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.

News 5/28/14

Top News

An MGMA survey of large (median of 10 FTE physicians), mostly independent physician practices finds that 62 percent are struggling to identify patients whose insurance came from an Affordable Care Act exchange and to verify their eligibility or obtain plan details. Most practices also say that patients who got their insurance via an ACA exchange are more likely to have high deductibles and don’t understand that fact. Half of the practices say they can’t provide services to ACA exchange patients because their practice is out of network.

Reader Comments

From Trinity: “Re: Meditech READY Certification Status. How many firms will be named to this list? What’s the upside for Meditech clients and the consulting firms?” Certainly READY Is one of the more contrived acronyms ever: rapid adoption, evidence based, advanced workflows, dedicated team, and your success. Apparently it’s an Epic-like certification that allows consulting firms to implement Meditech 6.x. The company says its purpose is to drive a big bang go-live and its implementation team members “will become workflow experts armed with a more global view of how the solutions work together and will be trained to collaborate with one another when the software is delivered to the customer.” The key components are (a) more application consultant time at the client site instead of having the customer travel to Meditech; (b) project leadership and physician training by Navin, Haffty & Associates; (c) delivery of standard system content; and (d) a course for hospital clinical leaders to address process improvement.

From Jockamo: “Re: Meaningful Use Stage 2. The attached document is from the administrator of a multi-specialty group.” The unnamed practice administrator urges everyone to tell CMS that MU Stage 2 is unreasonable via the comment period for the proposed changes. The main concerns: (a) 50 percent of patients must provide email addresses to meet the requirement that they have portal access; (b) orders must be initiated electronically directly by the clinician instead of dictated, written, or verbally issued to a clerical support person; (c) data entry timeliness is unworkable given that patients are to be given an electronic summary of care within one day; (d) summaries of care must be sent or received with each transfer out or in.

HIStalk Announcements and Requests

Listening: Portland-based Heatmiser, which in its five years of existence that ended in 1996 begat Elliot Smith (who died in 2003 at 34.)

Acquisitions, Funding, Business, and Stock

Risk scoring vendor Apixio raises $13.5 million in a Series C investment round.

PatientPay receives a $2.5 million investment from San Francisco-based Mosaik Partners.

Wisconsin-based payment analytics vendor Aver Informatics raises $8.5 million.

Cerner’s board approves a $100 million share buy-back, raising the total from the original $213 million repurchase program approved in December 2013.

Atlanta-based insurance software vendor Ebix acquires “ask a doctor” service vendor Healthcare Magic for $6 million and will roll it into its A.D.A.M. Health division.  

People

Helayne O’Keiff (IBM) joins Beacon Partners as senior regional director for the South.

Sean Nolan (Microsoft) will leave the company and his role with HealthVault.

August Calhoun, PhD (Dell) joins Truven Health Analytics as SVP/GM of the company’s Provider Solutions business.

Announcements and Implementations

AirStrip will incorporate PeriGen’s enhanced context and decision support tools for obstetrics into AirStrip One.

Government and Politics

From The Onion.

A Vermont Information Technology Leaders RFP indicates that the company will spend $175,000 on awareness advertising campaigns for the public and for providers as it prepares to launch the Vermont HIE, which is about to exit beta testing. VHIE drew controversy a few weeks ago when it announced that any provider will be able to look at any patient’s information, which the CEO says was done to reduce the number of forms patients would need to sign.

Innovation and Research

An engineer develops a $300 smart spoon that stabilizes up to 70 percent of a person’s hand tremor, allowing people with those conditions to eat without help. More attachments are coming.

Other

The Columbus, OH newspaper profiles Columbus-based CoverMyMeds and the prior authorization process.

AtlantiCare (NJ) will merge with Geisinger Health System (PA), with both organizations citing value-based care as their motivation. 

The VA hospital in Denver reports that two laptops containing respiratory testing information on 239 patients have been stolen from its pulmonary lab.

in England, NHS says the operating cost of its new e-Referral service will be 80 percent less than that of the $600 million Choose and Book system it replaces.

Also in England, the government opens bids for its Integrated Digital Care Technology Fund, which will provide up to $400 million in matching funds over the next three years to projects that create open source data sharing tools.

Sponsor Updates

• Technology leasing provider Winthrop Resources achieves its second “Peer Reviewed by HFMA” designation.
• The e-MDs 2014 user conference is scheduled for June 5-7 at the AT&T Executive Education and Conference Center in Austin, TX.
• TriZetto (Gateway EDI) offers four things to prepare for ICD-10 after attending WEDI’s ICD-10 Summit.
• Glytec receives FDA approval to add pediatric insulin dosing to its Glucommander.
• Greenway Health is recognized by Black Book Rankings as a Top EHR Vendor for ambulatory settings.
• Culbert Healthcare Solutions offers proactive steps in transition to value-based physician compensation.
• Liaison Technologies adds template-based mapping to its Contivo Data Integration Suite.
• Capsule’s Karen Lund discusses the importance of nurses understanding the ‘big picture.”
• Beacon Partners discusses the good and bad aspects of the recently proposed CMS rule that would defer MU Stage 2 until 2015.
• Phoebe Putney Health System is live on the Summit Healthcare Summit Care Exchange platform communicating with RelayHealth.
• CoverMyMeds’ CEO Matt Scantland shares the processes behind the company’s success with a local publication.
• McKesson will be the headline sponsor for the 5th Annual Health IT Leadership Summit November 20 in Atlanta.
• Newark Community Health Centers (NJ) will implement Forward Health Group’s PopulationManager for its seven clinics.

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.

Monday Morning Update 5/26/14

Top News

Cerner CEO Neal Patterson tells shareholders that the company is transitioning from a healthcare IT company to a healthcare company, echoing sentiments expressed in the company’s most recent earnings call. Cerner executives say the company will dominate areas that include aggregating information across providers, reducing healthcare costs, improving outcomes, and providing consulting services related to population health management.

Reader Comments

From Katherine Kroessler, MD: “Re: EMRs and Meaningful Use. The burden is overwhelming for small practices. More physicians will become employees and use systems where someone else crunches the numbers. My small practice’s EMR is fine for MU, but it has increased our overhead and staffing and thus has decreased physician income. We have some electronic lab/DI data and others come on paper. Docs fax paper referrals and we fax back paper consults because our systems don’t talk to each other. Information gets put in folders to be scanned and has to be tracked down when the patient is in the room. However, if you are in a large contained system, all of that works seamlessly. The government should have created an incentive for IT vendors to use the same interface requirements so their systems could talk to each other. Doctors are being reduced to clerks and spend more of their valuable time clicking boxes and coding unless they are part of a large infrastructure that automates that for you. I just hope that new doctors will know how to think about patients and not just how to copy and paste notes. Listening to our patients is our most important skill because, at least in neurology, 90 percent of the time the diagnosis comes from the history. Doctors will become employees of large systems and their thought processes and workups will be governed by those systems. Let’s hope the systems get it right because the MDs phasing out of medicine will all be Medicare patients soon enough.”

HIStalk Announcements and Requests

Eighty percent of respondents think ONC should certify EHRs only if they offer external program access (APIs) for interoperability. New poll to your right: is the Meaningful Use Stage 2 slowdown good or bad?

Announcements and Implementations

KLAS announces that it is developing a myKLAS mobile app.

Epic is named the #5 best company for employee pay and benefits in a Glassdoor review of employee surveys. It’s probably the one company on the list whose name the average American wouldn’t recognize.

Government and Politics

The White House says HHS has passed a cybersecurity assessment that was required by a presidential order, saying its voluntary efforts are sufficient to address cyber risk.

Oregon Governor John Kitzhaber said he fired the director of Oregon Health Authority in March effective immediately over the Cover Oregon health insurance exchange debacle that will end up costing nearly $300 million, but the local paper discovers that he’s still on full-time status and getting paid $14,425 per month, at least until July when his vacation pay runs out. Federal investigators issued several subpoenas last week to people at both the health authority and the insurance exchange, apparent interested in finding out whether state officials lied to CMS about the project’s status to get more federal money.  

CMS announces the second round winners of its Health Care Innovation Awards. Among them: $15.9 million to the American College of Cardiology Foundation for  the SMARTcare provider feedback and decision support tools for reduction of inappropriate procedures; $7 million to the Association of American Medical Colleges for an electronic consult and referral model in five academic medical centers; and $10 million to UCSF for a monitoring system for dementia patients.

Sam Foote, MD, the retired Phoenix VA doctor who turned wait list whistleblower, says in a New York Times opinion piece that he doesn’t think the current VA investigation will be effective because it’s being performed by Veterans Integrated Service Network office workers who will just ask employees a few questions, while he would rather see an anonymous electronic provider survey. He also says the VA’s VistA system is excellent and second to none in transferring information from one VA facility to another. He concludes by saying that any negative findings will be pushed back because it’s an election year.

Innovation and Research

Researchers at Stanford University develop an externally rechargeable embedded implant it calls an “electroceutical” that may be able to cure specific medical conditions using radio energy.

Other

The CEO of Athens Regional Health System (GA) resigns after problems with its Cerner implementation. A dozen doctors sent a letter to administration complaining about lost orders, medication errors, ED patients leaving AMA after long waits, and an inpatient who wasn’t seen for five days. They also complain that the implementation timeline is too aggressive and the users aren’t ready. The doctors claim that Cerner problems have caused several doctors to drop their hospital privileges and others to send patients to a competing hospital. The health systems foundation VP said in a letter to donors and volunteers, “The last three weeks have been very challenging for our physicians, nurses, and staff … parts of the system are working well while others are not.”

HIMSS congratulates some new EMRAM Stage 6 organizations.

Medical educators say that doctors are losing the ability to diagnose based on a physical examination, instead relying on sophisticated tests. One says he has seen cases where “technology, unguided by bedside skills, took physicians down a path where tests begot tests and where, at the end, there was usually a surgeon and often a lawyer. Sometimes even an undertaker.” Medical schools are going back to basics, teaching students, for example, to use a stethoscope instead of an EKG. A former NEJM editor weighs in after his experience as a patient at Mass General: “Doctors now spend more time with their computers than at the bedside,” with electronic medical records containing only short descriptions of how he felt and looked, but with “copious reports of the data from tests and monitoring devices” that generated few documented conversations. A professor and doctor tells the story of a resident desperately clicking through a febrile patient’s EHR looking for a cause when a short walk to the patient’s room would have made it obvious that his IV site was inflamed. Another says foreign doctors are more competent clinically than their American counterparts because they are either trained to rely less on technology or don’t have much of it available.

Saw screenshots of @VanderbiltU home-grown Electronic Medical Record today. Looks more impressive than Epic/Cerner.

— Pallav Sharda (@Pallavsharda) May 23, 2014

Someone asked me the other day if Vanderbilt was still using WizOrder. I assume so, even though McKesson’s commercialized version of it under the Horizon nameplate is being put slowly out to pasture.  Apparently this physician informaticist was impressed.

The Houma, LA paper profiles Objective Medical Systems, started by a group of cardiologists to create a specialty-specific EHR. It captures the output from medical devices, presents a combined view of test information, and can recommend research papers relevant to the patient’s condition.

Weird News Andy says we should fight illness with fist-bumps instead of handshakes according to a JAMA article that urges creating “handshake-free zones” to reduce the spread of pathogens. The article says shaking someone’s hand could eventually become as much of a social taboo as smoking.

Photo: Pete Marovich/EPA

Monday is Memorial Day, set aside to honor the one million US Armed Forces members who died while serving. Thanks to them, you are free to decide that you won’t fly the flag, visit a military cemetery, or think about those who made the ultimate sacrifice on your behalf. That’s not to say it wouldn’t be nice for you to do those things voluntarily on Monday. 

Book Report
Where Does It Hurt?

Where Does It Hurt? is an entertaining, punchy potpourri of ideas, just what you would expect from athenahealth’s Jonathan Bush and his professional co-author. The book is breezy and fun, with self-effacing humor and first-person stories about Bush’s experience with the healthcare system as a paramedic, a failed consultant, a failed birthing center operator, and now the successful co-founder of a pretty big back-office services and software provider.

Bush works his readers into righteous indignation by pointing out the fairly obvious things that are wrong with our broken and massively expensive healthcare system. Most of his anecdotal everyman ire is aimed at hospitals, which should be interesting since their fat and happy leadership (in his mind) are the prospects that will drive athenahealth’s planned growth into health systems. (He probably shouldn’t hand out copies of the book as part of the company’s pitch to hospital prospects.) 

Where Does It Hurt? delivers on its title, with nicely summarized and fun-to-read examples the maddeningly illogical healthcare system. Consumers rather than healthcare insiders are the target audience for the recitation of issues covered in far more specific and analytical detail elsewhere. As you would expect, Bush travels in circles different from the rest of us, so when he wants to learn something (and share it with readers), he has access to the CEOs and politicians who will tell him first hand.

Where it fails to deliver is on its subtitle: “An Entrepreneur’s Guide to Fixing Health Care.” The book is long on criticizing the system in its 241 pages, but short on offering new ideas about how fix it. He doesn’t fall short on “the vision thing,” but perhaps he could have been more prescriptive, especially given the barriers of government meddling, the political power of organizations profiting handsomely from the status quo, and the disconnect between those receiving services and those who pay for them, all of which have sucked the energy out of most of the good ideas that have floated around.

Early on, Bush declares that “healthcare is the new oil” in urging entrepreneurs to create profitable businesses that target monolithic, protective hospitals and the massive chunk of healthcare spending they consume. He provides fascinating examples such as Steward Health Care and Florida Woman Care, relayed mostly as conversations between himself and the CEO of those companies, and how they found easily picked low-hanging fruit in the inefficiency of their lumbering big-hospital competitors that weren’t adding much value in providing routine services.  He suggests that the idea of the Affordable Care Act had promise, but most of what it could have accomplished was neutered by special interest lobbyists into being little more than insurance for a lot more people instead of really reforming anything.

The “what should we do about it” message isn’t as clearly presented. After reading the book, I went back through it twice (it’s not all that big) to manually pick out what seem to be its main suggestions since it’s a bit all over the place.

• The industry should train lower-level people to perform routine tasks, just like the military does in turning an 18-year-old with poor academic achievement into a weapons operator by breaking everything down into simple steps. He wondered in his New Orleans EMT days why there weren’t a swarm of $9 per hour EMTs like himself providing services in the community rather than just hauling patients with routine problems to the ED (in the cab-u-lance, as he refers to it.) He sees retail clinics as a model that works for up to 70 percent of the patients who would otherwise be sitting in the expensive ED’s waiting room.
• Hospitals, especially academic medical centers, should transform into focused factories that offer fixed-priced services for specific, complex treatments in which they have developed notable expertise, leaving routine services to less-expensive providers. Hospitals fund their high-overhead operations by drastically marking up basic tests and procedures without adding any value and that money could be better spent elsewhere.
• Big hospitals should overcome their geographic constraints by employing telemedicine and providing air transportation for patients who need their specific treatments.
• Community hospitals shouldn’t get a free pass to make a lot of money just because they erect impressive buildings, staff EDs, hire a lot of people, and instill community pride. He says they should be reconfigured into providing emergency and high-acuity services and be paid accordingly since inpatient bed demand is already dropping significantly. He observes that hospitals are fighting to keep control of their fiefdoms, buying each other and medical practices to snuff out potential competitors that might undercut them in bidding for insurance company contracts.
• State-specific limitations on provider licensing and insurance sales should be eliminated, as should artificial provider limits such as certificates of need.
• Doctors should realize the power they have and band together rather than selling their practices to hospitals.
• The government should loosen up anti-kickback laws so that providers can pay each other for information, such as contributing data. (Bush adds an interesting note that doctors selling their practices to hospitals is the ultimate kickback given the increase in business hospitals get from their referrals.)
• The government should eliminate the requirement that only providers can run ACOs, opening up the market to entrepreneurs.
• Insurance companies should offer tailored packages instead of the one-size-fits-all type. They should also offer barebones plans for those who don’t need extensive coverage.
• The government should encourage new entrepreneurial insurance companies by backing their risk as it does mortgages through Fannie Mae.
• Patients should be financially engaged in the healthcare decisions they make, should learn from each other, and should demand data.
• Providers should manage populations and offer health management rather than just healthcare services, such as coaching, classes, and exercise.
• Epic is part of the problem because it was designed to do what big academic medical centers want – protect their near-monopolies. Its high price ensures that most independent practices can’t afford it, giving Epic’s big customers the leverage to tell those practices to use their Epic system (at a discount) or risk being left out, giving those hospitals more control of the market and the data needed to protect it.
• Entrepreneurs shouldn’t try to sell software to those big hospitals because the changes they will demand will reflect their inefficiency, turning the entrepreneur’s fresh approach into the same old systems everybody else is selling.
• Data is the key to figuring out which treatments are effective.

I enjoyed the book and recommend it for those not expecting magic answers. It contains a lot more observations of problems than solutions, and healthcare insiders won’t learn very much from the admittedly interesting presentation of what’s wrong with healthcare. If I got my $11.99 worth (Kindle edition) it would probably be because it’s entertaining to hear Bush’s take on what those of us in healthcare see every day as being part of that expensive system that needs to be overhauled. You can hear a lot of Jonathan Bush’s ideas for free by watching business TV shows, so there’s no reason to sit impatiently waiting for the sequel.

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 5/23/14

Top News

Nevada fires health insurance exchange contractor Xerox and announces plans to shut down its site, saying it will instead rely on Healthcare.gov for at least a year and then decide whether to spend many more millions to build a new exchange. The state has paid Xerox $12 million of the $72 million contract value and says the site’s many problems can’t be fixed by the next enrollment period that starts in November despite a personal promise from the CEO of Xerox. According to a board member, “We’ve seen so many broken promises from Xerox on how they’re going to fix it that at some point it just becomes not credible.”

Reader Comments

From Skeptic: “Re: Patrick Dempsey investing in CrowdMed. He made a big splash in Seattle about a year ago, coming in to ‘save’ Tully’s, a local coffee company. After incredible news coverage, he pulled out as an investor.” Dempsey ended up suing his investment partner, claiming that the owner borrowed money against the coffee company’s assets at an exorbitant rate without telling him. I think I would be cautious about bringing in a celebrity investor with deep pockets and high visibility, but also an ego accustomed to constant care and feeding.

From Jackie: “Re: HIStalk emails. Just wanted to say I love the new format with a snapshot of the article and the time it will take to read it. Great idea!” Thanks. I’m not doing it for news posts since those are broken out by category and therefore reading time isn’t as relevant since not everybody reads them all.

