CommonWell Answers HIStalk Reader Questions

David McCallie, Jr., MD, SVP of medical informatics for Cerner and co-founder of CommonWell Health Alliance, invited HIStalk readers to submit their questions about CommonWell. He obtained answers from the most appropriate CommonWell resource. These replies were provided by David along with Dan Schipfer (VP/GM of government for Cerner and CommonWell operating committee chair); Nick Knowlton (VP of business development for Brightree and CommonWell membership chair); Bob Robke (VP for Cerner and CommonWell treasurer); and Jitin Asnaani (director for Athenahealth and CommonWell operating committee co-chair).

How do organizations like CommonWell promote interoperable transfer of health information to non-members? If our goal is a national infrastructure for transfer of PHI, don’t these aggregations of health partners create barriers to a national solution?

From a strategic point of view, CommonWell’s founders created the network because they did not believe that any of the existing approaches met the need for national-scale federated query based on robust identity management and record locator services. CommonWell’s founders believe that regional and vendor-proprietary networks won’t meet the demand for universal query connectivity. In contrast, CommonWell membership is open to all HIT suppliers and their customers, nationwide. However, if other networks emerge that cover substantial portions of consumers, CommonWell is open to creation of bridging services that could interconnect with other networks.

More tactically today, we feel that CommonWell has already promoted interoperable transfer of health information by publicly calling out the important issue of the lack of a common patient identifier in US health care. Second, to advance the state of the art, CommonWell members have designed and published specifications that address the problem of the missing patient identifier. These specifications are available for any and all (i.e. members and non-members) to evaluate, improve, implement, and use under common open source licensing. 

Does CommonWell have any plans for taking the initiative outside of the US?

We’re taking it one step at a time. Currently, CommonWell’s focus is to deliver real-world interoperability services across the US.

Why did some folks refer to CommonWell (in its early days) as the "HIE killer" and is that still a valid point? Accordingly, do entities like Aetna (who has invested in Medicity) and Optum (with their Axolotl acquisition) consider CommonWell to be a threat?

It is difficult to speculate on behalf of “some folks,” but CommonWell is not attempting to “kill” any type of exchange. CommonWell is designed to offer a national-scale service because we believe that a patient’s provider should have access to that patient’s information regardless of where the information lives. Through this approach to “universal plumbing,” members can expect an increase in the access to health information for their providers and a decrease in the cost and time for providers and their patients to gain access to their health information.

By addressing shortcomings in existing exchange models (such as imprecise standards that inhibit vendor to vendor connectivity), CommonWell is drastically reducing time and associated expense to achieving health information exchange. Furthermore, in a world driving towards the triple aim, interoperability initiatives such as CommonWell are aligned with goals common to payers, patients, provider networks, and national healthcare delivery objectives.

How does CommonWell relate to the Argonaut project?

There is no formal relationship. The Argonaut Project is an industry-funded initiative to accelerate the development of technical standards (FHIR and OAuth) in conjunction with HL7. On the other hand, CommonWell is a trade association that is deploying a national network. The results of the Argonaut Project should complement CommonWell’s existing use of standards, which are partially based on FHIR, as well as on standard IHE profiles like XCA (for document-based exchange). The standards work stimulated by the Argonaut Project will be important to HIT in general. CommonWell hopes to leverage these new standards to provide enhanced services as they become formalized.

What fees will be collected for using CommonWell’s system, who pays those fees, and where does the money go?

CommonWell is a non-profit trade association that relies on two different fee sources to operate.

One is membership dues, as are common to most not-for-profit trade associations. The dues schedule is based upon an organization’s annual US HIT revenue and provides for the organizational expenses of running the Alliance. A more detailed breakdown of the membership fees is available on our website.

The second fee, a Service Fee, covers the cost of the core services provided by CommonWell to its members to facilitate data exchange and includes the identity management and record locator services. By doing this at the vendor level, CommonWell is able to achieve unprecedented economy of scale gains for streamlining connectivity. Members who provide access to CommonWell to their customers are free to charge (or not charge) for those services as they see fit. As a non-profit trade association, CommonWell has chosen not to mark up these costs to membership.

CommonWell cannot set the fees charged by member companies to their customers. However, our expectation is that those fees will be modest compared to the value of the services delivered and will be assessed in the “commodity service” philosophy espoused in our founding principles. As noted in CommonWell Board Chairman Jeremy Delinsky’s recent blog, athenahealth’s service fee equals about one-tenth of one-percent of their annual revenue.

What’s costly for everyone is the need to build numerous point-to-point interfaces and reinvent the wheel of patient identity management for every exchange scenario. Connecting once to a nationwide network, as the health care industry has done in other instances, has proven to be a better model for widespread data exchange.

Will EHR vendors pay a competitor (McKesson and CommonWell’s IT provider RelayHealth) to exchange information with other systems?

CommonWell Health Alliance delivers the services to the HIT members. RelayHealth is CommonWell’s initial contracted network service provider. As with any service offering that requires hardware and software, the services fees paid by the member to the Alliance help to offset the Alliance’s network service provider investment and compensate them for the costs of providing that service.

I heard it costs $2 million to become a member of CommonWell. What is the ROI for those members?

As noted above, if a vendor chooses to offer CommonWell Services to its clients, the vendor is charged a Service Fee in addition to the Membership dues. The Alliance currently charges an annual Service Fee to cover the cost of the core services. The Service Fee is based upon the Member’s annual HIT revenue. This annual fee allows the Member to onboard an unlimited number of clients onto the CommonWell Network.

CommonWell plans to publically post the Service Fee schedule on our website later this year, but for the vast majority of members, the costs will be far below that amount.

If I’m an Epic shop, what can CommonWell do that I can’t already do through Epic? What are the cost comparisons?

CommonWell provides a national-scale identity management service, nationwide record locator service, and universal connectivity to any vendor that offers the service. A single connection to the CommonWell network will enable providers and the patients they serve to access to their health information at all those various systems and organizations and won’t require peer-to-peer contracting for each provider you need to reach. The identity management and record locator services reduce matching errors and make it seamless for the provider since the patient does not have to remember the places where they have records. We don’t know of any single vendor network that can enable access to a patient’s health data regardless of where they have been seen.

Why would providers want a few publicly traded vendors running a fee-based backbone instead of pushing the government to create freely usable standards available to all vendors?

CommonWell’s founders believed that identity management and record locator services were necessary for effective national-scale query connectivity. Those services have to be organized and paid for by someone and the existing government-related approaches were not committed to delivering those services. Additionally, the founders believed that the vendor community was in the best position to “build in” support for efficient, seamless connectivity. The standards on which CommonWell is based are indeed freely available, but the national scale services that make those standards useful require an organization and appropriate organizational governance.

How are health plans and payers represented in the CommonWell alliance? Medicare’s risk adjustment have always demanded better access to and merging of administrative and clinical data. Now that the ACA demands risk adjustment for commercial population the need for this marriage is even greater. The ability for health plans to better assign risk to their members and the ability for providers to help close care gaps and meet their CMS-mandated obligations for data exchange can be greatly facilitated by providing improved attribution mechanisms for identifying members, providers, and specific encounters. And there should be a common means for plans to provide care gap info.

Right now, CommonWell is made up of 17 health IT vendor organizations, but we encourage membership to any organizations, including payors, that share the association’s values and vision for interoperability. In the early days of the Alliance, we had to remain focused on designing, building, and deploying our core services. These existing services offered by the Alliance are well aligned with offering improved delivery of healthcare for the nation, and that inherently provides benefits for all stakeholders – including patients, providers, and payors.

While this is a great start, we recognize that there are other opportunities to provide value for how healthcare is delivered and CommonWell certainly has an opportunity to build upon the established model to provide additional value. The Alliance welcomes participation from and conversations with payors and other healthcare stakeholders outside of the core EHR community. We have engaged early conversations with several payors that share our vision and understand how crucial interoperability and data liquidity are to improving care.

To complement this, the Alliance has established a process for reviewing member-proposed potential service line extensions and welcomes payors to help determine if the identity management and record locator services offered could add additional value to the patient populations represented by the members in the Alliance, through examples such as care gap closure, without compromising any of our core principles.

What factors convinced Cerner to join the CommonWell and what is Cerner’s play after the three years of free services?

The early days of CommonWell have been focused on getting the network deployed as widely as possible to ensure that meaningful health information is delivered. We understand that the value of the network depends upon how widespread the usage is. Cerner wants to remove as many barriers as possible to help speed deployment. Removing financial barriers to early adoption was a straightforward decision for us. After the initial three years, we expect that the costs associated with the services will be in line with other EDI like transactions and will be considered minimal in comparison to the value a client receives.

News 1/16/15

Top News

PwC adds Google to its Department of Defense EHR bidding consortium that is pitching the VA’s VistA. Google joins, PwC, General Dynamics IT, DSS, and Medsphere. Google’s contribution would be collaboration and search tools, which seems to be more sizzle than steak as PwC tries to make VistA sound sexier to the DoD, whose contempt for that system is legendary. The group has also put up a web page to make its case.

Reader Comments

From Weird News Andy: “Re: Iowa health insurance startup, the second-largest co-op in the country and heavily funded by the federal government, fails. The key is in this quote: ‘CoOportunity Health’s pool of people was larger than expected, was sicker than expected, so their risk became much greater than the funds that were available.’ That’s an economics lesson. Sicker people spend more and choose the one that saves them the most money, so you end up with a pool of sicker, more expensive members. If the founders of the organization did not see this going in and did not charge enough for their service, the fault is theirs. But then if they charged more, fewer people would select them and …” That’s a big problem with medical insurance. The fingers of insurance company actuaries fly over their Excel worksheets in their attempt to assemble a customer base that includes lower-risk, healthier patients to offset the expensive ones so they can bid competitively. However, individual patients sign up expecting to use more services than they’re paying for, to the point of not even buying insurance until they’ve accumulated enough problems to make it worth their while. It’s like a buffet restaurant eyeballing prospective diners at the door in trying to choose a profitable mix of picky eaters and starving chowhounds for a predetermined price, but their downfall is that few picky eaters will pay for an all-you-can-eat buffet knowing they’re subsidizing those who inhale everything in sight.

From RVA: “Re: concierge medicine. My PCP is moving to concierge practice, saying he doesn’t want to use Epic and that he can’t provide good care because his face is always in the computer ((FYI, he cashed his MU check). The concierge company touts their USB chart that allows you to take your important clinical information anywhere — apparently MyChart was not good enough (the guy sitting next to me joked that when they run out of USB drives, they’ll switch to 8-track tapes). He has approximately 1,200 patients (mostly Medicare) and a poorly-managed practice. They showed a scary video about how doctors are ‘forced’ to give up their practices and referenced the use of ‘mid-level providers’ in a negative way. A lot of people ate it up and started pulling out their checkbooks – oh, he has limited capacity, so it’s first-come, first-served at $2,500 per year. I’m worried that we’re creating a class system where those who can’t afford the fee get less than premium care.” It’s tough to ignore economics by suggesting that those who pay less should receive equally generous, excellent, and responsive healthcare services, even though we as decent people wish that were possible. All of us working in healthcare expect to be paid, so unless we turn it back over to the nuns and counties that ran hospitals as true non-profits using cheap and volunteer labor, those days are likely gone. The ED is the last foothold of healthcare democracy, where everybody is treated the same based on need, but then again, it’s a cost cesspool for that reason and hardly a poster child for open access to all. Healthcare economics is like a balloon – squeeze it in one place to cut costs and another part bulges out as providers who are understandably unwilling to reduce their personal standard of living figure out new ways to charge for their services. We’re at three tiers now: (a) those who use ED and public clinics or who don’t buy insurance because they don’t see the immediate value; (b) the large middle class who have insurance but are getting hit hard by out-of-pocket costs and sometimes facing bankruptcy because of huge and often questionable bills, with that group subsidizing the first one by paying excessive charges and taxes; and (c) those whose assets are adequate to self-insure and whose time is valuable enough to make it worth finding the best and most customer-friendly providers who don’t take insurance. It’s unrealistic to expect the care and outcomes to be identical across all three groups. It’s also reasonable to expect people in the middle group to move down rather than up, and it’s the loss of that group that threatens to implode the system. It’s just like the tax system: some percentage of people pay nothing, the wealthy pay a low overall percentage because of their small numbers and large accounting tricks, and those in the middle foot most of the bill.

HIStalk Announcements and Requests

Last year right before the HIMSS conference I supported Donors Choose by offering companies a large, short-term banner that appears beside the HIStalk title on every page, using the proceeds to fund a bunch of projects for classrooms in need. It felt good and it was fun, so I’m doing it again this year. Contact Lorre if you’d like to book the most prominent ad on the page and help needy students in the process. Like last year, I’ll write up the projects we funded and share the student comments and photos that result.

