Monday Morning Update 4/28/14

Top News

Cover Oregon waves the white flag and shuts down its $248 million health insurance exchange website without having enrolled a single citizen. The state will convert the site for Medicaid enrollment for an additional $35 million (federal taxpayers will pay 90 percent of that) and everything else will be turfed off to Healthcare.gov. The only winner is Oracle, which was paid $134 million even though the state says the company failed to deliver what it promised. The folks who run Cover Oregon, who seem to think their credibility emerged unscathed, say it would have cost $78 million to fix the disaster it oversaw but only $5 million to piggyback onto Healthcare.gov, which it could have done on Day 1. The money Cover Oregon wasted, like that of other states that decided they could build their own sites slightly less incompetently than the federal government, is pretty much gone since the site was to have paid for itself via a tax on insurance company sales.

Reader Comments

From The PACS Designer: “Re: Google Ara. Google’s approach to the next smartphone will be a modular one called Ara from Google’s ATAP (advances technology and projects) group. By allowing the Android phone to be constructed to a controlled style, it will let developers limit what a user can do with the smartphone. This should be of interest to those who want to reduce BYOD usages in institutional settings.” It’s an interesting approach, like taking tablets back to the IBM-compatible PC days when you could buy components from anybody and just plug them in. I suppose the upside is that your phone will have a long life cycle since it’s really just a core board that accepts components. On the downside, Google excels at building ugly, frustratingly non-standard products (Gmail) and Apple and Samsung phones are selling just fine even if they are rendered obsolete after only two or three years. Not to mention that Google has no retail stores from which to sell and support consumer hardware. I’m no expert, but this project has “bust” written all over it, which seems to be a regular occurrence among the Googlers these days.

From Ex-Epic: “Re: Epic. Has been sending a team of people to Denmark (Copenhagen) for a few months now on regular sales/early stage implementation meetings. Haven’t seen it mentioned here with the other international sales mentioned lately.” I mentioned in November 2013 that Epic would be providing systems for all of eastern Denmark.

HIStalk Announcements and Requests

Most poll respondents don’t think any differently about HHS after it released Medicare physician payment information. New poll to your right: do you use an activity tracker such as FuelBand or Fitbit at least five days per week? My sense is that the wearables fad is over – the devices don’t measure a whole lot given their cost and walking still isn’t fun or practical for many people – they don’t need discouraging electronic reminders that they failed to meet their goal.

Listening: new from Stream of Passion, because I can go only so long without needing some Dutch progressive-opera metal (fronted by a female singer from Mexico for some reason.)

I support DonorsChoose projects that help classrooms in need, and in return, I get nice thank-you emails and photos from the teachers who appreciate the support. I realize I haven’t mentioned the most satisfying part – receiving letters from the students themselves. This particular project was for remanufactured toner cartridges and file drawers for a total cost of $187 as donated by HIStalk on behalf of readers. One of the students said, “I’m grateful that you donated to us because some teachers don’t have any printing supplies and my teacher was one of those people, but now he’s not, so I’m thanking you.” This is from a highest-poverty school in Mississippi, where the teacher (Mr. Delperdang, a Teach for America teacher )was spending his own money printing classroom materials from home.  

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

From the Cerner earnings call:

• The company’s backlog increased to $9.24 billion. For non-investment types, “backlog” refers to products or services that have been sold, but whose revenue hasn’t been recognized due to accounting principles. In non-manufacturing businesses like healthcare IT, backlog is a good thing because it represents sales that haven’t shown up as income yet but will down the road. Backlog isn’t positive for manufacturers because it means your factory isn’t cranking out widgets fast enough, meaning you’ll need to make big capital investments to increase capacity or else your customers will find another vendor.
• Sales revenue increased 4 percent, but the big jump was in services at 25 percent. Cerner is very good at generating that kind of recurring revenue without having to go through the grueling process of finding new customers, especially ones who are also considering Epic.
• The company sold zero new ITWorks or RevWorks deals, and in fact “have not added a full RevWorks client in recent quarters.” Cerner just can’t seem to get anything right when it comes to financial software and services.
• 25 percent of the quarter’s bookings were to non-Millennium customers. That’s a big deal – obviously the company is taking business away from someone else’s customers.
• The company says the ICD-10 delay will give a slight boost to its revenue cycle business because some prospects were on a software hold while focusing on ICD-10. They didn’t mention that if that’s true, business will take the same slight downturn next year when ICD-10 looms again.
• Revenue from sales outside the US dropped 16 percent, mostly because of reduced low-margin hardware numbers.
• Cerner’s highly publicized deal with Intermountain Healthcare was summarized as pushing trigger events in front of clinicians, with the challenge being to turn the processes Intermountain has developed into “self-contained diagnostic, treatment, outcome, and reimbursement containers” that “replaces the claim in the fee-for-service world” and that can be used in non-Cerner systems. Sounds great if it works, which has never been the case in any example I can recall where a big-name hospital’s rules were benevolently sprinkled down like holy water on bowing masses of less-blessed hospitals.
• The company mentioned HIMSS exhibits that showed “elegant graphs that purport to provide great insight into the data,” but that unless you can put that information in front of the physician in real time, “you’re just reporting the news vs. making the news.” That sounds inherently true, but the reality isn’t quite that dramatic – a hospital could use an analytics system to find potential areas of improvement (right down to the individual physician) and then use its order entry/clinical decision support system to build in guidance make it easier for physicians to do the right thing. Hospitals have plenty of capability built into the systems they already own without chasing yet another Intermountain project that seems to work for nobody except Intermountain. Every hospital I’ve worked in had plenty of information that could have improved outcomes and cost – what they lacked wasn’t technology, but rather the willpower to make the significant percentage of cowboy doctors follow the agreed-on rules. They needed competence and leadership, not more information to ignore.
• Concluding the Intermountain hype was a statement saying that the most exciting part of the partnership is to sell Cerner consulting services.
• The company still claims it can steal some Epic clients who have reached EMRAM Level 7 “because they don’t feel like the solution they have will suit their future needs.” I would think the best chance of that happening would be to undercut Epic’s maintenance costs, but Cerner didn’t mention that.

Tee Green, CEO of Greenway Health, provided HIStalk with this statement regarding the departure of President Matt Hawkins (above),who came over from his previous role as CEO of Vitera when Vista Equity Partners bought Greenway and combined the two companies in November 2013:

Matt Hawkins was instrumental in driving the growth and operational efficiencies at Vitera Healthcare, helping position that organization to combine with Greenway Medical Technologies and SuccessEHS to form the company Greenway Health is today. As Matt prepares to assume a new leadership role outside of Greenway, we’re very excited for him and wish Matt and his family nothing but the best. As Greenway moves forward, our priorities remain the same: to continue supporting and enhancing our solutions and to help our customers remain efficient and financially strong as they deliver care that improves the health of their patients and whole patient populations.

Sales

Texas Health Resources will deploy the AirStrip One clinical mobility solution throughout its system.

People

Joshua Seidman, PhD (Evolent, ONC) joins Avalere Health as VP of the newly created Center for Payment and Delivery Innovation (according to the press release) or Center for Delivery System System and Payment Innovation (according to his LinkedIn profile.)

KentuckyOne Health (KY) names Doug Jones (Providence Health & Services) as regional CIO.

Government and Politics

The AMDIS listserv brings up an interesting CMS attestation calculation quirk: any measure that requires “more than” a specific percentage actually requires the next-higher whole number percentage. You fail if you hit 50.4 percent on a measure that requires “more than 50 percent” since CMS rounds down to 50 percent and you didn’t exceed that. It’s bizarre that they round numbers at all.

The HIMSS EHR Association offers its comments to ONC’s proposed 2015 EHR certification criteria:

• Early notice of proposed changes helps vendors prepare, but doesn’t address the real problem — certification rules are changed too often.
• Vendors would have less than a year to build 2015 requirements into their products, so they want the edition labeled as 2016 rather than 2015.
• Vendors can’t spend all of their time chasing certification requirements – they also have to consider customer requests and other government-mandated changes.
• ONC underestimates the cost for vendors to keep up with its requirements – EHR says the real cost numbers are 10 times those ONC puts out and the 2015 criteria will be more than 15 times more expensive than ONC claims.
• EHRA doesn’t think certification should be required for anything other than providers collecting HITECH money – certification should not be broadly expanded.
• EHRA says it’s not reasonable to put the electronic clinical quality measures in 2017 edition certified software – there’s not enough time left.   

Innovation and Research

Brigham & Women’s Hospital (MA) will hold Pilot Shark Tank on Monday, where entrepreneurs are invited to pitch their ideas to hospital doctors and nurses who can approve a pilot project. Finalists are CareMon (3D optical patient monitoring), Constant Therapy (iPad-based stroke rehab therapy), Healo (remote monitoring of wound healing), Home Team Therapy (PT programs for home), MySafeCare (patient and family reporting of safety concerns), Revvo (bio-adaptive exercise bike), Tenacity Health (peer health coaching), Twine Health (collaborative chronic disease management), VerbalCare (patient-caregiver communication), and Vital Score (Apgar-like scoring of unhealthy behaviors that contribute to chronic illness).

Technology

In the least-surprising news of the week, Google+ goes comatose as its leader quits, its teams are reassigned, and the groups working on its Hangouts and photo features are moved under the Android operating system. Only Google could have designed product even clunkier and more confusing than Facebook except without the first-mover advantage and network effect that keep Facebook popular (at least for now.) Nobody wanted to use it as a Facebook alternative, so maybe at least some of its expensively developed parts can be salvaged for something useful. People wants EHRs to be as simple to use as Facebook, so maybe Google could drag up the moldy source code for Google Health and kludge something together that would turn two flops into one success.

Most electronic hospital  equipment can be taken over by hackers,according to a study by healthcare provider Essentia Health: IV pumps can be changed over the network, Bluetooth-powered defibrillators can be triggered at will, and unsecured medical images can be viewed by anyone, for example. The Essentia team also found that they could reboot some devices to force them back to factory defaults and that many pieces of equipment are connected directly to the Internet instead of being inside the firewall, allowing any hacker to simply plug into an available hospital jack and start finding devices to hack. A key finding is that EHRs accept data from unauthenticated devices, so bogus information could cascade into more harmful treatment decisions.

More speculation on why Nike stopped manufacturing its FuelBand activity tracking hardware: the software portion (NikeFuel) may end up on Apple’s iWatch or other wearable platforms.

Other

Security experts say the hacker network that calls itself Anonymous may be responsible for a series of cyberattacks launched against the website of Boston Children’s Hospital (MA), which left patients and clinicians unable to use the hospital’s portal (the site is down as I write this Saturday afternoon). The group had demanded that the hospital fire the head of its child abuse prevention unit after a high-profile custody battle in which the hospital filed medical abuse charges against the parents of a 15-year-old female patient who was later placed in the state’s custody. Anonymous found itself embarrassed two weeks ago when it launched attacks against Israel-based sites, but Israeli hackers launched a counterattack by tracking the IP addresses of the Anonymous members and hacked their computers, including hijacking their webcams to snap and publish photos of the not so Anonymous members.

Athenahealth announced last week that it was dropping its membership in the HIMSS EHR Association, which it says “ostensibly” represents EHR vendors in federal policy debates. The company says it “never really belonged there in the first place” because EHRA is dominated by non-cloud EHR vendors and athenahealth isn’t really an EHR vendor but rather a services company (a debatable point.) Athenahealth (a) doesn’t like that EHRA pushes for more vendor-friendly federal policies (longer timelines, lower bars) and (b) wants CMS to name vendors whose customers seek hardship exemptions while EHRA “presses just as hard to protect its members from the consequences of their failures by opposing any such disclosure.” EHRA decided not to wage press release warfare with athenahealth, but says its membership diversity creates value and credibility and while it’s sorry to see athenahealth leave, some of the company’s statements are incorrect (specifically the one claiming that EHRA opposes hardship exemption transparency, about which I could indeed find no stated EHRA position.) Athenahealth also says it takes too much time to explain to people why it regularly disagrees with its own trade association. My opinion: athenahealth voluntarily joined EHRA hoping to gain something from it (DC influence, publicity) and is quitting for the same reason (publicity and hoping to differentiate itself competitively from its former fellow members, especially after ATHN announced unimpressive quarterly result last week). Customers don’t care one way or another, and with the company’s size, it can do its own Washington glad-handing. Every member of CommonWell Health Alliance (except Sunquest) is also a member of EHRA, so maybe athena should storm off from that group as well.  At some point, a large, publicly traded company crosses the line from “disruptor” to “disruptee” and athenahealth may be getting close.

ECRI Institute’s listing of healthcare IT data integrity as the #1 problem facing healthcare organizations includes specific examples: data entry errors, missing or delayed delivery, accepting incorrect default values, copying and pasting, using both paper and electronic systems, and incorrectly attributing device data to the wrong patient. It recommends assessing clinician use, improving testing, offering better training, and giving users an easy way to report system problems they see.

Athenahealth’s Jonathan Bush and business writer Stephen Baker team up to write Where Does It Hurt?: An Entrepreneur’s Guide to Fixing Health Care, available May 15. Sounds interesting except that JB’s incessant verbosity makes it tough to convince free milk drinkers to plunk down cash to buy the cow.

Strange: a New York doctor is sued for stiffing the Scores strip club for $135,000 worth of lap dances in four visits over 10 days. He claims he was drugged by club employees and disputes that he was even present despite security camera video suggesting otherwise. A Scores spokesperson said of the cardiologist, “If I had five dancers dancing for me, I’d be in the ICU. He’s a heart doctor – I guess he’s got a good heart.”

Sponsor Updates

• Liaison Healthcare enhances its EMR-Link EHR interoperability solution with Meaningful Use Stage 2 capability.

Switching from a Cloud-Based EHR Vendor

I mentioned a while back about hearing from a physician practice that was finding it next to impossible to extract EHR information from their cloud-based EHR to move to a different system. I offered to write about the experience from the points of view of both the vendor and the practice. Here is a summary of the communication, which should provide lessons learned for both customers and vendors.

From Matthew “Toby” Cox, MD, MPH, Families First Pediatrics, South Jordan, UT

• We started with ADP AdvancedMD in April 2011, but found it didn’t meet our needs and we are switching to the peds-specific PCC EHR.
• ADP Advanced MD claimed on their website that they won’t hold data hostage – they will provide an encrypted hard drive with all data plus mapping and documentation within one week for $1,250.
• We paid $1,250 on January 30, 2014 and received a thumb drive several weeks later. The new vendor, PCC, says the new information is a comma-separated value file that makes no sense.
• After several weeks of getting no response, ADP AdvancedMD (whose national headquarters is less than a mile from our practice) sent a technician, who said the file the practice was given was incomplete. Another file was supposed to be sent, but wasn’t.
• Three months later, we still have no usable data and the ADP AdvancedMD representative suggested pulling up every patient chart and printing a PDF.

Response from Jim Elliott, VP of marketing, ADP AdvancedMD

• The delay was due to a process issue that has been resolved.
• The ADP AdvancedMD rep hand-delivered the 4.5GB data file that can’t be split into smaller files readable by Access or Excel because records are sorted by date of service and that would break up a patient’s chart.
• The practice had set up templates and each field they used can only be defined by the practice since the system doesn’t “know” how they are being used.
• The new vendor, PCC, understood the layout and required no further changes.

From Dr. Cox

• Nobody from ADP AdvancedMD told us in training that when we added items to templates that we were adding “codes” that would complicate the data extraction process.
• Our last EHR conversion from another vendor at least gave us individual patient PDFs that could be accessed by a menu button – not ideal, but usable.
• The practice management data extract from ADP AdvancedMD was perfect. Only the EHR information is a problem.
• I asked ADP AdvancedMD during their sales pitch about our access to our data if we decided to leave since it seemed unusual that they were offering a month-to-month contract. Their salespeople said we would have access to the data and be provided a hard copy of it. I was not savvy enough at that time to probe deeper into this as I took their word for it (dammit Jim, I’m a doctor, not a computer data specialist!)

From a programmer at Physician’s Computer Company (PCC)

• We never indicated to ADP AdvancedMD that we found their extract usable. The limited guidance we received was weeks later and only after repeated requests.
• We do vendor conversions every week and have done every major vendor. This is the only one that we have not been able to convert.
• Anyone on ADP AdvancedMD who thinks they can switch vendors is deluded.
• Here is a consecutive snippet … it’s the same date of service for the same patient, but it’s a random mix of stuff.

From Dr. Cox to ADP AdvancedMD

• If you were handed that data file, how would you import the information into Advanced MD step by step?
• Has anyone every successfully imported that information into another system?
• Is a bulk export to an industry-standard layout (CCD/CCR/CCDA) possible?
• Can a mass export to PDF be done as a last-ditch effort to get patient information into their new system?

From Jim Elliott to Dr. Cox

• There were communications gaps between the two vendors. ADP AdvancedMD spoke to PCC’s technicians and understood that the new vendor had everything needed to convert.
• ADP AdvancedMD is still a few months away from delivering the capability to bulk export to CCD or CCR, but it can be retrieved from individual patient records.

The practice’s information is still not available in their new system three months after their initial request and payment and Dr. Cox is worried about the clinical impact to patients of missing three years’ of their data.

My suggestion: regardless of whether your EHR vendor is a traditional or cloud-based one, ask them now (not later) for the names of former customers who successfully migrated off their platform with all data intact (which will prove that it’s at least possible). Or, far less desirably, ask for a sample extract with documentation.

I’ll also ask the technical folks who work for EHR vendors to weigh in on the data snippet above. Would your company be able to migrate intact, complete patient records using a file with that layout? It looks to me as though the individual items are identified using free text and non-standard codes that would be meaningless outside the source system.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 4/25/14

Top News

Cerner delivers strong Q1 numbers: revenues up 15 percent, adjusted EPS of $0.37 versus $0.33 a year ago, both in line with analyst estimates. The company also reported its $910.2 million in bookings was an all-time number for a first quarter.

Reader Comments

From Haberdash: "Re: Matt Hawkins. Greenway sent an email to customers saying that President Matt Hawkins is on the way out.” The note, which was sent Tuesday, indicates that Hawkins is leaving the company to pursue “an exciting new leadership position outside of the company.” The departure of Hawkins, who was CEO of Vitera Healthcare prior to the Greenway/Vitera merger, could be unsettling for any Intergy customers already concerned about Greenway’s long term product strategy. I emailed the company Wednesday for a comment but have not yet received a reply.

HIStalk Announcements and Requests

Mr. H is out and about today so I am flying solo. I am not sure what he’s up to but since I’d like to be sitting on a beach with an umbrella drink, I’m just going to pretend he’s doing something fun like that.

Some highlights from HIStalk Practice this week include: EHR vendors could learn from Surescripts’ “alliance of foes” model. The AMA reminds providers to order their ICD-9 codebooks for 2015 now that ICD-10 has been temporarily shelved. CVS MInuteClinic surpasses 20 million patient visits since opening its first in-pharmacy site in 2010. Rushed physicians create frustration and tension for both patients and providers. Orthopedists were the most highly compensated physicians last year. Wikipedia trumps Google Flu Trends and the CDC in tracking flu outbreaks. Dr. Gregg promotes “multiview” as a necessary EMR feature. Thanks for reading.

This week on HIStalk Connect: Nike shuts down its Fuelband activity tracker line, cancels plans to introduce a new tracker this fall, and eliminates 55 of the 70 staff members in the activity tracker business unit. Twitter announces the winners of its #BigData grant program, half of which were healthcare-focused research projects. In an otherwise neglected market, eCaring raises a $3.5 million Series A for a simplified health journal designed to help seniors age in place by trending for changes in physical or behavioral health and alerting appropriate caregivers.

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

VMware reports Q1 results: revenues up 14.2 percent and adjusted EPS of $0.80 vs. $0.74, beating estimates.

Kaufman Hall, a provider of financial consulting services and software for healthcare, acquires Axiom EPM, a provider of financial performance management software for healthcare and other industries.

Huron Consulting Group enters into an agreement to acquire the assets of Vonlay.

Quest Diagnostics posts Q1 numbers: revenues down 2.3 percent and adjusted EPS of $0.84 vs. $0.89 a year ago, missing estimates. Quest blames an unusually harsh winter that deterred people from going to its centers for tests.

NexJ Systems acquires Liberate Ideas, developer of a point-of-care patient education solution.

Owlet, developers of a smart baby bootie monitor that measures a child’s heart rate, raises $1.85 million from multiple firms, including ff Venture Capital and Eniac Ventures.

Heart Corporation expands its Hearst Health group and Zynx Health division with the acquisition of CareInSync, the developer of a mobile platform for provider-patient communications.

CTG attributes its 22 percent drop in Q1 profits on lower revenue from its healthcare technology services business. CEO James R. Boldt says the lower revenues are the result of hospitals delaying EMR and other IT implementation projects as they manage Medicare cuts from a year ago.

HealthStream reports Q1 results: revenues up 29 percent and flat earnings of $0.07 per share, beating revenue estimates but missing on earnings.

Sales

Crozer-Keystone Health System (PA), Tahoe Forest Health System (CA), Capital Health (NJ) and Hocking Valley Community Hospital (OH) will implement the InteHealth Patient Portal.

Michigan Health & Hospital Association Keystone Center will use RegistryMetrix from ArborMetrix at 60 hospitals to capture OB data and measure clinical performance.

Johns Hopkins Health System selects Carestream Health’s Vue PACS system.

Southern Illinois University HealthCare selects Allscripts TouchWorks EHR for its physician clinics.

SCL Health System will implement Stanson Health’s clinical decision support system.

People

Population health management and patient engagement provider Rise Health names Connie Moser (McKesson) president and COO. Moser replaces Mark Crockett, MD, who will remain as CEO, and Fred Croft, who will shift to CFO.

QPID Health forms an advisory that includes David W. Bates, MD (Brigham and Women’s Hospital); John D. Halamka, MD (Harvard Medical School); Julia Adler-Milstein (University of Michigan); and Robert M. Wachter, MD (University of California, San Francisco).

Extension Healthcare hires Jill Vavala (CareFusion) as CNO.

Covisint names Michael Keddington (McDermott & Bull Executive Search) SVP of worldwide sales.

The NCQA appoints Michael S. Barr, MD (American College of Physicians) EVP in charge of leading the organization’s research, performance measurement, and analytics efforts.

David J. Bensema, MD moves from CMIO to CIO for Baptist Health (KY).

Essia Health names Rachel Leiber (Providence Health & Services)  to lead the company’s EMR implementation services division.