From MoreCowBells: “Re: new CMS rule. The press release includes the matrix you published, but not the asterisk and footnote. For Stage 2 sites, it makes a hug difference in what they will and won’t be able to do to attest.” Above is the footnoted version from the NPRM (highlighting mine), which seems to suggest that 2011 Edition CEHRT can be used in 2014 only if the provider’s EHR vendor hasn’t released a 2014 certified product. Lots of people are complaining about the proposed change for one reason or another, but the bottom line is that as long as providers plan to keep cashing HITECH checks, Uncle Sam gets to attach the strings. It also provides a lesson learned: if more than 20 percent of providers are moaning that they won’t be ready by a given federal deadline, don’t bother getting ready yourself because the date will be moved back.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Logicworks. The New York City-based company, founded in 1993, helps providers meet MU Stage 2 requirements to automate security risk analysis, address encryption and security of data at rest, and implement security updates. It offers an application-specific solution for NIST 800-certified cloud-based offsite disaster recovery for EHRs, with unplanned system failover with less than two hours of downtime. Its medical image archive and vendor-neutral archive for PACS breaks the never-ending cycle of adding storage capacity as imaging data grows. The company can help with application decommissioning as well, retaining legacy data in a cost-effective, HIPAA-compliant cloud. Logicworks also offers cloud solutions (public, private, and hybrid) and managed Amazon Web Services cloud hosting. As the company says, customers don’t come to it looking for a cloud, they’re looking for solutions for particular problems, and that’s what they offer. Thanks to Logicworks for supporting HIStalk.

I cruised YouTube to see what’s available for Logicworks and found this overview.

This week on HIStalk Practice: HHS representatives weigh the pros and cons of using Medicare data to alert public health officials to the potential needs of vulnerable patients during a disaster. Accountable Care Options and its physician network earn a $4.2 million bonus from CMS as part of its participation in the Medicare Shared Savings program. Oncologists list the pros and cons of moving from independent practice to hospital employment. A solo physician line items his reasons for closing up shop, citing meaningful use of an EHR as the final straw. Health systems and public health departments enter the new world of urgent care and retail clinics. The VA’s troubles show no signs of being swept under the rug. CMS and ONC publish a proposed rule that would slow down the MU program by extending Stage 2 through 2016. The government considers a national “biosurveillance” system that will give it near real-time access to the private medical information of citizens in the name of national security. Not all physicians stick their heads in the sand when it comes to online reviews. Thanks for reading.

This week on HIStalk Connect: As Apple’s WWDC nears, Dr. Travis speculates on how its anticipated new mHealth app Healthbook will work. Rock Health introduces its sixth class of startups that focus on ICU analytics tools, primary care telehealth, population health, and a private health insurance exchange. High school Junior Jack Andraka wins the Siemens We Can Change The World Challenge with a water purification text that is nearly 200,000 times cheaper than currently available tests, also having in 2012  won the Intel International Science and Engineering Fair with a new pancreas cancer screening test that is 168 times faster and 400 times more accurate than currently available tests. Mango Health raises a massive $5.25 million Series A round for its medication adherence app.

Acquisitions, Funding, Business, and Stock

Healthcare consumer marketing vendor Clariture gets $1 million in seed funding from Nashville VC The Martin Companies.

ZirMed acquires population health management platform vendor Intelligent Healthcare.

Sales

Marshfield Clinic chooses Strata Decision Technology’s StrataJazz as its integrated financial platform.

Community Care of North Carolina will implement CitiusTech’s BI-Clinical platform.

St. Joseph Health (CA) selects InterSystems HealthShare for its data sharing initiative.

People

AMC Health names Walter D. Hosp (HMS Holdings) to the newly created position of CFO.

Intelligent InSites names Shane Waslaski (Varistar) as president and CEO.

MEA|NEA appoints Mary Dooley (Xerox) as director of sales, partners, and channels.

Announcements and Implementations

Henry Schein Medical will offer athenahealth’s services to its customers as part of its ConnectHealth offering that includes Dell, Midmark, Siemens, and Welch Allyn.

Ping Identity announces Ping One, a mobile app for single sign-on for iPhone, iPad, and Android devices.

Government and Politics

The Senate shelves the Innovation Act, a patent reform bill overwhelmingly approved by the House that would have made it harder for patent trolls to sue companies (most of them in the technology sector) using dubious patent claims. Senator Patrick Leahy (D-VT) removed the bill from the Senate Judiciary Committee, stating in his announcement that patent trolls are a real problem, but that the proposed bill would have imposed unintended consequences on legitimate patent holders.  

Innovation and Research

A JAMA opinion article on big biomedical data says that deep EHR information can be connected to broad data sources such as claims data, social media, and credit card purchase history to create a big-picture view of individual patients and their health risks. The problems are lack of a national patient identifier and privacy and security concerns. The authors are Harvard docs Griffin Weber, MD, PhD; Kenneth Mandl, MD, MPH; and Isaac Kohane, MD, PhD. I would think that a patient survey would find considerable discomfort with this possibility.

Other

The Houston paper profiles Memorial Hermann Hospital’s Virtual Care Check program, in which discharged patients at high risk for readmission receive home visits and are monitored remotely via a scale, blood pressure cuff, pulse oximeter, daily questionnaires, and a tablet running software from the hospital’s partner Vivify Health.  The hospital says the program’s patients are readmitted as low as 5 percent of the time vs. the national average of 12-15 percent. Memorial Hermann also announces the rollout of a free 24-hour RN-staffed Nurse Triage Call Center that anyone in greater Houston can call to ask questions or determine where to seek care, created after a study found that about half of Harris County ED patients could have been managed in a primary care setting.

Valley View Medical Center (AZ) loses its external phone connectivity and computer network for 11 hours after a Frontier Communications outage caused by a damaged cable.

Surescripts says that more than half of all eligible prescriptions in 2013 were transmitted electronically, with nearly three-fourths of office-based physicians using e-prescribing.

A law firm that had just won a $25 million verdict against a Korea-based medical imaging company withdraws from the case when its client, Texas-based cardiac MRI vendor LDBS, admits that a Cerner contract it introduced into evidence was falsified by using a fictitious email address. The CEO of LDBS had claimed he attended RSNA 2010 and saw the Korean company’s engineers demonstrating LDBS’s technology in a competitor’s booth.

A Reuters investigative report says that a grand Black Sea estate allegedly built for Russian President Vladimir Putin was paid for by skimming money from $200 million in inflated medical equipment contracts. The report names two people it claims bought medical equipment from Siemens and then sold it at inflated prices to the Russian government as part of a $1 billion healthcare modernization project, with $56 million of the money finding its way to Swiss bank accounts and then to the builder of the estate.

An AHRQ hospital survey on patient safety culture finds that while organizations are encouraging teamwork and organizational learning, more than half of respondents fear mistakes they make will be held against them, nearly half say patient care information isn’t communicated well when patients are transferred or during shift changes, and nearly half think employees are too overworked to provide the highest quality care.

An PwC report says Hispanics will drive the US healthcare economy because: (a) more than 10 million of them will gain insurance through the Affordable Care Act; (b) they are cost-conscious; (c) they are heavy mobile users; (d) they don’t like sharing medical information; (e) less than half have a regular doctor and they don’t necessarily believe that the doctor knows best; (e) they will use retail clinics, community health clinics, and pharmacists to manage non-urgent problems; (f) they distrust the government and insurance companies and would rather see information in English since the translations are often poorly done.

NPR profiles Qstream, a Harvard-created company that sends sequential emailed quiz questions to doctors and nurses to keep their education current. Eight Boston hospitals are testing a series of blood pressure questions that use bizarre stock photos and memorably silly cases to entertain and inform the recipients, who often compete against other using assumed names. Hospitals are posting leaderboards of the aliased participants, and as always happens with anonymized physician performance metrics, the always-competitive doctors have figured out who is who and where they stand among their peers. 

Sponsor Updates

• HealthMEDX is rated as the #1 EMR vendor in the new KLAS report, “Long-Term Care 2014: Which Vendors Deliver on the Fundamentals?” with 100 percent of customers saying they would buy its product again.
• Forward Health Group CEO Michael Barbouche will speak at Connecting Michigan for Health June 4-6  in Lansing. He presented last week at the CEhp’s Alliance Industry Summit in New Brunswick, NJ.
• Nordic releases a case study on Baylor Scott & White’s use of its remote solutions offering for go-live support.
• DataMotion discusses current and future email regulations.
• Premier Inc’s safety expert Gina Pugliese joins The Physician-Patient Alliance for Health & Safety board of advisors.
• Kareo is selected as a 2014 Red Herring Top 100 North American award winner.
• GetWellNetwork clients experience a 76 percent improvement in pain well controlled as well as improvements in environment of care, medication teaching, heart failure readmissions, and falls.
• MedAssets announces that its 2014 Technology and Innovation Expo, to be held October 28 in Dallas, TX, is accepting applications for exhibitors.
• NTT Data commits  three years of support for the North Texas Food Bank’s Food 4 Kids – Plano Program.
• OTTR Chronic Care Solutions will integrate XynManagement’s XynSiteTM suite of data analysis tool with its longitudinal patient tracking solutions and services.
• Nuance will add voice capabilities to Oracle mobile apps.

EPtalk by Dr. Jayne

As you would expect, the hot news in the administrative halls of our medical group this week was the play by CMS to again change the game for Meaningful Use. On the first pass, it looks like a benefit for providers, but I’m always skeptical until I look at the complexity of the details. Honestly, I tried to read the entire document (which at only 28 pages is nothing compared to the other Proposed Rules that emanate from CMS) but just couldn’t make it through.

I’m a TV junkie, so I was reminded of an episode of “Grey’s Anatomy.” One of the characters has a photographic memory. Some of the senior residents need information from paper charts to prep for their oral board exams, but they can’t take the charts to study them. They convince Lexie to try to memorize the charts and she starts, but partway through, she just snaps and her brain quits working. Another character makes a comment along the lines of, “You broke her.”

After today, I know how that feels. My boss expects me to be an expert on everything CMS within moments of its release. There is just no way to do so. CMS often conflicts itself (look at the FAQ evolution if you think I’m kidding) and delegates authority to a maze of regional contractors who each make their own de facto rules.

As a provider, I’ve had it up to here with CMS and Congress meddling in health care. If I was an independent physician, this would be the final straw that would convince me to opt out of Medicare and take my chances.

I’m a good reader, logical thinker, and smart enough to make it through medical school, yet I cannot begin to understand all of the regulations, especially when they start conflicting with each other. Our health system now employs a team of people to try to keep up with them and we can barely keep our heads above water. By extension, I can see no way (other than paying a fleet of consultants or going crazy) an independent provider can hope to play the game.

And that’s what it is — a game. Meaningful Use is just another fiery hoop for everyone to jump through. Since it’s all or none, you can work yourself to the bone, have everything right, but be thwarted by arcane rounding rules (don’t get me started) that will defeat you in the end. You can be defeated by patients who refuse to comply with your advice and have no interest in accessing their records. (I was visiting a practice today where nearly 80 percent of the patients refused their clinical summary documents or left them in the exam room.)

You can be defeated by the inability to get all the reports to run at the end of your attestation quarter if you’re trying to hit July / August / September. There’s no grace period – attestation has to be done by October 1 – so prepare for an all-nighter. If you have a power outage, you’re doomed. Hope there aren’t any hurricanes that weekend for our east coast readers trying to squeeze it in.

Anyway, we’ve all been through the angst of this for months and months, and now they’re going to probably change the dates again. We don’t know whether we can trust CMS. We don’t know how hard to work in the mean time – there is a 60-day window for commentary on the rule and no guarantees that it will be put into place unchanged – so essentially many of us are still on the hamster wheel whether we want to be or not. It’s discouraging, disheartening, and disrespectful to the many people who have worked so hard over the last year, only to have the end game change again.

I understand how we came to be here. I understand population health and the need to have big data. I understand the need to see vast numbers of patients to make sure everyone is served. I understand the need to coordinate care. But on the other hand, I understand the need to be able to spend my time just being a doctor – listening to patients, understanding their needs, and helping them get better. It seems that has been completely lost in all the noise and churn of regulations, guidelines, and rulemaking.

I’m not old enough to have practiced in the “olden days” of medicine when you could get away with writing a note that said “Sick – Penicillin” and charge $5 and be done with it. I certainly see the appeal however. I wonder if I could deliver primary care much cheaper if I went to the old-school approach? Without insurance or all the referral-chasing, I could probably slash my overhead by 80 percent. Without all the overhead, I could lower my prices. With lower prices and fewer distractions, I could help more patients. This is the heart of the direct primary care model, which is gaining traction in many communities. It’s an appealing proposition for more and more physicians.

A lot of providers who are learning to use electronic health records complain of being turned into data entry clerks or having to take on the duties that used to belong to the unit secretary. I initially went into IT and administration to help patients (and my peers) at a higher level. Unfortunately, I’m spending more time chasing federal rules, reading legislation, and trying to understand arcane documents than I ever thought possible.

Maybe I should have gone to law school after all. Maybe it’s just CMIO burnout. Maybe my brain is broken. Maybe I just need to get over it.  But on the other hand, maybe we just need all these other entities to get out of our patient -physician relationships.

What do you think about the proposed changes to MU? 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 5/21/14

Top News

CMS and ONC publish a proposed rule that would slow down the Meaningful Use program by extending Stage 2 through 2016 (starting Stage 3 in 2017) and allowing providers to attest for FY2014 using a 2011-certified EHR. National Coordinator Karen DeSalvo, MD seemed to express concern that EHR vendors would not have their products certified under the 2014 criteria in time, referring to users would would miss the dates “through no fault of their own,” while the bill referred to “availability and timing of product installation, deployment of new processes and workflows, and employee training.” Public comment on the proposed bill will be open for 60 days. The proposed change follows CMS’s acknowledgment that almost no providers have attested for Stage 2 so far. CMS had also previously defined a easily claimed, one-year hardship exception for providers unable to meet Meaningful Use dates.

Reader Comments

From Hogan: “Re: Centura. Their selection of Epic hurts Meditech since they are a large percentage of Meditech’s Stage 7 hospitals. In England, InterSystems was named vendor of choice against Epic and Meditech in a three-trust procurement called SmartCare. Epic won the clinical vote, but lost on price. It’s interesting that outside the US, Epic and InterSystems compete.”

From Topaz: “Re: health equipment innovators. I live in the Netherlands and a colleague is looking for help for his 16-year-old daughter Doreen, who is paralyzed. It is hard to get equipment in Dutch healthcare. Are companies in America looking for people to test their developments?” I created an online contact form for anyone who wants to get in touch.

From Arborio MD: “Re: Health Datapalooza. I am so happy that Mr. H decided to go this year so we can all enjoy vicariously the platitudes from Vinod Khosla, who believes that 80 percent of doctors can be replaced by technology, and 20-cups-a-day coffee drinkers who in their garages and basements hope to disrupt healthcare and become millionaires overnight in the process. The sad part is that even respectable HIT leaders like Ed Park recognize the big schism between the promise of Big Data in healthcare and the reality. Last year athenahealth sent 40 people, while AMA – whose president, Dr. Ardis Dee Hoven, has not even heard of this conference — sent only one. I wonder how many docs toiling down in the trenches are even aware that a bunch of geeks are about to eat their lunch?”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Healthcare Data Solutions. The healthcare-only Irvine, CA-based company offers databases of providers (physicians, dentists, PAs, NPs, pharmacies, hospitals, and EHR users); email lists and services;  and real-time physician verification for open payments, state license verification, and DEA/NPI validation. Customer testimonials on the company’s site vouch for its “great pricing,” “most dependable data,” and “data models [that] are a perfect fit.” EHR vendors use the company’s physician database for marketing and to determine if the provider has implemented an EHR. The company offers white papers, webinars, and database layouts on its site. Clients include MD Anderson, UC Irvine Health, Cedars-Sinai, NextGen,, and Philips. Thanks to Healthcare Data Solutions for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Excited to announce my investment in @CrowdMed! Check out the @WSJ story by @lorakolodny: http://t.co/KhJbIW8szc. @jaredheyman @patrickchung

— Patrick Dempsey (@PatrickDempsey) May 20, 2014

”Grey’s Anatomy” actor Patrick Dempsey invests an unspecified amount in startup CrowdMed, which crowdsources diagnoses using volunteer clinicians called “Medical Detectives.” PR from someone who used to play a doctor on TV may not be all that appealing to the real experts whose free labor fuels the business model.

Cleveland Clinic forms a joint venture with telemedicine kiosk vendor HealthSpot and will integrate its product with the clinic’s Epic system.  

Sales

Vanderbilt University Medical Center chooses Allscripts EPSi for financial planning.

American Samoa Medical Center will implement Medsphere’s OpenVista EHR.

Atlantic Health System (NJ) selects TeraMedica’s Evercore Clinical Enterprise Suite for vendor-neutral archive storage of both DICOM and non-DICOM data.

Delaware Health Information Network will implement Halfpenny Technologies’ intelligent integration technology hub.

Advocate Health Care chooses identity and access management systems from Courion.

Avita Health System (OH) will implement NextGen Healthcare’s EHR, practice management, patient portal, population health EHR Connect, and ED solutions at its two hospitals.

People

Karen Chapman (Northrop Grumman) joins Medicomp Systems as senior product manager.

Phoenix Health Systems names Jim Griffith (Siemens Medical Solutions Health Services Division) as EVP/COO.

Vocera announces that CFO William Zerella will resign on June 6 to become CFO of an unnamed pre-IPO consumer wearables company. Vocera also announced that Bob Zollars has transitioned from executive chairman to chairman of the board.  

Terry Cameron (Emdeon) joins Recondo Technology as president and COO.

Announcements and Implementations

Beacon Partners will implement and offer advisory services to providers deploying Caradigm’s Risk Management and Care Management population health management products.

Philips releases eCareManager 4.0 that includes acute care, part of its Hospital to Home telehealth program.

MyMedicalRecords adds three more patents to sue EHR vendors over: EHRs in clinical trials, online sharing of medical records, and legal records including power of attorney and wills. As you might expect, the announcement promises litigation rather than innovation: “MMR’s goal is to leverage its products and services and patents and other intellectual property to create working relationships with more companies in the biotechnology field so that patients and shareholders ultimately benefit.”

Pharmacy systems vendor PioneerRX will replace its existing drug database with Elsevier’s Gold Standard Drug Database.

Greater Regional Medical Center (IA) goes live on PeriGen’s PeriCALM.

Government and Politics

The VA opens an investigation of the Gainesville, FL VA hospital after discovering that employees were keeping follow-up appointment schedules on paper instead of on the electronic system that made results visible to VA management.

House Oversight Chairman Rep. Darrell Issa (R-CA) chews out the CMS official in charge of fraud prevention for falling several months behind on delivering a report that will document the effectiveness of CMS’s fraud prevention software.

Other

The CEO of Massena Memorial Hospital (NY) blames Meditech’s LSS software, which he says “created some kind of strange numbers off the report,” for incorrect financial reports. He adds, “We’ve been experiencing over the last couple of months some significant issues with our LSS software system that was recently installed in a number of our physician offices.” 

The AMA’s American Medical News shuts down after 55 years due to a 67 percent drop in annual revenue caused by declining circulation and ad revenue. The publication transitioned poorly to an online format and was hit hard by declining drug company advertising.

In Australia, a review panel suggests that the personally controlled health record (PCEHR) be renamed to My Health Record, that participation be changed from opt-in to opt-out to increase enrollment from the current single-digit percentages, that physician usability be improved, and that doctors be paid incentives tied to meaningful use metrics and their contribution of patient data to the common record. The panel also recommends that the National eHealth Transition Authority be dissolved and its oversight role transferred to a group called Australian Commission for Electronic Health that would include clinicians and software vendors.

The City of New York temporarily halts its 911 communications project, which was supposed to take five years and cost $1.3 billion, now at the 10-year mark with estimated costs at over $2 billion.

