads of state at a 1980s summit at the request of President Reagan.

From Power Seeker: “Re: power strips. Joint Commission says that CMS ‘is no longer allowing relocatable power taps, referred to as RPTs or power strips, to be used with medical equipment in patient care areas, including operating rooms, patient rooms and areas for recovery, exams, and diagnostic procedures. The restriction does not apply to non-patient care equipment such as computers and printers or to areas such as nurse stations, offices, and waiting rooms.’ If this is true, time to invest in companies that sell UPS solutions.” It’s true. Patient care rooms are going to need a lot of red wall jacks to plug in medical devices individually. Hospitals will also need to check their liability insurance since power cords will be running all over the place and tripping people. I see the point – even UL-approved power strips aren’t intended for critical medical devices where failure could be disastrous (if there’s no battery backup, anyway) — but alleviating that risk will be ugly in already-crowded patient rooms.

From Wayne Tracy: “Re: Monday’s post. I’m very cynical about the VA’s problems and agree that because of commercial vested interests, VistA is quite likely to become a fall guy. VistA in my opinion is the most comprehensive user-developed healthcare clinical application. My fear is that the lack of advocacy is because: 1) Sonny Montgomery is no longer in Congress, 2) No vender will make money on it, 3) No consulting company can charge an arm and a leg to implement it. The proposals to do away will the VA healthcare system are at best naive. Last time I looked at our mental health system, I’m compelled to assert that it is woefully inadequate. What system can deal the population of amputees and brain trauma cases plaguing some two million recent vets? Some have suggested that some 50 percent are or will experience PTSD and related psychological problems. What civilian healthcare organization is prepared to deal with that large a patient population, or more importantly, has the proven expertise? If you think the backlog is bad now, just wait. This administration and Congress has good intentions that will potentially result in a diminished quality of care at greater expense.” Wayne is an industry long-timer and a retired Navy officer. I agree with all of his points. VistA will take a fall because the VA’s volume and people problems are drawing beltway buzzards and arrogant DoD’ers who can’t wait to see VistA replaced with something way more expensive even though it has been a poster child for doing IT the right way for patients (although the VA has struggled with automating patient scheduling). Nobody wants to talk about his second conclusion – we civilians weren’t really paying attention to what was happening in Iraq and Afghanistan because the death toll didn’t seem all that high. Our military participants were coming home alive but physically and mentally mangled and now we have to figure out how to pay for their care whether it’s delivered by the VA or otherwise. I’ve argued in the past that the VA should be dissolved and care provided by the existing healthcare system, but I’m not confident that system can handle the volume any better or that we can manufacture enough additional red ink to cover the cost.

HIStalk Announcements and Requests

Listening: Circa Survive, thoughtful indie rockers from Doylestown, PA. I’ve been listening to them nonstop once I got over my disappointment that the singer isn’t a sensitive female but instead is a high-voiced guy. Those of us with a clinical persuasion will appreciate this song title: “The Difference Between Medicine and Poison is in the Dose.” They’re touring now with Ume, who I also like a lot. Also, new albums from First Aid Kit and Passenger.  

I was reviewing Steve Blumenthal’s slides from the June 24 webinar below – he’s going to be fun, I suspect, especially for a lawyer. I also sat in on the rehearsal for the radiology workflow one and it was interesting to hear about teleradiologist workflow with the high volumes of images they deal with – no wonder they sit in a quiet, dark room and look at on-screen pictures while talking into a microphone all day. Like programmers, I’m guessing they rarely see daylight.

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  A Health Catalyst Overview: An Introduction to Healthcare Datawarehousing and Analytics. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This short, non-salesy Health Catalyst overview is for people who want to know more about the company and what we do, with plenty of time for questions afterward. Eric and Mike will provide an easy-to-understand discussion regarding the key analytic principles of adaptive data architecture. They will explain the importance of creating a data-driven culture with the right key performance indicators and organizing permanent cross-functional teams who can measure, make and sustain long-term improvements.

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

Acquisitions, Funding, Business, and Stock

T-System sells its ED billing business to Intermedix, saying it will focus on its clinical and coding initiatives that will continue to be offered under the RevCycle+ brand.

Indianapolis-based startup Indigo Biosystems raises $8.5 million in venture capital and replaces its CEO with the company’s founder. Its clinical laboratory software interprets visual results from instruments such as mass spectrometers, flagging outlier data for human review.

Oncology drug maker Celgene invests $25 million in NantHealth to develop personalized medicine for cancer. There’s a connection: NantHealth founder Patrick Soon-Shiong sold his own chemo drug company, Abraxis BioScience, to Celgene for $3 billion in 2010.

Sales

The federal government awards ScImage a two-year, $45 million contract for its Picom365 Enterprise system, including PACS, diagnostic viewers, VNA, and workflow tools.

United Arab Emirates-based physician helpline vendor Mobile Doctors will implement mobility solutions from Cerner.

Freestanding Cypress Creek ER (TX) chooses Wellsoft’s EDIS.

Mission Health (NC) will advance its population health management with Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

Children’s Health Alliance (OR) chooses Wellcentive’s population health management solutions.

Catholic Health (NY) selects Perceptive Software’s enterprise content management system to integrate with its Infor financial and HR systems.

People

Sunquest officially announces that Matthew Hawkins (Greenway Health) has joined the company as president.

Capsule Tech promotes Kevin Phillips to VP of marketing and product management.

Former athenahealth CFO Carl Byers (Fidelity Biosciences) joins the board of Netsmart Technologies.

Announcements and Implementations

ZeOmega announces the 5.6 release of its Jiva population health management system.

Healthcare Engagement Solutions signs an agreement with Cleveland Clinic Innovations to further develop its Uniphy mobile technology platform.

Rockcastle Regional Hospital (KY) goes live on Medhost, sending data to the Kentucky HIE through YourCareLink.

IntraCare North Hospital (TX) goes live on Medsphere’s OpenVista.

Belmont University and the Tennessee chapter of HIMSS launch a healthcare IT certification program for individuals.

The mHealth Summit announces that it will host the Global mHealth Forum for low- and middle-income countries, to be co-located at its December 7-11 conference in National Harbor, MD.

Castlight Health announces GA of Castlight Enterprise Healthcare Cloud, which provides four solutions for self-insured employers: cost-optimization analytics, benefits design, a catalog of available third-party services, and a mobile benefits app for employees. Shares were up 3 percent Tuesday, but still down 58 percent from the closing price on IPO day less than three months ago. The company’s valuation is $1.5 billion on $20 million in annual revenue and $75 million in annualized losses.

Government and Politics

A  VA self-audit of 731 facilities finds that 13 percent of schedulers were told to enter desired appointment dates different from what the patient requested, eight percent of facilities kept external scheduling lists invisible to the VA’s EWL/VistA systems, and unrealistic targets encouraged facilities to game the system. New patients waited up to three months to see a doctor. The VA announced immediate changes: eliminating the 14-day appointment target as unreasonable, implementing real-time patient surveys, conducting an external audit, freezing new hires and eliminating bonuses at VA headquarters and regional offices, and creating an HR team to get clinicians hired faster.

CMS may be congratulating itself publicly for releasing Medicare payment data (which it did only after losing a lawsuit in trying to prevent it), but the more the statistical jockeys play around with the databases, the more obvious it becomes that CMS is asleep at the taxpayer wheel. A Wall Street Journal analysis finds that 2,300 providers were paid $500,000 or more from performing single procedures or services, some of them operating well outside their area of expertise. A non-cardiologist was paid nearly all of the $2.3 million he billed Medicare for in 2012 for performing a rare and questionable cardiac procedure (“exercise while lying on your back,” advertised on his site above) on all of his Medicare patients, with his entire training in the procedure consisting of “reading lots of articles, studies, and clinical trials.”An orthopedic surgeon billed Medicare for $3.7 million in one year even though he didn’t perform a single surgery – he charged for 108,000 massages and manual manipulations. It was billed by his former employer, Abyssinia Love Knot Physical Therapy, a PT chain run by self-proclaimed “Pastor Shirley.”

HHS tweeted this picture, which it captioned, “Welcome Secretary Sylvia Mathews Burwell!” I haven’t seen anything official that she has been sworn in.  

The Indian Health Service contributes its VistA-based RPMS scheduling system to the OSEHRA open source community.

The Alliance for Connected Care writes to Sylvia Burwell even before she takes office as HHS secretary, urging her to use her authority to open up telemedicine reimbursement for all ACO providers, not just those located in specific rural areas as is the case today. The trade association, run by former government officials Tom Daschle, Trent Lott, and John Breaux, actually sent two letters, one signed by its business members (Walgreens, WellPoint, and Teladoc, for example) and the other signed by a couple of dozen big health systems. The American Telemedicine Association sent Burwell a letter of its own listing sweeping improvements that would be enabled by paying everybody for delivering telehealth services, with that letter signed by mostly by big vendors (and HIMSS.) One might infer that while patient care could improve under such an arrangement, vendor and provider revenue would most certainly do so. Sylvia hasn’t even found the restroom yet and already the special interests are pawing at her.

Statistics presented at Tuesday’s HIT Policy Committee meeting indicate that of EPs who first attested for Meaningful Use in 2011, 84 percent attested in 2012 and 75 percent in all three years of 2011, 2012, and 2013. Nearly half of those who attested the first year and then skipped 2012 returned in 2013. EHR incentive payments totaled $24 billion through the end of May.

AHRQ, presenting at the HIT Policy Committee meeting Tuesday, says that lack of EHR interoperability is a big problem, recommending that ONC define an “overarching software architecture” within 12 months and require EHR vendors to develop and publish APIs to support it. I’m pretty sure that’s not going to happen.

Other

St. Francis Hospital (GA) admits that one of its employees sent a mass email to 1,175 patients using CC: instead of BCC:, exposing the email addresses to all recipients. Apparently even that triggers the breach notification rule, at least according to the hospital’s interpretation.