I followed through on a reader’s suggestion of an HIStalk Book Club sort of thing where I review an HIT-related book and invite readers to share their thoughts. I reviewed Eric Topol’s “The Patient Will See You Now” and next up is “America’s Bitter Pill.” Read along, add your thoughts, and suggest what book I should read next. I have a copy of John Halamka’s “GeekDoctor: Life as a Healthcare CIO” that HIMSS sent me in return for completing a survey, so maybe that should be next.

I’m sure we’ll see this at the HIMSS conference: every hip meeting now includes a “graphics facilitator” who documents everything on a flipboard, compelling attendees to proudly tweet out photos of the drawing afterward. I don’t want to attend a conference where a cartoonist understands the presenter better than I do.

Here’s one last appeal for you to complete my once-per-year HIStalk reader survey, which takes just a couple of minutes but helps me immensely.

This is a fond farewell to Agilum Healthcare Intelligence, whose marketing person told us, “I’ve never even heard of HIStalk” in declining to renew their sponsorship after many years. They’ve been supporters for a long time and I appreciate it. I also appreciate the service of the marketing guy, who though he has zero health IT experience, is a former Army infantry captain who led a field artillery battery in Iraq, according to his LinkedIn profile.

This week on HIStalk Practice: Telehealth reimbursements are set to go live in New York. Tulane University Medical Group implements eCW’s CCMR. Etherapi takes advantage of the Kaiser strike in California. HHS breaks down its own silos, and enjoys flying first class. Dr. Gregg looks into the future of healthcare IT, circa 2037. Third-party patient portals go head to head with vendor-specific options. Thanks for reading.

This week on HIStalk Connect: 23andMe finds a new source of revenue as it closes a $60 million deal with Genetech in which it will use its dataset to support Parkinson’s disease research. Athenahealth acquires cloud-based inpatient EHR vendor RazorInsights, and confirms that it will move into the hospital space. Augmedix raises $16 million to scale a promising Google Glass-based telecharting business. 

Acquisitions, Funding, Business, and Stock

Todd Cozzens of Sequoia Capital is featured on Fox Business’s “Opening Bell” live from the JPMorgan Healthcare Conference. He mentions his firm’s investment in Health Catalyst (analytics) and MedExpress (retail clinics). A Forbes profile of Sequoia Capital mentions its 40-plus year history, including its 1980 investment in Apple’s IPO (the founder thought the 22-year-old Steve Jobs “looked like Ho Chi Minh”) and its recent gains from Airbnb, Dropbox, and WhatsApp. The firm’s partners make a fortune, apparently, as the article mentions a 2003 fund that returned gains of 41 percent per year for 11 years, with the firm’s partners pocketing $1.1 billion as “Sequoia is turning its own partners into billionaires while keeping outside investors purring.”

I mentioned that Athenahealth has acquired small-hospital EHR vendor RazorInsights for a rumored $40 million to give it an inpatient foothold. I really like what RazorInsights is doing in giving small hospitals an inexpensive, cloud-based system that covers both clinicals and financials, but I don’t see the benefit to Athenahealth in buying a four-year-old company with only a couple of dozen small customers. RazorInsights has much larger competitors (Meditech, CPSI, Medhost, NTT DATA, McKesson Paragon, etc.) with established infrastructure and most hospitals have already spent their money on a Meaningful Use dance partner, some of them even choosing to run Epic or Cerner as provided by another hospital (or to be acquired by those hospitals). Athenahealth has choked on its previous acquisition Epocrates, which is highly regarded but is stumbling even more than before under Athenahealth’s ownership. I think Athenahealth wants desperately to crack the inpatient market (after insulting that market for years), realizes it doesn’t have the expertise to build a new hospital system from scratch, and decided to spend money instead of time to get a name-plated product quickly to market and then ramp it up. The challenges are many:

• RazorInsights is small for a reason and not being owned by Athenahealth may not be it.
• Both product and company scalability are unknown.
• Few big companies have low-enough overhead to profitably roll out products to cash-strapped 25-bed hospitals.
• Expected synergies may (as they often do) prove to be elusive.
• Companies have been historically lured into unwise acquisitions because the product aroused them technically and filled a perceived immediate need at high expense (Allscripts buying Eclipsys).

I think Jonathan Bush will talk this up as though Athenahealth is the next Epic (or Salesforce or whatever high-flying comparison comes to mind), but the acquisition is just another distraction as the company tries desperately to keep its Wall Street plates spinning in the air despite concerning profits and a year-long share price stall.

Aetna announces that it will raise its minimum wage to $16 per hour in April and will offer an enhanced insurance plan for employees who participate in wellness programs starting in 2016.

Two former NantHealth executives file a whisteblower lawsuit against billionaire doctor Patrick Soon-Shiong’s company, claiming that NantHealth is “engaged in a multitude of fraudulent activities,” violates HIPAA requirements, has failed mock FDA audits, and offers products that harm patients. Stephanie Davidson (former SVP of professional services) and William Lynch (former senior director of marketing) also claim that several customers were prepared to stop using the company’s Clinical Operating System, citing an internal report that characterized that product as “10 years behind in technology capability” that “runs on LUCK.” The pair claims that NantHealth’s marketing material is misleading and that Soon-Shiong’s charitable foundation defrauded Medicare by donating millions to a hospital that would then use CMS matching funds to buy NantHealth’s products. NantHealth’s responds that the employees, who are in a romantic relationship and had worked for the company for only a few months, demanded that NantHealth pay them $2 million to prevent them from launching a pre-IPO smear campaign after NantHealth fired Davidson. Perhaps it’s not a coincidence that the lawsuit was filed just as Soon-Shiong gave the company’s investor pitch at the JPMorgan Healthcare Conference.

Craneware says second-half sales for 2014 increased 10 percent and its board is confident of meeting 2015 expectations.

Sales

Good Shepherd Health System (TX) chooses Strata Decision’s StrataJazz for decision support and cost accounting.

Healthfirst (NY) selects InterSystems HealthShare as its HIE and clinical portal.

Providence Health & Services expands its relationship with Kyruus, which offers a doctor web search tool. That’s how I would describe their business, anyway, but if you don’t get enough buzzwords, here’s theirs: “Kyruus is an enterprise healthcare provider solutions company that helps health systems optimize their Patient Access, Referral Management and Care Coordination operations. Leveraging the cloud and a proprietary Big Data approach, the company enables the integration of massive amounts of information to create a single source of truth of providers. Kyruus helps health systems create customizable protocols for referral and scheduling across all channels of patient engagement to improve patient access and patient experience.”

People

Ralph Keiser (Deloitte) joins Recondo Technology as chief growth officer.

John Glaser (Siemens Healthcare) joins the board of the American Telemedicine Association.

Hayes Management Consulting hires Gay Fright (Coastal Healthcare Consulting) as VP of strategic services.

Huntzinger Management Group promotes David DiChiara to CFO.

Sachin Jain, MD, MBA (Merck) joins care plan CareMore as chief medical officer. He worked for ONC for a short time a few years ago. He said in a talk last week that most health IT startups offer products that are interesting but not really useful because (a) they’re trying to make a quick buck, and (b) they are mostly run by young, prosperous, healthy people and develop products in the context of their peers rather than for the sick, expensive patients that need help. He also said HITECH came about because everybody knew EHRs were good for patients, but hospitals put the interest of their resistant doctors first because they’re the ones who admit patients.

Ken Pool, MD, co-founder of OZ Systems and co-chair of the HL7 Public Health and Emergency Response Work Group, has died, according to a posting on the group’s listserv.

Announcements and Implementations

An article by Brad Swenson of Winthrop Resources Corporation suggests that the total cost of ownership of hospital EHRs should use a 10-year forecast rather than the more common five or seven years. It quotes The Valley Hospital (NJ) VP/CIO Eric Carey, who used a 10-year timeframe to make an upgrade-or-buy decision: “We felt no one should be replacing an EHR platform in less than 10 years unless a catastrophe happens. Also, probably the most expensive part of an EHR project is the army of consultants, staff, and project managers you need to have to pull everything together. Our implementation has involved 20 FTE over at least one year. Most organizations can’t afford to do that more than once.”

McKesson announces Paragon Community Plus, a package that includes its Paragon system, implementation, training, and remote hosting.

Government and Politics

A House Committee on Energy and Commerce work group creates a draft policy that would require HHS to pay for telehealth services at the same rate as in-person visits within four years.

Innovation and Research

Philips gives MIT researchers access to the de-identified records of 100,000 ICU patients who were monitored via its eICU program. The records, which represent about 10 percent of all US adult ICU beds, include vital signs, medication orders, lab results, and severity of illness scores.

Technology

Google stops public sales of Google Glass and moves the product from its research lab to a separate business unit led by former fashion and eyewear designer Ivy Ross. Companies and developers will still be able to buy Glass units after the January 19 cutoff date. Google was supposed to release a new version of Glass in 2015 but hasn’t provided specifics. People seem to think this is the beginning of the end for Glass, but I’m not so sure: it desperately needed a reboot, graduation from beta status, and design help for its ugly form factor (which is true of most things Google), so perhaps this is its graduation into the real world, or even away from the consumer market and into the enterprise one.

A guest newspaper article by the CEO of a Missouri public policy organization says the state is still #49 in economic growth despite being one of nine labeled as “the corporate welfare kings of America.” He says of the Missouri’s $1.6 billion subsidy of Cerner’s $4.3 billion new campus, “If Cerner needs a corporate pleasure dome, it should pay for it on its own nickel.”

I thought sure this was a spoof since it was heavy with Star Trek puns and one of the pictures features a nurse wearing a 1970s-style cap, but apparently the just-started IndieGoGo campaign for the $3,500 Warp 3 Medical Tricorder is for real. It’s not the X-Prize, Scanadu-type consumer Tricorder, though – this China-based one will be just for doctors and will provide vital sign, ultrasound, and EHR functions.

Other

The local paper says that MultiCare Health System (WA) is not only represented on the advisory group IBM and Epic put together to help make their case to the Department of Defense as it selects its $11 billion EHR, but MultiCare will also serve as the pilot site should the IBM-Epic bid be chosen.

A physician’s New York Times editorial observes that 24 of the 141 medical schools in America are now named after big donors, causing graduates to be “embarrassed that there was a rich person’s name on their diploma, with the university name tucked below in small print.” Naming rights cost from $8 million (East Carolina University’s Brody School of Medicine) to $200 million (UCLA’s David Geffen School of Medicine, above). 

Sponsor Updates

• Imprivata integrates its Cortext secure communications platform with the Citrix XenMobile enterprise mobility management solution.
• HealthTronics selects AirWatch for enterprise mobility for its 500 employees.
• ZeOmega is named as one of the 100 fastest-growing Dallas companies.
• John Stanley of Impact Advisors is quoted in a San Diego newspaper’s article on the pros and cons of EMRs.
• Divurgent will participate in the HIMSS East Tennessee Summit in Knoxville on January 22.
• DataMotion covers the important role e-mail plays in file sharing in its latest blog.
• CompuGroup Medical will participate in the Critical Care Congress in Phoenix, AZ from January 17-21.
• CommVault expands its relationship with NetApp to offer integrated data protection solutions.
• TechGig outlines CitiusTech CEO Rizwan Koita’s predictions for 2015 healthcare technology trends.
• CareSync publishes a new blog on the importance of taking charge of a family’s health records.
• Dignity Health VP/CMIO David Lundquist, MD offers insight into how to keep patients in mind when discussing the future of healthcare at AirStrip’s Mobile Health Matters blog.
• ADP AdvancedMD offers “4 surefire signs you need a new EHR for MU2 and beyond” in its latest blog.

EPtalk by Dr. Jayne

It’s been a strange couple of weeks for me. We’re getting ready to go through some major changes at our hospital and everyone is on edge. Teams are being consolidated and it feels like the directors and VPs are playing a giant game of “Go Fish” only instead of cards, they’re playing with people. This comes right on the heels of our hospital’s push to reduce the number of accrued vacation days on the books, which had almost half of our employees taking significant time off during the last month or so.

Everyone is overworked and cranky as we try to make decisions based on forecast scenarios and half-developed plans. Sometimes we start to feel not only like the sky is falling, but that the world is burning down around us. We imagine it can’t possibly be this bad in other places. It’s difficult to reach out to colleagues at other organizations because we don’t want to admit that our own organizations are in frantic disarray.