A Commonwealth Fund survey finds that EHR adoption by federally qualified centers more than doubled from 2009 to 2013, with 93 percent of them running an EHR and 75 percent meeting MU requirements. Most of them do CPOE, clinical documentation, and lab results, but only about half say their providers have access to clinical decision support beyond canned drug warnings. The FQHCs say their biggest EHR-related problems are undertrained staff and loss of productivity.

A former nurse at Houston Methodist Hospital (TX) files suit against the hospital and hopes to turn it into a class action, claiming that the hospital’s time tracking system deducts 30 minutes for lunch even when the employee’s duties preclude stepping away.

In England, the CEO of a hospital is criticized for describing hospital patient care errors in her tweets. She has only 200 followers and uses her account mostly to praise employees and promote hospital events, but had some such as, “Signed patient letter enclosing incident investigation report following medication error openness+learning essential feedback= improvement.”

A care coordination “virtual health village” and single, real-time electronic health record for students of two Pennsylvania school districts has enrolled only 4,000 of 32,000 students, a quarter of the expected number. Health officials planned to make enrollment opt-out until attorneys from the school districts told them that HIPAA requires opt-in, meaning students have to request access. The schools used $850,000 in grant money to hire an outside vendor to create the exchange and connect it to the EHRs of local hospitals.

Weird News Andy calls this story “Wide-Eyed Wonder.” Texas doctors are working on an app that detects “white eye,” the opposite of the red-eye reflection effect that is normal when someone takes a flash picture. A white reflection is abnormal and indicate the possible presence of several eye problems, including a rare eye tumor.

Sponsor Updates

• InstaMed releases its “2013 Trends in Healthcare Payments Annual Report” as a video.
• CompuGroup Medical’s three EHRs earn ONC 2014 certification as Complete Ambulatory EHRs.
• McKesson Total Payment achieves a CMMI Level 3 appraisal rating.
• Arcadia Healthcare Solutions offers a white paper on pay-for-performance strategies.
• Extension Healthcare is participating in an elite platinum sponsor two-year initiative of the National Coalition for Alarm Management Safety.
• MissionPoint Health Partners (TN) and Hospital Corporation of America’s South Atlantic Division (SC/GA/FL) are awarded the 2014 Crimson Physician Partnership Award during The Advisory Board Company’s national Crimson summit in Orlando.
• EBSCO Health’s Patient Education Reference receives certification as an EHR Module for inpatient and ambulatory settings.
• Ingenious Med is named a Pacesetter by The Atlanta Business Chronicle.
• Sagacious Consultants launches Sagacious Go-Live Success for hospitals and clinics at the go-live juncture with Epic.
• Covisint launches its Certified Service Partner Program.
• NantHealth SVP and iSirona founder Dave Dyell is named a finalist for Ernst & Young Entrepreneur of the Year award.
• RazorInsights will incorporate TruCode’s Encoder Essentials into its ONE Enterprise HIS solution offering an integrated encoding solution with its HIS.
• Walnut Hill Medical Center (TX) opens its doors with 75 Voalte smartphones following its iHospital initiative.
• Valence Health launches Valence Partner Network to offer complementary solutions to its client base.

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.

Monday Morning Update 5/19/14

Top News

Robert Petzel, the VA’s undersecretary of health, resigns over allegations of falsified electronic wait time records at  the Phoenix VA hospital. The only benefit is political since Petzel had previously announced plans to retire this year. Arguably the VA and Kaiser have led the healthcare industry in innovation, quality management, and use of technology even though the VA is, like all federal agencies, a politically motivated money pit. The VA’s problem is the tsunami of returning veterans who were sent off in huge numbers to fight pointless political wars that left many of them physically and psychologically damaged, leaving the VA to pick up the healthcare pieces with minimal increases in funding. It would be interesting to see the VA’s volume and quality metrics over the past 10 years. The VA is the ultimate ACO provider that might be able to provide warnings about the hazards ahead to the ready-fire-aim pioneers charging down the path of managing populations even though their outcomes and cost effectiveness in managing individual encounters have been unimpressive.

Reader Comments

From Beth: “Re: IT productivity. I’m looking for better ways to measure and compare with other facilities. Do people use closed help desk tickets, number of network nodes, number of user accounts, adjusted patient days, or some other formula?” Leave a comment if you can help Beth. It’s always tough to benchmark IT as an entire department since hospitals configure it differently – outsource parts of it, include biomedical engineering or not, have field support in individual hospitals in the system that aren’t assigned to corporate IT, use external consultants for application support or training, etc. I’m always skeptical of benchmarking since it’s hard to find a two hospital IT shops that are mostly alike, not to mention that once metrics have been identified, everybody’s goal shifts to gaming them rather than actually improving service (see: VA patient scheduling.) It’s like school testing: the metrics are supposed to be a by-product of excellence, not the sole focus of the program where teachers teach run entire classes on how to pass standardized tests rather than comprehend reading and math. Maybe that’s a case for metric opacity vs. transparency – let an independent organization define and report the metrics as broad themes without telling anyone, including management, how they are measured. That keeps your help desk people from begging users on Friday to let them closed unresolved tickets so that Monday’s numbers don’t get them in trouble.

From The PACS Designer: “Re: Apple and biosensing. They have a patent for a pedometer that could be a biosensing device as well for an iWatch. Apple has hired biomedical engineers from Vital Connect, Masimo Corp., Sano Intelligence, and O2 MedTech.” The timing is good since the fitness tracking device craze is in full retreat, making it ripe to become just another part of your smartphone rather than a dedicated piece of hardware, much like portable music players. Few people want to pay $100 for a not terribly intelligent pedometer that needs to be recharged separately.

HIStalk Announcements and Requests

The recent buzz about athenahealth’s prospects and share price was negative to one-third of respondents. New poll to your right: should ONC require certified EHRs to offer open APIs? You can elaborate further after voting by adding comments to the poll.

Welcome to new HIStalk Platinum Sponsor Glytec. The Greenville, SC-based company is admirably focused on one big hospital problem: improving insulin management and glycemic control. Around 40 percent of inpatients experience hyperglycemia or hypoglycemia during their stay, which requires lot of clinician time and contributes to infection, length of stay, and mortality. Glytec’s Glucommander Suite is the only FDA-cleared glycemic management and surveillance system. It delivers physician-directed computer algorithms to both adult and pediatric patients and those on either IV or SC insulin. It offers one-click access to the patient’s chart in the EMR. GlucoSurveillance flags patients in real time who may require glycemic therapy, while GlucoMetrics Analytics monitors the success inpatient glycemic control initiatives. According to the VP of medical affairs of Sentara Healthcare, “If you aren’t using Glytec, you aren’t using the standard of care,” while University of Virginia’s consult team reported a length of stay reduction of over one full day in the first six months of using Glucommander. Thanks to Glytec for supporting HIStalk.

I found this just-published YouTube video by Sentara Healthcare describing  in a remarkably frank manner the problems it was having with glycemic control and how it uses Glytec’s eGlycemic Management system. It isn’t the usually glossy overview – the physicians in the video get into specific details, such as how they made EMR changes to drive some improvements but then “hit a wall.”

Listening: new Tori Amos.

Announcements and Implementations

Health Datapalooza announces the speaker lineup for its June 1-3 conference in Washington, DC: US CTO Todd Park, HHS Secretary Kathleen Sebelius, AHIP CEO Karen Ignagni, author and surgeon Atul Gawande, athenahealth CEO Jonathan Bush, UK Secretary of State for Health Jeremy Hunt, and Time author Steven Brill, among others. I’ll be there, so you’ll read more about it on HIStalk. I don’t attend many conferences and in fact I don’t even hear about most of them (the appetite for HIT-related conferences is apparently ferocious given the number of people who seem to make a career of tweeting from them), so if there’s one you recommend that’s worth the time and money to attend, let me know.

Massachusetts Health Data Consortium elects four new board members: Frank Barresi (VP/CIO, Fallon Health); Julie Berry (CIO, Steward Health Care System); Joseph Frassica, MD (VP and chief informatics / chief technology officer, Philips Healthcare); and James Noga (VP/CIO, Partners HealthCare.)

IBM announces that Modernizing Medicine is one of three partner companies that will release “Made with Watson” apps this year. The company offers specialty EMRs and is developing an iPad app that will guide physicians through a patient encounter to provide evidence-based medicine suggestions.

Other

Constantine Davides of AlphaOne Capital Partners LLC has updated his HIT Family Tree that shows pretty much every company’s acquisition history over the years. It is fascinating, useful, and sometimes a bit scary when you see the number of acquired pieces and parts that make up a vendor’s “integrated” systems.

Apple and Google drop their smartphone lawsuits against each other and agree to work together on patent reform.

The Chicago business paper describes interesting hospital-doctor conflicts at 313-bed Swedish Covenant Hospital (IL) following the hospital’s firing of its chief of medicine after he and other of his independent practitioner colleagues joined a rival hospital’s accountable care organization. The issues: (a) new payment models make it difficult for doctors who practice at multiple hospitals to choose their loyalties; (b) independent doctors say they are forced to take ED call, but most of the patients they see there are sent to the hospital’s employed physicians; (c) the hospital is demanding that independent practices adopt EHRs that integrate with their systems, leading to concerns that the hospital will use the information in them to tell them how to practice medicine (which of course they will since that’s the whole point of analytics-powered population health management, which like most powerful forces can be used for both good and evil.)

The former president of the Philippines, now a representative, proposes creating an Electronic Medical Record Center (an HIE-like central records strorage center) under the Department of Health, with initial funding of $230,000 USD.

Long Island Jewish Medical Center (NY) installs video cameras in all of its 24 operating rooms as a remote video auditing (RVA) system. Staff will check the cameras every two minutes to make sure the surgical teams take the mandatory pre-procedure timeouts and patient safety measures. The cameras will also be used to alert housekeeping of completed procedures so they can clean the room and as a video record that room disinfection was performed properly. The video can be monitored live throughout the OR and on smartphones. The system was provided by the hospital’s anesthesia contractor and Arrowsight, Inc., whose video system the hospital installed in 2011 to improve hand hygiene rates to nearly 90 percent (I’m picturing in-room loudspeakers from which emanate the stern voices of invisible handwashing video overlords who tell doctors to step away from the door and toward the sink.)

Centura Health (CO) will replace Meditech with Epic, a good source tells me.

Police say they may make more arrests in the identify theft case at Albany Medical Center (NY), in which a nurse and her boyfriend have been arrested for using the Social Security numbers of over 100 patients to apply for credit cards, write bad checks, and file fraudulent tax returns.

New tax returns filed by UPMC disclose that CEO Jeffrey Romoff was paid $6.6 million in 2012, with 30 other health system executives and physicians exceeding $1 million each in compensation. SVP/CIO Dan Drawbaugh makes the list with $1.6 million in 2012 income, a big drop from the $2.3 million he took home the previous year. UPMC is famously embroiled in a lawsuit with the City of Pittsburgh in claiming that it is a humble non-profit that should not contribute to the city’s budget by paying taxes.

Here is Regina Holliday’s keynote speech from the We Can Do Better conference from a couple of weeks ago.

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 5/16/14

Top News

Medfusion files suit against Allscripts, claiming the company didn’t live up to its agreement to resell Medfusion’s patient portal to EHR customers of Allscripts. Medfusion says Allscripts owes it $5 million, with damages potentially tripling the lawsuit’s value. The lawsuit claims:

• The companies signed a five-year agreement valid through July 17, 2014.
• Allscripts delayed implementation and billing of the Medfusion portal for more than a year for some customers, creating an unpaid backlog for Medfusion and causing the companies to amend the agreement to require Allscripts to start billing new customers within 30 days. Medfusion says that backlog cost it more than $10 million.
• Because Meaningful Use requirements were expected to boost demand for patient portals, Allscripts agreed to include the Medfusion portal in every new Enterprise and Pro deal it signed and market the product as its only portal solution.
• Allscripts refused to integrate Medfusion’s online forms capability.
• The companies amended their agreement to give Allscripts 55 percent of net revenue and recurring charges while Medfusion would get 45 percent.
• Allscripts acquired Jardogs early in 2013 and announced it without warning at HIMSS13, where Medfusion was co-marketing its portal with Allscripts.
• Allscripts started marketing the Jardogs product as its preferred solution (FollowMyHealth) before its contract with Medfusion ran out and also started converting customers waiting to have Medfusion’s portal implemented to the FollowMyHealth product.
• Allscripts created marketing material that compared the FollowMyHealth product to Medfusion’s with the conclusion that its own product was better.
• Allscripts stopped developing its end of any portal enhancements and blamed Medfusion when clients reported issues.
• Medfusion accused Allscripts of breach on April 14, 2014, saying it had not paid $5.5 million worth of outstanding invoices. Allscripts, it says, sent payment of just under $1 million in response and disputed the remainder.
• Medfusion says customers told it that Allscripts made misleading statements in trying to get them to sign three-year contracts with Allscripts, including that: (a) Allscripts had terminated the agreement due to Medfusion problems; (b) Medfusion was going out of business; (c) Medfusion wasn’t providing portal updates and the customer would have to implement the Allscripts product to qualify for Meaningful Use; and (g) customers would be invoiced for May even though Medfusion wasn’t invoicing Allscripts that month because of their dispute.

Reader Comments

From Hobie Cat: “Re: Google Glass. Being handed out to all medical students at UC Irvine. The link made the rounds this morning with the subject, ‘Does this have HIPAA violation written all over it?’ Perhaps someone from UC Irvine can chime in with thoughts on how they’re approaching HIPAA. I’ll also be curious about how patients respond to this technology during rounds and the perception of a student talking to themselves and head nodding toward the ceiling to wake up Glass while in the room with the patient… ‘Just turning on the Glass, yo!’” The medical school says students in their first two years will use Glass during anatomy and clinical skills courses, while those in their third and fourth years will wear it during their hospital rotations, especially in the ED and OR. Google stores the information saved by off-the-shelf Glass, so in the absence of a business associate agreement with Google (which they probably won’t sign since it’s a consumer device) and because Glass doesn’t encrypt, I would say its use in patient care settings is a HIPAA problem. However, the UCI announcement says they are using proprietary software that is HIPAA compliant, probably the Pristine system they were piloting earlier this year, so they are trusting their vendor.

From TooMuchCoffee: “Re: UK’s Royal Devon. Going to Epic, although ‘affordability is a huge issue.’ At least they’ll get something that works – NHS spent billions on a failed decade-long project involving GE Healthcare and other vendors that produced nothing.” Royal Devon and Exeter NHS Trust chooses Epic as vendor of choice. It will now undertake a 12-week study to see if it can afford it.

From Fighting Accountants: “Re: Northwestern telestroke team. Congratulations for winning the Innovation Award at their annual nursing fair. They save lives and improve outcomes where it wouldn’t otherwise be possible. Not all health IT is as painful as an EMR.”

From Joey Junior: “Re: Mayo. Heard any rumors about the Cerner-Epic faceoff?” I haven’t. I will defer to readers.

From Concerned: “Re: voice mail messages. I need HIStalk reader insight. A large academic hospital organization would like to store their voice mail messages on Exchange Server. I don’t feel that this is ideal, but does it actually violate HIPAA?” I’m sure an expert will weigh in, but my interpretation is that voice mails left by patients (which I assume is the content you are referring to) are not covered by HIPAA since they didn’t start out in electronic form, the provider didn’t listen to them initially, and nobody suggested the patient leave PHI-containing voice mails. Providers leaving messages for each other might be problematic, though, but the server is still inside the firewall and the messages can’t be forwarded outside or accessed without security credentials. I haven’t convinced myself, so let’s hear some other viewpoints.

HIStalk Announcements and Requests

Several of the reader-submitted items you see here came from the all-purpose contact form, which accepts comments and attachments and whisks them straight to my inbox, where they may age gracefully until I get to them.

Highlights from HIStalk Practice this week include: Xerox fares poorly when it comes to state Medicaid management systems. GA-HITREC’s Dominic Mack, MD weighs in on the HIMSS 2014 Regional Extension Survey results. Physicians have differing opinions about the business model of CrowdMed, which is looking to turn a profit via crowdsourced medical advice. ONC approves ANSI for a second term as an approved creditor for its HIT certification program. Athenahealth finds itself in the same quagmire as Facebook and Tesla. "Anonymous" sends letters to 30 patients alerting them to the ease of stealing their medical information. A solo-practice physician becomes the first in New Jersey to attest for MU Stage 2, thanks to help from NJ-HITEC. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the state of patient engagement and questions whether the Patient Engagement Framework, developed by the National eHealth Collaborative and HIMSS, is an ideal tool for benchmarking progress. Researchers at Johns Hopkins develop a smartphone-based carbon monoxide breathalyzer that they hope will provide smoking cessation programs the tools to objectively measure smoking abstinence more easily. Cedars-Sinai Health System announces that it has formed a partnership with MemorialCare Health System to create a shared health technology VC fund called Summation Health Ventures

Ms. Barnes sent this photo from her Mississippi kindergarten classroom, for which we as HIStalk readers provided write-and-wipe boards and markers (you can see them in front of the students) in response to her DonorsChoose grant request. She reports that the class is using them for practicing their writing and they wouldn’t have them otherwise because of district budget cuts.

Acquisitions, Funding, Business, and Stock 

Oscar, a technology-powered startup that sells medical insurance only to New York residents so far, raises another $80 million in funding, bringing its valuation to nearly $1 billion.

Sales

The VA chooses Agilex and Calgary Scientific for enterprise viewing of radiology images on a variety of devices.

People

Applied Health Analytics hires Craig Smith (The Advisory Board Company) as president of its Coalesce consulting division.

Lee Fowinkle (McKesson) joins InformedDNA as CTO.

Announcements and Implementations

 

Mercy Hospital (MO) breaks ground on its four-story, 120,000 square foot, $50 million virtual care center that will house its 300 telemedicine program employees for remote management of ICU, stroke, cardiology, sepsis, radiology, pathology, nurse on call, and home monitoring.

Health Care Cost Institute, a non-profit funded by UnitedHealth Group, will in Q1 2015 make available to the public medical claims data from private insurers, the first non-government healthcare pricing data to be released. Aetna, Humana, and Kaiser Permanente have signed on.

Government and Politics

HHS’s Medicare Fraud Strike Force charges 90 people, including 27 clinicians, for fraudulently billing Medicare for $260 million. The defendants were charged with a variety of activities that include paying pharmacy kickbacks, billing for undelivered products and services, charging the government for 1,000 unneeded power wheelchairs, and laundering money using Medicare beneficiary information. HHS also announced that it has indicted the Brooklyn surgeon who billed Medicare for $85 million worth of surgeries that he didn’t actually perform.

ONC chooses ANSI for a second three-year term as the accreditor of its certification bodies.

Innovation and Research

A study of primarily Iowa VA hospital ICUs finds that telemedicine didn’t reduce 30-day mortality rates or length of stay.

Other

A free, eight-week online course, “Exploration of SNOMED CT Basics,” runs through June 13 if you have time to double up on the video lectures to finish in time.

The Chicago-area nurses union National Nurses United launches a heavy-handed campaign against “experimental, unproven medical technology” (specifically, EHRs.) Much of it rings true, unfortunately, even the dot matrix printer.