Accretive Health CEO Stephen Schuckenbrock will step down from the troubled company when his contract expires October 2.  Last month the company was delisted from the NYSE after failing to file restated financial reports from 2012.

Announcements and Implementations

The Greater Houston Healthconnect network and the Austin-area Integrated Care Collaboration establish health information sharing through the Texas Health Services Authority’s HIETexas.

American Health Network implements eClinicalWorks Care Coordination Medical Record for population health management to manage its three ACOs in Ohio and Indiana.

Via Christi Health (KS), which is owned by Ascension Health, will go live on its $85 million Cerner system June 1 across all of its Wichita hospitals and clinics.

Behavioral Health Information Network of Arizona leverages NextGen’s Mirth Connect platform to become the first statewide behavioral health information exchange in the country.

Lady of the Sea General Hospital (LA) goes live with T-System’s EDIS EV.

The W. W. Caruth Jr. Foundation awards Parkland Center for Clinical Innovation (TX) a $12 million grant to establish the Dallas Information Exchange Portal to connect Parkland Memorial Hospital with local social service agencies.

Government and Politics

HHS says two entities have collectively paid almost $2 million to resolve potential HIPAA violations following the theft of unencrypted laptop computers.

The House Appropriations Committee approves a 2015 budget plan to that would hold back 75 percent of the VA’s requested funds to upgrade its EHR until Congress is convinced the DoD and VA are making progress in their efforts to share EMRs.

CNN reports on the Phoenix VA Health Care System and how delays in scheduling appointments has led to 40 deaths. The report also reveals details of a scheme by VA managers to hide the scheduling delays in order to improve official scheduling metrics. A retired VA doctor claims that the health system maintained a “sham” waiting list that was shared with Washington officials that showed timely appointments, as well as a real but hidden list with wait times of more than a year. To create the secret list, staff entered appointment details into the computer, printed the screen, but did not save what was entered. Patients remained on the secret list until the scheduled appointment was within 14 days, then details were transferred  to the sham list and the hard copy was shredded. The US House Veterans Affairs Committee is now investigating.

The FBI warns that healthcare systems and medical devices face an increased risk of cyberattacks because private health data has a higher financial payout on the black market than credit card numbers.

Other

The chairman of the board of supervisors for Riverside County Regional Medical Center (CA) takes Huron Consulting to task and questions its lack of progress fixing the hospital’s financial woes. Huron, which is six months into a $26 million dollar engagement, was hired to implement cost-saving initiatives to address the hospital’s $83.2 million cash shortfall, but so far the deficit has only been cut $1.2 million. The hospital’s CFO defended Huron’s work, noting that the company’s efforts have already contributed to $9 million in savings, but declining patient traffic during the same period has resulted in a $12 million decline in revenue.

The Department of Labor predicts a 22 percent increase in the number of jobs for medical records and health information technicians between 2012 and 2022.

Health IT, care coordination, and drug shortages lead an ECRI-complied list of top 10 patient safety concerns for healthcare organizations.

Forty percent of physician practices are looking to replace their existing EHR, according to a Software Advice report. Among buyers replacing their EHR product, the most common replacement reasons: the current solution is too cumbersome and/or integration is needed between applications.

A Rhode Island court issues a consent decree saying that the state’s EHR database CurentCare must be more transparent and offer patients more privacy protection. The ruling stems from a 2010 lawsuit filed by the ACLU that charged the state’s department of health didn’t spell out clearly or publicly enough how patients could remove or change their own records from the database.

A quaky lawsuit out of Oregon: a woman sues her mother’s neighbor after the neighbor’s pet duck attacked her. The duck ambushed the woman without provocation, causing her to fall, break her wrist, and sprain an elbow and shoulder. The victim, a retired nurse, is seeking $275,000 for pain, suffering, and other damages.

Sponsor Updates

• Elsevier will market Stanson Health’s CDS alerts and analytics solutions.
• IDC Health Insights names Wellcentive a leader in its MarketScape report on US population health management vendors.
• Merge Healthcare releases iConnect Retinal Screening for identifying and diagnosing patients with diabetic retinal disease.
• Quest Diagnostics recognizes Liaison Healthcare’s EMR-Link solution with its Quality Solutions Certification for meeting or exceeding HIT quality standards for secure clinical lab ordering and results reporting.
• BESLER Consulting will market the MedAptus charge capture management suite to its clients and MedAptus will promote BESLER’s revenue recovery and compliance services.
• McKesson Business Performance Services adds outpatient and inpatient facility coding services to its coding and compliance portfolio of services.
• CommVault enhances its PartnerAdvantage program for channel partners to accelerate revenue growth and simplify collaboration.
• Quest Diagnostics acquires the remainder of Steward Health Care System’s (MA) outreach laboratory services operations and will provide testing services to providers previously serviced by Steward.
• iHT2 posts highlights from its Atlanta Health IT Summit.
• Imprivata hosts its HealthCon 2014 conference May 4-6 in Boston.
• Aspen Advisors shares a white paper on building a technology roadmap to support an organization’s value-based model.
• Orion Health and two of its customers will discuss how state public health agencies can expand the use of integration engines to prepare for quality reporting during the Public Health Informatics Conference April 29-30 in Atlanta.
• Health Catalyst opens registration for the 2014 Healthcare Analytics Summit September 24-25 in Salt Lake City.
• Aspen Advisor principal Jim B-Reay offers tips for keeping the mind fresh in  CHIME’s CIO Connection.

EPtalk – by Dr. Jayne

I caught up with one of my medical school buddies this week as she was passing through town on the way to the class reunion that I’m skipping. She’s a primary care doc turned informaticist as well, so the opportunity to talk shop with someone who has walked a mile in the same virtual shoes as me was exciting. We got to chatting about the Flip the Clinic initiative which aims to “re-imagine the medical encounter between patients and care providers.”

The website has a variety of information on “flips” in categories like communication, design, education, empowerment, etc. The idea is that by making the clinical interaction better, patients will be healthier and providers happier. Although I like the idea it’s a little hard to get on board without some objective evidence that these interventions will make a difference. Some of them are straightforward: reducing noise in the healthcare environment, or removing physical barriers between patients and the office staff. Others are more abstract such as reforming the broken payment system. I think it’s great to have a discussion but I’m not seeing how some of these concepts will translate into practice, especially for those of us who are in employed models.

My former classmate and I have both struggled with being employed physicians and our inability to get buy-in from administrators when we want to try innovative maneuvers. Administrators frequently want proof that we’ll have positive return on investment but fail to realize not all returns are monetary. It’s difficult to try to find energy to fight the status quo when all the forces surrounding us (MU, CMS, HIPAA, and the rest of the alphabet soup) seem designed to stifle any attempt to think outside the box.

It’s going to take more than concerned individuals to truly Flip the Clinic. Organizations will need to address culture issues and there will need to be institutional buy-in before change can begin. The commitment needed to actually have that level of change take place, let alone “stick” and become hard-wired is something that very few of us can muster right now.

From Demo Dave: “Re: replacement systems. I sold EHR systems to physician groups for 15 years, all before MU started to skew the market. At least 30-35 percent of the systems I sold were to practices looking for additional functionality that was already in their existing system. These practices simply never learned to utilize the capabilities of their existing systems. When an administrator told me their existing EHR was lacking functionality or reporting, I simply smiled and confirmed what they wanted in a new system. I then focused demonstrations and implementations to meet their needs.” Many EHRs have gotten to the point where they have more features than users can understand let alone incorporate on a daily basis. Anyone who thinks they can learn a system with a few days of training and never think about it again is woefully shortsighted. Having workflow validation and optimization visits at 30, 60, and 90 days post go-live can help – any bad habits can be corrected and new features can be regularly introduced to those users who are ready for them. Customers should also consider actually reading the user manual and other documentation before they throw the proverbial baby out with the bath water.

Most of our readers know I enjoy a good cocktail and also love to travel, so I was intrigued by a story on NPR that talked about powdered liquor. I should have read it right away rather than bookmarking it for later – when I returned it had been updated stating it’s not actually legal in the US. Apparently I’ll have to go to Japan, Germany, or the Netherlands to check out the options.

Speaking of the need for a stiff drink, there’s still a fair amount of chatter about the release of the Medicare payment data. The newest Coda-a-Palooza challenge  calls for developers to leverage that data to “help consumers improve their health care decision-making.” I’m a professional, I understand what the Medicare data does and does not reflect, yet I still struggle to think of ways that the data can be useful in consumer decision-making. The site says the data “shed significant light on how physicians actually work.” Excuse me? How does data on Medicare payments explain how I care for patients? Maybe I’ll understand better in June when the winners are announced. In the mean time, any explanations that you can send my feeble post-call brain?

Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 4/23/14

Top News

Continua Health Alliance, mHealth Summit, and HIMSS launch the Personal Connected Health Alliance to represent the consumer voice in personal connected health to ensure that technologies are user-friendly, secure, and can easily collect, display, and relay personal health data.

Reader Comments

From Less Disruption Please: “athenahealth. Friday was a tough day. Their outage was apparently due to catastrophic loss of power. It took out email, production, and backup sites. At least they apologized.” Unverified.

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

AdverseEvents, a healthcare informatics company focused on drug safety and side effects, closes $2 million in Series A financing.

Informedika changes its name to Health Gorilla.

Lexmark reports that revenues for its Perceptive Software division grew 38 percent in the first quarter.

Sales

Evangelical Community Hospital (PA) selects dbtech’s eFolder solution for enterprise content management.

Griffin Hospital (PA) will implement athenaCoordinator Enterprise.

UMass Memorial Health Care (MA) will integrate Luminat’s end-of-life directives platform into its EHR.

Alder Hey Children’s Hospital (UK) selects Summit Healthcare’s interface engine technology.

Missouri Baptist Medical Center will deploy the Vocera Communication System.

People

EHR/PM provider Pulse Systems appoints Richard Ungaro (RU Investment) SVP of operations.

NoteSwift hires Stan Swiniarski (Nuance) as VP of products and Art Nicholas (Nova Dynamics) as VP of sales and business development.

MediTract, a provider of automated contract management solutions, appoints Ed Caldwell (Emdeon) SVP of sales and marketing.

CMS Principal Deputy Administrator Jonathan Blum, the administration’s top Medicare official, will resign effective May 16.

Cancer Treatment Centers of American names Kristin Darby (Tenet Healthcare) CIO.

Announcements and Implementations

Athenahealth reports that 95.4 percent of its participating providers successfully attested for MU Stage 1 in 2013. The company also resigns from the HIMSS Electronic Health Records Association (EHRA) trade association saying it “never really belonged” since it is neither an EHR company nor a software vendor.

Maine’s HealthInfoNet HIE offers providers access to the state’s Prescription Monitoring Program through the HIE’s portal, giving clinicians a single sign-on to both systems.

Children’s Hospital of Philadelphia and Virtua (NJ) integrate their imaging systems as well as CHOP’s Epic and Virtua’s Siemens EHRs to give both health systems access to each other’s radiology reports and diagnostic images.

Prince Mohammed Bin Abdulaziz Hospital in Saudi Arabia deploys Cerner after a nine-month implementation.

Government and Politics

CMS officials are considering whether to keep Accenture as its long-term prime contractor for the the HealthCare.gov website or seek a potential replacement. A “sources sought” notice posted by CMS says the agency is looking to see if any small businesses owned by veterans or minorities might be suitable candidates.

Other

Use of Epic’s Care Everywhere HIE tool helped four EDs within Allina Health (MN) reduce duplicate tests and procedures, according to a study published in Applied Clinical Informatics.

Boston Children’s Hospital (MA) partners with Etiometry to analyze information from ICU patient monitors to display a Stability Index.

Weird News Andy says patients have to pay for expensive ICU stays, but maybe this isn’t the best way. Police arrest a female ICU patient after a tip from hospital staff that she was receiving many visitors who stayed only 1-2 minutes. She was dealing heroin from her bed.

Sponsor Updates

• Kinetic Data names CareTech Solutions its Innovator of the Year for its innovative use of Kinetic Data products.
• Craneware enhances its supply management solution Pharmacy ChargeLink to include additional worklist functionality, benchmark pricing, and automated dosing tools.
• PaySpan will integrate MEA|NEA’s electronic claim attachment capabilities into its healthcare reimbursement platform.
• McKesson observes Earth Day with a Green Week celebration that focuses on informing employees about the company’s efforts to reduce its environmental footprint and engaging employees in environmental efforts.
• Wolters Kluwer Health releases the Medi-Span Medicare Plans File, which provides indicators to designate coverage under Medicare Part B and/or Part D.
• Holon explains why HIE implementations in rural healthcare can trump those in urban settings in a company blog post.
• The Advisory Board Company shares an infographic  that highlights how progressive organizations are focusing on primary care providers to achieve volume and quality goals.
• Surgical Information Systems updates its industry, client, and anesthesia events calendar.
• Aperek will participate in the SMI Spring 2014 Forum in Phoenix April 29-May 1.
• Halim Cho, Covisint’s director of product marketing will discuss the cloud’s disruptive power to transform enterprises at the May 5 Forrester Forum for Technology Management Leaders in Orlando.
• John Marshall, SVP and GM for AirWatch by VMware, offers his enterprise mobility market perspective in an interview.
• Shareable Ink’s founder and CTO Stephen Hau organized a Boston Marathon team that raised over $750,000 for last year’s bombing victims.
• Netsmart opens registration for its CONNECTIONS2014 conference October 6-9 in Anaheim, CA.
• The Orion Health Patient Portal v.4.0 achieves ONC HIT 2014 Edition Complete EHR Certification through ICSA Labs.
• Navicure adds 300 new clients representing 1,225 providers in the first quarter and posts a 19 percent increase in revenues versus a year ago.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 4/21/14

Top News

UPMC (PA) says that the information of 27,000 of its employees was exposed in a February breach and the hackers have filed fraudulent tax returns for 788 of them so far. A lawyer seeking class action status of his lawsuit asks the obvious question: why did the breach involve only 27,000 of UPMC’s 62,000 employees? The attorney points out that UPMC first claimed that only 20 employees were affected, then 322, and now 27,000, obviously concluding that all employees may be at risk despite the announcement. The tax scam is a smart one since the IRS, like HHS, pays first and asks questions later.

Reader Comments

From Weary CIO: “Re: branding. I have background in market research and healthcare IT branding is useless. It works in retail, so marketers in vendor companies use it to have something to do. They come up with thin and useless stuff like logos on napkins because if they don’t, they are out of a job. If marketing is what you do, that’s what you do. Private industry is more acutely aware that overhead positions are more vulnerable to reductions so they have to try to stay relevant. Waste creates so many employment opportunities!” I had questioned offline to Weary CIO the value of expensive signage and “branded” items at events when I rarely notice them. My enjoyment of HIStalkapalooza was unaffected logos on lampshades.

From Down Boy: “Re: athenahealth. Down Friday – all sites, communications, interfaces, etc. Confirmed with hospitals and practices in CA, MO, SD, NH, and ME.” Unverified.

From Locked Box: “Re: athenahealth. Their ‘More Disruption Please’ program was supposed to be a collection of companies offering easily integrated products that would give athena customers functionality the company doesn’t offer, which would support innovation by giving those companies access to customers. In return, the companies would offer a discount to their customers, lowering the barrier to innovation. Now athenahealth has changed the program to a revenue share model, which is a 20 percent tax on interoperability for us and our customers, which is why we joined. We are leaving the MDP program.”

From Excelsior: “Re: JASON report. HHS’s report is similar to the 2010 PCAST report, including calls to represent health information as ‘atomic data with associated metadata.’ Two people involved in the PCAST report were also involved in the JASON report: Craig Mundie and Sean Nolan, both of Microsoft.” The report says “the entire health data infrastructure will be crippled” without better interoperability and recommends that EHR information be stored using common mark-up language and that EHR vendors should open up their systems via APIs that allow third parties to build on them with new applications. EHR vendors aren’t likely to embrace this concept enthusiastically given that the report recommends architecture that can “provide a migration pathway from legacy EHR systems,” but of course their EHR customers would need to apply pressure on their vendors to make it happen anyway since government reports have zero bottom line impact. Other findings:

• Meaningful Use criteria “fall short of achieving meaningful use in any practical sense,” mostly having replaced faxed machines with electronic delivery of page-formatted records that patients can’t access directly.
• Current EHR interoperability work hasn’t developed opportunities for entrepreneurism.
• HHS could take an active role by using future Meaningful Use stages, starting with Stage 3, and certification to force an open software architecture. ONC should publish standards to accomplish that within one year.
• Researchers need better access to EHR data.
• Meaningful Use Stage 3 should require vendors to develop, publish, and verify APIs that allow searching their systems with semantic harmonization and vocabulary translation. System acquisitions by the VA and DoD should require those published APIs.
• EHR-powered fraud detection tools should be developed.

From Guillermo del Grande: “Re: consultants. Here’s a list of ‘Things Consultants Wish Their Customers Knew.’”

1. Very few consulting companies have a bench.
2. If you post a position with six different vendors, a consultant with a resume on Dice will receive six different calls.
3. If you yell at a consultant for looking at Facebook, chances are that’s why you need a consultant in the first place.
4. Trying to find someone with seven years of experience in an application that’s only been around for five years probably won’t end well.
5. If people can’t manage in the operations side, what the hell does putting them into the IT department going to accomplish?
6. Recruiting firms are really good at making phone calls and searching job boards. This is pretty much it. Many consulting firms are actually recruiting firms.
7. If you are going to be managing consultants, please do not panic when they know more than you about the application that you scraped through getting a certification in, and then ignored for several months before deciding you needed to augment your staff.
8. If you want the FTE to learn from the consultant, you may want to see if the FTE has a pulse and an IQ.
9. If you fire four consultants in a row, chances are that it’s not them, it’s you.
10. Two hiring managers with a feud fighting through hiring consultants and making them mess with each other is annoying, expensive, and somewhat common.
11. Yes, consultants have faults. Thank you for pointing them out every morning. Why did all your FTEs leave again?

HIStalk Announcements and Requests

The White House is most responsible for the ACA-related failures such as Healthcare.gov that led HHS Secretary Kathleen Sebelius to resign, according to 47 percent of poll respondents. New poll to your right: do you feel better or worse about HHS after its release of Medicare physician payment information? I felt worse: the lawsuit-mandated release of the data reminded that like pretty much all federal programs, taxpayers should be appalled at how their money is being spent, the cost of the self-protecting bureaucracy required to spend it, and the remarkably breezy oversight that expensive bureaucracy provides in return. Not to mention that Medicare payment rules are so convoluted that even they can’t figure out when they (meaning we) are being defrauded. HHS is like the IRS in that regard and I don’t trust either of them to enforce politics-embedded rules that nobody understands.

Listening: new from Atlanta-based melodic hard rockers Manchester Orchestra.

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

From the athenahealth earnings call:

• The Epocrates team “continued to struggle on new booking attainment” and missed revenue targets with an eight percent reduction since the acquisition. The company is looking for a VP of sales.
• The company started using the Net Promoter Score and fell short of its goal with a 44.7 vs. planned 47.3 (vs. a high 70s score for Amazon and Apple.)
• The company urged investors to look at full-year results instead of quarterly.
• In admitting that athenaCoordinator’s planned “one percent of system revenue” model was not followed in its first two sales, Jonathan Bush said that the company was desperate to get those sales and had no references for the prospects. The plan remains to collect a percentage of health system collections.
• The company blamed an increase in its AR days to health plan deductible resets, slower patient payments, vacation days, bad weather, and a weaker flu season.
• Low-margin real estate investments hurt gross margin.
• Bush says an obstacle to the company’s growth is that consulting companies can’t earn fees from its implementation, so it will be “repositioning ourselves around the larger process improvement for the health system around coordination and care that actually will generate very productive, useful as oppose to wasteful consulting fee in the interest of the consulting firms.”

Here’s a one-year view of ATHN’s share price (blue) vs. the Nasdaq (red).

Healthbox, which runs medical accelerator programs, raises $7 million in expansion funds. One of its investors is Intermountain Healthcare. The company also announces that it will launch Healthbox Solutions to showcase healthcare IT products to hospitals.

Government and Politics

A ProPublica analysis of the CMS physician payments database finds that doctors previously charged with fraud and Medicare overbilling continue to make big money from the program. Medicare paid a psychiatrist who was arrested and barred from the Medicaid program in 2011 $862,000 in 2012. Sen. Chuck Grassley (R-IA) said Medicare and Medicaid programs need to communicate since, “The new transparency makes it harder to ignore when doctors who harm patients or defraud taxpayers in one program face no consequences in the other program” (how about a little bit of interoperability push there?) A doctor who was convicted of paying patients via his charity to use his pain clinic was paid $500,000 in 2012 for treating 80 patients despite his pending 50-month prison sentence and $3.5 million fine, but his lawyer claims his conduct didn’t cost Medicare anything because somebody would have treated the patients even if it wasn’t him. A Michigan oncologist charged with misdiagnosing patients with cancer so he could bill them for unnecessary treatments was paid $10 million by Medicare in 2012. Pay-and-chase is working really well for criminals.

Innovation and Research

The consumer wearables fad seems to be over as Nike fires 55 of the 70 members of its FuelBand team and cancels the planned fall release of a new model. Nike says it wants to focus on software, not hardware. Most likely they realized that (a) high-tech versions of a $5 pedometer not only don’t usually motivate anyone except those who are already motivated, and (b) spending money to bring out new hardware versions is risky now that the competitive field has opened up. FeulBands may die off just as quickly as those once-ubiquitous yellow Livestrong wristbands that people couldn’t trash fast enough once the headlines forced them to belatedly realized what a scumbag Lance Armstrong is. There’s a Nike connection there too – they used to make Livestrong-branded products until Lance finally admitted that he’s a cheater and a liar.

Technology

John Gomez from Sensato provides suggestions on dealing with the Heartbleed SSL vulnerability, warning that hospitals “have an obligation to deal with it because it is a serious threat to privacy.” Even Healthcare.gov is telling users to change their passwords. John’s suggestions:

• Inventory systems that use SSL or similar encryption.
• Ask  technology partners providing services through an information or hosting agreement (HIE, hosting companies, portal vendors, kiosk vendors) for certification that they have determined that they are not vulnerable to Heartbleed.
• Ask HIPAA business associates to provide documentation of how they have eliminated their Heartbleed risk, especially companies who use online system to collect patient payments for billing or collections.