It was in that frame of mind yesterday that I was trying to catch up on the ridiculous thing that is my inbox. I’m on staff at another hospital that’s not part of my health system. I almost got whiplash doing a double take at one of the emails I received. It was discussing the final steps of a system conversion they’ve been working on for years. They’ve been running dual platforms for the last six months during the transition and are finally pulling the plug on the legacy application.

Despite the robust features of the new system, the email wording left something to be desired. “Many fixes and enhancements have been done to NewApp to make it usable.” The email was sent out under the CMIO’s banner. Knowing him as I do, I’m pretty sure that’s not what he intended. I forwarded it to one of my colleagues – not as a way to humor ourselves at someone else’s expense, but as a confirmation that the people at our competitor across town are likely under the same pressures as we are. No matter how hard and how many long hours we work, things are falling through the cracks.

I thought about how fortunate I’ve been that during most of my time as a CMIO I’ve been surrounded by colleagues who are competent, confident, and motivated. I’ve always felt like they have my back and in turn I’ve had theirs. Over the last year and a half, however, it seems that everyone has been stretched thinner and thinner. We’re to the point where we can barely support ourselves, let alone each other. Although we’re certainly experienced in delivering the impossible, it’s become harder and harder to make it a reality.

Looking at the last few months in particular, not only has our energy been sapped, but we’ve lost some of our support structures. Our standing team meetings have been fragmented as we’re pulled in countless directions by competing demands. Those were our opportunity to update each other on our projects, potential risks, and needs. We received feedback and encouragement as well as ideas to remove blockers or handle difficult situations. Colleagues who had been in similar situations provided pointers and tips and lists of “gotchas” to look for.

I should have taken that email as a warning to stay vigilant. By the end of the day today, I watched one of my key projects go off the rails. In hindsight, I should have seen it coming, but I didn’t. Although ultimately it’s no one’s responsibility but mine, I can’t help but think that if we weren’t all so scattered and overwhelmed that someone else might have picked up on subtle signs that I missed. I spent most of the day with an impending feeling of doom and heartburn that made me want to eat a box of chalk.

I realized that given our current state of being overextended, under-resourced, and fatigued that it’s likely this isn’t going to be the last time something like this happens. This is an uncharted place that I’ve never had to operate in before. I’m officially working without a net and it doesn’t feel very good. But given the state of our industry today, I’m sure I’m not alone.

Do you have tips for how to work without backup? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Athenahealth Acquires RazorInsights

Athenahealth announced this morning that it has acquired inpatient EHR vendor RazorInsights, which primarily serves rural, critical access, and small community hospitals. Terms were not disclosed, but an HIStalk reader who tipped me off early to the announcement says the acquisition price was $40 million.

Athenahealth says it will “leverage RazorInsights’ inpatient expertise and award-winning technology to extend its presence into the 50-bed-and-under inpatient care environment, which accounts for approximately one-third of the US hospital market.”

The announcement cites the RazorInsights customer base of 25 hospitals, the success of some of its customers in attesting for Meaningful Use Stage 2, and its cloud-based delivery model.

Athenahealth Chairman and CEO Jonathan Bush said in the announcement, “Today’s hospital market is woefully underserved when it comes to IT systems and IT partners that are accountable for reducing costs, increasing quality, and enabling a better patient experience. With RazorInsights, athenahealth will immediately be injected into the inpatient care environment; this is a natural extension for our cloud-based services, will tremendously grow our network knowledge, and will accelerate our introduction of results-oriented, inpatient solutions that hospitals can confidently invest in and demand accountability from.”

News 1/14/15

Top News

Pundits and associations won’t stop banging the “Meaningful Use is a failure” drum in pointing out low participation numbers, but ONC partially contradicts their grim calculations in reporting that 77 percent of MUS2-eligible hospitals have attested, as have 60 percent of MUS2-eligible practices. Those providers still have another one month and three months left, respectively, to attest. Those aren’t great numbers, but they’re a heck of a lot better than you might think, and as a taxpayer it’s nice to know that my money at least has minimal strings attached.

Reader Comments

From Poignant Moment: “Re: non-disclosure agreement. If a vendor requires a hospital to sign one for beta testing, how long does the vendor have to keep the NDA after testing is complete?” I’ll ask knowledgeable readers to help out, but I would say the signed copy should be retained at least until it expires since an NDA should cover a stated time period. That’s for making sure the agreement is followed – I doubt there’s any legal requirement to keep a copy at all.

HIStalk Announcements and Requests

I’m enjoying the articles written by startup CEOs and investors (Brian Weiss of Carebox, Bruce Brandes of Martin Ventures, and Marty Felsenthal.) Those authors and others will contribute ongoing articles on their experiences and lessons learned when working directly with startups. I appreciate their contribution. I’m learning from them since I’ve mostly only worked for non-profit hospitals and theirs is a foreign land to me.

Please take a couple of minutes to complete my once-yearly reader survey. I plan my entire year around the responses, so your time will be not only appreciated, but also well spent in my never-ending quest to reduce my level of suckitude.

Webinars

John Olmstead, RN, MBA, director of surgical and emergency services at The Community Hospital of Munster, IN delivered an absolutely perfect HIStalk webinar on Tuesday, “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” He was interesting, informative, and funny in describing technology used in his ED, including RTLS from Versus (who sponsored the webinar without turning it into a sales pitch), Epic EHR, Ascom phones, and Rauland nurse call. It did something that few webinars do in holding my rapt attention throughout and it wasn’t just me – the webinar’s control panel showed that 98 percent of attendees were hanging on to his words instead of checking email or web browsing. The average is more like 60 percent of people paying attention (and for companies that decline our webinar improvement suggestions, it’s as low as 15 percent). I’m confident that anyone with the slightest interest in ED challenges, quality improvement, and what happens when CDC shows up to investigate an infectious outbreak will enjoy this one a lot.

Acquisitions, Funding, Business, and Stock

Athenahealth adds two companies to its More Disruption Please Boston-based accelerator program: CredSimple (credentialing) and RubiconMD (referred remote consults). Athenahealth also announced that the accelerator will open a San Francisco office.

Augmedix, which offers Google Glass-powered physician documentation system, raises $16 million in Series A venture capital.

Kit Check, whose OR medication kit tracking system is live in 144 hospitals, raises $12 million in a Series B round led by Kaiser Permanente Ventures, increasing its total to $22 million.

Digital mental health solutions vendor Ginger.io raises $20 million in a Series B round.

Cary, NC-based SmartLink Mobile, a spinoff of referral coordination software vendor Infina Connect,  raises $2.5 million in funding for its secure patient-doctor texting platform.

Israel-based startup MediSafe, which offers a medication reminder app, raises $6 million and opens a Boston office. One of its new investors is 7wire Ventures, run by former Allscripts executives Glen Tullman and Lee Shapiro.

IT services provider Syntel sues Cognizant and TriZetto over the former’s acquisition of the latter for $2.7 billion last year, with a Syntel business unit saying TriZetto refuses to pay rebates to which it is entitled because of the acquisition. Syntel claims contract interference and misappropriation of confidential information and wants $3.4 million plus $6.1 billion (with a “b”) in punitive damages.

Alere completes the sale of its Alere Health business to Optum for $600 million in cash, announced in October.

Madison, WI-based population health software vendor Forward Health Group raises $5.7 million in funding.

AARP issues a call for startups with apps targeting the “50 and over” market for its May 14 pitch meeting in Miami. Applications are due by February 20, 2015 with no fee required. Companies will deliver a four-minute pitch, answer six minutes of questions from judges, and then have their idea voted on by consumers in attendance based on need, marketing, usage, and value.

Sales

Zwanger-Pesiri Radiology (NY) chooses the Visage 7 Enterprise Imaging Platform for its 58 Long Island radiologists, integrated with the practice’s vendor-neutral archive and enterprise workflow engine.

Eisenhower Medical Center (CA) chooses Mobile Heartbeat’s CURE clinical communications platform following its pilot project.

Good Samaritan Hospital-Southwest (CA) chooses Medhost’s remotely hosted clinical and financial solutions.

Mercy Health (OH) selects ProVation Care Plans from Wolters Kluwer Health for evidence-based care plan management.

People

Jamie Coffin, PhD (Clarify Healthcare) joins SourceMedical as CEO.

Announcements and Implementations

Wellcentive releases an analytics and reporting solution for providers participating in CMS’s Delivery System Reform Incentive Payment (DSRIP) program for Medicaid population care improvement.

HealthLoop releases an iPhone app that sends push notifications to a physician when a patient triggers a clinical alert or when another physician sends a triage handoff. It’s part of the company’s package that costs $199 per physician per month.

Bon Secours St. Mary’s Hospital (VA) goes live on Vox Telehealth’s OrthoCare program, which sends hip and knee replacement patients daily pre-op education and reminders and allows them to relay questions or concerns afterward.

Iatric Systems announces Auditor’s Desktop, which performs a daily risk analysis of potential privacy violations across multiple IT system audits.

Surgical Information System’s  anesthesia information management system is ranked #1 in a new KLAS report.

Government and Politics 

Congresswoman (and nurse) Renee Elmers (R-NC) reintroduces the Flex-IT act that would reduce the 2015 Meaningful Use reporting period from 365 days to 90.

A Washington Examiner investigative report finds that HHS spent $31 million on first-class flights between 2009 and 2013, including 253 trips that cost more than $15,000 each way. HHS executives taking the first-class flights claimed 70 percent of the time that it was necessary because of a medical disability. CMS officials paid $1,000 each for first-class tickets to fly from Charlotte, NC to Charleston, SC, which is a three-hour drive.

Other

Odd: Sentara Healthcare (VA) launches a web shop selling books, vitamins, exercise equipment, and non-prescription drugs, explaining it as “a branded option that offers a higher trust factor and unique patient experience.” A 200-tablet bottle of Advil is $27.99 vs. Walgreens online at $16.49; an Omron 5 blood pressure monitor is $95.99 vs. $45.95 on Amazon; and the book “Yoga Heals Your Back” is $19.99 vs.  $11.69 on Amazon (or $2.99 for the Kindle edition). Anyone smart enough to find and use Sentara’s site will also be web-competent enough to check prices elsewhere, so the site’s success will depend on how highly those people value the “unique patient experience” of clicking the “buy” button there vs. mainstream sites they’re already using. The underlying technology is from Paquin Healthcare, which also offers a system that integrates with EHRs to generate “lucrative new revenue streams” to “monetize major investments made in mandated EMR systems” by using the patient’s information to suggest that the doctor upsell items such as vitamins, wearables, and books. As the company explains, “If a patient’s medical record shows they have had heart disease, Embrace automatically recommends vitamins, pedometers, weight management tools, blood pressure monitors, and other such products suitable specifically for patients with that condition. When a patient purchases the recommended products or services, revenue from the sale is paid to the care provider.” 

Alibaba Health Information Technology settles its licensing dispute with Oracle. NYSE-traded, China-based e-commerce vendor Alibaba Group, whose shares are worth $255 billion and which has been predicted to be the world’s most valuable company in the next few years, bought and renamed the former Citic 21CN drug information business in early 2014.

A clinical documentation position paper from the American College of Physicians published in Annals of Internal Medicine says that EHRs provide minimal improvement over paper records because they were designed around billing and regulatory requirements and the practice of defensive medicine rather than improving patient care. It warns that the EHR is as overloaded with useless information as its predecessor paper chart (and will get worse with data from patient wearables) and that narrative entries are being unjustly devalued in favor of discrete data entry. The authors add that E&M guidelines forced data formatting rules that caused “coding and compliance trumping clarity and conciseness, as well as a harshly negative ‘gotcha’ mentality that saps the professionalism out of physicians.” The position paper says CMS overreacted in its condemnation of copied-pasted information, explaining that while copy-paste causes documentation bloat and perpetuation of originally incorrect information, physicians should not necessarily be required to create every new EHR entry manually – in other words, it’s the user and not the EHR function that should be of concern. The paper expresses tepid support for the Open Notes concept of letting patients review clinical documentation, saying it’s too early for a big rollout and that providers should be able to hide individual notes that could cause patient harm.

Huffington Post covers the growth of retail clinics. CVS alone plans to have as many MinuteClinics in operation by 2017 as exist overall today. Meanwhile, mall operators expect to fill empty spaces left by dying retailer chains such as Sears and RadioShack with walk-in clinics, of which more than a third of the 9,400 total are located in shopping centers.