BetaBoston profiles Seratis, a secure messaging app for care teams. The company is offering free personal use and hopes to get a Boston pilot. Their site is light on details, so it’s hard to determine whether its product is differentiated from similar apps from bigger players.

Victor Dzau, MD, stepping down as CEO of Duke University Health System (NC) on June 30 to become president of the Institute of Medicine, looks back on his tenure with comments about Duke’s $700 million Epic system:

I think we all recognize that to provide the best care for patients, you need an integrated information technology system … you can capture all the information of the patient made available to the providers and the patient, and make it available throughout the entire system … Through Epic, we are able to connect with other systems that have Epic, such as Novant and many others; now UNC just implemented it … It really is an entire information system that allows you to look at charge capture, laboratory testing, finances, work flow, decision-making … it’s a phenomenal system that can help us really improve patient care … about a year ago, I launched an institute called Health Innovation to try to make the whole place think about better ways to think about patients to try to bring together this whole large amount information that we have now through electronic health records and the use the analytic capabilities to look at data, big data, to determine how we can be a learning health care system, and try to use the new technology of digital technology sensors and others to manage patients better in the community in their homes and so they don’t have to use our facilities as much … we have Durham Health Innovation which is an initiative that we will work with the Department of Health and others bringing in geographic information systems, mapping the patient, the community, where do they live, what are the economic factors, what’s the closest clinic where’s the closest grocery store, the closest barber shop to work together to improve their health.

This seems like the worst app idea ever. A Singapore company creates Hospital PIX, the usual lame hospital finder app that also allows users to “post reviews about OBAMACARE.” That’s not even the “worst” part: it also encourages doctors, nurses, and patients to post their hospital photos (we have this thing called HIPAA over here). The fake photos from “Benson Hospital” feature an entirely Asian medical staff and the hospital distances shown are all from Indonesia, so perhaps the app’s localization isn’t quite complete.

In Alberta, Canada, the government-backed Telus Wolf system goes down on Monday, leaving practices without access to lab results, medical histories, and medications. According to one doctor, “There is no longer any government support. We pay $2,000 a month for this. Who is going to hold Telus accountable now? The government has abandoned us. Cost and issues switching patient data when systems are not compatible prevents us from going somewhere else.” Telus acquired Wolf Medical Systems in February 2012.

The Apple Toolbox site files a Freedom of Information Act request to find out what was discussed in several meetings between Apple and the FDA last year. The highlights:

• Apple thinks the FDA’s guidance on mobile medical apps is appropriate.
• The company believes it has a “moral obligation” to do more given the increasing number of available mobile sensors.
• FDA will regulate apps based on their intended use, not necessarily because they use a particular sensor. For example, FDA wouldn’t regulate an consumer-oriented information nutrition app that uses a glucometer, but would consider the same app a medical device if it is targeted to diabetics.
• Apple and FDA will work more closely together to ensure that Apple’s plans don’t run afoul of FDA’s requirements (it’s good to be Apple).

Weird News Andy questions whether this was really the “responsible” anesthesiologist. Washington’s health department suspends the license of a Seattle anesthesiologist for sexting during surgeries, accessing patient images for sexual gratification, and having sex at the hospital. Investigators found 250 sexually related messages he had sent while in surgery, including pictures he sent to patients of his exposed genitalia, one of which he captioned, “My partner walked in as I was pulling up my scrubs. I’m pretty sure he caught me.” 

Sponsor Updates

• Greenway customer ARcare (AR) earns recognition as Stage 7 of the HIMSS Ambulatory EMR Adoption Model.
• Impact Advisors is named to Crain’s Chicago “Fast 50 List” of high-growth companies.
• A pMD blog post addresses “Medical scribes: the solution to EHR inefficiencies, or just a temporary bandage?”
• First Coast Cardiovascular Institute (FL) reduces charge lag after going live on MedAptus charge capture.
• Kareo and ChartLogic partner to deliver cloud solutions for surgical, orthopedic, and otolaryngology specialties.
• Gartner names AirWatch as a Leader in the 2014 Magic Quadrant for Enterprise Mobility Management.
• Verisk Health SVP Matt Siegel will moderate a panel discussion on value-based healthcare at AHIP Institute June 12 in Seattle, WA.
• Truven Health Analytics launches its cost-sharing reduction analysis and reconciliation solution for health insurance exchanges.
• Merge Healthcare is hosting a Coding Contest for Computer Science students June 11 at the University of Waterloo in Canada.
• ADP AdvancedMD supports the Greater Springfield Habitat for Humanity during a corporate team-building day.
• NaviNet collaborates with Informatica to deliver a “smart” network.
• E-MDs will offer Lightbeam’s population health management solution to its clients.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Monday Morning Update 6/9/14

Top News

The Senate confirms Sylvia Burwell as secretary of HHS in a remarkably non-contentious process. Reports suggest that she will be sworn in and take office Monday.

Reader Comments

From Hallway: “Re: mapping applications. I saw your mention of Esri just after participating in a Google+ Hangout on Google Maps. One of the presenters was the CEO of Jibestream, which gives a hospital example.” Geographic tools will get a lot play because of consumerism and population health as health systems seek to understand their patients and target market better, move their health-related work into community social services, and  plan their locations and resource deployment. Tying databases to physical locations will become even more important with hospitals taking on risk-sharing arrangements and expanding to cover wider geographic areas. My advice to population health technology vendors and data geeks – get some exposure to geographic information systems now. The screen shot above is from another GIS mapping software vendor, Caliper’s Maptitude, which can be purchased online for $695 (I’m not recommending it since I don’t know anything about it – I just Googled and there it was.)

From The PACS Designer: “Re: Apple introduces new programming language Swift. It’s a variation of C intended to make it easier to create software solutions. Healthcare could use Swift to provide better access to siloed data and to sync consumer apps from iTunes.” It’s likely to be better and more programmer-friendly than its predecessor (Objective-C) but only if you don’t mind ignoring the majority of the world’s smartphone users who don’t use Apple devices. The non-fanboy market will decide if it really needs yet another programming language, especially a proprietary one. I would expect that for apps that don’t require a lot of hardware-intensive resources (anything but games, probably) HTML5 would work just fine and it runs on everything.

From Korn: “Re: Apple’s Health and Epic. Will it be as important as the hype suggests?” I doubt it. Apple probably hasn’t dug deep enough into healthcare to realize all of the potential issues as they (as one closed system) try to make something with universal consumer access to data from Epic (another closed system) and not run afoul of HIPAA issues. It’s great that a company the size of Apple is at least thinking about healthcare, but I think they are a lot more interested in consumer health monitoring since that might sell more Apple hardware in a way that I doubt hospital information would do. Surely Apple remembers Google and Microsoft stumbling in trying to turn personal health records into a business that consumers didn’t want. Think about it from your perspective: would anything from Epic be amazing just because you could do something new with it on an iPhone? I think the relationship is more in the other direction – Epic can take in information from Health, but that doesn’t really seem to benefit Apple very much. 

Meanwhile, the Australian free practice management systems vendor HealthKit was less than delighted to hear about the surprise use of its name by Apple, with one of its executives saying, “I’d like to think that [Apple] forgot to spend five seconds and type www.healthkit.com into their browser. But other people have said that possibly they did, and thought that we were just a startup and they could really just squash us.” In Apple’s defense, its product is called simply Health and only the development framework is called HealthKit. I’m sure Apple’s IP team did due diligence and saw no potential for confusion. I don’t think any names exist that someone hasn’t already locked down, which is why companies just make up words.

From Job Seeker: “Re: senior executive jobs in healthcare IT. Any idea what percentage are filled via retained search firm?” I don’t know, although I assume it’s different for provider CIO positions vs. vendor executive hires. Reader insight is welcome as long as it doesn’t contain a plug for a search firm.

From Arthur’s Sword: “Re: ONC’s new leadership. I wonder how many of the newly named folks have walked the walk and worked for a vendor or practice using an EMR? They are making important decisions for everyday physicians.” I found these backgrounds, but I will first say that I might question your premise of whether the folks in these positions really need current EHR exposure to do their jobs. Being an effective leader is more about listening than applying personal experience that might be dated or unrepresentative. It’s also not reasonable given the demands of these jobs to expect ONC’s people to deliver patient care or work with technology directly – they already work a lot of hours (for relatively low pay) and they solicit field input via committees, work groups, and the public comment process . My guess is that the “voice of the user” is represented behind closed doors when necessary by Reider and Murphy, who have the credibility to represent both the ambulatory and hospital providers, respectively. I would also question whether ONC will retain the influence you mention now that its money trough has mostly been lapped dry and providers rightfully start thinking about whether the dangling taxpayer cash is worth the hoop-jumping.

Kelly Cronin, healthcare reform coordinator.  Healthcare consulting, mostly government-related.

Jodi Daniel, policy. Lawyer and government.

Karen DeSalvo, national coordinator. Physician. Education, government. Her bio isn’t clear on when she last practiced medicine.

Doug Fridsma, chief science officer. Physician with clinical experience.

Lisa Lewis, deputy national coordinator for operations. Running federal grants programs.

Kim Lynch, programs. Government and REC.

Judy Murphy, deputy national coordinator for programs and policy. Nurse with extensive and recent hospital EHR leadership experience.

Seth Pazinski, planning, evaluation, and analysis. Government.

Joy Pritts, chief privacy officer. Lawyer and professor.

Jacob Reider, deputy national coordinator. Physician. Vendor and provider EHR experience.

Nora Super, public affairs. Government relations.

Steve Posnack, standards and technology. Government.

Speaking of ONC and HITECH, here’s what I said about it back in April 2009 (HITECH was approved in February 2009):

Healthcare is getting a lot of government money. Surely the feds wouldn’t start telling us how to run our shop, right? I wouldn’t count on it. We might be selling our souls here … Everybody’s clinking their glasses and high-fiving over the gravy train headed healthcare IT’s way. Fear the person from the government who’s here to help: there may be a hidden price. It’s clear that CCHIT (or something like it) will enjoy unprecedented power to set mandatory product requirements. “Effective use” will do the same for providers, spelling out exactly how they must use their technology. As Uncle Sam becomes an even more dominant buyer of healthcare services, the ratchet may be turned on reducing costs and following somebody’s medical cookbook … is the real agenda to use government clout to finally whip private industry around a little, making businesses behave in some unspecified way that runs contrary to the free market?