Roshni Nadar Malhotra, the only child of a technology billionaire from India, will spend $168 million to build a network of Johns Hopkins-affiliated health clinics starting in New Delhi. She says IT will be a key component.

The Pittsburgh business paper reviews the federal tax forms of West Penn Allegheny Health System, noting that Allscripts was its second-highest paid contractor at $7.3 million.

Employees of a company that won a $1.2 billion HHS contract to process paper insurance applications from health insurance exchanges are staring at computer screens with nothing to do, a whistleblower claims. The whistleblower says the employees have been told to refresh their screens every 10 minutes to give the appearance that they are accomplishing something. Serco, the British contractor that won the big contract, is under investigation in England for overbilling the government. I wrote about the company in October 2013, including the patient harm it caused when it took over the largest pathology labs in England’s NHS in 2009.

An editorial by Newt Gingrich on the VA’s problems says the VA and DoD need to integrate their IT systems (which is much more of a DoD problem than a VA problem):

Every effort to integrate Department of Defense and VA medical record systems has failed. The result has been an absurd process of transitioning from active duty health services to VA health services. At a time when you can instantly make airline and hotel reservations or get money from an ATM worldwide in seconds, it takes 175 days to transition a veteran’s care from the Defense Department to the Department of Veterans Affairs. The DoD and VA spent $1.3 billion to build a joint electronic medical record system for their health care services before the two secretaries announced in February that they were abandoning the effort. This is on top of the over $2 billion the Defense Department has spent on a failed upgrade to its own electronic medical system.

The mHealth Summit opens its call for presentations for the 2014 meeting, due June 27. The meeting will be December 7-11 in National Harbor, MD.

Interesting: a suspicious fire in the medical records department of a psychiatric hospital in Trinidad and Tobago erupts one month after the health authority requested copies of the hospital’s medical equipment purchasing records. The hospital, which is looking at EHRs, says it will have to create records by asking patients about their history. It hopes to make a second set of paper records for patients to take home.

Weird News Andy says when it comes to cancer vs. measles, it’s no contest for this patient. Mayo Clinic doctors try a desperate cancer treatment in injecting enough genetically modified measles virus into a female patient to inoculate 10 million people. The doctors say the use of viruses to fight cancer, known as oncolytic virotherapy, has been tried since the 1950s and in this patient’s case, seems to have worked.

Sponsor Updates

• Extension Healthcare sponsors the National Coalition for Alarm Management Safety.
• Capario shares five facts about eligibility verification.
• Capsule’s Halley Cooksey relates the NFL draft to selecting a committee to evaluate technology.
• PatientKeeper posts its summer conference event schedule.
• Orchestrate Healthcare posts an article called “What is Healthcare IT Integration?”
• HDS will attend MUSE on May 27-30 in Dallas.
• Park Place International offers seven tips for project managers to get and stay organized.
• Jennifer Crowley from MedAptus discusses the importance of time in the daily life of a provider.
• The Outsourcing Center names Springhill Medical Center (AL) and Allscripts winners of its 2014 Outsourcing Excellence Award in the Best Healthcare category.
• TriZetto will offer  grouping, edit, compliance and pay-for-outcomes logic from 3M in its NetworX Pricer and NetworX Modeler solutions.
• Iatric Systems launches Business Associate Manager as a tool for compliance with the HIPAA Omnibus Final Rule.
• Sentry Data Systems completes a Service Organization Control 3 examination.
• Summit Healthcare joins the federal initiative for standards-based healthcare communication DirectTrust.
• Black Book names ADP AdvancedMD, Allscripts, Aprima, Care360 Quest, eClinicalWorks, eMDs, Greenway, Kareo, McKesson, and Optum to its list of top EHR, PM, and billing vendors.

EPtalk by Dr. Jayne

I was excited to hear about HR 4077 , which would exempt physicians and other healthcare professionals from antitrust laws when they take part in contract negotiations with health plans. Although it doesn’t apply to Medicare, Medicaid, or other governmental payers, it seems like it could help independent physicians as they fight the big payers. Having been part of such a physician network in the past (although it was determined that we violated antitrust laws and our contracts were voided) it could be a help for many providers.

My informaticist friend @techydoc tweeted a link to this healthcare data map last week. It’s amazing all the places our data goes, sometimes whether we want it to or not. Apparently one place data doesn’t go, however, is to my mom’s doctor appointment. Her physician recently moved from one practice location to another within the same physician group. Despite the fact that they’re on a common EHR platform and also have an HIE in place, she was told they had to key in all her information again. It’s a shame they didn’t catch her last name and give a better answer, because I implemented the EHR and HIE in question. Sounds like someone needs an in-service.

HIStalk Practice picked this up first, but I wanted to throw in my two cents on this study that concluded that costs rise when hospitals own physician practices. The data used for the analysis was for the period 2001-2007. It doesn’t take into account the shared savings plans that have come into play during the last six or seven years. There are also just too many confounding factors present. To get an accurate analysis, I think you’d have to have to control many more of the variables. Maybe in a couple of years we can get some robust data from Accountable Care Organizations that have both employed and independent provider participants.

From The Major: “Re: site visits. As usual, thanks for sharing. I have been through a site visit (as a consultant, and my client was the jerk) like that. We had an hour ride back from the site to his hospital, where I naively told him he wouldn’t learn anything if he didn’t listen and ask good questions.” Several readers wrote to commiserate about my recent site visit experience. I’m happy to report that I received a note of apology and a cookie basket for my staff. Either the CMIO understands his behavior wasn’t appreciated or one of his accompanying colleagues is trying to smooth things over for him.

From Oceans Eleven: “Re: site visits. A long time ago we were an early adopter of a particular vendor. Based on our success, we eventually did about 100 site visits over the first few years. What became apparent after the first few minutes with a couple of them was that they had no intention of signing with any vendor. Much to the chagrin of the sales guys, we immediately scaled back our planned agenda and sent them on their way to the beach, which was probably the covert reason for the visit.” I’ve looked at dozens of products over the years and that approach hadn’t occurred to me. I’m thinking the next site visit we do might have to consider geography as well as how similar the facility is to ours. Besides, it’s been a long winter and I’m feeling a little pale. I’m sure an increase in my Vitamin D would be beneficial.

Anyone who has ever engaged in a friendly game of Office Bingo should appreciate this card, courtesy of a reader at Authentic Medicine. I used it during a recent pep talk from our chief medical officer. She was trying to explain why it was a good idea that all the experienced emergency physicians are being let go so we can replace them with cheaper independent contractors who don’t know our hospital or our patient population. Did I mention the emergency department is barely a third of the way through with a massive construction project that has required everyone involved to bend over backwards to preserve quality patient care? The hospital is transitioning in a little over a month – it will be interesting if nothing else since we’ll have new residents and new attending at the same time. I reached BINGO after barely a handful of sentences.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.

News 5/14/14

Top News

The Phoenix VA hospital that is charged with creating a secret waitlist to hid months-long treatment delays waited until the last minute to implement the electronic waitlist system whose VA rollout started in 2001. According to a former VA official, “Phoenix was one of the very last to deploy. Transition from a paper-based system to the electronic one was not handled well. From what I hear, there was a great deal of resistance from staff as well.” The electronic system was introduced to increase transparency and reduce paper-based mistakes.

Reader Comments

From KD: “Re: Epic. I heard a rumor they will buying InterSystems. Any chance you can get the lowdown?” I haven’t heard anything and my one possible source hasn’t responded. I’m highly skeptical. Arguments for: Epic customers pay a lot for InterSystems Cache’ licenses and Epic and its customers are heavily dependent on that company as a result. Arguments against: almost everything else. The companies have been working collaboratively together for decades, their founders are billionaires and don’t need the money, Epic has never done an acquisition and that would be a huge one, and both companies generally stick to their knitting (the exception being a couple of InterSystems application acquisitions years ago.) I can’t imagine this is true.

From Lee Brother: “Re: MU Stage 2. At a conference, John Halamka says most hospitals will either apply for an exemption or quit the program completely.” That’s likely given that only four hospitals have attested so far. Running your business is more important than running after government money that comes with strings attached.

Acquisitions, Funding, Business, and Stock

Pharma commercialization services vendor Quintiles will acquire consulting firm Encore Health Resources, hoping to use real-time EHR information to give drug companies outcomes data. Houston-based Encore has 250 consultants.

McKesson announces Q4 results: revenue up 25 percent, adjusted EPS $2.55 vs. $1.48, beating consensus estimates of both. From the conference call:

• Technology Solutions revenue was down 1 percent on the quarter, up 5 percent on the year.
• The company expects Technology Solutions revenue to “decrease modestly” in FY2015 because of declining Horizon business and “the impact of eliminating a low-margin product line.”

The Advisory Board Company says in its earnings call that it paid $25 million to acquire HealthPost, a physician finder and appointment scheduling site that will be rolled into the company’s Crimson analytics offerings that are used by 1,400 hospitals. HealthPost has seven employees, seven customers, $1 million in annual revenue, and is break-even on the P&L side. According to Advisory Board Chairman and CEO Robert Musslewhite,

“HealthPost is a cloud-based ambulatory scheduling solution that enables health systems to reduce referral leakage and track new patients by using it. It does it with what we felt like was a market leading SaaS technology that enables physicians and consumers to identify the right provider of care, based on certain criteria, especially in terms of geography and it makes it a very easy one-click appointment booking experience for either the provider or the patient. So we’re excited about it. In terms of how we’re going to roll it out, it’s still TBD. I imagine we will have a program launch coming from it, then more news on that down the line. But your question — as your question indicate, its certainly very complimentary to a lot of the works that we do in Crimson Market Advantage and with our MRS acquisition from last summer.”

WestView Capital Partners makes a minority growth investment in Meditech technology solutions provider Park Place International.

Three Lawson Software founders will pay $5.8 million to settle insider trading charges related to the company’s 2011 acquisition by Infor.

Sales

Partners HealthCare (MA) will consolidate several laboratory, pathology, and blood banking systems in moving to systems from Sunquest.

Saint Francis Health System (OK) will deploy Perceptive Acuo VNA. 

University of Louisville Physicians (KY) selects Shareable Ink’s Anesthesia Cloud and ShareMU for 45 of its providers across 20 operating rooms.

Vanderbilt University Medical Center (TN) chooses CitiusTech’s BI-Clinical health content and analytics.

UW Medicine (WA) hires Versio (formerly known as ScribeRight Transcription Agency) to bring legacy ambulatory data into its new Epic system.

People

Medfusion names Michael Raymer (MModal) as VP of solutions management.

Predixion Software names Costa Harbilas (HP Software) as SVP of global sales and Terri Avnaim (Quest Software) as VP of marketing.

Abington Health (PA) hires Jonathan Sternlieb, MD (Holy Redeemer Health System) as CMIO.

Greg Shorten (Allscripts) joins Shareable Ink as chief growth officer.

Announcements and Implementations

Nominations are open through Thursday for Mosby’s Superheroes of Nursing contest.

EClinicalWorks says that more than half (580 of 1,147) of Federally Qualified Health Centers use its products, four of them being Davies winners.

Cerner’s community health work in Nevada, MO is profiled in the Kansas City paper, which points out that the healthcare IT market is maturing and the project can help generate consulting revenue for Cerner and enhancement of its Healthe Intent population health management software. According to Cerner’s population health VP, “It’s in the DNA of our company to have the vision and passion to fix what’s broken in health care. We’ve solved the data problem. Now, it’s not about what the doctor does. It’s about what the individual does.” According to an analyst of the all-important stock market, “Other than goodwill with the client, I’m not sure how they get paid for thinking about real-world population management.” The Healthe Intent system is running at two hospitals, one in Chicago and another in Vancouver, with a third to be announced.

Government and Politics

The Massachusetts Health Connector health insurance exchange failed because the three state agencies involved didn’t communicate with each other, according to a board member of the $57 million site, which the state will be replacing. "There wasn’t a single point of management. It was poorly set up and it was this horrible combination where the contractor [CGI] would get different orders and would do none of them."

North Carolina’s HHS signs a data use agreement with the NCHIE as part of a House bill that requires hospitals to submit the demographic and clinical data of Medicaid patients to the HIE, allowing DHHS to monitor services and patient safety.

Innovation and Research

Researchers develop a smartphone app that analyzes the voice tone of callers with bipolar disorder to provide an early warning of mood changes.

The SVP/MD of medicine and technology of medical device maker Medtronic says the company’s biggest competitor won’t be current players, but rather “will be Google. I am certain of it.” He cites Google’s $8 billion annual R&D budget and its recent work on a smart contact lens that can measure glucose levels. He adds about healthcare, "It’s where the money is. We’re spending 18 percent of the GDP on healthcare. Why wouldn’t they think that’s where they want to be? We spend more on healthcare than we do on manufacturing in the US, so everybody thinks it’s their destiny.”

Venture capitalist Beth Seidenberg, MD of Kleiner Perkins Caufield & Byers offers advice for entrepreneurs trying to get a foothold in the tricky world of digital health:

• Build interfaces to open up intentionally built data silos
• Help customers make their own decisions.
• Figure out a revenue model upfront.
• Make healthcare apps social so users don’t get bored.
• Include healthcare experts on the management team.

Other

Confused about “correlation” vs. “causation” when a shoddily created study claims that Event A must have caused Event B because they happened together? See the chart above from a website devoted to ridiculous examples of “Spurious Correlations.”

It seems there’s a national healthcare IT conference every week, and despite claims that everybody in healthcare is struggling financially, somehow those conference rooms (and $300 hotel rooms) keep filling up with attendees. I suspect many of those attendees just keep popping up at one conference or another since I don’t know many working people who have the travel budget and time off to support endless conference attendance. One conference I hadn’t heard of is running now: the National Healthcare Innovation Summit in Boston. It’s put together by HIMSS, apparently, since membership gets you a $700 discount on the $1,095 registration fee and the browser’s tab title is “HIMSS Innovation Summit.”

Amazing how whiny ppl are about "burden" of MU requirements. Seriously? Too bad, govt will likely cave. Sorry patients!

— Sean Nolan (@familyhealthguy) May 13, 2014

Above is a tweet from Microsoft HealthVault GM Sean Nolan, who says Meaningful Use complainers are “whiny.”

Financially struggling Cochise Regional Hospital (AZ) is fined for violating its license by not providing surgical services for two years, last cleaning its operating rooms in July 2012. The 25-bed hospital says part of its correction plan is to spend $2 million on an EHR. Its website touts its advanced technology from Empower Systems, which I’ve only mentioned once in HIStalk, in 2011 when the company’s CEO quit.

A report finds that at least 15 hospital executives in Connecticut were paid more than $1 million last year, including six from Yale New Haven Hospital alone. The VP of psychiatry at Hartford Hospital made $3.24 million.

The UPMC employee who sued her employer for a data breach drops payroll processor Ultimate Software Group from her suit, saying she was mistaken in thinking that UPMC used its services.

University of Mississippi Medical Center CIO David Chou lists 10 technologies that are revolutionizing health IT:

1. Smartphones
2. WiFi
3. BYOD
4. Government mandates
5. VoIP
6. Social media
7. Virtualization
8. IP-based medical devices
9. Mobile health
10. Big data

Johns Hopkins School of Nursing offers a free, five-week course (known as a MOOC, or massive, online course) on “The Science of Safety in Healthcare” starting June 2. Pay $39 and you get a certificate; add another $60 for CNE hours. Peter Pronovost is one of the instructors.

Two tear-down analyses of Google Glass find that the $1,500 gadget contains either $80 or $152 worth of parts.

Weird News Andy questions, “Dim bulbs or bright lights?” Two British doctors refuse to use energy-saving light bulbs in their homes and instead stocked up on the obsolete incandescent types. One claims the bulbs cause sunburn-type damage over time, while the other worries about the possibility of cataracts and macular degeneration.

Sponsor Updates

• Portland (OR) IPA certifies a pilot group of clinics for NCQA’s Patient-Centered Specialty Practice Recognition using the IRIS referral management system of Proximare Health.
• Allscripts announces GA of Sunrise Surgical Care 14.2.
• GetWellNetwork CIO David Muntz will deliver the keynote address at the DoD/VA Healthcare Summit in San Antonio, TX next week.
• TriZetto will offer Enkata’s claims processing system to its consulting clients.
• EDCO Health Information Solutions publishes a blog post, “True or False: Decentralized Records Scanning Reduces Chart Quality.”
• A Beacon Partners blog post urges providers to use the ICD-10 delay to gain a competitive advantage.
• Visage Imaging will demonstrate its enterprising imaging platform at the SIIM annual meeting in Long Beach, CA this week.
• Holon discusses the use of HIE for for identifying and reducing ED frequent fliers in a recent blog posting.
• Wolters Kluwer will sell POC clinical decision support solutions to nursing schools for use in their curriculum.
• CliniComp will participate in the Association of Women’s Health, Obstetric and Neonatal Nurses 2014 Convention June 14-18 in Orlando.
• Health Catalyst shares its history, goals, and direction.
• AirWatch expresses its intention to continue working with BlackBerry.
• Shareable Ink announces the members for its newly-formed Anesthesia Leadership Board.
• ADP AdvancedMD offers a guide on how financial reporting is changing the way private practices operate.
• Terry Edwards, CEO of PerfectServe, will speak at the WLSA Convergence Summit in San Diego May 14.
• Arcadia Healthcare Solutions, Certify Data Systems, and CTG Health Solutions executives weigh in on the challenges of forming and operating an ACO.
• Truven Health Analytics will provide technical support for CMS during the Testing Experience and Functional Tools demonstrations in Community-Based Long Term Services and Supports program.
• CommVault extends its relationship with Microsoft to provide data management and protection.
• Navicure achieves faster product development times by using of VMware vCloud Suite for provisional testing and development environments.
• MModal opens a healthcare technology center in Bangalore, India.
• Lexmark’s Perceptive Software passes all integration tests at the 2014 IHE North American and European Connectathons.
• NextGen Healthcare earns its third Surescripts White Coat of Quality award.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.

Encore Health Resources, HealthPost Acquired

Drug research and services vendor Quintiles announced this morning that it will acquire health IT consulting firm Encore Health Resources. Terms were not disclosed.

According to Quintiles CEO Tom Pike:

Today’s announcement signifies the increasing importance of leveraging EHR and real-world information to inform our customers and improve their probability of success. Encore has significant EHR expertise, strong relationships with many large U.S. provider networks and academic medical centers as well as experienced consultants, proven tools, and methodologies. It will be a key strategic addition for our business that will extend our services suite and allow us to work with Encore to strengthen its provider-focused solutions.”

Encore Health Resources was founded in 2009 by Ivo Nelson and Dana Sellers.

Another Nelson-related company, online provider search and booking site HealthPost, has been acquired by The Advisory Board Company, according to an announcement this morning. No details were announced.

Monday Morning Update 5/12/14

Top News

Catholic Health Initiatives files a lawsuit against an unknown hacker, hoping to convince Microsoft to turn over the identities behind several of its email accounts that were used to breach CHI’s systems from Pakistan. The John Doe hacker redirected internal emails to his or her own account and  took control of some of the organization’s domain registrations. The systems of CHI affiliate Franciscan Health System were compromised in March when employees were fooled by a phishing scam into providing their login credentials to a hacker site.