I enjoyed these tips for making meetings more productive:

1. Don’t invite more than 10 people.
2. Schedule meetings for only 15 minutes, set a timer, and stop the meeting when the timer goes off.
3. Take away the chairs to encourage creativity instead of passivity.
4. Don’t allow laptops or phones – studies show taking notes by hand leads to greater understanding.
5. Assign every task to a directly responsible individual.
6. Take a two-minute silence break to think about a decision or issue.
7. Ask each attendee to answer the “why are we meeting” question in five words or fewer to make sure everyone expects the same outcome.

Weird News Andy understands that, “It’s hard to re-member.” A woman in China cuts off her husband’s penis after catching him sexting with his lover, but surgeons successfully reattach his manhood. The wife, obviously still unhappy, sneaks back into her recuperating husband’s hospital room and cuts his penis off again, this time throwing it out the window of his hospital room. The couple was caught on camera fighting in the street outside as the man was naked and bleeding, but he won’t be reorganized a second time – the hospital says a dog or cat must have run off with his severed penis because they couldn’t find it. However, he may yet have a happy ending since his lover says she will marry him anyway.

Sponsor Updates

• TransUnion unveils a new brand identity platform and logo.
• MedAptus joins Athenahealth’s More Disruption Please program.
• Forbes profiles the use of Strata Decision’s StrataJazz to reduce hospital costs.
• Zynx Health will exhibit at the HealthIMPACT Southeast event on January 23 in Tampa.
• Huron Consulting Group’s efacs software is selected as University Business Readers Choice Top Product.
• Voalte offers advice for setting goals in 2015 in its latest blog post.
• Verisk Health blogs about why value-based care will work.
• T-System Director of Documentation Solutions Robin Shannon, RN offers tips on how to maintain efficiency and throughput during high patient volumes in flu season.
• CEO/CFO Magazine interviews SyTrue CEO Kyle Silvestro on transforming medical data into refined smart data.
• Surgical Information Systems will participate in the MUSE Executive Institute in Amelia Island, FL on January 19-20.
• Summit Healthcare blogs about its preparations for the IHE North American Connectathon, taking place January 28 at the HIMSS Innovation Center in Cleveland.
• SRSsoft offers four key ways to make and keep resolutions in the new year.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 1/12/15

Top News

HLM Venture Partners, which made several health IT investments in its first three funds, is raising up to $150 million to launch a fourth fund. Its portfolio companies include Nordic Consulting, Aventura, Medicalis, Phreesia, and Teladoc.

The investment challenge, it seems to me, is that in the frenzy to throw money at unproven healthcare IT startups, we’re well past the wheat and deep into the chaff. It’s good that demand for new technologies seems strong, but too many no-name companies confuse the market and many of them will fizzle out quickly. Companies that are thrown together purely to chase money usually don’t find it and there’s only so much proven management talent to go around. Incubators and accelerators are encouraging a lot of shaky startups that will experience the inevitable Darwinism. Still, a few of them will avoid enough minefields to get market traction or sell out to a bigger player.

Reader Comments

From Frustrated Surgeon and Developer: “Re: big health IT. Epic and Cerner are using strong-arm techniques to counter any move to interoperability. Congressman Dave Camp (MI) testified before Congress that he was being pressured by lobbyists paid for by Epic to remove interoperability from MU 2 ( and now 3) to secure their business position. Cerner said they weren’t interested in interoperating with my cloud-based system that several hospitals are using. APIs and licensing fees never came up — they just won’t do it. Cerner’s representative to ONC’s Jason Task Force is pushing hard to stop MU 3 interoperability requirements. We should not look to Epic and Cerner to open the doors. We need a HIE which Epic, Cerner, and all other permitted applications should use. It’s the data, not the application.” Unverified. I searched the Congressional Record for Epic-related comments by Dave Camp (who is now retired) but didn’t see anything relevant, although the search isn’t exactly Google quality.

From Jack Gutenberg: “Re: HIStalk book club. You should invite readers to read along and add their comments to yours.” I like the idea. I’m just starting Eric Topol’s “The Patient Will See You Now” in case anyone wants to start it along with me and then add their comments once I’ve posted mine. I’m not only interested in critiquing the book itself, but also discussing the interesting ideas inside. Books I’ve summarized here previously include “Connected for Health,” “Your Medical Mind,” “Safe Patients, Smart Hospitals,” and “Where Does It Hurt?”

From The PACS Designer: “Re: Windows 10 browser. Rumors have been swirling for months about the next version of Windows 10 and its browser style since Internet Explorer and Bing have such a small market share compared to Firefox. The leaked browser is called Microsoft Spartan.”

HIStalk Announcements and Requests

More than three-fourths of poll respondents agree with a popular stock expert’s characterization of the Athenahealth as a “bubble stock” that won’t be “the backbone of anything” rather than the company’s stated high-flying ambition to be the Salesforce of healthcare. New poll to your right or here since I ask every year: what are your HIMSS15 attendance plans compared to HIMSS14?  

Ready for your input: the HIStalk reader survey and HISsies nominations. Thanks for participating. I’ll also randomly draw three reader survey responses for a $50 Amazon gift certificate.

I was thinking about Uber’s surge pricing model, where the app tells you in real time that local demand is high and you’ll have to pay more. I’m frustrated when I get that message, but it makes perfect sense from a supply and demand point of view. When cars are in short supply, the higher price does two things: (a) it allows price-sensitive consumers to seek alternatives to Uber such as taking a cab or walking, increasing Uber car availability for those willing to pay more; and (b) it encourages more Uber drivers to get out on the road and start picking up fares. (obviously it does a third thing: it raises Uber’s profits, so you have to trust them to proclaim surge pricing only when they really are swamped). An Uber model would work in medicine if it were a pure science instead of an art and if people actually paid cash for their services – you could have doctors willing to provide telemedicine consults at a given time and price via an Uber-type service and let patients decide what it’s worth to them, with an app setting the intersection of supply and demand. That leaves those unable to pay out of the picture, but medicine is already heading toward a two-tier system where cash-paying patients have better options anyway.

Last Week’s Most Interesting News

• IBM and Epic enhance their DoD EHR bid pitch by announcing that they’ve already installed an Epic model instance in a DoD-hardened environment for testing and also formed an advisory committee.
• Walgreens adds health management, real-time health coaching, and wearables connectivity to its website and mobile app, offering users reward card points for using the tools to meet their health goals.
• The AMA says EHRs, ICD-10, prior authorization, and Medicare fraud detection are barriers to care that it will target in 2015.
• Sue Schade of University of Michigan Hospitals and Health Centers wins the Gall CIO of the Year award.
• Analytics vendor Inovalon files for a $500 million IPO.
• Allina Health and Health Catalyst announced an analytics technology and quality improvement partnership, explained by Allina President and CEO Penny Wheeler, MD in my interview.
• Only 24 percent of respondents to my poll said their impression of HIMSS is positive.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

Acquisitions, Funding, Business, and Stock

Francisco Partners makes an unspecified investment in Olathe, KS-based revenue cycle solutions vendor eSolutions.

The Columbus paper profiles Lyntek Medical Technologies, whose PatientStorm Tracker software provides a weather radar-like display of an inpatient’s overall condition. It’s being beta tested by OhioHealth Riverside Methodist Hospital. Founder and pulmonologist Lawrence Lynn, DO says the outdated fire alarm model of medical monitoring systems doesn’t provide useful information until vital signs hit specific limits. He adds, “You can be in the hospital dying of sepsis with a smartphone in your pocket that can detect the pattern of a song just by listening to it, but this sophisticated-looking monitor above you can’t detect a single pattern of evolving death.”

Sales

Atlantis Health Group chooses Influence Health’s Navigate population health management solution.

People

UMass Memorial Medical Center (MA) appoints Pam Manor, RN, MSN, DNP (St. Francis Hospital) as chief nursing informatics officer. 

William Hersh, MD (Oregon Health & Science University) is named the winner of the 2014 HIMSS Physician IT Leadership Award.

Streamline Health promotes David Sides, who has been with the company for five months,  to president and CEO. Sides, on the left above, replaces Bob Watson, who will leave the company to become president of NantHealth but will remain on Streamline Health’s board. NantHealth announced in November that it will use Streamline Health’s analytics product in its system.

Government and Politics

The American College of Physicians urges Congress to: (a) repeal Medicare’s SGR formula; (b) continue Medicare’s 10 percent bonus for primary care; (c) restore the Medicaid program that pays primary care physicians no less than Medicare rates; and (d) provide relief from “burdensome and unrealistic” Meaningful Use requirements and “other excessive regulatory burdens.”

Other

An opinion piece slated for publication in Academic Medicine examines whether it’s ethical for medical students to use an organization’s EHR to track their former patients so they can match outcomes to the students’ original diagnosis and treatment. The authors conclude that the benefits outweigh the harms. I couldn’t agree more – it’s hard to believe that an intelligent argument could be made otherwise. The opportunity would only arise in teaching hospitals and I see no potential ethical or HIPAA conflicts since patients understand that their treatment has an educational component. The practice should not only be allowed, it should be mandatory, and perhaps not just for medical students. Medicine (and ancillary fields) are literature-based and that always involves aggregated, de-identified research, but what could be more educational than seeing how your care decisions impacted a particular patient’s life and whether your actions were ultimately right or wrong? The patient has to live with the impact, so  why shouldn’t the professionals who made those decisions? It would also be interesting to look at a patient’s overall perception of health and well-being (perhaps via a self-survey with results trended over time) instead of just a problem list if we’re really interested in improving their lives and not just their medical conditions. We have to leave the “treat ‘em and street ‘em” mindset behind.

The Wall Street Journal runs an essay by Eric Topol, MD titled “The Future of Medicine Is In Your Smartphone” in which he again predicts that technology will alter the patient-physician relationship, reduce costs, and empower patients. He thinks that doctors will still have a role, just not as today’s paternalistic “priestly class.” He has vested interests, however, even going beyond pitching his new book: he lists consulting engagements with Google, AT&T, Walgreens, Quanttus, and Sotera Wireless. A skeptical WSJ commenter weighs in: “I am in atrial fibrillation, now what? That is the rub. All these carnival barkers for the utopian vision of the smartphone/connected world are simply exhausting. For all its many benefits, the Internet is rife with misinformation when it comes to healthcare and the burden is now shifting to the consumer to sort out what is real and what is bogus.”

Ebola vaccine researchers face a surprising challenge: a sharp drop-off in the outbreak could make it hard to find enough victims to test new vaccines.

Sponsor Updates

• HCI Group CMIO William Bria, MD will present at IMN’s HealthIMPACT Southeast on January 23 in Tampa.
• Passport/Experian Health will exhibit and present at the HFMA Region 11 Healthcare Symposium January 11-14 in San Diego.
• nVoq releases a case study on the success Teleradiology Specialists (AZ) experienced with its SayIt cloud-based speech recognition technology.
• SCI Solutions VP of Business Development Bill Reid shares his thoughts on price transparency and how to equip patients with the right tools to understand the financial consequences of care.
• Netsmart will participate in the New York Coalition of Behavioral Health Agencies conference on January 27.
• Patientco outlines three healthcare finance game-changers for 2015 in a new blog.
• MedData will participate in the ACEP Reimbursement Trends and Strategies in Emergency Medicine Conference in Las Vegas from January 13-15.
• RazorInsights will exhibit at the Texas Hospital Association Annual Convention in Austin January 22-23.
• PMD recaps the previous week in healthcare in a new blog post.
• Nordic Consulting offers a new white paper, “Beaker Lab: Planning for Meaningful Use Stage 3.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 1/9/15

Top News 

 
IBM and Epic start background work on the $11 billion Department of Defense EHR project for which they are bidding even though the award won’t go out until summer, saying they need a head start to meet the DoD’s aggressive timelines. IBM has installed an Epic model system in one of its government-level security data centers so that it can test an integrated in a DoD-like environment. The companies also announce that they have formed a 17-member advisory group that includes former Kaiser Permanente CIO Bruce Turkstra and military patient advocate Major William Lyles.

Reader Comments

From Dan Nigrin: “Re: wayfinding apps. We’ve had Meridian’s technology in place for years at Boston Children’s.” Dan is the CIO at Boston Children’s, whose MyWay app offers a nice package of services for visitors and patients. I think hospitals that offer way-finding apps assume that everybody uses them, I bet the penetration is tiny. It would be nice as a patient to be able to get turn-by-turn instructions from the parking garage to a particular hospital department or physician office. Hospitals have the most consumer-unfriendly access that I’ve seen in any industry, starting with dreary pay parking garages and inadequate spaces for their huge numbers of employees. Tip: if you’re a vendor trying to get a meeting with a mid-level hospital IT executive whose non-CIO status doesn’t come with a reserved parking spot, offer to pick them up and drop them off curbside at their location – they’ll accept since they otherwise rarely leave campus for lunch because of the trek to get their car followed by endless cruising for an open space upon returning.

