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Monday Morning Update 10/10/16

October 9, 2016 News 18 Comments

Top News

The legal effort by Parkview Hospital (IN) to keep its chargemaster prices and insurance discounts secret fails, forcing it to provide the information demanded by an uninsured patient who sued the hospital after receiving a bill for $625,000 for a three-month stay after a car accident. The patient says the bill isn’t reasonable since the hospital discounts its services to insurance companies while charging uninsured patients list price. The state’s Hospital Lien Act allows patients to negotiate bills when a hospital files a collection lien against them.

The hospital’s attorney argues that insurers are given discounts because of the patient volume they provide and that the patient’s guardian signed a an admission agreement that included a 35-word “agreement to pay” paragraph. “We don’t think a person who is not a member of the club should get the benefits of the club,” he said. Other healthcare lawyers say hospitals don’t have a choice in offering discounts because insurers won’t sign a contract with them otherwise.

Legal experts say that if their debt collection practices are questioned by a ruling for the plaintiff in this case, hospitals will probably switch tactics to instead use breach of contract lawsuits, which have favorable legal precedents in Indiana.

A billing expert hired by the patient concludes that the reasonable value of the services he received was $247,000, which would represent a 60 percent discount to billed amount.

Reader Comments

From Stick and Rudder Man: “Re: Epic. Does its Boost program even exist? Our experience from making requests is that no one is ever available. Recent networking with other clients suggests that our experience is not unique.” I’m not familiar with that program and found no references to it on Epic’s site, so I’ll ask knowledgeable readers to comment.

From Golan Heights: “Re: MedCPU. Looks like leadership change.” I didn’t see an announcement, but comparing old vs. new versions of the company’s executive page calls out the removal of the company’s two co-founders, promotion of the CFO to the CEO position, and the departure of two other executives. MedCPU has raised $51 million, $35 million of it in May 2016.

From Block and Tackle: “Re: HIStalk. It’s being blocked in the Middle East countries, which I experienced when traveling to Bahrain and Dubai over the past two weeks. Not sure if you care much about getting traffic from there, although given the level of IT activities and the global nature of your sponsorship base, it could be an expansion opportunity. Not getting our weekly dose of HIStalk news causes a lot of anguish!” I’ve heard that before, although reports were inconsistent.

HIStalk Announcements and Requests

Attention speakers and Webinar presenters: people hate it when you: (a) read from your slides; (b) place your pitch ahead of the educational needs of your attendees; (c) cram too much material on your slides; and (d) talk too much about yourself and your employer. I’ll side with the majority: PowerPoint, when used by unskilled presenters as a Teleprompter instead of as a visual aid to complement their enthusiastic and not overly rehearsed verbal narrative, is pure evil.

New poll to your right or here: how much of your work day involves talking about patients and their needs?

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

Thanks to the IT department of Centura Health (CO), which raised $1,500 for my DonorsChoose project, doubling last year’s total. I applied matching funds in fulfilling these STEM-related grant requests Friday and have already received grateful emails from all of the teachers. Classroom photos will follow once the students begin using their new materials.

Genetics kits (plant lights and seeds) for Ms. T’s high school class in Juneau, WI
A document camera and wireless keyboard for Ms. N’s third grade class in Lugoff, SC
Math games for Ms. L’s kindergarten class in Chicago, IL
A math gaming system for Mrs. S’s second grade class in Virginia Beach, VA
A media studio for producing a daily school news show for Ms. C’s middle school class in Citrus Heights, CA
Multimedia teaching technology for Ms. C’s high school class in Philadelphia, PA
Math manipulatives for Ms. R’s elementary school class in New York, NY
Six tablets for Mrs. P’s kindergarten class in Dry Ridge, KY

I also received a donation from Mark and Tammy, which provided programmable robots for Mrs. E’s elementary school class in Greenwood, SC.

Welcome to new HIStalk Platinum Sponsor Black Book. The Tampa, FL-based company offers unbiased, transparently collected, survey-powered research services such as Black Book Rankings, vendor comparisons, customer satisfaction, and market and competitive intelligence. It measures image, attitudes, opinions, awareness, and market share. Users are invited to participate in its user satisfaction and loyalty surveys via its app, with their responses validated using sophisticated data quality tools to ensure accurate, authentic results. Kudos to the company for recently fine-tuning its methodology after noticing and fixing questionable results caused by hospitals completing surveys on behalf of their EHR affiliates, which it likened to a salesperson rating their own merchandise. Here’s the best part: nobody at Black Book has a financial interest in a vendor; the company doesn’t allow companies to pay to participate; and vendors don’t get to review the results until they’re published for the whole world to see. Thanks to Black Book for supporting HIStalk.

I’ve worked in hospitals affected by hurricanes. I would be interested in hearing about your experience with Hurricane Matthew. People might forget that while they’re being urged to evacuate or stay home, hospitals are being staffed by people who are protecting someone else’s family instead of their own.

Last Week’s Most Interesting News

Theranos exits the laboratory business, laying off 40 percent of its staff to focus on commercializing its MiniLab testing machine.
A single Brigham and Women’s researcher gets a $75 million, five-year grant to analyze study participant data, including that generated by wearables, hoping to find early predictors of heart disease.
Warburg Pincus Private Equity files FTC documents indicating that it will acquire Intelligent Medical Objects.
Evolent Health completes its acquisition of Valence Health for $219 million.
Cerner tells the local newspaper that it will aggressively expand its revenue cycle business.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Decisions

Logan County Hospital (KS) will go live on Athenahealth’s RCM system in January 2017.
Bayhealth (DE) switched from McKesson Horizon to Epic in August 2016.
Franciscan Missionaries of Our Lady Health System (LA) will replace Cerner with Epic.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.

People

Kyruus hires John Downey (McKesson Health Solutions) as SVP of sales.

Announcements and Implementations

Peer60 publishes “The Physician’s Take on EHR Suppliers 2016,” which surveyed around 1,000 doctors (75 percent of them in ambulatory practice) about EHRs. Adoption was 85 percent, with the most common systems being those from Epic, Cerner, and Allscripts. Most respondents say they aren’t planning to replace their current systems. Top-ranked Epic joined its competitors in scoring low in Net Promoter Score, but few of Epic’s users reported specific problems or plans to replace it. Usability topped the list of user concerns for all systems, while first-time adopters say cost is what’s holding them back. As Peer60 points out, the market seems to violate Economics 101 in that users are nearly universally unsatisfied with their systems, but don’t see more attractive alternatives.

Privacy and Security

The health minister of Australia apologizes to doctors for publishing a file of de-identified claims data covering 10 percent of the country’s population that was quickly re-identified by researchers who matched the records with other publicly available datasets.

Technology

A small study finds that paramedic documentation improves significantly when they are equipped with body-work video cameras that allow them to review their work afterward.

Other

The Green Beret brother of Maggie Stack, who played the lead role in the Epic UGM production of “Alice in Wonderland” two weeks ago, was killed by an IED while on patrol in Afghanistan last week. Staff Sgt. Adam S. Thomas of the 10th Special Forces Group (Airborne), 31, had earned several Army medals in deployments to Iraq and Afghanistan. ISIS has claimed responsibility for his death.

Vince and Elise close out their “Rating the Ratings” series with ideas on a “do it yourself” rating.

Sponsor Updates

Nordic is recognized in “Best Places to Work in Healthcare” for the third straight year.
T-System and Wellsoft will exhibit at ACEP16 Scientific Assembly October 15-18 in Las Vegas.
TierPoint completes a $12 million TekPark data center expansion.
Valence Health will exhibit at TAHP Annual Conference October 14-16 in Dallas.
Huron offices across the country donate over 4,000 backpacks to local nonprofit organizations.
ZeOmega will exhibit at Washington State Hospital Association’s annual meeting October 12-14 in Seattle.
Zynx Health will exhibit at the 2016 Meditech Physician and CIO Forum October 20-21 in Foxborough, MA.

Blog Posts

Are Your Improper Payments Hiding in Plain Sight? (Verscend Technologies)
Dawn Story’s: VitalWare’s Lesson in Hope (VitalWare)
Learning Curve? What Learning Curve? (Voalte)
OCR to Expand Compliance Reviews of Small Healthcare Breaches (Iatric)
The IMAX of Patient Care (West Corp.)
How we helped Montana expand Medicaid to nearly 50,000 (Xerox)
Put lost revenue from claim denials in the rearview mirror (ZirMed)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 10/7/16

October 6, 2016 News Comments Off

Top News

Theranos CEO Elizabeth Holmes announces that the company will close all its clinical labs and wellness centers and lay off nearly half of its employees to focus exclusively on trying to commercialize its MiniLab testing platform.

Theranos investors continue their high level of cluelessness by inexplicably keeping Holmes as CEO, although at this point her train wreck behavior is about all that remains interesting about the former high flyer.

My bet: Theranos will bleed out all its remaining investor cash before it can get its machine through the FDA to market, and even if the company is successful, nobody’s going to buy a MiniLab given the company’s historical lack of transparency and shady business practices (would you really want to buy diagnostic equipment from someone who is federally banned from all lab involvement?)

Reader Comments

From Tripp the Lite Fantastic: “Re: Drummond Group. A shakeup after it was sold – President Kyle Meadors has left.” Unverified. He’s still showing on the certification company’s executive page (which lists only two people), but his LinkedIn profile shows that he left the company in July. He took the job in November 2015 after the two co-founders stepped aside. I don’t recall that I knew (or cared) that the company was acquired. Drummond and CCHIT were named by ONC as the first authorized testing bodies for EHRs in 2010.

From Nasty Parts: “Re: NextGen. There’s a sales book on the street, according to contact there. The only insiders who will benefit are the Cardinal hires brought over by CEO Rusty Frantz, such as the new CFO whose package included 75,000 restricted stock units.” Unverified.

HIStalk Announcements and Requests

Sixteen companies have joined my little HIStalk sponsor family in the past handful of weeks, motivated in part by the fall new sponsor special offer that throws in the rest of 2016 free for a full-year 2017 sponsorship. Contact Lorre to join them.

Welcome to new HIStalk Platinum Sponsor Learn on Demand Systems. The company’s OneLearn training management system allows organizations of all sizes to deliver experience-based training, software demos, and performance-based assessments in managing programs, instructors, classrooms, schedules, and metrics. Its OneLearn lab-on-demand platform automates the delivery of hands-on labs and product demonstrations, using the hospital’s custom EMR instance (a mirror image, not a simulation) to deliver an Interactive Digital Lab with testing to identify those departments that are (or aren’t) ready for an implementation or upgrade go-live. Everybody gets a sandbox to play in whenever their schedule allows – no more marathon classroom sessions. You can try a live preview of a training lab – I did and it’s very cool (scroll down on the page to launch a sample environment with no sign-up required). The company has reached users in 145 countries, launched 10 million labs, and trained 5 million students for customers that include Google, Microsoft, Citrix, and Caradigm. Thanks to Learn on Demand Systems for supporting HIStalk.

Here’s a screenshot of my playing around with a live preview of Learn on Demand Systems. It presented an exam on the right with links to resources such as a network diagram while in the middle of the screen was a virtual live session of Windows NT (browser based, no setup required), allowing the student to work on a live server while completing a test on how to configure user e-mail accounts.

We provided math games for the third-grade class of Ms. Burkett in Missouri in funding her DonorsChoose grant request. She says her students get excited about math every day because the activities are fun and allow them to work together to solve problems.

The industry’s most talked-about HIMSS party is on. Would your company like to help me pay for it since I’m otherwise personally on the hook for the rather shocking price tag in entertaining 800 or so industry notables? Contact Lorre for sponsorship options that can range from small to blow-out.

This week on HIStalk Practice: Central Virginia Coalition of Healthcare Providers selects CCM software from Smartlink. CityMD partners with Par80 for referral management. Survey shows patients want pricing up front, but providers aren’t prepared to comply. Internet icon advocates for an "NIH for Cybersecurity." AMA unveils new MACRA tools for physician prep. MTBC acquires MediGain and Millenium Practice Management. NHHIO ED Jeff Loughlin helps New Hampshire providers set up a centralized data repository now that they’ve gotten over the EHR implementation hump.

Webinars

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

ICU surveillance monitoring technology vendor Sotera Wireless, which offers the ViSi Mobile wireless sensor, files for Chapter 11 bankruptcy. The company had raised $84 million in nine funding rounds, but none since early 2014.

Consumer wellness software vendor Welltok raises $33.7 million in a Series E funding round, increasing its total to $164 million.

In an unpleasant health IT flashback special, Vista Equity Partners will take England-based Misys public again on the London Stock Exchange, valuing the company at $7 billion in England’s largest IPO of 2016. Vista bought the company for $1.6 billion in 2012, five years after the banking software company sold off its Sunquest and CPR product lines as well as its majority stake in Allscripts in its hasty exit from the healthcare market (they’ve since added “financial software” to their logo to remind themselves of their unsuccessful sector unfaithfulness). I remain amused even now that two British banking software vendors – Misys and Sage – nearly simultaneously made a major mess in their pathetic and fortunately short-lived attempts to milk a US healthcare IT market that they clearly didn’t understand.

Evolent Health completes its acquisition of Valence Health, paying $219 million rather than the originally announced $145 million since the sale price was tied to Evolent’s share price. Evolent says Valence will generate revenue of around $85 million this year.

UPMC Enterprises makes an unspecified investment in RxAnte, a UPMC vendor that uses analytics to predict medication adherence. The company reports $4.6 million in fundraising, all of it in 2012.

Xerox, preparing to split itself into two publicly traded companies, names its business process services segment (which includes healthcare) Conduent. You’ll either be inspired or appalled by the lengthy, marketing-heavy explanation of what every aspect of the made-up word and logo signifies other than that they let creative types run expensively amok (“A bold typeface conveys stability and complements the symbol while acknowledging a 30-year history supporting the critical operations of businesses and governments. A connection between the ‘N’ and the ‘T’ in the typeface of ‘Conduent’ reinforces that the constituent is at the core of the company’s business model. The connected letters also draw the reader’s eye to this unique pronunciation of the coined name.”) Apparently the most important factor in the new company’s eventual success is allowing those last two letters to touch.

Sales

Harrison Memorial Hospital (KY) chooses Santa Rosa Consulting’s InfoPartners subsidiary as its Meditech 6.1 Ready implementation partner.

Island Hospital (WA) chooses Meditech.

In England, Chelsea and Westminster Hospital NHS Foundation Trust selects Cerner, sharing its implementation with Imperial College Healthcare NHS Trust.

In Canada, William Osler Health System will implement Extension Engage for unified clinical communications and collaboration.

Choosing Wellsoft’s EDIS are Angleton ER (TX) and the third freestanding emergency center of Cypress Creek ER (TX).

People

Harry Greenspun, MD (Deloitte) joins Korn Ferry as chief medical officer and managing director of its KF Health Solutions business.

PM/EHR vendor InSync Healthcare Solutions promotes Roland Therriault to president, replacing Tom Wilson.

Gregg Waldon (RedBrick Health) joins Kareo as CFO.

Government and Politics

CMS discloses that it (meaning we taxpayers) paid over $1 billion per year for the past five years buying Mylan’s EpiPens for Medicare and Medicaid patients. The government also claims that Mylan misclassified the allergy injection as a generic drug –which earns CMS only a 13 percent rebate– instead of a brand name product for which CMS would have received at least a 23 percent discount. CMS indignantly tells the press that it has repeatedly warned Mylan that they were mischaracterizing the drug, but doesn’t explain why it kept paying the inflated price anyway.

CMS Acting Administrator Andy Slavitt describes the state of healthcare insurance marketplaces in a Wednesday speech:

We’ve chosen to address the need to transform in most traditional American way possible– through the private sector. Which means we’re relying on innovation and competition to serve consumers best … If anyone’s premise was that by passing one law, we would fix the affordability of health care all at once, that’s just not how it works. We’re here because the law sets a path in motion … Particularly if you see churn in your book– as people move in and out of jobs and struggle with affordability, how do you build loyalty? Are you building on-boarding processes, monthly touch points, and other initiatives that create “stickiness?” Remember, consumers don’t like churning any more than you do … do you have your first tier hospitals contracted to manage aggressive ER utilization so people can get care in the right setting? Have you set up telemedicine, nurse lines, and other convenient forms of both coaching and steerage? Is there free primary care and other incentives to detect health concerns early?

CMS opens a search for a replacement for former CIO David Nelson, who was brought on to save Healthcare.gov before moving to the Nuclear Regulatory Commission in August.

CMS adds hospice payment information to its publicly available datasets.

Privacy and Security

In England, an NHS security official provides a specific example of how far hackers will go to penetrate a hospital. They targeted an employee, looked up his background on LinkedIn to find that he played college rugby, spoofed an email account using the name of the team captain he played with, and included an attachment claiming to be an old team photo of the two of them together. The victim clicked on the attachment, clicked OK to allow it to open, and in doing so permitted the installation of Trojan spyware that probed the network for two weeks until it was discovered. NHS’s particular problem is that 15 percent of its PCs still run the insecure Windows XP either because old apps and devices require it or that money is too tight to upgrade everything.

Innovation and Research

The American Heart Association, Verily Life Sciences (Google), and drugmaker AstraZeneca award a $75 million, five-year grant to Calum MacRae, MD, PhD, chief of cardiovascular medicine at Brigham and Women’s Hospital (MA), for a big data-powered study in which he will apply engineering, computing, and genomics expertise to the data of heart study participants to look for early markers for heart disease. His team will use data from wearables and patient-reported information in attempting to answer the question of why so many patients get heart disease despite having none of the currently known risk factors.

Technology

The RWJF-funded project The Mood Challenge names the finalists of its competition to use Apple’s ResearchKit to assess mood and its relationship to PTSD. BiAffect tracks and predicts mood episodes by the speed and accuracy of the user’s typing, while Aware Study administers weekly surveys and two daily tasks.

Other

In Australia, doctors at Cairns Hospital request an independent review of its Cerner rollout after learning that 48 mislabeled blood specimens have been identified this year vs. nine in all of 2013. Employees say the specimen collection workflow is convoluted and that printing tube labels for multiple patients on a single printer has caused mixed-ups.

The AMA publishes new MACRA tools for doctors: a calculator to predict the impact of payment changes on a given practice, new MACRA tools for its STEPS Forward practice redesign program, and a podcast series.

Internet pioneer and venture capitalist Marc Andreessen says in an interview that rising-cost sectors (mostly healthcare and education) are dragging down the economy in canceling out the benefits and lower prices created by technology, leading to stagnant incomes, loss of jobs, and a bigger chunk of personal income spent on those sectors:

You have the sectors in which prices are rapidly rising: healthcare, education, construction, prescription drugs, elder care, and child care. Here there’s very little technological innovation. Those are sectors with insufficient productivity growth, innovation, and disruption. You’ve got monopolies, oligopolies, cartels, government-run markets, price-fixing — all the dysfunctional behaviors that lead to rapid increase in prices. The government injects more subsidies into those markets, but because those are inelastic markets, the subsidies just cause prices to go up further … The problem is insufficient technological adoption, innovation, and disruption in these high-escalating price sectors of the economy. My thesis is that we’re not in a tech bubble — we’re in a tech bust. Our problem isn’t too much technology or people being too excited about technology. The problem is we don’t have nearly enough technology. These cartel-like legacy industries are way too hard to disrupt.