Other

T. J. Samson Community Hospital (KY) announces that 49 employees will be laid off and all employees will temporarily have their pay reduced due to effects of the Affordable Care Act and “the costly rollout of an inadequate software program.” That system is Siemens Soarian, which the hospital purchased in February 2012. Interim CEO Henry Royse says that Soarian “is still costing the hospital tens of millions of dollars in unrecoverable bad debt, consultant fees, and lost productivity” a year after it went live. He specifically says the implementation was rushed, Soarian can’t connect to its practice management systems, it can’t produce needed operational reports, and the hospital has been unable to send bills for 60-90 days at times. The hospital implemented Soarian to earn Meaningful Use payments.

Fast Company profiles SharePractice, which it describes as “a Yelp for medical treatments” in allowing physicians to review the success peers have had with specific treatments. The company calls its iPhone app “experience-based medicine.” The founder is a Naturopathic Doctor who works for San Francisco-based Care Practice, opened “like one would open a neighborhood restaurant with a focus on patient experience and developing a compelling identity and brand in a tough urban marketplace with fewer and fewer doctors.”

The outpatient clinics of Salem Health (OR) will begin their pilot with OpenNotes on Monday.

The CEO and CTO of Mississippi-based Samarion Solutions, which sold long-term care IT systems, are indicted for defrauding investors.

A study finds that US healthcare isn’t expensive because we use so much of it – the problem is that we pay the highest prices in the world for drugs and hospital procedures. As patients, it’s not altogether our fault that US healthcare is so expensive and produces unimpressive results for the impressive outlays. A day in the hospital costs less than $500 in Spain, $1,300 in Australia, and $4,300 here (and $13,000 for hospitals in the 95th percentile.)

A New York Post article names the highest-paid doctors in New York City, with two from Mount Sinai Hospital’s medical school topping the list: a urologist paid $7.6 million and a spine surgeon who made $6.9 million. The medical director of Consumer Reports Health summarized, “Whenever I see compensation data in health care, I’m stunned and nauseated. I’m embarrassed for the profession.”

In England, a review of a woman’s death after inpatient surgery finds that she was screaming and vomiting in her room afterward, even begging her children to call an ambulance to remove her from the hospital. Her doctor did not respond, the investigation found, because he was in the hall outside her room playing a video game.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 4/18/14

Top News

Nuance confirms its acquisition of Accelarad (reported on HIStalk  last weekend) and the immediate availability of the newly branded Nuance PowerShare Network.

Reader Comments

From Worth HIT: “Re: tradeshow blooper. At HIMSS Middle East, 3M’s booth described a new service offering, ‘Coding and Groping Quality.’ Go to love the high-tech fix … white tape.” The sign is full of inconsistencies: “groping” and “intelligence” are the only words not capitalized, “ICD-10” also appears as “ICD10,” some random commas found their way onto the page, and some lines end with periods while others don’t. You’re gonna need a bigger roll of tape.

From Pure Power: “Re: your 2009 thoughts about EHR data. Worth looking at again.” Well, here you go then, as I was referring five years ago to a research study about using EHR data in nephrology:

I don’t have access to the full text of the article, but I truly believe that once the pain of getting EMRs running as data collection appliances is over (meaning we’ve got data collection clerks known as doctors and nurses in place, which is the “pain” part), the benefit will be incredible. This article apparently deals with having nephrologists automatically consulted when the EHR finds problems. There are other benefits. You could do society-improving medical research by just slicing and dicing data from millions of patients, at least the parts of it that aren’t just clinical-sounding billing events that are useless or even misleading. You could find candidates for research trials. Patients could be followed over many years, even as they move around and use the services of a variety of providers. And for individual patients, there could be great value in putting research findings into the hands of front line doctors. Not to mention giving patients a platform whereby they can participate in their own care and add non-episodic information related to lifestyle, personal health assessment, etc. Clinical systems will not save time, as clinicians know – they exist to create data whose value mostly accrues to someone else. My advice to providers: much of your future income may be based on the data you create and the ownership in it you retain. Don’t be like the Native Americans and let greedy outsiders buy your land for trinkets.

HIStalk Announcements and Requests

A few highlights from HIStalk Practice this week include: US physicians produced $1.6 trillion in direct and indirect economic advantage in 2012. Steven Posnack creates a fun proof of concept graph that matches Medicare payment data with MU incentive payments. Boston doctors prescribe bike riding. AAFP’s president points out the disparity in compensation between family practice physicians and specialists, as evidenced by the recent release of Medicare payment data. CMS offers guidance on the Attestation Batch Upload option. A urology practice employee sends details on 1,114 patients to a competing practice to help the competitor solicit business. Thanks for reading.

This week on HIStalk Connect: Nuance acquires image-sharing vendor Accelarad, which will power a new cloud-based image and report exchange platform that integrates with its existing transcription product lines. In England, the NHS kicks-off a campaign to use telehealth and mHealth apps to reduce ED visits. The Mayo Clinic is funding a medical research assistant app designed to help consumers responsibly look up their symptoms and conditions. Dr. Travis recounts past mistakes the health IT industry has made with EHR data exchange and questions whether the same mistakes are being made with newer payment and care delivery models.

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

Athenahealth announces Q1 results: revenue up 30 percent, adjusted EPS $0.12 vs. $0.38, missing analyst estimates for both.

Liaison Technologies raises $15 million in funding.

HCA subsidiary Health Insight Capital makes an equity investment in Intelligent InSites.

One Medical Group, a 27-location practice that heavily promotes its use of healthcare IT in providing care, raises $40 million in growth capital, bringing its total to $117 million.

Great Point Partners makes a “significant investment” in Orange Health Solutions to finance the acquisition of MZI Healthcare, developers of EZ-Cap and other technologies for ACOs and IPAs.

CareCloud reports that it added 170 clients in Q1.

Sales

Australia’s Royal Children’s Hospital in Melbourne awards Epic a $48 million contract.

Sisters of Charity of Leavenworth Health System (CO) selects Allscripts EPSi as its financial decision support system.

University Health System (TX) will deploy PeraHealth’s PeraTrend real-time patient status system, which calculates a score of acuity called the Rothman Index.

People

Crain’s Cleveland Business names Cleveland Clinic CIO Martin Harris, MD as its CIO of the year.

Healthcare data analytics firm GNS Healthcare hires Mark Pottle (N-of-One/Optum Insight) as CFO.

Aventura names Bill Bakken (Nordic Consulting) COO.

NaviNet promotes Sean Bridges to CFO, Sridhar Natarajan to VP of software development, and Thomas Smolinsky to VP/CISO.

Announcements and Implementations

Steward Health Care System launches the StewardCONNECT patient portal based on Get Real Health’s InstantPHR patient engagement platform.

Park Nicollet Health Services (MN) will implement StrataJazz from Strata Decision Technology for cost accounting, contract modeling, long-range financial planning, and rolling forecasting.

The Patient-Centered Outcomes Research Institute (PCORI) provides an update on its $100 million initiative to develop the National Patient-Centered Clinical Research Network that was originally announced in December. PCORI’s executive director Joe Selby, MD outlines details on governance, data security, privacy, and interoperability as participants work to build a database of 26 to 30 million EHR records in support of retrospective clinical research.

The 25-bed Dan C. Trigg Memorial Hospital (NM), which is owned by Presbyterian Healthcare Services, implements Epic.

The Whitman-Walker Clinic (DC) is implementing Forward Health Group’s PopulationManager and The Guideline Advantage.

Cincinnati’s fire department rolls out Tempus Pro, a real-time vital signs monitoring system developed for battlefield use that allows hospital-based physicians to monitor patients being transported by ambulance.

Mayo Clinic and startup Better announce a $50 per month membership-based app that includes a symptom checker, health information, and access to a personal health assistant.

Government and Politics

The HHS’s OIG warns that some state Medicaid agencies may be putting patient health information at risk by outsourcing administrative functions offshore.

Innovation and Research

A VA survey of 18,000 randomly chosen users of its My HealtheVet system finds that a third of them use Blue Button, with three-quarters of those saying its main value is collecting their information in one place. Barriers to adoption were identified as low awareness and usability issues.

HIMSS Analytics says that healthcare IT systems with the highest growth potential are bed management, ERP, and financial modeling.

TechCrunch profiles One Medical Group, which has raised $117 million (the latest funding announcement is above) in funding to create a new kind of technology-powered medical practice, with its custom-developed EHR and portal offering appointment scheduling, refills, lab results, and access to a patient’s records from any of its 27 locations. Patients pay $149 per year for access and can use their health insurance.

Other

It’s not exactly health IT related, but appalling: Yahoo fires its COO of only 15 months after he fails to improve the company’s advertising revenue. He didn’t get a bonus because he didn’t make his numbers, but he still walked out with a severance check of $58 million.

The Bloomberg School of Public Health at Johns Hopkins University tweets that it has exceed 1 million enrollments in its free Coursera courses. Starting soon: Community Change in Public Health, Mathematical Biostatistics Boot Camp 2, The Data Scientist’s Toolbox, Getting and Cleaning Data, Exploratory Data Analysis, and The Science of Safety in Healthcare.

BIDMC CIO John Halamka, MD offers common sense HIPAA-related tips to hospitals using patient data for fundraising:

• Disclose fundraising activities in the Notice of Privacy Practices and include clear opt-out provisions
• Manage the data centrally and don’t allow departments to create their own databases
• Allow only experts to query the database and create views that respect the “need to know”
• Keep audit trails
• Provide tools to eliminate the need to query clinical systems directly

Interesting facts from an article on clinicians who use social media in the OR:

• A Texas woman died during a low-risk surgery because the iPad-using anesthesiologist didn’t notice her decreasing blood oxygen levels until she turned blue
• Nurse anesthetists and residents were distracted in 54 percent of cases, most often because they were on the Internet
• 56 percent of perfusionists admitted to talking on their cell phones during procedures, and only about half thought it was dangerous to text during surgery
• A quote from anesthesiologist who studies unfocused OR staff: “Airline pilots don’t allow themselves to be distracted by social media because they themselves do not want to die. To replicate that in healthcare, we’d have to say if there’s a wrong-site surgery or other error, we will shoot everybody in the OR.”

UNC Healthcare (NC) reduces patient volumes as it adjusts to its April 4 Epic go-live.

A seventh grader undergoing cancer treatment “attends” classes in his school more than 1,100 miles away from Children’s Hospital of Philadelphia by using VGo, an audiovisual-equipped robot he can steer down the school hallway and into classrooms as he says hello to classmates. The same VGo robot is used by hospitals for patient monitoring  and telemedicine.

Weird News Andy calls this story “Doc on the Run.” An Arkansas gynecologist allegedly takes smartphone pictures of his patients without their consent while they are in the stirrups. Police investigating a patient’s complaint find her photos on the doctor’s phone, but don’t initially find him (and thus WNA’s headline). Since then, however, he has been arrested and charged with video voyeurism.

Sponsor Updates

• PMD releases pMD Messaging, a secure text messing solution for providers that is integrated with the company’s mobile charge capture application.
• Surescripts awards DrFirst and 31 of its EMR partners that have integrated Rcopia e-prescribing software within their EMR with its White Coat of Quality Award.
• The Professional Association for Customer Engagement presents nVoq with its 2014 Technovation Award for demonstrating superior technological innovation and leadership in customer engagement.
• CCHIT certifies that PatientKeeper v8.1 software is compliant with the ONC 2014 Edition criteria as an EHR module.
• Netsmart joins Carequality, a collaborative formed to accelerate health data exchange, as a founding member.
• The Omega Management Group awards RelayHealth Financial its NorthFace ScoreBoard Awards for excellence in customer service and support.
• O’Reilly Strata RX Conference posts a wrap-up video from its Strata RX 2013 conference.
• GetWellNetwork announces details of its GetConnected 2014 conference in Chicago June 3-5.
• Deputy National Coordinator Jacob Reider, MD will deliver the keynote address at the 2014 Aprima User Conference in Dallas, TX August 8-10.
• Craig Greenberg, associate practice director for Beacon Partners, suggests in the company’s blog five areas of focus for improving and sustaining cash flow.
• Capsule Tech will exclusively resell in North America Clinical Vigilance for Sepsis software from Amara Health Analytics.
• A local news station highlights Jane Phillips Medical Center (OK) and its use of PatientTouch for nurse communications and patient documentation.
• Orion Health co-sponsors the Fifth National Accountable Care Organization Summit June 18-20 in Washington, DC.

Highlights from the Atlanta iHT2 Health IT Summit
By Jennifer Dennard

This was my third year in a row attending the Health IT Summit in Atlanta. It continues to be a great experience.

The conference, hosted by the Institute for Health Technology Transformation (iHT2), was held at Georgia Tech’s Academy of Medicine. It was an intimate gathering of providers, government healthcare reps, and vendors, with a few lab and pharma folks thrown in for good measure.

The topics of discussion both on stage and during networking breaks have moved over the last two years from Meaningful Use and EMRs to accountable care and patient engagement. Providers are concerned with:

• Finding the right leadership (including physicians) to implement and champion IT projects.
• Establishing trust between hospital executives and departments, including trust in the data they review.
• Analytics.
• Business process reengineering and Lean Six Sigma.

Mary Jane Neff, senior director of regional IS; Katheryn Markham, VP of IS planning; Lynda Anderson, senior director of regional IS, all of Kindred Healthcare.

Thea-Marie Pascal, certified Epic clinical documentation application coordinator; Susan Still, RN, Epic ASAP lead application coordinator; Makeba Lippitt, certified Epic clinical documentation application coordinator, all of Piedmont Healthcare.

The panel on "Transforming Health Care Through HIE: Driving Interoperability" featured (from left to right) moderator Kimberly Bell, executive director, Georgia Health Information Technology Extension Center at Morehouse School of Medicine; panelists Eddy Brown, VP of business development, TeraMedica; Steve Sarros, VP/CIO, Baptist Health Care; and Sonya Christian, CIO, West Georgia Health.

The keynote presentations were solid, though a high bar was set a few years ago by Naomi Fried, chief innovation Officer at Boston Children’s Hospital (MA). My favorite session was the last, with West Georgia Health’s CIO, CFO and director of nursing all participating on the same panel, answering questions about workplace culture, Lean Six Sigma, and patient safety.

Ten companies exhibited, among them Merge Healthcare, TeraMedica, VMware, Information Management Consultants, and Jvion. Nicole Cirillo from LabCorp explained how patients can review their own lab results through its portal (Georgia is not a right-to-know state.) LabCorp now offers its own portal through which patients can, with guidance from their physicians, access results.

EPtalk by Dr. Jayne

I had a run-in with one of our employed physicians yesterday. Some of these folks are really starting to wear me down. He’s been with us for a while, and unfortunately the EHR we purchased for our large multispecialty group many years ago does not have specific content for his specialty.

We knew this when we implemented him. We gave him the ability to use speech recognition to essentially dictate all of his office visit documentation except for orders, physical exam, and review of systems, which must be entered discretely. His staff enters other discrete data for patient history, allergies, etc.

Most of our other physicians (even those who do have content for their specialties) would kill for this arrangement. Still, it’s not enough for this guy, who demanded that I come to his office and personally shadow him to see how deficient the system is. I’m trying to win hearts and minds, so I agreed to go out. Rather than take the opportunity to show me how he sees patients and let me assess what his needs truly are, he preferred to spend the time we had standing in the hallway complaining about templates.

It turns out he has been using internal medicine templates to try to document his visits because he doesn’t like the dictation arrangements. He has the option to either dictate in the exam room with the patient present (many of our surgical consultants like this because it gives another opportunity for the patient and family to hear the diagnosis and plan of care one more time and ask questions), to release the patient to checkout and dictate in the exam room after the patient leaves, or to go to his administrative office to dictate. He has his own reasons why each of these is inadequate, but doesn’t have any suggestions for what he wants.

Of course, the internal medicine templates are completely overkill for what he’s trying to do. He has to weed through primary care clinical protocols and other information that’s not relevant to his specialty and feels frustrated. I reminded him that we didn’t train him to do this, that we recommended he use a specialty set that’s closer to his own instead, but he doesn’t like those either.

Most of our other specialists who don’t have content for their specialties are perfectly happy to dictate because it changed their workflow minimally from the paper world. Our primary care docs would love to be allowed to dictate as much as these guys can, but unfortunately for them, we need discrete data from more parts of the chart to meet payer incentive programs and other quality initiatives that we’re working on.

I’m not sure what he really wanted to get out of the visit other than to vent, which is fine, but it doesn’t change anything as far as documenting in the EHR. He wasn’t interested in any of the options I had to present and isn’t going to change his opinion. He doesn’t want a scribe. He doesn’t want to point and click. He doesn’t want to dictate. He doesn’t want a pen solution like Shareable Ink. His continued push-back (going on two years now) is an exercise in futility.

As I was driving back to my office, I got to thinking about that. This is a physician who deals regularly with patients who have life-altering injuries and conditions that cannot be fixed. His specialty is centered on helping people maximize the functionality they currently have and to compensate for what they have lost. He’s very good at what he does, yet he can’t see his EHR issues with the same perspective he uses when treating patients – helping them use what they have to the best of their abilities and not dwelling on what they don’t have or have never had.

We learn in medical school and residency to identify when interventions are futile. We call the code when there’s no hope of getting the patient back. We don’t perform surgeries when they’re not going to improve the patient’s condition. We understand that there are limits to technology and our ability to treat and cure. We’re pretty good at helping patients understand the options when they’re faced with a lack of good choices.

When it comes to limitations in information technology, however, we’re struggling mightily with the thought of applying those same concepts. The EHR of the future is going to look a lot different than what we have today – just like the laparascopic surgeries we do now are completely different from the open surgeries we did in the past. Maybe in the future we’ll beam your gallbladder out of your abdomen instead of having to cut you at all. But for the time being, we have to work with what we have as best as we can. We have to realize there are limits to everything. There’s no psychic module for EHR that’s going to document directly from your thoughts, at least not for now.

Fighting is good when it’s appropriate, but at some point, we have to realize when it’s futile and either accept our current situation or move on. I’m not sure what else to do with or for this physician since we’ve not been able to make him happy as long as we’ve been trying. I suspect there are other factors at play that have nothing to do with EHR, but they’re not within my realm to tackle. We’ll keep reinforcing his options, pair him up with peers that are successful, and encourage him. Until he’s ready to leave the group or retire, I’m not sure what else we can do.

Well, I guess there’s one more thing we could do – pastry therapy. I just dropped a little surprise at his office to thank him for his time yesterday. A girl can hope.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

News 4/16/14

Top News

FDA left unanswered questions about its FDASIA report, such as how to submit the comments the report solicits. The agency announces a free, three-day public workshop May 13-15 at NIST in Gaithersburg, MD that will also be presented via webcast. Comments on the FDASIA report can be left here.

Reader Comments

From Lois Lane: “Re: short label names for ICD-9, CPT, and MS-DRGs. Any source for these other than an EMR vendor?” If anyone knows, please leave a comment.

From Guillermo del Grande: “Re: signs that whoever is talking about Epic doesn’t know what they’re talking about.” GDG’s list:

1. “Model the Model”
2. “EPIC”
3. They think NVTs are actually meaningful.
4. They ask where they can buy Epic stock.
5. They wonder why Epic doesn’t hire doctors and nurses to help improve their product.
6. They don’t know that the god-awful screen they are looking at is customizable.
7. They think Epic was born as a billing product.
8. They don’t know real people work there, just implementers.
9. They actually think there’s no internal politics at Epic.
10. They think Epic’s the only software running a MUMPS descendant.

From Bill Kilgore: “Re: VerbalCare. I think you might like these guys. Very cool product.” Inpatients get an VerbalCare icon-driven tablet instead of the 1950s-era call button, allowing them to choose the icon describing their need instead of just pushing a call button or trying to communicate through a drive-through quality speaker-microphone. Employees can receive and acknowledge requests on their smartphones or from a central console. The interactions are also tracked for later analysis. VerbalCare offers a commitment-free pilot. Everything looks good except they spelled HIPAA as “HIPPA” on their site, which is almost unforgivable. You should at least correctly spell the name of the requirement with which you are claiming compliance.

HIStalk Announcements and Requests

Ms. Dayton, a Teach for America teacher in Arizona, sent pictures and her thanks to HIStalk readers for supporting her magnet school sixth graders by providing them with math stations. She explains, “You have truly transformed my classroom. My students now look forward to math and enjoy the time spent playing the wonderful games that you donated. On a daily basis I hear from my students, ‘Ms. Dayton, can we play the games today?’ or ‘Ms. Dayton, can we skip writing and do math all day?’ I hear these things because of you!”

Upcoming Webinars

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

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

Acquisitions, Funding, Business, and Stock

Truven Health Analytics acquires Simpler Consulting, a provider of Lean enterprise transformation services to healthcare, government, and other commercial organizations.

Struggling BlackBerry invests in Patrick Soon-Shiong’s NantHealth. The companies are jointly developing a smartphone optimized for viewing diagnostic images, scheduled for a late 2014 release.

Vocera opens an innovation center in Bangalore, India.

Sales

Lahey Health (MA) selects Phytel’s population health and engagement platform in support of its ACO.

Dialysis Clinic, Inc. will implement Sandlot Connect and Sandlot Dimensions from Sandlot Solutions for care coordination and analytics.

Shenandoah Medical Center (IA) will deploy Allscripts Sunrise solutions for its 78 beds.

The 260-provider Phoebe Physician Group (GA) selects athenahealth for EHR/PM and care coordination.

Citizens Medical Center (TX) will implement T-System’s EV emergency department information system and Care Continuity patient transition management solution.

People

Explorys appoints Tom Chickerella (Vanguard Health) COO.

Precyse promotes Christopher A. Powell from president to CEO, replacing company founder Jeffrey S. Levitt, who will assume the role of executive chairman of the board.

ESD promotes John Alexander to testing practice director and hires Mia Erickson (Epic) as Epic practice director.

CHIME names George McCulloch (Vanderbilt University Medical Center) as EVP of membership and professional development.

Edifecs names Dave Arkley (Parallels, Inc.) CFO and Michiel Walsteijn (Oracle) EVP of international business.

Health Data Specialists promotes Angie Kaiser, RN to clinical informatics officer.

Donna Scott (McKesson Health Solutions) joins USA Mobility as SVP of marketing.

MHealth Games names investor Keith Collins, MD as its board chair. He was at one time CIO of the University of Massachusetts Medical School.

Medicomp appoints Michael Cantwell, MD (National Library of Medicine) to its MEDCIN terminology team.

Healthcare technology services provider CitiusTech names Gary Reiner and Cory Eaves (both of its recent investor General Atlantic) to its board.

Announcements and Implementations

Kids First Pediatrics Group (GA) integrates PatientPay’s electronic billing and payment solution with its Greenway PrimeSUITE practice management system.

Memorial Community Hospital & Health System clinics (NE) will transition to Epic starting June 25.