Reader Comments

From Iron City: “Re: reduced readmissions. These stories get a lot of attention, but it’s easy to overstate the gains on readmissions from situations where the same patients were simply kept in the ER or observation instead. That is cheaper and still a partial success, but not the same as avoiding the readmission cost completely.” That’s a good point. You would have to take a guess at which patients would have been readmitted, then examine claims data to see if they were treated in other hospital settings instead. Just looking at the overall readmission percentage wouldn’t provide the full picture. I also question the historical inability of hospitals to understand their true marginal cost of an admission vs. their average cost of an admission – putting one more patient in a bed for the night doesn’t necessarily trigger the same high expense as having a post-up cardiac surgery patient occupying a similar bed during that same night.

From Blockade Runner: “Re: SuccessEHS. We are a FQHC with a grant to implement the product, which was bought by Greenway. The CEO failed to mention a long-term plan for it in a recent webinar even after saying it has 8,000 providers using it. We’re thinking about starting a search. We have specific needs for our UDS reporting and our sliding scale fees based on the Federal Poverty Line. Are any FQHCs using something that works?” My caution there would be to give Greenway a chance to address your concerns directly rather than reading too much into lack of encouraging news in a webinar. If you like their product, put your concerns in contractual T&Cs and see if they approve them – if not, your worst fears are probably justified.

HIStalk Announcements and Requests

Three-quarters of poll respondents say doctors should be licensed nationally rather than by individual states. New poll to your right or here: athenahealth got a lot of stock market attention last week. What was your reaction, if any?

Listening: new from Atlanta indie-soul singer Curtis Harding, sweet 1970s-style horns over a hip-hop beat. One track even goes disco while managing to sound great. I’m also still playing a lot of Georgia grunge rockers Dead Confederate.

Acquisitions, Funding, Business, and Stock

Friday’s market close share performance after Thursday’s earnings announcements: Castlight Health up 10 percent, Allscripts unchanged, Nuance down 3 percent, The Advisory Board Company down 2 percent.

From the Allscripts conference call:

• Quarterly bookings grew 26 percent, with recurring revenue making up 78 percent of the total.
• The $3 million drop in revenue came from an unnamed outsourcing client that took its $20 million per year effort in-house.
• Allscripts says constrained provider capital and a lack of enthusiasm for rip and replace projects will help it sell portal and interoperability products.
• The company says the 10-year, $500 million agreement it signed with Xerox’s ACS subsidiary in 2011 has “challenging economics” and may require changes.
• Paul Black says that hosting systems without owning any of the underlying infrastructure has “created a more virtual environment than we’re comfortable with” and that the company will be “much more active managers of our destiny.”
• Black says he feels “pretty good” about the company’s functionality for inpatient, outpatient, revenue cycle, population health management, and patient portal.

RadNet says in the earnings call that all of its 260 diagnostic imaging centers will be running eRAD RIS/PACS within a year. RadNet acquired the Greenville, SC-based eRad in September 2010 for $11 million.

A site promoting Utah tech business profiles Health Catalyst, which it says will generate up to $100 million in revenue this year and will IPO in 18-24 months.

People

Justin Barnes, VP of industry and government affairs at Greenway Medical, announced this week that  he’s leaving the company at the end of May. He tells our Jennifer Dennard that he’ll be stay busy over the summer with plans to start two companies (one of them in healthcare IT, with a nod toward consumerism, interoperability, and patient engagement), join a tech incubator, and continue his involvement with government issues in an unstated capacity. He says his Greenway departure is friendly and unrelated to its November 2013 acquisition by Vista Equity Partners or the April 2014 departure of Greenway President Matt Hawkins.

Speaking of Matt Hawkins, who was CEO of Vitera when it was acquired by Greenway in November 2013 — he’ll be replacing Richard Atkin as president of Sunquest, according to internal sources.

Government and Politics

The CEO of HMSA, Hawaii’s biggest medical insurance company, says the state should either shut down the Hawaii Health Connector insurance exchange site or let the federal government take it over. The exchange received $200 million in federal taxpayer money, spent $100 million developing the site, signed up just over 9,000 customers, and raised only $40,000 in user fees that were supposed to fund its ongoing operation. Hawaii didn’t really need the exchange at all since a state act requires employers to provide subsidized insurance to their employees.  In an interesting story twist, the state’s legislature passed a bill last week ordering HHC to kick out the insurance company members of its board, among them HMSA, which in that role oversaw the site’s creation and is now calling for its shutdown.

Other

Hospital music videos have probably reached the Peak of Inflated Expectations on Gartner’s hype cycle now that the marketing people are cranking them out for commercial benefit, but you might still be cheered up this Monday morning by HHC Elmhurst Hospital Center’s cover of “Happy.” Or not, since it probably drives cynics and pessimists crazy (although I’m both and I like it.) 

You also might be inspired (or not) by “Steve Jobs’ 13 Most Inspiring Quotes.” My favorites:

• "Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart."
• "I’m as proud of many of the things we haven’t done as the things we have done. Innovation is saying no to a thousand things."
• "Being the richest man in the cemetery doesn’t matter to me … Going to bed at night saying we’ve done something wonderful … that’s what matters to me."
  

The Massachusetts House passes votes to eliminate a law that would have required physicians to demonstrate EHR competency or Meaningful Use certification as a condition of earning or renewing their medical licenses after January 1, 2015. The House voted to delay from 2017 to 2022 a requirement that all providers use EHRs that are connected to the state HIE.

An interesting patient-centered technology example on ReelDX: the mother of a patient records her toddler’s respiratory symptoms on her smartphone. The question: why can’t the video (or other media) be included in the EHR?

Weird News Andy submits a spinning heart story from NEJM: a motorcyclist survives an accident in which his heart rotates 90 degrees due to air pressure in his chest. Doctors removed the air and the heart shifted back. And in a WNA-like story that he didn’t actually submit (yet), an English hospital admits that a man scheduled for an unspecified “minor urological procedure” was instead given a vasectomy.

A UPMC employee sues the health system and a payroll processing firm after a data breach in which hackers filed fraudulent tax returns using the identities of UPMC employees. What’s unusual about the lawsuit: (a) the employee is only asking for identity theft protection, which is usually offered anyway, although she wants 25 years of it instead of the usual one year; and (b) UPMC isn’t a client of the payroll processing firm she sued, according to that company.

Strange: Kosair Charities sues Kosair Children’s Hospital (KY), claiming the hospital is mismanaging its donations, while the hospital responds publicly that the charity isn’t giving it enough money. According to the IRS documents I found, the charity brings in $15 million per year, holds $163 million in assets, and gave the hospital $4 million in the most recent year. Hospitals are last on the list of charities I would support given the waste, mismanagement, and self-serving agendas I’ve seen firsthand in having worked for a few of them. Supporting hospitals isn’t the best way to support patients.

Here’s a brilliant flow chart whose author I can’t credit because it is has been tweeted / retweeted / incorrectly retweeted so many times I can’t figure out its source. Someone shares my intense annoyance at pedantic blowhards who hijack the microphone after a conference speaker has opened the floor to questions that turn out to be eloquent expressions of self love. Use the microphone kill switch, moderators, or take responsibility for the trampling injuries that will result from the mad dash for the exits.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.

News 5/9/14

Top News

Google Ventures invests $130 million in oncology data platform vendor Flatiron Health, which will use some of the money to acquire oncology EMR vendor Altos Solutions. The two 20-somethings who founded Flatiron Health sold Google their online advertising platform for $81 million in 2010. They knew nothing about advertising or healthcare before starting their companies. Their first Flatiron oncology rollout was in 2013. It’s a lot of money, so let’s hope Google’s investment outcomes exceed their healthcare ones.

Reader Comments

From Dave Miller: “Re: UAMS. We are now live fully everywhere on Epic. It has gone really well, with just a few of the usual minor bumps (printing, security, scanning, etc.). I think this has been the best of my three Epic go-lives (University of Chicago, Carle Foundation Hospital, now UAMS). I guess you can teach an old dog new tricks. We also did enterprise speech recognition, device integration, and barcoding among other things. We went from a HIMSS Stage 4 to a Stage 7 (application in process). My lab team made me an honorary member of the Beaker team with the shirt above, maybe because I am a former med tech.” Dave is vice chancellor and CIO of University of Arkansas for Medical Sciences in Little Rock. Congratulations to the team. I told Dave he has more Epic experience than some of the consultants out there.

From Joe: “Re: IBM’s Watson. I followed your link from HIStalk and got a Chat Now window on IBM’s page. I’m curious about Watson in healthcare, so I accepted. See the transcript – I decided to open with a (perhaps obtuse) nod to Alan Turing, which I figured any good IBMer should appreciate. Touchy, touchy! Or maybe they have an algorithm that indicates anyone skirting around Turing Test references is clearly a cycle-wasting tire kicker.” I replied to Joe, “Maybe the IBM rep was indeed a Turing fan and decided to prove in the most definitive way possible that he’s not a computer!” Joe says he’ll try again, asking, “Did you kill our previous session because you ARE a computer, or you are a human trying to PROVE that you’re not a computer?”

From Trey Hermanos: “Re: athenahealth. Can somebody tell me how many providers athenahealth has on their network? An article says 37,000, but Jonathan Bush said 52,000 at a recent conference. Their implementation is a breeze compared to others, but in their quest for growth and relevance, they risk losing the 1-10 doc practices that made them what they are today, the practices that aren’t getting decent service and call-backs from their account managers. They gave their award for improved patient experience to Target’s clinics, the same corporation that compromised the identities of millions. The company doesn’t think you need to see a doctor for ‘small things,’ a view held by many despite the fact that the knowing when something is simple or not requires skill and sophisticated knowledge. A recent article called ‘Nurses are not Doctors’ said you have to know a lot to do primary care – the Target and Walgreens clinics are there to sell what’s on their shelves. There is no respect for knowledge and we spoil our patients the way we spoiled our kids to the point they have no coping skills and grow up entitled. Athenahealth must feel undervalued and not appreciated enough, sort of like primary care.”

From HIT ESQ: “Re: patent troll. A company called Presqriber is filing a massive number of patent infringement cases against EHR vendors. It has no Google hits except these cases. Its patient is for an ‘Interactive Medication Ordering System.’ They appear to be the first major patent troll in a few years.” The patent is from 1998, so I bet someone bought it from a defunct vendor (“Poetry” is referenced as the system name, which had some California pharmacists and urgent care people involved and is presumably long gone) and hopes to milk vendors for go-away money. They hit all the majors in their list of 20 except one – Epic, who has a history of launching a full-scale legal counteroffensive on patent trolls. HIT ESQ also called attention to two class action lawsuits brought against Cerner for claimed labor standards violations, which although I can’t pull up the documents since I don’t have access to the PACER system, usually means a salaried employee claims they should have been paid for overtime because they were misclassified and should have been hourly. 

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: A report finds that higher payer doesn’t necessarily equal higher job satisfaction. Another says the physician industry generates $26 billion in sales revenue and supports $15 billion in wages and benefits. Northwestern Memorial Physicians Group and Northwestern Medical Group merge to form the second-largest physician group in Chicago. A trio of ophthalmologists turns to crowdsourcing to fund their digital physician on-call answering system. A study uncovers the fact that hospital prices and privately insured patient spending increase when hospitals acquire physician practices. A physician pleads with Forbes editors to get RAC bounty hunters off his back. Arizona Care Network and Northeast Medical Group launch separate ACO initiatives with payers. Don’t write athenahealth’s eulogy just yet –several company partners make product announcements. 

This week on HIStalk Connect: Google continues its move into healthcare, as it grows its team of A-list genetic scientists working on its Calico moonshot project. Google also led the massive $130 million Series B funding round of oncology data analytics startup Flatiron Health. In other non-Google related news, PatientsLikeMe CEO Jamie Heywood discusses the details of its recent Genetech deal. 

Listening: new from Brody Dalle, the former (female) lead singer of The Distillers.

Want to get in touch? I created a new contact form that covers everything I could think of. Submissions go straight to my inbox (which is usually overloaded, so keep expectations modest.)  There’s a link at the top of this page, too.

Acquisitions, Funding, Business, and Stock

Castlight Health reports Q1 results in its first report as a publicly traded company: revenue up 339 percent, adjusted EPS -$0.72 vs. –$1.19, beating on revenue but missing earnings estimates by a mile. The company, whose market capitalization is around $900 million, had revenue of $8.4 million and lost $24 million in the quarter. Shares have dropped nearly 75 percent since CSLT’s March IPO, which some analysts called at that time “the most overpriced IPO of the century.” Castlight Health was founded in 2008 by Todd Park (White House CTO and athenahealth co-founder), Bryan Roberts (Venrock), and Giovanni Colella, MD (RelayHealth). Shares that rocketed to $40 on IPO day are now worth around $10 less than two months later.

Allscripts reports Q1 results: revenue down slightly, adjusted EPS $0.07 vs. $0.09, missing expectations on revenue.  

Nuance reports Q2 results: revenue up 5.5 percent, adjusted EPS $0.28 vs. $0.34, beating expectations on both.  

The Advisory Board Company reports Q4 results: revenue up 15 percent, adjusted EPS $0.34 vs. $0.34, beating expectations on both.

Hedge fund manager David Einhorn sent athenahealth’s stock price reeling this week when he said his firm has shorted the company’s shares because athenahealth is a faux cloud vendor whose real business is unsexy business process outsourcing that doesn’t deserve high share valuation. He didn’t just blurt it out – his slides from the investor conference presentation summarize his analysis:

• The company has failed to meet its 30 percent organic growth target for 2013, analysts have cut revenue expectations for the next two years, and earnings estimates keep going down.
• He says ATHN and some of the friendly analysts who cover it use a lot of buzzwords in describing what the company does, hoping to make it sound cooler and deserving of high share price, instead of what it is – an efficient business process outsourcer similar to lower-margin companies like MedAssets and Accretive Health.
• The valuation numbers of Morgan Stanley, which also happens to be ATHN’s largest shareholder, are shaky (although that company might also question Einhorn’s negative analysis since he, too, is providing supposedly unbiased information that could move ATHN share price in a personally beneficial direction.)
• Einhorn questions Morgan Stanley’s assumption that athenahealth’s inpatient business will jump from 0 to 40 percent of its revenues and that it will launch an inpatient revenue management service that will bring in $2.5 billion a year.
• The report says Epic is unbeatable in hospitals and will expand into other markets, including gaining ground with hospital-acquired small practices that might otherwise be athenahealth prospects.
• He says that HITECH is winding down and practices that wanted EHRs have already bought them, with Kareo, eClinicalWorks, and CareCloud offering lower-priced RCM and EHR products as athenahealth competition.
• Capitation would hurt athenahealth, he says, because providers would be paid upfront and wouldn’t need its help.
• He predicts a worst-case share price of $14 vs. then-current $127 (now $107), saying ATHN is like the 2004-era WebMD.

Meanwhile, Jonathan Bush said Thursday that Einhorn doesn’t understand the company, which he then compared to Uber, Airbnb, and Amazon. He added, “The right price of athena is … completely out of my pay grade,” but told also CNBC that he’s sure ATHN is a $1,000 stock and then said, “Who cares about net income?”

Streamline Health will acquire the assets of cost and spend management solutions vendor CentraMed.

Cedars-Sinai Health System (CA) and MemorialCare Health System (CA) form Summation Health Ventures, a healthcare IT development fund that will seek startups not only for potential return, but their capability to create technology that the hospitals can use.

Sales

Lake Taylor Transitional Care Hospital (VA) will implement HCS Interactant for its LTACH and SNF service lines.

Announcements and Implementations

An engineer who helped develop ride service Uber launches Pager, which allows Manhattan residents to request an off-hours telephone consultation or house call from participating doctors. Telephone calls cost $50 (of which Pager skims $10), while house calls run $300 and the company keeps $50. Like Uber, Pager is thinking about surge pricing, raising charges when demand is high. It has only 20 doctors participating during its launch testing period. He should have chosen a less-generic name: Uber was always easy to find, but I couldn’t locate anything on Pager despite extensive Googling.

Policy documentation software vendor PolicyMedical will integrate with the Access electronic forms system.

Hybrent announces a medical supply ordering application for clinical staff.

Mandi Bishop, Nick Kypreos, and Lauren Still put together Team FloriDUH to create open source data visualization tools. They’ve been invited to compete at Health Datapalooza in Washington, DC June 1-3 and have formed a non-profit foundation to distribute tools they build. They are hoping to raise $10,000 in a Medstartr project that starts Friday, May 9 to cover travel costs and extend their product offerings.

Government and Politics

HHS Secretary Kathleen Sebelius, who I assumed was long gone but apparently isn’t, leads a thinly veiled cheer for the Affordable Care Act in touting its supposed benefits as analyzed from HHS’s databases: a tiny reduction in readmissions and a nine percent drop in hospital-acquired conditions in 2011-2012 and a claimed 15,000 lives and $4 billion in healthcare spending saved. President Obama’s nominee to replace Sebelius, Sylvia Burwell (above), faced her first Senate confirmation hearing Thursday and received near-universal compliments, even from Republicans.

New York-Presbyterian Hospital and Columbia University will pay $4.8 million to settle charges related a 2010 privacy breach in which the medical information of 6,800 patients was exposed when a CU physician-programmer tried to deactivate a personally owned server he had connected to NYP’s network, opening up the patient information it contained to the Internet. The error was discovered, as it always is, by someone Googling individuals and turning up inpatient clinical information. Neither organization had checked the server’s security, conducted a risk analysis of all systems, or developed policies and procedures for database access. It’s the largest HIPAA fine ever.

Health Information Technology Exchange of Connecticut will be shut down since the HIE has spent its federal grants without accomplishing a whole lot.

Other

A former Epic intern and employee who worked directly for Judy Faulkner for a time writes about his experience in a Madison online publication. He says Judy isn’t reclusive, just more interested in tending to her company and its customers than gabbing with reporters. He anguishes over whether the company spends too much on fancy buildings. He says Epic is good place to work because it quickly jettisons underperforming employees, but wonders if it shouldn’t hire more experienced people even if Judy’s long-held belief is that she can turn a new college grad into an “Epic person” in three years while experienced hires would take twice as long.

Weird News Andy reacts to this story by saying, “Mmmmm, bacon.” Scientists question the 1950s study that claimed saturated fats cause heart disease, saying the researcher chose specific countries that would prove his point, used small sample sizes, and studied one country during Lent when nobody was eating meat or cheese. The Wall Street Journal essay by the author of a pro-saturated fats book says that funding by Crisco’s manufacturer, Procter & Gamble, made the American Heart Association a national force and the group later spearheaded a move to vegetable oil for a “healthy heart” even though proof was lacking.