From Fracker: “Re: Meditech. Terminated its distribution agreement with Riyadh, Saudi Arabia-based National Technology Group.” Unverified.

From Vegas Baby: “Re: conferences CMIOs attend. Which ones are popular other than AMDIS?” The HIMSS conference probably has more CMIOs attending than any other conference, although obviously they make up a small percentage of attendees overall. AMIA would have a higher percentage but lower number, I’m guessing. Anyone have insight?

From Malice Cooper: “Re: HIStalkapalooza. Are you taking requests? I am sure demand is high, but I would love to be part of the event.” I haven’t yet put up the “I want to come” page. I need to finalize who’s sponsoring the event to figure out how many people I can afford to invite. That will tell me when I’ll have to cut off requests, assuming that demand exceeds supply, which has happened every year since the first (tiny) event in 2008. I’ll also have a great HIStalk sponsor networking event the Sunday of HIMSS week and will send details about that shortly for those looking to swap war stories or strike deals.

HIStalk Announcements and Requests

It’s time for my once-yearly HIStalk Reader Survey, which helps me picture who’s reading and to get your advice. I would really appreciate your participation since, as usual, I’ll plan everything I do this year based on the results. I’ll also randomly choose three respondents to win a $50 Amazon gift certificate. Thanks for taking a handful of minutes to help me out.

Early January also means its time for your HISsies nominations. Tell me the worst vendor, the smartest vendor action taken in 2014, the industry figure of the year, and the all-important “Industry figure in whose face you’d most like to throw a pie.” The final ballot will contain the most-nominated entries, so think of this as the primary election that precedes the general one by a couple of weeks.

This week on HIStalk Practice: New Hampshire pediatricians sound off on the state’s non-existent vaccine registry. HealthTap CEO brings telemedicine back down to Earth. HHS looks for vendors to run its National Data Warehouse. Healthcare gets New Jersey physicians down in the dumps. EHRs create threats to confidentiality. 23andMe sees investment revival. Thanks for reading.

This week on HIStalk Connect: The year’s biggest digital health stories are recapped, including: unprecedented VC funding levels for digital health startups; Apple, Samsung, and Google all expanding their presence in the digital health sector; 3D printing finding more uses in healthcare, DNA sequencing breaking through the long-awaited $1,000 price barrier, and IBM doubling-down on its Watson supercomputer despite a slower than expected road to profitability. During this week’s CES conference in Las Vegas, Withings unveils its newest fitness tracker, Alterica introduces a smartphone-connected EpiPen case, and Cambridge Consultants shows of breakthrough technology in sensor-laden sportswear.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

Acquisitions, Funding, Business, and Stock

Par8o, which grandly styles itself as “Healthcare’s Operating System,” raises $10.5 million in Series A funding. The referral management software company, whose name is a play on the word “Pareto,” was co-founded by Sermo co-founders Daniel Palestrant, MD and Adam Sharp, MD. Customers include hospitals that are part of the Harvard and Mount Sinai health systems.

Entrepreneur and author Sramana Mitra profiles for her upcoming book those “Unicorn” companies that generate their initial funding from sales rather than from financing, listing among them eClinicalWorks, which she says has $300 million in annual sales and, “If it were valued, it would easily be a multi-billion dollar company.” ECW’s Girish Kumar is among the most astute, genuine, and interesting people I’ve ever talked to.

HCS announces record sales in 2014 with 19 percent revenue growth and the addition of 30 employees.

McKesson shares hit a 52-week high Thursday, valuing the company at $50 billion. Above is the one-year share price of MCK (blue, up 24 percent) vs. the Dow (up 9 percent).

A venture capital firm increases its stake in Etransmedia with an unspecified investment that will support the company’s merger with physician practice services vendor DoctorsXL.

Chicago-based health analytics and algorithm sharing marketplace vendor Apervita, known until last week as Pervasive Health, completes an $18 million Series A funding round. It’s an interesting concept – allowing people to buy and sell health-related databases, algorithms, and measures.

Sales

Rush University Medical Center (IL) chooses Merge Cardiology PACS. MRGE shares have jumped 71 percent in the past 90 days vs. the Nasdaq’s gain of 8 percent.

Health Information Network of Arizona selects Quality Systems subsidiary Mirth to provide patient information exchange.

People

GetWellNetwork hires John George (StayWell) as chief growth officer.

Tom Stampiglia (Origin Healthcare Solutions) joins Surgical Information Systems as president and CEO.

Announcements and Implementations

Walgreens adds Your Digital Health Advisor, a virtual coaching program developed by WebMD, to its website and mobile app. The app includes programs for smoking cessation, weight management, nutrition, exercise, and emotional health and also offers real-time 24×7 coaching via Walgreens Pharmacy Chat. It will connect to WebMD’s iPhone app Health Target, which lets users upload their data from connected devices to receive physician-reviewed advice and tips. Users who meet their health goals earn Walgreens Balance Reward points.

Walgreens also announces that it will use Qualcomm’s medical device connectivity for remote patient monitoring and chronic care management, initially offering integration with Walgreens blood pressure cuffs and glucose meters. A new line of Qualcomm-branded devices will be announced in the next few months. This, too, will reward members with Walgreens Balance Rewards points for their participation. Walgreens is unbelievably ahead of just about everybody in healthcare in terms of technology use, consumer connection, and industry partnerships. Their technology creates revenue instead of just expense. I tried to connect with the company to interview its CIO, but they didn’t respond to my inquiry.

Capsule announces GA of its SmartLinx medical device information system that includes patient surveillance, clinical decision support, alarm interpretation and alerting, and asset tracking.

InterSystems HealthShare is certified as an eHealth Exchange Validated Product.

BD Medical gets FDA clearance for its Intelliport Medication Management System, which provides real-time drug identification, dose checking, and allergy detection at the point of IV bolus injection and then wirelessly documents the drug’s administration in the EHR. The system, which includes an IV access site sensor, wireless base, and table software, will reach the market in spring 2015. It will be marketed for use in perioperative areas to reduce syringe swap, dosing errors, and manual documentation requirements. This looks like a very cool product, even smarter in some ways than IV infusion pumps, and bolus dose errors cause patient problems much faster than an IV.

O’Reilly releases a freely downloadable e-book, “Data Driven: Creating a Data Culture,” that contains interesting business examples including a cool one that studied why people who had tried Twitter stopped using it. It’s a straightforward, hype-free overview of the possibilities of using data to do good work. I ran across it by accident – I like it a lot.

A DrFirst market share analysis of EHRs used in New York finds that 80 percent of the ambulatory EHRs and 85 percent of the hospital EHRs are ready for the state’s I-STOP law that takes effect March 27, 2015. The law requires that all prescriptions be sent electronically from prescribers to pharmacies. New York pharmacies aren’t as well prepared as prescribers, however, with only 58 percent of them ready to accept electronic prescriptions for controlled drugs.

NantHealth announces a new version of its HBox medical device that collects and transmits real-time information from blood pressure cuffs, scales, and other personal devices using technology from BlackBerry.

Skylight Healthcare announces a secure videoconferencing solution that connects hospitalized patients with up to four other people simultaneously via the company’s interactive patient engagement technology.

Erlanger Health System (TN) becomes the first US hospital to roll out AlarmNavigator from Excel Medical Electronics, which helps users analyze alarms from GE patient monitoring systems to support customizing settings to reduce alarm fatigue.

The Michigan Department of Community Health launches a mobile app and portal so that Medicaid patients can access their medical information remotely.

Government and Politics

The FCC proposes updating its 2010 definition that said “broadband” has a minimum speed of 4 Mbps down/1 Mbps up to instead require 25/3 Mbps. The agency says rural and Tribal lands are underserved, with the proposed definition change upping the requirements for broadband providers that requesting federal grant money to add services. Both AT&T and Verizon had already objected to a previously proposed 10/1 Mbps minimum speed requirement, saying 4 Mbps is plenty for consumers.

Innovation and Research

The Economist corrects yet another example of attention-seeking publications that create inaccurate headlines and stories hoping for salacious clicks. It turns out that despite the recent hype, getting cancer isn’t only due to bad luck. The original research paper said that two-thirds of the variation in cancer risk is caused by chance mutations, which is not the same thing as saying that two-thirds of the chance of getting cancer is due to luck (since not every mutation causes cancer in the given tissue). The authors explain that cancer is “a combination of bad luck, bad environment, and bad inherited genes” and people control 40 percent of the risk via their lifestyle decisions about smoking, diet, sunlight exposure, exposure to papilloma virus, obesity, exercise, and alcohol intake.

Technology

A survey finds that while fitness tracker companies desperately try to outdo each other with added features and higher prices, 85 percent of consumers have no plans to buy one.

Other

Athenahealth says its network and previous years’ data suggest that the flu season has peaked, although CDC’s just-updated report says 29 states have high flu intensity. February is usually the worst flu month.

A new survey finds that nearly two-thirds of Americans couldn’t afford to write a $1,000 check for an unplanned ED visit. More than one-third of them would dip into savings, 26 percent would have to cut back elsewhere, 16 percent would borrow the money from family or friends, and 12 percent would charge the amount to their credit card.

Sponsor Updates

• Allscripts will integrate Perceptive Software’s enterprise content management into its EHRs, giving customers a common infrastructure for storing and sharing patient content. 
• Medicity publishes case studies on Trinity Health’s use of Medicity HISP to transmit information and Intermountain Healthcare’s lab results notification and public health reporting via Medicity Exchange. Brian Ahier, Medicity’s director of standards and government affairs, publishes an article with Wisconsin Statewide Health Information Network COO Jean Doeringsfeld titled “FHIR and the Future of Interoperability.”
• Teramedica-sponsored Vendor-Neutral Archive Institute of Technology offers free online courses that include CPHIMS and CPHIMA credit.
• Direct Consulting Associates will sponsor “Becoming a Game Changer in the World of Healthcare Technology” on January 29, 2015 in Scottsdale, AZ. Texas Health Resources SVP/CIO Ed Marx will deliver the keynote address.
• Logicworks publishes a blog on healthcare security, highlighting three reasons why hackers target healthcare clouds.
• Liaison Technologies publishes a new blog on next-gen data integration and management by Chief Marketing Officer Manish Gupta.
• Local papers profile Ingenious Med President and CEO S. Hart Williford’s work with startups; and COO Mike Pickering’s work with the Atlanta All Stars Talent Show Network, a non-profit community outreach program he founded in 2004.
• Impact Advisors offers a snapshot of its latest white paper, on population health management, in a new blog.
• Huntzinger Management Group Client Executive Rob Tashiro will speak during a CHIME webinar on January 28 covering lessons learned from big bang implementations.
• Optum’s latest blog looks at how providers use analytics to better manage their populations and reduce costs.
• Healthfinch sets intentions for the new year in a new blog post.
• Healthcare Data Solutions shares insight into the Walgreens-Qualcomm partnership in a new blog post.
• HCI Group’s SVP of Delivery Operations Robert “Bob” Steele receives his HIMSS senior member certification.
• Hayes Management Consulting posts a new blog on the advantageous countdown to ICD-10.
• DocuSign will host the Tech Founders Forum in San Francisco on January 13.

EPtalk by Dr. Jayne

While I share many of Mr. H’s pet peeves with regards to grammar, my top peeve at the moment is misleading headlines. It was bad enough when it was just Yahoo and MSN, but now the sensationalism is rampant in various physician publications. Medical Economics screams “Meaningful use penalties sear more than half of EPs in 2015.” Personally, “sear” wouldn’t be the verb I would choose for a 1 percent Medicare penalty. Tintoretto’s “The Martyrdom of St. Lawrence” illustrates what it would really look like to be seared.

Massachusetts physicians will need to update their own pet peeve lists with this one. The Massachusetts Board of Registration in Medicine recently adopted a regulation that requires demonstration of Meaningful Use as a condition of licensure. It went into effect last week. Fortunately, they’ve built some flexibility into the final requirement. Beyond successful attestation as an Eligible Provider, other options include:

• Completing continuing medical education that discusses EHRs and the MU programs objectives and quality measures.
• Employment, contracting, or credentialing by a hospital that is participating in MU.
• Participating in the Massachusetts Health Information Highway.

Physicians renewing their licenses prior to March 31 can receive a single-use “get out of jail free” exemption. If you’re due for renewal within 60 days of the end of March, you can take advantage of it as well by applying early, so get those checkbooks ready.