Odd: a closed Ohio bridal shop sues a Texas Health Resources hospital for $1 million, saying it lost hundreds of thousands of dollars after one of the two THR nurses who contracted Ebola in 2014 tried on dresses there before she knew she was infected, after which the stigma of being known as “the Ebola store” caused the store’s failure.

I would say drug pricing and profits are way too complicated when I can’t even understand a dumbed-down graphic of where prescription money goes. I do understand, however, that despite the title that suggests middlemen are raking it in, the last line shows that the brand-name manufacturer still keeps 75 percent of whatever made-up price they choose (thus encouraging them to price accordingly).

A writer whose 34-year-old wife died in CHA Cambridge Hospital (MA) pens a moving letter to the ICU employees who cared for her:

When I needed to use a computer for an emergency email, you made it happen. When I smuggled in a very special visitor, our tuxedo cat, Cola, for one final lick of Laura’s face, you “didn’t see a thing.” And one special evening you gave me full control to usher into the ICU more than 50 people in Laura’s life, from friends to co-workers to college alums to family members. It was an outpouring of love that included guitar playing and opera singing and dancing and new revelations to me about just how deeply my wife touched people. It was the last great night of our marriage together, for both of us, and it wouldn’t have happened without your support.

Sponsor Updates

VMware shares its vision for intelligent analytics from VMware AirWatch.
Impact Advisors volunteers with SCARCE DuPage as part of its annual Operations Team meeting.
Catalyst’s HITRUST CSF certification is extended to customers using Microsoft Azure.
InstaMed recaps its event at Epic’s UGM.
HCI Group will exhibit at the Ministry of Health & HIMSS Middle East conference in Riyadh, Saudi Arabia next week.
Glytec is named an innovation award finalist for its diabetes management solution.
John Yurkschatt of Direct Conulting Associates is named to “2016 Millennials in Staffing.”
MedData will exhibit at the ACEP Scientific Assembly October 16-19 in Las Vegas.
A Spok survey finds that most hospitals are formalizing their mobile strategy, often with the help of outside experts, but are challenged by deficiencies in Wi-Fi and cellular coverage.
Meditech celebrates October’s health literacy heroes.
Wellsoft will exhibit at ACEP October 16-18 in Las Vegas.
Medicity President of HDMS Analytics Patrice Wolfe will keynote the New Jersey & Metro Philly HFMA Annual Institute taking place this week in Atlantic City.
Obix Perinatal Data System will exhibit at the Tennessee State AWHONN Conference October 7-8 in Memphis.
Experian Health will exhibit at the HFMA SoCal/Imperial Chapters Fall Conference October 9-11 in Newport Beach.
Red Hat will host its North America Partner Technical Exchange October 10 in Chicago.

Blog Posts

Medicity Client Summit 2016 – Collaborating to generate transformative ideas (Medicity)
Promoting Healthcare IT Cybersecurity Awareness on Capitol Hill (Imprivata)
Doctor! Doctor! (Iatric)
Would your hospital pass a workforce compliance audit? (Infor)
Doctor! Doctor! (Iatric Systems)
Will Your Organization Suffer the Next Big Email Scandal? (ID Experts)
Convince Your Executives and Physicians That Online Scheduling is a Win/Win (Influence Health)
What Do Health Systems, Hotels and Airlines Have in Common? (Kyruus)
Who Uses Image Sharing? (LifeImage)
Getting Ready for the End of the Hurricane – It’s the End of CMS’ Grace Period: How to Make Sure You’re Prepared (Navicure)
Bringing Home the Value of Health IT (Netsmart)
Respondents Wary of Value-Based Care: Population Health Management May Ease Fears (Orion Health)
Impact Advisors “Hearts” Healthcare IT (Impact Advisors)
Future-Proof Your Clinical Communications Strategy (PatientSafe Solutions)
Happy 1st Birthday ICD-10 (PatientKeeper)
Connect content to succeed in a value-based care environment (Lexmark Healthcare)
Don’t Even Think About Using the EMR for Provider Data Management! (Phynd Technologies)
Let’s Get Specific: What the End of the ICD-10 Grace Period Means for Your Practice (PMD)
Can Your Change Control Processes Support Affiliates? (Sagacious Consultants)
Technology’s Role in the Future of Healthcare (Surescripts)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 10/5/16

October 4, 2016 News 7 Comments

Top News

Private equity firm Warburg Pincus will acquire Intelligent Medical Objects, according to an FTC pre-merger filing.

Reader Comments

From The Truth: “Re: lying on contracts. I know a major EMR vendor who does it.” Only one? However, allow me to take the other side of the argument: a client who rightly insists on a properly detailed set of terms and conditions with appropriate non-performance penalties makes vendor lying pointless. My experience is that while salespeople might on occasion embellish the truth, skate to where the puck is going in describing offerings that technically might not actually exist, and sometimes speak in soothing but non-binding generalities, wise customers include everything they expect in their contracts. Hospital people are often so exhausted by their product selection process and so loath to restart it that they subconsciously align themselves with their vendor in treating the contract as a relief-inducing ceremonial formality than what it really is – the only tangible manifestation of all that prep work and the sole protection against an undesirable future state. Don’t be that football player who spikes the ball and commences a showily choreographed celebratory dance before the ball has actually crossed the plane of the goal line.

From In the Know: “Re: eClinical Works. Has lost two huge customers in their own back yard that are switching to Epic – the physician networks of Boston Children’s Hospital and Mount Auburn Hospital.” Unverified.

From Twice Bitten: “Re: Streamline Health. Laid off half its financial management and scheduling team (the 13 year in a row KLAS winner).” Unverified. Streamline Health acquired patient scheduling system vendor Unibased Systems Architecture in early 2014. USA’s product has always ranked high in KLAS but is pretty low profile, both in terms of existing customers and in STRM’s promotional material.

From Freddie Kroger: “Re: [publication name omitted]. They just gave a big splash to their EHR satisfaction results. Note the small print: they received only 340 responses.” That didn’t stop them from running a bunch of brashly written articles that tried to sound authoritative but were embarrassing given the complete lack of statistically defensible methodology. They got even fewer responses than the 400 last year that fueled a ridiculous salvo of pointless articles and overly cute graphics. The survey also seems to confuse inpatient and ambulatory EHRs and fails to distinguish among multiple EHRs offered by a single vendor. It’s a worthless survey other than for fueling clickbait. I ended my critique of last year’s version by listing factors to ponder in deciding whether to trust a survey’s results:

How did you choose your pool of potential survey respondents? Was random sampling of a known population used?
How did you invite participation?
What was your survey’s sample size and response rate?
What were the characteristics of your survey’s non-respondents?
What is the motivation of those who responded? (unsatisfied people are more likely to respond in most cases).
What were the demographics of your respondents?
How did you prevent ballot box stuffing?
What did your survey instrument look like? Were your questions clear, unbiased, and appropriate for those surveyed? Did the sponsoring organization create bias (unintentional or otherwise) in the choice and wording of questions?
Does your survey report include raw data that prove its conclusions? What type of statistical methods did you apply in analyzing the responses?
Do your conclusions overreach the underlying data in trying to gain publicity with catchy headlines and graphics that aren’t supported? Do your published results state the limitations of the survey?

HIStalk Announcements and Requests

Thanks to Jenn for covering for me as I took a few days off. I’m happy nobody missed me so I could enjoy my little vacation without feeling too guilty. I love traveling with my Chromebook for instant-on connections with a fantastic keyboard instead of an on-screen one. It has fully replaced my tablet and laptop for traveling, other than using the tablet as a Kindle reader on planes.

I was unfortunately imprecise in last week’s poll question, where I was interested in learning how providers view the resumes of salespeople, but my poor wording suggested I was also cultivating the opinions of those in a sales hiring role. Nonetheless, I’ll go with the most important salesperson attributes as voted: (a) a lifetime career in health IT; (b) a healthcare professional degree; and (c) consulting experience. Since earning a non-healthcare graduate degree ranked low, nothing important on my list is easily undertaken by someone already in sales who wants to make a better LinkedIn first impression, which means that professionalism, honesty, and interpersonal skills rule the day. I’m an outlier in that military service ranks #1 on my list, especially if the person either graduated from one of the service academies, served as an officer, or deployed overseas.

New poll to your right or here: what speaker tendency annoys you the most when attending a conference session or webinar? Early returns suggest the same problems that we vigorously coach against when we help people make their planned webinar better.

Welcome to new HIStalk Platinum Sponsor Dimensional Insight. The Burlington, MA-based data analytics and business intelligence solutions vendor offers the award-winning (Best in KLAS in BI/Analytics for five years) Diver Platform, an end-to-end enterprise reporting and analytics system that provides actionable, role-based business intelligence. Capabilities include diabetes management, MU compliance, quality reporting, population health, payroll analysis, product line analysis, reimbursement management, asset utilization, EHR reporting, staffing requirements forecasting, and strategic planning. Specific solutions include Physician Performance Advisor, which brings all KPIs into a single application; Surgery Advisor for OR management; Meaningful Use Advisor that allows measuring, analyzing, and attesting from a single app; and GL Advisor for allowing finance departments to answer their own questions using data integrated from multiple systems such as accounting, payroll, and time and attendance. See the case studies. Thanks to Dimensional Insight for supporting HIStalk.

I found this just-published Dimensional Insight customer testimonial from Henry Mayo Hospital (CA) on YouTube.

Welcome to new HIStalk Gold Sponsor Kyruus. I like the company’s description of what it does as “precise demand-supply matching,” which advocates that as an alternative to standardizing medical practices into a one-size-fits-all model, we should instead “understand, measure, and embrace the heterogeneity” in identifying patient outliers and matching them with doctors who are best at managing their condition. I had marginally fond, acetone-fumed memories of organic chemistry classes in reading the origins of the company’s name, which is derived from the word “chiral” and features two U’s to represent using big data to unleash physician potential. The company’s ProviderMatch helps access centers and networks (and even patients themselves) connect patients with the right doctor, taking into account doctor expertise, insurance acceptance, locations, availability, demographics, and business rules to enable real-time provider search, scheduling, and referral instead of the creaky and nearly worthless “doctor finder” webpages offered by most hospitals. The company’s executive roster boasts folks with impressive backgrounds. Customers include Beaumont, Keck Medicine of USC, MedStar Health, MercyHealth, Partners HealthCare, Providence and Swedish. Thanks to Kyruus for not only supporting HIStalk, but for putting up an interesting and passionate website.

I found this Kyruus video called “The Patient Access Journey” on YouTube.

Listening: new from Metallica, which sounds just like Metallica. They aren’t the most musically amazing group and aren’t likely to extend their loyal fan base with this offering, but they stick to their Flying-V knitting nicely and remain intense on stage.

Webinars

October 26 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, Founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Infor systems integrator Avaap acquires Falcon Consulting, which offers Epic consulting services that are ranked #1 in KLAS.

Consumer health site Sharecare, founded by TV huckster Dr. Oz, acquires BioLucid, which offers the You 3D human body simulator. The product might even accurately depict that portion of Dr. Oz’s anatomy from which his medical claims originate (it’s conveniently located right next to his wallet).

Wolters Kluwer will acquire patient engagement systems vendor Emmi Solutions for $170 million.

The innovations group of the ProMedica health system (OH) partners with app development technology vendor Kaonsoft to form Kapios health, which will apparently commercialize apps developed by ProMedica.

Cerner tells the Kansas City business paper that it will expand its revenue cycle management business “aggressively.”

Decisions

Cooperstown Medical Center (ND) will go live on Epic on November 2016 under the Community Connect program of Altru Health System.
Keefe Memorial Hospital (CO) went live on CPSI’s EHR and revenue cycle systems in June 2016, replacing systems from CPSI-acquired Healthland.
University Medical Center of Southern Nevada will replace McKesson Horizon with Epic in 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.

People

Keith Hagen (IHM Services) joins Aviacode as CEO.

Spok hires Andrew Mellin, MD, MBA (RedBrick Health) as chief medical officer.

Announcements and Implementations

In Africa, the World Health Organization is completing development of a phone-based app that will help non-specialists manage pregnancies, hoping to reduce child and maternal death by applying the knowledge gleaned from the hospital records of 10,000 pregnant women in a “patients like me” model.

Varian Medical Systems releases its 360 Oncology care management platform that supports virtual tumor board meetings, care coordination, trials management, and patient engagement.

Providence Hospital North Houston (TX) goes live on Wellsoft’s EHR. It’s a micro-hospital, a small facility that offers full services but with only a handful of inpatient beds intended for short stay, often built by a large health system that can’t justify developing a full-sized hospital in an otherwise attractive geographic area. Advisory Board has a nice overview of the concept, which is pretty fascinating. That handful of beds might be enough even for larger areas if hospitals can ever be financially convinced to manage the health of the populations they claim to serve instead of feeding their never-ending edifice complex.

FormFast launches Connect, which guides patients through their healthcare experience by making sure they read and complete forms and checklists before and after each care event, such as for pre-admissions or post care follow up.

VMware adds smart glasses management features to AirWatch, the first unified endpoint management solution to extend into wearables.

Carevive Systems will offer a CME/CNE-accredited symposium on applying the IOM care management plan to patients with non-small cell lung cancer on October 26 in Philadelphia.

Government and Politics

Non-profit Maryland insurer Evergreen Health switches to a for-profit company as it brings in private equity investors to avoid its imminent shutdown, leaving intact only five of the 23 non-profit insurance co-ops funded by the Affordable Care Act. The insurer blames ACA’s risk adjustment program, which resulted in the company’s receiving a $23 million bill for not having as many expensive patients as other insurance companies. Its website (and perhaps its mission) might need an update since it continues to declare that, “for far too long, health insurance carriers have put profits ahead of people.”

Former President and would-be First Gentleman Bill Clinton, stumping on behalf of his wife, calls the Affordable Care Act “the craziest thing in the world” that has provided insurance for 25 million more people, but with premiums doubled and coverage halved because those individuals have no leverage with insurers since they aren’t part of a big risk pool. He advocates Hillary Clinton’s proposal to allow middle-class consumers who aren’t eligible for federal insurance subsidies to buy into Medicare and Medicaid.

Meanwhile, UnitedHealth Group’s startup Harken Health, which offered relationship-based, lower-cost ACA insurance plans and healthcare services, pulls all of its offerings from the marketplace and fires its founding CEO, citing huge losses due to – like even the less-hip insurance companies — unexpectedly older and sicker enrollees.

The DEA will require opiate drug manufacturers to decrease production by 25 percent next year, with the federal government trying yet again to impose a war on drugs by limiting the supply instead of the demand. The main result will be to drive up the street price and shift more addicts to impure street products that will in many cases kill them.

Privacy and Security

From DataBreaches.net:

The US Surgeon General warns the 6,600 medical professionals of the Public Health Service that their information has been accessed by hackers.
An illegally operating medical marijuana dispensary in Canada exposes the identities of 500 of its customers when a now-fired employee uses CC: instead of BCC: in sending them a mass email.

Johnson & Johnson warns users of its Animas OneTouch Ping insulin pump, which the user controls via a Wi-Fi remote control, is susceptible to hacking, assuming the would-be hacker can get within 25 feet of it.

Innovation and Research

A UK-based project is studying 100,000 people in matching their brain imaging results to their demographic and medical history to identify early markers of age-related brain problems

Other

A fifth Texas man pleads guilty for his involvement in a scam in which the co-conspirators created a company called Cerner LLC and sold Summit Medical Center (OK) a new MRI machine. You might wonder how a surgery center’s due diligence could be insufficient to the point of not being aware that Cerner doesn’t sell MRI machines.

The mainstream press is amused that a hospital charged a father $39.95 to hold his newborn. They should be outraged that if he was a cash-paying customer, he would have been stuck with a $13,000 bill since he wouldn’t get the $5,600 discount extended to his insurance company.

In case you didn’t know, non-profit healthcare is a pretty big business.

Here’s some nicely dry wit from Acting CMS Administrator Andy Slavitt.

Here’s the new video from ZDoggMD.

Sponsor Updates

Medicomp Systems is hosting a sold-out training program in Bangkok, Thailand this week in which customers will learn how to integrate the company’s Quippe documentation tools into their EHRs.
Healthegy names Health Catalyst as its Digital Healthcare Innovator of the Year.
Optimum Healthcare IT launches a new website and branding.
Aprima will exhibit at the Patient-Centered Medical Home Congress October 7 in Chicago.
Audacious Inquiry releases a new video on “How to Reduce Hospital Readmissions.”
CompuGroup Medical releases a newly rewritten version of its Labdaq Teleios laboratory information system that includes best practices rules, an interactive performance dashboard, and an interface monitoring tool.
Bernoulli will exhibit at the American Association for Respiratory Care Congress 2016 October 15-18 in San Antonio.
Catalyze publishes daily recaps of Health 2.0.
Besler Consulting releases a new podcast, “Revenue recovery opportunities from class action settlements.”
CapsuleTech will exhibit at HIMSS Middle East October 12-13 in Riyadh, Saudi Arabia.
CTG’s Angela Rivera is featured in the San Diego Business Journal.
Cumberland Consulting Group Principal Taylor Ramsey speaks at the South Carolina HFMA Women’s Leadership Conference.
EClinicalWorks will exhibit at IPHCA’s 2016 Leadership Conference October 5-7 in St. Louis.
The Connecticut Technology Council and Marcum name Evariant to the Marcum Tech Top 40 list.
Two locations of Sutherland Healthcare Solutions earn URAC Credentials Verification Organization Accreditation, recognizing the company’s commitment to quality and best practices in the areas of credentialing, provider data management, claims administration, and population health solutions.
GE Healthcare creates a Centricity Partner Program.
A Journal of Diabetes Science and Technology study demonstrates Glytec’s superiority in meeting ADA guidelines.
HCS will exhibit at the NJ HFMA Annual Institute October 5-7 in Atlantic City.
Healthwise will exhibit at AdvancedMD Evo16 October 11-12 in Salt Lake City.