HIStalk Announcements and Requests

Poll respondents were mixed on whether Meditech’s competitive position is changing. New poll to your right: which events will you attend in the next year?

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

Lorre reports that she visited athenahealth’s Watertown headquarters in Boston last week, enjoying a social event, a campus tour, and a briefing from Jonathan Bush, who then autographed a copy of his new book for her. 

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  A Health Catalyst Overview: An Introduction to Healthcare Datawarehousing and Analytics. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This short, non-salesy Health Catalyst overview is for people who want to know more about the company and what we do, with plenty of time for questions afterward. Eric and Mike will provide an easy-to-understand discussion regarding the key analytic principles of adaptive data architecture. They will explain the importance of creating a data-driven culture with the right key performance indicators and organizing permanent cross-functional teams who can measure, make and sustain long-term improvements.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

Acquisitions, Funding, Business, and Stock

Allscripts opens its European headquarters in Manchester, England, expecting to hire up to 100 people in the next three years.

People

Mary Carroll Ford (MBC XPERT LLC) joins WeiserMazars as a principal in the company’s healthcare group.

3M Health Information Systems promotes JaeLynn Williams to president.

Andis Robeznieks at Modern Healthcare points out that the incoming president of the American Medical Association as of June 2014 is a healthcare IT guy (Robert Wah of CSC, who has been an associate CIO and ONC’s deputy national coordinator) and so is the next president who will take office in June 2015, Steven Stack (long-standing chair of AMA’s health IT group).

Announcements and Implementations

E-MDs is named as Austin’s top biomedical R&D employer by the local business newspaper, with 200 local employees.

The local paper covers the use of InteHealth’s patient portal at Raritan Bay Medical Center (NJ).

Government and Politics

More signs that the VA’s VistA baby will be thrown out with the agency’s dirty bath water:  the President says publicly that the VA needs a new information system. Evidence is ample that that the real problem was that VistA’s scheduling system was accurate and transparent, and due to the VA’s resource and management challenges, that created a reason for users to avoid using it. In other words, the system gets thrown out because it was doing exactly what it was supposed to do. The political heat will require taking decisive action quickly, which probably means the VA will be pushed in the same direction DoD is heading, which nearly ensures that Epic (under a fat cat contractor) will get the deal.

The good news for insurance companies is that HHS now allows them to run their connections to Healthcare.gov on Amazon Web Services, the cloud-based hosting solution used in all industries. The bad news is that most of those companies had already purchased their own servers since HHS rejected their request to use cloud-based hosting just six months ago.

Cleveland Clinic President and CEO Toby Cosgrove withdraws as a candidate for VA secretary. It probably wasn’t that hard of a decision given a massive pay cut (from a couple of million per year from the Clinic plus his highly profitable cozy vendor ties), never-ending political headaches, and moving from a highly regarded organization to one whose luster has been tarnished somewhat unfairly. Who would you choose? I might go with Paul Levy, who underwent his own form of tarnish, although I don’t know if he has any military experience and that would be nearly mandatory. @Farzad_MD has a good suggestion: HCA Chief Medical Officer Jonathan Perlin, MD, PhD, who was previously the VA’s Under Secretary for Health and then CEO of the Veterans Health Administration. A mid-sized health system CEO can make $1 million or more, so it’s tough to find someone who is highly credentialed, willing to take on massive federal bureaucracy, and move to Washington DC on a salary of maybe $200K.

Innovation and Research

Todd Park just announced OpenFDA at Health Datapalooza, but Social Health Insights already has created a query tool built over FDA’s adverse event reports database.

Other

A hospital in Israel implants a “connected” pacemaker that transmits cardiac condition information over the cellular network as low-bandwidth text messages.

New Google+ Hangout interview videos from John Lynn include John Squire (Amazing Charts), Mac McMillan (CynergisTek), Vishal Gandhi (ClinicSpectrum), Alan Portela (AirStrip), and Daniel Cane and Michael Sherling (Modernizing Medicine).

A patient sues University of Cincinnati Medical Center (OH) when her syphilis diagnosis and her medical bill is posted to a member-only Facebook group called “Team No Hoes.” The woman refused to tell her former boyfriend why she was being treated at the hospital, so he asked another girlfriend who worked in the hospital’s billing department, who looked it up in the EMR. The patient’s name and diagnosis was then posted to a Facebook page devoted to identifying supposedly promiscuous women. The hospital is named in the lawsuit along with the billing employee it fired over the incident.

Moody’s downgrades the bonds of Lifespan (RI) to near-speculative (junk) status, listing as its challenges shrinking margins, high area unemployment leading to bad debt, an underfunded pension plan, heavy employee unionization, and high IT costs. Moody’s says it will upgrade its ratings when Lifespan completes its Epic implementation and shows improved metrics. The system announced its choice of Epic in March 2013, saying the project would cost $90 million.

Here’s a brilliantly fun video from medical school students at University of Chicago. A bit of sleuthing finds that the talented medical student star is Beanie Meadow, who has appeared in several similar videos. 

Weird News Andy calls this “unencrypted notepad.” The information of 400 Connecticut health insurance exchange enrollees is exposed when someone finds a backpack containing their manual paperwork on a Hartford street. Access Health CT thinks the backpack was lost by an employee of its contractor Maximus, which provides call center services. Officials suggest that the contractor’s employee may have been stealing information.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.
Contact us online.

News 6/6/14

Top News

It’s been a busy week for ONC. After news of a reorganization, cheerleading for open data at Health Datapalooza, and receiving a letter from GOP leaders questioning its authority, the office publishes a 10-year vision statement on the future of interoperability. At 13 pages, it is “an invitation to health IT stakeholders … to join ONC in figuring out how we can collectively achieve interoperability across the health IT ecosystem.” Highlights include:

• Nine guiding principles that stress customization, educating and empowering the public, simplicity and modularity, and leveraging the market.
• Proposed development of an interoperability roadmap .
• Three-, six- and 10-year goals that widen the healthcare ecosystem with each successive year to incorporate stakeholders from outside of the traditional healthcare IT industry, as well as placing more responsibility on the individual patient to provide digital data to caregivers.
• Five building blocks upon which ONC will implement the aforementioned goals, focusing on core technical standards and functions, certification, privacy and security, HIE governance, and a supportive environment comprising all manner of stakeholders.

Several parts of the paper provide food for thought. How will the Meaningful Use deadlines line up with these goals? How will an organization like Epic react to ONC’s desire to “promote competition among network service providers in a way that avoids providers or individuals being ‘locked in’ to one mechanism to exchange health information?” The term “levers” is used throughout, prompting the question of whether ONC will continue to use carrots or sticks to promote interoperability.

It does mention that “ONC will help define the role of health IT in new payment models that will remove the current disincentives to information exchange,” so perhaps carrots will be the method of choice. All in all, the paper makes plain that ONC will be around for some time to come, both as a certification body and driver of regulatory health IT change.

Reader Comments

From Valleyproud: “Re: Valley Health in Winchester, VA. Implements Epic in all six hospitals and all of its physician offices and clinics. The Epic project went live in 11 months, big bang style. This is a huge achievement and one of the first projects of its kind, incorporating a partnership with INOVA Healthcare to share a patient database and single instance of Epic with no ownership ties between the two systems.”

From Still Holding On: “Re: Allscripts. Surprised not to see anything about the Allscripts layoffs last week. Hit the Burlington office fairly hard. Rumors in my area are saying 50+ folks got their walking papers.” Unverified. This is the first I’ve heard.

From Kit Kaboodle: “Re: dictation. Does anyone have a recommendation for a basic, phone-based dictation system? A group of a dozen docs that have accents that do not work well with Nuance’s Dragon is looking. It’s almost like they want a simple, old type Dictaphone machine except it records via the telephone handset, then just ability to listen to it. No other bells and whistles — they made a point of that.”

HIStalk Announcements and Requests

This week on HIStalk Practice: Eric Shinseki resigns from the VA amidst calls for out-of-network care for veterans. ONC shuffles its leadership team, while GOP leaders take it to task. VITL Medical Director Kate McIntosh, MD discusses the role of patient feedback in HIE development. A new report highlights the ICD-10 coding and reimbursement challenges faced by pediatric practices. CMS refuses to look more thoroughly at the claims of Medicare upcoders despite spending $6.7 billion too much on reimbursements. Arkansas taps North Carolina for guidance in setting up patient-centered medical homes. Physician leadership is found to be key to ACO success. Thanks for reading.

This week on HIStalk Connect:  Following Apple’s big entrance into health apps, Dr. Travis generates some heated debate with his post questioning Apple’s place as guardian of our health data. Kickstarter opens its crowdsourcing platform to just about everyone except health IT startups. At Health Datapalooza, StartUp Health introduces the newest class of startups accepted to its incubator program.

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  Building a Data Warehouse and Analytics Strategy from the Ground Up. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This easy-to-understand discussion covers the key analytic principles of an adaptive data architecture including data aggregation, normalization, security, and governance. The presenters will discuss implementation tactics (team creation, roles, and reporting), creating a data-driven culture, and organizing permanent cross-functional teams that can create and measure long-term improvements.

Acquisitions, Funding, Business, and Stock

Cerner leverages Red Hat Enterprise Linux to enhance the stability and performance of its CernerWorks application hosting services. Nearly 14,000 healthcare facilities host Cerner Millenium solutions remotely via the CernerWorks service.

GE Healthcare unveils its Clinical Engineering Technology Management service to assist IT and clinical engineering with design, deployment, maintenance and management of mission-critical networks, wireless networks, distributed antenna systems, and devices that connect and provide critical patient data to healthcare providers and hospital IT systems. The company also announces that it is partnering with Real Time Medical to combine its Omnyx Integrated Digital Pathology solution with RTM’s DiaShare workflow management platform.