The HEALTHeLINK clinical information exchange launches an automated syndromic surveillance state reporting service.

North-Shore-LIJ (NY) rolls out the Allscripts FollowMyHealth patient portal for its Plainview and Forest Hills hospital patients.

Geisinger Health Plan (PA) implements Caradigm Care Management for population health.

Government and Politics

CMS introduces a Code-a-Palooza Challenge to encourage developers to create apps that use the new Medicare payment data to help consumers improve their healthcare decision-making.

CMS, which has been strangely quiet about the implementation delay for ICD-10, finally acknowledges the legislation but notes only that it “is examining the implications of the ICD-10 provision and will provide guidance to providers and stakeholders soon.” Meanwhile, CMS still lists October 1, 2014 as the date ICD-9 will be replaced by ICD-10.

ONC invites voting for ideas submitted in its Digital Privacy Notice Challenge, which include games, responsive templates, a Web widget, and an NPP generator.

Innovation and Research

Meaningful Use of EHRs was not found to be correlated with performance on clinical quality measures in a study published in JAMA Internal Medicine. The  research compared quality scores of 540 physicians affiliated with Brigham and Women’s Hospital who achieved MU with those of 318 physicians who did not. Critics note several factors making the validity and applicability of the study difficult to evaluate, including the fact that MU quality metrics are so specific that they exclude many patients with particular conditions.

Technology

Google files a patent for a contact lens system that would include a built-in camera and could potentially be used as an alterative to Google Glass. That’s technology I could embrace since I don’t see myself as one of those nerdy hipster-types that Dr. Jayne and I continually made fun of as we walked the HIMSS exhibit floor.

Awarepoint introduces an RFID tag that monitors room humidity.

Other

The Coalition for ICD-10, an industry advocacy group whose members include CHIME, AHA, and AHIMA, calls on HHS to establish October 1, 2015 as the new ICD-10 implementation date.

The Oklahoman looks at the soon-to-be-launched Oklahoma City-based Coordinated Care Oklahoma HIE and the more established Tulsa-based MyHealth Access Network and considers the impact of having two competing networks in the state. It’s a scenario that will undoubtedly be repeated numerous times in coming months as funding disappears for older HIEs and newer organizations emerge.

An InstaMed report on trends in healthcare payments finds that patient payments to providers jumped 72 percent from 2011 to 2013, with the average amount increasing from $110.86 to $133.15.

Attorneys specializing in representing whistleblowers in healthcare pounce on the newly published Medicare data to search for evidence of fraud.

Travelers who pass through Madison, WI’s Dane Country Regional Airport (MSN) can now enjoy free Wi-Fi courtesy of Nordic.

The SMART project at Boston Children’s Hospital, which has been pretty quiet since its big “EMRs should work like smartphone apps” announcement four or so years ago, names a 14-member advisory board to promote its mission.

I paid a visit to my neighborhood ER over the weekend. Despite being the patient, I couldn’t help but check out their use of IT systems. It’s a boutique ER attached to a surgery center about two miles from my house. I was the only patient at the time (good to know that all my neighbors had better things to do on a Saturday night.) In terms of IT, what surprised me the most was the lack of it, at least at the point of care. They must have some sort of EMR because they printed out all my information from a visit last year, but everyone who treated me used pen and paper to note my vitals and whatnot. At discharge they handed me a generic patient education sheet with aftercare instructions, but no details on what meds they gave me (I recall one was a narcotic) and no medication information sheet warning me about possible side effects. They advised me to follow up with my regular doctor, but I’m now realizing that in my narcotic-induced haze I didn’t ask anything about the results of the tests from my blood draw. I’m sure if I had gone to the ER at the big chain hospital another 10 minutes away I would have left with more complete information, but I chose (and probably would again) the more convenient ER that otherwise provided good care. For all the great stories we constantly share about the amazing strides in automating healthcare, I’m sure there are just as many anecdotes that serve as a reminder that we are not “there” yet.

Sponsor Updates

• Talksoft Corporation makes its appointment reminder app Talksoft Connect available for Android devices.
• Columbus CEO magazine profiles CoverMyMeds in an article highlighting characteristics of top workplaces.
• The AHA exclusively endorses MEDHOST PatientFlow HD patient flow management solution.
• LifeIMAGE celebrates the growth of its network, which connects 533 hospitals and has exchanged 1.1 billion images over the last five years. 
• Health Catalyst releases a free eBook that explores common approaches to data warehousing in healthcare.
• AdvancedMD introduces the 1.5 version of its iPad app.
• A NueMD ICD-10 survey conducted prior to the official delay shows that the majority healthcare professionals participating wanted the ICD-10 transition to be pushed back or canceled.
• The Boston Business Journal ranks Nuance number two on its list of  top publicly traded Massachusetts software companies based on its $5.2 billion market capitalization.
• Kareo CMIO Tom Giannulli will discuss the role of technology in improving patient care at UBM Medica’s Practice Rx conference May 2-4 in Newport Beach, CA.
• Madhavi Kasinadhuni, consultant for The Advisory Board, explains the importance of measuring care episodes and not just individual encounters when identifying missed revenues.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 4/14/14

Top News

The New York Times says the White House decided that Kathleen Sebelius needed to go as HHS secretary after her “wooden” appearance on “The Daily Show with Jon Stewart” in October (during which Stewart speculated openly that Sebelius was lying to him about Healthcare.gov) and the pressure she was getting from Republican members of Congress. The President waited until last week until the Healthcare.gov crisis was over to give her the hook, with the Times calling it a “slow-motion resignation.” It may be a first that a Cabinet member was forced out because of a TV show appearance and for antagonizing the other party. Even her carefully orchestrated Rose Garden farewell speech was marred by technical difficulties – she stumbled because her notes were missing a page. I don’t expect much to change with her replacement – Congress and the White House can’t keep their hands out of what HHS is doing, so the Secretary’s job is to announce big changes rather than to propose them (and to be the President’s unusually obedient lap dog in Sebelius’s case.)

Reader Comments

From Anon: “Re: Wipro. Remember how they were going to save the day with low cost IT managed services? Won a $200m contract with Catholic Health Initiatives? Big problems. They can’t even keep Microsoft Exchange running, service applications, HR system, let alone CHI’s various EHRs. Unplanned downtime is becoming a daily occurrence.” Unverified. CHI signed the deal with the India-based Wipro in March 2013, saying it expected to save $42 million over five years.

From NoPicis: “Re: Picis. Just been in a meeting where complaints were ventilated on Picis not being MU2 certified. Nobody at Picis took the time to let their customers base know about their non-compliance.” Unverified. I contacted Picis/Optum but didn’t hear back. ONC shows Picic products as being certified under 2011 criteria.

From Pokey: “Re: Cerner-Intermountain partnership. The baby has a name!” The project will be called iCentra, which is how I would picture Brits pronouncing “eye centre” based on how they spell it.

From Biller: “Re: 1500 format. On April 1, 2014, CMS has required the use of new formats to submit bills, replacing the 1500 format. Our vendor was desperately unprepared and did not have the code to make the change.  And when they did, systems were crashing like cars in a sleet storm. Were the other vendors of billing systems so unprepared?” Readers: if you had this problem, leave a comment and name your vendor if you like.

From Mark: “Re: Oconee Medical Center (SC). A Paragon site, about to be absorbed by Greenville Health System, which is moving to Epic.”

HIStalk Announcements and Requests

It was political maneuvering that caused the ICD-10 delay, according to more than half of poll respondents. Anydoc had a good comment: “For sure, the lack of both provider and vendor readiness in an election year. One could easily imagine the backlash in November elections after a year of debating at nauseum the failures of Healthcare.gov compounded by providers frustrations with payment delays, lost productivity, etc. only one month before going to the polls.” New poll to your right: who is most responsible for the ACA failures like Healthcare.gov that led Kathleen Sebelius to step down?

Saturday is my grammar pet peeve day. Topping my list this week: people who write “it’s” as a possessive. Please, I know it isn’t logical, but the possessive form is “its” so just live with it, OK? Also driving me crazy: people who say “thanks but no thanks” thinking it’s cute, which requires double the number of syllables to say precisely the same thing as just “no, thanks.” OK, one more: using the word “very,” which when used often is either superfluous (“very interesting”) or incorrect (“very unique.”)

Listening: Superdrag, a decent, defunct alterna-pop band from Knoxville, TN. Not to be confused with my favorite Superchunk, which is better, non-defunct, and in fact celebrating their 25th anniversary.

I had HIStalk and the other sites migrated to a much larger server this weekend. It’s a dedicated one running a four-core Xeon processor, 16GB of DDR3 memory, a terabyte of 7,200 rpm disk, an identical second drive just for backups, MySQL databases running on a 120GB solid-state drive for extra speed, and 20TB of premium transfer. OS is CentOS Linux 64 bit and Litespeed. HIStalk keeps growing and response time was slowed at times when hundreds of readers were on at the same time, so the new server should be fast with plenty of capacity for continued growth.

Upcoming Webinars

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

A lifeIMAGE blog post says Nuance will enter the image sharing market in a Monday announcement that it will acquire “a small, Atlanta-based company.” I hear (unconfirmed) that company is Accelerad. KLAS ranked the company’s SeeMyRadiology.com #1 in image sharing in November 2013. It’s an odd business for Nuance to be entering, but shareholder pressure to deliver better results may have made diversification attractive for either strategic or accounting reasons even though it strays from the company’s traditional core mission of speech recognition and consumer apps (Dragon, Siri, and software for scanning and PDF editing.)

Medical cart maker Enovate Medical will expand its Murfreesboro, TN headquarters, with plans to create 410 jobs in the next five years.

People

Vermont Commerce Secretary Lawrence Miller, who was tapped to rescue the state’s Vermont Health Connect health insurance exchange after a rocky rollout, is named as the governor’s point person for healthcare reform. His previous background: he founded a brewing company and ran a business that sells pewter jewelry. Meanwhile, the state auditor will investigate Vermont Health Connect and its struggles with vendors Oracle and CGI after a consultant blamed the site’s problems on politics and inexperienced leadership. Vermont has up to $170 million in federal money to spend, gave CGI a contract worth $84 million, and has paid $54 million so far for a crippled site.

Announcements and Implementations

Penn Highlands Healthcare (PA) goes live on its patient portal, or actually “portals” in the plural since the some are Cerner, some are NextGen, and others don’t appear to be from either vendor.

Government and Politics

HIMSS loves Kathleen Sebelius and any other politician who helps divert taxpayer money into HIT vendor and provider pockets, so naturally they gave her a laudatory send-off, saying “the health IT community was blessed” to have her running the department overseeing HITECH payments (and plugging its own EMR Adoption Model in its praise.) I’m suspicious of anybody who refers to a “community” without defining it or explaining how they know what that “community” thinks, especially since most members of the health IT community are citizens paying the ever-rising taxes needed to fund HITECH, Healthcare.gov, and Medicare. Personally, I’m not feeling all that blessed.

The State of Maryland threatens to sue Noridian Health Care Solutions, the $85 million prime contractor of its health insurance exchange.

Technology

April 15 is more than just tax day for nerds jealous at their peers wandering around wearing Google Glass: anybody can buy a $1,500 Glass for that day only without being part of the Explorer program. The downside: it could go into commercial production soon at a lower price and possibly with better features.

The Heartbleed bug in OpenSSL that has exposed web server information (including passwords, credit card numbers, and potentially patient information) for years on two-thirds of the world’s websites was caused by programming error that wasn’t caught by the QA review of the small, open source project, according to the German developer who identified the exploit.

Other

The American Medical Association releases a laundry list of warnings about correlating Medicare payments information to physician incomes. A subset:

• The information could contain errors and CMS doesn’t allow doctors to report inaccuracies.
• Claims filed under a given National Provider Identifier can include services rendered by residents or other healthcare professionals.
• Payments include the cost of physician-administered drugs, which are low margin for doctors.
• Physician payments are actually practice payments that must also cover practice overhead – the physician doesn’t just pocket the Medicare check.
• Medicare’s coding and billing rules vary over time and even by location.
• Doctor’s don’t make all their income from Medicare.

A JAMA editorial by Farzad Mostashari, MD and colleagues from The Brookings Institution says that each primary care physician is in essence a CEO in charge of $10 million in annual revenue, that being the overall annual healthcare spending of the average practice’s 2,000 patients. It concludes that PCPs are underused and that physician-led ACOs will work better than those run by hospitals, but that success has been limited because practices haven’t spent enough on IT or on practice transformation services. It warns PCPs that they will lose control if they just continue with business as usual or sell out to hospitals. I’ll go with that: if you want to encourage efficiency, save money, and improve health and not just episodic healthcare services delivery, the last group you’d want to talk to would be hospitals.

Cleveland Clinic, which anyone who has walked its halls can tell has always treated a cash-paying Middle Easterners, will open a 364-bed hospital in Adu Dhabi, with CEO Toby Cosgrove, MD saying, “We look at it as our petrodollars coming home to Cleveland.”

I missed this announcement from earlier this month: ECRI Institute Patient Safety Organization launches a partnership to identify and learn from health IT safety issues. Among the collaborating organizations are HIMSS, AHIMA, AMIA, ISMP, and AMDIS. Several experts serve on its advisory panel, including David Bates, MD (Brigham and Women’s), Peter Pronovost, MD, PhD (Johns Hopkins), and Dean Sittig, PhD (UT Health Science Center at Houston.)

Contacts

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

More news, HIStalk Practice, HIStalk Connect.

HHS Secretary Sebelius Quits

President Obama has accepted the resignation of Health and Human Services Secretary Kathleen Sebelius, according to White House officials. Her five-year tenure was marred by political acrimony over the flawed rollout of the Affordable Care Act and Healthcare. gov, a source of embarrassment for the Obama administration. 

The President will on Friday nominate Sylvia Mathews Burwell, who has been director of the Office of Management and Budget for one year, to replace Sebelius. She was previously president of the Walmart Foundation, worked at the Bill & Melinda Gates Foundation,  and held several positions in the Clinton White House.

News 4/11/14

Top News

ONC head Karen DeSalvo proposes dissolving the agency’s workgroups and forming four new ones in order to reduce redundancy and create a “less siloed” approach. The proposed workgroups would focus on (a) health IT strategic planning; (b) advanced health models and Meaningful Use; (c) health IT implementation, usability, and safety; and (d) interoperability and health information exchange.

Reader Comments

From Jeff: “Re: Medicare reimbursement data. If you use the New York Times tool, it becomes very, very easy to look up your local docs and their payouts.” CMS released Medicare payment data on Wednesday on 880,000 providers who collectively received $77 billion in Medicare payments in 2012. I struggled to manipulate the data using Excel, but it took me just seconds to look up details on all my doctors (and a few doctor friends) using the Times tool. While I understand why doctors aren’t happy that the world can now see much of our tax dollars ended up in their individual bank accounts, the potential analytics value of the data is pretty exciting.

From Lincoln: “Re: Medicare reimbursement data. What’s your take, Mr. H?” The government didn’t release the data until forced, so chalk up one for the Freedom of Information Act and the responsible publications that pressed the issue. I agree with Inga that the information is interesting, but I think it will raise more questions than it answers. The public doesn’t realize how screwed up Medicare payments are, so the nuances of payments made to groups, doctors being paid directly for administering drugs, and other quirks are going to sail right over their heads. CMS isn’t known for outstanding customer service, so who’s going to answer that deluge of questions about specific examples that are so easy to find? Probably the high-earning providers themselves, who are getting calls from their local papers looking for a hot story. What will they say about Medicare rules allow a single specialist to crank out enough high-paying procedures to earn many millions vs. primary care guys barely making a living – it’s better than fraud, but brings up the whole value question that CMS encourages by paying heavily for procedure medicine. I’m also annoyed at the CMS insinuation that citizens should help them fight fraud –  why don’t some of their bureaucrats who understand the rules and are paid to enforce them look at the information themselves and realize that paying some doctor $20 million in a single year might be cause for concern instead of waiting for amateur SAS jockeys to point that out? Our “pay and chase” system is great for providers and great for hiding government inefficiency that would manifest itself as infinitely delayed payments, but it’s not so great for taxpayers. Patients don’t even know what is being billed and paid on their behalf and checks and balances are non-existent. The great thing about releasing this information is that everybody should be embarrassed at the sorry state and high cost of government-funded healthcare, especially the politicians who let it happen.

From CIO D: “Re: eating your own dog food. Here’s our policy on PC lockdowns. If the PC is used predominately by one person (i.e. that’s Joe’s Computer) it is NOT locked down. If the PC is used publicly by many people (i.e. at a nurse station or in a patient room) it is locked down. I think that’s a fair way to handle it.”

HIStalk Announcements and Requests

A few highlights from HIStalk Practice this week include: satisfaction is climbing among primary care EHR primary care users that implemented their system more than two years ago, according Black Book Rankings. Why I found  a Huffington Post article on patient etiquette offensive. CVS wants MinuteClinic to complement and support the broader healthcare landscape. The PQRS and e-Rx program saw sharp increases in physician participation in 2012. CMS offers a Stage 2 MU Attestation Calculator to assess readiness. Independence Blue Cross and DaVita launch a new healthcare business model aimed at reducing care costs. Securing a new-patient appointment is easier for individuals with private insurance. Culbert Healthcare Solutions’ Brad Boyd discusses three factors for success in using informatics. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses CRM for healthcare and the shift within emerging healthcare startups to focus on technology that enhances the doctor-patient relationship rather than building patient engagement apps. HIStalk Connect’s Q1 Digital Research Recap highlights some positive findings across telehealth, patient portals, and EHR-driven outcomes research. Scanadu halts shipments on its Indiegogo-backed, tricorder-like Scanadu Scout.

Upcoming Webinars

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

Minneapolis-based Healthcare Engagement Solutions, which offers physician collaboration tools, closes a $550,000 angel investment.

Drchrono secures $2.69 million in convertible debt funding, bringing the company’s total to $6.77 million.

Sales

Enclara Health will implement CoverMyMeds to automate prior authorizations in its hospice pharmacies.

Lakeland Regional Health Systems (FL) will expand its use of Allscripts ambulatory EHR and PM, use the company’s managed services, and implement its Payerpath financial management software.

Capital Regional Medical Center (MO) selects Patientco as its patient payment automation solution.

Health information organization SacValley MedShare (CA) selects ICA as its HIE vendor.

Deaconess Health System will integrate its network with Availity for clearinghouse and RCM services at five of its southern Indiana hospitals, 20 primary care clinics, and several specialty facilities.

The Greater Houston Healthconnect selects DICOM Grid to electronically deliver medical images to area hospitals and physicians at the point-of-care.

Bay Area Medical Center (WI) signs a  three-year agreement with Zix Corporation for email encryption.

People

Kareo names Tom Patterson (Teletrac) CFO.

Nextech hires Rhonda Russell (McKesson) as COO.

Carl Byers (Fidelity Biosciences) joins the board of Cureatr.

IMedicor promotes Srini Vasan from SVP of technology to CTO.

Announcements and Implementations

Dignity Health, Box, and The Social+Capital Partnership name WelVU the winner of their developer challenge for personalized patient engagement solutions. WelVU, which allows providers to create customized educational videos during appointments, received a $100,000 convertible note and one-month office space and mentoring.

New Jersey Health Commissioner Mary E. O’Dowd announces the launch of the New Jersey HIN, which connects six regional health information organizations and 9,000 providers.

Wesley Medical Center (KS) adds Lincor’s LINC Technology platform for patient engagement and entertainment to newly updated patient rooms.

Government and Politics

ONC renews its Cooperative Agreement with DirectTrust, a non-profit trade alliance that promotes secure HIE via Direct Protocol.

Technology

The folks at Vonlay remind Epic users that while the Heartbleed OpenSSL vulnerability doesn’t affect MyChart or EpicCare Link because Microsoft’s IIS isn’f affected, the non-Epic parts of the setup might be, such as the load balancer. Web servers can be checked here, assuming the guy who developed the page knows what he’s doing.

Other

An Institute of Medicine report recommends including information about patients’ social influences and behavioral habits in their EHRs to improve outcomes and advance public health research efforts.

HHS OIG reverses a 2011 advisory opinion that had allowed athenahealth to charge $1 to providers not on the athena network for processing their test orders, saying the arrangement could violate anti-kickback statutes. The termination means that athena can no longer discriminate between in-network and out-of-network providers and will therefore charge $1 for all orders. Athenahealth calls the reversal a “setback” for sustainable HIE.

Third-party ACO vendors outperform EMR vendors when it comes to meeting the needs of physician-led ACOs, according to KLAS. Epic and eClinicalWorks earned the top scores among EMR vendors in meeting physician needs.

Researchers at the UK’s Birmingham Women’s Hospital find that doctors save an hour per day using a tablet vs. paper.

I never cease to be amazed by physicians who totally ignore the business side of their practices. Case in point: a Pennsylvania woman, whose job duties included making bank deposits for her physician employers, is charged with stealing $106,000 over a six-year period, the time it took for anyone to notice that the deposits didn’t match collections.

Weird News Andy might have been predictable in titling this story “Nothing to sneeze at.” An MIT study finds that cough and sneeze droplets may travel up to 200 times further than previously thought, which should be comforting to think about when you hear that guy hacking up a lung 10 rows back on the plane.

Sponsor Updates

• Visage Imaging announces Version 7.1.5 of its Visage 7 Enterprise Imaging Platform.
• CCHIT certifies NextGen Emergency Department Solution version 6.0 as a ONC 2014 Edition criteria EHR module.
• HCI Group launches the HCIsustain service line to provide long-term EHR support.
• Greenway Health partners with TrustHCS to assist PrimeSUITE users with their ICD-10 preparation and transition.
• InterSystems will showcase its healthcare solutions and technology at the Ministry of Health and HIMSS Middle East Conference next week in Saudi Arabia.
• T-System CMIO Robert Hitchcock, MD is re-elected to the Emergency Department Practice Management Association board.
• Coastal Healthcare Consulting selects Divide to build its BYOD program.
• Holon is participating in this week’s Texas Organization of Rural and Community Hospitals Annual Conference & Trade Show in Dallas.
• Elsevier Clinical Decision Support posts two short, fun videos explaining how InOrder sets improve quality of care.
• MaineGeneral Health equips its newly-opened Alfond Center for Health with Versus RTLS and seven Versus applications.
• Coastal Healthcare Consulting offers a case study highlighting their data extraction project with Nebraska Medical Center.
• Marla Simmet, executive consultant for Beacon Partners, shares tips for surviving a MU audit on the company’s blog.
• Perceptive Software introduces Content 7, the latest version of Perceptive’s enterprise content management technology.
• UNC Charlotte and Premier partner to develop tools aimed at helping providers improve population health.