Sponsor Updates

• Alan Worsham (Sutter Health) and Joe Schmidt (Emory University School of Medicine) join Culbert Healthcare Solutions as practice directors.
• InterSystems TrakCare gains the largest share of non-US hospitals and is named a clear leader by KLAS.
• Perceptive Software’s Larry Sitka will speak on breast tomosynthesis and John Hamdor will present on image-enabled EMR management at the SIIM14 conference.
• Tampa General Hospital (FL) is live on Wolters Kluwer UpToDate Anywhere integrated into Epic.
• Extension Healthcare releases a two-part white paper to aid hospitals with compliance with clinical alarm safety.
• Capsule Tech celebrates National Nurses Week by posting celebrations and nurse-focused activities on the company’s blog.
• Merge’s Mark Bronkalla explains the service model of PACS shifting to enterprise IT in a recent blog posting.
• Gwinnett Medical Center and Connance will co-present at the Healthcare Business Insights’ Spring Member Retreat on “How Revenue Cycle Can Change Patient Loyalty.”
• ICSA Labs certifies 29 vendors in April, including HIStalk sponsors Iatric Systems, Quest Diagnostics, and Orion Health.
• Netsmart advocates for behavioral health providers on Capitol Hill.
• Visage Imaging offers a NVIDIA case study in connection with a video detailing the architecture of the Visage 7 Enterprise Imaging Platform.
• Aspen Advisors Founder and Managing Principal Dan Herman and principal Jody Cervank discuss IT’s impact on operations, clinicians, cost and productivity at a regional VHA COO/CFO Joint Affinity Group.
• Ashish Shah and Brian Ahier of Medicity discuss the landscape and future direction of data exchange networks in a recent article.
• Carolinas HealthCare System shares how Medicity was instrumental in its HIE CareConnect success.

EPtalk by Dr. Jayne

We hosted a site visit at the office yesterday. It’s been a long time since we’ve done one and I had somewhat forgotten what an adventure they can be. We’ve been a reference site for our ambulatory vendor for years, but because of everything going on with upgrades, Meaningful Use, and ICD-10 preparation, we had taken a break.

We’re old pros at site visits since we were early adopters of EHR and had put our ambulatory physician practices through an accelerated implementation that was not only rapid, but successful. We had only been live for a few months before the vendor started asking us to host site visits. Initially I was naïve enough to think it was simply because we had done a great job. Only later (after I swiped our vendor contract from an unattended filing cabinet) did I learn that our CFO had leveraged potential site visits against discounts on our initial software purchase. I’m glad he was confident in our potential abilities!

Our formula for site visits is pretty standard. Our local vendor exec and the prospect’s vendor exec bring the entourage to our corporate headquarters. We start with a presentation on the history of the physician group and our ambulatory project. We share some fairly detailed information about our methodology, decision making, and implementation processes and then talk about results we’ve achieved over the years.

Although most of the groups that visit us ask to go to the practices and shadow physicians, we have a strict policy of not allowing it. We make that clear when the site visit is scheduled. The disruption to patient care is aggravating to our physicians, and if I was a patient, I wouldn’t want a bunch of visitors looking over my doctor’s shoulder and asking questions about the software.

Instead, we invite some members of our clinical advisory board to join the group for lunch. Most of them will have their laptops or tablets with them, which allows for hands-on discussion of workflow or how they handle challenges. Not all of them are serious fans of EHR, but they usually provide a balanced perspective.

Although members of the vendor sales team are usually present, they’ve learned to just sit back and let it unfold. There have been a couple of account reps that tried to jump in and camouflage deficiencies in the product, but being on the receiving end of our evil eye usually shuts them up. We’re completely open about what the clinical and billing systems will (and won’t) do. Most of the reps have learned that prospects appreciate that level of candor.

We’ve had some visitors that were squeamish about having the vendor in attendance. When that’s the case, we’re happy to kick the vendor people across the street for coffee. Other visitors have tried to beat up on the vendor with them in the room in the hopes of increasing their negotiating power by making the product seem deficient.

My favorite site visit was a couple of years ago. The revenue cycle director and I are good friends and have done so many talks together that we decided to mix it up and do each other’s parts in the presentation. I’m not sure the prospect fully understood the humor of what was going on, but the sales execs could barely keep straight faces as I chatted about denial management and my billing colleague started talking about clinical quality.

Even though we’re somewhat contractually obligated to host site visits, our vendor has never asked us to hide anything or to portray anything other than our real experience. They’ve been respectful when we simply have too much on our plate and understanding when we refuse to do them because we’re waiting for delivery of code that’s been delayed and we want to make a point. We actually have fun doing them since we get to tell our story and we’re proud of what we’ve accomplished in an industry that’s still in its relative infancy.

You never know how visitors are going to behave in a site visit until they start talking. This one was one of those doozies.

It was a bit of an unusual visit to start with. The visitors were already live on our vendor’s platform, but had “paused” their implementation. They were coming to us to see an example of a success story and to hopefully learn ways to improve when they restarted their project. They are a high-value client, so a vendor VP and some other execs came along for the ride. Although they had provided us the back story beforehand, it was interesting to watch the visiting CMIO explain that his initiative was essentially a failure / money pit without actually admitting as much.

We set the stage with our group’s profile, which was similar to theirs when we started our project. We went through our financials, success metrics, clinical quality indicators, and then jumped into the discussion of our implementation methodology and physician adoption strategy. No matter what platform you’re on, the latter two are critical in my book. Implement faster than your organization can handle or slower than it needs and you have a mess. Fail to think about physician adoption and you have the same mess, but exponentially larger and more painful.

Barely two slides into our EHR implementation presentation, the visiting CMIO started interrupting. Every time I would talk about how we did something, he would jump in with a counterargument about why that wasn’t a good idea. I would talk about how we implemented our pilot practices in phases and he would explain that in his master’s coursework, they had discussed that phased implementations are a mistake. I’d talk about how we brought laboratory and document interfaces live with the billing system (months before EHR) to pre-populate charts and he’d argue with me about medico-legal risk. I would say the sky was blue and he would try to tell me it was brown.

I thought I was holding it together pretty well in the face of his bad attitude, but I had to work to not laugh at my co-workers, who kept darting their eyes around to see how people were reacting to his bluster. I spotted a sidebar conversation that I knew was probably an attempt to guess how long I was going to let him continue his boorish behavior. The sales execs were increasingly agitated and tried to redirect him without being adversarial, but no one from his hospital tried to intervene.

Finally, I reached my breaking point. You can make fun of some of our user engagement strategies. You can think we’re goofy at times with how we do team building and change management. But don’t diminish the product of thousands of hours of hard work by our staff and end users, especially when you’ve got your own project on hold and your vendor is flying you around the country trying to help salvage your implementation. And definitely don’t try to tell us our strategy “can’t possibly be effective” when we have brought hundreds of physicians live successfully with no real revenue impact to them.

I gave him my best “steely-eyed missile man” look – the same one I give medical students when they appear particularly unprepared and which has been honed by years of craziness in the ER. I simply said I guessed we didn’t have anything to really teach them and handed the presentation controller to my revenue cycle colleague.

She’s usually the master of the poker face, but this time her expression said it all. I thought I heard a couple of people suck in their breath, but they were drowned out by the sound of the vendor VP choking on his breath mint.

To her credit, my colleague rapidly advanced through the rest of my slides and dove right into the wonders of the central business office without missing a beat. I caught a couple of smirks among our site visit guests, so I’m encouraged that there is hope for them even though their boss is clearly a jerk. The CMIO seemed to be trying to figure out what had just happened and started sputtering and trying to backtrack, but my colleague pressed ahead. I’m betting our vendor won’t be inviting him to any other client sites any time soon. I’m hoping our next guests leave their confrontational physicians at home.

Are you a reference site? Have any good stories? How do you deal with adversarial visitors? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 5/7/14

Top News

Comments from hedge fund manager David Einhorn send shares of athenahealth down nearly 14 percent Tuesday after he tells investment conference attendees that ATHN is one of a few “bubble stocks” trading at high valuations for no good reason. He added that athenahealth really isn’t a cloud vendor deserving of high share price multiples since its main role is as a business process outsourcer of mundane back-office physician practice tasks. He also said that athenahealth’s promotional videos are full of buzz words and that “Epic’s dominance will only grow” as “the undisputed winner from the fragmented IT market.” He predicted the company’s shares will drop 80 percent. Above is the one-year chart of ATHN (blue) vs. the Nasdaq (red), with shares closing Tuesday as Nasdaq’s fifth-largest percentage decliner.

Reader Comments

From Bratman: “Re: Vonlay acquisition by Huron Consulting. The acquisition price was $35 million, all cash, and was a 1.2 times multiplier on revenue. There were several interested acquirers. The price may have ended up lower since Epic forced the Vonlay owners to modify the terms of the Vonlay-Epic agreement to extend the non-compete for former Epic employees from one year to two years. Epic required this change before it would agree to transfer the Vonlay agreement to Huron. The legality of forcing Epic employees into non-compete agreements they never knew about or agreed to is definitely up for debate and the length of the new non-competes likely makes them unenforceable. Epic seems to be using its power to try to minimize employee attrition and limit the supply of certified third-party consultants.” Unverified.

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

QPID Health raises $12.3 million in a Series B funding round and adds a board member from New Leaf Venture Partners.

Radiology outsourcer Alliance HealthCare Services acquires the assets of OnPoint Medical Diagnostics, which offers a cloud-based scanner quality control system used by 81 hospitals, for $1 million in cash and two years’ of royalties.

Huron Consulting Group closes its acquisition of Epic consulting firm Vonlay of Madison, WI.

Pittsburgh-based teledermatology technology vendor Iagnosis raises $2.8 million from angel investors.

Xerox will acquire ISG Holdings, which offers workers’ compensation software systems under the StrataCare and Bunch CareSolutions brands, for $225 million.

Sales

Valley General Hospital (WA) chooses Medsphere’s OpenVista EHR for its 68 beds.

Alere Accountable Care Solutions will build a community-wide HIE for Whittier Independent Practice Association (MA).

Emerald Physicians ACO (MA) selects the eClinicalWorks Care Coordination Medical Record.

People

Oneview Healthcare names Jeff Fallon (Fallon Strategy) as president, North America.

ESD hires Cinthia Tenorio, LPN (Lake Health System) as CDI practice director and John Ortego (CTG) as Meditech practice director.

Tracy Gregory (Linguamatics) joins SyTrue as chief scientist.

Patrick Clark (Vonage Business Solutions) joins Wellcentive as CFO.

Accenture CEO Jorge Benitez will retire from the company at the end of August.

Announcements and Implementations

MModal announces enhancements to its Fluency Flex mobile dictation application for iOS devices.

In Australia, Sydney Children’s Hospital Network announces plans to use commodity software for its telemedicine program, including Lync videoconferencing and Skype video calling, both from Microsoft.

RadNet goes live on Nuance PowerScribe 360 at the first of its 250 imaging centers and 27 practices.

Advocate Medical Group of Chicago (IL) implements Forward Health Group’s PopulationManager and The Guideline Advantage.

Propeller Health earns FDA approval for the new generation of its inhaler-measuring asthma monitoring system.

St. Joseph’s Hospital Health Center (NY) goes live with Epic.

Zoeticx makes available an API that it says will allow developers access to “any EMR system.”

Government and Politics

Massachusetts announces that it will abandon its $57 million CGI-built health insurance exchange website and hire hCentive, which developed three other state marketplaces, to build a new one. The state also says that just in case that doesn’t work, it will just join the federal exchange in November. Massachusetts isn’t sure if it will need to ask the federal government for more money than the $174 million it already received since it is disputing its CGI contract, but the “dual track” option it chose (the sequel to its disaster movie) will cost another $100 million.

CMS reports that only 50 doctors and four hospitals have successfully attested for Meaningful Use Stage 2 through (or “thru,” as the slide says) May 1. CMS also reports that it has approved 66 of 72 applications for hardship exceptions.

Michelle Consolazio of HHS tweeted this photo of the HIT Policy Committee thanking outgoing member and Epic CEO Judy Faulkner, who has been replaced as its vendor representative after four years by Cerner CEO Neal Patterson.

The talking heads in this hysterically partisan and sensationalist Fox News program seem exceptionally clueless yet smugly superior about nearly everything, but Jesse Watters (I don’t watch TV, so I don’t know who he is) outdoes himself at the 12:40 mark when talking about the VA wait list controversy by declaring, “They’re still using paper records at the VA. They’re not even computerized yet.” That’s embarrassing no matter what your political persuasion, but of course he only plays a journalist on TV and can’t be expected to differentiate between disability claims forms and medical records.

National Coordinator Karen DeSalvo, MD says her husband, also a doctor, uses a “clunky” EHR. A bit of Googling suggests that her husband is (or at least was) an ED doc at Lakeview Regional Medical Center in Covington, LA, so perhaps his clunky EHR could be identified. I assume it’s Meditech since it’s an HCA hospital.

Innovation and Research

MedStar Health (DC) will co-locate some of its employees in the offices of DC-based incubator 1776, connecting the health system with technology startups to arrange pilot projects. MedStar will also provide education for the 20 percent of 1776’s companies that deal with healthcare.

IBM names 25 finalists in its Watson Mobile Developer Challenge. Those that are healthcare-related include GoGoHealth (telemedicine), Ultramatics (personalized health answers), Ringful Health (patient-physician communication), GenieMD (health management), Biovideo (information for expectant mothers), and Sense.ly/MyIdealDoctor (medical information).

Other

Community Hospital (IN), which is treating the first US patient to be infected with Middle East Respiratory Syndrome (MERS), used its Versus RTLS system (along with video surveillance recordings) to identify employees that had come in contact with the patient, earning a mention on the local TV news report. Hospital CMIO Alan Kumar, MD says, “We can tell down to the second how long they were in contact with the patient, and how long they were in the room, and provide data to CDC.” According to the state’s health commissioner, “MERS picked the wrong hospital, the wrong state, and the wrong country to try to get a foothold.”

Durham County, NC commissioners vote to give Lincoln Community Health Center $500,000 to install Epic, half the amount it requested. The $2 million implementation would allow the clinic to connect with Duke University Health System’s Epic system. Commissioners suggested hitting up Duke for more than the $1 million it offered toward the cost, with one saying, “In the big scheme of what’s been invested at Duke, between $500 million and $700 million, this additional half a million, I would hope they would be able to absorb that and do what needs to be done.”

@venturevalkyrie leading great panel on "Digitizing Care Delivery" at #HEPSummit. pic.twitter.com/CYQmA9fEns

— David Jones (@dajonesjr) May 2, 2014

Investor Lisa Suennen (“Venture Valkyrie”) writes a blog post about the recent Health Evolution Partners Annual Summit that is brilliant in both insight and wit.

And this group of people, who know everything there is to know about how we got into such a healthcare system mess (because they helped create it) and what has got to be tackled to fix it (even if not how to do that exactly) is dealing with quite a conundrum. They are caught in a vortex where they have to straddle the old world and new world—the land where healthcare decisions are mostly still driven by volume and not quite ready to chuck it all for a world based on “value.” … it is impossible to train the entire hospital to act in two completely different ways based on the patient who shows up. You simply can’t run two different workflows and two different case management programs and two different follow-up programs efficiently. Most of the time the actual caregivers in a hospital—physicians, nurses, etc.—don’t even have a clue in what insurance program or risk-pool the patient is enrolled; certainly no one is yet handing out bar-coded wrist bands that tell the caregiver whether to minimize or maximize services, based on the financial motivation (I hope).

Points from the 2014 HIMSS Regional Extension Center Survey, with 37 of 60+ RECs (which have received $677 million in taxpayer support) responding:

• Nine out of 10 say their #1 business issue is staying alive, with several respondents saying financial sustainability isn’t possible or isn’t something they’ve planned adequately.
• One-fourth of the RECS say they won’t be viable by the end of the year, and half of those that say they’ll survive expect state grants to keep them solvent.
• Three-fourths of them want more ONC grants to keep afloat.
• One-fourth of the respondents say they will partner with other RECs to ensure their viability.
• Staffing ranged from two to 80, with an average of 23 FTEs.
• The #1 services priority is providing information services related to business intelligence and data warehouses, while optimizing EHRs and providing Meaningful Use services came in right behind.

Fitch downgrades the bonds of Centegra Health System (IL), blaming its acquisition of physician practices and its EHR rollout (McKesson Paragon, I believe) for “light operating profitability.”

Blue Cross Blue Shield of North Dakota fires its CEO right after the company reports an $80 million loss largely due to problems in its Noridian Healthcare Solutions subsidiary, which developed Maryland’s failed health insurance exchange website. Paul von Ebers had vowed Thursday to improve the organization’s financial position by reducing administrative overhead, which its board took to heart in unanimously voting Monday to fire him effective immediately.

Guess which vendor is looking for a marketing director? Wrong … it’s HIMSS, trying to find someone to help push its many publications.

@deansittig tweeted out a link to an Epic promo-type video by Lucile Packard Children’s Hospital Stanford (CA) that is well done, but I liked the one above better.  

Some hospitalists at the annual conference of the Society of Hospital Medicine focus on IT issues, urging their peers to “establish ourselves for the informatics role we have taken” by earning informatics subspecialty board certification.

Weird News Andy intones that “exercise can kill you.” In Portland, OR, a naked man doing pushups in the middle of the street at 4 a.m. is run over and killed by a car, with predictable toxicology results pending. WNA can’t keep his hands off his Oregon as he files another story that he calls, “is there a governor in the house?” as ED doc and Oregon Governor John Kitzhaber jumps out of his limo to perform CPR on a collapsed woman (WNA wonders he couldn’t spare some compressions for Cover Oregon.)

The family of a Miami doctor sues the driver of the Lamborghini in which he died when it crashed into a car stopped at a light at over 100 miles per hour two weeks ago. The driver, the founder of a vodka company, was drunk when he and the doctor left the Versace Mansion after discussing investments. The non-practicing doctor had a vodka company, too, going by the nickname Dr. Vodka.

Sponsor Updates

• Deloitee’s Harry Greenspun, MD is interviewed about mobile health devices on Federal News Radio.
• Strata Decision Technology, MedAssets, and Prominence Advisors are named to Becker’s “150 Great Places to Work in Healthcare.”
• Helen Figge with Alere Accountable Care Solutions discusses how to still meet requirements for MU Stage 2.
• Capsule’s Michelle Grate explores healthcare as a complex adaptive system and explains why it matters.
• Beacon Partners recommends five steps for developing a CDI program as part of preparation for ICD-10.
• Voalte releases a white paper offering three key elements to secure physician texting.
• Advanced Data Systems will integrate Merge Healthcare’s iConnect Network with its MedicsRIS.
• Truven Health reports that premature or low-birth weight infants funded by Medicaid cost nine times more than uncomplicated newborns.
• T-System’s Elizabeth Morgenroth offers three reasons to start documenting for ICD-10.
• Aventura CEO John Gobron discusses awareness computing bringing intelligence to the clinician workflow at the Healthcare IT Institute in Sarasota, FL.
• Cottage Hospital (NH) reports that it has saved over $100,000 in interface fees since going live on Summit Healthcare’s interface engine.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 5/5/14

Top News

Blue Cross Blue Shield of North Dakota partially blames its poor 2013 performance on newly implemented EHRs of providers that delayed their insurance claims submissions, which it says caused it to underestimate the value of those claims. I didn’t realize until reading the CEO’s discussion that Noridian Healthcare Solutions is a subsidiary of BCBS of North Dakota. Noridian built the failed Maryland health insurance exchange and was fired from its $193 million contract in February. Maryland has hinted that it may sue Noridian in hopes of getting back some of the $55 million it has already paid toward Noridian’s five-year contract. North Dakota’s insurance commissioner says the agency is watching BCBSND to make sure it doesn’t try to increase insurance premiums in the state to cover Noridian’s projected $17.8 million loss. Every time I hear that name I think of Veridan Dynamics from “Better Off Ted.”