Blog Posts

The Path to Health IT Project Success (Spok)
A Pathway to Alternative Payment Models (APMs) (AdvancedMD)
How to Manage Pharmacy Costs in an ACO (Arcadia Healthcare Solutions)
Can MACRA and MIPS Move the Needle for Healthcare Analytics? (Caradigm)
3 Major Benefits of Leveraging Mobile Health Tools (CareSync)
10 Ingenious Things You Can Do With Your CoverMyMeds Account (CoverMyMeds)
Benefits of Giving Back as an Organization (Direct Consulting Associates)
Improving Provider Efficiency and Satisfaction through EHR Optimization (Culbert Healthcare Solutions)
Choosing the Right Care Transformation Model (ECG Management Consultants)
Serving Clients Before and After the Sale with Extension Engage Health Checks (Extension Healthcare)
Why #IHeartHIT with a Passion (Galen Healthcare Solutions)
3 Ways Technology Must Show Up in the Consumerization of Healthcare (Hayes Management Consulting)
3 Unexpected Issues to Look Out for During an EMR Go-Live (The HCI Group)
The Right Amount of Disruption (Healthfinch)
Writing Content That Connects: This Time It’s Personal (Healthwise)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Monday Morning Update 10/3/16

October 2, 2016 News 3 Comments

Top News

Former and current National Coordinators Karen DeSalvo, MD and Vindell Washington, MD take to Health Affairs to detail the “health IT transformation” seen across the country since the HITECH Act was passed in 2009. A few stats:

96 percent of hospitals and 78 percent of physicians use certified EHRs.
84 percent of academic literature review studies showed that certified EHRs had a positive or mixed-positive effect on care quality, safety, and efficiency.
80 percent of hospitals electronically exchanged lab results, radiology reports, clinical care summaries, or medication lists with providers outside their organization in 2015.
84 percent of providers reported in 2015 that their EHR met or exceeded their expectations.
90 percent of hospitals had digital health data they needed from outside sources or providers available at the point of care – double the national average.

The duo, who both have fond memories of caring for patients in Louisiana, emphasize that continued transformation will require federally recognized standards, combating data blocking, and creating an ROI around interoperability.

Last Week’s Most Interesting News

Aetna announces plans to offer an Apple Watch subsidy through large employers and select individual customers to ramp up its wellness and care management programs.
InstaMed announces a $50 million investment from Carrick Capital Partners.
Former Tuomey Healthcare (SC) CEO Ralph Cox will personally pay a $1 million fine to settle Stark Law allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.
The FDA approves Medtronic’s artificial pancreas that automatically monitors a patient’s blood sugar levels and then administers the appropriate insulin dose.
Hilary Clinton outlines in NEJM her plans for improving healthcare, which includes improving ACA, working to “integrate our fragmented healthcare delivery systems,” and helping to increase research and innovation.

Webinars

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Safety Net Connect and private equity firm Gary Comer Inc. acquire Chicago-based patient engagement and care coordination technology company VCareConnect for an undisclosed sum.

Senior care services provider US CareNet forms a new company, HC360 Technologies, after purchasing the chronic care and transitional care management technology used in its NavCare care management division.

Announcements and Implementations

Miami Children’s Health System adds ambulatory business office services including RCM to its existing Millenium EHR partnership with Cerner.

Cohen Veterans Network (CT) selects Netsmart’s MyEvolv CareRecord to help it provide free mental healthcare to veterans and their families. The network, which launched in April, have opened five Steven A. Cohen Military Family Clinics across the country and plans to open 20 more over the next five years.

Community Health Partnership (CO) will implement ClientTrack case management software from Eccovia Solutions to better assist its membership of 25 organizations coordinate medical and behavioral healthcare.

Technology

Drchrono develops a “native” iPad and iPhone app for e-prescribing of controlled substances.

Government and Politics

The Dallas Morning News spotlights the refusal of the Texas Department of State Health Services to release data related to pregnancy and maternal death rates to reporters and other organizations looking to gain a better understanding of why the state’s death rates doubled between 2011 and 2012. The department has even refused – without explanation – to release a data record layout, akin to a table of contents that shows what data it collected and how it’s stored. “It’s ridiculous,” says Texas-based lawyer and open records expert Joe Larsen. “We have a clear public health problem, and the people really need to know what in the world is going on here, and they’re stymied by this," he said. "A record layout is not software. It’s not code. It’s not source code. Period. I liken it to the key of a map. It’s actually public information itself.”

Privacy and Security

From DataBreaches.net:

Marin Medical Practices Concepts notifies 5,000 patients that their medical records were lost during a recovery process stemming from a ransomware attack in July. After patient files were held for 10 days, the California-based billing and EHR company decided to pay an undisclosed ransom amount, which successfully unlocked the files. MMPC attributes the lost files to a faulty backup, adding that the recovery was done during a system upgrade.
Urgent Care Clinic of Oxford (MS) notifies patients seen before August 2 of a likely ransomware attack initiated in early July, noting in their letter that, “The hackers held the server for ransom before turning control back over to the Urgent Care staff.” The clinic shut down their server’s remote access shortly thereafter, implying that the hackers (thought to be of the Russian variety) snuck in via remote desktop access.
Martin Army Community Hospital (GA) alerts patients of a possible HIPAA breach that took place at Fort Benning between January 2011 and December 2013. The breach stems from “criminal activity involving identity theft by an employee in the laboratory shipping section.” The employee, who was tried for the crime and is now serving time, apparently used information from discarded lab specimen labels to file fraudulent tax returns.

Other

Ochsner Health System (LA) SVP David Carmouche highlights EHRs, registries, and new compensation models as integral to its population health activities and overall move away from fee-for-service:

“We’re leveraging electronic health records, which connect all of our systems. We have created some 20 registries identifying groups of patients with certain diseases and conditions, and we’re reaching out to them proactively, to make sure they’re getting the care they need, when they need it. We’re realigning physician compensation for Ochsner-employed physicians, moving away from fee-for-service payment to higher payment for high-value, high-quality care. We’re looking at physician preference items, trying to consolidate down to one or two knee implants, or one or two cardiovascular implants, so that we can get better pricing from manufacturers. The best way to keep costs down will be to provide high quality care, so patients can go home quickly and recover fully.”

The system went live on Epic in 2011, and three years later became the first provider to integrate Epic with Apple’s HealthKit.

Scientific American takes a long-form look at the ways in which the FDA (and, increasingly, other federal agencies) manipulates the media, denying access and offering not-so-true findings to some news organizations, while enforcing restrictive rules like the “close-hold embargo” on others. “By using close-hold embargoes and other methods, the FDA, like other sources of scientific information, are gaining control of journalists who are supposed to keep an eye on those institutions,” writes Charles Seife. “The watchdogs are being turned into lapdogs.”

Sponsor Updates

Forward Health Group CEO Michael Barbouche is featured in a Wisconsin State Journal article on Wisconsin healthcare technology.
The HCI Group launches a new “Monday Morning Podcast” series.

Blog Posts

Need help meeting your 2016 goals? Finish the year strong! (Nordic)
Nordic’s 5th annual Open House Recap (Nordic)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 9/29/16

September 29, 2016 News 2 Comments

There has been a lot of chatter in the physician lounge recently about the “Pick your Pace” options for Medicare-related quality reporting next year. Of course, most of the chatter has been either from hospital administrators or from physician leaders of larger groups, since many smaller and independent physician groups may not even be aware of what is about to happen. I was part of a lively exchange this week around the fact that the program has to be budget neutral. To recap, the four options are: 1) Test the quality payment program (no penalty); 2) Report for part of the calendar year (small incentive); 3) Participate for the full year (modest incentive); and 4) Participate in an Advanced Alternative Payment Model (5-percent incentive). The devil may be in the details since it’s unclear how no penalty and small incentives can balance out to be budget neutral. Where is the incentive money going to come from?

It’s also not clear what the actual “test” process in option 1 is going to entail. Unless you’re just starting on your EHR journey, most organizations should be able to report for at least part of the year without significant difficulty. The data may not be of great quality, depending on how well you’re using your EHR, but you can still report it out. We’ll have to wait for the final rule, however, to see what the reporting requirements end up looking like. The partial-year option is going to be attractive to a great number of providers whose EHRs may not be ready for full-year reporting, so I expect to see the most questions on that option.

For providers that are in the thick of trying to comply with all the federal requirements, the 2015 Annual Quality Resource and Utilization Reports (QRURs) were released this week. The QRURs show what a provider’s payment adjustment will be for 2017 based on analysis of quality and cost domains. I attended the Medicare Learning Network call on the topic today. If I didn’t already know a considerable amount about the Value Modifier payment adjustment and the PQRS payment adjustment, I might be more confused after attending the call. The call began with a presenter essentially reading slides to the audience. There were constant references to the appendix, and fortunately the slides were available for download at the beginning of the call so that attendees could follow along.

I’m still mystified by the fact that it takes 21 months to analyze and release the data. We’re talking about using data from 2015 to determine how providers are paid in 2017. Although there was a Mid-Year QRUR that was released in the summer, it didn’t fully illustrate how payment adjustments might be applied. Regardless, the Mid-Year QRUR has little utility to encourage providers to modify their behavior in order to avoid adjustments, since it’s a look-back document. When trying to modify behavior, it’s most useful to provide real-time or at least fairly immediate feedback. Under the CMS construct, the feedback loop is delayed. Does it really take 21 months to aggregate and interpret the data? Or maybe the delay is intentional, as providers move deeper and deeper into a state of learned helplessness.

After about 15 minutes on the call, I felt my brain going numb as the presenter reviewed all the steps needed to access the QRUR. Providers or their designees have to go through the process of requesting an Enterprise Identity Management (EIDM) account which has multiple steps and sub-steps. The acronym soup became less savory as we learned about Provider Transaction Access Numbers (PTAN), which have to be obtained from the Medicare Administrative Contractor (MAC). Once you go through all the related steps and click your heels a couple of times, you can either view or download the presentation.

The presenter tagged-out to a second presenter who went through a table explaining the different sections of a “hypothetical” QRUR. Again, it was basically someone reading a slide to the audience – actually showing the various exhibits and sections while talking about them would have been useful. They did eventually go through some of the specifics, but I wonder how many attendees were following especially if this was the first time they were seeing this material. As the talk moved into discussion of the various quality and cost composite scores, and the need for a statistically significant deviation from the mean to be categorized as more (or less) than average, I wondered how many people attending the webinar understood those statistical terms.

Having spent my final two years at Big Medical Center working on a provider attribution project, I was eagerly awaiting the discussion of how Medicare beneficiaries were assigned to their respective Taxpayer Identification Numbers (TIN). This attribution drives the cost composite score found in the QRUR. Not only is CMS looking at spending per beneficiary, they are also looking at per capita costs for beneficiaries with various chronic conditions including diabetes, chronic obstructive pulmonary disease, coronary artery disease, and heart failure. They didn’t go into anywhere near the detail I expected for a provider to actually understand how the attribution was done. There are detailed elements involving whether a given TIN provided the majority of primary care services during the year, whether primary care services were received from subspecialists in the TIN, and more. None of that was covered.

Heading into the discussion of the “Informal Review Process” that providers can use to disagree with Value Modifier calculated for their TIN, the presenter became flustered due to a missing slide and rather than vamping her way through it, actually paused the presentation while they tried to sort it out. When she restarted, she actually re-read some scripted comments. I felt bad for her – we’ve all been on the downside of presentations that don’t go as planned. She then went into a discussion of various tables in the appendix, which again weren’t on the screen. Apparently, providers can download them in Excel and use them to analyze their own data, even de-identifying it by removing specific columns. It would have been good to see a screenshot of the data format to go along with the discussion.

Once she finally made it to the discussion of the review process, things were back on track. The review period began September 26 and is open for 60 days. The review has to be requested using the EIDM system and the process includes a Multi-Factor Authentication (MFA) step. Users have to remember to use the same MFA device type that they selected to use when they first created their accounts. Depending on how long ago one’s account was created, this may be a challenge. Users can then request the review, which leads to an additional three steps that weren’t shown in the webinar. Users can download a quick reference guide from the CMS website for more information on the reviews, although the link wasn’t shown in the webinar. As a side note, there were a couple of times at the beginning of the webinar where the speaker gave Web addresses verbally but with no link or text shown. Especially with a webinar platform, is there any reason why a link shouldn’t be shown on the screen and provided in the deck that was given to attendees? Another unusual statement (given by two different speakers) was that users should disable their popup blockers and should not connect wirelessly or via VPN but should connect via a wired connection. In this day of mobility and multi-platform device use, it felt like CMS is out of touch with how people use devices to receive information.

They opened the call to Questions and Answers and the first one seemed to challenge them, about whether the adjustment would be provided on a claim-by-claim basis or at the end of the year. Eventually they arrived at the per-claim answer. They answered the second question (about beneficiary attribution) by referring users to yet another website. I finally figured out why they wanted popup blockers disabled when a poll popped up asking how many people were viewing the session with me. There were also polling questions on whether I had difficulty accessing the webinar and whether I was satisfied with the webinar platform used. The questions continued, including one from a group who had discrepancies in the data from their QRUR. She was instructed to submit informal review for both QRUR and PQRS, and the latter has to be done through a different process that the group had difficulty explaining. They had to pause while they conferred, agreeing to look it up and provide it later.

That only served to underscore how complicated these programs are and how challenging it will be for provider groups of all sizes to try to keep up. Staying current with software and enforcing end-user behavior is hard enough, but this adds an entirely different layer of challenges for practice operations and management teams. I had to duck out for another call but am looking forward to seeing the rest of the Q&A in the transcript.

How is your organization coping with the QRUR? Email me.

Email Dr. Jayne.

News 9/30/16

September 29, 2016 News 1 Comment

Top News

Aetna announces plans to offer an Apple Watch subsidy through large employers and select individual customers to ramp up its wellness and care management programs, and will provide its own 50,000 employees Apple Watches free of charge.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg pontificates on the proper way for vendors to apologize for unexpected downtime. Enjoin VP James Fee, MD describes how physician engagement efforts can improve clinical documentation. Malvern Family Medical Clinic Owner Shawn Purifoy, MD offers insight into the benefits of joining an ACO and the struggle to remain independent. Medecision William Gillespie, MD lists three population health must-haves for primary care. Midwest Nephrology Associates Owner Gary Singer, MD digs into the benefits of Carequality’s Interoperability Framework.

This week on HIStalk Connect: Sirono Chief Revenue Officer Peter Longo discusses the problem with hospital billing and keys to successful patient payments.

Webinars

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

Vidyo launches a clinical design service to help providers integrate telemedicine into their workflows.

PatientPing and Vermont Information Technology Leaders deem their care coordination technology collaboration a success at the six-month mark. Since going live, 400 provider locations in New England have been “pinged,” letting them know that their patients have been seen at local hospitals. PatientPing has recorded 62,000 notifications on 12,000 Vermont citizens.

UAB Medicine will replace its connectivity software with Orion Health’s Rhapsody Integration Engine – a project that will include rewriting 300 interfaces.

Cypress Creek ER (TX) selects Wellsoft’s EDIS for its third freestanding ER, set to open mid-October. Angleton ER (TX) will go live with Wellsoft technology when it opens in December.

NewCrop adds specialty medication prescribing software from AssistRx to its e-prescribing software.

Acquisitions, Funding, Business, and Stock

Former Tuomey Healthcare (SC) CEO Ralph Cox will personally pay a $1 million fine to settle Stark Law allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.

MedWand Digital Health secures a “major investment” from sensor technology-focused Maxim Ventures, which the Las Vegas-based startup will use to work towards anticipated 2017 FDA approval of its diagnostic device for virtual consults.

People

Wendy Deibert (The VirtualEngine) joins Vidyo as VP of clinical services.

Teladoc adds the new role of COO to CFO Mark Hirschhorn’s responsibilities.

Greg Alexander (Evolent Health) joins Lumeris as national VP of market operations.

The Chartis Group promotes Michael Topchik to head of the new Chartis Center for Rural Health.

Michael Bain, MD (Qualified Emergency Specialists) will head Cincinnati-based TriHealth’s new clinical informatics department as CMIO.

Technology

Dr. Oz lends his gravitas to San Francisco-based wearables startup IBeat, becoming an investor, partner, and advisor to the company as it launches its heart-monitoring smartwatch via an Indiegogo campaign. For a mere $5,000, buyers can purchase the “Meet Dr. Oz Special,” which includes VIP access to this show, a two-night hotel stay in New York City, two watches and monitoring services, plus a signed book and scrubs. Oz was not involved in last month’s seed funding round of $1.5 million.

Government and Politics

HHS and AARP announce the winners of their “A Bill You Can Understand” contest. Designs from Los Angeles-based RadNet, which won in the easiest-to-understand category, and San Francisco-based Sequence, which won in the overall approach category, will be tested or implemented in six healthcare facilities – including Cambia Health Solutions – across the country. (Jenn talked with CHS President and CEO Mark Ganz about the challenge as part of “The Hypocrisy of a Simpler Patient Bill.”)

Hillary Clinton takes to the New England Journal of Medicine to outline her vision for universal, quality, affordable healthcare. Her short op-ed hints at healthcare IT among her four goals: “I am also committed to expanding access to high-quality data on cost, care quality, and health delivery system performance to help patients and doctors make informed choices, and entrepreneurs build new products and services.” Donald Trump has thus far declined the same editorial opportunity.

ONC awards seven organizations $1.5 million to improve the flow of health data for patients and providers, particularly data related to medication management, laboratory data, and care coordination. The funding comes via the office’s High Impact Pilot and Standards Exploration Award programs.

HIMSS presents Acting Assistant Secretary for Health and former national coordinator Karen DeSalvo, MD with the Federal Health IT Leadership Award during its National Health IT Week festivities.

Privacy and Security

HITRUST connects and begins bi-directional sharing of cyber threat indicators with the Department of Homeland Security’s Automated Indicator Sharing Program. The information exchange corresponds with HITRUST’s new CyberAid program, which helps smaller organizations select security solutions and contribute to the exchange.

From DataBreaches.net:

The New Jersey Spine Center notifies patients of a July 27 ransomware attack that resulted in the provider paying an unspecified dollar amount to unlock all of its digital patient records. Files were reinstated on August 1.
Royal Cornwall Hospitals Trust in England suffers multiple ransomware attacks over the past year.
Australia Health Minister Sussan Ley apologizes to physicians for the accidental leaking of Medicare data, discovered after University of Melbourne researchers attempted to decrypt some of the data, thus inadvertently revealing sensitive information.

Research and Innovation

The FDA approves Medtronic’s artificial pancreas that automatically monitors a patient’s blood sugar levels and then administers the appropriate insulin dose.

An American Telemedicine Association/Wego Health survey of 429 patients finds that just 22 percent have taken advantage of video visits in the last year, with the average patient engaging in between one and four virtual consults. Of that percentage, as many patients requested telemedicine services as their providers initially offered it. I’m not sure that “strong demand,” as tweeted above, is warranted with these results.

Other

Seems like #HIMSSanity has already begun.

British researchers have created a 3D-printed replica of the human body to help train surgeons, particularly when it comes to making that initial slice.

Sponsor Updates

Fortified Health Solutions will exhibit at the HIMSS Southern California Annual Privacy & Security Forum September 30 in Newport Beach.
Frost & Sullivan recognizes Orion Health with the 2016 European Frost & Sullivan Award for Product Leadership.