For those of us who wear many different hats (CMIO, practicing physician, anonymous blogger) time management is a constant challenge. If you’re as compulsive as me about it, you’ll want to consider blocking time on your schedule to peruse the proposed rule for Meaningful Use Stage 3. I highly recommend slotting a weekend evening with a roaring fire and a nice bottle of wine, as that worked well for me when Stage 2 was released. Given the state of my average work week, there’s no way it’s going to happen during normal business hours.

If you’re new to the game, the proposed rule currently sits at the Office of Management and Budget. It will be published in the Federal Register once the OMB review is complete. Stage 3 is supposed to focus on using the work done in previous stages to actually drive improvements in patient outcomes. According to statements from HHS, there will also be changes in the reporting period and program structure.

They also hope to clarify the definition of Meaningful Use (given confusion about requirements from multiple stages and multiple revisions) and to make sure the program is sustainable. I don’t have a crystal ball, but I hope there’s a 90-day reporting period involved and that they give vendors at least a year after finalization of the Rule to write code and physicians a year to install and upgrade.

Earlier this year, the Health IT Policy Committee recommended that HHS incorporate fewer objectives and reduce the burden on providers. Various other constituencies have pushed for further narrowing of the requirements. I’d bet we have the NPRM in the Federal Register within the next few weeks, so get your wine selections ready.

HIMSS is releasing more information about the conference and several new offerings including a Cybersecurity Command Center, Disaster Preparedness Knowledge Center, and the HIMSS Health IT Value Suite. Another new offering is HX360 , a joint effort of HIMSS and AVIA to look at non-EHR technology that can benefit health systems and provider organizations. I was initially drawn to it, but seeing that they’re charging an additional fee to attend the “Venture+ Forum pitch competition for early stage companies” dampened my enthusiasm. I don’t think what they’re offering is worth an additional $225 (or $795 as a standalone) of my hospital’s money.

I’m a little more enthusiastic about the “HIMSS Speakeasy” theme for the opening reception, which is usually pretty vanilla. Who’s ready to bob their hair and pack their flapper dresses and dancing shoes? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 1/7/15

Top News

The American Medical Association says EHRs, ICD-10, prior authorization, and Medicare fraud detection programs are “barriers to providing high-quality care” that it will oppose in 2015. AMA will continue its push to make the Meaningful Use program more flexible, improve EHR usability, and expand EHR interoperability. It will also “urge regulators to ease this physician burden” of the October 1 implementation of ICD-10, study the physician workload impact of prior authorization, and push CMS to overhaul its RAC-centered “bounty hunter” fraud and abuse programs.

Reader Comments

From Hallway: “Re: smartphone wayfinding apps. I passed along information on Jibestream that you mentioned in June 2014. I agree that this type of application will offer competitive advantage, not only with patients and visitors, but for new hires, for patient transportation, and for ancillary staff that need to deliver services at the bedside, maybe even eventually to route robots delivering supplies (I can just picture R2D2s roaming the halls).”

From Title Contender: “Re: smartphone wayfinding apps. Check out Logic Junction, whose solution works on both web and mobile with a single database that can be updated in real time.” The company lists Cleveland Clinic, LA County, Sarasota Memorial, and the VA as clients. The online demo is pretty cool and doesn’t require registration to run. If I were the company, I would white label the product and let hospitals sell ads or promote their own services to make it cost neutral.

HIStalk Announcements and Requests

I’ve ordered Eric Topol’s “The Patient Will See You Now” and Steven Brill’s “America’s Bitter Pill,” so I’ll have book reports soon.

The latest in my long line of pet grammar peeves: starting sentences with “there.” The next-to-latest: sites that post articles with a question as the headline, indicating that the author isn’t confident enough to actually answer the question (meaning: the article is a complete waste of time). I’m curmudgeonly even in restaurants whose menus gets overly cute by offering “veggies” and “mashers.”

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

Acquisitions, Funding, Business, and Stock

Allina Health (MN) will take an equity position in Health Catalyst as part of a 10-year agreement in which the Allina will outsource its 60-employee analytics and quality improvement teams to Health Catalyst and will contribute its clinical expertise, while Health Catalyst earns a portion of its payment when Allina hits specific quality improvement targets as overseen by a governing committee. The organizations value the agreement at $100 million. I interviewed newly promoted Allina President and CEO Penny Wheeler, MD this week about the agreement and other topics.

Lexmark acquires Toronto-based medical imaging technology vendor Claron Technology for $37 million in cash. Lexmark will position the company’s medical imaging viewing platform and zero-footprint viewer within its Perceptive Software business, which offers a vendor-neutral archive and medical content management.

Staffing services company General Employment Enterprises acquires Jacksonville, FL-based medical scribe contractor Scribe Solutions.

Baltimore-based hospital hiring software vendor Pegged Software, which claims to have reduced employee turnover in its customers by an average of 45 percent, raises $9.2 million to increase its sales and marketing efforts.

Guided episode management software vendor Wellbe raises $2.42 million.

Honeywell renames its HomMed remote patient monitoring business to Honeywell Life Care Solutions.

The non-profit MedicAlert Foundation will reduce headcount and cut its budget “to better focus on its core mission of protecting and saving lives by serving as the global information link between members and emergency responders during medical emergencies and other times of need.” Beyond a variety of bracelet-type medical IDs, the organization offers an online health record linked to the medical ID number for an annual membership fee that starts at $19.99.

Sales 

Saint Luke’s Health System (MO) chooses Phynd to create a single provider profile of its 15,000 referring and credentialed physicians.

Children’s Hospital of San Antonio (TX) selects Ingenious Med’s patient encounter platform.

People

   

HIMSS adds four new board members who will serve three-year terms: Michael Nusbaum (MH Nusbaum & Associates); James Peake, MD (SVP, CGI Federal); Christopher Ross (CIO, Mayo Clinic); and Ferdinand Velasco, MD (CHIO, Texas Health Resources).  

CHIME names University of Michigan Hospitals and Health Centers CIO Sue Schade as its 2014 John E. Gall, Jr. CIO of the Year.

Rick Adam is named president and COO of analytics vendor Stanson Health. He has work for a variety of health IT vendors over the years, including Baxter, NEON, and Recondo Technology. The company’s board chair is Scott Weingarten, MD now with Cedars-Sinai after co-founding Zynx Health.

Halfpenny Technologies hires Carl Smith (Airclic) as CFO.

David Silberstein (Teradata) joins Leidos Health as service line director for analytics.

The former HHS acting director of cybersecurity is sentenced to 25 years in federal prison for distribution of child pornography, including participating in discussions with another member of a private website that the two get together to fulfill their mutual fantasies of raping and murdering children. The FBI says Timothy DeFoggi used the technology expertise he gained in working for HHS to evade detection, ultimately unsuccessfully.

Announcements and Implementations

Epic announces plans for Campus Five, a five-building expansion that will add 500,000 square feet of space, 1,600 offices, and 1,500 parking spaces, all with a children’s literature theme. The company says it needs the space because 45 percent of its employees are sharing offices. Epic’s Wizards Academy campus is already under construction and will open in about a year.

Connance adds a Claims Optimization platform to its predictive analytics solution.

The HCI Group creates a freely viewable e-book, “The Definitive EHR Go-Live Guide.”

Sure, I think there’s more focus, for example, on hospital readmission for Medicare patients, which is costly, but in the sum total of things, it’s kind of a drop in the bucket. There are little things like that, but there aren’t any big things, there’s nothing to control the price of drugs, there’s no tort reform, there’s nothing to control the profits of allegedly nonprofit hospitals. There’s nothing to deal with the profits and the secret contracts that device-makers negotiate with hospitals that buy their products.

It’s not just the lobbying influence. You combine that money with the emotional pull and fear that people have when they think about healthcare. People care more about their health than they do about healthcare policy. And then you add to that the multi-channel political power of the healthcare industry in every congressional district, because in about every congressional district, the largest employer is the local hospital. And the local hospital is again seen as a charity. You combine that kind of local power with the lobbying power, with the fear and emotion that’s attached to healthcare, and that makes for a toxic political stew.

How is that going to change? I think the only way it’s going to change relates to what the thinking was in Massachusetts when Romneycare passed. They’re very candid about this — we’ll give everybody coverage and then when people see how much it costs, there’ll be this huge political wave to say we have to reform this or we’re going bankrupt.

Technology

NPR’s “All Things Considered” covers the consumer medical devices being displayed this week at the International Consumer Electronics Show in a piece titled “Self-Tracking Gadgets That Play Doctor Abound at CES.” It mentions CellScope (a phone-powered ear camera that sends images to doctors for diagnosis) and Neurotrack (quiz-based Alzheimer’s diagnosis). The article wanders confusingly into thinking that phone apps have something to do with cyberattacks and telemedicine, so the only interesting aspect is that NPR wrote up the article in the first place.

An interesting use of telemedicine: St. Joseph’s Regional Medical Center (NJ) connects ED victims of domestic violence with county court officers, allowing them to take out restraining orders within 45 minutes directly from the hospital. The program is being expanded to make an iPad-equipped judge available around the clock to handle night and weekend cases, which are the majority.

Other

Physicians responding to a Sermo poll name wearables-based remote patient monitoring and telemedicine as the top two expected trends of 2015.

Surgeon and writer Atul Gawande, MD, MPH weighs in on technology in an interview with Bob Wachter, MD:

Information is our most valuable resource, yet we treat it like a byproduct. The systems we have – Epic and our other systems – are not particularly useful right now in helping us execute on these objectives. We’re having to build systems around those systems … the issues have less to do with systems than with governance … the residents feel they’re caught up in this world where everything they need to know is on the computer screen. That’s creating angst in their day-to-day life. You go up to the floor of the medical service in my hospital, and there are no doctors there. They come, they see the patients, and then they escape to this tribal room where all 15 residents hang out together, each doing his or her computer work. That means that many of the informal interactions that used to occur between the docs and the nurses, or the docs and the patients and their families, have withered away.

A veteran sues the Atlanta VA hospital that was treating him for PTSD, claiming that the single dose of antidepressant he was prescribed created a weeks-long erection that made him the laughingstock of doctors and nurses and resulted in improper treatment that left him disfigured. “One had mentioned that I should line up all the women. I haven’t had that many people who had seen it in my whole life until I went to that hospital.” His attorney (Mr. Johnson, strangely enough) cites another patient who took the same drug with the same result, to whom a jury awarded $10 million.

Weird News Andy drives us into the new year with a story he titles, “Making a turn for the better.” Surgeons remove a turn signal lever from a 1963 Thunderbird from the arm of a man who had been in a car accident 51 years ago, unaware until now that he had a seven-inch piece of metal embedded there.

Sponsor Updates

• Phynd publishes a blog post titled “Direct Addresses Are Yet Another Reasons Hospitals Need to Move to a Single Provider Profile (SPP) Model.”
• ADP AdvancedMD will integrate its EHR with physician practice reporting from Iron Bridge Integration, giving customers access to pre-built connections to 57 registries in 48 states to help meet Meaningful use Stage 2 requirements.
• Chadron Community Hospital (NE) successfully attests to Meaningful Use Stage 2 using NTT DATA’s Optimum product suite. I interviewed CIO/COO Anna Turman several months ago and it’s still among my favorites.
• Netsmart publishes several new white papers: “In Transition: How Electronic Data Sharing Enables Improved Outcomes and Reduced Costs,” “5 Things to Consider When Selecting Your New (Next) EHR,” and “Transforming the EHR into a Knowledge Platform to Ensure Improved Health and Healthcare.”
• Medhost describes the use by Larkin Community Hospital (FL) of its YourCareLink integration service to automate public health reporting for Meaningful Use Stage 2.
• Amerinet will offer the interoperability and population health management solutions of Sandlot Solutions to its members.
• A market research survey finds that VMware’s AirWatch enterprise mobility management solution is the #1 choice of decision-makers, handily beating out MobileIron.
• Four Army National Guard locations will use AtHoc’s network-centric crisis communications system, which allows base officials to quickly send deployment orders and emergency notifications via text, phone, and desktop.
• Besler Consulting offers a review of the FY2015 Hospital Outpatient Prospective Payment System.
• A CareSync blog post reviews CMS’s chronic care management reimbursement program and how doctors can use the company’s CareSync CCM product.
• Clinovations posts an article titled “Patient Access: What Does Failure Cost?”
• CommVault announces the schedule of its “Hockey Helping Kids” fundraiser.
• DataMotion publishes an article, “Want to ensure secure and compliant data exchange? Integrate security!”
• Divurgent will participate in the HIMSS East Tennessee Summit on January 22, 2015 in Knoxville and the HFMA Florida Mid-Winter Conference January 26 in Miami.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 1/5/15

Top News

Healthcare analytics vendor Inovalon Holdings (known until a 2012 name change as MedAssurant) files for a $500 million IPO. The CEO and board chair is cardiologist Keith Dunleavy, MD. The company’s technology is used by NextGen, Greenway, Allscripts, and Walgreens.  