EPtalk by Dr. Jayne

The hot news in the physician lounge (and in the elevator, the parking garage, and the locker room) this week was the publication of the Medicare physician payment data. Most of the websites I looked at played up the sensational aspect – the 344 physicians who received more than $3 million in payments in 2012. The AMA and other organizations have tried to block access to the data, citing physician privacy concerns and the potential for inaccurate information. Patient advocacy and consumer groups argue that the data will help the public identify providers who provide quality, cost-effective care.

I looked at the data in a couple of different formats:

• The data files directly available from CMS
• The New York Times site
• The Wall Street Journal site

I searched not only for myself in the database, but several of my friends and quite a few physicians who make me crazy at work. Just from eyeballing, I can see that there may be issues with the data. My OB/GYN BFF was cited as receiving barely more than $1,000 from Medicare – 18 breast exams and 15 pap smears. I’ve seen her data in our billing system and she saw (and was paid for) many more Medicare procedures in 2012 including hysterectomies, endometrial biopsies, and more. She doesn’t participate in Medicare Advantage plans, so I’m not sure why there are amounts missing.

In my opinion, the Wall Street Journal site had the best explanation about the data and what it does or does not represent. In short:

• It may not present the full picture about a physician’s practice and its revenue
• The complexity and similarity of CPT codes make it hard to compare physicians
• Physicians may have been paid for others working under their supervision
• Physicians caring for complex patients may be paid more
• It doesn’t include Medicare Advantage payments or procedures that a physician performed on 10 or fewer patients, nor does it include payments for services billed under an employer’s provider number
• Physicians who bill for imaging or other high-overhead services may receive higher payments
• Medicare payments are different across the country

The New York Times site had an explanation about the source data, but it wasn’t nearly that comprehensive. One CMS administrator was quoted as saying, “We want the public to help identify spending that doesn’t make sense.” I’m not sure how providing the data as it currently exists would help the general public decide whether it makes sense or not.

The payments also include reimbursements for drugs – from flu shots to high-dollar chemotherapy agents. Depending on the specialty and type of drug, the physician may be receiving anywhere from less than the cost of the drug to a significant markup or even rebates.

Major institutions including the Cleveland Clinic, the Mayo Clinic, and the University of Michigan Health Systems issued statements explaining how some of their physicians are compensated. Many are employed physicians. Others may be part of project such as the Michigan Primary Care Transformation demonstration project, where the director was tagged for more than $7.5 million in payments for 207,000 patients cared for by 1,600 physicians.

Given the nature of the data released, I don’t see how anyone could extrapolate quality of care or cost effectiveness. I would be concerned, though, if my physician was an outlier among those in the same area or specialty. Looking at one of the physicians who makes me crazy at work, he received more than four times the amount of payments of some of his colleagues. I know that he sees an insane amount of patients, works 12-14 hours a day six days a week, and is essentially a robot. His patients know he’s a robot because he refuses to address more than one patient concern in a single visit. Knowing those facts, maybe his numbers make sense.

If you’re a physician, did you look at your own data? Did you look at that of your peers? If you’re in IT like me, did you check out the physicians based on whether they are naughty or nice? What’s your take on the data? Email me.

Contacts

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

More news, HIStalk Practice, HIStalk Connect.

News 4/9/14

Top News

Minneapolis-based Medicare billing technology vendor Ability Network (formerly VIsionShare) will receive a $550 million strategic investment from Summit Partners. The company characterizes the investment as a recapitalization rather than an outright sale. CEO Mark Briggs has spent time with Carefx, NaviNet, and QuadraMed.

Reader Comments

From Smartfood99: “Re: Meditech. First it was a 400+ hospital in NJ, now an even larger academic hospital in GA. Does Epic not control this space any more?” Phoebe Putney Hospital (GA) will upgrade from Meditech Client/Server to Meditech 6.1, with the 691-bed hospital choosing that system because of its integration and lower cost of ownership. It would be fun to talk to someone there to find out what Epic and Cerner put on the table.

From Chris: “Re: OneReach Health. What do you hear about them?” Chris is a hospital guy and not a company shill, so I took a look. The Denver-based company offers Web-based VoIP phone solutions: inbound IVR-powered call management, text messaging, appointment confirmation, reminders, smart inbound call routing based on previous calls, and integration with EHRs. They were in the Startup Showcase at the HIMSS conference. That’s all I know.  

From Reluctant Epic User: “Re: eating your own dog food. I don’t see us doing that in my own IT shop. On the desktop side, we give our users a poorly configured, un-optimized desktop image and strip them of administrative rights so the machine that they have to use each day is so locked down it becomes unusable. Outside of the IT shop, the majority of us get our healthcare elsewhere, too.  IT users should be forced to use the same desktop image as everyone else. I would be curious to hear if others are attempting any sort of dogfooding.” I’ve often railed against IT shops that lock down PCs without regard to individual user expertise, solely to reduce  support desk calls, with IT and usually the finance departments being exempt. Readers are welcome to chime in – do IT department users get treated the same as the rank and file whose technology they oversee? 

From For Real: “Re: [PM / EHR /secure email vendor name omitted]. Word is they are finished. Layoffs and not paying vendors. No loss to the industry.” Shares dropped 23 percent Tuesday to $0.01, valuing the company at $6.5 million. For the last fiscal year, it reported revenue of $106,000 and a net loss of $7.2 million. As a comment on a stock message board questions, “Why does this thing even trade?” I omitted its name because it’s publicly traded, although at a penny a share nobody probably cares much.

From Dim-Sum: “Re: Defense Department EHR. DHMSM is rounding out their final RFI, but the DoD is wondering, ‘Did we ask the right questions?’ Vendors are scratching their heads wondering what am they are signing up for, and where is the ‘assumptions’ section? Do COTS vendors really want to sift through almost synchronized-archaic pre-Aramaic scribe data from CHCS – CHCS II, and AHLTA? Do they know the agony of making AHLTA data useful? Could the incumbent purveyor of AHLTA actually spell ONTOLOGY?  You are going to have to embrace the pain of migration and conversion. If you think that is bad, wait until you meet ‘Mr. MODS’ (Military Operational Deployment System) designed by a firm that cannot spell HealthKare. Rumor has it that the DoD wants to consolidate the solutions from Air Force, Army and Navy. As the SIs finalize their wooing of COTS vendors, we wonder will CSC announce that they are partnering with an outfit from Overland Park, KS? Will Leidos keep searching for a tenable partner or are they running on the fear that they may lose the re-compete? I guess Accenture and Leidos are not sure if they want to go to the prom together? Will IBM convince the DoD that once in for all a hardware company can install ‘Badger State’ software? Could anyone have predicted that the incumbent would have bowed out after a few phone calls to HCA Healthcare references? Where did McKesson go? Did the Allscripts Eclipsys ever come to fruition? Is it true that the Greek Goddess of Wisdom, Warfare, Divine Intelligence, and Service Oriented Architecture actually find their acute companion in Malvern, PA? And what about the VistA cult? Expect the RFP to drop Q4 2014 and your dreams should resonate on Q3/Q4 2015 when the prize will be rewarded to the team that approaches DHMSM from a practical, methodical, and sound technological foundation (as well as a sense of humor.)”

From FDASIA Work Group Member: “Re: FDASIA report. I’m not sure it’s fair to describe the work group members as pro-vendor. Much of the discussion was about increased regulation in certain domains, but unfortunately due to time limits, that didn’t make it into the report because we couldn’t come to agreement on what that would look like. I would have guessed the FDA would have regulated more given our discussion, but they also have to consider how practical enforcement would be as well as politics.”

From Epic Consultant: “Re: Epic post-live problems. I have worked with four relatively large places with consistent themes of failures in physician productivity, poor revenue cycle performance, and inability to manage patient navigation. It’s not news that later adopters are having issues given the sheer number of installed clients, but for every vendor that got to be Epic’s size, there was a rise in post-live problems where productivity never made it back to the baseline. I’m not sure if this is a general trend.” Readers are welcome to describe their experience.

From Graham Grieve: “Re: CDA security issues. Readers might be interested.” HL7-provided style sheets that display C-CDA documents have made 2014 Certified EHRs vulnerable to attacks from maliciously composed documents, according to ONC’s SMART project. If you are a vendor of a Web-based EHR, you should pay attention.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Validic. The Durham, NC-based company offers the healthcare industry’s premier technology platform for connecting health systems, providers, drug companies, payers, and health systems to 80 mHealth apps and devices (in-home monitoring, wearables, and apps) all with one easy connection. Its mobile ecosystem delivers standardized, FDA Class I MDDS, HIPAA-compliant consumer health data covering 30 million lives. Customers use it for monitoring patient engagement, monitoring patients remotely, collecting clinical trials data, and monitoring medication and preventive wellness adherence. Thanks to Validic for supporting HIStalk.

I learned something from this recent YouTube video about Validic that I found: Mark Cuban is an investor and talked up the company at SXSW a few weeks ago.

A tweet from an attendee of a healthcare marketing conference says that a survey by Agency Ten22 found that HIStalk is the most-read blog of hospital C-suite readers. Thanks if you are one of them.

Listening: new from Austin, TX-based Ume, a female-led melodic, guitar-heavy rock band (they sound a bit like Metric) that should be wildly popular but isn’t.

Upcoming Webinars

April 9 (Wednesday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 1 – Avoiding Analysis Paralysis. Sponsored by Premier. Presenters: Kristy Drollinger, senior director of population health analytics, Fairview Health Services; J.D. Whitlock, corporate director of clinical and business intelligence, Catholic Health Partners; Sean Cassidy, general manager of information technology services emerging business unit, Premier, Inc. Are you ready to invest in an integrated data platform? Do you have a strategy to make the information accessible and actionable? How will enterprise data warehousing transform care delivery? There’s more to data analytics than simply deploying an EDW. Learn what goes into becoming an information-driven enterprise in the first webinar in this series.

April 9 (Wednesday) 1:00 p.m. ET. The Path to Shared Savings With Population Health Management Applications. Sponsored by Health Catalyst. Presenters: Eric Just, vice president of technology, Health Catalyst; and Kathleen Merkley, clinical engagement executive, Health Catalyst. The presenters will look under the hood at several advanced applications built on a Late-Binding Catalyst data warehouse, showing how to identify care variability, define populations, report key indicators, apply flexible risk stratification models, and measure process metrics.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

Wellframe, developer of a mobile care delivery and management platform, secures $1.5 million in seed funding from multiple investors, including Jonathan Bush (athenahealth), Russ Nash (Accenture), and Carl Byers (Fidelity Biosciences).

Care management software developer Bjond raises $3.25 million in Series A funding.

Allscripts CEO Paul Black made 22 percent less income in 2013 than in 2012 because he didn’t earn a bonus, giving him $7.1 million in compensation for the year. CFO Richard Poulton’s total compensation was $3.9 million.

Sales

Antelope Valley ACO (CA) selects eClinicalWorks Care Coordination Medical Record for population health management.

The Defense Logistics Agency awards GE Healthcare’s Datex Ohmeda division a $19.8 million contract for patient monitoring systems and services.

People

Trace Devanny joins Nuance Communications as president of the company’s healthcare division after spending 30 months as chairman and CEO of TriZetto, leaving that company a month after it relocated its headquarters to Colorado.

EDCO Health Information Solutions promotes Andy Williams from director of field operations to VP of business quality and process improvement.

Huron Consulting Group hires Rob Schreiner, MD (Kaiser Permanente Georgia) as managing director of its healthcare practice.

Cumberland Consulting Group names Amy VanDeCar (Compliance Implementation Services) senior principal of its life sciences practice.

Freeman Health System (MO) names Thomas Glodek, MD (The Physician Advisory Services Group LLC) as CMIO.

Announcements and Implementations

Quest Diagnostics launches the MyQuest by Care 360 portal to provide patients direct access to their lab test reports. The release coincides with a federal rule going into effect this week that allows patients to view test results without physician approval.

Nine health systems and medical groups will adopt the OpenNotes movement in making clinician notes available to their patients Washington and Oregon, including Kaiser Permanente Northwest, which starting providing its information to members on Tuesday.

The Canadian Intellectual Property Office awards EDCO Health Information Systems a patent for its Solarity medical record scanning and indexing technology.

Government and Politics

CMS paid 367,228 eligible professionals $168 million under the PQRS program in 2012 and $335 million to 227,447 EPs under the e-Rx incentive program. Payments under the PQRS program decreased 35 percent from the previous year with EPs earning an average of $457. Under the eRx program, incentive payments jumped 18 percent and the average incentive payment was $1,474 per provider.

CMS releases Bonnie, a tool for testing implementation of electronic clinical quality measures (eCQMs) in EHRs. CMS also posts updated specifications for the Eligible Hospital eCQMs under Stage 2 MU.

Other

Lexicode, Anthelio, and KForce earn the top overall performance scores in a KLAS report on outsourced coding. Two-thirds of providers say they plan to keep or expand their current service.

A Computerworld IT salary survey finds that application development is the most sought-after skill in the IT world, followed by help desk and IT support. In 2013, IT salaries grew 2.1 percent and bonuses increased less than one percent. 

I love this list of things to look for before trusting the conclusions of an article or survey. Pay attention to these and you’ll ignore nearly every loudly trumpeted study or survey that earn simplistic headlines from sites too lazy to read beyond the executive summary:

• The headline may hype a conclusion that the research doesn’t deliver.
• The authors work for vendors or otherwise stand to benefit.
• It may conclude that A caused B rather than the actual fact that A was correlated to B without necessarily causing it.
• The sample size may have been too small, or even more importantly, may not have been carefully chosen as a proxy for the group it claims to represent.
• The authors focus on one aspect of a study and ignore the less-favorable findings.
• The publisher doesn’t have high review standards.

A low-income clinic requests that commissioners of  Durham County, NC give it $1 million to pay for an Epic implementation, with Duke University Health System offering to pick up the remaining tab of the $2 million project. Commissioners were surprised that the money was requested immediately in preparation for an implementation and go-live in three months.

Voters soundly defeat a $9 million property tax levy that would have allowed 40-bed St. Bernard Parish Hospital (LA) to replace its dysfunctional billing system and to implement electronic medical records. 

Crain’s New York Business reports that for former CEO of Barnabas Health (NJ) was paid $22 million when he retired in 2012, while the CEO of Atlantic Health made $10 million in the same year.

Beth Israel Deaconess Medical Center (MA) launches a pilot project in which it will share clinician notes with psychiatric patients,

Weird News Andy calls this article “New Organs from Old,” suggesting its use for giving a diabetic patient a new pancreas or a CIO a new liver. Stem cell scientists rebuild a functional mouse thymus by reversing age-relating shrinking.

Sponsor Updates

• Summit Healthcare and S&P Consultants partner to provide an enterprise-wide Cerner downtime solution.
• e-MDs adds PDR Brief to its EHR, giving users enhanced drug information and alerts from PDR Network.
• Borgess Health (MI) reports a $9 million increase in appropriate revenue within a year of implementing the Nuance Compliant Documentation Management Program.
• Health Data Specialists will attend the Cerner Pacific West Regional Users Group meeting in San Diego, CA on April 22-24 and will also attend the 2014 Texas Regional HIMSS Conference on April 22-23 in Dallas, TX.
• Cornerstone Advisors will offer two presentations at the 2014 Texas Regional HIMSS Conference on April 22-23 in Dallas, TX.
• The American Board of Internal Medicine uses Truven Health Treatment Pathways 3.0 to help identify wasteful healthcare as part of its Choosing Wisely initiative.
• Levi, Ray & Shoup introduces Independent Document Bundling, a document automation solution to automate the retrieval and merging of documents in different formats from various sources.
• Navicure posts its April and May events calendar.
• BlueTree Network co-founder Ted Gurman offers tips for making the most of the ICD-10 delay in a company blog post.
• Acadiana Center for Orthopedic and Occupational Medicine (LA) shares details of the benefits it has realized since implementing Greenway’s Intergy EHR and Practice Analytics.
• RazorInsights releases its April conference schedule.
• Deloitte seeks applications for its 20th annual ranking of the Technology Fast 500.
• Wolters Kluwer Health releases Lippincott Advisor App for Android and Apple smartphone and tablets.
• Perceptive Software launches its hybrid cloud foundation Perceptive Evolution at this week’s Inspire 2014 in Las Vegas.
• Bottomline Technologies announces the general availability of its Healthcare 5.1 platform, which includes enhanced functionality for eCapture, eSignature, and On-Demand forms.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 4/7/14

Top News

Thoughts on the months-late FDASIA report (based on an earlier work group report) that proposes minimal FDA oversight of healthcare information technology:

• Vendors should be breathing a sigh of relief. The report contains nothing new and in fact takes FDA further away from having health IT responsibilities.
• The report proposes that IT vendors continue to be self-regulated without FDA’s involvement, turfing any new responsibilities to ONC rather than FDA.
• The report is intended to stimulate discussion about what other parties might do. FDA’s only to-do is to “actively engage stakeholders” to implement the framework the report proposes. In other words, the report doesn’t impose responsibilities on anyone.
• The report seems uncomfortable addressing the issue that an IT system may or may not be safe depending on how its users implement and maintain it, which is a clear distinction compared to single-purpose medical devices approved for use in specific ways. That may have been the overriding factor – vendors could product a perfectly safe IT system that is rendered unsafe by how a customer does with it.
• Products will be regulated only if they post significant risk to patient safety. FDA does not propose regulating anything it isn’t already regulating. If it’s not a medical device, FDA won’t regulate it. The FDA’s definition is above, although it is more appropriate for distinguishing a medical device from a drug than for determining whether a given information technology is a medical device.
• The report proposes grouping products into three categories, but that’s irrelevant from a regulatory standpoint since the medical device category would continue to be the only one regulated.
• FDA’s recent Class 1 recall of an anesthesia information system that displayed the wrong patient information seems at odds with the draft, which says that FDA will focus only on the medical device portion of such a system.
• It’s still user beware when it comes to clinical decision support systems, order entry, and results reporting since FDA proposes no change in their current unregulated state.
• The report suggests that ONC create a Health IT Safety Center in collaboration with FDA, FCC, and AHRQ, which in effect puts IT patient safety under ONC’s purview rather than FDA’s.
• The report says that while ONC’s certification program addresses only EHRs, it has the authority to certify other health IT systems. That’s an interesting observation given that “certification” as it exists today only affects providers interested in collecting government handouts, but the implication seems to be that such certification should address all vendors and users. 
• Better interoperability standards and testing criteria are needed, the report says.
• The report urges adoption of practices for healthcare IT implementation that address installation, customization, training, contracting, and downtime, suggesting the use of ONC’s SAFER Guides as a starting point.
• The report proposes that vendors and products undergo “conformity assessment” that could include product certification, testing, inspection, or vendor attestations. It suggests private industry conformity assessments except in situations where patient safety is critical, in which case government assessments would be appropriate. It mentions NIST’s usability standards.
• The report notes that vendor contract terms and customer fear of liability impede the free flow of information.
• The report agrees with IOM in suggesting that vendors be required to list products that include any degree of patient risk with ONC. That’s a new suggestion, that ONC require software vendors to register products that meet specific criteria.
• The report has a 90-day comment period, although I could find no stated process for submitting comments.

The FDASIA’s original work group whose recommendations from last summer were incorporated into this report contained an industry-friendly mix of members. By my count, 15 of the 30 members represent vendors or investors, six come from government or associations, four are academics, three are providers, one is from a testing organization, and one is a consumer.

Reader Comments

From Jack: “Re: John Muir Health. It has been a long time coming, but we’ve arrived: our state-of-the-art electronic health record (EHR) and revenue cycle system are now live within John Muir Health! With today’s go-live, all of our hospitals, outpatient clinics, Home Health, John Muir Medical Group practices and several IPA practices are on our single, integrated EHR, as are our patients’ health records. This is great news for John Muir Health, and even better news for the patients and communities we serve. With the entire health system up and running on Epic, all patients will benefit from improved service and care coordination.”

HIStalk Announcements and Requests

Only 12 percent of respondents say they’ve benefitted as a patient from an HIE. New poll to your right: what force is to blame for the delay in ICD-10 enforcement? Clicking a radio button alone doesn’t provide much insight, which is why it would be swell if you’d click the “Comments” link at the bottom of the poll after voting to explain your position.

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

Listening: San Diego-based No Knife, apparently defunct since 2003 other than a few reunion shows. The were kind of emo-indie with quite a bit of complexity. Also: the re-formed and touring Zombies, with Rod Argent and Colin Blunstone (both 68 years old) sounding amazing on new stuff as well as “Time of the Season,” “She’s Not There” and Argent’s “Hold Your Head Up.”

I added my Twitter support to the Thunderclap project of OpenNotes. As a patient, I should able to see the notes providers have made about me. The fact that this is a controversial issue tells you how paternalistic and patient-unfriendly healthcare is.

The Twitter word that signals someone is about to do some stealth bragging: “honored” (us when humbly but firmly announcing their recent success in being published, featured as a speaker, or given a high-visibility role.)

Upcoming Webinars

April 9 (Wednesday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 1 – Avoiding Analysis Paralysis. Sponsored by Premier. Presenters: Kristy Drollinger, senior director of population health analytics, Fairview Health Services; J.D. Whitlock, corporate director of clinical and business intelligence, Catholic Health Partners; Sean Cassidy, general manager of information technology services emerging business unit, Premier, Inc. Are you ready to invest in an integrated data platform? Do you have a strategy to make the information accessible and actionable? How will enterprise data warehousing transform care delivery? There’s more to data analytics than simply deploying an EDW. Learn what goes into becoming an information-driven enterprise in the first webinar in this series.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

Interesting points on the big IPO of IMS Health. The company was taken private a few years ago and its three main private equity investors (who bought in for $5.2 billion) will nearly triple their money by taking it public again. As often happens when the private money guys take control, IMS has loaded itself with debt along the way, jumping from $1.3 billion in debt before they got involved to a current $4.9 billion. It will use the IPO proceeds to pay the debt down to $3.95 billion. Annual revenue is $2.5 billion.

Shares of athenahealth plunged 11 percent on Friday, with shares dropping 28 percent in the past month.

Sales

Etransmedia Technology licenses its Connect2Care patient engagement platform to Merge Healthcare.

People

Gary Lakin (Microsoft) is named CEO of Australia-based oncology vendor charmhealth.