Blog Posts

Ensuring a healthy, safe and environmentally conscious workplace—not only for patients, but your employees. (Infor Healthcare)
The Dawn of Artificial Clinical Awareness (ClinicalArchitecture)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Safeguarding Smartphones in an Era of Escalating Vulnerabilities

September 28, 2016 News Comments Off

HIPAA-related security concerns mount as smartphones become more ubiquitous across enterprise healthcare environments.
By @JennHIStalk

Ransomware headlines seem to reign supreme in healthcare news, and yet industry insiders know that the greater potential for cyberattack and financial loss resides in just about every person’s pocket (or pocketbook). Catholic Health Care Services of the Archdiocese of Philadelphia’s $650,000 settlement with OCR for HIPAA violations this summer is a prime example of the vulnerability of mobile smart devices. The settlement stemmed from the theft of a smartphone containing the PHI of 412 nursing home residents. Acting as a business associate, CHCS provided IT and management services to six SNFs, and was thus responsible for protecting resident PHI under HIPAA. OCR found that, in addition to a lack of encryption and password protection, CHCS also neglected to develop a risk analysis and accompanying plan for risk management.

While the organization’s lack of cyber safeguards and subsequent fine made headlines, it’s probably a safe bet to assume that other similar entities are operating without the appropriate security safety nets.

Getting on the MDM Hamster Wheel

Smartphone security “is a moving target,” says Alex Brown, director of strategy at healthcare communications company Voalte. “Today, there seems to be two layers of what people are looking into when it comes to smartphone security – applications on the device and the content of those applications. If your application has PHI sitting in it all the time, than you have a much higher risk than with an app that has PHI on it only when it’s connected to a server.

“Not every healthcare organization has the expertise to deploy security,” he adds, “which is why providers rely so much on vendors to make sure that they’re really keeping up to date with best practices around mobile device management.”

Brown finds that in today’s world of escalating cybersecurity concerns, constant dialogue with hospital customers about the importance of up-to-date MDM is a must. Hospitals are now faced with managing almost daily updates from Apple and Google, he explains, which, for many, has taken some getting used to.

“It’s an important piece that not a lot of sites think about,” Brown says. “It’s constantly moving. I like to refer to the smartphone space as a hamster wheel of updates. It can be a little daunting to get on it, and once you’re on it, you really have to keep up. If you don’t, that’s where you can introduce risk. The CHCS settlement was a gut check for other providers in the sense that they hopefully are now asking themselves, ‘Are we checking all the boxes constantly? Are there new boxes that we can now check?’”

Great Vendor Expectations

Parkview Medical Center (CO) CIO and Vice President of IT Steve Shirley has seen his fair share of cybersecurity practices, having spent 30 years in banking IT and nearly eight in healthcare. “In banking, we were mandated and audited on our vendor management programs. I routinely went onsite at vendor locations to audit their data centers, review their SaaS70 reports, and determine the overall security posture of the firm. We looked at their financials and did a significant amount of work to ensure the vendor was not only financially strong and stable, but secure, and that our data was safe.”

Shirley adds that security in the financial industry is at a higher level of maturation than in healthcare for obvious reasons. “They have to protect identities and money,” he explains. “Now that health data is under attack, we need to raise security to a higher standard. At Parkview, we’re heavy users of smartphones. The challenge is that in the BYOD world, other than our MDM strategy and provisioning, we don’t have a lot of control over what devices come in the door. And so we expect the highest level of security from our vendors. We include vendor management in our RFPs and require BA agreements for any vendor dialing into our system in any way. This is in addition to the standard requirement when the vendor has access to our data for things like analytical activity.

“When we implement new solutions,” he adds, “we collaborate with them to plan and design for security, whether at the mobile device level or system level. When we partnered with PatientSafe Solutions to roll out PatientTouch on the iPhone for services ranging from bedside medication verification to care team texting and communications, we brought in all of the vendors involved to develop a system that was not only reliable and functional, but also secure across all connections and access points. Six companies were involved: PatientSafe, their wireless vendor, our IT team and wireless vendor, Cisco, and Apple all participated in ensuring the system worked seamlessly and securely.”

Sticks Will Get the Cybersecurity Job Done

With regard to the CHCS breach, Shirley isn’t shy about sharing his opinion. “In the banking industry, I learned that we all mean to do good, but the movement of the day is so fast and furious that things tend to fall by the wayside,” he says. “And so the government stepped in with punitive measures for not meeting security or other standards. Y2K was a great example. The FDIC threatened to close banks if they didn’t have an appropriate Y2K strategy. I pray every day my hospital doesn’t get attacked and a breach occurs. As regretful and tough as the fine is, it’s a necessity because it creates an industry wakeup call for those who haven’t realized healthcare is under attack.

“It seems that while people understand that systems like servers, desktops, laptops, etc. are highly susceptible to attack if not properly protected, there’s a perception that smartphones are different,” he explains. “We, both industry and our consumers, need to get serious about understanding that a smartphone is a device that has access through the Internet and is thus vulnerable.”

Grace Hua, director of product management, clinical communications at PatientSafe, is of a like mind in her belief that hospitals should demand that vendors provide technology support and safeguards for clinician end users. “This should be a wakeup call not only for BAs, but for the industry as a whole,” she says in reference to the CHCS news. “BAs need to fully understand the importance of the data they are potentially putting at risk, and the implications of theft or security breach, as that data now has a dollar value tied to it. Hacking is now just as profitable in healthcare as other industries.”

Increasing Staff Awareness

When it comes to safeguarding smartphones and patient PHI, Shirley and his team are taking proactive measures to keep CHCS-type incidents at bay. Higher-level efforts include membership in security organizations like the SANS Institute and making sure that new technology deployments include a project milestone for evaluating and understanding potential security risks, and then developing a plan to mitigate them.

“This seems so intuitive,” he says, “but I think it is sometimes not the highest priority in the deployment of healthcare systems. Examples of this include installation of modalities for radiology that have communications facilities onboard, or even simple things like network printers.”

Shirley is especially excited about boots-on-the-ground efforts at Parkview. “We have a network security engineer who, in addition to his technical role, is responsible for security education. He regularly visits units during their daily huddles to give security tips like how to create strong passwords or how to validate that the person on the phone is authorized to receive information. Throughout the hospital, we use our digital wallboards to deliver security messages to everyone onsite. Our employee and physician newsletters have standing articles about safety. We’re also putting together a security video that will be required viewing for all employees. The effort has been huge in the last year to increase staff awareness.”

A Rising Tide Lifts All Cybersecurity Practices

Shirley is happy to report that his colleagues at neighboring institutions are paying just as much attention to securing mobile devices. “Two years ago, I would have said healthcare organizations are not paying enough attention to cybersecurity protection,” he says. “Now, I’m seeing new and extreme efforts every single day. Recently, a competitor healthcare system went to two-factor authentication for external access, and I think that’s awesome. At Parkview, we’ve implemented MDM for all of our devices. We don’t store data on laptops or mobile devices, and we don’t deploy any mobile hardware that hasn’t been encrypted. I think the industry understands healthcare is under threat and there are many points of potential vulnerability we need to address. It’s absolutely becoming more of a focus.”

News 9/28/16

September 27, 2016 News 2 Comments

Top News

InstaMed secures a $50 million investment from Carrick Capital Partners, bringing its total funding to nearly $126 million since launching in 2004. (CCP’s only other foray into healthcare IT seems to be a 2014 majority equity investment in post-acute software vendor Procura.) The Philadelphia-based company will use this latest round to further develop its healthcare payments technology and go-to-market strategy. CCP Managing Director Jim Madden will join InstaMed’s board, while colleague Chris Wenner will become a board observer.

Webinars

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Waycross, GA-based Salus Telehealth and Chicago-based VideoMedicine merge under the Salus brand name to offer telemedicine hardware and software, including a direct-to-consumer app. Salus CEO Paula Guy will remain in that role over the newly combined company. VideoMedicine founder and CEO Charles Butler, MD seems enthusiastic about the merger, though his role moving forward remains unclear. Fun fact: He competed at the age of 18 in the 1998 Nagano Winter Olympic Games in the sport of ice dancing.

PeriGen confirms the acquisition of Hill-Rom’s WatchChild Fetal Monitoring System. The newly combined team will be led by PeriGen CEO Matthew Sappern, while the management team will include executives from both companies. WatchChild General Manager Brian Bishop will join PeriGen as chief product officer. PeriGen also closed a corresponding investment round led by Ambina Partners, giving AP founder Greg Share a spot on PeriGen’s board.

People

Sentry Data Systems promotes Tom Tran to CFO and COO.

Cerner President Zane Burke joins the board of Truman Medical Centers (MO), which signed on to a 10-year EHR deal with Cerner last fall.

Shelby Solomon (Connecture) joins Medecision as SVP, corporate development and strategy.

Announcements and Implementations

Sunnybrook Health Sciences Centre will implement patient registration technology from Harris QuadraMed across its three facilities in Toronto.

Cigna adds virtual consults from American Well to its telemedicine offerings for 2017 employer-sponsored and individual health plans. The payer rolled out a similar service from MDLive in 2013.

Standards development organization NCPDP works with Experian Health to develop a vendor-neutral universal patient ID management tool.

Several hospitals, including Boston Children’s Hospital and Mercy Health System (WI), and a Pennsylvania-based care program for the elderly, roll out Circulation’s medical transportation technology, which takes advantage of Uber’s API to help providers and patients schedule rides that cater to specific needs and preferences.

Indiana-based HMO MDWise – a joint venture between Eskenazi Health and Indiana University Health – taps Valence Health to process its medical claims beginning January 1.

San Mateo County Health System (CA) implements NextGate’s EMPI patient-matching technology across its 10 divisions and six EHRs.

Privacy and Security

The GAO releases a “scathing” report on cybersecurity preparedness in health information technology, recommending that HHS “update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program.”

A former Alberta Hospital Edmonton employee inappropriately accesses the records of 1,300 patients over the course of 11 years, most likely out of “personal curiosity,” making it the Canadian province’s largest deliberate breach of health data.

Technology

SnapMD adds provider-to-provider consult capabilities to its telemedicine technology.

Varian Medical Systems develops new cancer care coordination software that aggregates EHR, IS, and portal data from the patient, PCP, radiation, medical and surgical oncology, and social services.

Memorial Healthcare System partners with American Well to offer a telemedicine app for members of its managed care or consumer health plans.

Casenet rolls out the latest release of its TruCare care administration and management software.

Government and Politics

President Obama gives his stamp of approval to National Health IT Week, reminding citizens of the “billions of dollars” spent to encourage the adoption of EHRs at 97 percent of the country’s hospitals, and his efforts to launch the Precision Medicine Initiative.

Coinciding with nationwide health IT marketing push, ONC releases its Health IT Playbook, a Web-based manual that updates the Patient Engagement Playbook for Providers, offering guidance on a wide variety of health IT products and topics. The playbook includes a guide to EHR selection and contracts.

Research and Innovation

Despite past “snake oil” commentary, an AMA survey of 1,300 physicians finds that a majority are optimistic about the potential of digital health tools to improve patient care. Enthusiasm seems to outweigh adoption: Physicians cite liability coverage, EHR workflow integration, and data privacy as must-haves for successful and consistent adoption.

Sponsor Updates

Forward Health Group Founder and CEO Michael Barbouche speaks at the Wisconsin BioHealth Summit September 27 in Madison.
Impact Advisors releases a new white paper, “Realizing Clinical Benefits from EHR Investments.”
Liaison Technologies and Meditech celebrate National Health IT Week.
Meditech releases a new white paper, “The Benefits of an Integrated Approach to Critical Care.”
Verscend Technologies kicks off its eighth annual conference, taking place in Palm Desert, CA through September 30.
Glytec receives three patent notices of allowance for its EGlycemic Management System.

Blog Posts

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Curbside Consult with Dr. Jayne 9/26/16

September 26, 2016 News Comments Off

National Health IT Week is underway. According to the press release, “This annual celebration is a time for all of us to reflect on the progress we have made and recommit ourselves to advancing the promise of health information technology.” The newest National Coordinator for Health IT, Vindell Washington, MD will host a Twitter chat on Tuesday starting at 11am ET using the hashtag #AskVindell. Topics include the current and future state of health IT as well as questions and answers. There are all kinds of National Health IT Week activities taking place across the country. I’m out with clients this week so I won’t make it to any of the festivities. Still, I wanted to take a chance to reflect on my own time in the Health IT trenches.

I was fortunate to attend a medical school that rotated its students through hospitals that embraced technology. Looking back, some of it was pretty primitive, but back in the day we thought we were cutting edge as we navigated through the lab system with light pens tethered to green-screen terminals. One hospital had started its own EMR. Even in the early days, it had most of the data needed to round on patients – laboratory data, vital signs, medication lists, and more. It was a luxury to prepare for rounds at a single workstation rather than having to round up paper charts and dig through them.

Surprisingly, the more advanced hospital was a community hospital rather than the primary academic hospital. Looking back, it may have been easier to pilot informatics platforms on the community side since the roster of admitting physicians was fairly stable. Although residents and students participated in patient care, it wasn’t at the same volume as the academic hospital. The community hospital was progressive in other ways, building the first hospitalist program in the city and serving as a pioneer in laparoscopic surgery.

My medical school class was the first one to have email accounts issued to everyone with the expectation that we’d actually use it, as opposed to it being optional. Granted, it was Lotus Notes, but it was high tech at the time. We still did our histology coursework looking at carousel after carousel of 35mm slides, however. We had a transcription service where someone took notes at every class and distributed them; without laptops, we took old-fashioned paper notes then typed them up later, printed them, and photocopied them. No one seemed to put two and two together that we could have been emailing them around. Today, my school augments its gross anatomy program with virtual anatomy – 3D computer simulations based on CT scans taken of live individuals. Very different than the cadaver cross sections that we worked with.

Health IT really started to boom while I was in my residency training, with increased nursing documentation being done electronically, although paper copies were still printed and added to the chart. There was a lot of fighting over PCs because the hospital hadn’t really thought through the computerization piece or what it would look like from a workflow standpoint. The residents thought we were cool because we could dictate our History and Physical documents and Admission notes using Dragon. It not only helped avoid the lengthy, handwritten note process but made sure the documents were on the chart quickly compared to the turn-around time required for “regular” transcription. No one at the time thought of outsourcing transcription services to 24×7 resources in another country, and certainly no one thought much about natural language processing.

I purchased my first handheld device as a Chief Resident. While others seemed to be leaning towards the Palm Pilot platform, I went with the Pocket PC. Although I legitimized my purchase by using it to take attendance at Grand Rounds and to use Excel to track various program requirements, I secretly thought the coolest feature was the fact that you could put music on it. The ultimate mix tape was now in your pocket at all times (or at least as long as the battery lasted). I found that Pocket PC in a drawer a few weeks ago and it fired right up. The data files were gone but the music was all still there, providing a much-appreciated blast from the past.

When I opened my solo practice, I was supposed to be on an EHR from day one, but there were implementation issues, forcing me to spend a year on paper charts in an office that wasn’t built to house paper charts. When we finally got our system, we learned a lot about vendor bait-and-switch, starting when the trainer first arrived and tried to train us on a system that was different than what we actually had installed. It went downhill from there and ultimately resulted in a de-installation. That experience, however, set the groundwork for my career in health IT, as hospital leadership realized I had been through the wringer but learned quite a bit, and could be an asset to their future EHR plans. I slowly crossed over into the technology side of things and never looked back.

People occasionally ask whether I think it was a waste of time to go to medical school. They often assume I don’t see patients anymore. Being a physician first was critical to me winding up in the wild and crazy world I work in today, and I wouldn’t trade it even with the hideous student loans and the long, torturous work hours. I learned health IT on the side and on the fly, while building a practice and settling in as a young physician. We’ve gone a long way past many of the things I used to struggle with early in my career – trying to access charts in the middle of the night, dealing with pharmacies that weren’t comfortable with electronic prescriptions, and bringing faxes directly into the EHR. Now we’re moving into an age where pharmacogenomics is a reality and we have the world’s library at the tips of our fingers at all times.

I remember doing an interview for the hospital newsletter early in my career. The CMO called to blast me for saying that having computers in the office allowed me to look things up during the patient visit. He felt that my statement implied that I was inexperienced and that patients would avoid me. Quite the opposite: Patients appreciated having a physician who was willing to look things up and show them the actual literature so that we could make decisions together. Having technology in the room transformed how I practiced in a positive way, and I know it made a particular difference for many of my patients. Sometimes, as we reflect on how we work with technology today, we tend to demonize it without putting into perspective what our daily lives would look like without it.

Even though it sometimes drives me crazy, I’m grateful for healthcare IT and what it has done for me personally. I’m hopeful for what the future holds, even despite the mandates and regulations. I can’t wait to look back in another five or 10 years and see where we’ve gone.

How has health IT impacted you, personally or professionally? Email me.

Email Dr. Jayne.

Monday Morning Update 9/26/16

September 25, 2016 News 4 Comments

Top News

GE Healthcare launches Five.Eight, an accelerator (not to be confused with the Athens, GA rock band) for global healthcare startups aimed at improving outcomes for the estimated 5.8 billion people in the world who don’t have access to quality, affordable care. The accelerator hopes to enroll 10 companies in its first program, each of which will work with GE on developing scalable products for potential distribution or integration into GE’s portfolio. Seed funding of up to $5 million per startup may also be available.

India-based Tricog is the first member of the new accelerator. The startup has developed technology to help ED physicians diagnose heart attack patients within minutes, decreasing time between symptoms and treatment and increasing survival rates.

HIStalk Announcements and Requests

It’s Hillary Clinton in a landslide with heavy HIStalk reader turnout. Maybe I’ll run it again after the debates. New poll to your right or here: continuing last week’s poll, which health IT salesperson LinkedIn credential would most impress you?

Welcome to new HIStalk Platinum Sponsor Ivenix. The Amesbury, MA-based company has transformed IV infusion delivery from the decades-old technology of competitors to the connected world to improve patient safety, eliminate workflow inefficiencies, and protect the hospital’s bottom line by reducing adverse events. The Ivenix Infusion Management System measures and adjusts IV flow rate in real time and supports mobile viewing of infusion status and alarms, integrating with the EHR to auto-program and auto-document. Adaptive technology eliminates the need for ongoing calibration, while software and security updates along with drug library updates are delivered without removing devices from the floors. Ivenix addresses the challenges of increasingly complex dosing regimens, the demand for EHR integration, and infusion technology-related patient safety issues. Thanks to Ivenix for supporting HIStalk.

I found this video that describes the benefits of the Ivenix Infusion Management System, including eliminating nurse time spent manually documenting IV pump information in the EHR.

Last Week’s Most Interesting News

Epic announces a number of new offerings and initiatives at its annual user group meeting, which attracted 18,000 attendees.
The Chan Zuckerberg Initiative donates $3 billion to “cure, prevent, or manage all diseases by the end of the century.”
Private GPs in England offer third-party video visits as an alternative to long appointment wait times, with NHS footing the bill.
The entire board of Cairns Hospital in Australia resigns following an unpopular and over budget Cerner rollout.
Appalachian Regional Healthcare (KY and WV) brings the computer systems of its several hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by a malware attack.

Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Blue Cross Blue Shield of Nebraska pulls out of the federal health insurance exchange, leaving Nebraskans with extremely limited purchasing options when open enrollment starts November 1.

TierPoint will spend $20 million to build the first phase of a 90,000 square-foot data center in Dallas.

Announcements and Implementations

Canopy Health, an accountable care network formed out of an affiliation between California-based UCSF Health and John Muir Health, selects financial risk management and population health services from Conifer Health.

Sydney-based Macquarie University’s MQ Health campus partners with Emory Healthcare (GA) to launch the country’s first remote intensive care unit monitoring program using technology from Philips.

Technology

MSN Healthcare Solutions incorporates SyTrue’s NLP OS operating system and AdvancedBI’s business intelligence tools into its new NLP-based analytics offering for radiologists.

VitreosHealth adds predictive risk models for identifying gaps in care, mental health conditions, and patient motivation to its population health management analytics engine. Models for palliative care will be rolled out towards the end of the year.

Research and Innovation

AHRQ looks for peer-reviewed, patient-centered outcomes research findings related to geriatric care shown to have improved patient outcomes for potential investment in broader dissemination and implementation.

I missed this a few weeks ago: The National Science Foundation awards Rice University mechanical engineer Marcia O’Malley a $1 million, three-year grant to develop a tool that will track the movement of a surgeon’s operating tool and emit a vibration if his or her technique is deemed too rough. (No details are given as to how “rough” will be determined.) O’Malley says the tool will combine virtual reality with real-time touch feedback that will hopefully make the process of learning how to perform delicate surgeries easier.

Privacy and Security

Care New England Health System pays a $400,000 HIPAA fine for neglecting to update its BA agreement with Woman & Infants Hospital (RI), for which it provides IT system technical support and information security. The lack of updated documents came to light when WIH reported the loss of unencrypted backup tapes containing the PHI-filled ultrasound studies of 14,000 patients. WIH ended up paying a $150,000 fine for its role in the breach.

Other

Iliuliuk Family and Health Services, the only clinic serving Alaska’s extremely remote Unalaska Island (which also happens to be one of the country’s busiest commercial fishing ports), launches virtual consults via satellite technology with Anchorage-based providers at Providence Alaska Medical Center. The local news reports that the service will connect mainland ED physicians with clinic staffers to treat injuries “among the Bering Sea crabbing fleet made famous by the Discovery Channel show ‘Deadliest Catch.’”

Sponsor Updates

Experian Health will host its Financial Performance Summit October 5-7 in Nashville, TN.
Patientco releases its annual State of the Industry Report.
PatientMatters will exhibit at the Arkansas Hospital Association Annual Meeting & Tradeshow October 5-7 in Little Rock.
PerfectServe will exhibit at ANCC 2016 October 5-7 in Orlando.
Lexmark Healthcare submits a formal pledge of commitment to interoperability.
Sagacious Consultants makes a charitable donation to Tri 4 Schools to help extend its Exercise to Achievement after-school program.
The SSI Group will exhibit at the AAHAM ANI 2016 conference October 5-7 in Las Vegas.
Summit Healthcare and ZeOmega will exhibit at InSight 2016 September 27-30 in San Antonio.
Sutherland Healthcare Solutions will exhibit at the HFMA NJ National Institute October 5 in Atlantic City.
Navicure receives number-one rankings in client satisfaction and client loyalty across three Black Book RCM survey categories.
Valence Health will exhibit at the Georgia Society for Managed Care Conference October 5-7 in Young Harris, GA.
ZeOmega releases a video, “SignalHealth Deploys Advanced Care Directives Repository Through Jiva HIE.
ZirMed ranks first for end-to-end RCM in the 2016 Black Book Report for the fifth consecutive year.

Blog Posts

Healthcare & Kitchen Table Economics (PatientPay)
What testing an airplane & obstetrics have in common (PeriGen)
Back to School – PMD at Academic Institutions (PMD)
Common FWA Overpayments Your Automated Claim Editing System May Miss (Verscend)
What You Need to Know: Proposed Federal Fiscal Year 2018 ICD-10 Code Updates (VitalWare)
Headsets in healthcare? It’s virtually guaranteed. (Voalte)
Our unconquerable soul (Xerox)
Avoiding Waste: Practicing at the Top of Your License (Zynx Health)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 9/23/16

September 22, 2016 News 3 Comments

Top News

Facebook founder Mark Zuckerberg and his wife Priscilla Chan, MD will donate $3 billion to “cure, prevent, or manage all diseases by the end of the century.” Zuckerberg noted that we spend 50 times more on disease treatment than prevention and says the couple’s donation will bring scientists and engineers together to build research tools and technologies.

The first project funded by the donation will be the $600 million Chan Zuckerberg Biohub, which will bring together scientists and engineers from Stanford, UCSF, and Berkeley. Its first two efforts involve infectious disease (developing a universal diagnostic test, using gene editing tools to create new drugs and monoclonal antibodies, using machine learning to mine clinical trials data for vaccine development, and deploying a rapid response team during disease outbreaks) and mapping all human cells to create the Cell Atlas for research.

It’s an impressive donation, but still only one-tenth of what the NIH spends on research in a single year. It’s trendy for tech companies (IBM, Google, Microsoft, etc.) to arrogantly think they can “solve” disease. I’m a bigger fan of Michael Bloomberg’s donations that involve public health or those efforts that involve personal responsibility or uncontrolled healthcare costs rather than chasing elusive magic bullets. At least these first projects commendably blend technology with developing a baseline of intelligence than can be built upon over the years.

Reader Comments

From Considering Further Education: “Re: your observation that salespeople typically don’t have advanced degrees. As a salesperson, how much more credible would I be with an MBA or other advanced degree? I’m young and motivated, but wondering if it would pay off.” My observation was that salespeople (and thus CEOs promoted from sales roles, as is often the case) often have no degree at all or unrelated bachelor’s degrees from universities not on anyone’s top lists, with my assumption being that they were so confident in their career path that they didn’t expect to be competing for jobs on the basis of educational credentials. I would place zero value on a salesperson having an advanced degree, but I’ll ask experienced readers to weigh in, especially as it pertains to moving from sales to executive positions.

I should mention that every time I talk about advanced degrees, I get a bunch of emails from indignant folks who don’t have them describing their personal success in a world of less-competent, less-motivated degree holders in thusly assuming they hold no value for anyone. I suspect that everyone’s ideal credentials are their own, with any more education being worthless paper-hanging and any less education failing to clear the slippery educational slope (if you don’t need a master’s, do you need a bachelor’s? What about a high school diploma?) Degrees don’t matter if you work for yourself, start Facebook, or land a CEO position, but for most people, they will elicit some reaction and affect employment opportunities at least indirectly.

From Ascetic Acid: “Re: integration report. What do you make of this gaffe?” Looks like bad strategery.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Sutherland Healthcare Solutions. The Clifton, NJ-based company is a leading provider of consulting, BPO, ITO, and analytics services to providers, payers, government, and ACOs, with 5,000 employees working from 15 sites around the world. It offers claims administration and adjudication, coding, technology services, end-to-end RCM, analytics, patient experience consulting, and population and payment solutions. Health IT services include product development, maintenance, and support; testing as a service; implementation; integration; clinical help desk; and training. Among the company’s 100+ clients are six of the top 25 US hospitals and three of the five largest US health plans. CEO Graham Hughes, MD is an industry long-timer, having spent time at IDX and GE Healthcare. Thanks to Sutherland Healthcare Solutions for supporting HIStalk.

This week on HIStalk Practice: Doctor on Demand CEO Hill Ferguson discusses the intersection of fintech and health IT. Health Systems Informatics launches population health management consulting services. FDA, USDA announce app development competition, telemed funding as part of Prescription Opioid and Heroin Epidemic Awareness Week. Coordinated Care Oklahoma adds DrFirst tech. Kansas City Care Clinic goes with care coordination tools from BluePrint Healthcare IT. Community Health Center selects Safety Net Connect IT as part of school-based effort in New Mexico. AAFP elects new president. Physician morale takes a nosedive.

Webinars

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

HIPAA-compliant hosting and EHR integration technology vendor Catalyze raises $6.5 million in a Series B funding round, increasing its total to $12.5 million.

Hill-Rom will sell its WatchChild fetal monitoring system business to advanced fetal monitoring and clinical decision support vendor PeriGen to focus on its core growth areas of falls prevention, patient satisfaction improvement, and infection prevention. The 18 CWS employees assigned to WatchChild will be offered positions with PeriGen. I described the company’s history in responding to a June 2012 reader rumor report that Hill-Rom was shopping WatchChild even then as:

The WatchChild OB monitoring system is owned by Hill-Rom, mostly known for selling expensive hospital beds and a few other marginally related product lines. WatchChild was supposed to be a natural extension of the company’s NaviCare nurse call system. HRC shares haven’t exactly shone lately, dropping from $48 in July 2011 to $30 now [note: they’ve rebounded to $61 since], so Hill-Rom may simply see the frenzy of M&A activity in healthcare IT as a good opportunity to sell some or all of its IT holdings to focus on core business. All of this is speculation since they’ve made no announcement that I’ve seen. Hill-Rom used to be known as Hillenbrand Industries, whose humorously complementary business was Batesville Casket Company. I’ve always wondered if they might put some of their nurse call technology in those caskets as an upgrade for those who fear being buried alive.

TransUnion acquires RTech, which offers post-service eligibility solutions to maximize hospital reimbursement, for $62 million.

Sales

CHI Franciscan Health (WA) chooses Glytec’s EGlycemic Management System for real-time insulin dosing in its eight hospitals, integrated with Epic.

Adventist Health chooses Oracle Applications Cloud for ERP, human capital management, analytics, and enterprise performance management.

Johns Hopkins Aramco Healthcare will deploy Epic and Hyland OnBase in its facilities in Saudi Arabia.

People

Clinical trials software vendor Cure Forward hires Frank Ingari (NaviNet) as CEO.

In England, NHS England chooses its just-appointed chief clinical officer Keith McNeil, MB to also head up its new Digital Delivery Board. McNeil resigned as CEO of Addenbrooke’s Hospital last year just before Cambridge University Hospitals NHS Foundation Trust (which includes Addenbrooke’s and The Rosie Hospital) was placed on “special measures” for a number of patient care problems; he was also CEO when the Regulator Monitor investigated the trust’s financial challenges following its $300 million Epic rollout.

Announcements and Implementations

Bakersfield Memorial Hospital (CA) rolls out a camera-equipped security robot that patrols the ED parking lot and offers visitors a button to call a security guard.

LiveProcess announces new mobile apps for patient care and transitions, discharge, staffing, transplant, and hospital operations.

St. Luke’s University Health Network (PA) goes live with Caradigm Care Management to support its Bundled Payments for Care Improvement program.

UPMC launches Curavi Health, which will offer telemedicine equipment and software to nursing homes and provide after-hours consults from University of Pittsburgh Physicians.

Engage, the IT services division of non-profit Inland Northwest Health Services (WA), offers a NetApp-powered cloud backup and recovery solution to the 40 hospitals whose Meditech systems it hosts.

Government and Politics

An HHS OIG audit finds that the state of Washington overpaid $9.2 million to 19 of the 20 hospitals that received Medicaid EHR incentive payments in 2011-2015.

Privacy and Security

From DataBreaches.net:

Keck Medical Center of USC notifies patients that it experienced a ransomware attack on August 1, adding that it recovered its systems without paying.
Codman Square Health Center (MA) notifies nearly 4,000 patients that an unnamed number of its employees looked up patient information on the New England Healthcare Exchange Network without authorization, with those employees since either suspended or fired. The employees viewed information of non-Codman patients whose information was stored on NEHEN, which is an interesting twist on the usual “viewed without authorization” situation.
The forever-bungling Yahoo warns users that it has become the victim of what is apparently the biggest breach in history, with the information of 500 million accounts exposed in 2014 by “a state-sponsored actor” with the announcement coming right before the company closes the sale of its pathetic dregs to Verizon for next to nothing. An interesting reader comment to that item says it’s suspicious that breached companies always scapegoat unverified “state actors” instead of “some 16-year-old kid.” At least the overused “sophisticated attack” excuse is now rare. Expect the average consumer to become even more wary of signing up for health-related apps and portals.
The information of thousands of patients whose information was stored by a now-closed physical therapy EHR vendor is exposed in a “leaky bucket” of its incorrectly configured Amazon Web Services S3 (Simple Storage Service) account.

In light of the AWS breach, DataBreaches.net suggests reviewing business associate agreements using the checklist above.

Hackers take ransomware up another notch with Mamba, which instead of encrypting files, encrypts the entire hard drive and offers to sell the password required to boot up the PC. At least some Luddite hospital might have its first laptop encrypted, although not in a good way.

A survey finds that half of IT professionals don’t understand that emptying a PC’s Recycle Bin doesn’t permanently erase the files it contains.

Other

Google parent Alphabet kicks off its carefully controlled DeepMind Health public outreach meeting with an apology that the event was held at Google’s opulent London offices, suggesting that more accessible community spaces might be more appropriate going forward. The company, which has been criticized for its lack of transparency for rolling out clinical products without the required government approval, says it has been clear since it acquired DeepMind for $500 million that intends to build a business model from its use of patient data it gets for free with use of its hospital software, but suggests that it would like to get paid for clinical outcomes rather than the traditional software vendor activity. A prototype of a patient portal app was shown, although development has not started.

In Australia, the entire board of Cairns Hospital resigns following massive budget misses following its implementation of a Digital Hospital program in which it installed Cerner Millennium. Employee surveys following the go-live earlier this year – results of which the hospital has declined to release but they leaked out anyway — found that the system was not intuitive and user friendly, endangered patients with its specimen order and collection workflow, and was brought live without adequate testing and support coverage.

The local paper says McDonough District Hospital (IL) has been live on a new EHR, Cerner Safari, for three months. I’m not sure where they got that name.

A Madison TV station runs a UGM-inspired video profile of Epic’s 90-employee culinary team led by Chef Eric Rupert (not to be confused with Chef Eric Ripert), where everything — right down to the hot dog buns and ice cream — is made from scratch.

The Madison paper runs some highlights from Epic UGM:

The company is working to provide Syrian refugees with their health information on flash drives.
Epic will offer free licenses and maintenance to federally qualified health centers.
MyChart will be enhanced to allow patients to get an estimate of their care costs and to apply online for charity care.
Epic will integrating with state doctor-shopper databases and using predictive modeling to help manage opioid use in individual patients.
Video visit capability will be built into Epic.
The company says its Cosmos Research Network of big health systems will support better understanding and treatment of diseases.

SNAGHTML24dc388b

Naveen Rao observes the hostile user response caused by United HealthCare’s recent app update, noting that the company even recycled an apparently rare positive user comment from an old press release touting a previous upgrade in the absence of any other positive user reaction. He questions how a company of UHG’s size with a technology and innovation budget of $3 billion could release an app that apparently won’t work for many people, why users should be expected to re-enter information from elsewhere, and why UHG seems indifferent to the feedback of its customers. My conclusion is that it’s not only tough to create a consumer app that’s easy to use, is thoroughly tested under an infinite number of scenarios, and gives immediate gratification, but it’s also true that app developers aren’t used to scaling their support services to meet the understandably high expectations of patient-customers who just want a human to respond to both their technical and medical needs.

Perhaps UHG should have read this fascinating article (thanks to Eric Topol, MD for tweeting it out) called “The Scientists Who Make Apps Addictive” that describes how the digital interface can be used to shape user decisions and how companies use complex psychology in their apps to get people to do their bidding. Expert B.J. Fogg gives Uber as an example of why companies should design for habits, where the experience is so positive that users won’t even consider alternatives. He also advocates that apps “make people feel successful,” as in Instagram’s photo options that make people feel like artists. The article notes Facebook’s use of psychology in playing to each user’s yearning for social approval via likes and invitations to connect, concluding that “whoever controls the menu controls the choices” in a digital world designed by a few 20-something men working for a handful of mega-app companies in San Francisco. The article compares apps to casinos, where slot machines are “Skinner boxes for people” and algorithms predict when a given player’s losses might encourage them to walk away, at which time the casino dispatches a “luck ambassador” to give them a free show ticket or a steak dinner to keep them losing money. The article brilliantly summarizes with insight that should interest app developers:

The casinos aim to maximize what they call “time-on-device.” The environment in which the machines sit is designed to keep people playing. Gamblers can order drinks and food from the screen. Lighting, decor, noise levels, even the way the machines smell – everything is meticulously calibrated … But it is the variation in rewards that is the key to time-on-device. The machines are programmed to create near misses: winning symbols appear just above or below the “payline” far more often than chance alone would dictate. The player’s losses are thus reframed as potential wins, motivating her to try again. Mathematicians design payout schedules to ensure that people keep playing while they steadily lose money. Las Vegas is a microcosm. “The world is turning into this giant Skinner box for the self,” Schüll told me. “The experience that is being designed for in banking or healthcare is the same as in Candy Crush. It’s about looping people into these flows of incentive and reward. Your coffee at Starbucks, your education software, your credit card, the meds you need for your diabetes. Every consumer interface is becoming like a slot machine.” These days, of course, we all carry slot machines in our pockets.

Sponsor Updates

Volunteers from Impact Advisors worked with an Illinois environmental education group to recycle crayons for children’s hospitals last week.
Iatric Systems, Meditech, and Santa Rosa Consulting will exhibit at InSight 2016 September 27-30 in San Antonio.
MedData will exhibit at the HFMA Fall Revenue Cycle September 28 in Bellaire, MI.
Black Book names Navicure #1 in end-to-end RCM technology solutions for hospitals under 100 beds.
Definitive Healthcare releases a new version of its app that provides access to its provider data from Salesforce.com.
NTT Data will sponsor Blue Cross Blue Shield’s Information Management Symposium September 25-28 in Detroit.
Obix Perinatal Data System will exhibit at the Nursing Perspectives Conference September 28-30 in Buford, GA.
NCQA awards PCMH 2014 pre-validation status to the analytics platform of Arcadia Health Solutions.

Blog Posts

Enabling Better Care With Workflow-Driven Technology (Spok)
6 best practices to grow your EMR to its full potential (Advisory Board)
Is it Time to Merge Privacy and Security Roles? (ID Experts)
CMS Eases MIPS/MACRA Reporting Requirements with “Pick Your Pace” Program (Impact Advisors)
Reduce Barriers to Your Click-Through Rate (Influence Health)
“Hut! Set! Hike!” – A Healthcare Provider’s Playbook to Consumer-friendly Payments (InstaMed)
Coding is About More Than Saving Money (Intelligent Medical Objects)
Pain in the Neck (National Decision Support Company)
Avoid Collections Agencies with Five Patient Payment Best Practices (Navicure)
Impossible – Amazing Stories of Recovery (Netsmart)
Unchaining the Block – 3 Ways Blockchain could upend healthcare (Orion Health)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 9/21/16

September 20, 2016 News 6 Comments

Top News

In England, private doctors are offering third-party video visits, such as those marketed by Babylon Health, as an alternative to long appointment wait times, with NHS footing the bill. The British Medical Association warns that it’s risky for patients to receive video advice from doctors who don’t have access to their NHS medical records.