Reader Comments

From KimJongDeux: “Re: Athenahealth. Interesting that Jonathan was the much celebrated, drunk, foul-mouthed (and most un-funny) host of HIStalkapalooza for a few years and the article above seems to indicate the bloom is off the rose. Guess he’s not on the program this year? We seem to have a company run by force of personality. The quote, ‘Those naysayers don’t understand the company’s business model’ is the same cry as we hear from self-styled ‘artists’ when their works are panned and from CEOs who either get no push back from their yes-men staffs or who weeds out or banishes anyone who disagrees. The fact that their corporate meeting involves officially sanctioned heavy drinking games tells me all I need to know. And the fact that the CEO openly supports it as a good thing is troublesome. I agree that if the force of personality ever left, the company would fold like a house of cards. Being brash, loud, and verbally overpowering others can keep the airplane aloft only so long.” The company has a new logo and website, I’ve noticed, moving away from the squint-inducing yellow and green color scheme to a more serious-looking purple and green.

From PM_from_Haities: “Re: Epic’s going public. It would have very little effect. The capital structure of a company (i.e. going from private to public) impacts who owns Epic, but it’s leadership would likely be unchanged. Given Judy has plenty of cash, it would make very little sense for her to add that kind of public scrutiny unless it helped in gaining government contracts. Epic would continue to deliver on its promises and continue to grow. If anything, Epic might get BETTER by being publicly traded as they would typically have a stronger marketing department.”

HIStalk Announcements and Requests

One-fourth of respondents to my poll expressed a positive impression of HIMSS, with 38 percent each having neutral or negative feelings. New poll to your right or here, triggered by last week’s Fortune article: which set of quotes best describes Athenahealth, the positive ones by CEO Jonathan Bush or the negative ones from a skeptical hedge fund manager? Vote and then click the “Comments” link in the poll box to explain yourself.

Attendees of our webinars have asked about the possibility of receiving continuing education hours. I looked into this years ago and concluded that the only way to accomplish that would be to connect with a university already set up to award CEUs to physicians, nurses, and pharmacists. I’m open to suggestions.

I registered for the HIMSS conference this weekend since the early full registration rate of $745 is good through January 27. My impressions:

• The online registration is slow because it tries to upsell you on extra-cost events, but it’s efficient otherwise.
• The registration policies document says that HIMSS doesn’t share attendee email addresses and to report any email received from an exhibitors. I assume that means that, as usual, registrants will receive a barrage of promotional snail mail (some of it invariably arriving after the conference has concluded).
• The registration policy references a “use of photographic images” clause in the same document, but the only related item involves “recording any educational session content,” so apparently the widely ignored ban against taking exhibit hall photos has been eliminated.

Divurgent, Elsevier, Falcon Consulting, Sunquest, and Thrasys have signed on as sponsors of HIStalkapalooza, which will be held Monday of the HIMSS conference week at the House of Blues Chicago. It’s an expensive event to put on — the facility, food, bar, and band add up to more than $175 per attendee — and the number and level of sponsors dictates the number of people I can invite (and thus the number I can’t invite) without going deep into the red. We still have a couple of weeks to add new sponsors – let me know if your company is interested in standing out among all the conference noise that week.

Last Week’s Most Interesting News

• An report looking at six ONC-funded state HIEs finds that large health systems can be either supporters or competitors, HIEs are beginning to embrace Direct despite its poor EHR integration, and the HIEs are still searching for use cases that the market wants.
• A Wall Street Journal report finds that a significant portion of Medicare fraud is perpetrated by the 45,000 newly registered providers each month that CMS says it doesn’t have the resources to review.
• CSC pays $190 million to settle an SEC fraud case that includes its UK NPfIT contracts.
• A Fortune profile contrasts Athenahealth’s high-flying public image with the skepticism of investment advisers and managers who say the company’s tiny market share and flattening performance suggests otherwise.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

People

OB/GYN EHR vendor DigiChart promotes Rodney Hamilton, MD to president and CEO.

Announcements and Implementations

Terrebonne General Medical Center (LA) goes live in its admissions area on RightPatient facial recognition software from Atlanta-based M2SYS Technology.

Government and Politics

The New York Times profiles US CTO Megan Smith, with insiders concluding that while she has a big vision and the president’s ear, she’s also in a position that comes with unclear mandates, minimal budget, and responsibility for outdated technology platforms. The article points out that the newly created United States Digital Service reports to the Office of Management and Budget instead of her office.

A class action lawsuit filed by doctors against North Carolina’s Department of Health and Human Services over software that incorrectly paid practices Medicaid rates for services provided to Medicare patients lingers on a year later. A family practice doctor says the state owes him $100,000, adding that in his pleas to DHHS, “There was a complete lack of courtesy. Those people have no humanity.” The NCTracks system was developed by CSC at a cost of $484 million, with a significant portion copied from a similar system CSC built for New York City. The US Justice Department sued CSC and New York City in October for Medicaid fraud, claiming that the $1 billion New York system didn’t correctly bill Medicaid secondarily to private insurance. Neither system was related to CSC’s $190 million settlement with the SEC last week over accounting and fraud claims involving the company’s work on the UK’s failed NPfIT project.

Oregon’s proposed 2015-2017 budget includes $3 million for a prison system EHR, which is expected to go live in early 2016.  

Privacy and Security

The US Postal Service announces that a previously reported breach of its systems that exposed the Social Security numbers of 800,000 employees also included medical information on 485,000 current and former employees as well as retirees who had filed for worker’s compensation. The most interesting aspect to me is the huge number of injury claims filed with USPS.

Technology

I mentioned last week that John Olmstead, who runs the ED and surgery departments of The Community Hospital (IN), says in an upcoming Versus webinar that he would like to see a GPS-wayfinding type technology so that hospital visitors could navigate around campus using their smartphones. Readers sent information on two companies that offer such technology:

Connexient offers a smartphone app that provides turn-by-turn navigation to visitors at Robert Wood Johnson University Hospital and will bring six more hospitals live on it in the next few months.

Madison, WI startup Solomo Technology is using similar technology to help conference attendees locate session rooms. It offers APIs so that developers can integrate its location and content services into their own apps.

An excellent analysis of the fitness tracker market makes great points:

• Courts are beginning to accept fitness tracker data in cases ranging from vehicular accidents to worker’s compensation, with resulting privacy concerns.
• Wearable device manufactures use glossy marketing to position themselves as health and wellness brands instead of step counters. “You will never find a review for Jawbone or Fitbit that says ‘works as advertised’ because no one knows what they’re advertising.”
• Trackers have penetrated only 3 percent of the market and the washout rate is high.
• The Scanadu medical tricorder-type device holds great promise, as does senior monitoring app Lively.
• Companies that have bought a single brand of fitness tracker for employees haven’t seen broadly successful results because people are motivated differently.
• Users don’t want more data, they want to have devices tell them what to do and to simplify their technology interactions rather than to add new ones.

Other

This headline from the Rome, GA newspaper succinctly describes a lot of what’s wrong with the US economy. Taxpayer-funded organizations that don’t pay taxes themselves shouldn’t be the only hope of employment growth. At least government hiring didn’t top the list.

The Madison newspaper profiles Nordic Consulting co-founder Mark Bakken’s transition from entrepreneur to venture capitalist. He’s putting together a $10-$20 million venture fund that will invest $300,000 to $500,000 in Madison-area companies whose technologies work with Epic. He has raised $4 million so far (including $1 million of his own money) and says several Epic-using health systems have expressed interest in investing. The article mentions that he has personally invested in eight startups (Catalyze, Forward Health Group, Wellbe, Moxe Health, 100health, Quietyme, Healthfinch, and HealthMyne) and four of those have hit $1 million in annual revenue. Bakken, who stepped down from the CEO role at Nordic last month but remains board chair, says he “won the lottery with Nordic,” which had $81 million in revenue in 2013.

A fundraising project for the children of The Johns Hopkins Hospital senior software engineer and bike shop owner Tom Palermo that included a 1,000-participant New Year’s Day ride has raised $60,000 so far, well beyond its original goal of $10,000. Palermo, 41, was killed last weekend when he was run over while bicycling by an Episcopalian bishop with a previous drunk driving arrest who fled the scene. She has been placed on administrative leave pending possible criminal charges following her admission that she hit Palermo, who leaves behind his wife, six-year-old daughter, and four-year-old son. The bishop had previously received probation for her 2010 DUI arrest (before she was hired by the diocese) in which she was driving a car with a tire shredded to the rim, told police she had drunk alcohol and smoked marijuana, and recorded a 0.27 on a blood alcohol breath test.

Five Michigan health systems receive $25 million in value-based payouts from Blue Cross Blue Shield of Michigan, which says the hospitals and physicians are communicating better because of EHRs and HIEs. The systems will also receive $500,000 each over three years to improve their IT systems and care coordination. The chief medical officer of Henry Ford Physician Network says he gets immediate notification if his patient is is seen by any provider in the network or at an area hospital that uses Epic, but otherwise he won’t know about it until he sees the patient next, so he’s looking forward to using the money to improve HIE connectivity and to improve data capture from physician practices.

Lenox Hill Hospital (NY), embarrassed by international press coverage of a British couple unfortunate enough to have their premature baby delivered in the US at a cost of $200,000 instead of free in England, hints that it will simply write off the bill, sticking less-publicized patients with the burden of its profitability. It really annoys me that when media outlets publicize a ridiculous hospital bill involving a feel-good patient, the hospital nobly agrees to cancel the bill as though it doesn’t really need the money. The rest of us who get equally absurd hospital bills are turned over to collections for every dime. Somehow the public never sees through this PR scam to realize that we’re all paying for it. The same hospital annoyed patients and families three years ago by restricting visitor access so that Beyonce and Jay-Z could have their baby in the manner to which they have become accustomed, with the star couple adding their own private security force to guard the VIP suite (the hospital denies rumors that the couple spent $1.3 million to upgrade their room). The CEO of North Shore-LIJ Health System, which owns the hospital, was paid $4.3 million in 2013.

The Sioux City paper describes the interoperability situation between UnityPoint Health – St. Luke’s and Mercy Medical Center, running Epic and Cerner, respectively, and still faxing scanned chart images back and forth. The hospitals are bringing up Iowa Health Information Network with hopes of electronically exchanging at least summary records.

Tennessee doctors are diagnosing and treating people with flu by telephone or telemedicine, telling them not to come to the office for fear they’ll spread the virus to other waiting patients.

A ProPublica investigative article exposes the billing practices of the for-profit debt collection agency run by non-profit health system Mosaic Life Care (MO), which has filed 11,000 lawsuits in five years to collect money from uninsured hospital patients and to garnish their usually low wages. The part of the story that always drives me crazy: uninsured patients are sued for the full (phony) list prices hospitals make up in order to give 90 percent discounts to insurance companies, so people are losing their homes to pay for $12 Tylenols and the ever-accruing interest charges and attorney fees. It seems reasonable that hospitals be required to charge cash-paying patients their lowest prevailing contracted prices.

A JAMA opinion piece written by informatics people from Christus Health points out the rising numbers of medical scribes, the number of companies (22) offering their services, and the creation of a scribe aptitude test and a vendor-led member association. It says that overuse of scribes to make up for EHR inefficiency can lead to compliance and clinical issues, concluding:

The answer to today’s inadequate EHRs is not scribe support. Instead, physicians should demand improved products, should educate vendors to ensure that they understand how physicians think clinically, and should clarify what is needed for an intuitive, quick, and navigable user interface. If such usual market forces are vibrant, and physicians engaged robustly, EHRs will evolve rapidly. Yet even after a decade of use, some EHRs and CPOE may not compete with the speed of a paper checklist, and may never.

The New York Times notes that a doctor whose office was raided by federal agents for writing oxycodone prescriptions for $200 in cash was caught only because neighbors complained about the traffic outside his unmarked office that was guarded by an armed bouncer. The doctor made $2.6 million in cash over two years writing narcotics prescriptions to patients who then turned the drugs over to “crew chiefs” to sell on the street. The practice created false medical records that included MRI reports and urinalysis results.