People

The HIMSS Privacy and Security Committee names Jeff Bell (CareTech Solutions) chairperson.

CompuGroup Medical USA promotes Christopher Lohl to the position of vice president for research and development for its webPRACTICE and webEHR products and hires Michael Marini (Thomson Reuters) as RVP of sales for the ambulatory information systems division.

Announcements and Implementations

A California grand jury report finds hospital leadership at fault in Ventura County Health Care Agency’s troubled Cerner rollout, claiming the organization failed to hire a project manager and create an implementation project plan. The jury’s findings are interesting given the recent C-suite fallout at Athens Regional Medical Center (GA) after its own troubled Cerner implementation. What seems to come through loud and clear in both cases is that technology implementations are only as successful as the leadership teams behind them.

Kettering Health Network (OH) connects to the HealthBridge HIE summary record exchange service. The new service will enable KHN to share more complete patient information including tests, procedures, medications, and diagnoses. Earlier this year, KHN became the first health system in the state to meet Stage 2 Meaningful Use requirements for reporting of laboratory results when it sent results for eight facilities to the Ohio Department of Health via the HealthBridge network.

Government and Politics

CMS releases its annual electronic clinical quality measures for eligible professionals, as well as corresponding specifications for electronic reporting. ECQM specifications are used for such programs as the Physician Quality Reporting System, to reduce the burden on providers to report quality measures, and to align with EHR incentive programs. While CMS encourages implementation and use of the updated eCQMs and specifications, it will accept all versions for the EHR incentive programs.

While the fact that VA hospitals use MS-DOS is nothing new, revelation that it takes more than a dozen steps and multiple users to schedule an appointment takes on heightened relevance in light of the ongoing VA wait times scandal. In other VA bad news, a local paper sheds light on delays and rising costs associated with 41 construction projects for new VA outpatient facilities. Like its wait times, these construction delays are no surprise: the Government Accountability Office revealed earlier this year that only two of the 41 projects were on time, with average delays running to 3.3 years and costs increasing from $153.4 million to $172.2 million.

Research and Innovation

A new report finds that CVS has the “dominating lead” when it comes to number of retail clinics, with more than double that of closest rival Walgreens. The report also finds that the CVS “MinuteClinic has earned a certain status among the healthcare establishment, forcing that establishment to recognize the retail clinic movement as a legitimate part of the healthcare ecosystem.”

Google Glass continues to make inroads as a support tool in surgical settings. This article highlights the pros and cons several surgeons have experienced as a result of consistent Glass use during operations. Pierre Theodore, MD cites poor internal battery life and difficulty giving voice commands in noisy environments as drawbacks, though they haven’t precluded him from using Glass for more than 30 patients. He  is the first surgeon to receive clearance from a local institutional review board to use Glass as an “auxiliary surgical tool” in the OR.

The HHS Idea Lab, ONC, and Total Communicator Solutions Inc. partner for a research project in workplace wellness as part of the SmartAmerica Challenge. Project Boundary is a mobile app that delivers personalized messages to help employees make healthier choices during the work day. Using Apple’s iBeacon technology, the app will send messages that offer health suggestions to workers near such places as stairways, elevators, vending machines, and water fountains. Employees will be incentivized with points to follow the automated suggestions. The idea to promote healthy choices at work is a good one, but the recent mania around consumer privacy and security will necessitate strong incentives to back up any “points” users may try to accrue.

NHS Scotland announces that it will roll out telemedicine equipment, incorporating iPhones and iPads to 300,000 households over the next two years as part of an initiative aimed at elderly patients with chronic conditions. The scope of the project and the results achieved thus far seem unprecedented no matter what side of the pond you’re on. NHS hopes to replicate the 70 percent reduction in hospital admissions seen during trial testing.

Other

Cerner’s plans for expansion at its Three Trails Campus take a back seat to the challenges of enforcing its dress code during the summer. Julie Wilson, the company’s chief people officer, tells the local paper that, “It’s a challenge for all of us. And it’s becoming more challenging as the workplace has become more casual.” Wilson has her work cut out for her. Cerner, one of the fastest-hiring companies in Kansas City, plans to add 6,000 employees over the next 10 years.

Vanguard Communications releases the Happy Patient Index, a ranking of 100 U.S. cities according to patient ratings of physicians, group medical practices, clinics, and hospitals found on Google+ and Yelp. The top three happiest cities are San Francisco/Oakland, Honolulu, and Madison, while the unhappiest are Laredo, Toledo, and Bakersfield. It would be interesting to compare the utilization of healthcare IT in the happiest cities with that of the unhappiest to see if any correlation exists.

The local paper covers the planned Cerner go-live at Chase County Community Hospital and Clinic (NE).

Sponsor Updates

• Voicebrook releases VoiceOver SRE for pathologists, powered by Nuance’s Dragon Medical 360 technology.
• BMH Physician Group launches MyHealthPortal powered by Medfusion.
• Hudson Valley Bone & Joint Surgeons (NY) will implement the SRS EHR for its nine providers.
• Victoria Romejko of Seamless Medical Systems discusses the ICD-10 drama and engaging patient in health on the company blog.
• SpeechCheck will participate in the AHRA’s 42nd Annual Meeting and Expo August 10-13 in Washington, DC.
• Validic adds Omron, Misfit Wearables, and Polar to its collaborators.
• Zephyr-Tec signs a reseller agreement with nVoq to offer speech recognition to its current and future EMR clients for dictation and navigation.
• Optum executives will participate in a workshop with HealthEdge at AHIP’s Institute 2014 June 11-12.
• Good Samaritan Hospital (IN) launches myGoodSamHealth its online patient portal, powered by RelayHealth.
• Clinical Architecture enhances Symedical, including 400+ terminologies and HL7 value sets to assist clients in meeting MU.
• PatientPay CEO Tom Furr shares the vision and goals behind the company in an online blog.
• Ingenious Med supports The Georgia Institute of Technology with a summer internship program.
• GetWellNetwork introduces its patient and family engagement technology incubator GetWell Labs.
• Halfpenny Technologies executives will participate in the AHIP Institute 2014 in Seattle, WA June 11-12.
• Elliot Health System (NH) will implement Besler Consulting’s Transfer DRG Revenue Recovery Service to identify and manage underpayments.
• NextGen’s Sharon Tompkins discusses HQM and P4P reporting and why it matters.
• Aperek CFO Phil Sandy is named 2014 CFO of the Year by Triangle Business Journal.
• Allscripts is hosting a population health management analyst summit at the CCM in Pittsburgh, PA with presentation replays on their website.
• Vigilance Health (CA) partners with Sandlot Solutions to provide HIE services including Sandlot Connect, Sandlot Dimensions, Sandlot Metrix, and Sandlot Care Assist.

EPtalk by Dr. Jayne

I was intrigued by this Smithsonian article that cites the pocket watch as the “world’s first wearable tech game changer.” It was interesting to learn how a simple thing like a watch impacted society. It goes on to discuss wristwatches and solutions like Pebble and Google Glass. I wonder what they’ll think about our technology in 100 years?

I’m still waiting to get my hands on technology from Ringly, which promises jewelry that will deliver phone notifications. I’m looking forward to a time where people can get their devices off the table and back in their pockets and purses where they belong. Despite rules about devices in meetings, I’ve seen a spike in people trying to multitask, which results in them completely missing the conversation in front of them.

Continuing the wearables theme this week, Intel releases information on its “smart shirt” that tracks heart rate without a separate chest strap. Data will go via Bluetooth or WiFi to a phone or computer. It looks quite a bit like a cycling jersey, so I don’t know if the fashion conscious will bite. Maybe we can get Ed Marx to field test it on one of his future adventures.

In other consumer news, the Journal of the American Osteopathic Association publishes a piece reviewing Wikipedia contents for the 10 most costly medical conditions, including heart disease, cancer, hypertension, and diabetes. Although the authors discourage professionals from using Wikipedia as a medical reference, I’ve found it useful as a means to see what my patients are reading and to find quick links to citations for traditional publications.

CMS releases its annual update of Clinical Quality Measures for 2014. I always enjoy their press releases: “To help eligible professionals navigate the updated eCQMs, several resources are available… particularly the Measure Logic Guidance Document, which contains the technical release notes, additional guidance, and additional resources for implementers.” Do they actually expect eligible professionals to read this stuff? The Measure Logic Guidance Document is 259 pages long and I can’t imagine any frontline provider reading it.

The call for proposals for HIMSS15 is open through June 16. That’s nearly 10 months before the actual conference, decreasing your chances of seeing presentations that are fresh and timely.

HHS announces the winners of the Code-a-Palooza challenge. The winning entry, Smart Health Hero, is “designed to help patients and their families use Medicare claims data to make health care choices.” I had mentioned before that I’m not sure how claims data can help patients make decisions (especially given the concerns regarding the integrity of the data itself) and am looking forward to seeing it. If you have the scoop (or information on any of the other winning entries) email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 6/4/14

Top News

Apple announces (but does not demonstrate) HealthKit at its developers’ conference, which will combine and present information from healthcare apps and wearables. It will be part of iOS 8. Apple said in the announcement that it’s been working with Mayo Clinic, which will connect to the Health app within HealthKit, and also Epic, which has integrated HealthKit information into MyChart.   

Reader Comments

From Carol R: “Re: Dana Moore interview on Epic at Centura. One point I thought would have made the article more real and interesting was if Dana had discussed the journey from Epic to Meditech and then back to Epic. Centura decommissioned Epic in 2006 when it was replaced by Meditech. That was a directive from the board and Dana for cost containment overall and possibly other reasons as he stated in his review. Kelsey-Seybold Clinic in Houston also moved off and then back to Epic. I think there is a lot to learn from other organizations on a big decision over time such as the purchase of Epic. Why not share this knowledge in case there are other organizations struggling to figure this out?” I’m happy to run any information anyone would like to provide. It’s an interesting topic. 