Announcements and Implementations

Scanadu starts distributing its wildly hyped $199 tricorder-type diagnostic to its Indiegogo backers, but has to stop when it finds a several problems, including algorithm errors, incorrect temperature readouts, and breakdown of the machinery that creates the device’s case. The Scanadu Scout can’t be sold until approved by FDA, so the backers had to sign up as study participants. With those kinds of problems, it’s a long shot that FDA will ever approve the device.

Government and Politics 

US CTO Todd Park has been minimally visible since the Healthcare.gov rollout fiasco and the ensuing Congressional subpoena, but he shared celebratory champagne with contractor QSSI early Tuesday morning after the site exceeded its goal of enrolling 7 million people.

The Wall Street Journal recaps the five states with the most problem-plagued health insurance exchanges, all covered here previously: (1) Oregon (still not working); (2) Maryland (dumping its dysfunctional system and moving to the one Connecticut developed); (3) Massachusetts (still not working); (4) Nevada (carriers are being sent incorrect information); and (5) Hawaii (not being used because state law already required employers to provide insurance).

Influential House lawmakers continued Thursday to press the Department of Defense and VA for failing to create a single EHR that would follow service members during and after their service. According to Rep. Rodney Frelinghuysen (R-NJ), who chairs the committee that funds the DoD, “It’s enormously frustrating. It makes us angry. … This is way beyond the claims backup VA has. It’s pretty damn important.” Rep. Pete Vicslosky (D-IN) added, “We fought a world war in four years. We’re talking interoperability of electronic medical records from 2008 to 2017, and I’m appalled.” The DoD’s assistant secretary of defense for health affairs says the current approach is to allow the two separate systems to talk to each other, which is says has been a problem nationally and why DoD wants to buy its own commercial product for $11 billion instead of using the VA’s VistA for free.

The State of Connecticut says that Windows XP, which finally goes off support Tuesday after Microsoft replaced it in 2008, still runs 20 percent of its computers, including all of the Department of Corrections and 43 laboratory instruments. The state is planning to pay Microsoft $250,000 to continue receiving Windows XP security patches, which may or may not keep it safe from potential HIPAA violations for running an unsupported and potentially compromised operating system. According to Microsoft, “Businesses that are governed by regulatory obligations such as HIPAA may find that they are no longer able to satisfy compliance requirements.” Another report finds that 77 percent of British companies still run XP and only a third of those surveyed plan to upgrade.

The Missouri House sends a bill to the Senate entitled the “Second Amendment Preservation Act” that would make it illegal for a healthcare professional to use an EMR that requires information about a patient’s access to firearms.

Innovation and Research

Maybe we really do need Amazon to get into healthcare. Check out its new Dash device that allows easy ordering through its AmazonFresh grocery delivery program (only available in Southern California, San Francisco, and Seattle for now.)

Technology

Billionaire AOL founder Steve Case decides on a whim to invest $100,000 each in all 10 startup teams pitching at the inaugural Google for Entrepreneurs Day. Among the companies funded is Nashville-based InvisionHeart, a Vanderbilt spinoff that is developing technology that converts EKGs to digital form for sharing in the cloud.

Other

The local paper covers the $33 million Cerner go-live at Beebe Medical Center (DE), featuring CMIO Jeff Hawtof, MD.

The two HIEs located in Columbia, MO (Missouri Health Connection and Tiger Institute Health Alliance) say they may talk about sharing information despite disagreements that arose when Missouri Health Connection demanded that Tiger Institute pay it. The current setup means that two Columbia hospitals could be close together but unable to share information because each participates in a different HIE.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 4/4/14

Top News

HHS releases a draft report from its FDASIA work group that includes a proposed strategy and recommendations for an HIT framework for maintaining appropriate patient protections and avoiding regulatory duplication. It reaffirms FDA’s position that its regulation is appropriate only for medical devices and not clinical software (including clinical decision support tools.) The report ponders the question of how a conformity assessment program (product testing, certification, and accreditation) might work and whether the government should play a role. It also recommends creating the Health IT Safety Center, seeking input on how it should be operated to share incidents, lessons learned, and user experience, also suggesting that third-party tests or reviews might play a role. The report describes three categories of health IT products:

• Products for admin HIT functions, such as software for billing, scheduling, and claims management  that pose little patient risk. No FDA regulation is proposed.
• Clinical software for health information and data management, medication management, physician order entry, electronic access to clinical results, and most clinical decision support software. No FDA regulation is proposed.
• Products with medical device functionality, such as computer-aided detection software, software for beside monitor alarms, and radiation treatment software. FDA would continue to regulate products falling into this category.

Reader Comments

From Harry-O: “Re: NTT Data-supported Indy car. I’m pleased that we are no longer a client. While I understand that vendors need to market their products, those of us in the trenches are struggling to survive and pay their (for the most part) exorbitant support fees. Wouldn’t it be nice if they could find a way to market and reduce costs at the same time? What a waste, paid for by a hospital near you.”

From Perky: “Re: ICD-10 delay. Does anyone have an inkling as to how things are going to proceed with such things as CQM reports and MU 2 demonstration/certification with the delay of the ICD-10?  As I try to think this through, my head sort of explodes. If they are going to continue to require ICD-10 codes for the CQM, PCMH, and MU 2 reports, then how are the codes going to get entered if we are not using them for billing? If they decide to stick with the ICD-9 for CQM, PCMH, and MU 2 reports, what happens with the certification process? If we are not allowed to use ICD-10 until after October 1, 2015, what happens with all of the products that are already certified to use ICD-10? Are they expected to rewrite their reports using ICD-9? Do they then need to go through the certification process again?” Unfortunately Perky just hits the tip of the iceberg with his list of questions and CMS may not have enough disk storage to adequately address all the new FAQs. CMS has been been oddly silent on the whole issue all week, suggesting that  no one at the agency saw the delay coming. One of the first steps towards clarity will be the issuance of a final rule for the new ICD-10 deadline. If anyone wants to stab at Perky’s questions, please share.

HIStalk Announcements and Requests

Assuming this isn’t your first time reading HIStalk, you contributed to the 8 million visit milestone. Thanks.

A few highlights from HIStalk Practice this week include: AMA remains tight-lipped about the ICD-10 delay. Physicians in academic settings report higher compensation when more time is spent seeing patients versus performing research. Specialists who are late in adopting EHRs may struggle to meet Stage 2 patient portal requirements. European Union GPs report that interoperability issues, a lack of regulatory framework, and inadequate resources are the biggest barriers to adopting ehealth tools. The GAO recommends CMS expand its benchmarks for assessing Medicare physicians. Dr. Gregg contends that HIT’s next big role is to motivate change in consumers that will drive transformation in providers. Thanks for reading.

This week on HIStalk Connect: IBM partners with the New York Genome Center to research genetics-driven brain cancer treatments with Watson. Rock Health’s digital health funding report recaps a record-breaking $700 million in funding in Q1, its strongest investment quarter to date. Airstrip acquires San Diego, CA-based Sense4Baby, a startup from the West Health Institute that markets wireless fetal monitors.

Upcoming Webinars

April 9 (Wednesday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 1 – Avoiding Analysis Paralysis. Sponsored by Premier. Presenters: Kristy Drollinger, senior director of population health analytics, Fairview Health Services; J.D. Whitlock, corporate director of clinical and business intelligence, Catholic Health Partners; Sean Cassidy, general manager of information technology services emerging business unit, Premier, Inc. Are you ready to invest in an integrated data platform? Do you have a strategy to make the information accessible and actionable? How will enterprise data warehousing transform care delivery? There’s more to data analytics than simply deploying an EDW. Learn what goes into becoming an information-driven enterprise in the first webinar in this series.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

GE Healthcare will acquire CHCA Computer Systems, the Canada-based developer of the Opera software application for OR management and analytics, of which GEHC Is a distributor.

MModal reaches an agreement with the majority of its bankruptcy creditors to cut its debt by over 55 percent, which is about $350 million. Investor’s Chair sitter Ben Rooks provides some financial perspective about the company in answering a reader’s question in his “Health IT from the Investor’s Chair”.

IMS Health Holdings, which sells de-identified patient prescription information, goes public in an IPO that values the company at over $6 billion.

Practice software vendor edgeMED acquires revenue cycle management company Physician’s Billing Alternative.

ZirMed acquires the payment processing, patient eligibility, and patient estimation business owned by TransEngen.

Pharmacy automation vendor Aesynt, which operated as McKesson Automation until its November acquisition by Francisco Partners, acquires Italy-based pharmacy IV technology vendor Health Robotics.

TreeHouse Health makes a six-figure cash investment in LogicStream, a provider of clinical decision support tools.

Sales

A healthcare quality collaborative headed by San Jose Clinic (TX) selects CompuGroup Medical’s CGM Enterprise suite for community health practice management.

Memorial Health Care System (TN) and St. Vincent Health System (AR) select MedAptus Professional Charge Capture for automated coding and billing.

Visiting Nurse Service of New York chooses Crescendo from Delta Health Technologies for homecare business management.

VNA of Albany and Visiting Nurses Home Care (NY) choose Homecare Homebase.

Oconee Medical Center (SC) adopts PeraHealth’s PeraTrend platform as its real-time clinical decision support tool.

The Center for Diagnostic Imaging (NJ) will implement Healthec’s HIE platform.

Craneware signs multi-year contracts with two unnamed hospitals in the Eastern US for about $6.9 million.

People

PatientSafe Solutions names Cheryl D. Parker chief nursing informatics officer.

Nextech appoints Ron Kozlin (Pilgrim Software) CFO.

CareCloud names Lee Horner (Eliza Corporation) chief sales officer.

Baylor Scott & White Health appoints 11 new members to its senior leadership team, including Matthew Chambers (Scott & White Healthcare) as CIO.

Aaron Karjala, CIO of the troubled Cover Oregon online marketplace, becomes the fourth top manager to resign his post.

Announcements and Implementations

Cherokee Regional Medical Center (IA) goes live on its $2 million Epic system.

Qatar’s Al Khor Hospital and Al Daayan Health Centre go live on Cerner.

Hudson Valley Hospital Center launches its MyHVHC patient portal.

Emory Healthcare and Grady Health System join the Georgia HIN.

The Spanish Catholic Center (DC) implements Forward Health Group’s PopulationManager and The Guideline Advantage. 

Government and Politics

CMS issues a Daily Digest Bulletin that summarizes the newly passed Protecting Access to Medicare Act of 2014, Noticeably absent is any mention of the ICD-10 delay. The Bulletin notes that “more information about other provisions will be forthcoming.”

Innovation and Research

The New York eHealth Collaborative and the Partnership Fund for NYC call for applications for the second class of the New York Digital Health Accelerator, a program that will give up to 10 early- and growth-stage companies $100,000 each to advance their digital health technology efforts.

Children’s Memorial Hermann Hospital (TX) offers patients a chance to virtually visit the Houston Zoo, located across the street from the hospital, from their hospital beds using Google Glass.

Other

I suppose this constitutes a bad day at the office, at least if you are the tree trimmer who is recovering after the chainsaw he was operating kicked back into his neck.

The local paper covers the plight of a 25-bed critical access hospital in Arkansas, whose February computer fees of $63,000 contributed to a loss of $142,000. Administrators expect a $1.2 million EHR incentive check in May, but those funds will be used to pay off  EHR vendor Healthland, which did not require the hospital to pay until it received its MU check.

Mercy Technology Services, the information backbone of the Mercy healthcare system, will market its services to other Epic users as the first provider accredited in the Epic Connect program.

A KLAS report on ICD-10 consulting services (with the unfortunately timed subtitle “Who Can Help in the Eleventh Hour”) ranks The Advisory Board highest for overall ICD-10 consulting performance, followed by Aspen Advisors. Optum and 3M earned the highest scores for on-site training.

The majority of health organizations participating in a HIMSS Analytics survey report having a formalized EHR governance structure in place with a structure that involves a cross-functional, multi-disciplinary advisory board or committee. The biggest EHR governance challenges are physician engagement and adoption.

Sponsor Updates

• 3M completes its acquisition of Treo Solutions, a provider of data analytics and business intelligence to providers and payers.
• Analyst firm IDC names Covisint a “major player” in worldwide federated identity management and single sign-on.
• Medworxx Solutions and Leidos Health will offer providers help with patient flow performance and analytics.
• Allscripts recognizes its customer Citrus Valley Health Partners (CA) for being one of the first organizations in the country to meet the 2014 MU Stage 2 requirement for electronic transitions of care, which it accomplished using Allscripts dbMotion.
• Wellcentive will demonstrate is population health management platform at this week’s AMGA meeting in Grapevine, TX.
• Biztech profiles ICSA Labs and its work certifying security products.
• The Health Catalyst team explains how population health management solutions lead to overall better health care.
• MedAssets president and CEO John Bardis headlines the SEMDA 2014 Conference as the Gala speaker May 7-8 in Atlanta.
• A local paper interviews Summit Healthcare founder and CEO Ted Rossi, who shares details of the company’s history and growth.
• A KLAS report on HIEs finds that 100 percent of InterSystems HealthShare customers have made HealthShare part of their long-term plans and say they would purchase HealthShare again.
• Craneware conducts its annual Executive Industry Leadership Survey to measure revenue integrity priorities.
• ADP AdvancedMD, Intelligent Medical Objects , The SSI Group and NextGen issue statements following the passage of the ICD-10 delay legislation.
• Kit Check adds Medi-span integration to its Trusted Pharmacist Medication Checks software.

EPtalk by Dr. Jayne

I seem to be rounding up lots of federal issues this week. Monday opened with an extremely heated discussion involving a hospital laboratory director, our medical group operations VP, and me. To make a long story short, one of our hospitals is refusing to play nicely in bringing a bidirectional interface live for our employed physicians. Although many of our physicians use a large national reference laboratory (mostly due to payer requirements) we have a handful of physicians who are being held captive because they are located in the hospital medical office building. The terms of their lease prohibit external vendors from picking up samples at the office after hours, which basically locks them out of the market. Since the practice specializes in OB/GYN and has a high volume of office-collected specimens, they’re stuck using the hospital’s lab and pathology services.

Although the hospital initially agreed to a bidirectional interface so the practice could meet its requirements for both structured data and CPOE, it is now balking under the excuse that a bi-directional interface isn’t “required” for Meaningful Use. They want the practice to figure out some way to create magic with electronic ordering that prints to paper requisitions and an unsolicited results interface. The orders can’t match up automatically, which makes a mess of all the numerators and denominators unless staff manually matches the results. I explained to the lab director in my best primary care voice that a bi-directional interface isn’t entirely about MU, but rather actually has a great deal to do with patient safety.

He didn’t seem to care that it would help close the loop on orders, making sure results were received and catching misses through electronic reporting. He actually suggested providers should use an accordion file and duplicate copies of the requisition. What century is this person living in? I understand competing priorities and limited budgets, but these are our employed physicians that we placed in the hospital building in good faith.

I thought at one point I was going to have to perform a stroke assessment on the operations VP. He made some threats about calling the hospital CEO to discuss breaking the lease and the lab guy still didn’t flinch. It was brinksmanship like I haven’t seen in a long time. I know the hospital CEO well and would love to be a fly on the wall when he calls the lab director and tells him to get it in gear. The bigger picture includes hundreds of newborn deliveries and even more GYN surgeries. Given the practice’s revenue boost to the hospital, I would bet money that the lab director will be singing a different tune by next week.

I’ve also been wrangling entirely too many consultants and administrators regarding the now-approved ICD-10 delay. We’re breathing a sigh of relief on the inpatient side because our hospital vendor still hasn’t delivered decent software. On the ambulatory side, I’m just aggravated, though. Our vendor worked extremely hard to deliver solid product and we’re upgrading very soon. I think of all the “real” enhancements they could have done to the software with the development dollars that they pumped into getting ICD-10 ready and out to the client base with ample time for everyone to upgrade.

Speaking of the legislation, did anyone read the whole thing? I did read the “Protecting Access to Medicare Act of 2014” and there were a couple of other gems that snuck in under the cover of the SGR patch. I love the fact that the Government Printing Office uses an old-school type face for the header on legislation. Check out Section 111, which gives hospitals some relief from the so-called “two-midnight rule” through March 2015. Of course “evidence of systematic gaming, fraud, abuse, or delays in the provision of care by a provider” can trigger an audit regardless.

Sections 205 and 206 include abstinence education and funding for the PREP personal responsibility education program. I know there are some sassy seniors out there, but I fail to see how throwing this in with the “Protecting Access to Medicare Act” makes logical sense. They should have called it the “Protecting Medicare, Serving Special Interests, and Tidying Up Odds and Ends Act.”

Fifteen million dollars for pediatric quality measures is in section 210. One of my favorite add-ons is section 216, “Improving Medicare policies for clinical diagnostic laboratory tests.” It requires laboratories to report their private payer contractual rates and test volumes to assist in establishing Medicare rates. So much for a free market (although we knew that was long gone with Medicare already.)

Another favorite (which I almost missed because of the mind-numbing and sleep-inducing effects of federal legislation) is section 218, which promotes evidence-based care by requiring physicians to use clinical decision support before they order certain radiology imaging studies. CDS modules can be part of certified EHR technology or independent. Eventually outlier physicians will require prior authorization before they can order studies. Just when you thought it was safe to go back into the water after MU2, there are more sharks circling. I hope the EHR vendors can code fast enough to keep them at bay.

The ICD-10 delay is in section 212, if anyone is interested. I gave up after page 31. A reader gave me my laugh of the day about the delay:

Dear Dr. Jayne,

I have three young boys and one of them is always winding up in the ER. This year alone we’ve already had boy vs. coffee table, boy vs. Evel Knievel bicycle jump, and boy vs. monkey bars. Every time our insurance pends the claim and sends me a letter asking for verification that the injury was not work-related or due to a motor vehicle accident. I wish they could figure out that if the boys are 4, 7, and 10 they’re probably not on the job. A quick skim of the ER note would give them the rest of the information. I was looking forward to ICD-10 because maybe the more specific codes would give the insurance company what it wanted in the first place. I guess I’ll have to wait another year to find out. Hopefully we’ll be less accident prone by then.

Those descriptions remind me of Struck by Orca and I’m thinking maybe a companion volume is in order. What’s your reaction to the ICD-10 delay? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 4/2/14

Top News

Implementation of ICD-10 will be delayed until at least October 1, 2015 (it’s up to HHS to set the exact date, apparently) as the Senate approves (64 to 35, with 60 votes required) a hastily assembled bill intended to once again delay the SGR-mandated 24 percent physician pay cut for another year, the 17th time it has been delayed rather than repealed and replaced. Nobody claims to know how the one-sentence ICD-10 language ended up in the otherwise unrelated bill. Sen. Jeff Sessions (R-AL) declares that the “doc fix” violates the just-passed Bipartisan Budget Act since there’s no money to pay for it. The patches have cost taxpayers an estimated $150 billion. The President signed the bill Tuesday. Several organizations expressed disappointment that ICD-10 was delayed and the AMA says it is “deeply disappointed” that the Senate kicked the can down the road again rather than repealing SGR instead of addressing Medicare physician payment reform. HIMSS didn’t announce a position on the delay, but CHIME said it wasn’t happy about the industry’s wasted efforts and the unknown aspects of the delay. A few sages predicted this could happen: the HHS big wheels declaring at the HIMSS conference that ICD-10 would not be delayed further are civil servants, not legislation-making members of Congress.

Reader Comments

From Minnesotan at Heart: “Re: Mayo Clinic in MN, AZ, and FL. Looks like they are looking at Epic and Cerner from this article in the employee newsletter.” According to the March 28 newsletter, Mayo will implement a single-instance EMR at all campuses and has narrowed the field to Cerner and Epic for demos.

From Vince Ciotti: “Re: Indy Car Grand Prix in St. Petersburg, FL. I took this picture of the NTT DATA car.” Many readers would have been jealous of the obviously great weather in Florida had spring not finally kicked off in some places.

From Todd Hatton: “Re: Saint Luke’s Health System. We have gone live on Epic inpatient clinical applications on March 28 at our seven metropolitan hospitals in a big-bang fashion. Applications implemented are ClinDoc, Stork, Rover, Haiku, Cantu, Orders, ASAP, Willow, Radiant, OpTime / Anesthesia. SLHS implemented on the Linux database platform. New wrap-around applications are Perceptive Software integrated document imaging, Nuance eScription partial dictation integration, Perigen fetal strip integration, and iSirona medical device integration for anesthesia, ventilators, and bedside monitors in ED, surgery, ICU, and NICU. Things are going well.” Congratulations to the Kansas City area SLHS, where Todd is associate CIO and is no doubt proud of the team that made it happen. A seven-hospital big bang Epic go-live is quite an accomplishment.

From Plausibility: “Re: Meditech. We are looking a vendor-agnostic solution that pulls contextual information from the patient’s record. I am concerned that Meditech will block access to its data. Has anyone used a solution like this without having Meditech block the information or have advice on encouraging them not to?”

From The PACS Designer: “Re: iPhone 6. Rumor has it there will be two designs, a 4.7-inch phone and a 5.7-inch phablet.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Navicure. The Duluth, GA-based company offers worry-free clearinghouse and payment solutions built for physician practices, supporting expanding health systems by accelerating and protecting practice cash flow, decreasing A/R days, providing enhanced eligibility verification, improving staff productivity, and giving patients tools to manage online statements and payments. The company serves over 50,000 providers, offering them a “3-Ring Policy” guaranteeing that support calls will be answered within three rings. Thanks to Navicure for supporting HIStalk.

I found this YouTube video overview of Navicure. 

I sent $50 Amazon gift cards to three randomly chosen readers who responded to my annual survey, but Lorre noticed that two other readers had written in that if they happened to win (they didn’t), they wanted their prize donated to my favorite charity, DonorsChoose. I was touched, so this is for you, Andrew Gelman of PDR Network and Pam Landis of Carolinas HealthCare. I funded an amazing DonorsChoose project with your $100. I found a grant program underwritten by Autodesk that helps pay most of the cost for certain classroom equipment, and your $100 bought – you won’t believe it – a $2,669 MakerBot 3D printer, supplies, and support package for Mr. Fraustro’s architecture, engineering, and construction classes at high-poverty John A. Rowland High School in Rowland Heights, CA.