Doctors in England can get paid as video visit providers as long as the patient is outside their geographic area, which critics have called a “slippery slope towards privatization.”

Reader Comments

From Spiffed Up: “Re: telemedicine visits. Have you ever had one?” I have not, counting myself among the 88 percent of respondents to my April 2016 poll who have not experienced a virtual visit of any kind. It would be fun to hear from doctors who have been involved in virtual visits, either as a provider or patient. I’m especially interested that despite the value we place on electronic medical records and continuity of care, we are OK with for-profit vendors of such services performing a kind of medical speed-dating (as mentioned in the news item above from England). On the other hand, Americans tend to undervalue those ongoing relationships in reducing the art of medicine to their 30-second description of their problem, preferably with the prescription-issuing process overlapping since that’s what they really want as an outcome. Patients will score doctors highly if they offer easy parking, don’t keep patients waiting, have good bedside manner, and crank out the meds. Only in medicine do we expect vendors (doctors) to exhibit ethical behavior in not selling people profitable things that are bad for them.

HIStalk Announcements and Requests

Eight companies have taken advantage of my New Sponsor Pledge Drive specials so far in September, earning bonus months added on to their new, year-long sponsorships. Contact Lorre to join them. Usually one of the first questions companies ask Lorre is, “Can we attend HIStalkapalooza?” (answer: yes, Platinum-level sponsors get two free tickets). Another is, “Can Mr. H interview our VP of sales about a new product we’re announcing?” (answer: no, I don’t do interviews that focus on company and product pitches and I only interview CEOs).

Speaking of HIStalkapalooza, I begrudgingly agreed to do it again despite the big personal check I’ll be writing if event sponsorships don’t cover the significant cost (the House of Blues bar tab analytics from previous years suggest that a good time was had by at least some). Contact Lorre for a sponsorship information packet. We’re even offering one and only one sponsorship for big spenders who want a bunch of invitations for clients and employees, CEO stage time, backstage access, and many other customized perks.

My latest industry observation: salespeople (and thus CEOs of companies that mostly promote salespeople) rarely have advanced degrees. it’s usually a state college or no-name bachelor’s at best.

Webinars

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Huntzinger Management Group acquires Next Wave Health Advisors.

WebMD parts ways with CEO David Schlanger by mutual agreement, replacing him with President Steven Zatz.

Morgan Stanley is reportedly facilitating discussions among Infor and buyout firms that are interested in investing in the business software company, whose value may exceed $9 billion.

Sales

McLeod Health (SC) chooses Cerner Millennium and HealtheIntent to replace its Invision and Soarian systems in seven hospitals.

Prime Healthcare chooses Santa Rosa Consulting for Epic go-live support at its 43 hospitals, with the first wave of activations scheduled for October 1.

People

Imprivata, fresh off the close of its acquisition by Thoma Bravo, names Gus Malezis (Tripwire) as president and CEO. He replaces Omar Hussain, whose plans were not announced.

Verscend Technologies (the former Verisk Health) hires Joe Morrissey (McKesson) as SVP of client services.

Video visit vendor HealthTap names Dan Edmonds-Waters (Edmonds Ventures) as VP of strategy and global sales operations.

Announcements and Implementations

McKesson announces Intelligence Hub, which connects its reimbursement solutions to third party solutions and to each other in providing API management, identity and access management, and application service orchestration.

ACOs using population health management solutions from Lightbeam Health Solutions delivered $84 million in savings to Medicare Shared Savings Program in 2015, the company announces.

Oneview Healthcare will hire 100 employees in 2016, half of them assigned to its headquarters in Dublin, Ireland and the rest to its offices in the US, Dubai, and Australia.

Craneware announces data transparency functionality to its chargemaster tools that allow organizations using integrated systems such as Epic and Cerner to view data in one place.

St. Louis-based Ascension will organize itself into two divisions, with the Healthcare Division covering its hospitals and clinics and its Solutions Division running its IT services, group purchasing, and investment activities that are in some cases marketed to other healthcare organizations. The company will also name its 141 hospitals consistently with “Ascension” first to emphasize its national footprint.

Surescripts will offer EHR vendors free access to its National Record Locator Service until 2019.

Coordinated Care Oklahoma will integrate DrFirst’s Backline communication and collaboration tool into its HIE.

Government and Politics

FDA announces the 2016 Naloxone App Competition, offering a $40,000 prize for an app that overdosing opioid users can use to connect with anyone nearby who is carrying the reversal drug naloxone. That’s both a creative technical solution and a sad commentary on America’s massive dependence on prescription and non-prescription narcotics.

A team from CMS’s Center for Clinical Standards and Quality wins the Federal Employee of the Year category in the annual Service to America (Sammies) awards.

The FDA, under pressure from well-organized and impassioned patient advocacy groups, approves a muscular dystrophy drug against the recommendation of experts who say there’s no evidence it works. Shares of Serapta Therapeutics — which offered as evidence only one poorly designed trial involving 12 patients — soared on the news, not surprisingly given that the new drug will cost $300,000 per year.

Privacy and Security

From DataBreaches.net:

A New Zealand medical resident is fired for obtaining information from the local health boards on two members of his family, which he then used as evidence in a court case against them.
Four former New York nursing home aides are charged with felonies for taking iPhone pictures of residents in undignified positions and filming themselves verbally and physically tormenting a resident, with some of the images being posted to Facebook.
A cybersecurity firm’s brute force scan of Internet-connected FTP servers finds at least 800,000 that can be accessed without logging in.

The quarterly threats report from McAfee Labs notes that hackers are targeting hospitals with ransomware because their legacy systems have weak security, employees don’t have much awareness about security, workforces are fragmented, and hospitals value immediate access to information above everything else. Interestingly, it reports that many hackers consider hospital hacking as violating the unwritten hacker code of conduct, with others worry that the resulting publicity will result in a backlash against Bitcoin. A ransomware author and distributor provides Bitcoin account screenshots that apparently prove that he raked in $121 million in just six months.

A man protests that a Montana law requiring renters to get permission from their landlords before growing medical marijuana for their own use is a HIPAA violation since it forces him to reveal medical information to a third party. Like many under-informed people (some of them in healthcare), he is mistaken in thinking HIPAA broadly guarantees medical privacy rather than requiring only that covered entities practice it (providing a roof over his head doesn’t qualify his landlord as a “covered” entity).

Technology

MIT researchers develop the experimental EQ-Radio, which uses wireless,room-based heartbeat and breathing sensors to analyze an individual’s mood with 87 percent accuracy.

McKesson CIO/CTO Kathy McElligott says that analytics and blockchain are the rising trends that most interest the company.

Other

Microsoft says it is working to “solve” cancer by using technology to individualize cancer treatments and analyze tumor images.

Apple hires Mike Evans, MD, a Toronto family practitioner best known for his five-year series of YouTube health cartoons. He declines to provide specifics about his new job, but says it involves his ability to convey a message. He describes the future of healthcare as:

I think the way we engage people will totally change. What happens now is I see you. Let’s say you have high blood pressure. I prescribe you a pill for that. I see you two or three times a year. In the future, I’ll prescribe you an app. One of our whiteboards will drop in and explain what high blood pressure is. The phone will be bluetoothed to the cap of your pills. I’ll nudge you towards a low salt diet. All of these things will all happen in your phone. I see you two or three days a year. The phone sees you every day.

A federal labor judge awards $216,000 to two laid-off CSC employees turned whistleblowers who had complained in 2012 that the company’s occupational medicine EHR could not accurately track patient health risks. CSC went live with the system despite acknowledging the problem, after which the employees were suspended for colluding with one of CSC’s subcontractors. The judge called CSC’s arguments “an astonishing display of chutzpah” given that the company couldn’t say what information the employees were supposed to have shared, could not identify who suspended them, and withheld the special pay it promised the employees for the extra hours required to bring the EHR live.

In South Australia, the Allscripts Sunrise EPAS system is blamed for losing computer entries and thus not allowing a hospitalized dementia patient’s death to be reported to the coroner as the law requires. The health minister says the system is being urgently upgraded to highlight deaths that occur while undergoing treatment.

In England, Leeds Teaching Hospitals NHS Trust diverts patients after a computer problem leaves it unable to report pathology lab test results.

Drug companies that sell opioid painkillers have unleashed an army of lobbyists and donated millions of dollars to political campaigns in trying to protect their profits by defeating proposals that would restrict the prescribing of narcotics. The companies are funding non-profits, including the American Cancer Society’s Cancer Action Network, that advocate narcotics-friendly policies. Drug companies even strong-armed the passage of a Maine law that they themselves wrote that requires insurance companies to pay for their particular painkillers.

A rural hospital in Iowa complains that it can’t always reach its doctors by telephone and patients who call the hospital for appointments don’t always get through. The problem is caused by the patchwork system of telephone carriers required to deliver calls to rural America, with big telephone companies sometimes electing to simply drop a call rather than pay a rural carrier an amount that would leave it with no profit.

In Australia, NSW Health pledges to implement chemotherapy dosing guidelines in its systems following the under-dosing of at least 130 patients by a “fly-in, fly-out” oncologist who responded to a pharmacist’s questioning of doses with, “Tell them to mind their own business.” The doctor argues that oncology dosing guidelines are often outdated and says he used lower doses to reduce toxicity.

A Validic survey of drug companies finds that 60 percent have used digital health technologies in their clinical trials and 97 percent expect their use of such tools to increase.

Epic UGM is underway in Verona, WI this week, with attendees and others tweeting some photos.

Sponsor Updates

Forward Health Group is sponsoring the Best Practices for Value-Based Care conference September 21-22 in Dallas, TX.
Aprima will exhibit at the American Academy of Pain Management annual meeting September 22-24 in San Antonio. The company also completes its move to new headquarters in Richardson, TX.
Aventura will exhibit at Health 2.0 September 25-28 in Santa Clara, CA.
GE Healthcare will invest €150 million to establish a biopharmaceutical manufacturing campus and advanced manufacturing training center in Ireland.
TeleTracking President Michael Gallup testifies before the House Ways and Means Subcommittee on Health.
Clinical Computer Systems will integrate its Obix Perinatal Data System with Medhost.
Impact Advisors is named to Modern Healthcare’s Largest Revenue Cycle Management Firms.
Besler Consulting releases a new podcast, “What the end of the ICD10 grace period means for your hospital.”
CapsuleTech and FormFast will exhibit at the InSight McKesson User Group Conference September 27-28 in San Antonio.
CoverMyMeds sponsors the Columbus Women in Technology Conference.
Cumberland Consulting Group will exhibit at HFMA’s Revenue Cycle Conference September 25-27 in Phoenix.
ECG Management Consultants will exhibit at the West Coast ASC Seminar September 27 in Los Angeles.
Built in Austin profiles E-MDs CTO Alan Ortego.
Extension Healthcare will exhibit at the AAMI Regional Event – Hot Topics in Clinical Care September 27-28 in Chicago.

Blog Posts

3 Tips for Stopping Revenue Leaks that are Draining Your Practice Profitability (AdvancedMD)
iOS 10 is Live! AirWatch Has Your Mobile Business Covered (AirWatch)
Data Visualization: Prescription Drug Costs (Arcadia Healthcare Solutions)
Some Flexibility on MACRA Requirements Announced (CareSync)
Leverage mobile and unlock your potential with managing healthcare assets (Infor)
Pick Your Pace in the Quality Payment Race (Galen Healthcare Solutions)
Keys to a Successful Project: Define Before You Jump Into Planning (Hayes Management Consulting)
The Best Screening Test is the One That Gets Performed (Healthwise)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Monday Morning Update 9/19/16

September 18, 2016 News 1 Comment

Top News

Appalachian Regional Healthcare brings the computer systems of its Kentucky and West Virginia hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by an attack of unspecified malware. At least one hospital source says the attack involved ransomware, but the hospital declined to confirm citing an ongoing federal investigation.

ARH says its IT department took its systems and network down to stop the spread of the virus, causing downtime it described as causing “some inconvenience for a few weeks.”

Reader Comments

From Follow the Money: “Re: Mayers Memorial Hospital District (CA). Their EHR was down for two weeks at a cost of $100,000.” The forwarded board of directors meeting agenda did not indicate the source of the downtime, but says half of the $100,000 was spent on “equipment to mitigate future issues.” I don’t know which system was down, but an earlier board meeting agenda mentions Paragon. It’s fun to read a small hospital’s simply written meeting information, which includes such interesting thoughts as an upcoming chocolate festival fundraiser, the poor attitudes of the ED doctors, a sticky ED door that unintentionally left the department open to the public, and the development of an IT disaster backup solution that might need to be revisited.

From HTCGLOBAL: “Re: CareTech Solutions. Jim Giordano is no longer president and CEO as of this past Friday. Seven top executives have resigned in the past six months. HTC Global continues to offshore work.” Unverified, but the company’s executive page and Giordano’s LinkedIn profile are unchanged. HTC Global Services, which offers IT and BPO services, bought the company in December 2014.

From Ex-PwC Consultant: “Re: PricewaterhouseCoopers Advisory Services. Has been quietly laying off workers all summer, with rumors of 20-25 percent let go.” Unverified.

HIStalk Announcements and Requests

Nearly half of poll respondents think the most important healthcare issue in the presidential election is healthcare costs. New poll to your right or here: who would you vote for if the presidential election were held today?

I’m excited to offer (below) the first of an ongoing series I’m calling Decisions. I’ve been talking with the folks at Definitive Healthcare about getting fresh updates about hospital software decisions and the company graciously offered to share what they learn with HIStalk readers. They didn’t even ask for anything in return, not even a plug, but it’s only fair to credit them as the source.

Last Week’s Most Interesting News

HHS awards $87 million in EHR improvement grants to 1,310 safety net health centers.
Altos announces that it will acquire Anthelio Healthcare Solutions for $275 million.
McKesson withdraws its participation in the independent InSight user group conference after Meditech and Cerner are invited to present alternatives to McKesson Paragon.
Russian backers breach the World Anti-Doping Agency’s systems and publish the medical records of Olympic athletes.
Apple releases iOS 10, which includes C-CDA support via HealthKit.
In England, NHS awards $13 million each to 12 health IT global exemplars to establish best practices.
Dartmouth-Hitchcock Medical Center (NH) will lay off 460 employees, blaming its financial losses on billing-related expenses and implementing of new IT systems.

Webinars

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Money-losing, for-profit hospital operator Community Health Systems is rumored to be exploring the sale of its business, although the company’s massive debt may limit interest. Shares are down 76 percent since June 2015 even after a 16 percent jump Friday when word of the possible sale leaked out. The company operates 158 hospitals.

Sales

The Healthix HIE (NY) chooses Verato’s identity management technology, which claims to deliver up to 98 percent matching accuracy by comparing known information to that contained in commercially available databases. The VA is another customer. Verato raised $12.5 million in a single funding round in January 2015 under its original name Araxid.

Decisions

Blue Mountain Hospital District (OR) will change time and attendance software from Healthland to ADP on October 1, 2016.
Valley Hospital (WA) will switch from Meditech to Cerner in 2017.
Lakes Regional General Hospital (NH) will move from NextGen to Cerner in December 2016.
Saint Clare’s Hospital – Denville (NJ) will replace Cerner with Epic in early 2018.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.

Announcements and Implementations

In England, Cambridge University Hospital NHS Foundation Trust will outsource its IT infrastructure services for an estimated $182 million over seven years. HPE provides those services now via a 10-year agreement signed when the trust chose Epic in 2012. The trust’s growing financial deficit and significant quality problems triggered the resignation of its CEO and finance director in September 2015.

Government and Politics

The National Institutes of Health will require drug and medical device companies to post the results of all NIH-funded clinical studies – not just the favorable ones – to ClinicalTrials.gov starting January 18, 2017.

Oracle will pay $25 million in cash and provide products worth another $75 million to settle lawsuits over its performance in the failed Cover Oregon insurance exchange, for which Oracle was originally paid $240 million. The state had sought $6 billion in damages, but wasn’t willing to take the case to trial since legal fees alone would have run $1.5 million per month and it had already paid lawyers $20 million in the several lawsuits each party filed against the other.

Privacy and Security

Forward Health Group’s security expert Ed Skaife is named Up and Comer Runner-Up in an international security leadership award competition.

Other

The three big drug companies that manufacture insulin have increased average prices more than tenfold in the past 20 years in lockstep, with all three companies expressing indignation that anyone would look at list prices since insures get big discounts. The chart above shows the price of Humalog and Novolog, but you would notice that only with sharp eyesight since the prices remained identical while rapidly increasing over 20 years.

Vince and Elise offer Part 7 of their “Rating the Ratings” series, this time looking at physician practice EHRs.

Sponsor Updates

Experian Health will exhibit at the RBMA Fall Educational Conference September 25-27 in New Orleans.
PatientMatters will exhibit at the Minnesota Hospital Association Annual Meeting September 21-23 in Brainerd.
Qpid Health, Sagacious Consultants, Versus Technology, and Zynx Health will exhibit at Epic’s UGM September 21-23 in Verona, WI.
Red Hat announces plans for new facility in Boston.
The SSI Group will exhibit at the AMSURG Connections Café September 28 in Lake Buena Vista, FL.
Sunquest Information Systems will exhibit at CAP’16 – The Pathologists Meeting September 25-28 in Las Vegas.
Surescripts will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
Audacious Inquiry is sponsoring the SHIEC Annual Conference in Scottsdale, AZ this week.
Meditech will attend the 2016 InSight Annual Conference September 27-30 in San Antonio, TX.
TeleTracking sponsors The DAISY Award for Extraordinary Nurses.
Tierpoint will host Techpalooza September 22 at its facility in Durham, NC.
Valence Health will exhibit at the ASHHRA annual conference September 24-27 in Grapevine, TX.
Verscend will host its annual conference September 27-30 in Palm Desert, CA.
Consulting Magazine includes Huron on its list of 2016 Best Firms to Work For.
Healthwise is included in Fortune’s “100 Best Workplaces for Women.”
ZeOmega launches the ZeExchange e-newsletter.
ZirMed will exhibit at HBMA The Healthcare Revenue Cycle Conference September 21-23 in Atlanta.