From Lyle: “Re: Epic. See the first comment after this article. I was subject to this during my time at Epic.” An anonymous comment to a post on the “Life After Epic” blog claims that Judy Faulkner “exhorted managers to be capricious. Her idea was that you keep people at peak productivity by making sure they never know, exactly, where the goal post is. Independently-minded malcontents won’t stand for it and will leave; but people eager to please — people who need to please — will just keep trying. So you can essentially keep pulling 125 percent out of them indefinitely by being an ass and constantly moving the marker of what they need to do or how they need to do it.” As an example, the commenter claims that Judy told team leaders to randomly deny employee vacation requests just to keep them guessing. The commenter also opines that “the software is basically an undocumented rat’s nest of bailing wire and duct tape that it works because Judy has an unlimited supply of college kids graduating in a crap economy to throw at it.”

HIStalk Announcements and Requests

Congratulations to HIStalk friend Barry Wightman of Forward Health Group, whose novel Pepperland (which I enjoyed immensely) just won a regional fiction award. Barry is just about the coolest guy I know.

I’m a bit stretched on time since I’m at Health Datapalooza, so I’ll keep it short this time and catch up by the weekend.

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  Building a Data Warehouse and Analytics Strategy from the Ground Up. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This easy-to-understand discussion covers the key analytic principles of an adaptive data architecture including data aggregation, normalization, security, and governance. The presenters will discuss implementation tactics (team creation, roles, and reporting), creating a data-driven culture, and organizing permanent cross-functional teams that can create and measure long-term improvements.

Acquisitions, Funding, Business, and Stock

Outpatient specialty documentation system vendor Net Health acquires The Rehab Documentation Company.

McKesson sells its European technology product line, which includes its System C hospital offerings acquired in 2011, to private equity firm Symphony Technology Group.

Sales

Orthopaedic Associates of Southern Delaware (DE) chooses SRS PM/EHR.

People

Healthgrades names Jeff Surges (Merge Healthcare) to the newly created role of president.

Announcements and Implementations

Boston Software announces GA of Boston WorkStation Version 10, its workflow automation technology.

Kareo releases a social media and reputation management guide for practices that have limited resources to develop an online presence.

NextGen Healthcare claims it has achieved “vendor agnostic interoperability” because one of its client practices has exchanged C-CDA Summary of Care messages with Tucson Medical Center’s Epic system using the Surescripts network.

Government and Politics

The federal Bureau of Prisons issues an RFI for an EHR to replace the system it has used since 2006.

The Wall Street Journal reports that the White House is considering Cleveland Clinic CEO Toby Cosgrove, MD as the next VA secretary.

Edith Dees, CIO of Holy Spirit Hospital (PA), says the hospital is trying hard to meet Meaningful Use Stage 2 requirements but is struggling with issues outside of its control, including one vendor’s requirement that its system run on an OS version the hospital doesn’t support, an HIE vendor whose product doesn’t meet Direct Project security standards, EHR vendors that require buying additional products such as patient portals and add-ons, and delayed and buggy vendor MU releases.  

Other

NPR covers Health Datapalooza, which it calls “an awkward adolescence” in which “2,000 people [are] shrieking with excitement over federal healthcare databases,” cautioning that all of those cool apps that people are developing trying to make a buck are largely unproven works in progress.

University of Arizona Health Network (AZ) has lost $28.5 million so far this fiscal year ending June 30, which it says is due to $32 million in unplanned training and support costs for its $115 million Epic implementation.

A ProPublica series on national prescribing irregularities wins the Health Data Liberators Award at Health Datapalooza.

The 12th International Congress on Nursing Informatics will be held June 21-25, 2014 in Taipei, Taiwan.

Weird News Andy titles this article “Daft Graft Graft,” adding that “he had skin in the game.” A Pennsylvania man is arrested for stealing skin grafts worth $350,000 from Mercy Philadelphia Hospital over two years.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.
Contact us online.

From Health Datapalooza 6/2/14

This is the first time I’ve attended Health Datapalooza. I thought from the name, location, and people involved that it would be entirely about government-released datasets and how companies are using them. Those topics were certainly covered, but many of the presentations and exhibitors had nothing at all to do with publicly available data or the government. Instead, Health Datapalooza is a seemingly random conglomeration of startups, consumer health, wellness, new payment models, chain drug stores, and just about anything else that bears (deservedly or not) the “innovative” label.

In that way, Health Datapalooza is identical to the mHealth Summit, held in December on the other side of the Potomac in National Harbor, MD. Health Datapalooza is mostly not about data and the mHealth Summit is mostly not about mobile. In fact, my first thought was that they should just combine the two conferences because they seem equally unfocused, like the HIMSS conference minus the hospital and ambulatory systems vendors, with skinny jean hipsters and Glass-wearing nerds intermingling uncomfortably with the stiff suits from insurance companies, federal agencies, and investment firms, all trying to figure out what they have in common other than patients and consumers.

I assume that most of the 2,000 Health Datapalooza attendees aren’t paying their own travel or registration costs. I tried to figure out the kinds of employers that would get their money’s worth sending their people, but I wasn’t coming up with much. I’ve seen many of the same faces you see at seemingly every conference held, the folks whose entire jobs seem to be tweeting and socializing from one conference to the next at their employer’s expense, but I don’t have a good feel for the demographic otherwise.

The event was held at the Washington Marriott Wardman Park in northwest DC. I didn’t stay there since I’m cheap: the special rate was still $224 per night and of course being a conference hotel everything costs extra – Internet access, breakfast, and the $46 per night parking charge. It looks great on the outside, but I wasn’t impressed with its 3.5 Tripadvisor stars, so instead I booked an $80, 4.5 star hotel in Alexandria (not far from Old Town) with free Internet, parking, breakfast, and shuttle to and from the Metro station. It took maybe 40 minutes to ride up the Yellow Line and switch to the Red Line to the Woodley Park Metro station, which is just a few hundred feet from the Marriott.

Monday’s keynote lineup was impressive: Elliot Fisher, MD, MPH (Dartmouth), Karen Ignagni (America’s Health Insurance Plans), Todd Park (US CTO), Jeremy Hunt (UK Secretary of State for Health), Jonathan Bush (athenahealth, unless you believe the conference agenda that says he’s the CEO of “aetnahealth), and Atul Gawande, MD, MPH (Brigham and Woman’s). Fisher had some strong opinions backed by data about the not-so-great state of US healthcare. Ignagni had some mildly interesting observations about insurers. Park was, as always, bursting with energy and enthusiasm about the “data liberators” and announced openFDA, which will give researchers API access to the FDA’s databases. Hunt was as charismatic and visionary as you would expect a politician to be and spoke eloquently about hospital errors and transparency. Bush was his usual shot-from-a-cannon rollercoaster of irreverent observations and insight. Gawande talked about the healthcare system and the use of data for quality improvement and also to target specific patients for interventions to improve their health and reduce their resource consumption.

It was a nice bonus that the conference provided lunch in the exhibit hall, with the only challenge being to find a table on which to eat it. The exhibit hall was manageable, with a few dozen exhibitors representing a wide variety of company types. I intentionally didn’t register as press since I wanted the same experience as everybody else.

I was admiring a book on geographic information systems at the Esri exhibit and they gave me a copy, which even included the mapping software DVD. It’s a really cool tutorial on the tools to apply geographic and mapping functions to databases. It would be a fun skill to learn for people who love tinkering with Access or data analysis tools.

This company’s booth was staffed by three reps, none of whom were coming up for air from poking at their phones while facing each other to form a protective circle against potential intruders.

Healthspek offers a free PHR, of which I’m skeptical, but it was a great-looking app, does some interesting merging of CCD data, has a provider view, and offers an emergency card that gives providers online access to the patient’s information in an emergency.

Validic had a nicely done graphical handout that described exactly what it offers, a digital health platform that connects medical devices, health apps, and wearables to the systems of hospitals, population management companies, pharma, and payers.

Some of the other booths I visited were:

• Privacy Analytics, which provides data anonymization services.
• AnalytixDS. The company’s Mapping Manager is a pre-ETL data mapping tool that caught my eye.
• Arcadia Healthcare Solutions, who gave me an overview of EHR services and data analytics solutions.
• Verisk Health. The company got a great off-the-cuff plug from Atul Gawande’s keynote in which he mentioned using their analytics tools to identify patients who were otherwise falling through the cracks and not receiving treatments and interventions they needed. His example was a blind diabetic patient who was racking up massive cost because of poor glucose control, which required only one visit to fix: he didn’t realize that he had to turn the insulin vial upside down to draw up his dose, so he was injecting himself with air instead.
• Healthy Communities Institute. It offers a population health improvement portal for communities. The rep didn’t seem too interested in telling me more, but it looked pretty cool.

Many of the booth reps seemed disengaged, even worse than at the HIMSS conference. Maybe it’s because companies don’t send their A-teams to Health Datapalooza, or that attendees are so diverse that there’s no clear sales opportunity, or maybe they just would rather play around with their phones than anything else. I walked up to several booths and was ignored completely, while others gave me a quick “let me know if you have any questions” before turning away (usually my intended question was “what do you do?” since it was often hard to decipher the buzzwords.) I saw one guy take a delivered pizza to the booth and eat it while the hall was open, while others abandoned their booths entirely or discouraged interaction by gabbing with each other.