Upcoming Webinars

April 2 (Wednesday) 1:00 p.m. ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

April 9 (Wednesday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 1 – Avoiding Analysis Paralysis. Sponsored by Premier. Presenters: Kristy Drollinger, senior director of population health analytics, Fairview Health Services; J.D. Whitlock, corporate director of clinical and business intelligence, Catholic Health Partners; Sean Cassidy, general manager of information technology services emerging business unit, Premier, Inc. Are you ready to invest in an integrated data platform? Do you have a strategy to make the information accessible and actionable? How will enterprise data warehousing transform care delivery? There’s more to data analytics than simply deploying an EDW. Learn what goes into becoming an information-driven enterprise in the first webinar in this series.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

Imprivata files for a $115 million IPO, planning to list its shares on the NYSE. According to the SEC filing, the company lost $5.5 million on revenue of $71 million for the year ended December 31, 2013, with 83 percent of its revenue driven by the OneSign single sign-on product that has 2.6 million licensed healthcare users and another 740,000 outside of healthcare. The S-1 registration statement also notes that the company uses a development firm in Ukraine with obvious exposure as Russia threatens. The fine print notes that BIDMC CIO John Halamka was given options worth $140,700 as a company director.

Sales

Florida Hospital Memorial Medical Center (FL) chooses Authentidate’s InscrybeMD telehealth solution to manage chronic disease patients in a partnership with Bethune-Cookman University.

ViaQuest’s Clinical Services Division (OH) will use Netsmart CareManager for its planned Health Home.

Ministry Health Care (WI) selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

People

Patty Griffin Kellicker (Humedica) joins Hayes management Consulting as VP of marketing and communications.

Announcements and Implementations

St. Francis Hospital’s (CT) use of ReadyDock’s storage, charging, and disinfecting system for mobile devices gets coverage on the local TV station.

Brigham and Women’s Hospital (MA) will expand its use of scribes to operate its EMR, at least until that system is replaced. According to CMIO for Health Innovation and Integration Adam Landman, MD, MS, MIS, MHS, “It lets me sit next to the patient and focus 100 percent of my attention on the patient. There are a few patients who don’t want the scribe involved in their care, and then I ask the scribe to leave.”

TigerText says it will cover up to $1 million in fines if its customers are charged with violating HIPAA secure messaging requirements.

Government and Politics

A GAO audit finds that Department of Defense is lousy at estimating long-term system costs, with its TMIP-J battlefield EHR (which includes the frontline portions of the AHLTA, CHCS, and DMLSS systems) being by far the most wildly underestimated. DoD estimated its cost at $68 million in 2002, but they’ve spent $1.58 billion on it so far.

Indiana’s professional licensing agency asks the state’s ethics commission to review a Board of Pharmacy decision that allows Walgreens pharmacists to use workstations that aren’t located behind counters in its “Well Experience” program. The pharmacy board’s president at the time the request was approved was a Walgreens manager. Consumer groups expressed concerns that pharmacists might leave the area and expose confidential computer or label information to customers.

Technology

Retired Akron, OH cardiologist Terry Gordon, who advocated placing automated external defibrillators in public areas, is working on a scavenger hunt-type game app that would encourage high school students to locate and report the AED locations to a central database so emergency responders can direct 911 callers to them in a cardiac emergency.

Other

In New Brunswick, the government’s $16,000 subsidy of the $24,000 Velante EMR sold by a for-profit venture of the New Brunswick Medical Society ended Monday. Expected physician enrollment was running well behind expectations through the end of February. The medical society partnered with a vendor who then contracted out system development to a New Zealand company.

Epic offers its usual April 1 merriment, declaring that it will immediately discontinue Meaningful Use support to allow clients to claim Stage 2 hardship exemptions, KLAS realizing that it has always spelled CLASS incorrectly, and Epic funding research into how to pronounce the name of its business intelligence suite Cogito but advising to just call it “ree-POR-ting” for now.

A new JAMA-published study finds that 19 of the 50 largest drug companies have at least one academic medical center leader on their boards, paying them an average of $313,000.

The chairman of an England-based CMIO-type organization says his organization can’t say anything negative about their software systems because vendors will sue them. “Our pockets are not deep enough to confront the legal departments of the suppliers,” he says, suggesting that instead trusts contact each other before buying.  

Weird News Andy titles this story “To Make You Feel Better.” Hearing-impaired California consumers who called the listed 800 number to receive help signing up for health insurance are surprised to hear, “Welcome to America’s hottest talk line.” The site’s incorrectly listed number was for a sex chat line. A Covered California spokesperson denied that its site listed the wrong number despite the local TV station’s screenshot clearly showing it. A Sacramento newspaper had made the same mistake previously, running a number that was one digit off and sending prospective subscribers to the same service.

Sponsor Updates

• Brad Levin, GM of Visage Imaging, contributes an AuntMinnie.com post titled “The Time is Now for Deconstructed PACS.”
• SyTrue is selected to present at the Healthcare Documentation Integrity Conference in Las Vegas, NV July 23-26, offering “Your ‘Hitchhiker’s Guide’ to Medicine’s ‘Tower of Babel.’”
• PerfectServe discusses clinician exhaustion and offers three steps to eliminate the problem.
• Harris Corporation’s FusionFX Patient Portal earns 2014 Edition Modular Ambulatory and Inpatient Certification from ICSA Labs.
• Health Care Software posts its event calendar through October.
• ESD celebrates 24 years in healthcare IT.
• Etransmedia Technology’s Direct Care Coordinator receives ONC-ACB certification.
• DrFirst and Insight Software partner to offer e-prescribing to eye care providers.
• First Databank will summarize research findings on drug pricing benchmarks at two pharmaceutical conferences in April and May.
• WebInterstate Inc partners with Liaison Healthcare to integrate its MediMatrix mobile imaging solution to multiple EMRs.
• MedAssets continues to support clients in preparation of ICD-10, saying the transition is “when” rather than “if.”
• Deloitte Analytics senior advisor Tom Davenport expounds on the findings of the strategic planning required for big data to be of use.
• Wellcentive will demonstrate its population health management platform during the AMGA conference in Dallas, TX April 3-5.
• Perceptive Software creates a blog to recap Inspire 2014 in Las Vegas April 4-9.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 3/31/14

Top News

The Washington Post reports that Maryland has such little hope that its $126 million health insurance exchange will ever work that it will be shut down permanently and replaced by Connecticut’s system. Nobody’s willing to talk about what the new system will cost, especially the politicians who botched the first one that crashed minutes after it was turned on. The only refreshing aspect about Maryland’s folly is that it was Noridian Healthcare Solutions that it had to fire instead of CGI and it’s also the first state to admit defeat and start over. Connecticut’s system was developed by Deloitte, which seems to be the only company that consistently delivered for those states that decided they couldn’t use the federal exchange.

Reader Comments

From Bruce Kee: “Re: patient privacy case. It’s a sticky situation.” Wisconsin Governor Scott Walker, while a county executive running for governor in 2010, received and shared information about a patient who was sexually assaulted at a county mental health facility as he and his political consultants tried to deflect criticism of four deaths that had occurred there. The attorney hired by the county explained in the draft response why the patient’s information should not be released to the newspaper, saying, “They and I are bound by laws and regulations governing, among other things, the confidentiality of certain information. What should we do? Should we disregard the rights of patients? The legal and ethical obligations imposed upon us? Please — please consult with someone familiar with the laws and regulations governing the disclosure of the information you seek.”  

From Vas DeFerence: “Re: cloud EHR vendors. A know of a practice that wants to switch systems ASAP, but can’t get their data even though their contract gives the practice ownership of it. The SaaS-based vendor won’t provide it or give the practice access, so the practice is actually thinking about manually printing out 80,000 charts to PDF. How are other practices and vendors dealing with SaaS-based database lock-in?” The obvious answer would be to sue the vendor, but that takes time and money the practice probably doesn’t have. The second would be to call the vendor out publicly and hope the possibility of negative publicity action heightens their data export enthusiasm. I’ll offer to be the intermediary if the practice wants to give me details on the record so I can get the company’s response. My pessimistic expectation is that the vendor doesn’t really know how to deliver on its promise and has little incentive to figure it out until the seat it occupies gets a bit hotter. Mass export capability should be part of certification given ONC’s push for interoperability, the practice’s equivalent of Blue Button that allows them to move to a new system without endangering patients by losing their information.

HIStalk Announcements and Requests

The huge amount of taxpayer money spent on dysfunctional health insurance exchanges is more the fault of bureaucrats rather than of contractors such as CGI, poll respondents said 51 percent to 29. New poll to your right: have you seen personal benefit from an HIE as a patient / consumer? I understand that maybe you wouldn’t necessarily know, but even then that’s the marketing challenge of HIEs.

My latest grammar peeve: specifying times as “EST,” which is wrong through November 2. Just say “Eastern” or “ET” year-round if you don’t want to be bothered with the seasonal intricacies of “EDT.” The only “standard time” in the summer is in Arizona, which confusingly but sensibly doesn’t observe Daylight Saving Time and therefore remains on MST all year.

Listening: ReVamp, operatic metal from the Netherlands featuring my favorite female singer, Floor Jansen (After Forever, Nightwish).

Upcoming Webinars

April 2 (Wednesday) 1:00 p.m. ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

Morgan Stanley places Cerner on its list of 44 companies whose stock fundamentals make them attractive for being acquired. 

TrueVault, which offers a programming API allowing software developers to store and use patient information in a HIPAA-compliant manner, raises $2.5 million in seed funding. The Mountain View, CA-based company charges $0.01 per programming call to its service. 

Government and Politics

A consultant hired to review Vermont’s insurance exchange lists problems that include changing federal expectations, inexperienced consultants provided by CGI, and putting political cronies in charge. It’s a well done and easily understood report, although I suspect that engaging a consulting firm to evaluate even a successfully executed project would result in a similar list.

A proposed California referendum that would increase the state’s $250,000 limit on non-economic malpractice awards adds two unrelated items added to make it more enticing to voters based on focus group response: requiring stringent drug testing of hospital-based doctors and mandatory use of a doctor shopping database that is already available but that nobody uses because it’s clunky. The special interests will be out in force: trial lawyers love the prospect of higher awards that will encourage them to represent injured patients instead of just turning them down as not being worth the effort, hospitals say the change will cost billions, and the guy pushing the database nobody uses was upset that he got only $250,000 when a doctor-shopping drug abuser ran over and killed his two children.

Check out C-Span video of the doc fix/ICD-10 delay being approved by voice vote, suspending the House’s own rules and skipping the recorded vote that would indicate who voted yes and no. The “no” votes sounded louder than the “yes” votes to me but the Chair gets to decide, not to mention that voice votes require legislators to be physically present, which isn’t common, and are usually used only for non-controversial issues for which support is nearly unanimous. The voice vote means the two-thirds majority wasn’t required, leading experts to say that both parties feared it wouldn’t pass otherwise by the April 1 deadline, the day after Monday’s Senate vote. Since the one-sentence ICD-10 delay got tacked on for some reason, it also passed without any kind of discussion or thoughtful process. An example of the political motivations comes from Minority Leader Nancy Pelosi (D-CA), who explained her support as, “The Republicans will say this is because of the Affordable Care Act, and I just don’t want to give them another opportunity to misrepresent what this is about.” Democrats want the SGR repealed, but Republicans say they haven’t offered a proposal on how the country will pay for it, leading in the regular “patches” that have prevented what would have been $160 billion in taxpayer savings over the past 10 years as the law requires.

HHS releases a security risk assessment tool for small to medium physician practices. It’s available for the desktop, iPad, or as Word documents.

Innovation and Research

Doctors in the Netherlands save the life of a 22-year-old woman by replacing most of her skull with a plastic one they created using 3-D printer. It’s refreshing that among all of the wildly overhyped technologies, 3-D printing has come out of nowhere and is solving big problems cost effectively.

Other

I thought this subject line of the promotional email from Next Wave Connect described either late-breaking news or fresh emanations from their in-house psychic related to Monday’s scheduled Senate vote (who also irrationally capitalized “Delayed”). Nope, it was just “click here’ bait for people who require assistance in comprehending what a one-year delay would mean to them (is it really that hard to figure out?)

Northern Berkshire Healthcare (MA), which operates 36-bed, 129-year-old North Adams Regional Hospital and its affiliates (visiting nurse service, hospice, and three practices) files Chapter 7 bankruptcy and shuts down the hospital due to declining revenue. The state’s attorney general, who is from the same town, has announced an investigation of the hospital’s board. Protestors showed up at the empty building, seemingly more interested in the loss of union jobs than any immediate danger to public health triggered by closing a facility short on patients. A court ordered competitor Berkshire Medical Center to take over the ED on Friday, but shortages of supplies and staff led it to delay the ED re-opening until Monday. The CEO of the state hospital association summarized the situation as, “Changes are taking place both in how care is paid for, and also how care is delivered. Not all hospitals will continue to operate as they used to. Possible solutions for this could include redefining what a hospital is to maintain basic services for a community, or cross-subsidization within a larger health system.” He didn’t mention the more Darwinian solution that needs to be on the table given healthcare costs: if you’re not providing a service the market demands or someone else is doing it better, shut down.

I saw a few mysteriously belated tweets about a 2013 Accenture study (complete with the usual cartoonish infographs for people too busy to actually read words) of what patients expect of drug companies, which concluded that: (a) patients want to hear directly from drug companies, preferably as they begin taking a new drug; (b) they want free stuff, like discounts or rewards; (c) two-thirds are willing to trade their personal information to get the aforementioned free stuff. The conclusion is that pharma has not met expectations for more actively engaging with its customers. What’s wrong with the study: (a) it was an online survey that is by definition skewed toward heavy online users who don’t have anything better to do than fill out surveys; (b) Accenture didn’t include the actual survey questions, which I expect were heavily suggestive of demonstrating unmet demand since Accenture sells consulting services to drug companies panicking that their Facebook page isn’t clever enough; (c) it didn’t compare non-online communication options (telephone or mail, for example) but instead just asked respondents to choose from several online technologies;  and (d) surveyed consumers almost always express an interest in something that’s free that they end up ignoring completely when it’s actually made available in response to questionable survey results (see: personal health records). My unscientific conclusion of what consumers want from drug companies: (a) discounts; (b) notice of any new information about the drugs they take; and (c) follow-up information about use, side effects, warnings, etc. a few weeks after starting a new chronic medication. They don’t want drug companies bugging them on Facebook and Twitter.

Sunday, March 30 is National Doctor’s Day, which means that hospitalists and ED docs will be about the only ones who get thanked directly since their peers won’t be working.

A Financial Times article warns that the concept of “big data” has consultants, entrepreneurs, and governments drooling, but Google Flu Trends is a good example of putting too much faith in easily collected data of unknown meaning. Everybody focuses on correlation rather than causation — just because people with the flu Google the word “flu” more often doesn’t mean that everyone who Googles “flu” has it. It also points out a common misperception: bigger data sets of uncertain selection bias aren’t as predictive as smaller data sets that are free of sampling bias, with an example being the prediction that Landon would convincingly defeat Roosevelt for President in 1936, which was based on 2.4 million mailed survey responses that turned out to be wildly wrong compared to 3,000-respondent survey that was more carefully designed. The article concludes that giant databases have people clamoring for information that statistical methods can’t always deliver.

Two ED registrars at Jamaica Hospital Medical Center (NY) are arrested for selling information from electronic patient files to rehab centers and personal injury attorneys, with one patient receiving a call from an ambulance-chasing lawyer while still sitting in the ED.

The founder of sexually transmitted disease testing app Hula says he won’t change the company’s name despite protests from Hawaiians, but he now understands the cultural insensitivity of company marketing materials that refer to “getting lei’d.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect

News 3/28/14

Top News

The House of Representatives approves, by an unusual voice vote, a hurriedly presented bill that would delay the mandatory implementation of ICD-10 until at least October 1, 2015. The bill, presented Wednesday and approved Thursday, primarily addresses a Sustainable Growth Rate fix that would prevent the 24 percent reduction in physician Medicare payments that will otherwise occur on April 1. The ICD-10 date change was contained in a single sentence in the bill, which will become law if it’s approved by the Senate on Monday and then signed by the President. HHS has been insisting the deadline wouldn’t change after two previous delays, providers and vendors should have been ready given the generous lead time and remaining six months, and most organizations agreed that it was time to rip the Band-Aid off and just do it. Now a delay gets snuck into an unrelated bill and pushed to approval in less than 24 hours, most likely by politicians who didn’t have a clue about what they were voting for. The bill proves how ineffective Congress can be – they can’t figure out how pay for fixing SGR, so they delay its implementation, and despite HHS claims that ICD-10 is vital, it’s easier to keep delaying it than to reach an actual decision about its merit.

Reader Comments

The saying is, “Build a better mousetrap and the world will beat a path to your door.“ The saying is not, “Build a different mousetrap, pay out 19 billion dollars in incentives to use the mousetrap, mandate its use by law and punish those who fail to adopt it. Then shove the world kicking and screaming against their will through your door” … For the federal government to mandate the use of EMRs by every physician out there just because it works at the VA would be like telling the entire world, “OK, we made it to the moon. Now it is your turn. Any country that has not put a man on the moon within the next five years will be bombed. Every country that complies with this mandate will get a check for $1B. For those countries who fail to comply with this mandate, shelling will begin at 1:00 a.m, five years from today.” …The EMR had become the primary influence in the interview. The dynamic had changed. The patient and I were now both in the room to feed the hunger of the software … Physicians used to write their orders and clerks would enter these data into the computer. Under the new mandates, the physician is now a data entry clerk. What’s next? Is each hospital CEO going to be required to spend two hours a day manning the switchboard?

From Dim-Sum: “Re: DoD EHR. DoD looked at Judith’s big Kaiser win, calculated additional funds for development of a down range medicinal solution, and added a chunk for COTS vendors to certify their teams for Tier 1,2 & 3 support. That figure, for all practical purposes, is $5.5 billion USD. The SI prime wants 40 percent of the pie. COTS EHR vendors will want $1.8 billion USD . Does anyone see the math does not add up? To add to the confusion and muffled numbers is the fact that a CMMI 3 firm will come in and state that COTS can’t create or engineer a down range solution, so they will want $500M – are we seeing a trend here? COTS EHR vendors cannot fathom Agile Scrum, let alone CMMI 3 mediocre results, Everyone forgets that software vendors in the US usually charge 16-20 percent of original software list for ongoing annual support — those numbers are included, so the hopes and dreams of the average EHR vendor is shattered. They will have to come down by $0.5 billion, round down their fee so they can recoup recurring revenue of 20 percent ($200 million a year) of the leftover amount to secure a more realistic number of $800 million. Your SI buddies want COTS vendors to be realistic, stop your silly dreams – you never heard of SPAWAR (Latin meaning “Beltway ONLY.”) SIs deserve the cash because they have no idea how to develop competitive software, so they want your knowledge on the cheap, they are program managers, they are the conduit in to the psyche of the DoD. The DoD does not value software, they value stability and sustainability and salute predictability. That is why it is so hard for COTS vendors to believe that the DoD blew $10+ billion USD for the monstrosity they have today and are hoping COTS EHR vendors can save the day.”

From Bill O’Sayle: “Re: FDA recalling McKesson’s anesthesia software. Both Cerner and Epic (for example) now have products to consume medical device data straight into their EMRs (i.e. Cerner iBus). Do you think this means then that EMRs with such capability are now at risk of such a recall? I can’t see Cerner putting their PowerChart install base at risk of a recall just so they (Cerner) can claim medical device integration. But if this is the logic of the FDA, then that seems to be the case, no?” The lab software model is that the instrument interface requires FDA’s approval, but the system that uses its information doesn’t (except for blood banking systems). I’m speculating, without knowing the details, that McKesson’s anesthesia product may have medical device integration built in, which puts the whole product within FDA’s purview. But given my “without knowing the details” disclaimer, I’d be interested to hear from someone who knows more than I.

From HIMSS EHR Association: “Re: EHR Developer Code of Conduct. A correction to Mr. H’s thoughts on the McKesson/FDA matter. The EHRA  strongly recommends that all vendors developing EHR products, regardless of membership in the EHRA, adopt the Code of Conduct. However, it is not a condition of membership in the EHRA. The 17 vendors that  adopted the Code of Conduct as of February were recognized at HIMSS14. Since then, three additional vendors have adopted the Code. The EHRA is hosting a webcast on Friday, March 28 to educate more vendors on the elements included in the EHR Developer Code of Conduct and the benefits of adoption.”

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: Dr. Gregg asks if being OK is OK and notes that the hard part isn’t achieving perfection but learning to be OK with OK. CMS warns EPs of possible system delays as providers submit MU attestation data by the March 31 deadline. The American Academy of Ophthalmology launches IRIS Registry, a centralized data repository that aggregates outpatient clinical data from EHRs. Epic, eClinicalWorks, and Allscripts claim the biggest shares of the ambulatory EHR market. Naval Branch Health Clinic Albany (FL) offers secure messaging services through RelayHealth. AHIMA warns that the use of copy and paste functionality in EHRs should be permitted only in the presence of strong technical and admin controls. While checking out these stories, why not sign up for the spam-free email updates so you won’t miss something important? Thanks for reading.

This week on HIStalk Connect: Six senators send a letter to the FDA seeking clarification over medical app regulation. Beth Israel Deaconess Medical Center will expand the use of Google Glass by ED clinicians after finishing a successful three-month trial. Reflexion Health raises $7.5 million to expand development of a Microsoft Kinect-based platform designed to support physical therapists and their patients.

I had some site problems over the weekend through Wednesday, which caused some downtime and the temporary disappearance of some posts and comments. Hopefully it’s all fixed now. Geek details: the webhost monitors web traffic and noticed IP traffic containing HIStalk’s server password, leading them to discover a root trojan that would have allowed its creator to take control of the server. That required building a new virtual server and migrating all the settings and large MySQL databases over to an environment containing fresh installs of PHP and Litespeed, which often brings up odd permissions and database problems. It’s been quite a pain – I watched the site and the open support ticket for 15 hours on Saturday alone and slept only a couple of hours, but problems delayed the actual migration until Tuesday evening.

Upcoming Webinars

April 2 (Wednesday) 1:00 p.m. ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

AirStrip acquires the assets of wireless fetal/maternal monitoring provider Sense4Baby and licenses the technology from the Gary and Mary West Health Institute.

Sales

Southern Illinois Healthcare selects CPM CarePoints, ExitCare, Mosby’s Nursing Consult, and Mosby’s Skills from Elsevier.

Gracepoint Management (FL) will implement the Plexus Revenue Cycle Management service from Netsmart across its network of 48 behavioral health and drug and alcohol treatment centers.

People

TeleTracking Technologies hires Susan Whitehurst (Joint Commission Resources) as managing director of consulting services.

Innovative Consulting Group names David Kissinger (Leidos Health) regional VP.

Wellspring hires Matthew Joyce (Stout Risius Ross) as SVP of sales.