Dr. Oz makes a lot of headlines, most of them negative. His ABC TV show, “NY Med,” takes heat when a female viewer watches her husband die in an episode filmed at New York-Presbyterian Hospital without the family’s permission. Producers blurred the man’s face in the video, but the woman recognized him and heard his last words as the cameras rolled. Her son has filed complaints with the hospital, the state’s Department of Health, and HHS’s Office for Civil Rights. The hospital and ABC claim the patient isn’t identifiable, ABC says news is protected by the First Amendment, and the hospital says the man’s privacy rights ended when he died and blames the family instead for calling attention to his identity by complaining.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/31/14

Top News

CSC will pay $190 million and will restate previous years’ financial statements to settle a variety of SEC fraud charges that includes its participation in the UK’s NPfIT program. That’s a minor amount compared to the $2.75 billion the company already wrote off for its work on the failed NPfIT project. CSC will change its 2011 balance sheet to reflect a $1.16 billion impairment charge.

Reader Comments

From Brandom: “Re: Barnes Jewish Christian. Rumor is it they will be installing Epic.” Unverified, but I ran a reader’s rumor saying the same thing on December 5. Often the earliest confirmation is a health system’s posting of a ton of open Epic positions, but BJC doesn’t have any of those on its recruitment site.

HIStalk Announcements and Requests

I have to disclose a brilliant idea I heard in listening to the rehearsal of the Versus webinar I mention below, which I honestly think is the most interesting webinar I’ve ever watched. John Olmstead of Community Munster captivated me all the way through on the hospital’s use of ED technology, but he really grabbed me at the end when he suggested technology tools he needs. His holy grail is a way-finding, GPS-type app that patients and visitors can use on their own devices to locate themselves precisely on a hospital floor plan, then receive directions to get them to a desired location. Example: I’m in room 4401 with my mom and I want to go to the cafeteria, then to the financial counselor, then to the gift shop, and then back to 4401, so give me turn-by-turn directions like I get with my car GPS. His take is interesting: patients will become so attached to hospitals that offer this app that they won’t consider going elsewhere, where they’ll go back to stumbling around lost or trying to follow decades-old red vs. green lines on the floor that lead to confusing elevators. Hospitals are always a poorly conceived patchwork of added-on construction that went up quickly as funding allowed, so visitors spend a lot of time wandering and wasting the time of employees who have to assist them. Turning that universally embarrassing situation into a competitive advantage is brilliant.

What’s really bugging me lately (it always has, but even more so now): companies that make portions of their name incorrectly upper or lower case, defying all of the civilized rules of spelling just because someone in marketing who’s never run a business has decided that being flagrantly incorrect is a desperate way to distinguish a company from its competitors. I’ve always refused to recognize all-caps vendor names like Meditech, Medseek, and Medhost, but I’ve also decided that I’m also no longer letting Athenahealth slide with the oh-so-cute small “a” at the beginning of the company’s name. Names in America start with a capitalized letter and then have all lower case letters following, so now I have to decide what to do with the many cutesy company names that stick capitalized letters midstream (even providers like Partners HealthCare mistakenly think that’s cool). I’ll even concede that HIStalk should really be Histalk if that will convince other companies to value conformity to accepted rules over marketing nonsense.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

Acquisitions, Funding, Business, and Stock

Fortune describes Athenahealth’s “More Disruption Please” conference as “the Animal House of corporate gatherings,” with the company’s 387-acre Maine resort hosting drinking games and an after-party cabin for investors and corporate hangers-on led by CEO Jonathan Bush, described as a “hyperactive, no-filter goofball of a chief executive.” The article contrasts the party atmosphere to skeptical investors who believe that Athenahealth shares are massively overvalued, especially since the company just announced that revenue growth has slowed as it continues to lose money. Bush says those naysayers don’t understand the company’s business model and will miss the building of a Salesforce-like technology company that will “create and curate the healthcare Internet.” Hedge fund manager and ATHN short-seller David Einhorn isn’t buying it (literally), saying, “They’re a niche provider way out on the periphery with a tiny market share. I don’t see how they’re going to become a backbone of anything.” My take is that Athenahealth would have been an obscure, offshore-powered medical paper pusher without the cult of Bush’s personality; investors had better hope he sticks around and keeps his mojo since that’s the only way shares can continue to trade independently of tepid company performance as a self-proclaimed Internet high flyer. The money gods would lose interest quickly if recommending or owning ATHN stock no longer paid the dues for being a member of JB’s frenetic fraternity.

Athenahealth shares (in blue above) did OK in the past year, falling a bit short of the Nasdaq’s 15.6 percent gain but 25 percent off their March 2014 highs. The company is valued at $5.6 billion on annual revenue of $711 million and a negative operating margin. Jonathan Bush hold shares worth $46 million.

The Forbes article on Athenahealth mentions that the company’s $1.1 million investment in Castlight Health was worth $75 million at the end of Q1, allowing Athenahealth to buy a private plane it calls “the Castlight jet.” At least Athenahealth ended up with something more high flying than CSLT shares — above is the CSLT price chart since its March IPO (blue, down 71 percent) vs. the Dow (up 12 percent).

Cincinnati-based revenue cycle management firm The Consult Inc. (TCI) will acquire RCM software and services vendor Physician Management Information Services of Denver.

Specialty EMR vendor Modernizing Medicine acquires Aesyntix Health, which offers dermatology practice RCM, inventory management, and group purchasing services.  

Sales

The federal government awards Accenture a five-year, $563 million contract to continue the work it started on Healthcare.gov after CGI Federal was fired.

Medical practice performance management company GloStream chooses DrFirst’s EPCS Gold 2.0 controlled drug e-prescribing system to comply with New York’s I-STOP mandatory e-prescribing requirement.

People

Tom Palermo, a 41-year-old senior software engineer at The Johns Hopkins Hospital (MD), was killed in a bicycling accident Saturday. Memorial Mass will be celebrated Saturday in Towson, MD.

Announcements and Implementations

Lafayette General Medical Center (LA) donates a telemedicine station to a local elementary school, allowing ill students to be evaluated by a physician without leaving school.

Government and Politics

An ONC-commissioned report studying HIEs in six states finds that they commonly offer care summary exchange, lab results reporting and exchange, public health reporting, and ADT messaging, but otherwise their technologies and strategies vary. Lessons learned include setting attainable short-term goals to maintain stakeholder interest, recognizing that big health systems can be either supporters or competitors of grant-funded HIEs, and data standards are often voluntary but need to be standardized to achieve real interoperability. Five of the six states plan to charge subscription fees but haven’t set rates (the sixth HIE already shut down). The study found that Direct is still a confounder, with HIEs originally seeing it as a competing model but are now looking at Direct as an easier workaround to problems they found with query-based services, but Direct is still poorly integrated with EHRS (usually requiring providers to log in to a separate portal) since it wasn’t required of vendors until Meaningful Use Stage 2 and they’ve been slow to incorporate it. Wyoming’s HIE gets a special mention for shutting down immediately once its federal grant money ran out. The issue of sustainability is nicely summarized by this statement: “In the short term, grantees are trying to identify use cases that align with the market” (i.e., we built it and they didn’t come before the government money ran out, so it’s like being the owner of a tattoo shop when the local military base closes).

Technology

Iltifat Husain, MD names his best medical apps for 2014:

• ASCVD Risk Estimator (#1)
• JAMA Network Medical Image Challenge
• Medscape MedPulse
• UMEM Pearls
• Multiple Sclerosis @Point of Care
• PreopEval14
• Pediatric Quick Reference
• Eye Emergency Manual
• Blood Donor by American Red Cross
• CDC Vaccine Schedules
• Family Practice Notebook
• Change Talk: Childhood Obesity and Motivational Interviewing

A German hacker replicates a politician’s biometric thumbprint using only a press conference photo and off-the-shelf software. The politician, ironically, was speaking at a hacker’s convention. The hacker, who’s apparently not a fan of biometric security, says he assumes that politicians will start wearing gloves when speaking in public.

Siemens has been caught countless times over at least 100 years for bribing people to earn government bids, so this is hardly news: Israel’s securities regulator arrests six electric company employees for accepting $20 million in Siemens bribes related to a power station turbine bid.

Other

Geisinger Health System CEO Glenn Steele, Jr., MD, PhD, who is retiring next year, comments on physician complaints about health IT in a Modern Healthcare interview:

Here’s my Jonathan Gruber statement: This is an issue of stupidity. If people believe that you can put IT in, continue working the same way you did before IT, and not get inefficiency, we are talking double-digit IQs here. What everybody’s learned over the last 15 to 20 years is if you put IT in, whether it’s hospital-based or ambulatory, you have to look at the entire workflow and use the IT implementation as an excuse for re-engineering your workflow from beginning to end. If you don’t do that, it’s going to create havoc. You’ve got to look at your patient-care processes from beginning to end and say, “How are we going to do it differently? How is this going to make it better?”

On the benefits of health IT, we couldn’t do point-of-service care innovation without having near real-time data fed back to us. You’ve got to have data both from the insurer side and the provider side to predict which patients or cohorts of patients are most likely to need the highest-intensity vigilance. If you don’t have feedback in a timely fashion, it’s not going to work.

The president and CEO of Campbell Soup Company says she’s a fan of the quantified self movement, in which people will “[take] charge of their well-being through the use of data and digital sensors, wearable health bands, and smartphone apps that can track and quantify everything from their heart rate, blood pressure, and sleep quality to steps walked and calories consumed. The word ‘quantify’ is what’s really important because people will use the personal data and feedback from these devices to make healthier lifestyle choices and adjust the way they eat, exercise, work and rest.”

I’m not interested enough to look up the details, but somehow Cerner and Allscripts are both involved in a patent dispute with RLIS, which apparently took a stab at the EMR market in the late 1990s but then folded. I mentioned a reader’s report of the lawsuit in mid-2012, so apparently it’s still churning its way through the court system.

CDC declares the 2014-15 flu season as an epidemic, with 22 states reporting significant influenza-like activity vs. 13 last week. Flu vaccine doesn’t seem to be working well against this year’s strain.

This is sad: a hospital Santa of 30 years hangs up her red and white suit, saying the drug test, background check, fingerprinting, and HIPAA requirements make it too much trouble to give young inpatients their December dose of Christmas cheer. At least a new Santa is happy to take over the suit, which the former Santa donated.

Only in America, home of too many lawyers trying to drum up work and too many righteously indignant people convinced that everything that happens to them is an egregious injustice wrought by deep-pockets defendants: the family of  a woman killed when a driver allegedly high on nitrous oxide rear-ends her as she slows for a traffic light sues: (a) the driver, which makes sense; (b) Toyota, because the family claimed the victim’s car was defective; (c) the driver’s sister, a doctor the family claimed helped the woman get drugs; (d) the towing company who released the driver’s car to her; and (e) a local ambulance company, who the family says caused the crash by responding to an accident with flashing lights on, causing cars to pull over right before the crash.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 12/29/14

Top News

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

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

Last Week’s Most Interesting News

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

People

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

Announcements and Implementations

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

Government and Politics

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

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

Technology

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

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

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

Other

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/24/14

Top News

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

People

 

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

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

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

Privacy and Security

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

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

Other

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

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

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

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

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

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

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

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

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Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Monday Morning Update 12/22/14

Top News

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

Reader Comments

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

Last Week’s Most Interesting News

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

MultiCare Health System (WA) joins Premier.

People

 

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

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

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

Anthelio names co-founder Chick Young to its board.

Announcements and Implementations

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

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

Government and Politics

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

Privacy and Security

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

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

Other

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/19/14

Top News

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

Pluses

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

Minuses

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

People

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

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

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

Announcements and Implementations

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

Government and Politics

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

Privacy and Security

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

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

Innovation and Research

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

Technology

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

Other

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

Are you ready for some holiday sparkle? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/17/14

Top News

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

Sales

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

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

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

People

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

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

Announcements and Implementations

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

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

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

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

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

Wellcentive joins the CommonWell Health Alliance.

Government and Politics

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

Privacy and Security

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

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

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

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

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

 

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

 

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

Technology

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

Other

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 12/15/14

Congress Moves on Federal Appropriations Bill

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

Federal defense contractors find a new profitable business: Obamacare

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

Tenet ends bid to acquire five Connecticut hospitals

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

Health Insurers Brace for Last-Minute Rush

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

Monday Morning Update 12/15/14

Top News

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

Reader Comments

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

MHealth Summit Review
By Plato’s Charge

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

HIStalk Announcements and Requests

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

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

Last Week’s Most Interesting News

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

Government and Politics

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

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

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

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

Other

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

News 12/12/14

Top News

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

Sales

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

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

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

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

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

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

People

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

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

MedAssets promotes Mike Nolte to president and COO.

ADP AdvancedMD hires Arman Samani (Medhost) as CTO.

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

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

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

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

Other

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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