I attended a session that was a panel discussion among investment guys (I say “guys” because they were all male and most were from insurance companies.) I didn’t realize how actively insurance companies are investing in healthcare IT now that their previously lucrative insurance profits are drying up. Some interesting points:

• Consolidation of hospitals and big practices could reduce the number of potential customers to a few hundred nationally.
• The market has too much noise. There’s no way Castlight Health will be worth as much in 10 years as it is today. Lots of companies are getting investments that haven’t really earned them and most of them will fail.
• Some of the big investors will put money into startups, especially those involved in consumer engagement, while others focus on later-stage companies that are already making money.
• Investors are wary of companies whose product adds another platform and instead look for products that fit easily into the ecosystem. “We don’t need any new shiny objects.”
• Investors won’t touch a healthcare software company whose business model assumes that consumers will pay for something.
• Up to 90 percent of the investments the panelists are making involve services rather than products businesses, but they have to be convinced that the business can scale and be productized.
• Investors don’t require a majority take as they often did previously, but they want enough equity to be worth their trouble and to give them some control over the company’s direction.
• Strategic investors aren’t as interested in steamrolling the founder as they once were – they will take a minority position and let the company grow.
• Investors have a strong interest in making investments in healthcare IT. Companies shouldn’t be shy about asking for what they really want.

If you are attending Health Datapalooza, leave a comment. What did you hope to accomplish there and how’s it going? Have you seen anything interesting?

Lorre’s Impressions

I was excited about attending Health Datapalooza 2014. HIStalk wasn’t exhibiting, so rather than spending the majority of time in a booth, I was free to participate. I mapped my day out in advance and set out bright and early to make the most of it.

Mr. H and I both attended the keynote events. Bryan Sivak did a great job moderating. He was interesting and energetic and injected relevant comments and some fun to keep people alert.

Todd Park announced the release of OpenFDA and discussed the need for more open data. He finished with a moving tribute to George Thomas, the chief data architect for the HHS Office of the CIO who died recently.

The Right Honourable Jeremy Hunt was passionate while talking about his priorities for improving health and care in the UK. He shared the data to illustrate their success with improving mortality rates to among the best in Europe. He emphasized the need to share electronic health information across borders and collaborate to solve common issues. What I found most interesting is his case for greater accountability and error reporting. Bryan mentioned that someone referred to Hunt as “dreamy” during the conference rehearsal and I would agree.

Atul Gawande, MD, MPH spoke about the importance of insurance coverage for everyone and emphasized it with personal experience. He was passionate in discussing the need to improve safety and performance in surgery, childbirth, and care of the terminally ill.

Jonathan Bush was a whirling dervish when he took the stage to talk about the importance of liberating data and discussing the attributes of organizations that suffer from “Upper Right Quadrant Syndrome” or URQS. He ended with a narration of a YouTube video that demonstrates what can happen when one person takes the lead and perseveres. He may have mentioned his new book, “Where Does It Hurt?” which is number 6 on the New York Times Bestseller List.

Between the keynote speakers, selected vendors gave short presentations on their companies and products. The best one by far was Purple Binder. President Joe Flesh did a fantastic job describing how the application enables people to quickly find available community resources for which they are eligible. The mission of the company impressed me and the application appears to be just as impressive.

I saw several attendees wearing their jackets as part of Regina Holliday’s “The Walking Gallery.” That’s always encouraging to see and the wearers are always eager to tell their patient advocacy stories.

After the keynotes, I went to the exhibit hall. I was eager to check out the booths, especially those of our nine sponsors who were there.

I visited all of the booths in the exhibit hall and introduced myself to the folks at the booths of our nine sponsors that are exhibiting. Only three seemed interested in talking to me about their products and services, so I can describe only what I heard from those.

It is always a pleasure to see our friends from CareSync. Amy and Travis were excited when they told me Amy would be giving a demonstration on the main stage on Tuesday. The person working in their booth was fun and attentive each of the times I stopped by during the day.

The folks manning the Validic booth were highly energized and eager to talk about their platform. As soon as I expressed interest, before they even knew I was with HIStalk, they were connecting me with the marketing manager to explain their product. I was impressed with the visual they use to explain how they take data from multiple sources and convert it to one language the end user can easily manipulate and use. It’s no wonder Gartner recently named them a Cool Vendor.

I especially enjoyed visiting the QlikView booth. The person in their booth was knowledgeable and interesting. He not only showed me how to use the application, he gave me instructions for downloading a free version of it.

The conference has well-managed logistics and the size is comfortable even though its focus is fuzzy. Health Datapalooza’s emphasis on patients is admirable and it’s always nice to reconnect with industry colleagues.

Monday Morning Update 6/2/14

Top News

From Anonymous Tipster: “Re: ONC reorganization. Looks like the current leadership is basically staying in place. Flattening of the structure and some folks got big promotions. Rearranging deck chairs on the Titanic?” An internal email to ONC staffers from Karen DeSalvo announces that the following will serve as ONC’s leadership team along with Deputy National Coordinator Jacob Reider, MD:

• Office of Care Transformation: Kelly Cronin
• Office of the Chief Privacy Officer: Joy Pritts
• Office of the Chief Operating Officer: Lisa Lewis
• Office of the Chief Scientist: Doug Fridsma, MD, PhD
• Office of Clinical Quality and Safety: Judy Murphy, RN
• Office of Planning, Evaluation, and Analysis: Seth Pazinski
• Office of Policy: Jodi Daniel
• Office of Programs: Kim Lynch
• Office of Public Affairs and Communications: Nora Super
• Office of Standards and Technology: Steve Posnack

It’s not uncommon for a new leader of an organization to restructure the org chart, so I don’t read too much into that. I do wonder with provider pushback on the fading Meaningful Use program whether ONC will retain its influence and keep all its people busy. Government agencies never just go away on their own – they always find ways to survive and try to keep their funding. ONC is part of HHS, which is swollen with so much bureaucracy that nobody’s going to notice ONC’s little corner of it, but other than cheerleading for EMRs, RECs, HIEs, and other big ideas whose funding (and thus interest) has expired, what will ONC’s couple of hundred employees work on?

From Anonymous Tipster: “Re: VA. My prediction: The VA and DoD will eventually decide to use a commercial vendor for a combined EHR (with a multi-billion dollar price tag) and Epic will ultimately win the bid. With the forgone conclusion of the Shinseki resignation now a reality, I am wondering if there are any implications for the VistA EHR system used by the VA. While the VA OIG report points to serious problems with the scheduling system, at last year’s summit of the Open Source Electronic Health Record Alliance (OSEHRA), Stephen W. Warren, executive in charge for information and technology at the VA, bragged about the scheduling system. The whistleblower in the case is pointing out some of these technology deficiencies and it seems that VistA could wind up being a tech fall guy for some of the VA’s problem. The VA inspector general has reported that an audit by an outside accounting firm revealed continuing problems protecting mission critical systems. Many of these problems rise from the fact that VA hasn’t instituted security standards on all its servers and systems. Remember back in 2009 when the VA canceled its patient scheduling system — dubbed the Replacement Scheduling Application Development Program — after spending $167 million over eight years and failing to deliver a usable product.” I agree that the VA scandal will blacken VistA’s eye along with the VA’s ability to run big software projects since people are starting to notice the VA’s scheduling history. On the other hand, DoD is a black hole of wasted taxpayer dollars. I think it’s safe to say that giving either agency a bunch of money for software in any form is likely to result in the usual budget overruns, missed dates, internal mismanagement, and a poor ROI when considering veteran/service member outcomes. Epic might be a safer choice, but those ever-present beltway bandits will figure out a way to make it less functional and more expensive. Regard Shinseki, I doubt he had any personal knowledge of the scheduling issues despite ample OIG warnings (which could also be said of the President) but clearly political pressure meant he had to go.

From The PACS Designer: “Re: Windows 8.1 for free. Microsoft has announced that it will offer tablet producers Windows 8.1 with Bing for free to ensure that it’s the platform sold to new customers. With Windows 9 coming next year, they’ll be able to get their next OS on these recently purchased tablets with an upgrade offer.” I would much rather get Android for free than Windows 8.1.

HIStalk Announcements and Requests

Respondents were split on whether the Meaningful Use slowdown is good or bad. New poll to your right: how do you see Meditech’s competitive position compared to a year ago?

Announcements and Implementations

Jamestown Regional Medical Center (ND) goes live with Epic, spending $1.2 million to replace HMS.

Government and Politics

The State of Maryland says it will fund development of a replacement health insurance exchange using $40-50 million in leftover funds and Medicaid funding without tapping into federal money. The state will pay Deloitte to customize Connecticut’s exchange for its use. Maryland fired contractor Noridian Healthcare Solutions in February after the $170 million Maryland Health Connection failed immediately on its October 1 go-live. Some state legislators wonder why it doesn’t just use Healthcare.gov, with one saying, “What still is amazing to me is why they don’t go to the federal exchange, which is free and works. You still have to spend $40 to $50 million. It is still money they are spending on something they don’t have to.”

Oregon Governor John Kitzhaber says the state will sue Oracle, hoping to recover the $134 million it paid the company to develop the failed Cover Oregon health insurance exchange.

Other

UPMC finally admits that that all of its 62,000 employees could be at risk for identity theft rather than the 27,000 it announced in April as unknown hackers breached its payroll system and used IDs to file 800 fraudulent tax returns.

A Kansas urologist who is also the president-elect of the Kansas Medical Society says his practice’s biggest problem is electronic medical records. “Now, we’re basically key-punch operators, transcriptionists having to input the data ourselves.  Voice-recognition software and some of those things help, but it has essentially tripled the time to complete a medical record. How do you accomplish that when we are already working 12 to 14 hours a day?” He says EMRs will shake out within 10 years, but doctors are quitting over them now.

Hurley Medical Center (MI) accidentally discloses the Social Security numbers of several employees when someone accidentally attaches an employee worksheet to a mass email about insurance.

Weird News Andy notes that Illinois closed three mental health facilities in 2012, but left behind heavy equipment, a medical specimen, and boxes of paper personnel and medical records.

Sponsor Updates

• The Advisory Board Company will participate in several events at Health Datapalooza. VP Piper Su will moderate a panel on “Creating Wellness Outside the Clinic.” Jay Nagy, associate principal of corporate strategy, will participate in a panel discussion on “Integration of Patient Generated Data into HCP Clinical Workflow to Achieve Improved Outcomes.” Jonah Czerwinski , managing director of strategic planning, will serve on a panel discussion, “Creating a Sustainable Future for Healthcare.”
• Validic  will exhibit at Health Datapalooza and will announce new device integration partners.
• Michael Simon, principal data scientist at Arcadia Healthcare Solutions, provides a recap of eHealth Initiative National Forum on Data and Analytics.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.
Contact us online.