Reader Comments

From Guillermo del Grande: “Re: CIOs. Here’s a list of “A Few Things CIOs Should Know (Or Think About).”

• If you want the FDA to regulate EMRs but have a service level agreement of two days for major fixes, you may want to learn about software development models. If you have to ask what a software development model is, how did you get to be a CIO?
• FDA requires waterfall development. This is not Niagara Falls.
• How many of the good EMRs use waterfall any more? Here’s a hint: not many. Most are agile. EMRs are more complicated than a medical device. How many different medical devices connect to your EMR? Do you even know? Do you feel like testing every scenario per medical device that connects to your EMR? Do you think your vendor does that?
• Are you afraid to let developers and your IT people watch healthcare and the software in action? You’re not agile. You’re going over the waterfall in a barrel.
• If your SLA is two days, but you require a change control meeting that only happens every two days, and then a software testing process that takes two days, and then another change control meeting, and then only migrate changes once a week, you may have a problem.
• How long does it take your vendor to fix a minor issue? You should be asking this question before you buy.
• What makes you think your IT staff can fix a problem in a SLA period when you don’t know if it’s something your IT folks can do or it’s something the vendor has to do?
• Do not try to manipulate an IT staff or a vendor into repairing your highest priority by only reporting that item. IT staff have lots of end users. Vendors have lots of customers and sometimes will fix issues only if lots of different customers are seeing them.
• If you think a problem made it to the field because the software testers at the vendor didn’t find the issue, you don’t know much about how software companies. Remember that story about the guy who had his heart burned out of his chest a few years ago because of a bug? If not, look it up on HIStalk — it was a known issue for 10 years. Ask your vendor how many known issues they have in their tracking system. Hint: they’re not all reportables.
• The Supreme Court is reluctant to take new cases and software developers are reluctant to fix bugs for many of the same reasons and use some of the same processes.
• “Not a customer workflow” is heard at many a vendor to defend not fixing a bug, often before there are any customers.

Thoughts on FSMB’s “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine”

The Federation of State Medical Boards is a Euless, TX-based non-profit trade association that represents all US medical boards that license physicians. It does not make regulations directly, but state boards usually adopt its recommendations.

Key points from its report include:

• Telemedicine is defined as requiring videoconferencing. Encounters conducted via telephone or email are not telemedicine.
• Physicians must be licensed in the state “where the patient is located” because physicians are licensed by individual states.
• A physician-patient relationship must exist, but it can be established using telemedicine technologies.
• The physician must document the patient’s history. Having the patient complete an online questionnaire doesn’t count.
• The physician should obtain the patient’s informed consent, including a description of the security features of the telemedicine technologies being used.
• The physician must make themselves available following the encounter.
• The physician may not promote services for which they are receiving payment or benefits.

The intention of the group is clear. It wanted to prevent providers from selling prescriptions online. Nearly all of the wording restates requirements that are already in effect for traditional physician-patient encounters, clarifying that those requirements hold true for telemedicine-based encounters. The policy attempts to prevent online-only practices by prohibiting misleading websites, undisclosed financial relationships, and running an online consultation service simply to sell drugs online.

The only significant (but unsurprising) recommendation is that physicians must hold a license in the state where the patient is physically located during the encounter. That also is no different for traditional medical practice – an ED doctor in Florida can see vacationing patients from anywhere in the world from a Florida-based hospital, but he or she can’t travel to those other states to treat the same patients at their homes unless licensed there.

The most positive development for telemedicine supporters is that the model policy allows patients to be managed entirely by telemedicine without an in-person component.

The negative aspects of the model policy are:

• FSMB isn’t a particularly transparent organization and didn’t disclose the members of the work group or who it consulted to develop its proposed policies. It also did not provide a way to incorporate industry or patient feedback.
• Doctors already diagnose and treat patients by telephone and email, but those options are not considered telemedicine in the model policy, although it doesn’t limit or prohibit them. That would suggest that nothing changes for those visits, although future questions may come up involving payment for services.
• Doctors must be licensed in the state where their patients are located, which isn’t even accurate in some cases (military physicians.)
• It doesn’t address the desirability (nor should it have, most likely) of national rather than state-by-state licensure of physicians or an expanded reciprocity program that would make it easier to practice across state lines. That’s the biggest clash between telemedicine proponents and state regulatory boards, whose revenue and power come from overseeing in-state professionals and (arguably) protecting them from competition.
• It calls for requirements that exceed those of non-telemedicine encounters, such as prohibiting randomly assigning patients to physicians (which EDs, walk-in clinics, and other services do routinely) and requiring that the medical records of patients be reviewed before treating them (which urgent care providers can’t do by definition.)

The conclusion is that telemedicine proponents wanted a policy that opened up state borders and encouraged innovative care, while FSMB’s goal was to prevent unethical doctors from running pill mills and online medical scams.

HIStalk Announcements and Requests

A commendable 37 percent of poll respondents use an activity tracker at least five days per week. New poll to your right: should doctors be licensed nationally instead of state by state? It’s an important question if you think telemedicine can improve the efficiency and geographic reach of physicians.

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

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

Vocera announces Q1 results: revenue up 10 percent, adjusted EPS –$0.14 vs. –$0.07, beating expectations for both. VCRA shares were the second-largest NYSE percentage losers on the news, shedding 14.7 percent. From the conference call:

• The company released the Vocera Collaboration Suite and an expanded Vocera Care Experience in the quarter.
• It opened a development shop in India.
• President and CEO Brent Lang called hospital spending “challenging” as hospitals wait to see where changes in patient population and healthcare reform go.
• He quoted a report that says 97 percent of hospitals don’t believe their nurses have the right tools to determine the availability of caregivers and that consumer-grade smartphones aren’t working well for hospitals.
• Lang mentioned a tentative US Army study in which use of Vocera’s system provided a 12-month payback.
• The alarm management system it gained with its mVisum acquisition in January 2014 will be launched this summer.
• Lang said the company will pursue more acquisitions.

Evariant, which offers a patient marketing platform, raises $18.3 million in a Series B funding round.

Hc1.com says it will create 175 jobs in central Indiana over the next five years, having just received $3 million in state tax credits. I can’t really tell what the company is selling since the site is a mess of buzzwords and vaguely feel-good statements behind one of the worst company names I can imagine (shades of 1999), but it seems to be a customer relationship management system for outreach labs and radiology practices.

General Dynamics will lay off at least 645 Utah-based call center employees it had hired under a CMS contract to take Healthcare.gov related inquiries about insurance.

CPSI announces Q1 results: revenue up 5 percent, EPS $0.69 vs. $0.63. From the conference call:

• The company installed financial systems in nine hospitals and clinical systems in 12.
• Add-on sales made up 26 percent of total revenue
• The company expects to gain ground with MU Stage 2 as “a number of our competitors continue to struggle with obtaining certification for their software, as well as struggling with the installation and usability of their software in the small hospital market.”
• Its new ED module will GA in Q3.
• CEO Boyd Douglas says that while Epic and Cerner talk about moving into smaller hospitals, CPSI isn’t seeing much of that, mostly just their usual small-hospital system competitors (Meditech, McKesson Paragon, and Medhost, I assume.)
• The Leerink Swann analyst managed to say “sort of” four times in one question, also using that annoying verbal crutch twice in a follow-up question.

Sales

The Defense Health Agency awards Leidos a $70.7 million, sole-source contract to support its EHR systems for the next 11 months.

Nashville-based MindCare Solutions signs the first customer for its tele-behavioral platform and provider network, Genesis HealthCare, which will offer remote psychiatric services to its 400 skilled nursing facilities.

Announcements and Implementations

New York State Immunization Information System will use Blue Button to make records available to the parents of patients.

AMIA calls for nominations for its 2014 awards for informatics leadership, nursing informatics, informatics health policy contributions, and informatics innovation. Winners won’t necessarily be the best, just the best who pay AMIA dues: a key selection attribute is “demonstrated commitment to AMIA through membership.”

The Boston Business Journal profiles Alere Accountable Care Solutions, mentioning that it will offer its care management, connectivity, and analytics systems in Europe. I interviewed CEO Sumit Nagpal in October 2013.

Government and Politics

President Obama makes fun of Healthcare.gov at the White House Correspondents Dinner on Saturday, saying that he has replaced his campaign slogan “Yes We Can” with “Control-Alt-Delete.” Near the end of his presentation, he pretended to have problems with a video and former HHS Secretary Kathleen Sebelius got a cameo as she rushed to the podium to fix it. The President’s last words of the evening, after thanking the press and uttering the obligatory “God Bless America,” were “Thank you, Kathleen Sebelius.” Other than following the party line, I question whether the fired Sebelius did anything worthy of that level of adulation.

Other

A Minneapolis cardiologist, intrigued by the use of scribes in the ED, tries them in his cardiology clinic. The four doctors he studied were spending all but two minutes of their average 13-minute patient visit working on the computer. Turning that work over to scribes shortened the visits to nine minutes, but beyond that efficiency gain, patients got seven minutes of that as face-to-face time, nearly four times as much compared to non-scribe visits. The doctors saw 60 percent more patients using scribes, boosting revenue by $206,000 in 65 clinic hours. Patient satisfaction was unchanged, which is nice for making a case for scribes but not so nice for the doctors — all that extra face time apparently didn’t impress patients.

Dr. Andy’s HIStalk Practice rant on the problem list is drawing interesting comments from his physician peers. Example: why can’t the problem list attribute cause and effect, or allow attaching meds to specific problems (or more than one problem?)

The dean of the new Dell Medical School at the University of Texas (I wonder who paid for that?) says that while Austin is behind in a competitive biotech industry market, “Areas like digital health and informatics, no one owns that right now. That is an area that’s rapidly growing and ultimately it will win and be a huge area … Companies who handle personal data see that health is a huge frontier and represents a huge economic engine, but no one has been able to innovate the platform that scales to a huge field … There are companies waiting to do that, but no one is inviting them in. We can do that.”

Mineral Community Hospital (MT) reports to its board that its NextGen implementation resulted in unplanned upgrade-related downtime and a 45-day delay in sending bills out for the 25-bed hospital.

A man Googling for CPAP machines for his sleep apnea notices that unrelated Google searches start displaying ads for those devices, leading him to complain to the Office of the Privacy Commission of Canada that targeting ads based on a health-related search constitutes a privacy violation. The office agrees after an investigation, determining that the practice not only violated its advertising guidelines, it also violated Google’s own policies that state the company won’t use health-related browser cookies to target ads. Google blames some of its advertisers and says it will improve its training and monitoring programs.

New York State Insurance Fund blames a software upgrade after the medical records of 20 worker’s compensation patients are to the wrong attorneys.

Bizarre: a mother is awakened by the sound of a man’s voice in her sleeping 10-month-old daughter’s room screaming, “Wake up, baby.” She runs into the room and sees the camera of the video baby monitor turn toward her as the hacker who is controlling the camera starts screaming obscenities at her. The woman’s Foscam IP camera had been updated to fix a security flaw, but she didn’t know about it. The conclusion is that the Internet of Things will give hackers a lot of household (and hopefully not hospital) gadgets to play around with.

Sponsor Updates

• The Health IT Quality Solutions Program of Quest Diagnostics certifies iPatientCare’s EHR as a Silver Quality Solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 5/2/14

Top News

Defense contractor ManTech International will acquire 7Delta, which provides healthcare IT contracting to the VA, DoD, and HHS. ManTech wants a piece of the VA’s Transformation Twenty-One Total Technology program, for which 7Delta has won more task orders than any other vendor.

Reader Comments

From Matthew Holt: “Re: HIMSS Analytics interview. Can the HIMSS PR people just stop with the BS? How many times do they have to say that they are a ‘cause-based, mission-based organization?’ This guy is selling market research to IT vendors and HIMSS non-vendor ‘members’ are all providers feeding at the federal teat. None of them are helping the starving in Africa. HIMSS has been on an acquisition tear in the conference and media business, including doing some extremely uncharitable activities towards its competitors there (not to mention the way they treat their vendor clients.) And Steve Lieber got paid $900K in 2011 and presumably over $1m by now. I’m a capitalist, I have no problem with anyone making money in healthcare while trying to change the world for the better, and I support the idea of more IT being a good thing. But seriously, who are they trying to fool with this rhetoric?” I seem to remember that HIMSS Analytics was originally set up as a for-profit subsidiary of HIMSS when it was first acquired many years, but something (presumably the IRS) forced a change. HIMSS is like hospitals: somehow it keeps minting more and more money and using it to buy for-profit companies (conference organizers and publishers, mostly) and then suddenly declaring them to be non-profit. The annual conference generates a ton of cash that can only go so many places: big salaries (check) and acquisitions (check). Or the less-obvious choice: HIMSS could scale its income to its expenses rather than vice-versa.

From Boy Wonder: “Re: Allscripts. The company sent an email to its portal users saying Medfusion caught the the company off guard with its announcement.” Medfusion announced this week that an unspecified payment dispute will force it to shut down access to its portal by Allscripts customers as of May 31, 2014 unless they sign a new contract directly with Medfusion. The Allscripts email reassures those users that they can be live on the Allscripts FollowMyHealth portal (the former Jardogs product it acquired in March 2013) by October 1 if they commit by May 31. The bottom line is that those 30,000 users have to make a commitment to one of the companies within four weeks, and if they choose Allscripts, they’ll have to try to strike their own deal with Medfusion to keep their portal running until they can make the switch. The Tullman-era Allscripts made a colossally bad decision to redistribute Medfusion’s portal instead of developing or acquiring its own, making both the company and its customers vulnerable to the actions of an external vendor. Allscripts predecessor Misys made a similarly bad decision in licensing a customer version of iMedica (now Aprima) that Allscripts resold as MyWay before retiring it and leaving those users in an equally unpalatable position through no fault of their own. In both cases, Allscripts gets a black eye for putting its customers in a jam and then trying to migrate them to another Allscripts product to fix it.

Dim-Sum provides the usual cryptic and amusing update of the Department of Defense’s commercial EHR system selection process, or as he or she describes, “Status and latest rumors in the halls of bedlam, located right K Street.” This is a huge many-billion dollar deal and the only insider reports I’ve seen are coming right here from Dim-Sum, so thanks for the update.

May 2014

1. DHMSM competitive teams are almost in place.
2. Themes are being discussed, ideas are being circulated and people are starting to wonder, “Why did I pick this team?”
3. CACI, where are you, and has anyone seen where Harris, SRA, and yes even CGI went?
4. HP is getting press and nobody knows why. I bet you wish you thought of the Newseum “experience” (outstanding job by IBM/Epic, or should it be Epic/IBM?)
5. Whatever you do, IBM, do not mix Epi-BM for your team moniker. That is a bad connotation in healthcare.
6. GDIT is sitting on the sideline with Northrop Grumman watching in awe as their fellow poobah Lockheed has found functional and willing partners in Siemens and Athena. Good luck, best of breeders! Lockheed please note: Boston is an academic mecca, you will be comfortable there. Now the firm in the Philly suburb, whatever you do, do not wear a Redskins tee shirt — Eagles fans will hurt you.
7. CSC is trying to figure out how they can make a cloud in the shape of an EHR – fun!
8. Accenture is still confident, proof positive that their strategy was focused on any large EHR vendor in the Central time zone. Personally, I like the combination – well done, Jim and Ken – airline tickets are cheaper to Kansas City anyway. Kansas City, sadly, is located 70 miles south of the airport.
9. Teams are congealing. However, smalls are scrambling and the ones invited to the table are excited. They tend to pontificate upon their vast knowledge of the current environment and then wonder if that is something to brag about.
10. IBM, can you please bring back the Blue Man Group for an epic focused percussion’ fest? That would be very cool, and yes, the pun was intentional.
11. There will be an online course for all participating COTS vendors explaining  cutting edge Kyrgyzstan interoperability standards like FTP, as well as expressing how each and every hospital across the Military Health System has one single positive attribute — they serve heroes. Outside of that, the technology is fair to awful.
12. Had some initial thoughts about themes for each team:IBM / EPIC: “Judy and Watson, sitting in a tree, K-I-S-S-I-N-G!”
    Lockheed / Athena, Siemens: “We build planes, ships, and missiles. How tough a nut can healthcare be?”
    Accenture / Cerner: “DHMSM is like an onion — lots of layers and lots of tears.” Sorry, Accenture, my kids are watching Shrek.

More in June…

HIStalk Announcements and Requests

I hear through murky sources that a huge acquisition will be announced Friday morning (by “huge” I mean “you won’t believe it.”) I’m skeptical, but also receptive to being tipped off early if you are knowledgeable of the supposed deal. The fact that I’ve heard it only once suggests that my caution is well placed.

The latest “CMIO Rant” from Andy Spooner, MD is on HIStalk Practice where he addresses “The Problem List: Foe or Enemy?” complete with screen mockups. His first rant was “The Great Prescription Pad Race.”

Highlights from HIStalk Practice this week include: Medfusion parts ways with Allscripts over payment disputes. The EHRA opposes ONC’s proposed 2015 voluntary EHR certification criteria. A National Quality Forum panel finds pay-for-performance programs unintentionally worsen disparities between rich and poor. Forty percent of physician practices are looking to replace their EHRs, while those struggling to improve collections are taking on more aggressive billing strategies. Researchers find that almost one-third of patients fail to fill first-time prescriptions. 2014 MU incentive payments indicate a potential slow-down in EP participation. Thanks for reading. This week on HIStalk Connect: NIH announces a series of grants aimed at spurring mHealth research focused on chronic disease management, remote patient monitoring, and telemedicine. Doximity, often described as LinkedIn for doctors, announces a $54 million Series C round. Israeli startup Consumer Physics launches a Kickstarter campaign to fund a handheld digital spectrometer that it claims can scan food and calculate calorie and nutritional content. Dr. Travis discusses the 10-year horizon of connected health devices and the implications that they could one day have on healthcare overall.

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

The Kuwait Investment Authority takes a $100 million position in Patrick Soon-Shiong’s NantHealth. I wasn’t paying attention to the company’s logo placement on the page above and thought that the female on the left was sporting a Hiawatha-like Native American headdress.

Merge Healthcare reports Q1 results: revenue down 20 percent, adjusted EPS $0.04 vs. –$0.01. From the earnings call:

• The ICD-10 delay moves up window during which hospitals may consider upgrading their imaging systems.
• The company’s MU2 certifications give it opportunities with ambulatory radiology and orthopedic customers.
• Merge improved its Epic integration and avoided an issue involving provisional patents.
• Merge’s eClinical OS clinical trials system has 18,000 users.
• The company will introduce a retinal screening product for diabetes and glaucoma patients, with the target customer being hospitals that are bearing risk.

Streamline Health announces that its Q4 and FY2013 results will be delayed until the end of May as the company’s new auditors review its internal controls. The company says three unnamed go-lives will contribute recurring revenue beginning in Q2 and it booked a new sale for one of the products it obtained in its $6.5 million acquisition of Unibased Systems Architecture in February 2014.