Blog Posts

Getting Serious About Smartphone Security (PatientSafe Solutions)
Six Focuses for a Happy L&D Unit (PeriGen)
Navigating the Population Health Storm – Is Big Data the Solution? (Impact Advisors)
The Trouble with Texting (PMD)
The Top 10 Takeaways from the Surescripts 2015 National Progress Report (Point-of-Care Partners)
20 Facts About Sepsis Your Medical Staff Needs to Know (Uniphy Health)
A Peek Inside America’s Medicine Cabinet (Surescripts)
Philly Fights Cancer (VitalWare)
The best care is built on trust. (Voalte)
Patient Relationships at Risk as Drug Store Volumes Rise (West Corp.)
Health IT Drastically Improves Sepsis Care (Wolters Kluwer POC Advisor)

Contacts

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News 9/16/16

September 15, 2016 News 12 Comments

Top News

HHS will provide $87 million to 1,310 safety net health centers for purchasing or upgrading EHRs, supported by the ACA’s Community Health Center Fund that was extended under MACRA.

HHS reports that 98 percent of health centers use EHRs. Nearly three-fourths of the patients they serve are insured.

Reader Comments

From Lana Retentive: “Re: Charleston Area Medical Center (WV). Goes live this week in the first prominent Soarian to Millennium conversion that was supposed to have been completed in June. The go-live vendor has been asked to bring in SMEs in charging and patient accounting, but no word on whether they’re using a charge validation vendor.” Unverified.

From Xander Steel: “Re: startups. You told the would-be CEO that HIStalk readers won’t be interested in companies until they reach either $1 million in funding or $5 million in revenue. I’m not really interested in stories about capital raised when there’s no existing demand. Any chance when you disclose investment funding that you can also mention whether the company has actual revenue? I know it’s easier said than done since the companies aren’t publicly traded.” I don’t know how to get revenue information since those small companies rarely want to disclose it (which tells you that it’s likely minimal) and their numbers would be self-reported and unaudited anyway. My newsworthiness threshold of $1 million in funding is low enough that many companies can raise that much without having any paying customers, which doesn’t necessarily mean you would be wise to become one. Significant funding suggests that investors with access to inside information bought in for good reason, but that might be based on future opportunity rather than present revenue (much less profit).

From Doughboy: “Re: Epic. Can you believe that a publication ‘reported’ that the company’s R&D spending exceeds Silicon Valley companies without doing any type of verification?” I believe it. The obviously star-struck publication ran Judy Faulkner’s claim that Epic spends 50 percent of operating expenses on R&D without validating that number, then compared it to the SEC-filed data of Epic’s publicly traded competitors in trying and failing to make a point without letting those companies respond. The goal was obviously to earn clicks, not to provide useful information.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor InMediata. The Charlotte, NC-based company‘s InBanking payment reconciliation solution eliminates manual ERA payment and patient payment reconciliation to bank deposits; automates complex billing scenarios by splitting ANSI 835 files into separate billing systems; and converts paper payments to electronic files for posting and reconciliation. CEO and industry long-timer John Marron explained the “banking as the last mile” problem well when I interviewed him a few months ago, pointing out that while front-end RCM functions are mostly automated and clearinghouses have become commoditized, the back-end work (payments, reconciliation, and payment analytics) is mostly inefficiently manual. Thanks to InMediata for supporting HIStalk.

This week on HIStalk Practice: Medical associations weigh in on new MACRA options. The Maine Medical Association endorses DrFirst eRx solutions. AMD Global Telemedicine expands Massachusetts headquarters. Mediware adds PQRS reporting capabilities to its rehab EHR. Lynchburg, VA-area practices join Privia Medical Group. CompuLink gets into telemedicine.

This week on HIStalk Connect: Sanofi and Verily Life Sciences launch diabetes management company. Chrono Therapeutics raises a $47.6 million Series B. Frost & Sullivan recognizes Validic with an innovation leadership award. Samsung-backed smart belt startup raises more than double its Kickstarter goal.

I’m beginning to think that a significant percentage of health IT executives sport disfiguring facial injuries or were raised in Amish families considering that their graven image is nowhere to be found on the Internet, including on their LinkedIn profiles. I frankly distrust people whose photos aren’t available online. It’s only slightly better when someone shrinks their LinkedIn photo in failing to understand that the right process is to use a full-sized image and let LinkedIn thumbnail it automatically, which doesn’t seem too far beyond the understanding of technology executives.

Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Huron Consulting Group renames itself to Huron.

Team messaging vendor Klara, which describes itself as “a professional WhatsApp for medicine,” raises $3 million, increasing its total to $5.5 million. The company pivoted from teledermatology software to messaging just a few weeks back. It did not inspire my confidence that the company’s website was down all day Thursday as I tried to learn more.

In Germany, officials reportedly raid the offices of eight drug wholesalers, including McKesson, to determine if they illegally conspired to avoid stealing each other’s customers.

A federal judge allows Cave Consulting Group’s antitrust lawsuit against OptumInsight to continue. CCG says OptumInsight, owned by UnitedHealth Group, controls 90 percent of the claims grouper software market only because the company it acquired in 2003, Symmetry Health Data Systems, lied on its patent application. UHG agreed in April 2015 to pay CCG $12 million for infringing on its patents.

A Network World review of the 500 largest publicly traded companies finds that 25 of them disclose CIO pay. On their list is former Kaiser Permanente CIO Phil Fasano, who joined insurer AIG in the newly created position of EVP/CIO in late 2014 and was paid $8.4 million in 2015 as the #3 top earner. Walgreens Boots Alliance CIO Tim Theriault took the #1 spot with $13.6 million.

Sales

Vigilance Health (CA) chooses population health management technology from EQHealth Solutions for chronic care management and care coordination programs in 51 California counties.

Nebraska Medicine chooses and implements Nuance Dragon Medical One for clinical documentation in Epic, with 94 percent of its surveyed doctors saying it helps them practice better medicine, 71 percent reporting that their documentation has improved, and 50 percent saying Nuance saved them at least 30 minutes per day.

People

Julie Boughn (Cognasante) joins Audacious Inquiry as senior director.

CTG promotes Angela Rivera and Robert Barras to vice president.

Announcements and Implementations

The Department of Defense approves the participation of Fort Drum Medical Department Activity (NY) with the HIE of HealtheConnections, which will combine the military’s medical records of soldiers and families with those contributed by 300 connected civilian facilities to create a single overall view.

Harvard Medical School launches Library of Evidence, which offers free, evidence-based imaging clinical decision support that can be embedded in EHRs to help clinicians choose the most appropriate imaging tests.

Lenovo Health and LifeMed ID partner to offer an identity management solution that includes a trusted patient ID token that links to medical records. According to Lenovo Health’s website, providers can “achieve 100% accurate.”

National Decision Support Company will offer cardiac imaging appropriate use criteria from the American College of Cardiology.

Government and Politics

Eight Republican senators that include HELP committee chair Lamar Alexander (R-TN) introduce emergency, one-year legislation that would eliminate ACA-mandated penalties for those who don’t buy health insurance and would allow consumers who are covered by exchange-issued plans to use their federal government premium subsidies to buy plans elsewhere.

Privacy and Security

From DataBreaches.net:

A dental practice whose patient information was exposed to the Internet explains the odd situation: (a) the practice gave live patient data to a vendor whose system it was considering; (b) the practice decided that same year not to buy that system; (c) the vendor took the server offline in 2004; and (d) somehow the server (now unsecured) was brought back online 10 years later for a two-week period in 2014 during which the practice’s patient information was exposed.
The Dark Overlord (or other hacker claiming to be him) threatens to publish patient information from St. Francis Health System (OK) unless it pays $15,000 by Sunday.
A single ransomware author claims to have made $94 million in profit during the first half of 2016.

A legal preview of patient and provider class action lawsuits brought against Banner Health (AZ) following a breach of its food service point-of-sale systems that exposed the information of 3.7 million people raises these issues:

The plaintiffs don’t know whether hackers actually accessed or used the information, only that they might at some point.
The suit does not claim breach of contract, which doesn’t always work in breach lawsuits, and instead argues that Banner made an enforceable promise without consideration (promissory estoppel).
The plaintiffs argue that Banner didn’t notify them promptly.
The case uses recent FTC enforcement actions to claim that Banner violated the FTC act that says lax cybersecurity constitutes “unfair or deceptive acts.”

Technology

Accenture announces a health IT innovation challenge tied to its venture fund.

BSX Athletics launches a Kickstarter campaign to fund its LVL wearable hydration monitor. It has raised $200,000 vs. a goal of $50,000 and is a smart idea that apparently actually works, although Kickstarter projects are notorious for failing and not everybody wants to wear a one-trick wristband 24/7 .

Other

An HHS OIG report finds that for-profit hospices are aggressively recruiting patients who aren’t terminally ill and who may not know that choosing palliative care means they won’t receive other treatment. Medicare paid $15 billion for hospice care in 2013 and is trying to recover $1 billion from for-profit hospices in which one in three patients leave the service without dying, double the rate of non-profit hospices. In Mississippi, 41 percent of hospice patients were discharged alive.

Former New York City Mayor Michael Bloomberg donates another $300 million to the Johns Hopkins Bloomberg School of Public Health, saying the US should lead the world in life expectancy instead of placing 31st. Bloomberg has donated $1.5 billion to Hopkins, of which the School of Public health received $684 million, explaining, “It’s a lot cheaper to prevent than to cure, and it’s certainly a lot more humane.”

A man who had been hospitalized for 22 years with spinal muscular atrophy dies at 54, to the consternation of employees who had grown attached to him. It would be interesting to see the final bill and to know who’s paying it.

Sponsor Updates

Impact Advisors and NTT Data make Consulting Magazine’s list of “Best Small Firms to Work For.”
InterSystems and Intelligent Medical Objects will exhibit at the Epic UGM September 21-23 in Verona, WI.
PDR Network CMO Sal Volpe, MD receives the 2016 Patient-Centered Medical Home Practice Award.
Live Process will exhibit at California Hospital Association Disaster Planning 2016 September 19-21 in Sacramento.
Nordic is named one of Madison Magazine’s best places to work.
Vyne President and CEO Lindy Benton presents at the HERe Conference in Nashville.
AlleyWatch spotlights MedCPU in its coverage of New York City startups that have raised the most amount of money.
Meditech and Nvoq will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
Navicure will exhibit at Kansas MGMA September 21-23 in Overland Park.
Netsmart will exhibit at the Kansas Public Health Association conference September 20 in Wichita.
Nordic will host an open house September 19 in Madison, WI.
Obix Perinatal Data System will exhibit at the Georgia Perinatal Conference September 21-23 on St. Simon’s Island.
Infor Healthcare will exhibit at ASHHRA 2016 September 25 in Grapevine, TX.
Clockwise.MD will exhibit at the UCAOA Fall conference in Nashville September 29 – October 1.
Christy Kaplan and Susan Tolan of The Chartis Group presented “Transforming Care Coordination: Keys to Operationalizing Your Pop Health Strategy” at the HIMSS Population Health Forum this week.

Blog Posts

Hurricane Data Breach: Assessing Severity in the Eye of the Storm (ID Experts)
3 Reasons Your Healthcare CRM Can’t Deliver the Results You Want (Influence Health)
Coding is about more than saving money (Intelligent Medical Objects)
Prior Mammogram Ownership Important for Patient Care, Improved Outcomes (LifeImage)
Put the power in their hands – Taking the patient experience to the next level (MedData)
Why Can’t the Caregiver Info that Really Matters Be Part of “Discharge Instructions?” (Nvoq)
Beyond Pokemon Go: 3 Ways Augmented Reality Will Change Healthcare Forever (Orion Health)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 9/14/16

September 13, 2016 News 1 Comment

Top News

France-based consulting firm Atos will acquire Anthelio Health Solutions for $275 million. The announcement states that Dallas-based Anthelio’s annual revenue is $200 million and that its owners are a London investment firm as well as McLaren Health Care Corporation (MI), Anthelio’s largest customer.

Anthelio CEO Asif Ahmad will stay on to lead the new company’s US healthcare practice. The former PHNS changed its name to Anthelio in early 2011.

The acquisition was accurately reported here on August 12 via a rumor report from HIT Enthusiast that Anthelio did not acknowledge when I inquired.

Reader Comments

From Tired CIO: “Re: InSight conference. The independent McKesson user group has invited Meditech and Cerner to attend its annual meeting in case someone wants to talk to them about replacing Paragon.” A forwarded email from McKesson says InSight’s board didn’t let the company know until September 7 that it was bringing in Cerner and Meditech as co-sponsors of the user group meeting. The McKesson email adds that having competitors in attendance makes it impossible to share the company’s proprietary information with the group, so it is pulling out of the conference. McKesson adds that it is considering extending its own user forums that run concurrently in San Antonio to include everything it had planned for InSight. It’s also creating its own user group.

From Mimsey: “Re: InSight conference. McKesson is expected to make an announcement Wednesday about the disposition of its Enterprise Information Solutions, which includes Paragon. Meanwhile, people aren’t happy that the company won’t be presenting at InSight.” At least one attendee says they may just cancel their non-refundable travel since they spend 90 percent of their InSight time attending McKesson-led sessions and workshops and it’s not worth it since McKesson isn’t coming. That person questions why Cerner and Meditech needed to be invited to the conference since they would happily travel to any prospect’s site to do demos without having to meet them at InSight. I have to agree with that attendee – even though McKesson has burned a lot of healthcare IT bridges and is about to leave its customers in a lurch of unknown dimensions, it’s unreasonable to expect McKesson to attend the meeting with its competitors who were invited specifically to pitch to its customers. Attendees got shafted once by McKesson and now by their user group. The InSight board should admit that it made a bad decision and un-invite Cerner and Meditech in trying to make up with McKesson one last time to salvage their conference. I doubt McKesson is really going to create its own UGM since it will be dumping all of the products into the new company formed with Change Healthcare anyway, so nobody will care about McKesson a year from now. Meanwhile, we’ll see what happens the morning of September 28 at the InSight session titled “EIS Roadmap.”

From Startup CEO: “Re: my startup. I would love to get a mention on HIStalk.” OK, here’s your mention, in the form of a list: (a) a one-person consulting company isn’t a startup since ‘startup’ implies impressive investment, momentum, and a team with ambitious goals; (b) you aren’t a real CEO if you’re the only employee; and (c) HIStalk readers won’t care about your company until it hits either $1 million in funding or $5 million in revenue (and maybe not even then).

HIStalk Announcements and Requests

I was surprised to receive an oddly worded bulk email from Black Book that included screen shots from the “Rating the Ratings” series Vince and Elise did. While I’m happy to be called “the industry’s objective health information systems resource,” let the record show that I wasn’t asked for permission, I didn’t actually rate anyone (Vince and Elise did that), and while I’ve run surveys in the past whose methodology and response rate I was proud of, this one wasn’t one of those – it was informal, not validated, and self-selected.

Medicity was the first HIStalk sponsor going back to 2004, so when they asked if I would be willing to return the favor and sponsor their Client Summit being held this week by providing pens and pads, I said sure (I just now realize the irony of giving digital health attendees old-fashioned pens and paper). I’m always scrounging at the HIMSS conference exhibit hall to get a (rare) notepad to go with the (ubiquitous) pens, so hopefully someone found the matching set useful.

Welcome to new HIStalk Platinum Sponsor Infor. The New York City-based company delivers industry-leading, healthcare-specific solutions used by 5,000 organizations in 30 countries (including 72 percent of US hospitals larger than 150 beds) to integrate, plan, track, and manage vital assets such as people, supplies, clinical data, relationships, and financial resources. On-premise or cloud-based solutions support human capital management, financial management, patient-centered supply chain management, enterprise performance, relationship management, business intelligence and analytics, and clinical interoperability. Thanks to Infor for supporting HIStalk.

I found this overview of Infor CloudSuite Healthcare on YouTube.

Listening: the impressively remastered (for the second time) the Beatles “Live at the Hollywood Bowl,” a fascinating audio memento of the band’s 1964 and 1965 concerts there. I’m sure today’s listener can hear the music better than the four lads back then given the insane fan screaming that overcame their primitive audio equipment but is nicely dialed back here. They sound surprisingly talented, warm, and tired but enthusiastic, just the way they should be remembered 50 years after their final August 1966 live performance in San Francisco after conquering the world by their early 20s. Also: new from Madison, WI-based Garbage, whose heavy-with-hooks sound is hard to categorize and equally hard to listen to without desk-drumming.

Webinars

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Bedside patient engagement technology vendor Lincor Solutions will merge with its Australia-based distributor to form Lincor Limited, which will be listed on the Australian Securities Exchange. Lincor CEO Chris Cashwell will be CEO of the new company.The Hills Health Solutions business generated $23 million for publicly traded parent company Hills Ltd. in the most recent financial year.

Surgery workflow management technology vendor ExplORer Surgical raises $1 million in a seed funding round. The company’s “surgical playbook” system was developed by University of Chicago, which is among its investors.

Diabetes management app vendors Glooko and Diasend merge.

Sales

Wise Health System (TX) chooses Allscripts Sunrise and CareInMotion.

Medical Center Hospital (TX) will expand its rollout of Spok Care Connect.

Graham Health System (IL) chooses electronic patient signature and e-forms from Access.

Nebraska Medicine chooses Epic’s Healthy Planet population health management system.

Palmetto Health (SC) will use Glytec’s eGlycemic Management System for the 40 percent of their hospitalized patients who require insulin. The system, which will integrate with Cerner, includes the Glucommander insulin dosing medical device, GlucoSurveillance to flag candidates for insulin therapy, and GlucoMetrics for monitoring key performance indicators.

Carilion Clinic (VA) selects PeraHealth’s clinical surveillance solutions.

People

Kit Check hires Gary Voydanoff (NextGen) as chief commercial officer.

Oneview Healthcare names Seth Bokser, MD (UCSF) as chief medical officer and Lyle Berkowitz (Northwestern Medicine, Healthfinch) as special advisor on innovation.

Imaging decision support vendor HealthMyne names Arvind Subramanian (Wolters Kluwer Health Clinical Solutions) as CEO and board member. He replaces Praveen Sinha, who remains on the board.

Ingenious Med hires Joe Marabito (IkaSystems) as CEO. He replaces the retiring S. Hart Williford, who will remain board chair.

Announcements and Implementations

HIMSS offers to match the 12 just-named NHS digital health Global Exemplars with an international provider partner, which is a condition of the $13 million in funding. The announcement suggests that HIMSS wants to sell its EMRAM and CCMM benchmarking services to the newly funded trusts, which have committed to partner with organizations such as Cleveland Clinic and Mayo Clinic to take advantage of their expertise.

Pallav Sharda, MBBS, MMI, MBA publishes “Before Disrupting Healthcare: What Innovators Need to Know.”

Vital Images adds support for Nuance PowerScribe 360 and PenRad PenLung to its lung screening application.

Government and Politics

ONC says 95 percent of US hospitals allow patients to view their information electronically, 87 percent allow them to download it, and 69 percent give patients the ability to view, download, and transmit the information. The information is self-reported by hospitals and therefore suspect based on the understanding of whoever filled out the AHA survey. I doubt that two-thirds of hospitals allow patients to transmit data via the Direct protocol or otherwise and I’m confident that very few patients have done so regardless. I say from experience that hospitals hold tightly onto the information they think is theirs, not the patient’s, and the HIM department or release-of-information vendors that are stuck in the 1960s guard those gates enthusiastically knowing that HHS OCR’s enforcement is indifferent.