News 5/30/14

Top News

An interimVA OIG report on patient wait times at the Phoenix VA verifies the whistleblower’s claim that employees were hiding patient scheduling delays. They bypassed the electronic wait list application and instead sent screen shots of the appointment request directly to the outpatient treatment area, which was then responsible for entering them into the system but often ran weeks or months behind. The improved wait times allowed leaders to collect bonuses. OIG investigators added that inappropriate scheduling is a national problem, with schedulers gaming the electronic system in a variety of ways to show short appointment waits. They also noted that audit controls for the Phoenix VA’s VistA system were turned off. There’s no way VA Secretary Eric Shinseki keeps his job past the middle of next week given that he’s like Moses parting the Red Sea as politicians and bureaucrats of both parties put whatever distance they can between themselves and him as the lightning rod for public outrage.

Reader Comments

From The Product: “Re: Covisint. Lays off over 100, about 25 percent of the newly IPO’d company. Healthcare was rumored to have taken a huge hit, especially in analytics. The new CEO came in with the promise to streamline and cut he did.” Unverified. The new CEO said in the earnings call last week (revenue down 5 percent, EPS –$0.27 vs. –$0.10) that he is disappointed in the company’s performance and plans to cut costs and change leadership.

HIStalk Announcements and Requests

The latest in the long list of things I hate about Gmail is that its overactive spam filter can’t be customized or turned off. A reader said they sent me several emails that I finally found in Gmail’s spam folder (or label or whatever Gmail calls it) even though they bore no resemblance whatsoever to spam. I created the above filter since I would rather manually delete 50 spam messages than lose one important one.

This week on HIStalk Practice:  An MGMA physician survey finds that both physicians and patients are frustrated with the impact of ACA insurance exchanges. Atlantic City casino workers take healthcare matters into their own hands. Seema Rao, MD offers six tips on how to prepare for Meaningful Use. Healthcare actually fares worse than retail when it comes to security performance. Thanks for reading.

This week on HIStalk Connect:  Dr. Travis covers Mary Meeker’s annual Internet Trends presentation, which touches on all things technology, and now includes a section on the convergence of technology and healthcare. The CEO of 23andMe discusses the future of personal genetics testing after the FDA shuts down sales of its healthcare-focused genetic testing product. Aver Informatics closes an $8.5 million Series A round to continue development on its "episode-based" financial analytics platform. 

Listening: Swedish indie pop from Lykke Li. If you like (or Lykke) her, you’ll probably enjoy Bat for Lashes.

Acquisitions, Funding, Business, and Stock

Quality Systems (NextGen) reports Q4 results: revenue up 4 percent, EPS $0.12 vs. $0.24., missing earnings estimates. From the earnings call, the acquisition of Mirth integration engine was important as the company tries to repackage its EHR offerings into a clinical data repository that has population health management potential. Sales of inpatient core clinicals and financials aren’t doing so well, apparently. QSII shares dropped 4 percent on Thursday after the pre-market open announcement. Above is the one-year share price chart of QSII (blue) vs. the Nasdaq (red).

Sales

Kimball Health Services (NE) chooses the RazorInsights One clinical and financial system.

Miami Children’s Hospital (FL) will implement Xerox’s ICD-10 Complete.

In England, Viapath signs a seven-year, $18 million contract to implement the Cerner PathNet anatomic pathology system at Guy’s and St. Thomas’s Hospital.

Colorado Regional Health Information Organization selects Sandlot Solutions to extend its interoperability capabilities.

Allina Health (MN) chooses Omnicell for medication automation.

Intermountain Healthcare will use genomics-driven cancer care software from Synapse.

Upper Peninsula Health Plan (MI) will conduct a pilot to manage its Medicaid readmissions using infrastructure from Informatics Corporation of America .

People

Richard A. Caplin, CEO of The HCI Group, is selected as a finalist for EY Entrepreneur of the Year for Florida.

Orlando Portale has resigned as chief innovation officer of Palomar Health and will advise companies, investors, and provider organizations.

Nephrology EHR vendor Acumen Physician Solutions promotes Hugh Gaston to VP of operations and Jason Holcomb to VP of business development.

Remedy Informatics hires Scott C. Howard, MD, MSc (St. Jude Children’s Research Hospital) as chief medical officer.

Danny Sands, MD, MPH joins “digital checkup” vendor Conversa Health as chief medical officer. 

The president and CEO of Athens Regional Medical Center (GA) stepped down last week over a problematic Cerner implementation and the ensuing physician revolt. SVP/CIO Gretchen Tegethoff has become the project’s second executive casualty as the hospital announced her resignation Thursday.

Announcements and Implementations

Arcadia Healthcare Solutions announces Launchpad, which allows users to create and monitor quality improvement programs and share them internally or with peer groups.

AMIA announces availability of its updated online Clinical Informatics Board Review Course to prepare physicians for the board subspecialty exam that includes new assessment questions and simulated exam questions. A 12-month subscription includes 23 hours of CME and costs AMIA members $1,495. AMIA reminds physicians that current practitioners need only take the exam to earn certification since they are grandfathered in until 2018, but starting then, a 24-month fellowship will be required.

The 2014 Health Privacy Summit will be held June 4-5 in Washington, DC, with National Coordinator Karen DeSalvo, MD as one of its keynote presenters.

Cerner makes 600 medical calculators available free as an MPage within PowerChart in a partnership with MedCalc3000.

PatientSafe Solutions makes Lead411’s list of “Hottest Southern California Companies.”

Government and Politics

HIMSS says ONC’s Security Risk Assessment Tool is not intuitive, contains legalese that the average provider won’t understand, and references only one of several security frameworks (NIST’s.) I also noticed that ONC can’t figure out how set up a download that works for Windows 8.1 (not running the tool, just downloading it) and when I installed it under Windows 7, it gives a warning that there’s no digital certificate and shows its source as “unknown publisher” (consider the irony given that this is a security tool.) I agree that it’s full of needlessly complex wording, a reminder that just as you don’t let programmers design apps on their own, government wonks should bring in someone to put some end-user polish on their prototype. I’m still trying to figure out how to de-install it since it didn’t add itself to the start menu, the desktop, or Control Panel’s list of installed programs. I finally figured out that it just downloads to your default location (without asking or telling) and runs directly from there, which is primitive.

ONC seeks work group members for its Health IT Policy and Health IT Standards committees. Applications are due Friday, June 6.

Meanwhile in Florida, Governor Rick Scott says he’ll sue the VA for not allowing state inspectors to conduct unannounced visits to its Florida hospitals. The VA has repeatedly reminded Scott that states have no authority over the VA, but the grandstanding governor keeps sending inspection teams for the VA to turn away. Scott gained personal expertise with unannounced hospital inspections in his role as chairman and CEO of Columbia/HCA when the FBI and IRS raided several of its hospitals for Medicare fraud in 1997, which the company later admitted and paid $2 billion to make go away.

Here’s US CTO Todd Park’s pitch for Health Datapalooza, which kicks off this weekend in Washington, DC. I would be more interested in hearing him describe his holdings and participation in IPO flameout Castlight Health, but I’ll still be at Health Datapalooza. I also noted in reading Jonathan Bush’s new book that he lavishes extensive praise on Todd Park’s work ethic, brains, and nerdiness. I’ve interviewed hundreds of people and he’s still one of the nicest and most interesting of them.

Speaking of athenahealth, the company owned 8 percent of Castlight Health at its IPO, with athenahealth’s Jonathan Bush saying the profits led him to invest in more companies. “We bought an airplane and we made enough on that to buy a bunch of airplanes.”

A TIME article says Congress killed the patent troll law because of pressure from Senator Harry Reid (D-NV), who has received $4 million in campaign contributions from lawyers and law firms (some of them listed above in his top contributors list). Patent troll lawsuits now make up 62 percent of all infringement suits, up from 29 percent just two years ago, with estimates of $29 billion in costs to defendants in the past three years. Companies will get no relief thanks to Senator Patrick Leahy (D-VT), who pulled the bill he had introduced while uttering an impressive array of unconvincing excuses that didn’t include being scared of Harry Reid.

An HHS OIG investigation finds that Medicare paid $6.7 billion too much for office visits in 2010 based on the judgment of professional coders reviewing a small random sampling of claims, but the agency says it’s not cost-effective to for it to review the billing history of doctors who always charge for level 5, the most expensive visits.

Meanwhile, The Economist says thieves pillage the American healthcare system for $272 billion per year. It cites an example of a luxury apartment complex in South Florida that housed 500 residents who were collecting Medicaid checks. It says that ethnic mobs with weapons stockpiles have moved from cocaine trafficking to prescription drug fraud because it pays as well and the penalties are lighter. It also points out medical identify theft and the fact that CMS has yet to act on a GAO suggestion that it stop printing Social Security numbers on Medicare cards. One doctor made $12 million for writing narcotics prescriptions, with the required documentation (images or urine samples) conveniently available for purchase from entrepreneurs who set up shop at the clinic’s front door. It could get worse, the article says, as Medicare and Medicaid beneficiaries move to managed care that will provide the minimally effective government watchdogs with even less information with which to direct their unremarkable efforts.

John Halamka offers thoughts on the Notice of Proposed Rulemaking that would change Meaningful Use attestation for this year. It’s really only a 90-day breather since the 2015 year still starts on October 1, 2014, so hospitals struggling with Transition of Care summary exchanges, electronic MARs, and portals don’t get much of a break. He suggests relaxing those requirements or changing the reporting period to any 90 day-period in 2015. Transition of Care is a noble idea, but community-based doctors can’t receive those summaries because they either don’t have a Direct address or there’s no way to look them up. He suggests allowing a hardship exemption where that’s the case. He adds that even CMS/ONC are confused because they keep individually tweaking the regulations such that, “It’s getting to the point that even the authors cannot answer questions about the regulations because there are too many layers.” He suggests simplifying the program for Stage 3, eliminating certification requirements and addressing only a few big-picture policy goals — he likes the idea of building Meaningful Use into the Merit-based Inventive Payment System that offers rewards but does not impose penalties.