Etransmedia Technology acquires Medical Billing Solutions, expanding its geographic presence placing it in the top 10 large scale RCM services business.

Athenahealth announces that CFO Tim Adams will leave the company to take the same role with electronic commerce vendor Demandware, naming VP/Controller Karl Stubelis as acting CFO.

Sales

New York City Health & Hospitals chooses UpToDate from Wolters Kluwer Health for mobile clinical decision support.

Citizens Medical Center (TX) chooses electronics forms management from Access.

People

IBM names Keith Salzman, MD (CACI International) as CMIO for IBM Federal, which hopes to sell Watson and other technologies to the federal government for healthcare use.

Health Data Specialists promotes Bill Chandler to national accounts manager.

TriZetto announces John McAuley (PatientPoint) as president of its provider solutions business.

John Thornbury, a highly awarded hospital IT leader in England, died on April 28.

Announcements and Implementations

We are live with @Cerner OneChart @StVincentsMC as of 4 AM. Patients are safe. Hospital and medical staff are amazing.

— Stuart Marcus MD (@StuartMarcusMD) May 1, 2014

St. Vincent’s Medical Center (CT) goes live with Cerner, according to a tweet from the hospital’s CEO.

Government and Politics

CMS proposes increasing Medicare payments by 1.3 percent overall for FY2015 for the 3,400 acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program and that have met Meaningful Use EHR requirements. Hospitals that haven’t met Meaningful Use would lose 0.675 percent of the proposed increase.

ONC releases a 30-second promotional video about Blue Button.

The VA says it will develop the next generation of its VistA EHR with the help of contests and challenges. Former VA guru Tom Munnecke is unimpressed: “It is not clear how the government owning all submissions in a contest will attract the best in the field. It is unlikely that many people would be interested in spending time and money to enter a contest where they give away their intellectual property.”

The Health IT Policy Committee will hold a May 7 public hearing in Washington, DC to review ONC’s certification process. It seeks input on allowing anyone to submit test cases so that certification measures real-world scenarios.

HHS didn’t want the Congress-mandated ICD-10 delay in the first place so it’s hardly shocking, but a proposed 1,700-page rule changing Medicare payments seems to confirm that ICD-10 will be implemented at the earliest date allowed by law – October 1, 2015. It could be that someone just updated the pre-delay document and forgot that Congress mandated only the earliest date, not the actual date – it’s only a proposed rule. The same document also spells “HIPAA” as “HIPPA,” so even the federal government gets confused.

Other

Most physicians order unnecessary tests and procedures if their patients insist, but they also agree that ordering such tests and procedures is a big problem. They think doctors are better equipped to solve the problem (58 percent) than the government (15 percent), according to the telephone survey funded by the Robert Wood Johnson Foundation.

Athenahealth VP Kyle Armbrester explains the company’s More Disruption Please program:

Our unique spin is that, because we take a percentage of net collection, we don’t actually partner with technology companies. We partner with outcomes companies like ourselves. So to be a part of the More Disruption Please program, we give our partner the scorecard, and that scorecard shows how they’re either driving more revenue to the doctors for doing the right things, or decreasing operational inefficiencies inside the providers’ workflow, or helping to improve patient and provider outcomes.

I’m always fascinated when family members riot and destroy hospital infrastructure after an unfortunate patient outcome (which doesn’t usually happen in the US, thankfully.) In Pakistan, a mob riots at a hospital, trashes the place, vandalizes cars in the parking lot, and beats up doctors and other employees after an appendectomy goes wrong and the patient ends up on a ventilator. Five days later, doctors haven’t declared the patient dead, and I wouldn’t either given the situation.

Microsoft gives in on its “no more updates for Windows XP” policy after the Department Homeland Security warns people to stop using Internet Explorer until the company fixes a security hole present in versions 6 through 11 that “could lead to complete compromise of the affected system.” The company says it will issue a one-time-only Windows XP auto-update to fix the vulnerability.

CHIME tweet out this photo of its 1994 Board of Trustees. Who can name them all?

Weird News Andy calls this story “Well Shut My Mouth.” Pediatrics nurses in a Saudi Arabian hospital are caught taping the mouths of babies shut to stop them from crying.

Sponsor Updates

• First Databank will present new safety guidelines for pediatric dosing at the 2014 Pediatric Pharmacy Conference April 30-May 4 in Nashville, TN.
• NC HIE upgrades its Orion Health Direct Secure Messaging.
• Ingenious Med will integrate Entrada’s dictation and content fulfillment technology into its charge capture platform.
• A report names Allscripts, Health Catalyst, McKesson and Verisk as key players in the population health management market.
• HCS will lead a discussion on LTCH CARE data set changes at the NALTH meeting in Washington, DC this week.
• Gartner names Validic in its 2014 Cool Vendors for Healthcare Payers report.
• Health Catalyst announces speakers and topics for the Healthcare Analytics Summit 2014, to be held September 24-25 in Salt Lake City, UT.
• DrFirst expands its Rcopia e-prescribing with electronic prior authorization functionality from CoverMyMeds.

EPtalk by Dr. Jayne

Mr. H already scooped me on this one, but the Federation of State Medical Boards (FSMB) recently adopted “Policy Guidelines for Safe Practice of Telemedicine.” My gut reaction is that this is just another way for licensing boards to extract more money from physicians by requiring additional licensure. My second response in actually reading the document (numbered line by line such that it reminded me of a deposition) is that there seems to be a whole lot of self-importance going on here. The seven-and-a-half page document has a Preamble, for goodness sake.

Physicians have been practicing by telephone and using secure messages for years, but apparently now we need to codify new standards just because there is technology involved. News flash: all the old standards (HIPAA, standard of care, ethics, etc.) already apply.

Some of the policy’s contents are very much common sense:

• The need for a “credible physician-patient relationship.” I suppose they’re trying to prevent physicians from turning into so-called pill mills, but then again they haven’t done a great job of preventing those in traditional face-to-face medicine. A quick look at the number of dishonest physicians selling work excuses and gratuitous prescriptions for controlled substances proves that.
• Adherence to privacy, security, consent, and safety principles. Again, already in force simply because we’re physicians.
• Proper supervision of non-physician clinicians.

On a subsequent read, however, several other provisions caught my eye.

• “Where appropriate, a patient must be able to select an identified physician for telemedicine services and not be assigned to a physician at random.” Isn’t this exactly what happens when a patient presents to the emergency department, an urgent care, or many public health clinics? They are seen by the next available physician. They don’t get to pick and choose. Same thing with the assignment of patients to managed Medicaid panels, at least in my state. Again, not a lot of choice there and often a random assignment. Why should telemedicine be treated any differently?
• “A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located.” Again, this feels like a money-grab. I practice in a border town. The idea that I should have to get a different state license to practice telemedicine on a patient when I can see them in person with the license I already have if they’re willing to hop in the car, bus, or train is preposterous. What is magical about telemedicine that I should have to prove my competence to another state board?
• “The practice of medicine occurs where the patient is located.” I tend to think the practice of medicine occurs where my brain and ears are located – where I can hear, understand, and process the patient’s story. In medical school, we learned that 80 percent of the diagnosis comes from the history. The exam just confirms it and provides additional information when it is unclear. I guess the FSMB is now going to turn that old adage on its head. What if my patient sends me a camera phone picture of her rash (via a secure patient portal message using Certified EHR Technology) while on her beach vacation? Do I need a Florida license now because that’s where the patient is? The policy seems to say so, per Page 4, Lines 3-5 and 13-14. Maybe those line numbers were handy after all.
• “The maintenance of preferred relationships with any pharmacy is prohibited.” Excuse me? I have had preferred pharmacies my entire career. I prefer Mom and Pop shops rather than chains, especially when they know their stuff and don’t try to sell my patients aisles of junk food, questionable candy, and outdated cosmetics. I really prefer a pharmacy that doesn’t tell the patient, “The physician never sent your script” when they’re too busy to check the secondary screen on their prescribing software. I agree with the follow-up sentence that physicians shouldn’t send scripts to a specific pharmacy in exchange for benefits if we’re talking about SIGNIFICANT benefits (oh yeah, there’s a typo on Page 7, Line 23) but really, no preferred pharmacy? Does the fact that the Mom and Pop down the street brings a physician homemade cookies during the holidays make her unduly coerced? After all, that’s a benefit. What if the physician also takes them cookies because she’s grateful they are so meticulous with her patients’ scripts? Does that negate the benefit?

In this day and age with the mobility of our society, mobility of physicians, and the technology at hand, it seems more and more preposterous that individual states should continue to license physicians individually and/or without a greater degree of reciprocity. There are all kinds of problems with physicians being disciplined in one state and just going for a license in another state. Why not have a national licensure process? I suppose a counter argument would be that Medicare has a single provider identifier but still can’t correctly identify fraud, but that’s another story.

I really like their closing paragraph. Here’s a winner: “…physician remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral)…” Why should this be unique to telemedicine? Isn’t this something we grapple with on a daily basis, patients who come in wanting a script or referral they don’t need? What about those that want a test “because Medicare pays for it” whether they need it or not? Often our remuneration is ultimately based on whether we comply, either through patient satisfaction scores or the simple fact that they will vote with their feet. On the flip side, what about aesthetic medical services? Aren’t those ultimately driven by patient-desired outcomes? Especially ones like this recent find for aesthetic foot surgery.

On its face, this policy regulates us too much in regards to telemedicine, but perhaps I’ll go a little Jonathan Swift and suggest that maybe we’re not regulated enough in regards to everything else. It’s like saying we’re going to regulate wine in a box but not in a bottle. At this point, the policy is “advisory” so states can take it, leave it, or modify it.

What do you think about the FSMB’s plans for telemedicine and telemedicine technologies? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 4/30/14

Top News

MModal files its plan to exit Chapter 11 bankruptcy by August 15. The company provided a statement: “MModal is pleased to have reached this important milestone in our financial restructuring process. The proposed Plan of Reorganization reflects the previously announced agreement the company reached with the controlling majority of its lenders and bondholders that will dramatically reduce the company’s debt, strengthen its balance sheet, and provide it with significant financial flexibility.”

HIStalk Announcements and Requests

Bonny from Aventura provides an Charles Schulz-powered illustration of the ICD-10 situation that will resonate with many people.

I noticed these signs in a doctor’s office today. It seems that all forms of customer-insulting emphasis are represented: capitalization, bolding, underlining, and massive deployment of exclamation points (always five except for the laptop message, which ends with an unprecedented six exclamation points for those undeterred by inferior numbers.)

Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

Physician networking site Doximity closes a $54 million Series C fundraising round, planning to expand into Canada and to add other healthcare professionals, such as nurses.

Truven Health Analytics acquires Fortel Analytics’ predictive healthcare fraud technology, which will be integrated into Truven’s payment integrity solutions.

General Atlantic commits $125 million to Alignment Healthcare, which offers a care coordination solution.

Alere reports Q1 results: revenue down three percent, adjusted EPS $0.55 vs. $0.53, missing revenue expectations. The company also reported that its Health Information Solutions segment experienced a decline in net product and services revenue from $134.2 million a year ago to $123.7 million.

Press Ganey acquires Dynamic Clinical Systems, a patient-reported outcomes services and solutions provider.

Infor completes its acquisition of substantially all the assets of GRASP Systems International, a provider of automated patient acuity, workload management, patient assignment, and consulting services.

Consumer engagement provider Accolade acquires konciergeMD, which offers a platform for care plan adherence.

For-profit hospital operator HCA discloses in its earnings call that it took in $30 million in EHR incentive money in Q1 vs. $39 million in 2013, incurring EHR-related expenses of $43 million and $26 million, respectively, meaning it spent exactly the same as it made in the two years. Seems like quite a coincidence.

Roper Industries says in its earnings call that its Sunquest operation experienced “double-digit revenue growth” due to improvements in its implementation process and expects to have a “quite an exceptional year in 2014.”

A German business magazine predicts that Siemens will announce on May 7  the elimination of 5,000 to 10,000 jobs and the merging of its four main divisions (industry, energy, healthcare, and infrastructure/cities) to create a flatter hierarchy.

Sales

Craneware wins a seven-year, $3.8 million contract with an unnamed US hospital group for its Chargemaster Corporate Toolkit.

Southern Illinois Healthcare, MBB Radiology (FL), Radiology Imaging Associates (CO), Southwest Diagnostic Imaging Center (TX), St. Paul Radiology (MN), and Washington Radiology Associates (VA) and 13 other organizations select Merge Healthcare’s iConnect Network interoperability platform for clinical data exchange.

CHE Trinity Health will implement Verisk Health’s Provider Intelligence solution and DxCG platform to manage its national population health management initiatives.

The board of trustees of Cumberland River Hospital (TN) approves $156,644 in upgrade costs to allow the hospital to update its CPSI software to meet Stage 2 MU requirements.

The University of Arizona Medical Center will use services from Besler Consulting to identify Medicare Transfer DRG underpayments.

Kettering Health Network (OH) selects Wolters Kluwer Health’s ProVation Order Sets.

University of New Mexico Medical Group chooses StrataJazz from Strata Decision Technology for budgeting and planning.

People

Castlight Health appoints Ed Park (athenahealth), brother of co-founder and US CTO Todd Park, to its board.

Symphony Technology Group promotes Al Vega to president/CEO of Symphony Performance Health.

Jonathan Perlin, MD, CMO will step down as chair of ONC’s HIT Standards Committee. He will be replaced by Jacob Reider, MD of ONC.

MEA|NEA appoints Scott Hefner (Jopari Solutions) VP of sales.

Announcements and Implementations

Practice Fusion launches a population health management offering in collaboration with drug manufacturer Merck, giving practices a real-time dashboard that compares a provider’s patient vaccination rate with the rates of other Practice Fusion providers.

Regional Medical Center Orangeburg (SC) goes live on Cerner’s patient portal.

Central Illinois Health Information Exchange, Lincoln Land Health Information Exchange, Illinois Health Exchange Partners, and MetroChicago Health Information Exchange connect their health information exchanges, which collectively serve 63 hospitals.

Government and Politics

CMS releases an interactive search tool to streamline access to Medicare provider payment data.

The GAO appoints three members to the Health Information Technology Policy Committee: Christop U. Lehmann, MD, American Academy of Pediatrics (representing vulnerable populations); Neal Patterson, Cerner (representing vendors); and Kim Schofield, Lupus Foundation of America’s Georgia chapter (representing consumers and patients.) Paul Tang, MD of Palo Alto Medical Foundation was reappointed as physician representative.

Innovation and Research

Physicians reviewing EHRs carefully read the impression and plan section, but only quickly scan details on medications, vitals, and lab results, according to a study published in Applied Clinical Informatics. Researchers recommend optimizing the design of electronic notes to include “rethinking the amount and format of imported patient data as this data appears to largely be ignored.”

Brigham and Women’s Hospital chooses four companies in its “shark tank” competition for pilot projects: Twine Health (collaborative chronic disease management), MySafeCare (patient and family reporting of safety concerns), Healo (remote monitoring of wound healing), and Tenacity Health (peer health coaching.) 

Other

The Federation of State Medical Boards approves telemedicine guidelines that include a policy to apply the same standards of care for remote medical encounters as for in-person encounters. The guidelines also call for physicians to care for only those patients located in their licensure coverage areas, establish a credible patient-physician relationship; and adhere to safety and privacy principles.

A Boston Globe columnist names Nuance Communications CEO Paul Ricci as the most overpaid executive in Massachusetts based on his compensation of $87 million over the past three years, during which time the company’s share price dropped 16 percent.

Medfusion ends its relationship with Allscripts “due to unresolved payment disputes” and gives the 30,000 Allscripts users of its patient portal until May 31, 2014 to sign a contract directly with Medfusion. The termination is hardly a surprise given Allscripts acquisition of the competing Jardogs product last year.

Boston Medical Center (MA) terminates its transcription contract with MDF Transcription Services after discovering that the records of 15,000 of its patients are visible on the company’s Internet server.

St. Joseph’s Hospital Health Center (NY) discloses in a prospectus offering to sell $68 million worth of junk-quality bonds to pay for a new power plant and EHR system that it will probably be sued over claims that a disruptive surgeon slapped and verbally abused anesthetized patients going back to early 2012.

Rural hospitals are considering EHR implementation assistance as one reason to affiliate with a larger organization, hoping to earn financial incentives or avoid penalties.

University of Mississippi Medical Center (MS) CIO David Chou recounts what it’s like when a hospital loses Internet connectivity and access to cloud-based applications. The article mentions that low adoption rates prevented using Twitter and Facebook for communication during the outage, which I assume means by smartphone cellular since nobody could get to those sites otherwise (although they could use self-hosted Yammer instead if Microsoft still offers that.)

A San Francisco Examiner opinion piece by an orthopedic surgeon complains about his hospital’s use of the “all-pervasive Epic” system, which he says has caused doctors to focus on the computer instead of the patient and has sterilized the medical record to the point of uselessness. He seems to blame the system for the behavior of its users, saying it only improves care “from the point of view who want to watch data from across the room” while he prefers to “talk to the patient” and be a “hands-on doctor,” neither of which as far as I know is prohibited among Epic users.

UPMC (PA) will partner with one of three unnamed companies to sell analytics software it developed to benchmark costs per individual physician. UPMC says it spent $5-12 million to develop the system, which it claims has reduced its readmissions by 37 percent.

A state audit reveals that a former IT consultant with the University of Iowa Hospitals and Clinics illegally sold $57,000 worth of hospital computers to staffers and friends between 2005 and 2013. A woman tipped off the IT department after trying to get technical support from Dell for a laptop the consultant gave her, only to be told that it was registered to the hospital.

Weird News Andy (“Weird News You Can Use”) finds this ironic: hundreds of attendees of the national Food Safety Summit in Baltimore get food poisoning. WNA is also transported by this story, in which doctors trigger vivid memories of a patient’s childhood as they stimulate areas of his brain with electrodes in trying to determine the cause of his epilepsy.

Sponsor Updates

• McKesson launches Managed Mobile Services to simplify mobile device management.
• iHS2 releases a research report entitled “Healthcare Security: 10 Steps to Maintaining Data Privacy in a Changing Mobile World.”
• Craneware and its customer Southeastern Ohio Regional Medical Center will discuss the future of patient access at the National Association of Healthcare Access Management 40th Annual Education Conference May 16 in Hollywood, FL.
• Independent auditor LBMC confirms that PerfectServe has achieved Service Organization Controls (SOC) 2 Type II of its security and privacy controls.
• Allscripts recognizes its customer Carson Tahoe Health (NV) for attesting for MU Stage 2 using Allscripts Sunrise.
• Medhost adds high-availability disaster recovery and remote monitoring and management to its managed IT service offerings.
• Shake IT Baby is the theme for Impact Advisors’ annual Impact Palooza April 30-May 2 in Scottsdale, AZ.
• William J. Leander, SVP for Santa Rosa Consulting, will discuss value-based healthcare at next month’s MUSE 2014 International Conference in Dallas.
• Allscripts profiles Unity Health System (NY) in a blog post and discusses how dbMotion’s HIE technology helped Unity achieve better outcomes.
• Liaison Healthcare partners with AOD Software to connect its long-term provider customers with lab and imaging vendors on the Liaison EMR-Link hub.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.