Announcements and Implementations

Bradley Healthcare and Rehabilitation Center (TN) begins transitioning to PointClickCare EMR.

Henry Ford Health System (MI) joins the Michigan Health Connect HIE.

Government and Politics

The HHS OIG finds that a federal database for tracking Medicaid fraud isn’t working as intended, with 17 states and the District of Columbia failing to provide information on providers banned from billing Medicaid. The database also contains missing National Provider ID numbers and  names of “terminated” providers who are actually dead.

Technology

Medicity earns a patent for its technology for connecting referral networks and another for its technology to centralize communications between providers and patients using cloud-based mobile technology.

Other

Continua Health Alliance announces availability of its 2014 Design Guidelines.

The eHealth Initiative launches its 2020 Roadmap to guide the transformation of the nation’s healthcare system by 2020. The roadmap will focus on recommendations tied to Meaningful Use, system interoperability, care delivery transformation, and a balance of innovation and privacy.

Online second opinion service Best Doctors launches the Medting medical exchange.

Weird News Andy calls this story “dueling paramedics.” A woman being transported by ambulance for possible stroke gets out of the ambulance after the two paramedics started arguing bitterly about a personal issue. WNA also observes the skyrocketing healthcare salaries in Cuba, where huge percentage boosts will give nurses an income of $25 per month, while physician specialists will earn $67 per month, up from $26.

Sponsor Updates

• HealthMEDX hosts its user group meeting next week in Branson, MO.
• CommVault publishes a white paper highlighting findings of a nationwide survey of healthcare IT managers, which suggest that healthcare data from a variety of sources could overwhelm the healthcare delivery system.
• HCS announces that all of its Interactant modules meet ICD-10 standards.
• Craneware hosts a series of one-day user group meetings in advance of its October Revenue Integrity Summit in Las Vegas.
• PDS provides details of its 2014 Tech Conference October 22-23 in Madison, WI.
• Nordic Consulting CEO Mark Bakken will deliver the keynote address at Madison’s startup incubator Gener8tor’s winter premiere night on April 3.
• Wolters Kluwer Health enhances its UpToDate App for the Android mobile platform.
• Kareo CEO Dan Rodrigues discusses his company and the power of cloud computing for small- to medium-sized practices.

EPtalk by Dr. Jayne

Everyone at the hospital is buzzing about the possibility that ICD-10 will be delayed as part of the legislation addressing the Medicare physician payment cut. Both CHIME and AHIMA have come out against the ICD-10 provision, stating that delaying it would negatively impact innovation and health care spending.

Athenahealth’s VP of government affairs, Dan Haley, quickly blogged about it in response. His main assertion is that a delay would only reward vendors who didn’t work hard enough to meet deadlines which have been published well in advance. His secondary point is that for the legislature to delay ICD-10 after the head of CMS has said multiple times that there will be no further delays is akin to a child receiving dessert after his parent had previously told him no.

As much as I’d hate to see my colleagues and their employers suffer when their vendors are not ready, it may take something this dramatic to really thin out the vendor herd. We’ve known this deadline was coming for a very long time and for vendors to still be unable to meet it is inexcusable. We can blame it on MU and the fact that we have a perfect storm of governmental requirements massing to hit us all at once. We can blame it on all kinds of things but the bottom line is that many vendors have delivered despite all those factors.

I don’t have a crystal ball to see how this is going to morph as it works its way through Congress, but it just goes to show that there’s never a dull moment in health IT. Many of my colleagues are already using it as an excuse to stop working on ICD-10 even though the legislation hasn’t been signed. In the words of Julia Roberts as Vivian Ward: “Big mistake. Big. Huge.”

Speaking of mistakes, several readers have written about the issues mentioned in Monday’s Curbside Consult. One of the problems I encountered was an issue with having multiple aliases in a hospital’s patient portal. A reader pointed out that issues like this are not only patient safety issues, but can also play into national safety:

I’m sure you’ve seen the articles about the so-called “Boston Bomber” entering the US undetected because he spelled his name differently than what was on the official watch list (Tsarnayev v. Tsarnaev). Seriously? The CIA was confounded by the unexpected insertion of the letter “y” into a person’s name … a person on a monitored watch list?  Seems incredible. If the CIA can’t figure out how to address probable name variances, then I’m not so surprised that your large academic medical center can’t figure out how to fix an alias name in its EMPI.

Other readers sent their own stories of IT systems run amok not only in healthcare, but in other industries as well. The pace of change is so great that little things like accuracy and completeness can’t seem to keep up. As long as the majority of people think technology is the solution to everything, I don’t see things slowing down.

I haven’t mentioned shoes or wine in a while, so I was excited to find this piece about a way to remove the cork from a wine bottle using only a man’s dress shoe.  The article contains an engineering explanation of the fluid dynamics responsible for it working. Unfortunately ladies’ heels don’t work well due to the angle of the sole, so Inga and I are out of luck. If you’re looking for a few good laughs, however, make sure you check out the comments section.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

News 3/26/14

Top News

The GAO looks at HIE efforts in four states and  finds a lack of sufficient health data standards, variations in privacy rules across states, difficulties matching patient records,  and concerns over covering exchange costs. GAO recommends that CMS and the ONC develop and prioritize specific actions to advance HIE and develop milestones with time frames to gauge progress.

Reader Comments

From The Reverend: “Exemption letter. A little mentioned part of the exemption that was offered up as “Vendor Certification Issues” for Meaningful Use 2 is that it requires the vendor to provide the EP with a letter. There is no guidance on what the letter must contain, who it needs to come from (vendor CEO, sales person, tier I tech support), or how to attach it to the exemption itself, but it a required (marked with a *) part of the exemption. The exemption also requires the EP to list the exact version they are currently running…which is obviously not the 2014 certified version (*because if it was, we wouldn’t be applying for the extension.) I am quite certain I am not the only concerned/confused person about this. It sure seems like it may be hard to extract this ‘letter of shame’ from the vendor. Can you help me?” If anyone can offer The Reverend some advice, please share.

HIStalk Announcements and Requests

Mr. H is taking the night off, hopefully doing something fun, meaning I’m flying solo. Thanks for reading.

Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries. 

Acquisitions, Funding, Business, and Stock

Healthcare data analytics firm IMS Health expects to set its IPO price at $18 to $21 a share, giving the company a valuation of up to $6.97 billion.

Cloud storage provider Box looks to raise $250 million in an IPO. For the year ending January 31 Box reported revenue of $124.2 million with losses of $168.6 million. 

Sales

Prime Healthcare Services’ Roxborough Memorial Hospital (PA) selects Wellsoft EDIS.

Baptist Health Care (FL) signs a multi-year agreement with MedAssets for multiple cost management and operational efficiency solutions.

People

Physician connectivity platform provider Updox hires Pat Bickley (Health Care DataWorks) to lead product management.

Xerox names Robert Zapfel (IBM) president of Xerox Services, replacing the retiring Lynn Blodgett.

Marc Krellenstein (Relay Technology Management) joins Decision Resources Group as SVP/CTO.

Health Revenue Assurance Holdings appoints Dennis Veasman (MModal) SVP of business development and sales.

Announcements and Implementations

Aprima Medical and Etransmedia announce an upgrade program for Etransmedia customers using the Allscripts MyWay platform. Etransmedia customers, which include providers that purchased MyWay through Costco, have the option to become an Aprima client, or, to use the Aprima system but remain a hosted client of Etransmedia. Both options provide current Etransmedia customers with one free Aprima licenses for each existing MyWay license.

ProHealth (WI) utilizes consulting services from Perficient to become the first healthcare system to produce reports and data out of Epic’s Cogito data warehouse in a production environment.

St. Francis Health System (OK) will go live across its 70 physician offices in May and at its hospitals in June.

The Robert Wood Johnson Foundation launches Flip The Clinic, an initiative meant to transform the average doctor visit to be more satisfying. The idea is to have the Flip The Clinic website serve as a hub for patients, providers, and other stakeholders to share ideas for improving the physician visit experience so that it’s more satisfying for patients and optimizes physician expertise. After reading Dr. Jayne’s latest Curbside Consult I’m hoping she will evaluate the site and share her opinions.

The South West Alliance of Rural Health’s Portland Hospital (AU) implements TrakCare Medication Management from InterSystems.

Government and Politics

Provider uncertainty is slowing implementation of the Designated Test EHR Program according to a representative from Meditech, which is one of three companies serving as test vendors. The ONC admits receiving a “decent amount” of questions on the program and says documentation is being developed to guide providers. Meanwhile, John Valutkevich, Meditech’s manager of interoperability initiatives notes that the ONC information already exists but many physicians and staff “don’t even know where to start.” I did a quick surf of the both the CMS and HealthIT.gov websites and I wasn’t able to locate relevant details, so I’m not surprised that providers are confused. Not for the first time I’m left to conclude that CMS and the ONC have plenty of “opportunities” to improve navigation on their sites.

HHS announces it strategic plan for 2014-2018 which includes an objective to meaningfully use HIT to improve healthcare and population health. Some of the noted HHS-supported initiatives include the promotion of HIT and standards through the MU programs; support for remote patient monitoring and telemedicine technologies; and promotion for programs such as Blue Button to engage and empower patients.

Massachusetts eHealth Collaborative CEO Micky Tripathi tells participants at a Federal Trade Commission workshop that HIT and HIE are “beginning to take off” now that the market is better rewarded for their adoption. He also warns that the industry is now seeing “a lot of tension” over the appropriate role of government in Stage 2 and Stage 3. I don’t know the full context of Tripathi’s statement but it seems the “tension” is less about the government’s role and more about what objectives and measures should be included and what tweaks should be made to the timing of the program. After all, doesn’t the government’s “role” include “owner” of the MU program?

Innovation and Research

Analysis by West Health Institute finds that widespread medical device interoperability could eliminate $36 billion in waste in the health care system and increase clinician efficiencies. Direct cost savings could be driven by avoiding redundant testing and reducing adverse events.

Other

EHR usage in small physician offices has helped spur overall EHR adoption to 61 percent, according to an SK&A report on physician office EHR use.

Disturbing: a Topeka, KS man opens a dumpster in his office complex and finds discarded medical records, complete with patient names and social security numbers. Perhaps not coincidentally a document scanning service also has an office in the same complex. The state attorney general’s office have removed the charts for further investigation.

The Federation of State Medical Boards consider a telemedicine policy that would require physicians to be licensed in the state where the patient is located and would require the same standards of care for both virtual and face-to-face encounters. Opponents of the proposal believe the licensing requirement creates an unnecessary barrier to telehealth expansion and adoption.

Scientists from Johns Hopkins University (MD) and George Washington University (DC) claim their flu tracking method using Twitter was 93 percent accurate during the last flu season when compared to CDC-collected data. Google’s Flu Trend tool was recently criticized for overestimating flu prevalence by more than 50 percent.

Some features of EMRs are unintentionally contributing to patient harm according to the recently released Maryland Hospital Patient Safety Program Annual Report. The report notes that the Office of Health Care Quality “received numerous reports of adverse events in which IT system omissions or glitches contributed to adverse events.”

Sponsor Updates

• Healthx will add InstaMed Member Payments to its member portal solution.
• Madison Magazine names Vonlay to its list of best places to work in technology for employers with over 100 employees.
• CareVia will integrate its remote patient monitoring capability with the Harris FusionRX healthcare integration platform.
• Surescripts awards e-MDs its White Coat of Quality award for applying best practices to the use of e-prescribing technology.
• PatientPoint will deliver its population health management solutions with HealthTronics IT solutions for urologists.
• Consulting Magazine names Akhila Skiftenes of Aspen Advisors and Ryan Uteg of Impact Advisors to its list of 35 Rising Star consultants under the age of 35.
• Vecna, a provider of patient self-service solutions, will add Fujitsu’s PalmSecure technology to Vecna’s On-Site Registration solution.
• TriZetto recommends that organizations identify the top ICD-9 codes used in their highest dollar claims to reduce claim rejections after the ICD-10 transition.
• Health Catalyst profiles Texas Children’s Hospital and how the organization used Health Catalyst’s late-binding Enterprise Data Warehouse and analytics apps in its Pediatric Radiology department to improve patient care and achieve $400,000 in savings.
• Health Catalyst hosts a two-day Healthcare Analytics Summit September 24-25 in Salt Lake City.
• Dallas Business Journal names MedAssets to its list of 2014 Healthiest Employers.
• CareTech Solutions serves as a technology sponsor for IABC Detroit’s Renaissance Awards, which honor the best in business communication in Southeast Michigan.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 3/24/14

Top News

Three Detroit hospital systems – Beaumont, Oakwood, and Botsford – announce plans to merge into an eight-hospital, $3.8 billion system, citing shared electronic medical records as one of their four goals.

Reader Comments

From Tom: “Re: McKesson’s FDA Class 1 recall. The description of their product Anesthesia Care could generically be applied to almost any EMR/EHR/CIS vendor’s AIMS product and yet the FDA’s decision-making clearly does not apply to vendors equally. Also I wonder how the regulation of CDS would affect a hospital who develops their own CDS?” FDA’s highest-level recall of McKesson Anesthesia Care may be sending a message that the agency considers even software-only clinical decision support to be high risk. McKesson defines its product as an anesthesia information management system, which it also calls an “anesthesia EMR.” McKesson sought and received FDA premarket clearance apparently because the system collects data from physiologic monitors. McKesson did a voluntary recall of its product in March 2013 after a customer reported that the software pulled up the wrong patient’s information, with two other customers reporting later that it had lost medical history comments and misconnected to a physiologic monitor, affecting one patient in each instance. Some thoughts:

• McKesson Anesthesia Care is a software-only system that does not control medical devices. It collects and uses information from patient monitors. Other than that, it’s like any other high-acuity, unregulated EHR (surgery, ICU, ED, etc.)
• FDA would not have been involved if the patient monitor connection hadn’t pushed the product into its regulatory arena. FDA regulates software that makes independent patient decisions or connects to regulated devices, with the idea being that those systems are devices working on their own rather than simply providing guidance to users.
• Software vendors usually hide contractually behind the “professional judgment” test that says even if their software gives incorrect information or bad advice that harms patients, the clinical professional who uses the system makes the final decision and is solely responsible for the result.
• The danger to patients is the same as for any other clinical decision support or even EHR software. Mixing up information between patients could be disastrous any time software is presented information or recommending actions. However, high-acuity systems give users less time to make important decisions, so that probably should be a consideration in determining patient risk.
• McKesson planned to announced a Class II recall (meaning the problem wasn’t likely to cause patient harm) but FDA overrode that proposal and initiated a Class I recall indicating that patients could be harmed.
• McKesson notified users almost immediately when the first problem was reported in March 2013, but FDA’s recall didn’t go out until a year later.
• It’s not clear what users of the system should do as an alternative, or what action they may have taken since the original McKesson notification last year.
• Vendors of systems that perform equally critical functions that aren’t connected to medical devices can take whatever action they want if they are faced with the same problem since their software isn’t regulated by FDA. Other than to avoid legal exposure, they could arguably not inform customers at all.
• McKesson is a member of the HIMSS Electronic Health Record Association, a trade group that requires them to sign the EHR Developer Code of Conduct asserting, “We will notify our customers should we identify or become aware of a software issue that could materially affect patient safety, and offer solutions.” The other inpatient EHR vendor members are Allscripts, Cerner, Epic, GE, NextGen, and Siemens.
• McKesson backed legislation introduced last month (along with athenahealth, IBM, and trade groups) that would reduce “unnecessary regulatory burdens” by limiting FDA’s oversight of “low-risk health IT, including mobile wellness apps, scheduling software, and electronic health records.” 
• FDA is running late in producing a report that it says will explain its position on regulation of clinical decision support systems.

From LochnessMonster: “Re: McKesson. Reduction in force 3/20/14, roughly 300 under Pat Blake organization (uncertain number).” Unverified, but reported by multiple readers, one of them saying that the targeted areas were Horizon and Paragon.

From Bootay: “Re: vendor-convened panels. You should participate or report the results.” I don’t think so. I’ve seen many times where properly objective people turned into fawning, attention-starved glad-handers just because some company tries to buy their love by inviting them to be a speaker or advisor. It makes my skin crawl to see the obvious mutual sucking up as mutually expectant backs wait to be scratched.

HIStalk Announcements and Requests

A slight majority of respondents don’t think patients should have a greater role in the HIMSS conference. New poll to your right: who’s most responsible for the problems with health insurance exchanges?

Welcome to new HIStalk Platinum Sponsor ScImage (pronounced sye-image). The Los Altos, CA-based imaging and informatics company offers solutions that include enterprise imaging, radiology, cardiology, Echo PACS, ECG, cloud PACS,  EMR content management, vendor-neutral archive, and a Web-based DICOM exchange. Case studies include Missouri Baptist Medical Center’s cardiology PACS, Blessing Hospital’s enterprise PACS, and US Air Force’s cardiology consultation program. The privately held, employee-owned, debt-free company says it has never sunsetted a product or required a forklift upgrade. According to a physician at Cedars Sinai Heart Institute, the company’s products are the “ultimate value proposition” to its cardiology practice. Thanks to ScImage for supporting HIStalk.

Here’s ScImage PACS consolidation overview I found on YouTube.

Teach for America teacher Ms. A sent pictures of her students using the Chromebook that we as HIStalk readers provided to her first grade classroom in Maryland via DonorsChoose. They’re using it to access online reading and math programs.

Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

Acquisitions, Funding, Business, and Stock

WelVU, which offers a personalized patient education application, raises $1.25 million in an initial seed round.

People

Effingham Health System (GA) promotes Mary Pizzino to CIO.

CHIME promotes Keith Fraidenburg to EVP/chief strategy officer.

Announcements and Implementations

Physicians at Jupiter Medical Center (FL) are piloting the use of email alerts and status updates when their ACO patients are seen in the ED or urgent care center. The press release is poorly written and the product has a confusing name: MicroBloggingMD. I saw their booth at HIMSS and thought it was yet another doctor writing a blog.

Government and Politics

Connecticut officials say Massachusetts owes the state $10 million of the $45 million in federal money it received to build its struggling Massachusetts Health Connector. The original grant called for Massachusetts to share its technology plans with other New England states, but those other states realized they could get their own federal money for building exchanges and went their own way, with Connecticut receiving $140 million, Rhode Island $113 million, Vermont $168 million, and Massachusetts a total of $179 million. Massachusetts says the money wasn’t intended for the other states – they were added on to the grant application at the last minute after pressure from the White House and Governor Deval Patrick to make Massachusetts a model for the rest of the country. Access Health CT’s CEO says that unlike the dysfunctional, CGI-built Massachusetts exchange, their Deloitte-created one works fine, adding, “Some states were trying to build a Maserati. We built a Ford Focus. It might not be as glamorous, but it runs. It can get you to the store.”

Technology

Google is a bit touchy over Google Glass, having previously urged its users to avoid the “Glasshole” label by not being “creepy or rude.” Now it shares “The Top 10 Google Glass Myths,” the one above being notable considering that people (some of them Glassholes, no doubt) are already using it in patient care. Google published the statement on Google Plus, which means almost nobody other than its own employees will see it.

Other

Duke University Health System (NC) will pay $1 million to settle charges that it overbilled the government by unbundling claims and billing for PA services in heart surgery. Duke says its mistake wasn’t intentional, but instead “resulted from an undetected software problem and through possible misapplication of certain technical billing requirements.” A former Duke employee had filed the whistleblower lawsuit.

In England, the local newspaper reviews the 2012 Meditech go-live at Rotherham NHS Foundation Trust that caused delays in cancer treatment, lost appointments, and cost the hospital $2 million in revenue. It mentions the project review, which found that delivery targets weren’t specific, penalties clauses were vague, and the 18-month timetable was unrealistic given that the system had never been implemented in the UK. Taxpayers got stuck with $17 million in cost overruns on top of the budgeted cost of $49 million.

A two-doctor cardiology practice in Texas will pay $3.9 million to settle Medicare fraud charges for conducting unneeded procedures. Authorities requested data from 100 nuclear tests that had been performed, but the doctors provided only 37, saying their computer had crashed and the other results were lost. The investigators found that 19 of the 37 tests had been interpreted incorrectly and 75 percent of them were performed wrong. The same foreign-born doctors were part of a group that settled for $27 million in a 2009 Medicare fraud case.

Stanford Hospital & Clinics and its former collections agency are expected to pay $4.1 million to settle charges that the information of 20,000 ED patients was posted online for nearly a year. Stanford says it encrypted the information sent to the agency, but that company forwarded it to get help creating a graph and the worksheet ended up on a student homework site.

A Motley Fool review of mobile health in China, which a Brookings Institution report says will be worth $2 billion per year by 2017,  says the three publicly traded companies that will benefit most are IBM, Microsoft, and Lenovo. It says the market won’t behave as it does here because Chinese medicine has different workflows, the language is hard, cloud-based security is a tough sell, and Apple’s mobile devices are much less popular than Android ones. It misses some facts: (a) most mHealth companies aren’t publicly traded; (b) those three companies are so large that whatever happens with mHealth in China isn’t going to move the share price; (c) it touts Microsoft as having implemented “a single, cloud-based system” that turns out to be the nearly forgotten HealthVault; (d) it predicts Lenovo’s success because it makes hybrid devices (laptop/tablet) that run Windows 8 and because it bought Motorola and found itself owning 11.8 percent of the smartphone market in China, although the article fails to mention Lenovo’s huge benefit: it’s a Chinese company.  

Sponsor Updates

• Health Data Specialists will exhibit at the Cerner Southeast Regional Users Group March 30 – April 4 at the Sheraton Sand Key in Clearwater Beach, FL.

Exhibitor Costs at the HIMSS Conference

Readers had asked for details on what it costs a company to exhibit at the HIMSS conference. I greatly appreciate the vendor executive (let’s call him “Larry,” just to keep things anonymous) who provided complete information from last month.

Booth construction: $132,000
Booth space (20×40): $26,000
Booth power and connectivity: $20,000
Breakfast briefing: $11,000
Hospitality suite: $15,000
Printing: $6,000
Giveaways: $4,000
Booth graphics: $2,500
Buying the attendee list: $1,800

Including some other smaller costs, the company’s total expense was $222,000. That doesn’t include employee salaries or travel costs.

Larry says he’s happy with the outcome. The company had 400 people visit the booth for meetings or to see a demo. About half of those had been scheduled in advance, which is an efficient way to meet with prospects, and the other 200 were walk-ups who might become prospects. He also sees value in the employee bonding experience and being able to learn from attendees.

It’s the same as for attendees, in other words: HIMSS benefits from putting interesting people in the same place at the same time. The attendees derive their value from each other.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.