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News 6/18/14

June 17, 2014 News 16 Comments

Top News

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

Upcoming Webinars

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

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

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

From the Streamline Health Solutions earnings call:

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

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

Sales

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

The FHP Health Center (Guam) selects eClinicalWorks.

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

People

Practice Fusion names Robert Park (Chegg) as CFO.

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

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

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

Innovation and Research

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

Other

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

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

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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Monday Morning Update 6/16/14

June 14, 2014 News 3 Comments

Top News

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

HIStalk Announcements and Requests

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

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

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

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

Announcements and Implementations

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

Government and Politics

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

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

Other

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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News 6/13/14

June 12, 2014 News 13 Comments

Top News

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

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

Upcoming Webinars

Acquisitions, Funding, Business, and Stock

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

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

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

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

Sales

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

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

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

People

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

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

Innovation and Research

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

Other

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Contacts

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

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News 6/11/14

June 10, 2014 News 12 Comments

Top News

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

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

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

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

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

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

People

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

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

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

Announcements and Implementations

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

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

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

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

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

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

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

Government and Politics

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

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

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

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

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

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

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

Other

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Monday Morning Update 6/9/14

June 8, 2014 News 6 Comments

Top News

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

Reader Comments

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

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

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

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

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

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

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

Jodi Daniel, policy. Lawyer and government.

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

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

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

Kim Lynch, programs. Government and REC.

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

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

Joy Pritts, chief privacy officer. Lawyer and professor.

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

Nora Super, public affairs. Government relations.

Steve Posnack, standards and technology. Government.

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

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

HIStalk Announcements and Requests

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

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

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

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

People

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

3M Health Information Systems promotes JaeLynn Williams to president.

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

Announcements and Implementations

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

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

Government and Politics

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

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

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

Innovation and Research

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

Other

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

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

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

12-12-2013 8-47-43 PM

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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News 6/6/14

June 5, 2014 News 12 Comments

Top News

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

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

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

People

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

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

Announcements and Implementations

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

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

Government and Politics

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

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

Research and Innovation

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

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

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

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

Other

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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News 6/4/14

June 3, 2014 News 13 Comments

Top News

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

People

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

Other

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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From Health Datapalooza 6/2/14

June 3, 2014 News 5 Comments

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

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

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

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

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

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

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

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

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

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

Some of the other booths I visited were:

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

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

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

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

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

Lorre’s Impressions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday Morning Update 6/2/14

May 31, 2014 News 12 Comments

Top News

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

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Announcements and Implementations

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

Government and Politics

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

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

Other

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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News 5/30/14

May 29, 2014 News 5 Comments

Top News

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

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

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

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

Allina Health (MN) chooses Omnicell for medication automation.

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

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

People

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

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

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

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

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

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

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

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

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

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

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

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

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

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

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

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

— Sherry Reynolds (@Cascadia) May 29, 2014

Other

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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News 5/28/14

May 27, 2014 News 4 Comments

Top News

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

People

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

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

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

Announcements and Implementations

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

Government and Politics

From The Onion.

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

Innovation and Research

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

Other

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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Monday Morning Update 5/26/14

May 24, 2014 News 13 Comments

Top News

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

Reader Comments

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

HIStalk Announcements and Requests

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

Announcements and Implementations

KLAS announces that it is developing a myKLAS mobile app.

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

Government and Politics

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

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

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

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

Innovation and Research

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

Other

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

HIMSS congratulates some new EMRAM Stage 6 organizations.

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

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

— Pallav Sharda (@Pallavsharda) May 23, 2014

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

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

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

Photo: Pete Marovich/EPA

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

Book Report
Where Does It Hurt?

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

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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News 5/23/14

May 22, 2014 News 3 Comments

Top News

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

ZirMed acquires population health management platform vendor Intelligent Healthcare.

Sales

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

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

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

People

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

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

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

Announcements and Implementations

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

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

Government and Politics

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

Innovation and Research

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

Other

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

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

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

What do you think about the proposed changes to MU? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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News 5/21/14

May 20, 2014 News 2 Comments

Top News

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

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

— Patrick Dempsey (@PatrickDempsey) May 20, 2014

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

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

Sales

Vanderbilt University Medical Center chooses Allscripts EPSi for financial planning.

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

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

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

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

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

People

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

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

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

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

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

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

Other

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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Monday Morning Update 5/19/14

May 17, 2014 News 15 Comments

Top News

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

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

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

Listening: new Tori Amos.

Announcements and Implementations

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

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

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

Other

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

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

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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News 5/16/14

May 15, 2014 News 2 Comments

Top News

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

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

People

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

Lee Fowinkle (McKesson) joins InformedDNA as CTO.

Announcements and Implementations

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

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

Government and Politics

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

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

Innovation and Research

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

Other

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.

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News 5/14/14

May 13, 2014 News 7 Comments

Top News

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

Reader Comments

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

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

Sales

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

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

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

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

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

People

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

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

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

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

Innovation and Research

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

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

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

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

Other

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

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

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

— Sean Nolan (@familyhealthguy) May 13, 2014

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

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

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

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

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

Smartphones
WiFi
BYOD
Government mandates
VoIP
Social media
Virtualization
IP-based medical devices
Mobile health
Big data

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.

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