A group of Republican congressional committee chairmen questions CMS’s “pay and chase” practices, asking Acting Administrator Andy Slavitt to provide more information about how CMS’s Fraud Prevention System is being used.

Privacy and Security

From DataBreaches.net:

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Russia-based hackers breach the World Anti-Doping Agency and publish the prescription information of US Olympic athletes. A group called Fancy Bears says it was shocked by “how Olympic medals are won” and will “start with the US team, which has disgraced its name by tainted victories.” I blurred the drug names on the file of tennis player Serena Williams above, but the hackers didn’t (the drugs were not performance-enhancing or even all that interesting, but I wouldn’t expect a hacker to know that).
Yuba-Sutter Medical Clinic (CA) notifies patients that it was hit by a ransomware attack on August 3. They say they regained access to their systems “relatively quickly,” but didn’t specify whether that was from restoring backups or paying off the hacker.
California-based occupational health provider US HealthWorks announces that a stolen laptop containing emails with patient information was encrypted, but apparently the employee had attached the password to the device.

Technology

HL7 chooses Bryn Lewis, PhD as the winner of its C-CDA viewer challenge.

Apple released iOS 10 — which includes C-CDA support via HealthKit — on Tuesday and Duke Health (NC) announces that it will allow patients to download their MyChart portal data into Apple Health, where it can be shared with other apps.

Other

Drug company Mylan, which enraged consumers with its never-ending EpiPen price increases, paid its five top executives $300 million over the past five years, more than competitors several times its size. The company, whose market cap is $22 billion, came in #2 behind Regeneron, which paid its top five executives more than $500 million.

A Health Affairs blog post co-authored by singer Barbra Streisand calls for researchers to include a representative number of women in their studies and to examine their data to see if findings have a gender-specific component. She says as an example that women’s heart disease is different from that of men, yet has not been as well studied or as consistently diagnosed.

BCS, The Chartered Institute for IT interviews Robert Wachter, MD about health IT, particularly that in England.

A reporter for the Tucson newspaper describes his first-hand experience watching Theranos CEO Elizabeth Holmes and the company’s lobbyists schmoozing state officials in convincing them to pass a law that allows consumers to order their own lab tests in Arizona and to allow Theranos to open wellness centers in Phoenix-area Walgreens stores. He summarizes:

This is where Arizona’s leadership fell down on the job: It failed to protect Arizona customers from a company that found the state an easy target in its zeal for deregulation. This wasn’t a company that was seeking tax breaks and incentives, which perhaps made their proposal an easier sale. What they needed was a law that gave them access to Arizona’s people.

Sponsor Updates

ComputerWorld profiles GE Healthcare’s move to a new transaction processing engine, and awards the company its Data+ Editors’ Choice Award.
HfS Research names Xerox a top business services provider in population health and care management as-a-service.
Aprima and Healthfinch will exhibit at AAFP’s Family Medicine Experience September 21-23 in Orlando.
Tech Week profiles Madison, WI-based Catalyze as part of its City Snapshot series.
LogicStream Health will host a wine tasting with appetizers for Epic UGM attendees on Wednesday, September 21 lakeside at Monona Terrace in Madison.
Besler Consulting produces a new podcast, “What to look for in the next generation of hospital finance professionals.”
The Tampa Bay Technology Forum includes CareSync in its list of finalists for its Technology Company of the Year Award.
CTG, Divurgent, and Healthwise will exhibit at the Epic UGM September 19-21 in Verona, WI.
Stella Technology will sponsor the SHIEC Annual Conference in Scottsdale, AZ September 18-21.
Healthcare Growth Partners advises Essette on its sale to HMS.
Cumberland Consulting Group becomes a sponsor partner of the HealthCare Executive Group and its annual forum being held this week in New York.
Healthgrades will present a session on launching startups internally during Denver Startup Week September 19.

Blog Posts

Sepsis: Reducing Mortality and Cost through Screening (Wolters Kluwer Clinical Drug Information)
Strategic Plan for Medical Practice Management (AdvancedMD)
AirWatch Connect Atlanta: 6 Reasons to Attend an Industry Workshop (AirWatch)
Winners of the 2016 CoverMyQuest (CoverMyMeds)
Don’t Hit the Snooze Button on MACRA (ECG Management Consultants)
Want a Successful Clinical Communication Project? Start with an Inclusionary Platform. (Extension Healthcare)
The Importance of the Client Role in Testing and Validation (Galen Healthcare Solutions)
Leading the Path with Information Governance (Hayes Management Consulting)
Epic Ambulatory Go-Live: 3 Tips to Avoid Revenue Loss (The HCI Group)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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MACRA’s Marketing Problem

September 12, 2016 News Comments Off

HIStalk digs into why provider awareness of MACRA is lacking and the likely impact it will have on their ability to stay in business.
By @JennHIStalk

The Medicare Access & CHIP Reauthorization Act has seen its fair share of headlines since it was introduced just before HIMSS15. MACRA’s implications for patients and providers contributed to a lot of the show-floor buzz in Chicago that year, while conversations around its potential for payment reform heated up even more in Las Vegas at HIMSS16. The release of a 962-page proposed MACRA rule in April provided fodder for industry media outlets, and last week’s release of four “pick your pace” options ahead of a final rule have no doubt eased the anxiety of many physicians fretting over the January 1, 2017 start date.

In short, it seems that MACRA has spent more than its fair share of time in the spotlight, leading many in the industry to assume that providers have been keeping up with its developments.

The results of a Deloitte survey of physicians on MACRA awareness and preparedness (conducted before the proposed rule was released) tell a very different story. Of the 600 primary care and specialty physicians surveyed, 50 percent admitted to having never heard of the legislation, while 32 percent knew it only by name. Independent physicians were more aware of it than employed MDs, though not by terribly much at 21 versus 9 percent.

Where does this unawareness stem from? Have providers become so accustomed to regulatory delays that they no longer pay attention until implementation is just weeks away? Has CMS, for lack of a better phrase, shot itself in the foot when it comes to introducing legislation that providers automatically assume is too cumbersome to digest and apt to be postponed numerous times?

Providers who have attempted to keep the lights on through Meaningful Use, ICD-10, and now MACRA surely can’t be blamed for not keeping up with the latest reforms issued from on high. Or can they?

Too Busy to Take Notice

“It’s not only physicians who have a lack of awareness,” explains Mitch Morris, MD, vice chair and a US global sector leader at Deloitte. “It really snuck up on the industry in general. Even now when we go in and do a briefing in the executive offices of a health system or payer, they say, ‘Wow, I didn’t realize all of that was in MACRA.’ It’s not very well understood. Unlike in the ACA, which had lots of publicity and everyone was dissecting it from Day 1, MACRA was thoroughly bipartisan and didn’t get a lot of [mainstream] publicity. The medical trade associations, the usual source of news for providers, just haven’t really been pushing this. On the surface, it sounds like a boring topic, but as you peel away the layers, you realize it’s going to be very impactful.”

AMA Immediate Past President and emergency department medical director Steven Stack, MD says Deloitte’s findings line up with the association’s own from its physician focus groups. “I think the upcoming changes are difficult for many to absorb while they are fully engaged in the day-to-day work of their practices,” he says. “And, keep in mind that when the legislation was enacted in April 2015, physicians were told the new system would not be implemented until 2019. They had good reason to believe there was no hurry for them to get up to speed.”

“Finally, it is simply not possible for the AMA or anyone else to begin broadly disseminating detailed educational material until the final regulation is issued,” Stack says. “We have been developing resources intended to help physicians get ready, but really all they want to know is what the rules are. We just don’t have all the information yet.”

Physicians working in the trenches of day-to-day care echo Stack’s observations. “I think most physicians would agree that the best use of their time and skill would be to simply treat patients and stop worrying about the endless administrative tasks of medical practice,” says Scott Mayer, MD, director of quality control at Today Clinic (OK). “Time to practice the art of medicine sounds so nice, but the reality is that being a physician these days requires so much time be spent outside of patient care that it has become increasingly difficult to keep up with so many changes in healthcare.”

“Patients need treatment now,” he emphasizes, “so unless a policy takes effect immediately, a lot of physicians don’t want to deal with it until it is absolutely necessary. I also suspect that many these days here the word ‘change’ and snort in disdain at the thought of something else that will further complicate their ability to practice medicine.”

University Physicians Group (NY) Medical Director and Aprima Chief Medical Officer Jeffrey Hyman, MD adds that lack of MACRA awareness on the part of employed physicians may stem more from the fact that once a physician is employed, the ‘business’ of running a practice becomes akin to background noise, outranked by patient care. “As an independent,” he adds, “you still have to worry about every issue of the practice of medicine to be successful and so attention is paid to every last detail.”

Today’s Diversions Trump Tomorrow’s Regulations

The details diverting the attention of physicians away from MACRA preparation are numerous and probably well known to HIStalk readers. “For physicians in private practice,” says Mayer, “a considerable amount of attention, resources, and stress are focused on just getting paid for the services they provide. Decreasing reimbursement rates, more regulations, more paperwork, and the increasing costs of maintaining a profitable medical practice are sure to distract a lot of us. We are wondering what the future of medicine looks like while doing our best to provide quality care now, find joy in our work, and avoid burnout.”

Hyman puts burnout at the top of his diversion list, too. “It’s a big deal these days,” he emphasizes, “and non-physicians have difficulty with this concept. Treating patients takes a great deal of concentration on details of their histories and physical findings, ordering lab and radiology tests, and then putting all these facts together and coming up with a successful treatment plan. Also, the need to think about formularies, getting pre-authorizations, and dealing with call-backs, admissions, and labs coming in … and don’t forget the EHR and all of its messages coming in at a furious pace. It takes a great deal of attention and MACRA, when read, sounds like a future issue. It just seems distant.”

Hyman’s observations on EHR-related physician burnout, while nothing new, seem to continually be backed up by studies large and small. A prime example is an AMA-sponsored time and motion study released last week that found ambulatory practice physicians spend almost twice as much time working on the EHR or performing other desk tasks as seeing patients. Observed MDs spent only 27 percent of their available time in face-to-face interactions with patients.

The results aren’t surprising to Morris, who notes that for the third year in a row of Deloitte’s research, three out of four physicians will answer that EHRs take too much of their time and cost too much money. “As an industry, we still have a long way to go so that they feel they add value. We’re not where we should be with the vision of EHRs.”

Morris is quick to add that no matter their employed or independent status, the time and attention of physicians are increasingly spent dealing with tremendous reimbursement pressures. “There’s a lot of pressure to move from volume to value-based payment systems,” he explains, “where part of their income is placed at risk. That pressure has many physicians very, very anxious and, to some degree, angry. They’re not always sure who to be angry with, but they’re not happy about the situation that they’re in. Even though the economy has recovered and there’s more discretionary spending, there’s still a lot of screws being turned down on physician incomes.”

Passing the Buck

Morris brings up a good point with regard to the slow boil of physician’s anger at being put in a position that leaves them little time with patients and even less to deal with impending regulations like MACRA. It could be argued that numerous entities should be on the receiving end of that emotion – CMS, payers, trade groups, and vendors – even patients and physicians. Fingers will likely start pointing to these same groups once MACRA hits, no matter the chosen start date, and physicians realize they’re out of time and unprepared.

“The industry has the obligation to educate and provide reasonable technology, tools, processes, and training to physicians to assist in the change management of MACRA,” says Kareo CMIO Tom Giannulli, MD, MS. “Those entities that contract with physicians should be very clear as to how their contracts will change. This includes CMS, which unfortunately does not communicate as well with physicians as they could, and based on their historical record, their deadlines are generally not respected. I would like to see them set up a website and online education program that requires each MACRA-participating physician to sign in and complete a half-day course on tech, tools, process, and regulation in order to continue their Medicare billing at full rate. There are a lot of other groups that have and can share a viewpoint, but those they contract with are the right source of information.”

Stack also feels that, while everyone has a role to play, CMS needs to reach out to provide simple tools and procedures to help physicians succeed. “They must strengthen their help lines and educate their staff so they can provide accurate information,” he adds. “CMS should also conduct train-the-trainer sessions and provide much more support to specialty societies to help them answer questions of particular interest to their members. Organizations like the AMA, state medical societies, and national physician groups can be very helpful by tailoring complex material more to the needs of their own members. Specialties, for example, can highlight quality reporting and CPIA activities that are most relevant to their audience, and so greatly simplify the learning process.”

“Employed physicians will likely be spared some of the specific tasks,” he adds, “and the need to be mindful of all the reporting deadlines, but there’s no doubt they will still encounter workflow and documentation issues.”

Hyman looks for MACRA guidance from Northwell’s dedicated group of staff already dealing with these issues and, as one would expect, UPG’s EHR vendor. “Aprima is also coding a great deal of information into their program to assist their doctors in getting this done successfully,” he adds.

Getting Started (but Preparing for Delay)

Hyman and his colleagues have been preparing for MACRA since it was first announced in 2015. “Our group of analysts, the Incentive Team , has begun the teaching process,” he says, “and we will interface between our physicians and the rules so it gets done in the most efficient way for our doctors. We will be ready with our team approach and help from our vendor, but understand that there most likely will be a delay as there was with ICD-10, Meaningful Use, and PQRS.”

Today Clinic staff, on the other hand, are just beginning their MACRA prep. “Our plan is to continue with our quarterly provider and staff meetings where we focus on things like MACRA,” Mayer explains, adding that he too wouldn’t be surprised if the start date was pushed back.

“Honestly, I don’t know how any practice can be prepared by January 1,” Stack says. “That is why the AMA and many others are recommending that the first reporting begin no earlier than July 1. Even compiling truly useful and accurate educational material by January is a heavy lift since we don’t expect to see a final rule until sometime in October and perhaps even as late as November 1. There is nothing in the MACRA statute that sets the start date for reporting, nor is there anything in the statute mandating that the reporting period be set at a full year, so CMS should have flexibility to begin at a later date.”

No matter the start date, Stack believes that, to get off on the right MACRA foot, physicians should first assess how they are performing under current programs since the new MIPS program will be based on those. “They also should begin exploring what qualified clinical data registries are available to them,” he adds, “since this is a new reporting vehicle that could simplify processes for them as well as yield more clinically useful feedback data.”

Morris has similar suggestions, but admits that, “You’d be hard-pressed to get everything in place by January 1 unless your organization already had a lot of this stuff in place and was just tweaking around the edges. I think the analytics capabilities and understanding your costs are difficult things. Even large health systems, which spend a lot of money on those things, struggle. Measuring my quality, having the data necessary to do that, and having the information necessary to understand my costs … I would include all of those as the biggest challenges to getting started with MACRA.”

Gauging the Likelihood of MACRA Success

MACRA’s marketing problem will eventually be a thing of the past. Delayed by choice or not, the program will be here sooner rather than later and physicians will have to make up their minds as to whether participation will be done with enthusiasm, trepidation, or opted out of altogether. MACRA will soon make clear just how painful a process it is for healthcare to move from fee-for-service programs to value-based payment systems.

“Money always talks,” says Mayer, “but to be honest, I am disappointed when the focus of policy changes or the support of policy changes is dependent on the money that will be generated, saved, or lost as a result. While it is very important to consider these things carefully, I worry that we don’t consider as thoroughly the impact such changes have on patients. Despite the intention of programs like MACRA to improve the quality of patient care, it may be hard to convince physicians to participate more for that reason than to avoid fines, decreased reimbursements, or for a promised bonus. Education, support, and follow-ups will be vital, which I think CMS is good at. What I hope to avoid is the need for more support staff to understand, implement, and maintain MACRA.”

Morris puts the move to value, which one could argue started long before MACRA was introduced, in perspective: “These are baby steps. The ACA was a step. Some of the initiatives after were steps. MACRA is another step. In many ways, this is the biggest step we’ve taken so far. I think the devil will be in the details of how well it’s executed. It’s one of those things that looks good on paper. Let’s see how it really works out.”

More on MACRA: Apples, Oranges, and Start-Date Changes

Most industry insiders familiar with MACRA seemed confident that the program’s start date will be delayed. Even CMS Acting Administrator Andy Slavitt hinted at that likelihood, and has since taken steps to ease the pain of participation with start-date options. The industry’s confidence in a delay is easy to understand, given that federal regulatory delays seem to have become the norm rather than the exception. Who can forget the beleaguered roll out of ICD-10? The anticipation of a MACRA delay lends itself to a comparative look at ICD-10.

“They’re definitely in the fruit category together,” says Mitch Morris, when asked if comparing the two is akin to looking at apples or oranges. “ICD-10 was a big change that was, for the most part, not welcome and being driven by the government. That’s definitely something they have in common. As you know, ICD-10 got delayed a couple of times before it was finally implemented, but it did really require some significant changes in office practice. If done well, it shouldn’t have had a negative impact on practice income.”

Morris adds, “With MACRA, also pushed by the government, there’s no formal sign of a delay, but as we learned from ICD-10, that can change with pressure applied to the appropriate places. MACRA has the potential to really change a physician’s income up or down, particularly those in independent practice, and particularly those who have a lot of Medicare patients. It will certainly change the dynamic, especially given the requirements and infrastructure necessary to participate.”

However, Steven Stack sees no similarities whatsoever. “I think this is entirely different,” he says. “ICD-10 in many ways was a simpler issue. It was a replacement for the already existing ICD-9 mandate. The ICD-10 issue focused on the need to be more detailed in documentation providers were already doing, in training their staff, and in lack of confidence that claims would be processed in a timely manner. Physicians were being told to keep enough money in reserves to cover their payroll and office expenses for six months due to anticipated claims payment delays. Physician practices don’t normally have that kind of cash on hand, and it was very alarming.”

“MACRA is largely about modifying an already complicated Medicare physician payment system, and then adding on new requirements for those who participate in advanced payment models,” Stack says. “There are a lot of changes happening at once all across the payment system. Quality reporting and meaningful use of EHR requirements are changing. A whole new method of measuring and comparing resource use has been proposed, new clinical practice improvement activities need to be identified and documented, and so forth. This transition will be far broader and much more complicated than the move to ICD-10.”

Morning Headlines 9/12/16

September 11, 2016 News Comments Off

New plans to expand the use of digital technology across the NHS

The NHS names 12 health IT “global exemplars” that will receive $13 million in health IT funding to establish best practices and a new digital health academy.

ARH continues to dodge questions on computer breach

Appalachian Regional Healthcare (WV) responds to a local paper covering its ransomware-related computer outage by sending a legal notice explaining that if the paper continued to “deliberately publish statements which defame ARH, or cast it in a false light, we will have no other recourse but to consult with our attorneys in WV, to determine appropriate legal action."

The Ethics of Behavioral Health Information Technology

A JAMA article argues that flagging emergency department frequent fliers with special icons in EHR software is unethical and clinically inappropriate because it could influence the initial interaction in a way that might lead to biased diagnostic judgment.

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