People tweet, blog, complain in public about #MU but only 8 comments on proposed rule? http://t.co/Zhsva81jN2 ^Plz share & comment

— Sherry Reynolds (@Cascadia) May 29, 2014

Other

Samsung announces Simband, an experimental wristwatch whose sensors can measure blood pressure, ECG, oxygen, and heart rate. Samsung will make the device available to researchers to develop their own health-related wearable apps and devices, referring to it as a “design platform” rather than a product. The company also announced SAMI, an open software platform that collects data from wearable devices. Samsung also announces the $50 million Samsung Catalyst Fund to ramp up development of “disruptive sensors and algorithms” and a partnership with UCSF to validate them. All this comes just ahead of Apple’s expected wearables announcement at its developer conference next week.

Rumors say that Microsoft may be working on wearable sensors of its own, possibly incorporating Kinect sensors in a smart watch. The potential data partner is rumored to be Caradigm, of which Microsoft owns 50 percent in its joint venture with GE.

Over 400 medical school graduates failed to match for a residency this year, victims of a system in which medical school enrollments have increased while the number of available residency positions has remained unchanged for more than 15 years. Congress pays the cost of residencies and hasn’t changed the $10 billion in annual taxpayer dollars it has made available since 1997 to fund them, creating a bottleneck where larger medical school classes won’t change the total number of new doctors. The only positive development is that competition has pushed more graduates out of high-income specialties such as dermatology and orthopedics and into primary care.

Fitch Ratings keeps the bonds of MetroHealth (OH) at A-, with one of its positive observations being that the health system’s Epic system has helped it stay profitable despite a challenging payor mix.

CIO writes about an informal, information-sharing alliance of three CIOs of non-profits who “join forces to battle cancer.” The CIOs are from the American Cancer Society, the Leukemia and Lymphoma Society, and the fundraising arm of St. Jude Children’s Research Hospital. The most interesting part is the description of the increasing ability to match large data sets (clinical or genomic) to an individual patient’s condition to optimize treatments. Its quotes from other CIOs include this one from Pat Skarulis of Memorial Sloan Kettering:  “Everyone on my staff knows someone who’s been affected. Some have fought cancer themselves. We’re not doing something for some remote benefit, something that might do some good in the future. We see on a day-to-day basis how what we do effects people’s lives. Every day that we don’t know something is a day we haven’t helped someone."

Sponsor Updates

• Ingenious Med’s Karen England discusses the ICD-10 delay.
• Concur App Center names Healthcare Data Solutions as its partner of the year for the second consecutive year.
• IHT2 offers a white paper on adding management to an LIS.
• Medical Records Associates acquires TrustHCS’s cancer registry services division.
• Awarepoint partners with Integrating the Healthcare Enterprise for interoperability demonstrations during AAMI 2014.
• DataMotion’s Bob Janacek details the difference of “push” and “pull” delivery methods for encrypted email.
• Arcadia Healthcare Solutions, CTG Health Solutions and Certify Data Systems discuss the challenges of creating and operating a successful ACO.
• PMD launches a HIPAA-compliant notification system with short, fun videos explaining the how and why.
• DrFirst, Forward Advantage, and Imprivata partner to provide e-prescribing of controlled substances for Meditech and MAGIC/OSAL platforms.
• Triangle Business Journal profiles PatientPay.
• HIStalk sponsors named on the HCI 100 for 2014 include 3M, ADP AdvancedMD, Alere Accountable Care Solutions, Allscripts, Beacon Partners, Capario, Capsule Tech, CompuGroup Medical, Craneware, CTG Health Solutions, Cumberland Consulting Group, eClinicalWorks, Elsevier, Emdeon, Encore Health Resources, ESD, Experian Health/Passport, Greenway, Harris Corp, Health Data Specialists, HealthStream, Iatric Systems, Impact Advisors, Imprivata, Infor, InterSystems, MModal, McKesson, MedAssets, Medhost, Merge, Navicure, Netsmart, Nordic Consulting, Optum, Orion Health, Perceptive Software, Premier Inc,, Quality Systems (NextGen), Siemens Healthcare, Sunquest Information Systems, Surgical Information Systems, T-System, TeleTracking Technologies, The Advisory Board Company, The SSI Group, Trizetto, Vocera, and Wolters Kluwer Health.

EPtalk by Dr. Jayne

I once read that part of being an effective writer is being a good reader. That’s pretty easy for me since I love to read. Sometimes I read for knowledge, sometimes I read for advice, and sometimes I just read for entertainment. Even in fiction my taste occasionally drifts to work-related content (Kate Scarpetta, anyone?) or high-tech thrillers (Dale Brown), although lately I’ve been choosing some fairly fluffy “beach read” type novels.

I’ve read a couple where the characters are in the film or TV industry. That’s about as far as it gets from my real life, so I suppose that’s good to allow my brain to recharge. Last week’s read included a plot line around a proposal for a TV show that was turned into a pilot and eventually a series. Assuming it was even halfway accurate, the process that a script goes through before it makes it to the home screen resembles either making sausage or creating CMS regulations, whichever you prefer.

There have been many notable medical TV characters. My personal favorites are the entire cast of “M*A*S*H,” “Quincy,” Beverly Crusher, and of course Dr. Quinn. I was too busy running a solo practice when “House” and “Grey’s Anatomy” initially came out, so I’m catching up on those via Netflix. My newest favorite, though, is BBC’s “Call the Midwife.”

I was in a 1950s public health mood (after finishing Season 2) when I read the HIStalk Monday Morning Update that referenced an article about physicians lacking physical diagnosis skills. I’ve had the privilege of working in extremely remote areas and I don’t disagree. I trained at a prominent medical school where technology was everywhere.

While on one rotation, I was asked what I thought about a murmur. My attending actually laughed at me when I said I thought we should get an echo for more information. Unlike the academic medical center where you could get a same-day echo, these patients had to travel several hours and generally wait a week or more to be scheduled.

During the first two years of medical school, the teaching of physical exam skills was cursory at best. We received a lecture about a given topic and were then turned loose to examine each other. It felt like preschoolers playing doctor. Unless someone has an unusual finding, there’s not much to learn from a crop of healthy 24-year-olds.

Even in third year when we examined real patients, we were generally by ourselves and without anyone more senior to make sure we understood the significance of what we were seeing, hearing, or feeling. Professional or “standardized” patients that coach students were just coming onto the scene.

The feeling that my medical education was somehow lacking (despite the steep tuition payments) became even clearer during a fourth-year rotation. I was at a community hospital that had a large number of residents who had trained at international medical schools. I quickly realized that most of them had not only studied in another country, they had been practicing physicians for years. They were repeating their training to try to get positions in the US.

My favorite resident was a neonatologist from the former Soviet Union. She could hear a tiny murmur from across the room and knew what it was before anyone else. Despite her busy schedule, she actually took the time to teach us, unlike many of the faculty who made it seem like teaching students was interfering with their research. Unfortunately, she couldn’t get a residency in her field and was therefore learning adult medicine after being in practice for nearly a decade.

There are a lot of pressures moving us away from physical diagnosis and towards tests. Patients often feel that high-tech evaluations are more accurate or just better than time honored skills. Others want data to convince them they’re OK rather than a person, who might be wrong. Defensive medicine, skyrocketing malpractice awards, and a fear of any kind of bad outcome (even if not preventable) cause unnecessary testing and added expense. Add that to the expectation that physicians complete an entire visit (including history, physical, documentation, and billing) in less than 10 minutes and corners are going to be cut.

In one of our offices, the exam rooms have speakers and a radio station constantly plays throughout the office to disguise the fact that there is no soundproofing in the walls. Without the radio, you can hear everything happening in the next room. Unfortunately, each room’s volume control is on the wrong side of the exam table, leading to decreased willingness for physicians to walk around, turn it down, use the stethoscope, and then turn it back up, especially during an increasingly compressed office visit.

The Washington Post article also mentions the fact that insurance pays for tests but doesn’t compensate us for spending extra time with the patient performing a more thorough history and physical. We are paid based on the amount of physical exam that is medically necessary based on the diagnosis – not what we do. I don’t get credit for performing diagnostic maneuvers if I end up determining that there is nothing wrong with you, because only a low level visit is justified.

Distraction is also an issue. I had a student shadowing me a few months ago. After seeing a particular patient for a rash, I asked what she thought about his tremor. She was so busy flipping through his chart that she missed a classic physical finding. I couldn’t blame the EHR for this one – the patient was a brand new patient and had brought his paper military file with him. The student was fixated on that, probably because it was a novelty.

Back to my initial thoughts about relaxing with a good book or learning about how TV shows are produced. A few years ago, there was a group of PBS series that took modern families and placed them in historical environments – “Frontier House,” “Colonial House,” and “The 1900 House” are the ones I remember watching. This was the educational aspect of the early reality shows.

If anyone knows anyone in the entertainment industry, I want to propose some sequels. Let’s do them all again, but with modern physicians in the cast. Let’s give them the tools of the trade appropriate to the time period and see how well they do with common period ailments.

Better yet, mix it up with graduates from top-tier research schools, primary care-oriented state schools, and schools in countries that lack abundant technology. In keeping with the spirit of today’s reality shows, let’s keep score. Any patient they misdiagnose or can’t help with the technology at hand gets added to their “kill chart” and lowers their rankings. And when they successfully figure out what to do with some of the odd-looking medical equipment from their time periods, they can earn points.

I think it would be entertaining, but I don’t think the outcomes would be surprising. I’ll bring my little black bag, my amputation knife, and my trephining drill. Who’s with me?

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.
Contact us online.